Malarial treatment Flashcards
What drug is most often given as prophylactic treatment (barring resistance)?
Chloroquine
What do prophylactic drugs do for you?
Just prevent symptoms, do not kill protozoite stage
How quickly do most deaths occur for malarial infection?
What does this say about treatment?
First 24-48 hours.
Treat QUICKLY. parenteral treatment
Which is the only drug that might work to kill liver latent infection?
Primoquine
How is chloroquine selective for plasmodium?
It accumulates 25x more in infected RBC’s than regular RBC’s
What is the mechanism of action for chloroquine?
Binds ferriprotoporphyrin XI to prevent hemozoin formation, leading to toxicity
What is the most important side effect of chloroquine?
Visual Sx. Blindness, severe eye damage
How do quinine and quinidine work?
Same way as chloroquine
What is used to treat chloroquine resistant P. falciparum?
quinine and quinidine
What are the most important side effects of both quinine and quinidine?
Eyes.
Tinnitus, nausea, diarrhea
What is the unique side effect of Quinidine?
Heart problems, so need cardiac monitering
What do you usually give IV for severe malaria?
Quinidine
How does mefloquine work?
Same as chloroquine
What is a unique side effect of mefloquine?
Neuropsychological effects: Dreams, hallucinations
What is the mechanism of Atovaquone?
depolarizes parasitic mitochondria leading to inhibition of ETC
What is often given along with Atovaquone?
Proguanil
What is the mechanism of proguanil?
Inhibits DHFR, increases mitochondrial toxicity
Why are atovaqone and proguanil often given together?
Decrease resistance because they work well to kill together
Why is atovaquone/proguanil not to be given alone with severe anemia?
SLOW onset
How should atovaquone/proguanil be taken?
daily
What is the mechanism of action of artemisinins?
Produces free radicals from heme in malarial pigment
Inhibits calcium ion ATPase in P. falciparum
How quickly do Artemisinins work? Should they be given alone?
FAST.
NO. don’t want resistance to develop.
What do you need to make sure a patient doesn’t have when giving primaquine?
G6PD deficiency
