Immune mediated Flashcards
what is the mechanism of action for modified cyclosporin?
– Drug crosses the plasma membrane into cytoplasm and binds to
cyclophilin
– The CsA-cyclophilin complex inhibits calcinuerin
– Prevent activation of NF-AT
MOA for Azathioprine and what its used for?
- Acts a purine analog that inserts itself into DNA causing missense
mutations - Leads to cell death
- Greatest effect on cell-mediated immunity
considered less safe than cyclosporin
dont use this in cats, they dont have the enzyme needed to break it down
what is chlorambucil used for? how does it work
Alkylating agent that cross-links DNA
used in pemphigous, usually in cats with it
what is tacrolimus and what is it used forf
similar to cyclosporin but topical, useful for focal conditions
what are our goals of immunosuppressive therapy?
- for combo therapy: a syngergistic benefit WITHOUT synergistic side effects
- immune diseases are usually not life threatening but the side effects can be! dont over treat
- avoid triggers like meds, sun, vaccines
- remission/resolution not possible, we are not curing them
- use lowest dose that controls clinical signs
wot dis and whata re your main other ddx?
pemphigus foliaceus
ddx: ringworm, pyoderma, demodex
describe pemphigus folicaeus
attack outer layers of keratinocytes adhesions
creates large non follicular papules/pustules that rupture quickly and progress to crusts
what sites does pemphigus folieaceous
face, nasal bridge and phalanum, pinna, paw pads
in cats: nail bed and nipples
how do you diagnose this guy?
skin scrape to rule out demodex
do cytology: look for acantholytic cells, neutrophils, sometimes eosinohpils, might see some cocci secondarily
biopsy needed for final diagnosis
wot dees
acantholytic cells=pemphigus
treatment of pemphigus folicaeous in dogs is
often combo therapym start pred first alone or combine with azathioprine or atopica
recheck every 2 weeks and taper once remission
if refractory: mycophenolate or chlorambucil
treatment for pemhigus foliaceous in cats is
prenisolone or another drug and recheck in 2 weeks
steroids alone works well in cats
topical therapy doesn’t work nearly as wel in cats
pemphigus erythematosus is
like PF but limited to the face, more benign
requires less aggressive therapy: tacrolimus, topical steroids, tetracycline
sun makes it worse
pemphigus vulgaris is
attac of the deep epidermal attachments, very rare, deep erosions, really bad, search for underlying disease like neoplasia
treat aggressively: combo therapy right away, steroids and all the other discussed
poor prognosis
what is discoid lupus erythematosus (DLE) and what are clinical signs?
lupus disorder confied to the skin/face
C/S: usually depigmentation of nasal phalanum first, loss of cobblestone, erosions, ulcers, scaling, crusting
wot dis? how diagnose and treat?
discoid lupus erythematosus
dx: cytology, skin scrape and ringworm culture to rule out other diseases, biopsy for difinitive, can look like mucocutaneous pyoderma so could try an antibiotic trial
tx: topical tacrolimus, steroids if neccessary, vitamin E and essential FAs, avoid the sun and sunscreen Q12
this is DLE, but what else could it be?
pemphigus erythematosus, mucucutaneous pyoderma, ring worm, pemphigus foliaceus, contact or solar dermatitis
