Insects and Infestations

Question 1

Pharmacologic treatment for fleas

Answer 1

PO antihistamines like cetirizine, loratadine, fexofenadine; topical corticosteroids

Question 2

Supportive measures for fleas

Answer 2

Kill adults on infested pets, destroy eggs, larvae, and adults in bedding, carpet, furniture

Treat pets and/or home with topical insecticides

Wash pet bedding frequently and keep carpets clean

Throw out infested furniture

Avoid scratching and wash area; use ice packs and calamine

Question 3

Pharmacologic treatment for bedbugs

Answer 3

Low or medium potency topical corticosteroid, systemic antihistamine, avoid scratching

Question 4

Supportive measures for bedbugs

Answer 4

Keep suitcases on luggage rack and not touching the wall or in the bathroom

Place worn garments in a sealed plastic bag

Don’t bring home furniture from the street

Kill all stages of bedbug: wash at 60ºC, dry at >40ºC x30mins, freeze ~17ºC x2 hours

Hire exterminator

Silica

Question 5

Self-care for bites

Answer 5

Wash with soap and water, then ice for ten minutes. Do this on/off for 30-60 minutes

Use external analgesic to relieve pain: local anesthetics and counterirritants (camphor/menthol).

Question 6

How to use external analgesic for bites?

Answer 6

AAA TID or QID for no more than 7 days

Question 7

Who should you not use external analgesics on?

Answer 7

Patients <2 years old

Question 8

What should you not use in bite treatment: dibucaine

Answer 8

Don’t use in large quantities over raw surfaces or blistered areas

Question 9

What should you not use in bite treatment: topical diphenhydramine

Answer 9

Don’t use longer than 7 days

Question 10

What should you not use in bite treatment: hydrocortisone

Answer 10

Don’t use in scabies, bacterial infections, fungal infections without medical recommendation

Question 11

Exclusions to self-care for bites

Answer 11

Hypersensitivity to insect bites resulting in systemic symptoms or symptoms away from the bite area

<2 years old

History of tick bite and systemic effects indicating possible infection

Suspected spider bite

Signs of secondary infection of the area

Question 12

Self-care for stings

Answer 12

Remove the stinger ASAP and ice alternating 10 minutes

OTC meds are the same as bites

PO Benadryl 25-50mg can help

Allergic reaction Sx- go to ER

Question 13

Exclusions to self-care for stings

Answer 13

Anaphylaxis reaction

Significant allergic response away from sting site

Previous sting by bee, wasp, or hornet

Previous severe reaction to insect bites

Personal or family history of significant allergic reactions

<2 years of age

Question 14

Permethrin brand name

Answer 14

Nix

Question 15

What strength of permethrin is used for head lice?

Answer 15

1%

Question 16

What strength of permethrin is used for scabies?

Answer 16

5%

Question 17

Nix counseling instructions

Answer 17

Shampoo hair, NO conditioner, rinse with water –> towel dry hair so it’s damp and completely saturate the hair and scalp with Nix; start with applying Nix behind the ears and scalp. Leave in for 10 minutes then rinse with warm water over the sink. Towel dry hair and comb out tangles.

Keep Nix out of the eyes

Question 18

What happens if live lice are seen 7 days or more after the first treatment of Nix?

Answer 18

Second treatment should be given

Question 19

Pyrethrin/piperonyl butoxide brand name

Answer 19

Rid

Question 20

Rid counseling instructions

Answer 20

Apply thoroughly to DRY hair or other affected area (for head lice, apply behind the ears and back of neck). Allow product to remain in for 10 minutes, then use warm water to form a lather, shampoo, then thoroughly rinse over the sink. Towel dry hair and comb tangles out

Question 21

Wet combing instructions

Answer 21

Wash hair with shampoo, then add a lot of conditioner. Straighten and detangle wet hair using a wide-toothed comb, then switch to lice detection comb. Comb hair from root to tip with the beveled edge down towards the scalp and check comb for lice after every stroke. Work through hair section by section, then rinse out the conditioner. Repeat the combing procedure in wet hair to check for lice again.

Question 22

Lindane toxicity

Answer 22

Neurotoxicity

Question 23

When do you use lindane?

Answer 23

In patients who can’t tolerate or who have failed other therapies for lice or scabies

Question 24

When is PO Bactrim and topical Nix used in head lice?

Answer 24

Resistant cases

Question 25

Permethrin 5% cream counseling instructions

Answer 25

Apply throughout body into skin from neck to soles of feet, including under the fingernails and toenails. Remove by washing 8-14 hours later, then reapply 1-2 weeks later.

Question 26

Where else should you apply permethrin 5% cream in geriatric and infant patients?

Answer 26

Hairline, neck, temples, and forehead

Question 27

Age indication for 5% permethrin

Answer 27

> 2 months

Question 28

Breastfeeding while on permethrin 5% cream

Answer 28

D/C temporarily

Question 29

Age indication for DEET use

Answer 29

> 2 months

Question 30

Concentration of DEET recommended for children

Answer 30

<30%

Question 31

Concentrations of DEET that will usually work

Answer 31

10-35%

Question 32

How often should you use DEET?

Answer 32

No more frequently than q4-8h

Question 33

Rare reactions of DEET

Answer 33

Dermatitis, allergic reactions, neurotoxicity

Avoid inhaling!