share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!

NBME 20 Answers

nbme20/Block 1/Question#24 (58.0 difficulty score)
A 50-year-old man comes to the physician ...

Login to comment/vote.

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

submitted by justgettinby(22),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

oaceaozInltr rresquie het adcici ertnnmoeniv fo eht csamoht to be o.sedrbba eoerlzmpOa ibtnihis eht +H/+K pmup of the ,tscoamh ytrehbe necdraegis the taidcyi fo het homacts. oS whne teh etpatin aetsk epealmzroO dan calteoznIoar ee,hgtotr rznelaaotoIc ot'wn eb bodrbaes nito teh byod. tsahT' yhw ti has no et.ffec

'tsI edcemodnerm to taek etcomdinisa ta alste 2 ouhrs roirp ot nakgit na caai.dnt

necrotizingfasciitis  Just adding support to the above explanation: +3  
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed? +2  
chandlerbas  just itraconazole and posaconazole +5  
lilyo  @chandlerbas, where did you find this information? I was looking over this on FA but they do not mention it and I would like a bit more information. Thanks! +5  
chandlerbas  haha no stress! the article above submitted by @necrotizingfasciitis does a descent job explaining it, however its not good enough, I looked into a bit more on uptodate but wasn't fruitful in my endeavours. goodluck! +  
haozhier  How are we supposed to know this!! It is not in UWORLD or FA right? +11  
kevin  Someone said it on here, since there was no CYP inducer of the answer choices, the only way to even think about an answer to this question was to just go with a less acidic environment from the PPI affecting absorption. It was simply the only reasonable answer choice, I don't think there's any way we were expected to know of this exact interaction prior +1  
aoa05  Golan pharm book states the exact same thing. Cannot be given to patients with acholrhydria. +  

submitted by nadhq(7),

I highly doubt that writers of this question expect us to know the relation between itraconazole and PPI but rather if a patient has a multidrug regimen (including a PPI), if there is no p450 related stuff going and drug absorbtion is defective we should be suspicious of the PPIs. Like a general rule or something like that.

Otherwise, if they expect us to know the specific relation between the two... meh this question sucks really hard then.

submitted by stepwarrior(22),

this is clearly another one of those trap questions for overthinkers

submitted by andremosq(3),

The encapsulated formulation of itraconazole has been associated with wide variability in plasma concentrations due to variability in absorption from the gastrointestinal (GI) tract.

Encapsulated itraconazole requires an acidic pH in the stomach for the proper dissolution and absorption in the duodenum (small intestine).

Proton pump inhibitor medications can increase the gastric pH and thereby decrease the dissolution of the capsule and the amount of itraconazole available for absorption from the GI tract for systemic delivery.

by:Anthony J. Busti, MD, PharmD, FNLA, FAHA

submitted by strugglebus(165),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

hsTi a CYP 540 ithobniir (SFICS.ACCKOME); ist het .O

coccidioinmytitties  Azoles, as a class, are CYP450 inhibitors [fungal > human; to prevent conversion of lanosterol to ergosterol]. Justget is correct- a ↓pH is needed for absorption and PPI/H2RA/antacids are contraindicated. +  

submitted by hayayah(1081),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Add on to the etohr :cnoetmm AMFI.ECSOCKCS we( nIh mA nrdgniki aerrGupfit uceij) is het neoinmcm ofr nmreibegrem het P4Y5C0 iontshIb:ir

  • S mdiou trplaaove
  • I odnizisa
  • C dnetmieii
  • K zlaeetcnooo
  • F uocalozeln
  • A utec oloalch busea
  • C pilnohraemchlo
  • E rmcy/ynicociitarmhohrytrnl
  • S moleundfsai
  • C pfiooncrialx
  • O arlpeozme
  • M lzaneorodtie

  • A rnoaomdei

  • tirfrGaupe ejcui
charcot_bouchard  Its not a cytochrome question. IK because i go t it wrong +  
waterloo  both azoles and PPI inhibit cytochrome P450. So one isn't causing the other's lack of effect. +8  
stepwarrior  Nope. Inhibiting CYP450 would enhance the effect of itraconazole, so that can't be the mechanism. +1