antiprotozoal- amoebiasis Flashcards
Which protozoa are included?
includes entamoeba histolytica, trichomonas vaginalis and giardia lamblia
drugs against tissue amoebas
6 drugs
metronidazol, tinidazol ornidazol. emetine. dehydroemetine. chloroquine
drugs against amoebas in the intestine.
diloxanide
idoquinol
paromomycine.
Iodoquinol mechanism kinetics. adverse clinical indications: 2
Mechanism of action: not fully understood
Pharmacokinetics: poor absorbtion given orally
Adverse: GI
Clinical indications:
1) in monotherapy for the treatment of intestinal asymptomatic amebiasis
2) in combination for the treatment of intestinal or
extraintestinal amebiasis
Diloxanid furoat Mechanism: Kinetics Adverse indication
Mechanism of action: not clear
Pharmacokinetics: its metabolite the diloxanid is absorbed
Adverse effects: GI
Clinical indications: alternative compound in asymptomatic amebiasisban
Nitroimidazoles- Metronidazole, tinidazole
Mechanism
CLinical indication
Mechanism of action: reactive reduction products have cytotoxic effect
Clinical indications: in combination for intestinal and extraintestinal infections
Paromomycin (aminoglycoside)
Mechanism of action: inhibits protein synthesis
Clinical indications: second line drug in intestinal and extraintestinal infections
Treatment of giardiasis:
two options for treatment:
First line drugs
1) Nitroimidazoles: metronidazole, tinidazole.
2) Nitazoxanid: broad spectrum antiprotozoal drug, not clear mechanism of action, few side effects.
Second line drugs
1) Paromomycin (aminoglycoside): poor absorbtion given orally.
2) Furazolidon: nitrofuran, oral drug with mainly GI adverse effects
3) Quinacrin: broad spectrum antiprotozoal drug, well absorbed orally,
long elimination half life (5 days), mainly GI adverse effects
Treatment of trichomoniasis
Nitroimidazoles: metronidazole, tinidazole
Treatment of toxoplasma gondii infection:
3 options
first choice –
1) Spiramycin (in pregnancy), Sulfamethoxazole +Trimethoprim
2) Pyrimethamine + Clindamycin + folinic acid
3) alternative compounds: - Pyrimethamine + Sulfadiazine + folinic acid
Treatment of pneumocystis jiroveci infection.
first choice – Sulfamethoxazole +Trimethoprim
alternative compounds:
- Pentamidine or Clindamycin + Primaquine
or Atovaquon
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form): - Eflornithin mechanism: Given- 2 forms. adverse effects- 3 indicated for- "
mechanism: inhibits ornithin decarboxylase
- given mainly i.v., orally.
- severe adverse effects (GI, seizures, bone marrow
suppression) causes diarrhoea.
- indicated for advanced (CNS) cases
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form): - Melarsoprol - Mechanism: Given- 1 Adverse: 4.
Mechanism: arsenic containing compound, enzyme inhibitory effect.
- given in slow infusion,
- adverse effects: GI, hepatotoxicity, arrhythmia,
encephalopathy.
- indicated in advanced (CNS) cases.
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form): Pentamidine Mechanism: Indicated- 3 given- 3 kinetics- 2 adverse- 5
Mechanism: effective against several protozoals
- unknown mechanism of action.
Given: IV, IM, aerosol.
Kinetics: half life is about 12 days, no CNS entry.
adverse effects: Pancreatic toxicity (hypoglycemia for some weeks then hyperglycemia), nephrotoxic, hallucination, arrhythmias, hypotension and more.
Indication:
1) it is used in early phase before the CNS involvement
2) other indication is the antimonial resistant leishmaniasis.
3) Pneumocystic jivoecii (usually used prophylatic).
4) it has fungicid effect as well.
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form): Suramin Mechanism: admin adverse effects: 3 indicated:
- mechanism: – not fully undertsood mechanism of action (inhibits protein synthesis but enzymes as well)
administered i.v., long half life (40-50 days)
- adverse effects: kidney impairment, dermatitis, neuropathy.
- indicated in the early phase, before CNS involvement