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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
MARF
Malaria Associated Renal Failure
16
Diagnosis of MARF
Serum creatinine>265umol/L Blood urea.20MMOL/L Serum creatinine increased>1.5fold or rising >26.5umol/l within 48hours
16
Prevalence of homozygous SSD
2.0% of the population
16
Respiratory distress in severe malaria
Intercostal and subcostal recession Increased respiratory rate Grunting Flaring Alae Nasi
16
Pathogenesis of SSD
Splenic and hepatic sequestrations Hypersplenism Intravascular and extravascular hemolysis
17
Flaring of the Alae nasi
Nasal flaring occurs when the nostrils widen while breathing
17
Differential diagnosis of respiratory distress in malaria
Pneumonia Acidosis Fluid overload Aspiration ARDS
18
Pathogenesis of heart failure in malaria
Anaemia Lactic acidosis Electrolyte imbalance
19
Electrolyte imbalances in malaria
Sodium Potassium Chlorides Bicarbonates
19
Cerebral malaria
1. Malaria parasetemia 2. Unconsciousness BCS<3 /5 or GCS ,11/15 3. No other cause of encephalopathy
19
Clinical signs of cerebral malaria
Convulsions Coma Posturing Bruxism Increased tone Increase refelxes Cranial nerve palsy
20
Differentials of cerebral malaria
Meningitis Hepatic failure Renal failure Septicemia with metabolic imbalance Endocrine causes
20
Bruxism
excessive grinding of the teeth or clenching of the jaw
21
Long term complications of severe malaria
Hearing loss Visual impairment Development regression
21
Independent prognostic Indicators of death or poor prognostic indicators in severe malaria
pCRT Coma Acidosis Respiratory distress
22
Differentials for complicated malaria
Meningitis with encephalitis Tonsillitis Pharyngitis Otitis media Viral respiratory infection Pneumonia Typhoid fever Measles
22
Parasitological diagnosis of malaria
Microscopy Rapid Diagnostic test (RDT)
22
RDT can be positive up to ......... post parasite clearance.
4 weeks
23
Sensitivity of thick and thin blood films
Thick>>Thin films for detecting low-density
24
Role of pCRT in malaria prognosis
prolonged Capillary Refill Time (>2sec) is an independent indicator of death in severe malaria
25
Antimalarials for severe malaria
IV/IM Artesunate IM Artemethre IM Quinine
26
Recommended medicine for severe malaria
IV/IM Artesunate
27
Dose of IV Artesunate
Children 20kg: 3mg/kg/dose Children and adults>20kg: 2.4mg/kg/dose 0,12 and 24hrs
28
When is oral ACT started
4 hours after the last dose of IV Artesunate
29
Maximum duration of parenteral artesunate
7 days
30
Injection rate of IV artesunate
3-4 ml/minute
31
Solutions for reconstituting artesunate
Normal saline 5%Dextrose
32
Reconstituting of artesunate powder 60mg
1. 5% NaHCO3 - 1ml 2. N/S or D5W 5ml for IV 2ml for IM
33
Concentration of artesunate for IV and IM
IV- 10mg/ml Im-20mg/ml
34
Dose for IM Artemether
3.2mg/kg loading dose 1.6mg/kg daily for 5 days
35
Side effects of quinine
Cinchonism Hearing loss Nausea Uneasiness/restlessness Tremors Blurring of vision. Hypoglycaemia
36
Cinchonism
ringing sounds in the ears -­‐ tinnitus
37
How long should parenteral antimalarials be given
Minimum of 24 hours before switching to orals
38
Oral antimalarials
Artemether lumefantrine Artesunate amodiaquine Dihydroartemisinin piperaquine Quinine clindamycin (pregnancy)
39
Oral dose of quinine
10mg/kg every 8 hours for 7 days. max;600mg/dose
40
Oral ACT avoided in pregnancy
Dihydroartemisinin piperaquine

PHARMACY PRACTICE II (17 decks)

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