Fungal Skin Infections: Lifespan Considerations (Nursing)

00:00 Let's consider how antifungal treatment approaches differ across the lifespan.

00:05 When you're treating fungal infections in children, you have to be particularly careful.

00:10 Many antifungals have limited FDA approvals for young children.

00:14 Topical treatment is preferred for pediatric clients when possible, oral therapy requires weight-based dosing, and children may have difficulty complying with long-term therapy.

00:25 If you're working with a pregnant client, antifungal medications need these specific considerations.

00:31 Topical azoles generally have better safety profiles during pregnancy based on limited systemic absorption.

00:38 Oral antifungals are generally used with caution during pregnancy due to potential risk.

00:44 Oral antifungals for a client who is pregnant requires very careful risk versus benefit assessment.

00:50 You want to consider these things.

00:52 How severe is the infection? What are the potential risks of an untreated infection? Which trimester of pregnancy is the client in? And take a close look at the available safety data for the specific antifungal.

01:05 So when a healthcare provider is prescribing antifungals during pregnancy, they'll consult current drug labeling or pregnancy-specific references for the most up-to-date safety information.

01:16 Now, let's consider our older adult patients.

01:19 They present some unique challenges when treating fungal infections.

01:23 Keep in mind, they have an increased risk of drug interactions due to their increased risk of polypharmacy.

01:29 Many older adults are taking multiple medications, and those could interact with the antifungals.

01:35 Older adults also have age-related changes in skin barrier function, and that might affect both the infection risk and topical drug absorption.

01:43 Now, the older adults might have a potentially longer treatment courses because they have slower healing and nail growth than younger adults.

01:51 Also, older adults have decreased hepatic clearance of oral agents, which might increase the risk of adverse effects.

01:59 So let's think about this in the form of a question.

02:02 What might you need to modify in your approach for an 85-year-old patient with multiple health conditions who has a toenail fungal infection? You might start with a topical treatment.

02:12 Now, I know it has a lower efficacy, but let's think about this unique population.

02:18 If the patient has multiple comorbidities, we might want to start with a topical.

02:23 We're also going to perform a comprehensive medication reconciliation because antifungals can have interactions with other medications.

02:32 And third, you might just consider a lower dose of the oral medication if they're absolutely necessary and increase the frequency of your monitoring for adverse effects.

02:42 Remember that in older adult patients, the risk-benefit assessment becomes even more important, and sometimes we just have to accept a less aggressive treatment approach to prioritize overall safety.

02:54 Now that we've covered the foundational knowledge about antifungal medications from pathophysiology through specific drugs and safety considerations, I want you to turn your attention to how we apply this knowledge in clinical practice.

03:06 This information we've discussed isn't just theoretical.

03:09 It should directly inform your clinical decisions that you'll make every day as a member of the healthcare team.

03:15 In the next section, we're going to take a look at how to integrate all this information into excellent patient care.