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Antiprotazoals Flashcards

1
Q

characteristics and classifications of protozoa

A
  • classified based on adult stage motility
  • unicellular
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2
Q

target transmission of protozoa

A

vectors
(insects and person to person)

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3
Q

considerations of anti-protozoal drugs

A

not safe during pregnancy
toxic at therapeutic doses
drug resistance

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4
Q

what anaerobic protozoa (amebiasis) causes disease

A

entamoeba histolytica

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5
Q

transmission of amebiasis

A

oral-fecal route

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6
Q

what does an amebic cyst do

A

survives GA contents, pass into lumen, transformes into trophozoites in large intestinal lumen and feed off of enteric bacteria

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7
Q

symptoms of amebiasis

A
  • asymptomatic - intestinal lumen
  • severe diarrhea, abdominal cramps
  • colitis and bloody diarrhea
  • amebic dysentery
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8
Q

when does a patient get amebic
- severe diarrhea and cramps
- dysentery
- liver abscess

A
  • trophozoites invade intestinal epithelium
  • ulcerate colonic mucosa in large intestine
  • infect portal vein and travel to liver
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9
Q

treatment of asymptomatic amebic intestinal lumen infection

A

paromomycin or iodoquinol (only dual therapy)

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10
Q

what type of antibiotic and amebicide is paromomycin

A

aminoglycoside
luminal amebicide

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11
Q

what type drug is iodoquinol (diiodihydroxyquinoline)

A

halogenated hydroxyquinoline
luminal amebicide

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12
Q

contraindications of iodoquinol

A

used in addition to other drugs used to treat other forms of amebiasis

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13
Q

what is used to treat moderate infection and invasive colitis (intestinal, extraintestinal, & tissue infection)

A

nitroimidazoles

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14
Q

clinical pearl of nitroimidazoles

A

avoid with alcohol

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15
Q

what does metronidazole treat

A

extraluminal amebiasis, amebic colitis, and dysentery

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16
Q

where is metronidazole less effective

A

eliminating cysts in bowel lumen

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17
Q

MOA of metronidazole

A

PFOR reduces ferredoxin which activates metronidazole through reduction which creates a short-lived nitro-free radical which binds to DNA protein and INHIBITS DNA synthesis and induces its degredation

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18
Q

metronidazole also kills

A

anaerobes

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19
Q

MOA of tinidazole

A

generation of cytotoxic free radicals and drug interactions

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20
Q

what can tinidazole treat

A

intestinal amebiasis and liver abscess

(not asymptomatic cyst/luminal)

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21
Q

what can nitazoxanide treat

A

metronidazole resistant protozoal strains

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22
Q

proposed MOA of nitazoxanide

A

noncompetitive inhibitor of pyruvate PFOR enzymes

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23
Q

symptoms of cryptosporidiosis

A

asymptomatic
watery diarrhea
stomach cramps
N/V
fever
weight loss
* life threatening in immune compromised individuals

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24
Q

treatment of cryptosporidiosis

A

nitazoxanide

25
Q

most commonly diagnosed intestinal parasite in the US that is transmitted as a cyst in feces contaminated water, soil, food, or water

A

giardiasis

26
Q

which giardia form is most drug resistant

A

cyst

27
Q

symptoms of giardia and its treatments

A

1 - metronidazole

asymptomatic to D, gas, abdominal cramps, greasy floating stools, dehydration
malnutrition in kids due to failure to absorb fat, lactose, vitamin A and B12

nitazoxanide
tinidazole

28
Q

cause of common forms of vaginitis and urethritis that is an STD

A

trichomoniasis

29
Q

symptoms of trichomoniasis

A

itching or irritation
discomfort during urination
discharge

30
Q

treatment of trichomoniasis

A

1 metronidazole

nitazoxanide
tinidazole

31
Q

a sporozoa, obligate intracellular parasite

A

toxoplasma gondii

32
Q

transmission of toxoplasma gondii

A

foodborne-undercooked, contaminated meat and veggies
human to animal (cats)
transplacental fetal infection

33
Q

symptoms of toxoplasmosis

A

asymptomatic
if immunocompromised: reactivation of tissue cysts in brain causing encephalitis (fever, confusion, HA, seizures, poor coordination)
mild flu like sx
stillbirth, miscarriage, child with toxoplasmosis - large/small head, vision loss, mental disability, seizures

34
Q

toxoplasmosis treatment

A

3 drug combo
- pyrimethamine (folate analog competitive inhibition)
- sulfadiazine (antifolate inhibiting protozoal dihydropteroate synthase and PABA)
- leucovorin calcium (reduced folate)

35
Q

why do you give leucovorin calcium

A

to offset hematologic complications due to pyrimethamine induced folic acid deficiency

36
Q

what causes African sleeping sickness

A

trypanosoma brucei gambiense or
T. b. rhodesiense

37
Q

what is trypanosomiasis transmitted by

A

tsetsefly

38
Q

early stage hemolymphatic trypanosomiasis

A

parasites live and grow in blood & lymph. Itching, fever, jpint pains, chills, HA, lymphadopathy

39
Q

late stage meningoencephalitis trypanosomiasis

A

invade CNS (severe HA)
inflammation of brain and spinal cord producing lethargy
mental deterioration
continuous sleep
coma
death if untreated

40
Q

treatment for early stage trypanosomiasis

A

pentamidine isethionate
suramin

41
Q

moa of pentamidine

A

binds DNA in kinetopast with high affinity, inhibits kinetopast replication and function

inhibits RNA, phospholipid, protein synthesis

42
Q

treats early and late stage t. b. (with CNS involvement)

A

eflornithine

43
Q

which type of T.b does eflornithine treat

A

ONLY t. b gambiense with nifurtimox

44
Q

adverse effects of suramin

A

neurological complications

45
Q

adverse effects of eflornithine

A

seizures in overdose
death

46
Q

only option and 1st line therapy for treating T. b. rhodesiense (2nd line for T b gambiense

A

melarsoprol

47
Q

MOA melarsoprol

A

inhibits pyruvate kinase –> inh. glycolysis –> inh atp synthesis

inhibits adenine and adenosine uptake by trypanosomal transporters

48
Q

adverse effects of melarsoprol

A

4-6% death rate
fever, vomiting, abdominal pain immediately
phlebitis
reactive encephalopathy - brain inflammation
polyneuropathy
renal disease
cardiac disease

49
Q

how to lessen adverse effects of melarsoprol

  • brain inflammation:
  • polyneuropathy:
    -GI side effects:
A

corticosteroids
thiamine
fasting prior to administration

50
Q

Chaga’s disease (american trypanosomiasis) cause and transmission

A

trypanosoma cruzi transmitted via reduviid insect vectors

51
Q

acute chaga’s disease symptoms

A

granuloma “chagoma”
unilateral orbital edema
fever, hepatosplenomegaly and lymphadenopathy

52
Q

chronic chaga’s disease symptoms

A

cardiomyopathy and HF
1st degree heartblock - right bundle branch block arrhythmias
enlargement of esophagus and color (mega syndrome)
meningoencephalitis
strokes
seizures
focal paralysis

53
Q

1st line treatment of chaga’s disease

A

benznidazole

54
Q

moa benznidazole

A

inhibits protein and RNA synthesis

55
Q

2nd line and investigational treatment of chaga’s disease

A

nifurtimox

56
Q

moa nifurtimox

A

generates intracellular oxygen radicals inhibits parasite enzyme trypanothione reductase

57
Q

what is special about nifurtimox

A

activity against motile parasites

58
Q

monitoring for both benznidazole and nifurtimox

A

blood count, hepatic, CMP

PDA (2 decks)

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