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PCM Exam 3 > Antimalarial Drugs > Flashcards

Antimalarial Drugs Flashcards

1
Q

SE Asia is known for being resistant to _____; what would you give in treating uncomplicated malaria in that area

A

mefloquine + artesunate

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2
Q

what re some AE of chloroquine?

A
  • causes oxidative stress on RBC’s so check if the patient has G6PD deficiency
  • pruritus (africans)
  • nausea, vomiting, abdominal pain etc

generally well tolerated

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3
Q

what are the symptoms of malarial paroxysm?

A

fever, anemia, jaundice, splenomegaly, hepatomegaly and these are associated with lysis of the RBC by the pathogen

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4
Q

which drugs are given for severe malaria caused by P. falciparum?

A
  • quinine/quinidine

- artemisinin

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5
Q

during what trimester is quinidine given to treat severe malaria in pregnant patients

A

1st trimester

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6
Q

can you give pregnant patients quinine/quinidine?

A

it is a category C drug so only give if the benefits outweigh the risks

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7
Q

what are the symptoms of cinchonism and what drugs can cause this AE

A
  • tinnitus (ringing in the ear), headache, nausea, dizziness, flushing and visual disturbances
  • quinine/quinidine
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8
Q

______ is an antimalarial drug that is teratogenic

A

halofantrine; do not give it with mefloquine

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9
Q

what is the MOA of artemisinin

A

binds to iron to break down peroxide bridges → generation of free radicals that damage parasite proteins

clears the parasites the fastest and can also destroy the gametocytes

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10
Q

how does primaquine exacerbate G6PD and lead to ↑ hemolysis

A
  • primaquine oxidizes GSH back to GSSG

G6PD produces more NADPH from NADP and the resultant NADPH is used to reduce GSSG to GSH. GSH is then used to neutralize toxic compounds
G6PD deficiency has ↓ G6PD and thus ↓ GSH; primaquine will ↓ GSH even more

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11
Q

is the combination of proguanil and pyrimethamine safe for use in pregnancy?

A

YES but not the first drug to be used

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12
Q

P. falciparum’s resistance to chloroquine is due to ______

A

mutation in the putative transporter PfCRT (plasmodium falciparum chloroquine resistance transporter)

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13
Q

a patient with malaria is given chloroquine but is ineffective. what is the MOA of the next drug that you would prescribe

A
  • destruction of asexual blood forms
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14
Q

pharmacological therapy for treating malaria would be guided by what 3 main factors?

A
  1. what Plasmodium species is responsible: if it vivax/ovale, then have to also kill the hypnozoites
  2. clinical status of the patients: complicated or uncomplicated malaria
  3. drug susceptibility of the infecting parasites
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15
Q

malaria caused by ______ can result in cerebral malaria

A

P. falciparum; irritability → seizures → coma

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16
Q

can chloroquine be used for treatment of malaria in young kids and pregnant patients?

A

YES

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17
Q

a patient complains of photosensitivity and has discoloration and hypoplasia of their teeth. What drug can cause these AE’s?

A

doxycycline

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18
Q

sulfadoxine inhibits folate synthesis by ________

A

↓ the activity of dihydropteroate synthase

sulfonamides directly complete with PABA (p-aminobenzoic acid) for binding with dihydropteroate synthase → ↑ PABA

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19
Q

what is the DOC for treatment AND prophylaxis of all P. vivax and P. ovale malaria infections

A

Chloroquine (use has been recently compromised by drug resistance)

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20
Q

when is primaquine contraindicated?

A

pregnant patients;

wait until after delivery to give them primaquine because the fetus has low levels of G6PD

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21
Q

what drug would you give to pregnant patient with chloroquine resistant P. vivax

A

mefloquine

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22
Q

_______ can cause hypoglycemia by stimulating insulin release

A

quinine/quinidine

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23
Q

metabolites of _____ have less antimalarial activity but more potential for hemolysis

A

primaquine; hemolysis or methemoglobin in G6PD deficient patients

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24
Q

what is the drug regiment in pregnant patients with severe malaria?

A
  • 1st option: aretsunate

- 2nd option: artemether

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25
Q

what symptoms help classify malaria as complicated

A
  • impaired consciousness, severe anemia, renal failure, pulmonary derma, ARDS, shock, DIC, acidosis, hemoglobinuria
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26
Q

what drug is give for prophylaxis against chloroquine resistant malaria

A
  • mefloquine, doxycycline, or primaquine

same method for pregnant patients but DONT GIVE DOXYCYCLINE

27
Q

________ drug for malaria works by disrupting the parasites replication and transcription

A

quinine/quinidine

28
Q

Malrone is given for ______

A

treatment and prophylaxis of P. falciparum

29
Q

what drugs are used to treat chloroquine resistant P. falciparum

A
  1. atorvaquone + proguanil (malarone)
  2. artemether-lumefantrine
  3. quinine + doxycycline
  4. mefloquine
30
Q

hyper/hypoglycemia is seen in malaria caused by P. falciparum

A

HYPOglycemia

31
Q

________ is the only drug that can treat the liver form (hypnozoites) of the parasite

A

primaquine; can also be used for chemoprophylaxis for all strains

32
Q

when would you give quinine/quinidine

A

quinine: oral form given for uncomplicated malaria caused by P. falciparum
quinidine: IV form given for severe malaria caused by P. falciparum

33
Q

what are 3 drugs that are folate synthesis inhibitors that can be used to treat malaria?

A
  • pyrimethamine
  • proguanil
  • sulfadoxine

used in combination

34
Q

_______ can be used as an alternative to doxycline in malaria

A

clindamycin

35
Q

what are some AE of quinine/quinidine

A
  • cinchonism
  • HS: rash, urticaria, bronchospasm, angioedema
  • hematological abnormalities: leukopenia, agranulocytosis, thrombocytopenia
  • hypoglycemia: due to stimulation of insulin release
  • induce uterine contractions
  • severe hypotension
  • QT prolongation
  • black water fever (acute renal failure): severe hemolysis and hemoglobinuria
36
Q

______ is one of the first line agents for severe falciparum disease

A

quindine (quinine is the oral form and quinidine is the IV form and in cases of severe disease, want to give the IV form)

37
Q

when would you give mefloquine?

A
  • as a chemoprophylaxis because it is effective against P. falciparum and P. vivax
  • treatment for mild to moderate malaria caused by P. falciparum and P. vivax
38
Q

pyrimethamine + proguanil inhibit folate synthesis by inhibiting ________

A

dihydrofolate reductase causing an ↑ in dihydrofolic acid

39
Q

which drug has the unique ability to reduce the ability of the mosquito to spread malaria

A

artemisinin because they can also destroy the gametocytes which are taken up by the mosquito again and then infects other people

40
Q

what is the MOA of malarone

A

it is a combination of atovaquone and proguanil (inhibits folate synthesis)

disrupts the mitochondrial electron transport

41
Q

_______ the preferred chemoprophylactic agent in areas without resistant falciparum malaria

A

chloroquine

42
Q

resistance to quinine can sometimes have some resistance to _______

A

mefloquine (they have similar chemical comp);

no mefloquine resistance in those resistant to chloroquine

43
Q

what kind of pathogens is aztreonam used for?

A

gram negative rods

44
Q

_________ is an antimalarial that can increase the plasma levels of warfarin and digoxin

A

quinine/quinidine

45
Q

what are some clinical applications of drugs that are folate synthesis inhibitors

A
  • chemoprophylaxis
  • intermittent preventative therapy in high risk patients regardless of infection status
  • treatment of chloroquine resistant falciparum malaria: w/ pyrimethamine + sulfadoxine but DO NOT USE FOR SEVERE MALARIA
46
Q

in treating SEVERE malaria in pregnant patients, the drugs that are used depends on what trimester the patient is in.
what is given in the 1st trimester?

A

quinidine / artesunate

only give quinidine in the 1st trimester because it can cause uterine contraction so can’t give it later

47
Q

a patient has infection by P. ovale and you want to treat the dormant hypnozoites in the liver. Before prescribing ______ what would you do first?

A

DOC: primaquine but because it can cause severe hemolysis in G6PD deficient patients, must test for G6PD deficiency first

48
Q

psychiatric symptoms such as ________ is an AE of what antimalarial drug?

A

anxiety, depression, hallucinations;

seen as an AE of mefloquine so dont give mefloquine to people with psychiatric disorders

49
Q

what is the MOA of quinine and quinidine?

A
  • ↓ O2 uptake and carbohydrate metabolism

- intercalates into DNA and disports parasites replication and transcription

50
Q

what is the MOA of chloroquine

A

concentrates in the parasite food vacuoles and prevents the plasmodium ability of biocrystallization of Hb breakdown production heme to non toxic hemozoin

parasite ingests host cells Hb for nutrients and the toxic byproduct, heme, is then polymerized to hemozoin by the parasite and stored in the parasites food vacuole

51
Q

what is the only medication that is recommended for chemoprophylaxis in pregnant women in chloroquine resistant areas

A

mefloquine

52
Q

when would you give chloroquine?

A
  • anti malarial DOC for non falciparum and sensitive uncomplicated malaria
  • DOC to treat P. vivax and P. ovale infection
53
Q

what do you give to treat severe malaria that can be caused by all species of plasmodium?

A
  • quinidine + doxycycline
    OR
  • artesunate
54
Q

quinine/quinidine should not be used concurrently with ______

A

mefloquine because they both have similar chemical compositions

55
Q

_____ and _____ species of plasmodium have different resistance patterns to drugs in different geographic areas

A

P. vivax and P. falciparum

56
Q

what kind of patients is chloroquine contraindicated with?

A
  • patients with psoriasis or porphyria

- retinal/visual field abnormalities

57
Q

describe the use of doxycycline in treating malaria

A

it is NOT active against the liver stage but is active against the erythrocytic schizonts of all malaria parasites

it is used to complete treatment of severe p. falciparum and thus is usually given after treatment with quinine/quinidine/artesunate

58
Q

what drug would you give to chloroquine resistant strains of plasmodium?

A

mefloquine

59
Q

in addition to P. falciparum, what other species tends to show chloroquine resistance?
how would you treat these resistant strains?

A
  • P. vivax
    1. quinine + doxycycline + primaquine
    2. malarone + primaquine
    3. mefloquine + primaquine
60
Q

what drugs would you give to a pregnant patient with chloroquine resistant P. falciparum?

A
  1. mefloquine

2. quinine + clindamycine (usually given with doxycycline but you cant give doxycycline to pregnant patients)

61
Q

______ is a drug that prevents the polymerization heme to non toxic form hemozoin

A

chloroquine

62
Q

a patient is traveling to SE Asia, when prescribing antimalarial drugs, which would you AVOID because of known resistance to it in that area

A

quinine/quinidine because that area is common for resistance to them

63
Q

QT prolongation is an AE of what antimalarial drug

A

quinine/quinidine

PCM Exam 3 (32 decks)

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