Antihelmintic Drugs

Question 1

Treatment options for enterobius (pinworm)

Answer 1

Mebendazole or Pyrantel pamoate or Albendazole

Question 2

Treatment options for trichuris (whipworm)

Answer 2

Mebendazole. Alternates - Albendazole or ivermectin

Question 3

Treatment options for ascaris (roundworm)

Answer 3

Albendazole or mebendazole or ivermectin

Question 4

Treatment options for necator americanus and ancylostoma duodenale (hookworms)

Answer 4

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

Question 5

Treatment options for strongyloides

Answer 5

Ivermectin. Alternative - albendazole

Question 6

Treatment options for trichinella

Answer 6

Steroids and albendazole. Alternative - Mebendazole

Question 7

Treatment options for dracunculus (guinea worm)

Answer 7

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

Question 8

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

Answer 8

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

Question 9

Treatment options for Loa Loa

Answer 9

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

Question 10

Treatment options for Onchocerca (river blindness)

Answer 10

Ivermectin

Question 11

Treatment options for intestinal trematodes

Answer 11

Praziquantel

Question 12

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

Answer 12

Praziquantel or albendazole

Question 13

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

Answer 13

Triclabendazole. Alternatives - biothionol or nitazoxanide

Question 14

Treatment options for pulmonary trematodes

Answer 14

Praziquantel. Alternatives - Triclabendazole or bithionol

Question 15

Treatment options for blood trematodes (schistosomas)

Answer 15

Praziquantel. Alternative - Oxamniquine for schistosoma mansoni

Question 16

Treatment options for hymenolepis nana (dwarf tapeworm)

Answer 16

Praziquantel. Alternative - Niclosamide

Question 17

Treatment options for diphyllobothrium latum (fish tapeworm)

Answer 17

Praziquantel. Alternative - Niclosamide

Question 18

Treatment options for taenia saginata (beef tapeworm)

Answer 18

Praziquantel. Alternative - Niclosamide

Question 19

Treatment options for taenia solium (pork tapeworm)

Answer 19

Praziquantel. Alternative - Niclosamide

Question 20

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

Answer 20

Praziquantel. Alternative - Niclosamide

Question 21

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

Answer 21

Albendazole

Question 22

Uses for albendazole

Answer 22

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)

Question 23

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

Answer 23

Inhibit microtubule synthesis in nematodes, impairing glucose transport

Question 24

AEs of albendazole

Answer 24

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

Question 25

Main differences between albendazole and mebendazole

Answer 25

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

Question 26

Mechanism of action of diethylcarbamazine (DEC)

Answer 26

Alters microfilarial surface membrane (immobilizes, dislocates)

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

Mechanism of action of ivermectin

Answer 29

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

Question 30

Does ivermectin cross the BBB?

Answer 30

No

Question 31

AEs of ivermectin

Answer 31

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

Question 32

Uses of ivermectin

Answer 32

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

Question 33

Mechanism of action of niclosamide

Answer 33

Inhibits and uncouples Ox Phos (immobilizing cestodes)

Question 34

AEs of niclosamide

Answer 34

None of significance. Very little absorbed from GI tract

Question 35

Uses of niclosamide

Answer 35

Alternative drug for many tapeworm (cestode) infections

Question 36

Mechanism of praziquantel

Answer 36

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

Question 37

AEs of praziquantel

Answer 37

Abdominal discomfort, skin irritation

Question 38

Uses of praziquantel

Answer 38

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

Question 39

Mechanism of pyrantel pamoate

Answer 39

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

Question 40

AEs of pyrantel pamoate

Answer 40

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

Question 41

Uses of pyrantel pamoate

Answer 41

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