[Pharm] GI Infections; Antibiotic and anti-parasitic agents

Question 1

What is clostridium difficile?

Gram? Areobic/Anarobic?

Answer 1

Gram (+) anaerobic rod

Question 2

C.diff makes it very difficult (difficile) to give patients what?

Answer 2

Broad spectrum antibiotics

Question 3

If a patient presents with diarrhea while on antibiotics, what do you need to consider?

Answer 3

C. diff

Question 4

What is the 4 point summary of treating a pt. with clostridium difficile?

Answer 4

1. Cessation of inciting antibiotic
2. Supportive care
3. Fecal transplantation
4. Pharmacological agents

Question 5

What is the reasoning behind using antimicrobial agents in the treatment of C.diff?

Answer 5

The antimicrobial agents that are RARELY associated are used because they are probably not the inciting cause of C.diff.

Question 6

What are the 3 pharmacological agents used to treat C.diff?

Answer 6

Vancomycin

Metronidazole

Fidaxomicin

Question 7

What are the frequently associated antimicrobial agents with c.diff?

Answer 7

Fluoroquinolones

Clindamycin

Cephalosporins

Penicillins

Question 8

What is the preferred treatment of CDI?

Answer 8

Vancomycin

Question 9

When would you use metronidazole for CDI treatment?

Answer 9

If oral administration wont work for the patient

Question 10

What are the UNIQUE AE of metronidazole?

probably a test question

Answer 10

DISULFURIME EFFECT = will cause N/V when alcohol is concomittently consumed

METALLIC TASTE IN MOUTH

Question 11

What drug do you use for recurrent CDI?

Answer 11

Fidaxomicin

Question 12

Most common cause of duodenal ulcers and chronic gastritis?

Answer 12

H. Pylori

Question 13

What is known as the “classic amoeba”?

Answer 13

Entamoeba histolytica

E. histolytica

Question 14

What are the 2 therapeutic goals of treating E.histolytica?

Answer 14

Eliminate the invading trophozoites

Eradicate intestinal carriage of the organism

Question 15

What drugs are used to eliminate the invading trophozoite in E.histolytica?

Answer 15

Metronidazole

OR

Tinidazole

Question 16

What drugs are used to eradicate the intestinal carriage of E.histolytica?

Answer 16

Paromomycin

OR

Iodoquinol

Question 17

What drug is used for asymptomatic carriers of E.histolytica?

Answer 17

Luminal amebicide agents

Question 18

What is the method of drug admin that will ensure that E.histolytica is erradicated?

Answer 18

Give metronidazole or tinidazole

WITH

a luminal amebicide (paromomycin or idoquinol)

Question 19

Iodoquinol

MOA?

Answer 19

UNKNOWN

Question 20

Iodoquinol

Unique structure? Considerations?

Answer 20

Contains iodine

Make sure to avoid giving this to pts with iodine intolerance

Question 21

What is a big difference b/w Giardia lamblia and E.histolytica stool presentaton?

Answer 21

NO BLOOD IN STOOL FOR Giardia lamblia

Question 22

What is the first line agent for treating Giardia lamblia?

Answer 22

Tinidazole

Question 23

What is the second line treatment for giardia lamblia?

Answer 23

Nitazoxanide

Question 24

MOA of nitazoxanide?

Answer 24

Inhibition of pyruvate-ferredoxin oxidoreductase enzyme

Question 25

Unique AE of **nitazoxanide?**

Answer 25

Flatulence ENLARGED **salivary glands** YELLOW **eyes** BRIGHT **yellow urine**

Question 26

What patient population is **cryptosporidium parvum** life threatening?

Answer 26

Immunocompromised

Question 27

What are the two antimicrobial agents used to treat **cryptosporidium parvum?** Name the preferred 1st

Answer 27

Nitazoxanide Paromomycin

Question 28

Is there an immune response to: Worms? Dead worms? Eggs?

Answer 28

Worms = NO Dead worms= Yes Eggs= Yes

Question 29

What is the diagnostic marker for **necator americanus/ancylostoma duodenale (hook worms)?**

Answer 29

Eggs in feces

Question 30

What is a big difference in the diagnosis of **strongyloides stercoralis?**

Answer 30

EGGS ARE NOT PASSED IN THE STOOL

Question 31

What do the eggs look like in **trichuris trichiura?**

Answer 31

Footballs

Question 32

What are the (5) drugs used to treat **nematodes?**

Answer 32

Albendazole Mebendazole Thiabendazole Ivermectin Pyrantel pamoate \*Look for the **bend** in the name! Treating worms! Helps!

Question 33

What are the (2) broad spectrum **anti-helminthic agents?**

Answer 33

Albendazole Mebendazole

Question 34

MOST of the anti-nemotode drugs MOA?

Answer 34

Inhibit microtubule synthesis PARALYZES worms

Question 35

What is different about **THIABENDAZOLE** that warrented a different slide from albendazole and mebendazole?

Answer 35

Thiabendazole is **MUCH MORE TOXIC** Don't give this drug

Question 36

MOA of **Ivermectin?**

Answer 36

Intensifies **GABA** mediated transmission of signals in PNS of nematodes **PARALYSIS** of nematodes

Question 37

MOA of **Pyrantel pamoate?**

Answer 37

**Neuromuscular blocking agent** results in **paralysis** and expulsion of nemotode

Question 38

What are the two **PRIMARY drugs** given to treat MOST nematodes?

Answer 38

Albendazole Mebendazole

Question 39

What drug that was introduced for nematodes (considered the evil brother) is NEVER USED?

Answer 39

Thiabendazole

Question 40

What is the primary drug geven for **S. stercoralis?**

Answer 40

Ivermectin

Question 41

Which nemotode doesn't care which drug is primarily used?

Answer 41

E. vermicularis

Question 42

What is the "hot dog bun" platyhelminth?

Answer 42

Schistosoma spp

Question 43

What is the drug used to treat **schistosoma?**

Answer 43

Praziquantel

Question 44

MOA of **praziquantel?**

Answer 44

Increases permeability of nematode cell membranes results in **PARALYSIS**

Question 45

What is the ONE DRUG that does NOT result in paralysis of the worm?

Answer 45

Niclosamide

Question 46

Niclosamide MOA?

Answer 46

Uncouples **oxidative phosphorylation** Blocks the **uptake of glucose** DEATH OF WORM

Question 47

What should you remember about **niclosamide?**

Answer 47

It's NOT given frequently. Sheehy just mentioned it because it is the ONLY drug that results in **DEATH** of the worm Has a shit ton of side effects