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Clinical 1 (Part A) > Lice & Scabies > Flashcards

Lice & Scabies Flashcards

1
Q

Pediculosis = ?

A

Lice

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2
Q

Describe Pediculosis (lice)

A
  • ectoparasites that live on human hosts
  • feed off of blood
  • live in hair (prefer clean hair)
  • do not burrow into skin
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3
Q

Read Pg 876 of CTMA 2 for lice pathophysiology

A

ok

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4
Q

pediculus humanus capitus

A

head lice

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5
Q

pedicures humanus corporis

A

body lice

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6
Q

phthirus pubis

A

pubic lice

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7
Q

Describe head lice

A
  • feed every 3-6 hours so eat about 3-4 times per day
  • live on hair close to scalp
  • need the heat from the scalp to maintain their body temperature
  • about 10-20 live lice per active infection
  • they are about the size of a sesame seed
  • they lay eggs called Nits
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8
Q

Describe body lice

A
  • body lice will live and hide in the seams of clothes
  • feed at night - which will cause nocturnal itching
  • body lice are bigger than head lice
  • body lice can spread disease
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9
Q

Describe pubic lice

A
  • can have pinchers, thats why they are called “crabs”
  • smaller pin sized head
  • they are shorter
  • arms are wider (need a longer reach because pubic hair is farther apart than normal hair)
  • small yellow, or light brownish when empty
  • brown/red when fed
  • public lice can also be found in armpits, eyelids, and beards
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10
Q

Risk factors for Lice

A
  • school aged children

- more prevalent in females (they have longer hair, share clothes/hats, and combs)

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11
Q

Is personal hygiene or socioeconomic status determine whether or not you or your kid will have lice?

A

not head lice

but can be a factor for body lice

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12
Q

T or F: lice spread disease

A

head lice - false

body lice - true

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13
Q

Describe the life cycle of lice

A
  • adult female life cycle = 30 days and she lays about 7-10 eggs per day
  • lice lays eggs (called a nit)
  • eggs hatch 8-10 days later and undergo 3 nymph stages to eventually mature into adult forms within 8-15 days (head and body) or 14-22 days (pubic)
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14
Q

How long can head lice survive off the human for?

A

4 days

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15
Q

How long can body lice survive off the human for?

A

3 days

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16
Q

How long can pubic lice survive off the human for?

A

3 days

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17
Q

Risk factors for head lice

A
  • aged 3-11
  • female
  • clean hair/healthy host
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18
Q

Risk factors for body lice

A
  • poverty
  • overcrowding
  • low hygiene
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19
Q

Risk factors for pubic lice

A
  • sexually active

- young adults

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20
Q

Transmission of head lice

A
  • head to head contact

- Fomites: hats, hair accessories, brushes, towels

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21
Q

Transmission of body lice

A
  • direct body contact with infested person

- shared clothing & linens

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22
Q

Transmission of pubic lice

A
  • mainly sexual or close body contact

- possibly fomites (why the f u wearing hats on ur junk ?)

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23
Q

How fast can lice run?

A

23cm/min

speedy

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24
Q

Signs and symptoms of head lice

A
  • pruritus (itching) especially the back and side of scalp
    • this occurs when the individual becomes sensitized to the saliva from the louse feeding (this can take 4-6 weeks for initial infestation or 1-2 days for secondary infestation)

-some people may be asymptomatic

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25
Q

Describe eggs & nits

A
  • nits are 0.3-0.8 mm in diameter (that’s why lice comb should have fine teeth - 0.2 to 0.3 mm apart)
  • viable nits generally blend in with hair colour & and located within 6 mm of the scalp
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26
Q

Gold standard for diagnosing head lice?

A

visualization of a live louse

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27
Q

Signs & symptoms of body lice

A
  • nocturnal pruritus
  • bite marks around the waist and axillae
  • potential secondary bacterial infection
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28
Q

Signs & symptoms of pubic lice

A
  • pruritus
  • bite marks
  • risk of secondary bacterial infection
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29
Q

Describe the wet combing technique

A
  • best way to detect lice infestation
  • wash hair then apply and leave in conditioner
  • brush hair
  • it may help to separate the hair into sections with clips
  • comb through hair with lice comb starting with comb touching the skin of the scalp and comb to the edge of the hair
  • look carefully at the teeth of the comb in good light
  • wipe the teeth with piece of paper towel
  • do this until the whole head has been combed through
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30
Q

Differential diagnosis for head lice: Need to consider what other possible conditions?

A
  • dandruff
  • seborrheic dermatitis
  • accumulation of hair cosmetics, paint flecks, or debris
  • pseudo-nits
  • psychogenic itch
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31
Q

Differential diagnosis for pubic lice: Need to consider what other possible conditions?

A
  • seborrheic dermatitis
  • folliculitis
  • dermatophytosis (jock itch)
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32
Q

Differential diagnosis for body lice: Need to consider what other possible conditions?

A
  • seborrheic dermatitis
  • folliculitis
  • eczema (atopic dermatitis)
  • impetigo (bacterial infection)
  • flea or insect bites

*also need to determine whether its body lice or bed bugs

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33
Q

Scabies:

describe it

A

-highly contagious infestation of the skin with the human mite

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34
Q

Scabies:

who is at risk

A

children, mothers of young children, sexually active adults, & elderly in nursing homes

so 91.6543% of the earth’s population

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35
Q

Contrast lice from scabies

A

lice - ectoparasite - lives outside the body

scabies - burrow into the top layer of the skin

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36
Q

Scabies:

Where do epidemics occur?

A

in poor living conditions (poverty, poor hygiene, overcrowding) & institutions

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37
Q

Scabies:

Required reading - describe the pathophysiology (Pg 881 CTMA 2)

A
  • transmitted through close personal contact, particularly sexual contact
  • spread by coming into contact with infested furniture, towels
  • an impregnanted mite - has a rounded body and 4 pairs of legs, and HAS THE AUDACITY to burrow into the upper most layer (stratum corneum) of the epidermis
  • she leaves a trail of shit as she does this - I shit you not
  • then this psycho lays 2-3 eggs every day.
  • she stays in the burrow (so lazy) and lays eggs til she dies (about 4-6 weeks later)
  • 3-4 days after the eggs are laid, they hatch and the large w 6 legs travel from the burrow to the skin surface to mature into adult mites within 14-17 days
  • then her little eggs grow up to be just as gross as their mother
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38
Q

On warm skin - mites can crawl how fast?

A

2.5 cm/min

fast little buggers

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39
Q

Pts typically harbour how many mites?

A

10-12 mites

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40
Q

How long can scabies survive off of the human host for?

A

2-36 hours at room temp

*in a cool humid environment survival is increased to about 19 days

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41
Q

Upon initial infection of scabies, how long does it take for sensation of the mites, eggs or feces to cause intense pruritus?

A

3-4 weeks

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42
Q

Upon secondary infection of scabies, how long does it take for sensation of the mites, eggs or feces to cause intense pruritus?

A

24-48 hours

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43
Q

Transmission of scabies

A
  • primarily by skin-skin contact

- transmission by fomites (furniture, towels, etc) is extremely rare unless Pt has a very high parasite load

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44
Q

Scabies:

signs & symptoms

A
  • redness of skin
  • linear burrow with visible tracts
  • itchiness (more intense at night or in warm conditions)
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45
Q

Scabies:

Why may you still experience itch after the parasite has left your body?

A

Because these gross fuckers literally leave their shit in your skin. That’s why.
You’re a fucking port-a-potty for mite shit, no wonder you’re fucking itching.

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46
Q

Scabies:

As a pharmacist can you diagnose scabies?

A

nope - must refer to physician for actual diagnosis

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47
Q

Scabies:

Differential diagnosis for scabies must look at other potential conditions such as?

A
  • seborrheic dermatitis
  • impetigo
  • body lice
  • bed bugs/insect bites
  • eczema (atopic dermatitis)
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48
Q

Contrast atopic dermatitis and scabies.

A

Atopic dermatitis:
the itch that rashes

Scabies:
the rash that itches

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49
Q

Out of all the types of lice and scabies - which are self-treatable?

A

Self-treatable:

  • head lice
  • body lice

Not Self-treatable (need referral):

  • pubic lice
  • scabies
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50
Q

Why do you need to refer public lice and scabies?

A

1 - scabies is a very difficult differential diagnosis

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51
Q

Scabies:

red flags/ when do you refer?

A
  • presence of secondary bacterial infection in lice or scabies infested areas (signs of infection include inflammation, pus, warm to touch)
  • resistant/recurrent cases
  • Pts with suspected scabies
  • Pts with pubic lice
  • Lice infestation in eyebrows and eyelashes
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52
Q

Non-pharmacological treatment & prevention for lice

A
  • nit removal - wet combing technique
  • avoid sharing personal items
  • items should be dry clean, washed in hot water, or stored in plastic bag for 10-14 days
  • soak combs and brushes in hot water for 5-10 mins or wash with pediculicide
  • carpets, rugs and furniture should be vacuumed

*ensure family members and bedmates be treated prophylactically

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53
Q

Lice & Scabies:

Goals of therapy

A
  • exterminate scabies or lice
  • relieve pruritus
  • prevent secondary bacterial infection
  • prevent spread of the infestation
54
Q

Treatment of Lice & Scabies:
Permethrin 1% & 5%:
brand name?

A

Nix (creme rinse, cream)
or
Kwellada P (creme rinse, lotion)

55
Q

Treatment of Lice & Scabies:
Permethrin 1% & 5%:
mechanism of action?

A

insecticide, respiratory paralysis

56
Q

Treatment of Lice & Scabies:
Permethrin 1% & 5%:
Indication?

A

head lice & scabies (pubic lice off-label)

57
Q

Treatment of Lice & Scabies:
Permethrin 1% & 5%:
NAPRA Schedule ?

A

2

58
Q

Treatment of Lice & Scabies:
Pyrethrin with Piperonyl but oxide (PPB):
brand name?

A

R&C (0.33/3%)
or
Pronto (0.33/4%)

59
Q

Treatment of Lice & Scabies:
Pyrethrin with Piperonyl but oxide (PPB):
mechanism of action?

A

insecticide, respiratory paralysis

60
Q

Treatment of Lice & Scabies:
Pyrethrin with Piperonyl but oxide (PPB):
indication?

A

Head & pubic lice (scabies - off label)

61
Q

Treatment of Lice & Scabies:
Pyrethrin with Piperonyl but oxide (PPB):
NAPRA Schedule ?

A

2

62
Q

Treatment of Lice & Scabies:
Isopropyl myristate 50%:
brand name?

A

Resultz (liquid)

63
Q

Treatment of Lice & Scabies:
Isopropyl myristate 50%:
mechanism of action?

A

noninsecticidal, dehydration (dissolves the exoskeleton)

64
Q

Treatment of Lice & Scabies:
Isopropyl myristate 50%:
indication?

A

head lice

65
Q

Treatment of Lice & Scabies:
Isopropyl myristate 50%:
NAPRA Schedule ?

A

3

66
Q

Treatment of Lice & Scabies:
Dimeticone 100 cSt 50%:
brand name?

A

NYDA (spray)

67
Q

Treatment of Lice & Scabies:
Dimeticone 100 cSt 50%:
mechanism of action?

A

non-insecticidal, suffocation (perhaps gut rupture)

68
Q

Treatment of Lice & Scabies:
Dimeticone 100 cSt 50%:
indication?

A

head lice

69
Q

Treatment of Lice & Scabies:
Dimeticone 100 cSt 50%:
NAPRA Schedule ?

A

3

70
Q

permethrin 1% used for?

A

lice

71
Q

permethrin 5% used for?

A

scabies

72
Q

pediculicide activity

A

ability to kill lice

73
Q

ovicidal activity

A

ability to kill viable eggs

74
Q

residual activity

A

retention of pediculicide on the hair and scalp after washing

75
Q

Which out of the 4 products (permethrin, PPB, isopropyl myristate, and dimeticone) have pediculicide activity?

A

all of them

76
Q

Which out of the 4 products (permethrin, PPB, isopropyl myristate, and dimeticone) have ovoidal activity?

A

permethrin: 70-80%
PPB: 70-80%
Isopropyl myristate: no
dimeticone: yes

77
Q

Which out of the 4 products (permethrin, PPB, isopropyl myristate, and dimeticone) have residual activity?

A

permethrin: yes?
PPB: no
Isopropyl myristate: no
dimeticone: no

78
Q

Cure rate for permethrin

A

96-100%

79
Q

Cure rate for PPB

A

94%

80
Q

Cure rate for isopropyl myristate

A

57-93%

81
Q

Cure rate for dimeticone

A

97%

82
Q

Go see Table 5: Topical Therapy for Treatment of Head Lice on pg 885-886 of CTMA 2

A

if i must

83
Q

When recommending permethrin or PPB, what allergy must you always ask the Pt about?

A

chrysanthemum or ragweed

if they do have allergies to either of these, do not recommend permethrin or PPB

84
Q

Permethrin:

can you use in pregnancy?

A

yes - it is the drug of choice

Briggs - Compatible

85
Q

PPB:

can you use in pregnancy?

A

yes - 2nd line choice

Briggs - likely compatible

86
Q

Isopropyl myristate:

can you use in pregnancy?

A

safety unknown

87
Q

Dimeticone:

can you use in pregnancy?

A

safety unknown

88
Q

Permethrin:

can you use when lactating?

A

yes - DOC (drug of choice)

Briggs - Compatible

89
Q

PPB:

can you use when lactating?

A

yes - 2nd line choice
Briggs - likely compatible

*infant risk cannot be ruled out

90
Q

Isopropyl myristate:

can you use when lactating?

A

safety unknown

91
Q

Dimeticone:

can you use when lactating?

A

safety unknown

92
Q

Permethrin:

can it be used in children and elderly?

A

use in children >2

*can be used when they’re younger under MD supervision

93
Q

PPB:

can it be used in children and elderly?

A

use in children >2

*can be used when they’re younger under MD supervision

94
Q

Isopropyl myristate:

can it be used in children and elderly?

A

use in children >2

*CPS clinical states not to recommend to infants and children <4

95
Q

Dimeticone:

can it be used in children and elderly?

A

use in children >2

96
Q

Pediculicide Resistance:

describe the 2 mechanisms of resistance

A

1) knockdown resistance - aka me when I’m drinking (kdb) - sodium channel gene mutation
2) enzyme upregulation (glutathione S-transferase)

97
Q

Non-Rx products used to treat lice:

Choice depends on?

A
  • local resistance patterns
  • previous treatment
  • product efficacy
  • safety considerations/patient characteristics: red flags, contraindications, age, allergies
  • ease of administration
  • cost
  • Pt preference
98
Q

Non-Rx products used to treat lice:

Permethrin 1%

A
  • first line treatment in canada
  • demonstrated efficacy, good safety profile
  • resistance found elsewhere
99
Q

Non-Rx products used to treat lice:

PPB

A
  • good alternative to permethrin 1%, also considered a first line treatment
  • resistance found elsewhere
100
Q

Non-Rx products used to treat lice:

isopropyl myristate Or dimeticone

A
  • when permethrin or PPB contraindicated
  • resistance to other agents suspected
  • patient preference/opinion
101
Q

Permethrin:

Describe hair, quantity, application, contact, directions, and when to reapply

A 
Hair-towel dried hair after a wash
Quantity-short hair = 30 mL
Quantity-long hair = 60 mL
Application - shake well and saturate hair &amp; scalp
Contact - 10 mins
Directions - rinse, remove nits
Reapply - 7 days
102
Q

PPB:

Describe hair, quantity, application, contact, directions, and when to reapply

A

Hair - dry
Quantity-short hair = 25 mL
Quantity-long hair = 100 mL
Application - saturate hair, massage into scalp
Contact - 10 mins
Directions - add small amounts of cool water, massage until lather forms. Rinse. Remove nits.
Reapply - 7-10 days

103
Q

Isopropyl myristate:

Describe hair, quantity, application, contact, directions, and when to reapply

A 
Hair - dry
Quantity - short = 30-60 mL
Quantity - medium = 60-90 mL
Quantity - long = 90-120 mL
Application - saturate hair, massage into scalp
Contact - 10 mins
Directions - rinse, remove nits.
Reapply - 7 days
104
Q

Dimeticone:

Describe hair, quantity, application, contact, directions, and when to reapply

A 
Hair - dry 
Quantity - short = 10 mL
Quantity - med = 18 mL
Quantity - long - 22 mL
Quantity - very long = 34 mL
Application - screw pump on. Spray hair to saturate and massage into scalp.
Contact - 30 mins
Directions - DO NOT RINSE. Remove nits. Leave on hair to dry at least 8 hours. Wash out with normal shampoo
Reapply - 8-10 days
105
Q

Why do we reapply at least 7 days after?

A

In case you haven’t killed all the nits. We do it 7 days after to ensure that the nit will have hatched but not have gone through the 3 bolts to form adult lice so they won’t be having more gross babies and causing further infestation.

106
Q

What things could cause head lice treatment failures?

A
  • misdiagnosis
  • improper application: incorrect technique, insufficient amount, second tx not give or at an inappropriate interval
  • re-infestation
  • resistance
107
Q

What do you do when a properly applied treatment fails?

A

switch to a product in a different pharmacologic class

*note - permethrin and PPB are in the same pharmacologic class

108
Q

List 3 other head lice treatments

A

1) 5% benzyl alcohol lotion (Ulesfia)
- approved for use in canada for 6 months old to 60 yrs old
- pediculicide effectiveness but not ovicidal
- 2nd treatment needed 9 days after 1st treatment
- can cause skin irritation as a side effect

2) 0.5% malathion lotion
- not available in Canada

3) Lindane
- no longer available in canada
- risk of neurotoxicity and bone marrow suppression
- WHO recently recategorized lindane as a probable carcinogen

109
Q

Alternative therapies to treat lice when standard therapy fails:
Permethrin 5%

A

leave on hair overnight covered with plastic shower cap

110
Q

Alternative therapies to treat lice when standard therapy fails:
Septra DS

A

apply BID for 10 days & Nix 1% applied for 10 mins on days 1 & 7-10

111
Q

Alternative therapies to treat lice when standard therapy fails:
Crotamiton

A

applied to scalp for 24 hours or 2 nighttime applications

112
Q

Alternative therapies to treat lice when standard therapy fails:
Ivermectin

A

dose 200 μg/kg as a single dose followed by 2nd dose in 7-10 days
*do not use in children less than 15 kg

113
Q

Alternative therapies to treat lice when standard therapy fails:
Herbal treatment

A

lack of adequate data to show efficacy of herbal agents and also side effects possible
ex. tea tree oil, lavender oil

114
Q

Alternative therapies to treat lice when standard therapy fails:
Home remedies

A

hair dye, mayonnaise, petroleum jelly and cetaphil

DO NOT WORK

115
Q

Alternative therapies to treat lice when standard therapy fails:
bug busting

A

where you heat the bugs up

-low efficacy

116
Q

Alternative therapies to treat lice when standard therapy fails:
head shaving

A

effective but unnecessary

117
Q

Treatment of pubic lice

First line treatment?

A

*needs a referral

  • pediculicides used to treat head lice are effective for pubic lice also
  • use of permethrin 1% cream rinse or PPB applied to affected areas then washed off after 10 mins are first line options, with second treatment in 7-9 days
118
Q

Treatment of pubic lice:

If eyelashes are infested ?

A
  • remove nits and lice using tweezers then

- apply white petrolatum (Tears Naturale is ophthalmic grade) twice daily for 10 days

119
Q

Treatment of pubic lice:

Sexual contacts within the previous ____ should be treated if infested

A

month

120
Q

Treatment of pubic lice:

if pediculicide causes itching - how do you treat it?

A

treat with oral antihistamine or topical corticosteroid

121
Q

Treatment of body lice

A

Pediculicides unnecessary (exception is if lice are adherent to body hairs)

Hygienic measures treatment of choice:

  • bathing
  • launder items in hot water/dry cleaning
  • seal items in plastic bags for 10-14 days
  • improve lining conditions
  • isolated from close contacts x 24 hours
122
Q

See pg 880 for Table 2 on monitoring therapy for lice

A

okay man

123
Q

Scabies:
infested persons and their close physical contacts from the previous ____ should be treated at the same time, WHETHER OR NOT SYMPTOMS ARE PRESENT

A

month

124
Q

Scabies:

non-pharm treatment and prevention

A
  • wash clothing and linens in hot water with soap and then through the hot cycle of the dryer
  • store unwashed clothing in plastic bags for 5-7 days
  • vacuum rugs, furniture and unwashable items
  • avoid body contact with others until treatment complete
125
Q

Treatment of scabies:

Most effective scabicide?

A

permethrin 5%

*can be used for adults and children > 2

126
Q

Treatment of scabies:

What is permethrin 5% available as?

A

Nix dermal cream

Kwellada-P lotion

127
Q

Treatment of scabies:

Second line options? (2)

A

1) crotamiton 10%
- antiparasitic, unknown mechanism of action
- less effective than permethrin and resistance has been reported

2) topical sulfur 5-10%
- keratolytic, fungicidal, parasitical, antibacterial
- prevents respiration in insects
- limited data demonstrating efficacy
- preferred treatment in infants < 2 months

128
Q

Treatment of scabies:

Describe application of permethrin 5%

A

1 - apply to clean, cool, dry skin
2 - massage cream into skin from neck to soles of feet
3 - if hands are washed - reapply
4 - remove after 8-14 hours by taking a shower or bath. Dress is clean clothes
5 - reapply 7 days later if necessary

129
Q

Treatment of scabies:

Nix dosing

A 
>12 = 30 g
5-12 = 15 g
2-5 = 7.5 g
<2 = 4-7 g

*if obese or scalp is involved - may need more than 30 g

130
Q

Go see table 4 on pg 884

A

ya ya ya ya ya

131
Q

Go see the 7 billion cases from Drena

A

alright alright alright alright alright alright alright alright

Clinical 1 (Part A) (15 decks)

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