Fungal & Protozoa Flashcards
- Histoplasmosis
- Coccidioidomycosis
- Cryptococcoisis
- Blastomycosis
- Paracoccidioidomycosis
- Sporotrichosis
Systemic mycoses caused by pathogenic fungi
- Candida albicans
- Aspergillus species
- Trichosporon
- Candida glabrate
- Fusarium
- Alternaria
- Mucor.
Opportunistic fungi
MOA:
- Selectively toxic to fungi
- Interacts w/ or inhibits the synthesis of ergosterol
- A sterol unique to fungal cell membranes
Antifungal agents
What are the 2 targets for antifungal drugs?
- cell membrane
- cell wall
Susceptibility Activity of which drugs?
- Candidemia
- Aspergillus
- Blastomyces
- Cryptococcus
- Coccidioides
- Histoplasma
- Mucormycosis
- Amphotericin B
- Azoles
- Ketoconazole
- Fluconazole* (prototype)
- Itraconazole
- Posaconazole
- Voriconazole
Which drug?
- Binds to ergosterol in fungal cell membranes forming “leaky pores”
- Tx Candidemia
- Nephrotoxicity is dose-limitng, additive w/ other nephrotoxic drugs
- Infusion rxns (Chills, fever, muscle spasms, hypotension)
Amphotericin B
“Amphoterrible”
Which drug?
- Interferes w/ DNA & RNA synthesis selectively in fungi
- Tx Cryptococcus and chromoblastomycosis infections
- Toxcities: renal excretions & myelosuppression
Flucytosine
MOA of Azoles as antifungals
- Ketoconazole
- Fluconazole
- Itraconazole
- Posaconazole
- Voriconazole
Inhibit fungal P450 dependent enzymes blocking ergosterol synthesis
- Resistance can occur w/ long-term use
What are the 3 clinical applications of Azoles
- Aspergillosis
- Blastomycosis
- Mucormycosis
- Azoles have various topical & oral forms for ____.
- Oral & parenteral forms for _____
- dermatophytoses
- mycoses
- Most azoles undergo ____ metabolism.
- ______ eliminated in urine unchanged.
- hepatic
- Fluconazole
- ______ is rarely used in systemic fungal infections owing to its inhibition of hepatic and adrenal P450s
- Other azoles are less toxic, but may cause which 2 sxs?
- _____ causes visual disturbances & class D for pregnancy risk
- Ketoconazole
- GI upsets & rash
- Voriconazole
Which drug?
- Inhibits epoxidation of squalene
- Tx for mucocutaneous fungal infections (accumulates in keratin)
- Oral: long duration of action (weeks)
- Toxicities: GI upsets / HA
Terbinafine
- What is the 1st line tx for Aspergillus species?
-
What is the 1st line tx for:
- Balstomyces
- Candida
- Cryptococcus
- Coccidioides immitis
- Histoplasma
- Mucoraceae
- Sporothrix
- Voriconazole
- Amphotericin B (if this is not an option choose an Azole)
Which 3 antifungals cause Nephrotoxicity?
- Amphotericin B
- IV Itraconazole
- IV Voriconazole
Which 4 antifungals cause abdominal discomfort?
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
Which antifungals cause increased hepatic transaminases?
All 6:
- Amphotericin B
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
- Echinoconazole
Which antifungals cause Rash & photosensitivity?
- Fluconazole
- Itraconazole
- Voriconazole (Vori-Malignancy)
- Posaconazole
- Echinoconazole
(All except Amphotericin B)
Which 2 antifungals cause Infusion related reactions/Histamine release?
- Amphotericin B
- Echinoconazole
Which antifungal causes CNS & visual disturbances?
- Voriconazole
Which antifungals cause Cardiomyopathy?
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
- Echinoconazole?
NOT ampho
The treatment for ____ actually made the condition worsen. Go to CDC website to find out what to give patients for tx.
Malaria
What tx?
- Used to tx infections caused by protozoa (single cell organisms that belong to type of parasites)
- Occur throughout the world
- Major cause of morbidity and mortality in some regions such as ____ & South-East Asia.
Antiprotazoal Treatments
What are the 3 diseases caused by protazoa?
- Malaria
- Giardia
- Trichomoniasis
What is special about the treatment of malaria?
They are used to both TREAT and PREVENT malaria
What are the 4 antimalarial drugs?
- Mefloquine
- Chloroquine
- Atovaquone-proguanil (Malarone)
- Doxycycline
- Pimaquine
What is the MOA of antimalarial drugs?
Kill / inhibit growth of protozoa by affecting different stage of parasitic life cycle
Prevention of Malaria
- Choice of drugs is based on what?
Destinations visiting
Which Tx of Malaria?
- Treatment & chemoprophylaxis of infections w/ sensitive parasites
Chloroquine
Which tx of Malaria?
- Chemoprophlaxis & tx of infections w/ P falciparum
- Mefloquine
- Atovaquone-proguanil (Malarone)
Which tx of Malaria?
- Radical cure and terminal prophylaxis of infections w/ Plasmodium vivax and Plasmodium ovale; alternative for malaria chemoprophylaxis
Primaquine
Which tx of malaria?
- Treatment (with quinine) of infections w/ P falciparum; chemoprophylaxis
Doxycycline
- GI upset, so give w/ Cola
- Photosensitivity
- Can give to children if duration is <21 days
Doxycycline
Which Malaria drug?
- Dyspepsia
- Insomnia
- Vivid dreams*
- Use w/ caution in pts w/ epilepsy, szs, depression, or other mental health problems, severe heart or liver problems
Mefloquine
Which Antimalarial tx?
- Convulsions
- Visual disturbances
- Depigmentation or loss of hair
- Use w/ caution in pts w/ neurological disorders (myasthenia gravis), glucose-6-phosphate dehydrogenase deficiency (which helps RBCs function), liver & renal problems
Chloroquine
Which antimalarial tx?
- Insomnia & “abnormal” dreams
- Depression*
- Should not be given to pregnant or breastfeeding women
- Not recommended for pts w/ severe kidney problems
Atovaquone-proguanil (Malarone)
Which antimalarial tx?
- N/V/D
- Causes yellow teeth and teeth disfigurement if taken during development
- Should not be given to pregnant/breastfeeding women & children under 8 yrs
- Avoid taking w/ antacids, milk , Ca, or Mg salts
- Photosensitivity may occur
- Avoid prolonged sunligh exposure and use appropriate sunscreen
Doxycylcine
What is the tx for Giardia lamblia?
- Metronidazole
Tx for Leishmaniasis
- Cutaneous is spread by what?
Sodium stibogluconate
- Sandflies
Protozoa tx for pregnancy
Spiramycin (daiy until delivery)
Protozoa tx for Trichomonas vaginalis
Metronidazole
