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Principles of Pharmacology and Therapeutics > Skin Therapy > Flashcards

Skin Therapy Flashcards

(49 cards)

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1
Q

What are the four ways allergic skin disease is managed?

A

Avoidance
Medication to control pruritis and erythema
Immunomodulation
Control of secondary flare factors

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2
Q

What is important to always rule out?

A

Adverse food reaction

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3
Q

What are the issues with avoidance?

A

Is it possible to avoid fleas - need strict control regimen
Environmental allergens hard to avoid
Can use shampoos to remove allergens from skin but lacking in evidence and poor compliance

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4
Q

What are the options for medical treatment of pruritis?

A

Glucocorticoids, Ciclosporin, Tacrolimus ointment
Antihistamines, EFAs, Herbal medicine
Combination of the above

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5
Q

What are the advantages of glucocorticoids as an anti-pruritic medication?

A

Effective
Readily available
Frequently used
Cheap

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6
Q

What are the immediate adverse effects of glucocorticoid therapy?

A

PD/PU, polyphagia, restlessness

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7
Q

What are the long-term adverse effects of glucocorticoid therapy?

A

Hyperadrenocorticism, weight gain, connective tissue…

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8
Q

What can topical glucocorticoids be used to treat?

A

Hot spots and ears

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9
Q

What is the dosing for oral glucocorticoid therapy?

A

Prednisolone at 0.5-1mg/kg/day in dogs, 1-2mg/kg/day in cats

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10
Q

What is the aim for long-term control with glucocorticoid therapy?

A

Lowest necessary dose given on alternate days

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11
Q

What is the mechanism of action of ciclosporin?

A

Cacineurin inhibitor with more specific T-cell suppression than glucocorticoids

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12
Q

What is a disadvantage of ciclosporin over glucocorticoids?

A

Slow onset of effect at about 4 weeks so not for acute itch

Expensive

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13
Q

What are the adverse effects of ciclosporin?

A

Transient vomiting and diarrhoea
Gingival hyperplasia
Hirsutism
Lameness

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14
Q

What is the mechanism of action of oclacitinib?

A

Janus-kinase 1 inhibitor

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15
Q

What is the trade name for oclacitinib?

A

Apoquel

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16
Q

What is Apoquel licensed to treat?

A

Dogs over 12 months for the treatment of pruritis associated with allergic dermaitits and the clinical manifestations of atopic dermatits in dogs

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17
Q

What are the potential adverse effects of Apoquel?

A

4.6% diarrhoea, 3.9% vomiting, 2.6% anorexia, 2.6% new cutaneous/subcutaneous lumps, 2% lethargy

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18
Q

How are antihistamines used to treat pruritic skin disease?

A

Little evidence for efficacy but try different types for 10-14 days each
None licensed for use in animals
May be more effective in seasonal disease

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19
Q

Which essential fatty acids (EFAs) can be used to treat pruritic skin disease?

A

N3 (fish oils) and N6 (plant-derived oils) interact with the arachidonic acid cascade

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20
Q

What advantages can EFAs have when used to treat pruritic skin disease?

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A

Safe

Steroid-sparing?

21
Q

What is a disadvantage to using EFAs to treat pruritic skin disease?

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A

Effect will take several weeks

22
Q

What is allergen-specific immunotherapy (ASIT)?

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A

Injections of allergen extract subcutaneously at increasing quantities to patients with atopic dermatitis
Aqueous, alum precipitated or glycerinated

23
Q

How long does ASIT take to work?

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A

May take up to 9 months for full effect

24
Q

What is the efficacy of ASIT?

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A

Up to 50% in dogs, higher in horses, unknown in cats

25
How are individual allergens identified for ASIT?
Intra-dermal skin test or IgE serology for allergen specific IgE
26
What is it important to keep in mind when performing an intra-dermal skin test/IgE serology?
Match test results to history and clinical signs as if it is a pollen allergy on the test but only reacts in winter it is unlikely to be the allergen causing the pruritis
27
What is sublingual immunotherapy (SLIT)?
Drops are placed under the tongue instead of injections with clinical improvement demonstrated in small studies and serological changes observed
28
What are the advantages of ASIT and SLIT?
Safety Potential adverse effects - rarely anaphylaxis with no long term side effects (vs steroids) Infrequent treatment required (monthy) Often more cost effective especially in large breeds Preventative rather than reactive
29
What are the disadvantages of ASIT and SLIT?
Initial cost Risk of anaphylaxis (although small) Full efficacy may not be seen for several months Compliance may drop with long term approach Flare factors need to be controlled during initial treatment to allow full assessment of efficacy Syringes dispensed to owner (not for SLIT)
30
What are the EBVM recommendations for treatment of acute flares of cAD?
Identify and remove causes of flares Non-irritating baths and topical glucocorticoids Oral glucocorticoids and antimicrobials if needed
31
What are the EBVM recommendations for treatment of chronic flares of cAD?
Identify and avoid triggers where possible Topical and oral glucocorticoids Oral ciclosporin Topical tacrolimus ASIT should be offered to prevent recurrence of signs
32
What are the most commonly recognised flare factors for atopic dermatitis?
Flea control Other concurrent allergens Staphylococcal pyoderma Malassezia dermatitis
33
Why is good client communication crucial in the treatment of canine atopic dermatitis?
Owner education of life-long implications and waxing and waning course of disease so don't lose faith Regular follow-up examination is required so pruritis levels are controlled adequately and to check on potential adverse effects of therapy (haem/biochem)
34
What needs to be considered when deciding which antibiotic to use?
``` Efficacy Delivery method Antimicrobial selection Side effects Length of treatment Cost ```
35
What are the two methods of antibiotic selection?
Empirical | Selection based on culture and sensitivity
36
How are antibiotics selected empirically?
Classically superficial pyoderma/folliculitis caused by S. pseudintermedius Wet lesions are caused by gram negatives Local knowledge of sensitivity patterns
37
What drugs can be used to treat superficial pyoderma?
Cefalexin (92% cure)or co-amoxy-clav (72% cure) Clindamycin Topical shampoos alone or in combination
38
What is the treatment used for deep pyoderma?
Based on culture and sensitivity | Whilst waiting for results use cefalexin for cocci and fluoroquinolone for rods
39
How long should treatment for pyoderma last for?
Superficial - 1 week past clinical cure | Deep - 2 weeks past clinical cure
40
What are the possible clinical causes of antibiotic 'resistance'?
``` Wrong dose Compliance Absorption Underlying cause Resistance developed during treatment ```
41
What are the possible bacterial causes of antibiotic 'resistance'?
``` Intrinsic resistance (natural trait) Acquired resistance (mutations..) ```
42
What is MRSP?
Meticillin-resistant Staphylococcus pseudintermedius | Gene encoding broad spectrum beta-lactam antibiotic resistance mecA positive (more resistant than MRSA)
43
What kind of infections does MRSP cause?
Superficial and deep pyoderma in dogs, cats, donkeys and horses Septicaemia, UTI, pneumonia and wound infections
44
What is the relevance of MRSA in veterinary practice?
Most pet isolates identical to human hospital lineages Animals as a reservoir Effective drugs licensed Ethical concerns if same antimicrobial used in humans Owner perceptions Personal and clinic hygiene - risk if immunocompromised
45
What are the treatment options for MRSP?
Systemic therapy if in vitro susceptibility identified Topical therapy alone Off-licensed treatment with exotic antibiotic
46
Which topical treatments can be used against MRSP?
Fusidic acid Chlorhexidine Benzoyl peroxide
47
Which exotic antibacterial drugs could be used against MRSP?
``` Apramycin Amikacin Vancomycin Chloramphenicol Rifampin ```
48
When should exotic antibacterial drugs be used?
Only after contacting an expert for advice on clinical aspects and comprehensive infection control strategy
49
How are antimicrobials used responsibly against staph?
Diagnosis of bacterial infection, pathogen and any underlying causes Focus on hygiene and good owner education Are systemic antimicrobials required? Targeted use, narrow spectrum for 1st time pyoderma and good follow-up

Principles of Pharmacology and Therapeutics (8 decks)

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