Flashcards in Antimalarials Deck (34):
Malignant tertian malaria. Most lethal. Fever occurs every third day. No secondary tissue forms. Cerebral malaria. Has many drug resistant forms.
Benign tertian malaria. Fever occurs every third day. Has dormant forms in the liver (hypnozoites). Relapses for months/years. Duffy antigen was thought to be protective but isn't.
Rare. Has secondary tissue forms in the liver (hypnozoites). Relapses.
Quartan malaria. Fever occurs every four days. No tissue forms but can cause chronic infection.
Act on RBC forms. Provide a clinical cure for vivax and ovale and a radical cure for malariae and faliparum.
Act on the hepatic stages. Doesn't effect the symptoms. Kill vivax and ovale to prevent relapse.
Eliminate proliferation. Doesn't cure the disease just sloes the spread.
Chloroquine (aralen) resistance
especially falciparum due to efflux pumps.
Actively concentrate in plasmodia food vacule where they interfere with the degradation of hemoglobin producing a toxic by product.
Oral. accumulates in melanin-rich tissue. metabolized by CYP3A4.
retinal/corneal toxicity, ototoxicity, hemolysis (G6PD deficiency), QT prolongation.
psoriasis and porphyria.
Mefloquine (Lariam) uses
Second-line drug for cholorquine-resistant strains.
1.) depression of the myocardium, potential cardiac toxicity. (don't combine with quinine).
2.) seizures and aggravation of latent psychoses.
3.) sleep and behavioral disturbances, vivid dreams
history of mental illness or epilepsy and pregnancy
Quinine/Quinidine Gluconate uses
DOC for complicated chloroquine-resistant plasmodia and for unconscious patients.
Quinine/Quinidine Gluconate kinetics
quinine=oral quinidine gluconate=IV. Combined with doxycycline or clindamycin to decrease the length of treatment.
Quinine/Quinidine Gluconate toxicity
Cinchonism (tinnitus, HA, dizziness, flushing, visual distrubances), antiarrhythmis agent, QT prolongation, Hemolysis (G6PD deficiency)
combined with Quinine/Quinidine Gluconate to treat complicated choloroquine-resistant strains.
pyrimethamine+sulfadoxine. Not available in the US
presumptive treatment and acute attacks. especially used in affected areas for pregnant women and children.
atovaquone+proguanil. Synergistic combo effective in regions with high resistance
Interferes with mitochondrial processes like the ETC/ATP and pyrimidine biosynthesis.
Active against blood and tissue forms.
Most rapid action against falciparum. Not on US market.
Available in the US for cholorquine resistant falciparum and vivax
Prolonged QT (don't use in patients with cardiac disease).
Only tissue schizonticide. Active against vivax and ovale for a radical cure.
G6PD deficiency, SLE, RA, pregnancy (due to unknown fetal G6PD status)
DOC for sensitive plasmodia
chloroquine or hydroxycholorquine
DOC for cholorquine resistant falciparum
1.) quinine with doxycycline or clindamycin
DOC for severe malaria
1.) Quinidine with doxycycline or clindamycin
2.) Artemisinin combo therapy