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Pharmacology Flashcards

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1
Q

Symptoms of dyspepsia?

A

Upper abdominal pain (above the navel)

Belching

Nausea

Abdominal bloating

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2
Q

Ratio of duodenal to gastric ulcers?

A

Duodenal:gastric 4:1

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3
Q

Which type of peptic ulcer is worse?

A

A gastric ulcer as it may become malignant, a duodenal ulcer is normally benign

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4
Q

What are the risk factors for developing a peptic ulcer?

A

H.pylori infection - acid increase

Smoking, predisposition, stress - acid increase and less mucosal defence

NSAIDS - less mucosal defence

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5
Q

Symptoms of duodenal ulcers?

A

Weight gain

Relieved by milk/eating/rest/antacids

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6
Q

Symptoms of gastric ulcers?

A

Vomit/Melena

Upper abdominal pain
Weight loss/appetite loss/anaemia

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7
Q

Complications associated with gastric ulcers?

A

Haemorrhages
Peritonitis
Obstruction
Pain

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8
Q

Main reason for GORD occurrence?

A

Lower Oesophageal Sphincter not closing properly, and acid reflux into the oesophagus

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9
Q

Symptoms of GORD?

A 
Belching
Chronic sore throat
Laryngitis
Gum inflammation
Bad breath
Sour taste
Pain on swallowing
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10
Q

Risk factors for GORD?

A 
Caffein
Chocolate
Smoking
Overweight
Alcohol
Tomato-based foods
Spicy foods
Mint flavouring
Citrus fruits
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11
Q

Two examples of classes of drugs that inhibit acid secretion?

A

PPIs

Histamine receptor antagonists

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12
Q

An example of a class of drug that neutralises excess acid?

A

Antacids

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13
Q

Three examples of classes of drugs that protect the GI mucosa?

A

Prostaglandin analogue
Gel formers
Dopamine receptor antagonists

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14
Q

An example of a PPI?

A

Omeprazole

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15
Q

S/E of PPIs?

A

Interactions with warfarin may enhance the metabolism due to acting on the p450 enzyme

only omeprazole and pantoprazole

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16
Q

How long does one dose of PPI last, why?

A

24hrs as it is irreversible and the proton pumps have to be resynthesized

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17
Q

Two examples of histamine receptor antagonists?

A

Cimetidine and Ranitidine

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18
Q

Interactions of Histamine receptor antagonists?

A

May inhibit p450 enzyme of Warfarin/Theophylline

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19
Q

Examples of antacids?

A

Aluminium hydroxide
Magnesium trisilicate
Calcium
Sodium Bicarbonate

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20
Q

What S/Es of antacids are there?

A 
Aluminium = constipation
Magnesium = Diarrhoea

Risk of malabsorption when taken with other drugs

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21
Q

Example of a prostaglandin analogue?

A

Misoprostol

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22
Q

Examples of gel formers?

A

Bismuth subsalicylate

Sucralfate

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23
Q

S/E of Bismuth?

A

Greying of tooth enamel

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24
Q

Examples of dopamine receptor antagonists?

A

Domperidone

Metoclopromide

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25
THow does treatment of GORD differ if the patient is H.Pylori positive to negative?
If positive give antibiotics then PPI, H2 antagonists, OTC antacids If negative then don't give the antibiotics
26
What is the H.Pylori treatment?
Triple therapy: Amoxicillin and clarithromycin/metronidazole and Omeprazole
27
What type of antibiotics are Amoxicillin/Clarithromycin/Metronidazole?
Amoxicillin - Cell wall synthesis inhibitor Clarithromycin - Protein synthesis inhibitor Metronidazole - Nucleic acid synthesis inhibitor
28
Why does diarrhoea develop in coeliac disease?
Less surface area fro water resorption
29
Common infective organisms that cause diarrhoea?
Bacteria: - E. Coli - Salmonella - Cholera - C. Difficile Viruses: - Norwalk virus - Rota virus Parasites: _ Cryptosporidium parvum
30
Three main types of drugs that cause diarrhoea, and why?
Cholinergics - Increased Ach Cytotoxic agents - Loss of gut epithelia Broad spectrum anitbiotics - Change in gut flora
31
Consequences of diarrhoea?
Dehydration Metabolic acidosis Potassium depletion Hypovolaemia CV collapse
32
Different dehydration signs at 95% hydration and 90% hydration?
95%: - Thirst - Skin turgor - Tachycardia - Sunken eyes 90% (life threatening) - Anuria - Hypotension - Feeble and rapid radial pulse
33
4 Main treatments for acute diarrhoea?
ORT (oral rehydration therapy) Antimotility drugs: Relieve symptoms Antispasmodics: reduce cramping + pain Antibacterials
34
What should the tonicity of ORT be?
Isotonic or slightly hypotonic when rehydrated
35
What does glucose do to sodium transport?
Aids sodium transport
36
How do antimotility drugs work?
Reduce awareness of urge, increase muscle activity but diminish propulsive activity
37
Examples of antimotility drugs?
Opiates: Loperamide, cophenotrope
38
Side effects of antimotility drugs?
Nausea and vomiting, cramps
39
Examples of antispasmodics?
Muscarinic antagonists: Atropine, Dicycloverine Peppermint oil: not an antimuscarinic but has direct smooth muscle relaxation
40
How are antibacterials used in diarrhoea?
Prophylaxis: Co-trimoxazole In infection: Ciprofloxacin, norfloxacin (quinolones) In psuedomembranous or C. difficile: Metronidazole
41
What drugs can be used in chronic diarrhoea?
Adsorbants: kaolin (binds toxins) Bulk forming agents: Methylcellulose Antimotility drugs (secondary to ORT) Opiates: loperamide hydrochloride, codeine phosphate
42
Exact definition of constipation?
Fewer than three bowel movements per week (A chamge to the normal routine) Stools hard, dry and small
43
Reasons for constipation? (get some)
Dehydration Travel Dehydration Chronic and idiopathic Milk Medications Reduced physical activity IBS Disease
44
Diseases associated with constipation?
Neurological: - MS - Stroke - Parkinsons Metabolic: - Diabetes - Uraemia - Hyperkalaemia Systemic disorders: - Amyloidosis - Lupus
45
Medications that can cause constipation?
Antidepressants Antiepileptics Diuretics Narcotics Antacids (aluminium)
46
How do bulk forming laxatives work to reduce constipation?
Increase faecal mass Stimulates peristalsis (as a reaction to mechanical stretch)
47
Drugs used in constipation?
Bulk forming laxatives Stimulants Foecal softeners Osmotics
48
Examples of stimulants?
Bisacodyl Dantron Senna
49
How do dantron and senna work?
Stimulate smooth muscle activity Stimulate myenteric plexus Increase intestinal motility
50
S/E of stimulants?
Cramp
51
Examples of foecal softeners
Detergent properties: Docusate Liquid paraffin (lubricate) Arachis oil (lubricate)
52
S/E of liquid paraffin?
Anal seepage Granulomatous reaction Lipoid pneumonia
53
How do osmotic laxatives work?
Withdraw fluid from the bowel or retain fluid they are administered with Accelerate the transfer through Gut tube, large volume in colon
54
Examples of osmotic laxatives?
Lactulose Macrogols Magnesium salts
55
Key examples of viruses that are based on RNA?
Influenza A,B and C RSV HIV
56
Key examples of viruses that are based on DNA?
HSV CMV Varicella
57
5 targets for antiviral drugs?
Fusion (to the cell) Uncoating Nucleic acid replication Protease Release
58
An antiviral drug that works at the fusion target? How's it work? S/E?
Enfurvitide binds to gp41 on HIV surface, and so inhibits CD4/HIV interaction. Infections, depression
59
An antiviral drug that works at the uncoating target? How's it work? S/E?
Amantadine: inhibits viral ion channel and stops uncoating, anti-influenza drug Dopaminergic effects, nervousness, anxiety, insomnia
60
Antiviral drugs (HIV) that work at the nucleic acid replication target? How's it work? S/E?
HIV Zidovudine: Inhibits reverse transcriptase, nucleoside, incorparated into viral RNA Nevirapine: non-nucleoside, inhibits RT by binding at a different site Anaemia, Bone marrow suppression, liver toxicity
61
Antiviral drug (Herpes) that works at the nucleic acid replication target? How's it work? S/E?
Acyclovir: Inhibits DNA polymerase, incorporated into DNA, guanine analogue Nausea and vomiting, headache
62
Antiviral drug that work at the protease target? How's it work? What virus? S/E?
HIV Indinavir - HIV protease inhibitor Kidney stones, hyperlipidaemia
63
Antiviral drug that work at the release target? How's it work? What virus? S/E?
Influenza Oseltamivir - inhibits influenza neuraminidase activity S/E: nausea/vomiting, diarrhoea, headache
64
Types of viral resistance?
HIV RT nucleoside inhibitors - mutation of drug binding site HIV RT non-nucleoside inhibitors - single point gene gene mutations HIV protease inhibitors - mutation in HIV target protein
65
Whats mycoses?
Fungal infection
66
What makes fungal infections much more likely?
Immunosuppression
67
Main categories of anti-fungal drugs?
Polyenes Imidazoles/Triazoles Others
68
Three main targets for anti-fungals?
Cell wall synthesis inhibitors Nucleic acid synthesis inhibitors Mitotic spindle
69
How do polyenes work?
Generates pores in cell walls - causing loss of K+ ions Replaces ergosterol in cell wall synthesis and incomplete chains are formed
70
Polyenes S/E's?
Nephrotoxicity
71
Two examples of polyenes?
Amphotericin Nystatin
72
How do Imidazoles and triazoles work?
Both inhibit the formation of ergosterol, by inhibiting the enzyme lanosterol demethylase
73
Three examples of imidazoles?
Clotrimazole Miconazole Ketoconazole
74
S/Es of Ketoconazole?
Hepatotoxicity
75
Three examples of Triazoles?
Fluconazole Itraconazole Voriconazole
76
Contraindications of intraconazole?
Contraindicated with calcium-channel blockers, caution use in heart failure
77
How does terbinafine work?
Inhibits squalene epoxidase, again leading to inhibition of ergosterol formation, and membrane disruption
78
How does flucytosine work?
Inhibits the conversion of uracil to DNA
79
Down sides of Flucytosine?
Resistance rapidly develops, only used in combination
80
IBD treatment in dietary changes?
High fibre, healthy diet
81
Treatment for IBS?
Propantheline, mebeverine (antimuscarinics)
82
Antibiotics in IBD?
Metronidazole, ciprofloxacin
83
Main two drug groups for use in IBD?
Immunosuppressants - antibody therapy, immunosuppressants Anti-inflammatory - steroids, aminosalicylates
84
What other adjunct drugs are used in IBD?
Antispasmodics Opioids Laxatives
85
What do aminosalicylates do in IBD treatment?
Maintain remission periods
86
Examples of aminosalicylates?
Sulfasalazine - severe and others mesalazine Olsalazine - mild Balsalazine
87
Aminosalicylates S/E's?
Nausea controlled through reduced dosing Mouth ulcers Loose bowels Rash
88
What do steroids do in IBD treatment?
Mainly used for acute attacks and to induce remission, can be used in maintenance but S/Es make this less suitable
89
Two main oral steroids used in IBD?
Prednisolone Budesonide
90
S/Es of steroid treatment?
Osteoporosis Diabetes Muscle wasting Cushings
91
What do immunosuppressants do in IBD treatment?
Prevent relapse
92
An example of immunosuppressants used in IBD?
Azathioprine (steroid dependent crohns) Methotrexate Calcineurin inhibitors: cyclosporin, tacrolimus.
93
S/E of immunosuppressants used in IBD?
Nausea, vomiting, pneumonia, herpes and diabetes.
94
Example of an antibody therapy drug used in IBD?
Infliximab - against inflammatory cytokines TNF, IL-12, IL-23
95
Four main areas of antibiotic resistance?
Drug inactivators Decreased accumulation Altered binding site Alternative pathways
96
Two ways that drug resistance is increased in a population of bacteria?
Selection Transference (with a plasmid)
97
Three main categories of antibiotic targets?
Cell wall synthesis inhibitors Nucleic acid synthesis inhibitors Protein synthesis inhibitors
98
Four main types of nucleic acid synthesis inhibitors?
Sulphonamides Trimethoprim Quinolones Nitroimidazoles
99
What do sulphonamides inhibit in nucleic acid synthesis, how does this prevent synthesis?
Dihydropteroate synthetase Inhibits the formation of dihydropteroic acid from P-Amino benzoic acid
100
What does trimethoprim inhibit in nucleic acid synthesis, how does this prevent synthesis?
Dihydrofolate reductase Inhibits the formation of tetrahydrofolic acid
101
What do quinolones inhibit in nucleic acid synthesis, how does this prevent synthesis?
Inhibit DNA gyrase and prevent the formation of DNA strands
102
What do nitroimidazoles do in bacteria?
Cause strand breaks in the DNA.
103
Examples of sulphonamides?
Sulfadiazine Sulfamethoxazole
104
Examples of quinolones?
Ciprofloxacin Norfloxacin
105
Example of nitroimidazoles?
Metronidazole
106
resistance and S/Es of sulphonamides?
Widespread resistance to hospital acquired infection S/Es: Hypersensitivity reactions, bone marrow suppression
107
What is co-trimoxazole?
Combination of trimethoprim and sulfamethoxazole.
108
Sulfonamides bacteriostatic or bacteriocidal?
Bacteriostatic
109
Quinolones bacteriostatis or cidal?
Bacteriocidal
110
Uses of Co-trimoxazole?
Pneumonia Otitis media Toxoplasmosis
111
Trimethoprim uses?
Invasive salmonella Respiratory tract infections Prostatitis/UTI
112
Quinolones first line uses?
Pyelonephritis pseudomonas Bacillary dysentry Gastroenteritis (severe)
113
First line uses of metronidazole?
Pelvic infections Infected wounds C. Diff colitis
114
Why are the cell wall synthesis inhibitors called the β-lactams? Why is this relevant to resistance? What can be done to prevent this?
They contain the β-lactam ring Some bacteria have developed resistance through the use of β-lactamase. Can administer with Clavulanic acid (CA) to inhibit lactamase enzymes
115
How do β-lactam antibiotics work?
They inhibit enzymes that cross-link peptidoglycan in cell walls
116
What penicillin is β-lactamase resistant? How does resistance develop to it?
Methicillin Through altered binding site
117
S/E of penicillin antibiotics? What group is particularly at risk?
Hypersensitivity reactions People with atopic allergies e.g. asthma, (shouldn't
118
First line uses of penicillins?
pseudomonas meningitis gonorrhoea Bronchitis/pneumonia
119
Four main groups of β-lactam antibiotics
Penicillins Carbapenems Monobactams Cephalosporins
120
Examples of penicillins?
Benzylpenicillin Methicillin Amoxicillin
121
Examples of cephalosporins?
Cephuroxime Cephalexin Cephotaxime
122
Cephalosporin uses?
UTI Peritonitis Septicaemia Meningitis
123
Carbapenem uses?
Pseudomonas Abdominal infections Community acquired pneumonia
124
Carbapenem examples?
Imipenem Meropenem
125
Monobactam example?
Aztreonam
126
Monobactam uses?
Gonorrhoea Pseudomonas Meningitis H. influenzae
127
Four main types of protein synthesis inhibitor antibiotics?
Aminoglycosides Tetracycline Macrolides Chloramphenicol
128
How do tetracyclines work?
Inhibit protein synthesis by blocking tRNA from binding
129
Two examples of tetracyclines?
Tetracycline Doxycycline
130
How does chloramphenicol work?
Inhibits peptidyl transferase, no protein made
131
How do aminoglycosides work?
Cause incorrect reading of mRNA
132
Aminoglycoside examples?
Gentamicin Streptomycin neomycin
133
How can resistance to aminoglycosides and chloramphenicol develop?
Reduced membrane permeability Increased acetylation Ribosomal mutation
134
How can resistance to tetracycline develop?
Efflux Ribosomal modification Tetracycline modification
135
Tetracycline uses?
Chlamydia Plague Cholera
136
Aminoglycoside S/Es?
ototoxicity, nephrotoxicity
137
Aminoglycoside uses?
Gram negative septicaemia MRSA Endocarditis
138
Macrolide examples?
Erythromycin Clarithromycin Azithromycin
139
Uses of macrolides?
Similar to penicillins in uses, used as alternative to penicillin in penicillin sensitive individuals Otitis media Resp. infection Legionnaires H. Pylori
140
Chloramphenicol uses?
Conjunctivitis, Meningitis, H. influenza
141
The four malaria plasmodium species?
Falciparum - malignant tertian malaria (blackwater fever) - Causes 95% of malaria deaths Vivax/ovale - Moderate 'benign' tertian Causes dormant liver infections Malariae - Mild quartan - long term dormant liver parasites
142
Difference in a tertian and a quartan malaria?
tertian - Fever on first and third days Quartan - Fever on first and fourth days
143
Four stages of malaria?
1. Premonitory - lassitude 2. Cold stage 3. Hot stage 4. Sweating
144
Why did the eradication of malaria fail in the 70's?
Resistance of Anopheles (mosquitos) to insecticides Banning of DDT Resistance of plasmodium (the malaria) to drugs
145
Why did the eradication of malaria fail in the 70's?
Resistance of Anopheles (mosquitos) to insecticides Banning of DDT Resistance of plasmodium (the malaria) to drugs
146
Why did the eradication of malaria fail in the 70's?
Resistance of Anopheles (mosquitos) to insecticides Banning of DDT Resistance of plasmodium (the malaria) to drugs
147
Rapid acting blood schizonticides?
Chloroquine Mefloquine
148
General mechanism of rapid acting blood schizonticides?
Bind to haemin and concentrate 100 fold in infected RBCs and eliminate them
149
Uses of Chloroquine?
In acute infection 3-4 days high dose course Clinical prophylaxis: Weekly dose
150
S/E of Chloroquine?
NVD, Retinopathy, hypersenitivity reaction
151
Uses of Mefloquine? S/E?
Used for chloroquine-resistant falciparum Acute malaria: 3-4 day course S/E: NVD, neuropsychiatric disorder
152
Slow acting blood schizonticides?
Proguanil Pyrimethamine
153
Uses of slow acting blood schizonticides?
Prophylaxis only Suppress the blood infection Partly suppress the liver infection, but no effect on an established liver infection
154
What are slow acting schizonticides mostly given with?
Sulphonamides
155
Mechanism of action of the slow acting schizonticides?
Inhibit plasmodial DHF reductase
156
Is pyrimethamine mostly given with a sulphonamide or without? S/E's?
Normally given with, Severe skin reactions Fatal hepatitis
157
Is proguanil usually given with a sulphonamide or alone? What's it given with if it is, and what is the combination called?
Mostly given alone Atovaquone, called malarone
158
What tetracycline antibiotic can also be given for Mefloquine resistant falciparum? S/Es?
Doxycycline S/E's include photosensitivity, sometimes severe
159
Liver schizonticide? Uses?
Primaquine Rapid cure, only agent that kills liver parasites
160
S/Es of primaquine?
NVD and rarely cyanosis
161
How is Glucose-6-dehydrogenase deficiency linked to primaquine?
Severe contraindication Will cause: - Intravascular haemolysis - Severe anaemia Have to test for it before administration of Primaquine
162
How is Glucose-6-dehydrogenase deficiency linked to primaquine?
Severe contraindication Will cause: - Intravascular haemolysis - Severe anaemia Have to test for it before administration of Primaquine
163
What do the tree stages of prevention mean, Primary, secondary and tertiary?
Primary: Preventing onset of disease, e.g. preventing people from smoking Secondary: Detecting disease at an early stage so it can be controlled. e.g. screening Tertiary: Minimising long term recurrence of disease.
164
What do the tree stages of prevention mean, Primary, secondary and tertiary?
Primary: Preventing onset of disease, e.g. preventing people from smoking Secondary: Detecting disease at an early stage so it can be controlled. e.g. screening Tertiary: Minimising long term recurrence of disease.
165
Screening methods for colorectal cancer?
Colonoscopy Rectal examination Barium enema Faecal occult blood
166
Screening methods for colorectal cancer?
Colonoscopy Rectal examination Flexible sigmoidoscopy Barium enema Faecal occult blood
167
Advantages and disadvantages of colonoscopy to detect colorectal cancer?
Gold standard, will detect all cancer Could increase prevalence Expensive Adverse effects
168
Advantages and disadvantages of flexible sigmoidoscopy to detect colorectal cancer?
Detects about 60% of cancers Less uncomfortable than colonoscopy
169
Advantages and disadvantages of barium enema to detect colorectal cancer?
Cheaper with fewer complications than a colonoscopy Invasive Poor results in elderly
170
Advantages and disadvantages of barium enema to detect colorectal cancer?
Cheaper with fewer complications than a colonoscopy Invasive Poor results in elderly
171
Factors you have to consider when choosing an appropriate antibiotic?
``` Spectrum Orally active Site of action Adverse affects Resistance Pharmacokinetics ```
172
Factors you have to consider when choosing an appropriate antibiotic?
``` Spectrum Orally active Site of action Adverse affects Resistance Pharmacokinetics ```
173
Before diagnosis is officially made, a patient with possible pneumonia, pleuritic pain, fever and productive cough should be treated with what?
Amoxicillin Or... co-amoxyclav/flucloxacillin
174
Most common community acquired infection causing pneumonia?
Streptococcus
175
Before diagnosis is officially made, a patient with possible pneumonia, pleuritic pain, fever and productive cough should be treated with what?
Amoxicillin Or... co-amoxyclav/flucloxacillin
176
Most common community acquired infection causing pneumonia?
Streptococcus
177
What would you treat community acquired streptococcal pneumonia with?
Amoxicillin Or... co-amoxyclav/flucloxacillin
178
What would you treat community acquired streptococcal pneumonia with?
Amoxicillin Or... co-amoxyclav/flucloxacillin
179
Presumptive treatment for pneumonia symptoms, with abscesses at hospital acquired infection?
Co-amxyclav or flucloxacillin
180
Likely infective organism for pneumonia symptoms, with abscesses at hospital acquired infection? Therefore what is treatment?
Staphylococcus Possible MRSA Treatment has to include beta lactamase resistant antibiotics due to possible MRSA: - Quinolones - Cephalosporins
181
31 yr old homosexual male with SOB and diffuse bilateral opacities on CXR, low PaO2. Possible diagnoses?
Pneumocystis carinii Pneumonia (PCP) infection (fungi infection) HIV associated TB
182
Treatment options for Pneumocystis carinii Pneumonia (PCP) infection, with possible HIV?
Co-trimoxazole for PCP, observed for allergy
183
Differences seen in TB to PCP infection?
PCP shows hypoxia on exercise CXR: PCP is bilateral reticular infiltrates, TB is Upper lobe rounded infiltrates. TB sputum may contain blood
184
Treatment for TB?
Streptomycin, ciprofloxacin, rifampicin, 5-ASA
185
Treatment for TB?
Streptomycin, ciprofloxacin, rifampicin, 5-ASA
186
Initial management of possible NVD infections (e.g. salmonella)?
ORT for 48 hours
187
Initial management of possible NVD infections (e.g. salmonella)?
ORT for 48 hours
188
Travellers diarrhoea treatment?
Ciprofloxacin and norfloxacin
189
Travellers diarrhoea treatment?
Ciprofloxacin and norfloxacin
190
Name for athletes foot?
Tinea pedis
191
Name for fungal infection in nail bed and groin?
Nail bed: Tinea unguium Groin: Tinea cruris
192
Examples of antifungals?
Clotrimazole - lanosterol demthylase Terbinafine - squalene epoxidase inhibitor
193
Clotrimazole mechanism?
Lanosterol demthylase inhibitor
194
Terbinafine mechanism?
Squalene epoxidase inhibitor
195
Oral antifungal treatment for systemic infection?
Ketoconazole, Miconazole or fluconazole
196
Contraindications of PPI on an antifungal?
In oral drugs absorption may be decreased due to less acidic stomach environment
197
Contraindications of PPI on an antifungal?
In oral drugs absorption may be decreased due to less acidic stomach environment
198
Infective organism in thrush?
Candida albicans
199
Tingling in lips associated with sexual encounters, most likely?
Herpes simplex
200
Herpes simplex treatment? Mechanism?
Acyclovir - viral thymidine kinase converts it to it's active form which has affinity for viral DNA polymerase, incorporating itself into the viral DNA and stopping replication
201
Herpes simplex treatment? Mechanism?
Acyclovir - viral thymidine kinase converts it to it's active form which has affinity for viral DNA polymerase, incorporating itself into the viral DNA and stopping replication
202
Herpes simplex treatment? Mechanism?
Acyclovir - viral thymidine kinase converts it to it's active form which has affinity for viral DNA polymerase, incorporating itself into the viral DNA and stopping replication
203
Laxative choices?
Senna Magnesium hydroxide
204
Drug to reduce diarrhoea and stomach cramps in travellers diarrhoea?
Loperamide
205
ABCD for malaria prophylaxis?
Awareness of risk Bites - reduce likelihood of bites from Anopheline mosquito (disk to dawn) Chemoprophylaxis Diagnosis
206
ABCD for malaria prophylaxis?
Awareness of risk Bites - reduce likelihood of bites from Anopheline mosquito (disk to dawn) Chemoprophylaxis Diagnosis

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