Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CFT II > Exam 2 - Therapeutics For Canine Atopic Dermatitis > Flashcards

Exam 2 - Therapeutics For Canine Atopic Dermatitis Flashcards

1
Q

what are the 5 principles for managing canine atopic dermatitis?

A
  1. control inflammation/pruritus
  2. improve dysbiosis (infection control)
  3. topical hygiene therapy/barrier restoration
  4. allergen identification & avoidance where possible
  5. +/- immunotherapy to redirect the course of disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the main goal when treating a dog with canine atopic dermatitis?

A

aim to reduce 80-90% of the signs at least 80-90% of the time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the disadvantages to lifelong therapy when treating a dog with canine atopic dermatitis?

A

cost

adverse drug effects

decreased quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the absolutes in regards to therapy for canine atopic dermatitis? what is the downfall when it comes to these interventions?

A

identifying & eliminating infections

flea control

topical therapy

they are extremely important for managing the disease but they are often neglected!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do you improve barrier function of the skin in a dog with canine atopic dermatitis?

A

exfoliate the surface of the skin with baths & consider the need of topical antiseptics - may need to supplement ceramides

skin’s natural barrier should keep bacteria & dirt out while keeping moisture in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what should be ruled out prior to diagnosing canine atopic dermatitis?

A

DEMODICOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is phase 1 of treatment for canine atopic dermatitis? what treatments are used?

A

phase 1: stop the flare using reactive therapy to induce remission

oral +/- topical glucocorticoids & then taper off into using oclacitnib in moderate to severe cases

may start with higher doses of oclacitnib for mild cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is phase 2 of treatment for canine atopic dermatitis? what treatments are used?

A

phase 2 : proactive therapy to prevent recurrences

allergen avoidance, proactive topical glucocorticoids, oclacitnib, lokivetmab, cyclosporine, +/- immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when picking treatment for phase 1 of canine atopic dermatitis, which medication has the broadest action? would you use it for a mild, moderate, or severe flare?

A

glucocorticoids, oral +/- topical

moderate to severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when picking treatment for phase 1 of canine atopic dermatitis, which medication has a semi-broad action? would you use it for a mild, moderate, or severe flare?

A

oclacitnib

mild to lower moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what dosing is used for glucocorticoids when treating canine atopic dermatitis?

A

prednisone at 0.5-1.0 mg/kg by mouth every 24 hours for 7 days & then tapering to the lowest effective dose every 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F: steroids are best used for seasonal atopic dermatitis and are not ideal for chronic use

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the MOA of glucocorticoids? why do they have the broadest anti-inflammatory effects?

A

pretty much suppress virtually every component of the inflammatory cascade

corticosteroid receptors are present in every cell in the body - why we see such a broad effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what adverse side effects are seen in the CNS from chronic use of glucocorticoids?

A

PU/PD

mood changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what adverse side effects are seen in the liver from chronic use of glucocorticoids?

A

fat accumulation & elevated liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what adverse side effects are seen in the adrenal glands from chronic use of glucocorticoids?

A

suppression or iatrogenic hyperadrenocorticism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what adverse side effects are seen in the kidneys from chronic use of glucocorticoids?

A

PU

altered electrolyte balance

protein losing glomerulonephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what adverse side effects are seen in the pancreas from chronic use of glucocorticoids?

A

predisposed to type II diabetes & pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what adverse side effects are seen in the bladder from chronic use of glucocorticoids?

A

increased susceptibility to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what adverse side effects are seen in the skin & fur from chronic use of glucocorticoids?

A

hair loss, thinning of the skin, increased susceptibility to infection, & calcinosis cutis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what adverse side effects are seen in the muscle from chronic use of glucocorticoids?

A

muscle thinning, weakness, pendulous abdomen, & temporal muscle atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what adverse side effects are seen in the heart & blood vessels from chronic use of glucocorticoids?

A

water retention & muscle weakening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what adverse side effects are seen in the lymph nodes from chronic use of glucocorticoids?

A

suppression of the immune system & lymphopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

this patient presents with bilateral symmetrical alopecia that spares the head & extremities, cutaneous atrophy with comedones & folliculitis, hypotonic/dry skin, & a rat tail, & has a history of chronic glucocorticoid use for canine atopic dermatitis, what do you suspect is going on?

A

iatrogenic hyperadrenocorticism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what skin lesion is seen here? what is it?

A

milia - entrapped comedones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what skin lesion is shown here?

A

calcinosis cutis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

T/F: for canine atopic dermatitis, oral prednisone is the most overused & abused drug

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if you have to use chronic glucocorticoid treatment for a patient with atopic dermatitis, what are your limits of use?

A

prednisone at 0.5 mg/kg every 48-72 hours

if needing use over 5 months - look at your other options!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when should you use oral prednisone for a dog with canine atopic dermatitis?

A

infections have been eliminated

tentative diagnosis is made

no contraindications are present

owner has been counseled

may use other therapies to reduce the amount of steroids needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the indications of using oclacitnib?

A

control of pruritus associated with allergic dermatitis & control of atopic dermatitis in dogs at least 12 months of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are some contraindications for using oclacitnib?

A

dog under 12 months old

not for dogs with serious infections

DEMODEX infections!!!

not for use in breeding dogs, pregnant dogs, or lactating dogs

may increase susceptibility to infection including demodicosis & exacerbate neoplastic conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

when would you consider using oclacitnib for treating a patient with canine atopic dermatitis?

A

atopic dermatitis is confirmed

patient has seasonal or non-seasonal canine atopic dermatitis

owner prefers daily at home medication - clinic visits are inconvenient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the benefits of using oclacitnib for treating canine atopic dermatitis? what are the disadvantages?

A

non-steroidal option

can combine with cytopoint to manage atopic flares

can’t taper beyond every 24 hours

34
Q

what dosing is used for oclacitnib for patients with atopic dermatitis?

A

0.4-0.6 mg/kg by mouth every 12 hours for 2 weeks & then once every 24 hours after that

35
Q

what is the pruritogenic cytokine involved in canine atopic dermatitis?

A

IL-31

36
Q

what are the pro-inflammatory cytokines involved in canine atopic dermatitis?

A

IL-2, IL-4, IL-6, & IL-13

37
Q

what is the mechanism of action of oclacitnib?

A

apoquel blocks pruritogenic & pro-inflammatory cytokines that utilize JAK1/JAK3 associated receptors

38
Q

how long does it take to see efficacy of action from apoquel & prednisone?

A

efficacy within 4 hours

39
Q

what are some potential adverse effects associated with oclacitnib?

A

vomiting/diarrhea, demodicosis, cystitis, behavior change, polyphagia, weight gain, non-clinical leukopenia, & cutaneous masses

40
Q

what is an example of an avoidance action for phase 2 of canine atopic dermatitis therapy?

A

bathing

41
Q

what is an example of a narrow action for phase 2 of canine atopic dermatitis therapy?

A

lokivetmab

42
Q

what is an example of a retraining action for phase 2 of canine atopic dermatitis therapy?

A

immunotherapy

43
Q

what is an example of a pro-active action for phase 2 of canine atopic dermatitis therapy?

A

topical glucocorticoids

44
Q

how do you select a candidate for allergen specific immunotherapy treatment?

A

based off of IDT and/or serology

45
Q

when would you consider pursuing ASIT for a dog with canine atopic dermatitis?

A

when clinical signs are present for more than 6 months out of the year & when symptomatic therapy isn’t tolerated/effective

46
Q

what is the mechanism of action of ASIT? what is the goal of using it?

A

retraining the immune system - reducing IgE, T-reg (IL-10), IgG blocking antibodies to cause desensitization

when used correctly, ASIT may reduce the extent/severity of disease but will not eliminate the disease

47
Q

how long does it take to see results from ASIT?

A

may take 6-12 months

48
Q

T/F: lokivetmab has a narrow anti-inflammatory action

A

true

49
Q

why would you pick lokivetmab for a dog with canine atopic dermatitis?

A

non-drug option - monoclonal antibodies

patient responds poorly to other therapies

preference for injection over oral medication

alternative when drug-drug or comorbidities are present

50
Q

what is the MOA of lokivetmab?

A

anti-IL-31 monoclonal antibody neutralizes only IL-31 cytokines before binding to the receptor so that downstream signaling isn’t triggered

51
Q

what are the differences between targets & metabolism between drugs & antibody therapy?

A

target of drugs - intracellular
target of antibodies - extracellular

metabolism of drugs - hepatic/renal metabolism & elimination
metabolism of antibodies - protein catabolism with minimal hepatic/renal elimination

52
Q

what is an epitope?

A

region of an antigen that is specific & binds to a certain antibody

53
Q

how are antibodies eliminated?

A

can be broken down by many cell types - within the cell, antibodies are degraded into amino acids which are reused by the body

54
Q

what is a caninized antibody? what is the purpose of using them for therapy of canine atopic dermatitis?

A

less immunogenic antibody - reducing immunogenicity within the patient’s bpdy

55
Q

what is lokivetmab?

A

an in-office subcutaneous injection that neutralizes IL-31 in dogs with allergic dermatitis & atopic dermatitis that helps provide sustained relief of signs

interrupts the itch cycle

56
Q

how long does lokivetmab work for? what dogs can you use it in?

A

relief up to 4-8 weeks

safe for dogs of all ages

57
Q

when may lokivetmab may be the better choice of therapy for atopic dermatitis?

A

when comorbidities & treatments prohibit use of other therapies!!!

diabetic dogs, demodicosis, side effects from steroids, etc

58
Q

what are some side effects associated with lokivetmab?

A

injection site sensitivity, urticaria, immune-mediated polyarthropathy

59
Q

what is the mechanism of action of cyclosporine?

A

binds to cyclophilin which inhibits calcineurin - inhibition works upstream blocking pro-inflammatory cytokines such as IL-2 & pro-inflammatory pathways

60
Q

what is the pathway of pruritus caused by calcineurin activation?

A
  1. antigen presentation
  2. increase in cytoplasmic calcium
  3. calcineurin activated
  4. nuclear factor of activated t-cells dephosphorylation
  5. RNA polymerase transcription of DNA
  6. translation of mRNA produces protein
  7. cell function is changed
61
Q

what is the pathway of pruritus caused by JAK enzymes?

A
  1. cytokine binds to receptor
  2. JAK activation
  3. STAT phosphorylation
  4. STAT dimerization
  5. RNA polymerase transcription of DNA
  6. translation of mRNA
  7. cell function changes - increase in IgE, lymphocyte proliferation, increase in cytokines, increase in cytokine receptor expression, & increase in chemokines causing pruritus
62
Q

JAK inhibitors work only when what?

A

only work to block the activity in cells where activity is mediated by cytokines that work through JAK

63
Q

when is cyclosporine a better choice for a patient with canine atopic dermatitis?

A

non-seasonal atopic dermatitis patient that has poor responses to other therapies

64
Q

how is cyclosporine dosed for patients with atopic dermatitis?

A

5 mg/kg by mouth every 24 hours for 4-6 weeks & then taper to every 48 hours after

daily dosing effective for 4+ weeks & then taper - combine with apoquel or steroids for the first 2-3 weeks

65
Q

what are 3 examples of indications for using glucocorticoids for canine atopic dermatitis?

A
  1. anti-pruritic/inflammatory - short term (flare) systemic use
  2. anti-pruritic/inflammatory - flare preventing topical use (2 consecutive days/week)
  3. severely inflamed/remodeled skin/ears (lichenification, pododermatitis, otitis)
66
Q

what is a contraindication for using glucocorticoids for treating canine atopic dermatitis?

A

many!!!! deep/systemic infections (fungal), demodicosis, diabetes mellitus, NSAID use

67
Q

what are the advantages & disadvantages of using glucocorticoids for treating canine atopic dermatitis?

A

advantages - very effective, fast, potent anti-inflammatory with pruritic relief, & cheap

disadvantages - high ‘off-target’ effect, many known adverse effects (PU/PD, weight gain, UTI, insulin resistance)

68
Q

what monitoring should be done for patients with canine atopic dermatitis on glucocorticoids for treatment?

A

regular clinical exams

periodic CBC, chemistry panels, & UA
consideration for periodic QUC

69
Q

what are 3 examples of indications for using cyclosporine for canine atopic dermatitis?

A
  1. anti-inflammatory - long term maintenance use
  2. alternative to glucocorticoids when broad anti-inflammatory is needed long-term
  3. severely inflamed/remodeled skin/ears
70
Q

what is a contraindication for using cyclosporine for treating canine atopic dermatitis?

A

deep/systemic infections (fungal) & neoplasia

71
Q

what are the advantages & disadvantages of using cyclosporine for treating canine atopic dermatitis?

A

advantages - effective anti-inflammatory for long term use, fairly well tolerated, can co-administer with other drugs, useful in atopics with recurring superficial pyoderma, & can sometimes maintain disease control with dose reduction

disadvantages - cost (especially larger dogs), 4 lb weight requirement, slow onset of action (not for flare ups), gi upset, & gingival hyperplasia

72
Q

what monitoring should be done for patients with canine atopic dermatitis on cyclosporine for treatment?

A

regular physical exams

periodic CBC, chemistry panels, & UA

73
Q

what are indications for using oclacitnib for canine atopic dermatitis?

A

anti-pruritic/inflammatory - short (flare) or long-term (maintenance) use

74
Q

what are contraindications for using oclacitnib for canine atopic dermatitis?

A

deep/systemic infections (fungal), demodicosis, & neoplasia

75
Q

what are the advantages & disadvantages of using oclacitnib for treating canine atopic dermatitis?

A

advantages - effective/fast pruritus relief, well tolerated, & drug-drug interactions unlikely

disadvantages - one year age requirement, less effective on severely inflamed/remodeled skin/ears, & rebound pruritus

76
Q

what monitoring should be done for patients with canine atopic dermatitis on oclacitnib for treatment?

A

regular physical exams

periodic CBC, chemistry, UA

consider periodic QUC with recurring UTI/UTI risk factors

77
Q

what are contraindications for using lokivetmab for canine atopic dermatitis?

A

none for the general population

78
Q

what are the indications for using lokivetmab for canine atopic dermatitis?

A

anti-pruritic for short term (flare) or long-term (maintenance) use

79
Q

what are the advantages & disadvantages of using lokivetmab for treating canine atopic dermatitis?

A

advantages - effective/fast relief, biologic with ‘high on target effect’ with ‘little to no off target effect,’ well-tolerated, can tailor frequency to patient needs, can administer with other drugs, & can use in the face of comorbidities

disadvantages - expensive, less effective for severely inflamed/remodeled skin, & may take 2-3 days to take effect

80
Q

what therapies work the fastest when treating a patient with canine atopic dermatitis?

A

glucocorticoids & apoquel

81
Q

what are some common allergens seen in dogs with canine atopic dermatitis?

A

flea saliva

airborne pollen

mold

epithelials/dander

mites & insects

foodstuffs

CFT II (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions