Question 1

A recent immigrant from the Middle East is being treated for P. falciparum malaria and has completed a course of chloroquine [Aralen Phosphate]. What will the nurse do?

Accepted Answer

P. falciparum malaria does not relapse once a clinical cure has been achieved, so no further treatment is necessary. Although this patient is from the Middle East and is at increased risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency, genetic testing is unnecessary unless primaquine is given. Because no further treatment is indicated, genetic testing is not necessary. There is no need to use nondrug methods, because the patient is no longer in an area where infection is likely. This form of malaria will not relapse, so there is no need to teach the patient to report new symptoms.

Question 2

Which are adverse effects of quinine [Qualaquin]?

Accepted Answer

Quinine can cause cinchonism, hemolysis in susceptible patients, and an increased ventricular rate. Mefloquine can cause nightmares and a prolonged QT interval.

Question 3

A patient who is a missionary has returned from Africa to the United States and has completed treatment for an acute attack of P. vivax malaria. The provider has determined that clinical cure has been achieved. The nurse will expect to teach this patient about:

Accepted Answer

Once a clinical cure has been achieved with treatment of an acute attack, radical cure is begun if the patient is out of a malaria-endemic region and not likely to become reinfected. Because this patient has returned to the United States, radical cure therapy may begin. Suppressive therapy is used to prevent infection in individuals traveling to areas where malaria is endemic. Insect repellants and mosquito netting are nondrug measures to prevent infection and are not necessary for this patient.

Question 4

The nurse is caring for a newly admitted African American patient who has just returned from a mission trip to Africa. The patient contracted malaria and is being treated with primaquine. What will the nurse monitor?

Accepted Answer

The nurse should frequently monitor the patient's urine for evidence of hemoglobin, indicating hemolysis, which is marked by darkening urine. The patient need not be monitored for photosensitivity, because primaquine does not cause that condition. The patient need not be monitored for icterus, because primaquine does not cause icterus. The patient's blood need not be monitored for evidence of hyperlipidemia.

Question 5

A patient has been treated for an acute attack of P. vivax malaria. For relapse prevention, the nurse expects the provider to order which medication?

Accepted Answer

The agent of choice for preventing relapse of P. vivax malaria is primaquine, which is highly active against the hepatic forms of P. vivax. Chloroquine is the drug of choice for treating mild to moderate acute attacks of either type of malaria. Doxycycline is used for chloroquine-resistant malaria. Quinine has little effect on hepatic forms of malaria, so it is not useful for relapse prevention.

Question 6

A patient who takes imipramine has a moderate infection with P. vivax that is chloroquine resistant. Which medication will the nurse expect the provider to order?

Accepted Answer

The combination of atovaquone and proguanil is highly effective for the prophylaxis and treatment of chloroquine-resistant malaria. Artemether/lumefantrine inhibits CYP2D6 and can raise the levels of drugs that are substrates for this enzyme, including imipramine. Artesunate is an investigational drug used for severe malaria. Quinine has many toxic side effects.

Question 7

A nurse is teaching a group of nursing students about the two most common forms of malaria, Plasmodium vivax malaria and Plasmodium falciparum malaria. Which statement by a student indicates a need for further teaching?

Accepted Answer

Relapse is likely with P. vivax malaria, because dormant parasites remain in the liver. Over time, episodes of relapse become less frequent and eventually stop entirely. Relapse does not occur with P. falciparum malaria, because this type does not form hypnozoites that can become dormant. Symptoms of P. falciparum malaria occur at irregular intervals, unlike those of P. vivax malaria, which peak every 48 hours. Drug resistance by P. vivax is relatively uncommon.

Question 8

A patient who has contracted falciparum malaria has received a prescription for artemether/lumefantrine [Coartem] and tells the nurse she thinks she may be pregnant. What will the nurse tell this patient?

Accepted Answer

Artemether/lumefantrine has undergone premarketing studies in pregnant women with no adverse effects, but all of the women were in their third trimester, but, since animal studies have demonstrated teratogenesis, is Pregnancy Risk Category C. The nurse should advise her to discuss another medication with her provider. Only the artemether component is not recommended as a single drug. Taking the medication with food does not prevent nausea. It is not known whether the drug is safe during the first trimester.

Question 9

A patient who frequently travels to Africa has been treated for an acute attack of P. vivax malaria. The patient asks the nurse about medications to prevent relapse. Which response by the nurse is correct?

Accepted Answer

Relapse prevention, or a clinical cure, is postponed in patients with P. vivax malaria as long as the risk of reinfection continues. P. vivax malaria does relapse, so this response is incorrect. Using nondrug measures can help prevent reinfection but are not guaranteed to do so. Prophylactic medications prevent acute symptoms but not invasion of the liver.

Question 10

A patient has severe P. falciparum malaria and is unable to tolerate oral medications. Which regimen is the U.S. Food and Drug Administration (FDA)-approved treatment of choice for this patient?

Accepted Answer

For patients with severe malaria, IV quinidine gluconate is the only drug approved by the FDA for parenteral therapy of malaria; it should be accompanied by clindamycin, doxycycline, or tetracycline. Artesunate is considered the drug of choice for severe malaria, but it has not yet been approved by the FDA and must be used under the provisions of an Investigational New Drug protocol from the Centers for Disease Control and Prevention (CDC). Quinine is effective but has serious cardiotoxic side effects, so it is not a drug of first choice. Mefloquine and primaquine are not available as an IV medication.

Question 11

A nurse is teaching a patient who is preparing to travel for a month-long missionary trip to Africa. The provider has ordered chloroquine [Aralen Phosphate] as suppressive therapy. Which statement by the patient indicates a need for further teaching?

Accepted Answer

Patients taking chloroquine as suppressive therapy should take the medication for 4 weeks, not 2 weeks, after returning from an area where infection is likely. The patient is correct to state that 500 mg of the drug should be taken weekly, that the first dose should be taken 1 week before travel, and that the drug should be taken with meals.

Quiz 98: Antiprotozoal Drugs I: Antimalarial Agents