Fundamentals of Pharmacology for Veterinary Technicians Chapter 15

Helminths

Nematodes Platyhelminths

Cestodes Trematodes

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Table 15-1 Helminths of Veterinary Signiﬁ cance

Main Location of Category Parasite Scientific and Common Names Nematodes Abomasal worms • Barberpole worm Haemonchus in ruminants or (R) stomach worms • Brown stomach worm Ostertagia in monogastric ostertagi (R) animals • Small stomach worm or hairworm Trichostrongylus axei (R, H) • Hyostrongylus rubidus (Sw) • Large-mouth stomach worm Habronema muscae (H) (Continued)

Table 15-1 (Continued )

Main Location of Category Parasite Scientific and Common Names Intestinal worms • Small intestinal worms Cooperia (R) • Hookworms Bunostomum phlebotomum (R), Ancylostoma sp (D, F) • Nodular worms Oesophagostomum spp. ( R, Sw) • Thread-necked intestinal worm Nematodirus helvetianus (R) • Bankrupt worm Trichostrongylus colubriformis (R) • Large strongyles Strongylus

Triodon- tophorus spp. (R, E) • Small strongyles Cyathostomum spp., Cylicocyclus spp., Cylicostephanus spp., Cylicodontophorus spp. (R) • Whipworms Trichuris suis (Sw), Trichuris vulpis (D) • Threadworms Strongyloides ransomi (Sw), Strongyloides westeri (E), Strongyloides stercoralis (D) • Ascarids Parascaris equorum (H), Toxocara canis (D), Toxocara cati (F), Toxascaris leonina (D, F) • Pinworms Oxyuris equi (E) Circulatory system • Heartworms Dirofi laria immitis (D, F) worms Lungworms • Dictyocaulus spp. (R, H) • Prostostrongylus rufescens (S, G) • Muellerius capillaris (S, G) • Metastrongylus spp. (Sw) • Filaroides spp. (D) Kidney worms • Stephanurus dentatus (Sw) Urinary bladder • Capillaria spp. (D, F) worm Gastrointestinal • Habronema spp. (H) worms • Draschia spp. (H) Skin worm • Onchocerca spp. (H) Cestodes • Moniezia benedeni (R) (tapeworms) • Taenia spp. (R, D, F) • Echinococcus granulosus (R is intermediate host, D) • Dipylidium caninum (D, F) • Anoplocephala perfoliata, A. magna (H) • Paranoplocephala mamillana (H) Trematodes Liver fl uke • Fasciola hepatica (R) (fl ukes) Deer liver fl uke • Fascioloides magna (R) Lung fl uke • Paragonimus kellicotti (D, F)

R = ruminants, C = cattle, S = sheep, G = goats, Sw = swine, D = dogs, F = cats, H = horses

Table 15-2 Protozoa of Veterinary Signiﬁ cance

Type of Location of Parasite Scientific and Movement Common Names None Gastrointestinal tract • Coccidia Eimeria spp. (R, Sw, H) None Gastrointestinal tract • Coccidia Isospora spp. (Sw, D, F) None Gastrointestinal tract; muscle tissue• Toxoplasma gondii (F) Flagellum Gastrointestinal tract • Giardia spp. (R, H, D, F) None Gastrointestinal tract • Cryptosporidium spp. (R, H, D, F, Sw) None Muscle in ruminants • Sarcocystis spp. (R in muscle) Gastrointestinal tract in dogs • Sarcocystis and cats shed in stool) Central nervous system • Sarcocystis neurona (H) Flagellum Reproductive tract • Tritrichomonas foetus (C) None Circulatory system • Babesia (C, H, D) None Circulatory system • Cytauxzoon felis (F) Flagellum Circulatory system • Tr ypanosoma (D, C) Cilia Gastrointestinal tract • Balantidium coli (Sw)

R = ruminants, C = cattle, S = sheep, G = goats, Sw = swine, D = dogs, F = cats, H = horses

Table 15-3 Administration Routes for Anthelmintics

Main Example Route Route Description Concerns Oral Tablets May be hard tablet, • Allows greater control chewable tablet, or bolus (large pill) that animal given ingests or is given • Palatability is important (especially with cats and horses)

Levasole oride) (levamisole hydrochl Cattle Wormer Boluses

CATTLE FOR ORAL USE IN

NET CONTENTS: 50 BOLUSES

Liquid May be in the form of • Drug must be shaken well a solution, suspension to ensure adequate mixing paste, paste syringe, or of chemical throughout drench the liquid • Paste syringes contain a precalibrated amount of paste that need not be shaken • Drenches are liquid forms given by mouth that force ivomec the animal to drink Eprinex • Allows greater control over amount of drug given

Feed May be in feed, added • Treats parasites in large additives to mineral mixes, added numbers of animals to drinking water, or • Allows little control over added to salt blocks amount of drug ingested by an individual animal • Is stress free for the animals • Saves expense of rounding up livestock

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Main Example Route Route Description Concerns Sustained- Device is implanted in • Saves time in retreating release rumen to allow slow of animals release of the drug • Can treat animals over a over time (especially period (like the complete helpful in treating later grazing season) stages of parasite larvae)

SR Bolus

Injectable Solution Given SQ usually (if • Easy way to administer given IM, may affect the • Local reaction is possible, but carcass) • Allows greater control over amount of drug given • Achieves higher blood CYDECTIN levels rapidly • Requires livestock to run through CYDECTIN chutes or be crowded into restricted spaces for injection with multidose syringes for treatment • Can control amount of drug given

Topical Solution Absorbed through the • Used in large animals (pour-ons) skin via the sebaceous • Achieves high blood levels glands and hair follicles rapidly • Easy to administer • Reduces stress for treated animals • Used for internal and external parasites ECTO METHRIN • Pour-ons are highly

ECTOMETHRIN

Table 15-4 Types of Antiparasitic Drugs

Benzimidazoles (nematodes) • thiabendazole • oxibendazole • mebendazole (also works on tapeworms) • fenbendazole (also works on tapeworms, fl ukes, and Giardia protozoa) • albendazole (also works on tapeworms, fl ukes, and Giardia protozoa) • oxfendazole (also works on tapeworms and fl ukes) • febantel (a probenzimidazole used in combination with other products to broaden its spectrum of activity) Imidazothiazoles (nematodes) • levamisole Tetrahydropyrimidines (nematodes) • pyrantel pamoate • pyrantel tartrate • morantel tartrate Organophosphates (nematodes; ectoparasites, including bots) • dichlorvos • coumaphos Piperazines (nematodes) • piperazine Avermectins (also called macrocyclic lactones) (nematodes; heartworm prevention; ectoparasites, such as bots and grubs) • ivermectin • eprinomectin • selamectin • moxidectin • milbemycin oxine • doramectin Depsipeptides (nematodes) • emodepside (used in combination with praziquantel) Pyrazine derivatives (platyhelminths) • praziquantel (tapeworms, fl ukes) • epsiprantel (tapeworms) Benzene sulfonamide (fl ukes) • clorsulon Coccidiostats (coccidia) • sulfadimethoxine • amprolium • decoquinate • nicarbazine • monensin • robenidine Nitroimidazoles (Giardia) • metronidazole Carbanilide derivative (Babesia) • imidocarb Aminoquinolone (Babesia) • primaquine Folic acid antagonist (Toxoplasma and Sarcocystis) • pyrimethamine Triazine (Sarcocytis) • ponazuril Nitrothiazolyl-salicylamide derivative (Sarcocystis) • nitazoxanide

Table 15-5 Application Methods for Ectoparasiticides

Type of Product Advantages Disadvantages Prediluted sprays (include • Convenient and easy to use (apply • Water-based sprays do not penetrate oily sprays for animals and from head to tail, avoiding eyes, mouth, coats or fabrics well premise sprays) and nose) • Alcohol-based sprays may be drying and • Usually has quick kill irritating to skin • May have residual effects • Available for animal and environment Concentrated Sprays • Concentrated form may offer cost • Error in dilution may occur savings • Diluted product may not have long shelf • Can be diluted at different concentrations life for different ectoparasites Ya rd spray/Kennel spray • Offer residual effects • Can only be used on environment • Effi cacy varies Dips • Offer residual effects • Must be diluted properly • Animal should be shampooed fi rst • Animal must dry with dip product on— cannot rinse product off Pour-ons • Can ensure that an individual animal is • Activity of drug may be limited if applied treated to unclean animal (e.g., animal with caked • May treat many animals at a time with mud or manure on its hide) proper application devices • May be applied incorrectly, resulting in limited value of the treatment or development of toxicity (application varies; may be along the backline from shoulders to the pelvis or in single spot) Shampoos • Rinse well • May only contain products for cleaning the • May contain medication effective coat against parasites • No residual effect even if medication present • May have to be diluted before use • Must leave on animal for a specifi ed time prior to rinsing (Continued)

Type of Product Advantages Disadvantages Dusts or powders • Can be used in animals that do not • Do not provide quick kill tolerate sprays • May irritate and dry skin Foggers • Work well in large, open rooms • Product does not get everywhere needed • Quick method for environmental (in corners or furniture); however, coverage control can be improved if premise spray is used with the fogger • Can be toxic to ﬁ sh; must cover food products when applying Oral products • No mess • May not kill all stages of the ectoparasite • Works for a period of time • May have systemic effects • Ectoparasite may have to take a

effective Topical long-acting • Long-lasting • May cause skin problem at site of (Spot-ons) • May work for multiple parasites application • May work for different stages of • Causes oiliness at site of application parasite development • Animal should avoid bathing or swimming • Work by providing area of repellent with some products near application site • May not be usable on young, old, or sick animals Injectables • Long-lasting in some cases • May cause adverse reaction at injection • Easier for owners who do not want to site administer medication to the animals • Should be given by veterinary staff themselves

Table 15-6 Chemical Products for Ectoparasite Control Generic and Trade Product Category Pyrethrins and pyrethroids: • pyrethrin (Mycodex Shampoo®, • Very safe • Names end in -rin or Bio Spot Shampoo®) • Quick kill -thrin • d-trans allethrin (Duocide • Adulticide, insecticide/miticide • Pyrethrins are natural Spray®) • Often manufactured with other products plant products • permethrin (ProTICall®) such as imidacloprid and pyriproxyfen • Pyrethroids are syn- • Acts on the parasite’s nerve cell thetic pyrethrins membrane to disrupt the sodium channel current, which delays repolarization and paralyzes the parsite • May have limited residual effects • Form labeled for dogs may be too high a concentration for cats • In small animals used primarily for fl eas and ticks in dogs • In large animals used primarily for fl ies, lice, mites, mosquitoes, ticks, and keds • Commonly used in sprays, dips, foggers, pour-ons, insecticidal ear tags, and premise sprays Insect growth regulators • methoprene (Ovitrol® and • Products with IGR provide the fl ea with (IGR): Siphotrol®) high levels of IGR, which mimics the • Include insect • pyriproxyfen (Nylar®, VectraTM) insect’s juvenile hormone (JH). Fleas need development low levels of JH to molt to the next stage; inhibitors and juvenile high levels interrupt normal molting, so hormone mimics the insect stays in the larval stage and eventually dies • When combined with an adulticide (permethrin, fi pronil, phenothrin, etc.), it kills all stages of the parasite, making reinfestation unlikely • Do not have adulticide activity by themselves • Found in sprays and fl ea collars (Continued)

Generic and Trade Product Category Chitin synthesis inhibitor • lufenuron (Program®) • Chitin is an insect protein that gives • lufenuron and milbemycin strength and stiffness to its body; chitin (Sentinel®) synthesis inhibitors prevent proper • lufenuron and nitenpyram formation of this protein (Capstar® Flea Management • Lufenuron is an oral tablet given to dogs System, Program® Flavor Tabs) and a suspension or tablet given orally or an injection given SQ to cats to protect against fl eas for 1 month • Fleas that feed on blood containing lufenuron continue to lay eggs, but the eggs fail to develop normally • Does not kill adult fl eas Neonicotinoid • nitenpyram (Capstar®) • Neonicotinoid compound that binds • nitenpyram and lufenuron and inhibits nicotinic acetylcholine (Capstar® Flea Management receptors System, Program® Flavor Tabs) • Tablet that kills adult fl eas within

against eggs or immature forms if used alone) • Can safely give a dose as often as one per day • Can use on puppies and kittens older than four weeks and weighing more than

• dinotefuran and pyriproxyfen • Third-generation neonicotinoid (dinotefuran) (VectraTM for Cats, VectraTM for and IGR (pyriproxyfen) that can be used on Cats and Kittens) kittens older than eight weeks of age • Once-monthly topical spot-on that kills adult fl eas within six hours and controls the development of all fl ea stages Synergists • piperonyl butoxide (Ecto-foam®, • Have limited activity against arthropods; Adams Flea & Tick Dust II®) (some inhibit insect metabolic enzymes); • N-octyl bicycloheptene however, they increase the effi cacy of dicarboximide (Ectokyl 3X Flea pyrethrins and pyrethroids & Tick Shampoo®, Pyrethrin Plus • Found in sprays, shampoos, dusts, and dips Shampoo®) Imidacloprid • imidacloprid (Advantage®)• Acts as an insect neurotoxin by binding to the niconyl receptor (inhibits cholinergic activity of the parasite) • Marketed for dogs and cats • Applied topically at the back of the neck, but is not absorbed into the blood • Kills adult fl eas on contact • Has four-week residual effect • imidacloprid and permethrin • Works synergistically to rapidly paralyze (K9 Advantix®) and kill parasites • Kills fl eas (adult and larval stages) and kills and repels mosquitoes, and ticks (deer, American dog, Brown dog, lone star) • For use on dogs and puppies seven weeks of age or older • Not for use on cats

(Continued)

Table 15-6 (Continued ) Generic and Trade Product Category • imidacloprid and moxidectin • Kills adult fl eas, adult and immature (Advantage Multi® for Dogs, hookworms, adult roundworms, adult Advantage Multi® for Cats) whipworms, and prevents heartworm disease in dogs over seven weeks of age • Kills adult fl eas, ear mites, adult and immature hookworms, adult roundworms, and prevents heartworm disease in cats over nine weeks of age • Once-monthly topical solution Phenylpyrazole • fi pronil (Frontline®) • Fipronil interferes with chloride channels • fi pronil with methoprene of insects, which overstimulates their (Frontline Plus®) nervous system causing death of adult fl eas, ticks, and chewing lice (Figure 15-5) • Methoprene is an insect growth regulator, which makes the combination product effective against fl ea eggs and fl ea larvae • Is applied topically, but is not absorbed into the blood • Collects in the oils of the skin and hair follicles and continues to be released over a period of time resulting in residual activity (spreads over the body in 24 hours) • Kills newly emerged adult fl eas before they can lay eggs • Residual activity even after bathing • Labeled for treatment of fl eas, ticks, and chewing lice when used monthly and control of sarcoptic mange with repeated treatments • Not for use in puppies or kittens less than eight weeks of age Semicarbazone • metafl umizone (ProMeris® for • Blocks sodium infl ux, which is needed to Cats) propagate a nerve impulse in fl eas that causes a reduction in feeding, paralysis, and death of adult fl eas • Once-monthly topical spot-on labeled for use in cats greater than eight weeks of age for treatment and prevention of fl eas • Hypersalivation may be seen if cat licks application site • metafl umizone plus amitraz • Combination product with amitraz is a (ProMeris® Duo for Dogs) topical spot-on for control and prevention of adult fl eas and ticks (Ixodes ricinus, Ixodes hexagonus, Dermacentor reticulates, Dermacentor variabilis, and Rhipicephalus sanguineus) in dogs over eight weeks of age; extra-label use for demodectic and sarcoptic mange mites • Hypersalivation may be seen if dog licks application site (Continued)

Generic and Trade Product Category

Avermectin • selamectin (Revolution®)• Interferes with postsynaptic stimulation of the muscle fi ber in arthropods or neurons in nematodes causing paralysis and death • In cats works on adult fl eas and eggs, heartworms, ear mites, hookworm, and roundworms • In dogs works on adult fl eas and eggs, heartworms, ear mites, sarcoptic mange, and American dog tick • ivermectin (Ivomec®, Equell® • Injectable or oral solution used for some paste, Equimax®, Eqvalan®) ectoparasites and endoparasites • Potentiates insect’s GABA neural and neuromuscular transmission • Blood-feeding ectoparasites (such as fl eas, mites, and lice) are killed much better with ivermectin than superfi cial, nonblood feeders (like Cheyletiella spp.) • Effective against the following ectoparasites: bots, grubs, lice, and mites (including demodex) • doramectin (Dectomax®)• Injectable and topical solution used for some ecto- and endoparasites. • Used as a pour-on in cattle for biting lice and mites; used in dogs and cats for generalized demodicosis • eprinomectin (Ivomec®, • Topical pour-on for beef and dairy cattle Eprinex®) • Used to treat and control GI nematodes and ectoparasites (cattle grubs, lice, mange mites, and horn fl ies), ear mites (Psorpotes cuniculi) in rabbits • Increases permeability of the cell parasite’s membrane to chloride ions resulting in paralysis and death of the parasite. • No milk or meat withdrawal Acetylcholine receptor • spinosad (Comfortis®)• One-month oral chewable fl ea protection agonist for treatment and prevention of fl eas in dogs 14 weeks of age or older • Causes involuntary muscle contractions in fl eas that leads to seizures, paralysis, and death • Fast acting and long acting • Flea death begins in 30 minutes and is complete in four hours • May cause systemic side effects such as vomiting, anorexia, lethargy, or diarrhea • Administration with food increases its effectiveness

(Continued)

Table 15-6 (Continued ) Generic and Trade Product Category Formamidines • amitraz (Mitaban® Dip, • Used for treatment of demodectic PrevenTIC® Collar, ProMeris® for mange and scabies in dogs; ticks, mange dogs, Taktic®EC) mites, and lice in beef and dairy cattle and swine (there is a withdrawal time in swine) • Alpha-2 agonist and monoamine oxidase inhibitor that causes excess adrenergic activity in the parasite’s nervous system • Animals may show sedation for 24–72 hours following treatment • Toxic to cats and rabbits (although has been used on cats in diluted form) • Use gloves and protective clothing when applying to animals; wash hands and arms after application to animal • Use in well-ventilated area • Flammable until diluted with water • Yohimbine and atipamezole are antagonists of amitraz Sulfurated lime solution • lime sulfur (Lym Dyp®, LimePlus • Provides antimicrobial and antiparasitic Dip®) activity through the formation of pentathionic acid and hydrogen sulfi de after application • Used in the treatment of sarcoptic and notoedric mange, cheyletiellosis, chiggers, fur mites, and lice; also demodicosis in cats • Also effective for the treatment of ringworm • May stain light-colored animals • Used as a rinse or dip following dilution Repellents • DEET (Blockade®) • Used to repel mosquitoes, fl ies, • butoxypolypropylene glycol and gnats (VIP® Fly Repellent Ointment) • May be used in combination with pyrethrins and pyrethroids • Include sprays, ear tags, and topicals for ear tips Rotenone • rotenone (generic) • Uncouples oxidative phosphorylation • Used in dips and pour-on liquids • Toxic to fi sh; consider pesticide runoff possibilities if rotenone is used to treat insects on plants • Not commonly used due to the availability of safer chemicals D-limonene • D-limonene (VIP Flea Dip and • Extract of citrus peel that has some Shampoo®) insecticidal activity • Provides quick kill • No residual • Pleasant smell • Used with other products

Table 15-7 Drugs for Monthly (or Longer) Prevention of Fleas, Ticks, and Heartworm Disease

Effective for Prevention of Effective for Fleas Effective for Ticks Heartworm Disease • dinotefuran and pyriproxyfen • amitraz(PrevenTIC® collar) • ivermectin (Heartgard®, (VectraTM for Cats, VectraTM for • fi pronil (Frontline®) Heartgard Plus®, Tri-Heart Cats and Kittens) • fi pronil with methoprene Plus®, and Iverhart™ Plus) (Plus • dinotefuran, pyriproxyfen, and (Frontline Plus®) products also work on some permethrin (VectraTM 3D) • permethrin (ProTICall®) intestinal parasites) • fi pronil (Frontline®) • selamectin (Revolution®) • milbemycin (Interceptor®, • fi pronil with methoprene (labeled for American dog tick Sentinel® [also works on some (Frontline Plus®) only) intestinal parasites]) • imidacloprid (Advantage®) • moxidectin (ProHeart®-6 works • imidacloprid and moxidectin for six months) (Advantage® Multi for dogs) • selamectin (Revolution®) (also • imidacloprid and permethrin works on ear mites) ®, Proticall®) • lufenuron (Program®) • metafl umizone (ProMeris® for Cats) • metafl umizone plus amitraz (ProMeris® Duo for Dogs) • nitenpyram (Capstar®) • nitenpyram and lufenuron (Capstar® Flea Management System, Program® Flavor Tabs) • permethrin (ProTICall®) • selamectin (Revolution®) • spinosad (Comfortis®)

Table 15-8 Internal Parasite Drugs

Parasite Category Drug Category and Examples Antinematodal Benzimidazoles oxibendazole (Anthelcide EQ Equine Wormer Paste®) mebendazole (Telmintic®) fenbendazole (Panacur®) albendazole (Valbazen®) oxfendazole (Benzelmin® Paste and Synanthic®) • febantel (Drontal Plus® also contains pyrantel pamoate and praziquantel combination) Imidazothiazoles • levamisole (Levasole® and Tramisol®) Tetrahydropyrimidines • pyrantel pamoate (Nemex® and Strongid-T®) • pyrantel tartrate (Strongid-C®) • morantel tartrate (Rumatel®) Piperazines • piperazine (Pipa-Tabs® and Hartz Advanced Care Once-a-Month Wormer® for Puppies) Avermectins or macrocyclic lactones • ivermectin (Heartgard®, Heartgard Plus®, Ivomec®) • eprinomectin (Ivomec®, Eprinex®) • selamectin (Revolution®) • moxidectin (ProHeart-6®, Cydectin®, Quest 2% Equine Oral Gel) • milbemycin oxine (Interceptor®, Sentinel®) • doramectin (Dectomax®) Depsipeptides • emodepside (Profender®, which also contains praziquantel)

Anticestodals Pyrazine derivatives • praziquantel (Droncit®, Profender® [which also contains emodepside], and Quest® Plus [which also contains moxidectin]) • epsiprantel (Cestex®) Benzimidazoles • albendazole (Valbazen®) • mebendazole (Telmintic®) • fenbendazole (Panacur®) • oxfendazole (Benzelmin® Paste and Synanthic®)

Antitrematodals Benzene sulfonamide • clorsulon (Curatrem®, Ivomec® Plus, which also contains ivermectin) Benzimidazoles • albendazole (Valbazen®) • fenbendazole (Panacur®) • oxfendazole (Benzelmin® Paste and Synanthic®) Pyrazine derivative • praziquantel (Droncit®, Profender® [which also contains emodepside], and Quest® Plus [which also contains moxidectin]) (Continued)

Table 15-8 (Continued )

Parasite Category Drug Category and Examples Antiprotozoals Coccidiostats • sulfadimethoxine (Albon®) • amprolium (Corid®) • decoquinate (Deccox®) • nicarbazine (Maxiban 72®) • monensin (Coban 60®, Rumensin®) • robenidine (Robenz Type A Medicated Article®) Nitroimidazoles • metronidazole (Flagyl®) Benzimidazoles • fenbendazole (Panacur®) • albendazole (Valbazen®) Carbanilide derivative • imidocarb (Imizol®) Aminoquinoline • primaquine (generic) Folic acid antagonist • pyrimethamine (Daraprim®) • pyrimethamine plus sulfadiazine (ReBalance®) Triazine • ponazuril (Marquis®) Nitrothiazolyl-salicylamide derivative • nitazoxanide (Navigator®)

Table 15-9 Heartworm Medication

Drug Category Examples

Adulticide • Melarsomine (Immiticide®)

Microﬁ laricides • ivermectin (Heartgard®, Heartgard Plus®, Heartgard® for Cats, Iverhart™ Plus, Tri-Heart™ Plus) • milbemycin (Interceptor®, Sentinel®) • levamisole (Levasole®, Tramisol®)

Preventatives • ivermectin (Heartgard®, Heartgard Plus®, Heartgard® for Cats, Iverhart™ Plus, Tri-Heart™ Plus) • milbemycin (Interceptor®, Sentinel®) • selamectin (Revolution®) • moxidectin (ProHeart-6®)