Antimalarials/Protozoals Flashcards
(79 cards)
1
Q
Most lethal and resistant protozoa
A
P. falciparum
2
Q
Have dormant liver stages (hypnozoites) (2)
A
- P. vivax
- P. ovale
3
Q
Rare protozoa
A
P. malariae
4
Q
- Act on ERYTHROCYTIC forms of the parasite
- Do NOT affect secondary tissue forms of Ovale and Vivax
A
Blood schizonticides
5
Q
- Eliminate proliferation
- Act on GAMETOCYTES
- Do NOT help individuals suffering from malaria, but may help SLOW SPREAD
A
Gametocidal agents
6
Q
- Act on HEPATIC stages
- Do NOT suppress symptoms one erythrocytic stages have been established
- Kill secondary tissue forms of Ovale and Vivax
- Can prevent prophylaxis but are too toxic
A
Tissue schizonticides
7
Q
Provide “RADICAL CURE”
A
Tissue schizonticides
8
Q
Can be used to suppress symptoms –> “CLINICAL CURE”
A
Blood schizonticides
9
Q
Most effective means of controlling malaria
A
- Avoid being bitten
- Eradicate mosquitoes and habitates
- Insect repellent
- Mosquito netting, tents with permethrin
10
Q
Drug effective against gametocytic and exoerythrocytic (tissue) formation
A
Primaquine
11
Q
Drugs effective against erythrocytic form, from illustration (5)
A
- Artemisinin
- Chloroquine
- Quinine
- Mefloquine
- Pyrimethamine
12
Q
DOC for Malaria (2)
A
- Chloroquine
- Hydroxychloroquine
13
Q
Blood schizonticides
A
- Chloroquine
- Hydroxychloroquine
- Mefloquine
- Quinine sulfate and quinidine gluconate
- Doxycycline or Clindamycin
- Atovaquone + Proquanil
14
Q
DOC and prophylaxis for sensitive organisms
A
Chloroquine
- Prophylaxis due to long duration of action (take once weekly)
15
Q
What form is resistant to Chloroquine and why?
A
- P. falciparum
- TRANSPORT PUMP removes drug from parasite
16
Q
Chloroquine MOA (2)
A
- Actively concentrated within plasmodia that reside in RBC
- May interfere with lysosomal degradation of Hgb
17
Q
Chloroquine Admin
A
- Oral
- Parenteral (slow)
18
Q
Chloroquine accumulates where? (2)
A
- Skin
- Retina
19
Q
Chloroquine SE (6)
A
- CNS (dizziness, HA, tinnitus)
- Retinal and corneal tox
- Ototoxicity
- Rash, pruritis
- HEMOLYSIS - G6PD (use caution, but not absolute CI)
- INCREASED RISK FOR QT prolongation (torsades)
20
Q
Chloroquine CI (2)
A
- Psoriasis
- Porphyria
21
Q
First line drug for tx and prophylaxis of chloroquine resistant strains?
A
Mefloquine
22
Q
Mefloquine Admin
A
Oral as single mega dose
23
Q
Mefloquine Features -
A
- Distributed to blood, urine, CSF, tissues and concentrated in RBC
- Metabolized by liver
- Eliminated very slowly
24
Q
Mefloquine SE
A
- SEIZURES AND PSYCHOSIS aggravation
- Potential CARDIAC TOX (do NOT combine with quinine)
25
Mefloquine CI
- In pts with any neuropsych problems
26
Quinine Admin and t 1/2
Oral, 5 - 16 hrs
27
DOC for complicated, chloroquine resistant plasmodia
Quinine and Quinidine Glyconate
| - Combined with Doxycycline or Clindamycin (if
28
Quinidine Glyconate Admin
IV
29
Other actions of Quinine and Quinidine Glyconate
- Analgesia
| - Antipyretic
30
Which drug has a narrow margin between an effective dose and toxic dose?
Quinine
31
Quinine and Quinidine Glyconate SE
- CINCHONISM (tinnitus, HA, dizziness, flushing, visual disturbances)
- ANTIARRYTHMIC agent (Quinidine)
- QT ELONGATION (do not combine with mefloquine)
- HEMOLYSIS in G6PD
- Stimulates insulin (caution in hypoglycemia)
32
Antibiotic combined with Quinine or Quinidine Glyconate for tx of complicated chloroquine resistant malaria
Doxycycline
33
Used for prophylaxis against multidrug resistant malaria, taken daily
Doxycycline
34
Atovaquone MOA
Interferes with mitochondrial process such as
- electron transport
- ATP synthesis
- pyrimidine synthesis
35
Proguanil MOA
- Inhibits dihydrofolate deductase
| - Blocks dihydrofolic acid to tetrahydrofolic acid
36
SYNERGISTIC combo effective in regions where chloroquine and mefloquine resistance is high
- Atovaquone + Proguanil
37
Atovaquone + Proguanil Tx (2)
- Uncomplicated, chloroquine resistant malaria
| - Prophylaxis against chloroquine resistant Falciparum
38
Atovaquone + Proguanil absorption increased by _____
- Fatty foods
39
Atovaquone + Proguanil Admin
Oral
40
Atovaquone + Proguanil active against what form?
- Tissue
- Erythrocytic
- NOT for radical cure
41
Atovaquone + Proguanil SE
Require D/C
- Rash, fever, V/D
- Caution in preg: mutanogenesis in mice
42
Tissue Schizonticide, only active against TISSUE FORMS AND GAMETOCYTES
Primaquine
43
Drug that will NOT suppress disease once developed
Primaquine
44
Primaquine Admin
Oral
45
Used with chloroquine as alternative tx for chloroquine-resistant Falciparum
Primaquine
46
Primaquine CI
NEVER GIVE THIS DRUG TO
- G6PD (hemolytic anemia)
- SLE or RA (granulocytopenia)
- Pregnancy (fetal hemolytic anemia)
47
Most drugs can provide a clinical cure to which species?
All four
48
Most drugs can provide a radical cure to which species?
Falciparum and Malariae
49
Drug used for radical cure of Vivax and Ovale, when used with RBC Schizonticide
Primaquine
50
Amebiasis infective form? invading and replicating form?
Infective: Cyst
| Invade/replicate: Trophozoite
51
Most common cause of non-bacterial diarrhea in N. America
Giardia
52
Trichomoniasis: who needs to be treated?
both partners
- Men often asymptomatic
- Women frothy, yellow, discharge
53
Toxoplasmosis during pregnancy (3)
- Heart problems
- Hydrocephalus
- Retinochorditis
54
P jirovecii: what is it?
Not a protozoa --> yeast-like fungus
55
Major cause of death in AIDs pt
P jirovecii
56
DOC for Amebiasis, Giardiasis, Trichomoniasis
Metronidazole
57
DOC for pneumocystosis
Bactrim (Trimethoprim plus sulfamethoxazole)
58
Drugs used for Amebiasis, Giardiasis, Trichomoniasis (5)
- Metronidazole (DOC)
- Tinidazole
- Iodoquinol
- Tetracycline & Erythromycin
- Paromomycin
59
Drug for Toxoplasmosis
Pyrimethamine + Sulfadiazine + Folinic acid (Leucovorin)
60
Alternate tx for Sulfa allergy, Pneumocystosis
Pentamidine
61
Tx Amebiasis
Metronidazole + Luminal amebicide
| --- Metronidazole is NOT AFFECTIVE AGAINST LUMINAL PARASITES
62
Tx for Giardiasis
Metronidazole
63
Tx for Trich
Metronidazole
64
Metronidazole MOA (2)
- Prodrug: non-enzymatically reduced by reacting with reduced ferredoxin (only found in anaerobes)
- Metronidazole metabolites are TAKEN UP INTO DNA, and form unstable molecules
65
Metronidazole Admin
- Oral
- IV
- Topical
66
Does metronidazole get into CSF?
Yes
67
Metronidazole SE (4)
- CNS toxicity: seizures and neuropathy
- Red urine
- Not to be taken with alcohol
- Metallic taste
68
Similar drug to Metronidazole, but better tolerated
Tinidazole
69
Luminal parasite drugs (3)
- Iodoquinol
- Paromomycin
- Tetracycline and Erythromycin
70
Drug that is useful for asymp amebiasis
- Iodoquinol
| - Paromomycin (also for asymp giard, trich)
71
Iodoquinol SE (3)
- Skin rxn, NA, D
- High IODINE CONTENT --> thyroid enlargement
- Optic neuritis and optic atrophy --> blindness
72
Drug class Paromomycin
Aminoglycoside
73
Alternative drugs for tx of amebiasis and giardiasis
Tetracycline and Erythromycin
74
Bactrim MOA
Inhibits folate metabolism
75
Bactrim SE
- Rash, pruritis
| - Cytopenias and transaminase elevation
76
Pentamidine MOA
Inhibit DNA replication
77
Pentamidine Admin and when to use
- IM (active infection)
| - Neubulization (prophylaxis)
78
Pentamidine SE
- Hypotension, arrythmias, hypoglycemia
- Tachycardia, HA, V, bronchospasms
- RENAL DYSFUNCTION
- Hepatic failure
79
DOC P. jirovecii
Bactrim + Folinic acid
