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Malaria Flashcards

1
Q
A
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2
Q

What population accounts for the majority of malaria deaths?

A

Children under 5 in the African region.

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3
Q

What are key risk factors for malaria?

A

Young children, pregnant women, travelers/migrants from non-endemic regions.

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4
Q

What are signs and symptoms of malaria?

A

Fever, chills, headache, GI upset, myalgia, weakness, confusion.

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5
Q

What are key lab findings in malaria?

A

Anemia, thrombocytopenia, hyponatremia, increased creatinine, hypoglycemia.

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6
Q

What is the gold standard diagnostic test for malaria?

A

Giemsa-stained thick and thin blood smears.

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7
Q

What is the purpose of a thick smear in malaria diagnosis?

A

To estimate parasite density.

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8
Q

What is the purpose of a thin smear in malaria diagnosis?

A

To identify the Plasmodium species.

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9
Q

How often should smears be checked to rule out malaria?

A

Every 12–24 hours x3.

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10
Q

Which Plasmodium species can cause severe malaria?

A

P. falciparum and P. knowlesi.

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11
Q

Which TB species can relapse due to liver hypnozoites?

A

P. vivax and P. ovale.

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12
Q

What defines severe malaria?

A

≥1: coma, Hb < 7 g/dL, AKI, ARDS, shock, acidosis, DIC, parasite density ≥ 5%.

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13
Q

What are key mosquito avoidance strategies?

A

Bed nets, indoor spraying, air-conditioned rooms, repellents like DEET.

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14
Q

Which malaria vaccines are available?

A

RTS,S/AS01 and R21/Matrix-M.

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15
Q

What is the indication for malaria vaccine?

A

Children in regions with moderate to high P. falciparum transmission.

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16
Q

What are first-line malaria prophylaxis options for all endemic regions?

A

Atovaquone-proguanil, doxycycline, tafenoquine.

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17
Q

Which prophylaxis can be used in chloroquine-sensitive regions?

A

Chloroquine, hydroxychloroquine.

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18
Q

Which prophylaxis is preferred in P. vivax-dominant regions?

A

Primaquine.

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19
Q

Which prophylaxis is weekly and pregnancy-safe?

A

Mefloquine.

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20
Q

Which prophylactic drug requires G6PD testing?

A

Primaquine and tafenoquine.

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21
Q

What is first-line for uncomplicated malaria in chloroquine-resistant regions?

A

Artemether-lumefantrine.

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22
Q

What is an alternative for chloroquine-resistant regions?

A

Atovaquone-proguanil or quinine + doxy/tetra/clinda.

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23
Q

What is first-line in chloroquine-sensitive areas?

A

Chloroquine or hydroxychloroquine.

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24
Q

What is added to treatment for P. vivax/ovale?

A

Anti-relapse therapy: primaquine or tafenoquine.

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25
What is the first-line treatment for severe malaria?
IV artesunate.
26
What oral regimens can follow IV artesunate?
Artemether-lumefantrine, atovaquone-proguanil, quinine combo, or mefloquine.
27
What is a side effect of IV artesunate?
Delayed hemolytic anemia; monitor CBC weekly for 4 weeks.
28
Where is chloroquine resistance most widespread?
Everywhere except parts of Central America, Haiti, and the Dominican Republic.
29
Where was artemisinin resistance first reported?
Southeast Asia in 2008.
30
What mutation causes artemisinin resistance?
Kelch 13 mutation.
31
Which prophylaxis requires continuation for 7 days post-travel?
Atovaquone-proguanil, primaquine.
32
Which prophylaxis requires continuation for 4 weeks post-travel?
Doxycycline, chloroquine, hydroxychloroquine, mefloquine.
33
What class is artemether-lumefantrine?
Artemisinin combination therapy (ACT).
34
What is the MOA of artemether?
Generates reactive radicals after activation by heme, damaging parasite proteins.
35
What is lumefantrine's role?
Provides longer-acting schizonticidal activity.
36
What is artemether-lumefantrine used for?
First-line treatment of uncomplicated P. falciparum malaria in most regions.
37
What is a key dosing requirement for artemether-lumefantrine?
Must be taken with fatty food to enhance absorption.
38
What class is atovaquone-proguanil?
Combination antimalarial.
39
What is the MOA of atovaquone?
Inhibits mitochondrial electron transport in Plasmodium.
40
What is the MOA of proguanil?
Converted to cycloguanil, inhibits dihydrofolate reductase (DHFR).
41
What is atovaquone-proguanil used for?
Prophylaxis and treatment of chloroquine-resistant malaria.
42
What is a key feature of atovaquone-proguanil?
Short half-life; stop 7 days after travel.
43
What is the MOA of doxycycline in malaria?
Inhibits protein synthesis in the apicoplast organelle.
44
What is doxycycline used for in malaria?
Prophylaxis and adjunctive treatment with quinine.
45
What is a major limitation of doxycycline?
Photosensitivity; not for use in pregnancy or children under 8.
46
What class is chloroquine?
4-aminoquinoline.
47
What is the MOA of chloroquine?
Prevents heme detoxification, leading to accumulation of toxic heme.
48
What is chloroquine used for?
Treatment and prophylaxis in chloroquine-sensitive areas.
49
What is a major toxicity of chloroquine?
Retinopathy with long-term use.
50
What is the MOA of primaquine?
Generates reactive oxygen species to kill hypnozoites.
51
What is primaquine used for?
Prevention of relapse in P. vivax and P. ovale infections.
52
What test is required before using primaquine?
G6PD deficiency test (due to risk of hemolysis).
53
What is tafenoquine used for?
Prevention and radical cure of P. vivax.
54
What is a key safety concern for tafenoquine?
Contraindicated in G6PD deficiency and pregnancy.
55
What is the MOA of mefloquine?
Unknown; thought to disrupt parasite membrane function.
56
What is mefloquine used for?
Prophylaxis and treatment in chloroquine-resistant areas.
57
What are major adverse effects of mefloquine?
Neuropsychiatric symptoms (e.g., vivid dreams, anxiety).
58
What class is quinine?
Cinchona alkaloid.
59
What is quinine used for?
Severe malaria (oral form after parenteral therapy).
60
What are adverse effects of quinine?
Cinchonism (tinnitus, headache, nausea), QT prolongation.
61
What is IV artesunate used for?
First-line treatment of severe malaria.
62
What is a key adverse effect of artesunate?
Delayed hemolytic anemia (monitor CBC for 4 weeks).
63
Which two Plasmodium species cause relapsing malaria due to hypnozoites?
P. vivax and P. ovale.
64
What is the first-line treatment for severe malaria?
IV artesunate.
65
Which Plasmodium species is most likely to cause cerebral malaria and severe disease?
P. falciparum.
66
What is the gold standard test for malaria diagnosis?
Thick and thin Giemsa-stained blood smears.
67
Which smear type is used for species identification?
Thin smear.
68
How frequently should blood smears be repeated to rule out malaria?
Every 12–24 hours for 3 sets.
69
Which prophylactic agent is taken daily and must be continued for 7 days post-travel?
Atovaquone-proguanil.
70
Which agent is contraindicated in G6PD deficiency but prevents relapse in P. vivax/ovale?
Primaquine.
71
What is the first-line prophylaxis in most malaria-endemic areas?
Atovaquone-proguanil, doxycycline, or tafenoquine.
72
Which malaria vaccine is approved for children?
RTS,S/AS01.
73
What is the mechanism of artemether?
Produces free radicals via activation by heme.
74
What is the role of lumefantrine in ACT therapy?
Provides long-acting schizonticidal activity.
75
What causes artemisinin resistance?
Kelch 13 gene mutations.
76
What is a key adverse effect of IV artesunate?
Delayed hemolytic anemia.
77
What is the mechanism of chloroquine?
Inhibits heme polymerase, leading to toxic heme buildup.
78
Where is chloroquine resistance most widespread?
All malaria-endemic regions except parts of Central America and the Caribbean.
79
What is the treatment for uncomplicated P. falciparum in a chloroquine-resistant region?
Artemether-lumefantrine.
80
What should be added for P. vivax/ovale treatment to prevent relapse?
Primaquine or tafenoquine (after G6PD testing).
81
What medication is used for malaria prophylaxis and has neuropsychiatric adverse effects?
Mefloquine.
82
What are the side effects of quinine?
Cinchonism, QT prolongation, hypoglycemia.

therapeutics V (19 decks)

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