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Skin Conditions, Parasites and Fungi Question Yeasts are multicelled organisms. A. True B. False B. False - Yeasts are single-celled organisms about the size of red blood cells. Physiology of Fungal Growth Fungi can be separated into two groups—yeasts and molds. Yeasts are single-celled organisms. Molds produce long, hollow, branching filaments called hyphae. Normally, the body has yeast colonies on the skin, mucous membranes, and GI tract. Immune mechanisms and competition for nutrients, provided by the body’s normal bacterial flora, ordinarily keep colonizing fungi in check. Fungi can produce disease in humans only if they can grow at the temperature of the infected body site. Fungal Infections Some Opportunistic Fungal Infections Aspergillosis is a fungus commonly found in soil, water, and decaying vegetation. Infection is airborne. Candidiasis is a yeast- like fungus that is almost always present as part of the normal population of organisms in the mouth, skin, intestinal tract, and vagina. Cryptococcosis, which usually manifests as cryptococcal meningitis, is the most serious of the fungal infections in immunocompromised patients. Mucormycosis is a fungal infection of the sinuses, brain, or lungs caused by fungi such as Mucor or Rhizopus. Pathophysiology of Fungal Infections Blastomycosis is a chronic infection characterized by granulomatous and suppurative lesions. Dermatophytic infections (tinea, ringworm) are fungal infections caused by mold-like fungi called dermatophytes. Tinea lives on the dead tissues on the skin and any structures that grow from the skin (e.g., hair or nails). Coccidioidomycosis is a disease of the lungs, is a fungal which is common in the Histoplasmosis infection that affects the lungs southwestern United States and northwestern Mexico. or other organs by dissemination. The disease is acquired by inhaling fungal spores. Tinea Infections Polyene Antifungal Agents Polyene antimicrobials include amphotericin B and nystatin. These drugs have high affinity for fungal infections and are therefore useful for treating systemic fungal infections. Unfortunately, the polyene antifungal drugs also have the ability to induce severe adverse effects. Prototype drug: amphotericin B (Fungizone) Amphotericin B: Core Drug Knowledge Pharmacotherapeutics Treats progressive and potentially fatal systemic fungal or protozoal infections Pharmacokinetics Administered: IV or oral. Metabolism: unknown. T½: 24 hours. Pharmacodynamics Binds to sterols in fungal cell membranes Amphotericin B: Core Drug Knowledge (cont.) Contraindications and precautions Caution in patients with preexisting anemia, hypokalemia, and hypomagnesemia Adverse effects Nephrotoxicity, hypokalemia, hypomagnesemia, hypochloremia, and hypocalcemia Question Which of the following is the common serious adverse effects of amphotericin B? A. Nephrotoxicity B. Ventricular tachycardia C. Bronchospasm D. Cardiac arrest A. Nephrotoxicity - Amphotericin B has an extensive adverse effects profile. In fact, some clinicians refer to it as “amphoterrible.” Nephrotoxicity occurs in more than 40% of patients receiving amphotericin B. Azole Antifungal Drugs The azole antifungal drugs can be classified into two subgroups: imidazoles and triazoles. Azole antifungal drugs can be used for both superficial mycoses and more serious systemic mycoses. Prototype drugs: fluconazole (Diflucan) ketoconazole (Nizoral) Metronidazole (Flagyl) Pathophysiology Malaria is caused by protozoan parasites of the genus Plasmodium. Pathophysiology (cont.) Parasitic diseases Amebiasis is most frequently caused by the microorganism Entamoeba histolytica, which is passed from host to host by ingestion of fecally contaminated food or water. Cryptosporidiosis is a diarrheal disease caused by Cryptosporidium parvum. Giardiasis is a common disease caused by a flagellated protozoan, Giardia lamblia. Pathophysiology (cont.) Trichomoniasis is an infection of the vagina caused by the parasite Trichomonas vaginalis. Toxoplasmosis is caused by a parasite found in a variety of animals, especially cats and birds. Pneumocystis jiroveci pneumonia is an opportunistic lung infection caused by a parasite of uncertain classification. Pathophysiology Helminthic infections Intestinal nematode infections The common intestinal nematodes are the giant roundworm, pinworm, threadworm, whipworm, and pork roundworm. Roundworms in human stomach: https://www.youtube.com/watch?v=8Snyr_6jY Mk Pathophysiology Blood and tissue nematode (roundworm) infections Filarial infections are among the more serious and debilitating helminthiases associated with blood and tissue nematodes. Pathophysiology (cont.) Cestode Infections Tapeworm infections are transmitted in contaminated raw or improperly cooked fish, beef, and pork. https://www.youtube.com/watch?v=-g7TVlWqDJ8 Pork tapeworms can invade other tissues via the bloodstream. Trematode Infections Cause schistosomiasis, leading cause of morbidity and mortality from parasitic disease; vector is small snail acquired through contaminated water. Pathophysiology (cont.) Ectoparasitic infections Scabies is a skin inflammation caused by a mite, Sarcoptes scabiei. Pediculosis is an infestation occurring on the scalp (pediculosis capitis), trunk (pediculosis corporis), or pubic areas (pediculosis pubis). Antiprotozoan Drugs Antiprotozoan drugs are used to treat many human infections, including amebiasis, giardiasis, trichomoniasis, toxoplasmosis, and opportunistic infections, such as PCP. Because of an increase in the past decade of protozoan infections in the United States, many new antiprotozoan drugs are being developed. Metronidazole (Flagyl) is the prototype. Metronidazole: Core Drug Knowledge Pharmacotherapeutics Treatment of trichomoniasis, amebiasis, and giardiasis Pharmacokinetics Administered: orally, intravenously, and topically. Metabolism: liver. Pharmacodynamics Acts against anaerobic bacteria by inhibiting DNA synthesis Metronidazole: Core Drug Knowledge (cont.) Contraindications and precautions Caution with alcohol or pregnancy Adverse effects Nausea, vomiting, dry mouth, altered sense of taste (dysgeusia), anorexia, and abdominal pain Drug interactions Ethanol Metronidazole: Teaching, Assessment, and Evaluation Patient and family education Create teaching plans that focus on explaining the potential adverse effects. When used for STI’s explain that partners must be treated as well Discuss the importance of refraining from ethanol or disulfiram use during therapy. Question Metronidazole should be used with caution in the patient who is dependent on alcohol. A. True B. False A. True because of the capacity for a disulfiram-like interaction (i.e., nausea, vomiting, headache, and chest pain), ingestion of metronidazole and alcohol should be separated by at least 1 day. Antiectoparasitic Drugs Antiectoparasitic drugs include permethrin, lindane, crotamiton, malathion, and pyrethrins \. These are topical drugs with local action. Although they can eradicate the parasite, they have minimal effect on the pruritus (itching) that frequently accompanies ectoparasitic infections. Resistance is problematic with all of the topical drugs. Prototype drug: permethrin (Nix) Permethrin: Core Drug Knowledge Pharmacotherapeutics Scabicide and pediculicide Pharmacokinetics Administered: topically. Excreted: kidneys. Pharmacodynamics Disrupts the parasite’s nerve cell membrane, resulting in paralysis and death. Permethrin: Core Drug Knowledge (cont.) Contraindications and precautions Hypersensitivity Adverse effects Burning, itching, numbness, rash, redness, stinging, swelling, or tingling of the scalp Drug interactions No drug–drug interactions are known to occur with permethrin. Permethrin: Planning and Interventions Maximizing therapeutic effects Instruct that permethrin is for external use only, and encourage the patient to use it exactly according to directions. Okay to use diphenhydramine (Benadryl) for itching Minimizing adverse effects Keep the drug out of the reach of children, who may ingest it accidentally. Permethrin: Teaching, Assessment, and Evaluation Patient and family education Emphasize the potential adverse effects of permethrin. Tell the patient to leave the permethrin cream on the skin for 8 to 14 hours. Ongoing assessment and evaluation After-treatment evaluations consist of monitoring for signs of successful treatment (eradication) or failure (reinfection). Acne Vulgaris Acne Acne is the most common skin condition in the United States. Without treatment, dark spots and permanent scars can appear on the skin as acne clears. Symptoms: Blackheads Whiteheads Papules Pustules (what many people call pimples) Cysts Nodules Cause of Acne Acne appears when a pore in the skin clogs. This clog begins with dead skin cells. Normally, dead skin cells rise to surface of the pore, and the body sheds the cells. When the body starts to make lots of sebum, oil that keeps our skin from drying out, the dead skin cells can stick together inside the pore. Instead of rising to the surface, the cells become trapped inside the pore. Causes of Acne (cont’d) Sometimes bacteria that live on our skin, p. acnes, also get inside the clogged pore. Inside the pore, the bacteria have a perfect environment for multiplying very quickly. With loads of bacteria inside, the pore becomes inflamed (red and swollen). If the inflammation goes deep into the skin, an acne cyst or nodule appears. Treatment for Acne Topical There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Procedures Lasers and other light therapies Chemical peels Acne removal: drainage and extraction Treatment for Acne Systemic Medications Birth control pills and other medicine that works on hormones (can be helpful for women). Isotretinoin (the only treatment that works on all causes acne). Antibiotics (helps to kill bacteria and reduce inflammation). Prototype: Tetracycline Tetracyclines The tetracyclines were developed as semisynthetic antibiotics based on the structure of a common soil mold. They are broad-spectrum antibiotics that affect both gram-positive and gram-negative bacteria. Over the years, major resistance has developed to tetracyclines. Tetracycline: Core Drug Knowledge Pharmacotherapeutics Rickettsia species, Mycoplasma pneumoniae, and Chlamydia trachomatis Pharmacodynamics Inhibits or retards the growth of bacteria but does not kill them Contraindications and precautions Allergy, pregnancy, or lactation Side/Adverse effects GI upset, Photosensitivity, and Rash. Tooth staining. Challenge Question Tetracycline should not be administered with milk or antacids. A. True B. False A. True - Tetracycline forms an insoluble chelate with aluminum, bismuth, calcium, iron, magnesium, and zinc salts, which are frequently an ingredient in antacids. Homework Assignment Please do Shadow Health Intermediate Case, Tina Jones. You don’t need to submit anything to the Canvas Assignment – that provides a placeholder for completion points. I will review your assignment in Shadow Health.