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2017 HCHB_digital

Bites and Stings Bites

Bites and Stings Bites and stings can be either venomous or non-venomous. Bees, hornets, wasps, jellyfish, and the katipo and red-back spider are venomous. Fleas, lice, mosquitoes, sandflies, scabies and ticks are non-venomous. In general, venomous stingers or biters inject a toxic and often painful venom into their victim as a defence mechanism to ward off attack. A stinging sensation or pain is felt in the area which becomes inflamed, swollen and sometimes itchy. Certain wasp or jellyfish stings are particularly painful and the pain may persist for several hours even after first aid has been applied. Most jellyfish stings in New Zealand can be attributed to bluebottles, lion’s mane jellyfish, mauve stingers, or hydromedusae (microscopic jellyfish larvae). Non-venomous biters pierce the skin and feed on their victim’s blood, resulting in a small raised red spot and often intense itching. Infection of the open sore commonly occurs due to scratching. Outside of New Zealand, many non-venomous biting insects carry diseases, for example, malaria, zika or dengue fever carrying mosquitoes (see also Travel Health). In most people, a bite or sting causes a mild reaction. However, a more serious allergic reaction known as anaphylaxis can occur in people who are sensitive to a particular venom, and occasionally in people who have never had a reaction before (see also Allergies). This results in facial swelling, difficulty breathing and an itchy rash (see also Urticaria) over most of the body. Immediate medical attention and treatment must be sought as this reaction can be life-threatening. TREATMENT OPTIONS Category Examples Comments Oral antihistamines Topical antihistamines Anti-pruritic (anti-itch) preparations Topical corticosteroids Local anaesthetics Anti-sting preparations PREVENTION Insect repellents Natural / herbal / supplements Non-sedating [PHARMACY ONLY MEDICINE] eg, cetirizine (Razene, Zetop, Zyrtec), desloratadine (Aerius), fexofenadine (Fexofast, Xergic), levocetirizine (Levrix), loratadine (Claratyne) Sedating [PHARMACIST ONLY MEDICINE] eg, dexchlorpheniramine (Polaramine), promethazine (Phenergan, Allersoothe) [PHARMACY ONLY MEDICINE] eg, mepyramine (Anthisan cream*) [GENERAL SALE] eg, Calamine, Itch-Soothe, Pinetarsol, Eurax [PHARMACY ONLY MEDICINE] eg, hydrocortisone 0.5% (DermAid Soft) [PHARMACIST ONLY MEDICINE] eg, hydrocortisone 1% (DermAid Soft) [PHARMACY ONLY MEDICINE] eg, lignocaine (Ethics 4 Way Antiseptic Soothing Cream [+ bufexamac], Medicreme Antiseptic cream, Soov Cream/Gel Bite [with cetrimide]) [GENERAL SALE] eg, Combudoron Spray, Click That Itch, Ozone Anti-itch, Stingose Spray/Gel* Anti-insect bands eg, Para'Kito Mosquito-band Topical insect repellents eg, picardin (eg, Repel New Era) eg, DEET (eg, Aerogard, Bushman, Repel) eg, essential oils (eg, Badger Anti-Bug Balm) Citronella, clove, eucalyptus, neem oil or cream Helps control total body itch and inflammation relating to bite or sting. More convenient for multiple bites/stings than topical antihistamines. Generally, non-sedating medicines do not cause drowsiness; however, some people may be more sensitive than others. Customers need to be warned about the risks of driving or operating machinery if they do get drowsy. Purpose is similar to non-sedating antihistamines (above) but can cause drowsiness which may be useful to improve sleep quality at night but not if alertness (ie, for driving or operating machinery) is required. Warn about sedating effects and advise customers to avoid alcohol. Not suitable for everybody (see Reference Section, OTC Medicine Precautions. Prescription medicine for children under two. Relieves local itch and inflammation. Use for only two to three days to help relieve itchy bites. Tar products (eg, Pinetarsol) help relieve generalised skin itching. Calamine lotion has a soothing, cooling effect and contains 0.5% phenol, which also provides a local anaesthetic action, but may dry out skin. Relieves local itch and inflammation. Apply a thin layer to skin. Do not use for more than one week unless under medical supervision. Avoid the face and genital area unless directed by a doctor. Early use may help relieve the initial sharp pain caused by stings. Bufexamac has anti-inflammatory properties and is thought to act by inhibiting the enzyme cyclooxygenase. Not suitable for those with eczema. May cause contact dermatitis. Combudoron spray contains arnica and herbs to relieve itch. Click That Itch generates a current using quartz crystals to relieve pain. Ozone Anti-itch contains ammonia, zinc and other ingredients to neutralise the bite area and soothe skin. Stingose contains aluminium sulphate and inactivates proteins in venom. Anti-insect bands contain natural oils. Protection against mosquitoes and other insects is provided over several days (see individual products) with continuous band wearing. DEET (N,N-diethyl-m-toluamide), picaridin, IR 3535 and synthetic oil of lemon eucalyptus are all effective at repelling disease-carrying mosquitoes. Recommend to people travelling overseas to at-risk countries. Plant-based insect repellents (eg, citronella, soybean, eucalyptus) are suitable for use in countries not at risk of mosquito-borne diseases (eg, New Zealand). Several essential oils are effective at repelling insects but to date have not shown to be as effective as DEET. Use only in countries not at risk of mosquito-borne diseases. Products with an asterisk have a detailed listing in the Bites and Stingssection of OTC Products, starting on page 221. SOOV BITE Fast relief from insect bites Cooling gel to help take away the urge to scratch after an insect bite or plant sting. Provides welcome relief from the pain and itchiness. • 3% w/w lignocaine hydrochloride to anaesthetise the area • 0.5% w/w cetrimide antiseptic to help prevent infection • Suitable for children above 2 years and adults Douglas Pharmaceuticals Ltd, Auckland Page 20 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Tips to avoid getting bitten •• Use insect repellents and cover arms and legs if in an area prone to insects. •• Avoid perfume or wearing bright-coloured clothing around bees; mosquitoes like dark clothing. •• Cover food and rubbish and try to minimise odours at picnics. Destroy hives or nests. •• Drain pools of stagnating water or add household bleach to them to eliminate mosquito larvae. •• Repel mosquitoes with electrical insect-repelling devices or citronella products when outside. •• De-flea cats, dogs and other household pets regularly. Initial assessment Ask your customer to show you the sting or bite mark if they are comfortable doing so in a private area. If they are unsure of the cause, the appearance, location and quantity of marks should give you some idea (for example, single bite: wasp or spider; multiple bites: mosquito or flea; itchy rash under swimsuit: hydromedusae). Wasp, bee, or hornet stings Most people will have successfully removed the stinger by the time they present to a pharmacy for treatment for a wasp or bee sting. If not, carefully scrape away the stinger with the side of your fingernail rather than grasping it, as this can accidentally squeeze more venom into the patient. Ice should be applied to the affected area and an antihistamine tablet offers the most effective treatment against inflammation and itch. For very minor stings, a topical corticosteroid cream may be used. Seek urgent medical help for anybody with a severe allergic reaction or with signs of anaphylaxis (see also Allergies). Advise customers with severe allergies to insect stings to carry adrenaline at all times and wear medical alert jewellery. Insect bites Suggest topical and oral antihistamines, anti-pruritic (anti-itch) products, topical corticosteroids, or topical local anaesthetic agents for itching. If the cause is thought to be due to scabies or head lice, treatment products should be used. Refer the customer to a pharmacist if they have recently been overseas and there is a possibility that they may have been bitten by a disease-carrying insect. Suggest ways to protect against future bites (see text box above). Spider bites New Zealand has many species of spider but only the red-back and katipo are considered poisonous; an anti-venom effective for both these spiders is available throughout NZ. No deaths from katipo spiders have been reported here since the 19th century. Although white-tailed spiders are known to bite, their venom from rarely causes harm, although some people develop an allergic reaction. Seek urgent medical help if the person has difficulty breathing or a severe reaction; otherwise ring the NZ Poisons Centre, 0800 POISON (764 766) for more advice. SOOV CREAM Soothing antiseptic cream Ideal for cuts and grazes, minor burns, scalds and sunburn. Relieves pain and contains antiseptics to help prevent infection. • 1% w/w lignocaine hydrochoride to provide fast, soothing pain relief • 1% w/w cetrimide antiseptic • Suitable for children and adults. Refer to PHARMACIST Seek urgent medical advice if the person with the bite or sting has had severe reactions in the past, or has any of the following symptoms: • feeling unwell, dizzy or vomiting • significant swelling, especially around eyes, lips, tongue or neck • fever, wheezing, tight chest, difficulty breathing or swallowing. Refer any customers with other health conditions such as immunosuppression, diabetes, or who are pregnant or breastfeeding and wanting advice about bite treatment or prevention to the pharmacist. Also refer customers seeking treatment for young children or with: • extensive swelling or redness around the site of the bite or sting • a previous bad reaction to a bite or sting • signs of infection (eg, pain, pus, crusting) • bites caused by an overseas or unknown source • allergies to certain medicines. Jellyfish Bluebottles Wash stung area in fresh or salt water and remove any stings or tentacles attached to the skin (but not with bare hands). Immerse affected area in warm water for 20 minutes then leave to dry without towelling. DO NOT apply vinegar (increases toxin release). Lion’s mane jellyfish/mauve stingers Apply wet sand or a towel soaked in sea water initially, then flush the area with warm sea water. Vinegar is effective for these types of jellyfish (but fresh water is not). Wipe remaining tentacles off with a dry towel after five minutes. Cold packs may help relieve pain. Hydromedusae Remove togs as soon as possible after leaving the water. Shower in preferably salt water. Wear tight-fitting clothes when swimming. Treatment after first-aid Lignocaine, calamine lotion, or a mild hydrocortisone cream may be applied to the skin and oral antihistamines taken if the skin is itchy. Oral corticosteroid tablets may be prescribed for extensive jellyfish stings. Medicines have benefits and some may have risks. Always read the label and use only as directed. If symptoms persist or you have side effects see your healthcare professional. TAPS PP 7868 Page 21

  • Page 1 and 2: HEALTHCARE HANDBOOK incorporating t
  • Page 3 and 4: 2017-2018 HEALTHCARE HANDBOOK PUBLI
  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 11 and 12: HELP KIDS BE THEMSELVES AGAIN NEW L
  • Page 14 and 15: NUROFEN ZAVANCE* IS ABSORBED UP TO
  • Page 16 and 17: Acne Acne is a common skin problem
  • Page 18 and 19: Allergies An allergy occurs when th
  • Page 20 and 21: Asthma and COPD Asthma New Zealand
  • Page 22 and 23: Baby Feeding Breastfeeding is best
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 36 and 37: Childhood Pain and Baby Teething Pa
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
  • Page 66 and 67: Ear Conditions Our ears allow us to
  • Page 68 and 69: Eye Conditions Almost two-thirds of
  • Page 70 and 71: Eye Conditions (continued) Type Sym
  • Page 72 and 73: Eyes: Contact Lenses Contact lenses
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    Fever What is fever Fever is define

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    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

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    Fungal Nail Infections (Onychomycos

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    Gout Historically known as the “d

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    Haemorrhoids Haemorrhoids (also cal

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    Hair Loss Alopecia is the medical t

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    Hay Fever Hay fever (also called in

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    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

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    Head Lice Head lice (pediculosis ca

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    Heart Health Cardiovascular (CV) di

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    Indigestion, Heartburn and Gastriti

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    Influenza Influenza (flu) is a comm

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    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

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    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

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    Migraine Migraines are a type of se

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    Muscular Aches, Pains and Tightness

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    Nappy Rash Nappy rash is a red rash

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    Oral Health Oral health disorders i

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    Osteoarthritis Osteoarthritis is th

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    Osteoporosis Osteoporosis (meaning

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    Period Pain and Endometriosis Perio

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    Poisonings Any substance that has t

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    Pregnancy Tests and Supplements Hom

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    Preventive Health There are certain

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    Probiotics and Prebiotics Probiotic

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    Psoriasis Psoriasis is a long-term

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    Scabies Scabies is a very contagiou

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    Shingles Shingles (herpes zoster) i

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    Sinus and Nasal Problems Sinuses ar

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    Sleep Problems and Snoring Sleep is

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    Smoking Cessation Almost 5000 New Z

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    Sore Throat Sore throats are very c

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    Strains and Sprains Sprains and str

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    Sun Care Sunburn Sunburn occurs fro

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    Sun Care: Eye Protection Protecting

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    Sweating: Excessive (Hyperhidrosis)

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    Toothache Toothache is the term use

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    Travel Health (including Vaccinatio

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    Travel Sickness Travel, or motion,

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    Urinary Incontinence Urinary incont

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    Urticaria (Hives) Urticaria refers

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    Vaginal Health The vagina is a clos

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    Varicose Veins and Support Stocking

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    Vitamins and Dietary Supplements Vi

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    Warts Warts are benign (non-cancero

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    Weight Loss Obesity has reached epi

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    Worms Pinworms (Enterobius vermicul

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    Wound Care Our skin acts as a barri

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    Wound Care (continued) Wound type M

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    Glossary WHAT DOES THAT WORD MEAN?

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    Chapter References (continued) Diar

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    Chapter References (continued) Gord

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    Significant learning opportunity: W

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    PharmacyToday A part of your everyd

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    OTC Medicines: Interactions When se

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Adverse Effects OTC

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Drugs in Sport Treating Athletes Me

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    Drugs in Aviation AVIATION - PRECAU

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    Drugs in Pregnancy Drug use in preg

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    NZ Support Groups ADHD Association

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    NZ Support Groups New Zealand AIDS

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    HEAT or INFLAMMATION Unlike heat ru

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    OTC Products Over-the-counter produ

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    OTC Products Index Foot Care - Fung

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    »» Acne CRYSTADERM CREAM AFT PHAR

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    »» Childhood Pain and Baby Teethi

  • Page 232 and 233:

    »» Colds BONNINGTON’S IRISH MOS

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    CODRAL RELIEF MAX STRENGTH COLD & F

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    OTRIVIN JUNIOR GLAXOSMITHKLINE CONS

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    DULCOLAX SANOFI CONSUMER HEALTHCARE

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    BENADRYL MUCUS RELIEF DOUBLE ACTION

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    »» Dandruff COCO-SCALP AFT PHARMA

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    EAR CLEAR WILSON CONSUMER PRODUCTS

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    »» Foot Care - Fungal Infections

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    TELFAST ORAL LIQUID SANOFI CONSUMER

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    NUROFEN ZAVANCE RECKITT BENCKISER (

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    MOOV HEAD LICE SOLUTION DOUGLAS PHA

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    GAVISCON DUAL ACTION LIQUID RECKITT

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    CODRAL COLD & FLU + COUGH JOHNSON &

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    »» Irritable Bowel Syndrome GASTR

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    VOLTAREN EMULGEL GLAXOSMITHKLINE CO

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    TURMERIC EXTRA STRENGTH GOOD HEALTH

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    PREGNOSIS EARLY PREGNANCY TEST DIP

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    »» Sexual Wellbeing - Contracepti

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    SUDAFED PE SINUS DAY + NIGHT RELIEF

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    NICORETTE INHALATOR JOHNSON & JOHNS

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    STREPSILS PLUS LOZENGES RECKITT BEN

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    TRAVACALM TRAVEL BAND WILSON CONSUM

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    CRYSTADERM CREAM AFT PHARMACEUTICAL

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    An ENHANCED ELearning Experience As

  • Page 280 and 281:

    Product Index ANIME LUBRICANT 50ML-

  • Page 282 and 283:

    Manufacturer’s Index AFT Pharmace

  • Page 284:

    Topiramate Actavis Topiramate 25mg,

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