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pharmacology > antiprotozoal drugs > Flashcards

antiprotozoal drugs Flashcards

(51 cards)

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1
Q

trypanosoma cruzi causes

A

chagas disease

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2
Q

taenia solium

A

pork tapeworm, cysticercosis, neurocysticercosis

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3
Q

toxacara

A

dog and cat roundworms, causes blindness in children

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4
Q

toxoplasma gondii

A

cat feces, new infections in pregnancy lead to birth defects

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5
Q

trichomonas

A

sexually transmitted

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6
Q

HIV associated parasitic infections in US

A

pneumocystis jirovecii - pneumonia
toxoplasma gondii - encephalitis
cryptosporidium - cryptosporidiosis

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7
Q

HIV associated parasitic infections globally

A

malaria
leishmania
trypanosoma cruzi - chagas disease

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8
Q

5 human malaria parasites

A

plasmodium: falciparum, vivax, ovale, malariae, knowlesi

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9
Q

parasite responsible for most malaria deaths

A

plasmodium falciparum

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10
Q

relapsing malaria

A 
plasmodium vivax (subtropics and temperate regions)
plasmodium ovale (west africa)
*caused by latent hypnozoites in liver
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11
Q

exoerythrocytic schizonticide

A

primaquine (merozoites and hypnozoites

atovoquone, artemisins (not hypnozoites

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12
Q

erythrocytic schizonticide

A

chloroquine, mefloquine, artemisinins, quinine, doxycycline

also tetracycline and clindiamycin

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13
Q

chloroquine and hydroxychloroquine sulfate - malaria prevention

A

only chloroquine sensitive areas, start 1-2 wk prior and continue 4 wk after leaving

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14
Q

atovaquone and proguanil - malaria prevention

A

all areas

start 1-2 days prior, continue 7 days after

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15
Q

mefloquine - malaria prevention

A

mefloquine sensitive areas, start >2 wk early and continue 4 weeks

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16
Q

primaquine - malaria prevention

A

P. vivax areas, start 1-2 d prior and continue 7 days after

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17
Q

doxycyline - malaria prevention

A

all areas, start 1-2 d prior and continue 4 weeks

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18
Q

Rx uncomplicated malaria and unknown species- chloroquine sensitive areas

A

chloroquine and hydroxychloroquine sulfate

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19
Q

Rx uncomplicated malaria and unknown species - chloroquine resistant areas

A

atovaquone + proguanil
artemether (artemesinin derivative) + lumafantrine (availability?)
quinine sulfate + doxycycline or tetracycline or clindamycin
mefloquine

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20
Q

Rx uncomplicated malaria - P. vivax or P. ovale, cq sensitive

A

chlorquine or hydroxychloroquine sulfate PLUS primaquine

14 days

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21
Q

Rx uncomplicated malaria - P. vivax or P. ovale, cq resistant

Study These Flashcards
A

quinine sulfate PLUS doxycyline or tetracycline PLUS primaqine
atovaquone + proguanil PLUS primaquine
mefloquine PLUS primaquine

22
Q

Rx uncomplicated malaria - P. malariae or P. knowlesi

Study These Flashcards
A

chloroquine or hydroxychloroquine sulfate

23
Q

complicated/severe malaria symptoms

Study These Flashcards
A

impaired consciousness, coma, severe normocytic anemia, renal failure, pulmonary edema…

24
Q

Rx complicated/severe malaria - first

Study These Flashcards
A

IV: quinidine gluconate
PLUS doxycyline, tetracycline, or clindamycine
Cardio consult and experienced physician
monitor hypotension, hypoglycemia, cardiac function (widening QRS, lengthening QTc interval)

25
Rx complicated/severe malaria - second
Artesunate (artemesinin derivative) - if quinidine gluconate not available or not tolerated follwed by: malarone or doxycyline (clindamycin if pregnant) or mefloquine IV only has IND (cal CDC malaria hotline)
26
artemisin
standard treatment globally endoperoxide blood schizonticide - 4 log reduction in numbers in 48 hours used for chloroquine resistant P. falciparum short half life, paired with other drugs (mefloquine, lumefantrine) not given in first trimester
27
artemisinin combo therapy
combined with longer half life drugs artemether + lumefantrine artesunate + mefloquine dinydroartemisinin + piperaquine
28
artemisinin derivatives
artesunate - water soluble, oral, IV, intramusc, rectal dihydroartemisinin - soluble, oral artemether - lipid soluble, oral, intramusc, rectal
29
chloroquine
4-susbstituted quinoline erythrocytic forms interferes with heme polymerization to nontoxic hemozoin inside food vacuole resistance - no drug accumulation in food vacuole designed for oral, well absorbed
30
contraindications for chlorquine
psoriasis or porphyria retina or visual field abnormalities myopathy
31
quinine and quinidine
rapidly acting blood schizonticide first line alternative for falciparum but toxic (IV for severe, oral for uncomplicated) MOA similar to chloroquine metabolized by CYP3A4 - warfarin, digoxin, antiretroviral drugs (HIV prevalent areas)
32
adverse effects of quinine
cinchonism (tinnitus, dizziness, headaches, nausea, flushing, visual disturbances) cardiotox uterine contractions hemolysis - G6PD deficiency, blackwater fever (hemoglobinurea) hypotension - too rapid infusion
33
mefloquine
increasing resistance prophylaxix and Rx erythrocytic forms adverse efects - neuropsych tox
34
primaquine
8-aminoquinoline unknown mechanism, probably ROS liver stages - only drug active against hyponozoites gametocidal against all four malaria parasites well absorbed orally too toxic for long term
35
primaquine contraindications
G6PD deficiency - hemolytic anemia, pregnancy (fetus G6PD deficient) granulocytopenia or methemoglubinemia myelosuppression (drugs, disorders)
36
antifolates for malaria
pyrimethamine, proguanil, fansidar (pyrimethamine-sulfadoxine) folate synth inhibitors slow acting erythrocytic schizonticides
37
MOA pyrimethamine
inhibits plasmodia DHF-reductase (1000 fold selectivity for plasmodium)
38
other uses antifolates
toxoplasmosis - pyrimethamine plus sulfadizine is first line, clindamycin can replace sulfadizine pneumocystis - fungal pathogen, trimethoprim plus sulfamethoxazole, atavaquone is alternative
39
malarone
combination of proguanil and atavaquone | atavaquone - disrupts mitochondrial electron transport (fails when used alone)
40
antibiotics for malaria
tetracycline, doxycycline, and clindamycin blood schizonticides targets the apicoplast (organelle)
41
metronidazole
anaerobic parasites extraintestinal entamoeba histolytica, giardiasis, trichomoniasis kills trophozoites, not cysts
42
tinidazole
similar to metronidazole with less toxicity, anaerobic parasites
43
metroindazole antabuse effect
blocks acetaldehyde dehydrogenase, build up acetaldehyde causes hypotension, nausea, vomiting, discomfort
44
iodoquinol
luminal amebicide, low bioavailability asymptomatic carriers (combine with metronidazole) kills trophozoites
45
pentamidine
``` parental administration accumulates in parasites highly toxic west african trypanosomiasis alternate treatment for visceral leishmania and pneumocystosis ```
46
nifurtimox
T. cruzi (chagas disease) reduces severity of acute phase, unlikely to eliminate parasite, does not prevent progression of disease orally available 3-4 month course toxicity common --> premature stoppage of treatment
47
miltefosine
``` phospholipid analog developed as anticancer drug approved for use against visceral leishmaniasis 28 daily doses teratogenic ```
48
nitazoxanide
giardia and cryptosporidium
49
chagas disease treatment
nifurtimox or benznidazole
50
sleeping sickness treatment west african
west african: early stage - pentamidine, late stages - eflornithine
51
sleeping sickness treatmetn east african
east african: early stage - suramin, late stage, melarsoprol

pharmacology (2 decks)

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