NR 566 ADVANCED PHARMACOLOGY
MIDTERM EXAM: 100 VERIFIED
QUESTIONS WITH ANSWER
RATIONALES (AY 2026/2027) \|
GRADED A+ /NEWEST
SECTION 1: ANTIFUNGAL AGENTS
Question 1
Which statement best explains why amphotericin B must be given
intravenously for systemic mycoses?
A. It causes severe tissue necrosis if given orally
B. It has very poor GI absorption, so therapeutic serum levels cannot be achieved
orally
C. It is inactivated by gastric acid
D. It must be administered with lipid formulations that are only available IV
Correct answer: B. It has very poor GI absorption, so therapeutic serum levels
cannot be achieved orally
Rationale: Amphotericin B is a polyene antifungal with extremely poor oral
bioavailability. After leaving the vascular space, it binds extensively to sterol-
containing membranes, but oral dosing does not provide adequate systemic
,absorption for treating invasive fungal infections. IV administration is required to
achieve therapeutic serum concentrations for systemic mycoses. The drug is available
in lipid formulations (e.g., liposomal amphotericin B) that reduce nephrotoxicity but
are still administered intravenously .
Why other options are incorrect:
• A: While amphotericin B can cause local reactions, tissue necrosis is not the
primary reason for IV administration
• C: Gastric acid inactivation is not the main issue; the problem is poor
absorption from the GI tract
• D: Lipid formulations are an option to reduce toxicity, not the reason for IV
administration
Question 2
Which intervention most effectively reduces the risk of amphotericin B–induced
nephrotoxicity?
A. Premedicating with acetaminophen
B. Administering the drug by rapid IV bolus
C. Infusing 1 liter of normal saline on days of treatment
D. Giving a loop diuretic before each dose
Correct answer: C. Infusing 1 liter of normal saline on days of treatment
Rationale: Amphotericin B-induced nephrotoxicity is a significant adverse effect
caused by vasoconstriction of renal afferent arterioles and direct tubular damage.
Saline loading (typically 500-1000 mL of normal saline IV before and after
administration) reduces kidney damage by maintaining renal blood flow and
,preventing hypovolemia. Additional preventive measures include using liposomal
formulations (e.g., AmBisome), monitoring renal function tests, and avoiding
concurrent nephrotoxic drugs. Doses exceeding 4g cumulative are more likely to
cause renal impairment, and treatment should be for the shortest effective duration .
Why other options are incorrect:
• A: Acetaminophen may help with infusion-related fever and chills but does
not prevent nephrotoxicity
• B: Rapid IV bolus increases toxicity risk; the drug should be infused slowly
• D: Loop diuretics can worsen volume depletion and kidney injury
Question 3
Which antifungal agent requires a patient to avoid simvastatin due to the risk
of rhabdomyolysis from CYP3A4 inhibition?
A. Fluconazole
B. Itraconazole
C. Terbinafine
D. Caspofungin
Correct answer: B. Itraconazole
Rationale: Itraconazole potently inhibits the CYP3A4 enzyme, significantly increasing
plasma concentrations of HMG-CoA reductase inhibitors like simvastatin and
atorvastatin. This interaction leads to an increased risk of myopathy and
rhabdomyolysis. Prescribers should either switch to pravastatin (which is not
metabolized by CYP3A4) or select an alternative antifungal agent. This is a critical
drug interaction to assess before prescribing itraconazole .
, Why other options are incorrect:
• A: Fluconazole is a moderate CYP3A4 inhibitor but less potent than
itraconazole for this interaction
• C: Terbinafine does not significantly inhibit CYP3A4
• D: Caspofungin is an echinocandin and does not interact with the CYP450
system in this manner
Question 4
Which organism and infection is treated with griseofulvin?
A. Candida albicans causing oral thrush
B. Dermatophytic infections of skin, hair, and nails (e.g., tinea capitis, tinea corporis)
C. Systemic aspergillosis
D. Cryptococcal meningitis
Correct answer: B. Dermatophytic infections of skin, hair, and nails (e.g., tinea
capitis, tinea corporis)
Rationale: Griseofulvin is a fungistatic agent given orally for dermatophytic
infections caused by Trichophyton, Microsporum, and Epidermophyton species. It is
the drug of choice for tinea capitis (scalp ringworm) in children, requiring 8-10 weeks
of therapy. It is also used for tinea corporis and tinea pedis when topical treatments
fail. Griseofulvin is NOT effective against Candida species or systemic fungal
infections. It works by disrupting fungal microtubule formation, interfering with
mitosis .
Why other options are incorrect:
• A: Candida infections require azoles, echinocandins, or nystatin
MIDTERM EXAM: 100 VERIFIED
QUESTIONS WITH ANSWER
RATIONALES (AY 2026/2027) \|
GRADED A+ /NEWEST
SECTION 1: ANTIFUNGAL AGENTS
Question 1
Which statement best explains why amphotericin B must be given
intravenously for systemic mycoses?
A. It causes severe tissue necrosis if given orally
B. It has very poor GI absorption, so therapeutic serum levels cannot be achieved
orally
C. It is inactivated by gastric acid
D. It must be administered with lipid formulations that are only available IV
Correct answer: B. It has very poor GI absorption, so therapeutic serum levels
cannot be achieved orally
Rationale: Amphotericin B is a polyene antifungal with extremely poor oral
bioavailability. After leaving the vascular space, it binds extensively to sterol-
containing membranes, but oral dosing does not provide adequate systemic
,absorption for treating invasive fungal infections. IV administration is required to
achieve therapeutic serum concentrations for systemic mycoses. The drug is available
in lipid formulations (e.g., liposomal amphotericin B) that reduce nephrotoxicity but
are still administered intravenously .
Why other options are incorrect:
• A: While amphotericin B can cause local reactions, tissue necrosis is not the
primary reason for IV administration
• C: Gastric acid inactivation is not the main issue; the problem is poor
absorption from the GI tract
• D: Lipid formulations are an option to reduce toxicity, not the reason for IV
administration
Question 2
Which intervention most effectively reduces the risk of amphotericin B–induced
nephrotoxicity?
A. Premedicating with acetaminophen
B. Administering the drug by rapid IV bolus
C. Infusing 1 liter of normal saline on days of treatment
D. Giving a loop diuretic before each dose
Correct answer: C. Infusing 1 liter of normal saline on days of treatment
Rationale: Amphotericin B-induced nephrotoxicity is a significant adverse effect
caused by vasoconstriction of renal afferent arterioles and direct tubular damage.
Saline loading (typically 500-1000 mL of normal saline IV before and after
administration) reduces kidney damage by maintaining renal blood flow and
,preventing hypovolemia. Additional preventive measures include using liposomal
formulations (e.g., AmBisome), monitoring renal function tests, and avoiding
concurrent nephrotoxic drugs. Doses exceeding 4g cumulative are more likely to
cause renal impairment, and treatment should be for the shortest effective duration .
Why other options are incorrect:
• A: Acetaminophen may help with infusion-related fever and chills but does
not prevent nephrotoxicity
• B: Rapid IV bolus increases toxicity risk; the drug should be infused slowly
• D: Loop diuretics can worsen volume depletion and kidney injury
Question 3
Which antifungal agent requires a patient to avoid simvastatin due to the risk
of rhabdomyolysis from CYP3A4 inhibition?
A. Fluconazole
B. Itraconazole
C. Terbinafine
D. Caspofungin
Correct answer: B. Itraconazole
Rationale: Itraconazole potently inhibits the CYP3A4 enzyme, significantly increasing
plasma concentrations of HMG-CoA reductase inhibitors like simvastatin and
atorvastatin. This interaction leads to an increased risk of myopathy and
rhabdomyolysis. Prescribers should either switch to pravastatin (which is not
metabolized by CYP3A4) or select an alternative antifungal agent. This is a critical
drug interaction to assess before prescribing itraconazole .
, Why other options are incorrect:
• A: Fluconazole is a moderate CYP3A4 inhibitor but less potent than
itraconazole for this interaction
• C: Terbinafine does not significantly inhibit CYP3A4
• D: Caspofungin is an echinocandin and does not interact with the CYP450
system in this manner
Question 4
Which organism and infection is treated with griseofulvin?
A. Candida albicans causing oral thrush
B. Dermatophytic infections of skin, hair, and nails (e.g., tinea capitis, tinea corporis)
C. Systemic aspergillosis
D. Cryptococcal meningitis
Correct answer: B. Dermatophytic infections of skin, hair, and nails (e.g., tinea
capitis, tinea corporis)
Rationale: Griseofulvin is a fungistatic agent given orally for dermatophytic
infections caused by Trichophyton, Microsporum, and Epidermophyton species. It is
the drug of choice for tinea capitis (scalp ringworm) in children, requiring 8-10 weeks
of therapy. It is also used for tinea corporis and tinea pedis when topical treatments
fail. Griseofulvin is NOT effective against Candida species or systemic fungal
infections. It works by disrupting fungal microtubule formation, interfering with
mitosis .
Why other options are incorrect:
• A: Candida infections require azoles, echinocandins, or nystatin
