Term
| what is the mechanism of action of Nitazoxanide? |
|
Definition
| interferes with PFDR enzyme-dependent *electron transfer reaction* which is critical for anaerobic metabolism |
|
|
Term
| What is metronidazole used to treat? |
|
Definition
| anaerobic bacteria, Giardia lambia, Entamoeba histolytica, Trichomonas vaginalis |
|
|
Term
| What is the mechanism of metronidazole? |
|
Definition
1)acts as an electron sink, depriving cells of reducing equivalents
2)inhibits DNA synthesis (induces strand breaks and alters repair) |
|
|
Term
| What part of the life cycle of protozoa does metronidazole work on? |
|
Definition
|
|
Term
| what is the bioavailability of metronidazole if taken orally? |
|
Definition
| almost 100% - absorbed very well |
|
|
Term
| When should metronidazole not be perscribed? |
|
Definition
| during the first trimester of pregnancy |
|
|
Term
| What happens if metronidazole is given to an alcoholic? |
|
Definition
| disulfiram-like reaction - violent emesis |
|
|
Term
| what are the side effects of metronidazole? |
|
Definition
| headache, metallic taste, vomiting, diarrhea, peripheral neuropathy, CNS toxicity, **disulfiram-like reaction |
|
|
Term
| When treating Entamoeba with metronidazole, you should also use _____________ |
|
Definition
|
|
Term
| Name two Luminal Amoebicides. |
|
Definition
Iodoquinol
Diloxanide Furoate |
|
|
Term
| What is a major side effect seen with prolonged use of Iodoquinol? |
|
Definition
| **subacute myelo-optic neuropathy |
|
|
Term
| what are the side effects of diloxanide furoate? |
|
Definition
GI intolerance
CNS toxicity |
|
|
Term
| what are the side effects of Nitazoxanide? |
|
Definition
| abdominal pain, headache, nausea, diarrhea |
|
|
Term
| what is nitazoxanide used to treat? |
|
Definition
| giardia and cryptosporidia |
|
|
Term
| what stage of Giardia is inhibited by nitazoxanide? |
|
Definition
|
|
Term
| what stage of Cryptosporidia is inhibited by nitazoxanide? |
|
Definition
|
|
Term
| what drugs are used to treat visceral Leishmania? |
|
Definition
pentostam
pentamidine
ampho B |
|
|
Term
| what is the mechanism of action of Pentostam (sodium-stibogluconate)? |
|
Definition
| used to treat Leshmania -interferes with parasitic glycolysis/energy production by blocking phosphorylation of Fructose6P dehydrogenase in amastigotes |
|
|
Term
| what stage of Leshmania is targeted by drugs? |
|
Definition
|
|
Term
| how is pentostam administered to treat Leshmaniaisis? |
|
Definition
| parenteral ONLY (injection) |
|
|
Term
| What are the side effects of Pentostam? |
|
Definition
| nausea, myalgia,arthralgia, flattening of T waves on EKG, increases hepatic transaminases (cardiac/liver toxicity) |
|
|
Term
| what drugs are used for the prophylaxis of malaria? |
|
Definition
Mefloquine-once a week
Atovaquone/proguanil
Doxycycline - once a day/ stay out of sun
chloroquine phosphate if susceptible |
|
|
Term
| what drug targets the hynozoites of plasmodium vivax? |
|
Definition
|
|
Term
| what can be used to treat chloroquine-resistant strains of Plasmodium falciparum? |
|
Definition
1)quinine + pyrimethamine/sulfadoxine
2)quinine + tetracycline or clindamycin
3)artesunate + amodiaquine or sulfadoxine/pyrimethamine |
|
|
Term
| why do patients have trouble completing a course of quinine for P. falciparum? |
|
Definition
|
|
Term
| what is used for the treatment and prophylaxis of P. malariae? |
|
Definition
|
|
Term
| what is the treatment for P. vivax/ovale? |
|
Definition
| Cholorquine phosphate(trophozoites-shizogony stage) + Primaquine phosphate(hypnozoites) |
|
|
Term
| what is the primary mechanism of chloroquine? |
|
Definition
| binds to hemeoglobin complex and inhibits heme polymerase causing an accumulation of heme byproducts(ferriprotoporphyrin 9) which are toxic/ lytic to the parasite |
|
|
Term
| what stage of malaria is targeted by chloroquine? |
|
Definition
| asexual erythrocytic stages |
|
|
Term
| what genes are associated with resistance to chloroquine? |
|
Definition
|
|
Term
| How is chloroquine administered? |
|
Definition
1)usually orally - very good absorption
2)IM injections for kids |
|
|
Term
| what part of the body does chloroquine distribute to? |
|
Definition
| accumulates in all tissues but GREATEST IN RBCs |
|
|
Term
| what are the side effects of chloroquine? |
|
Definition
GI intolerance, headache, pruritis
CNS toxicity, hemolysis
visual disturbances, alopecia, skin eruptions, **cardiac toxicity |
|
|
Term
| what side effects are seen with PROLONGED use of chlorquine? |
|
Definition
**cardiac toxicity- QT prolongation
visual problems
retinopathy
alopecia
skin eruptions |
|
|
Term
| Is a loading dose required for chloroquine or quinine? |
|
Definition
|
|
Term
| where does quinine accumulate? |
|
Definition
| in the tissues much more than in RBC |
|
|
Term
| what are the side effects of quinine? |
|
Definition
GI intolerance
**Cinchonism - headache, tinnitus, visual disturbances
hemolysis
cardiotoxicity |
|
|
Term
| what must be done if giving IV quinine? |
|
Definition
| must monitor in intensive care environment |
|
|
Term
| what mediates resistance to mefloquine? |
|
Definition
|
|
Term
| what is the mechanism of pyrimethamine/sulfadoxine? |
|
Definition
| inhibits synthesis of folic acid by PABA competition and inhibition of dihydrofolate reductase |
|
|
Term
| what is pyrimethamine/sulfadoxine used for? |
|
Definition
| used as a helper drug to prevent resistance when treating malaria |
|
|
Term
| what should patients be screened for before giving primaquine and why? |
|
Definition
| G6PD deficiency - can cause hemolytic anemia |
|
|
Term
| what is the mechanism of action of Atovaquone? |
|
Definition
| inhibits ETC, nucleic acid and ATP synthesis |
|
|
Term
| what is the mechanism of action of Proquanil? |
|
Definition
| inhibits parasite dihyrdofolate reductase |
|
|
Term
| which antimalarial drug is active aginst ALL erythrocytic stages? |
|
Definition
|
|
Term
| what is the mechanism of action of Artesunate? |
|
Definition
1)free radical production in parasite food vacuole
2)inhibits parasite calcium ATPase |
|
|
Term
| what must be given in combination with pyrimethamine/sulfadiazine when treating toxoplamosis and why? |
|
Definition
| Leucovorin - reduces the hematological toxicity of pyrimethamine |
|
|
Term
| what are the side effects of mefloquine? |
|
Definition
| dizziness, GI upset, nightmares, insomnia, panic attacks, seizures, **psychosis, cardiotoxicity |
|
|
Term
| where does pyrimethamine/sulfadoxine accumulate? |
|
Definition
| kidneys, liver, lungs, spleen |
|
|
Term
| How does pyrimethamine/suladoxine work? |
|
Definition
| inhibits folic acid synthesis by PABA competition and inhibting dihydrofolate reductase |
|
|
Term
| why is hemolytic anmeia seen in G6PD deficient individuals that take primaquine? |
|
Definition
| in their erythrocytes there is a failure to replenish NADPH - primaquine metabolites generate free radicals/peroxides which cause lysis of the RBC (older cells more susceptible) |
|
|
Term
| what are the treatments for Pneumocystis jiroveci? (4) |
|
Definition
1)**trimethoprim/sulfamethoxazole
2)pentamidine isethionate
3)atovaquone
4)clindamycin + primaquine |
|
|
Term
| what is used for the prophylaxis of P. jiroveci? |
|
Definition
1)trimethoprim/sulfamethoxazole
2)dapsone - use if allergic to sulfa drugs
3)atovaquone
4)aerosolized pentamidine |
|
|
Term
| How is pentamidine isethionate administered? |
|
Definition
| IV or aerosolized form ONLY (poor oral absorption) |
|
|
Term
| what are the side effects of pentamidine isethionate? |
|
Definition
| nephrotoxicity, hypotension, hypoglycemia,diabetes melltius, bone marrow suppression, pancreatitis |
|
|
Term
| what is the mechanism of dapson used to treat P. jiroveci? |
|
Definition
| inhibits utilization of PABA for folic acid synthesis |
|
|
Term
| what is dapsone used for? |
|
Definition
| PROPHYLAXIS of P. jiroveci |
|
|
Term
| what are the side effects of dapsone? |
|
Definition
nausea, anorexia, fever
**methemoglinemia,**hemolysis in G6PD deficiency
photsensitivity, agranulocytosis, aplastic anemia |
|
|
Term
| what drugs are used to treat Toxoplasma gondii? |
|
Definition
1)pyrimethamine/sulfadiazine
2)pyrimethamine + clindamycin |
|
|
Term
| what is used a prophylaxis for Toxoplasma gondii? |
|
Definition
| trimethoprim/sulfamethoxazole (Bactrim) |
|
|
Term
| what two drugs are used to treat Hookworm, Ascaris, or Whipworm? |
|
Definition
1)Mebendazole
2)*Albendazole - DOC bc better activity/toleration |
|
|
Term
| what should be used as adjunst therapy for Ascaris? |
|
Definition
| piperazine - muscle relaxer that can help with obstruction (esp in kids) |
|
|
Term
| what is the mechanism of action of mebendazole? |
|
Definition
| inhibits polymerization to form microtubules which prevents glucose uptake by the worm - gycogen depleted, ATP synthesis prevented so worm starves |
|
|
Term
| how is mebendazole administered? |
|
Definition
|
|
Term
| what is the mechanism of albendazole? |
|
Definition
| prevents glucose uptake in helminths |
|
|
Term
| what is piperazine citrate active against? |
|
Definition
|
|
Term
| what is the mechanism of piperazine citrate? |
|
Definition
| agonist of GABA-gated chloride channels in nematode muscle - results in worm being paralyzed (flaccid paralysis) and then passed in stool alive |
|
|
Term
| what is used as treatment for Strongyloidiasis? |
|
Definition
1)albendazole
2)ivermectin |
|
|
Term
| what is the mechanism of ivermectin? |
|
Definition
causes release/binding of GABA at postsynaptic site on NMJ which paralyzes the worm
also affects a glutamate-gated chloride channel in nerve and muscle |
|
|
Term
| what is ivermectin used to treat? |
|
Definition
1)nematodes - strongyloidiasis
2)arthropods - mites, fleas, ticks
3) heartworms in dogs |
|
|
Term
| what is the drug of choice for the treatment of pinworm? |
|
Definition
|
|
Term
| what two drugs can be used to treat pinworm? |
|
Definition
pyrantel pamoate
albendazole - drug of choice |
|
|
Term
| what is the mechanism of pyratel pamoate? |
|
Definition
| depolarizing nueromuscular-blocking agent/ inhibits cholinesterase ----**causes worm paralysis and expulsion from GI tract |
|
|
Term
| what is the drug of choice when treating tapeworms? |
|
Definition
|
|
Term
| what is the problem with treating neurocysticercosis? |
|
Definition
| precipitate an inflammatory response, cerebral edema and icreased mass effect, and increased intracranial pressure |
|
|
Term
| what two drugs can be used to treat neurocysticercosis? |
|
Definition
|
|
Term
| when should drugs be used to treat neurocysticercosis? |
|
Definition
| if there are multiple lesions, esp at the basilar cisterns or sylvian fissure |
|
|
Term
| what is the mechanism of praziquantel? |
|
Definition
1)increasees membrane permeability resulting in small holes in the worm
2)causes prolonged parasite muscle contraction and spastic paralysis |
|
|
Term
| what are the side effects of praziquantel? |
|
Definition
| headache, dizziness, nausea |
|
|
Term
| what is praziquantel used to treat? |
|
Definition
| tapeworms and trematodes(flukes) |
|
|
Term
| what is used to treat cysticercosis of T. solium and hydatid cysts of Echinococcus? |
|
Definition
|
|
Term
| what are the side effects of albendazole? |
|
Definition
| diarrhea, epigastric abdominal pain, leukopenia, hepatotoxicity |
|
|
Term
| Drug of choice for e. histolytica? |
|
Definition
|
|
Term
| How do luminal agents work? |
|
Definition
| they act in the bowel lumen |
|
|
Term
| What bacterial infection is associated with a higher mortality rate with treatment? |
|
Definition
| e. coli 0157H7 (enterohemorrhagic) |
|
|
Term
| Treat giardi lamblia with? |
|
Definition
|
|
Term
| treat trichomonas vaginalis with? |
|
Definition
|
|
Term
| Mechanism of metronidazole ? (according to vande's transcript) |
|
Definition
| Deprives reducing equivalents in protozoa and may inhibit DNA synthesis. Effects trophozoites rather than cysts b/c affects the actively metabolizing bugs |
|
|
Term
| _____________ may cause violent emesis in alcoholics |
|
Definition
|
|
Term
| side effects of metronidazole? |
|
Definition
| headache, nausea, vomiting, diarrhea (from a disulfram-rxn) |
|
|
Term
| 2 luminal agents dr. vande mentioned in case of resistance or intolerance to metronidazole? |
|
Definition
1)iodoquinol
2)diloxanide furoate |
|
|
Term
| side effects of iodoquinol? |
|
Definition
| subacute myelo-optic neuropathy and some peripheral neuropathy |
|
|
Term
| side effects of diloxanide furoate? |
|
Definition
| GI intolerance (dont really see CNS toxicity) |
|
|
Term
| Nitazoxanide is mainly aimed at what 2 protozoa? |
|
Definition
1)giardia (trophozoite)
2)crytposporidia (oocysts and sporozoites) |
|
|
Term
| what is the mechanism of action of nitazoxanide? |
|
Definition
| interferes with pyruvate ferredoxin oxidoreductase (PFDR) |
|
|
Term
| Pentostam, pentamidine and ampho B can all be used to treat what? |
|
Definition
| viceral leishmania and cutaneous is needed (it usually spontaneously resolves) |
|
|
Term
| what is the mechanism of action of Pentastam (sodium-stibogluconate)? |
|
Definition
| interferes with parasite glycolysis in the amastigote (leishmania) decreasing ATP production. |
|
|
Term
| how do you administer pentastam? |
|
Definition
|
|
Term
| side effects of pentostam? |
|
Definition
| (for leishmania) nausea, myalgia, arthralgia, flattening of T waves, increase in hepatic enzymes (just BAD) |
|
|
Term
| chinchona alkaloids can be used to treat? |
|
Definition
| chloroquine resistant malaria |
|
|
Term
| Artemisin (artesunate) can be used to treat? |
|
Definition
chloroquine resistant plasmodium
falciparum |
|
|
Term
|
Definition
|
|
Term
| name 2 chinchona alkaloids |
|
Definition
|
|
Term
|
Definition
| prophylaxis of malaria (falciparum) |
|
|
Term
| for chloroquine resistant malaria use? (falciparum) |
|
Definition
| artesunate or quinine + another drug (b/c srtessunate clears quicly and quinine can cause GI problems) |
|
|
Term
| for prophylaxis of chloroquine resistant malaria use? (falciparum) |
|
Definition
| mefloquin or doxycyccline or atovaquone |
|
|
Term
| Mechansim of action of chloroquine (aralen) |
|
Definition
| inhibits a heme polymerase causing a buildup of toxic metabolites in RBC, keeps bug from using heme (also kills rbc) |
|
|
Term
| PFMDR1 and cg2 are involved with? |
|
Definition
|
|
Term
| side effects of chloroquine? |
|
Definition
| hemolysis in G6PDH deficiency, visual disturbances, CARDIAC TOXICITY (there are more than just this) |
|
|
Term
| dont use chloroquine with? |
|
Definition
| another arrhythmogenic agent (can cause long QT syndrome) |
|
|
Term
| chloroquine and quinine both kill what form of the plasmodium? |
|
Definition
|
|
Term
|
Definition
| causes an accumulation of heme pigment but doesnt not affect the heme polymerase directly |
|
|
Term
| side effects of quinidine? |
|
Definition
1)GI intolerance
2)cinchonism (headache, tinnitus, visual disturbances)
2)hemolysis
(IV quinidine must be monitored in ICU) |
|
|
Term
| side effects of mefloquine? (worse in elderly) |
|
Definition
| dizziness, GI upset, nightmares and insomnia, night terrors, insomnia, can cause panic attacks, seizures and psychosis. Cardiotoxicity can occur, |
|
|
Term
| pyrimethamine/sulfadoxine is mainly used for? |
|
Definition
| as a helper drug to decrease resistance |
|
|
Term
| mechanism of action of pyrimehtamine/sulfadoxine? |
|
Definition
|
|
Term
| what side effects from sulfonamides are frequent? |
|
Definition
|
|
Term
| atovaquone/proquanil can be used for? |
|
Definition
| prophylaxis vs. chloroquine resistant falciparum |
|
|
Term
| what is the mechanism of action of atovaquone? |
|
Definition
| inhibits electron transport chain leading to decrease in ATP and nucleic acid synthesis |
|
|
Term
| the mechanism of action of proquanil is? |
|
Definition
| dihydrofolate reductase inhibtor |
|
|
Term
| what is the mechanism of action of artesunate? |
|
Definition
| It inhibits Ca ATPase which helps kill all forms of plasmodium including he gametocyte |
|
|
Term
|
Definition
|
|
Term
| main treatment for pneumocystis jiroveci? |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| Bactrim = __________________ |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| pentamidine is used to treat? |
|
Definition
| leishmania and pneumocystis jiroveci |
|
|
Term
| dapsone may be used as a prophylactic for? |
|
Definition
|
|
Term
|
Definition
1)methemoglobin
2)hemolysis in G6PD |
|
|
Term
| how do you treat toxoplasma gondii? |
|
Definition
| pyrimethamine/sulfadiazine or pyrimethamine + clindamycin |
|
|
Term
| what do you use for prophylaxis of tosoplasma gondii? |
|
Definition
| trimethoprim/sulfamethoxazole |
|
|
Term
| what drug do you use with pyrimethamine/sulfadiazine to reduce toxicity? |
|
Definition
|
|
Term
| tsetse fly is the vector for ? |
|
Definition
|
|
Term
| reduviids is the vector for ? |
|
Definition
|
|
Term
| Mebendazole or abendazole* can be used for |
|
Definition
| Hookworm, ascaris or whipworm |
|
|
Term
| a drug used as an adjunct therapy for ascaris and pinworm? |
|
Definition
| piperazine; it kinda paralyzes the worms so the can be flushed out |
|
|
Term
| mechanism of action of mebendazole? |
|
Definition
| depolymerizes microtubules causing a decreases in glycogen |
|
|
Term
| mechanism of action of albendazole? |
|
Definition
| blocks glucose uptake of helminthes |
|
|
Term
| One of the few parasitic infections they screen for before transplants |
|
Definition
| strongyloids b/c immunocomp state allows hyperinfection causing atypical pneumonia |
|
|
Term
| treat strongyloides with? |
|
Definition
| albendazole or ivermectin |
|
|
Term
| This drug may be used to treat strongyloides and heart worms in dogs |
|
Definition
|
|
Term
| Mechanism of action of ivermectin? |
|
Definition
| Binds GABA at post synaptic sites and also affects glutamate gated ca channel, paralyzes worms respiratory muscles |
|
|
Term
| adverse effects from ivermectin are only noted in conjunction with ___________ |
|
Definition
|
|
Term
|
Definition
| albendazole or pyrantel pamoate |
|
|
Term
| the machanism of action of pyrantel palmoate? |
|
Definition
| causes paralysis of the worm |
|
|
Term
| DRug of choice for tapeworms |
|
Definition
|
|
Term
| How do you treat neurocystocercosis? |
|
Definition
| praziquantel or albendazole, but really just need to leave untreated unless some kind of blockage |
|
|
Term
| how do you treat hydrocephalus asscoiated with neurocysticercosis? |
|
Definition
|
|
Term
| mechanism of action of praziquantel? |
|
Definition
| This drug causes prolonged parasite muscle CONTRACTION, so it’s not like the other drugs that caused paralysis! It causes a tonic phase in the parasite. Praziquantel is readily absorbed, which is what you want for treatment of the tissue phase. |
|
|
Term
| how do you treat tapeworm? |
|
Definition
|
|
