anti-malarials Flashcards by dena danji

chloroquine

tx and prophylaxis

P. vivax and P. ovale - active against blood parasites - NOT liver stage

How well did you know this?

Not at all

Perfectly

DOC for p.vivax and ovale

chloroquine

How well did you know this?

Not at all

Perfectly

DOC in tx in non-falciparum and sensitive uncomplicated falciparum malaria

chloroquine

How well did you know this?

Not at all

Perfectly

chloroquine MOA

concentrates in parasite food vaculoes

prevents biocrystallization of Hgb breakdown product heme to non-toxic hemozin = accum of heme results in lysis of parasite and RBC

How well did you know this?

Not at all

Perfectly

chloroquine resistance

putative transporter: PfCRT

How well did you know this?

Not at all

Perfectly

chloroquine AE

fatal = most common drug used for suicide

pruritus

hemolysis - G6PD

How well did you know this?

Not at all

Perfectly

chloroquine contraindication

psoriasis, porphyria, retinal abnormalities

How well did you know this?

Not at all

Perfectly

parenteral tx of severe falciparum

quinidine

How well did you know this?

Not at all

Perfectly

oral tx of falciparum (alt in chloroquine resistant areas)

quinine

How well did you know this?

Not at all

Perfectly

first line for severe falciparum

quinine/quinidine

How well did you know this?

Not at all

Perfectly

quinine/quinidne use

good against BLOOd - not liver stages

depresses O2 uptake and carb metabolism

intercalates into DNA = disrupting replication/transcription

How well did you know this?

Not at all

Perfectly

quinine/quinidine AE

cinchonism - tinnitus, HA, nausea

hematological abnl: thrombocytopenia, agranulocytosis

hypoglycemia - stimulates insulin release

uterine contractions: still used in pregnant pt (benefits outweigh risks)

hypotension

QT prolongation

blackwater fever: likely HS rxn - hemolysis and hemolgobinuria

How well did you know this?

Not at all

Perfectly

quinine/quinidine contraindications

visual/auditory problems
cardiac
don't use with mefloquine
can inc levels of warfarin and digoxin
renal insuff (dec dose)

Category C pregancy

How well did you know this?

Not at all

Perfectly

mefloquine

works against chloroquine resistant strains
related to quinine

MOA: destroys asexual blood forms

How well did you know this?

Not at all

Perfectly

only medication recommended for chemoprophylaxis in pregannt women in chloroquine resistant areas

mefloquine

How well did you know this?

Not at all

Perfectly

mefloquine use

effective against most strains of p. falciparum and vivax

How well did you know this?

Not at all

Perfectly

what combo is used in uncomplicated malaria in south east asia

mefloquine + artesunate

How well did you know this?

Not at all

Perfectly

mefloquine AE

neuro and psych: ringing, anxiety, depression, hallcuination

weekly dosing: n/v/d, beahviro disturbances

higher dosing: leukocytosis, thrombocytopenia, aminotransferase, arrhythmias

How well did you know this?

Not at all

Perfectly

mefloquine contraindications

hx of epilepsy, psych disorders, arrhythmia, cardiac conduction defects

DONT GIVE WITH quinine/quinidine, halofantrine

safe in young and pregant

How well did you know this?

Not at all

Perfectly

DOC eradication of dormant liver forms in vivax and ovale

primaquine

How well did you know this?

Not at all

Perfectly

Primaquine use

Study These Flashcards

acute vivax and ovale and terminal prophylaxis of vivax and ovale

chemoprophylaxis against falciparum and vivax

primaquine MOA

Study These Flashcards

not understood - maybe oxidants disrupting mitochondria binding to DNA

primaquine AE

Study These Flashcards

rare - leukopenia, agranulocytosis, leukocytosis, cardiac arrhtymias

**hemolysis or methemoglbinemia - esp in G6PD pt’s

what to test for before administering primaquine

Study These Flashcards

G6PD - if deficient, must deal with dormant stages, cannot take at all

primaquine contraindications

DO NOT USE DURING PREGNANCY - until fetus is born and found if deficient

malarone

(combo of atovaquone + proguanil) tx and prophylaxis of falciparum NOT SAFE IN PREGANCY

malarone MOA

disrupt mitochondrial electron transport

pyrimethamine

folate synth inhibitor

proguanil

folate synth inhibitor

sulfadoxine

folate synth inhibitor

folate synth inhibitor application

chemoprophylaxis - only in combo of proguanil + chloroquine (not recommended) intermittent therapy - high risk pt's recieve intermittent therapy regardless of infection status tx chloroquine resistant falciparum - NOT used in severe malaria

pyrimethamine + proguanil

act slowly against RBC form of malaria inhibit plasmodial dihydrofolate reductase

proguanil active against which form/s

only active against some hepatic forms

sulfonamides active against which form

weakly against RBC schizonts inhibit dihydropteroate synthase

folate synthesis inhibitors AE

well tolerated proguanil - mouth ulcers pyrimethamine-sulfadoxine = steven johnson sulfadoxine - blood, GI,CNS,derm, renal toxic proguanil and pyrimethamine-sulfadoxine = safe in pregancy

doxycycline

active against RBC schizonts NOT liver stage complete tx for severe facliparum (alongside quinine) after initial tx must be taken daily as chemoprophylaxis

doxycycline AE

photosensitive discoloration/hypoplasia of teeth not safe in pregnancy fatal hepatoxicity (in pregnancy(

artemisin

artesunate artemether dihydroartemesinin (oral only) coartem (artemether + lumefantrine)

artemesin use

IV severe falciparum malaria - don't use alone to protect against resistance only active in blood stage - not liver stage

artemesin MOA

binds iron, breaks down peroxide bridges = generates free radicals that damage parasites very short t 1/2 - IV therapy + logner acting agent

artemisin AE

neurotoxicity, QT prolongation safer in 2nd and 3rd trimersters only use in 1st if severe

other antimalarials:

clindamycin - doxy alternative halofantrine (RBC stages, teratogenic) lumefantrine (RBC stages, minor QT prolongation)

DOC chemophrophylaxis in pregnant women

chloroquine if chloroquine resistant: mefloquine

DOC SEVERE malaria tx in pregancy 1st trimester

quinidine or artesunate

DOC SEVERE malaria tx in pregnancy 2-3rd trimester

1st: artesunate 2nd: artemether

p. falciparum uncomplicated DOC

1) chloroquine/hydrochloroquine chloroquine resistant: 1) atovoquone-proguanil/malarone 2) co-artem 3) quinine+doxycycline 4) mefloquine

P. malariae DOC

chloroquine/hydroxychloroquine

P. vivax/ovale DOC

1) chloroquine + primaquine | 2) hydroxychloroquine + primaquine

P. vivax DOC in chloroquine resistant

1) quinine + doxycycline + primaquine 2) atovaquone - progaunil + primaquine 3) mefloquine + primaquine

uncomplicated malaria in pregnancy DOC

1)chloroquine/hydrochloroquine - chloroquine resistant (falciparum) 1) mefloquine 2) quinine + clindamycin - chloroquine resistant (vivax) Mefloquine

DOC severe malaria in all species

1) Quinidine + doxycycline or clindamycin | 2) artesunate, followed by atovaquone-proguanil, clindamycin, or mefloquine

anti-malarials Flashcards

(51 cards)