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Preventive And Social Medicine II > Chemotherapy of Helminthiasis Drugs > Flashcards

Chemotherapy of Helminthiasis Drugs Flashcards

1
Q

What are the DOC for A. lumbricoides?

A

MAPyPi

Mebendazole
Albendazole
Pyrantel pamoate
Piperazine - used less dt occasional neurotox and hypersensitivity

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2
Q

What is less often used due to occasional neurotoxicity and hypersensitivity reactions?

A

Piperazine - it greatly reduces the motility of worms reducing the hazard of migration

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3
Q

Used for asymptomatic to moderate ascariasis and used with caution to treat heavy as caries infections alone or with hookworms

A

Mebendazole and albendazole

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4
Q

Used for heavy infections and safe for use during pregnancy

A

Pyrantel or piperazine

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5
Q

What to feed on host blood and fluids which causes iron deficiency anemia and malnutrition?

A

Hookworm

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6
Q

What are the first drug of choice for hookworms?

A

Albendazole and mebendazole

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7
Q

Heavy mixed infections with ascariasis

Paralyzes ascaris

A

Pyrantel pamoate

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8
Q

It is d/t penetration of skin of humans by larvae of dog hookworm (Ancylostoma brazilianse)

A

Cutaneous larva migrans

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9
Q

What is the drug of choice for creeping eruption or cutaneous larva migrans?

A

Albendazole or ivermectin

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10
Q

Topical or oral thiobendazole is for?

A

Cutaneous larva migrans

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11
Q

What is the most effective and safest drug for T. trichiura?

A

Mebendazole and albendazole

Pyr pam - ineffective

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12
Q

What is ineffective for the treatment of whipworm?

A

Pyrantel pamoate

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13
Q

What is the best drug for the treatment of Strongyloides stercoralis (threadworm)?

A

Ivermectin

Thiabendazole > albendazole > mebendazole

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14
Q

DOC for pinworm

A

Pyrantel pamoate and mendazole

Other treatment: albendazole

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15
Q

DOC for T. spiralis

A

Mebendazole and albendazole
Against intestinal forms

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16
Q

What controls the acute and dangerous symptoms of trichinella spiralis infection?

A

Glucocorticoids

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17
Q

What controls the acute and dangerous symptoms of trichinella spiralis infection?

A

Glucocorticoids

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18
Q

DOC for filariasis

A

Diethylcarbamazine

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19
Q

Treatment for filariae

A

Diethylcarbamazine and ivermectin

- single oral dose of either together with an oral dose of albendazole

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20
Q

Treatment for loaisis

A

Diethylcarbamazine

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21
Q

Oncocerciasis treatment

A

Ivermectin

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22
Q

Drinking water containing copepods that carry infective larvae?

A

Guinea/dragon/medina worm
AKA
Dracunculus medinensis

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23
Q

Drug of choice for Dracunculus medinensis

A

Metronidazole 250 mg TIB x 10 days

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24
Q

How do you remove slowly Dracunculus medinensis worm?

A

Draw the live adult female worm out day by day by rolling it on to a small piece of wood

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25
Q

Drug of choice for capillaria philippinensis

A

Albendazole

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26
Q

What is the drug of treatment for taenia saginata?

A

Praziquantel

Can also be: niclosamide

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27
Q

What is the drug of choice for the treatment of T. solium?

A

Praziquantel or niclosamide

Cysticercosis: albendazole and praziquantel

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28
Q

What is the drug of choice for D. latum?

A

Praziquantel

Can also niclosamide

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29
Q

What is the drug of choice for Hymenolepis nana?

A

Praziquantel

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30
Q

What is the drug of choice for Echinococcus granulosus?

A

Albendazole - adjuvant to surgery

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31
Q

What organs are involved in schistosoma?

A

S. mansoni & S. japonicum: liver spleen and GI tract

S. haematobium: lower gut

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32
Q

What is the drug of choice for schistosoma?

A

Praziquantel

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33
Q

What is effective against s haematobium but not effective against s monson e & s japonicum?

A

Metrifonate

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34
Q

What is the drug of choice for paragonimus westermani?

A

Praziquantel (clinical)

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35
Q

DOC for clonorchis sinensis (chinese liver fluke), opisthorchis viverrini and opisthorchis felineus

A

Praziquantel

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36
Q

What is the drug of choice for fasiola hepatica?

A

Bithionol 30-50mg/kg given on alternate days for 10-15 doses

Also Triclabendazole

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37
Q

Drug of choice for fasciolopsis buski

A

Praziquantel or niclosamide

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38
Q

What can interfere with insect sodium transport proteins; neurotoxicity and paralysis

A

Permethrin

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39
Q

5% cream, cream rinse, topical solutions

approved for infants greater than or equal to 2 months old

A

Permethrin

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40
Q

Organochlorine compound

Induces neuronal hyperstimulation and eventual paralysis of parasites

A

Lindane

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41
Q

Second-line drug due to neurotoxicity

Inc toxicity in:
• children and adults less than 110 lbs
• patients with underlying skin disorder
     - atopic dermatitis
     - psoriasis
A

Lindane

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42
Q

Organophosphate
Binds acetylcholinesterase in lice; paralysis and death

Approved for treatment of head lice in children less than or equal to six years old

A

Malathion

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43
Q

5% lotion
Treatment of lice - inhi lice from closing their respiratory spiracles (obstruction of spiracles) asphyxiation of lice

More likely to cause resistance than traditional pesticides

A

Benzyl alcohol

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44
Q

Oral anti helminthic drug
Treatment of onchocerciasis and strongyloidiasis
- also for scabies and lice

A

Ivermectin

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45
Q

What has no major cns toxicity because it does not cross the blood brain barrier?

A

Ivermectin (200ug/kg, may be repeated after a wk - not used in children <15kg)

S/E: dizziness, somnolence, vertigo, tremor

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46
Q

What are other treatments for infestations?

A
  • 10% Crotamiton cream and lotion (Eurax)
  • 5% pptd sulfur in petrolatum
  • for px in whom Lindane or Permethrin are contraIx
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47
Q

What are the Benzimidazoles derivatives?

A
  • Thiabendazole
  • Mebendazole (prototype)
  • Albendazole
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48
Q

What are versitile agents highly effective in ascariasis, intestinal capillariasis, enterobiasis, trichuriasis, and hookworm?

A

Benzimidazoles (TAM)

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49
Q

What is the MOA of Benzimidazoles?

A

Binds to B-tubulin

50
Q

What contains a thiazole ring at position 2, is active against a wide range of nematodes that infect the GIT?

A

Thiabendazole

51
Q

What is a newer Benzimidazole that is used worldwide, primarily against a var of int abd tissue nematodes?

A

Albendazole

52
Q

What are drugs highly effective against the hookworm that cause cutaneous larval migrans?

A

Albendazole although thiabendazole can be used to topically

53
Q

Abs: limited solubility in water, abs rapidly after oral ingestion

Fate: peak plasma conc after 1 hr

EXCRETION: U w/in 24 hrs as 5-hydroxythiabenzadole, conjugated either as the glucoronide or as sulfate

A

Thiabendazole

54
Q

DOC for cutaneous larva migrans, S. stercoralis, and trichinosis

A

Thiabendazole

55
Q

What are the common side effects of thiabendazole?

A

anorexia
nausea
vomiting
dizziness

56
Q

Stevens-Johnson syndrome can be an occasional side effect of?

A

Thiabendazole

57
Q 
angioneurotic edema 
shock 
tinnitus 
convulsions 
intrahepatic cholestasis
A

Thiabendazole

58
Q

What is the contraindication of thiabendazole?

A

Should not be used in pregnancy

59
Q

Abs: poorly and erratically abs

Fate: conc in plasma are low, low sys bioavailability (22%), 95% bound to plasma proteins, active form

EXCRETION: conjugates and its metabolites hav been found in BILE, but little unchanged it appears in urine

A

Mebendazole

60
Q

What are the therapeutic uses of mebendazole?

A

Enterobiasis, ascariasis, trichuriasis, hookworm, c. philippinensis

61
Q

In cases of massive infestation and expulsion of GI worms, what are the common side effects of mebendazole?

A

abdominal pain
distension
diarrhea

62
Q

In high doses, what are the common side effects of mebendazole?

A 
allergic reaction 
alopecia
reversible neutropenia 
agranulocytosis 
hypospermia
63
Q

What are the contraindications for Mebendazole?

A

Potent embryotoxin and teratogen

64
Q

Abs: variably and erratically abs; enhanced by presence of fatty food and bile salts

Fate: metabolized rapidly in liver and intestine to Albendazole sulfoxide; well distributed into var tissues inc hydatid cyst (1/5)

ELIMINATION: plasma half life from 4-15 hrs; excreted mainly in urine

A

Albendazole

65
Q

What are the therapeutic uses of albendazole?

A

Enterobiasis/ascariasis/trichuriasis/hkwrm
Neurocysticercosis cb larval forms of T. solium
Lymphatic filariasis

66
Q

What are the most common side effects of albendazole?

A

Increase in serum aminotransferase

- monitor routine liver function during protracted therapy

67
Q 
Transient abdominal pain
Diarrhea
Nausea
Dizziness
Headache
A

Common side effects of albendazole

68
Q 
GIT pain
Severe headaches
Fever
Fatigue
Hair loss
Leukopenia
Thrombocytopenia
Teratogenic and embryotoxic
A

Benzimidazoles side effects

69
Q

Contraindications for albendazole

A

Patients with hepatic cirrhosis

Pregnant women

70
Q

What is the first line drug for control and treatment of lymphatic filariasis?

A

Diethylcarbamazine

71
Q

What is the action of the diethylcarbamazine?

A

It causes microfilariae to disappear from skin in nodules that contain the adult female

72
Q

It does not affect the microfilaria of w bancrofti in a hydrocele

A

Diethylcarbamazine

73
Q

It may disrupt arachidonic acid metabolism resulting vasoconstriction and aggregation of hosts platelet and granulocytes

A

Diethylcarbamazine

74
Q

Abs: rapidly from GIT

Fate: peak plasma lvls: w/in 1-2 hrs after a single oral dose

ELIMINATION: T1/2: 2-10 hrs
Excreted by urinary and extra urinary routes
- alkalinizing the urine - elevate plasma lvls and prolong t1/2
• inc therapeutic effect and toxicity

A

Diethylcarbamazine

75
Q

W. bancrofti, B. malayi and timori
Microfilaremia
Rapid disappearance of sx of tropical eosinophilia
Oncocerciasis

A

Therapeutic uses for diethylcarbamazine

76
Q

• Direct toxic reactions
• Anorexia, nausea, headache, vomiting
• Mazzotti reaction
- in patients with oncocerciasis
- occurs within a few hours after first oral dose
- intense itching and rashes
- enlargement and tenderness of lymph nodes
- find papular rash
- fever, tachycardia, arthralgia, and headache

A

Side effects for diethylcarbamazine

77
Q

Effective and highly potent

Immobilizes affected organism by inducing atonic paralysis of the musculature by acting on glutamate-gated chloride channels

A

Ivermectin

78
Q

Fate: peak plasma lvls - 4-5 hrd after oral admin

Excretion: T1/2 - 57grs - dt low systemic clearance and large volume of distribution

A

Ivermectin

79
Q

Oncocerciasis
Lymphatic filariasis
Intestinal nematode infections

Other indications
- first line drug cutaneous larva migrans

A

Therapeutic uses of ivermectin

80
Q

Toxicity Mazzotti-like reactions

Rarely:
High fever, tachycardia, HPOT, prostration, dizziness, headache, myalgia, arthralgia, diarrhea, and facial and peripheral edema
- responds to glucocorticoid therapy

A

Side effects of ivermectin

81
Q

Impaired blood brain barrier (African trypanosomiasis and meningitis)
Due to its effect on GABA receptors in CNS
Not approve for children less than 5 and pregnant women

A

Contraindications of ivermectin

82
Q

Organophosphate compound used for treatment of S. haematobium

A

Metrifonate (Bilaricil)

83
Q

Alternative to praziquantel for treatment of urinary schistosomiasis caused by s haematobium

A

Metrifonate (Bilaricil)

7.5-10mg/kg given orally 3x at intervals of 2 wks

84
Q

At prescription doses: inhibits activities of plasma cholinesterase and erythrocyte acetylcholinesterase

A

Metrifonate (Bilaricil)

85
Q

Recovery within weeks of stopping treatment

  • patients should be free from recent exposure to insecticide
  • should not receive and NMBs for at least 24 hours after treatment
A

Metrifonate (Bilaricil)

86
Q

Second choice for praziquantel for treating human intestinal infections in the treatment of T. saginata, D. latum, H. nana

A

Niclosamide (Niclocide)

87
Q

Risk for T. solium ova released from drug-damaged gravid worms dev into larva that can cause cysticercosis

A

Niclosamide (Niclocide)

88
Q

Second choice to praziquantel for treatment of schistosomiasis

S mansoni - highly susceptible

A

Oxamniquine (Vansil)

89
Q

Broad spectrum anti helminthic agent

But is ineffective against trichuris

A

Pyrantel pamoate

90
Q

What is the mode of action of Pyrantel pamoate?

A

Inhibits cholinesterases

- worm paralysis (spastic by depolarizing NMB agents)

91
Q

Alternative to mebendazole - ascariasis and enterobiasis

Used in combination with Oxantel

A

Pyrantel pamoate

92
Q 
Very large doses cause toxic effects
Transient and mild Gi symptoms
Headache
Dizziness
Rash
Fever
A

Pyrantel pamoate side effects

93
Q

Effective against ascaris lumbricoides and enterobius vermicularis
- causes flaccid paralysis an ascaris that results in expulsion of worm by peristalsis

A

Piperazine

94
Q

What can be an advantage of Piperazine?

A

It reduces the motility of the worms her by decreasing the hazard of migration

95
Q

Therapeutic uses:
Ascariasis
Enterobiasis

A

Piperazine

96
Q

ContraIx in patients with epilepsy

A

Piperazine

97
Q

• LOWEST EFFECTIVE CONCENTRATION CAUSES INCREASED MUSCULAR ACTIVITY FOLLOWED BY CONTRACTION AND SPASTIC PARALYSIS –> WORMS DETACH FROM BLOOD VESSEL WALLS THEN SHIFT FROM MESENTERIC VEIN TO THE LIVER

A

Praziquantel

98
Q

Increase concentration causes mental damage

A

Praziquantel

99
Q

Abs: readily abs after oral admin

Fate: peak plasma lvls (1-2 hrs)
- has extensive 1st oass metab

Excretion: T1/2 - 0.8-3 hrs depending on dose

A

Praziquantel

100
Q 
Therapeutic uses: 
Schistosomiasis
Liver flukes - C. sinensis
O. viverrini
Int flukes ( F. buski, H. hetero, Metagonimous yokogawi)
P. westermani
Fasciola hepatica - unresponsive
  • stored at temperature <30°C
  • bitter
A

Praziquantel

101
Q

The high-dose treatment alternative therapy for cysticercosis

A

Praziquantel

102
Q

Side effects:

Abdominal discomfort, pain and nausea, dizziness, drowsiness, headache
Transient and dose related

Neurocysticercosis (meningismus, seizures, mental changes, CSF pleocytosis)

A

Praziquantel

103
Q

Indirect effects

Fever, pruritus, urticaria, rashes, arthralgia, and myalgia (occ)

A

Praziquantel

104
Q

Is Praziquantel safe in children >4 y.o?

A

Yes

105
Q

ContraIx of Praziquantel bcs px may go blind

A

Ocular cysticercosis

106
Q

Praziquantel’s bioavailability is reduced by

A

Carbamazepine and phenobarbital

107
Q

Teratogenic drugs

A

Thiabendazole
Mebendazole
Albendazole

108
Q

DOC for S. stercoralis

A

Ivermectin

109
Q

What level of prevention? To reduce the impact of an ongoing illness that has lasting effects

A

Tertiary prevention

110
Q

Managing chronic condition to lessen long-term complications

A

Tertiary prevention

111
Q

Preventing the spread of dse, illness or infxn once it occurs

A

Secondary prev

112
Q

Reducing the incidence of dse or injury

A

Primary prevention

113
Q

Preventing exposure to risk factors that promote dse onset

A

Primordial prevention

114
Q

Adverse effect of Albendazole therapy for px w subarachnoid neurocysticercosis

A

Meningeal fibrosis

115
Q

Mazotti reaction

A

DEC

116
Q

Mazotti-like rxn

A

Ivermectin

117
Q

MOA
may disrupt arachidonic acid in microfilariae and host endothelial cells w resulting vasoconstriction and aggression of host plts and granulocytes around membrane-damage par

A

DEC

118
Q

MOA
immobilizes affected org by inducing a tonic paralysis of musculature by actung on glutamate gated Cl-channels

A

Ivermectin

119
Q

Before giving this drug, u have to check liver fxn test bcs it causes hepatotoxicity

A

Thiabendazole

120
Q

Before giving this drug, u have to check liver fxn test bcs it causes hepatotoxicity

A

Thiabendazole

121
Q

Occasional GI upset
Transient neurological effects
Urticarial rxns
Lethal doses - convulsing and respi depression
CIx w epilepsy

A

Piperazine side effects

Preventive And Social Medicine II (32 decks)

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