Pharm 48 Flashcards

Which antifungal belongs to the polyene macrolide class?

A) Fluconazole

B) Caspofungin

C) Terbinafine

D) Amphotericin B

What is the mechanism of action of amphotericin B?

A) Forms pores in fungal membranes

B) Inhibits fungal DNA synthesis

C) Blocks fungal cell wall synthesis

D) Inhibits fungal ribosomal activity

Which fungal membrane component is targeted by amphotericin B?

A) Ergosterol

B) Cholesterol

C) Squalene

D) Beta-glucan

Why does amphotericin B cause fungal cell death?

A) Prevents DNA replication

B) Inhibits mitochondrial protein synthesis

C) Causes leakage of intracellular contents

D) Blocks fungal cell division

What type of antifungal activity does amphotericin B generally produce?

A) Fungicidal

B) Fungistatic

C) Bactericida

D) Bacteriostatic

Which fungal infections may require amphotericin B treatment?

A) Superficial dermatophyte infections

B) Localized nail infections

C) Cryptococcosis and systemic mycoses

D) Mild vaginal candidiasis

Which combination describes major toxicities of amphotericin B?

A) Myelosuppression and optic neuritis

B) Hepatotoxicity and tooth discoloration

C) Tendon rupture and seizures

D) Nephrotoxicity and infusion reactions

Combining amphotericin B with other nephrotoxic medications increases the risk of which complication?

A) Bone marrow fibrosis

B) Hemolytic anemia

C) Acute kidney injury

D) Serotonin syndrome

Which antifungal belongs to the pyrimidine analog class?

A) Itraconazole

B) Terbinafine

C) Flucytosine

D) Caspofungin

What is the mechanism of action of flucytosine?

A) Blocks fungal cell wall synthesis

B) Interferes with fungal DNA and RNA

C) Forms pores in fungal membranes

D) Inhibits fungal squalene synthesis

Which antifungal is commonly combined with flucytosine for cryptococcal meningitis?

A) Ketoconazole

B) Amphotericin B

C) Caspofungin

D) Terbinafine

Which additional fungal infection may be treated with flucytosine in selected cases?

A) Chromoblastomycosis

B) Dermatophytosis

C) Aspergillosis

D) Sporotrichosis

Which major toxicity is associated with flucytosine?

A) Nephrolithiasis

B) Peripheral neuropathy

C) Ototoxicity

D) Myelosuppression

Which antifungal drug class inhibits ergosterol synthesis through fungal cytochrome P450 enzymes?

A) Echinocandins

B) Polyenes

C) Triterpenoids

D) Azoles

Which enzyme is directly inhibited by azole antifungal medications?

A) Beta-glucan synthase

B) Squalene epoxidase

C) Lanosterol 14-alpha-demethylase

D) DNA gyrase

Which azole has relatively poor selectivity and significantly inhibits mammalian steroid synthesis?

A) Fluconazole

B) Itraconazole

C) Voriconazole

D) Ketoconazole

Which endocrine effect can result from systemic ketoconazole treatment?

A) Increased cortisol production

B) Increased testosterone synthesis

C) Decreased steroid hormone synthesis

D) Increased aldosterone secretion

Why is systemic ketoconazole use limited?

A) Severe nephrotoxicity and ototoxicity

B) Aplastic anemia and seizures

C) Peripheral neuropathy and optic neuritis

D) Hepatotoxicity and drug interactions

Which azole is more selective for fungal enzymes than ketoconazole?

A) Ketoconazole

B) Miconazole

C) Itraconazole

D) Clotrimazole

Which systemic fungal infections can commonly be treated with itraconazole?

A) Histoplasmosis and blastomycosis

B) Cryptococcal meningitis and candidemia

C) Invasive mucormycosis and candidemia

D) Pneumocystis pneumonia and toxoplasmosis

Which azole is particularly useful in fungal meningitis because of excellent CNS penetration?

A) Itraconazole

B) Fluconazole

C) Ketoconazole

D) Clotrimazole

Which antifungal belongs to the echinocandin class?

A) Amphotericin B

B) Caspofungin

C) Itraconazole

D) Terbinafine

What is the mechanism of action of caspofungin?

A) Inhibits fungal DNA replication

B) Inhibits beta-glucan synthase

C) Blocks fungal squalene epoxidase

D) Forms fungal membrane pores

Which fungal structure is disrupted by caspofungin?

A) Cell wall

B) Nuclear membrane

C) Ribosomal subunit

D) Mitochondrial matrix

Caspofungin is fungicidal against which fungal genus?

A) Cryptococcus

B) Rhizopus

C) Candida

D) Trichophyton

Caspofungin can also be used as salvage therapy for which fungal infection?

A) Cryptococcal meningitis

B) Mucormycosis

C) Chromoblastomycosis

D) Invasive aspergillosis

Which medication can increase caspofungin exposure when administered simultaneously?

A) Rifampin

B) Phenytoin

C) Cyclosporine

D) Carbamazepine

Which adverse effects are associated with caspofungin?

A) Flushing and gastrointestinal upset

B) Tooth discoloration and photosensitivity

C) Aplastic anemia and neuropathy

D) Ototoxicity and nephrolithiasis

Which antifungal belongs to the allylamine class?

A) Terbinafine

B) Itraconazole

C) Flucytosine

D) Caspofungin

Which enzyme is inhibited by terbinafine?

A) Beta-glucan synthase

B) Peptidyltransferase

C) Lanosterol demethylase

D) Squalene epoxidase

What results from inhibition of squalene epoxidase by terbinafine?

A) Increased fungal DNA synthesis

B) Toxic accumulation of squalene

C) Increased fungal ergosterol synthesis

D) Reduced fungal membrane permeability

Which infections are commonly treated with terbinafine?

A) Cryptococcal meningitis

B) Dermatophyte skin and nail infections

C) Invasive candidemia

D) Invasive aspergillosis

Which adverse effects are associated with terbinafine?

A) Nephrotoxicity and infusion reactions

B) Myelosuppression and optic neuropathy

C) Tooth discoloration and photosensitivity

D) Gastrointestinal upset and hepatotoxicity

Which antifungal belongs to the triterpenoid class?

A) Fluconazole

B) Ibrexafungerp

C) Amphotericin B

D) Caspofungin

Which enzyme is inhibited by ibrexafungerp?

A) Squalene epoxidase

B) Lanosterol demethylase

C) Thymidylate synthase

D) Beta-glucan synthase

Which fungal infection is an approved indication for ibrexafungerp?

A) Cryptococcal meningitis

B) Vulvovaginal candidiasis

C) Invasive aspergillosis

D) Systemic histoplasmosis

Why is ibrexafungerp contraindicated during pregnancy?

A) Risk of fetal toxicity

B) Risk of neonatal ototoxicity

C) Risk of maternal neutropenia

D) Risk of placental thrombosis

Which adverse effects are associated with ibrexafungerp?

A) Aplastic anemia and neuropathy

B) Gastrointestinal upset and dizziness

C) Nephrotoxicity and electrolyte depletion

D) Photosensitivity and tooth discoloration

Why can oral amphotericin B act within the intestinal lumen?

A) Extensive renal excretion

B) Minimal gastrointestinal absorption

C) Rapid absorption into blood

D) Enhanced hepatic metabolism

Which route is generally used for systemic amphotericin B therapy?

A) Intravenous administration

B) Subcutaneous injection

C) Intranasal administration

D) Oral tablets

Which traditional antifungal is noted for exceptionally broad systemic coverage?

A) Griseofulvin

B) Flucytosine

C) Amphotericin B

D) Terbinafine

Which acute reaction may follow amphotericin B infusion?

A) Optic neuritis

B) Tooth discoloration

C) Fever and rigors

D) Tendon rupture

Which circulatory effect may accompany amphotericin B infusion reactions?

A) Polycythemia

B) Severe hypertension

C) Persistent bradycardia

D) Hypotension

What vascular change contributes to amphotericin B-associated reduced GFR?

A) Glomerular hyperfiltration

B) Renal arteriolar vasoconstriction

C) Renal vein thrombosis

D) Renal arteriolar dilation

Which renal tissue can be directly injured by amphotericin B?

A) Ureteral smooth muscle

B) Renal pelvis epithelium

C) Renal tubules

D) Glomerular podocytes

Which acid-base disorder can result from amphotericin B tubular toxicity?

A) Respiratory alkalosis

B) Distal renal tubular acidosis

C) Respiratory acidosis

D) Metabolic alkalosis

How can fungi develop resistance to amphotericin B?

A) Increased fungal ribosomes

B) Increased membrane ergosterol

C) Enhanced beta-glucan synthesis

D) Decreased membrane ergosterol

Flucytosine is converted within fungal cells into which antimetabolite?

A) Methotrexate

B) 6-Mercaptopurine

C) 5-Fluorouracil

D) Cytarabine

Which condition increases the risk of flucytosine toxicity?

A) Increased pulmonary ventilation

B) Hyperthyroidism

C) Renal impairment

D) Vitamin D deficiency

Which fungal enzyme converts flucytosine to 5-fluorouracil?

A) Squalene epoxidase

B) Lanosterol demethylase

C) Beta-glucan synthase

D) Cytosine deaminase

How do fungi commonly acquire resistance to flucytosine?

A) Increased ergosterol binding

B) Altered uptake or activation

C) Enhanced chitin synthesis

D) Reduced membrane cholesterol

Which fungus is classically treated using flucytosine in combination therapy?

A) Cryptococcus neoformans

B) Aspergillus fumigatus

C) Trichophyton rubrum

D) Rhizopus arrhizus

Flucytosine can sometimes be combined with other antifungals for infections caused by which genus?

A) Microsporum

B) Candida

C) Aspergillus

D) Mucor

Which blood-count abnormality can occur with flucytosine toxicity?

A) Neutrophilia

B) Polycythemia

C) Thrombocytosis

D) Pancytopenia

Which adverse effect is common to many azole antifungals?

A) Auer rod formation

B) Gastrointestinal upset

C) Gray baby syndrome

D) Aplastic anemia

What explains many clinically important azole drug interactions?

A) Reduced intestinal bile secretion

B) Inhibition of hepatic CYP enzymes

C) Direct beta-lactam hydrolysis

D) Increased renal filtration

Which older azole prominently inhibits mammalian steroid synthesis?

A) Ketoconazole

B) Posaconazole

C) Itraconazole

D) Fluconazole

Which medication can reduce itraconazole concentrations by inducing metabolism?

A) Cyclosporine

B) Ketoconazole

C) Clarithromycin

D) Rifampin

What does rifampin do to drug-metabolizing CYP enzymes?

A) Induces their activity

B) Directly acetylates them

C) Irreversibly destroys them

D) Blocks their transcription

Compared with ketoconazole, which azole generally has fewer CYP-mediated interactions?

A) Itraconazole

B) Voriconazole

C) Fluconazole

D) Miconazole

Which oral azole is commonly used for moderate or severe oropharyngeal candidiasis?

A) Fluconazole

B) Voriconazole

C) Posaconazol

D) Ketoconazole

Which mold is intrinsically resistant to fluconazole?

A) Candida albicans

B) Cryptococcus neoformans

C) Candida tropicalis

D) Aspergillus

Which CYP enzyme is inhibited by voriconazole and metabolizes tacrolimus?

A) CYP1A2

B) CYP3A4

C) CYP2E1

D) CYP2D6

Which distinctive adverse effect is associated with voriconazole?

A) Gray baby syndrome

B) Severe ototoxicity

C) Transient visual disturbances

D) Tooth discoloration

Which antifungal is a standard first-line option for invasive aspergillosis?

A) Griseofulvin

B) Fluconazole

C) Nystatin

D) Voriconazole

Which azole has broad activity against Aspergillus and some Mucorales?

A) Ketoconazole

B) Fluconazole

C) Clotrimazole

D) Posaconazole

What type of antifungal activity does griseofulvin produce?

A) Bacteriostatic

B) Fungistatic

C) Bactericidal

D) Fungicidal

Which cellular structure is targeted by griseofulvin?

A) Mitotic microtubules

B) Fungal DNA gyrase

C) Beta-glucan synthase

D) Ergosterol-containing pores

Where does griseofulvin accumulate to protect against dermatophytes?

A) Cerebrospinal fluid

B) Glomerular basement membrane

C) Newly formed keratin

D) Alveolar surfactant

Which autoimmune-like adverse effect is associated with griseofulvin?

A) Lupus-like syndrome

B) Graves-like syndrome

C) Guillain-Barré syndrome

D) Goodpasture syndrome

Which organ toxicity can occur with griseofulvin?

A) Ototoxicity

B) Hepatotoxicity

C) Retinotoxicity

D) Cardiotoxicity

Against dermatophytes, terbinafine usually has which activity?

A) Fungicidal

B) Virucidal

C) Bacteriostatic

D) Fungistatic

Why is nystatin useful for local oral candidiasis?

A) Negligible systemic absorption

B) Excellent systemic distribution

C) Rapid bloodstream accumulation

D) High cerebrospinal fluid penetration

Which nystatin formulation can treat oropharyngeal thrush?

A) Intravenous infusion

B) Transdermal patch

C) Intramuscular injection

D) Oral suspension

Which topical azoles can treat vulvovaginal candidiasis?

A) Fluconazole and voriconazole

B) Ketoconazole and isavuconazole

C) Clotrimazole and miconazole

D) Posaconazole and itraconazole