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PT3 ID 2 > malaria pharmacology > Flashcards

malaria pharmacology Flashcards

1
Q

most common strains of malaria

A

P.falciparum ~75%

P.vivax/ovale

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2
Q

p.falciparum characteristics

A
  • most common cause of mortality

- symptoms appear after 5-15 days after RBC lysis

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3
Q

p.vivax/ovale characteristics

A
  • look very similar

- exoerythrocytic (liver) stage lasts for long

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4
Q

infection sequence of malaria

A
  • female mosquito deposits spores
  • spores collect in liver where they multiply for days to weeks
  • spores enter RBCs, multiply
  • RBCs lyse and spread more spores
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5
Q

symptoms of malaria

A
  • anemia
  • fever
  • chills
  • nausea
  • flu-like symptoms
  • hypoglycemia
  • seizures
  • multiple organ failure
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6
Q

stages of infection

A
  • exoerythrocytic stage (liver)
  • erythrocytic stage (RBC)
  • latent (only P.vivax/ovale)
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7
Q

drug for exoerythrocytic stage

A

palurdrine (proguanil)

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8
Q

drug for latent exoerythrocytic

A

primaquine

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9
Q

rapid acting drugs for erythrocytic stage

A

chloroquine
quinine
mefloquine
artemisinin

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10
Q

slow acting drugs for erythrocytic stage

A

pyrimethamine
tetracyclines
sulfonamides

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11
Q

combo therapy drug

A

atovaquone/proguanil

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12
Q

proguanil MOA

A

inhibit plasmodial dihydrofolate reductase, inhibiting DNA synthesis

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13
Q

proguanil use

A

prophylaxis primarily, sometimes treatment

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14
Q

proguanil adverse effects

A

diarrhea

nausea

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15
Q

primaquine use

A

hepatic and latent p.vivax/ovule

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16
Q

primaquine adverse effects

A

mild GI

methemoglobinemia

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17
Q

primaquine contraindications

A

glucose-6-phosphate deficiency

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18
Q

chloroquine MoA

A

prevents parasite from inactivating heme

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19
Q

why isn’t chloroquine used much

A

resistance in p.falciparum is common enough

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20
Q

chloroquine adverse effects

A
  • GI disturbances
  • blurred vision
  • possibly hypotension and cardiac arrest
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21
Q

chloroquine contraindications

A

psoriasis or porphyria, can cause flares

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22
Q

quinine MoA

A

interference with heme metabolism

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23
Q

quinine use

A
  • treatment of choice for chloroquine resistant strains of p.falciparum
  • NO Prophylaxis
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24
Q

quinine adverse effects

A

GI
vision
hypoglycemia

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25
Q

mefloquine MoA

A

unknown, maybe similar to chloroquine

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26
Q

mefloquine unique ADME

A

really long half life - 12-33 days

27
Q

mefloquine use

A

prophylaxis and treatment

28
Q

mefloquine adverse effects

A

GI

rarely neuropsychiatric effects

29
Q

mefloquine contraindications

A

epileptic patients
psychiatric disorders
pregnant women

30
Q

artemisinin MoA

A

produce reactive oxygen species that damage parasitic macromolecules

31
Q

artemisinin use

A

initial treatment of p.falciparum

32
Q

artemisinin adverse effects

A

very few reported

maybe allergic reaction

33
Q

pyrimethamine MoA

A

inhibits plasmodial dihydrofolate reductase

34
Q

pyrimethamine use

A

treatment only of chloroquine resistant strains of p.falciparum
or
in combo with sulfonamide

35
Q

pyrimethamine adverse effects

A

GI

hypersensitivity reaction

36
Q

pyrimethamine contraindications

A

megaloblastic anemia

37
Q

tetracyclines use

A
  • prophylaxis and acute treatment of p.falciparum

- often used in combo with quinine

38
Q

most commonly used tetracyclines

A

tetracylcine

doxycycline

39
Q

tetracyclines adverse effects

A

photosensitivity

GI

40
Q

sulfonamides use

A

used in combo with pyrimethamine and quinine for resistant strains of p.falciparum

41
Q

sulfonamides MoA

A

dihydrofolate reductase inhibitor

42
Q

sulfonamides effectiveness

A

better at p.falciparum than vivax

43
Q

atovaquone/proguanil MoA

A

inhibit mitochondrial function AND dihydrofolate reductase

44
Q

atovaquone/proguanil counseling

A

eat with fatty meal once a day

45
Q

atovaquone/proguanil use

A

prophylaxis and treatment of p.falciparum and p.vivax

46
Q

atovaquone/proguanil adverse effects

A

uncommon

GI

47
Q

atovaquone/proguanil contraindications

A

small children

pregnancy/lactation

48
Q

malaria vaccine

A

RTS,S

49
Q

how long after infection does malaria become symptomatic

A

1-3 weeks

50
Q

phases of malaria infection

A 
prodrome (HA, fatigue, ~10-21 days after infection)
paroxysm (high fever, chills)
cold phase
hot phase (severe fever)
sweating phase
51
Q

fever is most common in which malaria strain

A

p.falciparum

52
Q

important complication of p.falciparum

A

severe anemia

53
Q

how to ensure positive diagnosis of malaria

A

thick and thin blood smears ever 12-24 hours for 3 days

54
Q

what does thick smear detect

A

if parasite is present

55
Q

what does thin smear detect

A

if plasmodium is present

56
Q

giemsa stain

A

stain of the blood that makes thick and thin blood smears more reliable

57
Q

treatment for uncomblicated malaraia

A

chloroquine

58
Q

treatment for p.falciparum and vivax infection or severe illness

A
  • admit to ICU
  • quinidine for at least 24 hours and until PO can be started
  • quinine + doxy
59
Q

treatment for chloroquine-R p.falciparum, vivax, and ovale

A

mefloquine

60
Q

treatment for p.falciparum if hx of seizure, cv issues or psychiatric issues

A

atovaquone/proguanil 2 BID for 3 days

61
Q

monitoring for quinidine

A

EKG for long QT

hypoglycemia

62
Q

monitoring for mefloquine

A

EKG

neurologic effects like hallucinations, psychosis

63
Q

what to do with quinidine if QT interval is >0.6 sec

A

slow infusion

64
Q

how often to check blood smears for parasitemia

A

every 12 hours until <1%

PT3 ID 2 (6 decks)

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