A 56-year-old woman with diabetes complains of thickening of the nail of the right big toe and a change in color (yellow). The podiatrist diagnoses the patient with onychomycosis of the toenails. Which is the most appropriate choice for treating this infection?
A. Terbinafine
B. Micafungin
C. Itraconazole
A. Terbinafine
B. Micafungin
C. Itraconazole
D. Griseofulvin
Answer: A. Terbinafine (half-life 200 to 400h)
A. Terbinafine is better tolerated, requires a shorter duration of therapy, and is more effective than either itraconazole or griseofulvin. Micafungin is not active for this type of infection.
02. A 44-year-old man presents to clinic with fevers and chills, headaches, and shortness of breath. He reports that he was exploring caves about 5 weeks ago. He is diagnosed with mild/moderate acute pulmonary histoplasmosis. Which is the most appropriate choice for treating this infection?
A. Micafungin
B. Itraconazole
C. Terbinafine
D. Griseofulvin
Answer: B. Itraconazole
03. A 32-year-old HIV-positive woman is admitled to the hospital with severe confusion and dizziness. She has been nonadherent with her HIV medications for several months. She is diagnosed with meningitis caused by Cryptococcus neoformans. Which is the most appropriate choice for treating the infection in this patient?
A. Anidulafungin alone
B. Amphotericin B plus flucytosine
C. Flucytosine alone
D. Isavuconazole plus anidulafungin
Answer: B. Amphotericin B plus Flucytosine
The treatment of choice for initial
therapy for cryptococcal meningitis is the combination of
amphotericin B and flucytosine. Flucytosine should not be
given alone because of the rapid development of resistance. Anidulafungin is not active against this type of infec-
tion. Isavuconazole has not been studied for the treatment
of cryptococcal meningitis.
04. A 22-year-old woman reports a cottage cheese-like vaginal discharge and slight dysuria for 1 week. The patient is diagnosed with vulvovaginal candidiasis VVC. She requests as short a course of treatment as possible due to her busy schedule. Which antifungal is thebest choice?
A. Oral fluconazole
B. Topical miconazole
C. Oral terbinafine
D. Topical efinaconazole
Answer: A. Oral Fluconazole
A. Oral fluconazole can be given as a one-
time dose for vulvovaginal candidiasis. Topical miconazole
requires multiple days of therapy. Terbinafine and efinacon-
azole are not used clinically for vulvovaginal candidiasis.
92% infections are caused by Candida Albicans.others Candida glabrata.
05. Which drug is relatively free of drug-drug interactions?
A. Voriconazole
B. Itraconazole
C. Micafungin
D. Terbinafine
Answer: C. Micafungin
The echinocandins (including micafungin) are not metabolized by the CYP450 enzyme system, so they have very few drug drug interactions. Voriconazole, itraconazole, and terbinafine are all metabolized by the CYP450 enzyme system, so they have significant drug-drug interactions.
06. Which drug works by creating pores/channels in the fungal cell membrane?
A. Fluconazole
B. Anidulafungin
C. Amphotericin B
D. Flucvtosine
Answer: C. Amphotericin B creates pores/channels
in the fungal cell membrane. Fluconazole works by inhibit-
ing the conversion of lanosterol to ergosterol. Anidulafungin
inhibits the synthesis of B-D-glucan. Flucytosine disrupts
nucleic acid and protein synthesis.
07. Which drug requires a loading dose?
A. Caspofungin
B. Micafungin
C. LIposomal amphotericin B
D. Tavaborole
Answer: A. Caspofungin is the only drug listed that
requires a loading dose before starting the maintenance
dosing.
08. Nephrotoxicity is commonly associated with following drug?
A. Fluconazole
B. Itraconazole
C. Amphotericin B
D. Posaconazole
Answer: C. Amphotericin B
Dose adjustment required in fluconazole but not associated with renal insufficiency. Itraconazole and posaconazole are metabolised by the Liver and are not associated with nephrotoxicity.
09. Which of the following drugs is best drug of choice for Aspergillus fumigatus?
A. Voriconazole
B. Flucytosine
C. Fluconazole
D. Ketoconazole
Answer: A. Voriconazole
Superior than Amphotericin B. Fluconazole, Flucytosine and Ketoconazole don't have activity so not recommended.
10. A drug with black box warning in patients with evidence of Ventricular dysfunction?
A. Micafungin
B. Terbinafine
C. Itraconazole
D. Posaconazole
Answer: C. Itraconazole should be avoided in heart patients because it has negative inotropic effect.
11. A Triazole antifungal has negative inotropic effect and should be avoided in ventricular dysfunction?
A. Micafungin
B. Ketoconazole
C. Flucytosine
D. Itraconazole
Answer: Itraconazole has a negative inotropic effect.
12. Which of the following drugs is drug of choice for treating dermatophyte onychomycosis?
A. Itraconazole
B. Griseofulvin
C. Terbinafine
D. Micafungin
Answer: C. Terbinafine (inhibit squalene epoxidase needed to synthesise ergosterol an assential component of cell membrane.
DOC: because better tolerated and shorter duration of therapy. And more effective than other drugs.
13. Which of the following drugs effective and active drug of choice to treat mild/moderate acute pulmonary histoplasmosis?
A. Micafungin
B. Itraconazole
C. Terbinafine
D. Griseofulvin
Answer: B. Itraconazole used to treat histoplasmosis in patients who had symptoms for more than 1 month.
14. Treatment of choice for initial therapy for cryptococcal meningitis is following?
A. Anidulafungin alone
B. Amphotericin B plus Flucytosine
C. Flucytosine alone
D. Isavuconazole plus aniduladungin
Answer: B. Amphotericin B plus Flucytosine
15. Which of the following drugs can be used to treat vulvovaginal candidiasis?
A. Oral fluconazole
B. Topical miconazole
C. Oral Terbinafine
D. A & B
E. All of the above
Answer: D. A & B
Oral fluconazole can be given one time dose for this infection and topical miconazole require multiple days of therapy.
16. Infection of the groin or jock itch is called?
A. Tinea cruris
B. Tinea corporis
C. Tinea pedis
D. Tinea Versicolor
Answer: A. Tinea cruris
Tinea corporis: Ringworm of the body
Tinea pedis: Infection of the feet
Tinea Versicolor: small discoloured patches of the skin
17. A drug cause accumulation of toxic amount of squalene results in increased membrane permeability and death of fungal cell?
A. Itraconazole
B. Amphotericin B
C. Flucytosine
D. Terbinafine
Answer: D. Terbinafine
18. Only Echinocandin drug that doesn't require a loading dose?
A. Caspofungin
B. Micafungin
C. Anidulafungin
D. Nystatin
Answer: Micafungin
Caspofungin and Anidulafungin need loading dose before starting the maintenance dose.
19. Unlike other azoles, following drug is not metabolised by CYP450 but is eliminated via glucoronidation?
A. Fluconazole
B. Voriconazole
C. Posaconazole
D. Isavuconazole
E. Itraconazole
Answer: C. Posaconazole
Fluconazole 25h half-life
Voriconazole dose dependent
Posaconazole 20-66h
Isavuconazole 130h
Itraconazole 30-40h
20. Which of the following drugs are part of Echinocandins?
A. Micafungin
B. Caspofungin
C. Anidulafungin
D. A & B
E. All of the above
Answer: E. All of the above
Echinocandins are fungistatic activity against Aspergillus Species
Fungicidal for Candida species
21. A pyrimidine antimycotic that inhibits the transport of essential elements in the fungal cell thus disrupting the synthesis of DNA?
A. Cyclopirox
B. Tavaborole
C. Tolnaftate
D. Efinaconazole
Answer: A. Cyclopirox
22. A drug that inhibit an aminoacyl-transfer ribonucleic acid synthetase preventing fungal protein synthesis?
A. Cyclopirox
B. Tavaborole
C. Tolnaftate
D. Efinaconazole
Answer: B. Tavaborole
23. A topical thiocarbamate distorts the hyphae and stunts mycelial growth in susceptible fungi?
A. Cyclopirox
B. Tavaborole
C. Tolnaftate
D. Efinaconazole
Answer: C. Tolnaftate
24. Which drug is relatively free of drug drug interaction?
A. Voriconazole
B. Itraconazole
C. Micafungin
D. Terbinafine
Answer: C. Micafungin
All of three Echinocandins are not metabolised by the CYP enzyme system so they have very few drug drug interaction. All other drugs are metabolised by CYP450 enzyme system.
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