Updated: 9/8/2019


Review Topic
  • Snapshot
    • A 25-year-old medical student is about to embark on an international rotation in Ethiopia. Given that malaria is endemic in that area, she presents to the travel clinic for required vaccination as well as chemoprophylaxis of malaria. Upon further investigating on the CDC website, she discovers that malarial strains in Ethiopia are resistant to chloroquine. As she is already on doxycycline for the treatment of acne, her travel clinic physician informs her that there is no need for additional chemoprophylaxis.
  • Introduction
    • Drugs
      • chloroquine
      • hydroxychloroquine
      • quinidine
      • quinine
      • artemether/lumefantrine
      • atovaquone/proguanil
      • artesunate
      • mefloquine
      • primaquine
      • doxycycline
    • Clinical use
      • malaria
        • treatment
        • prophylaxis
      • P. falciparum and, increasingly, P. vivax may be resistant to chloroquine, hydroxychloroquine, and mefloquine
      • Anti-Malarial Medications
      • Drug
      • Mechanism of Action
      • Adverse Effects
      • Indications
      • Chloroquine
      • Blocks heme polymerase, which causes heme accumulation
      •  Heme is toxic to plasmodia
      • Retinopathy
      • Pruritus
      • Gastrointestinal upset
      • Myopathy
      • All plasmodial species:
      • however, there is increasing resistance to P. falciparum and, recently, P. vivax
      • Hydroxychloroquine
      • Unknown, but impairs neutrophils and chemotaxis and may interfere with lysosomal degradation of hemoglobin
      • Retinopathy
      •  Bleaching of hair
      •  Gastrointestinal upset
      • All plasmodial species:
      • however, there is increasing resistance to P. falciparum 
      • Quinidine
      • A class IA antiarrhythmic drug
      • Diarrhea
      •  QTc prolongation
      •  Palpitations
      • Life-threatening/severe malaria due to P. falciparum:
      • drug is discontinued in the US
      • Quinine
      • Disrupts plasmodial DNA transcription and replication
      • Hemolytic anemia in G6PD deficiency
      •  Gastrointestinal upset
      •  Flushing
      • Chloroquine-resistant P. falciparum and P. vivax
      • Artemether/lumefantrine
      • Inhibits nucleic acid and protein synthesis
      • Gastrointestinal upset
      •  Headache
      •  QTc prolongation
      • Chloroquine-resistant P. falciparum and P. vivax
      • Atovaquone/proguanil
      • Unknown, may interfere with cell membrane permeability and cause paralysis in the helminth
      • Gastrointestinal upset
      •  Dizziness
      • P. falciparum
      •  Babesia (used with azithromycin)
      •  Chemoprophylaxis
      • Artesunate
      • Inhibits arachidonic acid metabolism, making the helminth more susceptible to the host's innate immune system
      • Hemolytic crisis in patients with G6PD deficiency:
      • test for G6PD deficiency prior to starting
      • First-line for life-threatening malaria due to P. falciparum
      • Mefloquine
      • Inhibits oogenesis and spermatogenesis
      • Central nervous system toxicity: dizziness, hallucinations, altered mental status
      •  Gastrointestinal upset
      • P. falciparum
      •  Also has increasing resistance
      • Primaquine
      • Interferes with electron transport chain in plasmodial mitochonrdia
      • Gastrointestinal upset
      •  Hemolytic crisis in patients with G6PD deficiency:
      • test for G6PD deficiency prior to starting
      • Adjuvant for P. vivax/ovale to eradicate hypnozoites
      •  Chemoprophylaxis
      • Doxycycline
      • Inhibits 30S ribosomal subunit
      • Gastrointestinal upset
      •  Esophagitis
      •  Photosensitivity
      • Chemoprophylaxis
      •  Adjuvant therapy with chloroquine, quinine, or primaquine

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
1 of 0
Private Note