Antimalarials

Question 1

Malaria is transmitted via the _____

Answer 1

Anopheles mosquito

Question 2

Antimalarial chemoprophylaxis prevents the ___, not the ___

Answer 2

disease; infection

Question 3

When considering prescribing antimalarials, what is your best resource for guidance?

Answer 3

CDC yellow book

Question 4

When prescribing antimalarial chemoprophylaxis, what should you as the provider consider about your patient?

Answer 4

immune status, intensity/duration of exposure, parasite drug resistance, and resources for diagnosis and treatment

Question 5

What are the antimalarial drugs that we have learned about so far?

Answer 5

Chloroquine, Atovoquone+proguanil, Quinine/Quinidine, Artemisinins, Mefloquine

Question 6

Which medications are first line for malaria?

Answer 6

Chloroquine and Atovoquone+proguanil

Question 7

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?

Answer 7

Atovoquone

Question 8

Which antimalarial was originally derived from cinchona bark?

Answer 8

Quinine/Quinidine

Question 9

What medication is a first line alternative for the treatment of malaria (CDC), or a first line medication according to WHO guidelines?

Answer 9

Artemisinins

Question 10

What are the medications of the Artemisinins subclass for treatment of malaria?

Answer 10

Artemether/lumefantrine (Coartem), Artemether artesunate, Artemisinin combination therapy, Artesunate + amodiaquine/mefloquine/sulfadoxine-pyrimethamine

Question 11

Chloroquine is considered to be (safe/not safe) for children/in pregnancy

Answer 11

safe

Question 12

Potential ADRs of patients who take Chloroquine include

Answer 12

pruritus (in dark skinned people), NVD, abd pain, HA

Question 13

Chloroquine has limited efficacy against ___ and is resistant to ___ from Oceania and South America

Answer 13

P. falciparum; P. vivax

Question 14

Chloroquine does NOT work on ___ stages of malaria

Answer 14

liver

Question 15

Atovoquone + proguanil’s works by inhibiting ____ and is effective against ___ intraerythocytic stages

Answer 15

DNA synthesis; asexual

Question 16

Atovoquone + proguanil may increase rifampin levels, which are ___ inducers

Answer 16

P450

Question 17

Potential ADRs that patients taking Atovoquone + proguanil may encounter include

Answer 17

NVD, abd pain, HA

Question 18

Any special instructions we should give to patients who are about to start taking Atovoquone + proguanil?

Answer 18

Take with food

Question 19

Atovoquone is not to be taken for malaria, and its MOA is not well known. What is the pregnancy category for this medication?

Answer 19

C

Question 20

What are potential adverse drug reactions when taking Atovoquone?

Answer 20

NVD, HA, hypotension, rash

Question 21

Quinine/Quinidine is effective against all 4 species of malaria, which are…

Answer 21

falciparum, vivax, malariae, ovale

Question 22

Quinine/Quinidine can be used off label for ___

Answer 22

leg cramps

Question 23

If therapeutic dose is exceeded in Quinine/Quinidine, ____ can occur.

Answer 23

long QT

Question 24

What are potential ADRs of Quinine/Quinidine?

Answer 24

Cinchonism (neurologic sx), tinnitus, NV, HA, dysphoria,

Question 25

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 ___.

Answer 25

early; qinghaosu

Question 26

Using Artemisinins (are/are not) recommended during pregnancy/in kids

Answer 26

are not

Question 27

In animal studies, Artemisinins can cause ___.

Answer 27

neurological lesions

Question 28

Artemisinins have not showed signs of resistance yet, but there can be high rates of ____ if used alone.

Answer 28

recrudescence

Question 29

Mefloquine is used as prophylaxis and should be started ___ weeks before travel. This medication (is/is not) used in children and pregnant women.

Answer 29

2; is not

Question 30

Potential ADRs when taking Mefloquine include

Answer 30

neuropsychiatric reactions, cardiac dysrhythmias, vomiting in children

Question 31

There is some resistance to Mefloquine, limited to ____ (geographic area)

Answer 31

Southeast Asia