A 37-year-old man complained of anorexia, nausea, enlargement of his breast and
impotence. The man, recently diagnosed with pulmonary coccidioidomycosis, has been
receiving an antifungal treatment for two weeks. Which of the following drugs most likely
caused these adverse effects?
A. Amphotericin B B. Nystatin C. Ketoconazole D. Flucytosine E. Griseofulvin F. Terbinafine
Ketoconazole-answer: ccoccidioides immitis is sensitive to amphotericin b and to antifungal azoles. amphotericin b isthe drug of choice for severe systemic coccidioidomycosis, but antifungal azoles are oftenpreferred in case of mild infection because they are orally active and much less toxic. .ketoconazole is an azole antifungal drug that can inhibit the cytochrome p450 system both infungal and mammalian cells. the inhibition blocks the synthesis of ergosterol in fungal cellmembrane, so leading to an antifungal effect, but can also block the synthesis of adrenal andgonadal steroids in mammalian cells. therefore the drug can cause gynecomastia, impotenceand infertility in males. the newer azoles appear to have greater affinity for fungal cytochromeenzymes and less interference with mammalian enzymes, so the above mentioned adverseeffects seem less frequent.a, b, d, e, f) the risk impotence with these drugs is negligible.