WEEK 3 ANTIFUNGAL DRUGS

40 years old female with neurogenic bladder on CBD. She was diagnosed to have cystitis ( Urine FEME, Culture and US bladder) secondary to Candida tropicalis, clinically stable. Which is the best agent to treat candida cystitis ?

• Fluconazole
• Itraconazole
• Micafungin
• Voriconazole
• Amphotericin B

Flucytosine can be used as monotherapy

• True
• False

Voriconazole has good activity against mould

• True
• False

Echinocandin has very good tissue penetration, including CNS and vitreous fluid.

• True
• False

Which of the following agent has no activity against mould infection?

• Itraconazole
• Posaconazole
• Echinocandin
• Fluconazole
• Amphotericin B

Which of the following agents requiring loading dose when treating systemic fungal infection?

• Itraconazole
• Posaconazole
• Isavuconazole
• Voriconazole
• All the above

Fluconazole is fungicidal

• True
• False

35 years old male, on capsule Itraconazole for Histoplasmosis. He is also on the below medications. Which are the medicines that has significant drug-drug interaction with Itraconazole ? ( more than one answers)

• Rifampicin
• Efavirenz
• Phenytoin
• Tenofovir emtricitabine
• Sodium Valproate

50 years old male with RVD, treatment naïve. He has Talaromycosis ( talaromyces marneffei) on Itraconazole 400mg OD and co-trimoxazole 2 tablets OD. He presented with a relapsed of talaromycosis. A GP prescribed him a course of Oral esomeprazole and antacids two weeks ago when he has gastritis. What is the possible reason of the relapse of fungal infection ?

• IRIS ( Immune Reconsitutional syndrome)
• Itraconazole resistant talaromyces
• Inadequate absorption of Itraconazole
• Wrong treatment dose of Itraconazole
• Wrong choice of antifungal agent

Which of the following is a true statement

• Suspension itraconazole is inferior to capsule itraconazole in term of bioavailability
• Suspension posaconazole 400mg BD is better absorbed comparing to 200mg QID
• Oral Itraconozaole should be taken after food to enhance bioavailability
• Oral voriconazole reaches steady-state concentrations after 7 days of treatment
• Oral Isavuconazole , the bioavailability is affected by gastric pH, food or high lipid meals