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Pharm Exam 8 > L15 Antiprotozoals > Flashcards

L15 Antiprotozoals Flashcards

1
Q

What protozoa can exist as a trophozoite or dormant cyst, is transmitted by ingestion of cysts in water, food, feces, primarily infects intestinal mucosa causing bloody diarrhea, but can also spread to liver?

A

Entamoeba histolytica

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2
Q

Features of Giardia

A

Protozoan active as a trophozoites or a dormant cyst
Infection route same as E. histolytica, i.e. ingestion of cysts from water, food, feces
Causes gastroenteritis, diarrhea major Sx c loss appetite, hematuria, loose stools, stomach cramps, bloating, gas
Sx appear 1-2 weeks after infection and can cycle
Binds small intestine and blocks nutrient absorbtion
Animals major reservoirs

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3
Q

What parasite exists in males and females, causes cervicitis, urethritis, vaginitis, yellow-green frothy itchy foul-smelling vaginal discharge, is sexually transmitted and is often asymptomatic in men?

A

Trichomonas vaginalis

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4
Q

Why are pregnant women and HIV patients not supposed to clean the litter box?

A

Domestic animals like cats carry Toxoplasmosis gondii
Mild with flu-like Sx in immune competent
AIDS or pregnant can cause disseminated life-threatening infection

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5
Q

What is one of the leading causes of death in HIV patients that involves a life-threatening pneumonia?

A

Pneumocystis jiroveci

Not sure if fungus or protozoan

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6
Q

What is the DOC for E. histolytica, G. lamblia, T. vaginalis?

A

Metronidazole (Flagyl)

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7
Q

What are the uses of Metronidazole (Flagyl)

A

DOC for E. histolytica, G. lamblia, T. vaginalis
Also used for some anaerobicbacterial infections like that from Bacteroides fragilis and C. difficile
Also used for non-specific bacterial vaginosis or Gardnerella vaginitis

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8
Q

Which anti-protozoal drug can cause a metallic taste, reddish urine, and disulfiram-like reaction, and must be used c caution in liver disease?

A

Metronidazole (Flagyl)

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9
Q 
What are the pharmacokinetics of Metronidazole?
Admin route
Metabolism
Where effective
Drug interactions
A

Oral, but can be IV or topical
Metabolized in liver–can affect drugs like cimetidine, hydantoins, oral anticoagulants, others
Caution in liver disease
Effective in intestines and extra-intestinal

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10
Q

What drug is similar to Metronidazole, has a long half-life, is better tolerated, and has same coverage? What is the coverage?

A

Tinidazole (Tindimax)

E. histolytica, G. lamblia, T. vaginalis

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11
Q

When must you combine a drug with Metronidazole or Tinidazole for effectiveness?

A

For luminal amoebiasis

Must use a luminal amoebicide like Iodoquinol

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12
Q

What is Iodoquinol (Yodoxin)?

A

Luminal amoebicide effective against trophozoites and cysts of E. histolytica
Often combine with Metronidazole

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13
Q

Which drug is assoc. c high iodine content leading to thyroid enlargement and also can cause serious adverse effects to the eye like optic neuritis and optic atrophy leading to blindness?

A

Iodoquinol (Yodoxin)

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14
Q

Paromomycin (Humatin)

A

Aminoglycoside antibiotic
Oral and cream
Effective for amoebiasis, giardiasis, T. vaginalis (cream)
Effective against luminal trophozoites b/c not well absorbed

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15
Q

What aminoglycoside antibiotic is useful for amoebiasis, giardiasis, T. vaginalis?

A

Paromomycin (Humatin)

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16
Q

Diloxanide Furoate (Furamide)

A

Luminal trophozoites but not tissue trophozoites like E. histolytica
Combined with metronidazole to treat amoebiasis and asymptomatic carriers
Only available from the CDC

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17
Q

What drugs can be used to treat asymptomatic amoebiasis?

A 
Iodoquinol (Yodoxin)
Paromomycin (Humatin)
Diloxanide Furoate (Furamide)
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18
Q

What drugs are combined with metronidazole to treat amoebiasis?

A 
Iodoquinol (Yodoxin)
Paromomycin (Humatin)
Diloxanide Furoate (Furamide)
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19
Q

What drugs can be given to treat severe intestinal or systemic E. histolytica when metronidazole is not an option? What are the SE?

A

Emetine and Dehydroemetine (Mebadin)
Parental only
Serious cardiotoxicity, teratogenicity, and GI effects

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20
Q

Tetracycline use for parasites

A

Tetracyclines are used to kill the bacteria that E. histolytica and G. lamblia require for life

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21
Q

What is the treatment of choice for toxoplasmosis?

A

Pyrimethamine + Sulfadiazine + Folinic acid

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22
Q

What is the drug of choice for pneumocystosis? What are the other uses of this drug?

A

TMP-SMX (Bactrim)
Alternate Tx fro toxoplasmosis
Prophylaxis for P. carinii in AIDS
Preferred Tx for P. carinii in kids

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23
Q

What drugs can be used if TMP-SMX is not an option for pneumocystosis?

A

Pentamidine (Pentam; Nebupent)
Treats an active infection and nebulizer can be used for prophylaxis
SE: hypotension, arrhythmias, hypoglycemia

Atovaquone (Mepron)

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24
Q

What kind of organism is cryptosporidium?

A

Protozoan parasite
Can infect the GI or the lungs
No real treatment

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25
Q

What is a helminth?

A

Parasitic worm

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26
Q

What are the 3 major groups of helminths?

A

Nematodes, cestodes, trematodes

27
Q

What are nematodes?

A

Roundworms

28
Q

Characteristics of Ascaris lumbricoides (roundworm)

A

Roundworm common in Asia, Africa, Latin America
Intestinal parasite
Infected by ingesting eggs from soil or water
Type of nematode

29
Q

What helminth lays eggs in perianal area at night?

Other characteristics?

A 
Enterobius vermicularis (pinworm)
Very common in US in crowded and unsanitary places like daycare centers
Intestinal parasite
Fecal-oral
Type of nematode
30
Q

Characteristics of Necator americanus

A 
(Hookworm)
Common in tropical areas and southern US
Intestinal parasite
Infects through the skin, migrates to lungs, up trachea, down to GI
Can cause pneumonitis in the lungs
Type of nematode
31
Q 
(Hookworm)
Common in tropical areas and southern US
Intestinal parasite
Infects through the skin, migrates to lungs, up trachea, down to GI
Can cause pneumonitis in the lungs
A

Necator americanus

Type of nematode

32
Q

Characteristics of Strongyloides stercoralis

A 
Threadworm
Warm climates and southern US
Intestinal tract
Go through the lungs and back to GI for autoinfection leading to high parasite loads
Type of nematode
33
Q

What dog parasite can infect humans but can’t fully develop in humans and migrates throughout many tissues causing eosinophilia and necrosis?

A

Toxicara canis (Visceral larva migrans)
Affects lung, brain, liver, muscles, etc
Type of nematode

34
Q

What parasite infects the epidermal/dermal junction and causes inflammation and scarring of the skin? Where does this parasite usually prefer to live?

A 
Ancylostoma braziliense (Visceral larva migrans)
Adult worm lives in the intestines of dogs
Type of nematode
35
Q

What worm is commonly acquired through eating raw or poorly cooked pork?

A

Trichinella spiralis (Trichinosis)
Type of nematode
Intestinal parasite of humans, pigs, and others
Larvae migrate through intestinal wall into other tissues like skeletal muscle, heart, lungs, etc.

36
Q

Wuchereria bancrofti

A 
Roundworm–Type of nematode
Major cause of lymphatic filariasis
Central Africa and Nile delta, S and Central America, tropical asia
Leads to elephantiasis
Spread by mosquitos
37
Q

Loa Loa

A

Round worm of the eye found in Africa and India

Causes filarial disease

38
Q

What worm causes river blindness?

A

Onchocerca volvulus

39
Q

What are cestodes?

A

Segmented Tapeworms

40
Q

What is the beef tapeworm and where in the world is it found?

A

Taenia saginata
Europe, Near East, South America
From undercooked beef containing cysticerci

41
Q

What worm can be picked up from eating raw fish from Japan, Europe, and parts of N and S America?

A

Diphyllobothrium latum (Fish tapeworm)

42
Q

What intestinal tapeworm is commonly found in Mexico, Latin America, Africa, SE Asia, Philippines, and can have larvae in the brain and muscle causing cysticercosis? How is this acquired?

A

Taenia solium

From eating undercooked pork

43
Q

What are Trematodes or flukes?

A

Non-segmented flatworms

44
Q

What are schistosomes?

A

Blood flukes and hepatic flukes
Penetrate skin from contaminated water and go through lymph and blood to liver to mature. Then migrate to vessels of the intestines or bladder as adults
Unique worms in that have male and female worms

45
Q

Schistosoma mansoni

A

Africa, Mid ast, S America
Dysentery and diarrhea
Intestinal schistosomiasis
Egg has characteristic lateral spine

46
Q

Schistosoma haematobium

A

Africa and Mid East
Hematuria and dysuria
Urinary schistosomiasis

47
Q

Schistosoma japonicum

A

Far East
Only blood fluke in China and Philippines
diarrhea and dysentery
Most infectious of schistosomiasis organisms
Eggs mostly in stool but can be in urine as well

48
Q

Normally, laxatives are not used with antihelminthics anymore except for one exception?

A

Taenia solium

Want to flush out adults before segments can burst with eggs

49
Q

What drugs are used for Nematodes (roundworms)?

A 
Pyrantel Pamoate (Antiminth)
Ivermectin (Mectizan)
50
Q

Pyrantel Pamoate (Antiminth)

A 
Oral drug for roundworms
Broad spectrum
Alternative to mebendazole
Cholinesterase inhibitor for the worms
Not well absorbed so few SE
OTC
51
Q

Ivermectin (Mectizan)

A 
Oral
Rapid absorption and wide tissue distribution
Effective against many roundworms
Drug of choice for filaria infection
Paralyzes roundworm by intensifying GABA
52
Q

What drug is useful for cestodes and trematodes?

A

Praziquantel (Biltricide)

53
Q

Praziquantel (Biltricide)

A

DOC for all schistosomes
First drug for neurocysticercosis
Increases worm permeability to Ca leading to contraction and paralysis
Well-absorbed so useful for systemic infections

54
Q

Drug for Trematodes only

A

Bithionol (Bitin)

55
Q

Bithionol (Bitin)

A

For trematodes
Uncouples oxidative phosphorylation
Oral, well absorbed in GI for systemic infections including liver and lung flukes
Only available from the CDC

56
Q

DOC for entamoeba histolytica

A

Metronidazole (Flagyl) + luminal amebicide

57
Q

DOC for giardia lamblia

A

Metronidazole (Flagyl)

58
Q

DOC for Trichomonas vaginalis

A

Metronidazole (Flagyl)

59
Q

DOC for Toxoplasma gondii

A

Pyrimethamine (Daraprim) + Sulfadiazine + folinic acid

60
Q

DOC for Pneumocystis jiroveci

A

TMP/SMX + folinic acid

61
Q 
DOC for roundworms (Nematodes)
Ascaris lumbricoides (roundworm)
Enterobius vermicularis (pinworm)
Necator americanus (hookworm)
A

Pyrantel pamoate (Antiminth)

62
Q

DOC for tapeworms (cestodes)

A

Praziquantel (Biltricide)

63
Q

DOC for flukes (trematodes)

A

Praziquantel (Biltricide)

64
Q

What is the only fluke not treated by Praziquantel?

A

Sheep liver fluke Fasciola hepatica

Use triclabendazole or bithionol instead

Pharm Exam 8 (6 decks)

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