Self-Care II (Bug Bites + Pinworms)

Modifiable Risk Factors of Mosquito/Insect Bites

Motions, bright colors, perfume, cologne, and other scents

Non-Modifiable Risk Factors of Mosquito/Insect Bites

CO2 productions, lactic acid production, and body heat

DEET (N, N-Diethyl-3-methylbenzamide) can be given to:

• Age: > ____

• MOA: ____ w/insect chemoreceptors

• Asceptically unpleasing = _______

• ADRs: _______

• __% concentrations

  • Increased concentration = Increased efficacy/duration BUT _______

  • __% → 4 hours

  • __% → 6 hours

2 months old
Interferes
Smelly odor and greasy
skin irritation and rashes
5-100
30% plateu
20
30

Non-DEET

• Not been evaluated as extensively as DEET

• ______ protection against insect bites

• Duration: similar to DEET

• Generally ______ when used correctly

• May provide some ______ vs DEET

Equivalent
Safe and nontoxic
Advantages

Picaridin/Icaridan

• ______ to DEET

• MOA: ______ w/insect chemoreceptors

• ______ vs DEET, other repellants

• ADRs: ______

• __% cocnentrations

Primary alternative
interferes
Cosmetic advantages
skin irritation and rashes
5-10

Biopesticide Repellents

• ______ products

• ______ (PMD) → leaves of eucalyptus trees

• ______ → Cymbopogon Grass

• Fragrances more cosmetically pleasing; found in many outdoor/garden products

• ______

• ADRs: ______, may predispose to ______

natural substance
Oil of Lemon Eucalyptus
Oil of Citronella
Volatile
SOB, chest/eye/nose irritation, lung cancer

Miscellaneous Insect Repellents

• ______: ______ barrier

• ______: Avon Skin-So-Soft products (duration: ______)

• ______: veg______gie oil made from fruit + seeds (______, possible infertility)

• ______ (ex. Peppermint, cedar, clove oils): highly ______, effect ______, needs ______ application

• ______ supplements Most important compared to other products

  • Odor ______ mosquitos/insects

  • Anecdotal evidence to support use

  • No evidence to support use

Bath oils, physical
IR3535, 30 mins to 2 hours
Neem, veggie, dermatitis
Essential oils, volatile, variable, constant
Thiamine/Garlic, repells

Intesticides: Permetherin

• ______-based ______ insecticide

• MOA: causes ______ leading to ______ of the insect upon contact

• ADRs:

  • ______ > repellents

  • ______

• __% as insecticide (__% for scabies → Rx ONLY)

contact, synthetic
CNS toxicity, death
skin irritation, rashes
0.5, 5

Insect Repellants (3)?

DEET, Non-DEET, and Picaridin/Icaridan

Factors Affecting Insect Repellant Protection

• ______: rain, sweating, swimming

• ______ (______): reapply as indicated + ______ products may offer ease of use

• ______: apply sunscreen ______ repellent BUT need more ______ reapplication

  • Avoid sunscreen/repellent ______

Moisture
Formulation, IR vs ER, ER
Sunscreens, before, frequent, combos

Counseling Points for Bug Bites

• General Avoidance

  • ______

  • ______ doors + windows

  • Cleaning up ______

  • ______ for sleep (travel)

  • ______ (travel)

air conditioning
screened
standing waters
insect netting
insecticide spraying

Counseling Points

• Insect Proofing

  • ______ shirts, pants, ______, and ______

  • ______ tucked into ______

  • Pant legs tucked into ______ (vice versa)

long-sleeved, boots, hats
shirt, pants
socks

Counseling Points

• Repellants

  • Apply to ______ ONLY

  • Do not let ______ apply repellants to themselves

  • Do not spray directly onto the ______

  • Sunscreen products → applied ______

  • Reapply product when ______ occur

  • Wash off repellants when ______

intact skin
children
face/body
first and then repellents
mosquito bites
not needed

Counseling Points

• Insecticides

  • Apply to ______ only (also tents, nets, etc.)

  • Do NOT apply to ______

  • Does not ______, ______

  • Maintains ______ for ~______ w/o washing

  • Potency is retained thru ~__ washings

clothing
skin
stain, odorless
potency, 2 weeks
3-4

Complications + Treatment Considerations for Insect Bites

• Risk of ______

  • Increased with ______ skin (______, purulent ______, significant ______)

• ______ reactions

• Goals of treatment: ______, prevent secondary bacterial infections

secondary skin infections, abraded, yellow crusting, drainage, redness/swelling
Hypersensitivity
Relieve Sxs

Exclusion Criteria

• Insect BITES

  • ______

  • < ______

  • ______ bite and possible systemic infection (e.g. ______)

  • Suspected ______

  • Suspected ______

  • ______ infection around bite site

Hypersensitivity
2 y/o
Tick, Lyme Disease
spider bite
scabies infection
Secondary

Exclusion Criteria

• Insect STINGS

  • ______

  • Previous ______ (possible development of hypersensitivity)

  • Previous ______

  • Personal or family ______ of significant ______

  • < ______

Hypersensitivity
Sting
Severe reaction
Hx, allergic reactions
2 y/o

Treatment Strategies for Bug Bites

• Pain and irritation

  • Application of ______ wrapped in cloth for ______ at site of bite/sting, ______ off

  • Consider topical products for ______ (up to ______)

  • AVOID ______

• Other considerations

  • Remove ticks intact with ______, clean skin with ______

  • ______ stingers away with fingernails or credit card

  • Keep insect in ______ if needed for future identification

  • Do not wear ______ clothing over site

  • Seek emergency medical attention for signs of ______

    • Recommend patients wear bracelets or other identifiers to indicate severe allergy potential

    • Carry epinephrine

icepack, 10 minutes, 10 minutes, analgesia, 7 days, scratching
tweezers, rubbing alcohol, scrape, closed container, abrasive, severe allergic reaction

Topical Anesthetic Products for Bug Bites

• ________ (gel, cream, ointment, spray)

• ________ (gel, cream, ointment, spray)

• ________ (gel, cream, spray, lotion, liquid)

Benzocaine
Lidocaine HCl
Pramoxine

Topical Anesthetic Products for Bug Bites

• SEs: _______

• Dosing: Use _______ concentration if non-intact skin. Apply sparingly to up to _______. Do not apply >_% of BSA

• MOA: Block initiation and conduction of sensory nerve impulses by _______ neuronal depolarization

numbness, hypersensitivity, and systemic toxicity, low, 3-4x/day, 2, inhibiting

Topical Counterirritant Products for Bug Bites

• _______ (10-60%)

• _______ (3-11%)

• _______ (1.25-16%)

• _______ (0.025-0.25%)

Methyl Salicylate

Camphor

Menthol

Capsicum

Topical Counterirritant Products for Bug Bites ADRs

• Methyl Salicylate:

• Camphor:

• Menthol:

• Capsicum:

Skin irritation, salicylate toxicity, and avoid in ASA allergy
Skin Irritation
Skin Irritation
Burning Sensation

Topical Counterirritant Products for Bug Bites MOA

• Methyl Salicylate:

• Camphor:

• Menthol:

• Capsicum:

Rubefaction (makes skin red to help with blood circulation)
Produces cooling sensation
Produces cooling sensation
Irritation w/o rubefaction

Brand Names:

• _________: various combo products (e.g. arthritis, Hot Cream, Bengay, Icy Hot, Salonpas)

• _________: Capzasin-HP, Zostrix

Methyl Salicylate, Camphor, and Menthol
Capsicum

Skin Protectants

• Apply ______

• MOA: reduce ______, in addition to protecting the affected area

• Helps to ______ from weeping lesions

PRN
inflammation and irritation
absorb fluids

Skin Protectants Products for Bug Bites

• _______ (8%), _______ (1%) = Caladryl, Calagesic

• _______ 80.5% + _______ 15.5% + _______ Oil + Vitamin A+D = A+D Original Ointment

• _______ 20-25% in _______ = Desitin Ointment

• Other: petrolatum, glycerin, colloidal oatmeal, allantoin, cocoa butter, shark liver oil, etc.

Calamine, Pramoxine
Petrolatum, Lanolin, Cod Liver
Zinc Oxide, white petrolatum

Topical Antihistamine for Bug Bites

• ______ 0.5%-2%

• Depress skin receptors, provides ______ from ______

• Apply ______

• Considerations:

  • May cause ______

  • Continued use increases risk of ______

  • Avoid application over ______ areas, ______ dressings

Diphenhydramine
temporary relief, itching and pain
3-4x/day
photosensitivity, contact dermatitis, large, occlusive

Topical Corticosteroid For Bug Bites

• ______ 0.5-1%

• Causes ______ leading to ______ and ______ effects

• Apply ______

• Considerations

  • Continued use increases risk of ______

  • Avoid application over ______ skin, ______ areas, ______ dressings

Hydrocortisone
vasoconstriction, anti-inflammatory, antipruritic
3-4x/day
contact dermatitis, broken, large, occlusive

General Features of Pinworm:

• Most common helminth infection in U.S., commonly affects children and caregivers

• Parasitic helminth infection caused by ______

  • Humans are the ______

  • ______ signs/symptoms of infection

  • Minimal ______ concerns, may infect ______ (very contagious)

• Spread by: 

  • ______ route, indirect through ______ (primary)

  • ______ (secondary)

• ______ is common

E. vermicularis
only host, limited, public health, household
Fecal-oral, fomites, inhalation
Reinfection

KNOW IMAGE

Pinworm Tape Test

Since patients may be asymptomatic or have vague symptoms, a pinworm tape test can be performed

• Test for ______ in a row

• Ensure child’s anal area is clean ______

• Do test ______ after child wakes (before ______ + ______)

  • Press the sticky side of clear tape against the skin near the anus

  • Apply the tape to a clear slide and put in a sealed container

  • Bring to HCP for visualization and confirmation

  • Wash your hands and don’t touch face

3 days
before bed
1st thing in the morning, bowel movement, washing

Signs/Sxs of Pinworm:

•  Mainly ______

•  ______ (noctural)

•  ______ trauma (pinworm neurosis)

asymptomatic
perianal pruritus
Psychological

Risk Factors of Pinworm:

• ______ d/t ______

• Endometritis, salpingitis, tubo-ovarian abscess, PID, vaginitis (when ______ is infected)

• Granuloma (when the ______ infected)

• Must r/o ______ (infants), ______ (adults)

• Visual inspection

• Goals of Treatment

  • ______, prevent ______, and prevent ______ to others (within the household)

secondary infections, pruritus
genital tract
peritoneal cavity

diaper dermatitis, constipation/hemorrhoids

kill pinworm, reinfection, transmission

Exclusions for Pinworm:

• Symptoms of more severe infections – REFER!

  • ______

  •  ______

  •  ______

  •  ______

  •  ______

• ______ disease

• ______ and ______

• ______ symptoms and ______ inspections

• Age < ______

• Weight < ______ (treat in collaboration with pediatrician)

• Need for ______ (treat in collaboration with pediatrician)

• ______

Diarrhea, anorexia, abdominal pain, nausea, insomnia/restlessness
Liver
Pregnancy, breastfeeding
Vague, negative visual
2 y/o
25 lbs
repeat treatment
Hypersensitivity

Pyrantel Pamoate

• MOA: ______ agent; ______ the worms and allows them to be passed in the ______

• __% effective with single dose

• Dose:

  • __ mg/kg (pyrantel base) x 1 single oral dose

  • Max dose is ______

  • May repeat in ______ if s/sx persist

• ADR’s: mild, not highly systemically absorbed

  • ______

  • ______

  • ______

  • ______

depolarizing neuromuscular, paralyzes, stool
90-100
11, 1 g, 2 weeks
N/V, anorexia, diarrhea, abdominal cramps

Counseling Points for Pinworm

• Pyrantel dosing (for the whole family)

• Possible need for repeat dosing

• Prevention may be difficult:

  • Clean hands (eating, restroom, etc), kids sleep in separate beds, good bathroom hygiene

• During treatment:

  • Cut/clean fingernails, avoid scratching, and keep fingers out of mouth, 

  • Change underwear BID/wash in warm/soapy water, daily showers, clean toilet seat, and disinfect fomites

  • Clean floors with disinfectant + vacuum around bed frequently/dispose of vacuum bag 

  • Wash linens with hot water + open window shades/curtains

KNOW

Nonpharm + Prevention for Pinworm

• Treat ALL members of the family

• Educate patients concerning personal hygiene

  • Wash hands before eating, before preparing food, and after using the toilet

  • Keep fingernails short to prevent harboring of eggs and autoinoculation

  • Discourage biting nails and scratching in the anorectal region

• Ensure that blinds or curtains are open in the affected room(s) since eggs are killed by sunlight/UV

• Change and wash bed linens, underwear, bedclothes, and towels of the infected with hot water daily during treatment.

• Bathe daily; showers are preferred over baths

• Change into clean underwear and nightclothes

• Use clean bed sheets daily for several days after treatment

• Clean and vacuum the house daily for several days after treatment

• Maintain the cleanliness of bathrooms and toilets

KNOW