Antimalarials

Question 1

What are the antimalarials

Answer 1

Chloroquine
Quinidine
Quinine
Mefloquine
Primaquine
Atovaquone
Proguanil
Pyrimethamine
Sulfadoxine
Doxycycline
Artemisinins
Halofantrine
Lumefantrine

Question 2

DOC Tx and prophylaxis Vivax and Ovale, uncomplicated Falciparum

Answer 2

Chloroquine

Question 3

DOC severe Falciparum

Answer 3

Quinidine
Quinine
Artemisinins (IV)

Question 4

Pregnant prophylaxis against Chloroquine-resistant

Answer 4

Mefloquine

Question 5

DOC dormant liver form eradication

Answer 5

Primaquine

Question 6

Tx and Prophylaxis uncomplicated Falciparum

Answer 6

Atovaquone

Proguanil

Question 7

Can cause Cinchonism

Answer 7

Quinidine

Quinine

Question 8

Great for blood schizonts, but not liver

Answer 8

Chloroquine
Quinidine
Quinine

Question 9

Safe in pregnancy

Answer 9

Chloroquine
Quinidine
Quinine
Mefloquine
Atovaquone
Pyrimethamine
Proguanil
Sulfadoxine
Artemisinins

Question 10

Contraindicated in pregnancy

Answer 10

Primaquine

Doxycycline\Halofantrine

Question 11

How does Chloroquine work

Answer 11

Raises internal pH of parasite
Interfere with Hb metabolism to hemozoin
Lysis of parasite and RBC

Question 12

Who do you not give Chloroquine to

Answer 12

G6PD deficiency
Psoriasis
Porphyria
Retinal/Visual field abnormalities

Question 13

How does Chloroquine resistance arise

Answer 13

Mutation in Falciparum putative transporter (PfCRT)

Question 14

When can you give Chloroquine for Falciparum

Answer 14

Uncomplicated disease

Question 15

Chloroquine AE

Answer 15

Pruritis
N/V
Abdomenal pain
HA, anorexia, malaise, urticaria

Question 16

What is the most important Chloroquine AE

Answer 16

Retinopathy

Question 17

What should you combine with Doxycycline for severe Falciparum

Answer 17

Quinidine

Quinine

Question 18

How do the Quinidines work

Answer 18

Decreased O2 and CHO metabolism

Intercalates DNA

Question 19

What do you not combine Quinidines with

Answer 19

Mefloquine

Question 20

Quinidine drug interactions

Answer 20

Increase serum Warfarin and Digoxin

Question 21

Where is Quinidine resistance rising

Answer 21

SE Asia

Question 22

What are the Quinidine AE

Answer 22

QT prolongation
Blackwater fever
HS
Heme disturbance
Hypoglycemia (increases insulin)
Uterine contraction
Hypotension

Question 23

What is Blackwater Fever

Answer 23

RBC hemolysis releasing Hb into blood and urine

Leads to kidney failure

Question 24

Useful for mild/moderate Chloroquine resistant strains

Answer 24

Mefloquine

Question 25

How does Mefloquine work

Answer 25

Destroys asexual blood forms

Question 26

Why don't you combine Mefloquine and Quinidines

Answer 26

Chemically related, so similar resistances

Question 27

When should you discontinue Quinidines in pregnancy

Answer 27

If there's hemolysis

Question 28

Who should avoid Quinidines

Answer 28

Visual/Auditory/Cardiac problems

Question 29

When is Mefloquine contraindicated

Answer 29

Epilepsy, psych problems | Arrhythmia, drug sensitivities

Question 30

What is the main Mefloquine AE

Answer 30

Neuropsychiatric toxicity

Question 31

What are the high dose Mefloquine AE

Answer 31

``` Leukocytosis Thrombocytopenia Aminotransferase elevation Arrhythmias Bradycardia ```

Question 32

What else do you not give Mefloquine with

Answer 32

Halofantrine

Question 33

What is Malarone

Answer 33

Atovaquone + Proquanil

Question 34

How does Malarone work

Answer 34

Disrupts Mito ETC

Question 35

What are the Malarone AE

Answer 35

Gi upset HA Rash

Question 36

Which schizonts is Malarone effective against

Answer 36

Tissue, RBC

Question 37

What are the inhibitors of Folate Synthesis

Answer 37

Pyramethamine Proguanil Sulfadoxine

Question 38

What are the Folate Synthesis inhibitors good for

Answer 38

Chemoprophylaxis | Intermittent prevention in high risk pts

Question 39

What can you give for mild/moderate Chloroquine-resistant falciparum

Answer 39

Pyrimethamine | Sulfadoxine

Question 40

Which Folate Synthesis inhibitor is slow against RBC form

Answer 40

Pyrimethamine + Proguanil

Question 41

Which Folate Synthesis inhibitor is good for some hepatic forms

Answer 41

Proguanil

Question 42

Which Folate Synthesis inhibitor is good for RBC forms

Answer 42

Sulfadoxine

Question 43

What does Sulfadoxine inhibit

Answer 43

Dihydropteroate reductase

Question 44

What does Pyrimethamine + Proguanil inhibit

Answer 44

DHF reductase

Question 45

Folate Synthesis inhibitor AE

Answer 45

GI problems Rash Itching

Question 46

Proguanil AE

Answer 46

Mouth ulcers | Alopecia

Question 47

Pyrimethamine + Sulfadoxine AE

Answer 47

Erythema multiforme | Stevens-Johnson syndrome

Question 48

Sulfadoxine toxicities

Answer 48

``` Hematological GI CNS Derm Renal ```

Question 49

What is an alternative to Doxycycline

Answer 49

Clindamycin

Question 50

What are the Doxycycline AE

Answer 50

``` Photosensitivity Discoloration and Hypoplasia of teeth Growth stunting GI upset Vaginal candidiasis Hepatotoxicity in pregnancy ```

Question 51

Works on RBC stage of all parasites

Answer 51

Halofantrine | Lumefantrine

Question 52

What are the Artemisinins

Answer 52

Artesunate Artemether Dihydroartemisinin

Question 53

What is Coartem

Answer 53

Artemether + Lumefantrine

Question 54

How do the Artemisinins work

Answer 54

Bind Fe Break down peroxide bridges Create free radicals

Question 55

Should not be used as monotherapy

Answer 55

Artemisinins

Question 56

What are the Artemisinin AE

Answer 56

Neurotoxicity | QT prolongation

Question 57

Do Artemisinins work on liver stage

Answer 57

No

Question 58

What is the Halofantrine AE

Answer 58

Cardiac toxicity

Question 59

How is Lumefantrine given

Answer 59

Only as Coartem

Question 60

What is the Lumefantrine AE

Answer 60

QT prolongation (Clinically insignificant)

Question 61

Why don't you give Artemisinins for prophylaxis

Answer 61

Short t1/2