Chloroquine

Ideally, chloroquine should be dosed depending on body weight and height. For use as malarial prophylaxis, the appropriate chloroquine dose is 5 mg/kg of body weight with a maximum of around 500 mg given on a once per week dosing regimen.[15] 

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 professionals that include a primary care provider, infectious disease specialist, 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. The recommended order of steps that should be taken by the team for the prevention and prophylaxis of malaria are as follows:

1. The patient informs their primary care provider about plans to travel to a country with a prevalence of malaria. Similarly, a primary care provider may also ask the patient during a normal history and physical whether the patient has any intention of traveling outside of the country in which they reside.
2. Once informed of out of country travel, the primary care provider will refer the patient to an infectious disease specialist.
3. 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.
4. 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.
5. The pharmacist will provide weight-dependent dosing of chloroquine and also provide instructions that maximize the effectiveness of the prophylaxis, such as taking the medication before, during, and after the expected travel.
6. Nursing staff can also counsel the patient regarding proper dosing and administration, as well as answer any question that the patient may have regarding the use and adverse events associated with chloroquine.

The treatment and prevention of malaria do not stop here. 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:

1. The patient will come to the primary care provider complaining of symptoms related to autoimmune and/or inflammatory disorders.
2. The primary care provider will perform a history and physical and provide proper referrals for the patient's treatment.
3. Referrals may be necessary for specialists, such as orthopedics and/or genetic counselors. 
4. The specialists can provide the right course of treatment or management of the inflammatory condition, most likely a chronic regimen of medications, including chloroquine. 
5. The pharmacist will adjust the dose depending on the weight and condition of the patient.
6. As above, nursing staff can offer patient counseling and directions on dosing and administration, as well as 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]