NBME 23 Inhibition of the cytochrome P450-dependent demethylation reaction (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 3/Question#48 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
Inhibition of the cytochrome P450-dependent demethylation reaction 🔍 / 📺 / 🌳 / 📖
tags: pharm repeat

+28 upvote downvote
submitted by ∗yotsubato(1208)

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So for Candida we can use

Azoles (fluconazole) (inhibit CYP450 demethylation)

Amphotercin B (pore formation in fungal cell membrane)

Caspofungin (prevent crosslinking of beta glucans in cell wall)

or Nysatin for oral or esophageal cases (pore formation)

This question is saying that she is taking an ORAL drug to treat candida vaginitis.

Amphotercin is IV

Caspofungin is also IV

so we're left with azoles

Azoles inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol.

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qball Nystatin does treat vaginal candidiasis but is TOPICAL. +2

thotcandy Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +2

staghorn Me - picks Metronidazole -_- +1

alexxxx30 @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +5

turtlepenlight I have seen that on the wards so I hope it works! +

fexx and my smartass picks amphp B +2

avocadotoast Please no one give a poor girl with a yeast infection amphoterrible +3

fatboyslim @alexxxx30 according to FA2020 page 153 Nystatin is only for oral. In the 2018 FA it did say it can be used for esophageal but they edited that in 2020. +

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submitted by ∗jrod77(32)

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Azoles inhibit cytochrome P450 enzyme that converts lanosterol to ergosterol.

this is the best treatment indicated for candida.

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submitted by dai89(0)

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isn't candida yeast form under body temperature? why the picture shows a mold form?

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danielautran Maybe because the picture wasn't taken from inside the body +1

fatboyslim Most dimorphic fungi are "mold in the cold" and "yeast in the beast". Candida however is budding yeasts w/ pseudohyphae in the cold, and germ tubes inside the body. The picture in the question is showing budding yeasts with pseudohyphae :) +1

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submitted by xmen(4)

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Asoles

FA 2019 P199........................

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