[Pharm] GI Infections; Antibiotic and anti-parasitic agents Flashcards
What is clostridium difficile?
Gram? Areobic/Anarobic?
Gram (+) anaerobic rod
C.diff makes it very difficult (difficile) to give patients what?
Broad spectrum antibiotics
If a patient presents with diarrhea while on antibiotics, what do you need to consider?
C. diff
What is the 4 point summary of treating a pt. with clostridium difficile?
- Cessation of inciting antibiotic
- Supportive care
- Fecal transplantation
- Pharmacological agents
What is the reasoning behind using antimicrobial agents in the treatment of C.diff?
The antimicrobial agents that are RARELY associated are used because they are probably not the inciting cause of C.diff.
What are the 3 pharmacological agents used to treat C.diff?
Vancomycin
Metronidazole
Fidaxomicin
What are the frequently associated antimicrobial agents with c.diff?
Fluoroquinolones
Clindamycin
Cephalosporins
Penicillins
What is the preferred treatment of CDI?
Vancomycin
When would you use metronidazole for CDI treatment?
If oral administration wont work for the patient
What are the UNIQUE AE of metronidazole?
probably a test question
DISULFURIME EFFECT = will cause N/V when alcohol is concomittently consumed
METALLIC TASTE IN MOUTH
What drug do you use for recurrent CDI?
Fidaxomicin
Most common cause of duodenal ulcers and chronic gastritis?
H. Pylori
What is known as the “classic amoeba”?
Entamoeba histolytica
E. histolytica
What are the 2 therapeutic goals of treating E.histolytica?
Eliminate the invading trophozoites
Eradicate intestinal carriage of the organism
What drugs are used to eliminate the invading trophozoite in E.histolytica?
Metronidazole
OR
Tinidazole
What drugs are used to eradicate the intestinal carriage of E.histolytica?
Paromomycin
OR
Iodoquinol
What drug is used for asymptomatic carriers of E.histolytica?
Luminal amebicide agents
What is the method of drug admin that will ensure that E.histolytica is erradicated?
Give metronidazole or tinidazole
WITH
a luminal amebicide (paromomycin or idoquinol)
Iodoquinol
MOA?
UNKNOWN
Iodoquinol
Unique structure? Considerations?
Contains iodine
Make sure to avoid giving this to pts with iodine intolerance
What is a big difference b/w Giardia lamblia and E.histolytica stool presentaton?
NO BLOOD IN STOOL FOR Giardia lamblia
What is the first line agent for treating Giardia lamblia?
Tinidazole
What is the second line treatment for giardia lamblia?
Nitazoxanide
MOA of nitazoxanide?
Inhibition of pyruvate-ferredoxin oxidoreductase enzyme
Unique AE of nitazoxanide?
Flatulence
ENLARGED salivary glands
YELLOW eyes
BRIGHT yellow urine
What patient population is cryptosporidium parvum life threatening?
Immunocompromised
What are the two antimicrobial agents used to treat cryptosporidium parvum?
Name the preferred 1st
Nitazoxanide
Paromomycin
Is there an immune response to:
Worms?
Dead worms?
Eggs?
Worms = NO
Dead worms= Yes
Eggs= Yes
What is the diagnostic marker for necator americanus/ancylostoma duodenale (hook worms)?
Eggs in feces
What is a big difference in the diagnosis of strongyloides stercoralis?
EGGS ARE NOT PASSED IN THE STOOL
What do the eggs look like in trichuris trichiura?
Footballs
What are the (5) drugs used to treat nematodes?
Albendazole
Mebendazole
Thiabendazole
Ivermectin
Pyrantel pamoate
*Look for the bend in the name! Treating worms! Helps!
What are the (2) broad spectrum anti-helminthic agents?
Albendazole
Mebendazole
MOST of the anti-nemotode drugs MOA?
Inhibit microtubule synthesis
PARALYZES worms
What is different about THIABENDAZOLE that warrented a different slide from albendazole and mebendazole?
Thiabendazole is MUCH MORE TOXIC
Don’t give this drug
MOA of Ivermectin?
Intensifies GABA mediated transmission of signals in PNS of nematodes
PARALYSIS of nematodes
MOA of Pyrantel pamoate?
Neuromuscular blocking agent
results in paralysis and expulsion of nemotode
What are the two PRIMARY drugs given to treat MOST nematodes?
Albendazole
Mebendazole
What drug that was introduced for nematodes (considered the evil brother) is NEVER USED?
Thiabendazole
What is the primary drug geven for S. stercoralis?
Ivermectin
Which nemotode doesn’t care which drug is primarily used?
E. vermicularis
What is the “hot dog bun” platyhelminth?
Schistosoma spp
What is the drug used to treat schistosoma?
Praziquantel
MOA of praziquantel?
Increases permeability of nematode cell membranes
results in PARALYSIS
What is the ONE DRUG that does NOT result in paralysis of the worm?
Niclosamide
Niclosamide
MOA?
Uncouples oxidative phosphorylation
Blocks the uptake of glucose
DEATH OF WORM
What should you remember about niclosamide?
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
