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Pharmacology I Exam 3 > Antiprotozoal & Anthelmintic Agents > Flashcards

Antiprotozoal & Anthelmintic Agents Flashcards

1
Q

How is Metronidazole (Flagyl) administered?

A

Oral, IV, Topical

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2
Q

What is the MOA for Metronidazole (Flagyl)?

A

Inhibits DNA synthesis; Reduced by rxn with reduced ferredoxin; Metabolites taken up into DNA

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3
Q

What is the spectrum of Metronidazole?

A
  • Anaerobes only
  • Bacteriocidal – kills amoeba in tissue (trophozoites)
  • Penetrates CSF
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4
Q

What are the uses of Metronidazole?

A

DOC:
E. histolytica (+ luminal amebicide) (symptomatic)
G. lamblia
T. vaginalis

Other: 
B. fragilis
C. diff
Non-specific BV
Rosacea (+ clinda)
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5
Q

What are the toxicities of Metronidazole?

A
  • Disulfiram-like rxn
  • Dysgeusia (metallic taste)
  • GI
  • CNS/PNS toxicity (rare)
  • Candida superinfection
  • Hypersensitivity
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6
Q

What is the MOA for Tinidazole?

A

Similar to Metronidazole

Inhibits DNA synthesis; Reduced by rxn with reduced ferredoxin; Metabolites taken up into DNA

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7
Q

What are the uses of Tinidazole?

A

2nd DOC:
E. histolytica (+ luminal amebicide) (symptomatic)
G. lamblia
T. vaginalis

Used in those who cannot tolerate Metronidazole

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8
Q

How is Emetin and Dehydroemetine administered?

A

SC or IM injection

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9
Q

What are the uses for Emetin and Dehydroemetine?

A

Alternate to metronidazole for
E. histolytica

Limited to unusual circumstances in which metronidazole is not effective (would be unable to use tinidazole as it is a derivative of metronidazole)

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10
Q

What are toxicities of Emetin and Dehydroemetine?

A
  • Cardiotoxicity
  • Serious GI effects
  • Teratogenicity
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11
Q

When is Emetin and Dehydroemetine contraindicated?

A
  • Cardiac disease
  • Renal disease
  • Pregnancy
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12
Q

How is Iodoquinol administered?

A

Oral

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13
Q

What are the uses for Iodoquinol?

A

E. histolytica (asymptomatic)

Luminal trophozoites

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14
Q

What are toxicities of Iodoquinol?

A
  • High iodine content (thyroid enlargement, nail/hair/skin/sweat discoloration)
  • Optic neuritis/Optic atrophy – can lead to blindness (rare)
  • Skin rxn, HA, diarrhea
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15
Q

How is Paromomycin administered?

A

Oral, cream

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16
Q

What is the MOA of Paromomycin?

A

Aminoglycoside

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17
Q

What are the uses of Paromomycin?

A

Asymptomatic E. histolytica (or with metronidazole for symptomatic)

Giardiasis, T. vaginalis

Luminal trophozoites

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18
Q

Why are the side effects of Paromomycin not as severe as a typical aminoglycoside?

A

Not significantly absorbed from GI tract, so do not see typical side effects associated with aminoglycosides

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19
Q

What are the uses of Diloxanide furoate?

A

Luminal trophozoites

20
Q

What needs to be administered with Pyrimethamine + Sulfadiazine and why?

A

Administer with folinic acid (leucovorin) as pyrimethamine prevents conversion of folic acid

21
Q

What are the uses of Pyrimethamine + Sulfadiazine?

A 
DOC: 
Toxoplasma gondii (Toxoplasmosis)
22
Q

What is the MOA for Trimethoprim + Sulfamethoxazole (Bactrim)?

A

Inhibition of folate metabolism

23
Q

What are the uses for Trimethoprim + Sulfamethoxazole (Bactrim)?

A

DOC:
P. jirovecii (Pneumocystis pneumonia)

Prophylaxis against P. jirovecii in AIDS

Toxoplasmosis

24
Q

How is Pentamidine administered?

A

IM - active disease

Nebulizer - prophylaxis

25
Q

What is the MOA for Pentamidine?

A

Inhibits DNA replication

26
Q

What are the uses for Pentamidine?

A

P. jirovecii

Reserved for those who cannot tolerate Bactrim

27
Q

What are the toxicities of Pentamidine?

A
  • Hypotension, arrhythmias, hypoglycemia
28
Q

What is the DOC for symptomatic E. histolytica?

A

Metronidazole + luminal amebicide (diloxanide furoate, iodoquinol, paromomycin)

29
Q

What is the DOC for G. lamblia?

A

Metronidazole

30
Q

What is the DOC for T. vaginalis?

A

Metronidazole

31
Q

What is the 2nd DOC for symptomatic E. histolytica?

A

Tinidazole + luminal amebicide (diloxanide furoate, iodoquinol, paromomycin)

32
Q

What is the DOC for Toxoplasma gondii (Toxoplasmosis)?

A

Pyrimethamine + Sulfadiazine + folinic acid (leucovorin)

33
Q

What is the DOC for P. jirovecii (Pneumocystis pneumonia)?

A

Trimethoprim + Sulfamethoxazole (Bactrim) + folinic acid (leucovorin)

OR

Pentamidine (Pentam) in IM form (if cannot tolerate Bactrim)

34
Q

What is used for prophylaxis against P. jirovecii in AIDS patients?

A

Trimethoprim + Sulfamethoxazole (Bactrim)

OR

Pentamidine (Pentam) in nebulizer form (if cannot tolerate Bactrim)

35
Q

What is the MOA for Albendazole and Mebendazole?

A

Binds to parasite beta-tubulin, inhibiting microtubule polymerization – inhibits the microtubule-dependent uptake of glucose

36
Q

What are the toxicities of Albendazole and Mebendazole?

A
  • May be embryotoxic/teratogenic
  • Abd discomfort, diarrhea
  • Monitor liver function with long-term therapy
37
Q

What is the MOA for Pyrantel Pamoate?

A

Cholinesterase inhibitor; produces depolarizing neuromuscular blockade in worm

38
Q

What is the MOA for Ivermectin?

A

Paralyzes parasite; intensifies GABA-mediated transmission of signals in peripheral nerves

39
Q

What is the DOC for roundworms/nematodes?

A

Albendazole or Mebendazole or Pyrantel Pamoate

40
Q

What is the 2nd DOC roundworms/nematodes?

A

Ivermectin

41
Q

What is the DOC for Flukes/Trematodes?

A

Praziquantel

42
Q

What is the DOC for Tapeworms/Cestodes?

A

Praziquantel

43
Q

What is the 2nd DOC for Tapeworms/Cestodes?

A

Albendazole

44
Q

What is the DOC for asymptomatic E. histolytica?

A

Luminal amebicide:

Iodoquinol (Yodoxin)
Paromomycin (Humantin)
Diloxanide furoate (Furamide)
45
Q

If a patient cannot tolerate Bactrim for their P. jirovecii infection, what should be given instead?

A

Pentamidine (Pentam)

Pharmacology I Exam 3 (8 decks)

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