Home' Australian Pharmacist : Australian Pharmacist August 2012 Contents Australian Pharmacist August 2012 I ©Pharmaceutical Society of Australia Ltd. 649
Continuing Professional Development
Submit your answers online at www.psa.org.au and receive automatic feedback
SOLUTIONS THROUGH COMPOUNDING
1. Onychomycosis, a term used for
a fungal infection of the nail, is
di cult to treat because:
a) it requires short courses of therapy and
has high recurrence rates.
b) infections are acute and resistant to
c) of the deep-seated nature of the
infection within the nail.
d) of the lack of di culty of oral and
topical drugs to reach the sites of
e) of the thickening and altered
appearance of the nail which has no
impact on the patient's social life.
2. Terbina ne is available in Australia
for topical use as a:
a. 2% cream.
b) 1% tincture.
c) 1% gel.
d) 2% liquid.
e) 1% ointment.
3. The role of _________ in the
terbina ne hydrochloride bilayer
nail lacquer formula is as a
a) hydroxypropyl methylcellulose.
b) macrogol 400.
c) poly(4-vinyl phenol).
d) dibutyl phthalate.
e) ethyl acetate.
4. Poly(4-vinyl phenol), an ingredient
in the hydrophobic layer, is:
a) immiscible with alcohol.
b) soluble in water.
c) a hydrophobic monomer.
d) a plasticiser.
e) able to form a durable lm which is
resistant to water.
5. Counselling/instructions to
patients on the use of terbina ne
hydrochloride bilayer nail lacquer
should include that:
a) the rst (hydrophobic) layer should be
applied to the surface of the a ected
nails, allowed to dry and followed with
application of the second (hydrophilic)
b) application is once or twice weekly,
with nails led but not required to be
cleaned before the repeat application.
c) storage is optimum at 2--8 °C,
protected from light.
d) the treatment should be continued
after resolution of the symptoms.
e) the length of time that the containers
are open should be minimised due to
the non-volatile nature of some of the
A score of 4 out of 5 attracts 1.25 CPD credits.
• It is advisable that where
onychomycosis may cause lower
extremity complications (e.g. in
diabetics) that patients be referred to
a podiatrist for advice on footwear,
foot hygiene, nail debridement, and for
surgical removal of the toenail.14
Patients should be counselled on
the importance of maintaining good
• Keep nails short and cut them straight.
• Wear correct tting footwear,
preferably consisting of a breathable
material or having an open-toed style.
• Use cotton socks and change them
at regular intervals. It is also advised
to launder socks in hot water, after
soaking in a disinfectant solution.14
• Protect toes from sources of infection
(e.g. avoid walking bare-foot through
damp areas, wear protective footwear
at a gym or pool, avoid sharing socks
and discard old shoes since they may
contain fungal spores).14
Key learning points
• Terbina ne nail lacquer may be a
bene cial topical monotherapy in the
initial stages or in combination with
oral therapy in the advanced stages of
• Pharmacists should be able to advise
patients on the appropriate storage of
the two liquids (formulations), based on
the nature of their components.
• Pharmacist should be able to support
patients with advice on foot hygiene
and identify those patients at risk of
complications for referral.
1. Yin Z, Xu J, Luo D. A meta-analysis comparing long-term
recurrences of toenail onychomycosis after successful
treatment with terbinafine versus itraconazole. J Dermatolog
Treat 2011(Jul 31, early online).
2. Therapeutic Guidelines. eTG Complete (electronic resource).
North Melbourne: Therapeutic Guidelines; 2012.
3. Australian Medicines Handbook. 13th ed. Adelaide: Australian
Medicines Handbook; 2012.
4. Shivakumar HN, Vaka SR, Madhav NV, et al. Bilayered nail
lacquer of terbinafine hydrochloride for treatment of
onychomycosis. J Pharm Sci 2010;99(10):4267--76.
5. Alley MR, Baker SJ, Beutner KR, et al. Recent progress on the
topical therapy of onychomycosis. Expert Opin Investig Drugs
6. Iorizzo M, Piraccini BM, Tosti A. Today's treatments options for
onychomycosis. J Dtsch Dermatol Ges 2010;8(11):875--9.
7. Gupta AK, Uro M, Cooper EA. Onychomycosis therapy: past,
present, future. J Drugs Dermatol 2010;9(9):1109--13.
8. Gupta AK, Simpson FC. New therapeutic options for
onychomycosis. Expert Opin Pharmacother 2012;13(8):1131--
9. Hay RJ, Baran R. Onychomycosis: A proposed revision of the
clinical classification. J Am Acad Dermatol 2011;65(6):1219--27.
10. Gupta AK, Ryder JE, Lynch LE, et al. The use of terbinafine in the
treatment of onychomycosis in adults and special populations:
a review of the evidence. J Drugs Dermatol 2005;4(3):302--8.
11. Van Duyn GL, Elewski BE. Recent updates in oral terbinafine:
its use in onychomycosis and tinea capitis in the US. Mycoses
12. Anderson J, White KG, Kelechi TJ. Managing common foot
problems in older adults. J Gerontol Nurs 2010;36(10):9--14.
13. Baran R, Sigurgeirsson B, de Berker D, et al. A multicentre,
randomized, controlled study of the efficacy, safety and cost-
effectiveness of a combination therapy with amorolfine nail
lacquer and oral terbinafine compared with oral terbinafine
alone for the treatment of onychomycosis with matrix
involvement. Br J Dermatol 2007;157(1):149--57.
14. Thomas J, Jacobson GA, Narkowicz CK, et al. Toenail
onychomycosis: an important global disease burden. J Clin
Pharm Ther 2010;35(5):497--519.
15. Allen LVJ. Terbinafine hydrochloride bilayer nail lacquer. IJPC
16. Martindale. The complete drug reference. London:
Pharmaceutical Press; 2012.
17. Rowe RC, Sheskey PJ, Quinn ME. Handbook of pharmaceutical
excipients. 6th ed. London: Pharmaceutical Press; 2009.
18. Allen LV, Popovich NG, Ansel HC. Ansel's pharmaceutical
dosage forms and drug delivery systems. 9th ed. Philadelphia:
Lippincott Williams & Wilkins; 2011.
19. Pharmaceutical Society of Australia. Professional Practice
Standards, Version 4: Compounding.2010. At: www.psa.org.au/
20. Australian Pharmaceutical Formulary and Handbook. 22nd ed.
Canberra: PSA; 2012.
Links Archive Australian Pharmacist September 2012 Australian Pharmacist July 2012 Navigation Previous Page Next Page