Which one of the following drugs used for treatment of malaria is contraindicated in pregnancy?

ESIC Nursing Officer-7July 2024

Pharmacology

Easy

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

Primaquine is an 8-aminoquinoline antimalarial that is absolutely contraindicated during all trimesters of pregnancy.
The primary reason is its potential to cause severe intravascular hemolysis in individuals with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency.
Since the G6PD status of the fetus is unknown and the drug crosses the placenta, it poses a significant risk of causing life-threatening hemolytic anemia in a G6PD-deficient fetus.

Option A: Chloroquine is generally considered the drug of choice and is safe for both treatment and prophylaxis of sensitive malaria strains throughout all trimesters of pregnancy.
Option C: Quinine is not absolutely contraindicated. It is an important drug used to treat severe or chloroquine-resistant P. falciparum malaria in pregnancy, especially in the first trimester, although it requires close monitoring.
Option D: This combination is not contraindicated; in fact, it is recommended by the WHO for Intermittent Preventive Treatment in pregnancy (IPTp) to prevent malaria. It is typically administered after the first trimester in malaria-endemic regions.

Visual 1: Table: Summary of Antimalarial Drug Use in Pregnancy - A table categorizing common antimalarials (Chloroquine, Quinine, Primaquine, SP, Artemisinins) by their safety status (Safe, Use with Caution, Contraindicated) across the three trimesters.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology of antimalarial drugs and their contraindications in pregnancy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's primary safety check before administering primaquine is to confirm the patient is not pregnant and to verify that a recent G6PD deficiency test result is normal.
Patient education for pregnant women with P. vivax/ovale malaria is crucial; they must understand the need for weekly chloroquine prophylaxis during pregnancy and definitive 'radical cure' with primaquine after delivery (and after G6PD testing).
What if? If a non-pregnant patient with P. vivax malaria has a documented G6PD deficiency, primaquine is still contraindicated. A specialist must be consulted for alternative regimens.

How to Approach the Question

First, identify the key terms in the question: 'malaria', 'contraindicated', and 'pregnancy'. The question asks for a drug that is strictly forbidden.
Next, recall the major classes of antimalarial drugs and their primary safety concerns.
Focus on absolute contraindications. While some drugs have warnings or require caution, the question asks for the one that is contraindicated.
Associate Primaquine with G6PD deficiency. This is a critical, high-yield link in pharmacology.
Extend this association to the fetus: if the mother takes the drug, the fetus is exposed. Since the fetus's G6PD status is unknown, the drug is deemed unsafe and therefore contraindicated.
Review the other options to confirm your choice. Chloroquine is known to be generally safe, Quinine is used for severe cases, and Sulfadoxine + Pyrimethamine is used for prevention in later pregnancy. This confirms Primaquine as the unique, absolutely contraindicated option.

Concept Tested & Keywords

Concept Tested: Pharmacology of antimalarial drugs and their contraindications in pregnancy.
Stem keywords: malaria, treatment, contraindicated, pregnancy
Lead-in keywords: Which one
Negative lead-in flag: false

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