Discussion 2 respond pharm

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  You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your responses must be substantive and not just agreeing with someone’s work. You need to add by explaining more, refuting a point or correcting a point.  a minimum of 150 words and one reference with in text citation, one reference for each respond.  

Discussion 1 (Rosa)

Module 1 Discussion

Module 1

Ms. Jones brings 6-week-old Sam to the clinic because of a bright red rash in the diaper area that has become worse since she started putting over-the-counter antibiotic cream on it 3 days ago. Sam is diagnosed with a diaper candida or a yeast infection. Clotrimazole (Lotrimin) topical TID for 14 days to the diaper area has been prescribed.

 Briefly describe the therapeutic actions of Clotrimazole (Lotrimin).

 Clotrimazole is a medication with broad-spectrum antimycotic activity. Dermal manifestations of tinea infections are seen globally and analyzed based on the affected body site (Woo et al., 2019). Clotrimazole belongs to a broader class of medications and is used to treat fungal infections of candidiasis involving the hair, skin, and nails. This medication should be applied orally, vaginally, or topically to treat itching, scaling, and the rash associated with candida. The therapeutic effect of Clotrimazole is achieved by inhibiting the growth of fungi by permeating the cytoplasmic membrane of Fungi.

 The skin is the largest organ and first line of defense located in the human body by surface area. The barrier provided by the epidermis functions to protect from invading structures. Clotrimazole inhibits the production of sterols, particularly Ergosterol (Links to an external site.)
. This sterol is a vital component of the fungal cell membrane. As a result, damaging and disrupting the permeability of the cell membrane (National Center for Biotechnology Information [NCBI], 2022) The therapeutic effect of Clotrimazole is achieved when fungal growth has been inhibited. More specifically when the cytochrome P450 enzyme has been breached.

 Best practices when using Clotrimazole include application to clean, dry skin and confinement to the affected area. It is usually applied twice a day or as indicated. Hands should be washed thoroughly after application. Discontinuing use before the designated time could cause the infection to return.

 Describe antifungal drug uses and side effects.

 Topical antifungal medications can have high toxicity levels and should be used with caution. They are relatively safe when used as directed. The recent increase in the incidence of fungal infections has caused an expansion in over-the-counter medication usage. Careful consideration must be exercised when prescribing because antifungals impact the cell wall, and toxicity can occur. Some of the most common side side-effects include redness and irritation at the site of application, itching, skin rash, and blistering.

 Develop a teaching plan for Ms. Jones with age-appropriate considerations for Sam.

 Appropriate education on the proper use of Clotrimazole will help the patient experience the therapeutic effects of the medication, provide resolution of the condition, and minimize side effects. Ms. Jones should be taught to keep the infected area clean and dry. More frequent diaper changes may be needed to accomplish this goal. Exposing the skin to air as much as possible is recommended because yeast tends to thrive in moist, dark environments. If Ms. Jones is using cloth diapers, she should be encouraged to use moisture-wicking, disposable diapers. If the cost associated with these diapers is an issue, a referral to community resources would be appropriate. Additionally, the medication should be applied to the skin after it has been cleaned with warm soapy water and for the recommended time frame to prevent reoccurrence.

 

References

 Felgueiras H. P. (2021). An insight into biomolecules for the treatment of skin infectious diseases. Pharmaceutics, 13(7), 1012. https://doi.org/10.3390/pharmaceutics13071012

Discussion 2 (Michell)

Clotrimazole and Age-Appropriate Teaching Plan

Briefly describe the therapeutic actions of Clotrimazole (Lotrimin)

            Topical azole antifungals, such as Clotrimazole, impair the synthesis of ergosterol, the main sterol of the fungal cell membrane. The impairment of the synthesis creates increased permeability and leakage of cellular components, resulting in cell death (Arcangelo et al., 2017). Clotrimazole also has other pharmacological actions, including inhibition of sarcoplasmic reticulum ca2+ ATPase, depletion of intracellular calcium, and blocking of calcium-dependent potassium channels and voltage-dependent calcium channels (Khatter & Khan, 2021). For this reason, Clotrimazole is known as a synthetic imidazole with a broad spectrum of antimycotic activity.  

Describe antifungal drugs uses and side effects

            Antifungal drugs are fungicides that are effective against cutaneous candidiasis, tinea pedis, tinea corporis, and tinea cruris. According to Arcangelo et al. (2017), topical antifungals should be applied once or twice a day for two to four weeks, and therapy should continue for one week after the lesions clear. Clotrimazole is offered under several FDA-approved brand names, including topical lotions, powders, oral lozenges, and vaginal inserts/tablets (Khatter & Khan, 2021). Therapy is contraindicated in pregnancy or lactation and should be used cautiously in patients with hepatocellular failure (Arcangelo et al., 2017). The adverse effects include pruritus, stinging, and irritation.

            Topical allylamine antifungals are effective against dermatophyte infections; however, it has limited effectiveness against yeast (Arcangelo et al., 2017). The dosage for this treatment is shorter with less likelihood of relapse. The potential side effects of allylamine antifungals include burning and irritation.

            Griseofulvin is an oral antifungal effective for tinea capitis, which includes a treatment for a minimum of eight weeks (Arcangelo et al., 2017). The action of Griseofulvin deposits in keratin precursor cells increasing new keratin resistance to fungal invasion. Since this drug may aggravate lupus erythematosus, evaluation of hepatic, renal, and hematopoietic system is recommended prior to starting therapy (Arcangelo et al., 2017). The adverse effects include photosensitivity, headache, nausea, vomiting, and diarrhea.

            The goal of therapy is directed at the offending fungus and site of infection. The treatment may be topical or systemic, depending on the location of the lesions. For example, systemic therapy is required for tinea capitis and tinea unguium. The primary treatment includes keeping the areas prone to fungal infections dry after bathing and applying powder, such as miconazole.

Develop a teaching plan for Ms. Jones including age-appropriate considerations for Sam

            Diaper Candida can develop due to prolonged contact with various agents, such as moisture, urine, and stool. Management includes the promotion of healing damaged skin and prevention of rash reoccurrence. Maintaining skin integrity and preventing further breakdown requires good hygiene. It is critical to clean and bathe the diaper area with a soap-free cleanser and water. Exposure to irritants, such as urine and feces, can be reduced by changing diapers frequently and using superabsorbent diapers, which help reduce skin over-hydration (Benitez Ojeda & Mendez, 2022). It is important to inform Ms. Jones that baby wipes should be free of soap, essential oils, other fragrances, and harsh detergents that can irritate the skin. The application of Clotrimazole should cover the affected area and surrounding skin. Most importantly, Ms. Jones must follow Clotrimazole treatment as directed for 14 days.

 

References

Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Wolters

           Kluwer.

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