Treatment and prevention

Question 1

Name the first discovered malaria drug, when it was found and how long it lasted before resistance developed

Answer 1

Quinine was found in the bark of a tree in the 1900s, chloroquinine; a synthetic derivative was refined in the 40s and lasted 16 years

Question 2

Name the subsequent malaria drugs and how long they lasted

Answer 2

Fansider lasted 6 years, Mefloquine 4 years and Atovaquone 6 months

Question 3

The current malaria drug and how WHO have chosen to distribute it

Answer 3

Artemisinin, and by ACT - artemisinin combination therapy.

Question 4

Give the mode of action for the quinolines

Answer 4

Accumulate in the food vacuole, kill sexual stages esp schizonts but not gametocytes

Question 5

Give the mode of action for the antifolates

Answer 5

inhibit nucleotide synthesis pathway

Question 6

Mode of action for primaquine

Answer 6

May block oxidative metabolism. Only drug to kill gametocytes and liver hypnozoites

Question 7

MOA for doxycycline

Answer 7

antibiotic, inhibits protein synthesis. Slow acting, only for prophylaxis

Question 8

MOA for artemisinin

Answer 8

v.rapid, 1-3 days. primarially trophozoites but also affects gametes. mech unknown

Question 9

Give the side effects for quinine

Answer 9

‘cinchonism’ vertigo, itching, nausea, occasional neuro effects

Question 10

Side effects for chloroquinine

Answer 10

‘pruritus’ itching

Question 11

Side effects for primaquine

Answer 11

Acute haemolysis in G6PDH deficients

Question 12

Side effects for Artemisinin

Answer 12

Few

Question 13

How do parasites become drug resistant?

Answer 13

incomplete dosing, counterfeit drugs, treatment in unconfirmed cases

Question 14

Give some current malaria prevention strategies

Answer 14

draining of standing water, insecticide-treated bednets/indoor spraying, biological control like the mosquito fish

Question 15

What treatment is given to pregnant women

Answer 15

IPT - intermittent pregnancy treatment

Question 16

Any hope with a vaccine for malaria?

Answer 16

Irradiated sporozoites effective but attempts have failed

Question 17

CONSTANT

Answer 17

VIGILENCE

Question 18

Name the drugs used to treat Leishmania and their downsides

Answer 18

Pentavalent antimonials, but painful 30 day course. Amphoteracin B, Miltefosin and Paromycin for cutaneous and visceral

Question 19

MOA - antimonials

Answer 19

inhibits enzymes involved in energy production

Question 20

MOA - amphoteracin B

Answer 20

binds ergosterol -ion leakage from cell membrane. human cells <leishmania

Question 21

Side effects of antimonials

Answer 21

Harmful to veins. N/V pancreatitis

Question 22

S.E amphoteracin b

Answer 22

fever/chills n/v, multiple organ damage,

Question 23

SE miltefosine

Answer 23

relatively benign

Question 24

SE paromomycin

Answer 24

relatively benign

Question 25

Resistance in leishmania drugs?

Answer 25

Minimal

Question 26

Prevention strategies in leishmania?

Answer 26

Vector control w/insecticides, reservoir control against dogs, vaccine under study

Question 27

What was the drug treatment in the 60s and 70s for schistosomiasis and what were its bad sides?

Answer 27

injections of antimony potassium tartrate and it was an emetic so has to be injected but severe side eggects when injected as antimony is toxic

Question 28

What has been the drug in use for schist since the 70s?

Answer 28

Praziquantel. Worm paralysis. racemate - only 1 enantiomer is active. Immune response to dying worms abdominal pain, diarrhoea.

Question 29

Drug resistance in schist?

Answer 29

Minimal, but some now reported, although hard to determine as resistance looks similar to re-infection

Question 30

What are the two main prevention strategies for control of schistosoma?

Answer 30

1) vector (snail control) 2) Treat/vaccinate animal reservoirs (cows, water buffalo)

Question 31

What are the limits for mass prevention treatment?

Answer 31

50% kids have blood in pee, treat whole village. 20-50% treat all school age kids <20% treat all symptomatic cases

Question 32

Future for schist control?

Answer 32

Solve racemate issue, find new drug targets

Question 33

SE to filariasis drugs?

Answer 33

Dying worms cause ‘mazzotti reaction’. fever, rash, abdominal pain

Question 34

Filarial worm drugs, 4 of em, name em motherfucka

Answer 34

1)ivermectin 2)albendazole 3) DEC 4)doxacycline