Pharm - Antimalarial Drugs

Question 1

Chloroquine (Aralen) indication

Answer 1

Use when malaria is chloroquine-sensitive. Cannot be used in areas with chloroquine or mefloquine resistance.

Question 2

Hydroxy-chloroquine indication

Answer 2

Use when malaria is chloroquine-sensitive. It cannot be used in areas with chloroquine or mefloquine resistance.

Question 3

Mefloquine (Lariam) indication

Answer 3

Use when malaria is chloroquine-sensitive and chloroquine-resistant

Question 4

Primaquine indication

Answer 4

Use when malaria is likely to be transmitted by the species: Plasmodium vivax

Question 5

Doxycycline indication

Answer 5

Use when malaria is chloroquine-sensitive, chloroquine-resistant, and mefloquine-resistant.

Question 6

Risks associated w/ chloroquine

Answer 6

• neuromyopathy (long term prophylaxis)

- retinopathy (high dose)

Question 7

cardiac consideration with chloroquine

Answer 7

can prolong QT interval

Question 8

frequency and duration of chloroquine

Answer 8

Start taking once a week for 1-2 weeks before and during travel, continue for 4 weeks after leaving high risk areas

Question 9

frequency and duration of hydroxy-chloroquine

Answer 9

Start taking once a week 1-2 weeks before travel, while there, and for 4 weeks after leaving.

Question 10

frequency and duration of mefloquine

Answer 10

Start taking once a week 2 weeks or more before travel, while there, and for 4 weeks after leaving.

Question 11

frequency and duration of primaquine

Answer 11

Start taking daily 1-2 days before travel, while there, and for 7 days after leaving.

Question 12

atovaquone-progruanil (Malarone) indication

Answer 12

use when malaria is chloroquine-sensitive, chloroquine-resistant, and mefloquine-resistant.

Question 13

frequency and duration of atovaquone-progruanil

Answer 13

Start taking one pill daily with food/drink for 1-2 days before travel, while there, and for 7 days after leaving.

Question 14

frequency and duration of doxycycline

Answer 14

Start taking daily for 1-2 days before travel, while there, and for 4 weeks after leaving.

Question 15

Which antimalarial drugs can be used during pregnancy?

Answer 15

• Chloroquine – all trimesters

* Mefloquine

Question 16

Identify the major categories of contraindications for mefloquine

Answer 16

• Neurologic and psychiatric disorders
• Significant family hx of seizures and major psych disorder
• Cardiac conduction abnormalities
• Allergies to quinine and quinidine

Question 17

Identify the adverse effects of mefloquine

Answer 17

• black box warning for dizziness*
• cardiac: bradycardia, arrythmias, EKG abnormalities
• sleep disturbances, strange dreams, insomnia
• rare: neuropathies, mood changes, panic attacks, confusion, hallucinations, aggression, paranoia, encephalopathies, seizures
• mefloquine-induced pneumonitis

Question 18

Identify the indications and uses of primaquine.

Answer 18

• Indication: Use when malaria is likely to be transmitted by the species: Plasmodium vivax.
• Use: is usually reserved for travel to places with >90% P. vivax because testing for G6PD deficiency is required before starting primaquine.

Question 19

What test is needed before prescribing primaquine?

Answer 19

• Primaquine can cause hemolytic anemia in those with G6PD deficiency. Therefore, patients should receive primaquine only if G6PD deficiency has been excluded.

Question 20

cardiac consideration of primaquine

Answer 20

can prolong QT interval

Question 21

CI to doxycycline use

Answer 21

• allergies to tetracyclines
• pregnancy
• children < 8 yo

Question 22

ADRs of doxycylcine

Answer 22

• GI discomfort and vaginal candidiasis are the most frequent complaints.
• Rsk of esophageal ulceration.
• Photosensitivity can occur, which can be concerning for fair-skinned travelers using it as prophylaxis for travel to the tropics.