Insects and Infestations Flashcards
Pharmacologic treatment for fleas
PO antihistamines like cetirizine, loratadine, fexofenadine; topical corticosteroids
Supportive measures for fleas
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
Pharmacologic treatment for bedbugs
Low or medium potency topical corticosteroid, systemic antihistamine, avoid scratching
Supportive measures for bedbugs
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
Self-care for bites
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).
How to use external analgesic for bites?
AAA TID or QID for no more than 7 days
Who should you not use external analgesics on?
Patients <2 years old
What should you not use in bite treatment: dibucaine
Don’t use in large quantities over raw surfaces or blistered areas
What should you not use in bite treatment: topical diphenhydramine
Don’t use longer than 7 days
What should you not use in bite treatment: hydrocortisone
Don’t use in scabies, bacterial infections, fungal infections without medical recommendation
Exclusions to self-care for bites
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
Self-care for stings
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
Exclusions to self-care for stings
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
Permethrin brand name
Nix
What strength of permethrin is used for head lice?
1%
What strength of permethrin is used for scabies?
5%
Nix counseling instructions
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
What happens if live lice are seen 7 days or more after the first treatment of Nix?
Second treatment should be given
Pyrethrin/piperonyl butoxide brand name
Rid
Rid counseling instructions
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
Wet combing instructions
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.
Lindane toxicity
Neurotoxicity
When do you use lindane?
In patients who can’t tolerate or who have failed other therapies for lice or scabies
When is PO Bactrim and topical Nix used in head lice?
Resistant cases
Permethrin 5% cream counseling instructions
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.
Where else should you apply permethrin 5% cream in geriatric and infant patients?
Hairline, neck, temples, and forehead
Age indication for 5% permethrin
> 2 months
Breastfeeding while on permethrin 5% cream
D/C temporarily
Age indication for DEET use
> 2 months
Concentration of DEET recommended for children
<30%
Concentrations of DEET that will usually work
10-35%
How often should you use DEET?
No more frequently than q4-8h
Rare reactions of DEET
Dermatitis, allergic reactions, neurotoxicity
Avoid inhaling!
