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scabicides
- treat affected person, all household/family members and close contacts at the same time
- apply to clean, dry skin
- apply to the scalp, neck, face and ears in children < 2 yrs, elderly and immunocompromised, ppl with tx failure or crusted scabies
- remember to apply between fingers, toes, under nails, skin folds, bellyi butoon, between buttocks and groin area
- soft toys, bed linen and clothing in contact with the person in the last 48-72 hrs should be washed and dried in a hot machine the morning after treatment or stored in tightly sealed plastic bags for 3 days
- improvement usually occurs w/in 1-2 days, but itch may last 2-3 weeks - manage with moisturiser, topical corticosteroids, crotamiton or antihistamine
- reinvestigate if itch still present after 4 weeks
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Head lice
- treat only if live louse is found - confirm using wet combing (itching, nits/eggs not necessarily indicator of active infection)
- examine family members and close contacts
- insecticides - 2 applications 7 days apart, avoid hair dryer (inactivates), do not overuse (e.g. for prevention) --> resistance and irritation
- children back to school after 1st tx, advice against sharing hats and brushes
- soak combs/brushes in hot water (>60oC) for 30 secs, wash pillowcases in hot water/dryer for 15 mins
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Permethrin 1% for head lice
- Quellada Head Lice treatment
- apply to damp hair after washing with usual shampoo
- leave in for 10 mins
- rinse with warm water
- rpt after 7/7
- Use fine tooth comb to remove dead lice/nits.
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Permethrin 5% for scabies
- Quellada Scabies Treatment 5% Lotion, Lyclear 5% Cream
- Apply chin-down and wash off with warm soapy water 8-14 hours later
- rinse thoroughly
- rpt after 7 days
- Also apply to neck, face, scalp and ears in children <2 yrs, elderly or immunocompromised ppl, tx failure
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Maldison 0.5% lotion, 1% shampoo
- KP24
- avoid contact in eyes/mouth/ears/inside nose
- wear gloves
- avoid excessive tx - irritation
- allow skin/hair to dry naturally without head - contains ethanol
- lotion preferred - longer contact time, shampoo may be diluted during use - reduced efficacy
- shampoo - preferred in asthma - no ethanol vapour
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xenical
- orlistat 120mg
- 1 TDS with main meals
- do not take if missing meal/no fat in meal
- eat low-calorie diet high in fruit and veges
- fatty/oily stools likely if meals too high in fat
- efficacy for up to 4 yrs - mean wt loss of 2-4kg in first yr
- may reduce absorption of fat-soluble vitamins - ADEK - supplement if necessary, take at least 2 hrs from orlistat BMI > 30 or >27 with other risk factors
- not recommended for children adolscents unless by specialist input - limited role and associated with comorbidity, lifestyle more imp
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Haemorrhoids
- confirm diagnosis - pts often misdiagnose
- avoid prolonged straining
- increase fibre (dietary, bulking agentst) and fluid intake
- topical corticosteroids - reduce inflammation, limit use to < 7/7 (local infection, skin atrophy)
- local anaesthetics - relieve pain, burning and itching (limit use to <7/7 - sensitise skin)
- GTN - relieve pain post haemorroidectomy, commonly causes headache
- stool softeners may be helpful
-
proctosedyl
hydrocortisone, cinchocaine
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scheriproct
prednisolone, cinchocaine
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hemocane
lignocaine, allantoin, zinc oxide
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rectinol
cinchocaine, hydrocortisone
-
rectogesic
- GTN
- NB: pain relief often occurs before anal fissure healing - ensure adequate tx course
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