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Virus, Fungi, and Parasite Drugs > Viral, Fungal, and Parasitic Drugs > Flashcards

Viral, Fungal, and Parasitic Drugs Flashcards

1
Q

Polio (picorna)

A

Tx: None

Prevention:

  • Salk (killed and IV)
  • Sabin (live and oral) Vaccine

*don’t give live to pregnant women and immunocompromised - can cause polio

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2
Q

Hep A (picorna)

A

TX: None

Prevention:

  • Killed vaccine for >1yrs, travelers, and risk groups
  • Gamma globulin for close contacts and travelers
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3
Q

Rubella (toga)

A

TX: None

Prevention: MMR live vaccine

* not good for pregnant women and immunocompromised

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4
Q

Yellow Fever (flavi - arbovirus)

A

Tx: None

Prevention: Live vaccine for travelers

* don’t give to pregnant women and immunocompromised

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5
Q

Hep C (flavi)

A

Tx:

Old (indirect antivirals)

  • Ribavirin (teratogen) + Peg interferon a (depression)

New

  • Sofosbuvir: nucleoside analog and polymerase inhibitor
  • Dasabuvir: non nucleoside analog and polymerase inhibitor
  • Simepravir, paritaprevir, telaprevir, boceprevir

NS 3&4 (protease) inhibitor

  • Ledispasvir, ombitasvir, daclatasvir: NS5A (protease) inhibitor
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6
Q

HIV (retro)

A

Tx: HAART

  • 2 NRTIs (nucleoside RT inhibitor) + 1 nNRTI (non nucleoside) + 1 PI (protease inhibitor) or 1 II (integrase inhib)
  • NRTIs (ends in -dine or -vir): tenofovir (nephrotoxic, osteopenia), abacavir (hypersensitivity in HLA alleles), emtricitabine (less toxic - hyperpigmentation), lamivudine (less toxic), zidovudine (anemia, neutropenia) - all mostly dyslipedemia and mitochondrial toxicity
  • nNRTIs (-vir in middle): rilpivirne (less toxic - rash), nevirapine (hepatoxic, rash), efavirenz (rash, vivid dreams) - all cyp450 interactions
  • PI (-navir at end): darunavir (rash), atazanavir (hyperbilirubinemia, kidney stones) - all cyp 450 interactions and dyslipedemia!
  • II (-tegra in middle): raltegravir, elvitegravir (combo pill), dolutegravir
  • PK boosters (cyp450 inhibitors - dyslipidemia): cobicistat, ritonavir
  • CCR5 inhibitors (not used, resistance): Maraviroc
  • Fusion inhibitors (not used, resistance): zenfuvirtide
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7
Q

Hep D (delta)

A

Tx: Treat Hep B

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8
Q

Flu (orthomyxo)

A

Tx:

  • Osetalmavir & Zanamavir (exacerbate COPD and asthma sxs): NA inhibitor - Sialic Acid Analogs
  • Amantadine (ataxia, dizziness, slurred speech): M2 inhibitor for strain A only; not really used due to resistance.

Prevention:

Killed vaccine, live intranasal vaccines, recombinant vaccine

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9
Q

Measles and Mumps (paramyxo)

A

Tx: Vit A for measles

Prevention: Live MMR vaccine

* don’t give to pregnant women and immunocompromised

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10
Q

RSV (paramyxo)

A

Tx: Ribavirin (teratogen, anemia) - nuceloside analog, polymerase inhibitor

Prevention: palivizumab, monoclonal Ab against fusion protein (passive) for high risk preemies

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11
Q

Parainfluenze (paramyxo)

A

Tx: Nebulized epinephrine or dexamethasone for croup

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12
Q

Rabies (rhabdo)

A

Tx: wound care, passive IgG immunization + killed vaccine (pre or post exposure)

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13
Q

Ebola (filo)

A

Tx: None; treat symptoms

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14
Q

Rota (reo)

A

Tx: none, oral rehydration

Prevention: live vaccine, some linked to intusussception

* don’t give to pregnant women and immunocompromised

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15
Q

HSV 1 &2 (herpes)

A

Tx:

  • Acyclovir or Valacyclovir(kidney crystals) - nucleoside analog, polymerase inhibitor, needs thymidine kinase
  • Foscarnet for resistance (nephrotoxic) - inorganic pyrophosphate, inhibits polymerase, bypasses thymidine kinase
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16
Q

HHV 8 (herpes)

A

Tx: treat HIV with HAART, give chemo if invasive

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17
Q

EBV (herpes)

A

Tx: None;

  • Rituzimab: passive monoclonal antibody against CD20 for some lymphomas for immunocompromised
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18
Q

CMV (herpes)

A

Tx:

  • Ganciclovir/Valganciclovir (bone marrow suppression) - nucleoside analog, polymerase inhibitor, needs viral kinase
  • Cidofovir (nephrotoxic)
  • Foscarnet (nephrotoxic) for resistance- inorganic pyrophosphate, inhibits polymerase, bypasses thymidine kinase
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19
Q

VZV (herpes)

A

TX:

  • Acyclovir/Valacyclovir, famcyclovir (all kidney crystals) for shingles- nucleoside analog, polymerase inhibitor, needs thymidine kinase
  • Foscarnet (nephrotoxic) for resistant strains- inorganic pyrophosphate, inhibits polymerase, bypasses thymidine kinase

Prevention: Live attenuated vaccine for chicken pox and Zoster (>60yrs)

* don’t give to pregnant women and immunocompromised

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20
Q

Hep B (hepadna)

A

Tx:

  • peg interferon a (depression) - indirect anti-viral
  • NRTIs (ends in -dine or -vir): tenofovir (nephrotoxic, osteopenia), lamivudine (less toxic), emtricitabine (less toxic - hyperpigmentation)

Prevention:

  • recombinant vaccine
  • IgG passive immunization
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21
Q

Adeno (adeno)

A

Tx: cidofovir (nephrotoxic) for immunocompromised - nucleoside analog, inhibits polymerase

Prevention: Live attenuated vaccine in military

* don’t give to pregnant women and immunocompromised

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22
Q

HPV (papilloma)

A

Tx: none; remove lesions/warts - cryosurgery (nitrogen) or salycylic acid

Prevention:

  • Gardasil vaccine (recombinant; 6, 11, 16, 18): genital warts and cervical cancer
  • Cervarix vaccine (recombinant; 16,18): cervical cancer
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23
Q

Histoplasma capsulatum, Blastomyces dermatidis, Coccoides immitis, Paracoccoides braziliensis, Penicillum marmeffei (systemic, endemic & dimorphic)

A

Tx:

Local and mild infections:

  • itraconazole (hepatoxic, taste disturbances), voriconazole (visual disturbances), fluconazole (hepatotoxic) - bind cyp450, inhibit ergosterol production, and thus PM

Systemic/disseminated infections:

  • amphotericin B (nephrotoxic, arrhythmias) - creates transmembrane hole in membrane causing lysis and electrolyte leakage

+ 5-FC (bone marrow toxicity) - inhibits DNA snthesis; for marmeffei only

24
Q

Candida Albicans (opportunistic and dimorphic)

A

Tx:

  • Fluconazole (hepatotoxic) for mild infections: bind cyp450, inhibit ergosterol production, and thus PM
  • Nysatatin : oral thrush and esophagitis
  • Miclonazole, Clotrimazole for cutaneous/ topical
    infections: bind cyp450, inhibit ergosterol production, and thus PM
  • Amphotericin B (nephrotoxic, arrhythmias): systemic and disseminated infections; creates transmembrane hole in membrane causing lysis and electrolyte leakage
  • Capsofungin (hypersensitivity): systemic and disseminated infections; resistance to amphotericin B; inhibits glucan synthesis and thus cell wall synthesis
25
Q

Cryptococcus (opportunistc)

A

Tx:

  • Amphotericin B (nephrotoxic, arrhythmias): creates transmembrane hole in membrane causing lysis and electrolyte leakage

+ 5 FC (bone marrow toxicity) : inhibits DNA synthesis

+ fluconazole (hepatotoxic) later for maintenance: bind cyp450, inhibit ergosterol production, and thus PM

26
Q

Mucormycosis (opportunistic)

A

Tx:

  • surgical debridement
  • posaconazole (prolonged QT with quinine): binds cyp450, inhibit ergosterol production, and thus PM
  • Amphotericin B (nephrotoxic, arrhythmias): for adjunctive therapy; creates transmembrane hole in membrane causing lysis and electrolyte leakage
27
Q

Aspergillus (opportunistic)

A

Tx:

  • Voriconazole (visual disturbances) for mild infections:

binds cyp450, inhibit ergosterol production, and thus PM

  • surgical removal of aspergilloma
  • corticosteroids for ABPA
  • Amphotericin B (nephrotoxic, arrhythmias) for disseminated: creates transmembrane hole in membrane causing lysis and electrolyte leakage
28
Q

PCP (opportunistic)

A

Tx:

  • TMP/SMZ (SJS, pancytopenia) : inhibits folate synthesis
29
Q

Malassezia Fur Fur (dermatophyte)

A

Tx:

  • selenium sulfide
  • topical azoles (miconazole, clotrimazole, tolnaftate):

binds cyp450, inhibit ergosterol production, and thus PM

30
Q

Trichophyton tinea species (dermatophyte)

A

Tx:

  • topical azoles (miconazole, clotrimazole, tolnaftate) except onychomycosis (use terbinafine aka lamisil): bind cyp450, inhibit ergosterol production, and thus PM
31
Q

Madurella grisea (subcutaneous)

A

Tx:

  • voriconazole (visual disturbances), posconazole (prolonged QT with quinine): bind cyp450, inhibit ergosterol production, and thus PM
  • surgical removal or amputation
32
Q

Sporothrix schenkii (subcutaneous)

A

Tx:

  • itraconazole (hepatotoxic, taste disturbances): binds cyp450, inhibit ergosterol production, and thus PM
33
Q

Ascaris Lumbricoides, Enterobis Vermicularis, Trichuris Trichuria, Ancylostoma Duodenale, Necatur Americanus, Strongyloides stercoralis (intestinal nematodes)

A

Tx:

  • alben/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
    • ivermectin (for strongyloides stercoralis): inhibits CNS function and muscle function thus paralysis
34
Q

Toxocara canis and ancylostoma brazilensis (tissue/ canine nematodes)

A

Tx:

  • alben/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
35
Q

Trichinella Spiralis (tissue nematode)

A

Tx:

  • steroids + alben/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
36
Q

Wucheria bancrofti/filariasis agents (tissue nematode)

A

Tx:

  • diethylcarbamazine (only for microfilariae and not for lymphedema): paralysis of microfilariae
37
Q

Onchocerca vovlulus (tissue nematode)

A

Tx:

  • ivermectin: inhibits CNS function and muscle function thus paralysis
38
Q

Dracunculiasis medinsis (tissue nematode)

A

Tx:

  • local cleansing of lesion
  • local antibiotics
  • progressive mechanical extraction over days
39
Q

Taenia saginata and solium (cestode)

A

Tx:

  • prazinquantel for tineasis: damages integument by ca2+ influx -> depolarization -> paralysis
  • self-limiting, surgical excisison of cysts or steroids + albe/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women) for neurocysticeros: inhibit microtubule assembly -> paralysis and also larvicidal
40
Q

Diphylobothrium latum (cestode)

A

Tx:

  • prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
41
Q

Echinococcus granulosis (cestode)

A

Tx:

lungs

  • prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
  • albe/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
  • surgical excision of cysts if necessary

liver

  • PAIR procedure (percutaneous, aspiration, installation, reaspiration)
42
Q

Schistosomes (trematode/ blood fluke)

A

Tx:

  • prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
43
Q

Opistorchis/ clonorchis sinensis (trematode/ chinese liver fluke)

A

Tx:

  • prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
44
Q

Paragonimus westermani (trematode/ lung fluke)

A

Tx:

  • prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
45
Q

Fasciola hepatica (trematode/ common liver fluke)

A

Tx: - vertinary triclabendazole

46
Q

Entamoeba histolytica (intestinal protozoa)

A

Tx:

  • metronidazole, tinidazole (no alcohol): upsets electron balance
  • iodoquinol (for cysts)
47
Q

Intestinal spore forming protozoa

Cryptosporidium parvum

Microsporidium

Isosopora belli, Cyclospora cayetanensis

A

Tx:

  • Nitozoxanide (healthy pts); immune reconstitution and oral rehydration therapy for cryptosporidum
  • immune reconstitution and oral rehydration therapy for microsporidium
  • tmp/smz (SJS, pancytopenia) for isospora and cyclospora: inhibis folate synthesis
48
Q

Giardia lamblia (intestinal protozoa)

A

Tx:

  • metronidazole or tinidazole (no alcohol): upsets electron balance
49
Q

Trichomonas Vaginalis (vaginal protozoa)

A

Tx: metronidazole or tinidazole (no alcohol): upsets electron balance

* treat partner as well

50
Q

CNS protozoa

Naegleria Fowleri

Acanthamoeba

A

Tx: none; palliative usually kills host

51
Q

Toxoplasma gondi (CNS protozoa)

A

Tx: pyrimethamine + sulfadiazine, tmp/smz (SJS, pancytopenia) prophylaxis forAIDs/immuno-compromised: all inhibit folate synthesis

52
Q

Trypanosoma brucei rhodesiense and gambiense

(CNS protozoa)

A

Tx:

  • Rhodesiense

early disease (periphery/blood): suramin

late disease (CNS): melarsoprol

  • Gambiense

early disease (periphery/blood): pentamidine

late disease (CNS): melarsoprol

53
Q

Trypanosoma cruzi (blood protozoa)

A

Tx:

acute chagas

  • nifurtimox
  • benzimidazoles (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtuble assembly, immobilizing, larvicidal

chronic chagas: none

54
Q

Leishmania mexicana, tropica, braziliensis and donovani (blood protozoa)

A

Tx:

  • pentavalent antimonialsis (cardiotoxicity, nephrotoxicity, pancreatitis, sterile abscess at injection site): heavy metals
  • miltefisone
  • amphotericin B (nephrotoxic, arrhythmias): binds ergosterol lyses fungal cell membrane
55
Q

Babesia Microti (blood protozoa)

A

Tx:

atovaquone + azithromycin (preferred; fewer SE)

quinine + clindamycin

56
Q

Plasmodium falciparum, vivax, ovale, and malariae (blood protozoa)

A

Tx: all antimalarials block heme polymerase

Ovale and malariae

  • chloroquine (teratogen, H/A, blurred vision, bitter taste, dizziness, nausea) for schizonts, also used as prophylaxis + primaquine (teratogen, hemolytic anemia in G6PD) for hypnozoites in ovale

Vivax

  • primaquine + chloroquine if sensitive, but mostly resistant
  • primaquine + [quini(di)ne, mefloquine, atovaquone + proguanil] for resistance; also used as prophylaxis except for quini(di)ne and primaquine

mefloquine (SE): SJS, vivid dreams, nonteratogenic

quini(di)ne (SE): cardiotoxicity, cinchoism (H/A, tinitis), hemoltyic anemia in G6PD

atovaquone+proguanil (SE): Few, GI intolerance

Falciparum

  • chloroquine resistant in most parts of the world.

less severe infections: mefloquine, atovaquine + proguanil, oral (quini(di)ne + doxycycline), artemesinins aka Chinese wormwood & derivatives

more severe infections: IV (artesunate, quini(di)ne + doxycycline)

doxy (SE): photo-sensitvity

Virus, Fungi, and Parasite Drugs (1 decks)

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