Question 1

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?&#10;A) Intravenous quinidine gluconate plus intravenous doxycycline [Vibramycin]&#10;B) Intravenous artesunate followed by atovaquone/proguanil [Malarone]&#10;C) Intravenous quinine [Qualaquin] plus intravenous clindamycin&#10;D) Intravenous mefloquine plus intravenous primaquine

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 2

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?

A) "I should continue taking the drug for 2 weeks after returning home."
B) "I should take 500 mg of this drug once each week."
C) "I should take the first dose 1 week before leaving for Africa."
D) "I should take this drug with meals."

"I should continue taking the drug for 2 weeks after returning home."

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.

Question 3

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?&#10;A) Chloroquine [Aralen Phosphate]&#10;B) Doxycycline [Vibramax]&#10;C) Primaquine phosphate&#10;D) Quinine [Qualaquin]

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 4

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?

A) "The form of malaria that you have does not relapse after a clinical cure has been achieved."
B) "Until you are no longer traveling to Africa, relapse drugs will be postponed."
C) "Using mosquito netting and DEET when you travel will prevent relapse."
D) "You will be given prophylactic medications when you travel to prevent relapse."

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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 5

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?&#10;A) Artemether/lumefantrine [Coartem]&#10;B) Atovaquone/proguanil [Malarone]&#10;C) Artesunate&#10;D) Quinine

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 6

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?

A) The patient's blood for evidence of hyperlipidemia
B) The patient's eyes for evidence of icterus
C) The patient's skin for photosensitivity
D) The patient's urinary output for evidence of darkening urine

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 7

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?

A) "Ask your provider about taking only the artemether component."
B) "The medication should be taken with food to prevent nausea."
C) "This drug is safe during the first trimester of pregnancy."
D) "You should talk to your provider about a different medication."

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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. The artemether component only 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 8

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?

A) "Once erythrocyte forms of P. falciparum are eliminated, relapse will not occur."
B) "Patients with P. vivax malaria experience relapse with increased frequency over time."
C) "Patients with P. falciparum malaria experience symptoms at irregular intervals."
D) "Patients with P. vivax malaria rarely encounter drug resistance."

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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 9

Which are adverse effects of quinine [Qualaquin]? (Select all that apply.)&#10;A) Cinchonism&#10;B) Hemolysis in patients with G6PD deficiency&#10;C) Increased ventricular rate&#10;D) Nightmares&#10;E) Prolonged QT interval

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 10

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?&#10;A) Ask the provider about genetic screening for this patient before starting the next medication.&#10;B) Contact the provider to discuss nondrug methods to prevent reinfection, such as DEET insect repellents.&#10;C) Teach the patient to notify the provider if symptoms recur so that relapse medication may be started.&#10;D) Tell the patient that no further treatment is necessary, because relapse in unlikely.

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 11

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:

A) beginning medications for a radical cure.
B) beginning suppressive therapy.
C) reporting visual disturbances and headaches.
D) using insect repellents and mosquito netting.

Accepted Answer

The answer of A patient who is a missionary has...

Deck 98: Antiprotozoal Drugs I: Antimalarial Agents