Antimalarials and Antiprotozoals

Question 1

Chloroquine and hydroxycloroquine

Answer 1

MOA: Actively concentrates in plasmodial RBCs
DOC and prophylaxis in SENSITIVE organisms
Do SLOW infusion
SE: Hemolysis with G6PD deficiency, QT prolongation
Resistance is serious problem

Question 2

Quinine sulfate (oral)
Quinidine gluconate (IV)

Answer 2

Decreases proliferation of vivax and ovale
DOC for COMPLICATED chloroquine resistant falciparum plasmodia
SE: Cinchonism (tinnitus, HA, etc)– Do not stop drug
QT prolongation (do not combine with mefloquine)
STIMULATES INSULIN RELEASE
Blackwater fever

Question 3

Doxycycline

Answer 3

combo with quinidine or quinine for complicated resistant malaria (may use Clindamycin too)
CI in PGN
Good for LAST MINUTE PROPHYLAXIS for MDR strains!

Question 4

Mefloquine

Answer 4

DOC and prophylaxis in chloroquine resistant strains
DO NOT USE IN PTS WITH MENTAL ILLNESS OR EPILEPSY
Elim via bile– very slow! single dose only!
SE: Cardiac tox with quinine!
PGN: Okay with CDC, bad with FDA

Question 5

Atovaquone + proguanil (Malarone)

Answer 5

Blocks mitochondrial ETC and ATP– inhibits folate pathway against tissue and RBC forms
Use: Uncomplicated resistant strains and prophylaxis
DOC for P. jirovecii
SE: potential mutagen

Question 6

Primaquine

Answer 6

ONLY WORKS FOR TISSUE FORMS AND GAMETOCYTES
RADICAL CURE FOR OVALE AND VIVAX
CI: SLE, PGN (HEMOLYTIC ANEMIA), G6PD
Prevents relapse, will not suppress disease once developed

Question 7

Metronidazole

Answer 7

Prodrug; BLOCKS DNA BY FORMING UNSTABLE MOLECULES- reduced to active via ferredoxin- needs anaerobes
DOC: AMEBIASIS, TRICHOMONIASIS, GIARDIASIS
Combo with luminal amebicide for amebiasis (iodoquinol, paromomycin, tetracycline and erythromycin)
SE: metalic tast– do not take with ETOH (Liver metabolism)

Question 8

Tinidazole

Answer 8

Used if flagyl is not well tolerated

Question 9

Iodoquinol

Answer 9

effective against luminal trophozoites
Along with Paromomycin, tetracycline, and erythromycin
SE: THYROID ENLARGEMENT– DISCONTINUE

Question 10

Doxycycline

Answer 10

Use: Amebiasis, giardiasis
SE: Diarrhea

Question 11

Pyrimethamine+sulfadiazine+folinic acid

Answer 11

prophylaxis for malaria

DOC TOXOPLASMOSIS

Question 12

Bactrim

Answer 12

DOC for Tx and Prophylaxis of PNEUMOCYSTOSIS

SE: RASH, PRURITIS

Question 13

Pentamidine

Answer 13

Inhibits DNA replication
PNEUMOCYSTOSIS when patients don’t tolerate Bactrim
IM/nebulizer (prophylaxis)
SE: RENAL FAILURE!!!!! Hypoglycemia