《ISPN学习》2019年10月25日总第550期
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风雨兼程，不忘初心；
有您相伴，奥医感恩。
From the Programs
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ISPN Review
Anthelmintics 抗蠕虫药
1. Therapeutic Action
The desired and beneficial action of anthelmintics is that they act on metabolic pathways present in the invading worm but are absent or significantly different in human host.
1、治疗作用
抗蠕虫药的预期和有益作用是对侵入人体的蠕虫的代谢通路发挥作用，但对人体宿主不起作用，或有作用但大不相同。
2. Indications
Anthelmintics are indicated for the following medical conditions:
Albendazole for the treatment of active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.
Ivermectin is used for the treatment of threadworm disease or strongyloidiasis and onchocerciasis or river blindness.
Mebendazole is for the treatment of diseases caused by pinworms, roundworms, whipworms, and hookworms.
Praziquantel is for treatment of a wide number of schistosomes or flukes.
Pyrantel is for treatment caused by pinworms and roundworms.
2、适应症
抗蠕虫药适用于下列情况：
阿苯达唑治疗猪肉绦虫引起的活跃期损伤和由狗绦虫引起的肝、肺及腹膜的囊性疾病。
伊维菌素用于治疗线虫病或类圆线虫病和盘尾丝虫病或河盲。
甲苯咪唑用于治疗由蛲虫、蛔虫、鞭虫和钩虫引起的疾病
吡喹酮用于治疗血吸虫病或吸虫病。
噻嘧啶治疗蛲虫和蛔虫引起的疾病。
Here are some important aspects to remember for indication anthelmintics in different age groups:
下列为不同年龄段患者使用抗蠕虫病药时应注意的一些重要因素：
Children
Culture of the suspected worm is important before beginning any drug therapy.
Albendazole, ivermectin, and praziquantel are more toxic so they are avoided in children. Instead, a chewable preparation of mebendazole is usually given.
Children may develop serious GI effects during therapy so nurse’s focus must be on nutritional status and hydration.
儿童
开始药物治疗前，须先进行可疑蠕虫培养，这很重要。
阿苯达唑、伊维菌素和吡喹酮毒性较大，应避免儿童使用。儿童一般使用可嚼型甲苯达唑。
治疗期间，儿童可能出现严重的GI效应，因此，护士重点必须在于营养状况和水化作用。
Adults
This age group might be repulsed by the idea that they have a worm infestation, and they may be reluctant to discuss the needed lifestyle adjustments and treatment plans.
Pregnant and nursing women should not use these drugs unless the benefits clearly outweigh the risks. Potential risks must be communicated to the patients.
成人
该年龄段可能对有蠕虫感染这一想法不感冒，可能不愿意讨论改变生活方式和治疗计划。
妊娠和哺乳期妇女不应使用这些药物，除非好处确实大于风险。必须将潜在的风险告诉患者。
Older adults
Older patients are more susceptible to GI and CNS adverse effects of Anthelmintics therapy particularly those with hepatic and renal dysfunctions.
老年人
老年患者现易受抗蠕虫疗法引起的GI和CNS不良效应影响，特别是有肝、肾功能障碍的患者。
3. Contraindications and Cautions
The following are contraindications and cautions for the use of anthelmintics:
Known allergy to the drug. Prevent hypersensitivity reactions.
Lactation. Drug can enter breast milk.
Renal and hepatic disease. Interfere with drug metabolism and excretion.
Severe diarrhea and malnourishment. Can alter effects of drug on the intestine and any preexisting helminths.
Pyrantel has not been established as safe for use in children younger than 2 years.
3. 禁忌症和注意事项
抗蠕虫药使用禁忌和注意事项如下：
已知的药物过敏。预防超敏反应。
哺乳。药物可以进入母乳。
肾、肝疾病。可影响药物代谢和排泄。
严重的腹泻和营养不良。可能改变药物对肠道和早已存在的蠕虫的效应。
噻嘧啶结2岁以下幼童的安全性尚未确立。
4. Adverse Effects
Use of anthelmintics may result to these adverse effects:
GI: abdominal discomfort, diarrhea, pain
CNS: headache, dizziness,
Immunologic: fever, shaking, chills, malaise, rash, pruritus, loss of hair
Albendazole is associated with severe bone marrow depression and renal failure.
4. 不良效应
使用抗蠕虫药可能导致下列不良效应：
GI：腹部不适，腹泻、腹痛
CNS：头痛，头晕
免疫系统：发烧、发抖，发寒，全身乏力，皮疹，瘙痒，掉发
阿苯达唑与严重的骨关骨髓抑制和肾衰相关。
5. Interactions
The following are drug-drug interactions involved in the use of anthelmintics:
Dexamethasone, praziquantel, cimetidine. Increased toxic effects of albendazole
5. 相互作用
抗蠕虫药使用相关的药药相互作用如下：
地塞米松、吡喹酮、西米替丁。增加阿苯达毒性效应。
Vocabulary for Today
pork tapeworm – 猪肉绦虫
dog tapeworm – 犬绦虫
praziquantel – n. 吡喹酮
pyrantel – n. 噻嘧啶
dexamethasone – n. 地塞米松
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Video
Helminth and Immunity 1
Test
1. The nurse is teaching the mother regarding treatment for enterobiasis. Which instruction should be given regarding the medication?
A. Treatment is not recommended for children less than 10 years of age.
B. The entire family should be treated.
C. Medication therapy will continue for 1 year.
D. Intravenous antibiotic therapy will be ordered.
2. Corinne is experiencing diarrhea after consuming her prescribed antibiotics for the whole week. This is because:
A. The drugs render food indigestible.
B. Gastric flora is disturbed.
C. Fluid is added into the intestine.
D. Normal intestinal bacteria are destroyed.
（本期答案见页底）
本期ISPN Review答案：
1. B. The entire family should be treated.
Enterobiasis, or pinworms, is treated with Vermox (mebendazole) or Antiminth (pyrantel pamoate). The entire family should be treated to ensure that no eggs remain. Because a single treatment is usually sufficient, there is usually good compliance. The family should then be tested again in 2 weeks to ensure that no eggs remain.
2. D. Normal intestinal bacteria are destroyed.
The destruction of normal intestinal flora causes diarrhea. In choice A, a drug that rendered food indigestible could not be given because it would cause severe malnutrition. Choice B is incorrect because there is no gastric flora. Choice C is incorrect because there is no way to add fluid into the intestine.
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