Podcast
Questions and Answers
A patient presents with malaria acquired in an area with known chloroquine resistance. Which of the following is the MOST appropriate treatment option?
A patient presents with malaria acquired in an area with known chloroquine resistance. Which of the following is the MOST appropriate treatment option?
- Primaquine
- Mefloquine
- Artemether/lumefantrine (correct)
- Chloroquine
A patient requires treatment for a life-threatening malaria infection. What test should be performed before administering IV quinidine or artesunate, and why?
A patient requires treatment for a life-threatening malaria infection. What test should be performed before administering IV quinidine or artesunate, and why?
- Renal function test to assess drug clearance.
- Liver function test to evaluate drug metabolism.
- G6PD deficiency test to prevent drug-induced hemolysis. (correct)
- Complete blood count to monitor for thrombocytopenia.
A returning traveler is diagnosed with Plasmodium vivax malaria. In addition to a drug targeting erythrocytic stages, which medication is necessary to eradicate hypnozoites from the liver?
A returning traveler is diagnosed with Plasmodium vivax malaria. In addition to a drug targeting erythrocytic stages, which medication is necessary to eradicate hypnozoites from the liver?
- Atovaquone/proguanil
- Quinine
- Primaquine (correct)
- Artesunate
Which of the following is the MOST concerning long-term side effect associated with chloroquine use, requiring routine monitoring?
Which of the following is the MOST concerning long-term side effect associated with chloroquine use, requiring routine monitoring?
A patient taking quinine for malaria develops tinnitus, blurred vision, and confusion. Which of the following adverse effects is the MOST likely cause?
A patient taking quinine for malaria develops tinnitus, blurred vision, and confusion. Which of the following adverse effects is the MOST likely cause?
Why should tetracyclines be avoided in children under eight years old and pregnant women?
Why should tetracyclines be avoided in children under eight years old and pregnant women?
Which of the following medications, when co-administered with doxycycline, would MOST significantly reduce doxycycline absorption?
Which of the following medications, when co-administered with doxycycline, would MOST significantly reduce doxycycline absorption?
A patient with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) might benefit from which tetracycline?
A patient with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) might benefit from which tetracycline?
A patient is prescribed tetracycline as part of a four-drug regimen for H. pylori eradication. What risk is associated with using tetracycline past its expiration date?
A patient is prescribed tetracycline as part of a four-drug regimen for H. pylori eradication. What risk is associated with using tetracycline past its expiration date?
Which of the following mechanisms is responsible for bacterial resistance to both chloroquine and atovaquone/proguanil in malaria treatment?
Which of the following mechanisms is responsible for bacterial resistance to both chloroquine and atovaquone/proguanil in malaria treatment?
Flashcards
Chloroquine
Chloroquine
Used to treat malaria caused by plasmodium species, but resistance is common. Side effects include retinopathy and pruitis.
Atovaquone/Proguanil
Atovaquone/Proguanil
Treats plasmodium falciparum and is used for both malaria treatment and prophylaxis. Resistance is caused by a membrane pump decreasing intracellular drug concentration.
Quinine
Quinine
Used for life-threatening malaria, also treats babesiosis. Side effects include cinchonism (flushing, tinnitus, blurred vision, confusion).
Tetracyclines (Doxycycline)
Tetracyclines (Doxycycline)
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Tetracycline Contraindications
Tetracycline Contraindications
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Tetracycline Side Effects
Tetracycline Side Effects
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Tetracycline Drug Interactions
Tetracycline Drug Interactions
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Study Notes
- Focus on medications and their uses for malaria treatment
Malaria Prevention
- Vaccine
Pharmacological Management
- Chloroquine is used for sensitive species
- Mefloquine is used for sensitive species
- Artemether/lumefantrine or atovaquone/proguanil are alternatives
- IV quinidine or artesunate is used for life-threatening infections, testing for G6PD deficiency is required
Specific Species Treatment
- For Plasmodium vivax or ovale: add primaquine for hypnozoite stage, test for G6PD deficiency
- For Plasmodium falciparum: treat with artemether/lumefantrine or atovaquone/proguanil
Chloroquine
- Treats plasmodium species
- Side effects include retinopathy and pruritus (itching)
- Resistance is due to a membrane pump that decreases intracellular drug concentration
Atovaquone/Proguanil
- Treats plasmodium falciparum
- Used for malaria treatment and prophylaxis
- Resistance is due to a membrane pump that decreases intracellular drug concentration
Quinine
- Used for life-threatening malaria cases
- Side effects: cinchonism (flushing, tinnitus, blurred vision, confusion, reversible high-frequency hearing loss, rash, lichenoid photosensitivity)
- Also used to treat babesiosis
Tetracyclines (Doxycycline)
- Inhibit bacterial protein synthesis by binding to the 30S subunit of the bacterial ribosome, preventing aminoacyl-tRNA binding
- Bacteriostatic
- Treats gram-positive organisms (Streptococcus, MSSA), gram-negative organisms (H. influenza), atypical organisms (Chlamydia pneumoniae, Legionella, Mycoplasma pneumoniae)
- Effective against community-acquired MRSA and Rickettsia
- Contraindications: children under eight and pregnant/breastfeeding women due to risk of permanent teeth discoloration and impaired teeth/bone growth
- Side effects: photosensitivity and intracranial hypertension (pseudotumor cerebri)
- Drug interactions: absorption decreases with antacids, dairy products, and products containing iron, magnesium, aluminum, calcium, or zinc; may increase bleeding risk with warfarin
- Demeclocycline is also used to treat SIADH
- Doxycycline is the drug of choice for Lyme disease and can be used for malaria prophylaxis
- Tetracycline can be used in a four-drug regimen for H. pylori
- Do not use after the expiration date (can cause Fanconi syndrome)
- Adjust the dose for all tetracyclines except doxycycline in cases of renal impairment
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