B7 Pharmacology Exam 1
Description of Malaria - paras inf by Plasmodium spp (P. falcip, P. vivax, P. ovale, P.
malariae, P. knowlesi) by Anopheles mosq vector not aff by paras
- complex life cyc incl erythro stage (want to prev this stage, causes clin illness) & exo-
erythro stage (dormant in liv as hypnozoites)
transm in regs near equat temps >68F
Non-Pharm Prevention of Malaria - - travs to endem regs receive chemo-proph dep on
who, where, when trav going, what style trav, trip dur
- NO proph regimen compl effec --> comb w/ pers prot meas (ie. repellant, long
sleeves+pants, mosq-free sleeping, bed nets)
- can be more severe in preg wom incr risk adv preg outc --> CDC rec avoid preg trav
b/c INCR SUSC to P. flacip inf by decr Bc imm
Examples of Drugs for Malaria Prevention - - Atovaqone/Proquanil
- Chloroquine
- Doxycycline
- Mefloquine
- Primaquine
- Tafenoquine
MOA, Indications, AEs, CIs, DIs, Clinical Pearls of Atovaquone/Proguanil - - MOA =
Atov sel inhib mitoch e- transp erythro+exoerythro stages stopping P. from making
energy; Prog metab to active cycloguanil inhib DHFR pyrim synth disr paras DNA synth
- Indics = uncomplic malar treat+proph of P. FALCIP+VIVAX
- AEs = common prur, GI disturb, elev LFTs; serious neutrop, pancytop, hep, liv fail
- CIs = proph in ren impair CrCl<30; only for treatm max 3d if benef>risk
- DIs = Warf --> incr INR so mon; Rifamycins --> incr metab decr antimal effic; live chol
vacc (get before starting Atov)
- Pearls = good for last min travs (1-2d prior to trip); well-tol, take w/ food/milk optim
absorp+decr GI up; **AVOID Atov in preg**; **TOC for peds>5kg**
MOA, Indications, AEs, CIs, DIs, Clinical Pearls of Chloroquine - - MOA = prev heme
biocryst w/ buildup causing uparas utox
- Indics u= uuncompl umalaria utreat+proph; ualso unon-intest uamebic uinf u& uoff-
lab ufor usarcoidosis
- AEs u= ucommon uprur, ublur uvis, uGI udisturb; userious uCV, uSJS, uTEN, uhypogly,
uhemol uanem, uanaph, useiz, umac/ret udisord uesp ufrom uLT uhigh-dose uther; u**hemol
uanem umost uin uG6PD udef upts**
- DIs u= uQTc uprol uags u(ie. uantipsychs, uazole uantifungs, uantiarr, uFQ uabx,
uTMP/SMX) udecr uabsorp; uCimetidine u--> uchloroq utox u(agit, useiz, ucard uarr);
uMg/Ca uantac u--> udecr uchloroq ugut uabsorp; uMefloq u--> uconvul, uEKG uabnorms,
ucard uarr; uRabies+Chol uvaccs udecr uAB uresp; uProguanil u--> umouth uulcers
- Pearls u= uNOT ugood ufor ulast umin utravel u(start u1-2w uprior); uDO uNOT uuse uin
uChlorq/Mefloq uresis uareas; ugive uweekly uso uGOOD ufor ulonger utrips;
uHydroxychloroq u(RA) uas uproph;
**SAFE uin upreg**
,B7 Pharmacology Exam 1
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uDoxycycline u- u- uMOA u= utetracyc
uinhib u30S uribos usubun uhalt uRNA utransc uintef uw/ ubac+paras uprot usynth
- Indics u= umalar utreat uadjunct, umalar uproph uesp uin uareas uhigh uprev uMDR uP. ufalcip
- AEs u= ucommon uphotosens u--> uwear usunscr/prot uclothing; userious uexfol urash,
uhepatotox,
C. udiff uassoc udiarr u(CDAD)
- DIs u= udi-/trival ucations uchelation; uPCN udecr ueffic; uMXT uincr utox; ulive uchol uvacc
udecr uimm uresp; uretinoids u(ie. uisoretinoin)
- Pearls u= uinexpensive; uGOOD ufor ulast umin utrav u(start u1-2d uprior); u**prev
uRickettsial udis u& uleptospirosis**; uno uadd umed uif utaking uchron ufor uacne; u**DO
uNOT uuse ufor upreg uwomen**
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uMefloquine u- u- uMOA u= uP.
uschizonticide ufor uerythro ustage; uelim ut1/2 u13-30d
- Indics u= uuncomplic uP. uFALCIP+VIVAX uproph/treat; uChloroq-resis uP. ufalcip
- AEs u= ucommon ubrady, uGI udisturbs, udizz, uneuro/psych uAEs; userious uprol uQTc
uinterv, useiz, usuicidality
- CIs u= uquinine/quinidine uhypersens; uprophyl uin upts uw/ uconvul udisords, upsych
uconds u(ie. udepr, uanx, upsych, uschiz) u--> uwors upsych usx uby ucrossing uBBB
- DIs u= uquinine, uQTc uprol uags u(many uCI), uCYP3A4 uinhibs ub/c uMefloq umetab uby u3A4
- Pearls u= utake uweekly uso ugood ufor ulonger utrip; u**RESIS uso unot urec ufor uSE uAs
uinf**; u**CAN ube uused uin upreg**; uNOT uREC ufor upts uw/ ucard ucond udisords, useiz
udisords, upsych uconds
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uPrimaquine u- u- uMOA u= utiss
ushizonticide uerad udev+lat uexoerythro ushiz uin uliv; uerad uhypnoz uin u"rad ucure" uP.
uOVALE+VIVAX
- Indics u= umalar urelapse uprev; uoff-lab ufor uproph
- AEs u= u**BBW uphysic ushould ucompl ufamil uthemselves uw/ ucompl uconts uleaflets
ubefore uRx uprimaq uphosph**; ucommon uGI; userious uhemol uanem, uleukop,
umetHgbemia u(rare uw/ umalar utreat)
- DIs u= upot uhemol udrugs u& uBM umyel uels udepressants
- Pearls u= umost ueffec ufor uP. uVIVAX uPREV; ugood ufor ulast uin utravs+shorter utrips
ub/c utake u1- u2d ubefore/7d uafter; u**MUST utest ufor uG6PD udef uprior**; uled uto udiscov
uof uG6PD udef
Description u& uSx uof uHemolytic uAnemia u- uacq uiatrog/inher uincr uRBC udestr
- G6PD u= uNADP+ uto uNADPH; uonly uRBC udef uag uoxid ustress uso udecr uRBC ulifesp
uif uG6PD udef; uXL umut uw/ udef uby udecr uin uvivo uenz ustab, udecr uenz uactiv uso uaccel
uRBC uaging; umaybe
P. ufalcip uresis
- precip uHgb udrop u--> uweak, ufatigue, upallor, udyp; ujaund+dark uur uby uhgburia uprogr uto
uARF
- incr uMCV+MCH, ubili, uLDH, udecr-decr uhaptogl
MOA, uIndications, uAEs, uCIs, uDIs uof uTafenoquine u- u- uMOA u= uanti-hyponoz uactiv,
ualso uag ueythro uforms+gametos
- Indics u= uP. uVIVAX u>/=16y/o ufor uprophyl, utreat, uRADICAL ucure; uprophyl ubut uNOT
utreat ufor
P. uFALCIP
,B7 Pharmacology Exam 1
- AEs u= ucommon udizz, uGI, uHA, uHgb udecr; usevere uhemol uanem, upsych uexac
- DIs u= uincr ulevs umetformin, uplat uchemo ucomps
**REQUIRES uG6PD udef uscreen uprior**
, B7 Pharmacology Exam 1
Atovaqone/Proguanil ufor uMalaria uProphylaxis u- u- utaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u7d uafter uleaving umal-end uarea
Chloroquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u1-2w ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Doxycycline ufor uMalaria uProphylaxis u- u- uTaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Mefloquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u2w ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Primaquine ufor uMalaria uProphylaxis u- u- uTaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u7d uafter uleaving umal-end uarea
Tafenoquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u3d ubefore uentering umal-end uarea
- Stop u7d(1x udose) uafter uleaving umal-end uarea
What uto uuse ufor uMalaria uProphylaxis uin uChloroquine-SENSITIVE uAreas u- u-
uChloroq/Hydroxychloroq
- Atov/Proguan
- Doxy
- Mefloq uesp uin uPREG
- Tafenoq
- Primaq uwhere uP. uvivax u>90% ucausative uorg
What uto uuse ufor uMalaria uProphylaxis uin uChloroquine uRESISTANT uAreas u- u- uAtov-
Proguan
- Doxy
- Mefloq uesp uin uPREG uunless uresis uprev
- Primaq uwhen uP. uviv ucaus uorg u>90% ucases
- Tafenoq
Alternatives ufor uMalaria uProphylaxis u- u- uPyrimethamine u= uNOT u1st uline, umay ube
ucost uprohib uso unot uwidely uavail; utaken uonce uweekly
- Sulfadoxine/Pyrimethamine u= uNOT u1st uline, utaken uonce uweekly ufor uthose
utrav uto uchloroq uresis uareas uw/ uallergs uto upref uproph; uif utake uin uthis ucase,
ubring uone udose utreatment ualong ujust uin ucase
- Dapsone u= uoff-lab uw/ ueffic uin upeds; uG6PD udef uscreen ureq+freq uCBCs uduring uinit
Description of Malaria - paras inf by Plasmodium spp (P. falcip, P. vivax, P. ovale, P.
malariae, P. knowlesi) by Anopheles mosq vector not aff by paras
- complex life cyc incl erythro stage (want to prev this stage, causes clin illness) & exo-
erythro stage (dormant in liv as hypnozoites)
transm in regs near equat temps >68F
Non-Pharm Prevention of Malaria - - travs to endem regs receive chemo-proph dep on
who, where, when trav going, what style trav, trip dur
- NO proph regimen compl effec --> comb w/ pers prot meas (ie. repellant, long
sleeves+pants, mosq-free sleeping, bed nets)
- can be more severe in preg wom incr risk adv preg outc --> CDC rec avoid preg trav
b/c INCR SUSC to P. flacip inf by decr Bc imm
Examples of Drugs for Malaria Prevention - - Atovaqone/Proquanil
- Chloroquine
- Doxycycline
- Mefloquine
- Primaquine
- Tafenoquine
MOA, Indications, AEs, CIs, DIs, Clinical Pearls of Atovaquone/Proguanil - - MOA =
Atov sel inhib mitoch e- transp erythro+exoerythro stages stopping P. from making
energy; Prog metab to active cycloguanil inhib DHFR pyrim synth disr paras DNA synth
- Indics = uncomplic malar treat+proph of P. FALCIP+VIVAX
- AEs = common prur, GI disturb, elev LFTs; serious neutrop, pancytop, hep, liv fail
- CIs = proph in ren impair CrCl<30; only for treatm max 3d if benef>risk
- DIs = Warf --> incr INR so mon; Rifamycins --> incr metab decr antimal effic; live chol
vacc (get before starting Atov)
- Pearls = good for last min travs (1-2d prior to trip); well-tol, take w/ food/milk optim
absorp+decr GI up; **AVOID Atov in preg**; **TOC for peds>5kg**
MOA, Indications, AEs, CIs, DIs, Clinical Pearls of Chloroquine - - MOA = prev heme
biocryst w/ buildup causing uparas utox
- Indics u= uuncompl umalaria utreat+proph; ualso unon-intest uamebic uinf u& uoff-
lab ufor usarcoidosis
- AEs u= ucommon uprur, ublur uvis, uGI udisturb; userious uCV, uSJS, uTEN, uhypogly,
uhemol uanem, uanaph, useiz, umac/ret udisord uesp ufrom uLT uhigh-dose uther; u**hemol
uanem umost uin uG6PD udef upts**
- DIs u= uQTc uprol uags u(ie. uantipsychs, uazole uantifungs, uantiarr, uFQ uabx,
uTMP/SMX) udecr uabsorp; uCimetidine u--> uchloroq utox u(agit, useiz, ucard uarr);
uMg/Ca uantac u--> udecr uchloroq ugut uabsorp; uMefloq u--> uconvul, uEKG uabnorms,
ucard uarr; uRabies+Chol uvaccs udecr uAB uresp; uProguanil u--> umouth uulcers
- Pearls u= uNOT ugood ufor ulast umin utravel u(start u1-2w uprior); uDO uNOT uuse uin
uChlorq/Mefloq uresis uareas; ugive uweekly uso uGOOD ufor ulonger utrips;
uHydroxychloroq u(RA) uas uproph;
**SAFE uin upreg**
,B7 Pharmacology Exam 1
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uDoxycycline u- u- uMOA u= utetracyc
uinhib u30S uribos usubun uhalt uRNA utransc uintef uw/ ubac+paras uprot usynth
- Indics u= umalar utreat uadjunct, umalar uproph uesp uin uareas uhigh uprev uMDR uP. ufalcip
- AEs u= ucommon uphotosens u--> uwear usunscr/prot uclothing; userious uexfol urash,
uhepatotox,
C. udiff uassoc udiarr u(CDAD)
- DIs u= udi-/trival ucations uchelation; uPCN udecr ueffic; uMXT uincr utox; ulive uchol uvacc
udecr uimm uresp; uretinoids u(ie. uisoretinoin)
- Pearls u= uinexpensive; uGOOD ufor ulast umin utrav u(start u1-2d uprior); u**prev
uRickettsial udis u& uleptospirosis**; uno uadd umed uif utaking uchron ufor uacne; u**DO
uNOT uuse ufor upreg uwomen**
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uMefloquine u- u- uMOA u= uP.
uschizonticide ufor uerythro ustage; uelim ut1/2 u13-30d
- Indics u= uuncomplic uP. uFALCIP+VIVAX uproph/treat; uChloroq-resis uP. ufalcip
- AEs u= ucommon ubrady, uGI udisturbs, udizz, uneuro/psych uAEs; userious uprol uQTc
uinterv, useiz, usuicidality
- CIs u= uquinine/quinidine uhypersens; uprophyl uin upts uw/ uconvul udisords, upsych
uconds u(ie. udepr, uanx, upsych, uschiz) u--> uwors upsych usx uby ucrossing uBBB
- DIs u= uquinine, uQTc uprol uags u(many uCI), uCYP3A4 uinhibs ub/c uMefloq umetab uby u3A4
- Pearls u= utake uweekly uso ugood ufor ulonger utrip; u**RESIS uso unot urec ufor uSE uAs
uinf**; u**CAN ube uused uin upreg**; uNOT uREC ufor upts uw/ ucard ucond udisords, useiz
udisords, upsych uconds
MOA, uIndications, uAEs, uCIs, uDIs, uClinical uPearls uof uPrimaquine u- u- uMOA u= utiss
ushizonticide uerad udev+lat uexoerythro ushiz uin uliv; uerad uhypnoz uin u"rad ucure" uP.
uOVALE+VIVAX
- Indics u= umalar urelapse uprev; uoff-lab ufor uproph
- AEs u= u**BBW uphysic ushould ucompl ufamil uthemselves uw/ ucompl uconts uleaflets
ubefore uRx uprimaq uphosph**; ucommon uGI; userious uhemol uanem, uleukop,
umetHgbemia u(rare uw/ umalar utreat)
- DIs u= upot uhemol udrugs u& uBM umyel uels udepressants
- Pearls u= umost ueffec ufor uP. uVIVAX uPREV; ugood ufor ulast uin utravs+shorter utrips
ub/c utake u1- u2d ubefore/7d uafter; u**MUST utest ufor uG6PD udef uprior**; uled uto udiscov
uof uG6PD udef
Description u& uSx uof uHemolytic uAnemia u- uacq uiatrog/inher uincr uRBC udestr
- G6PD u= uNADP+ uto uNADPH; uonly uRBC udef uag uoxid ustress uso udecr uRBC ulifesp
uif uG6PD udef; uXL umut uw/ udef uby udecr uin uvivo uenz ustab, udecr uenz uactiv uso uaccel
uRBC uaging; umaybe
P. ufalcip uresis
- precip uHgb udrop u--> uweak, ufatigue, upallor, udyp; ujaund+dark uur uby uhgburia uprogr uto
uARF
- incr uMCV+MCH, ubili, uLDH, udecr-decr uhaptogl
MOA, uIndications, uAEs, uCIs, uDIs uof uTafenoquine u- u- uMOA u= uanti-hyponoz uactiv,
ualso uag ueythro uforms+gametos
- Indics u= uP. uVIVAX u>/=16y/o ufor uprophyl, utreat, uRADICAL ucure; uprophyl ubut uNOT
utreat ufor
P. uFALCIP
,B7 Pharmacology Exam 1
- AEs u= ucommon udizz, uGI, uHA, uHgb udecr; usevere uhemol uanem, upsych uexac
- DIs u= uincr ulevs umetformin, uplat uchemo ucomps
**REQUIRES uG6PD udef uscreen uprior**
, B7 Pharmacology Exam 1
Atovaqone/Proguanil ufor uMalaria uProphylaxis u- u- utaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u7d uafter uleaving umal-end uarea
Chloroquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u1-2w ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Doxycycline ufor uMalaria uProphylaxis u- u- uTaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Mefloquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u2w ubefore uentering umal-end uarea
- Stop u4w uafter uleaving umal-end uarea
Primaquine ufor uMalaria uProphylaxis u- u- uTaken uDAILY
- Start u1-2d ubefore uentering umal-end uarea
- Stop u7d uafter uleaving umal-end uarea
Tafenoquine ufor uMalaria uProphylaxis u- u- uTaken uWEEKLY
- Start u3d ubefore uentering umal-end uarea
- Stop u7d(1x udose) uafter uleaving umal-end uarea
What uto uuse ufor uMalaria uProphylaxis uin uChloroquine-SENSITIVE uAreas u- u-
uChloroq/Hydroxychloroq
- Atov/Proguan
- Doxy
- Mefloq uesp uin uPREG
- Tafenoq
- Primaq uwhere uP. uvivax u>90% ucausative uorg
What uto uuse ufor uMalaria uProphylaxis uin uChloroquine uRESISTANT uAreas u- u- uAtov-
Proguan
- Doxy
- Mefloq uesp uin uPREG uunless uresis uprev
- Primaq uwhen uP. uviv ucaus uorg u>90% ucases
- Tafenoq
Alternatives ufor uMalaria uProphylaxis u- u- uPyrimethamine u= uNOT u1st uline, umay ube
ucost uprohib uso unot uwidely uavail; utaken uonce uweekly
- Sulfadoxine/Pyrimethamine u= uNOT u1st uline, utaken uonce uweekly ufor uthose
utrav uto uchloroq uresis uareas uw/ uallergs uto upref uproph; uif utake uin uthis ucase,
ubring uone udose utreatment ualong ujust uin ucase
- Dapsone u= uoff-lab uw/ ueffic uin upeds; uG6PD udef uscreen ureq+freq uCBCs uduring uinit
