Insect Bites and Stings Flashcards
What are the goals of treatment of insect bites and stings?
Prevent insect bites and stings
Prevent disease or reactions caused by stings or bites
Referral for medical attention when warranted in case of more severe reactions
Provide symptomatic relief for localized reactions
Describe the general treatment of insect bites and stings
Remove insect/stinger if applicable
Apply an ice pack to reduce swelling
Clean area well (warm water to relieve pain and inflammation/cool water to relieve itching)
Non-prescription oral antihistamines to relieve itching
Non-prescription topical steroid to relieve inflammation and itching
What are OTC options?
Hydrocortisone 0.5% or 1.0% (available as cream, ointment, lotion)
Oral antihistamines
-diphenhydramine (3-4 times daily)
-loratidine (once daily)
Topical anesthetics (benzocaine, lidocaine, pramoxine)
Topical antihistamines (diphenhydramine)
Skin protectants (calamine, zinc oxide)
What are counterirritant options?
Camphor or menthol (depress cutaneous receptors resulting in relieve of itching and irritation due to anesthetic effect)
Topical ammonia
-relief of itching and burning due to mosquito bites
-shown to be more effective than placebo (but not by much)
-product: AfterBite (ammonia and baking soda in the original formula)
What are oral treatment options?
Analgesics for pain relief (acetaminophen, ASA, ibuprofen)
Oral antihistamines for pain relief, itching and inflammation of insect stings (first and second generation)
How do topical anesthetic work?
They cause a reversible blockade of conduction nerve impulses where applied that results in a loss of sensation
They have short duration of action (15-45 minutes)
There is a risk of hypersensitivity reaction and systemic absorption/toxicity
Products: benzocaine, lidocaine, pramoxine
How to topical antihistamines work?
They cause an anesthetic effect by depressing cutaneous receptors to relieve pain and itching
They may cause allergic contact dermatitis and sensitization in some
Generally not absorbed enough to cause systemic side effect, but there have been causes of anticholinergic toxicity with excessive use in children
Products: topical diphenhydramine
What do skin protectants work?
They reduce inflammation and irritation
Absorbs fluids from weeping lesions
Products: zinc oxide, calamine
How do topical corticosteroids work?
Antipruritic and anti-inflammatory actions that can prevent or suppress development of deem, capillary dilation, swelling and tenderness associated with inflammation
Anti-inflammatory effects results in relief of pain and itching
Avoid prolonged use
Products: Hydrocortisone 0.5% (3-4 times daily) or hydrocortisone 1.0% (once daily)
What are the monitoring parameters for insect bites?
Pain/fever (monitor daily for up to 7 days as this may indicate signs of infection)
Itching (provide daily relief for itching - topical hydrocortisone should provide relief within minutes, oral products within an hour)
Swelling/redness (monitor daily for increased swelling or redness as this should decrease within 24 to 48 hours)
Signs of infection (increased redness, pain at site, fever)
Anaphylactic reaction (observe for at least 30 minutes or less for signs of reaction such as hives, excessive swelling of the area, dizziness, vomiting or difficulty breathing-closure of the throat, swelling of the tongue)
