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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
Q

Indications of Quinine

A

Drug-resistant Plasmodium falciparum

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26
Q

Indications of Quinidine

A

Severe malarial infection

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27
Q

Indications of Chloroquine

A

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

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28
Q

Indications of Hydroxychloroquine

A

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

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29
Q

Indications of Mefloquine

A

Treatment and prophylaxis of drug-resistant P. falciparum

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30
Q

Adverse Effects of Quinine

A

GI Effects
QT Prolongation
Cinchonism
Hemolysis/hemolytic anemia in patients with G6PD deficiency

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31
Q

Adverse Effects of Quinidine

A

GI Effects
QT Prolongation
Cinchonism

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32
Q

Adverse Effects of Chloroquine

A

N/V/D
QT Prolongation
Pruritus
Visual disturbances

Safe in pregnancy

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33
Q

Adverse Effects of Mefloquine

A 
N/V/D
QT Prolongation
Vivid dreams
HA
Anxiety
Psychosis
Seizures
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34
Q

Contraindications of Mefloquine

A 
**all BBW**
Epilepsy
Psychosis
Schizophrenia
Depression
Anxiety
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35
Q

Adverse Effects of Hydroxychloroquine

A

N/V/D
QT Prolongation
Pruritus
Visual disturbances

Safe in pregnancy

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36
Q

MOA of Primaquine

A

Unknown - likely generate reactive oxygen species

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37
Q

Indications of Primaquine

A

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

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38
Q

Adverse Effects of Primaquine

A

GI effects
QT prolongation
Hemolysis/hemolytic anemia in patients with G6DP deficiency

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39
Q

MOA of Atovaquone

A

Disrupts mitochondrial electron transport in parasite disrupting nucleotide synthesis

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40
Q

Indications of Atovaquone

A

Treatment and prophylaxis of chloroquine-resistant P. falciparum

41
Q

Indications of Proguanil

A

Treatment and prophylaxis of chloroquine-resistant P. falciparum

42
Q

Adverse Effects of Atovaquone

A

N/V/D
Abdominal pain
Mild/reversible increase in LFTs

43
Q

Adverse Effects of Proguanil

A

N/V/D
Abdominal pain
Mild/reversible increase in LFTs

44
Q

Which antibiotics can be used in prophylaxis of malarial infections or treatment when combined with quinine or quinidine?

A

Tetracycline
Doxycycline
Clindamycin

45
Q

MOA of Tinidazole

A

Reduction of nitro-group leads to free radicals causing DNA damage and bacterial cell death

46
Q

Indications of Tinidazole

A

Amebiasis
Giardiasis
Trichomoniasis

47
Q

Adverse Effects of Tinidazole

A 
N/V/D
Metallic taste
Furry tongue
Disulfiram reaction
Peripheral neuropathy
48
Q

MOA of Paromomycin

A

Binds to the 30S subunit to inhibit protein synthesis

49
Q

Adverse Effects of Paromomycin

A

N/V/D

Rash

50
Q

Indications of Paromomycin

A

Asymptomatic amebiasis
Intestinal amebiasis - give with metronidazole
Giardiasis - safer in pregnancy

51
Q

MOA of Iodoquinol

A

Unknown

Use against organisms in bowel lumen

52
Q

Adverse Effects of Iodoquinol

A

GI effects - mild diarrhea (take with food)

Enlargement of thyroid

53
Q

Indications of Iodoquinol

A

Amebiasis

54
Q

MOA of Nitazoxanide

A

Unknown - may interfere with electron transport

55
Q

Indications of Nitazoxanide

A

Giardiasis

Infectious diarrhea

56
Q

Adverse Effects of Nitazoxanide

A

Diarrhea
Abdominal pain
Take with food to prevent

57
Q

MOA of Albendazole

A

Interferes with microtubule synthesis starving the worm

58
Q

Adverse Effects of Albendazole

A

Mild GI disturbances

Elevation of liver enzymes (long-term tx)

59
Q

Patient Counseling Points of Albendazole

A

Take with a fatty meal (peanuts, ice cream)

60
Q

Indications of Albendazole

A

Nematodes (roundworms)

61
Q

MOA of Pyrantel pamoate

A

Neuromuscular blocking leading to paralysis of the worm

62
Q

Adverse Effects of Pyrantel pamoate

A

GI effects
Dizziness
Elevation of liver enzymes

63
Q

Indications of Pyrantel pamoate

A

Nematodes (roundworms)

poorly absorbed, best for luminal organisms

64
Q

MOA of Ivermectin

A

GABA agonist

Hyperpolarizes membrane leading to death of the parasite

65
Q

Adverse Effects of Ivermectin

A

Diarrhea
Pruritus

Do not use in pregnancy

66
Q

Indications of Ivermectin

A

Intestinal nematodes (NOT hookworm)
Strongyloidiasis (threadworm) - DOC
Onchocerciasis (river blindness)

67
Q

MOA of Praziquantel

A

Increase membrane permeability to Ca2+ leading to paralysis of the parasite

68
Q

Adverse Effects of Praziquantel

A

N/V/D
HA
Dizziness
Pruritus

69
Q

MOA of Amphotericin B

A

Interacts with ergosterol in fungal membranes to create pores

This is nystatin, swish and spit for thrush

70
Q

Indications of Amphotericin B

A 
DOC
Candidiasis
Cryptococcus
Aspergillus
Histoplasma
71
Q

Adverse Effects of Amphotericin B

A

Infusion-related reactions
Nephrotoxicity
Hypokalemia
Hypomagnesemia

72
Q

MOA of 5-FC

A

Penetrates cell wall converts to 5-FU and inhibits DNA/RNA synthesis

73
Q

Indications of 5-FC

A

Used in combination with Amphotericin B to treat Cryptococcus

74
Q

Adverse Effects of 5-FC

A

Anemia
Leukopenia
Thrombocytopenia

75
Q

MOA of Azoles

A

Inhibit lanosterol demethylase

76
Q

Name common Azoles

A 
Fluconazole
Voriconazole
Isavuconazole
Posaconazole
Itraconazole
77
Q

Indications of Fluconazole

A

Candidiasis

Cryptococcosis

78
Q

Indications of Isavuconazole

A

Candidiasis

Cryptococcosis

79
Q

Adverse Effects of Fluconazole

A

N/V

Hepatotoxicity

80
Q

Adverse Effects of Isavuconazole

A

N/V

Hepatotoxicity

81
Q

Indications of Voriconazole

A

Candidiasis
Cryptococcosis
Aspergillus

82
Q

Adverse Effects of Voriconazole

A

Visual disturbances
N/V
Hepatotoxicity

83
Q

Indications of Posaconazole

A 
Wide Spectrum
Candidiasis
Cryptococcosis
Aspergillus
Mucormycosis
84
Q

Adverse Effects of Posaconazole

A

N/V
Hepatotoxicity
well-tolerated

85
Q

Adverse Effects of Itraconazole

A

N/V
Hepatotoxicity
Cardiac

86
Q

MOA of Echinocandins

A

Inhibit beta-glucan synthase –> inhib of beta glucan synth

87
Q

Name common Echinocandins

A

Micafungin
Caspofungin
Anidulafungin

88
Q

Indications of Micafungin

A

Candidiasis

Aspergillus

89
Q

Adverse Effects of Micafungin

A 
Some histamine release
HA
Flushing
Pruritus
Urticaria
90
Q

MOA of Terbinafine

A

Inhibit squalene epoxidase

91
Q

DOC for P. malariae (non complicated)

A

Chloroquine

Hydroxychoroquine

92
Q

DOC for P. ovale, P. vivax, noncomplicated

A

Chloroquine or Hydroxychloroquine
+
Primaquine (if not G6PD deficient)

93
Q

DOC for P. falciparum, chloroquine sensitive area

A

Chloroquine

Hydroxychloroquine

94
Q

DOC of P. falciparum, chloroquine resistant area

A

Atovaquone-proguanil

Artemether-lumefantrine

Quinine+tetracycline/doxycycline/clindamycin

Mefloquine

95
Q

DOC of P. Falciparum, mefloquine resistant area

A

Atovaquone-proguanil

Artemether-lumefantrine

Quinine+tetracycline/doxycycline/clindamycin

96
Q

DOC for complicated malaria

A

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
Q

NRTI - bone marrow supression

A

Zidovudine

98
Q

NRTI - hyperpigmentation

A

Emtricitabine

99
Q

NRTI - ascending neuromuscular weakness

A

Stavudine

PPP Spring Final (2 decks)

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