Malaria

Question 1

Artesunate - target

Answer 1

Blood stage (asexual + gamete) of falciparum
Asexual of vivax

Question 2

Artemisins - mechanism

Answer 2

peroxide bridge - endoperoxide moiety

Question 3

Artemisins - excretion

Answer 3

biliary excretion

Question 4

Artemisins - prox?

Answer 4

NO

Question 5

Artemisins - in pregnancy?

Answer 5

NOT in 1st trimester or kids <5kg

Question 6

Artemisins - TOX

Answer 6

Decreased RBCs/neutrophils + heart block (REV)

Question 7

Artemether + Lumefantrine - administration?

Answer 7

Fat meal increases absorption

if vomit in 30 mins, retake

Question 8

Artemether + Lumefantrine - drug drug rx?

Answer 8

Antiretrovirals/PI

Question 9

Artemether + Lumefantrine - contraindicated in?

Answer 9

Cardiac disease, arrhythmias

Question 10

Chloroquine - target?

Answer 10

Drug of choice for falciparum (asexual + gamete)

Question 11

What is the drug of choice for falciparum?

Answer 11

Chloroquine

Question 12

Chloroquine - mechanism?

Answer 12

Blocks heme digestion

Question 13

Chloroquine - administration?

Answer 13

PO (parenteral is dangerous)

Question 14

Chloroquine - excretion?

Answer 14

Renal

Question 15

Chloroquine - resistance?

Answer 15

increased PfCRT (chloroquine efflux)

Question 16

Chloroquine - in pregnancy?

Answer 16

YES

Question 17

Chloroquine - TOX

Answer 17

visual disturbances, pruritis in Africans, G6PD - hemolysis, nail+mucous - discolor, parenteral > 5 gm =dead (CV + CNS tox)

Question 18

Chloroquine - CI?

Answer 18

Epilepsy, myasthenia gravis

Question 19

Chloroquine - caution?

Answer 19

Liver, GI, neuro, blood disorders

Question 20

Chloroquine - Avoid

Answer 20

kaolin, antacids, CYP2D6 (decreases yellow fever immunization)

Question 21

Quinine - target

Answer 21

asexual falciparum (resist to chloroquine)
gemetocidal vivax + ovale

Question 22

Quinine - mechanism

Answer 22

Inhibits heme digestion

Question 23

Quinine - administration

Answer 23

PO (IV is more toxic)

Question 24

Quinine - excretion

Answer 24

Renal

Question 25

Quinine - resistance

Answer 25

increased Pfmdr1

Question 26

Quinine - TOX

Answer 26

tinnitus, deafness, visual disturbance, HA, N/V, dizziness, postural hypotension (REV), blackwater fever (stop TX)

Question 27

Quinine - CI

Answer 27

Tinnitus, optic neuritis, renal

Question 28

Quinine - in pregnancy?

Answer 28

YES

Question 29

Quinine - overdose?

Answer 29

PO 2-8 gm - pulmonary edema, thrombocytopenia

Question 30

Quinine - drug drug rx

Answer 30

Inhibits CYP3A4 - (warfarin, digoxin) | Antacids decrease absorbption

Question 31

Primaquine - target

Answer 31

Primary and latent hepatic (ovale + vivax) Gametocidal (falciparum) NOT asexual blood stage

Question 32

Primaquine - caution

Answer 32

G6PD hemolytic anemia

Question 33

Primaquine - mechanism

Answer 33

electrophilic intermediate - mitochondrial ETC interference | decrease GSH antioxidant

Question 34

Primaquine - administration

Answer 34

PO

Question 35

Primaquine - CI

Answer 35

RA, Lupus

Question 36

Primaquine - in pregnancy

Answer 36

NO

Question 37

Atovaquone - target

Answer 37

``` Asexual falciparum Primary liver (no vivax) ```

Question 38

Atovaquone - mechanism

Answer 38

blocks mitochondrial ETC

Question 39

Atovaquone - caution

Answer 39

not MONO (+Proguanil - Malarone)

Question 40

Malarone

Answer 40

Prophylaxis and cure (falciparum)

Question 41

Atovaquone - excretion

Answer 41

Biliary

Question 42

Atovaquone - resist

Answer 42

Cyt b

Question 43

Atovaquone - pregnancy

Answer 43

NO

Question 44

Atovaquone - drug drug rx

Answer 44

Rifampin/tetracycline decrease levels

Question 45

Proguanil - target

Answer 45

asexual falciparum Primary liver falciparum Acute vivax

Question 46

Proguanil - drug or prodrug

Answer 46

Prodrug

Question 47

Which malaria drug is a prodrug?

Answer 47

Proguanil

Question 48

Proguanil - mechanism

Answer 48

inhibits dihydrofolate reductase

Question 49

Proguanil - pregnancy?

Answer 49

NO

Question 50

Mefloquine - target

Answer 50

``` asexual blood (good for resistsant falciparum) prophylaxis ```

Question 51

Mefloquine - excretion

Answer 51

Biliary

Question 52

Mefloquine - caution

Answer 52

vivid dreams

Question 53

Mefloquine - in pregnancy?

Answer 53

YES

Question 54

Mefloquine - blackbox

Answer 54

Neuro and psych

Question 55

Which malaria drug has a black box warning about neuro and psych problems?

Answer 55

Mefloquine

Question 56

Babesiosi - treatment

Answer 56

Quinine + Clinda | Atovaquone + azithro

Question 57

Amebiasis - treatment

Answer 57

Metron | Chloroquine

Question 58

PJP - treatment

Answer 58

Bactrim | Primaquine + clinda

Question 59

Malaria drugs ok in pregnancy?

Answer 59

Chloroquine Quinine + Clinda Mefloquine

Question 60

Malaria prophylaxis?

Answer 60

``` Chloroquine Atovaquone - proguanil Mefloquine Doxycycline (MDR) Primaquine (liver) ```

Question 61

Which malaria drugs are gametocytal?

Answer 61

Artemisinins | Primaquine

Question 62

Which malaria drug targets BOTH liver stages?

Answer 62

Primaquine

Question 63

Which malaria drug targets the primary liver stage?

Answer 63

Malarone