6/11/2023 0 Comments Ketoconazole xteam 60![]() High-dose ketoconazole has been shown to cause an increase in long bone fragility and lead to fracture. Hypersensitivity reactions have also been reported, such as anaphylaxis and urticaria. Ketoconazole can cause severe liver injury and jaundice. In high doses, it can also cause gynecomastia in males. Decreases in cortisol synthesis can lead to orthostatic hypotension. It can also cause adrenal insufficiency due to its role in the inhibition of enzymes in the steroid synthesis pathway. ![]() These include nausea, vomiting, constipation, abdominal pain, dry mouth, flatulence, and tongue discoloration. Systemic ketoconazole administration most commonly causes gastrointestinal side effects. The shampoo application should be slathered onto the scalp and rinsed thoroughly. Handwashing is necessary after the application of the cream and gel to prevent any adverse reactions from the medication. The foam should be applied directly to the infected area to avoid melting in the hands. Patients should apply the cream and gel only to the affected area and the areas immediately surrounding it. The eyes and mucous membranes should also be avoided. It should not be ingested or used intravaginally. Topical ketoconazole is only for external use. Adult and pediatric patients with achlorhydria should be given ketoconazole tablets with an acidic beverage to decrease pH and allow for optimal absorption. The high pH of the gastric contents would decrease absorption, so appropriate timing of administration is paramount to its absorption and subsequent efficacy. The oral form of ketoconazole is used for systemic administration and must be taken at least two hours before any antacids. It is also available in mixture products. Ketoconazole is available in tablet form and as a topical agent in creams, foams, and shampoos. By inhibiting enzymes involved in cortisol synthesis, ketoconazole can be a treatment option for Cushing syndrome. This enzyme is essential for synthesizing mineralocorticoids and glucocorticoids, such as cortisol, in the adrenal cortex. Ketoconazole inhibits the activity of the enzyme 21-hydroxylase. Ketoconazole can also inhibit the enzymes 17-alpha-hydroxylase and 17,20-lyase, which are necessary for the synthesis of steroids in the adrenal cortex, including testosterone. Ketoconazole, in high doses, can competitively bind to androgen receptors, such as that of testosterone and dihydrotestosterone, which can decrease the activity of testosterone and dihydrotestosterone in prostate cancer. Without ergosterol, the fluidity of the membrane increase, which in turn prevents fungal growth. Ergosterol is needed to maintain the integrity of the membrane of fungi. More specifically, ketoconazole inhibits the synthesis of lanosterol, a necessary precursor for ergosterol biosynthesis. This enzyme is responsible for inhibiting the biosynthesis of triglycerides and phospholipids by fungi. ![]() Ketoconazole works as an antifungal agent by inhibiting the cytochrome P450 14α-demethylase enzyme. Some of the off-label uses of ketoconazole include Cushing syndrome and prostate cancer. ![]() Ketoconazole is not indicated in the treatment of fungal meningitis because it does not penetrate the cerebrospinal fluid. Clinicians should avoid using ketoconazole in the treatment of onychomycosis, cutaneous dermatophyte, and candida infections. The use of this drug requires a careful risk-benefit analysis when selecting ketoconazole as the treatment of fungal infections. It should only be an option when other first-line treatments are not available or not tolerated by the patient. Due to the advent of more effective fungal infection treatment options, ketoconazole is typically not the first-line medication anymore. The most common use of ketoconazole for skin infections is that of tinea versicolor. These include blastomycosis, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and chromomycosis. Ketoconazole has approval for use in the treatment of fungal infections of the skin and systemic fungal infections. Summarize some interprofessional team strategies for improving care coordination and communication to advance ketoconazole and improve outcomes.Review the appropriate monitoring of ketoconazole.Describe the adverse effects of ketoconazole.Identify the mechanism of action of ketoconazole.This activity will highlight the mechanism of action, adverse event profile, and other key factors pertinent to members of the interprofessional team in the treatment of patients with fungal infection. This activity describes the indications, actions, and contraindications of ketoconazole as a valuable agent in treating fungal infections. It is in the imidazole antifungal class of medications. Ketoconazole is a drug used in the management and treatment of fungal infections.
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