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Drugs used to treat infections causd by Protozoa, Helminths,
and Ectoparasites
43
Pharmacology
Graduate
08/28/2010

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Term
Metronizadole therapeutic uses
Definition
used to treat trichomoniasis, giardiasis, amebiasis, and infections caused by the anaerobic bacteria (bactericidal) = Bacteroides fragilis and Clostridium dif
Term
Metronidazole Kinetics
Definition
Good po abs
Metabolized by the liver and cleared by the kidneys
Term
Metronidazole MOA
Definition
ETC contains ferredoxins which donate electrons to metronidazole to form a highly reactive nitro radical
the nitro radical attacks the protozoal DNA and destroys its helical structure to cause cell death
thus aerobic organisms do not produce the toxic metabolite from the prodrug metronidazole
Term
Metronidazole Contraindicated drugs
Definition
increased bleeding with warfarin
ethanol can cause n/v, abdominal pain, flushing due to accumulation of acetaldehyde in the blood, disulfiram inhibits acetaldehyde dehydrogenase
Term
Side Effects of Metronidazole
Definition
n/v/d, dizziness, headache, metallic taste, dry mouth xerstomia, abdominal pain
uncommon - leukopenia, uticaria, vag cand, periph neuropathy
Monitor CBC and LFT with prolonged treatment of recurrent trichomoniasis
Avoid use during 1st trimester of pregnancy
Term
Trichomoniasis treatment and clinical presentation
Definition
DOC is metronidazole oral or topical
incubation 5-28 days , vaginal discharge greenish yellow and frothy
males are often symptomatic
Term
Giardiasis Overview and Presentation
Definition
poor fecal oral hygeine and drinking untreated surface water
acute onset of diarrhea, cramping, bloating, flatulence
profuse watery and explosive stool initially then greasy and foul smelling later
NO blood pus or mucus in the stool
Term
Giardiasis treatment
Definition
DOC is metro for both children and adults
Nitazoxanide
rapidly converted to active metab tizoxanide
interferes with pyruvate: ferrodoxin oxidoreductase dependent ETC reaction which is required for anaerobc energy metabolism
S/E's abdominal pain, diarrhea, headache and nausea
Term
AMebiasis Overviw and presentation
Definition
most common in southwest
asymptomatic to fatal liver abscess
fecal oral, poor housing sanitation
Presents as:
1) non-invasive infection: abdominal pain, chronic liquid diarrhea
2) invasive (forms cysts): diarrhea, abdom pain, blood in stool, fever and enlarged liver
Term
Amebiasis (Ent Hist) Treatment
Definition
Metro is DOC for mixed amebicide, kills both luminal and systemic organisms
metro treatment may be followed with a luminal amebicide such as paromomycin
Term
Cryptosporidiosis clinical pres and treatment
Definition
oocysts spread via driect contact of contaminated water
Chlorination of water does NOT kill oocyts
Day care, male homosex, vets,
Milwakee dairy farm story
TREATMENT
Nitazoxanide
AIDS DOC: combined therapy with paromomycin and zithromycin is DOC
Term
Chagas' disease
Definition
Trypanosoma cruzi, spread by kissing bug triatomid, central south america
Nifurtimox is available from CDC
Term
Malaria Clinical Pres
Definition
cyclic fever with RBC lysis, CNS dysfunction
acute renal failure, black urine, pulmonary edema
P. falciparum is most fatal b/c this parasite occludes capillaries in the lungs, kidneys and brain
Term
P. faciparum and P. malariae life cycle
Definition
one cell cycle occurs in the liver, so the lover is free of infection after 4 weeks, this is why prophylactic therapy must be continued for several weeks
Treatment of RBC stage only, cures the infection
Term
P. ovale and P. vivax life cycle
Definition
hepatic infection is persistent, in order to cure the infection, you have to kill both the RBC stage and the hepatic stage
Term
Malaria treatment main two
Definition
chloroquine kills eryth stage so good for P. falcip and P. mal.
primaquine kills hepatic, so good for all, but don't give to preg women and may cause hemolytic anemia
Term
Used to treat MDR malaria
Definition
Doxycycline and clindamycin, active against the erythrocyctic forms
Term
used to treat severe infections caused by P. falciparum when the patient is NPO
Definition
quinidine, however it has cardiac toxicity
used in combination with pyrimethamine, tetracycline, or clinda mycin
also used in combination iwth doxy clinda or pyr-sulfa to treat chloroquine resistant P. falciparum
Term
Used for prophylaxis of malaria and for the treatment of chloroquine Resistant P. falciparum
Definition
atovaquone-proguanil
atov blocks cytochrome mediated ET which in turn destroys mitoch membrane potential difference
Term
artemisinins
Definition
rapidly clears parasites from the blood including gametocytes
produces a very high cure rate, even in MDR resistatn strains
has a low incidence of R
Term
Malaria Prophylaxis
Definition
Chloroquine in Chl sensitive area - safe in children
For Chloroquine Res areas:
atovaq +proguanil best tol. and safe children
mefloquine - safe children
doxycycline
primaquine
Term
Treatment of toxoplasma gondii (Toxoplasmosis)
Definition
combination of pyrimethamine-sulfadiazine is the DOC in immunocomp patients
Trimeth-sulfa is used for prophylaxis of toxoplasmosis in patients with AIDS
Term
Treatment of PCP, Pneumocystis jiroveci, Pneumocystis carinii
Definition
DOC is trim-sulfa, but may cause side effects
Pentamidine is 2nd choice, but less efficacious and even more toxic
Term
Drug that kills round and tape worms
Definition
mebendazole
Term
drug that kills round worms
Definition
pyrantel pamoate
Term
kills all worms in mixed infections
Definition
albendazole
Term
albendazole and mebendazole MOA
Definition

inhibits synthesis of microtubules needed for glucose uptake, parasite is immobilized and clear from the GI tract, also larva cidal and ovicidal

targets the bendy parts

Term
pyrantel pamoate MOA
Definition
ganglionic nicotinic cholinergic agonists = muscular tetany. Resulting neuromuscular paralysis allows peristaltic clearance from the GI tract
Term
piperazine
Definition
a GABA agonist at the NM jxn; increased CL conductance hyperpolarizes muscles and prevents the excitation caused byt Ach -> flaccid muscle paralysis
Term
ivermectin
Definition
releases Gaba and incr Gaba binding, opens chl channels in NM jxn which gives flaccid muscle paralysis
Term
praziquantal
Definition
opens calcium channels to cause muscular tetany; also causes tegmental damage which activates the host immune system
Term
niclosamide
Definition
kills cestodes by inhibition of oxidative phosphorylation, not in US
Term
pinworm treatment
Definition
mebendazole, pyr pam, or albendazole
Term
Roundworm treatment
Definition
albendazole, or piperazine, but pip has contraindications so use albendazole
Term
Hookworm treatment
Definition
albendazole, pyr pam, mebendazole
poor sewage or walking barefoot
Term
threadworm DOC
Definition
ivermectin, single dose given twice yearly kills the inf causing river blindness. Give to livestock 1x 30 days
Term
Cestodes or tapeworm treatemetn
Definition
DOC is albendazole, with a laxative
infections are usually asymptomatic but children will have focal neural findings, increases intracranial pressues and seizures. Larval cysts can become calcified and seen with imaging
can also treat with Niclosamide, but it is not available in the US
Term
Trematode (fluke) treatment
Schistosomiasis
Definition
DOC is praziquantal
presents as dermatitis from worm penetration, anemia, fever, chills, abdominalpain, fatigue, diarrhea, sweating, enlarged liver/spleen/lymph nodes, hepatitis
Term
Albendazole properties
Definition
broad spectrum: kills pinworms round worms,hookworms, threadworms, tapeworms, and flukes
DOC for mixed worm infections
very low bioavailabiltiy
S/E's abd pain, alopecia, increased LFT
Term
Treatment of lice, pediculosis
Definition
DOC is permthrin 1% cream
Malathion is available for infestations caused by lice resistant to permethrin
a 1% lindane shampoo is also available, DDT derivative
Term
Treatment of Scabies and clinical presentation
Definition
DOC is 5% permethrin
Caused by itch mite, intense itching which is more severe at night, classic burrows made by tunneling mites, screatching btwn fingers, buttocks, groin and scalp lead to 2ndary bacterial inf, skin scrapings under the microscope reveal the presence of mites
Term
Treatment of lice and scabies
Definition
1% permethrin is pediculicidal and 5% permethrin is scabicidal
Term
Ivermectin
Definition
especially useful int he treatment of scabies in immunocompormised patients, and patients with severely encrusted scabies or patients who have failed therapy with topical permethrin. Not FDA approved.
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