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IDMM > Antiungal and Antiparasitic Therapy > Flashcards

Antiungal and Antiparasitic Therapy Flashcards

1
Q

Polyenes (class, mechanism)

  • Amphotericin B
  • Nystatin
A

MOA: bind ergosterol in cell membrane, disrupt cell wall permeability, result in cell death

Special Considerations:

  • Fungicical
  • Amphoterocin associated with dose-related toxicities (“amphoterrible”): liposomal/lipid complex formulations more $$, but less nephrotoxicity
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2
Q

Amphoterocin B (IV)

A

Spectrum:

  • Candida (not C. lusitaniae)
  • Aspergillus
  • Coccidioides
  • Cryptococcus
  • Blastomyces
  • Histoplasma

Clinical:

  • Aspergillus
  • Cryptococcal meningitis (w. flucytosine)
  • Blastomycosis
  • Coccidiomycosis
  • **NOT 1st line for Candida
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3
Q

Nystatin (powder, ointment/cream, vaginal tablet, oral suspension)

A

Spectrum:
- Candida

Clinical:

  • oropharyngeal and vaginal candidiasis
  • skin infections of Candida
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4
Q

Azoles (class, mechanism)

  • Fluconazole
  • Itraconazole
  • Voriconazole
  • Posaconazole
A

MOA: Inhibit lanosterol C-14 demethylase to inhibit ergosterol synthesis

Special Considerations:

  • FungiSTATIC for Candida, fungiCIDAL for Aspergillus
  • fluconazole and voriconazole excellent bioavailability (PO)
  • potent CYP 3A4 inhibitors
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5
Q

Fluconazole (IV/PO)

A

Spectrum:

  • Candida
  • Coccidioides
  • Cryptococcus
  • Blastomyces
  • Histoplasma
  • NOT Aspergillus

Clinical:

  • invasive C. albicans
  • not empirical for non-albican infections
  • oral step-down for cryptococcus meningitis
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6
Q

Itraconazole PO (IV special access)

A

Spectrum:

  • Candida
  • Aspergillus
  • Cryptococcus
  • Blastomyces
  • Histoplasma

Clinical:

  • poorer oral bioavailability
  • oral step-down for dimorphic fungi (CBH)
  • alternate for Candida/Aspergillus (poorer oral absorption)
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7
Q

Voriconazole (IV/PO) - Broad Spectrum

A

Spectrum:

  • CACCBH
  • Fusarium, Scedosporium

Clinical:

  • reserve for Aspergillus, Fusarium, Scedosporium
  • drug-resistant fungal infections
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8
Q

Posaconazole PO

A

Spectrum:

  • CACCBH
  • Fusarium, Scedosporium, Zygomycetes

Clinical:

  • reserve for Zygomycetes, Fusarium, Scedosporium
  • drug-resistant fungal infections
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9
Q

Echinocandins (class, mechanism)

  • Anidulafungin
  • Capsofungin
  • Micafungin
A

Spectrum:
- inhibit beta-(1,3)-D-glucan production, essential component to cell wall synthesis

Special considerations:

  • fungiCIDAL Candida, fungiSTATIC Aspergillus
  • IV only! no PO absorption
  • higher MICs, for non-albican Candida
  • more activity for Candida generally
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10
Q

Anidulafungin IV
Capsofungin IV
Micafungin IV

A

Spectrum:

  • Candida
  • Aspergillus

Clinical:

  • serious NON-ALBICANS Candida infections
  • active vs Aspergillus (salvage tx only)
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11
Q

Topical Antifungals (MOA not impt)

  • Clotrimazole
  • Ciclopirox
  • Tolnaftate
  • Terfinibine
A

The 2 C’s:
- covers Candida, Malassezia furfur (tinea versicolor), trichophyton, Microsporum, Epidermophyton

The 2 T’s:
- cover Tinea infections

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12
Q

Clotrimazole

- Cream

A

Spectrum:

  • Trichophyton
  • Microsporum
  • Epidermophyton
  • Candida
  • Malassezia furfur

Clinical:

  • Tinea pedis (athlete’s foot)
  • Tinea cruris
  • Tinea corporis
  • Tinea versicolor
  • Cutaneous candidiasis
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13
Q

Ciclopirox

  • nail lacquer
  • cream
  • shampoo
A

Spectrum:

  • Trichophyton
  • Microsporum
  • Epidermophyton
  • Candida
  • Malassezia furfur

Clinical:

  • Lacquer for mild onychomycosis (nail fungi, trichophyton rubrum)
  • Tinea pedis (athlete’s foot)
  • Tinea cruris
  • Tinea corporis
  • Tinea versicolor
  • Cutaneous candidiasis
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14
Q

Tolnaftate

- cream, powder, solution, aerosol, spray

A

Spectrum: Dermatophytes NOT Candida

  • Trichophyton
  • Microsporum
  • Epidermophyton
  • Malassezia furfur

Clinical:

  • Tinea pedis
  • Tinea cruris,
  • Tinea corporis,
  • Tinea versicolor
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15
Q

Terfinabine

  • PO
  • Cream
A

Spectrum: Dermatophytes
- Trichophyton, Microsporum, Epidermophyton

Clinical:

  • PO for tinea captitis and onychomycosis (Trichophyton rubrum)
  • topical for tinea pedis/cruris/corporis, versicolor
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16
Q

Antimalarials

  • Chloroquine
  • Mefloquine
  • Atovaquine/proguanil
  • Artesunate
  • Quinine
  • Primaquine
A

Prophylaxis:

  • Chloroquine/Mefloquine/Atovaqine+proguanil
  • Doxycycline is an alternative for malarial prophylaxis for drug-resistant regions/drug intolerance

Treatment:

  • Artesunate, quinine, primaquine
  • clindamycin also alternative for combo malaria treatment of can’t use first line ORAL
17
Q

Chloroquine

A

MOA: active in erythrocyte stage

Spectrum:
- P. Falciparum, vivax, ovale, malariae, knowlesi

Clinical:
- prophylaxis or treatment for chloroquine susceptible regions

18
Q

Mefloquine

A

MOA: active in erythrocyte stage

Spectrum:
- P. falciparum, vivax

Clinical:

  • prophylaxis or treatment for chloroquine resistant/ chloroquine intolerance
  • occasional neuropsychiatric effects
  • usually not used for tx b/c higher doses required
19
Q

Atovaquone/proguanil

A

MOA: active in liver/erythrocyte stage

Spectrum: P. falciparum

Clinical:

  • Malaria prophylaxis for chloroquine/mefloquine resistant regions
  • Treatment 1st line for uncomplicated P. falciparum
20
Q

Artesunate IV

- special access via Canadian Malaria Network

A

MOA: active in erythrocyte stage
Spectrum: P. falciparum

Clinical:

  • preferred treatment of severe malaria
  • followed by PO therapy
  • short half-life
  • oral not available in Canada
21
Q

Quinine IV/PO

- IV special access via Canadian Malaria Network

A

MOA: active in erythrocyte stages
Spectrum: P. falciparum, P vivax

Clinical:

  • IV for 2nd line tx of severe malaria (+ PO therapy)
  • PO 2nd line tx for uncomplicated malaria (combo)
22
Q

Primaquine

A

MOA; active in liver stages
Spectrum: P. ovale, P. vivax

Clinical:

  • Terminal prophylaxis for P. ovale/vivax
  • primary prophylaxis
  • contraindicated in pregnancy, G6PD deficiency
23
Q

Albendazole PO

  • Special access program
  • class benzimidazole
A

MOA: inhibits MT formation (binds parasitic beta-tubulin), glucose uptake, depletes glycogen, decrease ATP production

Spectrum:

  • Strongyloides stercoralis
  • Ascaris lumricoides
  • Enterobius vermicularis
  • Trichuris trichuria
  • Ancylostoma duodenale
  • Necator americanus

Clinical Indications:
- alternative for strongyloidiasis, roundworm, pinworm, whipworm, hookworm

24
Q 
Mebendazole PO
- class benzimidazole
A

MOA: inhibits MT formation by binding beta-tubulin, gluclose uptake, depletes glycogen, decrease ATP production

Spectrum:

  • Ascaris lumricoides
  • Enterobius vermicularis
  • Trichuris trichuria
  • Ancyclostoma duodenale
  • Necator americanus

Clinical indications:
- roundworm, pin worm, whipworm, hookworm

25
Q

Ivermectin PO

- special access program

A

MOA: binds and activates glutamate-gated chloride channels

Spectrum:

  • Strongyloides stercoralis
  • Ascaris lumricoides
  • Trichuris trichuria

Clinical:

  • Strongyloidiasis
  • alternative for roundworm/whipworm
  • NOT for hookworm (A.duodenale, N. americanus)
  • Mazzotti reaction (host inflammatory reaction to death of parasites - fever, hives, asthma, GI upset)
26
Q

Pyrantel pamoate PO

A

MOA: cholinesterase inhibitor (increased ACh aides GI motility?)

Spectrum:

  • Enterobius vermicularis,
  • Ancyclostoma duodenale

Clinical Indications:

  • pinworm, hookworm
  • use in second, third trimesters in pregnancy
27
Q

Praziquantel PO

A

MOA: increases schistosome permeability to calcium (parasite contracts, paralyze and dies)

Spectrum:

  • Cestodes (tapeworms: Taenia spp, Hymenolepsis, Echinococcus)
  • Schistosoma (Trematode)

Clinical Indication:
- intestinal tapeworms

28
Q 
Iodoquinol PO 
- class antiprotozoal
A

MOA: unknown

Spectrum:

  • Blastocystis hominis
  • Dienteamoeba fragilis
  • Entamaeba histolytica

Clinical indications:

  • Dientameba fragilis
  • amebiasis
  • alternative for Blastocystis
29
Q

Paromomycin PO

- aminoglycoside

A

MOA: bind 30S ribosomal subunit to inhibit protozoal protein synthesis

Spectrum:

  • Dientamoeba fragilis
  • Entamoeba histolytica
  • Giardia lamblia
  • Cryptosporidia

Clinical Indications:

  • alterative agent for Dientamoeba fragilis
  • amebiasis
  • giardiasis
  • Metronidazole has activity against intestinal protozoa
30
Q

Permethrin

  • 5% or 1% creme rinse, cream, lotion
  • ectoparasitic therapy
A

MOA: alters neuron Na channels resulting in parasite paralysis/death

Spectrum:

  • Sarcoptes scabiei
  • Phthirus pubis
  • Pediculus humanus

Clinical indications:

  • Scabies (5%)
  • Lice (1%)

IDMM (8 decks)

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