Self-Care II Exam 2: MEDS (Lice/Scaly Dermatoses)

A parent asks for a head lice treatment that is applied to dry hair and requires a repeat treatment in 7–10 days. Which product should you recommend?

Rid (synergized pyrethrins + piperonyl butoxide)

Rid (synergized pyrethrins + piperonyl butoxide)

• RID = DRI = ______

• ______ application

• Leave on ______

• ______ hair

• ______

• Repeat in ______

Dry hair and repeat, Dry hair, 10 mins, rinse/shampoo, Use nit comb, 7-10 days

A parent wants a treatment that is applied to washed, towel-dried hair and usually does NOT require retreatment. Which product is preferred?

Nix (permethrin 1%)

Nix® (permethrin 1%)

• NIX = No repeat

• ______ hair first

• ______ dry

• Apply for ______

• ______

• ______ afterward

• Repeat ONLY if live lice are seen in ______

shampoo/rinse, towel, 10 mins, rinse, Nit comb, 7-10 days

Which OTC head lice product can also be used for head and pubic lice?

Rid

Which OTC head lice product is indicated only for head lice?

Nix

Which product should be avoided in patients allergic to chrysanthemums or ragweed?

Rid

A patient has a ragweed allergy. Which OTC head lice treatment is the safer choice?

Nix

Which product blocks the breakdown of pyrethrins to improve efficacy?

Piperonyl butoxide in Rid

Which product should be recommended if the patient prefers the least likelihood of retreatment?

Nix

Which product definitely requires a second treatment even if the patient feels better?

Rid

A caregiver asks whether a nit comb is necessary after treatment. Which products require nit combing?

Rid and Nix

Which lice treatment does NOT require nit combing?

Ivermectin 0.5% lotion

A 4-month-old infant has head lice. Can ivermectin lotion be recommended?

No (>6 mo.)

Which head lice treatment should be applied to dry hair, left on for 10 minutes, rinsed, and followed by no shampooing for 24 hours?

Ivermectin 0.5% lotion

If lice persist after using ivermectin lotion once, what should the pharmacist recommend?

Refer

What is the MOA of ivermectin lotion?

Binds glutamate-gated chloride channels on nerve and muscle cells, leading to nerve blockade (death)

When should patients seek medical care after OTC treatment?

• Significant ______

• ______ exposure

• Symptoms persist after the ______

irritation, eye or mucous membrane, 2nd application

Which alternative treatments work by suffocating lice rather than neurotoxicity?

Petroleum jelly, Mayo, Cetaphil + hairdryer (Nuvo method), and Dimethicone gel 100%

Which non-drug treatment physically removes lice using heated air?

AirAlle/LiceBuster

A patient with uncomplicated dandruff asks for a first-line OTC shampoo recommendation. What ingredient would you recommend?

Pyrithione zinc (0.3-2%)

A patient with seborrheic dermatitis presents with scalp erythema and flaking. What are the first-line OTC options?

Pyrithione zinc 0.95-2%, Selenium sulfide 1%, and Ketoconazole 1%

Which OTC product is considered first-line for seborrheic dermatitis because it targets Malassezia?

Ketoconazole 1%

What is the OTC drug of choice for erythematous psoriatic lesions?

Hydrocortisone 1%

Which ingredient is most useful when thick, adherent scales are present?

Salicylic acid

What is the MOA of pyrithione zinc?

Cytostatic

Before applying pyrithione zinc shampoo, what should the patient do?

Wash first with a nonmedicated, nonresidue shampoo

How long should pyrithione zinc remain on the scalp?

3-5 mins

A patient with dandruff asks how often to use pyrithione zinc.

QD x 1 week, then BIW-TIW × 2-4 weeks, and then QW-QOW maintenance

How does pyrithione zinc dosing differ for seborrheic dermatitis?

QD x 2 weeks, then BIW-TIW x 2-4 weeks, and Then QW-QOW maintenance

What adverse effect can occur if pyrithione zinc is used on broken skin?

Contact dermatitis

What is the MOA of selenium sulfide?

Cytostatic

What counseling point is unique to selenium sulfide?

Rinse hair thoroughly (2-3x) to prevent hair discoloration

Which dandruff shampoo may leave a residual odor and oily scalp?

Selenium sulfide

How long should selenium sulfide remain on the scalp?

3-5 mins

What adverse effects are shared by selenium sulfide and pyrithione zinc?

Eye irritation/stinging and Contact dermatitis on broken skin

What is the MOA of coal tar?

Cross-links DNA, which decreases epithelial turnover

A patient asks when to apply coal tar products. What should you recommend?

Apply at bedtime, then bathe in the morning

What counseling point should be given regarding coal tar use?

Avoid sun exposure for 24 hours

Which dandruff ingredient commonly stains skin, hair, and clothing and may worsen contact dermatitis upon exposure?

Coal tar

A patient develops folliculitis in the axilla and groin after treatment. Which product is the likely culprit?

Coal tar

What should be used before coal tar if inflammation is severe?

Topical corticosteroids

What is the MOA of ketoconazole?

Antifungal (anti-Malassezia)

Which OTC product contains ketoconazole 1%?

Nizoral AD

How is ketoconazole shampoo used?

Twice weekly x 4 weeks at least 3 days apart

Once seborrheic dermatitis is controlled with ketoconazole, how often is maintenance therapy?

Once weekly

What adverse effects are associated with ketoconazole shampoo?

• ______

• ______

• ______

• Skin ______

• ______ skin

• Abnormal hair ______

Hair loss, Burning, Pruritus, irritation, dry, texture

What is the MOA of salicylic acid?

Decreases skin pH, increases keratin hydration, and loosens/removes scales.

What counseling point should be given before applying salicylic acid to body lesions?

Soak the area in warm water for 10-20 mins first

How long does it take to see keratolytic effects from salicylic acid?

7-10 days

Why should salicylic acid not be applied over extensive areas?

Risk of systemic salicylate toxicity

What symptoms suggest salicylate toxicity?

N/V, Tinnitus, Dizziness, Lethargy/Drowsiness, Hyperpnea, Diarrhea, Psych disturbances, etc.

What is the MOA of sulfur?

Keratolytic, which increases sloughing of skin cells

Which ingredient has a strong odor and may dry or peel the skin?

Sulfur

What combination is sometimes used for seborrheic dermatitis but is NOT FDA approved?

Sulfur and salicylic acid

What conditions is hydrocortisone 1% FDA-approved to temporarily relieve?

Psoriasis-associated pruritus, Seborrheic dermatitis, and Minor inflammatory skin irritations

What is the dosing schedule for hydrocortisone 1%?

BID x 7 days

Which hydrocortisone dosage form has the lowest potency?

Pros:

• Good for _____

• _____ effect

Cons:

• _____ use

Lotion, hairy areas, cooling/drying, must shake before

Which hydrocortisone dosage form has moderate potency and is cosmetically appealing?

Cream

Which hydrocortisone dosage form has the highest potency?

Pros: _____

Cons: _____; avoid _____

Ointment, enhanced absorption, greasy, hairy areas

What adverse effects can occur with prolonged hydrocortisone use?

• Local _____

• Impaired _____

• Aggravation of _____

skin atrophy, wound healing, cutaneous infections

• Pyrithione Zinc = "Zinc Zaps turnover" (cytostatic)

• Selenium = "Smelly Selenium" → odor + oily scalp + rinse 2–3×

• Coal Tar = "Tar stains the CAR" → stains + photosensitivity

• Keto kills Ketoconazole's fungus (Malassezia)

• Salicylic acid = Scales → Salicylic

• Hydrocortisone = Hot, red psoriasis lesions

KNOW