1. Anti-parasitic Drugs - Antiprotozoals Part 2: Anti-helminthic Drugs

Question 1

Drugs Active Against Nematodes (4)

Answer 1

Albendazole (broad spectrum)

Diethylcabamazine (filariasis)

Ivermectin (oncercioasis)

Mebendazole (narrow spectrum)

Question 2

Drugs Active Against Trematodes/Flues (1)

Answer 2

Praziquntel

Question 3

Drugs Active Against Cestodes (2)

Answer 3

Albendazole: severe cases of tapeworm

Praziquantel: both cestode and tapeworms

Question 4

Pinworm: Parasite, Symptoms, Transmission, and Diagnosis

Answer 4

Enterbius vermicularis

Seen in children

Symptoms: Pruritis ani

Transmitted by ingestion of eggs which hatch intestines, female migrates and deposits eggs in perianal area

Diagnosed by *Scotch tape test, look for eggs and white worms

Question 5

Pinworm Rx (2)

Answer 5

Mebendazole

or

Pyrantel pamoate

Question 6

Ascariasis lumbricoides: Parasite

Answer 6

Ascaris lumbricoides

Question 7

Ascariasis lumbricoides: Tranmission (3)

Answer 7

Ingestion of eggs, humans are the ONLY HOST

Intestinal larva; migrates through blood to lung

Can cause intestinal obstruction, Loeffler’s eosinophilic pneumonitis

Question 8

Ascariasis lumbricoides: Rx (2)

Answer 8

Mebendazole

Pyrantel pamoate

Question 9

Visceral Larval Migrans (Toxicara canis, dog roundworm): Defined and Transmission

Answer 9

Young children ingest larva, which matures in intestines and then migrates to liver, brain, and eyes

Transmission: ingestion of eggs from dog feces

Question 10

Visceral Larval Migrans (Toxicara canis, dog roundworm): Rx (2)

Answer 10

Diethylcarbamazine

or

Albendazole

Question 11

Hookworm Disease: Parasites, MOA, Transmission

Answer 11

Old name: Acyclostoma duodenale (old)

New name: Necator americanus (new)

*MOA: Attaches to mucosa and causes Anorexia, Ulcer, and Iron deficiency microcytic anemia due to chronic intestinal blood loss

Transmission: Direct penetration of skin by larvae found in soil, larvae travel to lungs (Loffler’s), coughed up, swallowed, mature in gut and produce eggs

Question 12

Hookworm Disease: Rx (2)

Answer 12

Mebendazole

and

Pyrantel pamoate

Question 13

Schistosomiasis (Blood and Liver flukes, trematodes): Parasites, Hosts, and Symptoms

Answer 13

S. mansoni, japonicum, hematobium

Dermatitis/katayama fever

Snails are host

Cerecariae penetrate skin of humans, causes (5):
Granulomas
Fibrosis and inflammation of the spleen and liver
Portal hypertension
Hematuria
Bladder cancer

Question 14

Schistosomiasis (Blood and Liver flukes, trematodes): Other Parasites, Causes, and Symtoms (2)

Answer 14

Clonorchis sinensis: undercooked fish; causes inflammation of the biliary tract - pigmented gallstones

Pargonimus westermani: undercooked crab meat: inflammation and bacterial infection of the lung; hemoptysis

Question 15

Schistosomiasis (Blood and Liver flukes, trematodes): Rx (1)

Answer 15

Praziquantel

Question 16

Echinococcosis (tape worm): Echinococcosis granulosis (dog tapeworm) - Defined, Transmission, and Dx

Answer 16

Hydratid cysts in liver, lung, and brain –> cysts rupture and causes anaphylactic shock

Transmission: Eggs from dog or sheep feces

Dx: CT or MRI

Question 17

Echinococcosis (tape worm): Echinococcosis granulosis (dog tapeworm) - Rx (3)

Answer 17

Albendazole

Injection of ethanol

Surgery (not to rupture cyst)

Question 18

Echinococcosis (tape worm): Taenia Solium (Pork tapeworm) - Defined and Symptoms

Answer 18

Pigs intermediate host

Scolex: head with suckers and hooks

Symptoms: brain cysts and seizures

Question 19

Echinococcosis (tape worm): Taenia Solium (Pork tapeworm) - Rx (2)

Answer 19

Praziquantel for intestinal worms and cysticercosis

Albendazole for neurocyticerosis

Question 20

Echinococcosis (tape worm): Taenia saginatum (beef tapeworm) - Defined and Transmission

Answer 20

*Scolex: head with suckers but NO HOOKS

Transmission: eggs or larvae in undercooked meat

Question 21

Echinococcosis (tape worm): Taenia saginatum (beef tapeworm) - Rx (2)

Answer 21

Praziquantel or Niclosamide

Question 22

Filariasis/Elephantasis: Parasite (2)

Answer 22

Wuchereria bancrofti, brugia malayi

Question 23

Filariasis/Elephantasis: MOA

Answer 23

Filarial worms block the flow of lymph causing edema of arms, legs, and scrotum

Question 24

Filariasis/Elephantasis: Transmission

Answer 24

Anopheles and culex mosquitoes

Question 25

Filariasis/Elephantasis: Rx

Answer 25

Diethylcarbamazine or ivermectin

Question 26

Oncocerciasis (River blindness): Transmission, MOA, and Symptoms

Answer 26

Transmitted by blackfly Oncocerca form skin and subcutaneous tissues Adult worms live in subcutaneous tissues Microflilariae migrate across cornea, causing ocular damage

Question 27

Oncocerciasis (River blindness): Rx (2)

Answer 27

Suramin (adult worms) Ivermectin (microfilaria)

Question 28

Albendazole: MOA (2)

Answer 28

Inhibits microtubule synthesis Blocks glucose uptake

Question 29

Albendazole: Uses (5)

Answer 29

Ascariasis Trichuriasis Hookworm and pinworm Hydratid disease Neurocysticerosis

Question 30

Albendazole: Adverse Effects

Answer 30

Blood count and liver fxn tests should be monitored for long term use

Question 31

Diethylcarbamazine citrate: MOA

Answer 31

Immobilizes the microfilaria and alters their surface structure

Question 32

Diethylcarbamazine citrate: Uses (4)

Answer 32

Wuchereria bancrofti Brugia malayi Loa, loa Tropical eosinophilia

Question 33

Diethylcarbamazine citrate: Adverse Effects (5)

Answer 33

Headache Malaise Anorexia Weakness Mazzotti Reaction

Question 34

Ivermectin: MOA

Answer 34

Paralyze nematodes and arthropods by intensifying GABA

Question 35

Ivermectin: Uses (7)

Answer 35

Onchocerciasis Strongyloidiasis B. Malayi W. Bancrofti Scabies Lice Cutaneous larva migrans

Question 36

Ivermectin: Adverse Effects (8)

Answer 36

Due to killing of worms, side effects include (8) Fever Headache Dizziness Somnolence Rash Pruritis Joint and muscle pain Hypotension

Question 37

Mazotti Reaction: Defined and Symptoms

Answer 37

Seen with Diethylcarbamazine citrate Common side effect of many anti-parasitic medication, depending on severity of parasite load Symptoms: fever/chills, respiratory distress, and hypotension

Question 38

Praziquantel: MOA

Answer 38

Causes paralysis of worms by increasing the permeability of calcium

Question 39

Praziquantel: Uses (6)

Answer 39

Schistosomiasis Clonorchiasis Paragonimiasis Taieniasis Neurocystecercosis Hydatid disease

Question 40

Praziquantel: Adverse effects (4)

Answer 40

Fever Rashes Arthralgia Neurologic abnormalities

Question 41

Pyrantel Pamoate: MOA

Answer 41

Neuromuscular blocking by inhibition of cholinesterase --> paralysis of worms

Question 42

Pyrantel Pamoate: Uses (3)

Answer 42

Ascariasis Hookworm Necator americans

Question 43

Pyrantel Pamoate: Adverse Effects (1)

Answer 43

Liver dysfunction

Question 44

Thiabendazole: MOA

Answer 44

Same as albendazole: Inhibits microtubule synthesis Blocks glucose uptake

Question 45

Thiabendazole: Uses

Answer 45

Strongyloides

Question 46

Thiabendazole: Adverse Effects (1)

Answer 46

More toxic than benzimidazoles

Question 47

Anti-leprotic Drugs: Dapsone is rx for? (2)

Answer 47

Leprosy and dermatitis herpitiformis

Question 48

Anti-leprotic Drugs: Thalidomide - Rx use, pregnancy category, and risk?

Answer 48

Rx for erythema nodosum leprosum Pregnancy category X Risk for phocomelia (congenital malformation of limbs)