Fungal Tx, Protozoa Flashcards

Question

Artemether-lumefantrine (Coartem) -

Answer 1

ART approved in the US

Answer 2

* Activity against the erythrocytic stage of infection * Primiquine also kills intrahepatic forms and gametocytes (seen with P. vivax and P. ovale) ## Footnote queens stop RBC death prom queen kills liver/gametocyte

Answer 3

First line for tx and prophylaxis of susceptible pathogens MOA - accumulates in parasite food vacuole and complexes with heme, preventing heme breakdown and allowing cytotoxic free heme to accumulate Rapid onset - clears fever in 24-48 hrs and parasitemia in 48-72 hrs SE - usually minor; pruritis (MC); HA, N/V, abdominal pain, malaise | quinoline derivative ## Footnote pool queen

Answer 4

* Drug of choice for elimination of dormant liver cysts (P. vivax, P. ovale) * Typically used after tx with chloroquine or quinine * SE - prolonged QT, cardiac dysrhythmia, N/V/D, abdominal pain * CI - G6PD Deficiency, pregnancy, breastfeeding | Quinoloe derivative ## Footnote prom queen

Answer 5

* Mefloquine * Often used for prophylaxis - can be dosed weekly * Greater problems with toxicity when used therapeutically * SE - cardiac dysrhythmias, psychologic disturbances, seizures, N/V/D, HA, abdominal pain * CI/Avoid - hx of seizure disorder; hx of major psychiatric disorders; hx of dysrhythmia ## Footnote me-flow / air queen

Answer 6

* Quinine/Quinidine * Derived from the bark of the South American cinchona tree * MOA - Antimalarial MOA not well understood; quinidine is a class IA antiarrhythmic agent * SE - “cinchonism” - nausea, HA, tinnitus, blurred vision, dizziness * Hypersensitivity - rash, angioedema, urticaria, bronchospasm * Hematologic - hemolysis, agranulocytosis, leukopenia, thrombocytopenia * Cardiac - ECG changes (prolonged QT), arrhythmias * Given x 7 d; to reduce toxicity, often combined with abx (doxycycline) to shorten tx to 3 d** ## Footnote basic queen. princess?

Answer 7

* Antifolate Drugs * MOA - interferes with folate metabolism, blocking nucleic acid synthesis * SE - generally well tolerated; N/V, HA, abdominal pain, pruritis; transient AST/ALT elevation ## Footnote Aurora Queen/ A rowing queen

Answer 8

* Artemether-lumefantrine (Coartem) * Derived from leaves of Artemisia annua, an herb used in Chinese medicine * MOA - encourage formation of free radicals that damage parasite; active against all forms * Fastest parasite clearance times of any antimalarial * Rapid absorption, rapid onset * Short half-life - not good for chemoprophylaxis, and only given in combo regimens * SE - generally well tolerated; HA, N/V/D, anorexia * Rare - neutropenia, hemolysis, anemia ## Footnote Artemis

Answer 9

Chloroquin & Mefloquine once weekly dosing -safe for preg Have to start 1-2 weeks before trip and for 4 weeks after the trip | chloro=swim q, meflow=air q ## Footnote water & air

Answer 10

Can use the day before the trip -daily dosage -no preg/breastf atovaquone-proguanil (malarone) $$$ doxy - GI upset, photosens, yeast infection primaquine - CI G6PD def. or no test for it | malarone = atovaquone-proguanil ## Footnote mal, prom queen, doxy

Answer 11

* Intestinal - praziquantel (Biltricide) * May also try albendazole * Neurocysticercosis - controversial * Clearance of cysts vs. inflammatory response to dead/dying pathogens * When pharmaceutical treatment performed, albendazole +/- corticosteroids

Answer 12

-Hookworms Albendazole Mebendazole - lower cure rates Tx for anemia and low protein as appropriate ## Footnote All band vs me band (myself)

Answer 13

* MOA - allows increased calcium to enter parasitic cells, causing muscle spasms and paralysis and leading to worm detachment from host * CI - allergy to medication, ocular cysticercosis * DDI - several - antimalarials, grapefruit juice, cimetidine * SE - GI upset, headache, dizziness * May see 2o inflammatory response following pathogen death ## Footnote Praise or Prezident

Answer 14

MOA - inhibits helminth microtubule formation and glucose uptake CI - allergy to medication DDI - antimalarials, grapefruit juice, cimetidine, anticonvulsants SE - Abdominal pain, N/V/D Albendazole may cause elevated LFTs and/or, in long-term tx, neutropenia or agranulocytosis ## Footnote all band vs myself band

Answer 15

* aka pinworms enterobiasis * Albendazole x 1 dose or mebendazole x 1 dose * Repeat in 2 weeks! * Pyrantel pamoate preferred if pregnant * Tx of infected family members and close contacts * Washing bed sheets, clothing * Avoid perianal scratching * Education on hand hygiene ## Footnote alband or meband pin away if pregnant treat contacts

Answer 16

aka pin-away MOA - anticholinesterase drug; depolarizes neuromuscular cells and paralyzes the helminths Minimal systemic absorption - considered safer in pregnancy than other antihelminthic drugs CI - allergy to medication DDI - no known significant interactions SE - GI upset, headache, dizziness

Answer 17

* Mild infection - supportive care (analgesics, antipyretics, bed rest, steroids) * Systemic symptoms - albendazole or mebendazole +/- steroids * Prevention - thoroughly cooking meat ## Footnote only supportive unless systemic all band or me band

Answer 18

* Roundworms * Treatment - as with hookworms * Albendazole * Mebendazole * If pregnant - pyrantel pamoate ## Footnote all band or me band pin away if preg

Fungal Tx, Protozoa Flashcards

Exam 2 (43 cards)