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INTRODUCTION

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ketoconazole (systemic) (kee-toe-koe-na-zole)

Nizoral

ketoconazole (topical) (kee-toe-kon-a-zole)

Extina, Nizoral, Nizoral A-D, Xolegel

Classification

Therapeutic: antifungals (systemic)

Pharmacologic: imidazole

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Indications
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Systemic: treatment of Candidiasis (disseminated and mucocutaneous), Chromomycosis, Coccidioidomycosis, Histoplasmosis, Paracoccidioidomycosis.

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Unlabeled Use: Treatment of advanced prostate cancer. Treatment of Cushing's syndrome.

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Topical: treatment of a variety of cutaneous fungal infections, including cutaneous candidiasis, tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis (ringworm), dandruff (as a shampoo), seborrheic dermatitis, and tinea versicolor.

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Action
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Disrupts fungal cell membrane. Interferes with fungal metabolism. Also inhibits the production of adrenal steroids. Therapeutic Effects: Fungistatic or fungicidal action against susceptible organisms, depending on organism and site of infection. Spectrum: Active against many pathogenic fungi, including Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, Many dermatophytes.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness. EENT: photophobia. GI: DRUG-INDUCED HEPATITIS, nausea, vomiting, abdominal pain, constipation, diarrhea, flatulence. GU: azoospermia, ↓ male libido, menstrual irregularities, oligospermia. Derm: rashes, ↑ hair loss (shampoo). Endo: gynecomastia. Local: burning, itching, local hypersensitivity reactions, redness, stinging.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician immediately of these signs.

  • Monitor rashes or other severe skin reactions such as exfoliation, hives, itching, raised patches of red or white skin (welts), burning, acne, and abnormal sweating. Notify physician immediately because certain skin responses may indicate serious hypersensitivity reactions.

  • Assess dizziness or drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • For cutaneous infections, assess healing of skin lesions to help document drug effectiveness.

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Interventions
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  • Avoid contact with cutaneous lesions when treating patient.

  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Advise patient to take or apply this drug as directed for the full course of treatment even if feeling better.

  • Advise patient to report any increased local sensitivity to topical application of this drug (pain, burning, itching, swelling) or extensive hair loss when used as a shampoo.

  • Instruct patients with cutaneous infections about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

  • Inform patient that early relief of cutaneous symptoms may be seen in 2–3 days. Full therapeutic response ...

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