Antimalarials Flashcards Preview

Pharmacology > Antimalarials > Flashcards

Flashcards in Antimalarials Deck (34):
1

P. Falciparum

Malignant tertian malaria. Most lethal. Fever occurs every third day. No secondary tissue forms. Cerebral malaria. Has many drug resistant forms.

2

P. Vivax

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.

3

P. ovale

Rare. Has secondary tissue forms in the liver (hypnozoites). Relapses.

4

P. Malariae

Quartan malaria. Fever occurs every four days. No tissue forms but can cause chronic infection.

5

Blood Schizonticides

Act on RBC forms. Provide a clinical cure for vivax and ovale and a radical cure for malariae and faliparum.

6

Tissue schizonticides

Act on the hepatic stages. Doesn't effect the symptoms. Kill vivax and ovale to prevent relapse.

7

Gametocidal agents

Eliminate proliferation. Doesn't cure the disease just sloes the spread.

8

Malaria DOC

Chloroquine

9

Chloroquine (aralen) resistance

especially falciparum due to efflux pumps.

10

Chloroquine MOA

Actively concentrate in plasmodia food vacule where they interfere with the degradation of hemoglobin producing a toxic by product.

11

Chloroquine kinetics

Oral. accumulates in melanin-rich tissue. metabolized by CYP3A4.

12

Cholorquine toxicity

retinal/corneal toxicity, ototoxicity, hemolysis (G6PD deficiency), QT prolongation.

13

Cholorquine contraindications

psoriasis and porphyria.

14

Mefloquine (Lariam) uses

Second-line drug for cholorquine-resistant strains.

15

Mefloquine toxicity

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
4.) teratogenic

16

Mefloquine contraindications

history of mental illness or epilepsy and pregnancy

17

Quinine/Quinidine Gluconate uses

DOC for complicated chloroquine-resistant plasmodia and for unconscious patients.

18

Quinine/Quinidine Gluconate kinetics

quinine=oral quinidine gluconate=IV. Combined with doxycycline or clindamycin to decrease the length of treatment.

19

Quinine/Quinidine Gluconate toxicity

Cinchonism (tinnitus, HA, dizziness, flushing, visual distrubances), antiarrhythmis agent, QT prolongation, Hemolysis (G6PD deficiency)

20

Doxycycline uses

combined with Quinine/Quinidine Gluconate to treat complicated choloroquine-resistant strains.

21

Fansidar

pyrimethamine+sulfadoxine. Not available in the US

22

Fansidar uses

presumptive treatment and acute attacks. especially used in affected areas for pregnant women and children.

23

Malarone

atovaquone+proguanil. Synergistic combo effective in regions with high resistance

24

Atovaquone MOA

Interferes with mitochondrial processes like the ETC/ATP and pyrimidine biosynthesis.

25

Malarone uses

Active against blood and tissue forms.

26

Artemisinin (Qinghaosu)

Most rapid action against falciparum. Not on US market.

27

Artemeter/lumefantrine (Coartem)

Available in the US for cholorquine resistant falciparum and vivax

28

Coartem toxicity

Prolonged QT (don't use in patients with cardiac disease).

29

Primaquine

Only tissue schizonticide. Active against vivax and ovale for a radical cure.

30

Primaquine contraindications

G6PD deficiency, SLE, RA, pregnancy (due to unknown fetal G6PD status)

31

DOC for sensitive plasmodia

chloroquine or hydroxycholorquine

32

DOC for cholorquine resistant falciparum

1.) quinine with doxycycline or clindamycin
2.) Mefloquine
3.) Malarone
4.) Coartem

33

DOC for severe malaria

1.) Quinidine with doxycycline or clindamycin
2.) Artemisinin combo therapy

34

DOC for vivax or ovale

Always given primaquine to prevent relapse plus:
1.) choroquine
2.) quinine with doxycycline or clindamycin
3.) Mefloquine
4.) Malarone