Pharm: Anti-protozoans

Question 1

Treatment of an STI with vaginitis and purulent discharge, strawberry cervix.

Answer 1

Trichomonas vaginalis

Diagnosed with wet mount

Treatment: metronidazole

Question 2

Adverse effects of metronidazole and major contraindication.

Answer 2

AE: flattening of T wave on EKG

CI: teratogenic in pregnant pts.

Question 3

Treatment of patient with foul-smelling watery diarrhea after drinking beaver dam water.

Answer 3

Giardia lamblia

Treatment: metronidazole, tinidazole

Question 4

Treatment for bloody diarrhea accompanying hepatic abscess.

Answer 4

Entamoeba histolytica

Treatment:
Asymptomatic - paromomycin
Symptomatic - metronidazole followed by paromomycin

Question 5

3 main uses of metronidazole and tinidazole.

Answer 5

1. Trichomoniasis
2. Giardiasis
3. Amoebiasis

Question 6

Adverse effects of Tinidazole.

Answer 6

Erythema multiforme, Stephen Johnson syndrome

Question 7

Treatment for fever, chills, sweating, myalgia most severe in IC patients. Bug is diagnosed on thick and thin blood smears stained with Giemsa.

Answer 7

Babesia microti

Treatment:
Clindamycin + Quinine
or
Atovaquone + Azithromycin

Question 8

Treatment for a bug that causes cardiomyopathy, achalasia, megacolon.

Answer 8

Trypanosoma cruzi (chagas disease)

Treatment: Nifurtimox or Benznidazole

Question 9

Treatments for each Trypanosoma brucei type and the treatment for the CNS stage.

Answer 9

East Africa: Suramin
West Africa: Pentamindine Isethionate
CNS stage: Melarsoprol

Question 10

Treatment of Cryptosporidium infection in immunocompetent patients.

Answer 10

Nitazoxanide

Question 11

Treatment of a patient that visited the tropics and now has watery diarrhea, myalgia, N/V.

Answer 11

Cyclospora cayetansis

Treatment: TMP-SMX

Question 12

Group of people affected by Microsporidia and treatment.

Answer 12

AIDS pts.

Treatment: Albendazole

Question 13

Treatment of a patient with volcano lesions on his skin after he was bit by sand flies in the middle east. Also has fever, weight loss, splenomegaly.

Answer 13

Leishmaniasis

Treatment: Sodium Stibogluconate

Question 14

Treatment of respiratory infection in an HIV patient.

Answer 14

Pneumocystis jiroveci

Treatment: TMP-SMX

Question 15

Drug to use in patients that cannot tolerate sulfa-drugs.

Answer 15

Atovaquone

-used for pneumocystis j. or cyclospora if they can’t tolerate TMP-SMX

Question 16

Major adverse effect of taking Pentamidine

Answer 16

Pts. can develop insulin-requiring diabetes mellitus

Also used for pneumocystis pneumonia (PCP)

Question 17

Treatment of a patient with AIDS, encephalitis, caused by changing cat litter.

Answer 17

Toxoplasma gondii 
(can cross placenta and result in birth defects)

Treatment:
Folic acid + pyrimethamine + sulfadiazine
Folic acid + pyrimethamine + clindamycin

Question 18

Main thing to remember when using pyrimethamine

Answer 18

Inhibits dihydrofolate reductase so it must be given with folic acid supplements

Question 19

Treatment for a patient that has a fever of unknown origin and a history of travel.

Answer 19

1st line: chlorquinine drugs

2nd line: quinine sulfate + antibiotic