Insect bites Flashcards
1
Q
Pharmacologic therapy - Insect Bites
Local Anesthetics
A
(benzocaine, pramoxine, benzyl alcohol, lidocaine)
- MOA: block conduction of nerve impulses -> loss of sensation
- Apply 3-4 times daily no longer than 7 days
- Side effects: allergic dermatitis, irritation, sloughing off and necrosis of the skin
- overuse of local anesthetics…. Sensitization, specifically contact dermatitis
- pramoxine and benzyl alcohol have LESS ADR than Dibucaine and phenol
2
Q
Pharmacologic therapy cont. - Insect Bites
- Antihistamines
A
diphenhydramine 0.5-2%
- MOA: depress receptors to relieve pain and itch
- Apply 3-4 times for no longer than 7 days
- Side effects: hypersensitivity reactions (allergic and
photoallergic contact dermatitis)
- Drowsiness? Why? Can cross BBB
3
Q
Pharmacologic therapy cont. - Insect Bites
- Counter irritants (camphor and menthol)
A
- MOA: depresses cutaneous receptors
- Camphor is dangerous when ingested
4
Q
Pharmacologic therapy cont. - Insect Bites
- Hydrocortisone (up to 1%)
A
- MOA: reduces inflammation -> relief of pain and itching
- Apply TID no longer than 7 days
- Side Effects: epidermal atrophy, acneiform eruptions, irritation, folliculitis, and tightening and cracking of the skin
- DO NOT USE in patients with fungal/bacterial infections
5
Q
Pharmacologic therapy cont. - Insect Bites
- Skin Protectants
A
- (Zinc Oxide, Calamine, Titanium dioxide)
- MOA: protectants and reduce inflammation and irritation
- Has minimal adverse effects
6
Q
Nonpharmacologic Therapy for Insect Stings
A
- Ice pack in 10 mins interval to slow absorption and reduce itching, swelling and pain
- Remove stinger using finger nail/edge of credit card
- Avoid wearing perfume, bright colored shirt, scented lotions
7
Q
Pediculosis
A
- Head lice – most common, outbreaks common at school: causes wheal and papules
- Body lice – cooties usually controlled with appropriate hygiene
- Pubic lice – transmitted with high sexual contact, can be found in pubic areas
8
Q
Nonpharmacologic Therapy - Pediculosis
A
- Inspect hair and comb with nit comb
- Avoid physical contact with infested individual
- Wash clothing and bedding in hot water
- Control body hygiene
9
Q
Pharmacologic Therapy Pediculosis
Synergized pyrethrins
A
- For head and pubic Lice
- MOA : block nerve transmission ⇒ paralysis and death
- Apply for 10 mins then rinse/shampoo. Repeat in 7-10 days if necessary
- Side effects: irritation, erythema, itching, and swelling
- C/I in patients with chrysanthemums, ragweed allergy
- may be used on children ages 2 years and older
10
Q
Pharmacologic Therapy Pediculosis
2. Permethrin
A
- MOA: disrupt sodium channel -> delay depolarization and cause paralysis
- HEAD LICE only
- Side effects: transient pruritus, burning, stinging, irritation of the scalp.
- Same C/I as pyrethrin + infants <2 months
11
Q
Exclusions for self-treatment
A
- < 2 years for pyrethrins
- < 2 months for permethrins
- Lice infestation of eyelids or eyebrow
- Pregnancy
- Nursing
- Active tumors
12
Q
Clotrimazole and Miconazole Nitrate
A
- MOA: act by inhibiting the biosynthesis of ergosterol and other sterols and by damaging the fungal cell wall membrane
- Applied once in the morning and once in the evening. For athlete’s foot and ringworm, these drugs should be applied twice daily for 4 weeks; for jock itch they should be applied twice daily for 2 weeks.
- S/E: Rare - mild skin irritation, burning, and stinging
- DDI - with warfarin
13
Q
Butenafine (Lotrimin Ultra)
A
- Inhibit biosynthesis of ergosterol and damage fungal cell wall
- Applied bid x1 week then QD x 4 weeks
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14
Q
Terbinafine (Lamisil)
A
- Inhibits fungi sterol biosynthesis >>> cell death
- Indicated for Tinea Pedis
- Should be applied twice a day for 2-4 weeks
15
Q
Tolnaftate (Tinactin)
A
- Only one approved for prevention and treatment
- Applied sparingly twice a day, from 2-6 weeks
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