ID Exam 3

Desert Rheumatism / Posada-Wernicke Disease / San Joaquin Valley Fever

PCP

Athletes Foot

Chicago Disease / Gilchrist's Disease / North American Blastomycosis

Busse-Buschke Disease / European Blastomycosis

Farmer's Lung / Darling's Disease / Reticuloendothelial cytomycosis / cave disease / spelunker's disease

Jock Itch

Lutz-Splendore-Almeida Disease / South American Blastomycosis

Rose Handlers Disease

Ringworm

Barber's Itch

Onychomycosis

Which of the following is NOT TRUE concerning azole antifungal drugs:
A. They are synthetic compounds
B. They inhibit cholesterol synthesis
C. They have at least one five-member aromatic ring containing two or three nitrogen atoms
D. The N3 of their azole ring(s) bind(s) to the heme of cytochrome P450 enzymes

Which of the following is NOT TRUE concerning imidazoles:
A. They inhibit fungal cell wall synthesis
B. The family includes ketoconazole
C. This family is older than the triazole family of antifungal drugs
D. They inhibit ergosterol synthesis

Which of the following is NOT TRUE concerning triazoles:
A. The family includes posaconazole (Noxafil)
B. Their azole ring binds to both mammalian and fungal P450 enzymes
C. They are less specific and more toxic than imidazoles
D. Resistance to these drugs may involve mutation of fungal 14-alpha demethylase

Which of the following is NOT TRUE concerning azole side effects and drug interactions:
A. All azoles may be safely used during pregnancy
B. Azoles may inhibit P-glycoprotein efflux pumps
C. Some azole IV solutions contain a cyclodextrin vehicle which may be nephrotoxic
D. Side effects may include GI complaints and hepatotoxicities

Which of the following is NOT TRUE concerning ketoconazole:
A. It has the fewest P450-related drug interactions of the azole anti-infectives
B. Oral bioavailability depends on low pH for adequate dissolution and absorption
C. Concurrent administration of CYP3A4 inducers may cause therapeutic failure
D. It's antifungal mechanism results in lanosterol accumulation in fungal cell membranes

Which of the following is NOT TRUE concerning itraconazole (Sporanox):
A. Its therapeutic uses are confined to topical administration
B. It may increase the AUC of other drugs metabolized by CYP3A4
C. It shares many of the same drug interactions as ketoconazole
D. It has low aqueous solubility and drug products have variable oral absorption

Which of the following is NOT TRUE concerning fluconazole (Diflucan):
A. Its IC50 for fungal enzymes is less than the IC50 describing its interaction with mammalian enzymes
B. It has both high aqueous solubility and permeability
C. It is not metabolized itself; the majority of an oral dose is eliminated via the kidneys
D. Use is primarily limited by its unfavorable pharmacokinetics

Which of the following is NOT TRUE concerning voriconazole (Vfend):
A. It is primarily metabolized by glucuronyl transferase
B. One of its unique side effects is transient visual disturbances
C. There is interpatient variability in its rate of elimination
D. The P450 isozymes which metabolize the drug exhibit genetic polymorphism

Which of the following is NOT TRUE concerning flucytosine (Ancobon):
A. It is used in combination with amphotericin B
B. It is an azole antifungal drug
C. It is a pyrimidine analog
D. It is a prodrug, activated by a fungal deaminase to 5-fluorouracil

Which of the following is NOT TRUE concerning metronidazole (Flagyl):
A. Its nitro group must be reduced by anaerobic bacteria or protozoa to form an active metabolite
B. It inhibits fungal squalene epoxidase
C. It has antiprotozoal and antimicrobial actions
D. It is an azole anti-infective drug

Etiologic agent of Sporotrichosis

Etiologic agent of Blastomycosis

Etiologic agent of Histoplasmosis

Etiologic agent of Coccidioidomycosis

Etiologic agent of Cryptococcosis

Etiologic agent of PCP

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

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”

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

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 direct 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

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

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 37^oC
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

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

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 lesions
are pruritic and have an advancing erythematous
border
with central scaling and blanching

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 onychomycosis
that may require prolonged treatment with oral

griseofulvin, which may or may not be
curative

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

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

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” is 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

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

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 traumatic inoculation of contaminated material from
plants or the soil into the skin or subcutaneous tissue

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

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

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^®)

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 (25^oC) in their MOLD form but being found in humans
(37^oC) 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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