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Pharm Exam 2 > Antiparasitics 2 (LaCount) > Flashcards

Antiparasitics 2 (LaCount) Flashcards

1
Q

Parasitic infections associated with HIV (U.S. and Global)

A

US = PCP, Toxo, Crypto

Worldwide = Malaria, Leshmania, T. cruzii (Chagas)

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2
Q

Pentamidine mechanism

A

unknown

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3
Q

Pentamidine’s major problem

A

its highly toxic

50% of patients have sides

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4
Q

Pentamidine ROA

A

parenteral

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5
Q

Pentamidine Sides

A

hyper/hypoglycemia (rare)

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6
Q

Pentamidine is first line for what?

A

West African Trypanosomiasis

**also Alternative treatment for visceral leishmania and Pneumocystosis

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7
Q

Anaerobic protozoa

A
  • E. Hystolytica
  • Giardia
  • Trichomonas vaginalis
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8
Q

One of the most common water borne illnesses in US

A

giardia

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9
Q

Incidence of T. vaginalis in US

A

20-25% of women

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10
Q

E. Hystolytica cysts are killed by…

A

boiling, but not by chlorination

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11
Q

Amebiasis is more common ________, but…

A

Latin america, Africa, India

but it can occur anywhere

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12
Q

Most amebiasises are _____

but…

A

asymptomatic

but some people develop liver abscesses

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13
Q

Giardia incidence in developed countries

A

2% adults

7% kids

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14
Q

Most common intestinal parasite in US

A

giardia

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15
Q

Giardia Tx

A

Metronidazole

Nitazoxanide

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16
Q

Cryptosporidium is the most frequent cause of…

A

recreational water-related disease outbreaks

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17
Q

Most common Cryptosporidium symptom

A

watery diarrhea

other sx = N/V, cramps, dehydration, weight loss and fever!

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18
Q

Drug of choice for Cryptosporidium

A

Nitazoxanide!

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19
Q

T. vaginalis Sx

A

vaginitis with purulent discharge

vulvar and cervical lesions

(often asymptomatic in men)

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20
Q

Metronidazole is DOC for

A

E. histolytica, Giardiasis, Trichomonas

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21
Q

Mzole kills…

A

kills trophozoites, not cysts

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22
Q

Mzole mechanism

A

unknown

activated by anaerobe ETC proteins

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23
Q

Drug similar to Mzole? How is it different?

A

Tinidazole

lower toxicity

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24
Q

Mzole and alcohol may result in…

A

Antabuse effect

= N/V, Tachycardia

Mzole blocks ACETALDEHYDE DEHYDROGENASE

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25
Q

amebiasis treatment - drugs for intestinal forms

A

Paromomycin + Iodoquinol

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26
Q

Paromomycin catergory

distribution

also effective against…

A

Aminoglycoside

not significantly absorbed in GI

also effective against Cryptosporidium

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27
Q

Iodoquinol is an alternative to ____

commonly used in combo with _____

Mechanism?

A

Alt to Paromomycin

Combo wiht Mzole

Mechanism unknown

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28
Q

Nitazoxanide PK

Mechanism

inhibits what organisms?

A

Rapid metabolism to tizoxanide

Interferes with PFOR (pyruvate ferredoxin oxidoreductase)-dependent electron transport reaction —> inhibits anaerobic metabolism

Inhibits: Sporozoites + Oocysts of Cryptosporidium parvum

Trophozoites of Giardia

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29
Q

95% of trypanosomiasis due to what?

A

brucei gambiense – west african trypanosomiasis

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30
Q

5% of trypanosomiasis caused by …

A

brucei rhodesiense – east african trypanosomiasis

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31
Q

Chagas disease caused by

A

trypanosoma cruzii

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32
Q

Trypanosome unique features

A

Unique organelles - kinetoplast, glycosome

Distinct mech’s of gene expression

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33
Q

Leshmaniasis drugs

A

Sodium Stibogluconate

Amphotericin B

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34
Q

Alternative meds for leshmaniasis

A

pentamidine or MILTEFOSINE

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35
Q

African trypanosomiasis drugs

A

Early stage

  • Pentamidine (West)
  • Suramin (East)

Late stage

  • Melarsoprol (E/W)
  • Eflornithine (West)
36
Q

American trypanosomiasis drugs

A

Nifurtimox

Benznidazole

37
Q

Miltefosine is a ____ analog

Approved for use against ______ in india

A

Phospholipid

Visceral leishmaniasis

38
Q

Why would one avoid Miltefosine?

A

It is teratogenic

(avoid if pregnant)

39
Q

Most commonly used drugs for T. cruzi

A

Nifurtimox and Benznidazole

40
Q

Nifurtimox and Benznidazole mechanism

A

Activated by a NADH-dependent nitroreductase (mitochondrial)

= generation of nitro radical ions

41
Q

Benznidazole is preferred to nifurtomix because…

A

it is less toxic

42
Q

N + B reduce _______ of T. Cruzi

BUT they do not…

A

reduce the severity of the acute phase of T. Cruzi

…does not reverse the tissue damage caused by chronic infections

43
Q

With N + B treatment, ____ is common. over the course of treatment, which is about ________ in duration

A

toxicity

3-4 months

44
Q

Worms have a unique biology in that they… (2)

A
  • multiply outside of their definitive host
  • Evade the immune system (lifetime chronic infections)
45
Q

Helminths include what catergories

A

Cestodes (tapeworms)

Trematodes (flukes)

Nematodes (Roundworms)

46
Q

Echinococcosis

  • aka
  • forms what?
  • treatment
A

Dog tapeworm

forms hydatid cysts in the liver

Albendazole and surgical excision of cysts

47
Q

Cystercercosis

  • caused by
  • produces
  • Tx
A
  • caused by Taenia solium
  • produces cysterci in the brain and eyes
  • praziquantel, albendazole, surgery
48
Q

Taeniasis

  • caused by (aka)
  • produces
  • Dx and Tx
A

T. saginata (beef tapeworm)

does NOT produce cysterci

Dx by proglottids in stool, Tx: Niclosamide

49
Q

Diphyllobothriasis

caused by/aka

Dx/Tx

A

Caused by D. latum (fish tapeworm)

Stool eggs, Tx = Niclosamide

50
Q

Taenia solium causes what two syndromes

A

Taeniasis (intestinal infection, stool/niclosamide)

Cystercercosis (brain infection, prazi/albend)

51
Q

Which form of Taenia saginata/solium penetrate the intestinal wall and circulate to musculature

A

Oncosphere

52
Q

Cysticercosis 4 steps

A
  1. ingestion
  2. oncospheres hatch in intestine
  3. oncospheres invade intestinal wall and migrate to striated muscle, brain, liver
  4. develop into cysticerci
53
Q

Pinworm disease

  • organism
  • hosts
  • Dx and Tx
A

Enterobiasis

  • Ent. vermicularis
  • humans only host
  • perianal egg ID, Mebendazole or Pyrantel pamoate
54
Q

Roundworm disease

  • Organism
  • type of infection
  • Dx
  • treatment
A

Ascariasis

  • Ascaris lumbricoides (most prevalent multicellular parasite)
  • Intestinal growth of larvae
  • stool egg ID
  • Mebendazole or pyrantel pamoate
55
Q

Threadworm disease

  • organism
  • disease/infection characteristics
  • transmission
  • Dx and Tx
A

Strongyloidiasis

  • Strongyloides stercoralis
  • Usually benign, can be fatal in ICP due to CNS/organ infctn (HYPERINFECTION SYND)
  • Stool larvae, Tx = Thiabendazole, albendazole, ivermectin
56
Q

Hookworm disease

  • organism
  • transmission
  • Dx and Tx
A
  • Ancylostoma duodenale and Necator americanus
  • direct penetration of the skin
  • eggs in stool, pyrantel pamoate or mebendazole
57
Q

Whipworm disease

  • Organism
  • Sx
  • Transmission
  • Tx
A
  • trichuris trichiura
  • N/D, rectal prolapse
  • ingestion of contaminated soil
  • Mebendazole
58
Q

River blindness

  • organism
  • features/Sx
  • Transmission
  • Dx
  • Tx
A
  • Onchocerciasis (volvulus)
  • SubQ nodules, ocular lesions
  • blackfly bite
  • Detect microfiliariae in skin
  • Ivermectin or surgery
59
Q

Visceral larva migrans

  • organism
  • only ___ cause disease
  • Dx
  • Tx
A

Toxocara canis

only larvae cause disease

ID larvae in tissue

Mebendazole / thiabendazole

60
Q

Filariasis

  • organism
  • Sx
  • Transmission
  • Dx/Tx
A
  • Wuchereria bancrofti
  • elephantiasis
  • Anopheles or Culex mosquitoes
  • ID microfilariae in blood, Combo of DIETHYLCARBAMAZINE and ALBENDAZOLE
61
Q

Disease from loa loa

A

Loiasis

Larvae under skin, leave track marks

worms visible in subconjunctival space

Treated with diethylcarbamazine

62
Q

Dracunculiasis caused by…

A

drinking water containing intermediate host copepods where larvae live

…have to actually remove the subQ worms via surgery

63
Q

Trichinella spiralis diagnosis

A

muscle biopsy that shows coiled encysted larvae

64
Q

Benzimidazole drugs (3, one fact each)

A

Mebendazole (1st)

Thiabendazole (Toxicity limits use)

Albendazole (for GI and Tissue)

65
Q

Bendimidazole MOA

A

binds to tubulin ->> inhibits formation of MT at the PLUS end (minus end still shortens)

Doesn’t bind to mammalian tubulin

66
Q

Albendazole DOC for

A

Cysticercosis

67
Q

Albendazole rapidly converted to ______

A

albendazole sulfoxide

(active metabolite)

68
Q

Mebendazole used for..

A

pinworm, hookwarm, ascariasis, thricuriasis

69
Q

Thiabendazole is not preferred b/c…

A

toxicity and potential teratogen

70
Q

Praziquantel is effective against what catergories of organisms

A

cestodes and trematodes

NO effect on nematodes

71
Q

Praziquantel MOA (lower concentrations)

A

increased muscular activity at lower [C]

Worms detach from blood vessel walls

migrate from mesenteric vv. -> liver

72
Q

Praziquantel higher concentration MOA

A

tegumental damage

exposes a number of tegumentsl antigens

**may also disrupt CALCIUM homeostasis**

73
Q

Prazi is the DOC for..

Dosing?

A

all forms of schistosomiasis

high cure rate with 2-3 doses

–> single dose kills 100% of T. saginata/solium, and D. latum

74
Q

Toxicity for prazi:

A

more severe reaction to dying worms

75
Q

Ivermectin is DOC for

A

strongyloidiasis and onchocerciasis

76
Q

Ivermectin drug type

A

semisynthetic macrocyclic lactone

77
Q

Ivermectin MOA

A

Paralyzes microfilariae

Binds to Glutamate-activated Chloride channels in nematode nerve/muscle cells

causes hyperpolarization by increaseing internal [Cl-]

*also binds to GABA-gated and ligand gated chloride channels

78
Q

ivermectin doesnt kill…

A

adult worms

(only paralyzes)

79
Q

Ivermectin used to treat _____

A

onchocerciasis

also for ascaris, enteroboius, strongyloides, filariasis

80
Q

Treatment with ivermectin must be continued…

A

for the lifespan fo the adult worm

81
Q

Pyrantel pamoate is a…

MOA?

What does it treat? (and dosing?)

A

…broad spec antihelminth (OTC)

MOA = Causes Ach release and inhibits cholinesterase

Tx for pinworms (moderate against hookworms)

  • Ascariasis = one dose
  • Pinworms = 2 doses 2 weeks apart
82
Q

Scabies organism

A

sarcoptes scabiei

83
Q

scabies burrow in what tissue

A

stratum corneum of the skin

causes itching and rash

84
Q

Treatment for scabies

A

Permethrin cream

(salycylic acid if crusted scabies)

85
Q

Head live tx

A

Permethrin or pyrethrin

1st application 10 minutes, second application 10 days later

Malathion if chronic

Newer pediculicides contain benzyl alcohol, dimethicone, or spinosad

Pharm Exam 2 (12 decks)

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