Antimalarials Flashcards
Malaria is transmitted via the _____
Anopheles mosquito
Antimalarial chemoprophylaxis prevents the ___, not the ___
disease; infection
When considering prescribing antimalarials, what is your best resource for guidance?
CDC yellow book
When prescribing antimalarial chemoprophylaxis, what should you as the provider consider about your patient?
immune status, intensity/duration of exposure, parasite drug resistance, and resources for diagnosis and treatment
What are the antimalarial drugs that we have learned about so far?
Chloroquine, Atovoquone+proguanil, Quinine/Quinidine, Artemisinins, Mefloquine
Which medications are first line for malaria?
Chloroquine and Atovoquone+proguanil
Which medication is not for malaria, but is used second line for prevention of mild-moderate pneumocystitis jiroveci PNA in patients who do not tolerate TMP-SMX?
Atovoquone
Which antimalarial was originally derived from cinchona bark?
Quinine/Quinidine
What medication is a first line alternative for the treatment of malaria (CDC), or a first line medication according to WHO guidelines?
Artemisinins
What are the medications of the Artemisinins subclass for treatment of malaria?
Artemether/lumefantrine (Coartem), Artemether artesunate, Artemisinin combination therapy, Artesunate + amodiaquine/mefloquine/sulfadoxine-pyrimethamine
Chloroquine is considered to be (safe/not safe) for children/in pregnancy
safe
Potential ADRs of patients who take Chloroquine include
pruritus (in dark skinned people), NVD, abd pain, HA
Chloroquine has limited efficacy against ___ and is resistant to ___ from Oceania and South America
P. falciparum; P. vivax
Chloroquine does NOT work on ___ stages of malaria
liver
Atovoquone + proguanil’s works by inhibiting ____ and is effective against ___ intraerythocytic stages
DNA synthesis; asexual
Atovoquone + proguanil may increase rifampin levels, which are ___ inducers
P450
Potential ADRs that patients taking Atovoquone + proguanil may encounter include
NVD, abd pain, HA
Any special instructions we should give to patients who are about to start taking Atovoquone + proguanil?
Take with food
Atovoquone is not to be taken for malaria, and its MOA is not well known. What is the pregnancy category for this medication?
C
What are potential adverse drug reactions when taking Atovoquone?
NVD, HA, hypotension, rash
Quinine/Quinidine is effective against all 4 species of malaria, which are…
falciparum, vivax, malariae, ovale
Quinine/Quinidine can be used off label for ___
leg cramps
If therapeutic dose is exceeded in Quinine/Quinidine, ____ can occur.
long QT
What are potential ADRs of Quinine/Quinidine?
Cinchonism (neurologic sx), tinnitus, NV, HA, dysphoria,
Artemsinins are important in the treatment of malaria, as they act on the (early/late) parasite development stages. This medication is derived from the Chinese herb ___.
early; qinghaosu
Using Artemisinins (are/are not) recommended during pregnancy/in kids
are not
In animal studies, Artemisinins can cause ___.
neurological lesions
Artemisinins have not showed signs of resistance yet, but there can be high rates of ____ if used alone.
recrudescence
Mefloquine is used as prophylaxis and should be started ___ weeks before travel. This medication (is/is not) used in children and pregnant women.
2; is not
Potential ADRs when taking Mefloquine include
neuropsychiatric reactions, cardiac dysrhythmias, vomiting in children
There is some resistance to Mefloquine, limited to ____ (geographic area)
Southeast Asia
