B7 Pharmacology Exam

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) & exoerythro 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 paras tox - Indics = uncompl malaria treat+proph; also non-intest amebic inf & off-lab for sarcoidosis - AEs = common prur, blur vis, GI disturb; serious CV, SJS, TEN, hypogly, hemol anem, anaph, seiz, mac/ret disord esp from LT high-dose ther; **hemol anem most in G6PD def pts** - DIs = QTc prol ags (ie. antipsychs, azole antifungs, antiarr, FQ abx, TMP/SMX) decr absorp; Cimetidine --> chloroq tox (agit, seiz, card arr); Mg/Ca antac --> decr chloroq gut absorp; Mefloq --> convul, EKG abnorms, card arr; Rabies+Chol vaccs decr AB resp; Proguanil --> mouth ulcers - Pearls = NOT good for last min travel (start 1-2w prior); DO NOT use in Chlorq/Mefloq resis areas; give weekly so GOOD for longer trips; Hydroxychloroq (RA) as proph; **SAFE in preg*