Malaria Drugs

Question 1

Four classes of Antimalarials

Answer 1

Quinolines, Antifolates/Sulfa, Artemisinins, Antibiotics

Question 2

Quinoline MOA

Answer 2

Impair intra-parasitic heme polymerization into hemozoin - parasites die from their own waste

Question 3

Primaquine primarily used for

Answer 3

PART and Radical cure

Also gametocide for prevention of spread

Question 4

Quinolines used for prophylaxis

Answer 4

Chloroquine, mefloquine

Question 5

What are the two first line therapies for severe P. falciparum infections?

Answer 5

Quinidine and Artensuate

Question 6

Geographical limitations of chloroquine

Answer 6

Only used for falciparum in C. America, Haiti, and Dominican Rep. b/c of resistance
Used for other species in most locations

Question 7

Limitation of using mefloquine as chemoprophylaxis?

Answer 7

Neuropsychiatric side effects

Question 8

What is Presumptive Ant-Relapse Therapy (PART)

Answer 8

Prevention of relapses for those who have had prolonged exposure in malaria-endemic areas (missionaries and peace corps)

Question 9

What must you test for before using primaquine?

Answer 9

G6PD deficiency

Question 10

MOA of antifolates and sulfa derivatives

Answer 10

Inhibit dihypropteroate synthase and dihydrofolate reductase –> inhibit nucleic acid synthesis

Question 11

Sulfadoxine pyrimethamine combination is used for?

Answer 11

Intermittent preventive treatment of pregnant women

Question 12

Mechanism of action of Atovaquone

Answer 12

Inhibits parasite mitochondrial electron transport

Question 13

Malarone

Answer 13

Combination of Atovaquone and proguanil
Highly effective for prophylaxis and therapy
Use is limited to returned travelers

Question 14

Which drug combo should you use to treat a returned traveler?

Answer 14

Atovaquone-proguanil

Malarone

Question 15

Which antibiotics are used to treat/prevent malaria?

Where do they work

Answer 15

Doxycycline, tetracycline, clindamycin, azithromycin, fluoroquinolones
Work in the blood stage by targeting ribosomal function within the apicoplast organelle

Question 16

Drug combo used for ACT?

Answer 16

Artemether-lumefantrine (Coartem)

1st line for uncomplicated Pf in most of the world

Question 17

Artensuate

Answer 17

Artemisinin

1st line for severe malaria in most of the world, not yet FDA approved

Question 18

Why are arteminisins more potent?

Answer 18

They have a broader activity across the asexual life cycle

Question 19

Name 3 fist line options for oral treatment of uncomplicated P. falciparum malaria

Answer 19

Atovaquone-Proguanil
Artemether-lumefantrine
Quinine sulfate + doxy or clinda

Question 20

The WHO recommends __________ for treatment of uncomplicated malaria.

Answer 20

ACT

artemether+lumefantrine (Coartem)

Question 21

First line therapy in pregnant women

Answer 21

Quinine + Clindamycin

can use ACT in 2nd or 3rd trimester

Question 22

What is causal prophylaxis and an example?

Answer 22

Kills parasite in primary liver stage in blood stage.

Atovaquone-proguanil (also a suppressive)

Question 23

What is a suppressive prophylactic do and what are some examples?

Answer 23

Kills parasites in the erythrocytic stage only

Mefloquine, Doxycycline, Chloroquine