Antiprotozoals, Anthelmics Flashcards
What is the DOC for Amebiasis (Entamoeba hystolitica) (2)?
- Symptomatic: Metronidazole + Luminal
- Asymptomatic: ONLY Luminal
What is the DOC for Giardia?
Metronidazole
What is the DOC for Trichomonas vaginalis?
Metronidazole
What is the DOC for Toxoplasmosis?
Pyrimethamine-Sulfadiazine (+ Leucovorin)
What is the DOC for Pneumocystis jirovecii?
Trimethoprim-Sulfamethoxazole aka Bactrim (+ Leucovorin)
Describe the lifecycle of amebiasis
Cysts either…
- Enter liver and form trophozoites (tissue = symptomatic)
- Discarded in feces (asymptomatic)
What is Metronidazole the DOC for (3)?
- Amebiasis (Entamoeba hystolitica)
- Giardia
- Trichomonas vaginalis
What is the MOA for Metronidazole? What is the only type of organism it can interact with?
Reacts with ferredoxin and creates unstable DNA
- ONLY anaerobes
What are the two primary toxicities associated with Metronidazole?
- Disulfiram-like reaction
- Metallic taste (dysgeusia)
What is the alternative to Metronidazole, and why would you consider using it?
Tinidazole: alternative to Metronidazole and sometimes better tolerated
- Similar MOA as Metronidazole
What is the last resort option for treating tissue amebicides (2)? Why are they considered last resort options?
Emetine or Dehydroemetine
- VERY TOXIC
What are the three primary toxicities associated with Emetine or Dehydroemetine?
- Cardiotoxicity
- GI issues
- Teratogenic
What are the two primary luminal amebicides? What can these be combined with to treat tissue amebicides?
- Paromomycin
- Iodoquinol
Both can be combined with Metronidazole to treat tissue amebicides
What is Paromomycin the DOC for (3)?
Asympatomatic/luminal Entamoeba, Giardia, Trichomonas
What class of drugs is Paromomycin from, and how does this affect its toxicity?
Aminoglycoside BUT less toxic (no oto- or nephrotoxicity)
What is Iodoquinol the DOC for?
Asympatomatic/luminal Entamoeba
What are the two primary toxicities associated with Iodoquinol?
- High iodine content
- Eye issues
What is Pyrimethamine-Sulfadiazine the DOC for? What should it always be combined with, and why?
Toxoplasmosis
- Combine with Leucovorin (helps supplement folic acid lost - MOA is inhibition of folic acid synthesis)
What is Trimethoprim-Sulfamethoxazole (Bactrim) the DOC for? What should it always be combined with, and why?
Pneumocystis jirovecii
- Combine with Leucovorin (helps supplement folic acid lost - MOA is inhibition of folic acid synthesis)
What is the alternative medication used to treat Pneumocystis jirovecii, and under what conditions would it be used?
Pentamidine: alternative to Trimethoprim-Sulfamethoxazole (Bactrim) in treatment of Pneumocystis jirovecii
- Use if Bactrim not tolerated (allergy or HIV+)
What is the DOC for roundworms (3)?
- Albendazole OR Mebendazole
- Pyrantel Pamoate
What is the DOC for tapeworms?
Praziquantel
What is the DOC for flukes?
Praziquantel
What is the MOA for Albendazole and Mebendazole?
Binds to beta-tubulin and inhibits glucose uptake by microtubules
Why are Albendazole OR Mebendazole often considered the primary DOC for roundworms (2)?
- Broad spectrum
- Can be used for MIXED infection (multiple species at once)
What is the MOA for Pyrantel Pamoate?
Cholinesterase inhibitor → Depolarized neuromuscular blockade
What is Pyrantel Pamoate considered an alternative DOC for, and why is it the alternate/not the primary choice (think administration)?
Alternative DOC for roundworm (Albendazole OR Mebendazole are primary DOC)
- It can be obtained OTC (easier access)
What is Praziquantel the DOC for (2)?
- Tapeworms
- Flukes
