What is the most common fungus?
Candida (candidiasis)
What is the most common virus?
herpes simplex virus
What does saprophytic mean?
members of soil microbial.
What does commensals mean?
obtain benefit without causing harm (antifungals)
Most organisms associated with human disease are?
saprophytic
What is a a mycotic infection?
-opportunistic in nature
-complex pharmacologic tx
-subacute in nature
-relapse tendency
What are some mycotic infections?
-HIV infection
-increased risk for immunosuppression for organ transplantation
-tx of malignant diseases
What is the mechanisms of action for antifungal therapy?
-inhibit ERGOSTEROL SYNTHESIS
-disrupt fungal plasma by dividing to form ergosterol
-agents in dentistry act by these mechanisms
What is ergosterol?
the stability in the cell membrane
In antifungal therapy what do the drugs do to ergosterol?
They force ergosterol to detach from the cell wall of the fungus to make the cell wall weak
Ketoconazole, itraconazole, Vorioconazole, fluconazole, Clotrimazole are all what type of drugs? "that azole (ass) inhibits me from synthesis" ?
Antifungal agents that inhibit synthesis of ergosterol
T/F azoles are entirely selective for fungal enzymes?
False they are NOT entirely selective for fungal enzymes
What is major adverse effect of the -azoles?
hepatoxicity
Are there many drug to drug interactions with -azoles?
yes
What is a troche?
a lozenge
What is Clotrimazole?
a sugar-containing lozenge for oral use
What are the ADEs for clotrimazole?
-elevated liver enzyme in 15% pts
-FDA category C
What is ketoconazole for?
-Oropharyngeal candidiasis (thrush)
What does ketoconazole inhibit?
sex steroid biosynthese including testosterone. Can cause gynecomastia
What does gynecomastia mean?
No viable sperm, low sex drive, performance issues, man boobs.
Where is Ketoconazole metabolized?
liver
What is the FDA category for ketoconazole?
C, crosses placenta
Ketoconazole is not the drug of choice for what?
tinea (jock itch) and wide coverage of infections
What are the ADE's for KEtoconazole?
fatal hepatotoxicity, and not to take with rifampin
What treatment is Nystatin strictly limited to treat?
superficial candidal infections
Nystatin binds to ergosterol and what does this do?
increases the permeability, results in leakage of cellular components, leading to cell death
Nystatin has poor oral absorption and can be found in what forms?
-cream
-rinse (sugar added and held in mouth for 2 mins)
-lozenge
Which antifungal has no risk for drug-drug interactions?
nystatin
Oral pastilles for Nystatin are the formulation of choice and dissolve in mouth in how many mins?
15 mins
Where do candida albicans normally inhabit?
oral cavity
What are predisposing systemic factors of C. Albicans?
-HIVD
-corticosteroids (reduce immune response)
-Diabetes mellitus
-salivary flow changes
-antibacterial drug use
-Dental protheses
-advanced age
What are the clinical manifestations of oral candida?
-pseudomembranous candidiasis
-erythematous candidiasis (atrophic)
-Hyperplastic candidiasis
-Candida-associated denture stomatitis
-Median rhomboid glossitis
-Angular cheilits
What is pseudomembranous candidiasis?
-White lesion
-may be wiped off leaving a red painful mucosa
- common in neonates and immunosuppressed patients
What is erythematous candidiasis (atrophic)?
-red patch on palate or tongue
-burning sensation
-seen in HIV disease
What is hyperplastic candidiasis?
-least common candida
-antifungal therapy resolves "leukoplakia
-associated with inhaled corticosteroids
What is candida-associated denture stomatitis?
-Erythematous area beneath denture surface
-associated with bad hygiene and chronic wearing of dental prostheses
All of the following statements are true about nystatin except one. Which one is the exception?
a. Nystatin is an inhibitor of ergosterol synthesis
b. the use of nystatin is limited to the treatment of candidal infections of the skin, oral, and vaginal mu
A.
What is median rhomboid glossitis?
looks like a rhomboid on the tongue and is red
What is angular cheilitis?
-commissures of the lips
What are the Local treatments for orolabial candidal infections?
-proper cleaning of all tissues and all prostheses
-Take out prostheses before bed (hs)
-Chlorohexidine rinse + antifungal to disinfect prosthesis
If there is no resolution of local treatments for orolabial candidal infections whats next?
Use systemic antifungal:
1st use nystatin
then use diflucan
Nystatin vaginal tablets can be used in caries-prone patients, why?
they don't contain sugar
What antifungal is the refractory drug for nystatin?
clotrimazole is used if infection comes back after using nystatin
What time does it take for a clotrimazole to dissolve?
15-30 mins slowly
What drug should you take 2 hours before taking a GI drug and why?
Fluconazole (diflucan) because it needs an acidic environment to work
Which of the following candidiasis identifies as a red patch, usually on the palate or dorsum of the tongue with a loss of filiform papillae?
erythematous candidiasis
There is no specific treatment for most viral infections they just need to run their course, why is this?
Because most agents that interfere with replication are toxic to host cell.
What is the most common viral infection affecting dental professions?
HSV-1
What is the prodromal phase?
1-2 days before the virus is seen. with herpes you feel tingling before it pops on your lip a day later.
What is primary herpes?
-spontaneous 1 time event
What is herpes simplex (HSV-1)?
-recurrent herpes
T/F most antiviral agents are either purine or pyrimidine analogues that inhibit DNA synthesis
true
When are topical antiviral agents most effective?
during the early prodromal stage
When is HSV-1 most transmissible?
in the vesicular stage
What drug is not effective in herpes labialis but in herpes genitalis?
acyclovir
What drug is only effective in the initial herpes genitalis and not in the prevention or recurrent herpes genitalis?
acyclovir
T/F you can see a patient with active herpetic infections
false reschedule them
What drug is used for treatment of recurrent genital herpes and varicella zoster infections?
Famiciclovir (fam like family all gets it) and valacyclovir
Hairy leukoplakia is associated with what viral infection?
HIV
How to immunizations work?
inhibit viral infection by providing antibodies against viral envelope proteins and may be directly virucidal
The term that describes the most of the fungi that are associated with human disease is?
saprophytic
T/F hepatitis affects drug metabolism
true
T/F if pt has hepatitis or anticoagulants you should know how fast they clot.
true