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NBME 21 Answers

nbme21/Block 1/Question#38

A 47-year-old woman with aplastic anemia is being ...

Amphotericin B

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submitted by hungrybox(208),

My impression of Amphotericin B is that it's the BIG GUNS. It straight up attacks the sterols in the fungi plasma membrane.

Meanwhile lil bitch drugs like -azoles just inhibit sterol synthesis. (-terbinafine X lanosterol, -azoles X ergosterol)

Fungins X cell wall synthesis, flucytosine X nucleic acid synthesis.

et-tu-bromocriptine  Rule of thumb/shortcut: Nonserious fungal infections: treat with _conazole Serious fungal infection (eg, immunocompromised patients with disseminated infection): treat with amphotericin B Additional info The main classes of antifungal medications for usmle include: Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis +1  
et-tu-bromocriptine  Ripppp the formatting, but hopefully the idea gets across +  
et-tu-bromocriptine  Fixed it, see comment! +  




 +1  upvote downvote
submitted by et-tu-bromocriptine(14),

Rule of thumb/shortcut

  • Nonserious fungal infections: treat with _conazole
  • Serious fungal infections (eg, immunocompromised patients with disseminated infection): treat with amphotericin B

Additional info

  • The main classes of antifungal medications for usmle include:
  • Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis
  • Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes
  • Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls
  • Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis