Viral, Fungal, and Parasitic Drugs Flashcards
Polio (picorna)
Tx: None
Prevention:
- Salk (killed and IV)
- Sabin (live and oral) Vaccine
*don’t give live to pregnant women and immunocompromised - can cause polio
Hep A (picorna)
TX: None
Prevention:
- Killed vaccine for >1yrs, travelers, and risk groups
- Gamma globulin for close contacts and travelers
Rubella (toga)
TX: None
Prevention: MMR live vaccine
* not good for pregnant women and immunocompromised
Yellow Fever (flavi - arbovirus)
Tx: None
Prevention: Live vaccine for travelers
* don’t give to pregnant women and immunocompromised
Hep C (flavi)
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
HIV (retro)
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
Hep D (delta)
Tx: Treat Hep B
Flu (orthomyxo)
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
Measles and Mumps (paramyxo)
Tx: Vit A for measles
Prevention: Live MMR vaccine
* don’t give to pregnant women and immunocompromised
RSV (paramyxo)
Tx: Ribavirin (teratogen, anemia) - nuceloside analog, polymerase inhibitor
Prevention: palivizumab, monoclonal Ab against fusion protein (passive) for high risk preemies
Parainfluenze (paramyxo)
Tx: Nebulized epinephrine or dexamethasone for croup
Rabies (rhabdo)
Tx: wound care, passive IgG immunization + killed vaccine (pre or post exposure)
Ebola (filo)
Tx: None; treat symptoms
Rota (reo)
Tx: none, oral rehydration
Prevention: live vaccine, some linked to intusussception
* don’t give to pregnant women and immunocompromised
HSV 1 &2 (herpes)
Tx:
- Acyclovir or Valacyclovir(kidney crystals) - nucleoside analog, polymerase inhibitor, needs thymidine kinase
- Foscarnet for resistance (nephrotoxic) - inorganic pyrophosphate, inhibits polymerase, bypasses thymidine kinase
HHV 8 (herpes)
Tx: treat HIV with HAART, give chemo if invasive
EBV (herpes)
Tx: None;
- Rituzimab: passive monoclonal antibody against CD20 for some lymphomas for immunocompromised
CMV (herpes)
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
VZV (herpes)
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
Hep B (hepadna)
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
Adeno (adeno)
Tx: cidofovir (nephrotoxic) for immunocompromised - nucleoside analog, inhibits polymerase
Prevention: Live attenuated vaccine in military
* don’t give to pregnant women and immunocompromised
HPV (papilloma)
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
Histoplasma capsulatum, Blastomyces dermatidis, Coccoides immitis, Paracoccoides braziliensis, Penicillum marmeffei (systemic, endemic & dimorphic)
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
Candida Albicans (opportunistic and dimorphic)
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
Cryptococcus (opportunistc)
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
Mucormycosis (opportunistic)
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
Aspergillus (opportunistic)
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
PCP (opportunistic)
Tx:
- TMP/SMZ (SJS, pancytopenia) : inhibits folate synthesis
Malassezia Fur Fur (dermatophyte)
Tx:
- selenium sulfide
- topical azoles (miconazole, clotrimazole, tolnaftate):
binds cyp450, inhibit ergosterol production, and thus PM
Trichophyton tinea species (dermatophyte)
Tx:
- topical azoles (miconazole, clotrimazole, tolnaftate) except onychomycosis (use terbinafine aka lamisil): bind cyp450, inhibit ergosterol production, and thus PM
Madurella grisea (subcutaneous)
Tx:
- voriconazole (visual disturbances), posconazole (prolonged QT with quinine): bind cyp450, inhibit ergosterol production, and thus PM
- surgical removal or amputation
Sporothrix schenkii (subcutaneous)
Tx:
- itraconazole (hepatotoxic, taste disturbances): binds cyp450, inhibit ergosterol production, and thus PM
Ascaris Lumbricoides, Enterobis Vermicularis, Trichuris Trichuria, Ancylostoma Duodenale, Necatur Americanus, Strongyloides stercoralis (intestinal nematodes)
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
Toxocara canis and ancylostoma brazilensis (tissue/ canine nematodes)
Tx:
- alben/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
Trichinella Spiralis (tissue nematode)
Tx:
- steroids + alben/mebendazole (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtubule assembly -> paralysis and also larvicidal
Wucheria bancrofti/filariasis agents (tissue nematode)
Tx:
- diethylcarbamazine (only for microfilariae and not for lymphedema): paralysis of microfilariae
Onchocerca vovlulus (tissue nematode)
Tx:
- ivermectin: inhibits CNS function and muscle function thus paralysis
Dracunculiasis medinsis (tissue nematode)
Tx:
- local cleansing of lesion
- local antibiotics
- progressive mechanical extraction over days
Taenia saginata and solium (cestode)
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
Diphylobothrium latum (cestode)
Tx:
- prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
Echinococcus granulosis (cestode)
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)
Schistosomes (trematode/ blood fluke)
Tx:
- prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
Opistorchis/ clonorchis sinensis (trematode/ chinese liver fluke)
Tx:
- prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
Paragonimus westermani (trematode/ lung fluke)
Tx:
- prazinquantel: damages integument by ca2+ influx -> depolarization -> paralysis
Fasciola hepatica (trematode/ common liver fluke)
Tx: - vertinary triclabendazole
Entamoeba histolytica (intestinal protozoa)
Tx:
- metronidazole, tinidazole (no alcohol): upsets electron balance
- iodoquinol (for cysts)
Intestinal spore forming protozoa
Cryptosporidium parvum
Microsporidium
Isosopora belli, Cyclospora cayetanensis
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
Giardia lamblia (intestinal protozoa)
Tx:
- metronidazole or tinidazole (no alcohol): upsets electron balance
Trichomonas Vaginalis (vaginal protozoa)
Tx: metronidazole or tinidazole (no alcohol): upsets electron balance
* treat partner as well
CNS protozoa
Naegleria Fowleri
Acanthamoeba
Tx: none; palliative usually kills host
Toxoplasma gondi (CNS protozoa)
Tx: pyrimethamine + sulfadiazine, tmp/smz (SJS, pancytopenia) prophylaxis forAIDs/immuno-compromised: all inhibit folate synthesis
Trypanosoma brucei rhodesiense and gambiense
(CNS protozoa)
Tx:
- Rhodesiense
early disease (periphery/blood): suramin
late disease (CNS): melarsoprol
- Gambiense
early disease (periphery/blood): pentamidine
late disease (CNS): melarsoprol
Trypanosoma cruzi (blood protozoa)
Tx:
acute chagas
- nifurtimox
- benzimidazoles (reversible alopecia, abdominal pain, don’t give to pregnant women): inhibit microtuble assembly, immobilizing, larvicidal
chronic chagas: none
Leishmania mexicana, tropica, braziliensis and donovani (blood protozoa)
Tx:
- pentavalent antimonialsis (cardiotoxicity, nephrotoxicity, pancreatitis, sterile abscess at injection site): heavy metals
- miltefisone
- amphotericin B (nephrotoxic, arrhythmias): binds ergosterol lyses fungal cell membrane
Babesia Microti (blood protozoa)
Tx:
atovaquone + azithromycin (preferred; fewer SE)
quinine + clindamycin
Plasmodium falciparum, vivax, ovale, and malariae (blood protozoa)
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
