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term 4 > antiparasiticantifungalanesthetics > Flashcards

antiparasiticantifungalanesthetics Flashcards

1
Q

anti parasitic that has risk of optic neuritis with long term use

A

iodoquinol- due to dose related iodine toxicity

all of the luminal agents also come with mild GI upset

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2
Q

cryptosporidosis 1/2

A
  1. paromomycin (amino glycoside antibiotic)
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3
Q

eliminates trophosizes in liver abcess

A

chloroquine

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4
Q

back up drug for intestinal or hepatic amebas when no metronidazole

A

emetine/ dehydroemetine

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5
Q

DOC for invasive ameboas

A

metronidazole
followed by luminal

tinidazole is the new preference and better tolerated

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6
Q

Nitro group of acts as an electron acceptor à forming reduced cytotoxic compounds that bind to proteins and DNA, resulting in death of trophozoites.

A

Mixed Agents
Nitroimidazoles
- Metronidazole - Tinidazole

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7
Q

Not active against trophozoites
Converted in the gut to form amebicide

A

Luminal Agent
Diloxanide Furoate

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8
Q

Halogenated hydroxyquinoline – amebicidal; effective against the trophozoite and cyst forms

A

Luminal Agent
Iodoquinol

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9
Q

Aminoglycoside antibiotic; directly amebicidal, not significantly absorbed

A

Luminal Agent
Paromomycin

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10
Q

Prevents polymerization of heme->hemozoin Intracellular accumulation of heme is toxic to the parasite

A

Systemic Agent
Chloroquine

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11
Q

Blocks ribosomal movement along mRNA-> Inhibits protein synthesis

A

Systemic Agents
Emetine / Dehydroemetine

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12
Q

GI distress, rash, headache; auditory dysfunction and retinal dysfunction (high dose)

A

chloroquine

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13
Q

antifungalSevere toxicity, including gastrointestinal distress, muscle weakness, and cardiovascular dysfunction (arrhythmias and congestive heart failure)

A

Emetine / Dehydroemetine

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14
Q

alternative to antiparasitics for ameboicintestinal infection

A

intestinal infection: tetracycline

otherwise just stick with the formula mixed then luminal or the respective classes

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15
Q

giardia parasite tx 1/2

A

metro or nitazoxanide

GI sx

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16
Q

cryptosporidiosis parasite tx 1

A

nitazoxanide

GI sx

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17
Q

Trichimoniasis parasite tx

A

metro

(Trichomonas vaginalis)
cherry cervix

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18
Q

Trypanosoma brucei parasite tx

A

african sleeping sick

hematological = Suramin-east(r) / Pentamidine -west(g)

cns=melarosprol

lymph, int fever, sleep

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19
Q

Trypanosoma cruzi părăsite tx
and sx

A

American Trypanosomiasis - Chagas disease

Benznidazole Nifurtimox

megacolon, dilated cardiomyopathy, megaseophagus

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20
Q

leishmania parasite tx

A

Sodium Stibogluconate

Amphotericin B

Pentamidine[same as African west

intermittent fever, hepatosplenomegaly, pancytopenia, black fever

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21
Q

Toxoplasma gondii parasite tx

A

Pyrimethamine + Sulfadiazine OR

Pyrimethamine + Clindamycin
AND Leucovorin

chorioretinitis, hydrocephalus/seizures, intracranial calcifications, ring enhancing leasions

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22
Q

Primary Amebic meningoencephalitis
(Naegleria fowleri)

A

Amphotericin B

presents like meningoencephalitis with history of swimming

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23
Q

Babesiosis parasite

A

Atovaquone + Azithromycin

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24
Q

Inhibits microtubule synthesis & glucose uptake

A

Benzimidazoles
Albendazole Mebendazole Thiabendazole

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25
Q

reversible leukopenia, alopecia, elevated liver enzymes

others in this class and contraindications

A

albendazole

thiabendazole is more toxic than the others

not for pregnant and all can cause CNS disturbance

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26
Q

GABA agonist->causing enhanced Chloride influx-> hyperpolarization -> resulting in paralysis and death of the parasite

AE and contraindications

A

Ivermectin

-nematide

Mazotti-like reactions: fever, headache, dizziness, somnolence, and hypotension due to the killing of the microfilaria in onchocerciasis
The severity of this reaction is related to parasite load. Antihistamines or steroids may be given to improve the symptoms.

Contraindicated in pregnant women/
Avoid other drugs that enhance GABA activity, e.g., barbiturates, benzodiazepines, and valproic acid

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27
Q

Immobilizes microfilariae

A

Diethylcarbamazine
-nematode

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28
Q

Allergic reactions to proteins released by dying filariae include fever, rashes, ocular damage, joint and muscle pain, and lymphangitis.
Antihistamines or steroids may be co- administered minimize associated reactions.

A

Diethylcarbamazine and Ivermectan

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29
Q

Depolarizing, neuromuscular-blocker ->release of acetylcholine & acetylcholinesterase inhibition-> persistent activation of parasite’s nicotinic receptors-> paralysis and subsequent expulsion of the worm

A

Pyrantel Pamoate

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30
Q

Increases cell membrane permeability to calcium ->prolonged contraction & eventual paralysis of the worm musculature -> resulting in the detachment of suckers from the tissue wall

A

Praziquantel

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31
Q

Laxative should be administered prior to giving this drug orally, to purge bowel of all dead segments in order to preclude digestion & liberation of ova (may lead to cysticercosis); alcoholic consumption should be avoided within the 1st day of treatment

A

Niclosamide

leathal to on scolex but not ova

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32
Q

Inhibits mitochondrial phosphorylation of ADP & anaerobic metabolism of the parasite;

A

Niclosamide

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33
Q

Ascaris lumbricoides

A

round worm

Mebendazole OR Albendazole OR Pyrantel pamoate

sx: abd and resp

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34
Q

Necator americanus Ancylostoma duodenale

A

hook worm
Mebendazole OR Albendazole OR Pyrantel pamoate

itchy soles, gi, iron deficiency, malnutrition

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35
Q

Trichinella spiralis

A

Mebendazole OR Albendazole
+ Corticosteroids (severe infection)

orbital edema, five, muscle pain, vomitting

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36
Q

Trichuris trichuria

A

(Whipworm)

Mebendazole OR Albendazole

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37
Q

Enterobius vermicularis

A

(Pinworm)

Mebendazole OR Pyrantel pamoate

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38
Q

Strongyloides stercoralis

A

Ivermectin

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39
Q

Onchocerca volvulus

A

(River blindness)
Ivermectin

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40
Q

Loa-loa

A

(African eye worm)

Diethylcarbamazine

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41
Q

Wuchereria bancrofti Brugia malayi

A

(Lymphatic filaria)
Diethylcarbamazine

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42
Q

Schistosoma mansoni Schistosoma japonicum Schistosoma hematobium

A

Praziquantel

hematuria
portal hypertention

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43
Q

Clonorchis sinensis

A

(liver fluke)
Praziquantel OR Albendazole

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44
Q

Paragonimus westermani

A

(lung fluke)
Praziquantel

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45
Q

Taenia saginata

A

(Beef tapeworm)
Praziquantel Mebendazole Niclosamide

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46
Q

Taenia solium

A

(Pork tapeworm)
Praziquantel Niclosamide

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47
Q

Cysticercosis

A

(larval cyst of T. Solium)

Praziquantel Niclosamide

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48
Q

Diphyllobothrium latum

A

(Fish tapeworm)

Praziquantel

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49
Q

Echinococcus granulosus Echinococcus multilocularis

A

(Hydatid worm/ Dog tapeworm)

Albendazole

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50
Q

what are the three most common systemic fungal infections

A

candid
cryptococcus
aspergillosis

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51
Q

which antifungals:
1. disrupt microtubule fuctioning
2. disrupt nucleic acid synthesis
3. disrupt fungal cell wall
4. alter cell membrane permeability

A
  1. Griseofulvin
  2. Flucytosine
  3. echinocandidis/ capsofungin
  4. Alleles, allylamines polyenes
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52
Q

binds to ergosterol, forming
pores in the cell membrane.
* The pores allow leakage of intracellular ions and
macromolecules, leading to cell death

A

polyene, Amp B

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53
Q

preferred treatment for deep fungal infections during pregnancy

A

Amp B

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54
Q

INFUSION-RELATED TOXICITY
and other AE

A

amp B
\
Nearly universal. Fever and chills, muscle
spasms, vomiting, headache and hypotension..,. give antihistamine and steroids

**also binds to cholesterol causing renal toxicity eventually in all pts, prevent by loading sodium or by giving the lipid formulations!
Can cause anemia and electrolyte wasting
Intracranial administration can cause seizures

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55
Q

causes high level of nitrogen in the blood

A

amp B
Azotemia

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56
Q

what should be monitored if on amp B

A

should monitor renal
liver
electrolute(mg / K)
blood counts

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57
Q

Synthetic pyrimidine antimetabolite, Taken into fungal cells via the enzyme cytosine
permease then…

A

flucystosine

then becomes 5FU and blocks the synth of dTMP(inhibit DNA synth) and FUTP (inhibit protein synth)

ALWYAS USE WITH AMP B

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57
Q

Indicated only for serious infections caused by
susceptible strains of Candida and/or
Cryptococcus.

A

FLUCYTOSINE

and should be used with amp b always

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57
Q

flucytosine AE

A

makes 5 florouracil = bone marrow toxicity

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57
Q

inhibit cytochrome P450 enzyme
14-α-sterol demethylase

A

AZOLES

this plays a role in the PRODUCTION of ergosterol resulting in disrupted membrane permeability

58
Q

increase plasma
levels of phenytoin, zidovudine and warfarin

A

fluconazole

does have the least effect from all azaleas on P 450 (inhibits)

58
Q

DOC for coccidioidomycosis

A

FLUCONAZOLE

pulmonary sx

58
Q

DOC for initial and secondary prophylaxis
against cryptoccocal meningitis.

A

fluconazole

58
Q

DOC for consolidation and maintenance
therapy of cryptococcal meningitis

A

Amp B (IV)+ flucytosine

or Amp B (IV)+ flucytosine

or if not severe can be an alternative to amp B all together

58
Q

Azole AE

A

teratogenic
liver abnormalities
inhibit CYP 450

58
Q

DOC in esophageal, oropharyngeal,
vulvovaginal or urinary candidiasis, and candidiemia

A

fluconazole

58
Q

Inhibition of testosterone and corticosteroid
synthesis with high doses.
* Rare but severe liver toxicity.

A

ketoconazole

59
Q

Azole of choice for mycoses due to Histoplasma,
Blastomyces, and Sporothrix.Effective against Aspergillus

A

itraconazole

60
Q

Strong inhibitor of CYP3A4. May cause
potentially fatal arrhythmias when given
concurrently with cisapride or quinidine.

A

itraconazole

61
Q

Absorption reduced by antacids, H2 blockers
and proton pump inhibitors.

A

ketoconazole, itraconazole

62
Q

DOC for invasive aspergillosis

A

volconazole

63
Q

May cause transient visual disturbances

A

volconazole

64
Q

Most broad spectrum azole.

A

posaconazole

65
Q

Primarily
metabolized by glucuronidation

A

posaconazole

66
Q

Approved for invasive aspergillosis and
invasive mucormycosis.

A

ISAVUCONAZOLE

67
Q

azalea that penetrates the CNS the best

A

fluconazole

68
Q

azalea elimination

A

all hepatic except fluconazole is renal

69
Q

Active against candida and aspergillus but
not Cryptococcus neoformans

A

CASPOFUNGIN

70
Q

Inhibit synthesis of beta(1-3)-D-glucans in the
fungal cell wall.
* This results in disruption of the fungal cell wall
and cell death.

A

CASPOFUNGIN

71
Q
  • Only use: treatment of dermatophytosis.
  • Absorption improved when given with fatty
    foods.
A

GRISEOFULVIN

72
Q

Severe dermatophytoses of the skin, hair, and
nails.

A

griseofulvin

73
Q

Inhibition of squalene
epoxidase prevents
synthesis of ergosterol

A

Terbinafine, allylamine

It also causes
accumulation of toxic
levels of squalene in the
fungal cell.

74
Q

Disseminated Fusariosis

A

Voriconazole and/or Amphotericin B

74
Q

Polyene macrolide

A

Nystatin
same MAO as amp B

74
Q

Too toxic for IV administration.
* Used only for candidiasis.
* Supplied in preparations for cutaneous,
vaginal, or oral administration

A

nystatin

74
Q

when to give coricosteroids in PCP, which steroid

A

PaO2 <70 mmHg at room air or
* Alveolar-arterial oxygen gradient ≥35 mm

give steroid = prednisone

74
Q

The two azoles most commonly used
topically

A

clotrimazole and miconazole.

74
Q

Mucormycosis

A

Amphotericin B or isovuconazole

74
Q

Effective for tinea cruris and tinea corporis. nails

moa

A

turbinafine topical

blocks ergosterol by squalene buildup, allyamine

75
Q

phosphatonin released from bone in response to hyperphosphatemia or
hypervitaminosis D

what happens

A

Fibroblast Growth Factor 23

inhibits PTH secretion and renal activation of
Vitamin D…in excess leads to osteomalacia

75
Q

alternative tx for PCP

A

Clindamycin + primaquine

dapsone + trimethoprime

atovaquone

pentamidine

75
Q
A
75
Q

DOC for prevention of P jiroveci infection in immunocompromised
individuals

A

co-timoxazole

75
Q

hyper and hypocalcemia tx

A

hyper: loop diuretic
hypo: calcium g

75
Q

analogs of pyrophosphate

causing?

A

bisphosphonates

clast apoptosis
inhibits cholesterol biosynthesis

75
Q

osteoporosis drugs DOC

A

bisphosphonates
1st gen not rec= e.dronate

2nd gen= a/p dronate
3rd gen-most potent R/Z donaten

P and Z given IV and Z once a year

denosumab
teriparatide
SEMS
calcitonin

75
Q

aspergillosis 1 and 2

A
  1. volconazole
  2. amp B
75
Q

bisphosphnate AE

A

heart burn, esophageal irritation,

take on empty stomach, antacids and food in general will limit availability

not metabolizes so will stay on bones for months to years. over-suppress bone turnover
increasing risk of subtrochanteric femur fractures

75
Q

RANKL inhibitor

A

Denosumab

given every 6 months

75
Q

PTH analog

A

Teriparatide

75
Q

stimulates an increase in number and activity of osteoblasts

A

PTH analogue

even though PTH doesn’t do that

76
Q

hot flashes and increased risk of venous
thromboembolism

A

Raloxifene
Raloxifene has the following actio

76
Q

what drugs are used for osteomalacia

A

Ergocalciferol
Cholecalciferol

76
Q

elevated alkaline phosphatase, hypocalcemia and
hypophosphatemia

A

osteomalacia

77
Q

what are inhibitors of bone mineralization

A

fluoride and aluminum

77
Q

pagets disease drugs

A

bisphosphonates- 1st (NOT E.dronat)
calcitonin-2nd
Plicamycin- antineoplastic

78
Q

risk for osteonecrosis of the jaw

A

bisphosphonates
denosumab

79
Q

Chronic Kidney Disease Via D issue

A

if high bone turnover need to dietary restrict phosphatase and give phosphatase binder Sevelamer

if low bone turnover need to give ACTIVE vit D= doxicalciferol , paricalcital

80
Q

Calcium receptor Agonist

A

Cinacalcet used in chronic kidney disease with secondary hyper PTH

causes hypocalcemia

81
Q

management of hypercalcemia of malignancy

A

gallium nitrate

hydrate before to prevent nephrotoxicity

82
Q

topically as a cream, ointment or foam to psoriatic plaques.

A

Calcipotriol

synthetic D3

83
Q

Volatile halogenated hydrocarbons

A

DISME(flurane)
halothane

84
Q

IV anesthetics

A
  • Propofol
  • Ketamine
  • Etomidate
  • Barbiturates
85
Q

anesthetic potency corresponds to:

rate of onset:

A

potency = liposolubility
potency inverse to MAC
potency = oil/gas

onset inverse to blood solubility/ blood:gas
-onset inc when concentration inc
-onset inc when ventilation inc
-onset inc when cardiac output dec

86
Q

MAO of inhaled anesthetics

A

Positive modulation of GABAA and glycine
receptors.
* Inhibition of nicotinic receptors.

87
Q

Difference between the concentration of
anesthetic in arterial and venous blood reflects

A

the solubility of the anesthetic into tissues

more in tissues will slow onset and recovery

most inhales anesthetics dec MAP by vasodilation(halothane and enflurane do it by dec cardiac output with no effect of PVR, DIS vasodialate with no effect of cardiac output)

88
Q

which inhaled anesthetic is high risk for:
hepatic toxic
nephrotoxic
malignant hyperthermia

A
  1. halothane
  2. methoxyflurane
  3. halothane (succinylcholine)
89
Q

The increased Ca2+ concentration causes
increased muscle contraction which generates
heat…leading to

A

malignant hyperthermai

leads to hyperkalemia and myoglobinuria(especially with muscular dystrophies)

90
Q

Very prolonged exposure to N2O decreases

A

methionine synthase activity and causes
megaloblastic anemia.

91
Q

They decrease intracranial pressure.
* They do not produce analgesia.
* They may cause hyperalgesia.

A

barbiturates

92
Q

Primarily used for anesthetic induction of patients at
risk for hypotension

A

etoamide

93
Q

Associated with nausea and vomiting.
* Inhibits 11-beta hydroxylase.

A

etoamide

but no rest or cardiac depress effects like the others

94
Q

which of the IV anesthetics inc ICP

A

ketamine

95
Q

To prevent salivation and bronchial
secretions,

can also be used to prevent bradycardia

A

glycopyrrolate- anticholinergic

96
Q

block voltage-gated sodium channels

A

local anesthetics

97
Q

In spinal anesthesia,_________ acts on
α2-adrenoceptors, which inhibit release of substance P.

A

epi

Tizanidine as spasmolytic

98
Q

local anesthetics by duration of action

A

long acting: TER B caine
med actin: LMnoPrilo caine
short: ProC. caine

99
Q

which local anesthetic is the most cardiotoxic

inihaled?

A

Bupivacaine

halothane

100
Q

lead to accumulation of the metabolite o-toluidine

what happens

A

prilocain

makes hemoglobin to methoglobin

101
Q

local anesthetics are metabolized to
p-aminobenzoic acid derivatives

what happens

A

ester

can lead to allergic reaction

102
Q

_____is hydrolyzed in vivo to produce
paraaminobenzoic acid (PABA), which____

A

procaine

inhibits sulfa drugs

103
Q

musculoskeleatal blockers, nondepol

A

-curaine
Benzyil….MCAT
Ammonio….ProV

104
Q

how to reverse a NM block

A

inc Ach concentrations with neostigmine or edrophonium

105
Q

non depo NM blockers by duration of action

how does this affect metabolism

A

short acting: mivacuraine
med: AC RV

long: PanTub

if short half life probably metabolized by the liver

if long metabolized by the kidneys

106
Q

metabolites is laudanosine

causing

prevention

A

atracarium

hypotension and seizures

give cisatracurium to avoid metabolite

107
Q

butyrylcholinesterase

A

can prolongate
mivacarium or succinylcholine

108
Q

the most rapid onset among nondepolarizing
blockers

A

Rocuronium

109
Q

activates the nicotinic receptor and
depolarizes the junction.
- This causes fasciculation

A

succinylcholine

and eventually flaccid paralysis

110
Q

benzyl curain non depo blockersAE

A

may cause hypotension due
to histamine release and ganglionic blockade

111
Q
A
112
Q

block nicotinic receptors of the autonomic ganglia
and the adrenal medulla.
- This causes …

A

Tubocurarine

hypotension and tachycardia

113
Q

activates all autonomic cholinoceptors:
* Nicotinic receptors in both sympathetic and parasympathetic
ganglia
* Muscarinic receptors in the hear

AE

A

succinylcholine

hyperkalemia
histamine release
muscle pain
malignant hyperthermia
inc gastric and cranial pressure
bradycardia
but not any CNS effects bc cant penetrate BBB

114
Q

what drugs enhance NM blockers

A

TCA
Aminoglycosides
inhales anesthetics

115
Q

who is resistant to
nondepolarizing muscle relaxants

A

severe burns and UMN lesions

deploy blocker also shouldn’t be used

116
Q

GABA agonist at GABAB receptors.

cause

A

Baclofen

spasmolytic drug

117
Q

Interferes with the release of Ca2+ by binding to the
ryanodine receptor in the SR of skeletal muscle.\

used for?

A

dantrolene

malignant hyperthermia

118
Q

Drugs for Acute Spasm

AE

A

Cyclobenzaprine

Strong antimuscarinic side effects.

119
Q

high glucose, low calcium, normal to high phosphate and inc ALP

A

Kidney disease

120
Q

which anti parasite is not contraindicated in pregnancy

A

pyrantal pamoate

term 4 (13 decks)

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