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Last updated 2:38 AM on 1/26/23
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139 Terms
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protozoa
microscopic single-celled eukaryotic organisms
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plasmodium
parasite that causes malaria
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4 species of plasmodium causing malaria
p. falciparum
p. vivax
p. malariae
p. ovale
p. vivax
p. malariae
p. ovale
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p. falciparum
\-deadliest
\-drug resistance
\-drug resistance
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blood schizonticides
\-can prevent or treat symptomatic malaria
\-cannot prevent relapse of P. vivax or ovale
\-need to be taken for weeks for prophylaxis after exposure
\-cannot prevent relapse of P. vivax or ovale
\-need to be taken for weeks for prophylaxis after exposure
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Antimalarial drugs (3 types)
\-blood schizonticides
\-drugs targeting blood stages and primary hepatic stages
\-tissue schizonticides
\-drugs targeting blood stages and primary hepatic stages
\-tissue schizonticides
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blood schizonticide drugs
artemisins
chloroquine
mefloquine
quinine
quinidine
pyrethamine
sulfadoxine
tetracycline
chloroquine
mefloquine
quinine
quinidine
pyrethamine
sulfadoxine
tetracycline
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drugs targeting blood stages and primary hepatic stages
atovaquone
\-usually combined with proguanyl
\-cannot be used for prevention of relapse
\-usually combined with proguanyl
\-cannot be used for prevention of relapse
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tissue schizonticides
\-target liver stages (primary and latent)
\-does not treat symptomatic malaria or prophylaxis
\-prevents malarial relapse
\-does not treat symptomatic malaria or prophylaxis
\-prevents malarial relapse
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tissue schizonticide drugs
primaquine (& tafenaquine)
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chloroquine
\-effective
\-safe in pregnancy/children
\-1st line for all except falciparum
\-safe in pregnancy/children
\-1st line for all except falciparum
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SE of chloroquine
\-blurred vision
\-hemolysis (in G6PD deficient)
\-hemolysis (in G6PD deficient)
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Mefloquine
\-effective
\-safe in pregnancy/children
\-2nd line if chloroquine failed
\-safe in pregnancy/children
\-2nd line if chloroquine failed
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Mefloquine SE
increase QT interval
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Quinine & Quinidine
\-effective
\-1st line for resistant P. falci
\-1st line for resistant P. falci
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Quinine & Quinidine SE
\-toxic
-cinchonism
-hemolysis
-cinchonism
-hemolysis
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primaquine/tafenaquine
\-effective on hepatic forms
* primary and dominant
\-radical curve P vivax and ovale (combined with chloroquine)
* primary and dominant
\-radical curve P vivax and ovale (combined with chloroquine)
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primaquine/tafenaquine SE
hemolysis (in G6PD deficient)
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arteminsins
\-effective
\-fastest
\-1st line for treatment of all types
\-combinations exist to decrease resistnace
\-short t1/2 (not for prophylaxis)
\-fastest
\-1st line for treatment of all types
\-combinations exist to decrease resistnace
\-short t1/2 (not for prophylaxis)
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how to get amebiasis
ingesting cysts in food or water
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diagnosis of amebiasis
\-microscopic stool analysis
\-colonoscopy
\-antibodies in plasma
\-liver function or ultrasound imaging if needed
\-colonoscopy
\-antibodies in plasma
\-liver function or ultrasound imaging if needed
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combonations of artemisins
artemether/lumefantrine
artesunate/amodiaquine
dihydro-artemisinin/piperaquine
artesunate/amodiaquine
dihydro-artemisinin/piperaquine
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lumefantrine
\+ artemether
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atovaquone
\+proguanil
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FA antagonists
proguanil + arovaquone
sulfadxin + pyrimethamine
\
\-not effective in p. vivax, malariae, and ovale
sulfadxin + pyrimethamine
\
\-not effective in p. vivax, malariae, and ovale
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antibiotics
doxycycline + quinine
\
\-lower quinine toxicity
\-alone can be used for prophylaxis
\
\-lower quinine toxicity
\-alone can be used for prophylaxis
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symptoms of amebiasis
\-90% asymptomatic (if ameba does not come in contact with intestinal wall)
\-loose stool and abdominal pain (if come in contact with the cells lining the intestine)
\-blood diarrhea and dystentery (if ameba attaches and digests the intestinal wall)
\-amebic liver abscess (if ameba invades liver)
\-loose stool and abdominal pain (if come in contact with the cells lining the intestine)
\-blood diarrhea and dystentery (if ameba attaches and digests the intestinal wall)
\-amebic liver abscess (if ameba invades liver)
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E. histolytica causes __% of all amebiasis (pathogenic)
10%
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E. dispar and E. moshkovskii causes __% of all amebiasis (not pathogenic)
90%
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major complication of amebiasis
amebic liver abscess
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preferred drugs for amebiasis
metronidazole and tinidazole
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luminal amebicides
\-kill luminal trophozoites and cysts
\-alone for asymptomatic/mild cases
\-with metronidazole for serious invasive amebic disease
\-alone for asymptomatic/mild cases
\-with metronidazole for serious invasive amebic disease
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luminal amebicide drugs
\-paromomycin
\-iodoquinol
\-diloxanide furoate
\-iodoquinol
\-diloxanide furoate
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paromomycin
\-1st choice in US
\-safe in pregnancy
\-aminoglycoside (poorly absorbed)
\-safe in pregnancy
\-aminoglycoside (poorly absorbed)
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iodoquinol
\-chelates Fe ions essential for metabolism
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mixed amebicides drugs
\-metronidazole (oral and IV)
\-tinidazole
\-secnidazole
\-tinidazole
\-secnidazole
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metronidazole moa
\-NO2 group reduced by PFOR
\-form free radical
\-DNA/protein damage
\-form free radical
\-DNA/protein damage
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metronidazole use
\-1st choice for anaerobic protozoa
\-1st choice for anaerobic bacteria
\-low efficacy on cysts of E. hisolytica
\-safe in last 2 trimesters of pregnancy
\-1st choice for anaerobic bacteria
\-low efficacy on cysts of E. hisolytica
\-safe in last 2 trimesters of pregnancy
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metronidazole side effects
\-GIT: N/V, metallic taste
\-better taken with food
\-disulfiram like action
\-better taken with food
\-disulfiram like action
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tinidazole
\-longer effect (than metronidazole)
\-less side effects
\-no effect on bacteria
\-alternative for amebiasis and giardiasis
\-less side effects
\-no effect on bacteria
\-alternative for amebiasis and giardiasis
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secnidazole
\-more effective than metronidazole
\-less side effects
\-newbie
\-less side effects
\-newbie
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tissue amebicides (systemic) drugs
\-chloroquine
\-emetine (natural) & dehydroemetine (synthetic)
\-emetine (natural) & dehydroemetine (synthetic)
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use of tissue amebicides
invasive amebic liver abscess and extra-intestinal infection
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MOA of tissue amebicides
decrease protein synthesis
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side effects of tissue amebicides
\-nausea
\-interferes with muscles - leads to heart failure
\-used in hospitals only
\-interferes with muscles - leads to heart failure
\-used in hospitals only
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giardiasis
diarrheal disease caused by protozoan “Giardia duodenalis”
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symptoms of giardiasis
\-abdominal pain
\-malabsorption
\-decrease weight
\-greasy foul-smelling diarrhea
\-malabsorption
\-decrease weight
\-greasy foul-smelling diarrhea
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how is giardiasis spread?
\-food
\-water contaminated with fecal giardial cysts
\-water contaminated with fecal giardial cysts
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drugs for giardiasis
\-nitro-imidazoles (1st line)
\-paromomycin (1st line- pregnancy)
\-nitazoxanide (1st line in children)
\-paromomycin (1st line- pregnancy)
\-nitazoxanide (1st line in children)
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nitazoxanide MOA
\-tizoxanide inhibits PFOR
\-decreases electron transfer
\-decreases energy metabolism
\-decreases electron transfer
\-decreases energy metabolism
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treatment for amaebal cysts
paromomycin (preferred) or iodoquinol
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amebal dysentery, hepatic abscess and tissue amebiasis
\-metronidazole or tinidazole
* + luminal amebicide
* + luminal amebicide
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trichomoniasis
genito-urinary infection with “trichomonas vaginalis”
\-most common non-viral STD
\-often asymptomatic
\-most common non-viral STD
\-often asymptomatic
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tx of trichomoniasis
metronidazole
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african trypanosomiasis (sleeping sickness)
\-transmitted by Tsetse fly
\-1st stage- flu-like
\-2nd stage- confusion, slurred speech, seizures
\-1st stage- flu-like
\-2nd stage- confusion, slurred speech, seizures
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American trypanosomiasis (chagas disease)
\-kissing bugs
\-1st stage- flu-like
\-2nd stage (4-8w)- no symptoms, heart disease, enlarged esophagus/colon, nerve damage
\-1st stage- flu-like
\-2nd stage (4-8w)- no symptoms, heart disease, enlarged esophagus/colon, nerve damage
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drugs for early blood stage of African trypanosomiasis
\-suramin (1st line)
\-pentamidine (2nd line)
\-both injection only
\-pentamidine (2nd line)
\-both injection only
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drugs for late CNS stage of African trypanosomiasis
\-melarsoprol (1st line) - injection
\-eflornithin (2nd line)- injection or oral
\-eflornithin (2nd line)- injection or oral
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drugs for American trypanosomiasis
\-benznidazole (1st line)
\-nifurtimox (2nd line)
\-both oral only
\-nifurtimox (2nd line)
\-both oral only
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toxoplasmosis transmission
\-direct contact with cat poop
\-undercooked meat or contaminated vegetables
\-undercooked meat or contaminated vegetables
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treatment of toxoplasmosis
\-sulfadiazine and pyrimethamine
\-spiramycin in pregnancy
\-spiramycin in pregnancy
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Leishmania drugs
\-pentavalent antimony compounds
* Na stibogluconate (1st line)
* Meglumine antimoniate (1st line outside US)
\-amphotericin B
* 1st line for visceral form only
\-miltefosine
* for cutaneous & visceral form
* Na stibogluconate (1st line)
* Meglumine antimoniate (1st line outside US)
\-amphotericin B
* 1st line for visceral form only
\-miltefosine
* for cutaneous & visceral form
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treatment of cryptosporidium
nitazoxanide
\-less effective in immuno-comprimised
\-also used for giardia
paromomycin
\-off label use
\-less effective in immuno-comprimised
\-also used for giardia
paromomycin
\-off label use
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drug of choice for entameba
metronidazole with or without a luminal agent
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drug of choice for Giardia lamblia
metronidazole (or tinidazole)
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drug of choice for trichomonas vaginalis
metronidazole
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drug of choice for leishmania
Na stibogluconate or Meglumine antimoniate
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drug of choice for toxoplasma gondii
pyrimethamine + sulfadiazine (+ folinic acid)
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drug of choice for toxoplasma in pregnancy
spiramycin
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drug of choice for trypanosoma brucei
\-suramin (hemolymphatic)
\-melarsoprol (adv. CNS disease)
\-melarsoprol (adv. CNS disease)
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drug of choice for trypanosoma cruzi
benznidizole or nifurtimox
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drug of choice for cryptosporidium
nitazoxanide (or paromomycin)
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viral structure
\-nucleic acid (DNA or RNA)
\-protein coat (capsid)
\-outer lipid envelope with spike proteins
\-protein coat (capsid)
\-outer lipid envelope with spike proteins
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the envelope is composed of
matrix protein and the outer lipid membrane
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general life cycle of virus
1. attachment then penetration
2. uncoating
3. synthesis of new RNA/DNA copies and proteins
4. packaging to produce new viruses
1. shedding- virus copies exit host cell
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t/f: antibiotics can treat viral infections
false
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viral infections we dont treat
\-common cold
\-cough
\-diarrhea
\-mumps
\-cough
\-diarrhea
\-mumps
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viral infections we do treat
\-aids
\-herpes
\-hepatitis B & C
\-swine flu
\-herpes
\-hepatitis B & C
\-swine flu
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viral infection vaccines
\-influenza
\-hepatitis A
\-small pox
\-measles
\-polio
\-hepatitis A
\-small pox
\-measles
\-polio
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viruses can be
\-RNA
\-DNA
\-Retroviruses
\-DNA
\-Retroviruses
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RNA viruses examples
\-Hepatitis A, C, D, E
\-influenza A, B, C
\-corona virus
\-polio, measles, rubella, mumps
\-influenza A, B, C
\-corona virus
\-polio, measles, rubella, mumps
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DNA viruses examples
\-Hepatitis B
\-Herpes
\-Smallpox & monkeypox
\-Herpes
\-Smallpox & monkeypox
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retrovirus example
HIV
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MOA of antiviruses
1. decrease entry
2. decrease uncoating
3. decrease RNA/DNA synthesis
4. decrease post-translational processing
5. decrease exit of virus
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enfuvirtide
decreases entry
\-for AIDS
\-expensive
\-for AIDS
\-expensive
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amantadine
decreases uncoating
\-for influenza A
\-for influenza A
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ribavirin
decreases RNA polymerase
\-for several respiratory viruses
\-for several respiratory viruses
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Acyclovir/Ganciclovir
decrease DNA polymerase
\-acyclovir = 1st choice herpes
\-ganciclovir = for cytomegalovirus retinitis
\-acyclovir = 1st choice herpes
\-ganciclovir = for cytomegalovirus retinitis
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ritonavir
decreases protease
\-used for AIDS
\-used for AIDS
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oseltamivir
decreases exit of virus
\-decreases neuraminidinase
\-for influenza
\-decreases neuraminidinase
\-for influenza
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drugs for influenza A
1. neuraminidase inhibitors\*
2. amantadine & Rinamtadine
3. endonuclease inhibitors\*
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drugs for influenza B
1. neuraminidase inhibitors
2. endonuclease inhibitors
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oseltamivir and zanamivir
\-neuraminidase inhibitors
\-decrease virus neuraminidase
\-decrease virus budding
\-prophylaxis and tx of influenza A/B
\-decrease virus neuraminidase
\-decrease virus budding
\-prophylaxis and tx of influenza A/B
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Amantadine and Rimantadine
\-decrease uncaring of virus RNA
\-decrease virus replication
\-influenza A only (prophylaxis)
\-decrease virus replication
\-influenza A only (prophylaxis)
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baloxavir
\-endonuclease inhibitor
\-decreases endonuclease
\-treatment of influenza A/B
\-decreases endonuclease
\-treatment of influenza A/B
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zanamivir dosage form
\-dry powder (inhaled)
\-low bioavailability
\-low bioavailability
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amantadine is also used for
Parkinsons
\-increase dopamine release
\-increase dopamine release
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hepatitis A
\-RNA virus
\-transmission: fecal/oral
\-not chronic
\-vaccine available
\-transmission: fecal/oral
\-not chronic
\-vaccine available
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hepatitis B
\-DNA virus
\-transmission: blood, sex
\-10% chronic
\-vaccine available
\-transmission: blood, sex
\-10% chronic
\-vaccine available
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hepatitis C
\-RNA virus
\-transmission: blood
\-85% chronic
\-NO vaccine
\-transmission: blood
\-85% chronic
\-NO vaccine