Shingles Flashcards
Does the vaccine for shingles hurt?
If a person is over 50, they should get the vaccine. The vaccine hurts, but shingles itself is on another dimension of pain
What is the typical presentation of shingles?
Painful and tingly sensation on trunk
Development of small blisters along nerve pathways (oozing/crusting can occur)
Usually affects one side of the body (not bilateral)
Occurs in 10-30% of people
Before the rash appears, pain is possible
It takes 3-4 weeks to resolve
What pathogen causes shingles?
Reactivation of chicken pox (varicella) virus in nerves
When does shingles occur?
Usually 50 years after chickenpox infection (can happen in younger people, but rare)
What should pharmacists do when patients present with pain on one side of their back?
This is the realm of MD
Is shingles on the face a severe condition?
Yes, it is a medical emergency because it could spread to the eyes
What agents are used to treat the acute phase of shingles?
Antivirals within 72 hours (less effective in people younger than 50)
Analgesics (pain relief)
Cool compress/calamine (itch relief)
How long do people need to use antivirals to prevent shingles from getting really bad?
7 days
Are pharmacists prescribing a lot of antivirals for shingles?
No, Sask pharmacists only prescribed antivirals 65 times in 2019
Can NSAIDs be used to help with pain in shingles?
We can use NSAIDs in acute shingles, but not the chronic form
What is chronic shingles?
The skin has healed, but the pain remains for a longer period of time (post-herpetic neuralgia)
What drugs are commonly used to treat pain associated with chronic shingles?
TCAs (amytriptyline): very common choice
Capsaicin
What is the difference between neuropathic and somatic pain?
Neuropathic: The pain originates from the nerves and feels like hitting your funny bone 24/7
Somatic: The pain is from non-nervous tissue and it is like stubbing your toe (more temporary)
Are NSAIDs effective in managing pain in chronic shingles?
No, they do not help manage painin chronic shingles
What is the benefit of capsaicin?
It irritates the skin (counter-irritant), and it also reduces Substance P (associated with nerve pain)
Do not apply products with capsaicin on an active shingles rash (it will aggravate)
Can someone with shingles pass it to other people?
Shingles itself cannot be transmitted, but chickenpox can be spread (same pathogen)
How long does the immunity under shingles vaccines last?
4 years according to drug manufacturers
What is pityriasis?
A spotty rash that has ambigious visual presentation, but one large rash will dominate a sea of smaller rashes
Seen in younger adults
Unknown etiology
Can go away on its own (last 6-8 weeks)
Can use anti-itch products, but no definitive therapy
How to differentiate pityriasis vs. other skin conditions?
Tinea (tinea does not spread as fast)
Eczema (eczema will be in different spots, itchier and possibly blisters at start)
Psoriasis (silvery crust on lesions)
Hives (move faster, itchier, and no scaling)
What condition is butterfly rash indicative of?
Lupus (more than 90% of patients have skin symptioms)
