pharm antiparasitics by drug and organism

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USUHS14
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150783
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pharm antiparasitics by drug and organism
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2012-05-05 20:27:53
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pharm antiparasitics
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  1. Metronidazole
    • Use: E. histolytica, T. vaginalis, G. lamblia, and anaerobic bacteria
    • Mechanism: prevents terminal electron transport system from re-oxidizing NADH and NADPH
    • Pharmacology: good GI absorption; eliminated by kidneys; disulfiram like effects when taken with alcohol; do not use in pregnancy
  2. Iodoquinol
    • Uses: E. histolytica (only intestinal amebiasis)
    • Mechanism: liberated iodine, an amebicide
    • Pharmacology: not absorbed in GI tract; high dose can cause loss of visual acuity, optical atrophy, and blindness
  3. Paromomycin
    • Use: intestinal amebiasis and some intestinal cestode infections
    • Mechanism: aminoglycoside antibiotic - inhibits protein synthesis
    • Pharmacology: poorly absorbed in the intestine; can mess with gut flora and cause superinfection
  4. Nitazoxanide
    • Uses: giardiasis, cryptosporidiosis, and possibly amebiasis, I. belli, and some helminths
    • Mechanism: inhibits parasite pyruvate-ferredoxin (but different than metronidazole)
    • Pharmacology: Absorbed in GI tract; prodrug (active species is tizoxanide); mild side effects; no known drug interactions; safety in pregnancy not shown
  5. TMP/SMX
    • Uses: Cyclospora, Isospora belli, Pneumocystis jiroveci, toxoplasmosis prophylaxis
    • Mechanism: sequential blockade of folate synthesis
    • Pharmacology: Good tissue distribution (including CNS and prostate); not safe in pregnancy; patients with AIDS have a higher incidence of adverse effects
  6. Pyrimethamine + sulfadiazine
    • Uses: toxoplasmosis
    • Mechanism: folate antagonist
    • Pharmacology: must administer with folinic acid suplements; not safe in pregnancy
  7. Pentamidine
    • Uses: Trypanosomiasis gambiense, Leishmania donovani (kala azar), Pneumocystis jiroveci
    • Mechanism: selective breaks in the kinetoplast DNA
    • Pharmacology: not well absorbed from GI (give IM or IV); does not penetrate CNS; many toxic side effects including direct toxicity to beta islet cells
  8. Eflornithine
    • Uses: late stage trypanosomiasis
    • Mechanism: suicide inhibitor of ornithine decarboxylase (required for DNA synthesis)
    • Pharmacology: generally well tolerated and effective
  9. Mebendazole
    • Uses: whipworm, ascariasis, capillariasis, hookworm, visceral larval migrans, mixed infections of whipworm with Ascaris and/or pinworm
    • Mechanism: inhibition of microtubule polymerization by binding to beta-tubulin
    • Pharmacology: broad spectrum; virtually atoxic; can kill nematode eggs; poor GI absorption; contraindicated in pregnancy
  10. Albendazole
    • Uses: broad spectrum against intestinal helminths and neurocysticercosis
    • Mechanism: inhibition of microtubule polymerization by binding to beta-tubulin
    • Pharmacology: contraindicated in cirrhosis, pregnancy, and infants
  11. Pyrantel pamoate
    • Uses: pinworm and hookworm
    • Mechanism: depolarizing muscular blocker - leads to paralysis of worm and subsequent expulsion
    • Pharmacology: poorly absorbed form GI tract
  12. Diethylcarbamazine
    • Uses: both forms of W. bancrofti and Loa loa, but only the microfilariae of O. volvulus
    • Mechanism: unknown
    • Pharmacology: readily absorbed from GI tract; side effects from worm destruction; pre-treat with anti-histamines
  13. Ivermectin
    • Uses: O. volvulus, W. bancrofti, B. malayi, Strongyloides, Ascaris, Enterobius, and Trichuris
    • Mechanism: hyperpolarization via chloride ion influx resulting in muscle paralysis
    • Pharmacology: milder symptoms than DEC; side effects due to wirm destruction; CNS toxicity at high doses
  14. Praziquantel
    • Uses: Broad spectrum anti-schistosomal as well as some anti-trematode and anti-cestode activity
    • Mechanism: increases worm's permeability to calcium ions leading to vacuolization, contraction, and paralysis
    • Pharmacology: mild and transient side effects
  15. Ascariasis
    • Drug of choice 1: mebendazole, albendazole
    • Drug of choice 2: Ivermectin
  16. Capillariasis
    • Drug of choice 1: mebendazole
    • Drug of choice 2: albendazole
  17. Dracunculiasis
    Metronidazole
  18. Enterobiasis
    • Drug of choice 1: pyrantel pamoate
    • Drug of choice 2: mebendazole, albendazole
  19. Filariasis (Wuchereria bancrofti, Brugia malayi or timori)
    Diethylcarbamazine
  20. Filariasis (Mansonella perstans)
    Mebendazole
  21. Filariasis (Loa loa)
    Diethylcarbamazine
  22. Filariasis (Onchocerca volvulus)
    Ivermectin
  23. Hookworm
    • Drug of choice 1: Mebendazole, albendazole
    • Drug of choice 2: Pyrantel pamoate
  24. Cutaneous larval migrans
    • Drug of choice1: albendazole
    • Drug of choice 2: ivermectin
  25. Strongyloidiasis
    • Drug of choice 1: ivermectin
    • Drug of choice 2: albendazole
  26. Toxocaiasis
    • Drug of choice1: albendazole
    • Drug of choice 2: mebendazole
  27. Trichuriasis
    • Drug of choice1: mebendazole
    • Drug of choice2: albendazole or ivermectin
  28. Trichinella
    • Drug of choice 1: corticosteroids + mebendazole
    • Drug of choice 2: albendazole
  29. Beef tapeworm
    • Drug of choice1: praziquantel
    • Drug of choice 2: niclosamide
  30. Pork tapeworm
    • Drug of choice1: praziquantel
    • Drug of choice 2: niclosamide
  31. Neurocysticercosis
    • Drug of choice 1: antiseizure drugs + steroids + albendazole
    • Drug of choice 2: albendazole or praziquantel
  32. Diphyllobothriasis
    • Drug of choice 1: praziquantel
    • Drug of choice 2: niclosamide
  33. Echinococcosis
    • Drug of choice 1: albendazole
    • Drug of choice 2: surgical resection
  34. Alveolar hydatid disease
    • Drug of choice 1: albendazole
    • Drug of choice 2: surgical resection
  35. Schistosomiasis
    • Drug of choice 1: praziquantel
    • Drug of choice 2: oxamniquine (for S. mansoni)
  36. Intestinal fluke infection
    Praziquantel
  37. Liver fluke infection (Clonorchis & Opisthorchis)
    Praziquantel
  38. Fasciola hepatica
    • Drug of choice 1: triclabendazole
    • Drug of choice 2: bithionol
  39. Lung fluke infections
    • Drug of choice 1: praziquantel
    • Drug of choice 2: bithionol
  40. Chagas disease
    • Drug of choice1: nifurtimox
    • Drug of choice 2: benznidazole
  41. African sleeping sickness T. b. gambiense (no CNS involvement)
    • Drug of choice 1: pentamidine
    • Drug of choice 2: suramin
  42. African sleeping sickness T.b. rhodesiense (early stage)
    Suramin
  43. African sleeping sickness (late stage with CNS involvement)
    • Drug of choice 1: melarsoprol
    • Drug of choice 2: eflornithine (only against T.b.gambiense)
  44. Leishmaniasis (American cutaneous and mucocutaneous)
    • Drug of choice 1: sodium stibogluconate
    • Drug of choice 2: amphotericin B
  45. Leishmaniasis (visceral)
    • Drug of choice 1: sodium stibogluconate
    • Drug of choice 2: amphotericin B
  46. Leishmaniasis (cutaneous)
    • Drug of choice 1: sodium stibogluconate
    • Drug of choice 2: pentamidine
  47. Amebiasis (asymptomatic/mild intestinal infection)
    • Drug of choice 1: iodoquinol
    • Drug of choice 2: paromomycin
    • Alternative in europe: diloxanide furoate
  48. Amebiasis (moderate to severe infection)
    • Drug of choice 1: metronidazole + iodoquinol
    • Drug of choice 2: tinidazole
  49. Babesiosis
    • Drug of choice 1: clindamycin + quinine sulfate
    • Drug of choice 2: atovaquone
  50. Cycolsporosis
    TMP/SMX
  51. Cryptosporidiosis
    Nitazoxanide
  52. Giardiasis
    • Drug of choice 1: metronidazole
    • Drug of choice: nitazoxanide
    • Alternative: paromomycin
  53. Isosporiasis
    • Drug of choice: TMP/SMX
    • Alternative: paromomycin
  54. Microsporidiosis
    • Drug of choice 1: albendazole
    • Drug of choice 2: fumagillin
    • Alternative: paromomycin
  55. Pneumocystosis (PCP)
    • Drug of choice 1: TMP/SMX
    • Drug of choice 2: pentamidine isethionate or atovaquone
    • Alternative: paromomycin
  56. Toxoplasmosis (acute)
    • Drug of choice 1: pyrimethamine + sulfadiazine
    • Drug of choice 2: pyrimethamine + clindamycin or atovaquone
    • note: must give folinic acid (leucovorin) with pyrimethamine to protect bone marrow
  57. Toxoplasmosis (prophylaxis)
    • Drug of choice 1: TMP/SMX
    • Drug of choice 2: pyrimethamine + dapsone
    • note: must give folinic acid (leucovorin) with pyrimethamine to protect bone marrow
  58. Trichomonas
    • Drug of choice 1: metronidazole
    • Drug of choice 2: tinidazole
    • Note: treat partner

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