Lippincott Chapter 42: Antifungal Drugs

Question 1

42.1 Which of the following antifungal agents is MOST likely
to cause renal insufficiency?
A. Fluconazole.
B. Amphotericin B.
C. Itraconazole.
D. Posaconazole.

Answer 1

Correct answer = B. Amphotericin B is the best choice since
nephrotoxicity is commonly associated with this medication.
Although the dose of fluconazole must be adjusted for renal
insufficiency, it is not associated with causing nephrotoxic-
ity. Itraconazole and posaconazole are metabolized by the
liver and are not associated with nephrotoxicity.

Question 2

42.2 A 55-year-old female presents to the hospital with
shortness of breath, fever, and malaise. She has a history
of breast cancer, which was diagnosed 3 months ago,
and has been treated with chemotherapy. Her chest x-ray
shows possible pneumonia, and respiratory cultures are
positive for Aspergillus fumigatus. Which of the following
is the MOST appropriate choice for treatment?
A. Voriconazole.
B. Fluconazole.
C. Flucytosine.
D. Ketoconazole.

Answer 2

Correct answer = A. Voriconazole is the drug of choice for
aspergillosis. Studies have found it to be superior to other
regimens including amphotericin B. Fluconazole, flucyto-
sine, and ketoconazole do not have reliable in vitro activity
and are therefore not recommended.

Question 3

42.3 Which of the following antifungal agents should be avoided
in patients with evidence of ventricular dysfunction?
A. Micafungin.
B. Itraconazole.
C. Terbinafine.
D. Posaconazole.

Answer 3

Correct answer = B. There is a black box warning that warns
against the use of itraconazole in patients with evidence of
ventricular dysfunction, including patients with heart failure.

Itraconazole has been shown to have a negative inotropic effect, and has been associated with reports of congestive heart failure (CHF).

Question 4

42.4 A 56-year-old female with diabetes presents for routine
foot evaluation with her podiatrist. The patient 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 of the following is
the most appropriate choice for treating this infection?
A. Terbinafine.
B. Micafungin.
C. Itraconazole.
D. Griseofulvin.

Answer 4

Correct answer = 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.