Malaria Flashcards by Christopher Swims-Vernor

What is malaria

infectious disease affecting humans and other animals caused by parasitic protazoans (plasmodium type)

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What is the vector for malaria

Female anopheles mosquito

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What are the four plasmodium genes that causes marlaria, what type of malaria does each genus cause

Plasmodium falciprium -> tropica, Plasmodium vivax -> tertiana, plasmodium ovale -> tertiana, Plasmodium malariae -> quartana

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Which malaria is the most aggresive

tropica

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Which malaria is able to relapse, why

vivax, can stay dormant in liver cells

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T/F: Plasmodium knowlesi is a plasmodium genus that can cause malaria through transmission from monkeys to humans but needs a mosquito vector

True

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Where are malaria cases usually found

Around the equator

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When a mosquito bites a human where does the parasite reside to survive and spread, what is the purpose for this fluid in mosquito, what form is the parasite at

Saliva, used to prevent the blood from coagulating, sporozoites

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Once in the human blood stream where does the sporozoites go to take refuge, what happens once it has found refuge

The liver, multiply within hepatocytes until it bursts

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What is the parasite form that is released from the liver

Merozites

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Once the liver cell has been destroyed what form of the parasite looks for refuge in the blood stream, where does it take refuge

Merozites, RBCs

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When does the patient first start to feel the symptoms of having malaria

When the merozites have reproduced and burst the RBC and re-infect other RBCs

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What is a separate fate for RBCs if they do not burst

Become male or female gametocytes

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What happens to the gametocytes in a patient’s blood that has malaria that is ingested by a mosquito

Instead of being digested the mature to gametes and become a zygote

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What is the name of a mosquito zygote that becomes mobile

ookinete

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Where does a ookinete migrate to and what does it mature into

Cell wall of a mosquito’s gut, oocyst

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What happens when a oocyst bursts, what is the fate of the contents

Sporozoites are released and travel to the saliva glands of mosquitoes

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What are hypnozoites

Dormant liver form of malaria

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T/F: Liver schizonts are the liver cells infected that allow for sporozoites to mature to merozoites and eventually burst. Blood schizonts are infected blood cells that allow merozoites to reproduce and eventually burst

True

What are the three human drug targets to fight malaria

Hypnozoites, Schizonts, Gametocytes

What are the classes of drugs for fighting malaria

4-substituted quinolones, 8-substituted quinolones

What are the four different 4-sub quinolines

Quinine, Chloroquine, Mefloquine, Halofantrine

What are the two components of the drug quinine

quinoline and quinuclidine

What are the essential components of quinine to make it active

The two chiral carbons

What are the two conformations quinine must be in order to be active, what is the name of each

8S, 9R (quinine) and 8R, 9S (quinidine)

What are the unique subsitutions for mefloquine, halofantrine, and chloroquine

two fluorinated methyl groups, surronded by halogens, a single chlorine and a amino group

What is the MOA of 4-sub quinolines

Binds thus preventing hemozoin synthesis allowing the heme to kill the RBCs and therefore the merozites

What does the merozite use as sustenance while in a RBC, what is the consequence of this, how is this consequence dealt with

Hemoglobin, Heme has the potential to kill RBC, produces hemozoin to bind the heme and keep the RBC alive

How do 4 sub quinolines get into where the digestion happens

Enter the acidic environment easily because they are weak bases (tertiary amines) through a ion gradient, once in the acidic enviornment they become ionized and can no longer leave thus allowing them do to their action

T/F: 4-sub quinolines only work on blood schizonts

True

What is the resistance against 4-sub quinolines

Efflux pumps, increased plasmodium metabolism

What is the 8-substituted quinoline used in mylaria

Primaquine

What do the 8-sub quinolines work on

Liver hypnozoites, liver schizonts, and blood gametocides

T/F: Pregnant women can use both types of quinolines

False: 8-sub quinolines is not indicated to be used in pregnant women

What is the antifolate used in malaria, what is the MOA, what is used in combination with

Pyrimethamine, significantly higher affinity for binding the DHFR receptor leading to inhibit folic acid synthesis, Sulfadoxine

What do the DHFR- inhibitors target

Blood schizonts

What is MOA of artemisins, what do they work on

free radical formations, blood schzoints and young gametocides

What is the MOA of the dual product Atovaquone/Proguanil (Malarone)

Collapse of the mitochondrial membrane potential, inhibitor of dihydro folate reductase

T/F: Malarone (Atovaquone/Prguanil) only works on blood schizonts

True

T/F: If malaria infection occurs even though preventive drugs were used it is okay to keep the same regimen

False: If a malaria infection occurred despite the use of a preventative drug, that drug should not be used in the treatment regimen

What should be done if there is suspiscion of malaria but it cannot be confirmed

treat against CQ- resistant malaria immediately

What is the drug therapy if someone has CQ sensitive malaria)

CQ phosphate

What is the drug therapy if someone has CQ resistance

Malarone OR Coartem OR Quinine Sulfate plus doxycycline or tetracyline

What is the drug therapy if a patient has plasmodium Malariae or knowles

CQ phosphate

What is the drug therapy if a patient has plasmodium vivax or ovale

CQ phosphate PLUS primaquine phosphate

What is the drug therapy if a patient has severe malaria

Quinidine gluconate IV then Quinine OR Atovaquone-Guanil OR Artemether- Lumefantrine

What do pregnant patients with malaria recieve

CQ OR mefloquine plus clindamycin