Indications
Treatment of a variety of cutaneous fungal infections,
including cutaneous candidiasis, tinea pedis (athlete’s
foot), tinea cruris (jock itch), tinea corporis (ringworm),
tinea versicolor, seborrheic dermatitis, dandruff,
and onychomycosis of fingernails and toes.
Action
Butenafine, nystatin, clotrimazole, econazole, ketoconazole,
luliconazole, miconazole, naftifine, oxiconazole,
sulconazole, and terbinafine affect the synthesis of the
fungal cell wall, allowing leakage of cellular contents.
Tolnaftate distorts the hyphae and stunts mycelial A
growth in fungi. Ciclopirox inhibits the transport of essential
elements in the fungal cell, disrupting the synthesis
of DNA, RNA, and protein. Therapeutic Effects:
Decrease in symptoms of fungal infection.
Pharmacokinetics
Absorption: Absorption through intact skin is minimal.
Distribution: Distribution after topical administration
is primarily local.
Metabolism and Excretion: Metabolism and excretion
not known following local application.
Half-life: Butenafine—35 hr; Ciclopirox—5.5 hr
(gel); Terbinafine—21 hr.
TIME/ACTION PROFILE (resolution of
symptoms/lesions†)
ROUTE ONSET PEAK DURATION
Butenafine unknown up to 4 wk unknown
Luliconazole unknown 3–4 wk unknown
Tolnaftate 24–72 hr unknown unknown
† Only the drugs with known information included in this table.
Contraindications/Precautions
Contraindicated in: Hypersensitivity to active ingredients,
additives, preservatives, or bases; Some
products contain alcohol or bisulfites and should be
avoided in patients with known intolerance.
Use Cautiously in: Nail and scalp infections (may
require additional systemic therapy); OB, Lactation:
Safety not established.
Adverse Reactions/Side Effects
Local: burning, itching, local hypersensitivity reactions,
redness, stinging.
Interactions
Drug-Drug: Econazole mayqlevels of and risk of
bleeding from warfarin.
Route/Dosage
Butenafine
Topical (Adults and Children 12 yr): Apply once
daily for 2 wk for tinea corporis, tinea cruris, or tinea
versicolor. Apply once daily for 4 wk or once daily for 7
days for tinea pedis.
Ciclopirox
Topical (Adults and Children 10 yr): Cream/lotion—
Apply twice daily for 2–4 wk; Topical solution
(nail lacquer)—Apply to nails at bedtime or 8 hr
prior to bathing for up to 48 wk. Each daily application
should be made over the previous coat and then removed
with alcohol every 7 days; Gel—Apply twice
daily for 4 wk; Shampoo—5–10 mL applied to scalp,
lather and leave on for 3 min, rinse; repeat twice
weekly for 4 wk (at least 3 days between applications).
Clotrimazole
Topical (Adults and Children 3 yr): Apply twice
daily for 1–4 wk.
Econazole
Topical (Adults and Children): Apply once daily for
tinea pedis (for 4 wk), tinea cruris (for 2 wk), tinea
corporis (for 2 wk), or tinea versicolor (for 2 wk). Apply
twice daily for cutaneous candidiasis (for 2 wk).
Ketoconazole
Topical (Adults): Apply cream once daily for cutaneous
candidiasis (for 2 wk), tinea corporis (for 2 wk),
tinea cruris (for 2 wk), tinea pedis (for 6 wk), or tinea
versicolor (for 2 wk). Apply cream twice daily for seborrheic
dermatitis (for 4 wk). For dandruff, use shampoo
twice weekly (wait 3–4 days between treatments)
for 4 wk, then intermittently.
Luliconazole
Topical (Adults): Interdigital tinea pedis—Apply to
affected and surrounding areas once daily for 2 wk;
Tinea cruris and tinea corporis—Apply to affected
and surrounding areas once daily for 1 wk.
Miconazole
Topical (Adults and Children 2 yr): Apply twice
daily. Treat tinea cruris for 2 wk and tinea pedis or
tinea corporis for 4 wk.
Naftifine
Topical (Adults): Interdigital tinea pedis—Apply
cream or gel once daily for 2 wk; Tinea cruris or tinea
corporis—apply cream once daily for 2 wk.
Topical (Children 12 yr): Interdigital tinea
pedis—Apply cream or gel once daily for 2 wk.
Topical (Children 2 yr): Tinea corporis—Apply
cream once daily for 2 wk.
Nystatin
Topical (Adults and Children): Apply 2–3 times
daily until healing is complete.
Oxiconazole
Topical (Adults and Children): Apply cream or lotion
1–2 times daily for tinea pedis (for 4 wk), tinea
corporis (for 2 wk), or tinea cruris (for 2 wk). Apply
cream once daily for tinea versicolor (for 2 wk).
Sulconazole
Topical (Adults): Apply 1–2 times daily (twice daily
for tinea pedis). Treat tinea corporis, tinea cruris, or
tinea versicolor for 3 wk, and tinea pedis for 4 wk.
Terbinafine
Topical (Adults): Apply twice daily for tinea pedis
(for 1 wk) or daily for tinea cruris or tinea corporis for
1 wk.
Tolnaftate
Topical (Adults): Apply twice daily for tinea cruris
(for 2 wk), tinea pedis (for 4 wk), or tinea corporis
(for 4 wk).
Availability
Butenafine
Cream: 1%Rx, OTC.
Ciclopirox (generic available)
Cream: 0.77%. Gel: 0.77%. Lotion: 0.77%. Nail lacquer:
8%. Shampoo: 1%, 1.5%.
Clotrimazole (generic available)
Cream: 1%OTC. Solution: 1%OTC. In combination
with: betamethasone (Lotrisone). See Appendix B.
Econazole (generic available)
Cream: 1%.
Ketoconazole (generic available)
Cream: 2%. Shampoo: 1%OTC, 2%. Foam: 2%. Gel:
2%.
Luliconazole
Cream: 1%.
Miconazole (generic available)
Cream: 2%Rx, OTC. Lotion powder: 2%OTC. Ointment:
2%OTC. Powder: 2%OTC. Spray powder: 2%OTC. Spray
liquid: 2%OTC. Solution: 2%OTC. Tincture: 2%OTC. In
combination with: zinc oxide (Vusion). See
Appendix B.
Naftifine
Cream: 1%, 2%. Gel: 2%.
Nystatin (generic available)
Cream: 100,000 units/gRx, OTC. Ointment: 100,000
units/gRx, OTC. Powder: 100,000 units/gRx, OTC. In combination
with: triamcinolone. See Appendix B.
Oxiconazole (generic available)
Cream: 1%. Lotion: 1%.
Sulconazole
Cream: 1%. Solution: 1%.
Terbinafine (generic available)
Cream: 1%OTC. Gel: 1%OTC. Spray liquid: 1%OTC.
Tolnaftate (generic available)
Cream: 1%OTC. Solution: 1%OTC. Powder: 1%OTC.
Spray powder: 1%OTC. Spray liquid: 1%OTC.
NURSING IMPLICATIONS
Assessment
● Inspect involved areas of skin and mucous membranes
before and frequently during therapy. Increased
skin irritation may indicate need to discontinue
medication.
Potential Nursing Diagnoses
Risk for impaired skin integrity (Indications)
Risk for infection (Indications)
Implementation
● Consult health care professional for proper cleansing
technique before applying medication.
● Choice of vehicle is based on use. Ointments,
creams, and liquids are used as primary therapy. Lotion
is usually preferred in intertriginous areas; if
cream is used, apply sparingly to avoid maceration.
Powders are usually used as adjunctive therapy but
may be used as primary therapy for mild conditions
(especially for moist lesions).
● Topical: Apply small amount to cover affected area
completely. Avoid use of occlusive wrappings or
dressings unless directed by health care professional.
● Nail lacquer: Avoid contact with skin other than
skin immediately surrounding treated nail. Avoid
contact with eyes or mucous membranes. Removal
of unattached, infected nail, as frequently as
monthly, by health care professional is needed with
use of this medication. Up to 48 wk of daily application
and professional removal may be required to
achieve clear or almost clear nail. 6 mo of treatment
may be required before results are noticed.
● Ciclopirox or Ketoconazole shampoo: Moisten
hair and scalp thoroughly with water. Apply sufficient
shampoo to produce enough lather to wash
scalp and hair and gently massage it over the entire
scalp area for approximately 1 min. Rinse hair thoroughly
with warm water. Repeat process, leaving
shampoo on hair for an additional 3 min. After the
2nd shampoo, rinse and dry hair with towel or warm
air flow. Shampoo twice a wk for 4 wk with at least 3
days between each shampooing and then intermittently
as needed to maintain control.
● Ketoconazole foam: Hold container upright and
dispense foam into cap of can or other smooth surface;
dispensing directly on to hand is not recommended
as the foam begins to melt immediately on
contact with warm skin. Pick up small amounts with
fingertips and gently massage into affected areas until
absorbed. Move hair to allow direct application to
skin.
Patient/Family Teaching
● Instruct patient to apply medication as directed for
full course of therapy, even if feeling better. Emphasize
the importance of avoiding the eyes.
● Caution patient that some products may stain fabric,
skin, or hair. Check label information. Fabrics
stained from cream or lotion can usually be cleaned
by hand washing with soap and warm water; stains
from ointments can usually be removed with standard
cleaning fluids.
● Patients with athlete’s foot should be taught to wear A
well-fitting, ventilated shoes, to wash affected areas
thoroughly, and to change shoes and socks at least
once a day.
● Advise patient to report increased skin irritation or
lack of response to therapy to health care professional.
● Nail lacquer: File away loose nail and trim nails
every 7 days after solution is removed with alcohol.
Do not use nail polish on treated nails. Inform
health care professional if patient has diabetes mellitus
before using.
Evaluation/Desired Outcomes
● Decrease in skin irritation and resolution of infection.
Early relief of symptoms may be seen in 2–3
days. For Candida, tinea cruris, and tinea corporis,
2 wk are needed, and for tinea pedis, therapeutic response
may take 3–4 wk. Recurrent fungal infections
may be a sign of systemic illness.
ANTIFUNGALS (VAGINAL)
butoconazole
(byoo-toe-kon-a-zole)
Gynezole-1, Mycelex-3
clotrimazole (kloe-trye-ma-zole)
Canesten, Clotrimaderm, Gyne-
Lotrimin-3, Mycelex-7
miconazole (mye-kon-a-zole)
Monistat-1, Monistat-3, Monistat-7,
Vagistat-3
terconazole (ter-kon-a-zole)
Terazol-3, Terazol-7
tioconazole (tye-oh-kon-a-zole)
1–Day, Monistat-1Day, Vagistat-1
Classification
Therapeutic: antifungals (vaginal)
Indications
Treatment of vulvovaginal candidiasis.
Action
Affects the permeability of the fungal cell wall, allowing
leakage of cellular contents. Not active against bacteria.
Therapeutic Effects: Inhibited growth and death of
susceptible Candida, with decrease in accompanying
symptoms of vulvovaginitis (vaginal burning, itching,
discharge).
Pharmacokinetics
Absorption: Absorption through intact skin is minimal.
Distribution: Unknown. Action is primarily local.
Metabolism and Excretion: Negligible with local
application.
Half-life: Not applicable.
TIME/ACTION PROFILE
ROUTE ONSET PEAK DURATION
All agents rapid unknown 24 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity to active ingredients,
additives, or preservatives; OB: Safety not established;
Lactation: Safety not established.
Use Cautiously in: None noted.
Adverse Reactions/Side Effects
Derm: terconazole—TOXIC EPIDERMAL NECROLYSIS.
GU: itching, pelvic pain, vulvovaginal burning. Misc:
terconazole—ANAPHYLAXIS.
Interactions
Drug-Drug: Concurrent use of vaginal miconazole
with warfarinqrisk of bleeding/bruising (appropriate
monitoring recommended).
Route/Dosage
Butoconazole
Vag (Adults and Children 12 yr): 1 applicatorful
(5 g) at bedtime for 3 days (Mycelex-3) or one applicatorful
single dose (Gynezole-1).
Clotrimazole
Vag (Adults and Children 12 yr): Vaginal tablets—
100 mg at bedtime for 7 nights (preferred regimen
for pregnancy) or 200 mg at bedtime for 3 nights.
Vaginal cream—1 applicatorful (5 g) of 1% cream at
bedtime for 7 days or 1 applicatorful (5 g) of 2%
cream at bedtime for 3 days.
Miconazole
Vag (Adults and Children 12 yr): Vaginal suppositories—
one 100-mg suppository at bedtime for 7
days or one 200-mg suppository at bedtime for 3 days
or one 1200-mg suppository as a single dose. Vaginal
cream—1 applicatorful of 2% cream at bedtime for 7
days or 1 applicatorful of 4% cream at bedtime for 3
days. Combination packages—contain a cream or
suppositories as well as an external vaginal cream (may
be used twice daily for up to 7 days, as needed, for
symptomatic management of itching).
Terconazole
Vag (Adults): Vaginal cream—1 applicatorful (5 g)
of 0.4% cream at bedtime for 7 days or 1 applicatorful
(5 g) of 0.8% cream at bedtime for 3 days. Vaginal
suppositories—1 suppository (80 mg) at bedtime for
3 days.
Tioconazole
Vag (Adults and Children 12 yr): 1 applicatorful
(4.6 g) at bedtime as a single dose.
Availability
Butoconazole
Vaginal cream: 2%Rx, OTC.
Clotrimazole (generic available)
Vaginal tablets: 100 mgOTC, 200 mgOTC. Vaginal
cream: 1%OTC, 2%OTC.
Miconazole (generic available)
Vaginal cream: 2%OTC, 4%OTC. Vaginal suppositories:
100 mgOTC, 200 mgRx, OTC. In combination
with: combination package of three 200-mg suppositories
and 2% external creamOTC; one 1200-mg suppository
and 2% external creamOTC; 4% vaginal cream and
2% external creamOTC; seven 100-mg suppositories and
2% external creamOTC; 2% vaginal cream and 2% external
creamOTC.
Terconazole (generic available)
Vaginal cream: 0.4%, 0.8%. Vaginal suppositories:
80 mg.
Tioconazole
Vaginal ointment: 6.5%OTC.
No comments:
Post a Comment