Antimicrobials: itraconazole and heart failure: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antimicrobials: itraconazole and heart failure

Sample item

An elderly man treated for onychomycosis with an oral azole develops breathlessness, ankle oedema and an ejection fraction of 30%. Coronary angiography is normal. Which azole is the likely cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Itraconazole

Itraconazole has negative inotropic effects and can precipitate or worsen heart failure, so it is contraindicated in ventricular dysfunction. It also inhibits CYP3A4. Fluconazole and voriconazole do not have this effect, and clotrimazole is used topically.

Option by option

  • A. Clotrimazole

    Clotrimazole is used topically and is not absorbed enough to cause this.

  • B. Itraconazole (correct)

    Correct. This azole depresses myocardial contractility and can cause heart failure.

  • C. Fluconazole

    Fluconazole does not have a significant negative inotropic effect.

  • D. Voriconazole

    Voriconazole causes visual disturbance and hepatotoxicity, not heart failure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Itraconazole. Itraconazole has negative inotropic effects and can precipitate or worsen heart failure, so it is contraindicated in ventricular dysfunction.

Why is "Clotrimazole" not the answer?

Clotrimazole is used topically and is not absorbed enough to cause this.

Why is "Fluconazole" not the answer?

Fluconazole does not have a significant negative inotropic effect.

Why is "Voriconazole" not the answer?

Voriconazole causes visual disturbance and hepatotoxicity, not heart failure.

What concept does this question test?

It tests Antimicrobials: itraconazole and heart failure in Pharmacology. It also inhibits CYP3A4. Fluconazole and voriconazole do not have this effect, and clotrimazole is used topically.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antimicrobials: itraconazole and heart failure?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.