Pharm for Parasites/protozoa/C. diff

Question 1

Drugs used for Nematodes

Answer 1

• Albendazole
• Mebendazole
• Pyrantel pamoate
• Diethylcarbamazine
• Ivermectin

Question 2

Drugs used for Cestodes

Answer 2

• Albendazole
• Mebendazole
• Praziquantel
• Nicolsamide

Question 3

Drug used for Trematodes

Answer 3

Praziquantel

Question 4

What are the Soil-transmitted helminths

Answer 4

• Acaris
• hookworm
• Trichuris

Question 5

In endemic areas, these drugs are used for treatment of children with helminth infections

Answer 5

• single doses of Albendazole or the older mebendazole

- These are Benzimidazoles

Question 6

What is the Benzimidazoles that are only used for cutaneous infections

Answer 6

-Thiabendazole

Question 7

MOA of benzimidazoles

Answer 7

bind to parasite b-tubulin, disrupt microtubule polymerization and microtubule dependent processes like attachment and glucose transport

Question 8

Which benzimidazole has Poor absorption so low systemic exposure?

Answer 8

Mebendazole

Question 9

Which benzimidazole has modest absorption and has metabolites that can affect tissue dwelling helminths, cysts, and is cleared renally

Answer 9

Albendazone–>Albendazole sulfoxide (active metabolite) –> Albendazole sulfone (inactive and cleared renally)

Question 10

Benzimidazole used for larval migrans ONLY

Answer 10

Thiabendazole (has systemic toxicity)

Question 11

Enterobius vermicularis (pinworm . . itchy butt children)

Answer 11

Mebendazole

Question 12

Necator americanus and Ancylostoma duodenale (Hookworms)

Answer 12

Albendazole

Question 13

Ascaris Lumbricoides

Answer 13

Albendazole OR Mebendazole

Question 14

Trichuris trichuria (Whipworm)

Answer 14

Mebendazole or Albendazole (need 3 day course rather than single dose)

Question 15

Toxacara (Larval migrans)

Answer 15

Albendazole

Question 16

Benzimidazoles and pregnancy

Answer 16

teratogenic

Question 17

Alternative/Adjunct Nematode therapy that is effective against hook, pin, and round worms but NOT Trichuris trichiura
-MOA: binds to N-AChR causing spastic paralysis and depolarization

Answer 17

Pyrantel pamoate

Question 18

What is the indication for Pyrantel pamoate therapy

Answer 18

HEAVY Ascaris infection

Question 19

Pregnancy and Pyrantel Pamoate

Answer 19

Can use but be cautious

Question 20

Indications for Ivermectin

Answer 20

• Intestinal Strongloidyiasis (thread worm)
• Onchocerciasis (River Blindness)
• Also Lymphatic Filariasis (Wuchereria bancrofti and Brugia malayi)

Question 21

MOA of Ivermectin

Answer 21

-inactivates Glutamate-gated chloride channels causing hyperpolarization and paralysis

Question 22

When is Ivermectin contraindicated

Answer 22

-when BBB is disrupated like meningitis and trypanosomiasis

Question 23

What are the intestinal Cestodes (Tapeworms)

Answer 23

• Cysticercosis
• Echinococcosis
• Taeniasis (pork and beef)
• Diphyllobrothriasis (fish)

Question 24

What is the drug of choice for all ADULT form (Taenias and diphyllobothrium) tapeworm infections in US?

Elsewhere?

Answer 24

Praziquantel

Niclosamide

Question 25

Drug of choice for LARVAL forms (Cysticercosis and Echinococcus granulosus/cystic hydatid disease) of tapeworm infections? What is an adjunct therapy you can add on?

Answer 25

Albendazole Praziquantel

Question 26

What is a contraindication for Praziquantel therapy

Answer 26

treatment of ocular cysticercosis . . . destruction of organism in the eye may damage the eye

Question 27

What are the intestinal trematodes/flukes

Answer 27

Schistosomiasis

Question 28

What would you look for in a stool sample that has schistosomisasis

Answer 28

A spear head coming of the trematode

Question 29

drug of choice for schistosomiasis

Answer 29

praziquantel

Question 30

MOA of praziquantel

Answer 30

- interferes with calcium homeostasis and causes flaccid paralysis in adult flukes - causes antigen within parasite to be exposed to action of host antibodies

Question 31

Drug list for anti protozoal/antiamebic agents

Answer 31

- Metronidazole - Tinidazole - Nitazoxanide LUMINAL AMEBICIDES - Iodoquinol - Diloxanide - Paromomycin

Question 32

Metronidazole extensively used to treat what? What is unique about these organisms is used to target them?

Answer 32

- Entamoeba histolytica - Giardia Lamblia Lack mitochondria and do not rely on pyruvate dehydrogenase

Question 33

Explain the metabolism of E. histolytic and G. lamblia

Answer 33

Pyruvate -->pyruvate-ferredoxin oxidoreductase (PFOR)-->this activates metronidazole and damages DNA

Question 34

Drug of choice for E. histolytica? G. Lamblia?

Answer 34

Metronidazole Tinidazole

Question 35

Adverse effects of Metronidazole/Tinidazole?

Answer 35

- Metallic taste - Disulfiram-liek reaction - with intake of acohol -->abdominal distress, vomiting, flushing, headache, alcohol-withdrawal symptoms

Question 36

- one celled parasite | - can invade liver and form abscess

Answer 36

E. histolytica

Question 37

Symptomatic or invasive colitis is treated with what?

Answer 37

metronidazole followed by luminal amebicide (such as paromomycin, diiodohydroxyquin, or diloxanide furoate) to elminate intraluminal cysts

Question 38

- aminoglycoside (not orally absorbed) - Bind to 30S ribosome to disrupt protein synthesis - drug of choice for colonization of intesting with E. histolytica - Alternative to metronidazole for E. histolytica infection during PREGNANCY

Answer 38

Paromomicin

Question 39

Flagellated protozoan parasite

Answer 39

Giardia Lamblia

Question 40

Rice paddy fields? Treatment?

Answer 40

schistosomiasis Praziquantel

Question 41

Low CD4 count . . less than 100? Treatment?

Answer 41

cryptococcosis Tenovovir-Emtricitabine-Efavirenz

Question 42

Patient with C. diff . . doesn't respond to metronidazole. give this next ORALLY to treat the diarrhea

Answer 42

Vancomycin

Question 43

Recurrent hospital acquired infectious colitis (C. diff) . . . ICU acquired also

Answer 43

Fidaxomicin

Question 44

1st choice for C. Diff? Recurrence? ICU?

Answer 44

- metronidazole - Vancomycin Fidaxomicin