Running head: DISCUSSION CASE STUDY 1
DISCUSSION CASE STUDY 3
The antifungal medication that should be prescribed to the patient based on the guidelines of the AAFP/CDC
Onychomycosis is described as a fungal infection of either the fingernail pr the toenail. The infection caused by the microorganism belonging to a group of dermatophyte, for example, the tine unguium. Onychomycosis also occurs as a result of the infection by the microorganism belonging to Candida. The treatment of Onychomycosis infection requires an organized process with the continuous monitoring process. There are antifungal medications such as griseofulvin, ketoconazole, itraconazole, and terbinafine are used for the systematic treatment approach for the condition. For the case of this patient, the medication for treatment will involve the prescription of terbinafine 250mg 1 tab PO daily for 48 days. It is also possible to use terbinafine 250 mg 1 tablet PO for 48 days (Bhatia, Kanish, Badyal, Kate, & Choudhary, 2019).
The labs for baseline and the follow-up of the therapy to be ordered for this patient
During the treatment process, certain tests have to be done to help in monitoring the improvement in the condition of the patient. The labs procedures for the baseline and follow-up of therapy require test procedures such as live enzyme and the complete blood count (CBC). These tests are supposed to be performed every 24 or more days to help in the process of monitoring the complete blood count and liver enzymes. The follow-up therapy to be ordered for the patient is terbinafine since it is effective for the treatment of the superficial fungal diseases of both skin and the nails. This drug is effective since it provides superior long-lasting mycological as well as clinical efficacy. It is also associated with the low rates of the mycological and the clinical relapse as compared to the intermittent itraconazole drug (Tosti & Elewski, 2016).
References
Bhatia, A., Kanish, B., Badyal, K., Kate, P., & Choudhary, S. (2019). Efficacy of oral terbinafine versus itraconazole in the treatment of dermatophyte infection of the skin–A prospective, randomized comparative study. Indian journal of pharmacology, 51 (2), 116. Tosti, A., & Elewski, B. (2016). Onychomycosis: practical approaches to minimize relapse and recurrence. Skin appendage disorders, 2 (1-2), 83-87.
CASE STUD
Question 1
The laboratory test, physical examination as well as signs and symptoms show that the patient is suffering from Onychomycosis. Onychomycosis is a fungal infection that mainly affects the toe and fingernails. It causes the nails to thicken and discolor. If the patient is not treated it results in inflamed and pain in the nails, (Hare & Rich, 2018). The main cause of this illness includes dermatophytes and candida. Candida mainly affects individuals who live in hot climate regions while dermatophytes affect people who live in the western region. To treat the illness antifungal medications, have to be prescribed. The best medication for this illness includes Itraconazole and Terbinafine, (André, et al., 2019). Terbinafine can be used to cure illnesses caused by dermatophytes while Itraconazole is most effective as a short term therapy. Terbinafine 250mg should be taken daily for individuals with toenail infection for twelve weeks. Terbinafine 250mg should be taken daily for individuals with fingernails infection for about six weeks. Patients with toenail infection and fingernail infection are required to take 200mg of Itraconazole daily for twelve to six weeks respectively. The prescription for the patient should include:
RX: Terbinafine
Disp: 250 mg Capsules
PO: Once a day orally
Note: Take with meals.
Medication: Itraconazole
Quantity: 200 mg Capsules
PO: Once a day orally
Note: Take with meals.
Question 2
The baseline and follow up therapy will depend on the prescribed antifungal agent. The labs that I would have considered include blood count and liver blood tests. The results should be shown four to six weeks after the therapy. This test is vital since it determines whether the antifungal agent is effective as well as the related complications, (Lipner & Scher, 2019).
Reference
André, J., Rigopoulos, D., Elewski, B., & Richert, B. (2019). Histopathology of Onychomycosis. Onychomycosis diagnosis and effective management, 1, 60-65.
Hare, A. Q., & Rich, P. (2018). Grading Onychomycosis. Onychomycosis: Diagnosis and Effective Management, 41.
Lipner, S. R., & Scher, R. K. (2019). Onychomycosis: Treatment and prevention of recurrence. Journal of the American Academy of Dermatology, 80(4), 853-867.
Also regarded as tinea unguium, onychomycosis is a fungal infection for the nail(s) that makes the patient develop other complications. As an NP student and regarding the AAFP/CDC guidelines, the antifungal medication(s) that needs to be prescribed for the patient presented in the case study will be any of the three major antifungal medications. One of the first options is prescribing griseofulvin to the patient, which will be effective for remedying the above situation. The other option will be various medications in the azole group that include fluconazole and itraconazole (Rodgers, 2001). The third alternative will be prescribing terbinafine medications. In this case, the medication should be prescribed for 12 weeks as it involves the toenail fungus. In the case of fingernail fungus, the prescription would last for 8 weeks.
The patient in the case study also requires full prescriptions, and this may be done by following the prescription writing format. In the case of administering terbinafine, the description will be 250 mg per day for eight weeks. When administering itraconazole, the prescription will be, continuous therapy: 200 mg per day for 8 weeks and in case of fluconazole, the prescription will be 150 mg once every week until the nail is normal and this will require a prolonged duration for around six months, (Rodgers, 2001). The other instance involves ordering the labs for baseline and therapy follow up for the above patient.
In this instance, the recommended labs for baseline as well as therapy follow up include doing a complete blood count and AST and ALT levels at baseline. The above undertaking will be done every four weeks to six weeks during the period that the therapy is being administered. The rationale for carrying out this activity is to monitor the common drug interactions that may occur with the chosen antifungal agent. The antifungal agents interact with the body and may lead to further complications. As an example, the administration of griseofulvin has been highly limited as it carries the risk of hepatotoxicity despite it being very effective.
Reference
Phillip Rodgers and Mary Bassler. (February 15, 2001). Treating Onychomycosis: American Family Physician.
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