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28 Aug 2018 ... From free apps to edit PDFs to professional PDF document suites, these ... build mini-apps inside your PDF documents with JavaScript , and ... cated falciparum malaria, except when the infection was transmitted in an area without documented chloroquineresistant malaria Quinine is commonly used with a second drug (most often doxycycline in adults or clindamycin in children) to shorten the duration of use (usually to 3 days) and to limit toxicity Quinine is less effective than chloroquine against other human malarias and is more toxic, and it is therefore not used to treat infections with these parasites Quinine is not generally used in chemoprophylaxis due to its toxicity, although a daily dose of 325 mg is effective Therapeutic dosages of quinine and quinidine commonly cause tinnitus, headache, nausea, dizziness, flushing, and visual disturbances, a constellation of symptoms termed cinchonism Mild symptoms of cinchonism do not warrant the discontinuation of therapy Hypersensitivity reactions include rash, urticaria, angioedema, and bronchospasm Hematologic abnormalities include hemolysis (especially with G6PD deficiency), leukopenia, agranulocytosis, and thrombocytopenia Therapeutic doses may cause hypoglycemia through stimulation of insulin release; this is a particular problem in severe infections and in pregnant patients, who have increased sensitivity to insulin Quinine can stimulate uterine contractions, especially in the third trimester However, this effect is mild, and quinine and quinidine are the drugs of choice for severe falciparum malaria during pregnancy Intravenous infusions of the drugs may cause thrombophlebitis Overly rapid infusions can cause severe hypotension ECG abnormalities (QT prolongation) are fairly common with intravenous quinine and quinidine, but dangerous arrhythmias are uncommon when the drugs are administered appropriately in a monitored setting Blackwater fever is a rare severe illness, probably due to hypersensitivity, that includes marked hemolysis and hemoglobinuria in the setting of quinine therapy for malaria Quinine should not be given concurrently with mefloquine and should be used with caution in a patient with malaria who has previously received mefloquine chemoprophylaxis Absorption may be blocked by aluminum-containing antacids Quinine can raise plasma levels of warfarin and digoxin Dosage must be reduced in renal insufficiency 5 Primaquine Primaquine phosphate, a synthetic 8-aminoquinoline, is the drug of choice for the eradication of dormant liver forms of P vivax and P ovale It is well absorbed orally, reaching peak plasma levels in 1 2 hours, with a plasma half-life of 3 8 hours Primaquine is active against hepatic stages of all human malaria parasites It is the only available agent active against the dormant hypnozoite stages of P vivax and P ovale This action is optimal soon after therapy with chloroquine or quinine Primaquine is also gametocidal against the four human malaria species Primaquine acts against erythrocytic stage parasites, but this activity is too weak for the treatment of active disease The mechanism of antimalarial action is unknown Some strains of P vivax in New Guinea, southeast Asia, and perhaps Central and South America are relatively resistant to primaquine For this reason, the CDC has recently doubled the recommended dosage for primaquine to eradicate liver forms (to 526 mg primaquine phosphate, or 30 mg base/day), but it remains possible that liver forms may not be eradicated by a single treatment. javascript pdf viewer editor: Open source PDF readers, creators, and editors | Opensource .com jspdf edit existing pdf How do I use JavaScript in PDF - XChange Editor ? - Tracker Software ...
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