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Yisandra Delgado

Florida National University

Advanced Pharmacology – NGR 6172

Dr. Vardah Seraphin DNP, PMHNP-BC, FNP-C, APRN

June 3, 2021

Dermatology Case Study

Onychomycosis refers to the nails’ (both fingers and toes) infection that results in the thickening, discoloration, and separation of the nail from its bed. However, the infection is common in toenails due to reduced growth, blood supply, and the dark, along with a moist environment. Oral antifungals are recommended over topical antifungals since they are hardly effective.

Antifungal treatment interventions focus on the improvement of the nails’ appearance and prevention of associated complications. In this case scenario, the patient should take terbinafine, an allylamine. The drug works by preventing the oxidation of squalene to ergosterol by inhibiting the enzyme squalene epoxidase (“Terbinafine – LiverTox – NCBI bookshelf,” 2018). The drug affects the synthesis of fungus’ cell wall and squalene intracellular accumulation.

Antifungal Medication Prescription

Patient Name: E.D DOB: 00/00/83 (38 yo) Wt. 140 lbs

Terbinafine 250mg

Dispensing Instructions (Disp.): 30 tablets

(Sig.): 1 Tablet PO QD for 12 weeks for Onychomycosis

Refills: 2

Yisandra Delgado, ARNP Date: June 3, 2021

Laboratory Tests for Assessment

Stolmeier et al., (2018) study showed that terbinafine is a well-tolerated drug but can cause hematological (anemia, neutropenia, and lymphopenia) and hepatic abnormalities (elevated Aspartate Aminotransferase (AST), bilirubin, globulin, and total protein). Hepatoxicity is a common side effect associated with terbinafine oral therapy. It is important to assess the serum aminotransferases; in hepatoxicity, the enzymes are elevated.

Hepatoxicity occurs within the first six weeks since the initiation of the therapy (“Terbinafine – LiverTox – NCBI bookshelf,” 2018). The injury to the liver starts in a cholestatic pattern that can be prolonged and later affect the bile duct. Additionally, a complete blood count should be performed. For instance, aplastic anemia is associated with hepatoxicity: the condition results from bone marrow failure. Therefore, I will perform serum aminotransferases along with a complete blood count after the dosage completion.

References

Stolmeier, D. A., Stratman, H. B., McIntee, T. J., & Stratman, E. J. (2018). Utility of laboratory

test result monitoring in patients taking oral terbinafine or griseofulvin for dermatophyte infections. JAMA dermatology, 154(12), 1409-1416.

Terbinafine – LiverTox – NCBI bookshelf. (2018, January 1). Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK548617/

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