Therapeutics

Question 1

The human cycles of the malaria parasite are divided/classified based on occurring inside or outside of what type of cell?

Answer 1

RBC

Question 2

What organ does plasmodium first proliferate in?

Answer 2

liver

Question 3

What is a plasmodium-infected liver or red blood cell called?

Answer 3

schizont

Question 4

What is the form of parasite that is injected with a mosquito bite?

Answer 4

sporozoite

Question 5

At what time of day to mosquitos bite?

Answer 5

between dusk and dawn

Question 6

Approximately how long will it take for symptoms to develop after a mosquito bite?

Answer 6

10 days (7-30)

Question 7

Which part of the malarial life cycle is responsible for the symptoms/mortality of malaria?

Answer 7

RBCs rupture after trophozoites mature. If the causative agent is P. falciparum, RBCs become knobby and sticky and can sequestrate in microvasculature, cutting off circulation to organs.

Question 8

What are the symptoms of uncomplicated malaria?

Answer 8

fever (may be cyclic)
headache
fatigue
diarrhea
muscle/joint aches
anemia (esp with falciparum)

Question 9

Which organism is the most likely to cause severe malaria?

Answer 9

P. falciparum

Question 10

How may a patient with severe malaria present?

Answer 10

cerebral malaria, severe anemia, hypoglycemia, lactic acidosis, hemoglobinuria

Question 11

What are the s/sx of cerebral malaria?

Answer 11

altered consciousness
convulsions/seizures
coma
retinal hemorrhages

Question 12

Which malarial medication may exacerbate hypoglycemia in severe malaria patients, who are already at risk of hypoglycemia?

Answer 12

quinine (increases pancreatic insulin release)

Question 13

How often is a first blood smear positive in a case of malaria?

Answer 13

95%
Thus, blood smears should be evaluated every 6-12 hours, as detection can depend on smear preparation and lab tech expertise.

Question 14

What is the recommended first-line therapy for uncomplicated malaria?

Answer 14

artemisinin-based combination therapy, usually artemether/lumefantrine

Question 15

In Kenya, what is the preferred second-line treatment for malaria?

Answer 15

dihydroartemisinin/piperaquine

Question 16

As second-line therapy, artesunate or quinine can be combined with which 3 medications?

Answer 16

doxycycline, tetracycline, or clindamycin

7 days of therapy

Question 17

primaquine is active against what stage of the malarial life cycle?

Answer 17

gametocyte

Question 18

For severe malaria, what is the first-line treatment?

Answer 18

IV/IM artesunate

Question 19

What is second-line therapy for severe malaria?

Answer 19

IV/IM quinine

Question 20

Quinine was shown to have a higher prevalence of which adverse effects compared to artesunate?

Answer 20

seizures, hypoglycemia, and mortality

Question 21

Artemesinin is active against which stage of malarial parasites?

Answer 21

erythrocytic

Question 22

What are the 3 artemesinin derivatives used in malaria tx?

Answer 22

artesunate (PO, PR, IV)
artemether (IM)
artemesinin (PO, PR)

Question 23

What is a contraindication to artemesinin and its derivatives?

Answer 23

pregnancy

Question 24

artemesinin ADRS

Answer 24

N/V/D, dizziness

less common: blood dyscrasias, elevated LFTs, irreversible neurotoxicity

Question 25

lumefantrine ADRs

Answer 25

mild GI effects

Question 26

important lumefantrine counseling point

Answer 26

oral F increases 3-4x if taken with a fatty meal

Question 27

quinidine (quinine) SEs

Answer 27

cinchonism
hypersensitivity
hypotension and cardiotoxicity with IV form
seizures
hypoglycemia

Question 28

What is cinchonism? Which drug is it associated with?

Answer 28

a group of symptoms associated with quinidine (quinine)

Question 29

What are 4 prevention strategies for malaria?

Answer 29

insecticide treated nets
indoor residual spraying
larvicide
vaccination