Antiprotozoal and Antihelminthic Drugs_handout

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` Malaria

`  Amoebiasis

` Trypanosomiasis

` Leishmaniasis

` Giardiasis

` Trichomoniasis

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` Caused by the plasmodium protozoa

` Four different plasmodium species

` Vector: female Anopheles mosquito

` Transmitted via blood transfusion, congenitally, or 

via infected needles by drug abusers.

Life Cycle of the plasmodium:

Sexual ± in the mosquito

 Asexual ± in human EXOERYTHROCYTIC PHASE ± ³outside´ RBC 

ERYTHROCYTIC PHASE ± ³inside´ RBC

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` Erythrocytic: CHLOROQUINE, MEFLOQUINE, QUININE,

HYDROXYCHLOROQUINE

` Exoerythrocytic: PRIMAQUINE (prevents relapse)

` Chloroquine-resistant strains

QUININE  SULFADOXINE+PYRIMETHAMINE (Fansidar)

` Multi-drug resistant strains  Artemesin-lumerfrantine

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` CHLOROQUINE, MEFLOQUINE, QUININE,HYDROXYCHLOROQUINE 4-aminoquinoline derivatives

Bind to parasite nucleoproteins and interfere with protein

synthesis and alter pH of parasite Chloroquine ± prophylactic drug

Chloroquine & Hydroxychloroquine ± have

antiinflammatory effects

SIDE EFFECTS: N/V, D, anorexia, abd pain,

dizziness, headache

` Quinine: N/V, tinnitus, vertigo CINCHONISM SYNDROME

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 ADVERSE EFFECTS:` Hepatotoxicity

` Dermatological changes (rashes, alopecia)

` Hemolytic anemia (chloroquine)

` Permanent eye damage/blindness (chloroquine)

` Nephrotoxicity (quinine)

` Steven Johnson Syndrome (Fansidar)

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1. Screen the client for any contraindications (liver 

dysfunction, alcoholism, psoriasis, retinal

disease, pregnancy & lactation)

2.  Arrange for appropriate culture and sensitivitytests before beginning therapy

3.  Administer the complete course of the drug.

Mark a calendar for prophylactic doses.

4. Monitor hepatic function and ophthalmologicexamination before and periodically during

treatment

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5. Provide comfort and safety measures6. Maintain nutrition and address diarrheal

problems

7.  Advise clients traveling to malaria-infested

countries to receive prophylactic doses of antimalarial drug before leaving, during visit and

upon return.

8. Instruct client to take oral antimalarial drugs with

food or at mealtime9. Warn client about consuming large quantities of 

alochol

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`  Amoebiasis` Leishmaniasis

Skin, mucuous membrane infection

` Trypanosomiasis

 African sleeping sickness, Chaga¶s disease

` Trichomoniasis Vaginal infection

` Giardiasis Intestinal infection, traveler¶s diarrhea

` PCP/ Pneumocystis carinii pneumonia  ARC (lung)

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` METRONID AZOLE (Flagyl) Bactericidal (H. pylori, anaerobic bacterial infection),

Trichonacidal (trichomoniasis) & Protozoacidal/Amoebicidal

(amoebiasis)

Prophylaxis in colorectal surgery Has METALLIC TASTE; 

Side Effects/Adverse Effects:x N/V, D, headache, dizziness

x Neurotoxicity ± numbness, vertigo, ataxia

x Hepatotoxic

x DISULFIR AM-LIKE EFFECT

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`  Assess for hepatic function and CNS disease` Instruct client to avoid alcohol-containing products

during & 48 hours after tx completion.

` Client should complete the course of medication even

if symptoms disappear 

` Maintain nutrition & hydration

` Patient may take the medication with meals if GI upset

occurs; inform of the drug¶s metallic taste

` Inform patient that his/her urine may turn red-brown in

color (high doses)

` CNS effects/ safety precautions

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`  Atovaquone PCP

` Pentamidine

Trypanosomiasis Leishmaniasis

PCP

` Yinodazole Trichomoniasis, Giardiasis &

amoebiasis

` Paramomycin Intestinal amoebiasis

` Pyrimethamine Toxoplasmosis

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` Nematodes Elongated round worms

`

Cestodes True tapeworms

` Trematodes Flukes, flat-shaped flatworms

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` Intestinal parasitism

` Tissue-invading worm

infections: TRICHINOSIS

FILARIASIS

SCHISTOSOMIASIS

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` Mebendazole (Antiox)

Drug of choice:

` Whipworm, Pinworm, Hookworm, Roundworm

 Action: binds & interferes the synthesis of parasite¶s

microtublules and decreases glucose uptake

` Parasites are expelled in the feces

Side effects: Abd pain, diarrhea

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` Pyr antel pamoate (Combatr in)

` Uses: Pinworm, Hookworm, Roundworm

 Action: paralyzes the worm by depolarizing

neuromucsular receptor of parasites

` Parasites are expelled in the feces

Side effects: N/V, D

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` Albendazole (Albenza) Dog tapeworm and pork tapeworm

TER ATOGENIC

` Thiabendazole (Minthezol)

Uses: strongyloidiasis, trichinosis

 Action: microtubular aggregationSide effects: Steven-Johnson Syndrome

` Niclosamide

Use: Cestodes

` Pr aziquantel (Biltr icide) Use: Schistosomiasis

` Common side effects:

GI upset, dizziness,headache, drowsiness

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1. Collect stool specimen2. Obtain history of food intake & how the food was

prepared

3.  Administer antihelminthics after meals or with food toreduce gastric upset

4. Explain the importance of handwashing and proper hygiene; daily change & laundering of underwear,towels and bed linens, disinfection of toilet facilities

5. Maintain nutrition

6. Emphasize importance of taking prescribed drug atdesignated times and keeping HCP appointments

7. Safety precautions