Antimalarial Drugs

Presenter
Basil Mupita
RGN/BscNE
 Objectives
•Define antimalarial drugs.
•State the representative drugs for
antimalarial drugs.
•Describe the mode of action of
antimalarial drugs.
 Continued
•State the dose, route and frequency of
antimalarial drugs.
•State the indication, contraindication,
side effects and nursing implications of
antimalarial drugs.
 Introduction
•Antimalarial are drugs that are given in
combination form to attack the
Plasmodium at various stages of its life
cycle.
 Continued
•The drugs can be schizonticidal i.e.
acting against the red-blood-cell phase of
the life cycle.
•They can also be gametocytocidal i.e.
acting against the gametocytes.
 Continued
•The agents can also be sporontocidal i.e.
acting against the parasites that are
developing in the mosquito or work
against tissue schizonts as prophylactic
or antirelapse agents.
 Representative Drugs
•Chloroquine.
•Mefloquine.
•Primaquine.
•Pyrimethamine.
•Quinine.
•Coartem
 Continued
• Amodiaquine-Artesunate
• Chloroguanoide
• Sulphadoxine and Pytimethamine.
• Artemether-lumefantrine.
• Atersunate.
 Mode of Action
•Chloroquine drug enters human red
blood cells and changes the metabolic
pathways necessary for the reproduction
of the Plasmodium.
 Continued
•In addition, the agent is directly toxic to
parasites that absorb it; it is acidic and it
decreases the ability of the parasite to
synthesize DNA, leading to a blockage
of reproduction.
 Continued
•Mefloquine increases the acidity of
plasmodial food vacuoles, causing cell
rupture and death
 Continued
•Primaquine disrupts the mitochondria of
the Plasmodium and causes death of
gametocytes and exoerythrocytic forms
and prevents other forms from
reproducing.
 Continued
•Pyrimethamine in combination other
agents act more rapidly to suppress
malaria by blocking the use of folic acid
in protein synthesis by the Plasmodium
leading to inability to reproduce and cell
death.
 Continued
•Quinine and coartem inhibits nucleic
acid synthesis, protein synthesis and
glycolysis in P. falciparum.
 Dose, Route and Frequency
•Quinine 600mg po tds for 1/52 in
incidences of uncomplicated malaria.
•Quninine infusion 20mg/kg body weight
with 5% Dextrose over 4 hours and
maximum loading is 1200mg.
 Continued
•Then after 8 hours 10mg/kg body weight
and maximum maintenance dose is
600mg.
•Repeat after every 8 hours until able to
tolerate orally.
 Continued
•Refer to EDLIZ for doses of other
antimalarial agents.
 Indications
•Antimalarial agents are used for the
treatment of malaria.
•Some are used as prophylaxis when
visiting a malarial infected area.
 Continued
• Routine intermittent treatment of certain
groups in endemic regions i.e.
intermittent preventive therapy.
•Mefloquine is used in malarial
prevention as well as treatment.
 Continued
•Quinine is used to treat uncomplicated
malaria.
•Indicated for the management of
chloroquine-resistance has been
documented.
 Contraindications
•Hypersensitivity to any malarial agent.
•Liver disease or alcoholism because of
the parasitic invasion of the liver and
need for hepatic metabolism to prevent
toxicity.
 Continued
•Lactation because the drugs can enter
breast milk and be toxic to the infant.
•Drugs should be avoided during
pregnancy because of birth defects.
 Side Effects
•CNS:- headache and dizziness.
•Immune system:- fever, shaking, chills
and malaise due to the release of
merozoites.
 Continued
•GI:- nausea, vomiting, dyspepsia and
anorexia are associated with direct
effects of the drug on the GI tract and
CNS.
 Continued
•Dermatological:- include rash, pruritus
and loss of hair associated with changes
in protein synthesis of the hair follicles.
•Visual:- possible blindness related to
retinal damage and ototoxicity related to
nerve damage may occur.
 Continued
•Cinchonism i.e. nausea, vomiting,
tinnitus, and vertigo may occur with high
levels of quinine or primaquine.
 Nursing Implications
•Arrange for appropriate culture and
sensitivity tests before beginning therapy
to ensure proper drug for susceptible
Plasmodium species and treatment may
begin before test results are known.
 Continued
•Administer the complete course of the
drug to get the full beneficial effects.
•Provide oral hygiene and ready access to
bathroom facilities as needed to cope
with GI effects.
 Continued
•Monitor hepatic function and perform
ophthalmological examination before and
periodically during treatment to ensure
early detection and prompt intervention
with cessation of drug if signs of failure or
deteriorating vision occurs.
 Continued
•Provide comfort and safety measures if
CNS effects occur to prevent patient
injury.
•Provide small, frequent, nutritious meals
if GI upset is severe to ensure adequate
nutrition.
 Continued
•Instruct the patient on appropriate
dosage regimen and the importance of
adhering to the drug schedule to enhance
patient knowledge about drug therapy
and to promote compliance.
 Continued
•Encourage the patient to report blurring
of vision, which indicate retinal damage,
loss of hearing or ringing in the ears,
which indicate CNS toxicity and fever or
worsening of condition indicate a
resistant strain or non effective therapy.
 Homework
•Write notes on the following
(a) Quinine (10marks)
(b) Mefloquine (10marks)
(c) Atersunate (10marks)
 References
•Brenner, G. M. and Stephens, C. W
(2010) Pharmacology. 3 edition.
rd

Philadelphia.
•R. A. Leihne (2013) pharmacology for
nursing care. Elsevier.
 Continued
•Waugh, A. and Grant A. (2006) Ross
and Wilson Anatomy and Physiology in
Health and Illness. 9 Edition.
th

Philadephia: Churchill Livingstone,

2004.