Anti-Parasitics Flashcards
Metronidazole use and spectrum
Most commonly used for protozoa
Targets hydrogenosome
Anaerobic bacteria and protozoa (EH, NF)
Follow with luminal amebicide (paromomycin)
Giardiasis
Trichomoniais (must include all sexual partenrs as males typically asymptomatic)
Metronidazole mech and adverse effects
Causes loss of helical DNA structure resulting in inability of protein syntehsis and cell death
INhibits acetaldehyde dehrgoenase (aclocohl)
Peripheraly neuropathy
Dark urine
Paromomycin
Used to eliminnate intestinal coloniation bc not absorbed
Interferes with 30S subunit of ribosome
Use with metronid for amebiasis
Albendazole mech
Metabolite albendazole sulfoxide cause degen of cytoplasmic microtubules…glycogen depeleted and glucose uptake and cholinesterase secretion immpaired…desecretaory substancesd accumulate…ATP production decreases causing energy depleition, immobilization and worm death
Pyrantel pamoate mech
Release of Ach and inhibits cholinesterase…acts as depolarizing NM blocker to paralyze
Ivermectin mech
Binds to glutamate gated chloride ion channel…increased permeability of cell membranes tohloride ions leads ot hyperpolarization and death of parasite
Diethylcarbamazine mech
INvolve sesitizing the microfilaiae to phagocytosis…dependent on iNOS and COX1 path
Praziquantel mech
increases permeability to calcium in schistosomes causing contractions and paralysis of worm leading todetachment of sucks from blood vessel walls
Enterobius lines of defense
Albendazole/mebendaole 1st
Pyrantel 2nd
Treat entire fam
Ascaris lines
Alb/meb 1st
PP 2nd
Iver 2nd
Trichuris lines
Same as ascaris
Toxocara lines
Alb/meb 1st for visceral larva migrans
+glucocorticoid, +/- surgery
Trichinella lines
Alb/med plus glucocort
Hookworm lines
Alb/meb 1st
PP 2nd
Strgonyloids lines
Iver 1st
Alb/Med 2nd
Vector borne (filiaris or loa loa) lines
Diethyl carbamazine 1st
Alb/med 2nd
For annual, use both
Onchocerca lines
Iver 1st
Alb/med 2nd
For annual both
Tapeworm lines
For cysticerocosis, use alb/med and gluco
All other use prazi
Echinoccocus tapeworm lines
Surgical excision then alb
All flukes lines
Prazi
Fascicola hepatica
exception to flukes, use Alb or triclabenazole
Prevention of plasmodia
Avoidance/chemoprophylaxis
Presumptive tx of plasmodia
Self medication…drug should be different than chemoprophylaxis
Physician tx of plasmodia
Diagnose
Uncomp - fever, chills, N/V, sweats, muscle
Complication - confusion, coma, anemia, resp
Chloroquine use
Prophylaxis and tx of uncomplicated
Can use during pregnanzy
Blood schizonticide for all species but falcip and vivax have resistance
Can use for hepatic amebic abscess if metronidazole fails
Can use at anti-inflam for rhem dzs
Chloroquine mech
Concentrates in food vacuoles of parasites and prevents detox of heme…kills by oxidative effect
Blood Schizonticide and some gametocytocidal effects
Chloroquine kinetics and dosing
Long and vriable half life
2 weeks before, during, and 4 weeks after
Chlrooquine adverse effects
Pruritus
CV toxicv, CNS toxic, exofoliative dermatitive
Hemolysis due to G6PD def
Chlroquine contraindications
Cause with CNS probs or skin probs
DONOT use wit G6PD
Atovaquone proguanil uses
Prophylaxis, self tx, and treatment of all plasmodia
Reserve for P falcip and vivax that are chloroquine resistant
Blood schizonticide and some gametocytocidal
Mech of atovaquone proguanil
Atov - inhibits mito elec transport and collapses mitochondrial membrane potential
Proguanil - inhibis DHFR disrupting deoxythymidylate ynsthesis
A-P adverse effects
Ab pain, etc.
If vomiting within 30 mins, readmin
A-P dosing
Tx of uncomplicated - qd for 3 days
Prophylaixs - 1qd for 2 days b4 travel, during travle, and one week after
Mefloqine use, dosing
Prophylaxis and tx of all plasmodia
for proph - Weekly dosing 2 weeks before tavel, during, and 4 weeks after
Tx - 2 doses 12 hours apart
Use combo of mefloquine and artesunate more effective
Blood schizonticide
Adverse effects of mefloquine
Potential CNS toxicity Derm GI Myalgia Tinnitus
Might be okay for pregnancy
Doxycylcline use
Prophylaxis for chloroquine and mefloquine resistant falcip and vivax
Tx of uncomplication
Tx of complicated with quinine or artesunate
Blood schizonticide
Arthemeter-lumefantrine uses
Tx of uncompl falcip and vivax
Fast acting blood schizonticidal and gametocytocidal
Safe in children and adutls
Arthemeter mech
1 Heme iron from parasite cleaves endoperozide bridge
2) Structure rearrangsto yield free rad that damages parasite such as Ca ATPase
1-2 hour 1/2 life
Lumefrantrine mech
Prevents detox of heme
3-6 day 1/2 life
Artesunate use
Tx of complicated…only available through CDC because of potential bradycardia or AV block
Quinine/quinidine uses
Limited Tx of uncomplicated or complicated infectons
Both vailable in IV form…only qunidine used in US
Combine qunine with tetracycline, doxycycline, or clindamycin
Quninine mech
Like chloroquine binds heme and prevents detox
Quinidine/qunine other uses
Qunindine - antiarrhthmyc historically…Na and K channel blocker that prolongs refrect period
Quinine - used for nocturnal muscle cramps
Adverse effects and contraind of quinine and quniidine
Cinchonism
Hypoglycemia
Hpotension
hemolysis if G6PD def
Contraindications are hypersensitivity, CV dysrhythmia, OK in preg
Primaquine uses
Hepatic vivax and ovale
Tissue schizonticide and gametocidal for all
Also for penumo jiroveci
Mech of primaquine
Disrupts mitochondria and binds to DNA
Contraindications of primaquine
Dyscraisa
G6PD patient
pregnancy is G6PD fetus
Chloroquine table
Yes Yes Yes (no) Hemolysis if G6PD 2 weeks b4 travel and weekly
A-P table
Yes Yes Yes (no) Nausea and vomiting are major 2 days before travle and daily
Mefloquine table
Yes
Yes(no)
resistance, vivd dreams and psych concerns
2 weeks before travel and weekly
Doxy table
Yes
Yes (no)
2 days before travel and daly
A-L table
No
Yes
Yes (no)
Artesunate table
No
No
No (Yes)
Qunine/qunidine table
Maybe-used alone
Yes
Yes (yes)
G6PD
Primaquine table
Yes
Yes
Yes (no)
G6PD
