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

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)

get full access to all content ⋅ pick a username

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.

get full access to all content ⋅ pick a username

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. +

+3 upvote downvote
submitted by ∗jrod77(32)

get full access to all content ⋅ pick a username

Azoles inhibit cytochrome P450 enzyme that converts lanosterol to ergosterol.

this is the best treatment indicated for candida.

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by dai89(0)

get full access to all content ⋅ pick a username

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

get full access to all content ⋅ pick a username

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

+0 upvote downvote
submitted by xmen(4)

get full access to all content ⋅ pick a username

Asoles

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

get full access to all content ⋅ pick a username

Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled ‘D’ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled ‘C’ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...