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34 Cards in this Set
- Front
- Back
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Parasitic Infections In US Increasing
why |
Increased international travel
Increased military and humanitarian missions Influx of immigrants Increased immunocompromised population |
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Life Cycle of the Plasmodium
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Anopheles
(sexual stage) Primary-Exoerythrocytic liver state (Primaquine acts her) - symptomatic Latent Parasites in erythrocyte (intra-erythrocyte schizogony –cyclic, symptomatic)most work here |
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Clinical Presentation of Malaria
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Initial phase
Nonspecific fever, chills, rigors, malaise, vomiting Orthostatic hypotension, electrolyte abnormalities Erythrocytic phase Prodrome: headache, anorexia, malaise, fatigue Nonspecific complaints, Paroxysm: Fever, chills, rigor Severe pallor, cyanosis of lips and nail beds, goose flesh |
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Treatment Of Malaria
basic strategy and drugs Chemoprophylaxis Attacks - general Chloroquine-resistant (P. falciparum) attacks |
Chemoprophylaxis
Chloroquine supplemented with primaquine common Mefloquine where chloroquine-resistant common Attacks - general Chloroquine Quinine and quinidine Chloroquine-resistant (P. falciparum) attacks Mefloquine Quinine and quinidine |
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Chloroquine
moA what phase |
(Aralen)
Effective against intraerythrocytic forms since it is concentrated in parasitized red blood cells Specific uptake mechanism of the parasite Mechanisms of action ******Inhibition of heme processing******. Intracellular accumulation of heme is toxic to parasite |
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Chloroquine
indications |
Indications (Black Box Warning)(ONLY BLOOD)
Most blood-forms of the plasmodium parasite Drug of choice for acute attacks and prophylaxis |
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Chloroquine
common high dose |
Low doses - Common
Gastrointestinal upset Skin rash Headaches Blurring of vision High doses Skin lesions Peripheral neuropathies ALL THE QUINS---- ****Myocardial depression ***Central nervous system abnormalities (retinal, auditory, personality disorders) ***Blood dyscrasias |
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Primaquine
moA what phase |
Effective against hepatic (exoerythrocytic) form of parasite
Also effective against gametocytes Mechanism of action Activated to a ****cellular oxidant******, disrupts membranes and nucleic acid structures |
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Primaquine
indications |
Used daily for prevention of infection
Not very useful in acute attacks Used for part of a radical cure regimen Especially for Plasmodium vivax |
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Primaquine
ADV Rxs |
Adverse effects (Black Box Warning)
******Hemolytic anemia Glucose-6-phosphatedehydrogenase**** deficient patients at greatest risk Gastrointestinal upset Pruritus Headaches *****Blood dyscrasias |
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Primaquine
BBW |
Adverse effects (Black Box Warning)
Hemolytic anemia Glucose-6-phosphate dehydrogenase deficient patients |
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Quinine
Quinidine moA indications |
Mechanism of action
Interfere with heme polymerization Indications Chloroquine-resistant malaria by P. falciparum |
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Quinine
Quinidine adv rXs |
******Cinchonism
Gastrointestinal upset Headache Tinnitus Vertigo Blurred vision Cardiac conduction problems (Black Box Warning for quinidine) ********Pregnancy category X Hematological dysfunctions |
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Mefloquine
moA indications |
(lariam)
Mechanism of action unknown but likely damages parasites membranes Indications Prevention****** and treatment, especially in areas with known chloroquine-resistant malaria (huge T1/2 take once a week) |
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Mefloquine
Adv Rxs |
Adverse effects
Gastrointestinal upset Skin rash Headaches Dizziness High doses *****Neurological symptoms (Bigtime pstd, psych probs,believe the brits) ****Seizures Cardiovascular dysfunction when use with quinine or quinidine |
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Anti-folate Drugs
in malaria |
Inhibitor of dihydrofolate reductase
Pyrimethamine (Daraprim) Inhibitor of PABA conversion Sulfadoxine Super additive combination by sequential blockade of folate synthesis Pyrimethamine and sulfadoxine (Fansidar) Used for acute attacks and prophylaxis Resistance is common limiting their use |
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Sulfadoxine
Pyrimethamine adverse Rx |
Sulfadoxine
Skin rashes Gastrointestinal upset Hemolysis(g6pd Kidney damage Pyrimethamine Folic acid deficiency if used long term or high dose |
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Drugs for Amebiasis
intestinal liver |
usually Entamoeba histolytica
Intestinal Iodoquinol (Yodoxin) Diloxanide furoate Tetracyclines Paromomycin) Liver (will abcess) Chloroquine (Aralen) Metronidazole**** (Flagyl, MetroGel) |
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Iodoquinol
all about it (not much) |
(Yodoxin)
yes Quin toxicities Indicated for asymptomatic amebiasis alone or in combination with other drugs Mechanism of action is unknown** Generally well tolerated Gastrointestinal upset Thyroid enlargement (related to excessive iodine release from drug) Neurotoxicity and visual defects at high doses or with long term therapy |
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Diloxanide Furoate
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exists
Indicated for asymptomatic amebiasis alone or in combination with other drugs |
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Metronidazole
moA indications |
(Flagyl, MetroGel)
Highly effective against most amebic diseases***DOC*** Mechanism of action Formation of reactive oxidation products*******ROS****** disrupting membrane** and nucleic acid** structures Orally active and hepatically eliminated |
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Metronidazole
Adverse |
(Flagyl, MetroGel)
Gastrointestinal upset Metallic taste Dark urine Unsteadiness, vertigo, ataxia Leukopenia Disulfiram-like reaction with alcohol******As with the three cephalos Carcinogenic (black box warning) |
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Metronidazole
BBW |
carcinogenic
(especially at injetcion site) DON't use in cancer pts |
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Giardiasis Treatment
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malabsorption diarrhea (Duodenum)----FOUL
Metronidazole Paromomycin |
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Leishmaniasis Treatment
agent |
StiboGLUConate sodium
Contains antimony (a heavy metal) Mechanism of action likely related to antimony disruption of ***glycolysis in parasite Requires intravenous infusion Adverse effects Pain at injection site Gastrointestinal upset Cardiac toxicity |
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Trypanosomiasis Treatments
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African trypanosomiasis (sleeping sickness) caused by Trypanosoma brucei
American trypanosomiasis (Chagas’ disease) caused by Trypanosoma cruzi (nasty-granulomas---->cardiac,GI,CNS) Melarsoprol Pentamidine Nitrofurtimox |
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Melarsoprol
ind adv Rxs |
Trypanosomiasis
Central nervous system Encephalopathy (early but transient, can be fatal) Hypersensitivity Hemolytic anemia ***Especially in patients with glucose-6-phosphate dehydrogenase deficiency |
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Pentamidine (know this one)
moA indications |
(Pentam 300)
Mechanisms of action Binds to DNA and inhibits DNA replication Inhibits dihydrofolate reductase***(Like nitrofurans and sulfonimides) o Pneumocystic carinii prophylaxis** |
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Pentamidine
adverse Rx |
Adverse effects are frequent with parenteral route, less so with aerosol route
Respiratory stimulation followed by depression Renal dysfunction, transient Blood dyscrasias Fall in blood pressure Hypoglycemia or hyperglycemia **especially in diabetes |
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Nifurtimox
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exists
Generates highly reactive free radicals and hydrogen peroxides that disrupt parasite membranes and structures |
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Treatment of Cestode (Tapeworm) Infections
FORGET |
FORGET
Niclosamide (ni kloe s amide) (Nicozide) Mechanism of action Uncoupling oxidative phosphorylation Activating ATPases Adverse reactions Minimal, gastrointestinal upset |
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Treatment of Nematode Infections
forget |
Ivermectin (eye ver mek in) (Metazoan)
Mebendazole (me bend a zole) (Vermox) or Thiabendazole (thye a bend a zole) (Mintezol) Piperazine (pi per a zeen) (Vermizine) Pinworms (Enterobius vermicularis) Whipworms (Trichuris trichiura) Roundworms (Ascaris lumbricoides) Hookworms (Ancylostoma duidenale, Necator americanus |
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Ivermectin
moA indic |
nematodes
Intensifies GABA(a stimulant in worms)-mediated neurotransmission in nematodes causing paralysis MAZZOTTI RX (?) |
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Treatment of Trematode Infections
Forget |
(Fluke)
-Praziquantel (Biltricide) Mechanism of action Increases calcium permeability causing contraction of the fluke muscles to paralysis, followed by vacuolization and death. |
