1. PHPR 202: ANTIFUNGAL THERAPY Andrew Schmelz, PharmD Post-Doctoral Teaching Fellow Purdue University School of Pharmacy

2. 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

3. CANDIDIASIS VAGINAL Pregnancy Oral contraceptives Diabetes mellitus ORAL Infants Immunocompromised patients

4. SYSTEMIC INFECTIONS OPPORTUNISTIC More common candidiasis aspergillosis cryptococcosis NON- OPPORTUNISTIC Can occur in any host Uncommon histoplasmosis blastomycosis coccidiomycosis

5. SUPERFICIAL INFECTIONS Candida mucous membranes moist skin Dermatophytes scalp skin nails

6. CANDIDA INFECTION http://www.emedicine.com/PED/topic312.htm#section~pictures

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

8. ORAL THRUSH http://www.nlm.nih.gov/medlineplus/ency/imagepages/17284.htm

9. TINEA CORPORIS – RING WORM http://www.emedicine.com/aaem/topic380.htm#section~pictures

10. TINEA CORPORIS

12. JOCK ITCH

13. ATHLETES FOOT http://botit.botany.wisc.edu/toms_fungi/feb98.html

14. ATHLETE’S FOOT

16. ONYCOMYCOSIS

18. AGENTS FOR SYSTEMIC & SUPERFICIAL INFECTIONS

19. AZOLE ANTIFUNGALS THERAPEUTIC USES: Vary with agents available MECHANISM OF ACTION: Damages the fungal cell membrane resulting in a leakage of cellular components

20. ADVERSE EFFECTS GI effects: nausea, vomiting, and diarrhea Rash - (itraconazole) Liver toxicity

21. MONITORING PARAMETERS Drug interactions Liver function tests Jaundice, dark urine, and pale stools Hydration

22. SUPERFICIAL AGENTS

23. GRISEOFULVIN THERAPEUTIC USES: Superficial fungal infection Onychomycosis MECHANISM OF ACTION: Stops the fungal cell growth cycle

24. ADVERSE EFFECTS Transient headaches, nausea, vomiting,and diarrhea Rash Drowsiness Liver toxicity (rare) Photosensitivity (rare)

25. NYSTATIN THERAPEUTIC USE: Treatment of local fungal infections MECHANISM OF ACTION: Binds to cell membrane components and causes leakage of fungal cell components

26. NYSTATIN ROUTES OF ADMINISTRATION: oral topical ADVERSE EFFECTS: well tolerated nausea, vomiting, and diarrhea (large oral doses) local irritation (topical)

27. 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

28. ADVERSE EFFECTS Rash GI upset Hepatotoxicity Headache Neutropenia Dermatologic

29. TERBINAFINE (Lamisil®) MONITORING PARAMETERS: Liver function tests PATIENT EDUCATION: Complete full course of therapy May be taken with or without food

30. TOLNATATE (Tinactin®) INDICATIONS: Topical and localized infections MECHANISM OF ACTION: Unknown (may interfere with cell wall synthesis)

31. TOLNATATE (Tinactin®) ADVERSE EFFECTS: Local irritation and burning PATIENT EDUCATION: For external use Clean and dry thoroughly before use

32. 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