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Pharm 409A Primary Care Modules > Infections And Infestations > Flashcards

Infections And Infestations Flashcards

1
Q

What features do head lice have ? (3 points)

A
  • claw on each of the 6 legs to cling firmly onto host skin and hair
  • can survive without a host up to 3 days (55 hours)
  • can survive underwater
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2
Q

What is the life cycle of head lice?

A

2-3 weeks

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3
Q

What are the limitations of head lice? (2 points)

A
  • do not survive on household pets
  • do not jump or fly from host to host
  • prefer clean hair
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4
Q

What are nits? (3 points)

A
  • Greyish white oval Lice eggs.
  • These are laid by the adult female
  • hatch around 7-10 days
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5
Q

Where are the nits attached? (2 points)

A
  • on the hair shaft Around 0.5cm from the scalp

- cementing substance not easily dislodged keeps the nit in place

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6
Q

What do nits >1cm from the scalp indicate?

A

Nits have most likely hatched

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7
Q

What are the symptoms of head lice? (5 points)

A

Intense itchiness on the scalp and hair shaft

  • behind the ears
  • on the crown
  • at the nape of neck
  • facial hair elf, eyebrows, eyelashes
  • scratching may lead to secondary bacterial infection
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8
Q

How are headline detected? (2 points)

A
  • lower the head over pale surface and comb the hair from root to tip. Conditioner may help
  • life portions of hair around ears, crown or nape of neck to check for nits
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9
Q

What are the differential diagnoses of head lice? (2 points)

A
  • dandruff (white spears easily dislodged)

- dermatitis (itchy, but no nits present

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10
Q

What are the general rules for head lice treatment? (7 points)

A
  • use pediculicide to treat actual infestations (not for prophylaxis)
  • check all family members
  • follow directions carefully. Do not shorten the waiting time
  • do not share articles that have come into contact with infected persons head, neck or shoulders
  • wash brushes and combs in some pediculicide or very hot water.
  • brush hair nightly (breaks female louses legs and prevents egg laying)
  • wash clothes on hot wash
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11
Q

What can be done with clothing or linen that cannot be washed? (In the treatment of head lice)

A

-dry clean, hot iron, or bag in plastic for a few days

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12
Q

What are the different pediculicide treatments? (5 points)

A
  • paraplus aerosol
  • full marks mousse
  • a lices shampoo
  • parasidose lice repellant spray
  • lice blaster
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13
Q

What is paraplus aerosol? (3 points)

A
  • 0.25% malathion, 0.5% permethrin, 2% piperonyl butoxide
  • not heat resistant (do not blow dry), but chlorine resistant
  • spray in short bursts over DRY hair until fully covered and leave for 10mins
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14
Q

What is full marks mousse? (4 points)

A
  • 0.5% phenothrin
  • spray foam on hair and spread from root to tip. Dry. Leave for 30 min. Wash off with regular shampoo
  • repeat in 7 days. Up to 3 applications
  • not for children under 6 months
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15
Q

What is A lices shampoo? (4 points)

A
  • 1% malathion shampoo
  • lather into wet hair and leave for at least 10 min
  • repeat in 1 week
  • also used to treat pubic lice
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16
Q

What is parasidose lice repellant spray? (2 points)

A
  • essential oils of eucalyptus, clove, palmarosa, lavender, mint, rose, citronella, ylangylang, geranium, pettigrain
  • prevents lice infestation but based on weak evidence
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17
Q

What is lice blaster? (4 points)

A
  • contains herbs and essential oils
  • natural preparation but weak evidence
  • apply to dry hair and leave on for 20min. Rinse off with warm water
  • repeat in 1 week
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18
Q

What are the general advice for head lice shampoos? (6 points)

A
  • avoid mucous membranes and eyes
  • use at least 20ml depending on hair length
  • shampoo into dry or damp scalp (only use a little water)
  • Leave on for 10min and rinse off
  • use fine toothed nit comb to remove nits
  • soaking in 50/50 water/vinegar mix may help loosen glue holding the nits onto hair shaft
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19
Q

When should head lice be referred?

A

-when Secondary infection is present (weeping, swollen glands)

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20
Q

What are head lice?

A

Small wingless insects that feed on human blood

Ectoparasites

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21
Q

What is threadworms also known as? (2 points)

A
  • pin worm

- enterobios vernicularis

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22
Q

What is the prevalence of threadworms in NZ?

A

-accounts for 95% of human worm infestations

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23
Q

What is a threadworm?

A

-intestinal parasite passed on to humans when eggs are swallowed unknowingly

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24
Q

What is the life cycle of a threadworm? (5 points)

A
  • egg hatches out of duodenum
  • larvae pass into large intestine and grow into threadworms
  • adult female moves down the gut to anus to lay eggs
  • the glue sticking the eggs to the anus irritates the host causing scratching
  • eggs will stick onto fingernails and be transferred to mouth, other people, food, furniture, etc.
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25
Q

What are the signs and symptoms of threadworms? (4 points)

A
  • sometimes asymptomatic
  • usually itching around anus at night
  • white cotton pieces (5-10mm) wriggling around anus or outside of bowel motion
  • restless sleep, irritability, bedwetting, loss of appetite
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26
Q

What information must be gathered from the patient regarding threadworm treatment? (6 points)

A
  • confirmation of threadworm
  • treatments tried and efficacy
  • number in family
  • age and weight
  • other diseases (esp. Liver problems)
  • pregnancy/breastfeeding
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27
Q

How are threadworms treated? (7 points)

A
  • medicines and hygiene measures to prevent re-infection
  • treat whole family, tell child’s school teacher
  • thorough washing of hands and fingernails with soap and water esp. Before eating and after the toilet
  • children to wear close fitting underpants at night to stop scratching
  • shower before bed and again in morning to remove eggs laid at night
  • wash bed linen, bed clothes, underwear in hot water, vacuum bedroom and toilet floor to get rid of dry eggs
  • disinfect toilet seat, bath and shower
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28
Q

What are the anthelmintic agents to treat threadworm? (2 points)

A
  • Pyrantel ebonate

- Mebendazole

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29
Q

What is pyrantel ebonate? (6 points)

A
  • combantrin chocolate squares
  • paralyses worms which are then excreted
  • dosed by body weight (10mg/kg)
  • treats threadworm, roundworm and hookworm
  • okay for children from 1 year old
  • avoid in acute liver disease
30
Q

What is mebendazole? (7 points)

A
  • deworm, Vermont, combantrin-1.
  • interferes with worm glucose absorption causing starvation
  • one dose for all treatment (100mg)
  • treats threadworm, roundworm, hookworm, whipworm and tapeworm
  • avoid in pregnancy, acute liver disease, children
31
Q

What is scabies? (2 points)

A
  • Parasitic infestation of skin

- caused by 8 legged itch mite sarcoptes scabei var. hominins

32
Q

What is the nature of the scabies parasite? (2 points)

A
  • female burrows into skin to lay her eggs

- scabies is highly contagious but only transmitted by direct skin contact

33
Q

What are the signs and symptoms of scabies treatment? (6 points)

A
  • intense itching, especially at night 1-8 weeks after contact
  • mites or eggs present at end of red threadlike burrows (wrists me between fingers and toes
  • linear ink stains remaining under skin - burrows made by scabies
  • secondary bilateral itchy rash due to sensitisation of mite exudate and coat (wrists my hands, axillae, nipples, genitals, head and neck in infants
  • secondary bacterial infection
  • close personal or family contacts may be asymptomatic
34
Q

How long can the scabies sensitisation rash last for?

A

2-4 weeks after treatment,

This does not indicate treatment failure.

35
Q

What are the general treatment principles for scabies? (10 points)

A
  • treat individual and any close personal or family contacts (if they are asymptomatic they may reinfect the person as well as themselves)
  • do not over treat, 1-2 treatments is adequate, otherwise refer
  • wait until after initial scabei ice treatment to use topical CS
  • soap and water alone will not work. Need a scabicide
  • can be spread by sharing clothes or bedding
  • scabies do not live in furniture or carpets
  • follow directions for applying scabicide a exactly
  • clothes worn against the skin in the last week must be washed, not laundered or dry cleaned. Wash sheets but not blanket/duvet
  • children
36
Q

What are the different scabicides used? (4 points)

A
  • gamma benzene hexachloride 1%
  • malathion 0.5%
  • permethrin 5%
  • crotamiton
37
Q

What is gamma benzene hexachloride 1%? (6 points)

A
  • lindane, benhex cream
  • warm-cool bath first, dry thoroughly, cool down
  • massage into body neck down (infants include face, neck, ears and scalp)
  • Leave for 8-12 hours, then wash off
  • usually once application sufficient
  • avoid in pregnancy and young children
38
Q

What is malathion 0.5%? (6 points)

A
  • A lices, malathion lotion
  • warm cool bath first, dry thoroughly then cool down
  • massage from the neck down, ensure coverage under fingernails
  • leave for 24 hours then wash off
  • reapply 7-10 days later
  • caution in children
39
Q

What is permethrin 0.5%? (8 points)

A
  • lyderm cream, A-scabies lotion
  • warm cool bath, dry thoroughly, cool down
  • massage a thin layer onto whole body from neck down
  • leave for 8-14 hours (but best left until 24 hours)
  • usually one application is enough
  • do not use more than 2 tubes
  • transient stinging burning sensation but non staining and odourless
  • caution in children 70 years, and people sensitive to permethrin, pregnancy and breastfeeding
40
Q

What is crotamiton? (5 points)

A
  • eurax, itch-soothe
  • good antipruritic but weak scabicide
  • useful for post treatment itch
  • apply 2-3 times daily
  • not recommended in pregnancy or lactation
41
Q

What products can be used to treat the scabies itch? (5 points)

A
  • crotamiton
  • calamine lotion (may be drying) calamine cream
  • pinetarsol bath, or diluted as dab on lotion
  • topical CS (but only after scabicide is used, do not use on infested areas)
  • oral antihistamine (sedating helps with sleeping)
42
Q

When should scabies be referred? (4 points)

A
  • presence of secondary bacterial infection
  • rash does not respond at all to treatment (no decrease in itch 5 or more days after treatment)
  • resistance (live mites present even after appropriate treatment used)
  • uncertainty about diagnosis
43
Q

What are the two main types of fungal/yeast infections?

A
  • Candida albicans (topical yeast infections)

- tinea infections

44
Q

What are the main characteristics of topical yeast infections? (5 points)

A
  • red and scaly
  • poorly defined border
  • may have scattered satellite pustules outside main rash area
  • often assoc. with immunodeficiency and diabetes
  • usually located in warm moist areas such as skin creases
45
Q

What are the common sites of topical yeast infections? (5 points)

A
  • groin
  • nail fold
  • under breasts
  • between buttocks
  • between toes

“Warm moist areas”

46
Q

What are three main classes of dermatophytes that cause tinea infections ?

A
  • trichophyton
  • microsporon
  • epidermophyton
47
Q

What are the main areas involved with tinea infections? (3 points)

A

Hair, skin and nails

48
Q

What are the main types of tinea infections? (5 points)

A
  • corporis (body)
  • capitus (head)
  • cruris (groin)
  • pedis (feet)
  • ungium (nails)
49
Q

What are the main char actuaries of tinea corporis? (6 points)

A
  • affects the body e.g. Ringworm
  • spreading circular red lesions
  • rings can join together
  • scaling at leading edge of lesion
  • mild itch
  • hair loss within lesion area
50
Q

What are the main characteristics of tinea capitus? (4 points)

A
  • affects the head
  • spreading circular red lesions
  • scaling scalp
  • hair loss e.g. Broken off, or stubble
51
Q

What are the main characteristics of Texan cruris? (5 points)

A
  • affects groin e.g. Joggers itchy, jock itch, crotch rot.
  • very itchy, red spreading lesions
  • pimple like eruptions
  • marked red border at leading edge of lesion
  • may spread to buttocks
52
Q

What are the main characteristics of tinea pedis? (5 points)

A
  • affects the feet e,g, atheletes foot
  • mild redness with some scaling and peeling
  • may be macerated my weeping, bad smell (due to yeast, bacteria)
  • itch or burning sensation
  • often between the toes or soles/sides of feet
53
Q

What are the main characteristics of tinea ungium? (3 points)

A
  • affects the nails
  • often associated with tinea of the skin
  • associated with crumbling, yellow nails.
54
Q

What are the main principles of fungal infection treatment ? (5 points)

A
  • dry area thoroughly (saline soaks 3-4x/day to dry weeping areas)
  • most antifungals are applied once or twice daily and continued 1-2 weeks after infection has cleared
  • dry up wet areas with powder, gel or lotion
  • moisturise dry areas with creams and ointments (strengthen skin barrier)
  • do not use hydrocortisone unless combined with effective anti-fungal
55
Q

Why should hydrocortisone not be used alone in fungal skin infections? (2 points)

A
  • hydrocortisone does not treat the infection
  • it may reduce the immune response and encourage infection spread which causes strange and paler patterns known as tinea incognito
56
Q

How can fungal infections of the feet be prevented? (5 points)

A
  • keep areas dry, esp. Between ties
  • wear cotton socks (not nylon or acrylic)
  • avoid plastic or rubber shoes
  • don’t walk barefoot in public showers
  • use antifungal powder or spray to dust shows and feet
57
Q

How can fungal infections of the groin be prevented? (3 points)

A
  • wear cotton underwear
  • avoid wearing nylon next to the skin e.g. Pantyhose, underwear)
  • keep skin dry e.g. Neat feet range, products containing antiperspirants prevent swearing and chafing in these areas.
58
Q

What are the different dosage forms available to treat fungal/yeast infections? (7 points)

A
  • solutions
  • creams
  • lotions
  • ointments
  • gels
  • powders
  • sprays
59
Q

What are antifungal solutions suitable for? (3 points)

A
  • inflamed and moist areas
  • they have a cooling effect, especially between toes or hair areas
  • be careful with alcoholic vehicles as they may sting
60
Q

What are antifungal creams suitable for? (2 points)

A
  • general body surfaces

- caution as they tend to run when applied to weeping areas

61
Q

What are antifungal lotions suitable for? (3 points)

A
  • hairy and weeping areas
  • also suitable for inflamed and moist areas due to cooling effect
  • caution with alcoholic vehicles as they may sting
62
Q

What are antifungal ointment suitable for?

A

-dry, Scaly lesions

63
Q

What are antifungal gels suitable for?

A

-hairy areas

64
Q

What are antifungal powders suitable for? (2 points)

A
  • flexural areas and in between the toes to absorb moisture

- can be used once infection has cleared to dust skin and shows as a preventative

65
Q

What are antifungal sprays suitable for? (5 points)

A
  • all kinds of surfaces EXCEPT sensitive genital areas
  • can be used once infection has cleared to dust skin and shoes as a preventative
  • powder has good staying power on skin
  • as it is a non-contact delivery devices it can be used on many people due to no cross contamination
  • good for hard to reach areas and skin folds
66
Q

Which medications are used to treat fungal infections? (5 points)

A
  • imidazoles
  • terbinafine
  • ciclopiroxolamine
  • undecylenic acids, benzoic acids, salicylic acids
  • gentian violet, castellani’s paint
67
Q

What are the imidazoles? (5 points)

A
  • fungalstatic drugs such as clotrimazole, Miconazole, econazole, ketonconazole, tioconazole
  • active against candida and G+ bacteria
  • almost no systemic absorption
  • 70-100% cure rate
  • apply bd and 14 days after clearing
68
Q

What is terbinafine? (6 points)

A
  • fungalcidic drug e,g, allymine antifungal
  • active against some yeasts
  • apply bd for 1-2 weeks and another week after clearing
  • good skin penetration within 3 days, acts more rapidly than imidazoles to eradicate dermatophytes.
  • dermatophytes may be killed before skin has healed completely
  • also available as lamisil once but data on clearance rate not clear.
69
Q

What is ciclopiroxolamine ? (3 points)

A
  • broad spectrum antifungal and antibacterial
  • use bd and 14 days after clearing
  • available as nail lacquer to treat nail fungal infections
70
Q

What are the undecylenic acids, benzoic acids, salicylic acids? (2 points)

A
  • not active against candida or bacteria

- requires continual treatment 4 weeks after lesions have cleared

71
Q

What is gentian violet and castellani’s paint? (3 points)

A
  • old remedies for fungal skiing infections
  • gentian violet is rx only
  • stains clothing, messy to use and not recommended due to mutagenic activity

Pharm 409A Primary Care Modules (2 decks)

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