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Chloroquine is a medication used in the management and treatment of malaria and inflammatory diseases. It is in the sulfonamides class of drugs. This activity describes the indications, action, and contraindications for chloroquine as a valuable agent in the therapy of malaria, rheumatoid arthritis, and lupus erythematosus. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the treatment, prevention, and management of patients with malaria and related conditions. Objectives: Summarize the mechanism of action of chloroquine. Identify the most common adverse effects of chloroquine. Review the appropriate monitoring of patients treated with chloroquine. Outline the importance of collaboration and coordination among the interprofessional team that can enhance patient care when prescribing and monitoring chloroquine to improve patient outcomes for patients receiving prophylaxis and treatment with chloroquine. Access free multiple choice questions on this topic.

Chloroquine toxicity is rare but has been known to occur when unusually high doses of chloroquine are ingested or after chronic IV administration. Accidental ingestion has also occurred in children.[16] When toxicity is present, the most common symptom is retinal toxicity. Treatment of chloroquine toxicity includes mechanical ventilation and administration of diazepam and epinephrine, although these methods have not been a proven method of treatment in all cases.[17]

Safely and effectively treating and preventing malaria requires an interprofessional team of healthcare providers, including a clinician, infectious disease specialist, nurse, physician assistant, and pharmacist. Similarly, the treatment of autoimmune and inflammatory conditions requires an interprofessional team consisting of primary care providers, healthcare specialists, and pharmacists. Without proper consultation, patients are at risk of exposure to a very preventable disease. Therefore, the recommended order of steps that the team should take for the prevention and prophylaxis of malaria are as follows: The patient informs their primary care provider about plans to travel to a country with malaria prevalence. Similarly, a primary care provider may also ask the patient during a normal history and physical whether the patient intends to travel outside of the country they reside. Once informed of out-of-country travel, the primary care provider will refer the patient to an infectious disease specialist. The infectious disease specialist can assess the risks of transmission and infection of the patient, depending on the country to which they will be traveling. Following the risk assessment, the infectious disease specialist can recommend chloroquine as prophylaxis to malaria if the patient will be in a country where chloroquine-sensitive malaria is present. The pharmacist will provide weight-dependent dosing of chloroquine and provide instructions that maximize the effectiveness of the prophylaxis, such as taking the medication before, during, and after the expected travel. Nursing staff can also counsel the patient regarding proper dosing and administration and answer any questions that the patient may have regarding the use and adverse events associated with chloroquine. The treatment and prevention of malaria do not stop here. First, the patient must abide by the recommended regimen. If the patient fails to follow the regimen, they put themselves at a higher risk of infection. Similarly, prescribing chloroquine in the context of inflammatory diseases have a similar recommended course of action: The patient will come to the primary care provider complaining of symptoms related to autoimmune and/or inflammatory disorders. The clinician will perform a history and physical and provide proper referrals for the patient's treatment.

Similarly, prescribing chloroquine in the context of inflammatory diseases have a similar recommended course of action: The patient will come to the primary care provider complaining of symptoms related to autoimmune and/or inflammatory disorders. The clinician will perform a history and physical and provide proper referrals for the patient's treatment. Referrals may be necessary for specialists, such as orthopedics and/or genetic counselors. The specialists can provide the right course of treatment or management of the inflammatory condition, most likely a chronic regimen of medications, including chloroquine. The pharmacist will adjust the dose depending on the weight and condition of the patient. As above, nursing staff can offer patient counseling and directions on dosing and administration and adverse events for which the patient may need to be aware. The above exemplified the interprofessional healthcare team approach that makes chloroquine therapy more effective and with fewer adverse events, enhancing patient care. [Level 5]