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PPP Spring Final > HIV/Antifungal/Antiparasitic > Flashcards

HIV/Antifungal/Antiparasitic Flashcards

1
Q

Possible treatment regimens for newly diagnosed HIV patients?

A

2 NRTIs + 1 NNRTI
2 NRTIs + 1 PI
2 NRTIs + 1 INSTI

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2
Q

MOA of Maraviroc

A

Bind and inhibit CCR5

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3
Q

MOA of Enfuvirtide (Fuzeon)

A

Inhibit viral fusion by blocking gp41

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4
Q

Name common NRTIs (“nukes”)

A 
"dine, bine"
Tenofovir
Abacavir
Emtricitabine
Lamivudine
Zidovudine
Stavudine
Didanosine
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5
Q

Adverse Effects of NRTI’s (excluding abacavir)

A

PLAN
Pancreatitis - AE for all, BBW for didanosine
Lactic acidosis
Anemia
Neuropathy
Renal and bone toxicities - only tenofovir

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6
Q

Adverse Effects of Abacavir

A

Abacavir hypersensitivity = multiorgan clinical syndrome caused by HLA-B*5701

  • flu like symptoms + respiratory symptoms
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7
Q

Name common NNRTIs

A

Efavirenz
Nevirapine
Etravirine
Rilpivirine

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8
Q

Adverse Effects of NNRTIs

A

Rash
Hepatotoxicity
Vivid dreams/stoned feeling - efavirenz
Teratogenic

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9
Q

What NNRTIs do you take with or without food?

A

Efavirenz - without food
Etravirine - with food
Rilpivirine - with food

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10
Q

Name common INSTIs

A

Elvitegravir + cobicistat
Raltegravir
Dolutegravir

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11
Q

Name common PIs

A

Lopinavir + ritonavir
Atazanavir
Darunavir

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12
Q

Adverse Effects of Lopinavir + ritonavir

A

N/V/D
Increase transaminases
“Protease pouch”

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13
Q

Adverse Effects of Atazanavir

A

Indirect hyperbilirubinemia
nephrolithiasis
“Protease pouch”

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14
Q

Adverse Effects of Darunavir

A

Rash
Hepatotoxicity
“Protease pouch”

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15
Q

MOA of NRTI’s

A

Completely inhibit nucleotide binding to reverse transcriptase –> terminate DNA chain

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16
Q

MOA of NNRTI’s

A

Binds to RT, causes a conformational change and disrupts the catalytic center of the RT

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17
Q

Which NNRTI is not a CYP3A4 inDUCER?

A

Rilpavirine

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18
Q

MOA of Quinoline Derivatives (except primaquine)

A

Inhibits heme-polymerase activity leading to toxic build-up of heme

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19
Q

MOA of INSTIs

A

Interfere with the integration of viral DNA into host DNA

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20
Q

INSTI AE

A

GI

well tolerated

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21
Q

MOA of PI

A

Block proteolytic cleavage of protein precursors that are necessary for the production of infectious particles

Used generally with booster

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22
Q

Which PI is often used as a boostere?

A

Ritonavir

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23
Q

What are class interactions of PI?

A

PI are CYP inHIB

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24
Q

Name common quinoline derivatives

A 
Quinine
Quinidine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine
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25
Indications of Quinine
Drug-resistant Plasmodium falciparum
26
Indications of Quinidine
Severe malarial infection
27
Indications of Chloroquine
Treatment and prophylaxis of non-resistant P. falciparum and P. malariae Used in combo with primaquine to eradicate hepatic stages of P. vivax and P. ovale
28
Indications of Hydroxychloroquine
Treatment and prophylaxis of non-resistant P. falciparum and P. malariae Used in combo with primaquine to eradicate hepatic stages of P. vivax and P. ovale
29
Indications of Mefloquine
Treatment and prophylaxis of drug-resistant P. falciparum
30
Adverse Effects of Quinine
GI Effects QT Prolongation Cinchonism Hemolysis/hemolytic anemia in patients with G6PD deficiency
31
Adverse Effects of Quinidine
GI Effects QT Prolongation Cinchonism
32
Adverse Effects of Chloroquine
N/V/D QT Prolongation Pruritus Visual disturbances **Safe in pregnancy**
33
Adverse Effects of Mefloquine
``` N/V/D QT Prolongation Vivid dreams HA Anxiety Psychosis Seizures ```
34
Contraindications of Mefloquine
``` **all BBW** Epilepsy Psychosis Schizophrenia Depression Anxiety ```
35
Adverse Effects of Hydroxychloroquine
N/V/D QT Prolongation Pruritus Visual disturbances **Safe in pregnancy**
36
MOA of Primaquine
Unknown - likely generate reactive oxygen species
37
Indications of Primaquine
Used in combination with chloroquine to eradicate hepatic stages of P. vivax and P. ovale **only active agent against dormant hypnozoite stages of P. vivax and P. ovale** Gametocidal against all 4 malaria species
38
Adverse Effects of Primaquine
GI effects QT prolongation Hemolysis/hemolytic anemia in patients with G6DP deficiency
39
MOA of Atovaquone
Disrupts mitochondrial electron transport in parasite disrupting nucleotide synthesis
40
Indications of Atovaquone
Treatment and prophylaxis of chloroquine-resistant P. falciparum
41
Indications of Proguanil
Treatment and prophylaxis of chloroquine-resistant P. falciparum
42
Adverse Effects of Atovaquone
N/V/D Abdominal pain Mild/reversible increase in LFTs
43
Adverse Effects of Proguanil
N/V/D Abdominal pain Mild/reversible increase in LFTs
44
Which antibiotics can be used in prophylaxis of malarial infections or treatment when combined with quinine or quinidine?
Tetracycline Doxycycline Clindamycin
45
MOA of Tinidazole
Reduction of nitro-group leads to free radicals causing DNA damage and bacterial cell death
46
Indications of Tinidazole
Amebiasis Giardiasis Trichomoniasis
47
Adverse Effects of Tinidazole
``` N/V/D Metallic taste Furry tongue Disulfiram reaction Peripheral neuropathy ```
48
MOA of Paromomycin
Binds to the 30S subunit to inhibit protein synthesis
49
Adverse Effects of Paromomycin
N/V/D | Rash
50
Indications of Paromomycin
Asymptomatic amebiasis Intestinal amebiasis - give with metronidazole Giardiasis - safer in pregnancy
51
MOA of Iodoquinol
Unknown | Use against organisms in bowel lumen
52
Adverse Effects of Iodoquinol
GI effects - mild diarrhea (take with food) | Enlargement of thyroid
53
Indications of Iodoquinol
Amebiasis
54
MOA of Nitazoxanide
Unknown - may interfere with electron transport
55
Indications of Nitazoxanide
Giardiasis | Infectious diarrhea
56
Adverse Effects of Nitazoxanide
Diarrhea Abdominal pain Take with food to prevent
57
MOA of Albendazole
Interferes with microtubule synthesis starving the worm
58
Adverse Effects of Albendazole
Mild GI disturbances | Elevation of liver enzymes (long-term tx)
59
Patient Counseling Points of Albendazole
Take with a fatty meal (peanuts, ice cream)
60
Indications of Albendazole
Nematodes (roundworms)
61
MOA of Pyrantel pamoate
Neuromuscular blocking leading to paralysis of the worm
62
Adverse Effects of Pyrantel pamoate
GI effects Dizziness Elevation of liver enzymes
63
Indications of Pyrantel pamoate
Nematodes (roundworms) | **poorly absorbed, best for luminal organisms**
64
MOA of Ivermectin
GABA agonist | Hyperpolarizes membrane leading to death of the parasite
65
Adverse Effects of Ivermectin
Diarrhea Pruritus **Do not use in pregnancy**
66
Indications of Ivermectin
Intestinal nematodes (NOT hookworm) Strongyloidiasis (threadworm) - DOC Onchocerciasis (river blindness)
67
MOA of Praziquantel
Increase membrane permeability to Ca2+ leading to paralysis of the parasite
68
Adverse Effects of Praziquantel
N/V/D HA Dizziness Pruritus
69
MOA of Amphotericin B
Interacts with ergosterol in fungal membranes to create pores *This is nystatin, swish and spit for thrush*
70
Indications of Amphotericin B
``` DOC Candidiasis Cryptococcus Aspergillus Histoplasma ```
71
Adverse Effects of Amphotericin B
Infusion-related reactions Nephrotoxicity Hypokalemia Hypomagnesemia
72
MOA of 5-FC
Penetrates cell wall converts to 5-FU and inhibits DNA/RNA synthesis
73
Indications of 5-FC
Used in combination with Amphotericin B to treat Cryptococcus
74
Adverse Effects of 5-FC
Anemia Leukopenia Thrombocytopenia
75
MOA of Azoles
Inhibit lanosterol demethylase
76
Name common Azoles
``` Fluconazole Voriconazole Isavuconazole Posaconazole Itraconazole ```
77
Indications of Fluconazole
Candidiasis | Cryptococcosis
78
Indications of Isavuconazole
Candidiasis | Cryptococcosis
79
Adverse Effects of Fluconazole
N/V | Hepatotoxicity
80
Adverse Effects of Isavuconazole
N/V | Hepatotoxicity
81
Indications of Voriconazole
Candidiasis Cryptococcosis Aspergillus
82
Adverse Effects of Voriconazole
Visual disturbances N/V Hepatotoxicity
83
Indications of Posaconazole
``` Wide Spectrum Candidiasis Cryptococcosis Aspergillus Mucormycosis ```
84
Adverse Effects of Posaconazole
N/V Hepatotoxicity well-tolerated
85
Adverse Effects of Itraconazole
N/V Hepatotoxicity Cardiac
86
MOA of Echinocandins
Inhibit beta-glucan synthase --> inhib of beta glucan synth
87
Name common Echinocandins
Micafungin Caspofungin Anidulafungin
88
Indications of Micafungin
Candidiasis | Aspergillus
89
Adverse Effects of Micafungin
``` Some histamine release HA Flushing Pruritus Urticaria ```
90
MOA of Terbinafine
Inhibit squalene epoxidase
91
DOC for P. malariae (non complicated)
Chloroquine | Hydroxychoroquine
92
DOC for P. ovale, P. vivax, noncomplicated
Chloroquine or Hydroxychloroquine + Primaquine (if not G6PD deficient)
93
DOC for P. falciparum, chloroquine sensitive area
Chloroquine | Hydroxychloroquine
94
DOC of P. falciparum, chloroquine resistant area
Atovaquone-proguanil Artemether-lumefantrine Quinine+tetracycline/doxycycline/clindamycin Mefloquine
95
DOC of P. Falciparum, mefloquine resistant area
Atovaquone-proguanil Artemether-lumefantrine Quinine+tetracycline/doxycycline/clindamycin
96
DOC for complicated malaria
Quinidine (IV) + tetracycline/doxycycline/clindamycin If quinidine is unavailable, contact CDC malaria hotline for artesunate Switch to PO to complete the tx regimen after appropriate clinical response
97
NRTI - bone marrow supression
Zidovudine
98
NRTI - hyperpigmentation
Emtricitabine
99
NRTI - ascending neuromuscular weakness
Stavudine

PPP Spring Final (2 decks)

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