Fungal Tx, Protozoa Flashcards
Exam 2
Oral candidiasis
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
Esophageal candidiasis
Always systemic
Oral- Fluconazole
IV-Fluconazole
flying esophagus
Vulvovaginal Candidiasis
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
Candidal Intertrigo
Correct underlying factors.
Drying agents - talc, nystatin powder
Topical - Nystatin until resolve
Systemic - only if severe, fluconazole
Tinea Capitis
Systemic - griseofulvin, terbinafine; may consider fluconazole, itraconazole
Greasy Terbine
Tinea Corporis
RINGWORM
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
or, Fly! Greasy blue turbine
Tinea Cruris
JOCK ITCH
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 - Fly! Greasy blue wind turbine
Tinea pedis
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
Fly! Greasy blue turbine
Tinea Ungium
Topical - efinaconazole, tavaborole, or ciclopirox
Systemic - terbinafine, itraconazole
C Eh, boringtavern
blue turbine
Disseminated Candidiasis
First-line (especially if critically ill or non-albicans strain) - IV echinocandins
Caspofungin
Mild to moderate - fluconazole IV
casper the ghost
Histoplasmosis
- Mild-Moderate - itraconazole
- Severe - IV amphotericin B
- Granulomatous/Fibrosing Mediastinitis - may try itraconazole +/- rituximab, +/- corticosteroids; often need surgical intervention
farm with 4 crops
mildly blue, severely amphitheater
-granulomatous/fibrous media - granulomatous blue ritz crackers/cortico, +- surgery
Coccidioidomycosis
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
valley fever
mild -blue fly
severe/disseminated- amphitheater–> wizard
Blastomycosis
Mild-Moderate - itraconazole
Severe/CNS involvement - IV amphotericin B
woodsman disease. man on a hike looks at the sky. he comes to an ivy amp
its a (mild) blue (severe) amphitheater
Cryptococcosis
Pneumonia - fluconazole
Meningitis - IV amphotericin B + flucytosine, then fluconazole for 8 weeks
pidgeon park
mona lisa - fly
meningitis - amphitheater blue fly
Pneumocytosis
TMP-SMZ
sudden onset SOB
bactrim!
imagine falling back from SOB
Entamoeba Histolytica
Amebic Dysentery
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
Giardiasis
tinidazole
-nitaoxanide 1-3 y/o
-metronidazole less than 1 yr old
only Tin, nightox for 1-3, but infants on the metro
Nitazosanide
- interferes with normal reproduction cycle of Cryptosporidium and Giardia
- SE: discolored bright urine
“not azo” = nitazosanide. causes bright discolored urine
Cyclosporiasis
1st -Bactrim
2nd line- cipro, nitazoxanide
haiti peru nepal
1st Back (cycle type disease)
2nd sip nightox (chocolate milk)
Trichomoniasis
- Tinidazole or Secnidazole
- Alternative - metronidazole
- Refractory - tinidazole, +/- vaginal boric acid or paromomycin
- Must also treat all sexual partners!
Tin Sex (secnid), alt metro
Toxoplasma gondii
- 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
cat
1st self correcting
if it doesnt work, pyrimeth +lecava(lecavo) + sulfa OR clin
IC= sulfa + firemath
Delete card
- aka malaria
- 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 + Cava salad + sulfa OR clean
preg - spira
IC - firemath + sulfa
Plasmodium falciparum
P. vivax, P. ovale, P. malariae
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 (artemis OP)
falc/resist-alt - Mala-Quin (bad queen) + clinda, doxy, tetra
severe only- IV artesunate (CDC obtain first)
IVY -art-sun-ate picture ivy ruins w/ art on the walls and having to go summon something from ancient ruins b/c the malaria is so strong
Artemether-lumefantrine (Coartem) -
ART approved in the US
Quinoline Derivatives category
- 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
Chloroquine
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
Primaquine
- 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
Mefloquine
- 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
Qhinine/Quinidine
- 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?
Arovaquone-proguanil
- 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
Artemisinin Derivatives
- 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
Prophylaxis antimalarial- Chloroquin & Mefloquine
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
Antimalarial prophylaxis- atovaquone-
proguanil, doxycycline, primaquine
and their cons for each drug
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
Taeniasis
Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), Diphyllobothrium latum (fish tapeworm)
- Intestinal - praziquantel (Biltricide)
- May also try albendazole
- Neurocysticercosis - controversial
- neurocysticerosis is controversial bc Clearance of cysts vs. inflammatory response to dead/dying pathogens
- When pharmaceutical treatment performed, albendazole +/- corticosteroids
President intensinal tapeworm
or a full band
Ancylostoma duodenale, Necator americanus
-Hookworms
Albendazole
Mebendazole - lower cure rates
Tx for anemia and low protein as appropriate
All band more effective than my band
Praziquantel
- 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
Benzimidaoles
Albendazole, Mebendazole
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
Enterobius vermicularis
- 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
Pyrantel pamoate
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
Trichinella spiralis -
Trichinosis
- 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
Ascaris lumbriocoides
Ascariasis
- Roundworms
- Treatment - as with hookworms
- Albendazole
- Mebendazole
- If pregnant - pyrantel pamoate
all band or me band
pin away if preg
atovaquone is?
malarone
Cryptosporidiosis
Acute is self limiting
-if IC, nitazoxanide or paromomycin. can add Z if needed
giant pink easter egg in the pool
nightox or paramore =+ Z
