PHA 456 Oral and Vulvovaginal Candidiasis

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1

What is the most common pathogen in immunocompromised patients?

Candida albicans

2

T/F When candida albicans infection spreads to the esophagus it doesnt becomes severe

False, it does

3

T/F Oral Candidiasis if often symptomatic

False, it is asympotmatic

4

Which of the following is the most common cause of oral candidiasis?

A. Candida krusei

B. Candida albicans

C. Candida glabrata

D. Candida tropicalis

B

5

CR is an 80 year old male with diabetes, hypertension, and angina. Which of his disease states puts him at most risk of having oral candidiasis?

A. Angina

B. Diabetes

C. Hypertension

D. None of the above are risk factors

B

6

What are systemic risk factors of oral candidiasis?

Malignancies

Diabetes

HIV infection/AIDS

Neonates or the elderly

Drugs

Nutritional deficiencies

7

What are the local risk factors of oral candidiasis?

Disruption of oral mucosa

Smoking

Xerostomia

Dentures

Use of steroids and antibiotics

8

T/F Oral candidiasis can be defined as a case of severe thrush

True

9

T/F Topical agents are first line when treating a mild infections of oral candidiasis

True

10

T/F Systemic tablets are used in moderate-severe infections of of oral candidiasis

True

11

What are some 1st line agents that are used for mild oral candidiasis infections?

Clotrimazole 10 mg troches

Miconazole 50 mg adhesive tablets (BUCCALLY)

Nystatin 100,000 units/ml suspension

12

What is an oral agent that is used to treat moderate to severe cases of oral candidiasis?

Fluconazole 100-200 mg daily

13

What are the agents that are used as refractory in treating oral candidiasis?

Itraconazole 10mg/mL solution

Voriconazole 200mg tablets

Paraconule 40mg/mL suspension

Amphotericin B 100mg/mL suspension

14

How long should refractory agents be used to treat oral candidasis?

Treat for ≥ 14 days

15

Patient Case

TB is a 30 year old female who presents to your clinic with complaints of white patches in her mouth for one week. She has wiped away some of the patches which have caused her mouth to become sore and inflamed.

Past medical history: HTN, Asthma, GERD

Social history: No EtOH or tobacco

Home Medications: Advair Diskus 250/50 BID, Lisinopril 20mg daily, Omeprazole 20mg daily, HCTZ 25mg daily

16

What type of oral candidiasis does TB have?

A. Hyperplastic

B. Erythematous

C. Angular cheilitis

D. Pseudomembranous

D

17

Which of the following medications most likely contributed to TB’s oral candidiasis?

A. Lisinopril

B. Omeprazole

C. Advair Diskus

D. None of the above

C

18

Which of the following therapeutic options is most appropriate for TB at this time?

A. Voriconazole 200mg BID

B. Nystatin 100,000 units/mL suspension 5mL swish and swallow 4 times/day

C. Amphotericin B 100mg/mL suspension 5 mL swish and swallow 4 times/day

D. Any of the above therapies are appropriate

B

19

T/F The oral cavity should be clean before using a topical agent and apply after meals

True

20

T/F It is ok the chew or swallow troches

False, dissolve for 15-30 minutes

21

T/f It is permissible to swish suspensions around the mouth for 1 minute then gargle and swallow

True

22

What is the major pathogen of Vulvovaginal candidiasis?

Candida ablicans

23

What are the risk factors associated with Vulvovaginal candidiasis?

Sexual activity

Oral to genital contact

Douching

Diet

Tight fitting clothes

Antibiotic and immunosuppressant use

24

What are the signs of Vulvogainal candidiasis?

Thick, cottage cheese-like, white discharge

Vulvovaginal edema and erythema

25

What are the symptoms of Vulvogainal candidiasis?

Intense vulvar itching

Soreness

Irritation

Burning on urination

Dyspareunia

26

T/F Reliable diagnosis can NOT be made without laboratory tests

True

27

Mycelex-3® Cream

Butoconazole 2% use one applicator x 3 days

28

Mycelex-7® Cream

Gyne-Lotrimin® Cream

Clotrimazole 1% - 10%

Varies depending on formulation; 1,3, or 7 day treatment options available

29

Monistat®

Miconazole 2% or 4% cream and 100 or 200 mg suppositories

Varies depending on formulation; 1,3, or 7 day treatment options available

30

Vagistat 1® Ointment

Tioconazole 6.5% One applicator x 1 day

31

Terazol 3 (Rx only)

Terazol 7 (Rx only)

Terconazole 0.4 % or 0.8% One applicator x 3 or 7 days