Antifungals MCQ Questions

Question 1:
Which of the following is the mechanism of action of polyenes?

A) Inhibition of (1,3)-β-D-glucan synthase
B) Inhibition of lanosterol 14α-demethylase
C) Inhibition of squalene epoxidase
D) Binding to ergosterol in fungal cell membranes, forming pores
E) Inhibition of microtubule function

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Question 2:
Which antifungal is primarily used for superficial infections such as oral thrush and is administered as a swish, swirl, and swallow?

A) Fluconazole
B) Nystatin
C) Amphotericin B
D) Caspofungin
E) Terbinafine

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Question 3:
Which of the following antifungal classes inhibits the enzyme lanosterol 14α-demethylase, blocking ergosterol synthesis?

A) Azoles
B) Polyenes
C) Echinocandins
D) Pyrimidine Analogs
E) Allylamines

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Question 4:
Which of the following antifungals is a triazole used for systemic fungal infections?

A) Clotrimazole
B) Miconazole
C) Fluconazole
D) Terbinafine
E) Griseofulvin

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Question 5:
Which echinocandin is commonly used for invasive candidiasis and aspergillosis?

A) Terbinafine
B) Caspofungin
C) Fluconazole
D) Griseofulvin
E) Nystatin

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Question 6:
Which of the following antifungals inhibits squalene epoxidase, affecting ergosterol synthesis?

A) Amphotericin B
B) Micafungin
C) Voriconazole
D) Terbinafine
E) Flucytosine

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Question 7:
Which antifungal is used in combination with amphotericin B for systemic infections such as cryptococcal meningitis?

A) Caspofungin
B) Griseofulvin
C) Flucytosine
D) Tolnaftate
E) Miconazole

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Question 8:
Which antifungal disrupts microtubule function, inhibiting fungal cell division, and is used for dermatophyte infections?

A) Griseofulvin
B) Nystatin
C) Caspofungin
D) Fluconazole
E) Amphotericin B

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Question 9:
Which antifungal is commonly used for topical treatment of tinea infections, such as athlete’s foot?

A) Caspofungin
B) Tolnaftate
C) Voriconazole
D) Terbinafine
E) Flucytosine

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Question 10:
Which antifungal has poor gastrointestinal absorption and is primarily used for superficial infections like oral thrush and vaginal candidiasis?

A) Amphotericin B
B) Nystatin
C) Caspofungin
D) Fluconazole
E) Terbinafine

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Question 11: Amphotericin B for Invasive Fungal Infections

A 60-year-old man is admitted to the hospital with a diagnosis of invasive aspergillosis. Due to the severity of the infection, the physician prescribes liposomal amphotericin B (Ambisome) at a dose of 5 mg/kg/day. The patient asks the pharmacist about the side effects of this medication, especially since he has heard that amphotericin B can be toxic.

Question 1:
What should the pharmacist inform the patient regarding the difference in toxicity between conventional amphotericin B and liposomal amphotericin B?

A) Liposomal amphotericin B has the same toxicity profile as conventional amphotericin B.
B) Liposomal amphotericin B is associated with a significantly lower risk of nephrotoxicity compared to conventional amphotericin B.
C) Liposomal amphotericin B is more nephrotoxic than conventional amphotericin B.
D) Liposomal amphotericin B is only effective for mild fungal infections and has fewer side effects overall.
E) Both forms of amphotericin B cause severe hepatotoxicity rather than nephrotoxicity.

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Follow-Up Question:
What is a common infusion-related reaction that patients may experience during amphotericin B therapy?

A) Hypoglycemia
B) Fever, chills, and rigors
C) Bradycardia
D) Constipation
E) Euphoria

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Question 12: Nystatin for Oral Candidiasis

A 45-year-old woman with poorly controlled diabetes presents to her physician with white patches on her tongue and inner cheeks, which are diagnosed as oral candidiasis (thrush). She is prescribed nystatin oral suspension at a dose of 500,000 units four times daily. The patient asks the pharmacist how to use the medication effectively.

Question 1:
How should the pharmacist counsel the patient on the correct use of nystatin oral suspension for oral candidiasis?

A) Swish and swallow the suspension, making sure to hold it in the mouth for several minutes before swallowing.
B) Swallow the suspension immediately without holding it in the mouth.
C) Apply the suspension to the skin around the mouth instead of swallowing it.
D) Gargle with the suspension and then spit it out.
E) Dilute the suspension with water before use.

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Follow-Up Question:
What is a common side effect that the patient should be aware of when using nystatin oral suspension?

A) Severe diarrhea
B) Gastrointestinal upset
C) Hypokalemia
D) Nephrotoxicity
E) Hypertension

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Question 13
What is the typical oral dosing for Ketoconazole in systemic fungal infections?
A) 100-200 mg daily
B) 150-250 mg daily
C) 200-400 mg daily
D) 300-500 mg daily
E) 400-600 mg daily

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Question 14
Which of the following is a serious side effect of systemic Ketoconazole use?
A) Nephrotoxicity
B) Hepatotoxicity
C) Hyperglycemia
D) Cardiotoxicity
E) Hypokalemia

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Question 15
For what conditions is Ketoconazole primarily used topically?
A) Onychomycosis and athlete’s foot
B) Psoriasis and eczema
C) Seborrheic dermatitis, dandruff, and cutaneous fungal infections
D) Bacterial vaginosis and acne
E) Viral infections and keratitis

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Question 16
Which of the following is a common use of Clotrimazole lozenges?
A) Treatment of onychomycosis
B) Treatment of oral thrush
C) Treatment of bacterial vaginosis
D) Treatment of athlete’s foot
E) Treatment of seborrheic dermatitis

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Question 17
What is the correct dosing regimen for Clotrimazole lozenges in the treatment of oral thrush?
A) 5 mg lozenge twice daily
B) 10 mg lozenge 3 times daily
C) 10 mg lozenge 5 times daily
D) 20 mg lozenge once daily
E) 50 mg lozenge 4 times daily

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Question 18
Which antifungal is typically used for treating vaginal yeast infections, oral thrush, and cutaneous fungal infections?
A) Fluconazole
B) Clotrimazole
C) Itraconazole
D) Econazole
E) Miconazole

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Question 19
What is a common side effect associated with topical use of Miconazole?
A) Dry skin
B) Hair loss
C) Local irritation, burning, or redness
D) Hypotension
E) Weight gain

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Question 20
Which enzyme do Ketoconazole, Clotrimazole, and Miconazole inhibit, potentially causing drug interactions?
A) CYP1A2
B) CYP2D6
C) CYP2C19
D) CYP3A4
E) CYP2C9

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Question 21
What is the main use of Econazole in antifungal therapy?
A) Treating systemic fungal infections
B) Treating tinea pedis, tinea corporis, and tinea cruris
C) Treating bacterial infections
D) Treating onychomycosis
E) Treating viral infections

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Question 22
What is a key characteristic of Ketoconazole that limits its systemic use?
A) High bioavailability
B) Risk of hepatotoxicity and adrenal insufficiency
C) Low risk of drug interactions
D) Ability to treat viral infections
E) Excellent absorption

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Question 23:
Which formulation of fluconazole is available for administration?

A) Oral tablets
B) Oral suspension
C) IV
D) Oral powder
E) All of the above

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Question 24:
Fluconazole is preferred for which type of fungal infections?

A) Candida infections (except Candida krusei and Candida glabrata)
B) Invasive aspergillosis
C) Mucormycosis
D) Histoplasmosis
E) Tinea capitis

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Question 25:
Which of the following is a black box warning for itraconazole?

A) Hepatotoxicity
B) Heart failure
C) Visual disturbances
D) Hallucinations
E) Photosensitivity

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Question 26:
Which antifungal is first-line treatment for invasive aspergillosis?

A) Fluconazole
B) Voriconazole
C) Itraconazole
D) Posaconazole
E) Isavuconazole

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Question 27:
What is a notable side effect of voriconazole?

A) Visual disturbances (blurred vision, photophobia)
B) Heart failure
C) Rhabdomyolysis
D) Hypotension
E) Hematuria

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Question 28:
Which triazole antifungal is mainly used for prophylaxis of invasive fungal infections in high-risk patients?

A) Fluconazole
B) Posaconazole
C) Voriconazole
D) Isavuconazole
E) Itraconazole

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Question 29:
Which antifungal has fewer drug-drug interactions and a lower risk of QT prolongation compared to other triazoles?

A) Fluconazole
B) Voriconazole
C) Itraconazole
D) Posaconazole
E) Isavuconazole

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Question 30:
Which enzyme(s) do fluconazole and voriconazole inhibit, leading to potential drug-drug interactions?

A) CYP2C9 and CYP2C19
B) CYP3A4
C) CYP1A2
D) Both A and B
E) None of the above

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Question 31:
Which of the following triazoles is preferred for the treatment of cryptococcal meningitis?

A) Fluconazole
B) Voriconazole
C) Itraconazole
D) Posaconazole
E) Isavuconazole

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Question 32:
Which of the following triazoles requires an acidic environment for absorption when administered in capsule form?

A) Fluconazole
B) Voriconazole
C) Itraconazole
D) Posaconazole
E) Isavuconazole

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Question 33:
Ketoconazole shampoo is used primarily for the treatment of which conditions?

A) Acne
B) Psoriasis
C) Dandruff and Seborrheic Dermatitis
D) Eczema
E) Rosacea

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Question 34:
Ketoconazole is a potent substrate and inhibitor of which enzyme?

A) CYP2C9
B) CYP3A4
C) CYP1A2
D) CYP2D6
E) P-gp

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Question 35:
Clotrimazole is the drug of choice for which conditions?

A) Athlete’s Foot, Vaginal Candidiasis, and Complicated Diaper Rash
B) Seborrheic Dermatitis and Dandruff
C) Onychomycosis and Tinea Versicolor
D) Psoriasis and Eczema
E) Acne and Rosacea

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Question 36:
What is the first-line treatment for dandruff and seborrhea?

A) Itraconazole 1% cream
B) Clotrimazole 2% cream
C) Ketoconazole 2% cream or shampoo
D) Terbinafine 1% gel
E) Miconazole 2% cream

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Question 37:
Itraconazole is commonly used as an oral treatment for which condition?

A) Seborrheic Dermatitis
B) Vaginal Candidiasis
C) Onychomycosis
D) Athlete’s Foot
E) Tinea Capitis

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Question 38:
Which of the following is an alternative topical treatment for onychomycosis?

A) Ketoconazole 2% cream
B) Clotrimazole 1% cream
C) Efinaconazole 10% topical solution (Jublia)
D) Fluconazole oral suspension
E) Terbinafine 1% gel

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Question 39:
Itraconazole is metabolized into which active metabolite?

A) Hydroxy-fluconazole
B) Hydroxy-terbinafine
C) Hydroxy-itraconazole
D) Hydroxy-ketoconazole
E) Hydroxy-voriconazole

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Question 40:
Itraconazole oral capsules are primarily used for which condition?

A) Tinea Versicolor
B) Onychomycosis
C) Seborrheic Dermatitis
D) Athlete’s Foot
E) Vaginal Candidiasis

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Question 41:
Which of the following is both a substrate and inhibitor of CYP3A4?

A) Clotrimazole
B) Fluconazole
C) Itraconazole
D) Ketoconazole
E) Voriconazole

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Question 42
What is the standard oral dosing regimen of Terbinafine for toenail onychomycosis?
A) 100 mg daily for 4 weeks
B) 150 mg daily for 8 weeks
C) 200 mg daily for 6 weeks
D) 250 mg daily for 12 weeks
E) 300 mg daily for 10 weeks

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Question 43
Which of the following is a common side effect of oral Terbinafine?
A) Hepatotoxicity
B) Stevens-Johnson syndrome
C) Gastrointestinal upset
D) Neutropenia
E) Severe allergic reactions

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Question 44
Which of the following drugs could be affected by the CYP2D6 inhibitory effects of Terbinafine?
A) Ibuprofen
B) Fluoxetine
C) Omeprazole
D) Lisinopril
E) Metformin

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Question 45
In which of the following conditions is oral Terbinafine contraindicated?
A) Hepatic impairment
B) Heart failure
C) Hypertension
D) Asthma
E) Depression

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Question 46
Which of the following should be monitored in patients on long-term oral Terbinafine therapy?
A) Renal function
B) Blood pressure
C) Serum calcium levels
D) Liver function
E) Cholesterol levels

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Question 47
What is the typical dosing regimen for Flucytosine in the treatment of severe fungal infections?
A) 100-200 mg/day divided into 2 doses
B) 250-500 mg/day divided into 3 doses
C) 50-150 mg/kg/day divided into 4 doses
D) 500-1000 mg/day divided into 2 doses
E) 2000 mg/day in a single dose

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Question 48
Which of the following is a common side effect of Flucytosine?
A) Hyperkalemia
B) Bone marrow suppression
C) Hypertension
D) Peripheral neuropathy
E) Hyperglycemia

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Question 49
Flucytosine is commonly used in combination with which of the following drugs for treating cryptococcal meningitis?
A) Voriconazole
B) Itraconazole
C) Amphotericin B
D) Caspofungin
E) Terbinafine

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Question 50
Which of the following monitoring parameters is most important during Flucytosine therapy?
A) Blood pressure
B) Blood glucose levels
C) Complete Blood Count (CBC)
D) Serum potassium
E) Electrocardiogram (ECG)

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Question 51
Flucytosine requires dose adjustment in which patient population?
A) Patients with hepatic impairment
B) Patients with bone marrow suppression
C) Patients with renal impairment
D) Patients with hyperlipidemia
E) Patients with hypertension

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Question 52

A 65-year-old woman is prescribed itraconazole to treat a fungal toenail infection. She has a history of hypertension, controlled with an ACE inhibitor, and high cholesterol, for which she takes atorvastatin 40 mg daily. The patient is concerned about possible drug interactions with her new medication.

Question 1:
What potential risk exists when combining itraconazole with atorvastatin?

A) Increased blood pressure
B) Risk of gastrointestinal discomfort
C) Higher risk of muscle toxicity, including myopathy or rhabdomyolysis
D) Reduced effectiveness of atorvastatin
E) Increased blood sugar levels

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Follow-Up Question:
What action should the healthcare provider take to manage the risk of this interaction?

A) Continue both medications and monitor for muscle symptoms.
B) Stop the ACE inhibitor to avoid complications.
C) Consider reducing the atorvastatin dose or switching to a statin not metabolized by CYP3A4, such as pravastatin or rosuvastatin.
D) Advise the patient to take the medications at different times of the day.
E) Increase the atorvastatin dose to maintain cholesterol control.

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Question 53

A 40-year-old man visits the pharmacy with a prescription for ketoconazole 2% shampoo to treat his seborrheic dermatitis. He asks the pharmacist how to use the shampoo properly and if there are any side effects or precautions he should be aware of.

Question 1:
What instructions should the pharmacist provide to the patient regarding the proper use of ketoconazole shampoo?

A) Apply the shampoo to dry hair and scalp, leave it on for 30 seconds, and rinse immediately.
B) Apply the shampoo to wet hair and scalp, leave it on for 5 minutes, and then rinse thoroughly.
C) Use the shampoo once a month to prevent symptoms from worsening.
D) Apply the shampoo only to the affected areas and rinse after 1 minute.
E) Use the shampoo every day for the first week and then reduce to twice daily.

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Follow-Up Question:
What should the pharmacist advise the patient regarding the potential side effects of ketoconazole shampoo?

A) The shampoo can cause dizziness and fatigue.
B) The shampoo may cause local irritation, burning, or itching of the scalp.
C) The shampoo can lead to systemic side effects, including hepatotoxicity.
D) The shampoo will cause hair loss if used frequently.
E) The shampoo can cause gastrointestinal upset.