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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
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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

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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

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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!!!

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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

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6
Q

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

A

DEMODICOSIS

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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

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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

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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

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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

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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

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12
Q

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

A

true

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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

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14
Q

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

A

PU/PD

mood changes

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15
Q

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

A

fat accumulation & elevated liver enzymes

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16
Q

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

A

suppression or iatrogenic hyperadrenocorticism

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17
Q

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

A

PU

altered electrolyte balance

protein losing glomerulonephropathy

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18
Q

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

A

predisposed to type II diabetes & pancreatitis

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19
Q

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

A

increased susceptibility to infection

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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

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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

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22
Q

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

A

water retention & muscle weakening

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23
Q

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

A

suppression of the immune system & lymphopenia

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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

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25
what skin lesion is seen here? what is it?
milia - entrapped comedones
26
what skin lesion is shown here?
calcinosis cutis
27
T/F: for canine atopic dermatitis, oral prednisone is the most overused & abused drug
true
28
if you have to use chronic glucocorticoid treatment for a patient with atopic dermatitis, what are your limits of use?
prednisone at 0.5 mg/kg every 48-72 hours if needing use over 5 months - look at your other options!
29
when should you use oral prednisone for a dog with canine atopic dermatitis?
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
30
what are the indications of using oclacitnib?
control of pruritus associated with allergic dermatitis & control of atopic dermatitis in dogs at least 12 months of age
31
what are some contraindications for using oclacitnib?
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
32
when would you consider using oclacitnib for treating a patient with canine atopic dermatitis?
atopic dermatitis is confirmed patient has seasonal or non-seasonal canine atopic dermatitis owner prefers daily at home medication - clinic visits are inconvenient
33
what are the benefits of using oclacitnib for treating canine atopic dermatitis? what are the disadvantages?
non-steroidal option can combine with cytopoint to manage atopic flares can't taper beyond every 24 hours
34
what dosing is used for oclacitnib for patients with atopic dermatitis?
0.4-0.6 mg/kg by mouth every 12 hours for 2 weeks & then once every 24 hours after that
35
what is the pruritogenic cytokine involved in canine atopic dermatitis?
IL-31
36
what are the pro-inflammatory cytokines involved in canine atopic dermatitis?
IL-2, IL-4, IL-6, & IL-13
37
what is the mechanism of action of oclacitnib?
apoquel blocks pruritogenic & pro-inflammatory cytokines that utilize JAK1/JAK3 associated receptors
38
how long does it take to see efficacy of action from apoquel & prednisone?
efficacy within 4 hours
39
what are some potential adverse effects associated with oclacitnib?
vomiting/diarrhea, demodicosis, cystitis, behavior change, polyphagia, weight gain, non-clinical leukopenia, & cutaneous masses
40
what is an example of an avoidance action for phase 2 of canine atopic dermatitis therapy?
bathing
41
what is an example of a narrow action for phase 2 of canine atopic dermatitis therapy?
lokivetmab
42
what is an example of a retraining action for phase 2 of canine atopic dermatitis therapy?
immunotherapy
43
what is an example of a pro-active action for phase 2 of canine atopic dermatitis therapy?
topical glucocorticoids
44
how do you select a candidate for allergen specific immunotherapy treatment?
based off of IDT and/or serology
45
when would you consider pursuing ASIT for a dog with canine atopic dermatitis?
when clinical signs are present for more than 6 months out of the year & when symptomatic therapy isn't tolerated/effective
46
what is the mechanism of action of ASIT? what is the goal of using it?
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
how long does it take to see results from ASIT?
may take 6-12 months
48
T/F: lokivetmab has a narrow anti-inflammatory action
true
49
why would you pick lokivetmab for a dog with canine atopic dermatitis?
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
what is the MOA of lokivetmab?
anti-IL-31 monoclonal antibody neutralizes only IL-31 cytokines before binding to the receptor so that downstream signaling isn't triggered
51
what are the differences between targets & metabolism between drugs & antibody therapy?
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
what is an epitope?
region of an antigen that is specific & binds to a certain antibody
53
how are antibodies eliminated?
can be broken down by many cell types - within the cell, antibodies are degraded into amino acids which are reused by the body
54
what is a caninized antibody? what is the purpose of using them for therapy of canine atopic dermatitis?
less immunogenic antibody - reducing immunogenicity within the patient's bpdy
55
what is lokivetmab?
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
how long does lokivetmab work for? what dogs can you use it in?
relief up to 4-8 weeks safe for dogs of all ages
57
when may lokivetmab may be the better choice of therapy for atopic dermatitis?
when comorbidities & treatments prohibit use of other therapies!!! diabetic dogs, demodicosis, side effects from steroids, etc
58
what are some side effects associated with lokivetmab?
injection site sensitivity, urticaria, immune-mediated polyarthropathy
59
what is the mechanism of action of cyclosporine?
binds to cyclophilin which inhibits calcineurin - inhibition works upstream blocking pro-inflammatory cytokines such as IL-2 & pro-inflammatory pathways
60
what is the pathway of pruritus caused by calcineurin activation?
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
what is the pathway of pruritus caused by JAK enzymes?
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
JAK inhibitors work only when what?
only work to block the activity in cells where activity is mediated by cytokines that work through JAK
63
when is cyclosporine a better choice for a patient with canine atopic dermatitis?
non-seasonal atopic dermatitis patient that has poor responses to other therapies
64
how is cyclosporine dosed for patients with atopic dermatitis?
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
what are 3 examples of indications for using glucocorticoids for canine atopic dermatitis?
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
what is a contraindication for using glucocorticoids for treating canine atopic dermatitis?
many!!!! deep/systemic infections (fungal), demodicosis, diabetes mellitus, NSAID use
67
what are the advantages & disadvantages of using glucocorticoids for treating canine atopic dermatitis?
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
what monitoring should be done for patients with canine atopic dermatitis on glucocorticoids for treatment?
regular clinical exams periodic CBC, chemistry panels, & UA consideration for periodic QUC
69
what are 3 examples of indications for using cyclosporine for canine atopic dermatitis?
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
what is a contraindication for using cyclosporine for treating canine atopic dermatitis?
deep/systemic infections (fungal) & neoplasia
71
what are the advantages & disadvantages of using cyclosporine for treating canine atopic dermatitis?
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
what monitoring should be done for patients with canine atopic dermatitis on cyclosporine for treatment?
regular physical exams periodic CBC, chemistry panels, & UA
73
what are indications for using oclacitnib for canine atopic dermatitis?
anti-pruritic/inflammatory - short (flare) or long-term (maintenance) use
74
what are contraindications for using oclacitnib for canine atopic dermatitis?
deep/systemic infections (fungal), demodicosis, & neoplasia
75
what are the advantages & disadvantages of using oclacitnib for treating canine atopic dermatitis?
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
what monitoring should be done for patients with canine atopic dermatitis on oclacitnib for treatment?
regular physical exams periodic CBC, chemistry, UA consider periodic QUC with recurring UTI/UTI risk factors
77
what are contraindications for using lokivetmab for canine atopic dermatitis?
none for the general population
78
what are the indications for using lokivetmab for canine atopic dermatitis?
anti-pruritic for short term (flare) or long-term (maintenance) use
79
what are the advantages & disadvantages of using lokivetmab for treating canine atopic dermatitis?
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
what therapies work the fastest when treating a patient with canine atopic dermatitis?
glucocorticoids & apoquel
81
what are some common allergens seen in dogs with canine atopic dermatitis?
flea saliva airborne pollen mold epithelials/dander mites & insects foodstuffs

CFT II (28 decks)

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