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48 Cards in this Set
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Imidazoles
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all are hepatoxic
interact wiht fungal P450-->block demethylateion of LANOSTEROL to ERGOSTEROL. Ergosterol is need for fngal cell membrances-->less stable cell memb.-->fungal death |
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Fluconazole
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DOC for most fungal inf
DOC: thrush (candidiasis), severs but non-disseminated coccidioidomycosis, cryptococcal infx (except meningitis) |
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miconazole
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DOC: vaginal candidiasis (topically)
ALT in HIV pts is topical nystatis Alt in HIV negative pts is fluconazole |
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clotrimazole
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topical agent
oropharyngeal candidiasis |
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Itraconazole
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broad specturm, very potent
more hepatotoxic htatn fluconazole so use limited to resistant or severe systemic fungal infx ( fungal infx resitant to fluconazole) DOC: blastomycosis, frequently followed by 1 wk of amphotericin therapy first line in : surgical debridement, for infx with black molds ( black molds cause: phaeohyphomycosis) |
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posaconazole
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ALT DOC : mucormycosis ( caused by mold Rhizopus)
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Voriconazole
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DOC: ASPERGILLOSIS (ALT is amphotericin B)
DOC: Scedosporium apiospermum (rare) SE: severe skin rxn, phtosensensitivity, hepatotoxicity, VISUAL CHANGE. MUST MONITOR LFT and CREATININE. CONTRAINDICATED: in use wiht efaviraenz, ergots, phenobarbitol, rifabutnin, rifampin, ritonavir. cautuin wiht oral contraceps. |
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Ketoconazole
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for severe infx. rarely used due to toxicity (suppression of testosterone and cortisol production.
DOC: TINEA VERSICOLOR |
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Amphotericin B
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binds to Ergosterol-->form a pore-->leak electrolytes-->imbalance -->death
croses PLACENTA severe NEPHROTOXICITY-->can cause renal failure, type I renal tubular acidosis, hypokalemia DOC: ARPERGILLUS , MYCORMYCOSIS, FUSARIOSES. One of two DOC for CRYPTOCOCCAL MENINGITIS (used with flucytosine) A lipid-based amphotericin and liposomal amphotericin are prefered over std. nonlipid amphotericin B due to less toxicity |
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Nystatin
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same action as Amphotericin B but used topically becasue of high systemin toxicity.
can be used for thrush(swish adn swallow) althogh DOC for thrush is Fluconazole topical nystatic: alt to vaginal candidiasis in HIV (+) |
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griseofulvin
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interacts with microtubulesto disrupt mitotic spindles --> inhibit mitosis
accumulates in keratin--> making skin and nails unsuitable for fungal gowth used to treat dermatophytic infx (tinea) but alt to TERBINAFINE for tinea capitis, and BUTENAFINE for tinea corporis, curis, pedis |
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5 flucytosine
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nucleoside analog--> inhibit DNa synthesis
1st line for CRYPTOCOCCAL MENINGITIS and used wiht amphotericin therapy SE: Bone marrow suppression |
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Terbinafine
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DOC: ONYCHOMYCOSIS, TINEA CAPITIS
inhibit ergosterol synthesis by inhibiting SQUALENE EPOXIDE Oral agent: casue severe hepatitis so contraindicated in LIVER DIS pts. |
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Butenafine
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same MOA at terbinafine
cream limits its toxicity make it DOC for all types of TINEA (ringworm, dermatophytosis) except tinea capitis |
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Allylamines (terbinafine, butenafine)
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hepatotoxic, decreased with cream (butenafine)
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Griseofulvin
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heptatoxic, TERATOGENIC, induces human P450.
disulfiram like rxn photosensitivity rash when pts exposed to sunlight |
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Flycytosine
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BONE MARROW SUPPRESSION: leucopenia, thrombocytopenia, can cause aplastic anemia
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Nystatin /miconazole
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toxic if given systemically
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Amphotericin B
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severe kidney damage-->hypokalemia, anemia
hypotension, nurological effects SE decrease with lipid based Amphotericin B |
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Malaria
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plasmodium vivax, ovale, malaria, falciparum
Falciparum; most deadly P. vivax and ovale: treated for malaria + must recieve primaquine becasue form hypnozoites in the liver that can casue reoccurence |
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Malaria prphylaxis
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in chloroquine-sensitive are: chloroquine or atovaquone-proguanil
chloroquine: DOC in pregnancy chloroquine sensitive are: Haiti, dominican republic, central america northwest of panama canal, parts of middle east. chroloquine resistant areas: DOC is atovaquone/proguanil, 2nd line is mefloquine, or doxycycline. theese areas are south america, africa, india, asia, mexico, eastern europe, russia, south pacific. if pregnant: DOC is Mefloquine |
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Docycyline
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cant be used in less than 8 years old
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mefloquine
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serious SE: MI (when used wiht other quinine/quinine derivatives), drug induced PSYCOSIS (stops when drug is stopped), seizures
retinal damage, G66PD exacerbation. contrain: anxiety disorder, seizure dix,schizopherenia, or pyschotic dix., depression. effective for chloroquine resistant plasmodium falciparum |
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Atovaquone
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act as ubiquinone analog -->inhibit ETC -->decrease ATP
TERATOGENIC |
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CHLOROQUININE
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casue physical destruction to malaria
DOC: CHLOROQUINE SENSITIVE SPECIES. PREGNANT PTS. |
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chloroquine resistant p. falciparum
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quinine + either doxycyline, or tetracycline, or Clindamycin, or atovaquone-proguanil, or mefloquine
Pregnant: quinine + clindamycin |
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chloroquine resistant P. vivax
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DOC: quinine + either doxy, or tetracycline + primaquine
DOC: Mefloquine + perimaquine pregnant: DOC is quinine alone first treeat wiht chlroquine when no reponse to treatment then treat wiht chloroquinine resistant treatemtn |
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chloroquinin
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transforms heme into a toxin for plasmodia--> plasmodia eat heme and die
forms comlexes that lyse the plamodia adn rbc alkalizes the plasmodia food vacuole--> starving the organism inhibit splasmodia DNA synthesis crosses BBB and placenta |
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quinine
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SE: cinchonism ( tinnitius, photophobia,mental dullness, depression, confusion, headache, nausea)
inhibits plasmodial DNA synth. |
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primaquine
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prevent malaria relapls y by killing hypnozoites in liver. also prevents gametocyte formation-->prevents malarial spread
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Artemether
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combinded wiht lumefantrine
ALT: for chloroquine resistant P. Falciparum mostly used in 3rd world countries resolves parisetemia, fever, has significant gametocidal effect. |
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Metronidazole
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DOC: trichomoniasis vaginalis, entamoeba histolytica,
alt: giardia lamblia acts as elcetron acceptor -->forms compounds that bind organism proteins, and DNA--> death SE: DISULFIRAM LIKE RXN, DARKEN URINE, ocassion paresthesias, peripheral neuropathy, seizures ALT for Entamoeba is tinidazole Tinidazole: DOC for Giardia |
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Stibogluconate
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inhibits glycolysis
DOC: cutaineos leishmaniasis Mucosal or systemic infx wiht leishmania (Kala-azar): treated wiht amphotericin B |
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Suramin
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reacts wiht glucose 6 phosphate dehydrogenase-->cell destruction
doen't cross BBB so no effect on CNS infx. DOC: early stage East African sleeping sickness (trypanosoma brucei rhodensiense) contraindicated: in renal or liver dis SE: puritis and fever |
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pentamide
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DOC: early stage west african sleeping sikness (trypansosome brucei gambiense)
also prophylaxis inhibit topoisomerase Nephrotoix, can casue pancreatitis, hypotension |
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melarsoprol
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treat all forms of African sleeping sickness
reacts with sulfhydryl groups in organism and humans but organisms is more affected can cause: fatal neurotoxicity, sever HPS rxn and significant GI problem if the pt is not fasting. decrease neurotoxicity with coadministration of prednisone can cause Jarisch-herxheimer rxn crosses BBB |
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Eflornithine
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1st line for late stage west Africcan sleeping sickness.
inhibitor of ornithine decarboxylase -->limits polyanine production-->decrease cell growth and proliferation also used as a topical agent in the treatment of HISUTISM by inhibiting cell proliferation in teh hair follicle and stops unwanted hair growht. |
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nifurtimox
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treat Chagas dis (trypanosome cruzi) by creating radical o2 species and killing organism.
humans are protected by antioxidant mechanism SE: Abdo pain, nausea, vomit, polyneuritis contranin: in G6PD deficiency |
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Nitazoxanide
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DOC: cryptospridiosis
can also treat giardiasis prodrug that is converted to active metabolite, tizoxanide-->inhit ETC |
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Trimethoprim-sulfamehtoxazole
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DOC: pneumocyctitis jiroveci, Toxoplasma gondii (can also use pyrimehtamine+sulfadiazine+folnic acid)
inhibitdihydrofolate reductase-->decrease folate synt-->inhibit dna syn. SE: megaloblastic anemia ALT: DAPSONE (inhibits dihydropterate synthetase) +trimethoprim DAPSONE: contra: in G6Pd def--> can cause sulfone syndrome (rash, fever, liver damase, anemia) |
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Amphotericin B
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DOC: naegleria Fowleria (95 % treated pts still die)
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two types of flatworms
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cestodes (tapeworms), trematodes (flukes)
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praziqunatel
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DOC: all flatworsms except ECHINOCOCCUS GRANULOSUS (SURGERY)
SE:drowsiness |
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albendazole/mebendazole
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DOC; roundworms
bind tubulin--> inhibit microtuble formation-->inhibition of microtuble mediated glucose uptake by the worm--> starve to death ABSOLUTE CONTRADINDATION: PREGNANCY due to teratogenic effect of inhibiting microtuble synthesis, also contra in children less than 2. ( ivermectin is alt) only albendazole: DOC for trichinella spiralis ( also have prednisone added) |
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Ivermectin
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DOC: stongyloides stercoralis (roundworm)
opens voltage gated cl channels htat are found in only helminths and arthropods-->influx of cl into the worm cells -->casue flaccid paralysis SE: mild but can casue Mazzoti rxn (massive eosinophil degranulation that result in severe lesion at site of worm death) |
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Diethylcarbamazine
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given wiht doxy.
DOC: wuchereria bancrofti( lymphatic filarial organism) inhits metabolism of arachidonic acid in filarial organism. SE: puritis, type 1 HPS rxn. Mazzott rxn TERATOGENIC ONLY AVAILABLE THROUGH CDC |
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PERMETHRIN
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Cream or lotion
DOC: head lice, pubic lice, scabies inhibits trasmission of nerve impulses --> rapid paralysis |
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malathion or permethrin powder
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used to treat the bedding and clothing of pts's with body lice and who can't afford to discard their clothing and bledding
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