NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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Which combination of drugs is recommended for treating cryptococcal meningitis in HIV?

Amphotericin B + flucytosine
Valganciclovir + ganciclovir
Clarithromycin + ethambutol
Fluconazole + flucytosine

The correct answer is: Amphotericin B + flucytosine

The recommended combination of drugs for treating cryptococcal meningitis in HIV is Amphotericin B along with flucytosine. This combination is the first-line treatment for cryptococcal meningitis due to its effectiveness in penetrating the blood-brain barrier and targeting the fungal infection. Amphotericin B acts by binding to ergosterol in the fungal cell membrane, causing membrane permeability and cell death. Flucytosine works synergistically with Amphotericin B by inhibiting DNA and RNA synthesis in the fungal cells. Options B, C, and D are incorrect: - Valganciclovir and ganciclovir are antiviral medications commonly used to treat cytomegalovirus (CMV) infections, not cryptococcal meningitis. - Clarithromycin and ethambutol are antibiotics mainly used to treat Mycobacterium avium complex (MAC) infections in HIV patients, not cryptococcal meningitis. - Fluconazole is a less preferred alternative for treating cryptococcal meningitis but is not the first-line treatment. The synergistic effects of Amphotericin B and flucytosine make them the preferred choice for this particular infection.