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46 Cards in this Set
- Front
- Back
What are the uses of Metronidazole?
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Trichomonas, Giardiases, Amebiasis
Infections caused by Bacteriodes fragilis, Clostridium difficile (both anaerobic bacteria) |
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What are the kinetics of Metronidazole?
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Good p.o absorption
Metabolized by the Liver & cleared by the Kidneys |
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What is the MOA of Metronidazole?
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Ferrodoxins (ETC enzymes in protozoans and anaerobic bac.) donate electrons to Metronidazole
Metronidazole is transformed into a highly reactive nitro radical that attacks DNA and destroys its helical structure to cause cell death Aerobic organisms do not produce the toxic metabolite from the prodrug Metronidazole |
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What is the drug interactions of Metronidazole?
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1. Pts. taking Warfarin - inc. bleeding
2. Ethanol - if ingested while taking Metronidazole - disulfiram-like rxn (drug inhibits acetaldehyde dehydrog) |
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What are the COMMON adverse effects associated with Metronidazole?
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Headache
Metallic Taste |
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What pregnancy category is Metronidazole? When should pregos avoid it?
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Cat. B
Avoid during 1st trimester |
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What is the DOC for Trichomoniasis?
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Metronidazole
Female: oral & topical Male consort: p.o. only Cure rate: 80-90% |
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What is the DOC for Giardiasis?
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Metronidazole
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What is another drug used to treat Giardiasis other than Metronidazole?
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Nitazoxanide: rapidly converted to the active metabolie Tizoaxanide
Interferes w/ Pyruvate:Ferrodoxin oxidoreductase-dependent electron transfer system which is required for anaerobic energy metabolism |
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What is the DOC for Amebiasis?
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Metronidazole
*kills both the luminal and systemic organisms |
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What is the drug used to treat Cryptosporidiosis?
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Nitazoxanide (NI-taz-ox-ah-nide)
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What is the route of administration and dosing interval for Chloroquine?
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p.o. once per week
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What is the therapeutic effect of Chloroquine?
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Kills the ERYTHROCYTIC stage of P. vivax, P. ovale, P. malariae, and SENSITIVE strains of P. falciparum
*some P. falciparum strains are resistant |
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What effect does Chloroquine have on the the exoerythocytic (hepatic) stage of Malaria?
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None
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What is the MOA of Chloroquine?
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Prevents the polymerization of free heme into the malarial pigment Hemozoin
Free heme kills the parasite by oxidative damage of the cell membrane |
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What drug has the same MOA as Chloroquine?
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Mefloquine
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What drug is a gametocide against all Plasmodium spp. and kills the HEPATIC form of P. vivax and P. ovale?
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Primaquine
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When is Primaquine often given?
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After erythrocytic form has been killed by Chloroquine
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What can Primaquine cause in patients with a glucose-6-phosphate dehydrogenase deficiency?
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Hemolytic anemia
*pts w/ deficiency cannot make NADPH which protects the cell membrane from oxidative damage; primaquine metabolites can cause oxidative damage to RBC membrane |
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What patients (other than those w/ G-6-P deficiency) should you avoid the use of Primaquine in?
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Pregnant women: fetus does not have a well developed G-6-P dehydrogenase system
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Patients with a normal G-6P dehydrogenase system may develop __________________ when taking Primaquine
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methhemoglobinemia
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What is the dosing interval of Mefloquine?
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p.o. once / week
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What are the benefits of Mefloquine over other antimalarial agents?
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Suppress and cure infections caused by MDR strains of P. falciparum
*used for prophylaxis in people traveling to areas w/ MDR Malaria |
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What are the S/E's of Mefloquine?
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Frequent: n/v, diarrhea, abdominal pain, dizziness, dysphoria
50% of pts: headache, ataxia, visual/auditory hallucinations, dizziness; usually mild and self-limiting Rare = disorientation, seizures, neurotic/psychotic symptoms |
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What is the radical cure for P. ovale and P. vivax?
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1. Chloraquine --> kills RBC form
2. Primaquine --> kills liver hypnozoites |
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What is the dosing interval of of Atovaquone-proguanil?
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p.o. once a day
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What drug is used for the prophylaxis of chloroquine resistant malaria and for the treatment of chloroquine resistant P. falciparum?
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Atovaquone-proguanil
*the best tolerated |
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What is the recommended time interval of usage of Malaria prophylaxis?
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Start 2 wks prior to travel
Continue 4 wks after leaving endemic areas |
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What is the DOC for treating Toxoplasma gondii in immunocompetent patients?
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Pyrimethamine-Sulfadiazine
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What is DOC for treating Pneumocystis jiroveci?
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Trim-sulfa
*organism causes pulmonary infections in patients w/ AIDS |
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What are the side effects of high doses of Trim-sulfa used to treat PCP?
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Hemolytic anemia
Leukopenia Rash Steven-Johnson syndrome |
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What drug is the second choice of treatment for Pneumocystis jiroveci?
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Pentamidine
*less efficacious & more toxic than trim-sulfa |
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_________ is the most common helminthic infection in the USA
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Pinworm
*local itching, especially severe at night, local irritation from scratching, positive cellophane tape test for eggs |
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What can you treat Pinworm infections with?
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MAP
Mebendazole -- kills round & tape worms Pyrantel pamoate -- kills round worms Albendazole --kills all worms in mixed infections |
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What is the most common helminthic infection in the world?
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Roundworm
*presents with malnutrition, bowel obstruction |
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What do you treat a pt. with for a Roundworm infection?
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Albendazole
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What are the uses of Ivermectin?
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1. Single dose given twice yearly kills the filarial infection causing river blindness
2. Single dose given to livestock kills all roundworms and arthropods for 30 days |
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What is the DOC for Cysticercosis infections (tapeworms)?
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Albendazole
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What is the TEXTBOOK DOC for the treatment of tapeworms?
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Niclosamide
* Niclosamide |
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What is the DOC to treat Trematodes (flukes) that cause Schistosomiasis?
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Praziquantal
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What are the S/E's of Albendazole?
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Abdominal pain
Reversible alopecia Increased AST & ALT |
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What is the DOC for the treatment of Pediculosis (infestation w/ lice)?
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1% Permethrin
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What is the DOC for Scabies?
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5% Permethrin
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How is Permethrin solution used for the treatment of lice?
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Saturate hair w/ permethrin sol'n after shampooing and drying; wrap head in towel and wait 10 minutes; rinse drug from hair
Treat Clothes Pubus: apply 1% permethrin cream for 10 minutes, rinse |
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How is Permethrin solution used for the treatment of scabies?
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Scrub skin w/ warm, soapy water using a soft brush to remove mites
Apply 5% permethrin to entire body avoiding the face, mucus membranes and eyes Wait 8-14 h before bathing |
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What other drug can be taken p.o. and is very effective for the treatment of Scabies?
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Ivermectin
*NOT FDA approved *useful in treatment of scabies in immunocompromised, patients w/ severely encrusted scabies or patients who have failed therapy w/ topical permethrin |