Chapter·PharmacologyAntifungals

Antifungal resistance mechanismsDownloads

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1

You are taking care of a patient with renal failure secondary to anti-fungal therapy. The patient is a 66-year-old male being treated for cryptococcal meningitis. This drug has a variety of known side effects including acute febrile reactions to infusions, anemia, hypokalemia and hypomagnesemia. What is the mechanism of action of this drug?

AInhibition of squalene epoxidase

BBinding of the 50S subunit

CPore formation secondary to ergosterol binding

DDisruption of microtubule formation

EInhibition of 1,3-beta-glucan synthase

2

A 37-year-old woman with a history of anorectal abscesses complains of pain in the perianal region. Physical examination reveals mild swelling, tenderness, and erythema of the perianal skin. She is prescribed oral ampicillin and asked to return for follow-up. Two days later, the patient presents with a high-grade fever, syncope, and increased swelling. Which of the following would be the most common mechanism of resistance leading to the failure of antibiotic therapy in this patient?

AIntrinsic absence of a target site for the drug

BUse of an altered metabolic pathway

CProduction of beta-lactamase enzyme

DAltered structural target for the drug

EDrug efflux pump

3

A 46-year-old man with HIV infection comes to the physician because of a 1-week history of severe retrosternal pain while swallowing. He has not been compliant with his antiretroviral drug regimen. His CD4+ T-lymphocyte count is 98/mm3 (N ≥ 500). Endoscopy shows white plaques in the esophagus. The most appropriate immediate treatment is a drug that inhibits which of the following enzymes?

ADNA polymerase

BHydrogen-potassium ATPase

CCytochrome p450 enzymes

DPhospholipase A2

ESqualene epoxidase

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