2023 As an NP student you need to determine the medications for onychomycosis 1 According to the AAFP CDC Guidelines

As an NP student, you need to determine the medications for onychomycosis.

1.  According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

This is patient should be prescribed with Terbinafine; this is an antifungal systemic medication. This medication is indicated for different types of fungal infection and must be used for 12 weeks by oral 

Prescription:

Yamile Carrazana. FNP

Name: D.E  DOB: 00/00/0000  Date: 02/04/2020

Terbinafine 250 mg 

Disp: 30 Tablets

Sig: 1 Tablet PO Daily for 12 weeks. For Onychomycosis

Refill: 2.

Yamile Carrazana. FNP.  DEA# on file in Pharmacy.

2.  What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

For this patient I would like to order before to start the treatment a Liver Function Test, this test is in blood and measures specifics proteins and liver enzymes to get an overall sense of how the liver is working because this medication can be toxic for the liver and one of its contraindications is in chronic or active liver disease. One of the functions of the Liver is regulating the amount of sugar in the blood stream, this is a diabetic patient.

This test checks for ALT/SGPT: Alanine Aminotransferase, enzyme founding in the hepatic cells, if the liver is damaging this enzyme will be found in blood. Albumin is a protein made in the liver very helpful to diagnoses liver disease. Alkaline Phosphatase, Aspartate Aminotransferase, Bilirubin, Globulin, total protein.

Other test will be request is a Comprehensive Metabolic Panel to check electrolytes, renal function and glucose.

During the complete treatment and with regularity I would like to keep checking LFT’s (Liver Function test)

References:

Wood, M. & Robinson. M, V. Pharmacotherapeutics for Advanced Practice Nurse Prescriber. (4th Edition).

Arias, E. (2010). United States Life tables, 2006. National Vital Statistics Reports.

Medscape:  Clinically Relevant Drug-Drug Interactions in Primary Care Mary Carpenter, PharmD; Holly Berry, PharmD; Allen L. Pelletier, MD. Am Fam Physician. 2019;99(9):558-564.