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68 Cards in this Set
- Front
- Back
which form of malaria is most likely to kill you
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Plasmodium falciparum
most dangerous, potentially fatal accounts for most serious complications & deaths pts should be hospitalized for treatment |
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clinical symptoms from malaria are due to what?
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are due to blood forms of the malaria
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Plasmodium vivax and ovale are likely to be what kind of malarias?
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relapsing
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Blood schizonticides are the antimalarial drug class that act where? use how?
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Act on erythrocytic parasites
Used for clinical and suppressive care |
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Tissue schizonticides are the antimalarial drug class that act where? use how?
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Eliminate developing or dormant liver forms
Used for casual prophylaxis Used to prevent relapse and provide a radical cure |
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what is the target of treatment for P falciparum and P malariae
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Treatment eliminating erythrocytic parasites will cure infection
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in P vivax and P ovale what are we trying to attack?
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Hypnozoite (dormant hepatic state)
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drug used to stop relapses of P vivax and P ovale?
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Terminal prophylaxis with primaquine
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why don't you use primaquine all the time?
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you get drug resistance
so you don't want to give it prophylactically remember: this is the drug used to stop relapses of P vivax and P ovale (the liver forms of malaria) |
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What is the only drug that will hit the dormant liver form of malaria? what are the bugs causing that?
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Primaquine
P vivax and P ovale |
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is primaquine effective against blood schizonts
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NO
only good for dormant liver forms of P vivax and P ovale |
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what is the radical cure for malaria?
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Primaquine Used in combo w/ blood schizonticide (usually chloroquine) to do this
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Fetus/newborns should not use primaquine..why?
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Acute hemolytic anemia
Due to glucose-6-phosphate dehydrogenase deficiency G6PD deficiency |
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What is the most common enzymatic deficiency?
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GDPD deficiency
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largest adverse effect of primaquine?
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Acute hemolytic anemia
Due to glucose-6-phosphate dehydrogenase deficiency G6PD deficiency |
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Chloroquine is what kind of drug? effective against?
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A blood schizonticide
Effective against: Erythrocytic forms all Plasmodia except CQ-resistant falciparum Gametocytes |
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What type of schizonts is chloroquine not effective against?
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Not effective against tissue schizonts!!
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Why is Chloroquine not used as much anymore?
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resistance
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DOC for chemoprophylaxis & acute attacks
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Chloroquine
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can Chloroquine be used in preggos/kids
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YES
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MOA for Chloroquine
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Selective toxicity
Actively concentrated in parasitized erythrocytes Chloroquine binds to heme prevents heme polymerization to hemozoin (an insoluble pigment) Causes accumulation of free heme which is cytotoxic, this then kills the parasite |
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most P. falciparum are resistant to what drug?
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Chloroquine
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discuss the dosage of chloroquine
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only need to dose once a week (has large volume of distribution)
must start with a loading dose (volume of distribution x target therapeutic conc) |
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Rare but important adverse effects for Chloroquine?
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Acute hemolysis (G6PD deficiency)
bad with Rheumatoid arthritis as well (irreversible ototoxicity retinopathy myopathy peripheral neuropathy) |
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Treatment of mild to moderate acute malaria(P falciparum or P vivax) you should use...
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Mefloquine
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Mefloquine is used for ?
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Treatment of mild to moderate acute malaria(P falciparum or P vivax)
Recommended for CQ-resistant or multidrug resistant P falciparum |
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what drug is Recommended for CQ-resistant or multidrug resistant P falciparum
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Mefloquine
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MOA for Mefloquine
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unknown
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what anti-malarial has the worst neuropsychiatric effects?
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Mefloquine
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this drug is associated with Confusion, dysphoria, insomnia, anxiety, vivid dreams/nightmares, depression, hallucinations
Rarely psychosis, convulsions and is Contraindicated in pts with neurologic & psychiatric disorders |
Mefloquine
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in addition to neuro problems, what is another major contraindication for Mefloquine?
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Cardiovascular
Conduction abnormalities in combo w/ other drugs Don’t use in patients taking Beta blockers Calcium channel blockers |
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what drug can you not use in pts taking B-Blockers, Ca channel blockers?
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Mefloquine
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what do you use for hospitalized pts with severe/complicated falciparum infections...remember location
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Quinidine IV in US,
quinine outside the US |
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DOC for uncomplicated CQ-resistant strains of falciparum malaria
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oral Quinine
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when you have a pt who is on Quinine for treatment of uncomplicated CQ resistant falciparum malaria.. what drug combo will you use with it? Why?
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doxycycline or clindamycin (kids)
to shorten duration of use and limit toxicity |
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QT prolongation is a side effect of what anti-malarial drug
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Quinine
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Curare-like effects is a side effect of what anti-malarial drug
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Quinine
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what drug cant you use in pts with myasthenia gravis
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Quinine
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Oxytocic (promotes rapid labor by stimulating contractions of the myometrium) is a side effect of what drug?
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Quinine
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Cinchonism (tinnitus, headache, nausea, dizziness, flushing, visual disturbances; vomiting, diarrhea, abdominal pain) is a side effect of what drug?
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Quinine
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Hypoglycemia is a side effect of what?
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Quinine
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Blackwater fever (Massive hemolysis, hemoglobinemia, hemoglobinuria, renal failure) is a side effect of what?
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Quinine
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hemolysis (G6PD deficiency) and hypoglycemia can be side effects of what?
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Quinine
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what type of drug is Pyrimethamine? what is it used in combo with
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A blood schizonticide:
Slow acting Folate synthesis inhibitor Used in combination with sulfadoxine |
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what is Pyrimethamine effective against?
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P falciparum including CQ-resistant falciparum
Less active against other species |
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why is Pyrimethamine given with a sufa drug? what was this drug?
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Combination is synergistic
Combination retards the emergence of drug resistance combination with sulfadoxine |
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what is presumptive treatment of febrile illness with suspected malaria?
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Pyrimethamine
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MOA for Pyrimethamine
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Inhibits plasmodial dihydrofolate reductase (DHFR)
Synergistic with sulfonamides and sulfones in sequential inhibition of folate synthesis |
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why can't Pyrimethamine be used for prophylaxis
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Too toxic for prophylaxis
Hemolytic anemia and agranulocytosis (high doses) Sulfa’s usually account for toxicities in combo preps Hematologic, GI, CNS & renal Dermatologic; Potentially fatal reactions including Stevens-Johnson syndrome & toxic epidermal necrolysis |
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what is meant by the fact that Proguanil is a prodrug?
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requires metabolic activation
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which anti-malarial is a prodrug
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Proguanil
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MOA for Proguanil
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Inhibits dihydrofolate reductase (DHFR)
a folate synthesis inhibitor Has both tissue and blood schizonticidal activity No activity against hypnozoites |
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atovaquone + proguanil treats what? should be avoided in who?
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Prevention and treatment of P. falciparum incl CQ-resistant and MDR strains
Avoid in pregnant females |
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MOA of Atovaquone
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selectively deprives the parasite of energy by inhibiting mitochondrial electron transport
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together atovaquone + proguanil do what?
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they inhibit nucleic acid synthesis and replication
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what is a good prophylaxis for drug resistant falciparum
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Doxycycline
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what can't you use Doxycycline in?
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No kids, pregnant or lactating females, and avoid sun
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For travel to areas of risk where CQ-resistant P falciparum has NOT been reported what should you use to protect from malaria?
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chloroquine
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Travelers unable to take chloroquine can take what other 3 options?
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atovaquone + proguanil (Malarone)
doxycycline mefloquine |
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For travel in areas with risk of CQ-resistant P falciparum exist…take what 3 options?
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mefloquine
doxycycline atovaquone + proguanil (Malarone) |
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In mefloquine-resistant areas (P falciparum) take what? 2 options
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Either doxycycline or
atovaquone + proguanil can be used |
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What drug do you use:
areas with CQ-sensitive P falciparum |
cloroquine (CQ)
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What drug do you use:
areas with CQ-resistant P falciparum |
mefloquine (MQ)
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What drug do you use:
areas with MDR – P falciparum |
doxycycline
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What drug do you use:
alternative regimen to replace MQ |
atovaquone – proguanil
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What drug do you use:
terminal prophylaxis of P vivax and P ovale (when leaving area) |
primaquine
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What drug do you use:
P vivax and P ovale infections |
chloroquine then primaquine (if G6PD normal)
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What drug do you use:
CQ-sensitive P falciparum and P malariae infections |
chloroquine
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