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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
Treatment choices for cutaneous leishmania
Sodium stibogluconate or meglumine antimonite or miltefosine (PO)
26
Treatment choices for mucosal leishmania
Sodium stibogluconate or meglumonie antimonite or amphotericin B or miltefosine (PO)
27
Which leishmania treatment options can be used for all three types of leishmania?
Sodium stibogluconate, Meglumine antimonite, and Miltefosine (PO). Amphotericin B can be used for 2 of the three (Visc and Muc)
28
What is the delivery route of Amphotericin B?
IV
29
What are the clinically relevant trypanosoma species and what does each cause?
Trypanosoma brucei gambiense (W African Sleeping Sickness), Trypanosoma brucei rhodesiense (E African Sleeping Sickness) and Trypanosoma Cruzi (Chagas disease aka American SS)
30
What is the vector for trypanosoma?
Tsetse flies (trypanosomes develop in fly salivary glands)
31
Symptoms of a trypanosoma infection
Heache, lethargy, fever, cardiac and CNS symptoms. Can be acute or chronic
32
Treatment options for American Sleeping Sickness (Chagas disease)
Nifurtimox or Benznidazole
33
Treatment options for West African Sleeping Sickness
Pentamidine or suramine (alternative). After CNS effects (late stages) use Eflornithine or Eflornithine plus Nifurtimox or Melarsoprol
34
Treatment options for East African Sleeping Sickness
Hemolymphatic stage - Suramin, Late stages with CNS involvement - Melarsoprol
35
What drug is used for both East and West African Sleeping Sickness only after CNS involvement?
Melarsoprol (DOC for East, other options available for West)
36
Parasite that causes amoebae infections
Entamoeba histolytica
37
Symptoms of amoebae (entamoeba histolytica) infection
Asymptomatic intestinal infection, mild to moderate intestinal infection, or severe intestinal infection (dysentery), liver abscess, other extraintestinal symptoms
38
Treatment options for Asymptomatic Amoebae Infections
Iodoquinol (PO) or Paromomycin (PO) or Diloxanide Furoate (PO)
39
Treatment options for mild to moderate amoebae infections
Metronidazole or Tinidazole followed by an asymptomatic level treatment (Iodoquinol or Paromomycin)
40
Treatment options for severe interstinal or extraintestinal amoebae infections
Same as mild to moderate intestinal - Metronidazole or Tinidazole followed by an asymptomatic level treatment (Iodoquinol or Paromomycin)
41
What term describes the action of Diloxanide Fuorate, Paromomycin and Iodoquinol?
Luminal amebicide. They act in bowel lumen only
42
What term describes the action of Metronidazole and Tinidazole?
Tissue amebicides (eliminate parasites in bowel wall, liver, and other extraintestinal tissues)
43
Metronidazole kills amoebae in what stages? What type of drug should Metronidazole be used with?
Kills trophozoites but not cysts, use with a luminal amebicide (like Diloxanide fuorate, Paromomycin or Iodoquinol)
44
What is the vector for Giardia infection?
Ingestion of cysts or trophozoites in fecally contaminated food or water
45
Symptoms of Giardia infection
Abdominal distress, diarrhea, weight loss
46
Treatment options for Giardia infection
Metronidazole or Tinidazole or Nitazoxanide. Alternatives - Paromomycin, Furazolidine, Quinacrine
47
Symptoms of Trichomonas infection
Vaginal discharge (profuse, frothy, yellowish), Vaginal and vulvar irritation, dysuria, dyspareunia. Males are asymptomatic
48
Treatment options for Trichomonas infection
Metronidazole or Tinidazole. Do not use topical metronidazole
49
What is dyspareunia and what infection causes this symptom?
Pain during sexual intercourse. Is a symptom of trichomonas vaginalis infection
50
Symptoms of pneumocystis jiroveci infection
Progressive diffuse pneumonitis (hypoxia, tachypnea, dyspnea), Pulmonary infiltrates (non-productive cough, fever, rales)
51
Treatment options for pneumocystis jiroveci
Trimethoprim-Sulfamethoxazole. Alternatives - Pentamidine, Primaquine, Primaquine and Clindamycin, Trimethoprim and Dapsone, Atovaquone
52
Vector for toxoplasma infection
Uncooked meat, congenital infection, cat feces
53
Symptoms for toxoplasma infection
Lymphadenopathy, fever, headache, myalgia. Ranges from self-limiting febrile lymphadenopathy to lethal disease (immunocompromised pts) to congenital form.
54
Treatment options for Toxoplasma infection
Pyrimethamine with sulfadiazine or with clindamycin or with atovaquone. Alternative - Trimethoprim-Sulfamethoxazole
55
Vector for Cryptosporidia infection
Person to person, contamination of food or water with feces
56
Symptoms of cryptosporidia infection
GI. Worse in immunocompromised pts
57
Treatment options for cryptosporidia infections
Non-HIV - Nitazoxanide. HIV - No DOC. Can try Nitazoxanide, paromomycin, other combinations
58
Vection for microsporidia infection
Unknown
59
Symptoms of microsporidia infection
Ocular, intestinal (diarrhea), disseminated (kidney, liver, lung, peritoneal cavity). Worse in immunocompromised
60
Treatment options for microsporidia infection
Ocular - Albendazole plus fumagillin, Intestinal - Fumagillin or Albendazole, Disseminated - Albendazole.
61
What are sodium stibogluconate and meglumine antimonate used to treat and what is their mechanism?
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
Main AEs from Sodium Stibogluconate and Meglumine Antimonate
GI, fever, headache, myalgias, arthralgias, rash. Also EKG changes, abscess from IM administration
63
What is Pentamidine used to treat and what is its mechanism of action?
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
Main AEs of pentamidine
Toxicity limits use. Hypotension, tachycardia, dizziness, pancreatic toxicity, EKG changes, renal insufficiency
65
What is Paromomycin used to treat and what is its mechanism of action?
Amebiasis (luminal amebicide of choice), Giardia (2nd line), Leishmania (2nd line). Inhibits prokaryote protein synthesis
66
Main AEs of Paromomycin
GI symptoms, nephrotoxicity. Avoid in pts with renal disease or GI ulcers
67
What is miltefosine used to treat and what is its mechanism of action?
Leishmania (all types), Affects cell-signaling pathways and membrane synthesis
68
Main AEs of miltefosine
GI effects, elevation of hepatic enzymes and creatinine, teratogenic
69
What is Nifurtimox used to treat and what is its mechanism of action?
Trypanosoma cruzi (Chagas disease). Inhibits trypanothione reductase (specific to parasites), generating toxic oxygen radicals
70
Main AEs of nifurtimox
GI upset, fever, rash, CNS effects (neuropathies, seizures)
71
What drug is benznidazole similar to?
Nifurtimox (both used for acute Chagas disease). Benznidazole causes peripheral neuropathy and myelosuppression where Nifurtimox does not
72
What is eflornithine used to treat and what is its mechanism of action?
West African sleeping sickness (late stage with CNS involvement). Irreversible catalytic inhibitor of ornithine decarboxylase
73
Main AEs of eflornithine
Anemia, diarrhea, leukopenia, convulsions. Do not use during pregnancy
74
What is suramin used for and what is its mechanism of action?
East African SS (hemolyphatic stage), West African SS (2nd line). MoA largely unknown
75
Main AEs of Suramin
Really bad. Nausea, vomiting, seizures, shock death, fever, rash, headache, paresthesias, neuropathies, renal toxicity, hemolytic anemia, agranulocytosis
76
What is Melarsoprol used to treat and what is its mechanism of action?
East and West African SS (late stages with CNS involvement). Inhibits trypanothione reductase
77
Main AEs of melarsoprol
Toxicity limits use. Fever, vomiting, abdominal pain, arthralgias, reactive encephalopathy (death), renal and cardiac damage, hypersensitivity reactions
78
In what patients is melarsoprol contraindicated
Those with influenza, Glucose 6-PD deficiency
79
What is iodoquinol used to treat and what is its mechanism of action?
Asymptomatic amoeba infections (also plays role in more serious amoebae infections). MoA unknown

Immunity, Infection and Disease (86 decks)

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