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Flashcards in anti-parasitics Deck (80):
1

DOC for invasive amebiasis

metronidazole

2

Metronidazole use

giardia
trichomonas
anaerobic cocci
anaerobic gram - bacili
h. pylori in combo tx

3

metronidazole MOA

reduced by reacting with reduced ferredoxin = produces cytotoxic compounds

these bind proteins and DNA = unstable molecules - cell death

4

metronidazole PK

hepatic oxidation
glucuoronidation
CYP P450s

5

metronidazole AE

GI distress
**disulfiram with alcohol
leukopenia
unpleasant metallic taste

safety in pregnancy not established

6

Tinidazole

2nd generation nitroimidazole

better tolerated and shorter duration that metronidazole

7

Tinidazole AE

same as metronidazole

8

diloxanide furoate

luminal antiamebics

9

iodoquinol

luminal antiamebics

10

paraymomycin

luminal antiamebics

11

What can be used by itself to tx asymptomatic ameobiasis

diloxanide furoate

12

Iodoquinol use

orally against luminal trophozoite and cyst forms of entamobea

alternative to diloxanide furoate for mild-severe infections

13

Iodoquinol AE

Adverse: with long term use - risk of optic neuritis

rash, diarrhea, dose related peripheral neuropathy

14

Paramomycin

aminoglycside antibiotic

only effected against luminal forms of E. histolytica and tapeworm

alternative agent for cryptosporidiosis in AIDS pt

15

paromycin MOA

amebicidal = cell membranes become leaky

interferes with bacterial protein synthesis - binds to 30s ribosomal subunits

reduces intestinal flora population

16

chloroquine use

combo: metroniazole, diloxanite furoate


eliminates trophozites in liver abscesses

17

emetine/dihydroemetine

back up drugs for tx of severe intestinal or hepatic amebiasis

MOA: inhibit protein synthesis by bloking ribosomal movement along mRNA

18

albendazole MOA

tx of cestodal infections (t. solium, e. granulosis)

inhibits microtubule synthesis and glucose uptake

ATP production is decreased = worm immobilization and death

19

albendazole AE

1-3 days of tx: HA, nausea

3 months/hydatid tx: hepatotoxicity, agranulocytosis/pancytopenia

CONTRAINDICATED in pregnancy/children

20

DOC for trichuris trichuria

mebendazole (or albendazole)

21

DOC for enterobius vermicularis

mebendazole (or pyrantel pamoate)

22

DOC for hookworms/n. americanus and a. duodenale:

mebendazole (pyrantel pamoate or albendazole)

23

roundworm/ascariasis lumbricoides DOC:

mebendazole (albendazole, pyrantel pamoate)

24

mebendazole MOA

inhibts formation of helminth microtubules

blocks glucose tuptake

affects parasitse that are expelled with feces

25

mebendazole AE

contraindic in preg

caution in children <2 or with cirrhosis

26

Thiabendazole

tx: strongyloidiasis, cutaneous larva migrans, early stage of trichinosis

MOA: affects microtubular aggregation

27

thiabendazole AE

more toxic than other benzimidazoles

CNS disturbance
contraindic in pregnacy
erythema multiforme - stevens johnson

not used in presence of liver or kidney disease

28

doc for onchoceriasis

ivermectin

29

doc for CLM

ivermectin

30

doc for strongyloides

ivermectin

31

ivermectin MOA

GABA agonist

Cl- influx = inc hyperpolarization - death occurs later

does not cross BBB

32

Ivermectin AE

mazotti reactions with onchoceriasis: fever, dizzy, somnolence, hypotension

contraindic in pregnacy and meningitis

DONT give with drugs that enhance GABA: barbiturates and benzos

33

piperazine

alt drug for tx of pinworm and roundworm

34

piperaize MOA

GABA agonist -
explusion of worm by peristalsis

contraindicated in seizure pt's

35

pyrantel pamoate

tx roundworms, pinworms, hookworms

36

pyrantel pamoate MOA

depolarizing , NM blocker = persistent activation of parasite nicotinic-r = release of Ach and inhibition of cholinesterase

37

diethylcarbamazine

immobilizes microfilarier - makes suscpetible t ohost defense

38

DOC lymphatic filarisis

diethycarbamazine

39

diethylcarbamazine MOA

immobilizes microfilariae - susceptible to host defense

40

Doxycycline MOA

macrofilaricidal against wuchereria bancrofti

active against onchoceriasis

MOA - indirectly kills wolbachia - intracellular bacterial symbiont of parasite

41

Praziquantel

shisto, trematode, cestode, cysticerosis

42

DOC for schistomasiasis

Praziquantel

43

Praziquantel MOA

inc perm of cell membrane to calcium causing contracture and paralysis of worm = detachment of suckers from BV walls

44

DOC for cysticerosis

albendazole (praziquantel has similar efficacy)

45

praziquantel PK

extensive 1st pass metabolism

46

praziquantel AE

contraindicated in pregnancy, nursing mothers, and OCULAR CYSTICERCOSIS - destroying organism may damage eye

drug interactions (CYP P450)

47

bithionol

fasciolosis
alternative tx for pulmonary paragonimiasis

48

bithionol MOA

inhibition of helminth electron transport chain

49

DOC fasciolosis

bithionol

50

niclosamide

2nd line drug for most cestodes

uncommon b/c of effectiveness of praziquantel

51

niclosamide MOA

inhibition of parasite's mitochondrial phosphorylation of ADP

Lethal for cestode's scolex and segments - BUT not for ova

52

Niclosamide PK

laxative given prior to niclosamide to purge bowel of dead segments - in order to preclude digestion and liberation of ova

alcohol should NOT be given within 1 day of dose

53

tinidazole use

amebiasis
amebic liver abscess
giardiasis
trichomoniasis

54

diloxanide furoate MOA

converted in gut to diloxanide freebase active form

55

DOC for luminal amebicide

diloxanide furoate - not available in US

56

paromycin AE

GI distress - diarrhea

HA, dizzy, rash, arthralgia

57

systemic antiamebics

chloroquine
emetine
dehydroemetine

tx liver abscesses or intestinal wall infections

58

emetine/dihydroemetine AE

**pain at site of infection
cardiotoxicity
NM weakness
nausea

59

DOC asymptomatic intestinal infection

diloxanide furoate

alternative: iodoquinol, paromycin

60

DOC mild to mod intestinal infection

metronidazole + diloxanide furoate

alternatives: tinidazole or tetracycline or erythromycin + diloxanide furorate

61

DOC severe intestinal infection

metronidazole/tinidazole + diloxanide furoate

alternatives: tetracycline/emetine/dihydroemetine + diloxanide furoate

62

DOC hepatic abscesses and other extraintestinal disease

metronidazole/tinidazole + diloxanide furoate

alternatives: emetine/dihydroemetine + chloroquine + diloxanide furoate

63

DOC loiasis

diethylcarbamazine

64

DOC tropical eosinophilia

diethylcarbamazine

65

diethylcarbamazine AE

d/t host response following parasite death:
- fever, malaise, myalgias
- leukocytosis

can use anti-histamines/steroids to resolve AE

66

DOC visceral larva migrans (toxocariasis)

albendazole

67

DOC trichinosis (trichinella spiralis)

albendazole or mebendazole

68

DOC clonorchis sinesis

praziquantel

69

DOC paragonimus westermani

praziquantel

70

DOC echinococcosis

albendazole

71

DOC taeniasis solium/saginata

praziquantel or niclosamide

72

cysticercosis DOC

albendazole or praziquantel

73

diphyllobothriasis DOC

praziquantel or niclosamide

74

DOC giardia

metronidazole

75

DOC trichomonas vaginalis

metronidazole

76

DOC trypanosomiasis

melarsoprol or suramin

77

DOC hemolymphatic stage of trypanosomiasis and PCP infection

pentamidine

78

toxoplasmosis encephalitis DOC

pyrimethamine + clindamycin or sulfadiazine or folinic acid

79

DOC leishmaniasis (all stages)

sodium stibogluconate/amphoteracin B

80

DOC cystercosis with taenia solium larva

albendazole or praziquantel