DRUG CLASSIFICATION

chloroquine (Aralen)

MECHANISM OF ACTION

Chloroquine inhibits the action of heme polymerase in malarial trophozoites, preventing the conversion
of heme to hemazoin. Plasmodium species continue to accumulate toxic heme, killing the parasite.
Chloroquine passively diffuses through cell membranes and into endosomes, lysosomes, and Golgi
vesicles; where it becomes protonated, trapping the chloroquine in the organelle and raising the
surrounding pH. The raised pH in endosomes, prevent virus particles from utilizing their activity for
fusion and entry into the cell.

ADVERSE EFFECT

• headache nausea. loss of appetite. diarrhea. upset stomach. stomach pain. rash. itching

CONTRAINDICATIONS

• low blood sugar • glucose-6-phosphate dehydrogenase (G6PD) deficiency • low amount of

magnesium in the blood • low amount of potassium in the blood • porphyria • anemia • low levels of
white blood cells • alcoholism

NURSING CONSIDERATIONS

Resistance has developed in certain parts of the world.

- Recommendations for malaria prophylaxis should be based on up-to-date research.

- Prophylaxis is not 100 per cent effective. It is important to inform travellers about mosquito bites and
taking drug regularly.

- Rotate injection site.

- Orally, give same time each day to maintain levels.

- Ophthalmic tests required in long-term treatment.

- Observe for allergic reactions, such as pruritis, rash, urticaria.

- Observe for ototoxicity (tinnitus, vertigo, changes in hearing ability).

- Toxicity is a problem - observe for signs.

 DRUG CLASSIFICATION

Quinine (QUALAQUIN)

MECHANISM OF ACTION

Quinine inhibits nucleic acid synthesis, protein synthesis, and glycolysis in Plasmodium

falciparum and can bind with hemazoin in parasitized erythrocytes.

SIDE EFFECTS

 nausea.
 restlessness.
 difficulty hearing or ringing in the ears.
 confusion.
 Nervousness

Contraindications

 Hypersensitivity
 G6PD deficiency
 Optic neuritis, tinnitus, history of quinine-associated blackwater fever, and
thrombocytopenic purpura
 Pregnancy

Nursing considerations

Nursing implications

 Be alert for S&S of rising plasma concentration of quinine marked by tinnitus and
hearing impairment, which usually do not occur until concentration is 10 mcg/mL or
more.
 Follow the same precautions with quinine as are used with quinidine in patients with
atrial fibrillation; quinine may produce cardiotoxicity in these patients.

DRUG CLASSIFICATION
Mefloquine.

Mechanism of Action:
Membrane-bound mefloquine may inhibit merozoite invasion and interact with proteins
involved with parasite membrane lipid trafficking and nutrient uptake. Mefloquine binds to
haem, forming a complex that may also be toxic to the parasite.

Side effects

 nausea

 vomiting

 fever

 diarrhea

 pain on the right side of your stomach

 loss of appetite

 muscle pain

 headache

 sleepiness

 increased sweating

Contraindications
- History of neuropsychiatric disorders including depression and convulsions.
- Hypersensitivity to quinine.

Nursing considerations
- Mefloquine doses in the BNF may differ from those in product literature.
- Travellers should be informed about adverse reactions and, if they occur, that
they should seek medical advice on alternative antimalarials before the next dose
is due.
 - Travel to malarious areas should be avoided during pregnancy; if it is
unavoidable, effective prophylaxis must be used but mefloquine should be
avoided as a matter of principle. However, studies of mefloquine use in
pregnancy (including in the first trimester) indicate that it can be considered for
travel to chloroquine-resistant areas.
- Mefloquine is considered to be appropriate for use by people with renal
impairment and does not require dosage reduction.

Drug classification

Pyrimethamine (Daraprim)

Mechanism of Action:
Pyrimethamine inhibits the dihydrofolate reductase of plasmodia and thereby blocks the
biosynthesis of purines and pyrimidines, which are essential for DNA synthesis and cell
multiplication. This leads to failure of nuclear division at the time of schizont formation in
erythrocytes and liver.

Side effects

 sore throat, swelling in your tongue;

 pale skin, easy bruising, purple spots under your skin;
 the first sign of any skin rash, no matter how mild;
 blood in your urine;
 fever, cold or flu symptoms;
 new or worsening cough, fever, trouble breathing;
 irregular heartbeats;

Contraindications
Use of DARAPRIM is contraindicated in patients with known hypersensitivity to pyrimethamine
or to any component of the formulation. Use of the drug is also contraindicated in patients with
documented megaloblastic anemia due to folate deficiency.

Nursing considerations

 Monitor patient response closely. Dosages required for treatment of toxoplasmosis

approach toxic levels.
 Lab tests: Perform blood counts, including platelets, twice weekly during therapy.
 Withhold drug and notify physician if hematologic abnormalities appear.
Drug classification

Primaque

Mechanism of action

Primaquine's mechanism of action is not well understood. It may be acting by generating

reactive oxygen species or by interfering with the electron transport in the parasite. Also,
although its mechanism of action is unclear, primaquine may bind to and alter the properties of
protozoal DNA.

Side effects

Nausea,

 vomiting, 

dizziness, 

stomach upset, and

abdominal cramps

Contraindications

Contraindications in acutely an patients from systemic disease manifested by tendency to

granulocypenia such us reaumatoid arthristis and lupus ery thematosus in patients receiving
concurrently other potentially hemolytic drugs or depressants of myeloid elements of the bone marrow
it appears to potentiate the toxicity of antimalarial compounds which are structurally related to
primaquine, there fore, the use of quinacrine in patients recieving primaquine is contraindicated.
Similarly primaquine should not be administered to patients who have received quinacrine recently,
toxicity is increased. Use with caution and follow the weekly dosing regimen in patients with caution and
follow hemolytic anemia can occur.

Nursing considerations
  Be aware drug may precipitate acute hemolytic anemia in patients with G6PD deficiency,
an inherited error of metabolism carried on the X chromosome

Drug classification

Sulfonamide

Mechanism of action

s a sulfonamide antibiotic, sulfanilamide functions by competitively inhibiting (that is, by acting as a

substrate analogue) enzymatic reactions involving para-aminobenzoic acid (PABA). Specifically,
it competitively inhibits the enzyme dihydropteroate synthase. PABA is needed in enzymatic reactions
that produce folic acid, which acts as a coenzyme in the synthesis
of purines and pyrimidines. Mammals do not synthesize their own folic acid so are unaffected by PABA
inhibitors, which selectively kill bacteria. [11]

However, this effect can be reversed by adding the end products of one-carbon transfer reactions, such
as thymidine, purines, methionine, and serine. PABA can also reverse the effects of sulfonamides

Side effects

 Lethargy.
 Anorexia.
 Nausea.
 Vomiting.
 Dizziness.
 Headache.
 Photosensitivity (sunburn after exposure to sunlight)
 Serious skin rashes. Serious skin rashes include: Steven-Johnson Syndrome,
which causes aching joints and muscles, redness, blistering, and skin peeling.

Contraindications
Sulphanilamide is contraindicated in those known to be hypersensitive to sulfonamides, in nursing
mothers, during pregnancy near term and in infants less than 2 months of age

Nursing considerations
patients should be monitored carefully for adverse effects including delayed hypersensitivity
reactions. Sulfonamide medications increase the risk of crystalluria that can cause kidney
stones or decreased kidney function; therefore, patients should increase their water intake while
taking these medications
Patient teaching
patients should be educated to use sunscreen and protective clothing with sun exposure. 
The patient should also report any rash, sore throat, fever, or mouth sores that might occur. 
Unusual bleeding or bruising should also be reported to the provider.  If patients are receiving
prolonged therapy, they may require platelet count monitoring
Antiprotozoal drugs

Drugs classification

Metronidazole

Mechanism of Action:

.Metronidazole diffuses into the organism, inhibits protein synthesis by interacting with DNA and
causing a loss of helical DNA structure and strand breakage. Therefore, it causes cell death in susceptible
organisms.

The mechanism of action of metronidazole occurs through a four-step process. Step one is the
entry into the organism by diffusion across the cell membranes of anaerobic and aerobic
pathogens. However, antimicrobial effects are limited to anaerobes. Step two involves reductive
activation by intracellular transport proteins by altering the chemical structure of pyruvate-
ferredoxin oxidoreductase. The reduction of metronidazole creates a concentration gradient in
the cell that drives uptake of more drug and promotes free radical formation that is
cytotoxic. Step three, interactions with intracellular targets, is achieved by cytotoxic particles
interacting with host cell DNA resulting in DNA strand breakage and fatal destabilization of the
DNA helix. Step four is the breakdown of cytotoxic products. Metronidazole is also cytotoxic to
facultatively anaerobic bacteria like Helicobacter pylori and Gardnerella vaginalis, but the
mechanism of action to these pathogens is not well understood.

Side Effects:

Dizziness, headache, stomach upset, nausea, vomiting, loss of
appetite, diarrhea, constipation, or metallic taste in your mouth may occur

Contraindications

Hypersensitivity to metronidazole or other nitroimidazoles (although cautious desensitization has been

applied)

Pregnancy, 1st trimester (controversial)

Use of disulfiram within past 2 weeks; use of alcohol during therapy or within 3 days of discontinuing
therapy

Nursing considerations

Take full course of drug therapy; take the drug with food if GI upset occurs.

Do not drink alcohol (beverages or preparations containing alcohol, cough syrups); severe reactions may
occur.
Your urine may be a darker color than usual; this is expected.

Refrain from sexual intercourse during treatment for trichomoniasis, unless partner wears a condom.

Apply the topical preparation by cleansing the area and then rubbing a thin film into the affected area.
Avoid contact with the eyes. Cosmetics may be applied to the area after application.

You may experience these side effects: Dry mouth with strange metallic taste (frequent mouth care,
sucking sugarless candies may help); nausea, vomiting, diarrhea (eat frequent small meals).

Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

Drug classification

Paromomycin

Mechanism of action

Paromomycin inhibits protein synthesis by binding to 16S ribosomal RNA. Bacterial proteins are
synthesized by ribosomal RNA complexes which are composed of 2 subunits, a large subunit (50s) and
small (30s) subunit, which forms a 70s ribosomal subunit. tRNA binds to the top of this ribosomal
structure. Paramomycin binds to the A site, which causes defective polypeptide chains to be produced.
Continuous production of defective proteins eventually leads to bacterial death.

Side effects

Nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and heartburn

Contraindications
Paromomycin sulfate (paromomycin sulfate (paromomycin sulfate capsules) capsules) is
contraindicated in individuals with a history of previous hypersensitivity reactions to it. It is also
contraindicated in intestinal obstruction.
Nursing considerations

Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the

throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria).

Patient/Client-Related Instruction

 Instruct patient and family/caregivers to report severe or prolonged GI problems

including diarrhea, nausea, vomiting, and abdominal cramps.

Drug classification
Atovaquone(mepron)

Mechanism of Action

Atovaquone possesses a novel mode of action against P. falciparum through inhibition of the electron
transport system at the level of cytochrome bc1 complex. Atovaquone also causes collapse of the
parasite mitochondrial membrane potential in P. falciparum. The mechanism of action against P.
carinii is unknown. The synergistic activity between proguanil and atovaquone appears to be related to
proguanil per se, and metabolism to cycloguanil is not required.

Side effects

 nausea.
 vomiting.
 diarrhea.
 headache.
 dizziness.
 anxiety.
 difficulty falling asleep or staying asleep.
 Contraindications
Contraindicated in patients who develop or have a history of hypersensitivity reactions (e.g.,
angioedema, bronchospasm, throat tightness, urticaria) to atovaquone or any of the
components of atovaquone oral suspension.

Nursing consideration

Assess pulmonary function by measuring lung volumes, breath sounds, respiratory rate,
and other symptoms (cough, dyspnea, shortness of breath).

Report changes in pulmonary function to help document the effects of drug therapy in
treating PCP infections.

 Implement therapeutic exercises and airway clearance techniques as needed to maintain

and improve pulmonary function in patients with respiratory infections.

Patient/Client-Related Instruction

 Remind patient to take this drug as directed for the full course of treatment even if feeling
better.
 Instruct patient and family/caregivers to report other troublesome side effects such as
severe or prolonged headache, sleep loss, skin rash, fever, or GI problems (diarrhea,
nausea, vomiting).

Drug classification
Pentamidine

Mechanism of action

Pentamidine is an aromatic diamidine drug consisting of pentane-1,5-diol, which interferes with

polyamine synthesis, RNA polymerase activity,  enters the protozoal cell binding to transfer RNA,
and prevents the synthesis of protein, nucleic acids, phospholipids, and folate. Additionally, it is
known to be an anti-inflammatory agent, xenobiotic, and an antagonist of the NMDA receptor,
histone acetyltransferase, and calmodulin
Side effects
Cough, upset stomach, loss of appetite, nausea, vomiting, diarrhea, dizziness, headache,
burning feeling in the throat, or unusual taste/dryness in the mouth

Contraindications

 Congenital QT syndrome
 Electrolyte abnormalities, uncorrected

Nursing considerations

 Assess heart rate, ECG, and heart sounds, especially during exercise Report any rhythm
disturbances or symptoms of cardiac dysfunction, including palpitations, chest discomfort,
shortness of breath, fainting, and fatigue/weakness.

 Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms

(tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions associated
with Stevens-Johnson syndrome (exfoliation, rash, dermatitis, pruritus, urticaria).

 Monitor signs of pancreatitis, including upper abdominal pain (especially after eating),
indigestion, weight loss, oily stools. Report these signs to the physician immediately.

 Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia

(drowsiness, fruity breath, increased urination, unusual thirst).

 Assess blood pressure (BP) periodically and compare to normal Report low BP (hypotension)

 Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest), especially when

this drug is inhaled.
Drug classification

Albendazole

Mechanism of action

The principal mode of action for albendazole is by its inhibitory effect on tubulin polymerization
which results in the loss of cytoplasmic microtubules in the intestines of nematodes worms,
ultimately causing energy depletion and death of the organism

Contraindications

Albendazole is contraindicated in patients with known hypersensitivity to benzimidazole class of

compounds, and in pregnancy

Adverse effects

Abdominal pain

Nausea

Vomiting

Abnormal liver function tests

Headache

Dizziness

Fever

Nursing considerations

 Assess for the mentioned cautions and contraindications (e.g. known allergies,
hepatorenal dysfunction, pregnancy and lactation, etc.) to prevent any untoward
complications.
 Perform a thorough physical assessment (other medications taken, reflexes
and muscle strength, skin color, temperature, texture, etc.) to establish baseline data
 before drug therapy begins, to determine effectiveness of therapy, and to evaluate for
occurrence of any adverse effects associated with drug therapy.
 Assess the patient’s liver function, including liver function tests to determine
appropriateness of therapy and to monitor for toxicity.
 Obtain a culture of stool for ova and parasites to determine the infecting worm and
establish appropriate treatment.
 Assess the abdomen to evaluate for any changes from baseline related to the infection,
identify possible adverse effects, and monitor for improvement.

Drug classification

Pyrantel pamoate

Mechanism of action

Pyrantel pamoate acts as a depolarizing neuromuscular blocking agent, thereby causing

sudden contraction, followed by paralysis, of the helminths. This has the result of causing the
worm to "lose its grip" on the intestinal wall and be passed out of the system by natural
process. Since Pyrantel is poorly absorbed by the host's intestine, the host is unaffected by
the small dosage of medication used. Spastic (tetanic) paralyzing agents, in particular pyrantel
pamoate, may induce complete intestinal obstruction in a heavy worm load.[8] This obstruction
is usually in the form of a worm impaction and happens when a very small, but heavily
parasitized animal is treated and tries to pass a large number of dislodged worms at once.
Worms usually pass in normal stool or with diarrhea, straining, and occasional vomiting.

Side effects

nausea, vomiting, lack of appetite, and diarrhea

Contraindications

 Hepatic disease
Pyrantel should be used with caution in patients with hepatic disease.
 Phenylketonuria
Pyrantel chewable tablets contain phenylalanine; use with caution in patients with phenylketonuria.
 Pregnancy
Pyrantel is poorly absorbed from the GI tract. There are no well controlled studies of pyrantel use in
pregnant women. Use pyrantel with caution during pregnancy. Some experts suggest that single-
dose pyrantel therapy may be given to pregnant women. Pregnant women should not take pyrantel
unless directed by a doctor.
 Breast-feeding
There are no data regarding the presence of pyrantel in breast milk. Pyrantel is poorly absorbed
from the GI tract; therefore, excretion into breast milk may be minimal. Some experts suggest single-
dose pyrantel therapy may be given to breast-feeding women. Breast-feeding infant exposure may
be minimized if the drug is taken just before the longest sleep interval for the infant

Nursing considerations

 Monitor baseline and periodic AST/ALT in individuals with known liver dysfunction.

Patient & Family Education

 Do not drive or engage in other potentially hazardous activities until response to drug is
known.
 Do not breast feed while taking this drug without consulting physician.

Drug classification

Biltricide(praziquantel)

Mechanism of action

The drug's mode of action is not exactly known at present, but experimental evidence
indicates praziquantel increases the permeability of the membranes of schistosome cells
towards calcium ions. The drug thereby induces contraction of the parasites' muscle, resulting
in paralysis in the contracted state. The dying parasites are dislodged from their site of action
in the host organism and may enter systemic circulation or may be destroyed by host immune
reaction (phagocytosis). 

Side effects

Headache, dizziness, stomach pain, nausea, tiredness, weakness, joint/muscle

pain, loss of appetite, vomiting, and sweating
Contraindications

BILTRICIDE (praziquantel) is contraindicated in patients who previously have shown

hypersensitivity to the drug or any of the excipients. Since parasite destruction within the
eye may cause irreversible lesions, ocular cysticercosis must not be treated with this
compound.

Nursing considerations

Patient is reexamined in 2 or 3 mo to ensure complete eradication of the infections.

Patient & Family Education

 Do not drive or operate other hazardous machinery on day of treatment or the following
day because of potential drug-induced dizziness and drowsiness.
 Usually, all schistosomal worms are dead 7 d following treatment.
 Contact physician if you develop a sustained headache or high fever.
 Do not breast feed while taking this drug without consulting physician

Drug classification

Ivermectin

Mechanism of action
Ivermectin and its related drugs act by interfering with the nerve and muscle functions
of helminths and insects. The drug binds to glutamate-gated chloride channels common to
invertebrate nerve and muscle cells. The binding pushes the channels open, which increases the
flow of chloride ions and hyper-polarizes the cell membranes, paralyzing and killing the invertebrate.
Ivermectin is safe for mammals (at the normal therapeutic doses used to cure parasite infections)
because mammalian glutamate-gated chloride channels only occur in the brain and spinal cord: the
causative avermectins usually do not cross the blood–brain barrier, and are unlikely to bind to other
mammalian ligand-gated channels. \

Side effects

Headache, dizziness, muscle pain, nausea, or diarrhea

Contraindications
Ivermectin is contraindicated in children under the age of five or those who weigh less than 15
kilograms (33 pounds), and individuals with liver or kidney disease. The medication is secreted in
very low concentration in breast milk. It remains unclear if ivermectin is safe during pregnancy
Nursing considerations

 Monitor for therapeutic effectiveness: Indicated by negative stool samples.

 Monitor for cardiovascular effects such as orthostatic hypotension and tachycardia.
 Monitor for and report inflammatory conditions of the eyes.