Page 185 - 2022 Ranger Medic Handbook

PRIMAQUINE
Class: Antimicrobial – antimalarial
Action: Antiprotozoal agent that disrupts mitochondria and binds to DNA. Acts on primary exoerythrocytic forms of
Plasmodium vivax and Plasmodium falciparum. Destroys late forms of P. vivax preventing relapse
Dose: 30mg PO once daily × 14 days immediately following departure form malaria-endemic areas. Screen for G6PD
deficiency prior to providing as it can cause fatal hemolysis in severally G6PD deficient patients
Indications: Interruption of transmission of malaria, prevents relapse of P. vivax and P. ovale following travel to en-
demic areas
Contraindications: G6PD deficiency, rheumatoid arthritis, lupus, hemolytic drugs, bone marrow depression, NADH
methemoglobin reductase deficiency, pregnancy category avoid use during pregnancy and while breastfeeding infant
with G6PD deficiency but otherwise may use while breastfeeding (obtain negative pregnancy test before starting
medication)
Side-effects: Hematologic reactions to include acute hemolytic anemia if G6PD deficient; early hemolytic reaction
symptoms include darkening of the urine, decrease in urine volume, chills, fever, precordial pain, cyanosis; leuko-
cytosis, leukopenia, anemia, granulocytopenia, confusion, mental depression, visual accommodation disturbances,
hypertension, arrhythmias.
Interactions: Increased toxicity of both quinacrine and primaquine SECTION 4
Mission Impact: None

PROMETHAZINE (PHENERGAN)
Class: GI agent – phenothiazine; antiemetic, antivertigo
Action: Long-acting phenothiazine derivative with prominent sedative, amnesic, antiemetic, and anti–motion-sickness
actions and marked antihistamine activity; antiemetic action due to depression of CTZ in medulla; as with other anti-
histamines, it exerts antiserotonin, anticholinergic, and local anesthetic action
Dose: 12.5–25mg PO/IM/IV (IM must be deep injection into glut muscle, see adverse effects below) q4–6hr prn
Onset/Peak/Duration:
IV – Onset in 3–5 minutes/Duration 4–6 hours
IM – Onset in 20 minutes/Duration 4–6 hours
PO – Onset in 15–60 minutes/Duration 4–6 hours
Indications: For symptomatic relief from nausea, vomiting, motion sickness, or headache.
Contraindications: Phenothiazine hypersensitivity; narrow-angle glaucoma; stenosing peptic ulcer, BPH; bladder
neck obstruction; epilepsy; bone marrow depression; comatose or severe depressed states; Reye’s syndrome, en-
cephalopathy, hepatic diseases; pregnancy category caution advised during pregnancy and consider alternative while
breastfeeding
Adverse/Side-effects: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal reactions, night-
mares, CNS stimulation, abnormal movements; irregular respirations, respiratory depression; sedation drowsiness,
confusion, dizziness, disturbed coordination, restlessness, tremors; transient mild hypo- or hypertension; anorexia,
nausea, vomiting, constipation; leukopenia, agranulocytosis; blurred vision, dry mouth, nose, or throat; photosensitiv-
ity; urinary retention. If administering IV dilute and administer slowly, discontinue if severe burning occurs, can cause
tissue and digit necrosis.
Interactions: Alcohol and other CNS depressants add to CNS depression and anticholinergic effects
Mission Impact: GROUNDING medication for personnel on flight status

2022 RANGER MEDIC HANDBOOK 171