Home' Australian Pharmacist : Australian Pharmacist December 2013 Contents Australian Pharmacist December 2013 I © Pharmaceutical Society of Australia Ltd.
COUNSELLING IN PRACTICE
Key learning points
Common biting insects include mosquitoes,
fleas, lice, bed bugs, midges and some types
of flies. Insects bite in order to feed on the
host’s blood. They inject a small amount
of saliva‐containing substances to aid in
digestion, inhibit coagulation of the host’s
blood, increase blood flow to the site, or
anesthetise the bite area.
Common stinging insects include bees,
wasps and hornets. They inject venom into
the host’s tissues. A bee sting tears away
from the bee and remains embedded
in the host’s skin, continuing to pump
venom into the host. Many types of ants
defend themselves by biting and then
spraying formic acid into the wound. Some
ants can inflict painful and potentially
Most people have mild local reactions
to insect bites and stings. An insect bite
usually causes an itchy weal which develops
into a hard, itchy papule that can persist
for days, weeks or (occasionally) months.
Insect stings produce an initial sharp,
stinging sensation, after which the area
becomes painful, red and swollen, but not
Some people have allergic reactions
to insect stings and (less commonly)
bites. A mild allergic reaction can
manifest as a generalised, itchy
urticarial rash. Signs of a severe allergic
reaction (anaphylaxis) include anxiety,
disorientation, weakness, cramping,
diarrhoea, vomiting, urinary incontinence,
dizziness, fainting, hypotension, difficulty
breathing, respiratory failure and
The first priority for a bee sting is to remove
the sting as soon as possible. Pain and
swelling of bites/stings can be relieved
by intermittent application of an ice pack.
Itching can be relieved by application of
a corticosteroid cream or calamine lotion.
Oral antihistamines can be taken to reduce
the severity and duration of an allergic
reaction. A severe allergic reaction requires
urgent medical attention and (if available)
use of an adrenaline autoinjector
1. Which of the following counselling
points regarding biting and stinging
insects is CORRECT?
a) Most insects that bite do so in order to
b) Bull ants defend themselves by biting
and then spraying formic acid into the
c) Ants can sting multiple times, whereas
bees and wasps can only sting once.
d) Some biting insects inject saliva
containing substances that increase
blood flow to the bite area.
2. An itchy wheal that develops into a
hard, itchy papule is MOST likely to
have been caused by which of the
b) Black house ant.
c) Honey bee.
3. A customer requests something to
relieve a raised, red wasp sting. She
says it is painful but not itchy, and
she has no other symptoms. Which
of the following would be the MOST
a) The sting needs to be removed
immediately, and then the bite area
needs to be disinfected.
b) The customer should consult her
doctor for prescription of a potent
c) The sting area should be cleaned with
soap and water, and then an ice pack
d) The customer should apply 1%
hydrocortisone cream to the bite, and
take loratadine 10 mg daily.
4. Which of the following counselling
points regarding insect repellents is
a) DEET and IR3535 are the only two
chemicals that have been shown to be
effective as insect repellents.
b) The concentration of active ingredient
in an insect repellent affects the
degree, but not the duration, of
c) Insect repellents containing 70% DEET
are significantly more effective than
those containing 50% DEET.
d) Insect repellents containing citronella
oil as the active ingredient provide a
shorter duration of protection than
those containing DEET.
5. A customer asks if you can
recommend something to treat
a painful bee sting on her hand.
She says she got the sting 2 days
ago and has been using calamine
lotion on it, but the swelling and
pain are getting worse. Which of
the following would be the MOST
a) Recommend that she continue
applying calamine lotion and also take
fexofenadine 180 mg daily.
b) Advise her to consult her doctor.
c) Advise her to apply an ice pack to the
bite for 15 minutes at a time.
d) Recommend application of 1%
hydrocortisone cream to the bite as
well as intermittent use of an ice pack.
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NZ. At: www.dermnetnz.org/arthropods/bites.html
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4. Britton D. Insect bites and stings [revised Feb 2011]. Australian
Museum. At: http://australianmuseum.net.au/Insect-bites-
5. Commonwealth scientific and industrial research organisation
(CSIRO). Ants are everywhere [revised Feb 2013]. At: www.
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Melbourne: Therapeutic Guidelines; 2013.
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stings [revised Dec 2010]. At: www.rch.org.au/kidsinfo/
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Adelaide: Australian Medicines Handbook; 2013 Jan.
11. Zielinski-Gutierrez E, Wirtz RA, Nasci RC, Brogdon WG.
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arthropods. In: CDC health information for international travel
2012, Chapter 2. Centers for disease control and prevention.
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2012. Chapter 3: Environmental health risks. At: www.who.
13. Kongkaew C, Sakunrag I, Chaiyakunapruk N, Tawatsin
A. Effectiveness of citronella preparations in preventing
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experimental studies. Tropical Medicine & International
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