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Hunts 1A > Fungal Tx, Protozoa > Flashcards

Fungal Tx, Protozoa Flashcards

Exam 2

1
Q

Oral candidiasis

A

Topical - Nystatin, Clotrim, Micon
Systemic - Fluconazole
Alt - Gentian Violet x 3 d

all treatments 7 to 14 d

Topical - Nice Mico Clot
- nice small clot
Systemic- Fluconazole

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2
Q

Esophageal candidiasis

A

Always systemic
Oral- Fluconazole
IV-Fluconazole

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3
Q

Vulvovaginal Candidiasis

A

Topical -1 3 7 regimen of either Miconazole, clotrimazole, terconazole
Systemic - Fluconazole, Ibrexafungerp (1 d)
Recurrent - Azoles 1x wk or fluconazole 1xwk
Alternative tx - gent violet, boric acid

137 Small turkey clot

Flu rex (flying rex)

Recurrnt - azoles

alt- violet boric

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4
Q

Candidal Intertrigo

A

Correct underlying factors.
Drying agents - talc, nystatin powder
Topical - Nystatin until resolve
Systemic - only if severe, fluconazole

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5
Q

Tinea Capitis

A

Systemic - griseofulvin, terbinafine; may consider fluconazole, itraconazole

Greasy Terbine

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6
Q

Tinea Corporis

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine QD-BID until cleared (1-3 wks)
Systemic - extensive or refractory - griseofulvin, terbinafine, fluconazole, itraconazole

wizard, butane, Toll-na-fate, Circlepirate, Terbine

topical - Abc, tollnafate or terbine
systemic - Greasy turbine, fly its blue

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7
Q

Tinea Cruris

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine until cleared (1 wk); drying powders
Systemic - extensive or refractory - griseofulvin, terbinafine, fluconazole, itraconazole

Topical - abc, terbine, tollnafate
systemic - greasy turbine, fly its blue

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8
Q

Tinea pedis

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine
If macerated - consider adding aluminum subacetate soaks 20 min BID
Systemic - extensive or refractory - terbinafine, itraconazole, fluconazole, griseofulvin

abc, terbine, tollnafate
greasy turbine fly its blue

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9
Q

Tinea Ungium

A

Topical - efinaconazole, tavaborole, or ciclopirox
Systemic - terbinafine, itraconazole

CE, boringtavern
its a blue turbine

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10
Q

Disseminated Candidiasis

A

First-line (especially if critically ill or non-albicans strain) - IV echinocandins
Caspofungin

Mild to moderate - fluconazole IV

casper the ghost

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11
Q

Histoplasmosis

A
  • Mild-Moderate - itraconazole
  • Severe - IV amphotericin B
  • Granulomatous/Fibrosing Mediastinitis - may try itraconazole +/- rituximab, +/- corticosteroids; often need surgical intervention

mildly blue, severely amphitheater
-granulomatous/fibrous media - its blue ritz cortico, +- surgery

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12
Q

Coccidioidomycosis

A

Mild-Moderate - fluconazole or itraconazole

Severe/Disseminated - IV amphotericin then switched to azole

Abscesses may need surgical management

Prophylactic - AIDS pts with CD4 count <250 will require maintenance therapy with an azole to prevent relapse

mild -blue fly
severe/disseminated- amphitheater–> wizard

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13
Q

Blastomycosis

A

Mild-Moderate - itraconazole
Severe/CNS involvement - IV amphotericin B

its a (mild) blue (severe) amphitheater

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14
Q

Cryptococcosis

A

Pneumonia - fluconazole
Meningitis - IV amphotericin B + flucytosine, then fluconazole for 8 weeks

mona lisa - fly
meningitis - amphitheater blue fly

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15
Q

Pneumocytosis

A

TMP-SMZ

bactrim!

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16
Q

Amebic Dysentery

A

Initial - metronidazole (10 days) or tinidazole (3 days)
Eliminates E. histolytica trophozoites

Followed by - paromomycin
(PO aminoglycoside)
Eliminates E. histolytica cysts
May be only tx if pt has no s/s

first tin metro kills trophozioites, then paramore kills cysts

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17
Q

Giardiasis

A

tinidazole
-nitaoxanide 1-3 y/o
-metronidazole less than 1 yr old

Tin nightox for 1-3, but infants fo on the metro

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18
Q

Nitazosanide

A
  • interferes with normal reproduction cycle of Cryptosporidium and Giardia
  • SE: discolored bright urine

“not azo” = nitazosanide. causes bright discolored urine

19
Q

Cryptosporidiosis

A

Acute is self limiting
-if IC, nitazoxanide or paromomycin. can add Z if needed

nightox or paramore =+ Z

19
Q

Cyclosporiasis

A

1st -Bactrim
2nd line- cipro, nitazoxanide

1st Back, C nightox

20
Q

Trichomoniasis

A
  • Tinidazole or Secnidazole
  • Alternative - metronidazole
  • Refractory - tinidazole, +/- vaginal boric acid or paromomycin
  • Must also treat all sexual partners!

Tin Sex (secnid), alt metro

21
Q

Toxoplasma gondii

A
  • Immunocompetent - tx not necessary in acute disease
  • Prolonged or severe: 2-4 wks: pyrimethamine + lecovorin + sulfadiazine OR clindamycin
  • Pregnancy - Spiramycin (reduces transmission risk)
  • Immunodeficiency or Fetal Infection - pyrimethamine + sulfadiazine
  • Pyrimethamine is teratogenic - not used in early pregnancy

1st self correcting
if it doesnt work, pyrimeth + leco + sulfa OR clin

22
Q

Plasmodium falciparum

A
  • aka toxoplasmosis
  • Immunocompetent - tx not necessary in acute disease
  • Prolonged or severe: 2-4 wks: pyrimethamine + lecovorin + sulfadiazine OR clindamycin
  • Pregnancy - Spiramycin (reduces transmission risk)
  • Immunodeficiency or Fetal Infection - pyrimethamine + sulfadiazine
  • Pyrimethamine is teratogenic - not used in early pregnancy

acute - no treat unless IC
prolonged/severe - firemath + Le’cover + sulfa OR clean
preg - spira
IC - firemath + sulfa

23
Q

Plasmodium falciparum

P. vivax, P. ovale, P. malariae

A

first step is to hospitalize.

non-falciparum malaria:
* * 1st line for susceptible (non-falciparum) malaria: Chloroquine or Hydroxychloroquine

  • First line drugs now based on region acquired
    1st line for Falciparum and resistant non-falciparum malaria: **ACTs **
  • AC=Artemisinin-based combination therapy
  • Contain a short-acting artemesinin drug and a longer-acting partner drug
  • Artemether-lumefantrine (Coartem) - approved in the US

If resistant to ACT therapy or unable to tolerate…
* Malarone (atovaquone-proguanil)
* Quinine plus tetracycline, doxycycline, or clindamycin
* Mefloquine (Lariam) - resistance increasing

1st line - Severe Malaria
* IV artesunate - must be obtained from CDC

chloroqueen (swim at pool), hydroxy = hydra

hospitalize.
non-falc: swimming queen + hydra
falc/resist-ACT - artemether-lumefantrine (artsy mother)
falc/resist-alt - Mala-Quin (bad queen) + clinda, doxy, tetra

severe only- IV artesunate (CDC obtain first)

24
Q

Artemether-lumefantrine (Coartem) -

A

ART approved in the US

25
Q

Quinoline Derivatives category

A
  • Activity against the erythrocytic stage of infection
  • Primiquine also kills intrahepatic forms and gametocytes (seen with P. vivax and P. ovale)

queens stop RBC death
prom queen kills liver/gametocyte

26
Q

Chloroquine

A

First line for tx and prophylaxis of susceptible pathogens
MOA - accumulates in parasite food vacuole and complexes with heme, preventing heme breakdown and allowing cytotoxic free heme to accumulate
Rapid onset - clears fever in 24-48 hrs and parasitemia in 48-72 hrs
SE - usually minor; pruritis (MC); HA, N/V, abdominal pain, malaise

quinoline derivative

pool queen

27
Q

Primaquine

A
  • Drug of choice for elimination of dormant liver cysts (P. vivax, P. ovale)
  • Typically used after tx with chloroquine or quinine
  • SE - prolonged QT, cardiac dysrhythmia, N/V/D, abdominal pain
  • CI - G6PD Deficiency, pregnancy, breastfeeding

Quinoloe derivative

prom queen

28
Q

Mefloquine

A
  • Mefloquine
  • Often used for prophylaxis - can be dosed weekly
  • Greater problems with toxicity when used therapeutically
  • SE - cardiac dysrhythmias, psychologic disturbances, seizures, N/V/D, HA, abdominal pain
  • CI/Avoid - hx of seizure disorder; hx of major psychiatric disorders; hx of dysrhythmia

me-flow / air queen

29
Q

Qhinine/Quinidine

A
  • Quinine/Quinidine
  • Derived from the bark of the South American cinchona tree
  • MOA - Antimalarial MOA not well understood; quinidine is a class IA antiarrhythmic agent
  • SE - “cinchonism” - nausea, HA, tinnitus, blurred vision, dizziness
  • Hypersensitivity - rash, angioedema, urticaria, bronchospasm
  • Hematologic - hemolysis, agranulocytosis, leukopenia, thrombocytopenia
  • Cardiac - ECG changes (prolonged QT), arrhythmias
  • Given x 7 d; to reduce toxicity, often combined with abx (doxycycline) to shorten tx to 3 d**

basic queen. princess?

30
Q

Arovaquone-proguanil

A
  • Antifolate Drugs
  • MOA - interferes with folate metabolism, blocking nucleic acid synthesis
  • SE - generally well tolerated; N/V, HA, abdominal pain, pruritis; transient AST/ALT elevation

Aurora Queen/ A rowing queen

31
Q

Artemisinin Derivatives

A
  • Artemether-lumefantrine (Coartem)
  • Derived from leaves of Artemisia annua, an herb used in Chinese medicine
  • MOA - encourage formation of free radicals that damage parasite; active against all forms
  • Fastest parasite clearance times of any antimalarial
  • Rapid absorption, rapid onset
  • Short half-life - not good for chemoprophylaxis, and only given in combo regimens
  • SE - generally well tolerated; HA, N/V/D, anorexia
  • Rare - neutropenia, hemolysis, anemia

Artemis

32
Q

Prophylaxis antimalarial- Chloroquin & Mefloquine

A

Chloroquin & Mefloquine

once weekly dosing
-safe for preg

Have to start 1-2 weeks before trip and for 4 weeks after the trip

chloro=swim q, meflow=air q

water & air

33
Q

Antimalarial prophylaxis- atovaquone-
proguanil, doxycycline, primaquine

and their cons for each drug

A

Can use the day before the trip
-daily dosage
-no preg/breastf

atovaquone-proguanil (malarone) $$$
doxy - GI upset, photosens, yeast infection
primaquine - CI G6PD def. or no test for it

malarone = atovaquone-proguanil

mal, prom queen, doxy

34
Q

Taeniasis

Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), Diphyllobothrium latum (fish tapeworm)

A
  • Intestinal - praziquantel (Biltricide)
  • May also try albendazole
  • Neurocysticercosis - controversial
  • Clearance of cysts vs. inflammatory response to dead/dying pathogens
  • When pharmaceutical treatment performed, albendazole +/- corticosteroids
35
Q

Ancylostoma duodenale, Necator americanus

A

-Hookworms
Albendazole
Mebendazole - lower cure rates
Tx for anemia and low protein as appropriate

All band vs me band (myself)

36
Q

Praziquantel

A
  • MOA - allows increased calcium to enter parasitic cells, causing muscle spasms and paralysis and leading to worm detachment from host
  • CI - allergy to medication, ocular cysticercosis
  • DDI - several - antimalarials, grapefruit juice, cimetidine
  • SE - GI upset, headache, dizziness
  • May see 2o inflammatory response following pathogen death

Praise or Prezident

37
Q

Benzimidaoles

Albendazole, Mebendazole

A

MOA - inhibits helminth microtubule formation and glucose uptake
CI - allergy to medication
DDI - antimalarials, grapefruit juice, cimetidine, anticonvulsants
SE - Abdominal pain, N/V/D
Albendazole may cause elevated LFTs and/or, in long-term tx, neutropenia or agranulocytosis

all band vs myself band

38
Q

Enterobius vermicularis

A
  • aka pinworms enterobiasis
  • Albendazole x 1 dose or mebendazole x 1 dose
  • Repeat in 2 weeks!
  • Pyrantel pamoate preferred if pregnant
  • Tx of infected family members and close contacts
  • Washing bed sheets, clothing
  • Avoid perianal scratching
  • Education on hand hygiene

alband or meband
pin away if pregnant
treat contacts

39
Q

Pyrantel pamoate

A

aka pin-away
MOA - anticholinesterase drug; depolarizes neuromuscular cells and paralyzes the helminths
Minimal systemic absorption - considered safer in pregnancy than other antihelminthic drugs
CI - allergy to medication
DDI - no known significant interactions
SE - GI upset, headache, dizziness

40
Q

Trichinella spiralis -

Trichinosis

A
  • Mild infection - supportive care (analgesics, antipyretics, bed rest, steroids)
  • Systemic symptoms - albendazole or mebendazole +/- steroids
  • Prevention - thoroughly cooking meat

only supportive unless systemic
all band or me band

41
Q

Ascaris lumbriocoides

Ascariasis

A
  • Roundworms
  • Treatment - as with hookworms
  • Albendazole
  • Mebendazole
  • If pregnant - pyrantel pamoate

all band or me band
pin away if preg

42
Q

atovaquone is?

A

malarone

Hunts 1A (14 decks)

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