Lecture 173

Question 1

What disease does Entamoeba histolytica cause?

Answer 1

Amoebiasis

Question 2

How is Entamoeba histolytica spread?

Answer 2

Fecal-oral route

Question 3

What drug acts as a tissue-acting drug to eliminate invasive trophozoites in Amoebiasis?

Answer 3

Metronidazole

Question 4

What drug is a luminal agent that acts in the intestines to eliminate amoeba cysts and trophozoites in Amoebiasis?

Answer 4

Paromomycin

Question 5

What is the preferred drug regimen to treat Amoebiasis?

Answer 5

Metronidazole and paromomycin

Question 6

How is Giardia lamblia transmitted?

Answer 6

Contaminated water

Question 7

Diarrhea, cramping, and malabsorption are suggestive of what protozoal infection?

Answer 7

Giardiasis

Question 8

What class of antiprotozoal agents does metronidazole belong to?

Answer 8

Nitroimidazoles

Question 9

What class of antiprotozoal agents are converted by parasitic PFOR to toxic nitro free radical intermediates, causing parasite death?

Answer 9

Nitroimidazoles

Question 10

How is metronidazole metabolized?

Answer 10

CYP2A6

Question 11

What drug can be used to treat amoebiasis, giardiasis, and trichomoniasis?

Answer 11

Metronidazole

Question 12

Headache, nausea, dry mouth, and metallic taste are side effects of what antiprotozoal agent?

Answer 12

Metronidazole

Question 13

What special considerations should be made in the therapy of pregnant women with metronidazole?

Answer 13

Cross placenta but low risk to fetus

Question 14

What black box warning accompanies metronidazole?

Answer 14

Carcinogenic, unnecessary use should be avoided

Question 15

What drug should not be co-administered with metronidazole?

Answer 15

Warfarin

Question 16

How is Trypanosoma brucei spread?

Answer 16

Tsetse flies

Question 17

What does HAT stand for?

Answer 17

Human African Trypanosomiasis

Question 18

What geographical region is Gambiense HAT found?

Answer 18

West Africa

Question 19

What geographical region is Rhodesiense HAT found?

Answer 19

East Africa

Question 20

What disease does Trypanosoma brucei cause?

Answer 20

African sleeping sickness; HAT

Question 21

What is the incubation period of Gambiense HAT?

Answer 21

Weeks to months

Question 22

What is the preferred treatment for early-stage Gambiense HAT in children >6 years old, >20kg?

Answer 22

Fexinidazole (oral)

Question 23

What is the preferred treatment for early-stage Gambiense HAT in children <6 years old, <20kg?

Answer 23

Pentamidine (IM or IV)

Question 24

What is the preferred treatment for late-stage non-severe Gambiense HAT?

Answer 24

Fexinidazole (oral)

Question 25

What is the preferred treatment for late-stage severe Gambiense HAT in all ages?

Answer 25

Nifurtimox-Eflornithine combination therapy (NECT); oral Nifurtimox and IV eflornithine

Question 26

What is an alternative treatment for late-stage severe Gambiense HAT in all ages?

Answer 26

Eflornithine monotherapy

Question 27

What is the incubation period of Rhodesiense HAT?

Answer 27

Less than 3 weeks

Question 28

What is the preferred treatment for early-stage rhodesiense HAT in children >6 years old, >20kg?

Answer 28

Fexinidazole (oral)

Question 29

What is the preferred treatment for early-stage rhodesiense HAT in children <6 years old, <20kg?

Answer 29

Suramin (IV)

Question 30

What alternate treatment can be used for early-stage rhodesiense HAT in children <6 years old, <20kg?

Answer 30

Pentamidine

Question 31

What is the preferred treatment for late-stage rhodesiense HAT?

Answer 31

Melarsoprol (with oral prednisolone)

Question 32

What alternate treatment can be used for late-stage rhodesiense HAT?

Answer 32

Fexinidazole

Question 33

What nitroimidazole used to treat HAT is activated by parasite nitro reductase to nitro free radicals that damage DNA and proteins?

Answer 33

Fexinidazole

Question 34

How is fexinidazole metabolized?

Answer 34

CYPs

Question 35

How long is the loading dose maintained for fexinidazole?

Answer 35

4 days

Question 36

What medication used to treat HAT should only be used if there is high confidence for long-term follow-up (24 months)?

Answer 36

Fexinidazole

Question 37

What treatment for HAT produces AE such as neuropsychiatric effects, N/V, headache, dizziness, tremor, and QTc prolongation?

Answer 37

Fexinidazole

Question 38

What treatment for HAT impairs the parasite's mitochondrial activity and prevents synthesis of protein, nucleic acids, and phospholipids?

Answer 38

Pentamidine isethionate

Question 39

How is pentamidine isethionate administered?

Answer 39

Slow IV infusion or IM

Question 40

Nausea, fatigue, hypoglycemia, and injection site pain/local abscess are AEs of what HAT treatment?

Answer 40

Pentamidine isethionate

Question 41

What trypanocidal imidazole compound used to treat HAT is activated by parasite nitro reductase to nitroso free radicals that damage DNA and proteins?

Answer 41

Nifurtimox

Question 42

How can absorption of nifurtimox be improved?

Answer 42

Taken with food

Question 43

N/V, headache, dizziness, and polyneuropathy are common AEs of what HAT treatment?

Answer 43

Nifurtimox

Question 44

What treatment for HAT is an irreversible inhibitor of ornithine decarboxylase (suicide inhibitor); rapidly depletes parasites of polyamines?

Answer 44

Eflornithine

Question 45

What treatment for HAT is given by slow IV infusion every 6 hours for 7 days?

Answer 45

Eflornithine

Question 46

Fever, pruritus, hypertension, and hearing loss are AEs of what HAT treatment?

Answer 46

Eflornithine

Question 47

What HAT treatment forms stable complexes with proteins, interacting with biomolecules to inhibit parasite energy metabolism?

Answer 47

Suramin

Question 48

What HAT treatment is administered over slow IV infusion weekly for 4 weeks?

Answer 48

Suramin

Question 49

Bone marrow toxicity, nephrotoxicity, and peripheral neuropathy are AEs caused by extended use of what HAT treatment?

Answer 49

Suramin

Question 50

What HAT treatment should not be administered in patients that are co-infected with O. volvulus?

Answer 50

Suramin

Question 51

What HAT treatment is an arsenical prodrug converted to active melarsen oxide which inactivates most enzymes of both parasite and host?

Answer 51

Melarsoprol

Question 52

How is Melarsoprol administered?

Answer 52

Slow IV infusion

Question 53

What AE of Melarsoprol occurs in up to 18% of patients and is often fatal?

Answer 53

Melarsoprol reactive encephalopathy

Question 54

What disease does Trypanosoma cruzi cause?

Answer 54

Chagas disease

Question 55

How is Trypanosoma cruzi transmitted?

Answer 55

Triatomine bugs

Question 56

What is the preferred treatment for Chagas disease?

Answer 56

Benznidazole

Question 57

What is an alternative treatment for Chagas disease?

Answer 57

Nifurtimox

Question 58

What is the MOA of benznidazole and nifurtimox (used to treat Chagas disease)?

Answer 58

Reduced by parasitic nitro reductase to nitro free radicals that form covalent attachments to biomolecules

Question 59

N/V, headache, dizziness, and polyneuropathy are common AEs of what Chagas disease treatments?

Answer 59

Benznidazole and nifurtimox

Question 60

What is the dosing for benznidazole used to treat Chagas disease?

Answer 60

2x daily for 60 days

Question 61

What is the dosing for nifurtimox used to treat Chagas disease?

Answer 61

3x daily for 60 days

Question 62

What AEs are specific to benznidazole?

Answer 62

Photosensitivity leading to rash

Question 63

What microorganism is Leishmania?

Answer 63

Trypanosomatid protozoa

Question 64

How is Leishmania transmitted?

Answer 64

Sandflies

Question 65

Obligate intracellular parasites that infect and proliferate in macrophages, monocytes, and other phagocytes, leading to inflammation, infiltration, and necrosis describes what protozoa?

Answer 65

Leishmania

Question 66

Cutaneous, visceral, and mucosal are types of what protozoal infection?

Answer 66

Leishmaniasis

Question 67

What protozoal infection is sodium stibogluconate used to treat?

Answer 67

Leishmaniasis

Question 68

What protozoal infection is meglumine antimoniate used to treat?

Answer 68

Leishmaniasis

Question 69

What drugs used to treat Leishmaniasis are pentavalent prodrugs that are reduced by trivalent antimonial (Sb3+) by parasitic reductase?

Answer 69

Sodium stibogluconate and meglumine antimoniate

Question 70

How are Sodium stibogluconate and meglumine antimoniate administered?

Answer 70

IV or IM

Question 71

What is the first line therapy used for mucosal Leishmaniasis?

Answer 71

Sodium stibogluconate and meglumine antimoniate

Question 72

Intralesional injection of Sodium stibogluconate/meglumine antimoniate can be used to treat ____

Answer 72

Cutaneous Leishmaniasis

Question 73

Sodium stibogluconate and meglumine antimoniate are alternative agents used to treat what type of leishmaniasis?

Answer 73

Visceral

Question 74

Dose related muscle aches, N/V, fatigue, rash, and non-specific EKG changes are AEs of what drugs used to treat Leishmaniasis?

Answer 74

Sodium stibogluconate and meglumine antimoniate

Question 75

Monitoring of EKG, CBC, serum creatinine, transaminases, lipase, and amylase levels is necessary prior to and weekly during therapy with what Leishmaniasis treatment?

Answer 75

Sodium stibogluconate and meglumine antimoniate

Question 76

What Leishmaniasis treatment forms a complex with ergosterol in the cell membrane of protozoans, forming pores and causing leakage of cellular contents?

Answer 76

Amphotericin B Liposomal IV

Question 77

What is the preferred treatment for visceral Leishmaniasis (including during pregnancy)?

Answer 77

Amphotericin B liposomal IV

Question 78

How is Amphotericin B dosed for the treatment of visceral Leishmaniasis?

Answer 78

IV to cumulative dose and secondary prophylaxis IV every 3-4 weeks

Question 79

Infusion reactions ('shake and bake'), nephrotoxicity, anemia, and hypersensitivity reactions are AEs of what Leishmaniasis treatment?

Answer 79

Amphotericin B

Question 80

What Leishmaniasis treatment is also effective against free-living encephalitic amoeba, such as Naegleria fowleri?

Answer 80

Miltefosine

Question 81

Miltefosine is an alternative agent used to treat what type of leishmaniasis?

Answer 81

Visceral

Question 82

N/V, anemia, thrombocytopenia, increases serum aminotransferases, SJS, and reduced sperm count are AEs of what Leishmaniasis treatment?

Answer 82

Miltefosine

Question 83

What contraindications are there for miltefosine treatment?

Answer 83

Pregnancy

Question 84

What is the MOA of paromomycin in treatment of Leishmaniasis?

Answer 84

Protein synthesis inhibitor

Question 85

What is the preferred treatment for mucocutaneous Leishmaniasis?

Answer 85

Sodium stibogluconate and meglumine antimoniate

Question 86

What is the preferred treatment for visceral Leishmaniasis?

Answer 86

Amphotericin B

Question 87

What are preferred alternative treatments for visceral Leishmaniasis?

Answer 87

Pentavalent antimonial or miltefosine

Question 88

What is the preferred treatment of toxoplasmosis infection in a pregnant person at <14 weeks gestation?

Answer 88

Spiramycin

Question 89

What is the preferred treatment of toxoplasmosis infection in a pregnant person at >14 weeks gestation?

Answer 89

Pyrimethamine and sulfadiazine

Question 90

What is the preferred treatment in HIV/AIDS patients with cerebral toxoplasmosis?

Answer 90

Pyrimethamine and sulfadiazine

Question 91

What is the preferred suppressive therapy in HIV/AIDS patients with cerebral toxoplasmosis?

Answer 91

Pyrimethamine and sulfadiazine

Question 92

What is the MOA of pyrimethamine?

Answer 92

DHFR inhibitor

Question 93

What is the MOA of sulfadiazine?

Answer 93

DHPS inhibitor