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Guillain-Barre Syndrome (GBS)

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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?
First, I would need to rule out anaphylaxis by asking if he’s experiencing any respiratory symptoms, tachycardia, diarrhea, vomiting, or dizziness (Schaefer, 2017). I would also advise the patient to avoid identified triggers and avoid aspirin, alcohol, and NSAIDs as these might worsen the symptoms (Schaefer, 2017). I also need to determine if the patient took first or second-generation antihistamines.

First-generation H1 antihistamines such as Benadryl are faster acting but require more frequent dosing. Second-generation antihistamines like Clarinex are doses once per day (Schaefer, 2017). Depending on the patient’s answer, I can advise increasing dosage or simply waiting a little to determine if the medication helped. If discomfort persists or worsening condition occurs, H2 antihistamines or even corticosteroids therapy could be considered (Schaefer, 2017). Unfortunately, although self-limiting and uncomfortable, hives are primarily benign, and the symptoms can last hours, days, or even months (Schaefer, 2017). Treating the symptoms by moisturizing or applying cold compresses might also help.

Your patient works at a garden nursery and has seasonal allergies. Which antihistamine do you recommend while working, Benadryl or Claritin?
Benadryl is a first-generation H1 antihistamine, presenting more side effects such as sedation, confusion, dizziness, decreased psychomotor performance, and impaired concentration (Schaefer, 2017). Claritin is a second-generation H1 antihistamine and is relatively non-sedating at standard dosages once a day (Schaefer, 2017). For this reason, I would recommend Claritin in this particular situation.
A patient presents at the clinic with s/s of Guillain-Barre Syndrome, which vaccine may be associated with this condition?

Guillain-Barre Syndrome (GBS) is a rare autoimmune disorder that damages nerves, causes muscle weakness and sometimes paralysis (Centers for Disease Control and Prevention, 2021). The syndrome often follows a bacterial or viral infection, but its cause is not fully understood. Each year an estimated 3,000 to 6,000 people develop GBS in the United States (Centers for Disease Control and Prevention, 2021). In 1976 there were increasing reports of GBS after the public was encouraged to get the swine flu vaccine. Although the exact reason for the link remains unknown, the CDC monitors GBS cases each flu season (Centers for Disease Control and Prevention, 2021). There has been an increased risk of GBS after the flu vaccine, but it has been in the range of 1-2 additional GBS cases per one million flu vaccine doses administered (Centers for Disease Control and Prevention, 2021).

A patient is diagnosed with Scabies, she asks if an OTC medication like RID will work. What is your response?
I would inform the patient that no OTC products have been approved to treat scabies and that a prescription for a scabicide is required (Centers for Disease Control and Prevention, 2018). Medications commonly prescribed for scabies include permethrin cream, ivermectin oral medication, and crotamiton cream or lotion (Rosenthal & Rosenjack Burchum, 2021).
The patient is allergic to Sulfa drugs, how will this affect the medication choice for Herpes?
The prescription antiviral medications used to treat Herpes include acyclovir, famciclovir, and valacyclovir (American Academy of Dermatology Association, 2021). These medications do not contain sulfa. Medications that might trigger a reaction in people with sulfa allergies include Septra, erythromycin-sulfisoxazole, Azulfidine, and Dapsone (Rosenthal & Rosenjack Burchum, 2021).
You are considering prescribing Penicillin for your patient, what is extremely important to assess first and why?
Assessing for a history of allergy to penicillin is necessary. If applicable, assessing for severity, timing, and tolerance is essential because most patients who state they are allergic to penicillin are not really allergic (Devchand & Trubiano, 2019). However, penicillin allergies can be life-threatening, so providers need to ensure “that all patients with a recorded penicillin allergy label undergo a thorough antibiotic allergy assessment” (Devchand & Trubiano, 2019).
References
American Academy of Dermatology Association, (2021). Herpes simplex: Diagnostic and treatment. Retrieved September 3, 2021, from https://www.aad.org/public/diseases/a-z/herpes-simplex-treatment
Centers for Disease Control and Prevention. (2017). Guillain-Barre syndrome and vaccines. Retrieved September 3, 2021 from https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html
Centers for Disease Control and Prevention. (2018). Parasites-scabies. Retrieved September 3, 2021 from https://www.cdc.gov/parasites/scabies/treatment.html
Devchand, M., & Trubiano, J. A. (2019). Penicillin allergy: a practical approach to assessment and prescribing. Australian prescriber, 42(6), 192–199. https://doi.org/10.18773/austprescr.2019.065
Rosenthal, L. D., & Rosenjack Burchum, J. (2021). Lehne’s pharmacotherapeutics for Advanced Practice Nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
Schaefer, P. (2017). Acute and chronic urticaria: Evaluation and treatment. American Family Physician, 95(11), 717-724. https://www.aafp.org/afp/2017/0601/p717.html

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