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Therapeutics P3 Spring > Exam 5 Lecture 7 > Flashcards

Exam 5 Lecture 7 Flashcards

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1
Q

symotoms of lice

A

Often asymptomatic, most common sx is itching (may take 4-6 weeks for itching to appear)

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2
Q

How are lice spread and who is most at risk

A

Mainly spread by direct contact

CHildren most at risk

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3
Q

Treatment of lice clinical pearl

A

Tx only kills live lice, not unhatched eggs.

Usually require second tx 9-10 d later to kill newly hatched lice before they lay eggs

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4
Q

What are the two options to treat lice

A
  • OTC options (resistance observed)
    1. Naturally ocurring pyrethins
    2. synthetic pyrethoids- permethrin
  • prescription options
    1. spinosad 0.9% topical suspension
    2. benzyl alcohol lotion
    3. Ivermectin
    4. malathion
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5
Q

From the OTC section for lice, name naturally occuring pyrethrins, synthetic?

A

Naturally- extracts from chrysanthemum flower (A-200, pronto, R&C, RID and triple X)

Synthetic- permethrin

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6
Q

Helminth infestation effect on human health

A

Compromised nutritional status
Reduced cognitive processes
Tissue reactions
Intestinal obstruction

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7
Q

Who has highest burden of intestinal worms and schistosomes? What could this lead to?

A

Pre school and school aged children tend to have higher burdens

leads to
- stunted growth
- diminished physical fitness
- imapired memory and cognition

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8
Q

What are the 3 different types of helminths?

A

Cestodes (tape worms)
Trematodes (flukes)
Nematodes (rondworm)

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9
Q

Name soil transmitted helminths

A

Necator americanus
Ascaris lunvercoides
Strongyloides stercoralis
Trichuris trichuria

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10
Q

Most common helminthic infection? Who is it cmmon in?

A

Enterobiasis

Most common in school aged children
Institulazid persons
Household members or caretakers

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11
Q

How is entorobiasis transmission? diagnosis

A

Fecal-oral

Tape tests

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12
Q

Drug therapy for helminths

A

mebendazole
Thiabendazole
Albendazole
Triclabendazole

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13
Q

MOA of benzimidazole

A

Binds to tubulin and inhibits microtubule formation by capping microtubules to inhibit growth. Microtubules continue to be shortened from minus end

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14
Q

Can benzimidazoles bind to mammalian tubulin?

A

Yes, but have higher affinity to helminth tubulin

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15
Q

Drug of choice for treating pinworms

A

Albendazole

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16
Q

What is mebendazole used for

A

Pinworms, hook worms, ascaris and trichuriasis (not in pregnant women)

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17
Q

What is pyrantel pamoate used for?

A

Broad spectrum antihelminth used in pinworms and ascaris

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18
Q

MOA of pyrantel pamoate

A

Depolarizing neuromuscular blocking agent. Causes release of acetylcholine and inhibition of cholinesterase. Worms paraluyzed and expelled

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19
Q

Clinical use of pyrante pamoate

A

Ascaris and pinworms.

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20
Q

What are the 5 human paraistes for malaria?

A

Plasmodium falciparum and vivax are the most common. Falciparum responsible for most deaths.

Plasmodium ovale, malariae and knowlesi are others

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21
Q

Name the 2 different types of drugs used for malaria

A

Tissue schizonticides- kill liver stage parasites
Blood schizonticides- kill erythrocytic forms
Gametocytocides- kill sexual stages and block transmission

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22
Q

Name antimalarial drugs used

A

artemisinin
4 aminoquinolones
8 aminoquinolones
atovaquone
antifolates
antibioticsa

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23
Q

MOA of artemisinin

A

Not completely known

Must be activated by heme iron in food vacoule. Activated artemininin may form free radicals

may inhibit PfP13K

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24
Q

Does artemisiinin work against liver stage or hypnozoites

A

No

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25
Half life of artemisinin
Short half life (1-2 hrs)- commonly paired with longer half life drugs
26
What can artemisinin be mixed with
Most commmon is Coartem (combo name) ( with lumefantrine)
27
What is artemisinin converted to?
dihydroartemisinin (active form)
28
resistance mechanism of artemisinin
Mutations in kelch 13
29
Name the 4 aminoquinolone drugs
Qunine Chloroquine mefloquine aminoquinoline
30
Describe the hemoglobin metabolism seen in malaria
Malaria parasotes ingest hemoglobin from host cell. Degrade hemoglobin to amino acid and free heme in food vacoule Free heme is toxic Parasite polymerizes heme into hemozoin which is nontoxic Chloroquine accumulates in food vacoule and inhibits pheme polymerization
31
4 amino quinolones MOA
Interfere with heme polymerization
32
Name an 8 aminoquinolone drug
Primaquine
33
What is the drug of choice for liver stages (actively growing and hypnozoites) of P vivax and P ovale
Primaquine
34
MOA of primaquine
Metabolized by CYP2D6 in humans. metabolism required for activity
35
Name antibiotics used as blood schizonticides
tetracycline doxycycline clindamycin
36
What us doxy paired with to treat malaria
quinine and quinidine
37
What antimalaria do we need to be cautious with G6PD deficiency
Primaquine
38
Select chemoprophylaxis depending on region traveling to
All malaria endemic regions- Atovaquone, doxy, tafenoquine Regions with chloroquine sensitive malaria- chloroquine, hydroxychloroquine Regions primarily with P vivax- primaquine Regions with mefloquine sensitive malaria- mefloquine
39
Duration of atovaquine prophylaxis
Begin 1-2 days before departure and continue 7 days after leaving
40
Duration of chloroquine for prophylaxis? Hydroxychloroquin?
begin 1-2 weeks before departure Continue 4 wks after leaving region Only weekly dosing
41
doxy duration
begin 1-2 days Continue for 4 weeks after leaving place
42
mefloquin duration
Taken once a week Begin 2 weeks before departure and continue for 4 wks after leaving
43
Primaquine dosing duration
begin 1-2 days efore departure and continue for 7 days after leaving malaria area
44
What patient need G6PD testing
Primaquine and tafenoquine, may take some time to get results back
45
Duration of tafenoquine
begin 3 days before departure and continue for 1 week after leaving
46
When to consider if a patient has malaria
Fever AND has traveled to malaria endemic region before onset
47
symptom onset of malaria
Typically 2-4 wks after mosquito bite Can occur up to 3 years after exposure
48
What malaria can lie latent (dormant) for 3 yrs
P vivax and P ovale
49
s/s of malaria
Fever Headache Weakness Rigors Nigh sweats Insomnia Arthralgia
50
Lab findings of malaria
Anemia Thrombocytopenia Hyponatremia Acidemia
51
diagnosis of malaria
Thin and thick smear Thick tells you percentage of paracentemia. Thin layer shows species Should be checked every 12-24 hrs
52
Which strains of malaria are likely to progress to severe disease/death
P falciparum and P knowlesi are more likely to progress to severe disease/death
53
Which strains require treatment of hypnozoites
P vivax and P ovale
54
How do we classify if a patient has severe malaria
If they have > or = one of the following - impaired conciousness/coma - Hgb- < 7 - AKI - Acute respiratory disress syndrome (ARDS) - circulatory collapse/shock - Acidosis - Disseminated intravascular coagulation - parasite densoty of >5%
55
How to treat uncomplicated malaria with presence of chloroquine resistance or unknown resistance
Arthemether- lumefantrine- 3 days (main) Atovaquone- proguanil- 3 days Quinine sulfate PLUS doxy, tetra or clinda
56
quininine side effects
QTc prolongation
57
For uncomplicated malaria wuth chloroquine resistance and no mefloquine resistance what do we use
mefloquine
58
For chloroquine sensitive malaria what do we use
chloroquine Hydroxychloroquine
59
what do we use for anti relapse treatment of malaria for p ovale and p vivax
Primaquine phosphate Tafenoquine
60
When do we use tafenoquine
as anti relapse tx only if received chloroquine for tx
61
What drugs to use for malaria with P knowlesi and P malariae
Chloroquine Hydroxychloroquine
62
How often do we have to perform blood smears for TX OF severe malaria
Perform blood smears every 12-24 hrs until negative
63
Tx of severe malaria
IV artesunate until parasite density is <1%
64
What to transition into after IV artesaunate reaches <1% density
Artemether-lumefantrine (preferred) Atovaquone- proguanil Quinine + doxy Mefloquine
65

Therapeutics P3 Spring (33 decks)

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