Discussion response 3


Please respond to discussion below 
Discussion 2: Candida and antifungals
Clotrimazole (Lotrimin) is an over-the-counter (OTC) topical antifungal derived from the imidazole class. It has broad-spectrum properties and works by changing the cell membrane’s permeability (Zhao et al., 2020). The damage to the membrane inhibits 14 alpha lanosterol demethylation, subsequently inhibiting the biogenesis of ergosterol, a compound crucial to the survival of fungi and protozoa (Khatter & Khan, 2022). Without the production of ergosterol, the membranous cell wall cannot remain intact and will not have any functional ability. As a result of the membranous damage, intracellular contents such as potassium and phosphorous erupt, causing cell death.
Antifungal uses and side effects
Antifungals act in the same manner as clotrimazole. They intend to treat fungal or yeast infections locally or systematically. Some medications are OTC, and some are by prescription only. Fungal infections such as tinea capitis, tinea corporis, tinea pedis, and candidiasis are all diagnoses that require antifungal treatments. Tinea infections are caused by dermatophytosis and can affect nearly every body part, from head to toe. Candida infections can be found in the axilla, glans penis, nail folds, mouth and tongue, and under abdominal folds. The typical cause is a warm and moist environment or a break in the skin where the fungus can enter.
Side effects from antifungal use include erythema, pruritis, stinging, allergic contact dermatitis, and burning at the local site of application (Arcangelo et al., 2021). Shampoo, such as selenium sulfide, may cause hair loss or irritation to the scalp. Oral agents may cause GI upset such as nausea, vomiting, and oral irritation. A commonly used antifungal, Diflucan, can cause QT prolongation and potentiates warfarin and theophylline. Long-term antifungals, like itraconazole and Diflucan, require monitoring of liver and kidney function (Arcangelo et al., 2021).
Teaching plan
Ms. Jones should be instructed to use the clotrimazole ointment as prescribed: topically TID (three times daily) for 14 days to the affected area. The ointment should be applied in a gentle massage-like motion with a cotton swab so as not to rub it too harshly, preventing further irritation to the skin. She should be aware that while the rash may lighten or disappear before the end of the 14-day prescription, she should continue using it for the entire duration of therapy (Arcangelo et al., 2021). Side effects should be discussed, including the potential for burning or stinging after application and associated pruritis with an antifungal. It is essential to keep the area as clean and dry as possible, taking note to bathe Sam regularly. Ms. Jones should change Sam’s diapers as soon as possible after soiling and allow airflow to the affected area as much as possible to allow natural moisture evaporation. In addition, Ms. Jones should be educated on proper hand hygiene and to wash hands directly after diaper changes and ointment applications to prevent the spread of the infection. Education should also include using scent-free soaps and lotions to avoid skin irritation and to avoid using powder in the area. Using ointments such as zinc on intact skin can help prevent skin breakdown and minimize future fungal infections. Lastly, Ms. Jones should contact the practitioner for any worrisome or bothersome side effects or if the condition does not improve upon therapy completion.

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