ID Exam 3

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ID Exam 3
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  1. Desert Rheumatism / Posada-Wernicke Disease / San Joaquin Valley Fever
    Coccidioidomycosis
  2. PCP
    Pneumocystis jiroveci Pneumonia
  3. Athletes Foot
    Tinea Pedis
  4. Chicago Disease / Gilchrist's Disease / North American Blastomycosis
    Blastomycosis
  5. Busse-Buschke Disease / European Blastomycosis
    Cryptococcosis
  6. Farmer's Lung / Darling's Disease / Reticuloendothelial cytomycosis / cave disease / spelunker's disease
    Histoplasmosis
  7. Jock Itch
    Tinea Cruris
  8. Lutz-Splendore-Almeida Disease / South American Blastomycosis
    Paracoccidioidomycosis
  9. Rose Handlers Disease
    Sporotrichosis
  10. Ringworm
    Tinea corporis
  11. Barber's Itch
    Tinea Barbae
  12. Onychomycosis
    Tinea Unguium
  13. Which of the following is NOT TRUE concerning azole antifungal drugs:
    A. They are synthetic compounds
    B. They inhibit cholesterol synthesis
    C. The N3 of their azole ring(s) bind(s) to the heme of cytochrome P450 enzymes
    D. They have at least one five-member aromatic ring containing two or three nitrogen atoms
    B. They inhibit cholesterol synthesis
    (this multiple choice question has been scrambled)
  14. Which of the following is NOT TRUE concerning imidazoles:
    A. They inhibit ergosterol synthesis
    B. The family includes ketoconazole
    C. This family is older than the triazole family of antifungal drugs
    D. They inhibit fungal cell wall synthesis
    D. They inhibit fungal cell wall synthesis
    (this multiple choice question has been scrambled)
  15. Which of the following is NOT TRUE concerning triazoles:
    A. Resistance to these drugs may involve mutation of fungal 14-alpha demethylase
    B. They are less specific and more toxic than imidazoles
    C. The family includes posaconazole (Noxafil)
    D. Their azole ring binds to both mammalian and fungal P450 enzymes
    B. They are less specific and more toxic than imidazoles
    (this multiple choice question has been scrambled)
  16. Which of the following is NOT TRUE concerning azole side effects and drug interactions:
    A. Side effects may include GI complaints and hepatotoxicities
    B. All azoles may be safely used during pregnancy
    C. Some azole IV solutions contain a cyclodextrin vehicle which may be nephrotoxic
    D. Azoles may inhibit P-glycoprotein efflux pumps
    B. All azoles may be safely used during pregnancy
    (this multiple choice question has been scrambled)
  17. Which of the following is NOT TRUE concerning ketoconazole:
    A. Oral bioavailability depends on low pH for adequate dissolution and absorption
    B. It has the fewest P450-related drug interactions of the azole anti-infectives
    C. It's antifungal mechanism results in lanosterol accumulation in fungal cell membranes
    D. Concurrent administration of CYP3A4 inducers may cause therapeutic failure
    B. It has the fewest P450-related drug interactions of the azole anti-infectives
    (this multiple choice question has been scrambled)
  18. Which of the following is NOT TRUE concerning itraconazole (Sporanox):
    A. Its therapeutic uses are confined to topical administration
    B. It has low aqueous solubility and drug products have variable oral absorption
    C. It shares many of the same drug interactions as ketoconazole
    D. It may increase the AUC of other drugs metabolized by CYP3A4
    A. Its therapeutic uses are confined to topical administration
    (this multiple choice question has been scrambled)
  19. Which of the following is NOT TRUE concerning fluconazole (Diflucan):
    A. It is not metabolized itself; the majority of an oral dose is eliminated via the kidneys
    B. Its IC50 for fungal enzymes is less than the IC50 describing its interaction with mammalian enzymes
    C. It has both high aqueous solubility and permeability
    D. Use is primarily limited by its unfavorable pharmacokinetics
    D. Use is primarily limited by its unfavorable pharmacokinetics
    (this multiple choice question has been scrambled)
  20. Which of the following is NOT TRUE concerning voriconazole (Vfend):
    A. There is interpatient variability in its rate of elimination
    B. One of its unique side effects is transient visual disturbances
    C. It is primarily metabolized by glucuronyl transferase
    D. The P450 isozymes which metabolize the drug exhibit genetic polymorphism
    C. It is primarily metabolized by glucuronyl transferase
    (this multiple choice question has been scrambled)
  21. Which of the following is NOT TRUE concerning flucytosine (Ancobon):
    A. It is a prodrug, activated by a fungal deaminase to 5-fluorouracil
    B. It is a pyrimidine analog
    C. It is used in combination with amphotericin B
    D. It is an azole antifungal drug
    D. It is an azole antifungal drug
    (this multiple choice question has been scrambled)
  22. Which of the following is NOT TRUE concerning metronidazole (Flagyl):
    A. It inhibits fungal squalene epoxidase
    B. Its nitro group must be reduced by anaerobic bacteria or protozoa to form an active metabolite
    C. It has antiprotozoal and antimicrobial actions
    D. It is an azole anti-infective drug
    A. It inhibits fungal squalene epoxidase
    (this multiple choice question has been scrambled)
  23. Etiologic agent of Sporotrichosis
    Sporotrichum schenckii
  24. Etiologic agent of Blastomycosis
    Blastomyces dermatitidis
  25. Etiologic agent of Histoplasmosis
    Histoplasma capsulatum var. capsulatum / Histoplasma capsulatum var. duboisii
  26. Etiologic agent of Coccidioidomycosis
    Coccidioides immitis / Coccidioides posadasii
  27. Etiologic agent of Cryptococcosis
    Crytococcus neoformans
  28. Etiologic agent of PCP
    P. jiroveci
  29. Statement #1:
    Are produced by organisms that colonize in cells that are not alive and thus cause little discomfort

    Statement #2: Microscopic examination of a skin scraping that has been treated with KOH to destroy tissue elements prior to staining may aid in diagnosis

    Statement #3: Commonly are limited to the outermost layers of the stratum corneum of the skin and the outer epithlelial layer of hair

    Statement #4:
    Most have a tendency to
    be minor “cosmetic” problems that are easily diagnosed and treated

    Superficial Mycoses
  30. Statement
    #1
    : Infections tend to be characterized by the formation of macular darkly colored lesions on the soles of the feet and palms of the hands and is most commonly found among individuals who are resident of the tropics or subtropics

    Statement #2: Skin scrapings may be pretreated with KOH solution to destroy tissue elements and then stained with an appropriate stain prior to microscopy

    Statement #3: Is considered to be a dimorphic fungus that is colored brown-to-black because the organism produces MELANIN

    Statement #4: Infections tend to be limited to the skin and are typically preceded by some sort of injury involving “traumatic inoculation”, with treatment consisting of topical antifungal therapy involving an appropriate “-azole”

    Tinea Nigra
  31. Statement
    #1
    : Is characterized by the production of soft, white-to-creamy yellow lesions as a
    “sleeve” or “collarette” surrounding the hair shaft

    Statement #2: May be differentiated from the nits of pediculosis via a direct microscopic examination of the hair shaft

    Statement #3: Is a yeast-like organism that grows well on Sabouraud’s Dextrose Agar (Sabouraud’s Medium)

    Statement #4: Is more commonly found in tropical areas among those with poor hygiene, with treatment consisting of shaving the infected hairs close to the surface of the scalp

    White Piedra
  32. Statement #1: Shaving the infected hairs close to the surface of the scalp will effect a cure which will be permanent if the patient practices good hygiene

    Statement #2: Culture is NOT NECESSARY for identification
    because d
    irect microscopic examination of the infected hair shaft permits differentiation from the nits of pediculosis

    Statement #3: Is produced by a telemorphic fungus that grows on the hair shaft producing hard, gritty, darkend nodules

    Statement #4: Occurs more commonly in tropical regions among individuals with poor hygiene

    Black Piedra
  33. Statement #1: Sometimes called “tinea versicolor” is not caused by the same organisms that produce classical tinea infections but instead is part of the
    normal skin flora

    Statement #2: Is a lipophilic yeast-like fungus that prefers to grown in areas rich in sebaceous glands producing disease that may be symptomatically-treated with keratolytics such as salicylic acid or selenium disulfide, but requires topical “-azole” therapy to eradicate the infection
    Statement #3: Is characterized by the development of macular, discrete, hyper- or hypo-pigmented lesions that are commonly found on the torso or abdomen in healthy young adults

    Statement #4: When a skin scraping is appropriately stained, the organism may appear in the form of characteristic “spaghetti and meatball” fungal forms

    Pityriasis Versicolor
  34. Statement #1: Geophiles are dermatophytes that tend to be found in the soil and usually produce acute inflammatory reactions in humans that either heal spontaneously or respond well to topical antifungal therapy
    Statement #2: Topical “-azole” therapy tends to be sufficient for most skin infections but oral griseofulvin therapy may be necessary for infections of the
    hair

    Statement #3: Tend to produce infections that are restricted to areas of nonviable skin because the organisms are dermatophytes that are unable to grow in the presence of serum or at 37oC
    Statement #4: Zoophiles are dermatophytes that are normally found on animals and are not as well adapted to human hosts but will produce acute inflammatory reactions in humans
    that may heal spontaneously or that will respond nicely to topical “-azole” therapy

    Cutaneous Mycoses
  35. Statement #1: Anthropophiles are dermatophytes that produce the greatest number of human infections, with most infections being relatively mild, but having a tendency to become chronic and difficult to eradicate

    Statement #2: Growth on Sabouraud’s Dextrose Agar Medium in the laboratory may aid in the identification of the infecting pathogen by revealing the following characteristics of the fungal colonies: color (pigmentation), rate of growth and surface texture

    Statement #3: Microscopic identification of the three major genera of these pathogens is aided by the presence or absence of macroconidia and microconidia, including their morphological characteristics

    Statement #4: Are dermatomycoses classically produced by various
    species of one or more of the following genera:
    Epidermophyton, MICROSPORUM and Trichophyton

    Cutaneous Mycoses
  36. Statement
    #1
    : Lesions tend to be annular (ring-shaped) and are more commonly found on
    smooth, nonhairy skin

    Statement #2: Is also referred to as Ringworm of the Body and may be characterized by the production
    of erythema, pruritus and the formation of vesicles

    Statement #3: Symptoms are produced when fungal metabolites, antigens and enzymes
    diffuse through the viable layers of the epidermis

    Statement #4:
    Typically the le
    sions
    are pruritic and have an advancing erythematous

    border
    with central scaling and blanching

    Tinea Corporis
  37. Statement
    #1
    : Has a tendency to occur following a prolonged infection with
    tinea pedis

    Statement #2: Hyphal invasion of the nailbed by the
    appropriate pathogen initiates symptomatic disease

    Statement #3: Tends to be characterized by the
    development of thick, crumbling,
    discolored toenails and/or fingernails

    Statement #4:
    Is an o
    nychomycosis
    that may require prolonged treatment with oral

    griseofulvin, which may or may not be
    curative

    Tinea Unguium
  38. Statement #1: Tinea cruris typically involves intertriginous areas of the body, and mainly affects males > females

    Statement #2: The dermatophytid “-id” reaction is less commonly associated with tinea manus than it is with tinea pedis

    Statement #3: “Jock Itch”, also known as Tinea Cruris, is characterized by dry, pruritic lesions that began on the scrotum of the male and then spread to the groin

    Statement #4: Ringworm of the Hand, also known as Tinea Manus, tends to be
    characterized by the development of dry, scaly, pruritic lesions on the hands and fingers

    Tinea Cruris/Tinea Manus
  39. Statement
    #1
    : Commonly known as “Athlete’s Foot”, this
    infection tends to begin with itching between the toes, which is subsequently
    followed by a
    discharge
    of a thin fluid

    Statement #2: Does not commonly occur in pediatric
    patients, but may infect adults for years if untreated and is more commonly
    found in males than in females

    Statement #3: Classical symptoms include scaling
    and pruritic fissures that occur between the interdigital spaces of feet of
    individuals who traditionally wear shoes

    Statement
    #4
    : Is acknowledged as the most prevalent
    infection produced by dermatophytes and if untreated for a long period of time
    may predispose toward the development of Tinea Ungium

    Tinea Pedis
  40. Statement
    #1
    : Tends to begin with the invasion of the skin of the scalp,
    only then to spread down the keratinized wall of the hair follicle to an area
    just above the root of the hair

    Statement #2: Also designated as “Ringworm of the
    Scalp/Hair” i
    s commonly
    characterized by the development of circular alopecious areas, scaly pruritus
    and short hair stubs

    Statement #3: Is usually more common in pediatric patients,
    with males being more commonly infected than females

    Statement #4:
    The location of the lesions may be
    ectothrix, endothrix or favic, with the

    FAVIC form being the one in which the
    fungus is both within the hair shaft and at the

    root of the hair shaft

    Tinea Capitis
  41. Statement
    #1
    : Lesions most generally occur in the hair of the beard

    Statement #2: May be a highly inflammatory condition if the infecting species is a zoophilic

    Statement #3: Diagnosis may initially be challenging
    because
    the lesions may resemble those of a bacterial pyogenic infection

    Statement #4:
    Also being designated
    “Barber’s Itch” tends to produce symptoms that are
    characterized
    by the development of erythematous lesions and localized edema

    Tinea Barbae
  42. Statement
    #1
    : Tend to produce insidious, chronic, granulomatous infections that
    originate on the extremities, then slowly extend into the regional lymphatics,
    with mycetoma being a classical example

    Statement #2: Characteristically produce infections that RARELY disseminate to the
    bloodstream and become life-threatening if not treated promptly

    Statement #3: The initial lesions of these diseases tend to involve the deeper layers
    of the dermis and subcutaneous tissue, gradually extending back upward into the
    epidermis to produce skin surface lesions

    Statement #4: Tend to
    originate via the t
    raumatic inoculation of contaminated material from
    plants or the soil into the skin or subcutaneous tissue

    Subcutaneous Mycoses
  43. Statement #1: Sometimes known as “Rose Handlers Disease”,
    is characterized by an initial lesion on the extremities that progresses through
    nodular states to the lymphatics

    Statement #2: Is produced by a dimorphic fungus that is
    commonly found on vegetation, including grasses/trees, rose bushes and sphagnum
    moss (peat moss)

    Statement #3: Although easily and cheaply treated via oral therapy
    with SSKI, this drug tends to produce nausea, thus making oral therapy with an
    appropriate “-azole” more acceptable

    Statement #4: Tends to follow a course that involves the
    development of multiple subcutaneous nodules and abscesses that follow the
    lymphatics

    Lymphocutaneous Sporotrichosis
  44. Statement #1: Microscopic examination of lesion exudates or
    biopsy material via staining with an acceptable fungal cell wall stain is
    useful in diagnosis

    Statement #2: It is not unusual to find multiple
    subcutaneous nodules and abscesses following the track of the lymphatics

    Statement #3: Occurs following the traumatic inoculation of
    the dimorphic fungus Sporothrix schenckii
    into the skin

    Statement
    #4
    : Is a worldwide infection, usually involving
    more males than females due to the increased exposure of males to outdoor
    work-related activities

    Lymphocutaneous Sporotrichosis
  45. Statement #1: May follow the traumatic inoculation of the
    fungus into the skin and be characterized by the development of a verrucous
    lesions that extend into the draining regional lymphatics

    Statement #2: Pathogens are found in a group of
    dematicaeous fungi and when viewed microscopically in lesion biopsy material
    exhibit classical Medlar Bodies

    Statement #3: Tends to occur on the extremities, where it
    appears in nodules that are described as being “cauliflower-like”, with the
    presence of hemopurulent abscesses and ulcerations

    Statement #4: Lesions may be treated via surgical excision
    if small enough, otherwise pharmacotherapy would include the administration of
    an appropriate “-azole” or flucytosine (Ancobon
    ®)

    Chromoblastomycosis
  46. Statement #1: Occur following infection with fungi that are
    geographically restricted in distribution and are endemic to particular regions

    Statement #2: The primary focus for these infections is the
    lung, but systemic disease sometimes occurs depending on the infecting pathogen
    and the immune status of the host

    Statement #3: Are produced by fungal pathogens that are
    classical dimorphs, occurring in nature/and the laboratory (25oC) in their MOLD form but being found in humans
    (37oC) in their YEAST form

    Statement
    #4
    : Are produced by fungal pathogens that possess
    certain biochemical properties that enable the pathogens to evade human host
    responses

    Systemic Mycoses
  47. Statement #1: Inhalation of fungal conidia or hyphal
    fragments meets with immune response because macrophages are
    activated and thus engulf the invading pathogen

    Statement #2: The infection is not transmissible
    from person-to-person via droplet infection and tends to mild in most
    individuals

    Statement #3: The fungus persists in nature in its mold
    form in the soil, as well as in certain avian habitats, including bird/bat
    feces

    Statement #4: Although severe, systemic disease may require
    the administration of intravenous Amphotericin B, the administration of an
    appropriate “-azole” for a number of months is appropriate pharmacotherapy for
    mild-to-moderate disease

    Histoplasmosis (var. capsulatum)
  48. Statement #1: Microscopic examination of an appropriately
    stained blood sample may aid in diagnosis, although serological
    radioimmunoassay (RIA) is a sensitive and reliable diagnostic indicator of
    infection

    Statement #2: The infection begins by inducing an
    inflammatory reaction in the pulmonary system that becomes granulomatous, with
    a minority of cases going on to develop a self-limiting acute pneumonia with
    influenza-like symptomatology

    Statement #3: Common sites of infection that are cited by
    epidemiologists include barns, pigeon roosting areas in city parks, caves and
    demolished buildings in urban areas

    Statement
    #4
    : May also be known as “Cave Disease” or
    “Spelunker’s Disease” and is produced by Histoplasma
    capsulatum
    , an organism endemic to the Ohio River/Mississippi River Valley
    regions

    Histoplasmosis (var. capsulatum)
  49. Statement #1: Most commonly occurs in the same geographic
    regions on the North American continent as does Histoplasmosis

    Statement #2: Although many initial infections tend to be
    asymptomatic, primary pulmonary disease may ultimately produce lesions on the
    skin

    Statement #3: Unlike Histoplasmosis, pulmonary infiltrates
    do not produce calcifications in the lung

    Statement
    #4
    : May be acquired via the inhalation of
    infective conidia of Blastomyces
    dermatitidis
    , a fungus believed to be present in the soil

    Blastomycosis
  50. Statement #1: Symptomatic infection with the pathogen
    include fever, cough, malaise and myalgias, thus making the infection
    indistinguishable from other acute lower respiratory tract infections

    Statement #2: Microscopic examination of sputum or lesion
    biopsies, followed by the usual fungal stains aid in diagnosis, although
    immunoassay techniques are available

    Statement #3: Intravenous Amphotericin B is necessary for
    the treatment of both confined/localized and systemic disease because the
    fungal pathogen will not respond to appropriate “-azole” therapy

    Statement
    #4
    :
    Is known to be a source of a large number of asymptomatic infections in human
    beings, but may be a serious veterinary problem because the disease may be
    rapidly fatal in canines

    Blastomycosis
  51. Statement #1: Sometimes called San Joaquin Valley Fever,
    the infection may be characterized by the development of certain
    hypersensitivity reactions, notably erythema nodosum and erythema multiforme

    Statement #2: Is a fungal infection that tends to be
    restricted to the southwestern United States and northwestern Mexico, with the
    rate of infection usually being highest during the summer months because of the
    increased amount of air-borne dust containing infective fungal forms

    Statement #3: Diagnosis is aided via the microscopic
    examination of sputum or other bioexudates/biofluids for spherules and
    endospores, with confirmation being achieved via the use of a specific DNA
    probe

    Statement
    #4
    :
    < 1% of all patients undergo disease
    dissemination from the lungs, with coccidioidal meningitis being the most
    common complication

    Coccidioidomycosis
  52. Statement #1: Although symptomatic primary infection is
    usually only treated via supportive therapy, disseminated disease requires
    treatment with an appropriate “-azole” or intravenous Amphotericin B for
    periods that may exceed one year

    Statement #2: Sometimes denoted as Posada-Wernicke
    Disease, the infection is produced by a fungus that produces arthrospores and
    arthroconidia that are strongly resistant to adverse environmental conditions

    Statement #3: Inhalation of infective arthroconidia
    initiates infection, with most cases tending to follow an asymptomatic course,
    while fewer cases result in the development of self-limiting, influenza-like
    symptoms

    Statement #4: A hallmark symptom of symptomatic patients is
    the development of arthralgias

    Coccidioidomycosis
  53. Statement #1: Is a well-known mycotic infection of those
    who are HIV-infected or immunocompromised AND who reside in or visit Southeast
    Asia

    Statement #2: Inhalation of the conidia of the dimorphic
    soil fungus Penicillium marneffei is
    commonly followed by hematogenous dissemination

    Statement #3: Requires antifungal pharmacotherapy, with
    Amphotericin B with or without Flucytosine being administered, this being followed by
    administration of an appropriate “-azole”

    Statement
    #4
    : Is classically characterized by the onset of
    fever and cough, with lymphadenopathy, anemia, leukopenia and thrombocytopenia
    following

    Penicillinosis Marneffei
  54. Statement #1: Healthy, immunocompetent individuals are
    constantly exposed to common opportunistic mycoses in the environment without
    developing infection/illness

    Statement #2: The two most common opportunistic mycotic
    pathogens are Candida albicans and Aspergillus fumigatus

    Statement #3: Immunocompetent individuals do not
    tend to become infected because of a significant degree of innate resistance to
    fungal colonization, in addition to the low inherent virulence of these fungi

    Statement #4: Immunosuppressed individuals, such as those
    being administered cancer chemotherapeutic agents with/without irradiation, as
    well as organ transplant patients and AIDS patients, are predisposed to the
    development of various opportunistic mycotic infections

    Opportunistic mycoses
  55. Statement #1: Is caused by an organism that is surrounded
    by a glycosaminoglycan-containing antiphagocytic capsule

    Statement #2: Primary pulmonary infection in
    immunocompetent patients is commonly asymptomatic or relatively mild and does
    not require
    pharmacotherapy

    Statement #3: Immunocompromised individuals tend to suffer
    from a chronic meningitis, with periods of spontaneous remissions followed by
    periodic exacerbations, but will ultimately succumb to the disease if not
    treated

    Statement #4: Sometimes referred to as European
    Blastomycosis, is a worldwide disease that has been found in pigeon-inhabited
    areas and has its natural reservoir in the tree sap of a particular Eucalyptus
    tree

    Cryptococcosis
  56. Statement #1: Diagnosis consists of two important
    tests: first, the direct microscopic
    examination of an India-ink stained sample of cerebrospinal fluid showing
    budding yeast cells surrounded by a large capsule; and second, a latex agglutination
    test based on detection of the capsule antigen

    Statement #2: May NOT be transmitted to an AIDS patient via
    inhalation of droplets containing encapsulated yeast cells of the fungus Cryptococcus neoformans from aerosolized
    secretions of an immunocompetent patient with a primary pulmonary infection (no person-to-person transmission)

    Statement #3: Dissemination of the organism from a primary
    pulmonary cite to the meninges will lead to cryptococcal meningitis

    Statement #4:
    Therapy of the disseminated form of the disease is mandatory for
    survival, with
    intravenous Amphotericin B, flucytosine and
    an appropriate “-azole” all being useful, particularly in the appropriate
    combination therapy

    Cryptococcosis
  57. Statement #1: Is responsible for the development of
    pneumonia in patients with iatrogenic immunosuppression or debilitation, with
    disease symptomatology including the observation of tachypnea, dyspnea, and
    cyanosis

    Statement #2: Is initiated via droplet inhalation of Pneumocystis jiroveci, a uniformly
    common organism in humans and other mammals

    Statement #3: Extrapulmonary infections tend to occur in
    AIDS patients, thus making these individuals acceptable candidates for
    prophylactic pharmacotherapy

    Statement #4: Is classically recognized as a febrile
    interstitial pnumonitis with an insidious onset in immunocompromised and
    malnourished patients

    PCP
  58. Statement #1: Although it has been proposed by some that
    this pathogen is part of the normal flora, no natural reservoir has been found
    to date

    Statement #2: Is reasonably postulated to be an atypical
    fungus because of its different morphology/phenotypic features when compared to
    other fungi, as well as its failure to respond to classical antifungal agents

    Statement #3: Is commonly treated with
    trimethoprim-sulfamethoxazole (TMP-SMX), although a number of other
    alternatives are available, including
    primaquine, clindamycin and pentamidine

    Statement #4: Subclinical infections in healthy individuals
    are likely to occur, with serologic evidence indicating that infection most
    probably occurs at an early age

    PCP
  59. Statement #1: Although there are three asymmetric (chiral)
    carbon atoms present in the structure indicating the possibility of 4
    diastereoisomers, only one of these 4 isomers possess antifungal activity

    Statement
    #2
    :
    Would be more effective in the therapy of a Trichophyton sp. tinea infection when administered orally than when
    applied topically because the drug is not translocated within existing
    hyphae and must be deposited in precursor cells of keratin or diseased tissue

    Statement
    #3
    : Has NOT been employed
    in the therapy of various conditions that are not fungal infections likely
    because its ineffective against other organisms

    Statement
    #4
    :
    The degree of absorption from the gastrointestinal tract is dependent on
    the particle size of the crystalline drug, with the ultramicrosize crystalline
    form being absorbed to a more significant degree than the microsize crystalline
    form because the ultramicrosize crystals are partially dissolved in a PEG
    (polyethylene glycol) and dispersed throughout the tablet matrix

    Griseofulvin
  60. Statement #1: Fungal resistance to the drug does not
    tend to develop readily

    Statement
    #2
    : May cause damage to the human
    fetus when used in pregnant women because the drug has been shown to be
    carcinogenic, teratogenic and embryotoxic in studies in mammalian test
    animals

    Statement
    #3
    : The drug has not been
    established to be a strong inducer or a strong inhibitor of various CYP
    isoforms

    Statement
    #4
    : The compound is a highly
    lipophilic, colorless molecule with low water solubility that is biosynthesized
    in its source as a polyketide metabolite

    Griseofulvin
  61. Statement #1: Would not be an appropriate drug for
    the therapy of mucosal candidiasis in an immunocompetent individual because the
    drug lacks activity against Candida sp.

    Statement
    #2
    : Patients should be advised to
    use protective clothing or sunscreens when taking this medication because the
    compound has been known to produce photoallergic or phototoxic rash in some
    individuals

    Statement
    #3
    : Useful in the therapy of
    superficial tinea infections produced by species of the genera Epidermophyton, Microsporum and Trichophyton because the drug is a
    fungal antimitotic that binds to the tublin dimer and arrests cell division in
    the metaphase

    Statement
    #4
    : Would not likely be
    considered to be the drug of first choice in the therapy of newly diagnosed
    tinea corporis because the the drug is not recommended for minor or
    trival infections that will respond to therapy with topical agents alone

    Griseofulvin
  62. Statement #1: Oral administration may be accompanied by
    minimal adverse effects, notably gstrointestinal upset

    Statement
    #2
    : Dosage of various dosage forms
    may commonly be expressed in hundred thousand units

    Statement
    #3
    : Most mucosal candidal infections
    are susceptible to therapy, particulary oral, intestinal and vaginal but
    esophageal infections are known for their potential to be refractory

    Statement
    #4
    : The presence of conjugated
    double bonds in the molecule leads to photo-oxidative instability because the
    antifungal is a polyene macrocyclic lactone that undergoes light-catalyzed
    photo-oxidation across these double bonds

    Nystatin
  63. Statement #1:
    Amphoteric because of the presence of a
    weakly basic amine group in the amino sugar and a weakly acidic carboxylic acid
    group on the polyene ring

    Statement
    #2
    : A skipped polyol-polyene with a
    low water solubility that may sometimes be employed as an aerosol for
    bronchopulmonary candidiasis and a flush for intravenous catheters and
    cannulas

    Statement
    #3
    : Considered to possess greater
    toxicity than Amphotericin B on intravenous administration because the toxicity
    of polyene macrolides varies inversely with the number of conjugated double
    bonds and Amphotericin B has more conjugated double bonds than nystatin

    Statement #4:
    Useful in the therapy of various infections due to Candida albicans because the drug is a channel-forming ionophore
    that binds to fungal ergosterol in the cell membrane, producing a leakage of
    intracellular K+ and other
    small molecules, resulting in disruption of cellular integrity

    Nystatin
  64. Statement #1: The
    development of drug resistant strains occurs but not in overwhelming numbers

    Statement
    #2
    :
    Intravenous administration is commonly associated with dose-dependent
    renal toxicity, including polyuria, hyposthenuria and azotemia

    Statement
    #3
    : Is known to irreversibly inhibit
    the action of the enzyme ergosterol ATPase, an enzyme that catalyzes the
    formation of fungal cell wall sterol ergosterol

    Statement
    #4
    : Fungal meningitis due to both
    Coccidioides sp. and Cryptococcus sp. would be appropriately
    treated with Amphotericin B therapy

    Amphotericin B
  65. Statement #1: Renal toxicity may be controlled by
    appropriate monitoring of BUN and serum creatinine, thus limiting
    serious nephrotoxicity and preventing irreversible damage

    Statement
    #2
    : The major rate-limiting factor
    in therapy is nephrotoxicity because the compound is eliminated via the
    biliary-fecal route following extensive enterohepatic recycling

    Statement
    #3
    : Liposomal or lipid-based
    formulations are generally prescribed at higher doses than conventional
    Amphotericin B

    Statement
    #4
    : It is believed that concurrent
    administration with one of the drugs of the “-azole” antifungal group should be
    avoided because the azoles are known to
    inhibit cell membrane formation via inhibiting ergosterol synthesis and
    AmB binds to fungal ergosterol

    Amphotericin B
  66. Statement #1: An amphoteric heptaene macrolide with low
    water solubility that may be increased on addition of Na2HPO4
    + sodium desoxycholate because these two sodium salts increase ionization of
    the weakly acidic carboxylic acid function present in the molecule

    Statement
    #2
    : Is a channel-forming ionophore
    that is widely distributed and highly bound to serum proteins following
    intravenous administration

    Statement
    #3
    : Is most commonly “known” for its
    therapeutic utility in the intravenous therapy of progressive and potentially
    fatal systemic mycoses

    Statement
    #4
    : Administration of intravenous
    AmB tends to be followed by the onset of constitutional toxic reactions
    characterized by fever, rigors and tachypnea, with anitpyretics and Meperidine (Demerol
    ®) being used to lessen or prevent these symptoms

    Amphotericin B
  67. Statement #1: Adverse effects of therapy can be traced, at
    least in part, to the fact that the drug binds to renal, erythrocytic and
    myocardial lipids, including cholesterol, with dissolution of these cells

    Statement
    #2
    : If Amphotericin B Lipid Complex
    (Abelcet
    ®) is administered at a dosage appropriate for
    Amphotericin B desoxycholate (Fungizone
    ®), underdosing may occur

    Statement
    #3
    : Assembly of the macrolide ring
    portion of the molecule occurs in nature via condensation of acetate + malonate
    + methylmalonate molecules

    Statement #4:
    Oral administration should not be employed for the therapy of a
    disseminated mycosis because of poor/negligible drug absorption from the
    gastrointestinal tract

    Amphotericin B
  68. Statement #1: Has found utility in the intravenous therapy
    of certain protozoan infections, including leishmaniasis and primary amoebic
    meningoencephalitis

    Statement
    #2
    : Dexoxycholate solutions should not
    be treated with solutions containing electrolytes (NaCl, KCl, etc) because this
    may result in precipitation of the antifungal from its colloidal solution due
    to the phenomenon of “salting out”

    Statement
    #3
    : If the desoxycholate preparation
    (Fungizone
    ®) is mistakenly administered at a dosage appropriate
    for the liposomal preparation (AmBisome
    ®), serious and potentially fatal overdosing may occur

    Statement
    #4
    : Administration of AmB to a
    patient being treated with parenteral Tobramycin may result in increased
    nephrotoxicity because of additive effects

    Amphotericin
  69. Statement #1: A
    tetrane macrolide antifungal that will undergo light-catalyzed auto-oxidation
    when suspensions are exposed to light of the proper wavelength

    Statement
    #2
    : Fusarium solani
    conjunctivitis, blepharitis, and keratitis may be treated via the instillation
    of an aqueous ophthalmic suspension, with blindness being prevented if
    administration begins at an early enough time

    Statement
    #3
    : Is known to have a wider
    (broader) antifungal spectrum than Amphotericin B because natamycin is active
    against tinea organisms, Candida albicans
    and various deep mycoses

    Statement
    #4
    : Has the same mechanism of action
    as nystatin, but being a smaller ring polyene in comparison to nystatin,
    natamycin is both fungistatic and fungicidal within the same
    concentration range

    Natamycin
  70. Statement #1:
    Metabolism occurs via N-acetylation and hydrolysis, as well as spontaneous degradation to a ring-opened
    peptide

    Statement #2: The diacetate parenteral formulation is
    unstable in certain diluents and for this reason one must be careful of the
    choice of a parenteral diluent

    Statement
    #3
    : The central ring of the compound
    contains both weakly acidic and weakly basic ionizable groups, as well as a
    highly lipophilic aliphatic side chain

    Statement #4:
    Useful in the intravenous therapy of several candidal infections,
    including canidemia, candidal peritonitis, and esophageal candidiasis

    Caspofungin
  71. Statement #1:
    Numerous adverse reactions may occur on parenteral administration, not
    the least of which is infusion site phlebitis

    Statement
    #2
    : Recent studies utilizing the
    orally-administerered pivoxil ester in the therapy of aspergillosis have NOT been
    successful, because it's not absorbed orally!

    Statement
    #3
    : Being a semisynthetic,
    amphoteric lipopeptide with poor water solubility, the compound is solubilized
    for intravenous administration via the formation of its diacetate salt

    Statement #4:
    Studies have indicated that there does not appear to be a strong likelihood of antagonism of the antifungal
    effects of Amphotericin B when both drugs are administered simultaneously

    Caspofungin
  72. Statement #1: This
    semisynthetic compound is the initial compound to be marketed in a new series
    of antifungal agents that have been labeled “echinocandins”

    Statement
    #2
    : Has been shown to be embryotoxic
    in mammalian test animals and should only be used if the potential benefit to
    the mother justifies the potential risk to the fetus

    Statement
    #3
    : Invasive aspergillosis may be
    treated via intravenous therapy with this compound because caspofungin inhibits
    the biosynthesis of
    β(1,3)-D-glucan, a
    carbohydrate polymer present in the cell walls of susceptible fungi but not
    present in mammalian cells

    Statement
    #4
    : The cyclic peptidic ring of this
    molecule contains some unusual hydroxylated amino acids

    Caspofungin
  73. Statement #1: The drug is a semisynthetic cyclic peptide
    that contains distinct elements of lipophilicity in at least one of its side
    chains

    Statement
    #2
    : Patients with pre-existing
    mild-to-moderate hepatic impairment should be monitored carefully for potential
    worsening of this situation when treated with this compound

    Statement
    #3
    : Has become the drug of choice
    for the intial therapy of esophageal candidiasis

    Statement
    #4
    : Following intravenous
    administration, the compound is highly bound to plasma proteins, widely
    distributed and principally excreted (as drug and metabolites) in the
    feces

    Micafungin
  74. Statement #1: Is
    characterized by the ability to inhibit the biosynthesis of
    β(1,3)-D-glucan, a carbohydrate polymer
    present in the cell walls of susceptible fungi but not in mammalian
    cells

    Statement
    #2
    : Developmental abnormalities and
    abortion have been observed to occur in mammalian test animals that have been
    treated with this compound

    Statement
    #3
    : A semisynthetic lipopeptide echinocandin
    employed in the therapy of patients with esophageal candidiasis

    Statement #4:
    Not absorbed following oral administration, the compound is
    administered intravenously as its water soluble sodium salt

    Micafungin
  75. Statement #1: Its
    cyclic peptidic structure is fundamentally lipophilic with low water
    solubility, but one of its peripheral constituents is an aryloxysulfonic acid
    that can be converted to a water soluble sodium salt

    Statement #2: Shaking a freshly reconstituted sample,
    instead of gentle swirling, may cause foaming

    Statement
    #3
    : Compound metabolism occurs via
    the action of an arylsulfatase enzyme to produce a catechol, with the cathechol
    being further metabolized via the action of catechol-O-methyltransferase (COMT)

    Statement
    #4
    : Some patients have suffered anaphylactic reactions, including shock

    Micafungin
  76. Statement #1:
    Semisynthetic lipopeptide of the echinocandin class with low water
    solubility that is dissolved in Dehydrated Alcohol in Water for Injection

    Statement
    #2
    : Has not been demonstrated to
    inhibit the activities of the major human CYP isoforms

    Statement
    #3
    : No adjustments to dosage are
    considered necessary in patients with renal impairment

    Statement
    #4
    : Developmental effects have been
    observed to occur in the fetuses of mammalian test animals that have been
    treated with the drug

    Anidulafungin
  77. Statement #1: The
    central peptide ring of the molecule is composed of a number of unusual
    hydroxylated amino acids

    Statement
    #2
    : Esophageal candidiasis and
    candidemia are well treated vi intravenous administration

    Statement
    #3
    : Its mechanism of action is
    unlike that of nystatin
    but identical to that of caspofungin
    Statement #4:
    Has demonstrated activity against some fluconazole-resistant strains of Candida albicans

    Anidulafungin
  78. Statement #1: Not
    useful in the therapy of candidemia when administered orally because the drug
    is not absorbed to any effective degree

    Statement
    #2
    : Excessively rapid infusion of an
    intravenous solution may precipitate histamine-mediated symptoms, including
    pruritus, urticaria and rash

    Statement
    #3
    : Another cyclic lipopeptide that
    acts via inhibition of the biosynthesis of
    β(1,3)-D-glucan,
    thereby inhibiting the proper formation of the fungal cell wall

    Statement
    #4
    : A cyclic peptide with stongly
    lipophilic side chain that is solubilized with aqueous dehydrated alcohol

    Anidulafungin

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