Antihelmintic Drugs Flashcards by Mark Sutherland

Q

Treatment options for enterobius (pinworm)

A

Mebendazole or Pyrantel pamoate or Albendazole

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Q

Treatment options for trichuris (whipworm)

A

Mebendazole. Alternates - Albendazole or ivermectin

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Q

Treatment options for ascaris (roundworm)

A

Albendazole or mebendazole or ivermectin

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Q

Treatment options for necator americanus and ancylostoma duodenale (hookworms)

A

Albendazole or mebendazole or pyrantel pamoate. (Ivermectin is NOT effective)

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Q

Treatment options for strongyloides

A

Ivermectin. Alternative - albendazole

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Q

Treatment options for trichinella

A

Steroids and albendazole. Alternative - Mebendazole

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Q

Treatment options for dracunculus (guinea worm)

A

No DOC, drug therapy not curative. Slow extraction of worm and wound care with pain management

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Q

Treatment options for lymph node filarial worms (wuchereria bancrofti and brugia malayi)

A

Diethylcarbamazine (DEC). Albendazole and Ivermectin also used in efforts to eradicate disease (they do not kill adult worms)

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Q

Treatment options for Loa Loa

A

Diethylcarbamazine (DEC). Can also use antihistamines and corticosteroids to decrease acute reaction

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Q

Treatment options for Onchocerca (river blindness)

A

Ivermectin

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Q

Treatment options for intestinal trematodes

A

Praziquantel

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Q

Treatment options for clonorchis sinesis (chinese liver fluke, a hepatic trematode)

A

Praziquantel or albendazole

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Q

Treatment options for fasiola hepatica (sheep liver fluke, a hepatic trematode)

A

Triclabendazole. Alternatives - biothionol or nitazoxanide

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Q

Treatment options for pulmonary trematodes

A

Praziquantel. Alternatives - Triclabendazole or bithionol

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Q

Treatment options for blood trematodes (schistosomas)

A

Praziquantel. Alternative - Oxamniquine for schistosoma mansoni

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Q

Treatment options for hymenolepis nana (dwarf tapeworm)

A

Praziquantel. Alternative - Niclosamide

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Q

Treatment options for diphyllobothrium latum (fish tapeworm)

A

Praziquantel. Alternative - Niclosamide

Q

Treatment options for taenia saginata (beef tapeworm)

A

Praziquantel. Alternative - Niclosamide

Q

Treatment options for taenia solium (pork tapeworm)

A

Praziquantel. Alternative - Niclosamide

Q

All 4 of the tapeworms (cestodes) we learned about have the same treatment options in the adult, intestinal stage. What are they?

A

Praziquantel. Alternative - Niclosamide

Q

What is the treatment for hydatid cysts (tapeworm larval (tissue stage))

A

Albendazole

Q

Uses for albendazole

A

All the nematode infections we learned about (but 2nd line for Trichuris and Strongyloides). Also, Hydatid disease and Cysticercosis. Also clonorchis sinensis (chinese liver fluke)

Q

Mechanism of Action for Benzimidazoles (Albendazole, Mebendazole and Triclabendazole)

A

Inhibit microtubule synthesis in nematodes, impairing glucose transport

Q

AEs of albendazole

A

Do not use in pregnancy or children. During prolonged use - hepatic changes, GI, rash, leukopenia, myelosuppression

Main differences between albendazole and mebendazole

Melbendazole has few AEs (but still dont use in pregnancy), more resistance in mel, albendazole more versatile (covers chinese liver fluke and hydatid cysts)

Mechanism of action of diethylcarbamazine (DEC)

Alters microfilarial surface membrane (immobilizes, dislocates)

Most AEs with diethylcarbamazine are related to what and what is given to reduce these AEs?

Related to the dying worms (eosinophilia, reversible proteinuria, nodular swelling). Can give antihistamines or corticosteroids to minimize these

The Mazzotti reaction is a very serious set of AEs to a given drug in a given filarial infection. Name the infection, the drug, and the components of the Mazzotti reaction

After 1st dose of diethylcarbamazine in onchocerciasis. Includes itching, skin rashes, lymphadenopathy, fever, tachycardia, arthralgia, headache, retinal hemorrhage, encephalopathy

Mechanism of action of ivermectin

Reduces microfilariae production of adult female onchocerca (no lethal effect on adult worms), tonic paralysis of peripheral musculature and potentiation of the relase and binding of GABA

Does ivermectin cross the BBB?

No

AEs of ivermectin

Lethargy, mydriasis, ataxia, postural hypotension, mild Mazzotti reaction. Do not give during first trimester

Uses of ivermectin

DOC for onchocerca (river blindness) and stronglyoides. Alternative for scabies

Mechanism of action of niclosamide

Inhibits and uncouples Ox Phos (immobilizing cestodes)

AEs of niclosamide

None of significance. Very little absorbed from GI tract

Uses of niclosamide

Alternative drug for many tapeworm (cestode) infections

Mechanism of praziquantel

Increases membrane permeability to cations (esp Ca), causes spastic paralysis (worms detach), messes up tegument of schistosomes

AEs of praziquantel

Abdominal discomfort, skin irritation

Uses of praziquantel

Infection with schistosomes and cestodes. Also many trematodes (but not fasciola hepatica). Alternative in hydatid disease. Contraindicated in ocular cysticercosis

Mechanism of pyrantel pamoate

Depolarizing neuromuscular blocking agent (release of ACh and inhibition of cholinesterase). Worms are paralyzed and expelled

AEs of pyrantel pamoate

Mild GI, not for use in pregnancy. Is poorly absorbed, most ends up in feces

Uses of pyrantel pamoate

The nematodes we learned about EXCEPT trichuriasis and strongyloidiasis. Not effective for migratory stages in tissue or in ova