Anti Malarials

Question 0

Quinolines and related cmpds ( 3)

Answer 0

Quinine
Chloroquine
Primaquine

Question 1

Artemesins (2)

Answer 1

Artemether

ACT with lumefantrine

Question 2

Adjunctive with quinolines

Answer 2

Doxycycline
Clindamycin
Atovaquone-proguanil

Question 3

Artemesins work against

Answer 3

P. Falcifarum

Asexual blood stages of p. Vivax

Question 4

Artemisinins’ anti malarial activity attributed to:

Answer 4

Endoperoxide moiety

Question 5

Artemisinins are not useful as prophylaxis (or mono therapy) due to

Answer 5

Short t 1/2

Question 6

ACT (artemisinin based combo therapy) increases ___ and decreases ___

Answer 6

Efficacy

Resistance

Question 7

Eg of ACT

Answer 7

Artemether-lumefantrine

Question 8

ACT has drug-drug interactions with

Answer 8

Antiretrovirals/ protease inhibitors

May need to increase ACT dose

Question 9

Artesunate provided by CDC only for

Answer 9

Pts with severe malaria dz, high level of malaria parasites in blood, inability to take oral meds, lack of access to IV quinidine, quinidine failure or contraindications

Question 10

Quinine indications

Answer 10

• Chloroquine-R and MDR p. Falciform asexual blood stages

- gametocyte- cidal against p. Vivas and p. Ovale

Question 11

Quinine interferes with ____ digestion

Answer 11

Heme

Question 12

Quinine resistance in SE Asia and SA due to

Answer 12

Pfmdr1 gene amplification

Question 13

Quinine adult fatal oral dose

Answer 13

2-8mg

Question 14

Quinine toxicities

Answer 14

Generally well-tolerated

-cinchonism, tinnitus, deafness, visual disturbance, HA, NVD, flushing

Question 15

Quinidine SE w/ G6PD deficiency

Answer 15

Hemolysis

Question 16

Quinidine CI and drug interactions

Answer 16

• hypersensitivity
• hemolysis
• tinnitus, optic neuritis
• caution w/ cardiac dysrythmias
• aluminum antacids delay GI abs
• increases warfarin and dig levels
• decrease dose for renal dz

Question 17

Quinine adjunctive therapies

Answer 17

Doxy, tetracycline, Clindamycin inhibit protein translation (kill progeny)

Question 18

Chloroquine can be given ____. IM/IV/SC can be given with caution!

Answer 18

Oral

Question 19

Chloroquine resistance associated w/

Answer 19

Pfcrt mutation

Question 20

Chloroquine adverse effects

Answer 20

CV, CNS, pruritis, hemolysis with G6PD deficiency

Question 21

Primaquine indications

Answer 21

• Acts on primary and latent hepatic stages of plasmodia

- effective against relapse of p vivax and p ovale

Question 22

Primaquine adverse effects

Answer 22

• hemolysis (MUST screen for g6pd deficiency)
• hypoTN with parenteral routes
• CI in pregnancy
• must r/o g6pd for breast feeding infants

Question 23

Primaquine mechanism

Answer 23

Electrophilic intermediates/ redox rxn

Question 24

Atovaquone active against

Answer 24

P falciform blood and LIVER stages

Question 25

Atovaquone mechanism

Answer 25

Inhibits electron transport

Question 26

Atovaquone has high cure rates when combined with

Answer 26

Proguanil

Question 27

Malaria prophylaxis

Answer 27

Atovaquone plus proguanil

Question 28

Activations adverse effects

Answer 28

Decreased levels with rifampin/ tetracycline

Question 29

Proguanil mechanism

Answer 29

Inhibits dihydrofolate reductase

Question 30

Drugs that can target liver stage

Answer 30

• Atovaquone plus proguanil

- primaquine