Anti-Malarial/Protozoal Flashcards
Causes of Protozoal Infections
Insect Bites
* Malaria
* Trypanosomiasis
* Leishmaniasis
Ingestion or Contact with the Causal Organism
* Amebiasis
* Giardiasis
* Trichomoniasis
Risk Factors for protozoal infections
- Unsanitary, crowded conditions: unclean water, poor waste removal practices
- Poor hygienic practices: not washing hands after using bathroom or before eating
Plasmodium falciparum
Protozoal Parasite identified as a cause of malaria
* Considered the MOST dangerous type of protozoan
* Causes severe fever, hypotension, ⬇️ RBCs, death
Plasmodium vivax
Protozoal Parasite identified as a cause of malaria
* Milder form of disease
* Seldom results in death
Plasmodium malariae
Protozoal Parasite Identified as a cause of malaria
* Endemic in tropical countries
* Mild symptoms
Plasmodium ovale
Protozoal Parasite identified as a cause of malaria
* Caused by two different species
* Both are most prevalent in Africa
* Mosquito has developed resistance to inseticides
What does Malaria mostly affect?
- Destroys red blood cells
- Causes severe acute reaction in the body
Lifespan considerations for Antiprotozoal Therapy
In Children
- Very sensitive to effects of drugs; more severe reactions
- Extreme caution should be used
- Avoid travel in endemic areas
- Consult health department when travel is necessary
Lifespan considerations for Antiprotozoal Therapy
In Adults
- Advise about the need for prophylaxis
- It is essential to mark a calendar as a reminder of days drugs should be taken
- Avoid in pregnancy and lactation
- Women of childbearing age should use contraceptives
Lifespan considerations for Antiprotozoal Therapy
In Older Adults
- More susceptible to adverse effects; monitor closely
- Hepatic dysfunction at increased risk of worsening hepatic problems
- Dose may need to be lowered
Antimalarials
Drug Names
“quins”
Quinine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine
Antimalarials
Adverse Effects
- CNS: headache, dizziness, fatigue
- GI: Nausea, vomiting, anorexia
- Hepatic dysfunction
- Dermatological: rash, pruritis, hair loss
- Blindness
- Ototoxicity
- Cinchonism syndrome: Overdose of “quins” leading to N/V, ringing in ears, vertigo
Antimalarials
Drug Interactions
- Quinine and quinine derivative - increased risk of cardiac toxicity and convulsions
- Anti-folate drugs - increased risk of bone marrow suppression (ie Methotrexate & Sulfonamides)
Antimalarials
Mechanism of Action
Varies by drug; prevents malaria replication or causes malaria cell death
Antimalarials
Contraindication
Absolute:
* Known Allergy
* Pregnancy and Lactation
Cautions:
* Liver disease (infection damages liver as well)
* Alcoholism (inc. risk of toxicity)
* Retinal disease (makes worse)
* Psoriasis (makes worse)
* Porphyria (makes worse)
Antimalarials
Assessment
History:
* Check for allergy, pregnancy, lactation
* Check for liver disease, alcoholism, retinal disease, psoriasis, or porphyria
Physical:
* CNS: reflexes, muscle strength, LOC, seizure activity, altered mental status
* Ophthalmic and retinal examination
* Auditory screening: check for baseline tinnitus
* Inspect skin for color, temperature, texture, lesions
Labs:
* Liver function
* Blood culture (confirm presence of parasite)
Antimalarials
Diagnoses
- Impaired comfort (r/t GI, CNS, and skin adverse effects)
- Altered sensory perception (r/t CNS effects)
- Injury risk (r/t CNS changes)
Antimalarials
Implementation/Patient Teaching
- Arrange for culture and sensitivity tests before beginning therapy
- Administer full course of the drug
- Mark a calendar for prophylactic doses to remember when they should be taken
- Monitor hepatic function and perform ophthalmological examination before and during treatment
- If CNS effects occur, provide comfort and safety measures (sisde rails, assistance with ambulation)
- Provide oral hygiene and ready access to the bathroom
- Monitor nutritional status; encourage small frequent meals for GI effects
- Instruct patient on appropriate dosage and importance of adhering to the drug schedule.
- Report vision changes; hearing changes; jaundice
Amebiasis
- Contaminated food or water or direct contact with contaminated feces
- Causes GI symptoms
- Treated with: Metronidazole and Tinidazole
Leishmaniasis
- Carried by sand flies
- Causes skin sores and organ damage
- Treated with Pentamidine
Trypanosomiasis
(aka Chagas)
- Carried by “kissing bugs”
- Acute phase of disease causes fever, fatigue, swelling at bite location
- Untreated, disease can lead to serious heart or digestive issues (sometimes 10-30 years later)
- Treated by Pentamidine, pediatric: Benznidazole 9
Trichomoniasis
- Sexually transmitted
- Causes genital itching, discharge, discomfort (men usually have no symptoms but can transmit it)
- Treated with: Metronidazole & Tinidazole
Giardiasis
- Transmitted through contaminated water
- Causes GI issues
- Treated with Tinidazole & Metronidazole
Pneumocystic jiroveci pneumonia
- Airborne
- Mostly affects immunocompromised
- Lung infection
- Treated with Atovaquone & Pentamidine
Toxoplasmosis
- Transmitted commonly through cat litter or uncooked meat
- Can cross the placenta and cause major birth defects or miscarriage
- Flu-like symptoms
- Treated with Pyrimethamine
Atovaquone
- Other antiprotozoal drug
- Prevents and treats Pneumocystic jirovecii pneumonia (PCP)
Metronidazole
- Other antiprotozoal drug
Treats
* Amebiasis
* Trichomoniasis
* Giardiasis
Pentamidine
- Other antiprotozoal drug
Treats
* Pneumocystic jirovecii pneumonia
* Trypanosomiasis
* Leishmaniasis
Tinidazole
- Other antiprotozoal drug
Treats
* Trichomoniasis
* Giardiasis
* Amebiasis
Benznidazole 9
- Other antiprotozoal drug
Treats
* Pediatric patients with Chagas (trypanosomiasis)
Pyrimethamine
- Other antiprotozoal drug
Treats
* Toxoplasmosis
Other Antiprotozoal Drugs
Mechanism of Action
Inhibit DNA synthesis in susceptible protozoa
Other Antiprotozoal Drugs
Adverse Effects
- Headache, dizziness, ataxia, peripheral neuropathies, loss of coordination
- Nausea, vomiting, unpleasant taste, diarrhea
Other Antiprotozoal Drugs
Contraindications
Absolute:
* Allergy
Cautions:
* CNS diseases: seizures, stroke, brain tumor
* Hepatic disease
* Pregnancy/lactation
Other Antiprotozoal Drugs
Drug Interactions
- Alcohol (within 3 days)
- Anticoagulants (within 8 days)
- Disulfiram (within 2 weeks)
Other Antiprotozoal Drugs
Assessment
History:
* Check for allergy, liver impairment, pregancy/lactation, CNS issues
Physical:
* CNS: reflexes and muscle strength
* Examine skin for lesions, color, temperature, and texture
Labs:
* Hepatic function tests
* Cultures to confirm parasite
Other Antiprotozoal Drugs
Nursing Diagnoses
- Impaired comfort (r/t GI and CNS effects)
- Malnutrition (r/t severe GI effects)
- Altered sensory perception (r/t CNS effects)
- Knowledge Deficit
Other Antiprotozoal Drugs
Implementation/Patient Teaching
- Arrange for culture and sensitivity tests before beginning therapy
- Administer a complete course of the drug
- Monitor hepatic function
- For CNS effects: side rails, assistance with ambulation, ready access to bathroom
- GI effects: small frequent meals, take with food
- Arrange for treatment of superinfections
- Monitor nutritional status
- Report impaired liver symptoms: yellowing, dark urine, pale stools, abdominal pain
