Anthelmintic - Pharmacology

Helminths are large organisms (parasitic worms) that feed on host tissue. The most common site is the intestine. Other sites are the lymphatic system, blood vessels, and liver.

There are four groups of helminths:

  1. Cestodes (tapeworms) (enter via contaminated food [pork (trichinosis), fish, dwarf])
  2. Trematodes (flukes)
  3. Intestinal nematodes (roundworms)
  4. Tissue-invading nematodes (tissue roundworms and filariae)

The nursing process related to treatment of patients who are taking anti-helmiths is:

  • Assessment
    • History of foods eaten, especially meat and fish and how it was prepared °
    • Note if other persons in household have been checked for worms °
    • Obtain baseline vital signs and collect a stool specimen
  • Nursing diagnoses
    • Altered comfort
    • Activity intolerance related to dizziness, headache, drowsiness
    • Altered nutrition
    • Alteration in skin integrity
  • Planning
    • Patient will be free of helminths
    • Patient/family will understand how to prepare foods to avoid recurrence
  • Interventions
    • Collect stool specimen
    • Administer the prescribed anthelmintics after meals
    • Report side effects to the health care provider
  • Patient teaching:
    • Explain importance of hand washing
    • Instruct to take daily showers, NOT baths
    • Instruct to change sheets, bedclothes, towels, and underwear daily
    • If problem persists, a second course of therapy may be necessary
    • Take prescribed drug at the designated time and keep health care appointments
    • Alert that drowsiness may occur; avoid operating a car or machinery if drowsiness occurs
    • Report side effects to health care provider
  • Evaluation
    • Evaluate effect of the anthelmintics and absence of side effects
    • Determine if patient is using proper hygiene to avoid spread of parasitic worms
  • Side effects and adverse reactions:
    • Common side effects include GI upset such as anorexia, nausea, vomiting, and occasionally diarrhea and stomach cramps; neurological problems include dizziness, weakness, headache, and drowsiness; Adverse reactions do not occur frequently

Examples of anti-helmiths include:

  • Diethylcarbamzine (Hetrazan); Used for nematode-filariae; PO: 2-3 mg/kg/tid
  • Ivermectin (Mectizan) broad-spectrum antiparasitic drug; PO: 200 ug/kg/1dose
  • Mebandazole (Vermox); used for giant roundworm, hookworm, pinworm, whipworm. PO: 100 mg. bid x 3 d; repeat in 2-3 wk if necessary
  • Niclosamide (Niclocide) used for beef and fish tapeworms: PO 2 g, single dose; treatment of dwarf tapeworms PO: 2 g/d x 1 wk
  • Oxamniquine (Vansil) treatment against mature and immature worms; PO: 15 mg/kg/bid for 1-2 d
  • Piperazine citrate (Antepar, Vermizine); treatment of roundworms and pin-worms; Roundworms: PO: 3.5 g/d x 2 d; Pinworms: 65 mg/kg/d x 7 d max: 2.5 g/d
  • Praziquantel (Biltricide) treatment for beef, pork, fish tapeworms; PO: 10-20 mg/kg single dose; Blood flukes: PO 20 mg/kg, tidx 1 d; liver, lung, and intestinal flukes; 25 mg/kg tid 1-2 d
  • Pyrantelpamoate (Antiminth) treatment of giant roundworm, hookworm, pinworm; PO: 11 mg/kg single dose; repeat in 2 weeks if necessary
  • Thiabendazole (Mintezol, Minzolum) treatment of threadworm and pork worm; PO 25 mg/kg 2-5 d; repeat in 2 d if necessary

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