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106 Cards in this Set
- Front
- Back
DOC most fungal infections
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Fluconazole
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Specific DOC for thrush (candidiasis), severe but non-disseminated coccidioidomycosis, cryptococcal infection
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Fluconazole
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DOC vaginal candidiasis
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Miconazole
(Alt HIV(+) nystatin, HIV (-) fluconazole) |
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DOC oropharyngeal candidiasis
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Clotrimazole
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What limits the use of Itraconazole
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Hepatotoxicity
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DOC blastomycosis, histoplasmosis, sporotrichosis
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Itraconazole
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Tx of black mold (dematiaceous fungi - Scedosporium proliferans)
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Surgical debridement & 1 wk amphotericin
Followed by Itraconazole |
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DOC mucormycosis (mold, Rhizopus)
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Amphotericin B
(alt. Posacanazole) |
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DOC aspergillosis
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Voriconazole
(alt. Amphotericin B) |
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SE Voriconazole
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Severe skin rxn
Photosensitivity Hepatotoxicity Visual changes |
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What should be monitored if pt on Voriconazole
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LFT
Creatinine |
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Contraindications for use of Voriconazole
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Pt taking
efavirenz ergots phenobarbital rifabutin rifampin ritonavir OCP |
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Ketoconazole is DOC for
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Tinea versicolor
(not used much d/t toxicity) |
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Toxicity a/w ketoconazole
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Suppression of testosterone & cortisol
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MOA of imidazoles
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interact w/ fungal P450, blocking demethylation of lanosterol to ergosterol
(ergosterol required for stable fungal cell membranes) |
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MOA Amphotericin B
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Bind ergosterol --> creates pore in fungal cell membrane --> electrolytes in/out
Resulting in severe electrolyte imbalances & fungal death |
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SE Amphotericin B
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Severe nephrotoxicity
Potential to cause -RF -type I renal tubular acidosis -hypokalemia |
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Amphotericin B used to tx
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Alt - Aspergillus, mucormycoses, fusarioses
DOC - cryptococcal meningitis (1 of 2 DOC) used w/ flucytosine |
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MOA Nystatin
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similar to Amphotericin B
-binds ergosterol --> pore in fungal cell membrane --> electrolyte imbalance |
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Nystatin is used to tx
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Thrush (alt)
Vaginal candidiasis in HIV(+) (alt) |
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MOA Griseofulvin
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interacts w/ microtubules to disrupt mitotic spindles --> inhibiting mitosis
(accumulates in keratin) |
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Grisefulvin used to tx
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Tinea (alt)
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DOC tinea capitis
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Terbinafine
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DOC tinea corporis, cruis, pedis
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Butenafine
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MOA 5-flucytosine
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Nucleoside analog --> inhibits DNA synthesis
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5-flucytosine used to tx
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Cryptococcal meningitis (another 1st line)
*used in combo w/ Amphotericin B |
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SE 5-flucytosine
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Bone marrow suppression
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MOA Terbinafine
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Inhibit ergosterol synthesis via inhibiting squalene epoxidase
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Terbinafine used to tx
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Onychomycosis
Tinea capitis |
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SE Terbinafine
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Severe hepatitis
(CI in pt w/ liver disease) |
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Butenafine used to tx
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All types of tinea (except capitis)
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SE imidazoles
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Hepatotoxic
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What are the imidazoles
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Fluconazole
Miconazole Clotrimazole Itraconazole Posaconazole Voriconazole Ketoconazole |
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Why is nystatin and many anti-fungals given topically?
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Very toxic if given systemically
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SE Griseofulvin
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Hepatotoxic
Teratogenic Induces human P450 Disulfiram-like rxn if taken w/ alcohol Photosensitivity |
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4 species of organisms that cause malaria
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Plasmodium vivax
P. ovale P. malariae P. falciparum |
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What malaria species is most devastating & deadly
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P. palciparum
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If infected w/ P. vivax or P. ovale, how do you tx? Why?
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Malari tx & Primaquine
-form hypnozoites (latent form in liver) |
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DOC for prophylaxis tx chloroquine-sensitive malaria
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Chloroquine
(DOC if pt pregnant) Atovaquone-proguanil |
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What areas are considered chloroquine-sensitive?
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Haiti
DR Central America (NW of Panama canal) parts of the Middle East |
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DOC for prophylaxis tx chloroquine-resistant malaria
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Atrovaquone/Proguanil
Alt: Mefloquine or Doxycycline (Mefloquine if pregnant) |
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Areas considered chloroquine-resistant malaria
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South America
Africa India Tajikistan Asia Mexico Eastern Europe Russia South Pacific |
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Who is doxycycline contraindicated in?
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< 8 yo
Pregnant |
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SE doxycycline
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Discolors developing teeth & bones
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SE Mefloquine
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MI (used in combo w/ quinines)
Drug-induced psychosis Seizures Retinal damage G6PD exacerbation |
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Who is mefloquine contraindicated in?
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GAD
Seizure d/o Schizophrenia MDD |
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MOA Atovaquone
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Ubiquinone analog --> inhibits protozoan's mitochondrial ETC
**Teratogenic |
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DOC tx chloroquine-sensitive malaria
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Chloroquine
(can use if pregnant too) |
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DOC tx chloroquine-resistant P. falciparum
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Quinine PLUS (1 of these)
-Doxycycline -Tetracycline -Clindamycin OR Atovaquone-proguanil or Mefloquine |
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DOC tx chloroquine-resistant P. falciparum (Pt pregnant)
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Quinine AND Clindamycin
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DOC tx chloroquine-resistant P. vivax
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Quinine AND
(Doxycycline or tetracycline) AND Primaquine OR Mefloquine AND Primaquine |
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DOC tx chloroquine-resistant P. vivax (Pregnant)
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Quinine alone (NO primaquine)
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MOA Chloroquine
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- transforms heme into toxin. Plasmodia eats heme --> poisoned
-forms complexes that lyse Plasmodia & RBC its in -alkalizes Plasmodia food vacuole (must be acidic to digest food) -inhibits Plasmodia DNA synthesis |
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Does chloroquine cross BBB? Placenta?
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Yes & Yes
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SE Quinine
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Cinchonism
-tinnitis -photophobia -mental dullness -depression -confusion -HA -N |
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MOA Quinine
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inhibits Plasmodial DNA synthesis
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MOA Primaquine
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Prevents malaria relapse by killing organisms in the liver
Prevents gametocyte formation (prevents spread) |
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Drug combo being used in 3rd world countries for chloroquine-resistant P. falciparum
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Artemether & lumefantrine
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MOA Metronidazole
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Electron acceptor --> compounds that bind organisms proteins and DNA --> organism death
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Metronidazole used to tx
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DOC - Trichomoniasis & Amoebiasis
Alt - Giardia lamblia |
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SE Metronidazole
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Disulfiram-like rxn (if taken w/ alcohol)
Dark urine (benign) Paresthesia, peripheral neuropathy, seizures (occasional) |
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DOC Giaridasis
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Tinidazole
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DOC cutaneous leishmaniasis
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Stibogluconate
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MOA Stibogluconate
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inhibits glycolysis
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DOC early East African sleeping sickness (Trypanosoma brucei rhodensiense)
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Suramin
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MOA Suramin
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reacts w/ metabolic enzymes (esp. G6PD) --> cellular destruction
**Does not cross BBB |
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SE & CI Suramin
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Pruritis & fever
CI in pt w/ renal or liver dz |
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DOC early West African sleeping sickness (Trypanosoma brucei gambiense)
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Pentamidine
(can also be used prophylactically) |
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MOA Pentamidine
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Inhibits topoisomerase
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SE Pentamidine
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Nephrotoxic
Pancreastitis Hypotension |
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DOC for all late stage African sleeping sickness
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Melarsoprol
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MOA Melarsoprol
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Reacts w/ sulfhydryl grps (esp. on enzymes) in both organism & human
** penetrates BBB |
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SE Melarsoprol
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Fatal neurotoxicity (decreased if given w/ Prednisone)
Severe hypersensitivity Significant GI problems Jarish-Herxheimer rxn |
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What is Jarish-Herxheimer Rxn
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Lg amt of microorganisms die in the body --> toxins released into body (more than what liver & kidney can remove)
Excessive release TNF-a, IL-6, other cytokines |
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First line DOC late stage West African sleeping sickness
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Eflornithine
(also used topically to tx hirsutism) |
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MOA Eflornithine
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Inhibits ornithine decarboxylase
(normally involved in catalyzing 1st step polyamine biosynthesis required for cell division) |
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MOA Nifurtimox
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Creates ROS
(contraindicated in G6PD deficiency) |
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DOC Chagas disease (Trypanosoma cruzi)
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Nifurtimox
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SE Nifurtimox
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Abd pain (N/V)
Polyneuritis |
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DOC cryptosporidiosis
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Nitazoxanide
(also can use to tx giardiasis |
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MOA nitazoxanide
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prodrug that is rapidly converted to active metabolite (Tizoxanide)
-inhibits the ETC in organism |
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DOC tx Pneumocystis jiroveci
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Trimethoprim-Sulfamethoxazole
(alt. Dapsone w/ TMP) |
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MOA TMP-SMX
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inhibits folate use and synthesis
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SE Trimethoprim
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Megaloblastic anemia
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Dapsone MOA
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inhibits dihydropteroate synthesis --> inhibiting folate synthesis
(CI in pt w/ G6PD deficiency) |
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SE Dapsone
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Sulfone syndrome
(rash, fever, liver damage, hemolytic anemia) |
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DOC tx toxoplasma encephalitis
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TMP-SMX or
Pyrimethamine-Sulfadiazine-folinic acid |
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MOA Pyrimethamine
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inhibits dihydrofolate reductase --> inhibits folate synthesis
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MOA Folinic acid (leucovorin)
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Derivative tetrahydrofolate --> easily converted to other reduced folic acid derivatives (w/o acution dihydrofolate reductase)
Allows some purine and pyrimidine synthesis --> normal DNA and RNA processes to occur in human |
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DOC (only) for Naegleria fowleri, amoeba
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Amphotericin B
**even w/ tx 95% pt die |
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DOC flatworms (cestodes & trematodes)
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Praziquantel
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MOA Praziquantel
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-Increases cell membrane permeability to Ca --> tetanic-like contraction --> paralysis --> worm death
-Prevents uptake of adenosine |
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DOC roundworms
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Albendazole or mebendazole
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MOA Albendazole or mebendazole
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bind tubulin--> prevent microtubule formation
-inhibition of mictrotubule-mediated glucose uptake |
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Who is albendazole and mebendazole contraindicated in?
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Pregnant (teratogenic)
< 2yo (use ivermectin) |
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DOC trichinosis
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Albendazole only
(give w/ prednisone) |
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DOC Strongyloides sterocoralis
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Ivermectin
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MOA Ivermectin
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Opens voltage-gated Cl channels --> hyperpolarize --> flaccid paralysis & neurologic inhibition
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SE Ivermectin
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Mazzotti rxn
(massive eosinophil degranulation resulting in severe lesions at site of worm death) |
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1st line tx Anisakis? Dranunculus?
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a - endoscopic or surgical removal
d - manual removal |
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1st line tx Onchocerca
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6 wk Doxycycline
followed by Ivermectin |
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1st line tx Wuchereria bancrofti
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Diethylcarbamazine
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SE Diethylcarbamazine
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Pruritis & other type I hypersensitivity
Mazzotti rxn Teratogenic |
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DOC head lice or pubic lice
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Permethrin
**recommended to spray mosquito netting too |
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MOA Permathrin
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inhibits transmission of nerve impulses --> rapid paralysis
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Used to tx bedding & clothing of pt w/body lice
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Malathion & Permethrin
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