NAPLEX Question of the Week: Scratching the Surface

A common conundrum for patients requiring treatment is the subject of our question of the week!
NAPLEX Question of the Week: Scratching the Surface
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NM is a 34-year-old male who comes into your pharmacy with a question regarding an itch on his right foot. When asked questions, he responds that his signs and symptoms of dry, scaly skin between his toes started 3-4 days ago after a fishing trip. He has tried to clean the area thoroughly with soap and water, but it has not gotten better. You have discerned this as a tinea pedis infection. NM has no prior PMH and currently does not take any medications. He has not tried any OTC medications yet and asks you what you recommend OTC therapy for his foot infection.  Which of the following cream options would be appropriate for NM? Select all that apply. 

A. Monistat 3 

B. Lamisil 

C. Loprox 

D. Tinactin 

E. Lotrimin AF

F. NM should be referred to his primary care physician for treatment

 

 

 

 

 

 

 

 

 

 

 

Answer Choices B, D, and E are correct 

Brand/Generics covered: Monistat 3 (Miconazole), Lamisil (Terbinafine), Loprox (Ciclopirox), Tinactin (Tonaftate), and Lotrimin AF (Clotrimazole)  

Answers with rationale:  

Tinea Pedis, also known as Athlete’s Foot, is a common fungal infection that can be caused by a constant warm and wet environment in closed fitted shoes. The most common symptom is a dry, scaly rash causing itch that may burn or blister. This infection is contagious and can spread via contact exposure like clothing. Most cases can be resolved with non-pharmacologic and pharmacologic care. 

Answer choice A is incorrect as although miconazole is a treatment of tinea pedis infections, the Monistat 3 formulation is used for vaginal yeast infections. The right route of administration should be considered when selecting appropriate OTC medications for patients. Miconazole is available as a generic cream OTC. 

Answer choice B is correct as Lamisil is available OTC as a treatment for Athlete’s Foot. Lamisil works by inhibition of squalene epoxidase, an enzyme vital to upkeep of the fungal cell membrane resulting in fungal death. The cream formulation is applied topically to the affected areas once to twice daily until 1 week after clinical resolution. Adverse effects include local irritation and burning sensation of the skin. 

Answer choice C is incorrect as Loprox is a prescription only medication and is not available OTC. This would have been a choice for resolving Athlete’s foot.  

Answer Choice D is correct as Tinactin is available OTC as a treatment for Athlete’s Foot. The mechanism of action is distortion of the hyphae and prevents mycelial growth of the fungi. The cream formulation is applied topically to the affected areas twice daily until 1 week after clinical resolution. This medication can be used for prevention of Athlete’s foot as well. Adverse effects include local irritation and burning sensation of the skin. 

Answer choice E is correct as Lotrimin is available OTC as a treatment for Athlete’s Foot. Lotrimin can come with different active ingredients including miconazole and butenafine. Lotrimin blocks the synthesis of ergosterol, causing damage to the fungal cell wall membrane resulting in fungal death. The cream formulation is applied topically to the affected areas twice daily until 1 week after clinical resolution. Adverse effects include local irritation and burning sensation of the skin. 

Before application of the medication cream, wash the area thoroughly with soap and water. Also, dry the areas thoroughly and then apply the agent to the affected area. If the Athlete’s foot does not provide relief of symptoms within 2 weeks or symptoms worsen, then refer the patient to their primary care provider (answer choice F is incorrect). 

Resources: 

Lamisil Drug Label 

Tinactin Drug Label 

Lotrimin Drug Label 

NAPLEX Competencies covered: 

1.2 – From patients: treatment adherence, or medication-taking behavior; chief complaint, medication history, medical history, family history, social history, lifestyle habits, socioeconomic background 

2.1 – Pharmacology, mechanism of action, or therapeutic class 

2.2 – Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions; or how supplied 

3.1- Triage or medical referral

3.5 – Drug route of administration, dosage forms, or delivery systems

Have a great week everyone!

Dr. B

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