Anti Helminthic Drugs Flashcards by Iseoluwa Ojo

Helminthiasis or parasitic worm infection

•Prevalence greatest in the ______

•Spread is by _______,____,______ activity

tropics

travel, migration, military

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These helminthes are Metazoa:

Roundworms (_________)

Flatworms 2a._____(______) 2b. Another type of flatworms are ______ (________)

nematodes

Flukes; trematodes

tapeworms; cestodes

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The helminthes are biologically diverse eukaryotes

T/F

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(Mature or Immature?) forms of helminths invade human beings through the ______ or ____

Immature

skin or GIT

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Apart from few exceptions such as _________ and _________ , these organisms do not normally _________ in humans

Therefore the _________ to the organisms dictates the ______ of infection

reduction of adult worm by chemotherapy is sustained unless ______ occurs.

Strongyloidis and Echinococcus

complete their life cycle

extent of exposure

severity

reinfection

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Antihelminthes act (locally or systematically?) to ____ worms from the ____ or (locally or systemically?) to eradicate adult worms or developemental stages from ____ and ____

Locally

expel; GIT

systemically

tissues and organs

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FILARIASIS

ADULT WORMS DWELL IN THE ____ TISSUES ALONE IN THE INFECTIONS CAUSED BY- ______,______,______

LYMPHATIC

Wurchereria bancrofti, Brugia malayi, Brugia timori

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FILARIASIS

WHILE FOR THE FOLLOWING INFCTIONS ADULT WORMS ARE FOUND IN OTHER TISSUES- _______,___________,_________

Loa loa, Onchocerca volvulus, Mansonella species.

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FILARIASIS

Nearly ________ people are affected, 90% by _______, 90% of the remaining by _________.

90 million

W. bancrofti

Brugia malayi

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FILARIASIS

W. bancrofti- IS FOUND IN _______, ______, India, Sothern China, widely through out the ______

Brugia malayi –_________,______, _______

Brugia timori-_______

Central Africa; S. America; tropics

Indonesia; South East Asia; Central Africa

Indonesia

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Bancroftia And Brugian HOST Reactions To adult Worms Include fevers , __________,____________; lymphatic obstructions Is Typified BY _______,_______,_________ .

Tropical ______________ also Occurs In Some INDIVIDUALS

LYMPHANGITIS, LYMPHADENITIS

Lymphedema, Hydrocele, Elephantiasis

Pulmonary Eosinophilia

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Loa loa-

•Transmitted by ______

•L. loa, aka _________

•Is a ________ parasite In large ____ Of central Africa And west Africa .

Deer flies

African eye Worm

Migrating Filarial ; Rivers

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Loa loa-

•Adult worms occur in ______ tissue

•causes Episodic _______ and _______

can Penetrate the ______ and _____

•rarely, __________,_______, or ________ With Heavy Infection occur.

Subcutaneous

Calabar Swellings; Allergic reactions

Skin And Conjunctiva.

Encephalopathy, Cardio pathy OR nephropathy

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O. vulvulus-

•transmitted by _____ near __________ and _______

•Inflammatory reactions TO _______ not ______

black Flies; Fast Flowing Streams And Rivers

Microfilaria; Adult worms

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O. vulvulus-

•Affect _______________ and _________

•____ LEADING CAUSE OF _____ WORLD WIDE

Subcutaneous lymph Nodes and Eyes

2ND

BLINDNESS

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Mansonella spp.

•Transmitted By _________

• Is (common or rare?) And Variably Responsive to Chemotherapy.

midges

Rare

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____________(DCM)

___________(IVM)

Diethylcarbamazine

Ivermectin

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________ and _______ ARE Primary Compounds For The Treatment Of lymphatic Filariasis

Diethylcarbamazine(DCM) and Ivermectin (IVM)

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Filariasis treatment

Population Based, Yearly Single dose of ______ or -______

______ + ________, Or ________ + ________ markedly decrease microfilarial and prevalence

DCM Or IVM

IVM+ ALBENDAZOLE

DCM+ ALBENDAZOLE

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_____ Is safer when Bancrofti coexists with Loasis Or Onchocerciasis

________ + _________ MAY BE USED IN OTHER CASES

IVM

DCM+ ALBENDAZOLE

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Treatment of filariasis

IT IS better TO start Treatment early before ___________ OCCUR IN Wurchereria and Brugia INFECTIONS,

HOWEVER, IN SOME LATE STAGES SOME IMPROVEMENT OCCUR

OBSTRUCTION OF THE LYMPHATICS

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IN LONG STANDING ELEPHANTIASIS, _____ IS NEEDED TO INCREASE LYMPH DRAINAGE AND REMOVE REDUNDANT TISSUE

SURGERY

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_______ IS THE BEST SINGLE DRUG FOR LOASIS, BUT SHOULD START WITH ——— DOSE TO DECREASE ________ TO DESTROYED _________

DCM

SMALL

HOST REACTION

MICROFILARIAL WORMS

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____________ NEEDED TO CONTROL ACUTE ADVERSE DRUG REACTIONS

GLUCOCORTICOIDS ARE

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Rarely, Serious cerebral reactions occur because of ___________________ IF Severe ______ Occurs Or there Is evidence OF Adult Worm near THE ____, caution IS REQUIRED FOR INITIAL DOSING

Destruction OF Microfilaria IN Brain headache Orbit

____________ IS THE BEST SINGLE DRUG FOR CONTROL AND TREATMENT OF Onchocerciasis Because of __________ and Few ______ complication

IVERMECTIN MILDER REACTIONS Occular

DIETHYLCARBAMAZINE DCM A water (soluble or insoluble?) salt _______ TASTE,_______ ODOR (Stable or unstable ?) to heat

Soluble TASTELESS ODORLESS Stable

DIETHYLCARBAMAZINE DCM ANTIHLMINTHIC ACTION: KILLS ______ Of _________,______, and ________ IN BLOOD

Microfilaria Wuchereria bancrofti Brugia malayi and Loaloa

DIETHYLCARBAMAZINE DCM KILLS MICROFILARIA OF Onchcerca IN ___ BUT NOT IN _____ WHERE _____\ ARE.

SKIN NODULE ADULT WORMS

DIETHYLCARBAMAZINE DCM affects Microfilaria in hydrocoele T/F

F IT DOES NOT AFFECT MICROFILARIA IN HYDROCELE DESPITE PENETRATION THERE

DIETHYLCARBAMAZINE DCM KILLS ADULT WORMS OF Wuchereria , Brugia, Loaloa. T/F

F IT IS NOT CERTAIN IF DCM KILLS ADULT WORMS OF W, B, L

DCM Exerts No action Against adult worms OF Onchocerca T/F

F little action

Mechanism of action of DCM: •IT appear To perturb ______________IN humans AND Host _____________ cells With Resultant Vaso__________ and HOST’S Platelet and Granulocyte __________________ Around ______ OF damaged parasites

Arachidonic Acid Metabolism constriction; Aggregation membrane

Mechanism of action of DCM: It Activates ______ But not _______ Immunity. It also appears To compromise _______________ and ____________ TO plasma Membranes.

Innate Adaptive; Intracellular Processing AND transport OF certain Macromolecules

A F E of DCM: (Slowly or Rapidly?) Absorbed from GIT. Peak plasma Levels IN 1-2 HRS, after single ____ T1/2 IS 2-10 HRS Depending ON ________ PH

Rapidly P.O. Urinary PH

(Slow Or Rapid?) and extensive metabolism occurs. Major metabolite Is ____________ IS (active or inactive ?) .

Rapid DITHYLCARBAMAZIN-N-OXIDE Active

Excretion of DCM • Is Both ________ and ______ • >50% Appears In (Acid or Alklaine ?) urine AS urine IS _______

URINARY And EXTRAURINARY Acid ALKALINE

Excretion of DCM •(Acidifying or Alkalinizing?) urine Increases plasm level, Prolongs T1/2 •THE dose Should Be _____eased IN renal dysfunction Or there should be sustained ______________

Alkalinizing decr ALKALINIZATION OF urine

Therapeutic uses of DCM in Wurchereria bancrofti, Brugia malayi and Brugia timori Mass Treatment To Decrease To _______ Levels and Therefore Interrupt ______ transmission

Sub infective; Mosquitoes

Therapeutic uses of DCM in Wurchereria bancrofti, Brugia malayi and Brugia timori the _____ Is given As 0.2% TO 0.4% weight of the base, This decreases The prevalence, severity and transmission.

table Salt

Therapeutic uses of DCM in Wurchereria bancrofti, Brugia malayi and Brugia timori •Single ____ Dose of ___ mg/kg every ________ is equally effective •annual single P.O. Dose ____ MG/KG + another Anti helminthic E.G. _____ Is equally Effective •6 mg/kg _____+ 400MG _____ IS more appropriate

P.O. ; 6; 6-12 months 6; Ivermectin DCM; albendazole

Therapeutic uses of DCM in Wurchereria bancrofti, Brugia malayi and Brugia timori •While 2 mg/kg _____ X 14/7 IS PRESCRIBED FOR TROPICAL _____________________ •test Dose, Of _____ Is Adviceable Before the Full Dose of ___ mg/kg

TID Pulmonary eosinophilia 50mg; 6

TID Is administered FOR 21/7 In the case of _______ In the clinic, this Is different From __________ Described Above, which was to reduce _______,______, and _______

Treatment mass Eradication Prevalence, severity And transmission.

Loa loa • ________ + ______/_____ •ADRs Includes severe ______ To Dying Microfilaria and Adult worms and Occasionally ________ and ______ because Of Invasion OF ____ by microfilaria.

DCM + Glucocorticoids or antihistamines Allergic Reaction MENINGOENCEPHALITIS AND coma brain

In treatment of LOA LOA ADRs are rare unless _____ OF 8-10MG/KG Is ______ And ADRs ________________ as treatment continues.

daily dose exceeded; disappear In few days

In treatment of LOA LOA ADRs ANOREXIA, nausea, Headache, AND Vomiting Occur ______ damage Occurs In Heavy Loa loa Infection and ______

RETINAL ENCEPHALITIS

____ reaction May occur IN Onchocerca volvulus.

Mazzotti

In treatment of onchocerca volvulus Mazzotti: A few hours after 1ST ____ dose, Intense ________,______, INCREASE IN _____ and _____ OF lymph nodes, Fine papular rash, FEVER, Tachycardia, Arthralgia, Headache,

Oral ITCHING, Rashes Size And TENDERNESS

In treatment of onchocerca volvulus Mazzotti: These Last for _________ Days, Then subside

3-10

After the mazzotti reaction, high doses ARE Tolerated T/F

In treatment of onchocerca volvulus Mazzotti: Occular affection include ______, PUNCTATE _____, _____ , atrophy of ____________________

LIMBITIS; KERATITIS; UVITIS Retinal pigment epithelium

In treatment of bancroftian or brugian infections, _________ along THE LYMPHATICS and LYMPHADENITIS subside in ____ DAYS. ______ occur ON second DAY OF Treatment and peak by the _____ or ____ Day, It Subsides over A few weeks Reversible ______ and ______ ALSO Occur

NODULAR SWELLINGS Few LEUKOCYTOSIS 4TH OR 5TH Proteinuria AND EOSINOPHILIA

IVERMECTIN MECHANISM OF ACTION : •ITS EFFECT IS ON _____ GATED CL- CHANNEL OF MUSCULATURE. •THIS INCLUDES THE MUSCULATURE OF _______ MUSCLES thereby PREVENTING _____ OF THE FILARIAL WORMS,

GLUTAMATE PHARYNGEAL

IVERMECTIN MECHANISM OF ACTION : •ALSO CAUSES _____ OF THE WORMS, thereby PREVENTING ____ of______ FROM ADULT FEMALE UTERUS.

PARALYSIS EGRESS OF MICROFILARIA

Ivermectin : mechanism of action THESE glutamate gated Cl- CHANNELS OCCUR IN INVERTEBRATES and VERTEBRATES. T/F

F ONLY IN INVERTIBRATES

ALSO, IVERMECTIN BINDS ____ RECEPTORS IN INVETEBRATES AND VERTEBRATES

GABA

ANTIHELMINTIC ACTION of ivermectin: CAUSES MARKED DECREASE IN ________ IN ______ and _______ LASTING 6-12/12

MICROFILARIA Skin Ocular tissue

ABSORPTION FATE AND EXCRETION of ivermectin: •(Little or Large?) APPEARENT VOLUME OF DISTRIBUTION IS NOTED, IT IS ____% BOUND TO PLASMA PROTEIN •IT IS EXTENSIVELY CONVERTED BY CYP ____ TO >___ METABOLITES (MOSTLY _________ and ________ DERIVATIVES)

Large 93; 3A4 10; HYDROXYLATED AND DEMETHYLATED

Absorption fate and excretion of overmen: •IT PENETRATES THE CNS (well or Poorly?) (THOUGH HIGHLY LIPO_____) •__________ PUMP IN BLOOD BRAIN BARRIER PREVENTS ACCESS TO THE BRAIN

Poorly PHILIC P-GLYCOPROTEIN EFFLUX

THERAPEUTIC USES of ivermectin on onchocerciasis •IT CAUSES _______ OF _______ AND ACUTE INFLAMMATORY CHANGES IN ____ TISSUES AND ARRESTS FURTHER _____ PATHOLOGY •IT CAUSES DECREASE OF MICROFILARIA IN _______ and _______ TISSUE IN FEW DAYS, THE EFFECT LASTS 6- 12 MOTHS AFTER WHICH THE DOSE HAS TO BE REPEATED

REVERSAL; LYMPHADENOPATHY OCCULAR; OCCULAR SKIN AND OCCULAR

Ivermectin in onchocerciasis results in cure T/F With reason

F IT DOES NOT RESULT IN CURE BECAUSE OF LITTLE EFFECT ON ADULT WORMS

Ivermectin to treat LYMPHATIC FILARIASIS: _______ 400MG+IVERMECTIN 200-400 μg/Kg SINGLE ANNUAL DOSE, PERIOD OF TREATMENT IS 4-6YEARS

ALBENDAZOLE

SINGLE DOSE OF 150-200 μg/Kg OF IVERMECTIN CAN CURE HUMAN STRONGYLOIDIASIS T/F

INFECTIONS WITH INTESTINAL NEMTODES: SINGLE DOSE OF 150-200 μg/Kg OF IVERMECTIN CAN CURE ____________ ALSO, THIS DOSE IS EFFECTIVE AGAINST CO-EXISTING ______,______ and ______

HUMAN STRONGYLOIDIASIS ASCARIASIS, TRICURIASIS AND ENTEROBIASIS

100 μg/Kg IVERMECTIN + _________ IS EFFECTIVE AGAINST INTESTINAL STRONGYLOIDIS AND (MORE OR LESS?) TOXIC THAN USE OF HIGHER DOSES OF THIABENDAZOLE ALONE

THIABENDAZOLE Less

150-200 μg/Kg SINGLE DOSE IVERMECTIN, P.O. FOR CUTANEOUS ________ BY DOG OR CAT _______, And THE SAME DOSE IS REQUIRED FOR _______ and _______ EVEN IN HIV INFECTED PATIENTS

LAVAL MIGRANS HOOKWORMS HEAD LICES AND SCABIES

Ivermectin’s ADRs: ______ LIKE REACTIONS TO DYING ______, THE INTENSITY AND NATURE OF THIS RELATE TO _______ AND DURATION AND TYPE OF FILARIAL INFECTION. AFTER TREATMENT, ADRs LIMITED TO _________,_______, and _______ IN 5%-35% OF PEOPLE, IT LASTS FEW DAYS AND IS RELIEVED BY ______,________ DRUGS.

MAZZOTTI MICROFILARIA; MICROFILARIAL BURDEN MILD ITCHING, SWOLLEN, TENDER LYMPH NODES ASPIRIN, ANTIHISTAMINE

Ivermectin’s ADR: RARELY, PATIENTS CAN EXPERINCE HIGH FEVER, ____CARDIA, ____TENSION, _______, DIZZINESS, HEADACHE, MYALGIA, ARTHRALGIA, DIARRHOEA, FACIAL _______ WHICH RESPOND TO ________.

TACHY; HYPO PROSTRATION PERIPHERAL EDEMA; GLUCOCORTICOIDS

IVRMCTIN WILL EXACERBATE LESSIONS OF OOULAR TISSUES IN Onchocerciasis T/F

F IVRMCTIN WILL NOT EXACERBATE LESSIONS OF OOULAR TISSUES IN Onchocerciasis

Using ivermectin, IN Onchocerciasis there IS MARKED ________ and _______ WHEN CO- INFECTED WITH HEAVY BURDENS OF L. loa microfilaria

DISABILITY AND ENCHEPHALOPATHIES

IVERMECTIN IS CONTRAINDICATED IN PATIENTS WITH ________________, FOR EXAMPLE THOSE WITH ___________ or ____________ BECAUSE OF THE EFFECT ON _____ RECEPTORS IN THE _____.

IMPAIRED BLOOD-BRAIN-BARRIER AFRICAN TRYPANOSOMIASIS AND MENINGITIS GABA CNS

Ivermectin CAUTION SHOULD BE EXERCISED IN PATIENTS ON ________

CNS DEPRESSANTS

HIGH LEVELS OF IVERMECTIN ARE FOUND IN BREAST MILK

F LOW LEVELS OF IVERMECTIN ARE FOUND IN BREAST MILK

DRACOTIASIS CAUSED BY _____________ OTHER NAMES INCLUDE _________ or ___________.

Dracunculus medinensis. GIUNEA DRAGON OR MEDINA WORMS

DRACOTIASIS •IT IS IN (INCLINE OR DECLINE?) , MOSTLY FOUND IN SUDAN AND WEST AFRICA •IT IS CAUSED BY ________ THAT CONTAINS ______ THAT CARRY INFECTIVE LARVAE.

Decline DRINKING WATER COPEPODS

DRACOTIASIS AFTER ____ ADULT FEMALE WORM EMMERGE FROM THE _____

1 YEAR SKIN

DRACOTIASIS TREATMENT: _______ on _______ , BUT RISK IS _________ IF _______ OCCURS.

WINDING ON STICK SEVERE INFECTION RUPTURE

DRACOTIASIS : TREATMENT •____________ 200MG TID X 10/7, THE MEDICATION ALLEVIATES THE SYMPTOMS AND CAUSES FUNCTIONAL RELIEF BECAUSE IT ____________ THEREBY FACILITATING REMOVAL OF WORM. •________ OF DRINKING WATER •AVOID CONTACT OF INFECTED PERSONS WITH ________

METRONIDAZOLE REDUCES HOST’S INFLAMMATORY RESPONSE FILTRATION SURFACE WATER

METRONIDAZOLE IS A PRODRUG T/F

METRONIDAZOLE •IS A PRODRUG WHICH REQUIRES _____ ACTIVATION OF THE _____ GROUP BY SUSCEPTIBLE ORGNISMS. •IT POSSESS SELECTIVE TOXICITY TOWARDS ____________________________ PATHOGENS E.G. ________ PROTOZOA, T._________ , E._______ and G._______ Because OF THEIR METABOLISM.

REDUCTIVE; NITRO ANAEROBIC AND MICROAEROPHILIC AMITOCHONDRIATE vaginalis; histolytica; lamblia

METRONIDAZOLE Activation of metronidazole: THESE ORGANISMS AND ANAEROBIC BACTERIA CONTAIN ELECTRON TRANSPORT COMPONENTS E.G. ______,______ THAT HAVE A SUFFICIENTLY ____________________ TO DONATE e- TO METRONIDAZOLE.

FERRODOXINS, SMALL Fe-S PROTEINS Negative REDOX POTENTIAL

METRONIDAZOLE Mechanism of action: THE SINGLE ELECTRON TRANSFER FORMS A ________ ——— _____ ——— _______ THAT KILLS SUSCEPTIBLE ORGANISMS TARGETING ____ AND OTHER BIOMOLECULES

HIGHLY REACTIVE NITRO RADICAL ANION DNA

ABSORPTION FATE AND EXCRETION: •metronidazole Is (completely or incompletely?) And (slowly or rapidly?) ABSORBED

completely Rapidly

Metronidazole ADRs: •GIT (NAUSEA,________, ___ MOUTH), VOMITING, ABDOMINAL PAIN •CNS- DIZZINESS,____,_____, _______ , ATAXIA, SENSORY NEUROPATHY

METALLIC TASTE; DRY VERTIGO; ENCEPHALOPATHY; CONVULSION

Metronidazole ADRs: •PATIENTS EXPERIENCE _______ EFFECT IF ALCOHOL IS TAKEN AT SAME TIME OR WITHIN 3/7 AFTER TREATMENT •_______INCREASES ITS PLASMA LEVEL.

DISULFIRAM CIMETIDINE

METRONIDAZOLE (PROLONGS or SHORTENS?) PROTHROMBIN TIME OF PATIENTS ON COUMARIN ANTICOAGULANTS

PROLONGS

BENZIMIDAZOLES: _______,_______,________

thiabendazole, mebendazole albendazole

BENZIMIDAZOLES ________ is significantly more toxic than others so currently use more ______ for _____________ While ________ and _____ are used for GIT helminthiasis

thiabendazole topically cutaneous larva migrans mebendazole, albendazoloe+

ALBENDAZOLE: metabolism •IT IS ______ and _____ ABSORBED AFTER P.O. •ABSORPTION IS INCREASED BY ____ FOODS AND _______.

VARIABLY AND ERRATICALLY FATTY; BILE SALTS

ALBENDAZOLE : metabolism •IT IS (slowly or Rapidly?) METABOLISED IN THE ______ and ____ TO 2 SULFOXIDE METABOLITE WHICH HAVE (mildly or Highly?) POTENT ANTIHELMINTIC ACTIVITY.

Rapidly LIVER AND INTESTINE Highly

ALBENDAZOLE IS (WELL or POORLY?) DISTRIBUTED

WELL

ALBENDAZOLE UNDERGOES SELF INDUCED HEPATIC METABOLISM. T/F

ALBENDAZOLE : excretion THERE IS FURTHER OXIDATION TO (ACTIVE or INACTIVE?) NONCHIRAL SULFONE METABOLITE WHICH IS EXCRETED IN THE ______

INACTIVE URINE

MEBENDAZOLE Like Albendazole is a (natural, semi synthetic, or synthetic?) _______ compound •(well or Poorly?) absorbed, excreted as the decarboxylated compound

synthetic; benzimidazole Pooh

MEBENDAZOLE •It possibly acts by inhibiting _______ formation

mirotubule

MEBENDAZOLE •Side effects are (mild or severe?) , but the drug is ______ in animals •However ________ reactions may occur in high doses •_______ have been reported in children under 2

Mild teratogenic hypersensitivity Convulsions

PYRANTEL PAMOATE : •It is a _______________ derivative •Active only against _____ organisms, peak concentrations are reached in 1-3 hours and excreted mostly unchanged

tetrahydropyrimidine luminal

PYRANTEL PAMOATE : •It is a _____________ •Dose: 11 mg/kg as a single dose but may be repeated

neuromuscular blocker

PYRANTEL PAMOATE : Indications: _______,________,_________ ADR: (mild or severe?)

pinworms, ascariasis, Trichostrongylus orientalis Mild

SCHISTOSOMIASIS:praziquantel •Indicated for (all ,some or most?) schistosome infections (all, some , or most?) trematode and cestode infections, and _______ •It is a (natural,synthetic or semi synthetic ?) isoquinoline-pyrazine derivative

All Most cysticercosis Synthetic

SCHISTOSOMIASIS:praziquantel •it is (able or not able?) to cross the blood brain barrier •It is extensively _______ •Its bioavailability is improved by _____ and ______ but reduced by ______ and ______

Able hydroxylated food and cimetidine phenytoin andcarbamazepine

SCHISTOSOMIASIS:praziquantel It acts by ___________ of trematodes and cestodes membranes to _____

increasing the permeability calcium

SCHISTOSOMIASIS:praziquantel Clinical Indications: _________, _____, opisthorchiasos, ________,______,_______,________,_______ , hydatid disease

all forms of schistosomiasis clonorchiasis paragonimiasis Teeniasis, Diphylobothriasis, neurocysticercosis, hymenolepsis nana

SCHISTOSOMIASIS:praziquantel ADR: •mild reactions, in ________ •neurological abnormalties may be exergerated due to _________: _____, nausea, vomiting, seizures, metrifonate,oxamiquine

neurocysticercosis inflammation around the dying worms meningism

oxamiquine •Indicated in _______ infections not effective against ________ or ________ •It is a (synthetic or semi-synthetic?) tetrahydroquinoline

S mansoni S haematobium or S japonicum semi-synthetic

oxamiquine •it is extensively metabolized with inter individual variations. The metabolite is (active or inactive?) •Active against the __________ stages of S mansoni

Inactive mature and immature

oxamiquine ADR: _____ to _____ discoloration of the urine, nausea, vomiting, diarrhoea, colic, _____ and ______ Used with care in _____ and contraindicated in _____

orange to red pruritus and urticaria epilepsy; pregnancy

METRIFONATE •It is an _________ compound indicated for _________________________ but not _____ •It is transformed to ______ which is the active metabolite

organophosphate schistostoma haematobium adult worms the eggs dichlorvos

METRIFONATE Its mechanism of action is through _________________ The _____ worms are shifted from the _______ to the ________ where they are trapped and encased by the immune system

cholinesterase inhibition paralysed bladder venous plexus to the lungs

METRIFONATE ADR:(mild or severe?) ____________ symptoms

mild cholinergic