59.下列何者為最適當的經驗性療法？ (A)nystatin 500,000 ..-阿摩線上測驗

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59.下列何者為最適當的經驗性療法？
(A)nystatin 500,000 units swish and spit QID
(B)fluconazole 200～400 mg PO QD
(C)amphotericin B 500 mg swish and swallow 4～5 times daily
(D)voriconazole 200 mg PO BID

專技 - 藥物治療學- 109 年 - 109-2 專技高考_藥師（二）：藥物治療學#89128

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	Joca (2020/07/29) 抗黴菌藥物一、口腔、陰道黏膜的念珠菌感染... (內容隱藏中) 查看隱藏文字

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	13F 洪峻澤大三上 (2023/06/14) 大家看到Candida，應該都會馬上聯想到fluconazole 但是要小心後面的種小名，有時國考會在這邊做陷阱！！ azole類的Candida抗菌範圍整理： fluconazole：Candida albican, Candida glabrata (對C. krusei無效) itraconazole：Candida albican, Candida glabrata (對C. krusei無效) voriconazole：Candida albican, Candida glabrata, Candida krusei posaconazole：Candida albican, Candida glabrata, Candida krusei 幾個常考的無效範圍： 1.對Aspergillus無效：fluconazole 2.對Candida krusei無效：fluconazole、itraconazole 3.對Cryptococcus neoformans無效：echinocandin類(-fungin... 查看完整內容大家看到Candida，應該都會馬上聯想到fluconazole 但是要小心後面的種小名，有時國考會在這邊做陷阱！！ azole類的Candida抗菌範圍整理： fluconazole：Candida albican, Candida glabrata (對C. krusei無效) itraconazole：Candida albican, Candida glabrata (對C. krusei無效) voriconazole：Candida albican, Candida glabrata, Candida krusei posaconazole：Candida albican, Candida glabrata, Candida krusei 幾個常考的無效範圍： 1.對Aspergillus無效：fluconazole 2.對Candida krusei無效：fluconazole、itraconazole 3.對Cryptococcus neoformans無效：echinocandin類(-fungin) 檢舉
	14F 請新蓋一樓回覆我(不然都沒大一上 (2023/07/07) 之前實習的時候，學長說通常看黴菌感染到多深，不一定會吐掉或喝下去~ 檢舉
	15F jostud 大三上 (2023/07/21) 考前來更新一下如果以下有誤再麻煩各位提醒了 REF : uptodate mild disease 局部 •clotrimazole troches (one 10 mg troche dissolved in the mouth five times daily) •miconazole mucoadhesive buccal tablets (50 mg once daily applied to the mucosal surface over the canine fossa) •nystatin swish and swallow (400,000 to 600,000 units four times daily) 全身 • fluconazole (200 mg loading dose, followed by 100 to 200 mg daily for 7 to 14 days) moderate to severe disease In patients with moderate to severe disease, we suggest systemic therapy with fluconazole (200 mg loading dose, followed by 100 to 200 mg... 查看完整內容考前來更新一下如果以下有誤再麻煩各位提醒了 REF : uptodate mild disease 局部 •clotrimazole troches (one 10 mg troche dissolved in the mouth five times daily) •miconazole mucoadhesive buccal tablets (50 mg once daily applied to the mucosal surface over the canine fossa) •nystatin swish and swallow (400,000 to 600,000 units four times daily) 全身 • fluconazole (200 mg loading dose, followed by 100 to 200 mg daily for 7 to 14 days) moderate to severe disease In patients with moderate to severe disease, we suggest systemic therapy with fluconazole (200 mg loading dose, followed by 100 to 200 mg daily for 7 to 14 days) rather than topical therapy Other oral azoles (eg, itraconazole oral solution, posaconazole suspension, voriconazole) also appear to be effective for initial therapy Echinocandins and intravenous amphotericin b deoxycholate can also be used as treatment of thrush, but these are rarely indicated. 那如何判斷輕中重度 •輕度疾病：散在、不融合的病灶大小 >2 毫米 •中度疾病：多個病灶大小>2mm •嚴重疾病：廣泛、融合的病變該病人口腔和食道皆有病灶，起碼中度症狀以上（A）nystatin 500,000 units swish and spit QID 適用在輕度症狀，劑量正確（看過仿單是說吞下或是漱口都可）（B）fluconazole 200～400 mg PO QD 輕中重度都可以，劑量也正確，選（B）（C）amphotericin B 500 mg swish and swallow 4～5 times daily 中重度使用，或是使用fluconazole無效後的選擇，uptodate未寫口服劑量，偏後線使用附上原文（部分擷取，若需要了解更多詳見uptodate) Echinocandins and intravenous amphotericin B can also be used as treatment for refractory thrush, but these are rarely indicated. Amphotericin B deoxycholate oral suspension is also available in some countries for treatment of refractory thrush; however, it is not available in the United States and has to be compounded by a pharmacy.（口服或注射都可，但美國無口服劑型）小小補充：esophageal candidiasis fluconazole（第一選擇） •IV echinocandin •Lipid formulation of amphotericin B (3 mg/kg IV daily）腎毒性較低，有考過 33.王先生67歲，7年前腎臟移植，長期服用cyclosporine。2週前不明原因發燒，使用ceftriaxone及 imipenem/cilastatin治療無效。血液培養出Candida tropicalis，為保護其腎臟，下列何者為治療首選？ (A) vancomycin (B) amphotericin B（liposomal） (C) ketoconazole (D) acyclovir 專技 - 藥物治療學-107年 - 107-1 專技高考_藥師、藥師（二）：藥物治療學#67638 答案： B 3.與傳統的amphotericin B相較，下列何者是liposomal amphotericin B製劑的優點？ ①治療效果較好 ②價錢較便宜 ③腎毒性較少 ④輸注時之不良反應較少 (A)①② (B)②③ (C)③④ (D)①④ 專技 - 藥物治療學- 107 年 - 107-2 專技藥物治療學#70392 答案：C （D）voriconazole 200 mg PO BID 中重度使用，或是使用fluconazole無效後的選擇，劑量正確，但毒性較高較不建議（臨床數據也較少），偏後線使用也為麴菌首選檢舉

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59.下列何者為最適當的經驗性療法？ (A)nystatin 500,000 ..-阿摩線上測驗

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