Approach to Treatment of Insect Bites Goals of self treatment Relieve symptoms

Approach to treatment of insect bites goals of self

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Approach to Treatment of Insect Bites Goals of self-treatment Relieve symptoms Prevent secondary bacterial infections Referral when indicated Buff W, Powell P. Insect Bites and Stings and Pediculosis. In: Krinsky DL, Handbook of nonprescription drugs . 17 th ed. Washington DC: American Pharmacist’s Association; 2012; 675-691. Establish appropriateness of Self-Care for Insect Bites Exclusion Soft Hard Hypersensitivity to insect bites < 2 years of age History of tick bite and systemic effects Suspected spider bite Signs of secondary infection Buff W, Powell P. Insect Bites and Stings and Pediculosis. In: Krinsky DL, Handbook of nonprescription drugs . 17 th ed. Washington DC: American Pharmacist’s Association; 2012; 675-691. Nonpharmacological Therapy Ice packs Helps slow absorption Reduces itching, swelling, and pain Avoid scratching Avoid irritating clothing over bite area Removal of offending agent Ticks
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10/21/2016 5 Pharmacologic Therapy Local anesthetics Antihistamines Counterirritants Anti-inflammatory Agent Skin Protectants Buff W, Powell P. Insect Bites and Stings and Pediculosis. In: Krinsky DL, Handbook of nonprescription drugs . 17 th ed. Washington DC: American Pharmacist’s Association; 2012; 675-691. Local anesthetics Name Examples MOA OTC Strength Directions Length of Treatment Adverse Effects Notes Benzocaine Pramoxine Benzyl Alcohol Lidocaine Dibucaine Itch-X™ LMX 5™ Sarna Sensitive™ Nupercainal Reversible blockade of nerve impulses, producing loss of sensation. Benzocaine 10%-20% Lidocaine 1%-5% Apply up to 3-4 times a day. Up to 7 days. Relatively non- toxic when applied topically. Allergic contact dermatitis may occur Systemic toxicities (Dibucaine) Pramoxine and benzyl alcohol do not commonly cause adverse effects. Available as creams ointments aerosols lotions Phenol Depression of cutaneous sensory receptors. 0.5%-1.5% Apply up to 3-4 times a day. Up to 7 days. Systemic toxicities Phenol solutions greater that 2% are irritating and may cause sloughing and necrosis of skin Should not be applied to extensive areas of the body and should be avoided in pregnant patients and children. Buff W, Powell P. Insect Bites and Stings and Pediculosis. In: Krinsky DL, Handbook of nonprescription drugs . 17 th ed. Washington DC: American Pharmacist’s Association; 2012; 675-691. Antihistamines Name Examples MOA OTC Strength Directions Length of Treatment Adverse Effects Notes Topical Diphenhydramine Benadryl Blockade of H-1 receptors. 0.5%-2% Apply up to 3-4 times a day. Up to 7 days. Allergic and photoallergic contact dermatitis Generally not absorbed in quantities to cause systemic side effects. Do not use in children less than 2 Oral Diphenhydramine Benadryl Blockade of H-1 receptors. 12.5mg- 25mg Q4-6Hprn 6-12yrs old Max 150mg/day >12yrs old Max 300mg/day Up to 7 days. Sedation, dizziness, xerostomia, somnolence, photoallergic contact dermatitis Off label use Young children may experience a paradoxical excitation effect.
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