GI Infections Pharm

Question 1

Antiobiotics that cause C. diff (4)

Answer 1

Fluoroquinolones
Clindamycin
Broad specturm cephalosporins
Broad spectrum penicillins

Question 2

C. diff Treatment

Drugs (3), Indications and Distributions

Answer 2

Vancomycin
Severe infection
Oral dose, stays in GI tract

Metronidazole
Mild Infection
IV/Oral dose, goes systemic

Fidaxomicin
Recurrent infection

Question 3

Metronidazole Adverse Effects (2)

Answer 3

Metallic taste in mouth

Disulfiram-like effect (vomiting if taken with alcohol)

Question 4

Invading Entamoeba histolytica

Complications (2) Diagnosis and Treatment (4)

Answer 4

Liver abscesses
Pulmonary abscesses (deadly)

Visualize amoeba with ingested RBC in cytoplasm

Treat with Invading and Luminal Amebicides:
Metronidazole
Tinidazole
Paromomycin or Iodoquinol

Question 5

Asymptomatic Entamoeba histolytica

Diagnosis and Treatment (2)

Answer 5

Amoeba visualized without RBC in cytoplasm

Luminal amebicides:
Paromomycin*
Iodoquinol

Question 6

Iodoquinol
Adverse Effects (3)

Answer 6

Iodine allergies
Mild GI/CNS issues
Rash

Question 7

Giardia lamblia
Clinical Description (2), Appearance and Treatment (3)

Answer 7

Causes steatorrhea without blood
Coats small intestine without invading

Kite shaped trophozoid

Tinidazole*
Metronidazole
Nitazoxanide

Question 8

Nitazoxanide

MOA (2) and Adverse Effects (4)

Answer 8

Prodrug that inhibits pyruvate-ferrodoxin oxidoreductase

Flatulence
Yellow eyes
Bright yellow urine
Enlarged salivary glands

Question 9

Cryptospiridium parvum
Clinical Features (2) and Treatment (3)

Answer 9

Severe, life threateneing diarrhea (3-17 L/day)
Seen in immunocompromised patients

Nitazoxanide
Paromomycin
Loperamide

Question 10

Necator americanus/Ancylostoma duodenale (Hook)

Key Life Cycle Features (2), Presentation (5) and Treatment (3)

Answer 10

Penetrates feet
Eggs excreted in feces (stool analysis to diagnose)

Diarrhea 
Abdominal pain
Weight loss
Anemia
Penetration site itching

Albendazole**
Mebendazole
Pyrantel pamoate

Question 11

Ascaris lumbricoides

Key Life Cycle Features (2), Presentation (2) and Treatment (3)

Answer 11

Infects via egg consumption
Excreted in feces (stool analysis to diagnose)

Abdominal cramping
Malnutrition

Albendazole**
Mebendazole**
Ivermectin

Question 12

Strongyloides stercoralis

Key Life Cycle Features (5) and Unique Clinical Feature

Answer 12

Worms penetrate skin
Eggs hatch in GI (eggs not in feces)
Larvae autoinfect
Larvae infect perianal area
Larvae excreted in feces

Immunosuppression via prednisone for asthma can lead to severe autoinfection

Question 13

Strongyloides stercoralis

Presentation (5), Diagnosis (2) and Treatment (2)

Answer 13

Vomiting
Bloating
Diarrhea 
Anemia
Weight Loss

Larvae in feces
Enterotest (eggs on ingested string)

Ivermectin**
Albendazole

Question 14

Trichuris trichiura

Key Life Cycle Features (6), Presentation (2) and Treatment (3)

Answer 14

Infection via football shaped egg ingestion
No larvae
No invasion
No lung involvement
No eosinophilia
No autoinfection

Abdominal pain
Diarrhea

Mebendazole**
Albendazole
Ivermectin

Question 15

Enterobius vermicularis

Key Life Cycle Features (2) Clinical Features (2) and Treatment (3)

Answer 15

Infection via egg ingestion
Female lays eggs in perianal area at night

Severe perianal itching
No eosinophilia
Diagnose with scotch tape test

Albendazole**
Mebendazole**
Pyrantel Pamoate**

Question 16

Albendazole and Mebendazole

Description (2) and MOA (2)

Answer 16

Broad spectrum prodrugs

Paralyze worms by inhibiting microtubule synthesis

Question 17

Thiabendazole

MOA and Adverse Effects (4)

Answer 17

Inhibit microtubule synthesis

Liver toxicity
Dizziness
Anorexia
N/V

Question 18

Ivermectin

MOA (2)

Answer 18

Paralyzes worms by increasing GABA signaling in peripheral nerves

Question 19

Pyrantel Pamoate

MOA (2)

Answer 19

Paralyzes worms by increasing acetycholine and decreasing acetylcholinesterase to blockade NMJ

Question 20

Schistosomas (blood flukes)

Key Life Cycle Features (5) Presentation (3) and Treatment

Answer 20

Invade any exposed skin
Eggs hatch in water
Adult worms do molecular mimicry to avoid immunity
Japonicum/Mansoni release eggs into feces
Haemotobium release eggs into urine

Dermatitis
Katayama Fever (fever, hives bronchospasm)
Chronic fibrosis

Praziquantel

Question 21

Praziquantel

MOA and Adverse Effects: Immediate (4) and Late (3)

Answer 21

Paralyze worms via increased Calcium permeability

Immediate: Headache, Dizzy, Drowsy, Lassitude
Late: Low grade fever, Pruritis, Skin rash

*Immediate are from drug and late are from immmune reaction to dead worms

Question 22

Taenia solium and Taenia saginata
Key Life Cycle Features (2), Animal Hosts (2)
Presentation (2)

Answer 22

Animal eats from field contaminated by human feces
Human eats undercooked meat and ingests eggs

Taenia solium found in pork
Taenia saginata found in beef

Weight loss
Malnutrition

Question 23

Diphyllobothrium latum

Infectious Route, Diagnosis (2) and Presentation

Answer 23

Ingesting larvae in raw freshwater fish

Proglottids and eggs in feces

Vitamin B12 deficiency (pernicious anemia)

Question 24

Echinococcus granulosus

Life Cycle Features (3)

Answer 24

Humans ingest eggs from dog feces
Eggs hatch in intestines
Larva form hydatid cysts in muscle

Question 25

Cestodes (Tape worms)

Examples (4) and Treatment (3)

Answer 25

Taenia solium
Taenia saginata
Diphyllobothrium latum
Echinococcus granulosus

Praziquantel**
Albendazole**
Niclosamide

Question 26

Niclosamide

MOA (2) and Issues (3)

Answer 26

Kills parasite by uncoupling Oxidative Phosphorylation

Side effects
Long therapy duration
Lack of availability