Terbinafine (Systemic)

INTRODUCTION

Indications

Systemic: Onychomycosis (fungal nail infection). Tinea capitis.

Topical: Treatment of a variety of cutaneous fungal infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).

Action

Interferes with fungal cell wall synthesis (ergosterol biosynthesis) by inhibiting the enzyme squalene epoxidase. Therapeutic Effects: Fungal cell death. Spectrum: Active against dermatophytes and other fungi.

Adverse Reactions/Side Effects

CNS: headache. Resp: cough, nasopharyngitis. CV: CHF. GI: HEPATOTOXICITY, anorexia, diarrhea, nausea, stomach pain, vomiting, altered taste. Derm: TOXIC EPIDERMAL NECROLYSIS, itching, rash. Hemat: neutropenia, pancytopenia. Misc: STEVENS-JOHNSON SYNDROME, pyrexia. Local: burning, itching, local hypersensitivity reactions, redness, stinging.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

• Monitor rashes or other severe skin reactions such as exfoliation, hives, itching, raised patches of red or white skin (welts), burning, acne, and abnormal sweating Notify physician immediately because certain skin responses may indicate serious hypersensitivity reactions (toxic epidermal necrolysis, Stevens-Johnson syndrome).

• Monitor other signs of allergic reactions and anaphylaxis, including pulmonary symptoms such as tightness in the throat and chest, wheezing, cough, and dyspnea. Notify physician immediately if these reactions occur.

• Assess signs of congestive heart failure (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance). Report these signs to the physician.

• Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemias or other blood dyscrasias. Notify physician of these signs.

• For cutaneous or nail infections, assess healing of lesions to help document drug effectiveness.

Interventions

• Avoid contact with cutaneous lesions when treating patient.

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to take or apply this drug as directed for the full course of treatment even if feeling better.

• Advise patient to report any increased local sensitivity to topical application of this drug (pain, burning, itching, swelling).

• Instruct patients with cutaneous infections about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

• Inform patient that early relief of cutaneous symptoms may be ...