Pharmacology of Antimalarial Drugs Flashcards
What are the non-pharmacological prophylactic measures?
Nets
Permethrin
Citronella
Diethyl toluamide
Describe the use of prophylactic antimalarial medication
also name the drugs
- Mefloquine
-1 week before, and 1 week after return
absoprtion increased by food - Doxycycline
-q day before/daily/ 4 weeks after return - Atovaquine-proguanil
- 1 day before/daily/1 week after return
Artemether-lumefantrine is used as standby medication
Describe the agents used to treat P.Falciparum Infections
Uncomplicated
1.Artemether-lumefantrine (with long plasma half life of 4-6 days, Slow acting and low recrudescence rate)
2.Quinine + Doxycycline/Clindamycin
Complicated
Artesunate (IV) (short plasma half-life of 2 hours, fast acting and High recrudescence rate)
Describe the agents used to treat other Plasmodium infections other than falciparum
P. Vivax, Ovale, Malariae, Knowlesi
Agents:
1. Artemether-lumefantrine
2. Quinine-Clindamycin
3. Doxycycline
4. Primaquine
Describe the Use, Contraindications, Adverse Effects, and Cautions of Primaquine
Indications- P.vivax and P.Ovale
Contraindications:
Pregnancy, Children under 6 months and severe G6PD deficiency
Adverse Effects: Headache, Pruritis
Take caution in G6PD deficiency, acute haemolytic anaemia
Describe the Side Effects of Quinine A/E
Mild: Tinnitus, Blurred vision, slight hearing impairement, headache, naesea, dizziness
Severe:
CNS: Visual and Auditory loss, coma and even death
CVS: Hypotension, Ventricular Arrythmia, Severe thrombocytopenia and hypoglycaemia
Pregnant women are high risk patients for malaria. When infected with P. Falciparum, they could have cerebral malaria/hypogycaemia, and suffer miscarriage, stillbirth, premature delivery, low birth weight
Describe Prophylaxis and Treatemt of Malaria.
Treatment
Avoid Malaria Areas
Use Mefloquine-it is preferred
Doxyclycline and Atavaquone-proguanil is contraindicated in such cases
Treatment
All trimesters, SEVERE: Quinine and Clindamycin
2nd/3rd trimester, Uncomplicated: Artemether-Lumefantrine
(NB) ((Primaquine is Contraindicated in first trimester
Antimalarial Drugs
What agent is contraindicated in breastfed infants?
there is no malarial protection from mother’s prophylaxis in breastfed
infants
Atovaquone-Proguanil
children under the age of 5 years should avoid high risk malaria areas and use non-pharmacological measures to prevent malarial infection.
Describe the pharmacological measures if it happens a paediatric is infected with malaria.
Use all agents, but depending of the weight of the patient.
Mefloquine is contraindicated in patients less than 5kg
Doxycycline is contraindicated in patients less than 8kg
Atavaquone-proguanil is ONLY used in patients equal or greatwe than 11kg
Describe malarial prophylaxis and treatment in elderly patients
Prophylaxis
1. Mefloquine, but it is contraindicated in Cardiac conduction abnormalities
Contraindications Include: Quinidine, Beta-Blockers, Calcium Channel Blockers and Oral Typhoid Vaccine
2. Doxycycline: Phototoxicity(AE)
3. (NB) Atovaquone-proguanil is contraindicated
TREATMENT
1. Use Artemether-Lumefantrine [C/I in Cardian conduction abnormalities and Quinine+Clindamycin/Doxycycline in uncomplicated cases
2. Use Artesunate and Quinine in severe cases
List the Drugs that prolong the QTc interval
- Amiodrone
- Macrolide
- Floroquinolone
- Imidazole/Triazole antifungals
- Tergenadine/Astemizole
- CYP2D6 metabolism
HIV positive patients are at high risk of malarial infection
Describe the drugs used in their Prophylaxis, Treatment(uncomplicated and severe cases)
Prophylaxis
USe Doxycycline and Atovaquone-Proguanil. But these can have side effects in combined, such as GIT, Mouth Ulcers, Headache, Insomnia, Hair loss, Aneamia, Neutropenia
Treatment
Uncomplicated- use Artermether-lumefantrine or Quinine + Clindamycin
Severe cases- use __Artesunate or Quinine**
Note (HIV)
Efavirenz decreases Concentration of Lumefantrine and Quinine
Artemether cocnentration is decreased by NRTIs and ritonavir
Describe the agents used for Prophylaxis and Treatment of TB patients,
Prophylaxis
Mefloquine, Doxycycline and Atavoquone- plasma concentration decreases due to rifampicin use
Treatment
In uncomplicated cases, use Artemether ( decreased conc) and Quinine +Clindamycin/Doxycycline
USe Artesunate and Quinine in Severe cases
describe treatment and prophylaxis of patients with Epilepsy
Same as TB patients
Side effects of combination of Artemether-Lumefantrine
1. Sleep distrubances
2. headache
3. dizziness
4. palpitations
5. GIT
Fatigue
Arthralgia
Cough
Asthama
Rash
Which agent is contraindicated in people requring motor skills?
Mefloquine
