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Thera VIII > 18a Treatment for Parasitic Infection (Malaria) Goad > Flashcards

18a Treatment for Parasitic Infection (Malaria) Goad Flashcards

1
Q

What are Nematodes?

A

Round worms

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2
Q

What are Trematodes?

A

Flukes

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3
Q

What are Cestodes?

A

Tape worms

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4
Q

What are some laboratory tests for Parasitology?

A

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

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5
Q

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

A

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

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6
Q

What are the different species of Plasmodium?

A

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

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7
Q

Which Plasmodium is most severe?

A

P. falciparum > vivax > malariae > ovale

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8
Q

Which Plasmodium causes the highest rate of anemia?

A

P. falciparum > vivax, malariae > ovale

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9
Q

What is autochthonous malaria?

A

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

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10
Q

What is Induced Malaria?

A

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

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11
Q

What is Relapsing Malaria?

A

Renewed manifestations > 45 days after a previous malaria case

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12
Q

What is Cryptic Malaria?

A

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

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13
Q

What is the clinical picture of Malaria?

A

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

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14
Q

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

A

Vivax malaria

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15
Q

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

A

Atovaquone. Primaquine. Tafenoquine

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16
Q

What malaria drugs are used for the Erythrocytic Cycle?

A

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

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17
Q

What malaria drugs are used for Relapse?

A

Primaquine, Tafenoquine (not available in the US)

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18
Q

What is Coartem?

A

Artemether + Lumefantrine

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19
Q

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

A

Chloroquine. Hydroxychloroquine sulfate. Primaquine

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20
Q

How is Chloroquine dosed for malaria chemoprophylaxis?

A

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

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21
Q

What is the sig for Chloroquine dosed for malaria chemoprophylaxis?

A

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

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22
Q

How is Hydroxychloroquine sulfate dosed for malaria chemoprophylaxis?

A

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

23
Q

What are the general characteristics of Chloroquine (Aralen)?

A

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

24
Q

What are the ADRs associated with Chloroquine?

A

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

25
Q

What caution needs to be used with Chloroquine?

A

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

26
Q

What are the general characteristics of Primaquine?

A

8-aminoquinoline. Tissue schizonticidal (exoerythrocytic)

27
Q

What is Primaquine used for?

A

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

28
Q

What is a contraindication for Primaquine use?

A

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

29
Q

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

A

Mefloquine. Doxycycline. Azithromycin (less effective than others)

30
Q

How is Mefloquine dosed for malaria chemoprophylaxis?

A

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

31
Q

How is Doxycycline dosed for malaria chemoprophylaxis?

A

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

32
Q

What are the ADRs associated with Doxycycline?

A

GI, esophagitis (caps > tabs), vaginal candidiasis

33
Q

What are the general characteristics of Mefloquine (Lariam)?

A

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

34
Q

What are the DDIs associated with Mefloquine?

A

Typhpoid vaccine PO; cardiac drugs

35
Q

What are the ADRs associated with Mefloquine?

A

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

36
Q

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

A

Atovaquone + Proguanil (Malarone). Doxycycline

37
Q

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

A

250mg + 100mg fixed dose combination

38
Q

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

A

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

39
Q

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

A

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

40
Q

What are the DDIs associated with Atovaquone/Proguanil?

A

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

41
Q

How is Atovaquone/Proguanil used in “standby therapy”?

A

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

42
Q

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

A

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

43
Q

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

A

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

44
Q

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

A

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

45
Q

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

A

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

46
Q

For Malarone, use caution with…

A

Pregnancy, renal

47
Q

For Doxycycline, use caution with…

A

Pregnancy, children, sun, esophagitis, DDIs

48
Q

For Mefloquine, use caution with…

A

CV, Psych, CNS, Seizure

49
Q

For Chloroquine, use caution with…

A

Eye, QT, psoriasis

50
Q

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

A

Artemether-Lumefantrine

51
Q

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

A

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

52
Q

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

A

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

53
Q

What is the DOC for Severe Malaria?

A

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

Thera VIII (24 decks)

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