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Therapeutics > Rational Drug Use: Malaria > Flashcards

Rational Drug Use: Malaria Flashcards

1
Q

The ABC of malaria prevention

A

A: Awareness and Assessment of Malaria Risk

B: Avoidance of mosquito Bites

C: Compliance with Chemoprophylaxis, if indicated

D: Don’t delay malaria Diagnosis

E: Early, effective treatment

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2
Q

What percentage of travelers took no prophylaxis?

A

80% of travelers took no prophylaxis.

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3
Q

Of the travelers who took prophylaxis, what percentage took it appropriately?

A

Only 25% of those who took prophylaxis took it appropriately.

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4
Q

What is the most common travel destination for travelers who took prophylaxis?

A

The most common travel destination is Mozambique.

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5
Q

Which regions in South Africa are primarily endemic for malaria?

A

In South Africa, the endemic areas are mainly north-eastern Limpopo and eastern Mpumalanga (northern KwaZulu-Natal).

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6
Q

Why is it important for people living in endemic areas to be aware of malaria?

A

It is important because living in or traveling to endemic areas increases the risk of contracting malaria, making awareness and appropriate preventive measures crucial.

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7
Q

When is malaria chemoprophylaxis indicated?

A

Malaria chemoprophylaxis is indicated for travelers and residents in malaria-endemic areas.

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8
Q

Which drugs are recommended for malaria chemoprophylaxis?

A

The recommended drugs for malaria chemoprophylaxis are mefloquine, atovaquone-proguanil, or doxycycline.

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9
Q

Besides chemoprophylactic drugs, what other measures should be taken to prevent malaria?

A

In addition to chemoprophylactic drugs, non-drug measures such as using insect repellent, sleeping under mosquito nets, and wearing protective clothing should be taken to prevent malaria.

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10
Q

During which months should malaria chemoprophylaxis and non-drug measures be used?

A

Malaria chemoprophylaxis and non-drug measures should be used from September to May

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11
Q

Non- drug measures

A

ALWAYS use non-drug measures:
- Remain indoors between dusk and dawn
- Wear long, light coloured clothing.
- Screen doorways and windows
- Apply a DEET-containing repellent (repeat every 4-6h if outdoors)
- Use mosquito mats & coils,
- Use (long-lasting) insecticide-treated bed nets & IRS sprayed accommodation
- Spray aerosol insecticide
- Use ceiling fans /air conditioner.

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12
Q

DEET containing products

A

N,N-diethyl-meta-toluamide

Recommended strength 20- 50%

Tabard
Peaceful sleep
Mylol

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13
Q

Which malaria chemoprophylaxis options provide high protective efficacy against P. falciparum if adherent?

A

Atovaquone-proguanil, doxycycline, and mefloquine provide high protective efficacy against P. falciparum if taken as prescribed.

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14
Q

What is chemoprophylaxis

A

Chemoprophylaxis against malaria involves the use of medications to prevent malaria infection in individuals who are traveling to or living in areas where malaria is endemic

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15
Q

Example of atovaquone proguanil

A

Malanil
Malateq
Mozitec

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16
Q

Frequency of atovaquone proguanil

A

Daily

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17
Q

Start of atovaquone proguanil

A

1-2 days before travel

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18
Q

Until when to continue atovaquone proguanil

A

7 days after leaving malaria area

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19
Q

Examples of doxycycline

A

Doxymal
Cyclidox
Doxytab
Doxycycl

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20
Q

Frequency of doxycycline

A

Daily

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21
Q

Start of doxycycline

A

1-2 days before travel

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22
Q

Until when to continue doxycycline

A

4 weeks after leaving malaria area

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23
Q

Examples of mefloquine

A

Lariam
Mefliam

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24
Q

Frequency of mefloquine

A

Weekly

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25
Q

Start of mefloquine

A

1-2 weeks before travel

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26
Q

Until when to continue mefloquine

A

4 weeks after leaving malaria area

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27
Q

The life cycle of the malaria parasite

A
  1. Sporozoite stage
  2. Liver stage (Exoerythrocytic cycle)
  3. Blood stage (Erythrocytic cycle)
  4. Gametocyte stage
  5. Mosquito Stage (Sporogonic cycle)
28
Q

How does the malaria parasite (Plasmodium species) initially enter the human body?

A

The life cycle begins when an infected Anopheles mosquito bites a human and injects Plasmodium sporozoites into the bloodstream.

29
Q

What happens to Plasmodium sporozoites after they enter the human bloodstream?

A

The sporozoites travel to the liver within minutes and invade hepatocytes (liver cells).

30
Q

How do Plasmodium sporozoites develop within liver cells?

A

Inside the hepatocytes, the sporozoites mature into schizonts over a period of about 1-2 weeks. Each schizont contains thousands of merozoites.

31
Q

What occurs when liver cells burst during the malaria parasite life cycle?

A

The liver cells burst, releasing merozoites into the bloodstream, which then invade red blood cells (RBCs).

32
Q

What is the process of asexual reproduction in Plasmodium species within red blood cells?

A

Inside RBCs, merozoites mature into trophozoites, which grow and consume hemoglobin. Trophozoites develop into schizonts, which divide to produce more merozoites. The RBCs burst, releasing new merozoites to infect other RBCs, causing the clinical symptoms of malaria (fever, chills, anemia).

33
Q

What are gametocytes in the malaria parasite life cycle?

A

Some merozoites develop into sexual forms called gametocytes (male and female)

34
Q

How are gametocytes transmitted back to a mosquito?

A

When another mosquito bites the infected human, it ingests these gametocytes along with the blood meal.

35
Q

What happens to the gametocytes inside the mosquito?

A

In the mosquito’s stomach, male and female gametocytes fuse to form zygotes

36
Q

How do zygotes develop within the mosquito?

A

The zygotes develop into ookinetes, which penetrate the mosquito’s gut wall and form oocysts.

37
Q

What happens inside the oocysts in the mosquito?

A

Inside the oocysts, the zygote undergoes multiple divisions to produce thousands of sporozoites.

38
Q

How do sporozoites reach the mosquito’s salivary glands?

A

The oocysts burst, releasing sporozoites that migrate to the mosquito’s salivary glands

39
Q

What occurs when a mosquito with sporozoites in its salivary glands bites another human?

A

When the mosquito bites another human, the cycle begins again with the injection of sporozoites. This ensures the transmission and propagation of the malaria parasite between human hosts and mosquito vectors

40
Q

What are the two types of malaria prophylaxis?

A

The two types of malaria prophylaxis are causal prophylaxis and suppressive prophylaxis.

41
Q

What is the aim of causal prophylaxis for malaria?

A

Causal prophylaxis aims to prevent the initial liver stage of malaria.

42
Q

Which medications are used for causal prophylaxis of malaria?

A

Drugs such as atovaquone/proguanil (Malarone) and primaquine are used for causal prophylaxis.

43
Q

How long should causal prophylactic drugs be taken for effective prevention?

A

These drugs need to be taken before, during, and after potential exposure. For example, atovaquone/proguanil should be taken 1-2 days before entering a malaria-endemic area, daily during the stay, and for 7 days after leaving the area.

44
Q

What is the aim of suppressive prophylaxis for malaria?

A

Suppressive prophylaxis targets the blood stage of the parasite, preventing the symptoms of malaria from developing.

45
Q

Which medications are commonly used for suppressive prophylaxis of malaria?

A

Common suppressive prophylactic drugs include chloroquine, mefloquine, and doxycycline

46
Q

How long should suppressive prophylactic drugs be taken for effective prevention?

A

These medications should be started 1-2 weeks before travel, taken weekly or daily while in the endemic area, and continued for 4 weeks after leaving the area.

47
Q

What factors determine the choice between causal and suppressive prophylaxis?

A

The choice depends on the specific medication, the region of travel, and individual health considerations

48
Q

Patient counselling: General

A
  • Take measures to prevent being bitten by mosquitoes.
  • Take dose at same time every day / same day every week
    -If you miss a dose, take it as soon as possible and carry on as before.
  • If vomiting occurs within one hour of taking the dose, repeat it.
    -Report any adverse effects that occur.
    -Get a malaria test within 24 hours if you develop fever / flu-like symptoms
49
Q

Most common ADRs for mefloquine

A

Nausea
Strange dreams
Dizziness
Mood changes
Insomnia
Headache
Diarrhoea

50
Q

Special precautions for mefloquine

A

Avoid if requires fine motor coordination

51
Q

Most common adverse drug effects doxycycline

A

Photosensitivity
Oesophageal ulceration
GIT symptoms
Candida super-infections (GIT/ vaginal)

52
Q

Special precuations doxycycline

A

Sunscreen
Take with a full glass of water
Don’t lie down for 1 hr after dose

53
Q

Adverse drug effects of atovaquone- proguanil

A

Well tolerated
Headache
Mouth ulcers
Stomatitis
Abdominal pain

54
Q

Special cautions of atovaquone- proguanil

A

Take with water / food for better absorption

55
Q

Individualise prophylaxis choice for each traveler

A
  • Age and weight
  • Pregnant / breastfeeding (contraception; infants)
  • Activities - scuba diving, flying
  • Concomitant medication e.g. ARVs, rifampicin, chloroquine, doxycycline (e.g. for acne), anticoagulants, antimalarial allergy
  • Other medical conditions e.g. epilepsy, mental health problems, diabetes, cardiac patients, renal / hepatic impairment, etc.
56
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in pregnancy

A

Mefloquine: Use
vs
Doxycycline: Contraindicated
vs
Atovaquone- proguanil: contraindicated

57
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in breastfeeding

A

Mefloquine: Use

Doxycycline: ? Use (AAP, WHO if short trip)

Atovaquone- proguanil: ? Use (CDC if >5kg baby)

58
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in children

A

Mefloquine: Use >5 kg

Doxycycline: > 8 years

Atovaquone- proguanil: >11 kg

59
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in HIV +ve

A

Mefloquine: Potential Drug Interactions

Doxycycline: Use

Atovaquone- proguanil : Potential Drug Interactions

60
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in Epilepsy

A

Mefloquine: Contraindicated

Doxycycline: Use (some Drug Interactions)

Atovaquone- proguanil: Use

61
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in psychiatric conditions

A

Mefloquine: Contraindicated, even if only as a medical history

Doxycycline: Use

Atovaquone- proguanil: Use

62
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in renal impairment

A

Mefloquine: Contraindicated in severe hepatic impairment

Doxycycline: Use

Atovaquone- proguanil: Contraindicated in GFR< 30ml/ min

63
Q

Mefloquine vs Doxycycline vs Atovaquone- proguanil in diabetics (monitor glucose levels)

A

Mefloquine: Use

Doxycycline: increase insulin related hypoglycemia

Atovaquone- proguanil: Use

64
Q

Are there any chemoprophylaxis options that are not recommended?

A

Some chemoprophylaxis options are not recommended, especially if they have not been proven effective or have significant limitations.

65
Q

What is the efficacy of complementary preparations for malaria prevention

A

Complementary preparations have no proven efficacy in preventing malaria.

66
Q

How effective is citronella oil as an insect repellent compared to DEET, and what is its regulatory status?

A

Citronella oil is less effective than DEET and needs to be reapplied every 40-90 minutes. It has been withdrawn as an insect repellent in the EU.

67
Q

How should artemisinin derivatives be used for malaria treatment?

A

Artemisinin derivatives should ONLY be used as part of combination treatment for malaria. They are not recommended as monotherapy.

Therapeutics (15 decks)

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