Anti-Malaria Agents / Antiprotozoal Agents Flashcards

1
Q

What is Amebiasis?

A

Intestinal infection caused by the parasite Entamoeba histolytica. Which is typically transmitted through contaminated food and water have signs and symptoms such as diarrhea, abdominal pain and in severe cases liver abscesses which is all Amoebic dysentery s&s.

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2
Q

What is Anopheles mosquito?

A

A type of mosquito responsible for transmitting malaria parasite to humans through its bite. Essential to the life cycle of Plasmodium.

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3
Q

What is Cinchonism?

A

A toxic side effect such as ringing in the ears. nausea, vertigo and HA caused by the use of quinine or related drugs used to treat malaria.

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4
Q

What is Giardiasis?

A

Intestinal infection caused by the protozoan Giardia lamblia , which leads to symptoms like diarrhea, cramps and nausea. Typically transmitted through contaminated water.

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5
Q

What is Leishmaniasis?

A

Parasitic infection caused by Leishmania species and is transmitted by sand flies, This infection may cause skin sores, mucosal damage and visceral organ involvement.

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6
Q

What is Malaria?

A

Infectious disease caused by the Plasmodium parasites and in transmitted through the bites of infected anopheles mosquitoes. The infection makes red blood cells rupture from the parasites and causes cyclic fever, chills and damage to the liver, CNS, heart and lungs.

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7
Q

What is Plasmodium?

A

A genus of parasitic protozoa that causes malaria in humans through the transmission of its spores by anopheles mosquitoes.

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8
Q

What is Protozoa?

A

Single celled microorganisms that have at least one stage of their life as a human parasite. Can cause diseases such as Malaria, Giardiasis and Trichinosis. Usually found in areas with poor sanitation or crowded living conditions.

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9
Q

What is Trichomoniasis?

A

Sexually transmitted infection caused by the protozoan Trichomonas vaginalis. symptoms : vaginal discharge, itching and discomfort. Symptoms only experienced by females and may cause preterm labor in pregnancy.

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10
Q

What is Trophozoite?

A

Active motile and feeding stage of certain protozoan parasites and is responsible for causing infections such as Giardiasis and Amebiasis.

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11
Q

What is Trypanisomiasis?

A

Also known as sleeping sickness and Chagas disease is a parasitic disease caused by Trypanosoma species. It is transmitted by the tsetse fly. Its characterized by fever, fatigue and neurological symptoms. Chagas disease also causes cardiomyopathy.

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12
Q

What are causes of Protozoal Infections (how does humans get infected) ?

A

●Insect Bites leading to :
○Malaria
○Trypanosomiasis
○Leishmaniasis

●Ingestion or Contact with
the Causal Organism leading to :
○Amebiasis
○Giardiasis
○Trichomoniasis

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13
Q

Where in the world are people most likely to get an protozoal infection?

A

In tropical areas of the world.

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14
Q

What are 2 risk factors for Protozoal Infections?

A
  • Unsanitary and crowded conditions
  • Poor Hygiene practices
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15
Q

How is a person most likely to contract Malaria?

A

Through the bite of an infected Anopheles mosquito, which transmits the Plasmodium parasite.

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16
Q

How is a person most likely to contract Trypanosomiasis ?

A

Through the bite of an infected Tsetse fly which then transmits the Trypanosoma parasite.

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17
Q

How is Leishmaniasis most commonly contracted?

A

Through the bite of an infected sandfly which transmits the Leishmania parasite.

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18
Q

How is Amebiasis most commonly contracted?

A

By ingesting food or water contaminated with Entamoeba histolytica.

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19
Q

How is Giardiasis most commonly contracted?

A

ingesting contaminated water or food containing the parasite Giardia.

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20
Q

How is Trichomoniasis most commonly contracted?

A

Through sexual contact with and infected partner which carries the parasite Trichomonas vaginalis.

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21
Q

How come protozoal parasites thrives in refugee camps?

A

Due to being crowded areas where it is difficult to keep water sanitary and have poor waste disposal. Giardia is common due to fecal matter in these areas may easily contaminate water supply.

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22
Q

What may happen if a person does not wash their hands after using the rest room?

A

There is a possibility of coming into contact with your own or other peoples feces when using bathrooms and not washing hands prior to eating may lead to ingestion of giardia which can cause an infection. Preparing food without hand washing can also have the same effect.

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23
Q

What are the protozoal parasites which are identified causes of Malaria disease?

A

All start with Plasmodium.

●Plasmodium falciparum
○Considered the most dangerous type of protozoan- fever, hypertension, decrease in RBC’s & death.
●Plasmodium vivax
○Milder form of the disease; seldom results in death
●Plasmodium malaria
○Endemic in tropical countries; mild symptoms in local population but more severe in tourists and travelers.
●Plasmodium ovale
○Caused by two different species, both most prevalent in Africa;
mosquito has developed resistance to insecticides

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24
Q

What are the s&s associated with Malaria disease?

A

Signs and symptoms are related to the destruction of red blood cells and toxicity to the liver.

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25
Q

What are two specific reasons as to why there’s been an increase in Malaria cases?

A

The mosquitoes has developed a resistance to insecticides.
The Protozoa have become resistant to the antimalaria treatment.

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26
Q

How does the Malaria disease progress once the Protozoa is inside the body of a human?

A

They will infect human cells (mostly red blood cells) , and after reaching certain stages in its lifecycle the human cells will burst. The rupturing of the RBC’s will trigger a severe acute inflammatory response in the body and at this point the cyclic fever and chills will begin which may last for yrs.

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27
Q

What is the reason the fever and chills of malaria may last for years if untreated?

A

Because the protozoa may go into dormant stages and hide in the cells and become active again through different times.

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28
Q

What is another dangerous thing that may happen when the RBC’s rupture due to protozoa infecting them?

A

Large amounts of RBC rupturing may also lead to clogged capillaries which will decrease circulation to vital organs and may therefore lead to death.

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29
Q

How do we treat Malaria disease?

A

The treatment aims to attach the parasite at the various stages of development inside and outside the human body.

The type of medication given depends on if there is a know resistance to another medication in the area the patient contracted malaria in, it will also depend on the severity of the symptoms and if they were taking prophylactic medications prior to infection.

30
Q

What may Malaria do to the liver?

A

The parasites may also infect the liver which may cause liver inflammation and contribute to jaundice and organ dysfunction.

31
Q

What are some lifespan considerations that we should take into account when treating children with antiprotozoal agents?

A

Children may have more severe reactions to the drugs due to higher sensitivity.
Extreme caution should be used.
Travel to endemic areas should be avoided.
Health department should be consulted prior to travelling.

32
Q

What are some lifespan considerations that we should take into account when treating adults with antiprotozoal agents?

A

Should be advised of the need for prophylactic treatment.
Advised to seek help immediately if they have any s&s.
Should be advised to mark a calendar or set reminder for days the drugs should be taken after first dose is taken (dose is important to effectively eliminate parasite in all stages of its lifecycle)
Should be avoided in pregnancy and lactation.
Women of childbearing age should use contraceptive.

33
Q

What are the signs and symptoms of malaria?

A

Cyclic fevers, chills, profuse sweating, anemia and fatigue.

34
Q

What are the names of the two types of parasites that are prone to be able to relapse during malaria treatment and why?

A

Plasmodium Vivax and Plasmodium Ovale may remain dormant in the liver and cause reinfection if not treated thoroughly.

35
Q

What are some lifespan considerations that we should take into account when treating older adults with antiprotozoal agents?

A

More susceptible to adverse reactions - monitor closely.
Patients with hepatic dysfunction at increased risk of worsening hepatic problems.
Dose may need to be lowered.

36
Q

What is the suffix(es), names or outliers for antimalarials?

A

“-quin”
Quinine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine

37
Q

Which Malaria drug was the first drug to be found effective for treating malaria and was taken off the market for a short while before becoming available again?

A

Quinine

38
Q

Where have malaria resistance to quinine been reported?

A

Southeastern Asia incl Thailand, Cambodia and Vietnam and some regions in the sub-Sahara and South America although less common in these regions.

39
Q

how does antimalaria drugs work?

A

Varies by the drug ; prevents malaria replication or causes malaria cell death.

40
Q

What are the specific MOA’s of Quinine and Chloroquine?

A

Prevents the parasites ability to digest hemoglobin in the RBC’s.

41
Q

What is the specific MOA for Primaquine?

A

Targets the liver stage to prevent relapse in species Plasmodium Vivax and Plasmodium Ovale.

42
Q

What are the two most significant contraindications of antimalarial drugs?

A

Allergy and pregnancy & lactation. Pregnancy only when necessary.

43
Q

What are some things we should be cautious of when giving a patient antimalaria drugs?

A

Liver disease
Alcoholism
This is because the infection itself damages the liver and secondly the drug is metabolized in the liver which may lead to toxic levels if accumulated.

Retinal disease or damage
Psoriasis or porphyria

44
Q

What are the most known adverse reactions to antimalarial medications?

A

CNS - HA and dizziness.
Immune reaction - Fever, chills and malaise.
GI - Nausea, vomiting, dyspepsia, anorexia
Hepatic Dysfunction r/t to disease itself as well as medications = jaundice, dark urine, pale, stool, URQ pain & itching, elevated enzymes AST and ALT & fatigue.
Dermatological - Antimalarial may exacerbate psoriasis or porphyria & rash, pruritus & hair loss.
Blindness - Vision & retinal changes (increased in patients with retinal damage)
Ototoxicity - Cinchonism caused by the toxicity of the drugs (s&s : nausea, vomiting, tinnitus & vertigo)

45
Q

What is porphyria?

A

rare group of genetic metabolic disorders that affect how the body produces heme, an iron-containing molecule that carries oxygen in the blood and bone marrow.
S&S = Itching, blisters, swelling, fragile skin, infection, scarring, and changes in skin pigmentation.

46
Q

What are some known drug-drug interactions with antimalarial medications?

A

A combination of quinine derivative and quinine increases the risk of cardiac toxicity and convulsions. (monitor patient closely)
Anti-folate drugs (Methotrexate & Sulfonamides) increase bone marrow suppression and should not be used with antimalarials. (Diarrhea, fatigue, weight loss and anemia)

47
Q

What assessments should be done prior to administer antimalarial medications to patients?

A

Assessing for C&C’s
Physical assessment :
Assess CNS (reflex & muscle strength to monitor for neurotoxic effect, seizures and altered mental status).
Ophthalmic & retinal examination & auditory screening (asking about visual disturbances, blurry vision, night blindness & difficulty seeing)
Assess for tinnitus (hearing loss and dizziness)
Inspect skin closely for color (jaundice), temperature, texture & evidence of lesions.
Monitor liver function (liver enzymes & bilirubin), obtain blood cultures (to confirm presence of parasites).

48
Q

What Nursing Diagnoses can we make prior to administering antimalarial medications to patients?

A

Impaired comfort r/t GI, CNS and skin effect of the drug.
Altered sensory (kinesthetic, visual) perception r/t CNS effect
Injury risk r/t CNS changes
Knowledge deficit r/t drug therapy.

49
Q

What Nursing Implementations should we be prepared for when giving patients antimalarial medications? (long answer)

A

○Arrange for appropriate culture and sensitivity tests before
beginning therapy - to ensure right drug for right parasite.

○Administer a complete course of the drug. Mark a calendar for
prophylactic doses. (complete drug regimen is important to treat potential resistance)

○Monitor hepatic function and perform ophthalmological
examination before and periodically during treatment

○If CNS effects occur, provide comfort and safety measures (e.g.,
side rails and assistance with ambulation if dizziness and weakness
are present). Provide oral hygiene and ready access to bathroom

○Provide small, frequent, nutritious meals if GI upset is severe; take
with food (important to prevent malnutrition)

○Instruct the patient concerning the appropriate dosage regimen
and the importance of adhering to the drug schedule

○Provide thorough patient teaching

50
Q

What are the other 7 Protozoal infections that we need to know the names of?

A

●Amebiasis - contaminated food & water or by fecal oral contact - diarrhea & stomach pain.
●Leishmaniasis - sand flies - skin sores and possibly internal organ damage.
●Trypanosomiasis (Chagas) - Tsetse flies or kissing bugs - fever, fatigue & swelling.
●Trichomoniasis - STD - itching, discharge and genital discomfort.
●Giardiasis - contaminated water - diarrhea, stomach pain, bloating.
●Pneumocystic jiroveci pneumonia - airborne particles (fungus) - lung infection, can affect HIV & AIDS patients more.
pneumonia (PCP)
●Toxoplasmosis - cat feces or undercooked meat - flu like symptoms, pregnant women at risk.

51
Q

Why should pregnant women not change cat litterboxes during pregnancy?

A

This may cause Toxoplasmosis which may enter the blood stream and cross into the placenta and cause still birth or birth defects such as hydrocephalies (fluid buildup in the brain, severe eye problems or neurological issues to the fetus.

52
Q

What are the other 6 Antiprotozoal Agents that we need to know?

A

●Atovaquone
●Metronidazole
●Pentamidine
●Tinidazole
●Benznidazole 9
●Pyrimethamine

53
Q

What does Atovaquone treat?

A

Prevention and treatment of Pneumocystis jirovecii pneumonia
(PCP)

54
Q

What does Metronidazole treat?

A

Treats amebiasis, trichomoniasis, and giardiasis

55
Q

What does Pentamidine treat?

A

Treats PCP, trypanosomiasis, and leishmaniasis

56
Q

What does Tinidazole treat?

A

Treats trichomoniasis, giardiasis, and amebiasis

57
Q

What does Benznidazole 9 treat?

A

Pediatric patients with Chagas

58
Q

What does Pyrimethamine treat?

A

Treatment of toxoplasmosis

59
Q

Why would you give a patient any of the “other” antiprotozoal drugs?

A

To treat infections caused by susceptible protozoa.

60
Q

How does the “other” antiprotozoal drugs work?

A

Inhibit DNA synthesis in susceptible protozoa which prevents replication.

61
Q

What are the known contraindications to the “other” antiprotozoal drugs?

A

known allergy

62
Q

What should we be cautious of when giving a patient “other” antiprotozoal drugs?

A

CNS disease ( Pre-existing history of seizures, stroke or brain tumor ) drug may exacerbate these conditions.
Hepatic disease - may occur with drug (patients with pre-excising needs to be monitored closely)
Lactation/pregnancy - Reaction not know, benefit must outweigh risk.

63
Q

What are some adverse reactions that we should be aware of when it comes to “other” antiprotozoal drugs?

A

HA
Dizziness
Ataxia (neurological sign that indicates a loss of muscle coordination and control)
Peripheral neuropathies (disease or damage to the peripheral nervous system)
Loss of coordination
* These conditions are due to drug passing blood-brain barrier.
Nausea
Vomiting
Diarrhea
* These conditions are due to electrolyte imbalance and may leave to severe malnutrition.

64
Q

How come antiprotozoal drugs may cause toxicity in the brain, liver and stomach?

A

Because these drugs cause cellular disruption in both the parasite and the host.

65
Q

What are known drug-drug interactions of “other” antiprotozoal drugs?

A

Alcohol - adverse effects become severe - should not drink within 3 days of taking medication.
Anticoagulants - increase effectiveness of these drug - may lead to bleeding. - not take within 8 days.
Disulfiram - psychotic reactions may occur - not take within 2 weeks.

66
Q

Before giving patients Tinidazole, what should we assess for?

A

Before giving Tinidazole as well as “other” Antiprotozoal Agents we should be assess for
C&C’s - Liver impairment, allergy, pregnancy/lactation, or CNS disease that may worsen.
Physical assessment : reflexes and muscle strength, Skin; lesions, color, temperature and texture.
Evaluate liver function & obtain cultures (blood culture to treat right infection)

67
Q

What nursing diagnoses may be expected prior to administering Atovaquone?

A

With Atovaquone and other Antiprotozoal Agents we may expect impaired comfort r/t GI & CNS effects of the drugs, malnutrition r/t severe GI effect, Altered sensory perception (kinesthetic and visual) r/t CNS effect & knowledge deficit.

68
Q

What nursing implementations should we be prepared for when giving patients Metronidazole?

A

With Metronidazole a and other Antiprotozoal Agents we may expect to
Arrange for appropriate culture and sensitivity tests before
beginning therapy
○Administer a complete course of the drug
○Monitor hepatic function (repeat labs)
○If CNS effects occur, provide comfort and safety measures, such as
side rails and assistance with ambulation if dizziness and weakness
are present
○Provide oral hygiene and ready access to bathroom facilities as
needed
○Arrange for the treatment of superinfections as appropriate
○If GI upset is severe, provide small, frequent, nutritious meals; take
with food
○Monitor nutritional status, and arrange a dietary consultation as
needed
○ Give instructions regarding dosage regimen.

69
Q

What is Amoebic dysentery?

A

Amoebic dysentery, also known as amebiasis, is a parasitic infection of the intestines caused by the microscopic amoeba Entamoeba histolytica. Symptoms can range from mild to severe, and may include:
Diarrhea, Bloody diarrhea, Abdominal pain, Lethargy, Weight loss, Fever, and Vomiting

70
Q

What is Plasmodium?

A

Plasmodium is a genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects. The life cycles of Plasmodium species involve development in a blood-feeding insect host which then injects parasites into a vertebrate host during a blood meal.

71
Q

Which infection is spread by sexual contact?

A

Trichomoniasis.