phpr 202: antifungal therapy andrew schmelz, pharmd post-doctoral teaching fellow purdue university...

PHPR 202: ANTIFUNGAL THERAPY

Andrew Schmelz, PharmDPost-Doctoral Teaching Fellow

Purdue University School of Pharmacy

FUNGAL INFECTIONS

MYCOSES: an infection caused by fungi• Mild to severe

• Superficial or systemic

Candida albicans• Normal flora

• Overgrowth can lead to infections

• Agents can promote overgrowth

SUPERFICIAL INFECTIONS

Candida

• mucous membranes

• moist skin

Dermatophytes

• scalp

• skin

• nails

ORAL THRUSH

http://www.nhsdirect.nhs.uk/SelfHelp/conditions/oralthrushchild/_im027.asp

TINEA CORPORIS – RING WORM

http://www.emedicine.com/aaem/topic380.htm#section~pictures

TINEA CORPORIS

ATHLETES FOOT

http://botit.botany.wisc.edu/toms_fungi/feb98.html

ATHLETE’S FOOT

ATHLETE’S FOOT

ONYCOMYCOSIS

ONYCOMYCOSIS

AGENTS FOR SYSTEMIC & SUPERFICIAL INFECTIONS

AZOLE ANTIFUNGALS

THERAPEUTIC USES:• Vary with agents available

MECHANISM OF ACTION:• Damages the fungal cell membrane resulting

in a leakage of cellular components

ADVERSE EFFECTS

GI effects: nausea, vomiting, and diarrhea

Rash - (itraconazole)

Liver toxicity

MONITORING PARAMETERS

Drug interactions

Liver function tests

Jaundice, dark urine, and pale stools

Hydration

SUPERFICIAL AGENTS

GRISEOFULVIN

THERAPEUTIC USES:• Superficial fungal infection

• Onychomycosis

MECHANISM OF ACTION:• Stops the fungal cell growth cycle

ADVERSE EFFECTS

Transient headaches, nausea, vomiting,and diarrhea

Rash Drowsiness Liver toxicity (rare) Photosensitivity (rare)

NYSTATIN

THERAPEUTIC USE:• Treatment of local fungal infections

MECHANISM OF ACTION:• Binds to cell membrane components and

causes leakage of fungal cell components

NYSTATIN

ROUTES OF ADMINISTRATION:• oral

• topical

ADVERSE EFFECTS:• well tolerated

• nausea, vomiting, and diarrhea (large oral doses)

• local irritation (topical)

TERBINAFINE (Lamisil®)

INDICATION• Onychomycosis

• Topical/localized infections

MECHANISM OF ACTION• Interferes with cell wall synthesis and causes

fungal cell death

ROUTES OF ADMINISTRATION• Oral

• Topically

ADVERSE EFFECTS

Rash GI upset Hepatotoxicity Headache Neutropenia Dermatologic

TERBINAFINE (Lamisil®)

MONITORING PARAMETERS:• Liver function tests

PATIENT EDUCATION:• Complete full course of therapy

• May be taken with or without food

TOLNATATE (Tinactin®)

INDICATIONS:• Topical and localized infections

MECHANISM OF ACTION:• Unknown (may interfere with cell wall

synthesis)

TOLNATATE (Tinactin®)

ADVERSE EFFECTS:• Local irritation and burning

PATIENT EDUCATION:• For external use

• Clean and dry thoroughly before use

IMPLICATIONS FOR PHYSICAL THERAPY

DISEASE STATE• Systemic infections are serious

• Superficial infections occur commonly

• Educate patients

• Recognize symptoms

• OTC therapies can be considered

DRUG THERAPY• Monitor for adverse effects with systemic agents

• Minimal adverse effects with superficial treatment