4 times daily for up to 7 days Safety Very dangerous if ingested Keep out of reach of children Pharmacologic Treatment of Insect Bites: Counterirritants
Trade Name Primary Ingredients Blue Star Ointment Camphor 1.24% Sarna Anti-itch Lotion Original Camphor 0.5%; menthol 0.5% Pharmacologic Treatment of Insect Bites: Counterirritants (Table 37-3)
• Example: Topical hydrocortisone 1% • Indication: temporary relief of minor insect bites • Dosing: Apply to the bite area up to 3 – 4 times daily for up to 7 days Pharmacologic Treatment of Insect Bites: Corticosteroids
Trade Name Primary Ingredients Aveeno Maximum Strength Anti-itch Cream Hydrocortisone 1%; aloe vera Cortaid Intense Therapy Cooling Spray Hydrocortisone 1% Cortizone-10 Easy Relief Liquid Hydrocortisone 1%; aloe vera Pharmacologic Treatment of Insect Bites: Corticosteroids (Table 37-3)
• Examples: zinc oxide, calamine, and titanium dioxide • Dosage forms: lotions, ointments, and creams • MOA: • Protectant, tend to reduce inflammation and irritation • Zinc oxide mild astringent with weak antiseptic properties • Zinc oxide and calamine absorb fluids from weeping lesions Pharmacologic Treatment of Insect Bites: Skin Protectants
• Dosing: Apply to affected area as needed • Safety: minimal adverse effects • Recommended for adults, children, and infants Pharmacologic Treatment of Insect Bites: Skin Protectants
Trade Name Primary Ingredients Aveeno Anti-Itch Concentrated Lotion Pramoxine HCl 1%; calamine 3%; dimethicone Caladryl Clear Lotion Pramoxine HCl 1%; acetate 0.1%; camphor Campho-Phenique Gel Camphor 10.8%; phenol 4.7%; eucalyptus oil Chigarid External Analgesic Camphor 2.8%; phenol 1.5%; menthol 0.1%; eucalyptus oil 0.5% in collodion StingEze Insect Bite Relief Benzocaine 5%; phenol 1.35% Sting-Kill Swabs Benzocaine 20%; menthol 1% Pharmacologic Treatment of Insect Bites: Combination Products (Table 37-3)
• Use and overuse of local anesthetics sensitization, contact dermatitis • Lowest adverse effects pramoxine, benzyl alcohol • Highest adverse effects dibucaine, phenol • Prolonged use of topical antihistamines allergic or photoallergic contact dermatitis • Scabies / bacterial infections / fungal infections do NOT use hydrocortisone without medical supervision (masks these disorders) • Children avoid camphor due to risk of accidental ingestion Pharmacologic Treatment of Insect Bites: Product Selection
• Bees • Wasps • Hornets • Yellow jackets • Fire ants Pathophysiology of Insect Stings
• Pain, itching, and irritation at the site following an insect sting • Insect sting allergy hives, itching, swelling, and burning sensations of the skin • Severe allergy fall in blood pressure, light-headedness, chest tightness, dyspnea, and even loss of consciousness Clinical Presentation of Insect Stings
• Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing • Significant allergic response away from site of sting • Previous sting by honeybee, wasp, or hornet (need to evaluate possible development of hypersensitivity) • Previous severe reaction to insect bites • Personal or family history of significant allergic reactions (e.g., hay fever) • < 2 years of age Exclusions for Self-Treatment of Insect Stings
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