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Block 6 > Anti-Parasitic therapy > Flashcards

Anti-Parasitic therapy Flashcards

1
Q

Tinidazole

toxicities:

dosing:

Uses:

A

toxicities:

Similar toxicities to Metronidazole

dosing:

More convenient dosing schedule

Oral only

Not FDA indicated for anaerobic infection, would not use for this purpose

Used for:

Amebiases

Trichomoniasis (relaspe or 2nd attempt, reinfection)

Giardiasis

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2
Q

Iodoquinal

mech:

absorption:

adverse:

spectrum

A

mech: unknown

absorption:

  • poorly absorved oral formulation

- active in intestinal lumen

adverse:

nasuea, vomiting, rashes

spectrum:

-amebiasis tx only

  • followup tx for severe amebiasis after a course of metronidazole
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3
Q

Nitazoxanide

mech:

admin:

adverse:

uses:

A

Mech:

interferes with electron transfer necessary for anaerobic metabolism

Admin:

oral only

Adverse:

Gi upset, headache

uses:

giardiasis

cryptosporidiosis

C. difficile

Hep C

not first line, expensive and not more effective that metro

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4
Q

Trypanosomiasis TX

A

T cruzi:

  • nifurtimox (CDC only)
  • Benznidazole (CDC only)
  • available in South america

T. brucei gambiense:

  • pentamidine or suramin (dont memorize)
  • need CDC approval
  • late disease treated with eflornithine and nifurtimox

T. Brucei rhodesiense: (dont memorize)

  • suramin or melarsoprol
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5
Q

Chloroquine

A

Malaria chmoprophylaxis

  • Quinacrine

- inhibits polymerization of hemozoin in PLasmodium food vacuole

  • inexpensive

- only weekly dosing

  • AEs: itching in Africans, vomiting, rashes

Widespread resistance of P. Falciparum

  • Efflux pump reduces concentraiton in food vacuole
  • REsistance restricts to select areas
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6
Q

Mefloquine (Larium)

A
  • later generation quinacrine
  • dosed weekly
  • active against chloroquine reistant malaria
  • Toxicities: vertigo, lightheadedness, neuropsychiatric (nightmares, psychosis, suicide)

better drugs avavilable

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7
Q

Doxycycline

A

dosed daily

Malaria prophylaxis

increased sun sensitvitiy, Gi upset not for children, pregrant women (staining of developing teeth)

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8
Q

Malaria self tx

A

Atovaquone proguanil

Mefloquine

Artemesinins

Less use of pyrimethamine sulfadoxine due to resistance, toxicities

rapid diagnostic tests on rise

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9
Q

Pryantel pamoate

A

Tx of pinworm, hookworm

Toxicities: GI upset, dizziness

Vet use

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10
Q

Lice, scabies (ectoparasites)

topical tx:

systemic tx:

A

topical:

  • permethrin (Elimite, nix), insect neurotoxin
  • Malathion

Systemic:

  • ivermectin
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11
Q

summary

A

Metronidazole use for protozoa

Praziquantel, mebendazole, abendazole, ivermectin for worms

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12
Q

Ivermectin

uses:

A

Tx for:

  • ascariasis, toxocariasis, cutaneous larva migrans
  • onchocerciasis
  • some filaria
  • lice
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13
Q

Antiprotozoal treatments

A

metronidazole, tinidazole

iodoquinol

paromomycin

nitazoxanide

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14
Q

Metronidazole

mech:

distribution:

spectrum:

adverse:

A

Mech: Acts as an electron acceptor, once activated by reduction, it damages DNA and other macromolecules

Distribution:

penetrates well into all tissues

Spectrum:

highly bactericidal for anaerobic bacteria

protozoan infections:

trichomoniasis

Giardiasis

Amebiasis

Adverse:

beware of disulfiram-like reactions, metallic taste, neuropathy with prolonged use

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15
Q

Paromomycin

mech:

admin:

adverse:

uses:

A

mech:

proteins synthsis inhibitor, binds16s ribosomal RNA

admin:

oral only

adverse:

nausea, diarrhea, abdoinal pain

Uses:

amebiasis

alternative tx for leishmaniasis

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16
Q

Toxoplasmosis tx

  • prophylaxis of reactivation in AIDS:
  • treatment with ____ + _______.
A

trimethoprim sulfamethozazole- prophylaxis in AIDS patients

treament with prymethamin + sulfadiazine or clindamycin or atovaquone

17
Q

Leishmaniasis

-visceral

A
  1. Liposomal amphotericin B (ergosterol in cell membrane)
  2. Sodium stibogluconate (pentavalent antimony)
  3. Paromomycin is an alternative
18
Q

Atovaquone proguanil (malarone)

A

Malaria prolaxis

  • expensive

- dosed daily

  • atovaqone inhibit mitochondrial electron transport
  • proguanil acts as a DHFR inhibitor
  • toxicities: Gi upset, rash, well tolerated
19
Q

Malaria tx

  • uncomplicated for mild P. falciparum
A

atovaquone proguanil

artemther/ lumafantrine (coartem)

Artesunate (CDC)

20
Q

Artemesinins

A
  • tx of malaria
  • chinese herbal derivatives- qinghaosa
  • monotherapy not recommended
  • emerging reisistence in SE asia
21
Q

Quinine

A

tx of malaria

  • quinine sulfate + doxycyline or clindamycin

Toxicity: flushing, tinnitus, confusion, cardiac conduction

  • Mefloquine
22
Q

Tx for severe Malaria

A

P. Falciparum

  • quinidine gluconate IV
  • Quinine dihyrdochloride IV
  • plasma exchange in severe cerebral malaria
  • close monitoring of volume status to avoid pulmonary edema due to capillary leak syndrome
23
Q

Tx of P. vivax

A

reactivation prevented by followup tx with primaquine to kill hypnozoite stage in liver

  • check GPD level to exclude deficiency prior to use to avoid hemolysis
24
Q

praziquantel

A

**- **Antihelminthic tx

  • unknown mech
  • toxicities: GI upset, ab pain, rash
  • tx of: schistosomiasis, chlonorchiasis, other flukes (not Fasiolahepatica)
25
Q

Albendazole, Mebendazole

A

mech: inhibit tubulin polymerization, microtubule formation in worms
toxicities: GI upset, headache

Uses:

  • pinworm, whipworm, hookworm, ascariasis
  • echinoccocus, cysticercosis, trichinosis
  • strongyloidiasis, toxocariasis, cutaneous larva migrans
  • filaria
26
Q
A

Block 6 (17 decks)

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