Anti-Malarial Agents

Question 1

Across the lifespan of children

Answer 1

-Very sensitive to adverse effects of drugs; more severe reactions expected
(Risks associated with untreated infection are higher than treatment with these drugs)
-Extreme caution should be used
-Avoid travel to endemic areas
-Consult health department when travel is necessary

Question 2

Across the lifespan of adults

Answer 2

-Advise about the need for prophylactic treatment for tropical travels
-Mark calendar as reminder of days drugs should be taken
(proper timing and completion of treatment helps prevent relapse and kill the protozoa at all stages)
-Avoid in pregnancy and lactation
-Childbearing women should use contraceptives
-Seek help immediately if they have s/s of infection

Question 3

Across the lifespan of older adults

Answer 3

-More susceptible to adverse effects; monitor closely
-Hepatic dysfunction at increased risk of worsening hepatic problems
-Dose may need to be lowered (hepatic patients)

Question 4

Drug class: Antimalarials
What are the suffixes or drug names in this class?

Answer 4

“Quin”
● Quinine
○First drug found effective in treatment of malaria (unless the patient contracted infection in an area that is known to have resistance to this drug type)
○Absent from the market for a while but now available for treating
uncomplicated malaria.
●Chloroquine
●Hydroxychloroquine
●Mefloquine
●Primaquine

Question 5

Drug class: “Quins”
What are the indications?

Answer 5

Treatment of malaria

Question 6

Drug class: “Quins”
What are the actions?

Answer 6

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

Quinine + chloroquine inhibit the parasites ability of digest hemoglobin in red blood cells
Primaquine targets the liver stage to prevent relapse in species like plasmodium vivax and plasmodium ovally

Question 7

Drug class: “Quins”
What are the contraindications?

Answer 7

Known allergy, pregnancy/lactation

can be used in pregnancy if benefit outweighs the risk

Question 8

Drug class: “Quins”
What are the cautions?

Answer 8

-liver disease + alcoholism = (infection damages the liver and the drug needs to be processed in the liver/toxic levels can accumulate)
-retinal disease or damage (can be exacerbated by anti malarial meds)
-psoriasis (can be exacerbated by anti malarial meds)
-porphyria (can be exacerbated by anti malarial meds)

Question 9

Drug class: “Quins”
What are the adverse effects?

Answer 9

-CNS = headache, dizziness
-Immune reactions = fever, shaking, chills, malaise
-GI = nausea, vomiting, dyspepsia, anorexia
-anti-malarials are hepatotoxic (s/s of hepatic adverse drug effects are jaundice, dark urine, pale stool, abdominal pain in the upper right quadrant and itching)
-Dermatological = rash, pruritus, and hair loss
-Retinal damage which could lead to blindness
-Ototoxicity

Question 10

Whats cinchonism?

Answer 10

Syndrome that is caused by the toxicity of these drugs

s/s = nausea, vomiting, tinnitus, vertigo

Question 11

Drug class: “Quins”
What are the drug-drug interactions?

Answer 11

-Patient who is receiving combinations of quinine derivative and quinine is at increased risk for cardiac toxicity and seizures
-Anti-folate drugs (sulfonamides and methotrexate) increase bone marrow suppression

Question 12

Nursing Considerations for Patients Receiving Antimalarial Agents
Assessment:

Answer 12

Assess for contraindications or cautions
-Perform a physical assessment
-Assess the CNS (reflexes and muscle strength).
-Perform ophthalmic and retinal examinations and auditory screening (ask patient for any visual disturbance like blurry vision, night blindness, or difficulty seeing)
-Inspect the skin closely for color (jaundice), temperature, texture, and evidence of lesions
-Monitor liver function, obtain blood cultures

by ensuring were treating the infection with the correct drug will reduce the chance of the parasite building resistance to medications

Question 13

Nursing Considerations for Patients Receiving Antimalarial Agents
Nursing diagnoses:

Answer 13

-Impaired comfort related to GI, CNS, and skin effects of the drug
-Altered sensory (kinesthetic, visual) perception related to CNS effects
-Injury risk related to CNS changes (fall/running into things)
-Knowledge deficit regarding drug therapy

Question 14

Nursing Considerations for Patients Receiving Antimalarial Agents
Implementation:

Answer 14

-Before giving the drug arrange for appropriate culture and sensitivity tests
-Administer a complete course of the drug. Mark a calendar for prophylactic doses.
-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
-Monitor nutritional status, and arrange a dietary consultation as needed
-Instruct the patient concerning the appropriate dosage regimen and the importance of adhering to the drug schedule
-Provide thorough patient teaching

Question 15

Nursing Considerations for Patients Receiving Antimalarial Agents
Evaluation:

Answer 15

-Monitor patient response to the drug (resolution of malaria or prevention of
Ex: relief of fever, chills, sweats, headache, muscle pain, fatigue, nausea, vomiting
-Monitor for adverse effects (orientation and affect, nutritional state, skin color and lesions, hepatic function, and visual and auditory changes).
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to the regimen.

Question 16

Whats amebiasis?

Answer 16

Spread through ingestion of contaminated food or water or by fecal or oral contact

Infection spread through the intestines causing diarrhea, stomach pain and can lead to dysentery

Question 17

Whats leishmaniasis?

Answer 17

Disease caused by parasites spread by sand flies which leads to skin sores or in severe cases - internal organ damage

Question 18

Whats trypanosomiasis (Chagas)?

Answer 18

Parasites disease transmitted by insects like flies or kissing bugs that causes fever, fatigue, and swelling

Question 19

Whats trichomoniasis?

Answer 19

A common sexually transmitted infection that causes itching, discharge, and discomfort in the genital area

Question 20

Whats giardiasis?

Answer 20

An infection that leads to diarrhea, stomach cramps, and bloating- usually from contaminated water

Question 21

Whats pneumocystic jioveci?

Answer 21

Lung infection transmitted through airborne particles from an infected person caused by a fungus
-often affecting people with weakened immune systems like those with HIV or AIDS

Question 22

Whats toxoplasmosis?

Answer 22

Infection caused by contact with cat feces or undercooked meat which can cause flu like symptoms and be risky for pregnant women and those with weak immune systems

Question 23

What antiprotozoal agent treats pneumocystis jiroveci (PCP)?

Answer 23

Atovaquone

Question 24

What antiprotozoal agent treats amebiasis trichomoniasis, and giardiasis?

Answer 24

Metronidazole

Question 25

What antiprotozoal agent treats PCP, trypanosomiasis, and leishmaniasis?

Answer 25

Pentamidine

Question 26

What antiprotozoal agent treats trichomoniasis, giardiasis, and amebiasis?

Answer 26

Tinidazole

Question 27

What antiprotozoal agent treats pediatric patients with chagas?

Answer 27

Benznidazole 9

Question 28

What antiprotozoal agent treats toxoplasmosis?

Answer 28

Pyrimethamine

Question 29

Other Antiprotozoal Agents

Answer 29

● Indications
-Treatment of infections caused by susceptible protozoa

●Actions
-Inhibit DNA synthesis in susceptible protozoa (prevents replication)

●Contraindications
-Known allergy

●Cautions
-CNS disease, hepatic disease, lactation/ pregnancy

●Adverse Effects:
-Headache, dizziness, ataxia, peripheral neuropathies, loss of coordination,
nausea, vomiting, and diarrhea

●Drug-Drug interactions:
-Alcohol (within 3 days of taking med), anticoagulants (within 8 days of taking med), disulfiram (within 2 weeks of taking med)

Question 30

Nursing Considerations for Patients Receiving Antiprotozoal Agents
Assessments:

Answer 30

Assess for contraindications and cautions (liver impairment, allergy, pregnancy/lactation)
-Perform a physical assessment
-Evaluate reflexes and muscle strength
-Examine for lesions, color, temperature, and texture
-Evaluate liver function & obtain cultures

Question 31

Nursing Considerations for Patients Receiving Antiprotozoal Agents
Nursing diagnoses:

Answer 31

-Impaired comfort related to GI and CNS effects of the drug
-Malnutrition related to severe GI effects of the drug
-Altered sensory (kinesthetic, visual) perception related to CNS effects
-Knowledge deficit regarding drug therapy

Question 32

Nursing Considerations for Patients Receiving Antiprotozoal Agents
Implementation:

Answer 32

-Arrange for appropriate culture and sensitivity tests before beginning therapy
-Administer a complete course of the drug
-Monitor hepatic function
-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
-Instruct the patient about the appropriate dosage regimen
-provide patient teaching

Question 33

Nursing Considerations for Patients Receiving Antiprotozoal Agents
Evaluation:

Answer 33

-Monitor patient response to the drug (resolution of infection and negative cultures for parasite).
-Monitor for adverse effects (orientation and affect, nutritional state, skin color and lesions, hepatic function, and occurrence of superinfections).
-Evaluate the effectiveness of the teaching plan. The patient should be able to name the drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.
-Monitor the effectiveness of comfort and safety measures and adherence to the regimen.