Pharmacology & Nail Treatments Flashcards

What is the mechanism of action of topical antifungal nail lacquers (e.g., ciclopirox)?

Answer: They penetrate the nail plate to inhibit fungal cell membrane function and disrupt fungal metabolism

Topical antifungal lacquers like ciclopirox work by chelating metal ions essential for fungal enzyme function and disrupting cell membrane integrity, inhibiting growth and survival of dermatophytes, yeasts, and molds.

Why do oral antifungal medications require liver function monitoring?

Answer: Because antifungal drugs like terbinafine and itraconazole can cause hepatotoxicity (liver damage)

Systemic antifungal medications are metabolized by the liver and can cause elevated liver enzymes or liver damage in some patients. Baseline and periodic liver function tests are required to detect problems early.

What is KOH (potassium hydroxide) testing used for in nail diagnostics?

Answer: To dissolve keratin in a nail sample and allow microscopic visualization of fungal elements

KOH dissolves keratin (the nail protein), leaving fungal structures (hyphae, spores) visible under microscopy. This simple, rapid test helps confirm suspected onychomycosis before starting antifungal treatment.

What is the typical duration of oral antifungal treatment for toenail onychomycosis?

Answer: 12 weeks (3 months) for terbinafine, with the nail continuing to clear over 6-12 months as it grows out

Oral terbinafine is typically prescribed for 12 weeks for toenails. However, because toenails grow slowly (1mm per month), it takes 12-18 months to see the full result as the healthy nail grows out completely.

What is nail debridement?

Answer: The mechanical reduction of thickened, dystrophic nail tissue using specialized instruments or drills

Nail debridement involves carefully reducing thickened or damaged nail tissue using electric drills, nippers, or files to improve comfort, appearance, and penetration of topical medications.

What precaution is needed when using an electric nail drill?

Answer: Use appropriate speed settings, avoid excessive pressure and heat generation, wear dust masks, and never drill into live tissue

Electric nail drills generate heat, dust, and aerosols. Operators must use low-medium speed, light pressure, proper dust extraction, respiratory protection, and careful technique to avoid thermal injury and live tissue damage.