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Immunity, Infection and Disease > Antiprotozoal and Antiparasitic Drugs > Flashcards

Antiprotozoal and Antiparasitic Drugs Flashcards

1
Q

Main AEs of iodoquinol

A

GI, neurotoxicity, affects iodine uptake

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2
Q

What is diloxanide furoate used to treat and what is its mechanism of action?

A

Asymptomatic amebiasis cysts. MoA unknown

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3
Q

Main AEs of diloxanide furoate

A

Mild (GI, flatulence). Do not use in pregnancy

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4
Q

What is metronidazole used to treat and what is its mechanism of action?

A

Extraluminal amoebae, Giardia, Trichomonas. Binds proteins and DNA, inhibits DNA replication, causes cell death

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5
Q

Main AEs of metronidazole

A

Nausea, headache, dry mouth, metallic taste, dark or red brown urine, GI, CNS effects. No use in pts with CNS disease

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6
Q

What two antiprotozoal or antiparasitic drugs h ave significant drug interactions?

A

Metronidazole and Trimethoprim-Sulfamethoxazole

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7
Q

What is tinidazole used to treat and what is its mechanism of action?

A

Everything essentially same as metronidazole (but may be better tolerated). Use for extraluminal amoebae, giardia, trichomonas

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8
Q

What is furazolidone used to treat?

A

Giardia (2nd line)

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9
Q

What is trimethoprim-sulfamethoxazole used to treat and what is its mechanism of action?

A

Mainly used for treatment and prophylaxis of pneumocystis infections (regarding protozoa and parasites). Inhibits folic acid synthesis

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10
Q

Main AEs of trimethoprim-sulfamethoxazole

A

Megaloblastic anemia, leukopenia, granulocytopenia (give folinic acid), GI upset, CNS effects, drug fever, rash

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11
Q

What is pyrimethamine-sulfadiazine used to treat and what is its mechanism of action?

A

Toxoplasmosis. Inhibits DHF reductase

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12
Q

What is nitazoxanide used to treat and what is its mechanism of action?

A

Crytopsporidium (immunicompetent). Interferes with pyruvate ferredoxin oxidoreductase (PFOR)

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13
Q

What drug may have activity against metronidazole-resistant protozoa?

A

Nitazoxanide

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14
Q

What is albendazole used to treat?

A

Microsporidia, also helmintic infections

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15
Q

What is the infection rate of Borrelia burgdorferi after a single tick bite?

A

Less than 2%. Based on studies, antibiotic prophylaxis after a tick bite is not considered necessary.

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16
Q

What causes Rocky Mountain Spotted Fever (RMSF)? What is the reservoir?

A

Caused by Rickettsia rickettsii, which is transmitted by the wood tick, the dog tick, and the Lone Star tick. Wild mammals, as well as the tick itself, act as the reservoir.

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17
Q

How does Rocky Mountain Spotted Fever (RMSF) usually present?

A

Headache, fever, myalgia, malaise. Muscle pain (especially in calf region) is common. Characteristic rash (maculopapular or petechial) appears, usually on wrist, ankles, palms, and soles.

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18
Q

Let us talk about human ehrlichioses. What tick species is responsible for transmitting Anaplasma phagocytophilum? Ehrlichia chaffeensis?

A

Anaplasma phagocytophilum: Ixode ticks (same as Lyme disease). Ehrlichia chaffeensis: Lone Star tick, wood tick (same as RMSF).

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19
Q

What causes human monocytotrophic ehrlichiosis (HME)? What causes human granulocytic ehrlichiosis (HGE)/anaplasmosis?

A

HME = Ehrlichia chaffeensis. HGE = Anaplasma phagocytophilum.

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20
Q

What is the only oral drug available to treat leishmania infection?

A

Miltefosine

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21
Q

Vector for leishmania

A

Sandflies

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22
Q

Symptoms for leishmania infection

A

Ranging from self-limiting cutaneous leisons to mucocutaneous lesions to severe life-threatening visceral infections (can be fatal if untreated)

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23
Q

Three main types of leishmania infections

A

Visceral, cutaneous and mucosal

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24
Q

Treatment choices for visceral leishmania

A

Liposomal Amphotericin B or Sodium Stibogluconate or Miltefosine (PO) or Meglumine antimonite (Amphotericin B and Paromomycin sulfate are second lines)

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25
Q

Treatment choices for cutaneous leishmania

A

Sodium stibogluconate or meglumine antimonite or miltefosine (PO)

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26
Q

Treatment choices for mucosal leishmania

A

Sodium stibogluconate or meglumonie antimonite or amphotericin B or miltefosine (PO)

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27
Q

Which leishmania treatment options can be used for all three types of leishmania?

A

Sodium stibogluconate, Meglumine antimonite, and Miltefosine (PO). Amphotericin B can be used for 2 of the three (Visc and Muc)

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28
Q

What is the delivery route of Amphotericin B?

A

IV

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29
Q

What are the clinically relevant trypanosoma species and what does each cause?

A

Trypanosoma brucei gambiense (W African Sleeping Sickness), Trypanosoma brucei rhodesiense (E African Sleeping Sickness) and Trypanosoma Cruzi (Chagas disease aka American SS)

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30
Q

What is the vector for trypanosoma?

A

Tsetse flies (trypanosomes develop in fly salivary glands)

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31
Q

Symptoms of a trypanosoma infection

A

Heache, lethargy, fever, cardiac and CNS symptoms. Can be acute or chronic

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32
Q

Treatment options for American Sleeping Sickness (Chagas disease)

A

Nifurtimox or Benznidazole

33
Q

Treatment options for West African Sleeping Sickness

A

Pentamidine or suramine (alternative). After CNS effects (late stages) use Eflornithine or Eflornithine plus Nifurtimox or Melarsoprol

34
Q

Treatment options for East African Sleeping Sickness

A

Hemolymphatic stage - Suramin, Late stages with CNS involvement - Melarsoprol

35
Q

What drug is used for both East and West African Sleeping Sickness only after CNS involvement?

A

Melarsoprol (DOC for East, other options available for West)

36
Q

Parasite that causes amoebae infections

A

Entamoeba histolytica

37
Q

Symptoms of amoebae (entamoeba histolytica) infection

A

Asymptomatic intestinal infection, mild to moderate intestinal infection, or severe intestinal infection (dysentery), liver abscess, other extraintestinal symptoms

38
Q

Treatment options for Asymptomatic Amoebae Infections

A

Iodoquinol (PO) or Paromomycin (PO) or Diloxanide Furoate (PO)

39
Q

Treatment options for mild to moderate amoebae infections

A

Metronidazole or Tinidazole followed by an asymptomatic level treatment (Iodoquinol or Paromomycin)

40
Q

Treatment options for severe interstinal or extraintestinal amoebae infections

A

Same as mild to moderate intestinal - Metronidazole or Tinidazole followed by an asymptomatic level treatment (Iodoquinol or Paromomycin)

41
Q

What term describes the action of Diloxanide Fuorate, Paromomycin and Iodoquinol?

A

Luminal amebicide. They act in bowel lumen only

42
Q

What term describes the action of Metronidazole and Tinidazole?

A

Tissue amebicides (eliminate parasites in bowel wall, liver, and other extraintestinal tissues)

43
Q

Metronidazole kills amoebae in what stages? What type of drug should Metronidazole be used with?

A

Kills trophozoites but not cysts, use with a luminal amebicide (like Diloxanide fuorate, Paromomycin or Iodoquinol)

44
Q

What is the vector for Giardia infection?

A

Ingestion of cysts or trophozoites in fecally contaminated food or water

45
Q

Symptoms of Giardia infection

A

Abdominal distress, diarrhea, weight loss

46
Q

Treatment options for Giardia infection

A

Metronidazole or Tinidazole or Nitazoxanide. Alternatives - Paromomycin, Furazolidine, Quinacrine

47
Q

Symptoms of Trichomonas infection

A

Vaginal discharge (profuse, frothy, yellowish), Vaginal and vulvar irritation, dysuria, dyspareunia. Males are asymptomatic

48
Q

Treatment options for Trichomonas infection

A

Metronidazole or Tinidazole. Do not use topical metronidazole

49
Q

What is dyspareunia and what infection causes this symptom?

A

Pain during sexual intercourse. Is a symptom of trichomonas vaginalis infection

50
Q

Symptoms of pneumocystis jiroveci infection

A

Progressive diffuse pneumonitis (hypoxia, tachypnea, dyspnea), Pulmonary infiltrates (non-productive cough, fever, rales)

51
Q

Treatment options for pneumocystis jiroveci

A

Trimethoprim-Sulfamethoxazole. Alternatives - Pentamidine, Primaquine, Primaquine and Clindamycin, Trimethoprim and Dapsone, Atovaquone

52
Q

Vector for toxoplasma infection

A

Uncooked meat, congenital infection, cat feces

53
Q

Symptoms for toxoplasma infection

A

Lymphadenopathy, fever, headache, myalgia. Ranges from self-limiting febrile lymphadenopathy to lethal disease (immunocompromised pts) to congenital form.

54
Q

Treatment options for Toxoplasma infection

A

Pyrimethamine with sulfadiazine or with clindamycin or with atovaquone. Alternative - Trimethoprim-Sulfamethoxazole

55
Q

Vector for Cryptosporidia infection

A

Person to person, contamination of food or water with feces

56
Q

Symptoms of cryptosporidia infection

A

GI. Worse in immunocompromised pts

57
Q

Treatment options for cryptosporidia infections

A

Non-HIV - Nitazoxanide. HIV - No DOC. Can try Nitazoxanide, paromomycin, other combinations

58
Q

Vection for microsporidia infection

A

Unknown

59
Q

Symptoms of microsporidia infection

A

Ocular, intestinal (diarrhea), disseminated (kidney, liver, lung, peritoneal cavity). Worse in immunocompromised

60
Q

Treatment options for microsporidia infection

A

Ocular - Albendazole plus fumagillin, Intestinal - Fumagillin or Albendazole, Disseminated - Albendazole.

61
Q

What are sodium stibogluconate and meglumine antimonate used to treat and what is their mechanism?

A

DOC for cutaneous and mucosal leishmania (can also use for visc leishmania). May inhibit glycolysis (PFK) and Fatty Acid B Oxidation. Also bind to sulfhydryl groups

62
Q

Main AEs from Sodium Stibogluconate and Meglumine Antimonate

A

GI, fever, headache, myalgias, arthralgias, rash. Also EKG changes, abscess from IM administration

63
Q

What is Pentamidine used to treat and what is its mechanism of action?

A

DOC for Trypanosoma (West African hemolymphatic stage only), Pneumocystis (2nd line), Cut Leishmania (2nd line). May interact with nucleotides, interfere with uptake and function of polyamines, May inhibit DHF reductase

64
Q

Main AEs of pentamidine

A

Toxicity limits use. Hypotension, tachycardia, dizziness, pancreatic toxicity, EKG changes, renal insufficiency

65
Q

What is Paromomycin used to treat and what is its mechanism of action?

A

Amebiasis (luminal amebicide of choice), Giardia (2nd line), Leishmania (2nd line). Inhibits prokaryote protein synthesis

66
Q

Main AEs of Paromomycin

A

GI symptoms, nephrotoxicity. Avoid in pts with renal disease or GI ulcers

67
Q

What is miltefosine used to treat and what is its mechanism of action?

A

Leishmania (all types), Affects cell-signaling pathways and membrane synthesis

68
Q

Main AEs of miltefosine

A

GI effects, elevation of hepatic enzymes and creatinine, teratogenic

69
Q

What is Nifurtimox used to treat and what is its mechanism of action?

A

Trypanosoma cruzi (Chagas disease). Inhibits trypanothione reductase (specific to parasites), generating toxic oxygen radicals

70
Q

Main AEs of nifurtimox

A

GI upset, fever, rash, CNS effects (neuropathies, seizures)

71
Q

What drug is benznidazole similar to?

A

Nifurtimox (both used for acute Chagas disease). Benznidazole causes peripheral neuropathy and myelosuppression where Nifurtimox does not

72
Q

What is eflornithine used to treat and what is its mechanism of action?

A

West African sleeping sickness (late stage with CNS involvement). Irreversible catalytic inhibitor of ornithine decarboxylase

73
Q

Main AEs of eflornithine

A

Anemia, diarrhea, leukopenia, convulsions. Do not use during pregnancy

74
Q

What is suramin used for and what is its mechanism of action?

A

East African SS (hemolyphatic stage), West African SS (2nd line). MoA largely unknown

75
Q

Main AEs of Suramin

A

Really bad. Nausea, vomiting, seizures, shock death, fever, rash, headache, paresthesias, neuropathies, renal toxicity, hemolytic anemia, agranulocytosis

76
Q

What is Melarsoprol used to treat and what is its mechanism of action?

A

East and West African SS (late stages with CNS involvement). Inhibits trypanothione reductase

77
Q

Main AEs of melarsoprol

A

Toxicity limits use. Fever, vomiting, abdominal pain, arthralgias, reactive encephalopathy (death), renal and cardiac damage, hypersensitivity reactions

78
Q

In what patients is melarsoprol contraindicated

A

Those with influenza, Glucose 6-PD deficiency

79
Q

What is iodoquinol used to treat and what is its mechanism of action?

A

Asymptomatic amoeba infections (also plays role in more serious amoebae infections). MoA unknown

Immunity, Infection and Disease (86 decks)

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