1. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 96 Anthelmintics

2. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.2 Helminths  Parasitic worms  Helminthiasis – worm infestation  Frequently asymptomatic – treatment not always indicated  More than 2 billion people affected worldwide (most prevalent in areas with poor sanitation)  Intestine – most frequent site of infection (others include liver, lymphatic system, blood vessels)

3. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3 Anthelmintics  Agents against parasitic worms  Classes and common names of parasitic worms  Nematodes (roundworms) Intestinal, tissue Intestinal, tissue  Cestodes (tapeworms) Beef, pork, fish Beef, pork, fish  Trematodes (flukes) Blood, liver, intestinal, lung Blood, liver, intestinal, lung

4. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.4 Nematode Infestation (Intestinal)  Ascariasis (giant roundworm infestation)  Most prevalent – one of every three people affected worldwide  Serious complications if worms migrate to pancreatic duct, bile duct, gallbladder, or liver  Ancylostomiasis and necatoriasis (hookworm)  Trichuriasis (whipworm)  Strongyloidiasis (threadworm)

5. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.5 Nematode Infestation (Extraintestinal)  Trichinosis (pork roundworm)  Wuchereriasis and brugiasis  Onchocerciasis (river blindness)

6. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6 Cestode Infestation  Taeniasis (beef and pork tapeworm)  Diphyllobothriasis (fish tapeworm)

7. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.7 Trematode Infestations  Schistosomiasis (blood fluke)  Fascioliasis (liver fluke)  Fasciolopsiasis (intestinal fluke)

8. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 Drugs for Helminthiasis  With the exception of thiabendazole, anthelmintic drugs are generally devoid of serious adverse effects.

9. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9 Drugs of Choice for Helminthiasis  Mebendazole (Vermox)  Albendazole (Albenza)  Thiabendazole (Mintezol)  Adverse effects GI distress in one-third of patients GI distress in one-third of patients Neurologic reactions Neurologic reactions  Pyrantel (Antiminth)  Praziquantel (Biltricide)  Diethylcarbamazine (Hetrazan)  Ivermectin (Stromectol)

10. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.10 Drugs of Choice for Helminthiasis  Diethylcarbamazine (Hetrazan)  Ivermectin (Stromectol)