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PR - INFECTIONS > MALARIA > Flashcards

MALARIA Flashcards

1
Q

Bite protection

A
  • Mosquito nets impregnated with permethrin

  • Diethyltoluamide (DEET) 20-50% (50% lasts longer protection)
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2
Q

DEET

A

o Suitable for anyone over 2 months old

o Avoid ingestion - was hands before eating

o Suitable for pregnancy and breastfeeding (wash breast before feeding)

o Apply DEET after sunscreen
 DEET reduces SPF of sunscreen - use high SPF lotion

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3
Q

DEET and pregnancy

A

Suitable for pregnancy and breastfeeding (wash breast before feeding)


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4
Q

DEET and sunscreen

A

DEET reduces SPF of sunscreen - use high SPF lotion

DEET after sunscreen

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5
Q

Prophylaxis treatment

A

Malarone
Chloroquine
Proguanil
Mefloquine
Doxycycline

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6
Q

Malarone

A

1-2 days before travel
1 daily
1 week after travel
Max use: 1 year

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7
Q

Chloroquine

A

1 week before travel
1 weekly
4 weeks after travel
long term

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8
Q

proguanil

A

1 week before travel
1 daily
4 weeks after travel
long term

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9
Q

mefloquine

A

2-3 weeks before travel
1 weekly
4 weeks after travel
Max use: 1 year

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10
Q

Doxycycline

A

1-2 days before travel
1 daily
4 weeks after travel
max use: 2 yrs

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11
Q

prophylaxis should be continued for 4 weeks after leaving the area, except for the following which should be stopped one week after leaving

A

atovaquone with proguanil hydrochloride

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12
Q

Illness occurring within 1 year, especially 3 months of return

A

might still be malaria – see doctor early, mentioning malaria

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13
Q

Proguanil in pregnancy

A

can no longer be used in malaria prophylaxis in pregnant patients. Only chloroquine now licenced

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14
Q

Pregnancy

A
  • Avoid traveling to malarious regions
  • Chloroquine can be given - avoid other medications

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15
Q

Folic acid and antimalarials

A

give folic acid (dosed as a pregnancy at high risk of neural tube defects) for the length of time that it is used during pregnancy
5mg OD

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16
Q

if a pregnant woman is travelling to high risk areas or there is resistance to other drugs, consider this drug in the 2nd and 3rd trimesters. it can be used in 1st trimester with caution if benefits outweigh risks.

A

mefloquine

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17
Q

use of doxycycline for prophylaxis during pregnancy

A

doxy is CI in pregnancy
however it can be used for malaria prophylaxis if other regimens are unsuitable, and if the entire course of doxy can be completed before 15 weeks gestation

18
Q

doxycycline is contraindicated in pregnancy however it can be used for malaria prophylaxis if other regimens are unsuitable, and if the entire course can be completed before ….

A

before 15 weeks gestation

19
Q

this combination should be avoided during pregnancy however it can be used during 2nd and 3rd trimester if no suitable alternative. you will also need to give folate supplementation during the length of time it is used during pregnancy (using 5mg which is the dose for pregnancy at high risk of neural tube defects)

A

Atovaquone with proguanil hydrochloride

20
Q

Asplenia

A

Asplenic patients are at risk of severe malaria

21
Q

Epilepsy

A

Avoid chloroquine and mefloquine – reduces seizure threshold

22
Q

a patient is enquiring about malaria tablets before she goes on a trip with her family. she mentions that her daughter is on a lot of medications for epilepsy. you cannot use chloroquine and mefloquine in patients with a history of epilepsy. what are the alternatives?

A

doxycycline (but this can interact with some antiepiletpics and its dose may need adjustment)
atovaquone with proguanil

23
Q

doxycycline can be used for malaria prophylaxis in pt with history of epilepsy. however, it interacts with some anti epileptics and its dose may need adjustment. name and explain some interactions

A

inducers:carbamazepine, phenytoin, barbiturates

these drugs DECREASE the concentration of doxycycline. adjust dose of doxy

24
Q

Warfarin

A
  • Begin treatment 2-3 weeks before departure
  • INR should be stable before departure
  • Measure INR before antimalarials, 7 days after starting and after completing course
  • Prolonged stay – check INR regularly
25
Q

travellers taking warfarin need to begin malaria chemoprophylaxis ….. before departure and their INR needs to be stable before departure

A

2-3 week before departure

26
Q

when should warfarin INR be measured for pt taking chemoprophylaxis?

A

before starting chemoprophylaxis
7 days after starting
after completing course

27
Q

Mefloquine caution

A
  • History of psychiatric disorders - if these develop = STOP and seek medical
  • attention
  • History of convulsions
  • Reduces seizure threshold
28
Q

Chloroquine side effects

A
  • History of convulsions
  • Can be retinotoxic – eye symptoms
  • ototoxicity
29
Q

Proguanil cautions

A
  • Renal Impairment - reduce dose
30
Q

Doxycycline cautions

A

Avoid exposure to sunlight
Not for under 12

31
Q
A
32
Q

Standby treatment

A
  • Travellers visiting remote areas should carry standby emergency treatment if they are likely to be more than 24 hours away from medical care.
  • Self-medication should be avoided if medical help is accessible.
  • Self-treat if medical help is not available within 24 hours of fever onset.
33
Q

in order to use standby emergency treatment appropriately, the traveller should be provided with

A

Travellers should be provided with written instructions:
Seek urgent medical attention if fever (38°C +) develops 7+ days after arriving in a malarious area

34
Q

should you use the same drug that was used for chemoprophylaxis for emergency standby treatment

A

A drug used for chemoprophylaxis should not be considered for standby treatment for the same traveller due to concerns over drug resistance and to minimise drug toxicity.

35
Q

A patient wants some malaria tablets before he goes away next week. you look at his PMR and see that he is taking takes azithromycin for lyme disease (500mg OD for 17 days). from this information which anti-malarial would you ideally want to avoid and why?

A

ideally avoid chloroquine because A + C = increased risk of CV events including angina, chest pain and HF and mortality.

36
Q

chloroquine is associated with ocular toxicity. this is unlikely if the dose of chloroquine phosphate does not exceed ….

A

4mg/kg daily

37
Q

chloroquine is …toxic so there is increased risk of …toxicity with drugs e.g.

A

ototoxic
ototoxicity risk with loop diuretics, aminoglycosides, vincristine vinblastine etc

38
Q

important side effect of mefloquine and which patients it is contraindicated in

A

potentially serious neuropsychiatric reactions
common: abnormal dreams, insomnia, anxiety, depression
psychiatric symptoms should be regarded as potentially prodromal for a more serious event
adverse reactions may occur and persist up to several months after discontinuation due to Long half life
avoid for prophylaxis if Hx psychiatric disorders (including depression) or convulsions

39
Q

a patient needs some anti malarial tabs for prophylaxis. she takes sertraline 100mg daily. she is contraindicated for this drug because…

A

mefloquine contraindicated for prophylaxis if Hx psychotic disorders including depression
it is associated with potentially serious neuropsychiatric reactions
long half life so can persist up to several months after discontinuation

40
Q

mefloquine - family of quinine so it has this important interaction with drugs

A

increased risk of QT prolongation with amiodarone, antipsychotics, dronedarone, fluconazole, erythromycin, methadone, etc

41
Q

a patient is taking atovaquone with proguanil for prophylaxis of malaria. they develop diarrhoea and vomitting. what does this mean.

A

caution in diarrhoea or vomiting as reduced absorption

PR - INFECTIONS (39 decks)

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