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
2
Q
cryptosporidosis 1/2
A
- paromomycin (amino glycoside antibiotic)
3
Q
eliminates trophosizes in liver abcess
A
chloroquine
4
Q
back up drug for intestinal or hepatic amebas when no metronidazole
A
emetine/ dehydroemetine
5
Q
DOC for invasive ameboas
A
metronidazole
followed by luminal
tinidazole is the new preference and better tolerated
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
7
Q
Not active against trophozoites
Converted in the gut to form amebicide
A
Luminal Agent
Diloxanide Furoate
8
Q
Halogenated hydroxyquinoline – amebicidal; effective against the trophozoite and cyst forms
A
Luminal Agent
Iodoquinol
9
Q
Aminoglycoside antibiotic; directly amebicidal, not significantly absorbed
A
Luminal Agent
Paromomycin
10
Q
Prevents polymerization of heme->hemozoin Intracellular accumulation of heme is toxic to the parasite
A
Systemic Agent
Chloroquine
11
Q
Blocks ribosomal movement along mRNA-> Inhibits protein synthesis
A
Systemic Agents
Emetine / Dehydroemetine
12
Q
GI distress, rash, headache; auditory dysfunction and retinal dysfunction (high dose)
A
chloroquine
13
Q
antifungalSevere toxicity, including gastrointestinal distress, muscle weakness, and cardiovascular dysfunction (arrhythmias and congestive heart failure)
A
Emetine / Dehydroemetine
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
15
Q
giardia parasite tx 1/2
A
metro or nitazoxanide
GI sx
16
Q
cryptosporidiosis parasite tx 1
A
nitazoxanide
GI sx
17
Q
Trichimoniasis parasite tx
A
metro
(Trichomonas vaginalis)
cherry cervix
18
Q
Trypanosoma brucei parasite tx
A
african sleeping sick
hematological = Suramin-east(r) / Pentamidine -west(g)
cns=melarosprol
lymph, int fever, sleep
19
Q
Trypanosoma cruzi părăsite tx
and sx
A
American Trypanosomiasis - Chagas disease
Benznidazole Nifurtimox
megacolon, dilated cardiomyopathy, megaseophagus
20
Q
leishmania parasite tx
A
Sodium Stibogluconate
Amphotericin B
Pentamidine[same as African west
intermittent fever, hepatosplenomegaly, pancytopenia, black fever
21
Q
Toxoplasma gondii parasite tx
A
Pyrimethamine + Sulfadiazine OR
Pyrimethamine + Clindamycin
AND Leucovorin
chorioretinitis, hydrocephalus/seizures, intracranial calcifications, ring enhancing leasions
22
Q
Primary Amebic meningoencephalitis
(Naegleria fowleri)
A
Amphotericin B
presents like meningoencephalitis with history of swimming
23
Q
Babesiosis parasite
A
Atovaquone + Azithromycin
24
Q
Inhibits microtubule synthesis & glucose uptake
A
Benzimidazoles
Albendazole Mebendazole Thiabendazole
25
reversible leukopenia, alopecia, elevated liver enzymes
others in this class and contraindications
albendazole
thiabendazole is more toxic than the others
not for pregnant and all can cause CNS disturbance
26
GABA agonist->causing enhanced Chloride influx-> hyperpolarization -> resulting in paralysis and death of the parasite
AE and contraindications
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
27
Immobilizes microfilariae
Diethylcarbamazine
-nematode
28
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.
Diethylcarbamazine and Ivermectan
29
Depolarizing, neuromuscular-blocker ->release of acetylcholine & acetylcholinesterase inhibition-> persistent activation of parasite’s nicotinic receptors-> paralysis and subsequent expulsion of the worm
Pyrantel Pamoate
30
Increases cell membrane permeability to calcium ->prolonged contraction & eventual paralysis of the worm musculature -> resulting in the detachment of suckers from the tissue wall
Praziquantel
31
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
Niclosamide
leathal to on scolex but not ova
32
Inhibits mitochondrial phosphorylation of ADP & anaerobic metabolism of the parasite;
Niclosamide
33
Ascaris lumbricoides
round worm
Mebendazole OR Albendazole OR Pyrantel pamoate
sx: abd and resp
34
Necator americanus Ancylostoma duodenale
hook worm
Mebendazole OR Albendazole OR Pyrantel pamoate
itchy soles, gi, iron deficiency, malnutrition
35
Trichinella spiralis
Mebendazole OR Albendazole
+ Corticosteroids (severe infection)
orbital edema, five, muscle pain, vomitting
36
Trichuris trichuria
(Whipworm)
Mebendazole OR Albendazole
37
Enterobius vermicularis
(Pinworm)
Mebendazole OR Pyrantel pamoate
38
Strongyloides stercoralis
Ivermectin
39
Onchocerca volvulus
(River blindness)
Ivermectin
40
Loa-loa
(African eye worm)
Diethylcarbamazine
41
Wuchereria bancrofti Brugia malayi
(Lymphatic filaria)
Diethylcarbamazine
42
Schistosoma mansoni Schistosoma japonicum Schistosoma hematobium
Praziquantel
hematuria
portal hypertention
43
Clonorchis sinensis
(liver fluke)
Praziquantel OR Albendazole
44
Paragonimus westermani
(lung fluke)
Praziquantel
45
Taenia saginata
(Beef tapeworm)
Praziquantel Mebendazole Niclosamide
46
Taenia solium
(Pork tapeworm)
Praziquantel Niclosamide
47
Cysticercosis
(larval cyst of T. Solium)
Praziquantel Niclosamide
48
Diphyllobothrium latum
(Fish tapeworm)
Praziquantel
49
Echinococcus granulosus Echinococcus multilocularis
(Hydatid worm/ Dog tapeworm)
Albendazole
50
what are the three most common systemic fungal infections
candid
cryptococcus
aspergillosis
51
which antifungals:
1. disrupt microtubule fuctioning
2. disrupt nucleic acid synthesis
3. disrupt fungal cell wall
4. alter cell membrane permeability
1. Griseofulvin
2. Flucytosine
3. echinocandidis/ capsofungin
4. Alleles, allylamines polyenes
52
binds to ergosterol, forming
pores in the cell membrane.
* The pores allow leakage of intracellular ions and
macromolecules, leading to cell death
polyene, Amp B
53
preferred treatment for deep fungal infections during pregnancy
Amp B
54
INFUSION-RELATED TOXICITY
and other AE
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
55
causes high level of nitrogen in the blood
amp B
Azotemia
56
what should be monitored if on amp B
should monitor renal
liver
electrolute(mg / K)
blood counts
57
Synthetic pyrimidine antimetabolite, Taken into fungal cells via the enzyme cytosine
permease then...
flucystosine
then becomes 5FU and blocks the synth of dTMP(inhibit DNA synth) and FUTP (inhibit protein synth)
ALWYAS USE WITH AMP B
57
Indicated only for serious infections caused by
susceptible strains of Candida and/or
Cryptococcus.
FLUCYTOSINE
and should be used with amp b always
57
flucytosine AE
makes 5 florouracil = bone marrow toxicity
57
inhibit cytochrome P450 enzyme
14-α-sterol demethylase
AZOLES
this plays a role in the PRODUCTION of ergosterol resulting in disrupted membrane permeability
58
increase plasma
levels of phenytoin, zidovudine and warfarin
fluconazole
does have the least effect from all azaleas on P 450 (inhibits)
58
DOC for coccidioidomycosis
FLUCONAZOLE
pulmonary sx
58
DOC for initial and secondary prophylaxis
against cryptoccocal meningitis.
fluconazole
58
DOC for consolidation and maintenance
therapy of cryptococcal meningitis
Amp B (IV)+ flucytosine
or Amp B (IV)+ flucytosine
or if not severe can be an alternative to amp B all together
58
Azole AE
teratogenic
liver abnormalities
inhibit CYP 450
58
DOC in esophageal, oropharyngeal,
vulvovaginal or urinary candidiasis, and candidiemia
fluconazole
58
Inhibition of testosterone and corticosteroid
synthesis with high doses.
* Rare but severe liver toxicity.
ketoconazole
59
Azole of choice for mycoses due to Histoplasma,
Blastomyces, and Sporothrix.Effective against Aspergillus
itraconazole
60
Strong inhibitor of CYP3A4. May cause
potentially fatal arrhythmias when given
concurrently with cisapride or quinidine.
itraconazole
61
Absorption reduced by antacids, H2 blockers
and proton pump inhibitors.
ketoconazole, itraconazole
62
DOC for invasive aspergillosis
volconazole
63
May cause transient visual disturbances
volconazole
64
Most broad spectrum azole.
posaconazole
65
Primarily
metabolized by glucuronidation
posaconazole
66
Approved for invasive aspergillosis and
invasive mucormycosis.
ISAVUCONAZOLE
67
azalea that penetrates the CNS the best
fluconazole
68
azalea elimination
all hepatic except fluconazole is renal
69
Active against candida and aspergillus but
not Cryptococcus neoformans
CASPOFUNGIN
70
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.
CASPOFUNGIN
71
* Only use: treatment of dermatophytosis.
* Absorption improved when given with fatty
foods.
GRISEOFULVIN
72
Severe dermatophytoses of the skin, hair, and
nails.
griseofulvin
73
Inhibition of squalene
epoxidase prevents
synthesis of ergosterol
Terbinafine, allylamine
It also causes
accumulation of toxic
levels of squalene in the
fungal cell.
74
Disseminated Fusariosis
Voriconazole and/or Amphotericin B
74
Polyene macrolide
Nystatin
same MAO as amp B
74
Too toxic for IV administration.
* Used only for candidiasis.
* Supplied in preparations for cutaneous,
vaginal, or oral administration
nystatin
74
when to give coricosteroids in PCP, which steroid
PaO2 <70 mmHg at room air or
* Alveolar-arterial oxygen gradient ≥35 mm
give steroid = prednisone
74
The two azoles most commonly used
topically
clotrimazole and miconazole.
74
Mucormycosis
Amphotericin B or isovuconazole
74
Effective for tinea cruris and tinea corporis. nails
moa
turbinafine topical
blocks ergosterol by squalene buildup, allyamine
75
phosphatonin released from bone in response to hyperphosphatemia or
hypervitaminosis D
what happens
Fibroblast Growth Factor 23
inhibits PTH secretion and renal activation of
Vitamin D...in excess leads to osteomalacia
75
alternative tx for PCP
Clindamycin + primaquine
dapsone + trimethoprime
atovaquone
pentamidine
75
75
DOC for prevention of P jiroveci infection in immunocompromised
individuals
co-timoxazole
75
hyper and hypocalcemia tx
hyper: loop diuretic
hypo: calcium g
75
analogs of pyrophosphate
causing?
bisphosphonates
clast apoptosis
inhibits cholesterol biosynthesis
75
osteoporosis drugs DOC
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
aspergillosis 1 and 2
1. volconazole
2. amp B
75
bisphosphnate AE
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
RANKL inhibitor
Denosumab
given every 6 months
75
PTH analog
Teriparatide
75
stimulates an increase in number and activity of osteoblasts
PTH analogue
even though PTH doesn't do that
76
hot flashes and increased risk of venous
thromboembolism
Raloxifene
Raloxifene has the following actio
76
what drugs are used for osteomalacia
Ergocalciferol
Cholecalciferol
76
elevated alkaline phosphatase, hypocalcemia and
hypophosphatemia
osteomalacia
77
what are inhibitors of bone mineralization
fluoride and aluminum
77
pagets disease drugs
bisphosphonates- 1st (NOT E.dronat)
calcitonin-2nd
Plicamycin- antineoplastic
78
risk for osteonecrosis of the jaw
bisphosphonates
denosumab
79
Chronic Kidney Disease Via D issue
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
Calcium receptor Agonist
Cinacalcet used in chronic kidney disease with secondary hyper PTH
causes hypocalcemia
81
management of hypercalcemia of malignancy
gallium nitrate
hydrate before to prevent nephrotoxicity
82
topically as a cream, ointment or foam to psoriatic plaques.
Calcipotriol
synthetic D3
83
Volatile halogenated hydrocarbons
DISME(flurane)
halothane
84
IV anesthetics
* Propofol
* Ketamine
* Etomidate
* Barbiturates
85
anesthetic potency corresponds to:
rate of onset:
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
MAO of inhaled anesthetics
Positive modulation of GABAA and glycine
receptors.
* Inhibition of nicotinic receptors.
87
Difference between the concentration of
anesthetic in arterial and venous blood reflects
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
which inhaled anesthetic is high risk for:
hepatic toxic
nephrotoxic
malignant hyperthermia
1. halothane
2. methoxyflurane
3. halothane (succinylcholine)
89
The increased Ca2+ concentration causes
increased muscle contraction which generates
heat...leading to
malignant hyperthermai
leads to hyperkalemia and myoglobinuria(especially with muscular dystrophies)
90
Very prolonged exposure to N2O decreases
methionine synthase activity and causes
megaloblastic anemia.
91
They decrease intracranial pressure.
* They do not produce analgesia.
* They may cause hyperalgesia.
barbiturates
92
Primarily used for anesthetic induction of patients at
risk for hypotension
etoamide
93
Associated with nausea and vomiting.
* Inhibits 11-beta hydroxylase.
etoamide
but no rest or cardiac depress effects like the others
94
which of the IV anesthetics inc ICP
ketamine
95
To prevent salivation and bronchial
secretions,
can also be used to prevent bradycardia
glycopyrrolate- anticholinergic
96
block voltage-gated sodium channels
local anesthetics
97
In spinal anesthesia,_________ acts on
α2-adrenoceptors, which inhibit release of substance P.
epi
Tizanidine as spasmolytic
98
local anesthetics by duration of action
long acting: TER B caine
med actin: LMnoPrilo caine
short: ProC. caine
99
which local anesthetic is the most cardiotoxic
inihaled?
Bupivacaine
halothane
100
lead to accumulation of the metabolite o-toluidine
what happens
prilocain
makes hemoglobin to methoglobin
101
local anesthetics are metabolized to
p-aminobenzoic acid derivatives
what happens
ester
can lead to allergic reaction
102
_____is hydrolyzed in vivo to produce
paraaminobenzoic acid (PABA), which____
procaine
inhibits sulfa drugs
103
musculoskeleatal blockers, nondepol
-curaine
Benzyil....MCAT
Ammonio....ProV
104
how to reverse a NM block
inc Ach concentrations with neostigmine or edrophonium
105
non depo NM blockers by duration of action
how does this affect metabolism
short acting: mivacuraine
med: AC RV
long: PanTub
if short half life probably metabolized by the liver
if long metabolized by the kidneys
106
metabolites is laudanosine
causing
prevention
atracarium
hypotension and seizures
give cisatracurium to avoid metabolite
107
butyrylcholinesterase
can prolongate
mivacarium or succinylcholine
108
the most rapid onset among nondepolarizing
blockers
Rocuronium
109
activates the nicotinic receptor and
depolarizes the junction.
- This causes fasciculation
succinylcholine
and eventually flaccid paralysis
110
benzyl curain non depo blockersAE
may cause hypotension due
to histamine release and ganglionic blockade
111
112
block nicotinic receptors of the autonomic ganglia
and the adrenal medulla.
- This causes ...
Tubocurarine
hypotension and tachycardia
113
activates all autonomic cholinoceptors:
* Nicotinic receptors in both sympathetic and parasympathetic
ganglia
* Muscarinic receptors in the hear
AE
succinylcholine
hyperkalemia
histamine release
muscle pain
malignant hyperthermia
inc gastric and cranial pressure
bradycardia
but not any CNS effects bc cant penetrate BBB
114
what drugs enhance NM blockers
TCA
Aminoglycosides
inhales anesthetics
115
who is resistant to
nondepolarizing muscle relaxants
severe burns and UMN lesions
deploy blocker also shouldn't be used
116
GABA agonist at GABAB receptors.
cause
Baclofen
spasmolytic drug
117
Interferes with the release of Ca2+ by binding to the
ryanodine receptor in the SR of skeletal muscle.\
used for?
dantrolene
malignant hyperthermia
118
Drugs for Acute Spasm
AE
Cyclobenzaprine
Strong antimuscarinic side effects.
119
high glucose, low calcium, normal to high phosphate and inc ALP
Kidney disease
120
which anti parasite is not contraindicated in pregnancy
pyrantal pamoate
