Drugs For Malaria, Schistosoma, And Filaria

Question 1

T or F: All episodes of malaria should be treated with only one effective antimalarial medicine.

Answer 1

F. At least two.

Question 2

No antimalarial drug kills sporozoite

Answer 2

True

Question 3

Group 1 antimalarial drugs? MOA?

Answer 3

Artemisinin
Chloroquine
Mefloquine
Quinine
Quinidine
Pyrimethamine
Sulfadoxine
Tetracycline

MOA: against asexual blood stages
Use: for symptomatic malaria

Question 4

Group 2 antimalaria?

Answer 4

Atovaquone
Proguanil

MOA: targets asexual erythrocytic forms and primary liver stages of P. Falciparum

Shortens required period for post-exposure chemoprophylaxis

Question 5

Group 3?

Answer 5

Primaquine

Against primary, latent liver stages and gametocytes

Against hypnozoites

Question 6

Role of quinine and precautions?

Answer 6

MOA: not clearly understood, involve in inhibition of heme detox inside food vacuole

Kills ring and trophozoite
Gametocidal against malariae, vivax and ovale

Tx for uncomplicated malaria (oral) and severe (parenteral)

Precaution: narrow therapeutic range

Question 7

Artemisinin-based combinaion therapy

Answer 7

Artemisinin: clears parasite from blood

Longer-acting antimalaria: protetction against devt of resistance

1. Artemether + Lumefantrine
2. Artesunate + amiodiaquine
3. Artesunatte + mefloquine
4. Artesunate + SP
5. Dihydroartremisinin + piperaquine

Question 8

Monitoring response to antimalarial tx

Answer 8

• daily blood film microscopy until end of admin of 1st line of drugs
• weekly until 28th day after start of tx

Question 9

When to consider 2nd line anti-malarial?

Answer 9

When asexual forms are detected during monitoring period

Question 10

1st line drugs for P. Falciparum? 2nd line?

Answer 10

1st:

• Quinine + Clindamycin (infants)
• Artemether-Lumefantrine + pimaquine (children and adults)

2nd:

• quinine sulfate + clindamycin
• tetracycline/doxycycline + primaquine

Duration: 3 days (<6 months = 7 days)

Question 11

Severe P. Falciparum

1st line?

Answer 11

1st linne
Children: artenusate IV or IM dissolved in NaHCO3
Adult: artenusate IV or IM
Artemether-Lumefantrine and primaquine (oral)

Question 12

1st line drugd for uncomplicated p. Vivax and p. Ovale? 2nd?

Answer 12

1st: Chloroquine +Primaquine
2nd: Artemether-Lumefantrine + primaquine

Duration: 14 dys

Precutions: do NOT give primaquine to px with G6PD def

Question 13

Drugs for relapse of vivax and ovale

Answer 13

-Chloroquine/Artemether-Lumefantrine + primaquine

Shift to artemether-lumefantrine if RECURRENCE occus within 28 days of tx with chloroquine

Question 14

Preferred regimen for filariasis

Answer 14

Day 1: Diethylcarbamazine (DEC) 6 mg/kg in 3 divided doses (after meals) PLUS Albendazole 400 mg

Day 2-12: DEC 6 mg/kg in 3 divided doses

Question 15

Preferred regimen for schistosomiasis

Answer 15

Praziquantel 40 mg/kg/dy in 2-3 divided doses for 1 day (given on a full stomach)

Follow up done 1 month later

Question 16

ADR of Praziquantel

Answer 16

Headache, dizziness, abdominal discomfort

Question 17

Indications for hospital referral (schistosomiasis)

Answer 17

(+) complications:

• periportal fibrosis
• Splenomegaly
• portosystemic collateral BV
• cor pulmonale
• glomeruloneph

(+) CNS schistosomiasis