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PHARMACY PRACTICE II > MALARIA > Flashcards

MALARIA Flashcards

1
Q

Types of malaria

A

Symptomatic malaria
Complicated
Uncomplicated

Asymptomatic malaria

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2
Q

Three stages in the plasmodium life cycle

A

Mosquito stages (Sporogonic cycle)
Human Liver stages(Exo-eryhtrocytic cycle)
Human blood stages (Erythrocytic cycle)

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3
Q

Name for the dormant liver stage of the plasmodium parasite

A

Hypnozoite

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4
Q

Which plasmodium species have a dormant stage

A

P. vivax
P. ovale

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5
Q

Exo-erythrocytic cycle

A

Sporozoites from mosquito infect liver cells
Schizonts
Merozoites

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6
Q

What population of the world is at risk of malaria

A

4 billion ( almost half)

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7
Q

Erythrocytic stage

A

Merozoites from liver infects RBCs
Ring stage trophozoite
Trophozoite OR Gametocytes
Schizont
Merozoites

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8
Q

Sporogonic cycle

A

Micro and macrogamete ingested by mosquito
Ookinete
Oocyst
Sporozoites

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9
Q

pfEMP1

A

Plasmodium falciparum erythrocyte membrane protein 1

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10
Q

Location of pfEMP1

A

Present on plasmodium infected RBCs

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11
Q

Function of pfEMP1

A

Rosetting
Clumping
Microvascular adhesion

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11
Q

Rosetting

A

Replication and sticking of infected RBC to non-infected RBC

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11
Q

Clumping

A

interactions with platelets that can lead to clumping of infected RBCs invitro

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12
Q

Microvascular adhesion

A

Cytoadherence of infected RBCs to endothelial cells

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12
Q

Symptoms of severe malaria include

A

Respiratory distress
Convulsions
Posturing
Prostration
Hypoglycemia
Jaundice
Neurological sequelae
Metablic acidosis
Pulmonary edema
Renal failure
Bleeding/Clotting disturbances
CSF opening pressure

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12
Q

Symptoms of uncomplicated malaria

A

Fever
Vomiting
Diarrhoea
Abdominal discomfort
Difficulty breathing
Cough

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13
Q

Symptom of severe malaria very common in children

A

Convulsions

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13
Q

Pregnant women susceptible to severe malaria

A

1st & 2nd Pregnancies
2nd & 3rd trimesters

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14
Q

Comorbid conditions that increase risk for severe malaria

A

HIV/AIDS infection
Splenectomy

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14
Q

Risk groups for severe malaria

A

Children < five years
Pregnant women
Persons with Low/No immunity
Person with comorbid condition

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15
Q

Prevalence of sicke cell disease

A

15% of population

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15
Q

Prognostic indictators of life-threatening malaria in african children

A

Impaired consciousness
Respiratory distress
Hypoglycemia
Jaundice

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15
Q

Persons with low/ no immunity to malaria hence are at risk of severe malaria

A

Visitors from areas with little or no malaria

Returnees who pass more than 6 months in a non-endemic area and return to Ghana

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15
Q

Signs of jaundice in malaria

A

Serum bilirubin >50mcmol/l
MPS: >100000mc/L

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16
Q

MARF

A

Malaria Associated Renal Failure

16
Q

Diagnosis of MARF

A

Serum creatinine>265umol/L
Blood urea.20MMOL/L

Serum creatinine increased>1.5fold or rising >26.5umol/l within 48hours

16
Q

Prevalence of homozygous SSD

A

2.0% of the population

16
Q

Respiratory distress in severe malaria

A

Intercostal and subcostal recession
Increased respiratory rate
Grunting
Flaring Alae Nasi

16
Q

Pathogenesis of SSD

A

Splenic and hepatic sequestrations
Hypersplenism
Intravascular and extravascular hemolysis

17
Q

Flaring of the Alae nasi

A

Nasal flaring occurs when the nostrils widen while breathing

17
Q

Differential diagnosis of respiratory distress in malaria

A

Pneumonia
Acidosis
Fluid overload
Aspiration
ARDS

18
Q

Pathogenesis of heart failure in malaria

A

Anaemia
Lactic acidosis
Electrolyte imbalance

19
Q

Electrolyte imbalances in malaria

A

Sodium
Potassium
Chlorides
Bicarbonates

19
Q

Cerebral malaria

A
  1. Malaria parasetemia
  2. Unconsciousness BCS<3 /5 or GCS ,11/15
  3. No other cause of encephalopathy
19
Q

Clinical signs of cerebral malaria

A

Convulsions
Coma
Posturing
Bruxism
Increased tone
Increase refelxes
Cranial nerve palsy

20
Q

Differentials of cerebral malaria

A

Meningitis
Hepatic failure
Renal failure
Septicemia with metabolic imbalance
Endocrine causes

20
Q

Bruxism

A

excessive grinding of the teeth or clenching of the jaw

21
Q

Long term complications of severe malaria

A

Hearing loss
Visual impairment
Development regression

21
Q

Independent prognostic Indicators of death or poor prognostic indicators in severe malaria

A

pCRT
Coma
Acidosis
Respiratory distress

22
Q

Differentials for complicated malaria

A

Meningitis with encephalitis
Tonsillitis
Pharyngitis
Otitis media
Viral respiratory infection
Pneumonia
Typhoid fever
Measles

22
Q

Parasitological diagnosis of malaria

A

Microscopy
Rapid Diagnostic test (RDT)

22
Q

RDT can be positive up to ……… post parasite clearance.

A

4 weeks

23
Q

Sensitivity of thick and thin blood films

A

Thick»Thin films for detecting low-density

24
Q

Role of pCRT in malaria prognosis

A

prolonged Capillary Refill Time (>2sec) is an independent indicator of death in severe malaria

25
Q

Antimalarials for severe malaria

A

IV/IM Artesunate
IM Artemethre
IM Quinine

26
Q

Recommended medicine for severe malaria

A

IV/IM Artesunate

27
Q

Dose of IV Artesunate

A

Children 20kg: 3mg/kg/dose
Children and adults>20kg: 2.4mg/kg/dose

0,12 and 24hrs

28
Q

When is oral ACT started

A

4 hours after the last dose of IV Artesunate

29
Q

Maximum duration of parenteral artesunate

A

7 days

30
Q

Injection rate of IV artesunate

A

3-4 ml/minute

31
Q

Solutions for reconstituting artesunate

A

Normal saline
5%Dextrose

32
Q

Reconstituting of artesunate powder 60mg

A
  1. 5% NaHCO3 - 1ml
  2. N/S or D5W
    5ml for IV
    2ml for IM
33
Q

Concentration of artesunate for IV and IM

A

IV- 10mg/ml
Im-20mg/ml

34
Q

Dose for IM Artemether

A

3.2mg/kg loading dose
1.6mg/kg daily for 5 days

35
Q

Side effects of quinine

A

Cinchonism
Hearing loss
Nausea
Uneasiness/restlessness
Tremors
Blurring of vision.
Hypoglycaemia

36
Q

Cinchonism

A

ringing sounds in the ears -­‐ tinnitus

37
Q

How long should parenteral antimalarials be given

A

Minimum of 24 hours before switching to orals

38
Q

Oral antimalarials

A

Artemether lumefantrine
Artesunate amodiaquine
Dihydroartemisinin piperaquine

Quinine clindamycin (pregnancy)

39
Q

Oral dose of quinine

A

10mg/kg every 8 hours for 7 days. max;600mg/dose

40
Q

Oral ACT avoided in pregnancy

A

Dihydroartemisinin piperaquine

PHARMACY PRACTICE II (17 decks)

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