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Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Microbiology, Pharmacology |SubCategory=Dermatology |MainCategory=Microbiology, Pharmacology |SubCat..."
 
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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Microbiology, Pharmacology
|MainCategory=Microbiology, Pharmacology
Line 20: Line 20:
|MainCategory=Microbiology, Pharmacology
|MainCategory=Microbiology, Pharmacology
|SubCategory=Dermatology
|SubCategory=Dermatology
|Prompt=A 42 year old female patient presents to the dermatology clinic with a complaint of nail lesion.  Following appropriate work-up, the diagnosis of onychomycosis is made.  She was prescribed an antimicrobial medication that was then stopped due to alteration of liver function tests.  What is the mechanism of action that best describes the medication prescribed for this patient?
|Prompt=A 42-year-old female presents to the dermatology clinic with complaints of a nail lesion.  Upon diagnosis of onychomycosis she is prescribed an antimicrobial medication that is then promptly stopped due to alteration of liver function tests and taste disturbance.  Which of the following is the mechanism of action that best describes the medication prescribed?
|Explanation=Terbinafine is considered first line treatment for onychomycosis.  Terbinafine is an antifungal that inhibits squalene epoxidase.  Its most common side effects are altered liver function tests (LFTs) and visual disturbance.  Patients are usually requested to routinely perform LFT testing during treatment with terbinafine to monitor to drug-induced liver injury (DILI).
|Explanation=[[Terbinafine]], considered a first line treatment for [[onychomycosis]], is an anti-fungal medication that inhibits squalene epoxidase.  The most frequently occurring side effects of [[Terbinafine]]] are altered liver function tests (LFTs), GI upset, and taste disturbances.  During treatment with [[terbinafine]], patients are requested to routinely perform LFT testing to monitor to drug-induced liver injury (DILI).
 
|EducationalObjectives= [[Terbinafine]], considered a first line treatment for [[onychomycosis]], is an anti-fungal medication that inhibits squalene epoxidase.
The most frequently occurring side effects of [[Terbinafine]]] are altered liver function tests (LFTs), GI upset, and taste disturbances.
|References= First Aid 2014 page 190


Educational Objective:
Terbinafine is first line treatment for onychomycosis.  It is an antifungal that inhibits squalene epoxidase.  Liver injury is a potential side effect of terbinafine.
|AnswerA=Inhibits squalene epoxidase
|AnswerA=Inhibits squalene epoxidase
|AnswerAExp=Terbinafine is a squalene epoxidase inhibitor. It is the first line treatment for onychomycosis.  Liver function tests must be monitored due to terbinafine's hepatic adverse reaction.
|AnswerAExp=See explanation.
|AnswerB=Inhibits DNA polymerase  
|AnswerB=Inhibits DNA polymerase  
|AnswerBExp=Several antiviral medications inhibit DNA polymerase.  They are not used to treat onychomycosis.
|AnswerBExp=Several antiviral medications, which are not used to treat onychomycosis, inhibit DNA polymerase.  
|AnswerC=Inhibits aminoacyl-tRNA attachment
|AnswerC=Inhibits aminoacyl-tRNA attachment
|AnswerCExp=Tetracyclines inhibit aminoacyl-tRNA attachment.  They are not used to treat onychomycosis.
|AnswerCExp=Tetracyclines, which are not used to treat onychomycosis, inhibit aminoacyl-tRNA attachment.
|AnswerD=Inhibits synthesis of beta-glucan
|AnswerD=Inhibits synthesis of beta-glucan
|AnswerDExp=Caspofungin inhibits synthesis of beta-glucan.  It is not used to treat onychomycosis.
|AnswerDExp=Caspofungin, which is not used to treat onychomycosis, inhibits synthesis of beta-glucan.  
|AnswerE=Inhibits ergosterol synthesis
|AnswerE=Inhibits ergosterol synthesis
|AnswerEExp=Azoles inhibit ergosterol synthesis. They are not used to treat onychomycosis.
|AnswerEExp=Azoles, which are not used to treat onychomycosis, inhibit ergosterol synthesis.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=terbinafine, drug, induced, liver, injury, DILI, adverse, reaction, side, effect, adverse drug reaction, side effect, antifungal, onychomycosis, liver, function, test, LFT, liver functon test
|WBRKeyword=terbinafine, drug induced liver injury, DILI, adverse reaction, side effect, adverse drug reaction, antifungal, onychomycosis, liver function test, LFT, dermatology, digestive system, fungus
|Approved=No
|Approved=Yes
}}
}}

Revision as of 14:35, 29 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Microbiology, MainCategory::Pharmacology
Sub Category SubCategory::Dermatology
Prompt [[Prompt::A 42-year-old female presents to the dermatology clinic with complaints of a nail lesion. Upon diagnosis of onychomycosis she is prescribed an antimicrobial medication that is then promptly stopped due to alteration of liver function tests and taste disturbance. Which of the following is the mechanism of action that best describes the medication prescribed?]]
Answer A AnswerA::Inhibits squalene epoxidase
Answer A Explanation AnswerAExp::See explanation.
Answer B AnswerB::Inhibits DNA polymerase
Answer B Explanation AnswerBExp::Several antiviral medications, which are not used to treat onychomycosis, inhibit DNA polymerase.
Answer C AnswerC::Inhibits aminoacyl-tRNA attachment
Answer C Explanation AnswerCExp::Tetracyclines, which are not used to treat onychomycosis, inhibit aminoacyl-tRNA attachment.
Answer D AnswerD::Inhibits synthesis of beta-glucan
Answer D Explanation AnswerDExp::Caspofungin, which is not used to treat onychomycosis, inhibits synthesis of beta-glucan.
Answer E AnswerE::Inhibits ergosterol synthesis
Answer E Explanation AnswerEExp::Azoles, which are not used to treat onychomycosis, inhibit ergosterol synthesis.
Right Answer RightAnswer::A
Explanation [[Explanation::Terbinafine, considered a first line treatment for onychomycosis, is an anti-fungal medication that inhibits squalene epoxidase. The most frequently occurring side effects of Terbinafine] are altered liver function tests (LFTs), GI upset, and taste disturbances. During treatment with terbinafine, patients are requested to routinely perform LFT testing to monitor to drug-induced liver injury (DILI).

Educational Objective: Terbinafine, considered a first line treatment for onychomycosis, is an anti-fungal medication that inhibits squalene epoxidase. The most frequently occurring side effects of Terbinafine] are altered liver function tests (LFTs), GI upset, and taste disturbances.
References: First Aid 2014 page 190]]

Approved Approved::Yes
Keyword WBRKeyword::terbinafine, WBRKeyword::drug induced liver injury, WBRKeyword::DILI, WBRKeyword::adverse reaction, WBRKeyword::side effect, WBRKeyword::adverse drug reaction, WBRKeyword::antifungal, WBRKeyword::onychomycosis, WBRKeyword::liver function test, WBRKeyword::LFT, WBRKeyword::dermatology, WBRKeyword::digestive system, WBRKeyword::fungus
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