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PHAR 398: Minor Ailments > Skin Conditions of Childhood > Flashcards

Skin Conditions of Childhood Flashcards

1
Q

What are two dermatological conditions that pharmacists should be more aggressive in regarding therapy?

A

Eczema and Acne

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2
Q

In acne, what should be the starting point for acne treatment as of now?

A

Almost a defacto starting point for combination therapy

  • BP combomination with a retinoid
  • Retinoid with an antibiotic
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3
Q

When would mono-therapy for acne be appropriate for acne?

A

Only time to use a single agent would be in the mildest case of acne possible

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4
Q

What is a major difference in the treatment of acne between the USa and Canada?

A

Differin - Adapalene
- OTC in the USA; not CAnada

Should be used by more children; need to be more aggressive with therapy here

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5
Q

Describe the available strengtbs of benzyl peroxide and if they are OTC or not

A

OTC –> 2.5-5%
Rx –> 10%

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6
Q

Indication of Benzyl peroxide

A

Solo for mild acne (rare)

Combination for moderate acne

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7
Q

Describe the mechanism of action of benzyl peroxide?

A

Anti-bacterial action - Delievers a blast of oxygen and decreases P. acnes

Exfoiliant Action = Mild surface peeling - Closed comedos open up and have less build up

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8
Q

How long should benzyl peroxide be trialled before a benefit may be seen?

A

3 months of a try to ramp up

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9
Q

What is the most common formulation of benzyl peroxide? Issue on this front?

A

Gels and lotions are the most common

BP Lotion - 6-8 hours of contact time
BP Washed - 15 hours of contact; washes may be more valuable than once thought

Do not need soap/wash and lotion/gel –> Only one BP product required

BP Washes - Benzac Wash (4 or 5%) - Not enough contact time; new reports coming out that may be more effective than once thought
–> Can go to BID-TID

Old Thinking –> More redness; OD to start and then BID-TID after a month

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10
Q

What are some common adverse effects of Benzoyl peroxide?

A

Redness, peeling, dryness, burning, bleaches clothes

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11
Q

Describe the role of spot treatment in acne?

A

Acne Patches:
- People report that they love them and say they “work”
- Astringent in there
- 4 or 5 versions; can be useful

Emergency Skin Patch - Okay

Emergency benzoyl peroxide should not be used
–> SPOT TREATMENT is still not effective

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12
Q

In acne, what is a cornerstone of therapy for everyone?

A

Normal skin care should be included in therapy

Skin Cleansing BID

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13
Q

Describe the indication of retinoids in acne?

A

Very effective topical agents

First-line agent or added to others

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14
Q

Describe the mechanism of action of retinoids?

A

Decrease the cohesiveness of the follicular wall

Increases the penetration of other agents

Vitamin A derivatives - reduce follicular stickness by retinoid receptors

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15
Q

Describe the avilable retinoids and there main adverse effects

A

Adapelene - least irritating
Tretinoin - Most photosensitizing
Taxarotene - Most potent

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16
Q

How can retinoids be dosed in acne?

A

Choose a formulation (examples: tretinoin 0.01% or 0.025% cream or 0.025% gel and 0.005% gel)

Start low and then assess in 2 months

Dose HS (photosensitive agents)

Skin needs to be dry prior to application

Pea-sized amount - disappear on skin in 1 min

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17
Q

Critical Counselling Point with Retinoids

A

Initial worsening of acne

Bring out everything clogging the pores that are hiding underneath

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18
Q

How can one apply benzoyl peroxide and retinoid in acne? Exceptions?

A

Apply retinoid at night
Apply BP during the day
–> Tretinoin and BP at same time –> D.I. and phosotosensitivity issue

BP can degrade (oxidize) tretinoin if used simulataneously, but this does not occur wjen using micronized tretinoin gel
–> patient could use both at HS

Adapalene and BP Combo Product - Tactupump - AVoids drug inetraction

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19
Q

What type of condition is diaper rash?

A

Irrirant contact dermatitis

Self-limiting - Episodes last approximately 2-3 days

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20
Q

Where does diaper rash commonly affect?

A

Only affects areas where diarhhea splashes

Skin folds are typically spared

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21
Q

What are some causes of diaper rash?

A

Fecal/urine contact –> Viral gastroenteritis ( stomach flu) leads to harsh diarhhea and harsh GI enzymes in the feces

Chemical residue (laundry detergent, wipes)

Chaffing

Antibiotic - Diarhhea as s/e

Formula more problematic than breast milk

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22
Q

What are some differentials f diaper rash?

A

Eczema - Typpically on face; not diaper area

Impetigo - Different presnetation, splotches

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23
Q

How can diaper rash be prevented?

A

Change diapers as quickly as possible

Keep the area clean

Barrier products - Tx and rotection - Vaseline

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24
Q

Describe the treatment of diaper rash

A

Keep the area clean
USe a barrier product at every diaper change
Allow air time
Steroid cream can be used

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25
Q

Describe the duration of treatment and agents for diaper rash

A

If just a diaper rash –> TX < 3 days
If yeast infected, >3 days and:

a) Fiery Red
b) vesicles/Sqatellites
c) Skin fold involvement

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26
Q

Describe the treatment agents for yeast-infected diaper rash

A

Keep the area clean
Anti-fungal
Steroid Cream
Barrier Cream

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27
Q

What is one way a pharmacist can conclude that diaper rash is yeast infected without seeing the rash?

A

Infant Oral Thrush - Yeast infection of the mouth

If have oral thrush with a diaper rah, automatically fungal

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28
Q

What anti-fungals and other agents can be used in the treatment of diaper rash? Duration?

A

Antifingals:

1) Clotrimazole 1%
2) Miconazole 2%

Applied BID for approximately 1 week and 1 week after clearing

If no improvement - suspect bacterial - MD referral

Steroids (0.5-1% HC - Can go up to Spectro Eczema - legal aspects here tho) for 2 days –> 1 FTU

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29
Q

Describe the application of the agents for diaper rash in infected and non-infected states? Can the agents be mixed together?

A

Antifungla –> HC –> Barrier
- Wait 2-3 mins between each application
- Ensure barrier is completly removed before the next application

Uninfected:

1) HC 0.5-1 % BID for 1-2 days
2) BArrier Creamk 4-5x day everyday

Infected:

1) ANti-fungal cream BID for 14 days
2) HC 0.5-1% BID for 1-2 days
3) Barrier Cream 4-5x per day everyday

** Do not mix corticosteroids and antifungals prior to applying

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30
Q

When should a child be refrred to an MD for diaper rash?

A

Refer to doctor if the rash does not improve in 7 days or resolve within 14 days

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31
Q

What is the difference between lice and nits?

A

Lice are alive
Nits are the eggs of lice and are laid close to the scalp for warmth - Glued to the hair shaft and do not wash out (need a special comb)
Symptoms –> None to itching

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32
Q

What are the two main OTC agents used for lice? Drug of choice?

A

Nix and Kwellada-P –> Permethrin 1% - pediculocides

Physical Agents –> Resultz (ispropyl myristate), ZAP (coconut and anise oil), NYDA (dimethicone)

Drug of Choice –. NYDA

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33
Q

Describe how NIX can be used for the treatment of lice?

A

Permethrin 1%
- Synthetic Pyrethroid (incraesed potency)
- High amount of safety in children

Application:

1) Wash hair with regular shampoo
2) Add creme rinse for 10 minutes
3) Rinse out

Manufacturer states that repeats are not needed as has residual activity and enough will hang around to kill the nits
–> Cut the losses and repeat to be sure

Will need to remove the nits and resistance is possible

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34
Q

What is Resultz? How to use?

A

Isopropyl Myristate
- Not an insecticide; dissolves lice exoskeleton

10 Mins of Application

Repeat in 7 days

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35
Q

What is NIx Ultra?

A

Resistant Lice - Resistant to insecticides

Anise Seed Oil 15% added
–> Aromatic compounds are somewhat deadly to lice
–> Very hard to see what is in the ultra version on website
–> Aromatic, some of the aromatic compounds have anti-lice properties whether agricultural or on people

Permethrins - Use it twice - Some resistance developping to NIX

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36
Q

What is the drug of choice for lice? What is the agent? Describe its mechanism of action?

A

Dimethicone
- Penetrates deeply and suffocates the lice and egg’s breathing system
- Physical and contact reaction with the lice

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37
Q

What is ZAP in the treatment of Lice? Efficacy?

A

Coconut/Anise OIl
–> 15 minutes of contact
- Nit pick
–> Repeat in 9 days

  • Still a decent choice
  • Aromatic oils have some value; do not know the concentration of effective dosages of the oils
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38
Q

Describe how NYDA should be used?

A

1) Dry hair
2) Apply NYDA (10-34 mL)
3) After 30 minutes of contact, then start nit-combing with product in the hair and product will dry
4) Leave the product in the hair for 8 hours (if overnight can use shower cap)
5) Wash out with regular shampoo in the next morning
6) Re-check the hair in 8-10 days
7) Repeat in 9 days (range 7-10 days)

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39
Q

What may occur after any treatment of lice?

A

Scalp can be itchy for a few days after lice treatment
–> Lice will put anti-coagulants in the scalp

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40
Q

Describe the rates of lice resistance to treatments

A

Lice can develop resistance to insecticides

Lice will not develop resistance to NYDA

Used to be worried about repeats to reduce resistance - NYDA can be repeated safely

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41
Q

What can be done if their is treatment failure of lice?

A

Suspect resistance if treatment resistance

Use a different agent (a different drug)

No resistant lice to NYDA so can use it again; most likely missed some of the lice

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42
Q

What strength of steroid can be used for diaper rash?

A

Can use spectro eczema on diaper rash area
- Spectro eczema for 1 dose for 2 days
- Spectro eczema is used in the UK for diaper rash
- Not indicated on label

HC 1% is low level; HC 2.5% can be prescribed as an RX; and is better agent

Zincofax - Use the CS once a day; covering it up, more absorption but not too concerned for one day use

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43
Q

How can a diaper rash be diagnosed as fungal? Is this diagnostic criteria?

A

Rash in the folds - Not a complete disganostic yes or no for for a fungal infection

3 day rule - Dial more into fungal infection

Spots above or below the diaper area - Thinking infection

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44
Q

What anti-fungals can be used for diaper rash?

A

Can use Canesten (vaginally or for the feet)
–> off the shelve

MD may prescribve ketoconazole for insurnace coverage reasons

Ketoconazole is similar to Canesten

1 vs 2% Canesten - Go with 1% - Nothing compels us to go with xtra strength

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45
Q

What are warts?

A

Human Papilloma Virus

Transmission - Touch to touch (self-innoculation can occur)

25% “spontaneously” regress –> Fail to mention spontaneous is one year

Cosmetic nuisance up to being painful

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46
Q

What is a solution agent that can be used for the treatment of warts?

A

Salicyclic Acid Preps

Duofilm Liquid (Salicylic acid and lactic acid)

Compound W for 8 weeks

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47
Q

How can duofilm be used for a wart?

A

Soak the wart first
Rub off dead skin
Vaseline at the base
Apply the drops
Cover the wart
Continue OD for 8-12 weeks

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48
Q

Describe the duration fo treatment with solution therapies for warts?

A

Duofilm Liquid - 8-12 weeks

Compound W - 8 weeks

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49
Q

Describe how to use OTC Cryotherapy for warts 9Compound W freeze off)

A

1) Lightly press the tip
2) Attach the tip to the applicator
3) Press down the tip into the canister and hold for 2 to 3 seconds - will hear a hiss sound
4) Apply the cold tip precisely on the wart

  • Soak the wart first

20 Seconds on the Hand
40 Seconds on the Foot (20 seconds, reload, another 20 seconds)

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50
Q

Describe the duration of use and repeats of cryotherapy for warts

A

Apply every 2-3 weeks for about 4 repeats

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51
Q

Is there a difference in efficacy between salicylic acid and cryotherapy for warts?

A

Equally effective so let the parent decide based on what they think the child can handle

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52
Q

When should a pharmacist refer for warts?

A

On the Face –> Refer
Multiple Lesions - Likely refer

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53
Q

What severity of acne can pharmacists prescribe for?

A

Mild acne –> Comedonal

< 20 comedones (whitehead/blackhead)
Or
< 15 inflammatory papules, or a lesiob count < 30

54
Q

What is a concern regarding plantar warts?

A

Core is a concern

Need to remove the core to remove the wart

55
Q

What is a solution agent that can be sued for plantar warts? Duration?

A

School Wart Remover (40% Salicylic Acid)

12 weeks for a wart

56
Q

Dual Action and Non-Dual Action for Plantar Warts Therapy

A

Dual Action: Freeze area then apply salicylic acid OD for 14 days - repeat for 4 cycles

Non-Dual Action: Freeze area Q2-3 weeks

57
Q

Salicylic Acid on Plantar Wart Duration

A

OD to Q2days for 12 weeks

58
Q

How can one distinguish a rash from teething from one of eczema on a child?

A

Saliva is contact dermatitis from teething
If not sure, just refer
Eczema and teething are common at this age
If parent is whiping saliva off the cheek, then more clues to a rash from teething

Teething around 6 months; eczema also common the face at this age

59
Q

What is fifth disease?

A

Starts with cold symptoms and then a rash develops
AKA - Slapped Cheek

60
Q

What causes fifth disease?

A

Human Parvovirus

61
Q

What is the difference between fifth and sixth disease in relation to when it occurs?

A

6th Disease - 2-3 years of age
5th Disease - 5-6 years of age and up to early adolescence
5th Disease commonly develops after 6th disease

62
Q

If fifth disease contagious? What is the treatment of fifth disease?

A

Fifth disease is contagious although it is a mild disease

No treatment for fifth disease
- Rash is not itchy
- Low grade fever can be present and Advil or Tylenol is unlikely required

63
Q

Describe rashes and URTi. How can one know if fifth disease has occured?

A

Rashes and utricaria (hives) are common with URTi
–> Hives will tend to be itchy and move
–> Rash with fifth disease is unlikely to be itchy

No one will know its fifth disease as it will intially present just as cold type symptoms

A low grade fever (not flu symptoms) may be present

Will know its fifth disease when a rash hits and develops

Fifth –> Virus with a little bit of cold symptoms and a rash

64
Q

Describe what commonly occurs with fifth disease and Tylenol/Advil?

A

The rash is due to the virus

If Tylenol or Advil is given prior to the rash, the drug will commonly be blamed for the rash (drug-induced rash)

65
Q

Describe the symptoms of fifth disease

A

Fifth disease begins with a low fever, headache, and mild cold-like symptoms

A rash appears a few days later

A distinctive red rash on the face that makes the child appear to have a “slapped cheek”

A few days later the rash spreads down to the trunk, arms and legs and usually lasts 1-3 weeks

After a few days, the rash, which may be itchy (unlikely), takes on a lacy-net like look

In the time it takes for the rash to completly clear, it may seem to get worse before it finally fades away

66
Q

What is the Roseola also known as?

A

AKA Sixth Disease

67
Q

Describe sixth disease

A

URTi initially; presents like a cold however a fever is present

The rash develops later

Contagious

68
Q

What is a common issue in sixth disease compared to fifth disease regarding medication usage?

A

High fever in sixth disease compared to fifth disease so therefore antipyretic medication usage is more common

Tylenol and Advil are more likely to be blamed for the rash rather than sixth disease

69
Q

Describe the treatment of sixth disease? How does the rash present?

A

No treatment for the rash; treatment of fever does not help with the rash

The rash is not blistering and no puss present

A splotchy rash that develops on the face and trunk and then spreads to the legs and arms

Rash should go away in 2-3 days

No treatment here

70
Q

Describe the difference in rash duration between fifth and sixth disease? Rash presnetation?

A

In sixth disease, rash should disappear in 2-3 days
- Rash is maculopapular (flat lesions, pimple like)

In fifth disease, the rash lasts longer (approx. 2 weeks)
- Erythema rash (just redness)

71
Q

Describe the symptoms of sixth disease?

A

Starts with a high fever that lasts for 3 to 5 days

Most children are nit very sick during the fever stage
–> Some children the fever can be associated with febrile seizures

CHild may be cranky or irritable

When the fever ends, a rash of small pinkish-red spots develop on the childs face and body

The spots will turn white when you touch them and they may have a lighter ring around them

The rash usually spreads to the neck, face, arms and legs

The rash can last from a couple of hours up to 2 days

The rash is not commonly itchy

72
Q

What is a maculopapular rash?

A

A maculopapular rash is made of both flat and raised lesions

A marker for many diseases, allergic reacytions, and infections

Most of the time, the cause is a viral infection

73
Q

What is hand/foot/mouth disease? How does it appear?

A

GI Virus - Gets past the gut
Starts with a cold

Appears as 2 days of fever, 2 days of mouth sores and 2 days of a rash

Cold symptoms initially, then get mouth ulcers (spots in the mouth that burst open)

If involves the hands and feet, easily diagnositic

74
Q

Is the diagnosis of hand/foot/mouth disease easy?

A

Somewhat easier to diagnosis than other childhood derm conditions when limited to the hands, feet and mouth

Sometimes may not present in the mouth and may only presnet around the mouth

75
Q

What age group is hand/foot/mouth disease common in?

A

Ages under 5 years old

76
Q

Treatment of hand/foot and mouth disease?

A

Nothing for treatment here
Maybe some eczema cream - Not as itchy as chicken pox
Tough it out situation

77
Q

Is hand/foot/mouth disease a serious or mild disease?

A

Hand, foot and mouth is usually not a severe dillness

78
Q

What are some of the main symptoms of hand, foot and mouth disease?

A

Small, painful ulcers in the mouth

A skin rash that looks like red spots, often with small blisters on top that appears on the hands (palms) and feet (soles), buttocks and sometimes other places

79
Q

How can hand/foot/mouth disease spread?

A

Disease is spread via contact with an infected person’s saliva or stool

Not spread for animals

80
Q

Are antibiotics necessary for hand/foot/mouth disease? Duration of disease?

A

Antibiotics are not required for hand/foot/mouth disease (viral) and will not help it go away any faster

It can last for 7-10 days

81
Q

What is molluscum? How many lesions?

A

A viral infection that is transmitted via skin to skin contact
- 10-20 lesions on average

82
Q

Describe the difference between molluscum and warts?

A

Similar to the wart virus

Warts are dense (vasculature and core udnerneath)

Molluscum lesions are soft and malleable
–> Dome shaped with indentations on the top

83
Q

Describe the treatment of molluscum?

A

Self-limiting: Will disappear in 6-9 months with the immune system

MD is required for treatment
- No OTC therapies effective here

First Line –> Frozen off by cryotherapy
Second Line –> curretage (cutting) of lesions - lidocaine injection underneath

Cantharine (beetle juice) is not likely to be effective here

84
Q

What age group is commonly effected by molluscum?

A

Any age can be effected by molluscum
In adults - Differential –> STD

Traditionally affects children 10 years and younger

85
Q

Describe the lesions of molluscum? Symptoms?

A

Firm, dome shaped, flesh-colored bumps

Relatively painless, but they can be very itchy

Molluscum is generally asymptomatic and is often not accompanied by a fever or malaise

May have only one lesion but often presents as a group of papules spread throughout the body

86
Q

What is a concern with mollusucm?

A

The disease can spread throughout the body via self-contamination

87
Q

What is milia?

A

Used to be called childhood acne
- Cosmetic front here; low level stuff
Self-limiting and will go away on its own in a couple of weeks
Little white bumps that commonly occur along the nose line

88
Q

Describe the treatment of milia

A

No pharmacological therapy here

A face cloth can be used to help get rid of the little bumps

89
Q

Is milia common in pediatrics? When does it appear?

A

About to 40-50% of newborn babies will have milia; most often on the cheek, nose and chin

Typically appears a day or two after birth

90
Q

What is angular chelitis? WHat is impetigo? How can one distinguish between both disease states?

A

Angular Chelitis - Bust open the sides of the mouth and get irritation

Impetigo - Vesicles and lesions around the mouth (commonly) that have golden and yellow exudate

91
Q

Simply describe a pharmacists role in impetigo?

A

Pharmacists have prescribing authority for impetigo
- Does the individual have access to care?
While we have prescribing authority here, impetigo can have various presentations so it is okay to refer

92
Q

Describe the prevalence of impetigo

A

Most common bacterial skin infection in children aged 2-5 years old

93
Q

Describe the symptoms of impetigo

A

Contagious skin infection that mainly affects children and infants

Appears as red sores on the face, especially around a child’s nose and mouth and on hand and feet

The sores burst open and develop honey coloured crusts
–> Sores that do not blister aare common (non-bolous) - No blistering other than oozing (70%)

Red sores that quickly rupture, ooze for a few days, and then form a yellowish-brown crust

Itching and soreness are generally mild

94
Q

What time of the year is impetigo more common?

A

Impetigo is more common in the summer

95
Q

Describe impetigo as a disease state

A

All age groups, but is usually seen in young children

96
Q

Describe impetigo: Age, causuative organism; sx, and duration

A

All age groups, but is usually seen in young children

Streptococcus pyogenes or Staphylococcus Aureus

Involves the face

Has regional lympadenopathy

Self-limited to 2 to 3 weeks

Vesicles may progress to pustules –> easily rupture –> honey-coloured crusts

97
Q

Does impetigo have one or multiple condition presentations?

A

A less common form of impetigo, called bullous impetigo, may feature large blisters that occur on the trunk of infants

A more serious form of impetigo, called ecthyma, penetrates deeper into the skin - causing painful fluid-or pus-filled sores that turn into deep ulcers –> RAre

98
Q

What age does impetigo commonly affect?

A

Commonly occurs in children aged 2-5 years old

99
Q

How can impetigo be spread?

A

Crowded Conditions - Spreads easily in schools and child care setting

More common in the summer

Transmitted through skin to skin contact

100
Q

What is the differential of impetigo?

A

Eczema - Will be itchier, less crusts

Contact Dermatitis - Will have contact with something

Herpes SImplex - Painful and tingling

Impetigo is not painful or itchy; golden crusts can hue us into impetigo

Impetigo can affect other areas other than around the mouth –> e.g. butt

101
Q

How can a pharmacist differentiate between impetigo and a cold sore?

A

Cold Sores –> More cases of impetigo than herpes simplex; however symptoms are close enough that they can through us off

Cold Sore - Typically around the age of 10
Impetigo - Typically around 2-5 years of age

Cold Sores –> HAve a little vesicle inside

When its off the lip margin –> Impetigo

If on the lip margin –> Cold Sores - Older kids, more painful and little vesicles

102
Q

What are the main differences between cold sores and impetigo?

A

1) Cold sores, for the most part, form red blisters. Although impetigo can be red, the blisters break quickly and turn brown

2) Impetigo spreads faster than cold sores

3) Impetigo never develops inside the mouth and form anywhere on the body. Although not uncommon, that is by and largely not the case with HSV-1. (Minimal of having a cold sore on the body e.g. knee)

4) Impetigo is usually painless. While cold sores can cause discomfort, impetigo is usually visual only. Early stages of cold sore development also involve tingly of the infected area. Typically not the case for impetigo

5) HSV is a virus transmitted by bodily fluid. Most notably HSV-infected salivia. THis is why you rarely see cold sores in areas other than the mouth, lips, nose, eyes, cheeks and genital region. Impetigo is caused by a bacteria that preys on skin that has been manipulated and therefore can occur anywhere on the body

103
Q

Does impetigo require treatment?

A

Impetigo is self-limiting and often improves within a week of treatment or within a few weeks without treatment

104
Q

Can polysporin be used for impetigo? What agents in the polysporin are we wanting the agent to include?

A

Polysporin can be used; however, prescribed agents are more effective

Do not select polysporin unless there is no acess to Fucidin or mupirocin

Polysporin - Not concerned about gram negtaive here (polymyxin); use of this agent is for gram positive coverage (bacitran and gramcidin)

105
Q

What are some prescription agents that can be used for impetigo? Application?

A

Mipirocin and Fucidin

If crusts are thick, use warm water compress to soften the crusts first and then remove for better antibiotic contact

106
Q

Effect of Topical Antibiotics in Impetigo

A

Self-limiting condition
- Should have a couple of days less when treated

107
Q

Describe how the prescription agents should be used for impetigo

A

Impetigo usually requires 5-7 days of therapy - Often go for 5 days here

Mupirocin 2% cream or ointment
Apply to affected areas three times daily for up to 10 days. Rub in gently.

Fusidic ACid 2% Cream or Oitment
Apply to affected areas three to four times daily for 7-14 days. RUb in gently. (Just choose TID or QID)

108
Q

Describe the duration of topical antibiotics in impetigo

A

Impetigo requires 5-7 days of therapy –> Just go for 5 days
Once its clear, stop –> No need to continue for 1 week after like antifungals
If trajectory is not better in 5 days, cosnider misdiagnosis

109
Q

What is a new treatment for impetigo? How is it used?

A

Ozanex (ozenoxacin) - Quinolone cream for impetigo
- Continue to recommend mupirocin or fusidic acid
- Apply a thin layer to the affected areas 2 times a day for 5 days

110
Q

What are some conditions in children that are unlikely to be seen in a pharmacy? Why?

A

Measles
Mumps
Rubella (German Measles)
Chicken Pox

MMRV (MEasles, Mumps, Rubella, varicella) Vaccinations

111
Q

What does the MMRV vaccine protect an child from?

A

Chicken Pox
Measles
Meningitis
Mumps
Polio
Whooping Cough

112
Q

When do children recieve the MMRV vaccine?

A

12 Months old

18 Months old

Grade 6 –> Varicella (Chicken Pox) vaccine

113
Q

What are some main points regarding Measles, chicken pox, mumps?

A

All conditions are viral

Measles harder on children than German measles
Chicken pox is itchier than measles
Chicken pox are small vesicles that crust over
Mumps mainly hits the jaw glands

Not a lot of therapy for any of them

114
Q

Describe measles

A

Starts with a fever (39-40 C), runny nose, red watery eyes, and a cough (dry raspy) that can last after the rash clears

Red bumps with tiny white dots appear a few days later on the inside of the cheeks

Rash appears on face and progresses down the back and trunk to arms and hands and finally legs and feet

Classic MAculaopapular Rash - Flat, red lesions but eventuallyd evelops bumps that may be itchy

Rash lasts about 5 days; total illness lasts 7-14 days

Quite sick for 3-5 days

115
Q

What is german measles also known as?

A

Rubella

116
Q

Describe german measles (rubella)

A

Generally a mild disease in children

Occurs most often in children aged 5 to 9 years of age

Starts with 1-2 days of a mild fever (37 C), swollen and tender lymph nodes

Rash then begins on face and spreads downward

Standard MAculopapular rash - Rash can itch and last for up to 3 days

MLess tough on a child than measles
- MIld skin reaction, low fever, low cold-like symptoms

About a week and then done

No treatment here

Many individuals with rubella have few or no symptoms

117
Q

Is mumps a deadly disease?

A

Not leading to death - However can be painful

118
Q

Describe mumps

A

Parotid Glands well and patient develops a “hamster-like” face - Painful and swollen salivary galnds

The symptoms of mumps normally appear 2-3 weeks after the patient has been infected; however, almost 20% of people with the virus do not suffer any sigbs or symptoms at all

119
Q

Describe when the symptoms of a rash occur after vaccination? Which vaccines are the worst for rashes?

A

Most reactions at the injection site occur within 2 weeks and most general reactions or fever within 7 days

  • Chicken pox and measles are the worst for rashes –> More than just local reactions
  • Measles Vaccine Rash - Call MD if rash onset at day 7-10 and persists for > 3 days
120
Q

What are some common symptoms that can develop after vaccination? Which is less common?

A

Fevers are still common for most vaccinations as moutning an immune response

Rashes are quite rare –> No more than 5%

Most rashes are not caused by the vaccine - Large rashes have a low potential to develop

Feverish and local site reactions are common after vaccination

121
Q

Describe symptoms that may occur after the DTAP vaccine

A

Pain, tenderness, swelling or redness at the injection site lasts for 24 to 48 hours (51% of children)

fever lasts 24-48 hours

122
Q

Describe symptoms that develop after Measles vaccine

A

Can result in a fever (10%) and rash (5%) about 7 to 10 days following injection

fever lasts 2 or 3 days

The mild pink rash is mainly on the trunk and last 2 or 3 days. No treatment is necessary and child is not contagious

123
Q

Describe symptoms that may occur after Chicken Pox Vaccination

A

Pain or swelling at the injection site for up to 1-2 days (19% of children)

Fever lasting 1 to 3 days begins 17 to 28 days after vaccine (14%) - Can give acet or ibu
–> never give ASA to a child within 6 weeks of recieving vaccine - Reye’s Syndrome

Chicken Pox-like vaccine rash (usually 2 lesions) at the injection site (3%)

Chicken Pox like vaccine rash (usually 5 lesions) scattered over the body (4%)

The mild rash begins 5 to 26 days after the vaccine and usually lasts a few days

Children with these vaccine rashes can go to day care or school
–> Vaccine rashes are not contagious, avoid school if widespread and weeping lesions (likely chickenpox)

124
Q

Describe the symptoms that may occur after the pneumonoccocus vaccine

A

Pain, tenderness, swelling OR redness at the injection site in 15-30%
Mild fever in 15% for 1-2 days
No serious reactions

125
Q

Describe the rash that may occur after the MMRV vaccine

A

A rash that looks like measles, rubella. or chicken poc may occur about 1-2 weeks after the vaccine

126
Q

Describe the symptoms of chicken pox

A

Incubation period of chickenpox ranges from 11-21 days

Prodromal Sx –> Low grade fever, headache and malaise

On the following day, charcteristic rash begins
–> Lesions evolve from erythemous macules to form small papules

Quickly, a clear vesicle arises on the erythemous base
–> Vesicles turn into lesions

Described as “de-drop on a rose petal”

127
Q

Describe the progression of the rash in chicken pox

A

1) Chickenpox rash starts with red spots that can occur anywhere on the body

2) The spots fill with fluid. The blisters may burst. They may spread or stay in a small area.

3) The spots scab over. More blisters might appear while others scab over.

Scabs 4 or 5 days later - Could be mistaken as molluscum

128
Q

What are some therapies that a patient may use for chicken pox? Describe if the agnets are effective?

A

1) Polysporin - Chicken pox is a virus so not effective

2) Calamine/Witch Hazel –> Astringents - Can use to help relieve itchiness and dry skin out

3) Benadryl –> Not effective

4) Cool Compress - Can be effective to help reduce swelling

5) Tylenol (yes), Advil (No)

129
Q

What are some non-pharamcological stratgeies that can be sued for symptom management in chicken pox?

A

Take a cool oatmeal bath
Calamine Lotion
Cool, wet wash cloth for itchy areas

130
Q

Describe the use of Tylenol and ADvil in Chicken Pox

A

Tylenol - Can help relieve pain with sores that develop on skin ir in the mouth

Ibuoprofen and NSAID’s - NOOO - CAn make you very ill

131
Q

Describe the use of NSAID’s in Chicken Pox

A

NSAID’s - Risk of necrotizing soft tissue infections

-Necortizinfg Fascitis/Cellulitis - Cannot use ASA for this reason; Ibuprofen now on the radar

Chicken pox is not that painful but can have a mild fever

  • Ibuprofen can likely be used; however, LEGAL - Do not recommend

Ibuprofen should not be recommended for chickenpox management
–. Sufficient evidence to contraindicate ibuprofen for the management of chickenpoix symptoms due to elevated risk of NSTI

132
Q

What is the firts line anti-pytretic io children with chicken pox?

A

ACETAMINOPHEN

PHAR 398: Minor Ailments (9 decks)

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