ORG: Anti-malaria

Question 1

Most dangerous malaria species

Answer 1

Falciparum

Question 2

What causes periodic episodes of fever in malaria

Answer 2

Synchronized rupture of RBC with release of merozoites and rise in concentration of tumor necrosis-factor alpha in the plasma

Question 3

Erythrocytic cycle of falciparum (hours)

Answer 3

48 hours

Question 4

What species causes malignant tertian malaria

Answer 4

Falciparum

Question 5

What species causes benign tertian malaria

Answer 5

Vivax

Question 6

Erythrocytic cycle of ovale (Hours)

Answer 6

48 hours

Question 7

Erythrocyctic cycle of malariae

Answer 7

72 hours

Question 8

Quinine is highly effective schizonticide agains what species of malaria?

Answer 8

All four species

Question 9

Dextrorotatory isomer of quinine

Answer 9

Quinidine

Question 10

Quinine is gametocidal to

Answer 10

Vivax and Ovale

Question 11

MOA of Quinine

Answer 11

Inhibition of heme polymerase and acts as general protoplasmic poison

Question 12

DOC for severe falciparum malaria

Answer 12

Quinine or Quinidine

Question 13

First line therapy for Chloroquine resistant falciparum malaria

Answer 13

Quinine

Question 14

Quinine is given with what drugs to shorten usage time and reduce toxicity

Answer 14

Doxycycline and Clindamycin (Children)

Question 15

First line therapy for in the treatment of Babesia microti

Answer 15

Quinine + Clindamycin

Question 16

A/E of quinine

Answer 16

Cinchonism
Hypoglycemia
ECG abnomalities (QT prolongation - IV Quinidine)
Blackwater fever

Question 17

How does quinine cause hypoglycemia

Answer 17

Through stimulation of insulin release

Question 18

Rare severe illness that includes marked hemolysis and hemoglobinuria

Answer 18

Blackwater fever

Question 19

Contraindication of quinine

Answer 19

Visual or auditory problems

Cardiac Abnormalities

Question 20

Mefloquine is a strong blood schizonticide against what malarial species?

Answer 20

Falciparum and Vivax

Question 21

MOA of mefloquine

Answer 21

Inhibition of heme polymerase

Question 22

Anti malarial drug effective in prophylaxis against most strains of falciparum and all other malarial species except for those with no chloroquine resistant strains

Answer 22

Mefloquine

Question 23

A/E of Mefloquine

Answer 23

Neuropsychiatric toxicities
Arrhythmias and Bradycardia
Thrombocytopenia, Leukocytosis, Aminotransferase elevation
GI disturbance

Question 24

C/I of Mefloquine

Answer 24

Pregnancy
Epilepsy or psychiatric disorders
Cardiac conduction defects (or with drugs that cause this)

Question 25

Mefloquine should not be co-administered with

Answer 25

Quinine Quinidine Halofantrine NOTE: Caution is required when administering Quinine/Quinidine after Mefloquine Prophylaxis

Question 26

The two drugs under Quinoline-Methanols

Answer 26

Quinine | Mefloquine

Question 27

Chloroquine is a highly effective blood schizonticide against what malarial species?

Answer 27

The four species

Question 28

Chloroquine is a gametocide against

Answer 28

Vivax Ovale Malariae

Question 29

MOA of Chloroquine

Answer 29

Prevent polymerization of heme to hemozoin. | Heme will then be toxic to the parasite.

Question 30

DOC in the treatment of nonfalciparum malaria

Answer 30

Chloroquine

Question 31

Preferred chemoprophylactic agent in malarious regions without resistant falciparum malaria

Answer 31

Chloroquine

Question 32

Drug used for amebic abscesses that fail initial therapy with metronidazole

Answer 32

Chloroquine

Question 33

Adverse effect of Chloroquine

Answer 33

Pruritus (Common in africans)

Question 34

C/I of Chloroquine

Answer 34

Psoriasis and Porphyria

Question 35

Route of administration of Quinine/Quinidine

Answer 35

PO, IV, IM

Question 36

Route of administration of Mefloquine

Answer 36

PO

Question 37

Route of administration of Chloroquine

Answer 37

PO, IV, IM

Question 38

Halofantrine is effective against what species of malaria

Answer 38

The four species, especially chloroquine resistant falciparum

Question 39

Absorption of halofantrine is increased with

Answer 39

Fatty foods

Question 40

Route of administration of halofantrine

Answer 40

PO

Question 41

Lumefantrine and Artemether is used for what malarial species

Answer 41

Falciparum

Question 42

Brand name of lumefantrine + artemether

Answer 42

Coartem

Question 43

Adverse effect of Halofantrine

Answer 43

``` GI disturbance (ab pain, diarrhea, vomitting) Cough Hypersensitivity (rash, pruritus) HA Elevated liver enzymes QT and PR Prolongation ```

Question 44

QT and PR prolongation observed in halofantrine at what dose? and is worsened by?

Answer 44

Standard doses | Prior mefloquine therapy

Question 45

Coartem exhibits also cardiac toxicity seen in halofantrine (T/F)

Answer 45

False

Question 46

C/I Halofantrine

Answer 46

Pregnancy (Embryotoxic) Cardiac conduction defects Mefloquine

Question 47

Active metabolite of proguanil

Answer 47

Cycloguanil

Question 48

Proguanil has some activity against hepatic form (T/F)

Answer 48

True

Question 49

MOA of pyrimethamine and proguanil

Answer 49

Inhibit folate utilization by inhibiting dihydrofolate reductase

Question 50

Drug combination which is an alternative to mefloquine

Answer 50

Proguanil and Chloroquine

Question 51

Presumptive treatment of falciparum malaria

Answer 51

Fansidar

Question 52

Adjuct to quinine therapy to shorten the course of quinine and limit toxicity

Answer 52

Fansidar

Question 53

Treatment of multi drug resistant falciparum in africa

Answer 53

Chlorproguanil + Dapsone

Question 54

First line therapy for treatment of acute toxoplasmosis

Answer 54

Sulfadiazine + Pyrimethamine

Question 55

Sulfadiazine can be replaced with what drug as treatment for acute toxoplasmosis

Answer 55

Clindamycin

Question 56

First line therapy for pneumocystosis

Answer 56

Co-trimoxazole

Question 57

Standard chemoprophylactic drug for the prevention of P. jiroveci infection in immunocompromised individuals

Answer 57

Co-trimoxazole

Question 58

A/E of proguanil

Answer 58

Mouth ulcers | Alopecia

Question 59

Fansidar A/E

Answer 59

Erythema multiform SJS Toxic epidermal necrolysis

Question 60

Atovaquone absorption is increased by

Answer 60

Fatty foods

Question 61

MOA of atovaquone

Answer 61

Mimic ubiquinone thereby inhibiting the parasite's mitochondrial electron transport chain

Question 62

Treatment of mild to moderate P.jirovecii pneumonia

Answer 62

Atovaquone

Question 63

Highly effective for the treatment and chemoprophylaxis of falciparum malaria

Answer 63

Atovaquone + Proguanil

Question 64

A/E Atovaquone

Answer 64

Fever, Rash Nausea Vomitting Diarrhea Headache Insomia

Question 65

Artemisinin and Derivatives are active agains what form of malarial parasite

Answer 65

All four

Question 66

Active metabolite of artemisinin

Answer 66

Dihydroartemisinin

Question 67

Artemisinin route of administration

Answer 67

PO

Question 68

Artesunate ROA

Answer 68

PO IV IM rectal

Question 69

Artemether

Answer 69

PO IM Rectal

Question 70

`MOA of Artemisinin

Answer 70

Production of free radicals that follows the iron-catalyzed cleavage of the artemisinin endoperoxide bridge in the parasite food vacuole Inhibition of parasite calsium ATPase

Question 71

Only drugs reliably effective against quinine-resistant strains

Answer 71

Artemisinin

Question 72

A/E of Artemisinin

Answer 72

Nausea Vomiting Diarhea

Question 73

Treatment of highly resistant falciparum malaria in thailand (with mefloquine)

Answer 73

Artesunate

Question 74

Primaquine is gametocidal against what malarial species?

Answer 74

All four

Question 75

MOA Primaquine

Answer 75

Through a quinolone-quinoline metabolite that inhibits coenzme Q mediated respiratory chain of the exoerythrocytic parasite

Question 76

Most effective antimalarial drug for preventing transmission of the disease in all four species of plasmodia

Answer 76

Primaquine

Question 77

Only available agent active against the dormant hypnozoite of vivax and ovale

Answer 77

Primaquine

Question 78

Hemolysis or methemoglobinemia is an A/E caused by primaquine especially in patients with what condition

Answer 78

G6PD-Deficiency

Question 79

Metabolites of primaquine have lesser activity than parent compound (T/F)

Answer 79

False. Greater activity

Question 80

Treatment strategies for G6PD-deficient patients with malaria

Answer 80

1. ) Withhold therapy; treat relapse with chloroquine 2. ) Give standard dose but monitor hematologic status 3. ) Treat weekly with primaquine (45mg base) for 8 weeks 4. ) Discontinue if with anemia

Question 81

Malarial drugs used to prevent transmission

Answer 81

Primaquine Pyrimethamine Proguanil