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Antiprotozoal Drugs Nursing Pharmacology Study Guide - Nurseslabs
Antiprotozoal Drugs
By Iris Dawn Tabangcora, RN - January 18, 2017
Antiprotozoals are agents used to treat protozoan infections. Protozoan infections are
common in tropical areas. Protozoans are single-celled organisms that pass through several
stages in their life cycles, including at least one phase as a human parasite. While protozoans
thrive in tropical climate, they may also survive and reproduce in any area where people live in
very crowded and unsanitary conditions.
1. Antiprotozoal Drugs: Generic and Brand Names
2. Disease Spotlight: Protozoal Diseases
2.1. Malaria
2.2. Amebiasis
2.3. Leishmaniasis
2.4. Trypanosomiasis
2.5. Trichomoniasis
2.6. Giardiasis
3. Antimalarials
3.1. Therapeutic Action
3.2. Indications
3.3. Pharmacokinetics
3.4. Contraindications and Cautions
3.5. Adverse E ects
3.6. Interactions
3.7. Nursing Considerations
3.7.1. Nursing Assessment
3.7.2. Nursing Diagnoses
3.7.3. Implementation with Rationale
3.7.4. Evaluation
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4. Other Antiprotozoal Agents
4.1. Therapeutic Action
4.2. Indications
4.3. Pharmacokinetics
4.4. Contraindications and Cautions
4.5. Adverse E ects
4.6. Interactions
4.7. Nursing Considerations
4.7.1. Nursing Assessment
4.7.2. Nursing Diagnoses
4.7.3. Implementation with Rationale
4.7.4. Evaluation
5. Practice Test: Antiprotozoal Agents
6. References and Sources
Antiprotozoal Drugs: Generic and Brand Names
Here is a table of commonly encountered antiprotozoals, their generic names, and brand
names:
Classi cation
Antimalarials
Other Antiprotozoals
Generic Name
Brand Name
chloroquine
Aralen
me oquine
Lariam
primaquine
*generic
pyrimethamine
Daraprim
quinine
Qualaquin
atovaquone
Mepron
metronidazole
Flagyl
nitazoxanide
Alinia
pentamidine
Pentam 300
tinidazole
Tindamax
Disease Spotlight: Protozoal Diseases
Malaria
It is a disease characterized by a cycle of fever and chills transmitted through a bite of a
female Anopheles mosquito. Identi ed causes include Plasmodium falciparum, vivax,
malariae, and ovale. Malaria is endemic in many parts of the world.
Sporozoites travel through bloodstream and become lodged in the liver and other tissues.
Amebiasis
It is an intestinal infection caused by Entamoeba histolytica. It is often known as amoebic
dysentery. The disease is transmitted through fecal-oral route.
Amebiasis is characterized by mild to fulminant diarrhea. In worst cases, it is able to invade
extraintestinal tissue.
Leishmaniasis
Is a disease caused by a protozoan that is passed from sand ies to humans. It is
characterized by serious lesions in the skin, viscera, and mucous membranes of host.
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Trypanosomiasis
Is caused by Trypanosoma leading to African sleeping sickness and Chagas’ disease.
African sleeping sickness is caused by T.brucei gambiense and is transmitted by tsetse y.
It is characterized by lethargy, prolonged sleep, and even death.
Chagas’ disease is caused by T.cruzi and is passed to humans by common house y. It is
characterized by severe cardiomyopathy.
Trichomoniasis
Is caused by T.vaginalis, a common cause of vaginitis (reddened, in amed vaginal mucosa,
itching, burning, and yellowish-green discharge).
It is usually transmitted through sexual intercourse.
Asymptomatic in men
Giardiasis
Is caused by G.lamblia, the most commonly diagnosed intestinal parasite in the United
States.
Transmission is through contaminated water or food, and trophozoites.
Characterized by diarrhea, rotten egg-smelling stool, and pale and mucus- lled stool. Some
patients experience epigastric pain, weight loss, and malnutrition.
Antimalarials
Antimalarials are agents used to attack Plasmodium at various stages of its life cycle.
Through this, it becomes possible to prevent acute malarial reaction in individuals who have
been infected by the parasite.
These agents can be schizonticidal (acting against the red-blood-cell phase of the life
cycle), gametocytocidal (acting against the gametocytes), sporontocidal (acting against
the parasites that are developing in the mosquito), or work against tissue schizonts as
prophylactic or antirelapse agent.
Quinine (Qualaquine) was the rst drug found to be e ective in the treatment of malaria.
Therapeutic Action
The desired and bene cial action of antimalarials is:
Entering human red blood cells and changing the metabolic pathways necessary for the
reproduction. Chloroquine, the mainstay of treatment, in addition to this main mechanism,
is directly toxic to parasites and decreases the ability of the parasite to synthesize DNA.
Indications
Antimalarials are indicated for the following medical conditions:
Treatment of malaria, prevention of relapse, and other protozoal diseases like
extraintestinal amoebiasis (chloroquine) and toxoplasmosis (pyrimethamine).
Here are some important aspects to remember for indication antiprotozoals in di erent age
groups:
Children
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This age group is very sensitive to the e ects of most antiprotozoals and therefore more
severe reactions can be expected.
In addition, many antivirals do not have proven safety and e cacy in children.
Adults
This age group should be well advised about the need for prophylaxis against various
protozoal infections and the need for immediate treatment if disease is contracted.
Administration of drug in pregnant and nursing women is only justi ed if bene ts clearly
outweigh the risk.
Women of childbearing age are advised to use barrier contraceptives when any
antiprotozoal drug is being taken.
Older adults
Older patients are more susceptible to adverse e ects of antiprotozoal therapy, particularly
those with hepatic and renal dysfunctions.
Pharmacokinetics
Here are the characteristic interactions of antimalarials and the body in terms of absorption,
distribution, metabolism, and excretion:
Route
Onset
Peak
Duration
Oral
Varies
1-2 h
1 wk
T1/2: 70-120 h
Metabolism: liver
Excretion: kidney (urine)
Contraindications and Cautions
The following are contraindications and cautions for the use of antimalarials:
Known allergy to the drug. Prevent hypersensitivity reactions.
Liver disease or alcoholism. Parasitic invasion of the liver and need for hepatic
metabolism to prevent toxicity.
Lactation. Drugs can enter breast milk and could be toxic to infant.
Pregnancy. Associated with birth defects. Pregnancy should be avoided two months after
completion of therapy using me oquine.
Retinal disease or damage. Drugs can a ect vision and retina, and the likelihood of
problems increase if the retina is already damaged.
Psoriasis or porphyria. Skin damage as a result of drugs on proteins and protein synthesis.
Adverse E ects
Use of antimalarials may result to these adverse e ects:
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CNS: headache, dizziness
Immunological: fever, shaking, chills, malaise
GI: nausea, vomiting, dyspepsia, anorexia, hepatic dysfunction
Dermatological: rash, pruritus, loss of hair associated with changes in protein synthesis
Eyes: visual changes, possible blindness
Ears: ototoxicity related to nerve damage
Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of quinine
or primaquine.
Interactions
The following are drug-drug interactions involved in the use of antimalarials:
Quinine and quinine derivatives: increased risk for cardiac toxicity and convulsions
Anti-folate drugs (methotrexate, sulfonamides): increased bone marrow suppression with
pyrimethamine. Discontinue pyrimethamine if signs of folate de ciency develop (diarrhea,
fatigue, weight loss, anemia).
Nursing Considerations
Here are important nursing considerations when administering antimalarials:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history
taking, and examination:
Assess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal
impairment, pregnancy and lactation, visual disturbances, etc.) to prevent any untoward
complications.
Perform a thorough physical assessment (other medications taken, re exes and muscle
strength, skin color, temperature, texture, etc.) to establish baseline data before drug
therapy begins, to determine e ectiveness of therapy, and to evaluate for occurrence of
any adverse e ects associated with drug therapy.
Perform ophthalmic and retinal examinations and auditory screening to determine the
need for cautious administration and to evaluate changes that occur as a result of drug
therapy.
Assess the patient’s liver function, including liver function tests to determine
appropriateness of therapy and to monitor for toxicity.
Obtain blood culture to identify the causative Plasmodium species and ensure appropriate
use of the drug.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of these drugs for
therapy:
Acute pain related to GI, CNS, and skin e ects of the drug
Disturbed sensory perception (kinaesthetic, visual) related to CNS e ects of the drug
Risk for injury related to CNS changes
Implementation with Rationale
These are vital nursing interventions done in patients who are taking antimalarials:
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Arrange for appropriate culture and sensitivity tests before beginning therapy to ensure
proper drug for susceptible Plasmodium species.
Administer the complete course of the drug to get the full bene cial e ects.
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 occur.
Provide comfort and safety measures if CNS e ects occur (e.g. side rails and assistance with
ambulation if dizziness and weakness are present) to prevent patient injury. Provide oral
hygiene and ready access to bathroom facilities as needed to cope with GI e ects.
Educate client on drug therapy to promote understanding and compliance.
Evaluation
Here are aspects of care that should be evaluated to determine e ectiveness of drug
therapy:
Monitor patient response to therapy (resolution or prevention of malaria).
Monitor for adverse e ects (e.g. orientation and a ect, nutritional state, skin color and
lesions, hepatic function, and visual and auditory changes, etc).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse e ects to watch for.
Monitor patient compliance to drug therapy.
Other Antiprotozoal Agents
Therapeutic Action
The desired and bene cial action of other antiprotozoal agents is:
Inhibiting DNA synthesis in susceptible protozoa, interfering with cell’s ability to reproduce,
subsequently leading to cell death.
Indications
Other antiprotozoal agents are indicated for the following medical conditions:
Treatment of infections caused by susceptible protozoa.
Pharmacokinetics
Here are the characteristic interactions of other antiprotozoal agents and the body in terms of
absorption, distribution, metabolism, and excretion:
Route
Onset
Peak
Duration
Oral
Varies
1-2 h
N/A
IV
Rapid
1-2 h
N/A
T1/2: 6-8 h
Metabolism: liver
Excretion: kidney (urine), colon (feces)
Contraindications and Cautions
The following are contraindications and cautions for the use of other antiprotozoal agents:
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Known allergy to the drug. Prevent hypersensitivity reactions.
Pregnancy. Drug e ects on developing fetal DNA and proteins can cause fetal
abnormalities and even death.
CNS disease. Possible disease exacerbation due to drug e ects on the CNS.
Hepatic disease. Possible exacerbation when hepatic drug e ects occur.
Candidiasis. Risk of superinfection
Lactation. Can pass breast milk and cause severe adverse e ects to the infant.
Tinidazole should never be combined with alcohol.
Adverse E ects
Use of other antiprotozoal agents may result to these adverse e ects:
CNS: headache, dizziness, ataxia, loss of coordination, peripheral neuropathy
GI: nausea, vomiting, diarrhea, unpleasant taste, cramps, changes in liver function
Superinfections
Interactions
The following are drug-drug interactions involved in the use of other antiprotozoal agents:
Alcohol: severe adverse e ects with tinidazole and metronidazole. Avoid alcohol for at least
3 days after treatment.
Oral anticoagulants: increased bleeding with metronidazole and tinidazole
Disul ram: increased psychotic reactions with metronidazole and tinidazole. Two weeks
should elapse between tinidazole therapy and start of disul ram.
Nursing Considerations
Here are important nursing considerations when administering other antiprotozoal agents:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history
taking, and examination:
Assess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal
impairment, pregnancy and lactation, etc.) to prevent any untoward complications.
Perform a thorough physical assessment (other medications taken, re exes and muscle
strength, skin and mucous membrane color, temperature, texture, etc.) to establish
baseline data before drug therapy begins, to determine e ectiveness of therapy, and to
evaluate for occurrence of any adverse e ects 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 cultures to determine the exact protozoal species causing the disease.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of these drugs for
therapy:
Acute pain related to GI and CNS e ects of the drug
Imbalanced nutrition: less than body requirements related to severe GI e ects of the drug.
Disturbed sensory perception (kinaesthetic, visual) related to CNS e ects of the drug
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Implementation with Rationale
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These are vital nursing interventions done in patients who are taking other antiprotozoal
agents:
Arrange for appropriate culture and sensitivity tests before beginning therapy to ensure
proper drug for susceptible species.
Administer the complete course of the drug to get the full bene cial e ects.
Monitor hepatic function before and periodically during treatment to ensure early detection
and prompt intervention with cessation of drug if signs of failure occur.
Provide comfort and safety measures if CNS e ects occur (e.g. side rails and assistance with
ambulation if dizziness and weakness are present) to prevent patient injury. Provide oral
hygiene and ready access to bathroom facilities as needed to cope with GI e ects.
Educate client on drug therapy to promote understanding and compliance.
Evaluation
Here are aspects of care that should be evaluated to determine e ectiveness of drug
therapy:
Monitor patient response to therapy (resolution of infection and negative cultures for
parasite).
Monitor for adverse e ects (e.g. orientation and a ect, nutritional state, skin color and
lesions, hepatic function, and occurrence of superinfections, etc).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse e ects to watch for.
Monitor patient compliance to drug therapy.
Practice Test: Antiprotozoal Agents
Practice quiz for this nursing pharmacology study guide:
EXAM MODE
In Exam Mode: All questions are shown but the results, answers, and rationales (if any)
will only be given after you’ve nished the quiz.
Practice Test: Antiprotozoal Agents
Start
PRACTICE MODE
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a
single page and correct answers, rationales or explanations (if any) are immediately
shown after you have selected an answer. No time limit for this exam.
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Practice Test: Antiprotozoal Agents
Start
TEXT MODE
1. Chagas’ disease is passed to humans by which of the following vector?
A. female Anopheles mosquito
B. house y
C. tsetse y
D. dragon y
1. Answer: B. house y.
Option A is for malaria while option C is for African sleeping sickness.
2. Which of the following patient statements should alert the nurse for possible
high levels of quinine?
A. “I feel weak, especially after ambulating.”
B. “My throat is sore. I think I’m down with a u.”
C. “When I went out of my bed, it felt like the room swayed.”
D. “I don’t feel like eating anything. I just want to sleep.”
2. Answer: C. “When I went out of my bed, it felt like the room swayed.”
This might be vertigo which is part of the constellation of manifestations of cinchonism
which is associated with high levels of quinine or primaquine.
3. A traveler diagnosed with malaria is also receiving sulfonamide for a respiratory
infection. What should the nurse watch out for in this drug combination?
A. increased intracranial pressure
B. urinary retention
C. blood component levels
D. serum BUN and creatinine
3. Answer: C. blood component levels.
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This combination can lead to bone marrow suppression.
4. How many days should the patient avoid alcohol after treatment with
metronidazole?
A. 1 day
B. 3 days
C. 5 days
D. 7 days
4. Answer: B. 3 days.
5. Disul ram and tinidazole therapy can lead to increased psychotic reactions. How
long after tinidazole therapy can we safely start disul ram therapy?
A. 7-10 days
B. 14 days
C. 3 days
D. One month
5. Answer. B. 14 days.
References and Sources
References and sources for this pharmacology guide for Antiprotozoal Drugs:
Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer
Health/Lippincott Williams & Wilkins. [Link]
Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing
care.
Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing.
Philadelphia: JB Lippincott.
See Also
Here are other nursing pharmacology study guides:
Nursing Pharmacology - Study Guide for Nurses
Gastrointestinal System Drugs
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Antacids
Histamine-2 Antagonists
Proton Pump Inhibitors
Respiratory System Drugs
Antihistamines
Bronchodilators and Antiasthmatics
Decongestants
Expectorants and Mucolytics
Inhaled Steroids
Lung Surfactants
Endocrine System Drugs
Adrenocortical Agents
Antidiabetic Agents
Glucose-Elevating Agents
Hypothalamic Agents
Insulin
Parathyroid Agents: Bisphosphonates, Calcitonins
Pituitary Drugs
Sulfonylureas
Thyroid Agents
Autonomic Nervous System Drugs
Adrenergic Agonists (Sympathomimetics)
Adrenergic Antagonists (Sympatholytics)
Anticholinergics (Parasympatholytics)
Cholinergic Agonists (Parasympathomimetics)
Immune System Drugs
Antiarthritic Drugs
Immunostimulants
Immunosuppressants
Nonsteroidal Anti-In ammatory Drugs
Salicylates
Chemotherapeutic Agents
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Anthelmintics
Anti-Infective Drugs
Antibiotics
Antifungals
Antineoplastic Agents
Antiprotozoal Drugs
Antiviral Drugs
Reproductive System Drugs
Male Reproductive System Drugs
Female Reproductive System Drugs
Nervous System Drugs
Antidepressants
Antiparkinsonism Drugs
Antiseizure Drugs
Anxiolytics and Hypnotic Drugs
General and Local Anesthetics
Muscle Relaxants
Narcotics, Narcotic Agonists, and Antimigraine Agents
Neuromuscular Junction Blocking Agents
Psychotherapeutic Drugs
Cardiovascular System Drugs
Antianginal Drugs
Antiarrhythmic Drugs
Antihyperlipidemic Drugs
Antihypertensive Drugs
Cardiotonic-Inotropic Drugs
Diuretics
Drugs A ecting Coagulation
Further Reading and External Links
Recommended resources and reference books. Disclosure: Includes Amazon a liate links.
1. Focus on Nursing Pharmacology - Easy to follow guide for Pharmacology
2. NCLEX-RN Drug Guide: 300 Medications You Need to Know for the Exam - Great if
you're reviewing for the NCLEX
3. Nursing 2017 Drug Handbook (Nursing Drug Handbook) - Reliable nursing drug
handbook!
4. Lehne's Pharmacology for Nursing Care - Provides key information on commonly used
drugs in nursing
5. Pharmacology and the Nursing Process - Learn how to administer drugs correctly and
safely!
6. Pharm Phlash Cards!: Pharmacology Flash Cards - Flash Cards for Nursing Pharmacology
Last updated on June 7, 2019
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Iris Dawn Tabangcora, RN
Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include
Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as
her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.
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