18a Treatment for Parasitic Infection (Malaria) Goad

Question 1

What are Nematodes?

Answer 1

Round worms

Question 2

What are Trematodes?

Answer 2

Flukes

Question 3

What are Cestodes?

Answer 3

Tape worms

Question 4

What are some laboratory tests for Parasitology?

Answer 4

Ova and Parasites (O&P: stool specimen, eggs, cysts, trophs, larvae). Examination (pinworms). CBC (Eosinophilia: Helminths, not Protozoal). Entero-test (string test). Thick and thin blood films - malaria and filaria. Giemsa stains

Question 5

What is usually done at a Pre-Travel Health Clinic?

Answer 5

Ideally 6 weeks before departure. 30 minute consultation. 15 minutes for vaccinations. Prescriptions filled while drawing up vaccines. Individuals or groups

Question 6

What are the different species of Plasmodium?

Answer 6

P. vivax, P. ovale, P. falciparum, P. malariae, P. knowlesi

Question 7

Which Plasmodium is most severe?

Answer 7

P. falciparum > vivax > malariae > ovale

Question 8

Which Plasmodium causes the highest rate of anemia?

Answer 8

P. falciparum > vivax, malariae > ovale

Question 9

What is autochthonous malaria?

Answer 9

Indigenous: mosquito borne transmission of malaria in geographic area where malaria occurs regularly. Introduced: mosquito borne transmission of malaria from a person with an imported case in an area where malaria does not occur regularly

Question 10

What is Induced Malaria?

Answer 10

Malaria acquired through artificial means, i.e. blood transfusion, shared needles

Question 11

What is Relapsing Malaria?

Answer 11

Renewed manifestations > 45 days after a previous malaria case

Question 12

What is Cryptic Malaria?

Answer 12

A case of malaria for which epidemiologic investigations fail to identify a plausible mode of acquisition

Question 13

What is the clinical picture of Malaria?

Answer 13

10-14 day incubation. FEVER, HA, DIARRHEA, malaise, chills, and sweats. Periodic fever an uncommon finding. Labs: THROMBOCYTOPENIA, ELEVATED LFTs, normal hb/hct/WBC

Question 14

What is the primary type of malaria seen in patients when they come in after 42 days of being infected?

Answer 14

Vivax malaria

Question 15

What malaria drugs are used for Primary (Causal Protection), liver cycle?

Answer 15

Atovaquone. Primaquine. Tafenoquine

Question 16

What malaria drugs are used for the Erythrocytic Cycle?

Answer 16

Atovaquone. Azithromycin. Chloroquine. Doxycycline. Mefloquine. Proguanil. Tafenoquine

Question 17

What malaria drugs are used for Relapse?

Answer 17

Primaquine, Tafenoquine (not available in the US)

Question 18

What is Coartem?

Answer 18

Artemether + Lumefantrine

Question 19

For malaria chemoprophylaxis, what is used for Chloroquine-sensitive P. vivax malaria?

Answer 19

Chloroquine. Hydroxychloroquine sulfate. Primaquine

Question 20

How is Chloroquine dosed for malaria chemoprophylaxis?

Answer 20

500mg PO once/week in adults. 8.3mg/kg PO once/week for children

Question 21

What is the sig for Chloroquine dosed for malaria chemoprophylaxis?

Answer 21

Start 1-2 weeks before entering malarious area, then weekly in malarious area, then weekly x4 weeks after leaving the area

Question 22

How is Hydroxychloroquine sulfate dosed for malaria chemoprophylaxis?

Answer 22

400mg PO once/week for adults. 6.5mg/kg PO once a week for children

Question 23

What are the general characteristics of Chloroquine (Aralen)?

Answer 23

4-aminoquinoline. High resistance. Schizonticidal: erythrocytic only. Relatively safe during pregnancy

Question 24

What are the ADRs associated with Chloroquine?

Answer 24

Retinopathy (high dose), psychosis (rare), and itching, wide QRS complex (rare), exacerbate psoriasis and porphyria

Question 25

What caution needs to be used with Chloroquine?

Answer 25

Caution in G-6-PD deficiency (testing NOT required). Pregnancy Category C, but CDC recommends use when needed

Question 26

What are the general characteristics of Primaquine?

Answer 26

8-aminoquinoline. Tissue schizonticidal (exoerythrocytic)

Question 27

What is Primaquine used for?

Answer 27

Prophylaxis (off label) and relapse prevention (terminal prophylaxis and radical care). Against: P. vivax and P. ovale. Daily during last 2 weeks of post departure schedule

Question 28

What is a contraindication for Primaquine use?

Answer 28

G-6-PD deficiency. MANDATORY testing. More likely in African American, Mediterranean, Asian. Results in hemolytic anemia

Question 29

What drugs are often used in malaria chemoprophylaxis in chloroquine-resistant P. falciparum malaria (CRPF)?

Answer 29

Mefloquine. Doxycycline. Azithromycin (less effective than others)

Question 30

How is Mefloquine dosed for malaria chemoprophylaxis?

Answer 30

250mg PO once/week in adults. 5mg/kg PO once/week in children

Question 31

How is Doxycycline dosed for malaria chemoprophylaxis?

Answer 31

100mg PO once/day in adults. 2mg/kg PO once/day in children > 8 years of age (contraindicated < 8 years of age)

Question 32

What are the ADRs associated with Doxycycline?

Answer 32

GI, esophagitis (caps > tabs), vaginal candidiasis

Question 33

What are the general characteristics of Mefloquine (Lariam)?

Answer 33

Used for Chloroquine resistant Plasmodium (especially P. falciparum). Schizonticidal; erythrocytic phase only

Question 34

What are the DDIs associated with Mefloquine?

Answer 34

Typhpoid vaccine PO; cardiac drugs

Question 35

What are the ADRs associated with Mefloquine?

Answer 35

Neuropsychiatric (HALLUCINATIONS, convulsions (CI'd in seizure patients), TREMOR, vertico), CV. Pregnancy Category C, but CDC recommends use when needed

Question 36

What is used for malaria chemoproplylaxis is Chloroquine-resistant P. falciparum malaria (CRPF) and Mefloquine-resistant Pf (MDR PF or MRPF)

Answer 36

Atovaquone + Proguanil (Malarone). Doxycycline

Question 37

How is Atovaquone + Proguanil (Malarone) dosed for malaria chemoprophylaxis?

Answer 37

250mg + 100mg fixed dose combination

Question 38

What is the sig for Atovaquone + Proguanil (Malarone) in malaria chemoprophylaxis?

Answer 38

Take 1 tab QD starting 1-2 days before entering malarious area, daily while at risk, then daily for 7 days after departing malarious area

Question 39

What are the general characteristics of Atovaquone/Proguanil (Malarone)?

Answer 39

Chloroguanide = Proguanil (Proguanil converts to Cycloguanil = active form, up to 20% less conversion in Asian and AA). Take with food (or milky drink)

Question 40

What are the DDIs associated with Atovaquone/Proguanil?

Answer 40

Rifampin, Rifabutin, TCN, Reglan decrease efficacy. Pregnancy Category C - do not use in pregnancy

Question 41

How is Atovaquone/Proguanil used in "standby therapy"?

Answer 41

Presumptive treatment and prophylaxis of P. falciparum: 4 tabs QD x3 days

Question 42

What is the general scheduled use of Mefloquine for malaria chemoprophylaxis during a trip?

Answer 42

1-2 weeks before trip. Weekly during trip. 4 weeks after trip

Question 43

What is the general scheduled use of Doxycycline for malaria chemoprophylaxis during a trip?

Answer 43

1-2 DAYS before trip. Daily during trip. 4 weeks after trip

Question 44

What is the general scheduled use of Chloroquine for malaria chemoprophylaxis during a trip?

Answer 44

1-2 weeks before trip. Weekly during trip. 4 weeks after trip

Question 45

What is the general scheduled use of Malarone for malaria chemoprophylaxis during a trip?

Answer 45

1-2 DAYS before trip. Daily during trip. 1 week after trip

Question 46

For Malarone, use caution with...

Answer 46

Pregnancy, renal

Question 47

For Doxycycline, use caution with...

Answer 47

Pregnancy, children, sun, esophagitis, DDIs

Question 48

For Mefloquine, use caution with...

Answer 48

CV, Psych, CNS, Seizure

Question 49

For Chloroquine, use caution with...

Answer 49

Eye, QT, psoriasis

Question 50

What drugs need to be used if targeting blood-staged schizonticide AND gametocytocide?

Answer 50

Artemether-Lumefantrine

Question 51

What are the common drugs and their doses used for Chloroquine-resistant P. falciparum or Chloroquine-resistant P. vivax?

Answer 51

Mefloquine 2 doses over 12hrs. Quinine + Doxycycline Q8hrs x3days + BID x7 days. Atovaquone/proguanil 4 tabs QD x3 days. Artemether/Lumefantrine x3 days

Question 52

What are some general characteristics of Coartem (Artemether and Lumefantrine)?

Answer 52

Rapid kill w/ artemether; sustained kill with lumefantrine. Not used for prophylaxis, only treatment. Cure rate up to 90% at 28 days. Many DDIS

Question 53

What is the DOC for Severe Malaria?

Answer 53

Artesunate. Artemisinin derivative given IV. Prodrug: dihydroartemisinin (DHA). Obtained from the CDC