Malaria Flashcards
How is malaria transmitted
female anopheles mosquito
What is the infectious agent of malaria
plasmodium falciparum
-protozoan parasite
Name 2 4-aminoquinolines
chloroquine
amodiaquine
MOA of 4 aminoquinolines
inhibit DNA & RNA polymerase
Internal pH changes
Nucleoprotein synthesis interference
When are 4 aminoquinolines utilized?
Active malaria, and prophylaxis
ADRs of 4-aminoquinolines
HA, dizzy, GI
Pruritus- transient, unresponsive
Drug interactions for 4-aminoquinolines
CYP2D6 and CYP3A4
Inducers will decrease blood levels of chloroquine
Inhibitors will increase blood levels of chloroquine
Dose a prophylactic dose for a 4-aminoquinolines
Chloroquine 500mg
once a week always on the same day
(want to start 1-2 weeks pre-trip, continue 4 weeks once home)
Name 2 4-methanolquinolines
Quinine Sulfate (not used anymore) Mefloquine
MOA of 4-methanolquinolines
Depress oxygen uptake & carbohydrate metabolism
Disrupt replication & transcription
What are 4-methanolquinolines used for
active and prophylaxis
ADRs of 4-methanolquinolines
Cardiovascular- qtc prolong, ECG changes
CNS- szs may increase pre-exist condition
Neuropsych warnings
Misc- rash, tinnitus, anorexia
Drug-drug interactions of 4-methanolquinolines
CYP3A4 substrate (major)
Inhibits 2D6, 3A4
P-glycoprotein weakly
Dose a 4-methanolquinolines for prophylaxis
Mefloquine 250mg
once a week
Name 2 8-aminoquinolines
Primaquine
Lumefantrine
Halofantrine
MOA of 8-aminoquinolines
Questionable
-disrupts mitochondria and binds to DNA
8-aminoquinolines can be used to tx
Active and prophylaxis
What screening should be done before using 8-aminoquinolines
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- watch for sxs hemolytic anemia
ADRs of Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Rare cardiac arrhythmias Headache Pruritus Abdominal cramps, nausea, vomiting Ocular Visual accommodation disturbances
Dose a 8-aminoquinolines
Primaquiine 30mg
once daily for 14 days
Name an anti-folate
sulfadoxine/pyrimethamine
atovaquone/proguanil
MOA of anti-folates
blockade of mitochondrial transport chain
Dihydrofolate reductase inhibition
Anti-folates and renal therapy
Don’t do prophylactic tx if <30ml/min
can use to treat active but with extreme caution and good benefit to risk ration
ADRs of anti-folates
Gi- abd pain, n/v
Hepatic- elevated LFTs
CNS- dizzy HA
Neuromuscular- weakness
Dose an anti-folate
Malarone 250/100
One tablet daily starting 1-2 days before entering malaria-endemic area
Name an antimicrobial used to tx Malaria
Tetracycline
Doxycycline
Clindamycin
Dose an antimicrobial to prevent Malaria
Doxycycline 100mg
1 tab daily starting 1-2 days prior to travel to malaria-endemic area
Name two artemisinin derivatives
Artemether
Arteether
Artesunate
MOA of artemisinin derivatives
Schizontocides
- inhibits calcium ATP
- generates free radicals
Artemisinin derivatives can be used for
active malaria
Couse or therapy for artemisinins is
no less than 5-7 days to prevent recurrent parasitemia
ADRs or artemisinins include
generally mild, low incidence
transient neurological sym
-nystagmus
-balance disruptions
Drug interactions of artemisinins
CYP3A4 and 2D6
3A4 inducer to reduce effects of other drugs
2D6 inhibitor to increase effects of other drugs
Dose an artemisinin
Coartem™
Four (4) tablets now and 8 hours later on Day 1, 4 tablets twice a day on Day 2 and Day 3
MC intestinal protozoal infection in U.S.
Giardiasis
How is trichomoniasis transmitted
STD
Common sources of toxoplasmosis include
undercooked meats with tissue cysts
vegetables contaminated w/ soil containing oocytes
cats
How is cryptosporidiosis transmitted
Infected fecal material via human-to-human contact or through contaminated water
“sleeping sickness” is
Trypanosomiasis
Infectious vector for trypanosomiasis
tsetse fly
“assassin/kissing bugs”- Chagas Disease
Drug choice for amoeba for mild to severe intestinal, hepatic abscesses, ameboma, and extraintestinal disease
Metronidazole (Flagyl)
MOA of metronidazole
interacts with DNA; loss of helical structure
ADRs of metronidazole
possible carcinogenesis
alcohol interaction?
When would metronidazole need to be dose adjusted?
severe liver impairment
MOA of paromomycin
interferes w/bacterial protein synthesis by binding to 30s ribosomal subunits
Drug of choice for E. histolytica
Paromomycin
ADRs of Iodoquinol
Myelo-optic neuropathy
Peripheral neuropathy
Dose dependent
