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INTRODUCTION

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chloroquine (klor-oh-kwin)

Aralen

Classification

Therapeutic: antimalarials, antirheumatics (disease-modifying antirheumatic drugs [DMARDs])

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Indications
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Prophylaxis and treatment of acute attacks of malaria. Treatment of extraintestinal amebiasis. Unlabeled Use: Treatment of severe rheumatoid arthritis. Treatment of systemic lupus erythematosus.

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Action
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Inhibits protein synthesis in susceptible organisms by inhibiting DNA and RNA polymerase. Therapeutic Effects: Death of plasmodia responsible for causing malaria. Death of ameba responsible for causing amebiasis. Improvement in inflammation in rheumatoid arthritis and systemic lupus erythematosus.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, delirium, depression, headache, personality changes, psychosis. EENT: hearing impairment, retinopathy, tinnitus, visual disturbances. CV: cardiomyopathy, ECG changes (T-wave abnormalities, QRS prolongation), hypotension. GI: abdominal cramps, anorexia, diarrhea, nausea, vomiting. Derm: alopecia, dermatoses, photosensitivity, pigmentary changes, pruritus, skin eruptions. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, LEUKOPENIA, thrombocytopenia. Neuro: neuromyopathy, peripheral neuritis, weakness.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

  • Monitor signs of agranulocytosis and leukopenia (fever, sore throat, mucosal lesions, signs of infection, bruising), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to aplastic anemia. Periodic blood tests may be needed to monitor WBC and RBC counts.

  • If treating rheumatoid arthritis or lupus erythematosus, periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

  • Be alert for signs of peripheral neuromyopathy and neuritis (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

  • Monitor signs of cardiomyopathy, including dyspnea, shortness of breath, exercise intolerance, peripheral edema, and rales/crackles. Notify physician of these signs immediately.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of cardiac dysfunction, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure periodically, and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

  • Monitor changes in personality, mood, and behavior, including depression, delirium, psychosis, and other personality changes. Notify physician if these changes become problematic.

  • If treating malaria, monitor any changes in symptoms (decreased fever, chills, sweating) to help determine if antimalarial drug therapy is successful.

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Interventions
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  • Because of the risk of ECG changes and cardiomyopathy, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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