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《ISPN学习》总第549期
日期：2019-11-23 18:41:38
《ISPN学习》2019年10月23日总第549期
相识是缘，相知是福；
风雨兼程，不忘初心；
有您相伴，奥医感恩。
From the Programs
（From the Programs [课程选粹]栏目登载奥医网络课程材料精选，旨在帮助读者了解ISPN/NCLEX-RN考试复习课程内容，并加深对考试相关内容的学习、掌握[课程详情见网站或点击阅读原文]。您的需要就是我们的努力方向。谢谢）
| 想提高专业英语听力吗？想边练听力边增加护理专业知识吗？《Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。 |
ISPN Review
Anthelmintic Drugs – Trematodes and Cestodes
抗蠕虫药 – 吸虫类和绦虫类
1. Praziquantel for Trematodes
The trematodes (flukes) are leaf-shaped flatworms that are generally characterized by the tissues they infect (for example, liver, lung, intestinal, or blood).
1. 吡喹酮治疗吸虫
吸虫为叶状扁形虫，通常具有感染组织特征（如肝、肠、血液）
Praziquantel is an agent of choice for the treatment of all forms of schistosomiasis, other trematode infections, and cestode infections such as taeniasis. Praziquantel is also used off-label in the treatment of cysticercosis (caused by Taenia solium larvae). Praziquantel should be taken with food and not chewed due to a bitter taste. It is rapidly absorbed after oral administration and distributes into the cerebrospinal fluid (CSF). The drug is extensively metabolized, and the inactive metabolites are excreted primarily in the urine. Common adverse effects include dizziness, malaise, and headache as well as gastrointestinal upset. Dexamethasone, phenytoin, rifampin, and carbamazepine may increase the metabolism of praziquantel. Cimetidine causes increased praziquantel levels. Praziquantel is contraindicated for the treatment of ocular cysticercosis, because destruction of the organism in the eye may cause irreversible damage.
吡喹酮是治疗所有血吸虫病、其他吸虫感染及绦虫感染，如绦虫病，的首选药物。吡喹酮与食物同服，不得嚼碎，因为其味苦。口服后迅速吸收，并分布进入脑脊液（CSF）。药物代谢广泛，非活代谢物主要经尿排出。常见不良效应包括头晕、不适、头痛及胃肠不适。地塞米松、苯妥英、利福平和卡马西平可增强吡喹酮代谢。西咪替丁导致吡喹酮浓度增高。吡喹酮禁忌用于治疗眼囊尾蚴病，因为 眼睛生物破坏可能引起不可逆性眼睛损伤。
2. Drugs for Cestodes
The cestodes, or “true tapeworms,” typically have a flat, segmented body and attach to the host’s intestine. Like the trematodes, the tapeworms lack a mouth and a digestive tract throughout their life cycle.
2. 绦虫药
典型的绦虫，或称“真绦虫”，有一个扁平、节段性身体，吸附与宿主肠内。与吸虫一样，绦虫一生没嘴没消化道。
Niclosamide is an alternative to praziquantel for the treatment of taeniasis, diphyllobothriasis, and other cestode infections. It inhibits the mitochondrial phosphorylation of adenosine diphosphate (ADP) in the parasite, making it lethal for the cestode’s scolex and segments but not for the ova. Anaerobic metabolism may also be inhibited. A laxative is administered prior to oral administration to purge the bowel of all dead segments and to enhance digestion and liberation of the ova. Alcohol should be avoided within 1 day of niclosamide use.
氯硝柳胺替代吡喹酮，用于治疗绦虫病、裂头绦虫病及其他绦虫感染。抑止寄生虫二磷酸腺苷（ADP）线粒体磷酸化，导致绦虫关节和身段死亡，但不会导致虫卵死亡。还可抑制无氧代谢。口服前使用轻泻药，以清洁肠道内所有死亡节段，加强虫卵的消化和释放。使用氯硝柳胺后一天内应避免饮酒。
Albendazole, another benzimidazole, inhibits microtubule synthesis and glucose uptake in nematodes and is effective against most nematodes known. Its primary therapeutic application, however, is in the treatment of cestodal infestations, such as cysticercosis and hydatid disease (caused by larval stage of Echinococcus granulosus). [Note: Albendazole is also very effective in treating microsporidiosis, a fungal infection.] Albendazole is erratically absorbed after oral administration, but absorption is enhanced by a high-fat meal. The drug distributes widely, including the CSF. It undergoes extensive first-pass metabolism, including formation of an active sulfoxide. Albendazole and its metabolites are primarily excreted in the bile. When used in short-course therapy (1 to 3 days) for nematodal infestations, adverse effects are mild and transient and include headache and nausea. Treatment of hydatid disease (3 months) has a risk of hepatotoxicity and, rarely, agranulocytosis or pancytopenia. Medical treatment of neurocysticercosis is associated with inflammatory responses to dying parasites in the CNS, including headache, vomiting, fever, and seizures.
阿苯达唑，为苯并咪唑一种，可抑制线虫微管合成和葡萄糖摄取，对多数已知线虫有效。不过，它的主要治疗应用是用于治疗绦虫侵袭，如囊虫病和棘球蚴病（由细粒棘球绦虫幼虫期引起）。[注意，阿苯达唑也治疗微孢子虫病也非常有效，该病属于真菌感染]。阿苯达唑口服后吸收无规律，但高脂餐可加强其吸收。该药分布广泛，包括脑脊液。首过代谢广泛，包括活性亚砜形成。阿苯达唑及其代谢物以经胆汁排出为主。小疗程（1-3天）治疗绦虫感染时，其不良效应轻、短暂，包括头痛和恶心。细粒棘球绦虫治疗（3个月）具有肝毒性风险，罕见粒细胞缺乏症和全血细胞减少症。神经系统囊虫病的药物治疗与CNS死亡寄生虫炎症响应有关，包括头痛、呕吐、发烧及癫痫发作。
Vocabulary for Today
trematode – n. 吸虫
fluke – n. 吸虫
praziquantel – a. 吡喹酮
schistosomiasis – n. 血吸虫病
cestode – n. 绦虫
taeniasis – n. 绦虫病
cysticercosis – n. 囊虫病
Taenia solium larvae -- 猪肉绦虫蚴虫
dexamethasone – n. 地塞米松
tapeworm – n. 绦虫
niclosamide – n. 氯硝柳胺
diphyllobothriasis – n. 裂头绦虫病
mitochondrial – a. 线粒体的
phosphorylation – n. 磷酸化
adenosine diphosphate (ADP) -- 二磷酸腺苷
scolex – n. 头节
cestodal – a. 绦虫的
hydatid – n. 包虫，囊虫
echinococcus granulosus -- 细粒棘球绦虫
microsporidiosis – n. 微孢子虫病
erratically – ad. 不规则地，不定地
sulfoxide – n. 硫氧化物，亚砜
pancytopenia – n. 全血细胞减少症
neurocysticercosis – n. 神经系统囊虫病
Video
Trematodes
Test
1. A client is receiving and IV antibiotic infusion and is scheduled to have blood drawn at 1:00 pm for a "peak" antibiotic level measurement. The nurse notes that the IV infusion is running behind schedule and will not be completed by 1:00. The nurse should:
A. Notify the client's health care provider
B. Stop the infusion at 1:00 pm
C. Reschedule the laboratory test
D. Increase the infusion rate
2. A 2 year-old child is being treated with Amoxicillin suspension, 200 milligrams per dose, for acute otitis media. The child weighs 30 lb. (15 kg) and the daily dose range is 20-40 mg/kg of body weight, in three divided doses every 8 hours. Using principles of safe drug administration, what should the nurse do next?
A. Give the medication as ordered
B. Call the provider to clarify the dose
C. Recognize that antibiotics are over-prescribed
D. Hold the medication as the dosage is too low
（本期答案见页底）
本期ISPN Review答案：
1. C: Reschedule the laboratory test.
If the antibiotic infusion will not be completed at the time the peak blood level is due to be drawn, the nurse should ask that the blood sampling time be adjusted
2. A: Give the medication as ordered.
Amoxicillin continues to be the drug of choice in the treatment of acute otitis media. The dose range is 20-40 mg/kg/day divided every 8 hours. 15kg x 40mg = 600mg, divided by 3 = 200 mg per dose. The prescribed dose is correct and should be given as ordered.
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