Antimalarials: The Harem
Once upon a time in a parallel Universe, there was a swampy kingdom ruled by
King Medico. So, the story goes that once the kingdom was attacked by an
epidemic of Malaria (Attack of the Plasmodia). The King (who is you in this
story) decided to send his Queens out to destroy Malaria (much like in Chess:
the Queen goes out to destroy, the King sits at home and watches ESPN!) He had
10 queens (including one eunuch), a mafia couple, a cyclist-warrior, a new
warrior, and a CIA agent.
Chloe-Queen (Chloroquine).
Right, so…Chloe the Queen was a pretty effective warrior; she fought fast and
long.
The parasites had occupied the Temples of the Red Corpuscles and were trying to
degrade the sacred substance Heme, but she complexed with Heme and together
their combined forces destroyed the plasmodial membranes. She could kill most of
the erythrocytic schizonts (Bloody schizos!), but couldn’t kill the resting
forms in the
liver (where they had set up their base camp).
She did manage to kill a few vivax babies (gametes), though, but not enough to
prevent relapses.
Her strategy of complexing with Heme was so effective that other queens
(Queen-9, Mufflo-Queen, Mepacrine) also used it (with variable success).
When plasmodial resistance to her increased, the King sent a spy called Viru
Tamil (Verapamil) who penetrated the evil plasmodial defenses and allowed Chloe
to do her job. Later in the war, a mafia couple (Sulfa-Pyri) took su-pyri to do
the job.
She was useful in other Wars too:
1. Killed E. histolytica and Giardia
2. The Great War of RA (Rheumatoid Arthritis)
3. DLE
4. Lepra reactions
5. She also gave symptomatic relief to the King after he got Infectious
Mononucleosis from kissing a teenage chambermaid.
Chloe the queen had the adverse effects of a typical woman:
• got under your
SKIN (high affinity for melanin) and gave you
an itch.
• got deep into the core of your being (high affinity for nuclear chromatin)
• aur aankhon mein bas gayi ( retinal accumulation). Love is Blind.
She gave the King headache and uneasiness, loss of hearing, blindness, mental
disturbances and graying of hair. (damn typical woman!)
She did get pregnant though, and gave birth to a normal heir (no teratogenicity).
When the King drank himself to
liver damage, she caused him to have seizures.
Being named after Chloro (Latin for green) she was a jealous queen, and the King
could not be seen in the company of Mufflo-Queen, Amiodarone and other girls who
could stop your
heart from fluttering (antiarrhythmics).
She completely rid the kingdom of Falciparum (except some resistant forms), but
vivax and ovale kept coming back. If the King went to an endemic area, he had
her by his side for a week before and 10 weeks after.
Amodia-Queen (amodiaquine)
She was the African twin of Chloe; ditto on all counts but only called upon in
time of war. Once the King took her on an endemic area junket, she almost killed
him from toxic hepatitis and agranulocytosis. Known to be less toxic than Chloe,
though – caused less of an itch.
Mufflo-Queen (mefloquine)
Mufflo came along to help Chloe get the falciparums that got away. She was very
effective, fighting fast (though not as fast as Chloe) and long, but couldn’t
kill vivax babies. She was more toxic than Chloe. She was called Mufflo because
she muffled and shuffled about (disturbed sense of balance, ataxia, errors in
operating machinery), yes indeed, she was quite the Klutz of the palace (strange
dreams, anxiety, hallucinations). She tends to get lost in the bile circulation.
Safe in pregnancy, but the first trimester is always a time to avoid her. She
was also quite the
heart stopper and a bitter kisser, like
Queen-9, and was only allowed to come out in very resistant attacks (kinda like
Kumbhkarna, only female, and prettier). Allowed to go on trips ( a week before
and 3 weeks after) to endemic areas but you gotta bring her back and not leave
her there for the locals.
Mepacrine
He was the palace eunuch, tried to act like Chloe, but was quite ineffective,
very toxic, caused the King to vomit and go mad (psychosis). Was banned and
thrown out of the Kingdom. Keeps cryin’ all the time – hence called Mepa-crine.
Queen-9 (Quinine)
Holy mo’fo’ big bad mamma. Queen-9 was like Chloe in the War, killing vivax
babies and bloody schizos, but slightly slower to act (and shorter) and very
very toxic. “Very bitter kisser,” said the King, “makes my stomach turn she
does, the irritating bitch. Makes me deaf and blind, stimulates then depresses
my
brain. Sometimes I swear I can hear a ringing
in my ears, did so the first time I met her – she said they were wedding bells!
She is damn pretty though, quite the
heart-stopper, and caused nausea, hypoglycemia, heavy breathing,
fever, weakness in the legs and collapse in many of her suitors. Some even died.
She aborted her babies, and killed my sperm, the bitch. She is a relief in
varicose veins and when I get leg cramps at night though, and then she’s the
typical wife. I reserve her for the times when falciparum attacks the palace (brain).
She’s an effective killer when she teams up with the mafia Supyri, and the small
time killers tetra and doxy.
In this scenario she is sometimes supported by Mufflo’s team with Arti-Sunita
the Chinese Queen.
Progu-Anil Cyclewala (proguanil)
Progu-Anil got on his cycle (cycloguanil) and went to kill the bloody schizos
too. This he accomplished by inhibiting DHFRase, a strategy also employed by the
mafia couple Sulfa-Pyri. He was kinda slow like Queen-9, but fought longer. His
major achievement was getting into the enemy base camp (got his inspiration from
Prima-Queen!) and killing the sleeping falciparums and some vivaxes too. He
didn’t kill any babies but didn’t let them grow up. He was much less toxic than
the queens - caused the King some tummy upset, and almost caused him some loss
of hair. He was safe to hang around in pregnant times but mostly went along with
Chloe to swampy battlegrounds that didn’t agree with Chloe very much (not just
to give her company!)
Prima-Queen (primaquine)
She didn’t kill any bloody schizos, but she killed the babies, and all the
sleeping ones in the base camp. They gave her the Prima title then
Terrible effects in G6PD deficient people. Roots out relapsing malaria.
Bula-Queen
Indian twin sister of prima, safe in G6PD.
Sulfa-Pyri
Pyri (pyrimethamine) was the female Sulfa-Pyri mafia team. She could kill the
enemy by inhibiting DHFRase directly (without getting on her cycle). Also didn’t
let the babies grow up, like Anil. Sulfadoxine was her mate, he blocked the
enemy a step ahead of Pyri. Together, these slow to act, but durable fighters
exhausted the vivaxes in a strategy similar to the Septran Gang (trimethoprim-sulfamethoxazole).
PABA ---X-----> Folate ----X---->THFA
Sulfa Pyri/Trim
This gang took the su-pyri to kill the enemy when Chloe was ineffective. They
took along Tetra and Doxy in their gang.
Tetra and Doxy
Small time killers. Slow, short acting, assist the Sulfa-Pyri gang to kill
bloody schizos, and some falci sleepers.
The Chinese Queens
Very fast acting (like the Chinese playing ping-pong or like Jackie Chan) and
short acting. Arti-Sunita (Artesunate) and Arti-Mathur (Artemether) killed the
enemy babies. (These names are not real, guys). Used only for acute attacks of
MDR falci. These beautiful ladies are
heart stoppers too (QT prolonged, first degree A-V block), but they
are kept secure in the palace. Ar-teeth-er (Arteether) (yes she’s got the
typical Chinese teeth!) only for institutional use in cerebral malaria.
Halofantrine is a last resort (like a CIA agent used for assassination)
and acts like Mufflo-Queen, also cross-reacts with her. May cause VT. Toxic
fellow.
Atovaquone is a new warrior that teams up with Progu-Anil to kill bloody
schizos. Also fights P. carinii and Toxoplasma gondii (Pyri was in the latter
fight too)
Disclaimer: My
apologies for all the sexist, racist remarks in this story. It is fictional like
Star Wars, but more palpable. No offense is meant to female humans,
schizophrenics, eunuchs, Chinese, Parsis, Tamilians, Africans, Klutzes,
womanizers, and the characters are not intended to look like real people, only
fairy tale chumps.
Note: Great Article! Excellent memory booster. Highly recommended by RxPG. Originally posted in Offbeat forum at http://www.rxpgonline.com/postt12041.html
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