Discussion Response – Persistent Hives and Allergy Management

Discussion Response – Persistent Hives and Allergy Management

Hello,

Great post! I agree with the response you proposed for the patient who is worried about persistent hives despite the use of antihistamines. To add to this, the doctor can also increase the dosage of the antihistamines or recommend oral steroids. Furthermore, medication such as epinephrine or cortisone can be administered through injections if a patient is above 12 years old. Other recommendations for the management of hives include wearing lightweight clothes that fit loosely, taking cool showers, and application of cool compresses. These strategies alleviate the pain and discomfort associated with hives (Healthline Media, 2021). Claritin is recommended for allergies due to its less severe side effects. However, the patient should be informed that a daily dosage of the antihistamine is necessary to manage the allergies.

As you have stated, it is necessary to ask the patient about their known allergies to penicillin. However, some may be unaware. This situation may require the medic to describe to the patient the signs of penicillin allergy. If they relate to such observations that may have occurred in the past while on a different medication that contains penicillin, they should not have the same prescription. However, if they are still unaware of the possibility of exhibiting allergic reactions, they should take the medicine home and be asked to cease taking it if they observe any of the contraindications (AAAAI, 2021). At this point, they should revisit the facility for a different prescription. I specifically like the responses you have provided as it pertains to Sulfa, scabies, and Guillain-Barre Syndrome. These answers are easy to comprehend, provide information, and are enlightening for the reader. Despite the use of technical terms, it is still possible to relate to the answers that you have provided. Great post!

References

AAAAI. (2021). Penicillin Allergy FAQ. Retrieved from https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Allergies/Penicillin-Allergy-FAQ

Healthline Media. (2021). When Antihistamines Don’t Work for Chronic Hives: What to Ask Your Doctor.

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Your patient calls and is worried because his antihistamine has not taken away the hives he broke out with today. What do you tell him?

Hives (Urticaria) will not be cured by an antihistamine. Antihistamines, An H1 antagonist, are considered the classic antihistamine and will help control symptoms of redness, swelling, and itching but not reduce them completely (Rosenthal & Burcham, 2021). A corticosteroid, like prednisone, may be prescribed for short-term use if the antihistamine is not effective (" Hives,"
2020).

Your patient works at a garden nursery and has seasonal allergies. Which antihistamine do you recommend while working, Benadryl or Claritin?

I would recommend Claritin (Loratadine), which is a second-generation antihistamine, because it causes less sedation than Benadryl (Diphenhydramine), which is a first-generation antihistamine that causes more sedation (Shapiro, Bombatch, Garrett, & Veverka, 2021).

A patient presents at the clinic with s/s of Guillain-Barre Syndrome, which vaccine may be associated with this condition?

The Centers for Disease Control and Prevention (CDC) reported out of 12, 589, 910 cases, 99 were positive cases of Guillain Barr syndrome (GBS). The CDC states that there is no clinical foundation to prove that Guillain Barr syndrome is related to the MCGV4 vaccine. The MCV4 vaccination, Menactra and Menveo are considered meningococcal conjugate polysaccharides.
These vaccines protect against four meningococcal serotypes. MCV4 (Menactra) is recommended for ages 9 months to 55 years old, and Menveo is recommended for ages 2 years to 55 years old (Rosenthal & Burcham, 2021).

A patient is diagnosed with Scabies; she asks if an OTC medication like RID will work. What is your response?

The primary treatment for scabies (mites) is permethrin 5% topical cream (Elimite), which is not an over-the-counter (OTC) medication. Permethrin 1% can be bought OTC, but is not effective for scabies, it is only effective for lice. Ivermectin is the second line of defense for scabies and should only be prescribed when all other methods of treatment are ineffective. Ivermectin (Stromectol) can be prescribed in two oral doses, one week apart. Ivermectin has side effects of lymph node enlargement, arthralgias, skin tenderness, pruritis and fever (Shapiro, Bombatch, Garrett, & Veverka, 2021).

The patient is allergic to Sulfa drugs; how will this affect the medication choice for Herpes?
Acyclovir (Zovirax) is an inti-viral medication and is the first line of choice for treatment of herpes simplex virus (HSV) and varicella zoster virus (VZV). Acyclovir can be administered orally, topical, and intravenous. Acyclovir should be used with caution in patients with renal impairment, or those receiving nephrotoxic agents (Shapiro et al., 2021).

If you are considering prescribing Penicillin for your patient, what is extremely important to assess first and why?

The first question you should ask your patient is, “Are you allergic to penicillin, and what are the symptoms?” If the patient verbalizes a penicillin reaction, then it should not be prescribed.
Depending on the reaction to the penicillin, it should determine if the entire penicillin family should be avoided. Cephalosporin can be considered if the allergy to penicillin is mild, and if the allergy is severe, then another antibiotic should be considered. Some alternative choices would be vancomycin or clindamycin (Rosenthal & Burcham, 2021).

References

Nursing-Discussion Response

Histamine toxicity. (2020). Retrieved from https://www.aaaai.org/conditions-and- treatments/related-conditions/histamine-toxicity
Hives: Diagnosis and treatment. (2020). Retrieved from https://www.aad.org/public/diseases/a- z/hives-treatment
Immunoglobulin (IGE) definition. (2020). Retrieved from https://www.aaaai.org/conditions-and- treatments/conditions-dictionary/immunoglobulin-e-(ige)
Is it really a penicillin allergy? (n.d.). Retrieved from https://www.cdc.gov/antibiotic- use/community/pdfs/penicillin-factsheet.pdf?fbclid=IwAR3ZNiSoof- zmgHRQaXnf2DjWP_vnGAhKgDOs6yQm-LpnjhsS-bjgBxTyCo
Rosenthal, L. D., & Burcham, J. R. (2021). Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, Mo: Elsevier.
Shapiro, K., Bombatch, C., Garrett, S. D., & Veverka, A. (2021). 2021 Naplex course book: Study guide for the naplex and clinical content for the cpje for those testing in 2021. n.p.