Katzung Pharmacology - Chapter 48 Qs

If amphotericin B is administered, the patient should be pre- medicated with (A) Diphenhydramine (B) Ibuprofen (C) Prednisone (D) Any or all of the above (E) None of the above

*(D) Any or all of the above*

Which statement about fluconazole is accurate? (A) Does not penetrate the blood-brain barrier (B) Drug of choice in treatment of aspergillosis (C) Induces hepatic drug-metabolizing enzymes (D) Has the least effect of all azoles on drug metabolism (E) Oral bioavailability is less than that of ketoconazole

*(D) Has the least effect of all azoles on drug metabolism*

Interactions between this drug and cell membrane compo- nents can result in the formation of pores lined by hydrophilic groups present in the drug molecule. (A) Caspofungin (B) Flucytosine (C) Griseofulvin (D) Nystatin (E) Terbinafine

*(D) Nystatin*

Which drug is least likely to be effective in the treatment of esophageal candidiasis if it is used by the oral route? (A) Clotrimazole (B) Griseofulvin (C) Ketoconazole (D) Itraconazole (E) Nystatin

*(B) Griseofulvin*

Which is the drug of choice if this patient is suffering from persistent lung lesions or disseminated disease caused by Coccidioides immitis? (A) Amphotericin B (B) Flucytosine (C) Itraconazole (D) Micofungin (E) Terbinafine

*(C) Itraconazole*

Serious cardiac effects have occurred when this drug was taken by patients using the antihistamines astemizole or terfenadine (A) Amphotericin B (B) Griseofulvin (C) Ketoconazole (D) Terbinafine (E) Voriconazole

*(C) Ketoconazole*

Questions 3-5. A 37-year-old woman with leukemia was under- going chemotherapy with intravenous antineoplastic drugs. Dur- ing treatment, she developed a systemic infection from an opportunistic pathogen. There was no erythema or edema at the catheter insertion site. A white vaginal discharge was observed. After appropriate specimens were obtained for culture, empiric antibiotic therapy was started with gentamicin, nafcillin, and ticarcillin intravenously. This regimen was maintained for 72 h, during which time the patient's condition did not improve sig- nificantly. Her throat was sore, and white plaques had appeared in her pharynx. On day 4, none of the cultures had shown any bacterial growth, but both the blood and urine cultures grew out Candida albicans. At this point, the best course of action is to (A) Continue current antibiotics and start griseofulvin (B) Continue current antibiotics and start amphoter

*(D) Stop current antibiotics and start amphotericin B*

10. Regarding the clinical use of liposomal formulations of amphotericin B, which statement is accurate? (A) Amphotericin B affinity for these lipids is greater than affinity for ergosterol (B) Less expensive to use than conventional amphotericin B (C) More effective in fungal infections because they increase tissue uptake of amphotericin B (D) They decrease the nephrotoxicity of amphotericin B (E) They have a wider spectrum of antifungal activity than conventional formulations of amphotericin B

*(D) They decrease the nephrotoxicity of amphotericin B*

Candida is a major cause of nosocomial blood stream infection. The opportunistic fungal infection in this patient could have been prevented by administration of (A) Caspofungin (B) Flucytosine (C) Nystatin (D) Voriconazole (E) None of the above

*(E) None of the above*

Questions 6-7. A 28-year-old man living on the East Coast was transferred by his employer to California for several months. On his return, he complains of having influenza-like symptoms with fever and a cough. He also has red, tender nodules on his shins. His physician suspects that these symptoms are due to coccidioi- domycosis contracted during his stay in California. This patient should be treated immediately with (A) Amphotericin B (B) Caspofungin (C) Ketoconazole (D) Terbinafine (E) None of these drugs

*(E) None of these drugs*