Amebicidals and Entamoeba Histolytica Life Cycle

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Questions and Answers

Which of these is a clinical use for Diloxanide furoate?

  • In combination after treatment with metronidazole (correct)
  • Dysentery
  • Enteritis
  • Treatment for Amebiasis

What is the mechanism of action for Diloxanide furoate ?

  • Acts on the bacterial nucleus
  • Inhibit protein synthesis (correct)
  • Inhibits bacterial protein synthesis
  • Inhibits bacterial protein synthesis and nucleic acid synthesis

Which of these is a clinical use of Iodoquinol?

  • Asymptomatic Intestinal Amebiasis
  • In combination after treatment with metronidazole
  • T. vaginalis
  • Treatment for Amebiasis (correct)

What is the similarity between Iodoquinol and Diloxanide furoate?

<p>Both are used to treat asymptomatic intestinal amebiasis (C)</p> Signup and view all the answers

Iodoquinol is used to treat Amebiasis, but is also used to treat:

<p>All of the above (D)</p> Signup and view all the answers

Which adverse reaction can occur when combining metronidazole with disulfiram or disulfiram-like drugs?

<p>Confusional and psychotic states (C)</p> Signup and view all the answers

What is the primary clinical use of chloroquine?

<p>Anti-malarial (C)</p> Signup and view all the answers

Which pharmacological class does chloroquine belong to?

<p>Aminoquinoline derivative (B)</p> Signup and view all the answers

What mechanism of action does chloroquine utilize to inhibit the growth of organisms?

<p>Increasing internal pH by concentrating within acid vesicles (C)</p> Signup and view all the answers

What is the bioavailability range of chloroquine upon absorption?

<p>52-100% (B)</p> Signup and view all the answers

Which group of drugs could potentially lead to a disulfiram-like reaction when taken with chloroquine?

<p>Cephalosporins (B)</p> Signup and view all the answers

Which of the following does NOT describe the metabolism of chloroquine?

<p>Excreted unchanged in urine (C)</p> Signup and view all the answers

What percentage of chloroquine is bound to plasma proteins during distribution?

<p>46-47% (D)</p> Signup and view all the answers

Which of the following is the primary cause of amebiasis worldwide?

<p>Entamoeba histolytica (C)</p> Signup and view all the answers

What is the primary clinical manifestation of symptomatic amebiasis?

<p>Fulminant Amebic Colitis (B)</p> Signup and view all the answers

Which drug is classified as a luminal amebicide for treating amebiasis?

<p>Iodoquinol (B)</p> Signup and view all the answers

What percentage of the world's population is believed to be affected by amebiasis?

<p>10% (A)</p> Signup and view all the answers

Which amebicidal drug is primarily used for cerebral amebiasis?

<p>Metronidazole (D)</p> Signup and view all the answers

Which of the following statements about Entamoeba histolytica is incorrect?

<p>It causes disease only in individuals with prior infections. (A)</p> Signup and view all the answers

Which infections are effectively treated by histolytica?

<p>Amebic Colitis and Giardiasis (B), Amebic Liver Abscess and Trichomoniasis (C)</p> Signup and view all the answers

Which condition is most directly associated with amebic liver abscess?

<p>Amebic Colitis (D)</p> Signup and view all the answers

What type of bacteria does metronidazole show effective antibacterial properties against?

<p>Anaerobic cocci (D)</p> Signup and view all the answers

Which of the following is NOT a limitation of metronidazole?

<p>Resistance to anaerobic gram-negative bacilli (A), Ineffective against anaerobic cocci (B)</p> Signup and view all the answers

Which of the following groups is at greater risk for developing amebiasis?

<p>People living in crowded conditions (C)</p> Signup and view all the answers

Which group of bacteria is effectively treated by metronidazole?

<p>Microaerophilic bacteria (A), Anaerobic spore-forming gram-positive bacilli (D)</p> Signup and view all the answers

Which of the following conditions is metronidazole primarily ineffective against?

<p>Aerobic bacterial infections (D)</p> Signup and view all the answers

What types of infections are classified under extraluminal amebiasis?

<p>Amebic Colitis and Amebic Liver Abscess (B)</p> Signup and view all the answers

Which of the following microorganisms is NOT susceptible to metronidazole?

<p>Staphylococcus spp. (C)</p> Signup and view all the answers

Which of the following best describes the mode of action of metronidazole?

<p>Disrupts DNA synthesis in anaerobic microorganisms (C)</p> Signup and view all the answers

What is the primary mechanism of action for luminal amebicides?

<p>Act on parasites in the bowel lumen (B)</p> Signup and view all the answers

Which drug is rapidly hydrolyzed to its active metabolite Tizoxanide?

<p>Nitazoxamide (C)</p> Signup and view all the answers

What percentage of Nitazoxamide is bound to proteins?

<p>99% (B)</p> Signup and view all the answers

Through which organ is the majority of luminal amebicides excreted?

<p>Kidneys (B)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect associated with luminal amebicides?

<p>Headache (D)</p> Signup and view all the answers

Which drug listed is considered a prototype for its class?

<p>Nitazoxamide (A)</p> Signup and view all the answers

How long is the half-life of the luminal amebicide discussed?

<p>7 hours (B)</p> Signup and view all the answers

Which luminal amebicide is considered safe for use during pregnancy?

<p>Paromomycin (B)</p> Signup and view all the answers

What is the primary mechanism of action of Chloroquine?

<p>Raising the pH of the bacterial cell (B)</p> Signup and view all the answers

What happens to a cell if it cannot generate ATP?

<p>It will experience ineffective protein transmission. (D)</p> Signup and view all the answers

Which enzyme is critical for anaerobic metabolism and is affected by Diloxanide furoate's mechanism?

<p>Pyruvate-ferredoxin oxidoreductase (PFOR) (A)</p> Signup and view all the answers

What is a consequence of improper enzyme function in a cell?

<p>Ineffective cellular function (C)</p> Signup and view all the answers

What does the reduction of metronidazole facilitate?

<p>Formation of a drug concentration gradient (A)</p> Signup and view all the answers

Which of the following is true about the function of Emetine?

<p>It is important for cellular growth. (B)</p> Signup and view all the answers

What is a consequence of imbalanced pH in bacterial cells?

<p>Cellular death (C)</p> Signup and view all the answers

Which statement best describes the role of anaerobic metabolism?

<p>It is essential for energy generation in the absence of oxygen. (B)</p> Signup and view all the answers

Flashcards

Amebiasis

An invasive disease caused by the parasite Entamoeba histolytica that can lead to significant morbidity and mortality.

Entamoeba histolytica

The most pathogenic species of Entamoeba, responsible for causing amebiasis and known to have humans as its only host.

Asymptomatic Amebiasis

A symptom-free form of amebiasis where the parasite is present in the body without causing noticeable illness.

Fulminant Amebic Colitis

A severe form of amebiasis characterized by rapid and intense inflammation of the colon, leading to potential complications.

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Ameboma

A localized mass-like formation in the colon caused by Entamoeba histolytica infection.

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Amebic Liver Abscess

A common complication of amebiasis characterized by a localized abscess in the liver.

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Luminal Amebicides

Drugs that target and kill Entamoeba histolytica within the intestinal lumen.

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Tissue Amebicides

Drugs that target and kill Entamoeba histolytica in various body tissues, including the liver, lungs, and brain.

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Chloroquine - Drug Class

A medication in the aminoquinoline drug class, often used for malaria, amebiasis, and some rheumatic diseases. It also shows potential against Zika virus.

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Chloroquine - Mechanism of Action

Chloroquine inhibits the growth of parasites primarily by concentrating in acidic vesicles, thus increasing internal pH levels.

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Chloroquine - Pharmacokinetic Properties

The process by which chloroquine is absorbed, distributed, metabolized, and eliminated in the body. It has a high absorption rate (52-100%) and a moderate level of protein binding (46-47%).

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Chloroquine - Drug Interactions

Taking Chloroquine with metronidazole or disulfiram can lead to confusion and psychotic states.

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Disulfiram-like Reaction

A type of drug reaction characterized by adverse effects when combined with certain medications. These reactions can include confusion and psychosis.

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Cephalosporins (Cefamandole, Cefoperazone, Cefotetan, Moxalactam)

A group of antibiotics including cefamandole, cefoperazone, cefotetan, and moxalactam. When combined with certain medications, they can lead to disulfiram-like reactions.

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Chloral Hydrate

A sedative medication that, when combined with certain medications, can lead to disulfiram-like reactions.

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Disulfiram

A medication used to treat alcohol dependence, known for its disulfiram-like reaction when combined with certain medications.

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Metronidazole

A medication used to treat infections caused by the parasite Entamoeba histolytica.

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Amebic Colitis

A type of amebiasis affecting the colon, causing inflammation, ulcers, and diarrhea.

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Giardiasis

A parasitic infection caused by Giardia lamblia, affecting the small intestine.

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Trichomoniasis

A sexually transmitted infection caused by the parasite Trichomonas vaginalis.

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Anaerobic Bacteria

A group of bacteria that are unable to thrive in the presence of oxygen and often cause infections.

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Microaerophilic Bacteria

Bacteria that can survive in environments with low oxygen levels, but prefer higher oxygen levels.

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Emetine

Emetine is a medication used to treat parasitic infections. It disrupts protein synthesis in the cells of parasites, preventing their growth and replication.

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Paromomycin

Paromomycin is an antibiotic that prevents protein synthesis in the cells of bacteria, leading to their death.

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Diloxanide furoate

Diloxanide furoate is a drug that treats amoebic infections. It disrupts the metabolic processes of parasites, leading to their death.

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Chloroquine

Chloroquine is a medication used to treat malaria. Chloroquine raises the pH (acidity) of parasitic cells, making them unable to effectively metabolize nutrients, leading to their death.

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Reductive Activation

Reductive activation is a process where a drug is converted into its active form by gaining electrons. In the case of metronidazole, this process generates a toxic compound that damages the DNA of anaerobic bacteria.

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Pyruvate-ferredoxin Oxidoreductase (PFOR)

The pyruvate-ferredoxin oxidoreductase (PFOR) is a key enzyme involved in anaerobic metabolism. Metronidazole disrupts the function of this enzyme, hindering the production of ATP, energy essential for anaerobic bacteria.

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Anaerobic Metabolism (in relation to Metronidazole)

Anaerobic metabolism is a metabolic process that occurs without oxygen. In the case of bacteria, anaerobic metabolism is disrupted by metronidazole, leading to their death.

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Diloxanide Furoate Mechanism of Action

A medication that inhibits protein synthesis, a vital process for the parasitic organism, effectively targeting Entamoeba histolytica.

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Iodoquinol

A quinoline derivative medication used to treat various amebic infections, including dysentery and enteritis, and also effective against Trichomonas vaginalis.

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Iodoquinol Mechanism of Action

Iodoquinol exerts its effect by targeting the bacterial nucleus, disrupting its DNA structure, and ultimately preventing the parasite's ability to replicate.

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Iodoquinol Usage

A medication for the treatment of amebiasis, dysentery, enteritis, and infectious diarrhea, and is also effective against Trichomonas vaginalis. It acts on the bacterial nucleus to prevent the parasite from multiplying.

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What are luminal amebicides?

Drugs that target and kill Entamoeba histolytica within the intestinal lumen.

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List common luminal amebicides.

Diloxanide Furoate, Nitazoxamide, Quiniodochlor, Iodochlorhydroxyquin, Diiodohydroxyquin, Iodoquinol, Tetracycline, Paromomycin.

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How does Diloxanide Furoate work?

Tizoxanide is the active metabolite of diloxanide furoate.

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Describe the metabolism of Diloxanide Furoate.

Diloxanide furoate is rapidly hydrolyzed to Tizoxanide in the intestine. Tizoxanide is then conjugated to Tizoxanide Glucuronide.

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What is the half-life of Diloxanide Furoate? How is it mainly excreted?

Diloxanide Furoate has a half-life of 7 hours and is mainly excreted in the urine.

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What are the potential side effects of Diloxanide Furoate?

Diloxanide Furoate can cause adverse effects such as diarrhea, vomiting, abdominal pain, and a greenish tint to the urine.

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Is Diloxanide Furoate safe for use in pregnancy?

Diloxanide Furoate is considered safe for use during pregnancy.

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What is the difference between luminal and tissue amebicides?

Luminal amebicides target the parasite in the intestinal lumen, while tissue amebicides target the parasite in other tissues.

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Study Notes

Amebicidals

  • Amebiasis affects about 10% of the world's population
  • It is a significant cause of morbidity and mortality due to its invasiveness.
  • It is the third leading parasitic cause of death in humans, after malaria and schistosomiasis
  • It is mostly seen in individuals living in poverty, crowding conditions, and areas with poor sanitation
  • Entamoeba histolytica is the most pathogenic species, capable of causing disease and humans are its only known host.

Life Cycle of Entamoeba Histolytica

  • Infection begins when mature cysts are ingested.
  • Mature cysts enter the body via the fecal-oral route.
  • Cysts travel down the gastrointestinal tract.
  • They reach the ileum of the small intestine and transform into trophozoites.
  • During the chronic or fulminant stage, trophozoites are the parasitic form capable of invasion.
  • They can invade adjacent structures, such as the liver, lungs, and brain.
  • The trophozoites form cysts that are passed out in the stool.

Clinical Manifestations

  • Asymptomatic Amebiasis: Infection present but mild or no symptoms
  • Symptomatic Amebiasis: Pathological disease:
    • Amebic Colitis: inflammation of the colon
    • Fulminant Amebic Colitis: severe form of amebic colitis, often life threatening
    • Ameboma: mass of inflammatory tissue
    • Amebic Liver Abscess: Infection of the liver
    • Pulmonary Amebiasis: Infection of the lungs
    • Cerebral Amebiasis (rare): Infection of the brain

Anti-Amebic Drugs

  • Divided into two main categories:
    • Tissue Amebicides: Used for extraintestinal amebiasis (amebic colitis, liver abscess)
    • Luminal Amebicides: Used for intestinal amebiasis
  • Metronidazole: Effective against extraintestinal amebiasis.
  • Tinidazole: Related to metronidazole, similar activity
  • Emetine: Used for severe extraintestinal amebiasis (liver abscess).
  • Chloroquine: Used for extraintestinal amebiasis.

Mechanism of Action

  • Metronidazole mechanism of action involves reactive reduction of a nitro group by anaerobic bacteria and sensitive protozoans, producing an active reduction product.

Pharmacokinetics

  • Rapid absorption, penetrates most tissues, and metabolized by oxidation in the liver.
  • Half-life of around 8 hours, mostly eliminated in the urine.
  • Metronidazole has disulfiram-like effects, so patients should avoid alcohol during and for three days after use.
  • Lithium toxicity can occur with concurrent metronidazole use.
  • Various drugs may interact with each other.

Adverse Effects

  • Common: Headaches, nausea, dry mouth, metallic taste.
  • Uncommon: Vomiting, diarrhea, abdominal distress
  • Rare: Dysuria, cystitis, sense of pelvic pressure
  • Neurotoxic effects (dizziness, vertigo, encephalopathy, convulsions, incoordination, ataxia, numbness, paresthesia).

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