antiprotozoal- amoebiasis Flashcards

1
Q

Which protozoa are included?

A

includes entamoeba histolytica, trichomonas vaginalis and giardia lamblia

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2
Q

drugs against tissue amoebas

6 drugs

A
metronidazol,
tinidazol
ornidazol.
emetine.
dehydroemetine.
chloroquine
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3
Q

drugs against amoebas in the intestine.

A

diloxanide
idoquinol
paromomycine.

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4
Q
Iodoquinol
mechanism
kinetics.
adverse
clinical indications: 2
A

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

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5
Q
Diloxanid furoat
Mechanism: 
Kinetics
Adverse
indication
A

Mechanism of action: not clear

Pharmacokinetics: its metabolite the diloxanid is absorbed

Adverse effects: GI

Clinical indications: alternative compound in asymptomatic amebiasisban

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6
Q

Nitroimidazoles- Metronidazole, tinidazole
Mechanism
CLinical indication

A

Mechanism of action: reactive reduction products have cytotoxic effect

Clinical indications: in combination for intestinal and extraintestinal infections

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7
Q

Paromomycin (aminoglycoside)

A

Mechanism of action: inhibits protein synthesis

Clinical indications: second line drug in intestinal and extraintestinal infections

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8
Q

Treatment of giardiasis:

two options for treatment:

A

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

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9
Q

Treatment of trichomoniasis

A

Nitroimidazoles: metronidazole, tinidazole

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10
Q

Treatment of toxoplasma gondii infection:

3 options

A

first choice –

1) Spiramycin (in pregnancy), Sulfamethoxazole +Trimethoprim
2) Pyrimethamine + Clindamycin + folinic acid
3) alternative compounds: - Pyrimethamine + Sulfadiazine + folinic acid

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11
Q

Treatment of pneumocystis jiroveci infection.

A

first choice – Sulfamethoxazole +Trimethoprim
alternative compounds:
- Pentamidine or Clindamycin + Primaquine
or Atovaquon

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12
Q
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form):
- Eflornithin
mechanism:
Given- 2 forms.
adverse effects- 3
indicated for- "
A

mechanism: inhibits ornithin decarboxylase
- given mainly i.v., orally.
- severe adverse effects (GI, seizures, bone marrow
suppression) causes diarrhoea.
- indicated for advanced (CNS) cases

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13
Q
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form):
- Melarsoprol - 
Mechanism:
Given- 1
Adverse: 4.
A

Mechanism: arsenic containing compound, enzyme inhibitory effect.
- given in slow infusion,
- adverse effects: GI, hepatotoxicity, arrhythmia,
encephalopathy.
- indicated in advanced (CNS) cases.

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14
Q
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form):
Pentamidine
Mechanism:
Indicated- 3
given- 3
kinetics- 2
adverse- 5
A

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.

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15
Q
Treatment of african trypanosomiasis (gambienese and rhodesience--> acute form):
Suramin
Mechanism:
admin
adverse effects: 3
indicated:
A
  • 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
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16
Q
Treatment of american trypanosomiasis
1) Nifurtimox:
Mechanism:
indicated:
admin:
Adverse:

2) Benznidazol:
mechanism
Route
Adverse:

A
  • Nifurtimox - might act by radical metabolites
  • effective mainly in the acute phase
  • administrated orally
  • adverse effects: GI, neuropathy, seizures
  • Benznidazol – inhibits protein synthesis and RNA synthesis
  • administrated orally
  • adverse effects: GI, neuropathy, psychosi
17
Q

Treatment of leishmaniasis:
Mention 4 drugs and which one do you use for which!
Leishmania donovani-> visceral and kala-azar disease.
leishmania tropia-> cutaneous leishmania.
L. Braziliensis-> mucocutaneous form.

A

Drugs used for the treatment:

1) Amphotericin B – mainly in the visceral leishmaniasis
2) Miltefosine – orally given in the visceral form

3) pentavalent antimonials:
A) sodium stibogluconate
B) meglumin antimoniat
intravenously administrated drugs for different
leishmania forms with few side effects. 
First choice drugs in mucocutaneous
18
Q
Pentamidine (Drugs used in leishamania)
mechanism
adminstration
adverse effects: 4 
reserved for?
A
  • not fully understood mechanism of action (inhibits protein synthesis,
    inhibits DHFR?)
  • parenteral administration
  • severe adverse effects: arrhythmias, liver and kidney disturbances, Stevens-Johnson syndrome
  • reserve compound in resistant cases
19
Q

sodium stibogluconate
admin- 2
mecha- 1
adverse: 4

A

administered IV or IM
mechanism unknown
adverse: GI myalgia, headache, QT prolongation.