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Pharmacology > Therapy of dermatological disorders > Flashcards

Therapy of dermatological disorders Flashcards

1
Q

Whaat is the most common cause of canine pyoderma?

A

staphylococcus pseudintermedius

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2
Q

Where is staph pseudintermedius found on canine?

A

skin flora, URT, oral cavity, anal region, eternal ear canal

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3
Q

What does staph pseudintermedius have that allows it to cause pyodermas/

A

produce slime that allow bacteria to adhere to cells

have protein A that activate complement cascade and incites inflammation

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4
Q

What are 3 gram - bacteria that can transiently colonize the skin and occasionally become involved in pyoderma secondary to staph infection?

A

e. coli, proteus, pseudomonas

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5
Q

What are occasional strange bacteria that can be involved in skin disease?

A

actinomyces
actinobacillus
mycobacteria
various fungi and yeast (malassezia)

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6
Q

What are the important guidelines for treatment of superficial bacterial folliculitis and deep pyoderma due to staph pseudintermedius?

A
  1. choose appropriate antimicrobial against b-lactamase producing staph susceptible to methicillin
  2. accurte body weight, give antimicrobials 7d past clinical cure for superficial, 14d past for deep
    (usually 3-6weeks)
  3. avoid concurrent clucocorticoid use unless hot spot
  4. search for underlying pathology
  5. if initial therapy fails, consider MRSP
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7
Q

What is the most common cause of recurrent canine SBF/pyoderma?

A

canine atopy

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8
Q

What antimicrobials does staph pseudintermedius have high resistance to?

A
  1. penicillin
  2. ampicillin
  3. amxicillin
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9
Q

What antimicrobials does staph pseudintermedius have moderate resistance to?

A
  1. erythromycin
  2. clindamycin
  3. lincomycin
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10
Q

What antimicrobials does staph pseudintermedius have low resistance to?

A
  1. TMP/sulfa

2. doxycycline

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11
Q

What antimicrobials does staph pseudintermedius have no resistance to intiailly?

A
  1. cloxacillin
  2. cephalexin
  3. fluoroquinolones
  4. amoxicillin/claulanic acid
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12
Q

In addition to resistance to beta lactam, MRSP show high rates of resistance to which antimicrobials?

A
  1. macroldies
  2. lincosamides
  3. gentamicine
  4. fluroquinolones
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13
Q

Some MRSP and MRSA remain susceptible to what drugs?

A
  1. TMP/sulfa
  2. tetracylcines
  3. chloramphenicol
  4. rifampin
  5. amikacin
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14
Q

What drugs that can be used in antimicrobial treatment of superficial bacterial folliculitis?

A
  1. amoxicillin-clavulanic acid (clavamox, clavseptin)
  2. cephalexin (generics, vetolexin)
  3. cefadroxil (Cefa-Drops)
  4. cloxacillin (generics)
  5. clindamycin (antirobe, human generics)
  6. Erythromycin (human genercs) and lincomhuman, tribrissen)ycin (with sepctinomycin in lincospectin)
  7. TMS commbinations
  8. cefovecin (convenia)
  9. cefpodoxime (simplecef)
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15
Q

What are the advantages of amoxcillin-clavulanic acid (clavamox, clavaseptin)

A

a good first choice for treatment of SBF/pyoderma

available in human generic or vet approved tablets or suspension

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16
Q

What are advantages/disadvaentages of cephalexin in treatment of SBF/pyoderma?

A

comparable spectrum of activity and pharm characteristics to amoxcillin-clavulanic acid (except enteroccocci!–inherently resistant!)
more likely to cause GI upset, esp in cats
human generic and paste available

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17
Q

What are the characteristics of cefadroxil in treatment of SBF/pyoderma?

A

cefa-drops is vet approved first gen cephalsporine

equivalent to cephalexin and comes in suspension

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18
Q

What are the features of cloxacillin in teatment of SBF/pyoderma?

A
  1. excellent anti-staph activity
  2. poor against gram negative
  3. poor bioavailability
  4. dosing every 8 hrs
  5. not usually in vet clinic, can get from human pharmacy
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19
Q

What are the features of clindamycin in treatment fo SBF?pyoderma?

A
  1. very active against staph and anaeboes
  2. high Vd
  3. retains activity in purulent material
  4. resistance develops failry rapidly
  5. cross resistance with lincmycin, macrolides
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20
Q

What is the D test? When should it be performed?

A

The D test is performed to check for inducible clindamycin resistance. When you see a susceptibility profile with resistance to erythromycin and susceptibility to clindamycin then that is a red flag

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21
Q

What are the characteristics of erythromycin and lincomycin and treatment for SB/pyoderma?

A
  1. ok for first line
  2. recurrent infection likely resistant
  3. erythromycin associated with high incidence of GI upset
  4. often inconvenient for clients
  5. not good for recurrent infections
  6. no oral lincomycin formulations in canada so inconvenient!
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22
Q

What are the characteristics of TMS for treatment of SBF/pyoderma?

A
  1. good for first time SBF/pyoderma
  2. high Vd
  3. many adverse effects so not used first line
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23
Q

What are the characteristics of cefovecin for treatment of SBF/pyoderma?

A
  1. injectible
  2. 2 weeks of therapy
  3. high degree of protein binding
  4. more effective for deeper pyodermas than cephalexin (infam proteins carry drug to infection)
  5. hard to justify use for SBF or pyotraumatic dermatitis!
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24
Q

What are the characteristics of cefpodoxime (simplecef) for treatment of SBF/pyoderma?

A
  1. oral, once daily 3rd gen

2. hard to justify use of 3rd gen

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25
Q

How long is treatment usually for superficial bacterial folliculitis?

A

3-6 weeks

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26
Q

What are 4 primary factors for succcessfuls topical therapy of pyoderma?

A
  1. efficacy against oragnism
  2. adequate delivery vehicle
  3. proper contact time
  4. residual activity
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27
Q

What cases of SBF/pyoderma is shampoo therapy best used for?

A

generalized, esp if affecting torso. usually 1/day

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28
Q

Whata re the most widely used shampoos for SBF/pyoderma?

A
  1. benzoyl peroxide
  2. chlorhexidine
  3. ethyl lactate
  4. lactic acid
  5. iodine
  6. triclosan
  7. benzalkonium chloride
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29
Q

What is North Carolina State shampoo?

A

2 parts lemon dish soap
1 part white vinegar
1 part glycerin
fill with water

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30
Q

What are two topical ointments/gels/liquids that can be used to treat localized infections on cats and dogs?

A
  1. fusidic acid (fuciderm gel)

2. mucopirocin (bactroban)

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31
Q

Why is the issue with topical antimicrobials?

A

messy and not very client-friendly. best for local spots

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32
Q

What are the features of fusidic acid?

A
  1. lipophilic sterid antibiotic
  2. prevents protein syntehsis
  3. bactericidal against gram +
  4. initially good against staph aureus, staph pseudintermedium
    but RESISTANCE emerges rapidly
  5. does not work against gram negative rods
  6. vet product in canada
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33
Q

What are the features of mupirocin (bactroban)

A
  1. stopss protein syntehsis
  2. active against gram +
  3. MRSA, MRSP typically susceptible
  4. bacteriostatic (cidal at lower pH at many parts of skin)
  5. only topical b/c rapidly metabolized
  6. resistnce soon emerges
  7. important for human treatment of MRSA so only use short term of acute infections!!!
34
Q

What do recurrent infections with resistant bacteria and deep pyoderma indicate?

A

presence of more severe predisposing causes

35
Q

What drugs should be reserved for antmicrobial therapy of deep pyoderma and short-term therapy of recurrent pyoderma whenre known resistance to first line treatments has developed?

A
  1. enrofloxacin (baytril)
  2. marbofloxacin (zenequin)
  3. orbifloxacin (orbax)
  4. pradofloxacin (veraflox)
36
Q

Enrofloxacin, marbofloxacin, orbifloxacin, pradofloxacin have excellent activity against what?

A

pseudomonas and proteus, that are frequent secondary invders

37
Q

What are the pharmacokinetic properties of fluoroquinolones that make them good choices for deep pyoderma/recurrent pyoderma?

A
  1. high Vd
  2. accumulate in leukocytes
  3. retain activity in necrotic and purulent debris
  4. high dose daily admin ideal because [] dependent killers
38
Q

When should fluoroquinolone therapy be avoided?

A

chronic low dose or pulse dose therapy because chromosomal mediated resistance occurs with chronic exposure
(staph pseudintermedius resistance rapidly increasing)

39
Q

What are the advantages of chloramphenicol treatment for deep pyoderma?

A
  1. broad spectrum of activity
  2. high Vd
  3. MRSA, MRSP strains in NA usually susceptible
40
Q

What are disadvantages of chloramphenicol treatment for deep pyoderma?

A
  1. pseudomonas, proteus suceptibility variable
  2. human toxicity from handling
  3. adverse GI effects, liver enzyme increase, anemia
  4. bone marrow suppresion in cats within 14 (glucuronide conjugation substate)
41
Q

What are the features of using doxycycline for deep pyoderma treatment?

A
  1. good activity against staph including MRSA, MRSP
  2. caution in cats due to esophageal necrosis
  3. if resistance, minocycline may still work (human)
42
Q

What are the features of rifampin for treatment of deep pyoderma?

A
  1. works against intracellular pathogens
  2. inhibits DNA dependent RNA polymerase
  3. bacteriostatic, time dependent, long post antibiotic effect
  4. active against MRSA, MRSP
  5. may cause hepatitis in dog
  6. don’t use alone because rapid resistance emergence
43
Q

Why is maintenance antimicrobial therapy (low dose or pulse dose) no longer recommended?

A

increasing rates of antimicrobial resistnace

44
Q

How can desensitization to staph antigens be attempted?

A

with a bacterin, such as SPL

used for treatment of idopathic canine pyoderma

45
Q

What is the most common yeast the causes concurrent infection in dog pyoderma what plays a major role in developmetn of dermatitis?

A
  1. malassezia pachydermatis

2. hypersensitivity

46
Q

Why is dermatophytosis generally treated?

A

zoonotic potential

47
Q

What are potential systemic therapies for ringworm. What are there issues?

A
  1. ketoconazole, itraconazole
  2. expensive therapy, esp itraconazole, though it is less toxic
  3. hepatotoxicity with ketoconazole
48
Q

What drug is approved for topical treatment of dermatophyte infections in dogs and horses?

A
  1. enilconazole (imaverol)
  2. miconazle cream (conofite)
  3. silver sulfadiazine (sivadene)–found in maytril otic
49
Q

How are food animals with ringworm treated?

A
  1. iodine shampoos
  2. chlorhexidine
  3. fluorinated toothpaste
50
Q

Why are degreasing agents used with malassezia dermatiti?

A

to remove oily scales and exudate
benzoyl peroxide, sulphur, selenium sulfide shampoos
+ nizoral shampoo or enilconazole or vinegar and water

51
Q

What is the pathogenesis of otitis externa?

A
  1. potential pathogenic bacteria normally present in low numbers in external ear canal
  2. primary disease damages ear canal, flora cause secondary infection
  3. staph speudintermedius common
  4. CNS, e coli, corynebacterium pseudomonas
52
Q

Why willl antimicrobial therapy alone fail to cure pseudomonas otitis externa?

A

because underlying pathophysiology not corrected. multi-drug resistance instead likely to occur. also malassezia pachydermaitis may become significant in otitis externa, esp after antmicrobial therapy

53
Q

What are inciting causes of otitis externa?

A
  1. allergic dz (atopy, food allergy, drug eruptions)
  2. parasites–mites
  3. metabolic disorders (hypothyroid, idiopathic seborrhea)
  4. glandular disorders (sebaceous hyperplasia)
  5. foreign bodies
  6. autoimmune dz (lupus erythematosus, pemphigus foliaceus, pemphogus erythematosus)
54
Q

What are predisposing factors for otitis externa

A
  1. conformation
  2. excess moisture
  3. inappropriate treatment
  4. obstructive ear dz
55
Q

How are uncomplicated cases of otits externa best treated?

A

with topical antimicrobials, anti-inflammatories, ear cleaning

56
Q

How is therapy selected for otitis externa?

A

cytological examination

57
Q

When should microbiological culture and susceptiblity testing be caried out for otitis externa?

A

if cytology reveals rods or animal has chronic otitis externa

58
Q

Topical preparations for otitis externa usually have?

A

gluocorticoids
antimicrobials
antifungals
parasiticides

59
Q

When should systemic antimicrobial therapy be used for otitis externa?

A

when antmicrobials cannot reach infection site or when otitis media or interna is present

60
Q

Why should fusidic acid not be used on its own to treat MRSA, MRSP?

A

because only a single point mutation is required to result in resistance

61
Q

Polymixin B is noted for its activity against what?

A

pseudomonas aeruginosa
gram negative pathogens
binds phospholipid (endotxin) of gram negative cell membrane
no activity against gram +

62
Q

Why is polymixin B not used systemically?

A

nephrotoxicity and neurotoxicity

63
Q

What is thistrepton

A

a topical antimicrobal with gram + and gram - activity

64
Q

What is bacitracin?

A

antmicrobial bactericidal to gram + due to interfering with cell wall formation
is highly nephrotoxic so only topical

65
Q

When are aminoglycosides chosen (otitis externa)

A

efficacy against staph and gram negative bacteria

66
Q

Why are aminoglycosides less effective in inflammed/infected tissues?

A

activity reduced bynucleic acid material released by decaying WBC

67
Q

What can happen with topical application of neomycin?

A

contact hypersensitivity

68
Q

Why do you have to be careful with using aminoglycosides for prolonged treatment of chronic otitis with ruptured tympanic membrane?

A

ototoxic

69
Q

Why are fluoroquinolones not very good for otitis externa?

A

fluoroquinolone resistance emerges rapidly

pseudomonas aeruginosa mutants emerge with gyrA gene and overexpression of efflux pumps

70
Q

What is the spectrum of thiabendazole, miconozole, clotrimazole used in otic products?

A

broad specturm antifungals

some activity against gram +

71
Q

What does Baytril otic not contain?

A

corticosteroid

72
Q

What is synotic?

A

a glucocorticoid and DMSO. useful adjunct to antimicrobials for otitis externa

73
Q

What does Epi-otic have?

A

hydrocortisone

74
Q

Why is important to perform cytology and culture of both the external and middle portions of the ear in a dog with otitis externa and media?

A

the organisms cultured differ 90% of the timme

75
Q

Nonpliable external ear canals is a sign of what?

A

end stage otitis externa

76
Q

Is systemic antimicrobial therapy helpful for initial treatment of otitis externa?

A

no. likely contributes to colonization by resistant bacteria. only necessary when cellulitis, or otitis interna is present

77
Q

In swine and cattle, what is recommended for systemic therapy of staph aureus infectuion?

A

TMS or ceftiofur

78
Q

What are topical therapies for bacterial skin infections in large animals?

A

chlorhexadine
povidone iodine
light mineral
potassium monopersulfate

79
Q

What are common causes of pyogranulomatous infections in large animals?

A

(actinomycetic)

  1. trueperella pyoegnes
  2. actinobacillosis lignieresii
  3. dermatophilus congolensis
80
Q

What causes rain rot/grease heel/scratches/mud fever

A

dermatophilus congolensis

81
Q

How should dermatophilus congolensis infection be treated?

A
  1. remove from damp environment
  2. clean lesions with iodine or chlorhexadine and thoroughly dried
  3. scabs should be removed
  4. clipping may reduce serum scald
  5. topical antimicrobials +/- corticosteroids (e.g. special formula)
  6. systemic therapy usually reserved for severe cases

Pharmacology (8 decks)

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