Wilkes Pha-425 Insect Bites, Stings And Pediculosis

Front 1

what is Pediculosis humanus corporis?

Back 1

body lice. the lice live hide and lay eggs in clothing seams.

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diseases that can come from body lice

Back 2

typhus and trench fever

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what is Phthirus pubis

Back 3

pubic lice. can also be found in armpits, eyelashes and facial hair

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ways pubic lice are transmitted

Back 4

sexual contact, toilet seats, shared garments or bedding.

Front 5

Head lice life cycle

Back 5

Lasts 20-30 days
1. Female deposits up to 150 nits at base of hair shaft.
2.Nits hatch into nymphs ~1 wk later. Must feed w/ in 24h.
3. Adult louse attaches to hair 8-9 days later and feeds off scalp.

Front 6

Primary age affected by head lice

Back 6

3-12

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What happens when a louse bites the scalp?

Back 7

immediate wheal, local papulae within 24 h, pruritis.

Front 8

Non-pharm therapy for head lice

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fine toothed comb to remove nits, avaiod contact, wash clothing and bedding on hot cycles, unwashed items should be placed in a sealed bag for 2 weeks, vacuum carpets, car, etc.

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Pyrethrins mechanism

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binds to sodium channels of nerve membranes and prolongs open times of the channel, increasing depolarization

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Piperonyl butoxide mechanism

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thought to inhibit CYP450 of parasie thus inhibiting oxidation which would usually inactivate pyrethrins

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ratio of pyrethrins to piperonyl butoxide in most products

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10:1

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Pyrethrins/piperonyl butoxide dosing regimen

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OTC
1. apply to DRY hair starting at base
2. leave in for 10 min then rinse
3. use fine-toothed comb
4. repeat in 7-10 days

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Pyrethrins/piperonyl butoxide adverse effects

Back 13

irritation, itching, erythema, swelling. possibility for cross sensitivity

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age for Pyrethrins/piperonyl butoxide

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2 years and older

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Permethrin mechanism

Back 15

disrupts sodium channels which delay repolarization and causes paralysis of the parasite

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Indications for permethrin

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1% nonRx pediculosis capitus
5% Rx for scabies, but can be used for head lice.

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permethrin dosing regimen

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1. wash hair w/ shampoo, no conditioner, towel dry
2. shake well and apply creme. leave in for 10 min
3. rinse with warm water & towel dry
4. use fin-toothed comb
5. Do not need to repeat unless live lice are seen in 7-10 days

Front 18

permethrin adverse effects

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transient pruritis, burning, stinging, irritation

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age for permethrin

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can use in 3 months and older, but under 2 years must see pediatrician first.

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dimethicone mechanism

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immobilizes louse and prevents ability to manage water

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dimethicone dosing regimen

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OTC
apply 4% lotion to dry hair for 8 hours, then rinse with plain shampoo. reapply within 7-10 days.
(70% kill rate)

Front 22

dry on suffocation-based pediculocide (nuvo lotion) regimen

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1. apply lotion to head; leave in for 2 minutes &comb out unnecessary lotion
2. dry hair with hair dryer
3. wash hair w/ in 8 h with shampoo.
4. repeat in 7-10 days
(96% efficacy rate)

Front 23

LiceMD and other pediculocide free agents regimen

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OTC. apply to hair and leave in for 10 min. manually remove nits and lice with fine toothed comb. wash hair with shampoo
(95% effective with proper combing techniques)

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Lousebuster dosing regimen

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OTC. 30 min applications, 59 C at 3X force of regualr hair dryer. (94.8% effeecting in one study)

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lindane mechanism for head lice

Back 25

blocks GABA causing CNS stimulations and parasite death.

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lindane indications

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Rx for scabies and second lone for head lice.

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lindane dosing regimen

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1. clean hair to remove oils
2. apply 1% shampoo, leave in for 4 min
3. wash out and use fine toothed comb

Front 28

lindane adverse effects

Back 28

CNS stimulation: dizziness, headache, seizures.

Front 29

malathion mechanism for head lice

Back 29

inhibits cholinesterase activity

Front 30

malathion indication

Back 30

Rx treatment of pediculosis capitus in patients 2 years and older

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malation dosing regimen

Back 31

1. apply 0.5% lotion to DRY hair thoroughly.
2. allow hair to dry naturally, leave in for 8-12 hours
3. shampoo, rinse and use a fin toothed comb.
4. repeat if lice are still present in 7-9 days

Front 32

malathion adverse events

Back 32

skin and scalp irritation, contact with eyes may lead to conjunctivitis.

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benzoyl alcohol mechanism for head lice

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inhibits lice from closing their respiratory spiracle leading to asphyxiation

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age for benzoyl alcohol

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Rx for patients 6 months and olders.

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benzoyl alcohol dosing regimen

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1. apply to DRY hair
2. leave in for 10 min, then rinse with water
3. repeat in 7 days.

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benzoyl alcohol adverse events

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application site irritation (pruritis, erythema), ocular irritation

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spinosad mechanism for head lice

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kills lice by rapid excitation of nervous system upon ingestion

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age for spinosad

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Rx for patients 4 years and older

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dosing regimen for spinosad

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1. apply to DRY scalp and then DRY hair.
2. leave on for 10 min and then rinse with warm water
3. repeat in 7 days if live lice are still seen

Front 40

spinosad adverse events

Back 40

application site irritation (pruritis and erythema), ocular irritation

Front 41

Other Rx options for head lice, not FDA approved

Back 41

SMX-TMP, ivermectin, crotamiton

Front 42

1st line agents for head lice

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permethrin or pyrethrins and piperonyl butoxide

Front 43

alternate agents for head lice

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malathion, spinosad, benzoyl alochol, lindane, SMX-TMP, ivermectin, permethrin 5% (Rx).

Front 44

Head lice exclusions for self-care

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hypersensitivity to chrysanthemums, secondary skin infection, infestation of eyes or eyebrows, active tumors, children < 2, pregnancy, failure of 2 previous applications of self care products.

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disease concerns with mosquitoes

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malaria and west nile virus

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presentation of mosquito bite

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small papule with itching, usually on exposed areas.

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products used for prevention of mosquito bites

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DEET, a volatile repellant that discourages insect approach

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DEET dosage

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no more than every 4-8 hours. do not apply to broken skin. Children should use < 30%, while adults can use up to 100%

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DEET adverse events

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skin irritation, seizures, ataxia, hypotension, angioedema.

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age for DEET

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> 2 months

Front 51

disease concern with fleas

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bubonic plague and endemic typhus

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presentation of flea bites

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small, multiple grouped bites on legs and ankles with erythema around a small punctur, as well as pruritis.

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concern with scabies

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intense itching and infalmmation

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presentation of scabies

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small grayish lines ~ 1 cm in length in spaces b/w fingers, flexor surface or wrist or male genetalia. usually pruritic.

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concern with bedbugs

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possible risk of hepatitis b transmission, but has not been confirmed

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presentation of bedbugs

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small dermal hemorrhage around bite. may take up to 2 weeks to develop. can be seen in sheets, etc. rusty colored blood spots and a sweet musty odor.

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bedbugs treatment

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FDA recommends professional exterminator, but many products are available

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disease concerns with ticks

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rocky mountain spotted fever and lyme disease

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presentation of tick bite

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initially a small papule at site.

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presentation of lyme disease

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small papulae at site with a clear center resembling a bullseye ~3-30 days after bite. disappears within 3-4 weeks. flu-like symptoms

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presentation of rocky mountain spotted fever

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fever, rash, N/V,

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treatment for rocky mountain spotted fever and lyme diease

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tetracylcine or doxycyline

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concern with chiggers

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intense itching

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presentation of chiggers

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red papule with intense itching

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concern with spider bites

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Brown recluse: spreading ulcerated wound at bite site.
Black widow: intense joint pain, joint stiffness, fever, chills
possible allergic reactions

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presentation or spider bites

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often not noticed but can have serious symptoms later

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treatment options for bites

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local anesthetics, topical antihistamines, counterirritants, steroids

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dosing of treaments for bites

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3-4 times/day for no more than 7 days

Front 69

local anesthetics used for bites

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benzocaine, lidocaine, pramoxine, benzoyl alcohol, phenol.

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mechanism of local anesthetics

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reversibly block conductions of nerve impulses at site of action.

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adverse events of local anesthetics

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systemic toxitcity, convulsions, myocardial depression, death(systemic). Do not apply to broken skin or large areas.

Front 72

topical antihistamines (diphenhydramine) mechanism

Back 72

depress cutaneous receptors yielding anesthetic effect.

Front 73

adverse events of topical antihistamines

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hypersensitivity, esp. with continued use.

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counterirritants used in bites

Back 74

camphor and menthol

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counterirritants mechanism

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depress cutaneous receptors causing an overall warming or cooling snesation.

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adverse event of counter irritants

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camphor: high doses may lead to N/V, headache, dizziness, convulsions, coma
menthol: rare sensitization leading to urticaria adn erythema

Front 77

steroids used for bites

Back 77

hydrocortisone

Front 78

mechanism of hydrocortisone

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depresses inflammatory mediators that lead to edema, capillary dilation, swelling and tenderness

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adverse events of hydrocortisone

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prolonges use may lead to epidermal atrophy, irritation and folliculitis. do not use on scabies, fungal infections, bateial infections or candidiasis

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insect bite exclusions for self treatment

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hypersensitivity to bite, <2 years old, suspected tick bite, spider bite or scabies, or signs of secondary infection.

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treatment for insect stings

Back 81

remove stinger, apply ice pack for 10 minutes intervals, use insect bite therapies.

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insect stinges exclusions for self-care

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hives, excessive swelling, dizziness, vomiting, difficulty breathign, no previous stings, family history of allergic reaction, <2 years old.