Chapter 37-39: Eyes/Ears/Nose/Skin Conditions

Question 1

How do allergic rhinitis and colds differ in terms of symptoms and causes, and what are the potential implications of untreated allergic rhinitis?

Answer 1

Allergic rhinitis, or hay fever, presents cold-like symptoms such as congestion, runny nose, sneezing, and itchy eyes due to allergen exposure like pollen or pet dander. It can be distinguished by rapid sneezing, watery, itchy eyes, and nose and throat itchiness after exposure. Symptoms can be occasional or chronic, disrupting daily life and productivity. Untreated, it may lead to sinusitis, ear infections, and worsened asthma. Many asthma patients also have allergic rhinitis, as both conditions involve inflammatory reactions triggered by various factors.

Question 2

Allergic Rhinitis: Nondrug Treatment/ Approach

Answer 2

To reduce allergic symptoms, avoid known allergens when possible, such as dust mites and animal dander. Allergens can be identified through skin prick or blood tests. Common allergens include pollen, molds, dust mites, and animal dander. HEPA filters can help with pollen and mold, while regular vacuuming with a HEPA vacuum reduces dust mites. Limit outdoor activities during poor air quality days, monitored by the Air Quality Index. High pollen days may require staying indoors with closed windows and air conditioning. Balancing exposure levels is important for children’s immune system development (no overly clean enviroment!)

Question 3

Allergic Rhinitis: Nasal Irrigation/ wetting agent

Answer 3

Nasal irrigations and wetting agents offer relief from nasal congestion, runny nose, and sneezing. Petrolatum nasal gels, such as Allergen Block, create a physical barrier around the nostrils to block pollens and allergens. These products are generally safe for various populations, including children and pregnant women.

Wetting agents, like commercially available saline solutions such as Ocean, Little Remedies, or Simply Saline, contain saline, propylene glycol, or polyethylene glycol to provide moisture and reduce nasal passage irritation.

**Nasal irrigation involves using isotonic (0.9%) or hypertonic (2-3.5%) **saline solutions to rinse out allergens and mucus, improving ciliary function and reducing swelling. Premixed saline packets are available commercially, or a saline solution can be prepared at home. However, it’s crucial to use distilled, sterile, or previously boiled and cooled water for preparing the solution to avoid infections. Tap water (potable water) should be avoided due to the risk of causing infections.

Nasal irrigations can be administered using a syringe or a neti pot. Neti pots resemble small genie lamps or teapots and are popular for this purpose. The prepared saline solution is poured into one nostril and drained out of the other while breathing through the mouth. Mild nasal stinging or burning may occur, particularly with higher concentrations of saline. After each use, the neti pot should be rinsed with distilled, sterile, or boiled water and left to air dry. Sharing neti pots with others should be avoided.

Question 4

Drug Treatment for Allergic Rhinitis

Intranasal steroids are first line for chronic, moderate-to-severe symptoms! List some drugs, general dosing, warning, SEs, notes

Answer 4

Drugs:
- Budesonide (Rhinocort Allergy) OTC: 1 spray per nostril QD
- Fluticasone (Flonase) OTC: 1-2 sprays/ nostril QD
- Triamcinolone (Nasacort) OTC: 1-2 sprays/nostril QD
.
Warnings/SEs: Avoid if you have recent nasal ulcers, high dose for long period can cause adrenal suppresion/ growth suppression in children, use caution when use in glucoma/ cataract; can cause Epistaxis (nose bleed)
.
Note: Budesonide and beclomethasone are the top choices for nasal steroids during pregnancy.
.

Question 5

Drugs Treatment for Allergic Rhinitis

Antihistamines: When are they use? What are the differences between first and second-generation antihistamines, and how do they each contribute to managing allergic symptoms?

Answer 5

Oral antihistamines are commonly used for mild to moderate allergies, effectively reducing symptoms like itching, sneezing, and runny nose. They work by blocking histamine at the histamine-1 (H1) receptor site. While first-generation antihistamines like hydroxyzine, Diphenhydramine, and meclizine may cause more sedation, second-generation ones are preferred due to their lower sedative effects and cognitive impairment. They’re particularly useful for allergic conjunctivitis symptoms like itchy, red eyes. However, they have little effect on nasal congestion.

Question 6

Select First-Generation Oral Antihistamines

1st Gen Antihistamine: Names, general dosing, warning, C/I, SEs

Answer 6

Drugs:
- Diphenhydramine (Benadryl): adult 25-50mg; children +6: 12.5-25mg
- Chlorpheniramine (Aller-Chlor): 4IR mg-12ER mg
- Doxylamine (Unisom Sleep tab)
.
C/I: Newborns/ premee, lactating women, acute asthma, do not use with MAO inhibitors
.
Warning: Avoid in the elderly (due to strong anticholinergic effects - Beers), use caution in patients with CVD, enlarged prostate, glucoma
.
SEs: Somnolence, cognitive impairment, strong anticholinergic effects (dry)

Question 7

Second-Generation Oral Antihistamines

2nd Gen Oral Antihistamines: Drug, notes

Answer 7

Drugs:
- Cetirizine (Zyrtec): 2.5 (children) - 10mg (adults)
- Levocetirizine (Xyzal Allery): 1.25mg (children) - 5mg (adult)
- Fexofenadine ( Allegra Allergy)/ + pseudoephedrlne (Allegra-D): 30 mg BID (child) - 60 mg BID (adult)
- Loratadine (Claritin) +pseudo (Claritin-D): 5- 10mg
.
If using in pregnancy, loratadine and cetirizine are preferred
More sedating: cetirizine and levocetirizine
Less sedating: fexofenadine and loratadine

Question 8

Drugs for Allergic Rhinitis: Decongestants

Decongestants: general, what are decongestants

Answer 8

Decongestants are alpha-adrenergic agonists that work by constricting blood vessels in the nasal passages, reducing swelling and congestion effectively. Products with a “D” in their name, like Mucinex D, typically contain decongestants like phenylephrine or pseudoephedrine. Phenylephrine has limited oral absorption and is often found in nasal inhalers but may cause more side effects and have a shorter duration of action compared to oxymetazoline inhalers. Pseudoephedrine is a potent systemic decongestant but is subject to restricted distribution due to its potential misuse as a precursor to methamphetamine.

Question 9

Drugs for Allergic Rhinitis: Decongestants

Decongestants: COMBAT METHAMPHETAMINE EPIDEMIC ACT 2005!

Answer 9

To curb methamphetamine abuse, over-the-counter products containing pseudoephedrine, phenylpropanolamine, and ephedrine are restricted. They are kept behind the counter or in locked cabinets and are subject to federal purchase limits of 3.6 grams per day and 9 grams in a 30-day period.

Question 10

Systemic Decongestants

Systemic (oral) decongestants: names, C/I, warnings/ SEs

Answer 10

Drugs:
- Phenylephrine (Sudafed PE); Pseudoephedrine (Sudafed, Nexafed)
.
C/I: Do not use within 14 days of MAO inhibitors
.
WARNINGS: Avoid in children < 2 (FDA)/ < 4 (package insert), use caution in patients with CVD/ HTN, can cause: tachycardia, palpitations, high BP, insomnia

Question 11

Topicals (Intranasal) Decongestants

Oxymetazoline (Afrin): dose, SEs

Answer 11

2-3 sprays per nostril Q12H PRN; SEs: Rhinitis medicamentosa (rebound congestion if used longer than 3 days)…do not use with MAO inhibitor!

Question 12

Additional Allergy Medications

Intranasal Cromolyn: MOA

Answer 12

Intranasal cromolyn (NasalCrom) is an over-the-counter mast cell stabilizer for allergic rhinitis. It requires regular, not as-needed, use starting at allergy season onset. While not as potent as other options, it’s safe for children over 2 years old and during pregnancy

Question 13

Additional Allergy Medications

Oral Leukotriene Receptor Antagonist: warnings?

Answer 13

Montelukast (Singulair) is the sole leukotriene modifier approved for both allergic rhinitis and asthma, frequently prescribed for children. However, the FDA has issued a boxed warning due to potential serious neuropsychiatric side effects. It should be considered for allergic rhinitis only when other treatments prove ineffective

Question 14

COUGH AND COLD: Natural Products Used for Colds

Answer 14

Zinc, available in lozenges and syrup, is used for cold prevention and treatment. Proper usage may reduce cold duration. However, they can cause mouth irritation, metallic taste, and nausea, and long-term use may lead to copper deficiency.
.
Vitamin C supplements are commonly used but show little efficacy in cold prevention. However, high doses (4g/day or more) may cause diarrhea and possibly kidney stones. Echinacea is also rated as “possibly effective” for cold treatment.
.
Popular options like Airborne and Emergen-C Immune+ contain various ingredients including vitamin C, vitamin E, zinc, and echinacea.

Question 15

Cough/ Cold Medicine

Expectorants: Cold-related coughs are typically dry, or nonproductive. However, if a productive cough occurs, expectorants can help by thinning mucus and facilitating its removal from the respiratory tract:
.
Name the medication/ SEs

Answer 15

Drug:
Guaifenisen (Mucinex, Robitussin,
Robafen) +/-dextromethorpham (DM - cough suppressor)
.
SEs:N/V, HA, Dizziness, rash

Question 16

Cough Suppressant:What are the mechanisms of action of common cough suppressants, and what are the potential risks associated with their use, particularly concerning abuse potential and regulatory restrictions?

Answer 16

Cough suppressants are used for dry, nonproductive coughs or to manage nighttime coughing for better sleep. Dextromethorphan and codeine target brain regions, like the medullary cough center, to suppress the cough reflex. Benzonatate works by numbing respiratory stretch receptors. However, opioids and dextromethorphan carry abuse potential. Dextromethorphan acts as a serotonin reuptake inhibitor, showing no addictive properties at antitussive doses, but at high doses, it can lead to euphoria and hallucinations by blocking NMDA receptors. Due to abuse potential, some states restrict their sale to minors. Codeine cough products are classified as CV schedule drugs.

Question 17

Cough Suppressants

Cough Suppressants: Drug names, C/I, SEs, Notes

Answer 17

1. Dextromethorphan (Delsym,
   Robafen, Robitussin) + guaifenesin (DM); C/I:Do not use within 14 days of an MAO inhibitor; SEs: Serotonin syndrome
2. Codeine (C-II for pain; but mixed with cough med CV): Warning: Children who metabolize codeine quickly due to a genetic variation (CYP450 2D6 polymorphism) are at risk of respiratory depression and death after tonsillectomy or adenoidectomy. FDA advises against using codeine-containing cough < 18 years old.
3. Benzonatate (Tessalon Perla)
4. Diphenhydramine (Benadryl)

Question 18

Cough combo products and what the accromin

Answer 18

• D = decongestant (e.g., phenylephrine or pseudoephedrine)
• PE = phenylephrine
• DM = dextromethorphan
• AC = contains codeine

Question 19

EYE & EAR PRESCRIPTION INTERPRETATION

Answer 19

Question 20

GLAUCOMA

Glaucoma: What are the key characteristics of glaucoma, and how does its treatment vary between the two main forms, open-angle and angle-closure glaucoma?

Answer 20

Glaucoma is an eye disease causing optic nerve damage and visual field loss. It often involves elevated intraocular pressure (IOP), leading to symptoms like eye pain, headaches, and vision decline. Treatment aims to lower IOP. Open-angle glaucoma, the most common type, is managed with eye drops or surgery. Angle-closure glaucoma, a rarer form, presents as a sudden increase in IOP due to blockage and requires immediate surgical intervention

Question 21

Glaucoma

Drugs that can increase IOP

Answer 21

• Anticholinergics (e.g., oxybutynin , tolterodine,
  benztropine, trihexyphenidyl , TCAs)
• Cough, cold and motion sickness medications
  (e.g., antihistamines , scopolamine)
• Chronic steroids, especially eye drops such as
  prednisolone
• Topiramate (Topamax)

Question 22

Glaucoma Treatment Goal: DECREASE BP! What are some medication options? General info

Answer 22

■ Reduce aqueous humor production (make less fluid): Beta-blockers. like timolol
■ Increase aqueous humor outflow (move fluid out): Prostaglandin analogs, like latanoprost
■ Or, do both: often achieved with add-on treatment –> Alpha-2 agonists, like brimonidine

Question 23

GLAUCOMA Treatment

Prostaglandin Analogs: MOA, Drugs, Warning, SEs, Notes

Answer 23

• MOA: Increase aqueous humor outflow (move fluid out)
• DRUGS: Bimatoprost (Lumigan), Latanoprost (Xalatan, Xelpros), Bimatoprost (Latisse - for eyelash growth: do not use with prostaglandin analogs indicated for glaucoma) - all are 1drop QHS
• Warning: Ocular effects: darkening of the iris, eyelid skin and eyelashes; eyelash growth
• SEs: Blurred vision, stinging , increased pigmentation of the iris/ eyelashes
• Notes: prost = prostaglandin analog

Question 24

GLAUCOMA Treatment

Beta Blockers: MOA, Drugs, C/I, SEs, Notes

Answer 24

• MOA: Reduce aqueous humor production (make less fluid)
• DRUGS: Timolol 0.25% or 0.5% (Timoptic, lstalol): 1 drop daily or BID
• C/I: Sinus bradycardia, significant heart block (except in those with a pacemaker), cardiogenic shock, uncompensated heart failure, and bronchospastic disease
• SEs: Burning, stinging, bradycardia/fatigue , bronchospasm
• Notes: All are non-selective beta-blockers except betaxolol

Question 25

GLAUCOMA Treatment

Other agents and drug classes: General

Answer 25

1. Cholinergics (Miotics): increase aqueous humor outflow; Dorzolamide (Trusopt) + timolol (Cosopt, Cosopt PF);Brinzolamide (Azopt); oral agents avalible as well! WARNING: Sulfonamide allergy
2. Andrenergic Alpha-2 Agonist: Increase aq humor outflow/ decrease production; Brimonidine (Alphagan P)
3. Rho Kinase Inhibitors : increase aqueous humor outflow: Netarsudil (Rhopressa)

Question 26

CONJUNCTIVITIS

CONJUNCTIVITIS: General Info; What are the common causes and preventive measures for conjunctivitis?

Answer 26

Conjunctivitis, commonly known as “pink eye,” causes swelling, itching, burning, and redness in one or both eyes. It can result from a virus, bacteria, allergen, or ocular irritant. Most cases cause mild discomfort and clear without treatment, but some may require treatment. Viral and bacterial conjunctivitis are highly contagious, especially in children. Infected individuals, particularly children, should stay home until treatment begins, unless systemic symptoms are present. To prevent spread, patients should avoid touching their eyes, practice proper hand hygiene, change towels daily, and discard eye cosmetics like mascara.

Question 27

CONJUNCTIVITIS

Viral: Causes, tx?

Answer 27

• Cause: Adenovirus
• Tx: N/a just suffer

Question 28

CONJUCTIVITS

Bacterial: Causes, Tx?

Answer 28

• Cause: Staphylococcus aureus, more severe cases: Neisseria gonorrhoeae, chlymidia
• Tx: Select topical antibiotic eye drops or ointments: Moxifloxacin (Vigamox), Neomycfn/Polymyxln B/ Dexamethasone (Maxltrol), Trlmethoprim/Polymyxin B (Polytrim)

Question 29

CONJUNCTIVITS

Allergies: Causes, TX

Answer 29

• Common allergens include pollen, dust mites, animal fur
• Tx: Azelastine, Olopatadine,Ketotifen - antihis

Question 30

OTHER OCULAR CONDITIONS + TREATMENTS

1. Inflammation
2. Dryness
3. Chronic Dry Eye
4. Redness

Answer 30

1. Inflammation: steroid (Prednlsolone) or NSAID
2. Dryness: Refresh, Systane
3. Chronic Dry Eye: Cydosporlne Emulsion Eye Drops (Restasis)
4. Redness: Naphazollne (Clear Eyes Redness (OTC)
Naphazollne/ phenlramlne (Naphcon A, Vislne A -OTC)
Brimonidine (Lumify) (OTC)

Question 31

Common Drugs that Causes Eye Issues

Answer 31

Question 32

Common Ear Issues + Treatment
1. Outer Ear Infection (Otitis Externa)
2. Earwax (Cerumen buildup)

Answer 32

1. Outer Ear Infection (Otitis Externa): Ciprofloxacin and dexamethasone (Ciprodex)
2. Earwax (Cerumen buildup): carbamide peroxide (Debrox), triethanolamine

Question 33

SKin Conditions

List some common natural products and their use for different skin issues

Answer 33

Aloe vera is a natural product used for various skin conditions like sunburn and psoriasis, providing soothing effects when applied as a gel or lotion.** Tea tree oil** is utilized for acne and may help alleviate symptoms of onychomycosis. Lysine is taken orally or applied topically for cold sore prevention and treatment. Biotin is a vitamin used for hair loss and brittle nails. Topical vitamin D is used for skin conditions like diaper rash and psoriasis.

Question 34

Drugs that can discolor skin and body secretion

Answer 34

Question 35

Treatment/ drug options for ACNE

Answer 35

• Benzoyl peroxide (BPO):
  Most effective over-the-counter (OTC) medication.
  Available by prescription alone or in combination with hydrocortisone, adapalene, erythromycin, or clindamycin.
• Salicylic acid:
  Mildly useful OTC medication.
• Retinoids (e.g., topical tretinoin):
  Preferred prescription medication for acne and wrinkle reduction.; Teratogenic; avoid in pregnancy or breastfeeding.; may cause mild skin irritation and photosensitivity. Use nightly. Takes 4-12 weeks to show effects; acne may worsen initially.
• Oral retinoid isotretinoin -
  Isotretinoin is for severe acne. Women must sign a consent form due to birth defect risks. They need two negative pregnancy tests before and must avoid pregnancy one month before, during, and after treatment. They can’t breastfeed or donate blood until one month after stopping the drug. reserved for severe nodular acne, with strict safety considerations.
• Oral contraceptive pills:
  Some women benefit, particularly if acne aligns with menstrual cycle or if symptoms of androgenic excess are present.
• Spironolactone:
  Aldosterone receptor antagonist with antiandrogen effects. Not FDA-approved for acne but recommended for some females.
• Azelaic acid (Azelex, Finacea):
  Topical dicarboxylic acid cream or gel for acne and rosacea.
• Oxymetazoline hydrochloride 1% cream (Rhofade):
  Approved for rosacea-associated erythema.

Question 36

Cold Sores: Treatment options

Answer 36

Cold sores, caused by herpes simplex virus type 1 (HSV-1) and sometimes HSV-2, are highly contagious and spread through active lesions, kissing, and sharing drinks. They typically appear at the junction of the upper and lower lip, preceded by prodromal symptoms like tingling or itching. Triggers include fatigue, stress, sun exposure, and dental work.
.
TX: Docosanol (Abrevo) - OTC; Acyclovir topical cream/ointment (Zovirax) - RX

Question 37

Dandruff: Treatment Options

Answer 37

Ketoconazole 1% shampoo (Nizoral
AD) - OTC; Ketoconazole 2% shampoo (Nizoral)

Question 38

Alopecia (hair loss): What are some causes?

Answer 38

Hair loss commonly occurs with age, hormonal changes, medical conditions, and medications. Hereditary male-pattern baldness is the most common cause, followed by female-pattern baldness. Hormonal shifts in women during pregnancy, childbirth, or menopause can also lead to hair loss. Medical conditions like hypothyroidism, alopecia areata, and scalp infections contribute to hair loss, as do certain medications including chemotherapeutics and drugs like valproate and spironolactone. Deficiencies in zinc and vitamin D can also play a role in hair loss.

Question 39

Alopecia: Treatment Options

Answer 39

• Finasteride (Propecia): 5-alpha reductase
  type 2 inhibitor also approved for BPH! 1mg QD
• Minoxidil topical (Rogaine) (tablet is for HTN)

Question 40

ECZEMA (ATOPIC DERMATITIS) - Treatment

Answer 40

Hydration is crucial for managing disease severity. Moisturizers should be used regularly (aquaphor).
.
Treatment options include topical steroids, occasional oral courses if necessary, antihistamines for itching, and immunosuppressant calcineurin inhibitors (eg. Tacrolimus (Protopic)- ointment or Pimecrolimus (Elidel) - cream).
.
In severe cases, oral immunosuppressants like cyclosporine or methotrexate may be used, or monoclonal antibody drugs in refractory cases. Dupilumab (Dupixent) is approved for moderate to severe eczema and is administered via subcutaneous injection every other week. Other off-label treatments are also available.

Question 41

FUNGAL INFECTIONS: SKIN

Describe the different fungal infection:
1. ATHLETE’S FOOT (TINEA PEDIS)
2. JOCK ITCH (TINEA CRURIS)
3. RINGWORM (TINEA CORPORIS)
4. CUTANEOUS (SKIN) CANDIDA INFECTIONS

Answer 41

1. ATHLETE’S FOOT (TINEA PEDIS): caused by fungi like trichophyton rubrum, presents with itching, peeling, redness, mild burning, and occasionally sores, commonly affecting individuals who use public pools, showers, and locker rooms
2. JOCK ITCH (TINEA CRURIS): Affects the genitals, inner thighs and buttocks. The rash is red, itchy and can be ring-shaped
3. RINGWORM (TINEA CORPORIS): Not a worm, but a skin fungal infection. Ringworm can appear anywhere on the body and typically looks like circular, red, flat sores
4. CUTANEOUS (SKIN) CANDIDA INFECTIONS: Topical Candida infections cause red, itchy rashes, most commonly in the groin, armpits or anywhere the skin folds

Question 42

FUNGAL TREATMENTS FOR THE SKIN: OTC Products

Answer 42

• Terbinafine (Lamisil AT)
• Butenafine (Lotrimin Ultra cream)
• Clotrimazole (Pro-Ex Antifungal, Shopka Athletes Foot cream)
• Miconazole (Lotrimin AF, Cruex, Desenex)
• Tolnaftate (Tinactin powder, cream, spray)
• Undecylenic acid (Fungi-Nail)

Question 43

FUNGAL TREATMENTS FOR THE SKIN: RX Products

Answer 43

• Betamethasone/Clotrimazole (Lotrisone): Popular for tinea with inflammation and itching.
• Ketoconazole: Available as cream and foam (Extina).

Question 44

FUNGAL INFECTIONS: TOENAIL & FINGERNAIL

Answer 44

Onychomycosis, caused by fungi like tinea unguium, can result in pain, discomfort, and disfigurement, leading to physical limitations and psychological issues. Topical drugs are limited and not potent enough for most cases; systemic therapies like itraconazole and terbinafine are common treatments. Treatment duration is lengthy, especially for toenails, which are more commonly infected. Pulse therapy may reduce costs but might be less effective. A 20% potassium hydroxide (KOH) smear is crucial for diagnosis due to similar presentations with other conditions.
.
Regimen: Terbinafine 250 mg PO daily for 6 weeks (fingernail) or 12 weeks (toenail)

Question 45

FUNGAL INFECTIONS : VAGINAL - Treatment

Answer 45

Mild-moderate, infrequent infection: 1, 3 or 7 day treatment, with vaginal cream, ointment or vaginal suppository/tab
.
- Topical OTC:
Clotrimazole (Gyne-Lotrimin, others)
Miconazole (Monistat 3, others)
Butoconazole (Gynazole-1, others)
Terconazole (Terazol 7, others)
- Oral (Rx):Fluconazole (Diflucan) 150 mg PO x 1
.
Complicated infections, pregnancy: 7-10 days treatment, or refer to healthcare provider

Question 46

DIAPER RASH: **Prevention and treatment? **

Answer 46

Consider using a skin protectant such as:
- Petrolatum ointment (e.g., A & D Ointment, store brands), containing vitamins A & D, which is effective for prevention.
- Petrolatum with zinc oxide, suitable for babies prone to rash as it helps dry out the skin.
.
Treatmentr: For stubborn rashes potentially caused by yeast, consider: Clotrimazole, Miconazole, Nystatin. Also, hydrocortisone cream at 0.5-1% concentration.

Question 47

What are some effective strategies for managing hemorrhoids, considering their common causes and symptoms?

Answer 47

Hemorrhoids are swollen blood vessels in the lower rectum, often caused by constipation and straining during bowel movements. Common symptoms include itching, burning, and rectal bleeding, typically bright red. Increasing dietary fiber, using products like psyllium, and taking stool softeners such as docusate can help alleviate symptoms by reducing straining.

Question 48

Various treatments for hemorrhoids include:

Answer 48

• Witch hazel (Tucks pads), acting as a mild astringent, can alleviate mild itching.
• Barriers like petrolatum can reduce irritation from stool/urine.
• Phenylephrine (found in Preparation H and others) is a vasoconstrictor that reduces hemorrhoid size, relieving burning and itching.
• Hydrocortisone

Question 49

What are the common characteristics, diagnostic methods, and treatment options for pinworm infection, and what preventive measures should be taken to manage this condition effectively?

Answer 49

Pinworm infection, common in children, manifests as anal itching. Anthelmintics (antiparasetic) like mebendazole, pyrantel pamoate, and albendazole treat Enterobius vermicularis. Diagnosis involves the “tape” test, applying tape around the anus in the morning to collect eggs. Handwashing and household-wide treatment are essential preventive measures.

Question 50

Lice / Scabies Treatment and Management

Answer 50

Lice treatment overlaps with scabies treatment methods. Scabies spreads through close body contact and is primarily treated with permethrin cream (Elimite) and oral ivermectin (Stromectol) in two doses, a week apart. Oral ivermectin may cause side effects such as lymph node enlargement, arthralgias, skin tenderness, pruritus, and fever. Topical ivermectin (Sklice) is also available for lice treatment but is not first-line and requires a minimum body weight of 15 kg. Lice, primarily affecting elementary school-age children, are commonly treated with over-the-counter pyrethrins and permethrin, although caution is advised for those with allergies to chrysanthemums or ragweed. Malathion lotion (Ovide), benzyl alcohol lotion (Ulesfia 5% lotion), and lindane shampoo 1% (Kwell) are alternative treatments with specific usage considerations and precautions due to potential skin irritation, flammability, neurotoxicity, and age restrictions.

Question 51

BURNS

What are the different types of burns and their characteristics, and what are the recommended topical treatments for minor burns, including both over-the-counter and prescription options, to prevent infection and promote healing?

Answer 51

Burns can be categorized into first degree (red/painful), second degree (thicker, very painful with blisters), and third degree (damage to all skin layers, appearing white or charred). For minor burns, ointments like Aguaphor, containing 80% oil and 20% water, help protect the skin, retain moisture, and reduce scarring risk. Silver sulfadiazine (Silvadene; SSD) is effective topically for infection prevention and healing. Over-the-counter triple antibiotic ointments (e.g., Neosporin Original) or alternatives like Polysporin or bacitracin alone can be used for neomycin allergies. Prescription mupirocin (Bactroban) offers strong staph and strep coverage.

Question 52

Sunscreen and Sun Protection: Importance of sunscreen and discuess the Time to Burn equation and how it works

Answer 52

• Applying sunscreen is important due to the risk of sun damage/ cancer. But sunscreen also blocks vitamin D production in the skin.
• Advisable to stay out of the sun when it is strongest
  (between 10AM - 4PM)
• Use a minimum SPF 30. Reapply at least every two hours and reapply after
  swimming or sweating. The AAP recommends keeping babies less than 6 months old out of the sun.
  .
  TIME TO BURN (TTB)
  TTB (with sunscreen in min)= SPF X TTB (without sunscreen)
• How SPF works: if someone would normally burn in 10 minutes, an SPF of 5 would extend the time they would burn to 50 minutes (5 x 10 = 50.)
  .
  Sunscreen labeling is no longer permitted to use
  “waterproof” or “sweatproof” since they all wash of.. They can claim to be “resistant” but only for 40 - 80 minutes.