Dermatology Case Study Onychomycosis 3
Dermatology Case Study Onychomycosis 3
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.
According to the CDC/AAFP guidelines, the Caucasian patient should get antifungal drugs that can be taken either orally or by applying to the nail. If the condition is severe, like in her case, topical and oral antifungal therapies can be combined. Intraconazole and terbinafine are oral drugs that can be used in this case since they facilitate the growth of new nails, which are free from infection, since they replace the infected areas (Muth, 2017). These drugs should be taken for 6-12 weeks. However, the infection may heal after four months or take more time, especially for older adults. However, these drugs hurt the body and may cause liver damage or skin rash. As a result, they are not recommended to patients with heart failure, liver diseases, or those under other medications. Medicated nail cream can also be rubbed in the infected area to kill the fungus. In this case, the patient should take 250g of terbinafine and 200mg of intraconazole every day for three and two months, respectively.
Notes: Take with food.
RX: Terbinafine
PO: Once a day orally
Disp: 250mg Capsules
Notes: Take with food
RX: Itraconazole
PO: Once a day orally
Disp: 200mg Capsules
2.What labs for baseline and follow up of therapy would you order for this patient? Give rationale.
Before recommending any labs for the Caucasian patient, I would first examine the antifungal agents present in the previous medications given to her. Afterward, I would conduct some blood tests to evaluate the AST and ALT levels of the patient. The normal AST range is recorded between ten to forty units per liter, while ALT is 7 to 56 units in every liter, as noted by Wollina, Nenoff, Haroske, & Haenssle (2016). As therapy continues, these tests would be given after four to six weeks. The tests help monitor the antifungal agents like those in Intraconazole to ensure discomfort and pain is relieved.
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References
Muth, C. C. (2017). Fungal nail infection. Journal of the American Medical Association, 317(5), 546. doi:10.1001/jama.2016.20617.
Wollina, U., Nenoff, P., Haroske, G., & Haenssle, H. A. (2016). The diagnosis and treatment of nail disorders. Deutsches Aerzteblatt International, 113(29-30), 509-518.
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