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PHRM 865 > Management of Malaria > Flashcards

Management of Malaria Flashcards

(55 cards)

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1
Q

What has the potential to increase the distribution of malaria?

A

changing climate

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2
Q

Malaria is what?

A

a plasmodium species that cause infections in humans:
* P. falciparum
* P. malariae
* P. knowlesi
* P. vivax
* P. ovale

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3
Q

Malaria prevention - vector control

A

Global Malaria Eradication Program: Lead to the elimination of malaria in many countries.
Aimed to kill mosquito reservoir by using:
Indoor residual spraying - Coats the walls and surfaces in the house
DDT - No longer recommended due to environmental concerns and resistance

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4
Q

When is malaria primarily transmitted?

A

at dawn and dusk

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5
Q

What are measures to reduce transmission at residence?

A

Sleep under mosquito nets
Stay in enclosed air- conditioned rooms
Use mosquito coils in living spaces

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6
Q

Mosquito repellant and treated clothing

A

Use effective mosquito repellent: Apply to all parts of skin AFTER sunscreen; Permethrin treated clothing and gear

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7
Q

Malaria vaccines and indication:

A

Malaria vaccines available:
* RTS, S/ AS01; R21/Matrix-M
indication: Childrenlivinginregions with moderate to high Plasmodium falciparum transmission
4 doses of vaccine starting at ~5mo of age

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8
Q

What is the malaria risk assessment?

A

travel destination, altitude of destination, time of travel, type of accomodation, length of stay

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9
Q

Selection of chemoprophylaxis depends on what?

A

the region you are traveling to

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10
Q

What is used for prophylaxis in all malaria-endemic regions?

A

Atovaquone/proguanil
Doxycycline
Tafenoquine

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11
Q

What is used for prophylaxis in regions with chloroquine-sensitive malaria?

A

Chloroquine
Hydroxychloroquine

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12
Q

What is used for prophylaxis in regions primarily with P. vivax?

A

Primaquine

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13
Q

What is used for prophylaxis in regions with mefloquine-sensitive malaria?

A

Mefloquine

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14
Q

What is the duration + counseling points of atovaquone/proguanil?

A

Begin 1-2 days before departure and continue for 7 days after leaving endemic area
take with food/milk
SE: N/V, HA, abdominal pain

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15
Q

When to avoid atovaquone/proguanil?

A
  • CLcr < 30 ml/min (contraindicated)
  • Women who are pregnant
  • Women breastfeeding infants < 5 kg
  • Children < 5 kg
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16
Q

What is the duration + counseling points of chloroquine?

A

Begin 1-2 weeks before departure and continue for 4 weeks after leaving malaria endemic areas
SE: blurred vision, dizziness, GI disturbance, headache, insomnia, pruritus

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17
Q

When to avoid chloroquine?

A

leaving in <1 week

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18
Q

What is the duration + counseling points of hydroxychloroquine?

A

Begin 1-2 weeks before departure and continue for 4 weeks after leaving malaria endemic areas
SE: blurred vision, dizziness, GI disturbance, headache, insomnia, pruritus

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19
Q

When to avoid hydroxychloroquine?

A

leaving in <1 week

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20
Q

What is the duration + counseling points of doxycycline?

A

Begin 1-2 days before departure and continue for 4 weeks after leaving malaria endemic areas
* Wear sunscreen
* Separate ingestion from positive cations (ex: calcium carbonate)
* Side effects: diarrhea, abdominal pain, photosensitivity, vulvovaginal candidiasis

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21
Q

When to avoid doxycycline?

A
  • Women who are pregnant
  • Children <8 years old
  • Allergy to tetracyclines
  • Women prone to getting vaginal yeast infections
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22
Q

What is the duration + counseling points of mefloquine?

A

Begin ≥2 weeks before departure and continue for 4 weeks after leaving malaria endemic areas
* Has been associated with rare but serious reactions (e.g. psychosis, seizures)*
* Side effects: abnormal dreams, anxiety, depression, dizziness, GI disturbance, headache, insomnia, visual disturbances

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23
Q

When to avoid mefloquine?

Study These Flashcards
A
  • Allergic to mefloquine or related compounds (quinidine, quinine)
  • Active/recent depression
  • Recent history of psychiatric disorders or
    seizures
  • Cardiac conduction abnormalities
24
Q

What is the duration + counseling points of primaquine?

Study These Flashcards
A

Begin 1-2 days before departure and continue for 7 days after leaving malaria endemic areas
* Take with food to minimize GI upset
* Side effects: GI disturbance

25
When to avoid primaquine?
* G6PD deficiency * Have not been tested for G6PD deficiency * Women who are pregnant * Women who are breastfeeding unless infant tested for G6PD deficiency
26
What is the duration + counseling points of tafenoquine?
Begin 3 days before departure and continue for 1 week after leaving malaria endemic areas * Take with food to minimize GI upset * Side effects: GI disturbance, headache, dizziness
27
When to avoid tafenoquine?
* G6PD deficiency * Have not been tested for G6PD deficiency * Women who are pregnant * Women who are breastfeeding unless infant tested for G6PD deficiency * Psychotic disorders * Children
28
When to consider malaria?
when a patient presents with: fever AND has traveled to a malaria endemic region before fever onset
29
What is the symptoms onset of malaria?
* Typically, 2-4 weeks after mosquito bite * Can occur up to 3 years after exposure to P. vivax or P. ovale
30
What are clinical symptoms of malaria?
* Fever * Headache * Weakness * Rigors * Night sweats * Insomnia * Arthralgias/myalgias * GI distress (N/V/D) * Neurologic complications (dizziness, confusion, coma, disorientation)
31
What are lab findings of malaria?
* Anemia * Thrombocytopenia * Hyponatremia * Acidemia * Increased creatinine * Hypoglycemia
32
What is the diagnosis of malaria?
Giemsa-stained blood smear: Standard for malaria diagnosis! - Thick & thin smear Thick smear: RBCs are lysed so visualize parasite outside of cells - Use to estimate parasite density Thin smear: used to determine the Plasmodium species Check blood smear every 12-24 hrs x3 to rule out malaria also have rapid diagnostic tests
33
Why is consideration of plasmodium spp important?
Infection severity: P. falciparum and P. knowlesi are more likely to progress to severe disease/death Treatment: P. vivax and P. ovale also require treatment of hypnozoites (dormant liver stage) Antimalarial resistance: P. falciparum and P. vivax have different drug resistance patterns in various regions
34
What is severe malaria?
Patients have severe malaria if they have ≥1 of the following: * Impaired consciousness/coma * Hemoglobin < 7 g/dL * Acute kidney injury * Acute respiratory distress syndrome (ARDS) * Circulatory collapse/shock * Acidosis * Disseminated intravascular coagulation * Parasite density of ≥ 5% typically caused by P. falciparum
35
What is the treatment for uncomplicated malaria where presence of chloroquine resistance or unknown resistance?
Artemether–lumefantrine Atovaquone-proguanil Quinine sulfate PLUS doxycycline, tetracycline, or clindamycin
36
What are counseling points for Artemether–lumefantrine?
* Take with food or milk * Repeat dose if vomits within 30 mins of taking dose * Side effects: N/V/D, headache, dizziness, fever, myalgia
37
What are counseling points for Atovaquone-proguanil?
* Take with food or milk * Repeat dose if vomits within 30 mins of taking dose * Side effects: N/V, abdominal pain, increased LFTs
38
What are counseling points for quinine?
Side effects: headache, dizziness, blurred vision, arrythmias, QTc prolongation, hypotension
39
What are counseling points for tetracyclines?
* Wear sunscreen * Separate from cations * Side effects: diarrhea, abdominal pain, photosensitivity, vulvovaginal candidiasis
40
What are counseling points for clindamycin?
Side effects: diarrhea, Clostridioides difficile infection
41
What is the treatment for uncomplicated malaria where presence of chloroquine resistance, no mefloquine resistance, or unknown resistance?
mefloquine
42
What are counseling points for mefloquine?
* Has been associated with rare but serious reactions (e.g. psychosis, seizures) * Side effects: abnormal dreams, anxiety, depression, dizziness, GI disturbance, headache, insomnia, visual disturbances * Avoid use if history of psychiatric disorders or seizures
43
What is the treatment for uncomplicated malaria - chloroquine sensitive?
chloroquine hydroxychloroquine
44
What are counseling points for chloroquine?
Side effects: blurred vision, dizziness, GI disturbance, headache, insomnia, pruritus
45
What are counseling points for hydroxychloroquine?
Side effects: blurred vision, dizziness, GI disturbance, headache, insomnia, pruritus
46
What is anti-relapse treatment for P. vivax and P. ovale infections?
primaquine phosphate tafenoquine
47
What are counseling points for primaquine?
* Need G6PD testing before use (only use if G6PD is normal) * Side effects: GI disturbance, headaches, hemolysis
48
What are counseling points for tafenoquine?
* Need G6PD testing before use (only use if G6PD is normal) * Side effects: GI disturbance, headaches, hemolysis * Avoid if history of psychotic disorder
49
What is the treatment of uncomplicated malaria if P. falciparum or unknown species acquired in area with chloroquine resistance?
Preferred: Artemether-lumefantrine Alternatives: * Atovaquone-proguanil * Quinine PLUS tetracycline, doxycycline, or clindamycin * Mefloquine
50
What is the treatment of uncomplicated malaria if P. falciparum or unknown species acquired in area with NO chloroquine resistance?
Preferred: * Chloroquine * Hydroxychloroquine
51
What is the treatment of uncomplicated malaria if P.ovale or P. vivax acquired in area with chloroquine resistance?
Preferred: * Artemether-lumefantrine Alternatives: * Atovaquone-proguanil * Quinine PLUS tetracycline, doxycycline, or clindamycin * Mefloquine (if no other options) PLUS anti-relapse treatment (must do G6PD testing first) - Primaquine
52
What is the treatment of uncomplicated malaria if P.ovale or P. vivax acquired in area with NO chloroquine resistance?
Preferred: * Chloroquine * Hydroxychloroquine Alternatives: any options used for treatment of chloroquine-resistant infections PLUS anti-relapse treatment (must do G6PD testing first) * Primaquine * Tafenoquine (can only be used if received chloroquine for treatment)
53
What is the treatment of uncomplicated malaria if P. knowlesi or P. malariae acquired in any area?
Preferred: * Chloroquine * Hydroxychloroquine Alternatives: * Artemether-lumefantrine * Atovaquone-proguanil * Quinine PLUS tetracycline, doxycycline, or clindamycin * Mefloquine (if no other options)
54
What is the treatment for severe malaria?
Perform blood smears every 12-24 hrs until negative Treatment: IV artesunate - Continue treatment until parasite density ≤ 1% (up to 7 days) After finishing, transition to one of the following oral treatment: Artemether-lumefantrine (preferred) Atovaquone-proguanil Quinine PLUS doxycycline or clindamycin Mefloquine
55
IV artesunate comments
expensive!! many hospitals don't carry - While waiting treat with oral treatment option including: * Artemether-lumefantrine * Atovaquone-proguanil * Quinine PLUS doxycycline or clindamycin * Mefloquine Side effect: delayed post-artemisinin hemolytic anemia; Rare but higher likelihood if high parasite density; After use of IV artesunate get weekly CBCs for 4 weeks to monitor

PHRM 865 (61 decks)

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