Chapter 67 - Pharmacology for the Primary Care Provider - Test Bank

Chapter 67: Antifungals Test Bank MULTIPLE CHOICE 1. A patient was diagnosed with tinea corporis and given topical ketoconazole. The patient tells the primary care nurse practitioner (NP) that the infection is not getting better. The NP should: a. prescribe griseofulvin. b. prescribe oral ketoconazole. c. obtain a culture of the infection site. d. recommend 3 more weeks of treatment with the topical medication. ANS: C If infection is unresponsive to empirical therapy, cultures must be obtained to confirm the diagnosis and rule out resistant organisms. This should be done before changing treatment. DIF: Cognitive Level: Applying (Application) REF: 719 2. A female patient has vaginal candidiasis and has taken a single dose of fluconazole without resolution of the infection. The primary care NP obtains a culture and should order: a. oral ketoconazole. b. griseofulvin for 4 weeks. c. another dose of fluconazole. d. topical miconazole (Monistat). ANS: D Topical miconazole is still recommended as the drug of first choice and should be given when oral fluconazole has failed. Fluconazole has been approved for single-dose treatment of vulvovaginal candidiasis, although the Centers for Disease Control and Prevention continues to recommend topical therapy with an imidazole derivative because of fluconazole-resistant candidiasis. Ketoconazole and griseofulvin are not recommended first-line treatments for vulvovaginal candidiasis. Another dose of fluconazole would not be effective if resistance is present. DIF: Cognitive Level: Applying (Application) REF: 718 - 719 3. A parent brings a 6-year-old child to the clinic for evaluation of a rash. The primary care NP notes three annular lesions with elevated borders and central clearing on the child?s face and a similar lesion on the back of the neck that extends above the hairline. The NP should prescribe: a. fluconazole. b. griseofulvin. c. oral ketoconazole. d. topical ketoconazole. ANS: B Griseofulvin is used for tinea infections of the skin, hair, and nails that are not responsive to topical therapy. Topical treatment of tinea capitis is usually ineffective because the fungus invades the hair shaft. Fluconazole is not indicated for tinea infections. DIF: Cognitive Level: Applying (Application) REF: 719 4. A woman who takes oral contraceptive pills develops vaginal candidiasis. The primary care NP prescribes a single dose of fluconazole. When counseling the patient about this drug, the NP should tell her: a. that the drug is safe if she were to become pregnant. b. that she may consume alcohol while taking this medication. c. to use a backup contraceptive method for the next 2 months. d. that she may need a lower dose of fluconazole because she takes oral contraceptive pills. ANS: C Women using oral contraception who take antifungals should be advised to use supplemental contraception during and for 2 months after antifungal therapy. Antifungals have teratogenic effects and are not safe during pregnancy. Patients should not consume alcohol while taking antifungal medications. It is not necessary to lower the antifungal dose in women taking oral contraceptive pills. DIF: Cognitive Level: Applying (Application) REF: 719 - 720 5. A patient is diagnosed with onychomycosis. The primary care NP notes that the patient takes quinidine. The NP should prescribe: a. terbinafine (Lamisil). b. fluconazole (Diflucan). c. itraconazole (Sporanox). d. griseofulvin (Gris-PEG). ANS: A Sporanox and terbinafine are both indicated to treat onychomycosis. Sporanox is not indicated in patients taking quinidine because of the risk of cardiac arrhythmias. Fluconazole and griseofulvin are not indicated to treat onychomycosis. DIF: Cognitive Level: Understanding (Comprehension) REF: 718 6. A patient has been taking griseofulvin for 4 weeks to treat a tineal capitis infection. The primary care NP notes improvement but not complete cure. The NP should: a. obtain a culture and change to ketoconazole. b. add a topical antifungal cream and refill the griseofulvin prescription for 2 weeks. c. renew the prescription after obtaining renal, liver, and hematopoietic tests. d. prescribe griseofulvin for 4 more weeks and then re-evaluate the infection. ANS: C Tineal infections may take 6 weeks to respond to griseofulvin. Patients taking griseofulvin longer than 4 weeks should have renal, hepatic, and hematopoietic functions monitored periodically. Topical antifungals typically are not effective for tinea capitis. Ketoconazole is usually not effective for tinea capitis. DIF: Cognitive Level: Applying (Application) REF: 724