Antimicrobials
3.17 Antimalarials
Malaria is a prevalent protozoal disease impacting individuals across the world. According to the Centers for Disease Control, approximately 450 cases of malaria are diagnosed in Canada each year.[1]
Indications for Use: Antimalarials are used for the prevention or treatment of malaria.
Mechanism of Action: Antimalarial agents work by targeting specific intracellular processes that impact cell development.[2]
Nursing Considerations across the Lifespan: Antimalarial agents are safe to use for all age groups. Dose adjustments are not needed for renal or liver dysfunction.
Special Administration Considerations: Antimalarial medications may impact hearing and vision so clients should be monitored carefully for adverse effects. Additionally, antimalarial medications may cause GI upset, so clients should be instructed to take these medications with food.
Client Teaching & Education: Clients should receive instruction to take medication as prescribed and adhere to the full prescription regimen. Clients should minimize additional exposure to mosquitoes using preventative means such as repellents, protective clothing, netting, etc. Clients on chloroquine therapy should also avoid alcohol. Chloroquine can be extremely toxic to children and should be safely stored and out of reach. Clients receiving antimalarial therapy may have increased sensitivity to light and should be counseled to wear protective glasses to prevent ocular damage. Treatment often requires sustained regimens of six months or greater so clients should be monitored carefully for adherence and compliance.[3]
Chloroquine Medication Card
Now let’s take a closer look at the medication card on chloroquine.[4][5] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 3.17.1: Chloroquine
Class: Antimalarials
Prototypes: chloroquine
Therapeutic Effects
- Discuss importance of medication compliance
- monitor for side effects
Administration
- Contraindicated in clients hypersensitive to drug and in those with retinal or visual field changes
- Use cautiously in clients with severe GI, neurologic, or blood disorders; hepatic disease or alcoholism; or G6PD deficiency or psoriasis
- Take with food to prevent GI upset
- In severe or resistant cases, artesunate IV may be prescribed
Indications
- Treatment of malaria
Side Effects
- Changes in vision
- Changes in hearing
- Monitor renal function closely
- Monitor client for overdose, which can quickly lead to toxic symptoms: headache, drowsiness, visual disturbances, nausea and vomiting, cardiovascular collapse, shock, and convulsions
Therapeutic Effects and Nursing Considerations
- Prevention of malaria or improvement of an acute attack of malaria
- For malaria prevention, the CDC recommends that clients take drug for 4 weeks after leaving the area
Using the above information, consider the following clinical scenario question:
A nurse is providing medication teaching to a client who is planning on visiting a country with high rates of malaria to do mission work. The client states, “I’m glad I only have to take this medication for a week. The side effects sound horrific!” What is the nurse’s best response regarding the length of therapy?
Note: Answers to the activities can be found in the “Answer Key” sections at the end of the book.
- Malaria. (2016). Surveillance of Malaria. https://www.canada.ca/en/public-health/services/diseases/malaria/surveillance-malaria.html#shr-pg0 ↵
- Achieng, A., Rawat, M., Ogutu, B., Guyah, B., Ong'echa, J.M., Perkins, D., & Kempaiah, P. (2017). Antimalarials: Molecular drug targets and mechanism of action. Current Topics in Medicinal Chemistry, 17, 1-15. ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019 ↵
- UpToDate (2021). Chloroquine. https://www.uptodate.com/contents/search ↵