Anti- Malaria Drugs

Front 1

Areas with chloroquine resistance

Back 1

Malarone
Mefloquine

Front 2

Areas with multiple drug resistance

Back 2

Doxycycline

Front 3

Areas with P. vivax and/or P. ovale

Back 3

Primaquine

Front 4

P. vivax & ovale

Back 4

Chloroquine then primaquine

Front 5

Chloroquine sensitvie P. falciparum & malariea

Back 5

Chloroquine

Front 6

Uncomplicated infection with resistance P. falciparum

Back 6

1st: quinidine + doxy or tetracycline or clindamycin
2nd: Malarone or Mefloquine or coartem

Front 7

Severe or complicated infection with P. falciparum

Back 7

1st: Artesunate then doxy or clindamycin or malarone or mefloquine
1st: Quinine plus doxy or tetraccline or clindamycin
2nd: Artemether then doxy or clindamycin or malarone or mefloquine

Front 8

Chloroquine

Back 8

Prop: Rapid onset, long half life, antacids decrease absorption
MOA: Inhibit hemozoin metabolism
Resistance: Altered chloroquine- transporter protein CG2
Action: Sensitive to all blood schizont, all gametes- falciparum; not useful for tissue forms of P. ovale or vivax
Uses: acute attacks (P. v, o, m & f), prophylaxis, hepatic amebiasis
Contra: epilepsy, myasthenia gravis, mefloquine
SE: Heart, confusion, convulsion, coma, pruritus, treat OD with epi, diazepam, ventilation
Precautions: G6PD, QRS- interval, pregnancy

Front 9

Quinine and quinidine

Back 9

Anti malarial: against asexual plasmodia, gametocidal for P. v, m NOT P. f
Uses: DOC for drug resistant P. falciparum, used in combo with doxy or clindamycin, safe in pregnancy
SE: QT elongation, cinchonism, hygoglycemia
Precaution: G6PD def
Contra: tinnitus, dizziness, optical neuritis

Front 10

Mefloquine

Back 10

Prop: oral only
Actions: all blood schizonts, no activity on gametes
Uses: Prof/ treatment of P. v & f, prophylaxis for travelers, in combo with artesunate (SE Asia & S. Am)
SE: GI, seizures, psychiatric, bradycardia, QT prolongation, arrhythmia
Contraa: cause still birth, DOC for prophylaxis in pregnancy

Front 11

Primaquine

Back 11

Prop: oral, DOC for treating hyponozoites
MOA: electron transport--> ROS
Malarial: All P. v & o, gametocytes of all P
Uses: terminal prophylaxis, radical cure of P. o & v
SE: GI, pruritus, methemoglobinemia, headaches
Contra: G6PD and pregnancy

Front 12

Atovaquone, atovquone + proguanil

Back 12

Prop: oral absorption inc with fatty foods
MOA: Inhibits electron transport, collapse mitochondrial membrane potential
Resistance: Mutations in mitochondrial b- gene
Malarial: all blood schizonts, liver stages of P. f but not against P. v hypnozoites
Uses: Proph & treatment of malaria, pneumonia, brain & eye infections
SE: abd. pain, nausea, vomiting, headache, diarrhea
Precaustions: rifampin--> inc P450--> decrease atovaquone, co- admin with tetracycline--> decr plasma atovaquone
Contra: pregnancy & lactating mothers

Front 13

Tetracycline, doxy, clindamycin

Back 13

Prop: useful in SE Asia, slow acting schizontocides
MOA: Inhibits protein elongation
Malarial: tissue schizonts of P. f
Uses: alone (prophylaxis in chloroquine & mefloquine resistant), w/ quinine/ quinidine- clindamycin
SE: bones & teeth
Contra: pregnancy, infancy <8

Front 14

pyrimetamine + sulfadoxine and dapsone

Back 14

MOA: anti folate synthesis
Malarial: all blood schizonts
Uses: Quinine--> drug res. P. f
SE: bone marrow depression, erythema multiform, epidermal necrolysis
Contra: lactating mothers, infants < 2 months
Precautions: IC

Front 15

Artemisinins

Back 15

MOA: Free radical disrupts protein, heme function
Malarial: Blood schizonts of P. v & f
Uses: W/ lumefantrine, mefloquine--> severe P. f, schistosomiasis
Precautions: Kids, pregnancy

Front 16

Amodiaquine

Back 16

Use: Chloroquine- rest P. f
SE: Hepatotoxicity, agranulocytosis

Front 17

Halofantrine

Back 17

Prop: cardiotoxity, erratic bioavail
X- res to mefloquine and lumefantrine (/artemisinin--> multidrug rest P.f)

Front 18

Lumefantrine

Back 18

Used in combo with arteminsins--> multidrug rest P. f