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106 Cards in this Set

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DOC most fungal infections
Fluconazole
Specific DOC for thrush (candidiasis), severe but non-disseminated coccidioidomycosis, cryptococcal infection
Fluconazole
DOC vaginal candidiasis
Miconazole

(Alt HIV(+) nystatin, HIV (-) fluconazole)
DOC oropharyngeal candidiasis
Clotrimazole
What limits the use of Itraconazole
Hepatotoxicity
DOC blastomycosis, histoplasmosis, sporotrichosis
Itraconazole
Tx of black mold (dematiaceous fungi - Scedosporium proliferans)
Surgical debridement & 1 wk amphotericin

Followed by Itraconazole
DOC mucormycosis (mold, Rhizopus)
Amphotericin B

(alt. Posacanazole)
DOC aspergillosis
Voriconazole

(alt. Amphotericin B)
SE Voriconazole
Severe skin rxn
Photosensitivity
Hepatotoxicity
Visual changes
What should be monitored if pt on Voriconazole
LFT
Creatinine
Contraindications for use of Voriconazole
Pt taking
efavirenz
ergots
phenobarbital
rifabutin
rifampin
ritonavir
OCP
Ketoconazole is DOC for
Tinea versicolor

(not used much d/t toxicity)
Toxicity a/w ketoconazole
Suppression of testosterone & cortisol
MOA of imidazoles
interact w/ fungal P450, blocking demethylation of lanosterol to ergosterol

(ergosterol required for stable fungal cell membranes)
MOA Amphotericin B
Bind ergosterol --> creates pore in fungal cell membrane --> electrolytes in/out
Resulting in severe electrolyte imbalances & fungal death
SE Amphotericin B
Severe nephrotoxicity
Potential to cause
-RF
-type I renal tubular acidosis
-hypokalemia
Amphotericin B used to tx
Alt - Aspergillus, mucormycoses, fusarioses

DOC - cryptococcal meningitis (1 of 2 DOC) used w/ flucytosine
MOA Nystatin
similar to Amphotericin B
-binds ergosterol --> pore in fungal cell membrane --> electrolyte imbalance
Nystatin is used to tx
Thrush (alt)
Vaginal candidiasis in HIV(+) (alt)
MOA Griseofulvin
interacts w/ microtubules to disrupt mitotic spindles --> inhibiting mitosis

(accumulates in keratin)
Grisefulvin used to tx
Tinea (alt)
DOC tinea capitis
Terbinafine
DOC tinea corporis, cruis, pedis
Butenafine
MOA 5-flucytosine
Nucleoside analog --> inhibits DNA synthesis
5-flucytosine used to tx
Cryptococcal meningitis (another 1st line)

*used in combo w/ Amphotericin B
SE 5-flucytosine
Bone marrow suppression
MOA Terbinafine
Inhibit ergosterol synthesis via inhibiting squalene epoxidase
Terbinafine used to tx
Onychomycosis
Tinea capitis
SE Terbinafine
Severe hepatitis

(CI in pt w/ liver disease)
Butenafine used to tx
All types of tinea (except capitis)
SE imidazoles
Hepatotoxic
What are the imidazoles
Fluconazole
Miconazole
Clotrimazole
Itraconazole
Posaconazole
Voriconazole
Ketoconazole
Why is nystatin and many anti-fungals given topically?
Very toxic if given systemically
SE Griseofulvin
Hepatotoxic
Teratogenic
Induces human P450
Disulfiram-like rxn if taken w/ alcohol
Photosensitivity
4 species of organisms that cause malaria
Plasmodium vivax
P. ovale
P. malariae
P. falciparum
What malaria species is most devastating & deadly
P. palciparum
If infected w/ P. vivax or P. ovale, how do you tx? Why?
Malari tx & Primaquine

-form hypnozoites (latent form in liver)
DOC for prophylaxis tx chloroquine-sensitive malaria
Chloroquine
(DOC if pt pregnant)
Atovaquone-proguanil
What areas are considered chloroquine-sensitive?
Haiti
DR
Central America (NW of Panama canal)
parts of the Middle East
DOC for prophylaxis tx chloroquine-resistant malaria
Atrovaquone/Proguanil

Alt: Mefloquine or Doxycycline
(Mefloquine if pregnant)
Areas considered chloroquine-resistant malaria
South America
Africa
India
Tajikistan
Asia
Mexico
Eastern Europe
Russia
South Pacific
Who is doxycycline contraindicated in?
< 8 yo
Pregnant
SE doxycycline
Discolors developing teeth & bones
SE Mefloquine
MI (used in combo w/ quinines)
Drug-induced psychosis
Seizures
Retinal damage
G6PD exacerbation
Who is mefloquine contraindicated in?
GAD
Seizure d/o
Schizophrenia
MDD
MOA Atovaquone
Ubiquinone analog --> inhibits protozoan's mitochondrial ETC

**Teratogenic
DOC tx chloroquine-sensitive malaria
Chloroquine

(can use if pregnant too)
DOC tx chloroquine-resistant P. falciparum
Quinine PLUS (1 of these)
-Doxycycline
-Tetracycline
-Clindamycin

OR

Atovaquone-proguanil or Mefloquine
DOC tx chloroquine-resistant P. falciparum (Pt pregnant)
Quinine AND Clindamycin
DOC tx chloroquine-resistant P. vivax
Quinine AND
(Doxycycline or tetracycline) AND
Primaquine

OR

Mefloquine AND Primaquine
DOC tx chloroquine-resistant P. vivax (Pregnant)
Quinine alone (NO primaquine)
MOA Chloroquine
- 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
Does chloroquine cross BBB? Placenta?
Yes & Yes
SE Quinine
Cinchonism
-tinnitis
-photophobia
-mental dullness
-depression
-confusion
-HA
-N
MOA Quinine
inhibits Plasmodial DNA synthesis
MOA Primaquine
Prevents malaria relapse by killing organisms in the liver
Prevents gametocyte formation (prevents spread)
Drug combo being used in 3rd world countries for chloroquine-resistant P. falciparum
Artemether & lumefantrine
MOA Metronidazole
Electron acceptor --> compounds that bind organisms proteins and DNA --> organism death
Metronidazole used to tx
DOC - Trichomoniasis & Amoebiasis

Alt - Giardia lamblia
SE Metronidazole
Disulfiram-like rxn (if taken w/ alcohol)
Dark urine (benign)
Paresthesia, peripheral neuropathy, seizures (occasional)
DOC Giaridasis
Tinidazole
DOC cutaneous leishmaniasis
Stibogluconate
MOA Stibogluconate
inhibits glycolysis
DOC early East African sleeping sickness (Trypanosoma brucei rhodensiense)
Suramin
MOA Suramin
reacts w/ metabolic enzymes (esp. G6PD) --> cellular destruction

**Does not cross BBB
SE & CI Suramin
Pruritis & fever

CI in pt w/ renal or liver dz
DOC early West African sleeping sickness (Trypanosoma brucei gambiense)
Pentamidine

(can also be used prophylactically)
MOA Pentamidine
Inhibits topoisomerase
SE Pentamidine
Nephrotoxic
Pancreastitis
Hypotension
DOC for all late stage African sleeping sickness
Melarsoprol
MOA Melarsoprol
Reacts w/ sulfhydryl grps (esp. on enzymes) in both organism & human

** penetrates BBB
SE Melarsoprol
Fatal neurotoxicity (decreased if given w/ Prednisone)
Severe hypersensitivity
Significant GI problems
Jarish-Herxheimer rxn
What is Jarish-Herxheimer Rxn
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
First line DOC late stage West African sleeping sickness
Eflornithine

(also used topically to tx hirsutism)
MOA Eflornithine
Inhibits ornithine decarboxylase

(normally involved in catalyzing 1st step polyamine biosynthesis required for cell division)
MOA Nifurtimox
Creates ROS

(contraindicated in G6PD deficiency)
DOC Chagas disease (Trypanosoma cruzi)
Nifurtimox
SE Nifurtimox
Abd pain (N/V)
Polyneuritis
DOC cryptosporidiosis
Nitazoxanide

(also can use to tx giardiasis
MOA nitazoxanide
prodrug that is rapidly converted to active metabolite (Tizoxanide)

-inhibits the ETC in organism
DOC tx Pneumocystis jiroveci
Trimethoprim-Sulfamethoxazole

(alt. Dapsone w/ TMP)
MOA TMP-SMX
inhibits folate use and synthesis
SE Trimethoprim
Megaloblastic anemia
Dapsone MOA
inhibits dihydropteroate synthesis --> inhibiting folate synthesis

(CI in pt w/ G6PD deficiency)
SE Dapsone
Sulfone syndrome
(rash, fever, liver damage, hemolytic anemia)
DOC tx toxoplasma encephalitis
TMP-SMX or
Pyrimethamine-Sulfadiazine-folinic acid
MOA Pyrimethamine
inhibits dihydrofolate reductase --> inhibits folate synthesis
MOA Folinic acid (leucovorin)
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
DOC (only) for Naegleria fowleri, amoeba
Amphotericin B

**even w/ tx 95% pt die
DOC flatworms (cestodes & trematodes)
Praziquantel
MOA Praziquantel
-Increases cell membrane permeability to Ca --> tetanic-like contraction --> paralysis --> worm death
-Prevents uptake of adenosine
DOC roundworms
Albendazole or mebendazole
MOA Albendazole or mebendazole
bind tubulin--> prevent microtubule formation
-inhibition of mictrotubule-mediated glucose uptake
Who is albendazole and mebendazole contraindicated in?
Pregnant (teratogenic)
< 2yo (use ivermectin)
DOC trichinosis
Albendazole only

(give w/ prednisone)
DOC Strongyloides sterocoralis
Ivermectin
MOA Ivermectin
Opens voltage-gated Cl channels --> hyperpolarize --> flaccid paralysis & neurologic inhibition
SE Ivermectin
Mazzotti rxn

(massive eosinophil degranulation resulting in severe lesions at site of worm death)
1st line tx Anisakis? Dranunculus?
a - endoscopic or surgical removal
d - manual removal
1st line tx Onchocerca
6 wk Doxycycline
followed by Ivermectin
1st line tx Wuchereria bancrofti
Diethylcarbamazine
SE Diethylcarbamazine
Pruritis & other type I hypersensitivity
Mazzotti rxn
Teratogenic
DOC head lice or pubic lice
Permethrin

**recommended to spray mosquito netting too
MOA Permathrin
inhibits transmission of nerve impulses --> rapid paralysis
Used to tx bedding & clothing of pt w/body lice
Malathion & Permethrin