antifungal - okt3 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 1 (https://www.usmleforum.com/forumdisplay.php?fid=2) +--- Thread: antifungal - okt3 (/showthread.php?tid=228016) |
antifungal - okt3 - ArchivalUser - 10-05-2007 Which of the following statements concerning antifungal therapy is correct? A) Dose-related hepatotoxicity is a complication of ketoconazole treatment. B) Clotrimazole is the preferred imidazole for the treatment of vaginal candidiasis. C) Oral fluconazole may be used as primary therapy in patients with aspergillosis. D) Flucytosine plus amphotericin B is useful in cases of refractory hepatic candidiasis. E) The treatment of candidal hepatitis frequently requires 2 weeks of daily intravenous administration of amphotericin B. 0 - ArchivalUser - 10-05-2007 A? 0 - ArchivalUser - 10-05-2007 A? 0 - ArchivalUser - 10-05-2007 try again 0 - ArchivalUser - 10-05-2007 BB 0 - ArchivalUser - 10-05-2007 what is correct aswer? 0 - ArchivalUser - 10-05-2007 3 options are left 0 - ArchivalUser - 10-05-2007 ok, maybe C ? 0 - ArchivalUser - 10-05-2007 The answer is D. Successful treatment of antifungal infections is not as straightforward as that for bacterial infections. The topical imidazoles that are available for the treatment of vaginal candidiasis include miconazole, clotrimazole, and butoconazole; the triazole terconazole is also available. No substantial difference in efficacy or toxicity among these agents has been noted. Ketoconazole therapy is useful in the treatment of several fungal infections, including esophageal candidiasis, but is associated with several dose-related toxicities, including anorexia and inhibition of steroidogenesis in the adrenal cortex or gonads; hepatotoxicity is idiosyncratic. Fluconazole is an orally administered triazole that may have activity in candidal infection and is useful in a prophylactic role in allogeneic bone marrow transplant patients. Amphotericin B itself is a difficult drug toadminister because of frequent toxicities, including azotemia, anemia, hypokalemia, nausea, anorexia, weight loss, phlebitis, and hypomagnesemia. Nonetheless, amphotericin B is indicated for the treatment of invasive infections such as candidal hepatitis. Given a daily dose of about 0.5 mg/kg and the requirement that at least 2 g of the drug should be given in this situation, prolonged therapy is required. Flucytosine, a synthetic oral drug converted to the antimetabolite 5-FU in the fungal cell, may aid in the treatment of refractory invasive candidal disease that is not responsive to amphotericin B alone. Flucytosine is not substituted for, but instead is added to, amphotericin B. Patients on flucytosine should be monitored carefully, since this drug may be myelosuppressive. |