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Oral candidiasis — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectionsOral candidiasisGPhC CRA

A patient taking a cobicistat-boosted HIV regimen has developed facial rounding, proximal weakness and easy bruising after six months of high-dose inhaled fluticasone. What is the most likely medicines-related explanation and response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Review for fluticasone accumulation and associated adrenal suppression

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

A reverses the interaction mechanism. B would worsen glucocorticoid exposure. C is false because strong CYP3A inhibition can make even inhaled fluticasone systemically important. D risks HIV treatment failure and does not safely manage possible adrenal suppression. E is correct: boosted therapy can cause iatrogenic Cushing syndrome and adrenal suppression; coordinate urgent specialist review, avoid abrupt steroid withdrawal, assess adrenal function and consider a lower-interaction steroid such as beclometasone if clinically appropriate.

Reference: MHRA: Cobicistat, ritonavir and coadministration with a steroid. https://www.gov.uk/drug-safety-update/cobicistat-ritonavir-and-coadminsitration-with-a-steroid-risk-of-systemic-corticosteroid-adverse-effects