AAFP/CDC Guidelines to antifungal medication

AAFP/CDC Guidelines to antifungal medication

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AAFP/CDC Guidelines to antifungal medication

Peer reply pharmacy DB5

DERMATOLOGY CASE STUDY

Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills.

1.According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

AAFP/CDC Guidelines to antifungal medication – Nurses Homework | Nurses Homework

Onychomycosis is a fungal infection of the nail, either fingernail or toenail. The common dermatophyte that is found in onychomycosis is tinea unguium , with candida infections also a cause . Effective treatment usually involves months of systemic antifungal medication, commonly griseofulvin, ketoconazole ,itraconazole or terbinafine. Topical treatment is usually not effective except for ciclopirox nail lacquer (Woo & Robinson, 2016).

Terbinafine 250mg 1 tab PO daily x 12 weeks

Terbinafine 250mg take one tablet by mouth daily for 12 weeks

2. What labs for baseline and follow up of therapy would you order for this patient?

Liver enzymes and complete blood count should be monitor every 6 weeks if treatment last longer than 6 weeks.

Terbinafine is an orally and topically active allylamine fungicidal agent which is used to treat superficial fungal infections of the skin and nails. Terbinafine has been clearly linked to rare instances of acute liver injury that can be severe and sometimes fatal.

Drug induced liver injury due to terbinafine was identified shortly after its introduction into medical use. Oral therapy with terbinafine is associated with elevations in serum aminotransferases in less than 1% of patients and the elevations are generally asymptomatic and resolve without stopping therapy. The estimated probability of developing elevated serum aminotransferase levels requiring stopping treatment is about 0.31% for 2 to 6 weeks’ treatment and 0.44% for treatment longer than 8 weeks (“Terbinafine”, 2019).