Insect bites, stings and pediculosis

Question 1

When should you not self-treat a bug bite

Answer 1

history of hypersensitivity to insect bites or symptoms distant from area of bite
younger than 2 years of age
infected bite area
Deer tick bite(possibility of lyme disease)
brown recluse or northern black widow spider bite

Question 2

What are the goals of therapy when treating bug bites

Answer 2

prevent bites
relieve symptoms
prevent secondary bacterial infections

Question 3

What are some non-pharmacologic options for the prevention of bites/stings

Answer 3

cover skin with clothing
avoid infested areas
remove standing water around home
limit time outside at dawn/dusk
window screens
pet “prevention”
avoid wearing scents/perfumes

Question 4

What non-pharmacologic options can a patient do to relieve bite symptoms

Answer 4

apply ice 10 min on/off at a time
avoid scratching
comfortable clothing
nail polish over chigger location

Question 5

How do you remove a tick

Answer 5

1. use clean, fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible
2. pull upward with steady, even pressure. Do not twist or jerk the tick
3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water
4. Never crush tick with your fingers. Dispose of live tick by putting it in alcohol, placing in a sealed container, wrapping tightly in tape, flushing down the toilet

Question 6

What OTC options are available for the prevention of insect bites

Answer 6

Repellants (skin-safe or pre-treat clothing)

Question 7

What OTC treatments are available to treat bug bites/stings

Answer 7

external analgesics
topical hydrocortisone
skin protectants

Question 8

When should someone be referred to a medical provider is OTC treatments are not working

Answer 8

symptoms of infection develop around bite location
symptoms have not resolved after 7 days
Lyme disease “bullseye” develops

Question 9

What insects does DEET protect against

Answer 9

mosquitoes
blackflies
midges
mites
ticks
chiggers

Question 10

What is DEET safe to use on

Answer 10

skin
nylon and natural fibers

Question 11

What is the efficacy of DEET

Answer 11

90% repellency at 30% DEET
lasts approximately 6-8 hours

Question 12

What are some cautions of DEET

Answer 12

avoid if history of sensitivity
avoid direct eye, nose or hand application
stop if dermatitis occurs
use sparingly
avoid unintended removal

Question 13

What is the number of applications of insect repellant should be applied to children daily

Answer 13

for children months to 2 years: 1 application per day
for children aged 2 to 12 years: 3 applications per day
*max of 10% DEET in repellant for children under the age of 12

Question 14

What is the advantage of using picaridin over DEET

Answer 14

you can use on children older than 2 months
will not damage plastic or fabric
odorless

Question 15

What is the efficacy of Picaridin

Answer 15

at concentrations of up to 20% it is effective for up to 8-10 hours

Question 16

What is the name of the repellant that is applied to clothing

Answer 16

permetherin

Question 17

What is the dosing of local anesthetics for treatment of bug bites and spider bites

Answer 17

apply 3-4 times a day for up to 7 days

Question 18

What is the dosing of topical hydrocortisone for treatment of bug bites and spider bites

Answer 18

apply 3-4 times a day for up to 7 days

Question 19

What is the dosing of skin protectants for treatment of spider bites and bug bites

Answer 19

applied as needed up to 4 times a day

Question 20

What are the presenting symptoms people may experience when they have been stung by an insect

Answer 20

No known allergy: pain, itching, irritation at site, possibility of delayed local inflammation 1-2 weeks later
Allergy known: hives, swelling, burning, possible anaphylaxis

Question 21

When should you not self-treat and insect sting

Answer 21

symptoms of severe allergic reaction
allergic response distant to sting
previous sting
previous severe reaction to bites/stings
younger than 2 years of age

Question 22

What can be done treatment wise when someone is stung

Answer 22

remove the stinger
ice pack on for 10 minute intervals
pharmacologic therapy
*no topical diphenhydramine: NOT effective

Question 23

How do you remove the stinger& venom sac removal and clean the site

Answer 23

1. remove as quickly as possible*only need 2-3 minutes for venom sac to empty into the skin
   **to remove stinger, scrape with fingernail or credit card
2. Clean site with hydrogen peroxide(preferred) or alcohol

Question 24

What are some additional pharmacist interventions

Answer 24

epinephrine emergency kite
look for medical ID

Question 25

What is pediculosis

Answer 25

head lice

Question 26

How are head lice transmitted

Answer 26

direct head-to-head contact
*not commonly transmitted thru sharing hats, pillows, etc…

Question 27

Why do you not need to “worry” about getting head lice from sharing of hats?

Answer 27

adult louse will die in 1-2 days without blood

Question 28

What is the head lice life cycle

Answer 28

Eggs(6-8 days)
Nymphs(9-12 days): must feed within 24 hours or they die
Adults(live 30days WITH blood meals): both male and female lice cause infestations
*female lice lay 7-10 eggs per day

Question 29

Under what circumstances should someone not self-treat headlice

Answer 29

hypersensitivity to chrysanthemum/ragweed plant family
hypersensitivity to pediculicide ingredients
secondary skin infection in lice-infested area on scalp
infestation of eyelids or eyebrows
pregnancy or lactation
regional resistance
those under the age of 2 years should not use pyrethrins
those under 2 months should not use permethrins

Question 30

What nonpharmacologic treatments should a person do if they or someone they live with has head lice

Answer 30

Avoid sharing objects that come in contact with infected hair
*soak combs/brushes in water that is at least 130F for 5-10 minutes
Vacuum floor and furniture
Machine wash and dry headwear and linen on HOT cycles
*can dry clean as well or seal in bag for 2 weeks

Question 31

If someone in a family is infected with head lice, should you treat everyone regardless of if they are infected or not

Answer 31

NO, only treat if infested
Treat those that are infested at the same time

Question 32

What is the proper steps for treating of lice

Answer 32

1. remove or protect clothing
2. wash hair with regular shampoo ONLY, rinse and towel dry hair
3. apply pediculicide(may need 2 bottles for longer hair)
   allow to sit on hair for 10 minutes
   **rinse with water
   **avoid washing hair for 1-2 days after removal of pediculicide
4. dress in clean cloting
5. check hair 8-12 hours later
   *if no dead lice, call medical provider
6. check and nit/flea comb every 2-3 days for 2-3 weeks

Question 33

How do you determine if you need to retreat with OTC

Answer 33

Retreat on day 7-9 to kill surviving hatched lice before they produce eggs

Don’t retreat if few lice remain and are sluggish, can just comb out

Question 34

Who should no use pyrethrum extract to treat lice

Answer 34

those allergic to chrysanthemum or ragweed
children under the age of 2 years

Question 35

What is the process used for wet combing

Answer 35

1. wet hair and apply conditioner/olive oil/vinegar to allow easier movement thru hair with comb
2. take fine toothed comb and comb until no lice found in session
3. repeat every 2-3 days for several weeks until 2 weeks after the last adult louse is found