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PPOM1 Block 4 > Lecture 170 > Flashcards

Lecture 170 Flashcards

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1
Q
A
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2
Q

Malaria life cycle phase in the liver cells of the host before parasites invade red blood cells; parasites develop and multiply in the liver.

A

Exoerythrocytic stage

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3
Q

Malaria life cycle phase where parasites infect and multiply within red blood cells.

A

Erythrocytic stage

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4
Q

What stage of the malaria life cycle causes clinical malaria?

A

Erythrocytic stage

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5
Q

Malaria life cycle stage where the parasites undergo asexual reproduction within hepatocytes and then in red blood cells, producing thousands of merozoites.

A

Schizont stage

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6
Q

Asexual reproduction of plasmodium.

A

Schizogony

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7
Q

Plasmodium daughter cells produced during schizogony that invade red blood cells.

A

Merozoite

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8
Q

Dormant phase of P. vivax and P. ovale in the liver that can remain inactive before causing a relapse.

A

Latent liver stage (hypnozoite)

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9
Q

A drug class that targets and destroys the schizont stage of plasmodium.

A

Schizonticide

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10
Q

A drug class that destroys the gametocytes of malaria parasites, preventing transmission to mosquitos.

A

Gametocide

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11
Q

An iron-containing pigment; a breakdown product of hemoglobin due to parasitic digestion of hemoglobin and conversion of heme.

A

Hemozoin

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12
Q

Persistent high fever, hyperparasitemia, cerebral symptoms, and organ system dysfunction suggests what type of malaria infection?

A

P. falciparum malaria

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13
Q

What plasmodium subtype can cause anemia and remain dormant in the liver causing relapses?

A

P. vivax

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14
Q

What plasmodium subtype can cause anemia and splenomegaly and remain dormant in the liver causing relapses?

A

P. ovale

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15
Q

What plasmodium subtype typically results in chronic low-level parasitemia but can cause severe anemia and other complications?

A

P. malariae

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16
Q

What plasmodium subtype is uncommon to find in humans?

A

P. knowlesi

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17
Q

What malaria chemoprophylaxis is preferred against non-falciparum species and in regions without P. falciparum resistance?

A

Chloroquine

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18
Q

What malaria chemoprophylaxis is used in chloroquine-resistant areas and should not be used during pregnancy?

A

Atovaquone-Proguanil

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19
Q

What malaria chemoprophylaxis is used in chloroquine-resistant areas and is safe to use in pregnancy?

A

Mefloquine

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20
Q

What malaria chemoprophylaxis is used in chloroquine-resistant areas and should not be used in pregnancy or in children < 8 years old?

A

Doxycycline

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21
Q

What malaria chemoprophylaxis is used exclusively in adults?

A

Tafenoquine

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22
Q

What malaria chemoprophylaxis is used for short-duration travel to areas with principally P. vivax?

A

Primaquine

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23
Q

IPTp

A

Intermittent preventative treatment in pregnancy

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24
Q

What malaria chemoprophylaxis is given for IPTp?

A

Sulfadoxine-pyrimethamine

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25
ACT
Artemisinin combination therapy
26
What is the preferred treatment for uncomplicated P. falciparum malaria and other species?
Artemether-Lumefantrine
27
What is the preferred treatment for severe P. falciparum malaria treatment?
Parenteral artesunate (IV/IM)
28
What is the preferred treatment for pregnant patients with severe malaria?
Artesunate IV or IM
29
What is the preferred treatment for pregnant patients with uncomplicated chloroquine-resistant malaria?
Artemether-lumefantrine
30
What medications are used as a radical cure for P. vivax and P. ovale relapses?
Primaquine and tafenoquine
31
What screening test must be completed prior to administration of primaquine or tafenoquine treatment?
G6PD deficiency
32
What medication is preferred for a radical cure in patients of all ages?
Primaquine
33
What medication should only be used for a radical cure in patients older than 16?
Tafenoquine
34
What antimalarial drug enters the parasites food vacuole and disrupts heme sequestration by preventing the polymerization of toxic heme to non-toxic hemozoin?
Chloroquine
35
What antimalarial class does chloroquine belong to?
Blood schizonticide
36
How is chloroquine metabolized?
CYP3A4
37
What dosing considerations need to be made for chloroquine?
Loading dose required
38
How does P. falciparum become resistant to chloroquine?
P. falciparum chloroquine resistant transporter (PfCRT) on the food vacuole membrane
39
How are adverse effects of low prophylactic dose chloroquine mitigated?
Take with food
40
What route of administration of chloroquine should be avoided due to acute toxicity?
Rapid IV infusion
41
What adverse effect can become cumulative if chloroquine is combined with other drugs with the same AE?
QT interval prolongation
42
What class of antimalarials is mefloquine?
Blood schizonticide
43
How is mefloquine metabolized?
CYP3A4
44
Mefloquine resistance is associated with amplified ____
Pfmdr1 (P-glycoprotein transporter gene)
45
What black box warning is associated with mefloquine?
Neuropsychiatric effects (anxiety, depression, psychosis, hallucinations)
46
What antimalarial is contraindicated in patients with major psychiatric disorders or seizure disorders?
Mefloquine
47
What class of antimalarials does quinine sulfate belong to?
Blood schizonticide
48
Quinine may be used in pregnancy but is not preferred due to risk of ____
Recurrent hypoglycemia
49
Quinine must be co-administered with ____ when used as an alternative to ACT?
Long-acting agent
50
How is quinine metabolized?
CYP3A4
51
Tinnitus, headache, vasodilation, sweating, nausea, dizziness, and visual disturbances are a constellation of symptoms associated with what antimalarial?
Quinine
52
Rapid IV infusion of quinine can cause what AEs?
Hypotension, QTc prolongation
53
Malarial hemolytic anemia with quinine treatment is known as ____
Blackwater fever
54
What life-threatening, drug-induced, immune-mediated reaction is associated with quinine therapy?
HUS/TTP (thrombocytopenia)
55
What antimalarial is a p-glycoprotein inhibitor?
Quinine
56
What class of antimalarials does primaquine belong to?
Tissue schizonticides
57
What class of antimalarials does tafenoquine belong to?
Tissue schizonticides
58
A single dose of ____ with ACT can reduce P. falciparum gametocyte carriage and transmission in low-transmission areas.
Primaquine
59
What tissue schizonticide can still be used with dose modification in G6PD deficiency?
Primaquine
60
How is primaquine metabolized?
CYP1A2, 2D6, 3A4
61
Tafenoquine absorption is improved by ____
High-fat meal
62
What antimalarial class is sulfadoxine-pyrimethamine?
Blood schizonticide
63
What pharmacokinetic property of SP predisposes it to increased resistance?
Long half-life allows selection of resistant organisms
64
What component of SP competitively inhibits dihydropteroate synthase (DHPS)?
Sulfadoxine
65
What component of SP inhibits dihydrofolate reductase (DHFR)?
Pyrimethamine
66
What AE is associated with sulfadoxine therapy?
Severe skin rashes (SJS/TEN, DRESS)
67
High doses of pyrimethamine can cause what hematological related adverse effects?
Megaloblastic anemia, leukopenia, thrombocytopenia
68
What class of antimalarial does atovaquone belong to?
Blood schizonticide
69
Atovaquone is used in fixed combination with ____ for prophylaxis and treatment of chloroquine-resistant malaria?
Proguanil
70
What antimalarial binds to the cytochrome bc1 complex on the inner mitochondrial membrane of plasmodium, inhibiting electron transport?
Atovaquone
71
Point mutations in the cytochrome b gene within the cytochrome bc1 complex of plasmodium would confer resistance to what antimalarial?
Atovaquone
72
What drug works synergistically with atovaquone, both by producing an active metabolite and by accentuating the MOA of atovaquone?
Proguanil
73
Artemisinins contain what essential component for activity?
Endoperoxide bridge
74
What class of antimalarials do artemisinins belong to?
Short-acting blood schizonticides
75
How is artemether administered?
Oral, with high-fat meal
76
How is artemether metabolized?
CYP3A4
77
How is artesunate administered?
IM/IV
78
What group of antimalarials interact with heme iron, forming covalent complexes so that heme cannot be detoxified within plasmodium?
Artemisinins
79
What additional activity against plasmodium do artemisinins produce?
Gametocidal activity
80
What antimalarial drug(s) are also used for nonplasmodial infections, including leishmania, toxoplasma, and Schistosoma species?
Artemisinins
81
How is resistance to artemisinins managed?
Therapy extended from 3 to 6 days, with daily smears until negative
82
What delayed onset adverse effect does artemisinins cause?
Acute hemolysis, 1-3 weeks post therapy
83
What life-threatening adverse effect is associated with artesunate IV treatment?
Blackwater fever
84
What antimalarial drug is used only in fixed-combination with artemether for treatment of uncomplicated malaria?
Lumefantrine
85
What class of antimalarials is lumefantrine?
Blood schizonticide
86
How is lumefantrine administered?
Oral, with high-fat meal
87
How is lumefantrine metabolized?
CYP3A4
88
What cardiac AE is associated with lumefantrine treatment?
Mild QT interval prolongation
89
What is the target for malaria vaccines?
Recombinant P. falciparum circumsporozoite protein (CSP) central repeat region
90
When are malaria vaccine courses started?
5 months of age
91
What antimalarial activity does antibiotics possess?
Slow-acting schizonticides in the blood stage
92
Impaired expression of the apicoplast gene leading to death of the progeny of drug-treated parasites describes the MOA of what antimalarial?
Doxycycline/clindamycin
93
What antibiotic is used as an adjunct to quinine or artesunate for uncomplicated or severe malaria?
Doxycycline
94
What antibiotic is used as an adjunct to quinine or artesunate for uncomplicated or severe malaria in children < 8 years of age and pregnant people?
Clindamycin

PPOM1 Block 4 (44 decks)

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