Phar 362 - Parasites: Lice

Front 1

What are the tree species of Lice?

Back 1

1) Pediculus Humanus Capitis (Head)

2) Pediculus Humanus Corporis (Body)

3) Phtirus pubis (Pubic)

Front 2

How long is the Lice's adult life cycle?

Back 2

30 days

Front 3

How long can the different types of lice survive off the human host?

Back 3

Up to 4 days for Head lice and Nymphs. Up to 3 days for Body and Pubic Lice

Front 4

How long can nits (i.e. baby lice) survive away from the host?

Back 4

Can survive up to 10 days BUT only under ideal temp and environment

Front 5

"Nits require a desirable amount of warmth in order to hatch" True or False?

Back 5

TRUE

Front 6

What are the goals of therapy for the treatment of Lice?(4)

Back 6

1) Eradicate the infestation

2) Relieve Pruritis (itching)

3) Prevent Secondary Bacterial Infections

4) Prevent the transmission of lice to others

Front 7

Which type of lice is most common in children aged 3-12 yrs old?

Back 7

Head Lice

Front 8

"Head lice is more common in Males than Females" True or False?

Back 8

False. Females>Males, due to the longer hair and shared brushes

Front 9

Which months are most commonly seen in Head Lice?

Back 9

August - November

Front 10

"Head lice is related to Hygiene and nutrition" True or False?

Back 10

FALSE

Front 11

"Body lice is related to Hygiene and nutritional status"True or False?

Back 11

TRUE

Front 12

"Head lice is NOT a self limiting condition" True or False?

Back 12

TRUE

Front 13

"Pubic lice is common with sexually active adults" True or False?

Back 13

TRUE

Front 14

What is the method of transmission for Head Lice?

Back 14

Via Hair-Hair contact (formite transmission is controversial)

Front 15

"Formite Transmission(Blankets) is very common for Head Lice" True or False?

Back 15

False, has not been confirmed if plausible

Front 16

What is the method of transmission for Body Lice?

Back 16

Via Direct Physical contact or with contact with infested clothing, bedding, etc

Front 17

What is the method of transmission for Pubic Lice?

Back 17

Via close physical contact like sexual contact

Front 18

What are the signs and symptoms for Head Lice?(4)

Back 18

1) Pruritis (3-4 wks after 1st bite)

2) Papules, Wheals (can be difficult to see)

3) Possible concurrent symptoms: Conjunctivitis, Cervical Lymphadenopathy, Generalized rash

4) Possible Secondary Infection

Front 19

What are the signs and symptoms for Body Lice? (4)

Back 19

1) Pruritis

2) Red Marks

3) Papules

4) Parallel linear excoriations

[symptoms common in areas where clothing is snug e.g. shoulders, waist, buttocks]

Front 20

What are the signs and symptoms for Pubic Lice? (3)

Back 20

1) Pruritis

2) Presence of rust covered specks in pubic hair 3) Excoriations,bluish macules

[can also affect pubic area but can also affect eyelashes, eyebrows and other facial hair]

Front 21

"There is no firm consensus on the definition or best method of diagnosis for Lice" True or False?

Back 21

TRUE

Front 22

What is the 362 method of diagnosis for Lice?

Back 22

The presence of >1 live louse or a viable nit

Front 23

"A viable nit is usually close to the _______"

Back 23

Scalp

Front 24

"Nits farther than _____ are not considered viable"

Back 24

6mm

Front 25

What are the methods of detection for Lice? (3)

Back 25

1) Visible inspection of the hair

2) Wet combing with conditioner

3) Dry detection Combing

Front 26

What are the non drug measures for Head Lice? (5)

Back 26

1) Check all households members

2) Cleaning: sterilize combs, brushes, hats, pillows, towels and stuffed animals [carpets and furniture is controversial]

3) Nit Combs (daily for 2 weeks)

4) Wet Combing Method (aka BugBusting)

5) Hot Air Methods(e.g. LouseBuster/AirAlle)

Front 27

How do you sterilize combs and brushes?

Back 27

Soaking in medication of head lice or 2% Lysol for 1 hour OR immerse in boiling water for 10mins

Front 28

How do you clean Hats, Pillows, Towels or Stuffed Animals?

Back 28

Via machine wash, hot water, or hot dry OR store in a sealed plastic bag for 2weeks

Front 29

What are the non drug measures for Body Lice? (3)

Back 29

1) Improve Hygiene (wash body, clean clothes)

2) Wash all clothes, bedding in hot water OR store in a sealed plastic bag for 14days

3) Prefer to live in seams of clothing so steam iron the seams

Front 30

What are the non drug measures for Pubic Lice? (7)

Back 30

1) Check all households members

2) Cleaning: sterilize combs, brushes, hats, pillows, towels and stuffed animals [carpets and furniture is controversial]

3) Nit Combs (daily for 2 weeks)

4) Wet Combing Method (aka BugBusting)

5) Hot Air Methods(e.g. LouseBuster/AirAlle)

6) Treat Sexual Partners

7) Petrolatum BID for Eyelashes x10 days

Front 31

What is the drawback to using Louse Busting Services to remove lice and Nit?

Back 31

They can be quite expensive and require more than one visit to be effective

Front 32

What are the three categories for pharmacological methods of Head Lice?

Back 32

1) Paralysis of Respiration:

Permithrin 1% + Pyrethrins

2) Dehydration:

Isopropy Myristate 50% + Cyclomethicone 50%

3) Suffocation:

Home Remedies, Essential Oil Products, Nuvo Lotion, Dimethicone

Front 33

What are the Product names for Permithrin 1%?

Back 33

Nix Cream Rinse, Kwellada-P

Front 34

What is the MOA for Permithrin 1%?

Back 34

Synthetic pyrethroid affects Na+ channels and disrupts neurons resulting paralysis

Front 35

What is the toxicity for Permithrin 1%?

Back 35

Low toxicity to humans due to minimal percutaneous absorption

Front 36

What is the efficacy rates for Permithrin 1%?

Back 36

Lice eradication rate ranges from 13-75% depending on Country

Front 37

What are the contraindications for Permithrin 1%?

Back 37

Hypersensitivities to Chrysanthemums, ragweed or pyrethrins

Front 38

What are the side effects for Permethrin 1%?

Back 38

Transient Skin Irritations (tingling, burning, erythema, itching)

Front 39

Which drug is 1st line for Children >2months old with lice?

Back 39

Permitrhin 1%

Front 40

Which drug is 1st line for Adults with lice?

Back 40

Permitrhin 1%

Front 41

Which drugs are recommended for Children <2 months old?

Back 41

Permitrhin 1%

Front 42

Which drugs are considered safe for Pregnancy and Lactation?

Back 42

1) Permithrin 1% [first line]

2) Pyrethrins 0.33%/ Piperonyl Butoxide 3%[Category C; low absorption but considered safe] 3) Isopropyl Myristate 50% + Cyclomethicone 50% [no data]

4) Dimethicone 100cst 50% w/w [no date]

Front 43

What are the directions for use for Permithrin 1%? (6)

Back 43

1) Wash hair with shampoo

2) Rinse thoroughly and towel dry hair

3) Shake product well and apply to saturated hair and scalp (min: 25mL)

4) Leave on for 10 minutes

5) Rinse thoroughly with cold water

6) Re-apply after 7-10 days

Front 44

What are the Product names for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 44

R & C Shampoo, Pronto Shampoo

Front 45

What is the MOA for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 45

Made from natural extracts of Chrysanthemums. Affects Na+ channels and disrupts neurons resulting in paralysis

Front 46

What is the toxicity for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 46

Low toxicity to humans

Front 47

What is the efficacy rates for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 47

Lice eradication rate ranges from 13-75% depending on Country

Front 48

What are the contraindications for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 48

Hypersensitivities to Chrysanthemums, ragweed or pyrethrins

Front 49

What are the side effects for Pyrethrins 0.33%/Piperonyl Butoxide 3%?

Back 49

Contact Dermatitis. Mucous membrane irritation.

Itching and burning of the scalp.

Front 50

What are the directions for use for Pyrethrins 0.33%/Piperonyl Butoxide 3%? (5)

Back 50

1) Saturate Dry Hair and scalp

2) Leave on for 10mins

3) Add small amount of water and massage into scalp to lather

4) Rinse throughly with cold water

5) Re-Apply after 7-10 days

Front 51

What are the Product names for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 51

Resultz

Front 52

What is the MOA for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 52

Detergent which dissolves the lice exoskeleton leading to dehydration

Front 53

What is the toxicity for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 53

Very low toxcitiy to humans, since it is a non insecticide detergent

Front 54

What is the efficacy rates for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 54

More effective than Permethrin 1%. Phase II trial efficacy RCTs

Front 55

What are the contraindications for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 55

None

Front 56

What are the side effects for Isopropyl Myristate 50% + Cyclomethicone 50%?

Back 56

Mild Erythema. Pruritis.

Front 57

What are the directions for use for Isopropyl Myristate 50% + Cyclomethicone 50%? (4)

Back 57

1) Apply to dry hair and massage until hair and scalp is wet

2) Leave on for 10mins

3) Rinse with warm water

4) Repeat in 7-10 days

Front 58

What is the correct amount of product to be used in hair?

Back 58

Short Hair: 30-60mL

Shoulder Length Hair: 60-90mL

Long Hair: 90-120mL

Front 59

What are the Product names for Dimethicone 100cst 50% w/w?

Back 59

NYDA Spray

Front 60

What is the MOA for Dimethicone 100cst 50% w/w?

Back 60

Fills spiracles and trachea of louse (and embryos) this disrupts water management, and leads to osmotic stress and rupture of the guts

Front 61

What is the toxicity for Dimethicone 100cst 50% w/w?

Back 61

Very low toxicity to humans, since it is a non insecticide

Front 62

What is the efficacy rates for Dimethicone 100cst 50% w/w?

Back 62

RCTs show it to be more effective than Permethrin [issues with methodology]

Front 63

What are the contraindications for Dimethicone 100cst 50% w/w?

Back 63

None

Front 64

What are the side effects for Dimethicone 100cst 50% w/w?

Back 64

<1% of Patient suffer from Ocular Irritation

Front 65

What are the directions for use for Dimethicone 100cst 50% w/w?(5)

Back 65

1) Spray onto hair to completely saturate hair

2) After 30mins use lice comb to remove the dead lice, nymphs and nits

3) Leave the solution to dry on hair for at least 8hrs

4) Wash out with regular shampoo

5) Repeat treatments in 8-10 days

Front 66

"Home remedies like olive oil, glycerin, petroleum jelly are cosmetically unappealing and dangerous and not considered efficacious" True or False?

Back 66

TRUE

Front 67

"Tea Tree Oil (Melaleucia oil) is equally as effective as Permithrin 1%" True or False?

Back 67

FALSE, it has no evidence for efficacy

Front 68

"Ylang Ylang Oil/Coconut Oil/Anise Oil combo product when applied TID q5days is as successful as Permithrin 0.43%"True or False?

Back 68

TRUE (but investigators were not blinded and involved contact with family members who had underwent the trial before)

Front 69

What is Zap and how is it applied to the head?

Back 69

Is an ileum verum 15% with coconut oil, ylang ylang oil and isopropyl alcohol.

1) Spray onto dry hair until lightly wetted

2) Massage in and leave for 15mins then wash out

3) Then we use nit combs before drying hair

4) Repeat in 9 days

Front 70

What are the cautionary points for Zap? (2)

Back 70

1) Avoid in kids <2 years old

2) It is Flammable!!

Front 71

"Nuvo Lotion is not shown to be effective for Head Lice" True or False?

Back 71

TRUE

Front 72

What is the definition for "Treatment Failure"?

Back 72

Live Lice present 12-24hrs post treatment

Front 73

"Itching will continue only if treatment failure occurs" True or False?

Back 73

FALSE, Itching can continue despite treatment success

Front 74

What are the recommended days of therapy for a 3day therapy?

Back 74

Days: 0, 7, 12

Front 75

What are the recommended days of therapy for a 2day therapy?

Back 75

Days: 0, 9

Front 76

What should you do if the lice undergoes two ineffective treatments?

Back 76

Refer to a physician

Front 77

What is the recommended treatment for Body Lice?

Back 77

Drug treatment is not recommended. But can use antipruritics (Crotamiton, Calamine, Topical Corticosteroids, 1st oral AH)

Front 78

What is the recommended treatment for Pubic Lice?

Back 78

1st Line: Permethrin 1% Cream Rinse 2nd Line: Pyrethrins with piperonyl butoxide shampoo OR Lindane 1% Shampoo/Lotion