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SS - Exam 4 > Pharm For Skin 2 > Flashcards

Pharm For Skin 2 Flashcards

(45 cards)

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1
Q

Uses for inflammatory /auto immune conditions

A

Atopy
Flea allergy
Food allergy
Culicoides hypersensitivity
Pemphigus

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2
Q

Glucocorticoids doses

A

Immunosuppressive does higher than anti inflammatory/anti allergic dose
- prednisolone: 2.5-6.6mg/kg
- dexamethasone: 0.2-0.5mg/kg vs 0.1-0.2mg/kg

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3
Q

GC’s

A

Standard treatment for inflammatory /auto immune
Highly effective
Work at multiple sites of cascade
Can cause transactivation of anti inflammatory genes and treansrepression of pro inflame genes

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4
Q

Major ADR of corticosteroids

A

Derm:
Cushingoid appearence
Skin thinning
Alopecia
Hirsutism
Hypertrichosis

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5
Q

Alternatives for GC’s - allergic

A

Allergic/inflammatory
- cyclosporine
- oclacitinib
- lokivetmab
- antihistamines

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6
Q

Alternatives for GC’s - auto immune

A

Auto immune:
- azathioprine
- chlorambucil
- cyclophosphamide
- mycophenolate mofetil

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7
Q

Cyclosporine

A

Used locally on the eye in all species
- KCS, anterior uveitis, immune mediated keratitis
- FDA approved for dogs

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8
Q

Use in cyclosporine

A

Systemic use is mainly for Tx of atopic dermatitis
- dogs & cats
- FDA approved for dogs & cats
Use in immune-mediated disease require higher doses
- response varies
- used in perianal fistulas

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9
Q

Bioavailability of cyclosporine

A

Greatly affected by formulation & feeding
FDA approved formulations are microemulsions
- capsules for dogs, solution for cats
- smaller particle sizes increase absorption

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10
Q

Metabolism of cyclosporine

A

EXTENSIVELY metabolized by CYP450 enzymes
- drugs that INHIBIT cyp450 INCREASE CsA conc.
- drugs that INDUCE cyp450 DECREASE CsA conc.

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11
Q

Cyclosporine p-glycoprotein efflux pumps

A

Substrate for p-glycoprotein efflux pumps
- drugs that INHIBIT p-Gp INCREASE CsA conc.
- drugs that INDUCE p-gp DECREASE CsA conc.

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12
Q

Ketoconazole inhibits

A

CYP450
P-glycoproteins
Decreases metabolism of CsA

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13
Q

Cyclosporine & ketoconazole

A

Almost doubles plasma & skin CsA concentrations
Cuts cost of CsA almost in half - cheaper

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14
Q

Contradictions for cyclosporine

A

Use with history of NEOPLASIA
Systemic immunosuppressant
- increase the susceptibility to development of neoplasia
- exacerbate sub clin neoplasic conditions

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15
Q

precautions of cyclosporine

A

Should be used with caution in animals w RENAL insufficiency

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16
Q

Precautions of cyclosporines

A

GI problems
Gingival hyperplasia @inital dose
May cause hirsuitsm in dogs
Killed vaccines are recommended

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17
Q

Diabetes and cyclosporines

A

Affects glucose metabolism
- decreased insulin secretion
- increased insulin resistance
PK are altered in diabetic dogs = decreased concentrations

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18
Q

Length of effect

A

Several weeks
After Initial dosing period, every other day may be effective

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19
Q

Oclacitinib

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A

NIB = inhibit kinases
JAK 1,3 kinase inhibitor
Blocks signal for cytokine transduction
Inhibits IL-31 mediated pruritis

20
Q

IL and oclacitinib

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A

Inhibits
IL-31 med pruritis
IL involve in allergies, 2,4

21
Q

Apoquel in dogs

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A

Tx for atopic dermatitis & itch in allergic dermatitis
Safe in other species

22
Q

Apoquel in cats

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A

Used for NON flea, NON food induced hypersensitivity dermatitis

23
Q

Apoquel in horses

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A

Culicoides hypersensitivity, asthma
Anecedontal evidence only

24
Q

PK of oclacitinib

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A

Well absorbed EVEN in horses
Moderately /widely distributed
HIGHLY metabolized - eliminated by metabolism
No effects on CYP450 enzymes
Eating does not affect absoption

25
PD of oclacitinib
Controls itch within 4 hours Lasts for 24 hours after dosing No effects on CYP450 enzymes Feeding does not affect absorption
26
ADR of oclacitinib
Generally safe - V/D most common Transient leukopenia Pododermatitis Papillomas Aggression
27
Lokivetmab
FDA approved for Atopy in dogs - Cytopoint 1st vet monoclonal antibody cIL-31 inhibitor - stops itch cycle to brain
28
Monoclonal antibodies PK
NOT orally absorbed - admin IV, IM, SC Absorbed via lymphatics Binds to target receptor cells
29
Metabolism and admin of monoclonal antibodies
Met by peptides & amino acids - circulated by phagocytic target cells Admin xxx can trigger an immune response - form anti drug antibodies - rapid destruction - decreased efficiency
30
ADR of lokivetmab
Lasts <3 days Can cause urinary incontinence, pain at inj site hyper-excitability, somewhat expensive
31
Dosing oclacitinib
Range 0.4-0.6mg/kg Tablets: 3.6mg, 5.4mg, 16mg
32
Dosing lokivetmab
2mg/kg 1mL vials at 10mg, 20mg, 30mg, 40mg concentrations
33
Antihistamines
Not as effective Lower role in skin disease in vet species First and second gen
34
First gen antihistamines
Diphenhydramine - Benadryl Hydroxzyine Chlorpheniramine
35
Second generation antihistamines
Loratadine - Claritin Cetirizine - Zyrtec Fexofenadine - Allegra
36
ADR of antihistamines
Relatively safe Sedation+/- Mild GI Anti muscarinic effects (dry mouth, urine retention, constipation) Topical cal cause local allergic reactions Sever overdose = CNS & convulsions
37
Claritin vs Claritin D
Need formulation without decongestion - can cause behavior changes, panting, tachy, hypertension H1 receptor blocker
38
Oddball drugs
Azathioprine Chlorambucil Mycophenolate mofetil
39
azathioprine
Purine antagonist - affects RNA/DNA Decreases antibody production - pemphigus** NOT safe in cats - Myelosuppression Hepatotoxicity common in dogs Safe in horses
40
ADR of azathioprine
GI - v/d Pancreatitis Skin eruptions Poor hair growth ^ susceptibility to infection Teratogenic in rats, mice, humans
41
Drug/drug interactions - azathioprine
Allopurinol - weird drug, used for leishmania - risk of Myelosuppression CsA GC’s
42
Chlorambucil
Alkylating agent - cross linking DNA Targets B cells Onset is slow - 2 weeks for activity
43
ADR of chlorambucil
Myelosuppression - mild, reversible, 7-14d of initial therapy GI toxicity Reversible neurotoxicity (myoclonus) w overdose Safer than azathioprine for cats
44
Mycophenolate mofetil
MPA inhibits inosine monophosphate dehydrogenate - suppresses lymphocyte proliferation - decreases antibody production
45
Mycophenolate mofetil absorption
Variable absorption & elimination dogs Commonly combined w GC’s Reduced Hepatotoxicity & cytotoxicity vs azathioprine GI ADR are common in dogs

SS - Exam 4 (28 decks)

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