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Pharm > Antimalarials/Protozoals > Flashcards

Antimalarials/Protozoals Flashcards

1
Q

Most lethal and resistant protozoa

A

P. falciparum

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2
Q

Have dormant liver stages (hypnozoites) (2)

A
  • P. vivax

- P. ovale

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3
Q

Rare protozoa

A

P. malariae

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4
Q
  • Act on ERYTHROCYTIC forms of the parasite

- Do NOT affect secondary tissue forms of Ovale and Vivax

A

Blood schizonticides

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5
Q
  • Eliminate proliferation
  • Act on GAMETOCYTES
  • Do NOT help individuals suffering from malaria, but may help SLOW SPREAD
A

Gametocidal agents

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6
Q
  • Act on HEPATIC stages
  • Do NOT suppress symptoms one erythrocytic stages have been established
  • Kill secondary tissue forms of Ovale and Vivax
  • Can prevent prophylaxis but are too toxic
A

Tissue schizonticides

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7
Q

Provide “RADICAL CURE”

A

Tissue schizonticides

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8
Q

Can be used to suppress symptoms –> “CLINICAL CURE”

A

Blood schizonticides

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9
Q

Most effective means of controlling malaria

A
  • Avoid being bitten
  • Eradicate mosquitoes and habitates
  • Insect repellent
  • Mosquito netting, tents with permethrin
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10
Q

Drug effective against gametocytic and exoerythrocytic (tissue) formation

A

Primaquine

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11
Q

Drugs effective against erythrocytic form, from illustration (5)

A
  • Artemisinin
  • Chloroquine
  • Quinine
  • Mefloquine
  • Pyrimethamine
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12
Q

DOC for Malaria (2)

A
  • Chloroquine

- Hydroxychloroquine

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13
Q

Blood schizonticides

A
  • Chloroquine
  • Hydroxychloroquine
  • Mefloquine
  • Quinine sulfate and quinidine gluconate
  • Doxycycline or Clindamycin
  • Atovaquone + Proquanil
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14
Q

DOC and prophylaxis for sensitive organisms

A

Chloroquine

- Prophylaxis due to long duration of action (take once weekly)

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15
Q

What form is resistant to Chloroquine and why?

A
  • P. falciparum

- TRANSPORT PUMP removes drug from parasite

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16
Q

Chloroquine MOA (2)

A
  • Actively concentrated within plasmodia that reside in RBC

- May interfere with lysosomal degradation of Hgb

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17
Q

Chloroquine Admin

A
  • Oral

- Parenteral (slow)

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18
Q

Chloroquine accumulates where? (2)

A
  • Skin

- Retina

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19
Q

Chloroquine SE (6)

A
  • CNS (dizziness, HA, tinnitus)
  • Retinal and corneal tox
  • Ototoxicity
  • Rash, pruritis
  • HEMOLYSIS - G6PD (use caution, but not absolute CI)
  • INCREASED RISK FOR QT prolongation (torsades)
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20
Q

Chloroquine CI (2)

A
  • Psoriasis

- Porphyria

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21
Q

First line drug for tx and prophylaxis of chloroquine resistant strains?

A

Mefloquine

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22
Q

Mefloquine Admin

A

Oral as single mega dose

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23
Q

Mefloquine Features -

A
  • Distributed to blood, urine, CSF, tissues and concentrated in RBC
  • Metabolized by liver
  • Eliminated very slowly
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24
Q

Mefloquine SE

A
  • SEIZURES AND PSYCHOSIS aggravation

- Potential CARDIAC TOX (do NOT combine with quinine)

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25
Q

Mefloquine CI

A
  • In pts with any neuropsych problems
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26
Q

Quinine Admin and t 1/2

A

Oral, 5 - 16 hrs

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27
Q

DOC for complicated, chloroquine resistant plasmodia

A

Quinine and Quinidine Glyconate

- Combined with Doxycycline or Clindamycin (if

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28
Q

Quinidine Glyconate Admin

A

IV

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29
Q

Other actions of Quinine and Quinidine Glyconate

A
  • Analgesia

- Antipyretic

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30
Q

Which drug has a narrow margin between an effective dose and toxic dose?

A

Quinine

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31
Q

Quinine and Quinidine Glyconate SE

A
  • CINCHONISM (tinnitus, HA, dizziness, flushing, visual disturbances)
  • ANTIARRYTHMIC agent (Quinidine)
  • QT ELONGATION (do not combine with mefloquine)
  • HEMOLYSIS in G6PD
  • Stimulates insulin (caution in hypoglycemia)
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32
Q

Antibiotic combined with Quinine or Quinidine Glyconate for tx of complicated chloroquine resistant malaria

A

Doxycycline

33
Q

Used for prophylaxis against multidrug resistant malaria, taken daily

A

Doxycycline

34
Q

Atovaquone MOA

A

Interferes with mitochondrial process such as

  • electron transport
  • ATP synthesis
  • pyrimidine synthesis
35
Q

Proguanil MOA

A
  • Inhibits dihydrofolate deductase

- Blocks dihydrofolic acid to tetrahydrofolic acid

36
Q

SYNERGISTIC combo effective in regions where chloroquine and mefloquine resistance is high

A
  • Atovaquone + Proguanil
37
Q

Atovaquone + Proguanil Tx (2)

A
  • Uncomplicated, chloroquine resistant malaria

- Prophylaxis against chloroquine resistant Falciparum

38
Q

Atovaquone + Proguanil absorption increased by _____

A
  • Fatty foods
39
Q

Atovaquone + Proguanil Admin

A

Oral

40
Q

Atovaquone + Proguanil active against what form?

A
  • Tissue
  • Erythrocytic
  • NOT for radical cure
41
Q

Atovaquone + Proguanil SE

A

Require D/C

  • Rash, fever, V/D
  • Caution in preg: mutanogenesis in mice
42
Q

Tissue Schizonticide, only active against TISSUE FORMS AND GAMETOCYTES

A

Primaquine

43
Q

Drug that will NOT suppress disease once developed

A

Primaquine

44
Q

Primaquine Admin

A

Oral

45
Q

Used with chloroquine as alternative tx for chloroquine-resistant Falciparum

A

Primaquine

46
Q

Primaquine CI

A

NEVER GIVE THIS DRUG TO

  • G6PD (hemolytic anemia)
  • SLE or RA (granulocytopenia)
  • Pregnancy (fetal hemolytic anemia)
47
Q

Most drugs can provide a clinical cure to which species?

A

All four

48
Q

Most drugs can provide a radical cure to which species?

A

Falciparum and Malariae

49
Q

Drug used for radical cure of Vivax and Ovale, when used with RBC Schizonticide

A

Primaquine

50
Q

Amebiasis infective form? invading and replicating form?

A

Infective: Cyst

Invade/replicate: Trophozoite

51
Q

Most common cause of non-bacterial diarrhea in N. America

A

Giardia

52
Q

Trichomoniasis: who needs to be treated?

A

both partners

  • Men often asymptomatic
  • Women frothy, yellow, discharge
53
Q

Toxoplasmosis during pregnancy (3)

A
  • Heart problems
  • Hydrocephalus
  • Retinochorditis
54
Q

P jirovecii: what is it?

A

Not a protozoa –> yeast-like fungus

55
Q

Major cause of death in AIDs pt

A

P jirovecii

56
Q

DOC for Amebiasis, Giardiasis, Trichomoniasis

A

Metronidazole

57
Q

DOC for pneumocystosis

A

Bactrim (Trimethoprim plus sulfamethoxazole)

58
Q

Drugs used for Amebiasis, Giardiasis, Trichomoniasis (5)

A
  • Metronidazole (DOC)
  • Tinidazole
  • Iodoquinol
  • Tetracycline & Erythromycin
  • Paromomycin
59
Q

Drug for Toxoplasmosis

A

Pyrimethamine + Sulfadiazine + Folinic acid (Leucovorin)

60
Q

Alternate tx for Sulfa allergy, Pneumocystosis

A

Pentamidine

61
Q

Tx Amebiasis

A

Metronidazole + Luminal amebicide

— Metronidazole is NOT AFFECTIVE AGAINST LUMINAL PARASITES

62
Q

Tx for Giardiasis

A

Metronidazole

63
Q

Tx for Trich

A

Metronidazole

64
Q

Metronidazole MOA (2)

A
  • Prodrug: non-enzymatically reduced by reacting with reduced ferredoxin (only found in anaerobes)
  • Metronidazole metabolites are TAKEN UP INTO DNA, and form unstable molecules
65
Q

Metronidazole Admin

A
  • Oral
  • IV
  • Topical
66
Q

Does metronidazole get into CSF?

A

Yes

67
Q

Metronidazole SE (4)

A
  • CNS toxicity: seizures and neuropathy
  • Red urine
  • Not to be taken with alcohol
  • Metallic taste
68
Q

Similar drug to Metronidazole, but better tolerated

A

Tinidazole

69
Q

Luminal parasite drugs (3)

A
  • Iodoquinol
  • Paromomycin
  • Tetracycline and Erythromycin
70
Q

Drug that is useful for asymp amebiasis

A
  • Iodoquinol

- Paromomycin (also for asymp giard, trich)

71
Q

Iodoquinol SE (3)

A
  • Skin rxn, NA, D
  • High IODINE CONTENT –> thyroid enlargement
  • Optic neuritis and optic atrophy –> blindness
72
Q

Drug class Paromomycin

A

Aminoglycoside

73
Q

Alternative drugs for tx of amebiasis and giardiasis

A

Tetracycline and Erythromycin

74
Q

Bactrim MOA

A

Inhibits folate metabolism

75
Q

Bactrim SE

A
  • Rash, pruritis

- Cytopenias and transaminase elevation

76
Q

Pentamidine MOA

A

Inhibit DNA replication

77
Q

Pentamidine Admin and when to use

A
  • IM (active infection)

- Neubulization (prophylaxis)

78
Q

Pentamidine SE

A
  • Hypotension, arrythmias, hypoglycemia
  • Tachycardia, HA, V, bronchospasms
  • RENAL DYSFUNCTION
  • Hepatic failure
79
Q

DOC P. jirovecii

A

Bactrim + Folinic acid

Pharm (10 decks)

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