Pharm #3 - Anti-Malralial drugs for treatment or prophylaxis

Question 1

chloroquine

MOA

• stage of life inhibited

Adverse effect

Answer 1

1. inhibit heme polymerase –> increase free heme
2. RBC schizont inhibited
3. Pruritis
   - safe in kid s& pregnancy

Question 2

Quinine, Quinidine

MOA

• stage of life inhibited

Answer 2

MOA:

1. inhibit heme polymerase –> increase free heme
2. RBC schizont inhibited (gametocytes of Vivax and Ovale)

Question 3

Quinine, Quinidine

Adverse effects (3)

Answer 3

1. CINCHONISM
2. Hypoglycemia
3. Blackwater fever

DOC for severe malaria

Question 4

Mefloquine

MOA

stage of life inhibited

Adverse effect

Answer 4

MOA:

1. inhibit heme polymerase –> increase free heme
2. RBC schizont

Neuropsychiatric toxicities (less common with prophylaxis)

DOC for chemoprophylaxis, not recommended for severe malaria

Question 5

Primaquine

MOA

stage of life inhibited

Adverse effect

Answer 5

1. inhibit heme polymerase –> increase free heme (toxic)
2. Hypnozoite, gametocyte
   - cure for P. Vivax and Ovale
3. Hemolysis in G6PD deficiency

** unsafe in pregnancy

Question 6

Proguanil

MOA

stage of life inhibited

Answer 6

MOA:

1. inhibit plasmodial DHFR
2. RBC schizont, hypnozoite of P. Falciparum

w/ chloroquine or atovaquone for chemoprophylaxis

Question 7

Atovaquone

MOA

stage of life inhibited

Adverse effect

Answer 7

1. Inhibit parasite mitochondrial electron transport
2. inhibit RBC schizont, hypnozoite of P. Falciparum

w/ proguanil for chemoprophylaxis

GI side effects, contraindicated in renal impairment

• not for preg, or kids
• give with food or milky drink

Question 8

Doxycycline

MOA

stage of life inhibited

Adverse effect

Answer 8

MOA:
1. inhibit protein synthesis in parasite organelles

2. RBC schizont
3. Phoosensitivity , esophagiitis
   * adjuvant tx. of p.falciparum and chemoprophylaxis

Question 9

Artemisinin

MOA

stage of life inhibited

Adverse effect

Answer 9

MOA:
- binds iron in malaria pigment producing free radicals

2. RBC schizont, gametocyte
3. Potential neurotoxicity (ototoxicity)

Question 10

tx for cysticercosis and hydatid disease

Answer 10

Albendazole

Question 11

tx for pinworm

ascaris

trichuria

hookworm

Answer 11

Mebendazole

Question 12

tx for strongyloides and onchocerciasis

Answer 12

Ivermectin

Question 13

tx for pinworm, ascaris

Answer 13

pyrantel pamoate

Question 14

tx for schistosomiasis

Answer 14

praziquantel

Question 15

tx for filariasis, loaiasis, tropical eosinophilia

Answer 15

Diethyl carbamazine citrate

Question 16

DOC for onchocerciasis

Answer 16

Ivermectin

Question 17

Ivermectin

MOA

Adverse

Answer 17

MOA: paralyzes nematodes and arthropods by intensifying GABA-mediated signals

Adverse: (mild) hypersensitivity from worm death
Mazotti reaction* – severe in onchocerciasis

TOC strongyloidiasis and onchocerciasis

Question 18

Pyrantel Pamoate

MOA

Answer 18

MOA: depolarizing neuromuscular blocking

Causes release of AcH and inhibition of cholinesterase resulting in worm paralysis

Cautions: Liver disease; kids

Question 19

mebendazole

• use (6)
• adverse

Answer 19

• ascariasis
• hookworm
• pinworm
• taeniasis
• trichinosis
• strongyloidiasis

Adverse: minimal GI to neutropenia and hepatic with long term therapy; hypersensitivity

Question 20

Contraindication for praziquantel

Answer 20

Contraindications: ocular cysticercosis (inflammation)

Question 21

DOC acute T cruzi (Chagas disease)

Answer 21

nifurtimox

Question 22

First line tx for african trypanosome hemolympahtic disease

Answer 22

Suramin

Question 23

Agent for late stage T. Rhodensiense infections

Answer 23

Melarsoprol

Question 24

DOC for Leishmaniasis

Answer 24

Sodium Stibogluconate

adverse: Gi, fever, QT prolongation!!

miltefosine used primarily for visceral leishmaniasis

Question 25

what is the tx for toxoplasmosis - what must be added t this tx (1 acid, and 2 drugs)

Answer 25

1. Pyrimethamine 2. Folinic Acid - Sulfadiazine or clindamycin

Question 26

tx for immunosuppressed w/ Crptosporidiosis

Answer 26

Nitazoxanide - can also use paromomycin

Question 27

Iodoquinal Use ADRS

Answer 27

-Used for luminal amebic infections, other intestinal protozoa Not for parasites in the intestinal wall or extraintestinal infections ADRs: Neurotoxicity and nausea and vomiting reported but rare at recommended doses

Question 28

name the drug: DOC extraluminal (tissue) amebiasis Also treats giardia, trichomonas (and anaerobic bacteria) Used for tissue stages of amebiasis including dysentery, ameboma, and liver abscess

Answer 28

metronidazole

Question 29

metronidazole MOA ADRS

Answer 29

MOA: ferredoxin-linked processes reduce nitro group to a product that is lethal against anaerobic organisms Adverse: nausea, vomiting, metallic taste, disulfuram-like

Question 30

tx of amoebic colitis and amoebic liver access

Answer 30

Metronidazole