Self Care: Gastrointestinal (GI) Disorders Pinworm Infection PDF

Self Care: Gastrointestinal (GI) Disorders Pinworm Infection D R G E R B E R , P H A R M D, B C G P, FA S C P OFFICE: 201-15 EMAIL: [email protected] 1 Please use Canvas Inbox for “email” course communication to Dr. Gerber, instead of MWU em...

Self Care: Gastrointestinal (GI) Disorders Pinworm Infection D R G E R B E R , P H A R M D, B C G P, FA S C P OFFICE: 201-15 EMAIL: [email protected] 1 Please use Canvas Inbox for “email” course communication to Dr. Gerber, instead of MWU email. A succinct subject line is appreciated. Example subject line: Close family contacts should also be treated for pinworm infections? This will help Dr. Gerber respond to communication more efficiently and quickly. Every effort is made to respond to Canvas Inbox 2 messages within 48 hours. © D. Gerber 2020  1. Classify the severity of a patient’s GI complaints. After attending 2. Describe issues that can exacerbate a pinworm infection. these lectures, 3. Recommend an appropriate drug treatment completing the selection for a patient with a pinworm required readings infection. and studying 4. Formulate appropriate counseling information to be provided a patient on a these handouts, given treatment regimen for a pinworm the pharmacy infection. ** student should be able to: Required Reading: Handbook of Nonprescription Drugs: Pinworm chapter 3 Terminology Helminth = worm Pinworm infection = Enterobius vermicularis Fomites = an object that may be contaminated with infectious organisms and serve in their transmission 4 Epidemiology Most common 40 million infected Relatively helminthic infection School children persons in the uncommon in those in the United States aged 5-10 yrs United States under 2 years old and Western Europe 5 Myths Pets cannot transmit ◦ Only transmitted by human to human Do not live in soil or water Not limited to rural or poverty areas Infect all socioeconomic populations Transmission occurs most effectively when people are living in closed, crowded conditions 6 Transmission Initial infection ◦ Anus to mouth transfer when use contaminated fingers or fomites to handle and ingest goods/food ◦ Oral-anal sex possible Re-infection ◦ Eggs often found under fingernails after scratching infected anal area ◦ Transferred by fomites, dust, and air ◦ Eggs remain infective for many days, especially under humid conditions ◦ Can spread through family ◦ Eating food that has been touched by unclean hands 7 8 Sign and Symptoms Minor Major Complications Asymptomatic Abdominal discomfort Scratching → Irritated perianal area or pain/Nausea infection at night Insomnia Female genital tract Perineal itch at night Nervousness, inability Helminth infection to concentrate Loss of appetite Diarrhea 9 Visual – perianal area, not stool A commercially prepared product coated with adhesive material is also available (SWUBE paddle). ◦The device is applied to the perianal folds; any adherent eggs can by visualized by microscopy. Diagnosis 10  Debilitating symptoms Pregnancy CDC: “Risk of treatment in pregnant Accompanied by severe women who are known to have an diarrhea, constipation, GI infection needs to be balanced with the bleeding risk of disease progression in the absence of treatment.” Unintentional weight loss Lactation The WHO classifies pyrantel pamoate as compatible with breastfeeding Children Risk vs benefit SPECIAL CONDITIONS POPULATIONS Exclusion of self-treatment 11 LactMed: A New NLM Database on Drugs and Lactation LactMed, a free online database with information on drugs and lactation, is one of the newest additions to the National Library of Medicine's TOXNET system, a Web-based collection of resources covering toxicology, chemical safety, and environmental health. LactMed may be searched at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT Geared to the healthcare practitioner and nursing mother, LactMed contains over 450 drug records. It includes information such as maternal levels in breast milk, infant levels in blood, potential effects in breastfeeding infants and on lactation itself, the American Academy of Pediatrics category indicating the level of compatibility of the drug with breastfeeding, and alternate drugs to consider. References are included, as is nomenclature information, such as the drug's Chemical Abstract Service's (CAS) Registry number and its broad drug class. LactMed was developed by a pharmacist who is an expert in this subject. Three other recognized authorities serve as the database's scientific review panel. Ancillary resources, such as a glossary of terms related to drugs and lactation, and breastfeeding links are also offered. 12 13 Eggs viable for 20 days HT T P :/ /WW W.CDC.GOV/PA RASITES/PI NWOR M/INDEX.HTML 14 Treatment Pyrantel Pamoate ◦ Pin-X®; Reese's® Pinworm Medicine ◦ MOA - a depolarizing neuromuscular blocker, paralyzing the helminthes loosening their hold on intestinal wall and passed out in the stool ◦ No affect on eggs/larvae ◦ Dosage ◦ Oral: 11 mg/kg or 5mg/lb administered as a single dose ◦ maximum dose: 1 gram ◦ Dose should be repeated in 2 weeks if s/s do not resolve ◦ re-infection may be due to eggs, larvae, environment or fomites ◦ Household contacts: Since pinworm infections are easily spread to others, treat all family members in close contact with the patient. 15 Treatment Drug Interactions ◦ Aminoquinolines (antimalarial): May decrease the serum concentration Warnings/Precautions ◦ Disease-related concerns ◦ Anemia: Use with caution in patients with anemia ◦ Hepatic impairment: Use with caution in patients with hepatic impairment ◦ Malnutrition: Use with caution in patients with malnutrition. ◦ Special populations: ◦ Pregnancy: Use with caution in pregnancy. 16 PATIENT EDUCATION **ROLE OF THE PHARMACIST** 17 Bathe when you Disinfect toilet Change and Frequent Wash in hot wake up to help seat wash your changing of water reduce the egg underwear each night clothes are underwear, night contamination. day. recommended. clothes, and sheets after each treatment for infected patient and family members. Patient Education 18 Because the eggs Personal hygiene Trim fingernails Discourage nail- are sensitive to should include short. biting and sunlight, open washing hands scratching bare blinds or curtains after going to anal areas. These in bedrooms the toilet, before practices help during the day. eating and after reduce the risk changing of continuous diapers. self reinfection. 19  Children may Close family If the infection Playmates, return to day care contacts should occurs again, you schoolmates, after the first also be treated. should search for close contacts treatment dose, the source of the outside the after bathing, infection. house, and and after household trimming and members should scrubbing nails. be considered. 20 Make it Stick! A single, simple quiz after reading a text or hearing a lecture produces better learning and remembering than rereading the text or reviewing lecture notes. Brown, Peter C.. Make It Stick (p. 3). Harvard University Press. Kindle Edition. 9/28/2022 MIDWESTERN UNIVERSITY COLLEGE OF PHARMACY-GLENDALE 21  Step 3: To learn, retrieve Test yourself! USING ONLY YOUR MEMORY.…. WRITE 4 patient education statements regarding pinworm treatment/prevention? 9/28/2022 MIDWESTERN UNIVERSITY COLLEGE OF PHARMACY-GLENDALE 22  Make it Stick! https://forms.office.com/r/ukzHNh7uVa 24  1. Classify the severity of a patient’s GI complaints. After attending 2. Describe issues that can exacerbate a pinworm infection. these lectures, 3. Recommend an appropriate drug treatment completing the selection for a patient with a pinworm required readings infection. and studying 4. Formulate appropriate counseling information to be provided a patient on a these handouts, given treatment regimen for a pinworm the pharmacy infection. ** student should be able to: Required Reading: Handbook of Nonprescription Drugs: Pinworm chapter 25