Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to D&D Midterm > peds ezcema part 2 > Flashcards

peds ezcema part 2 Flashcards

1
Q

when are wet wraps used

A

for areas liquenified and not healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when using a wet wrap, when should it be applied

A

bath, drug, then moisturizer, then wet wrap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

why are wet wraps used?

A

they can increase the penetration of the steroid, decrease the itch, and prevent scratching
soothe the skin and itch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

explain how wet wraps should be applied and for how long

A

wet layer of cotton (old cotton shirts or cotton bed sheets), and then dry layer of cloth/gauze

keep in place 3-8 hours

can use overnight for up to 1 week or 24-72 hours if changing every 3-8 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when may CS side effects be more pronounced?

A

if applied to thin skin like face/neck/groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

name some skin-related side effects of topical CS

A

acne
perioral dermatitis (if used near mouth)
hypopigmentation
rosacea
cutaneous atropy (striae, thinning, telangectasia – like spider veins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are some adverse effects if topical CS are applied near the eyes

A

cataracts
glaucoma
intraocular HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

name 3 VERY RARE systemic adverse effects of CS

A

adrenal suppression
growth retardation
reduced bone density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when is there a risk of flare relapse?

A

if the steroid is ABRUPTLY discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TRUE OR FALSE

CS tends to be more effective then calcineurin inhibitors

A

FALSE —- efficacy is same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TCIs are _____ agents.
how do they work?

A

immunosuppressive

suppress T cell activation and cytokine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how often are TCIS applied

A

like CS - BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

true or false

TCIs are immunosuppressives

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how long do TCIs take to work

A

within 3 days of starting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tacrolimus 0.1% ointment

who is it FDA approved for

A

children greater than or equal to 16 and adults with mod-sev AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tacrolimus 0.03% ointment
pimecrolimus 1% cream

who is it FDA approved for?

A

children greater than or equal to 2 and adults with mild-moderate AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which is more effective - pimecrolimus or tacrolimus?

A

tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name some adverse effects of TCIs and how to avoid them

A

localized burning and stinging — to reduce, can pre treat with topical CS

roseacea, contact dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

as mentioned, burning and stinging is an adverse effect of TCIS
is it worse for tacrolimus or pimecrolimus

A

tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

as mentioned, TCIs and Cs’s have the same efficacy

what is an advantage of TCI over CS?

A

they cause less skin atrophy and ocular AE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

name 3 disadvantages of TCIs

A

more expensive
burning and stinging
BBW: malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

WHY are topical TCIs like tacrolimus 0.1% not indicated in patients younger than 2?

A

they tend to absorb more drugs through the skin, and these drugs have a black box warning of possible development of skin cancer and lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

TCIs are ________ line therapy for AD

A

2nd line - when others not effective or tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is it considered if children younger than 2 use TCIs?

A

considered off label

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what to counsel pts on getting TCI

A

apply with SPF-30 (reduce cancer risk)
use smallest amount needed for shortest period of time -AVOID continuous use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

TCIs should be avoided in ____ persons

A

immunocompromised

because they suppress T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

true or false

TCIs are intended for long term treatment of milk-moderate AD

A

FALSE - short term
should not be used continuoisly

typically used for mod-severe – but can be milkd-mod (lower doses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

besides CS and TCI what is another treatment for AD flares

A

topical PDE4 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

name a topical PDE4 inhibitor

A

Crisaborole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

who is indicated for treatment with crisaborole

A

treat mild-moderate flares of AD in infants greater than or equal to 3 months!!!

when TCS/TCI cannot be used or is not effective

31
Q

how does crisaborole work in managins AD flares

A

decreases cytokine production by inhibiting PDE4

32
Q

true or false

crisaborole is applied twice a day

A

true

33
Q

how long does crisaborole take to work?
compare to TCS/TCI

A

AROUND 8 DAYS AFTER STARTING

TCS/TCI is 3 days

34
Q

name some adverse effects of crisaborole

A

burning and stinging at the application site

35
Q

after the flare has been cleared, what is the treatment for preventing relapses?
state treatment for both topical CS and TCI

A

corticosteroids - apply to previously affected area ONCE DAILY twice a week for 2 consecutive days
up to 16 weeks

TCI - once daily, 2-3 times a week for 10-12 MONTHS

36
Q

phototherapy is a ____ agent for severe, refractory AD

A

systemic

37
Q

what is a disadvantage of using phototherapy?
how does it work?

A

takes a LOT of treatments, and done 3x a week

has anti inflammatory effecs, dec cytokine production, and antimicrobial effects by decreasing staph colonization

38
Q

in what age is phototherapy avoided

A

children and young adults - bc skin cancer risk

39
Q

what are some AE of phototherapy

A

skin erythema and pain, itching, malignancies, premature skin aging

40
Q

____ may be used as bridge therapy from systemic and back to topical once the pt improves

A

phototherapy

41
Q

when are SYSTEMIC corticosteroids used for AD?

A

for exacerbations that havent responded to topical therapy

42
Q

why are systemic corticosteroids not recommended to be taken long term

A

toxicity

rebound flares – when you come off you may flare up

43
Q

what is allergen specific immune therapy

A

can be used in AD when the allergen is identified – but risk of anaphyalxis

44
Q

what is cyclosporine A

A

a systemic agent for refractory (keeps coming back) AD

45
Q

how does cyclosporine A work as a systemic agent for refractory AD

A

suppresses inflammatory cytokine gene transcription in T cells

46
Q

what are some AE of cyclosporine A

A

GI
headache
hephrotixic

dont use more than 1 year - malignancy concern

47
Q

name 3 systemic agents that inhibit murine synthesis

A

azathioprine
mycophenolate
methotrexate

48
Q

what is interferon gamma

A

systemic agent used in refractory AD
down regulates helper T cell function — but causes flu like msyptoms

49
Q

what is an issue with systemic agents for refractory AD

A

they take a long time to work and have a lot of adverse effects

50
Q

name 1 monoclonal antibody and 3 JAK inhibitors that are biologics and can be used in AD

A

monoclonal – dupilumab

JAK inhibitors - baricitinib
abrocitinib
upadacitinib

51
Q

biologic therapies are specific to the _________ of AD

A

pathophysiology

52
Q

explain the MOA of bupilumab (dupixent)

A

inhibits signaling of IL4 and IL13 tH2 cytokine pathways

53
Q

in what age/severity is dupilumab indicated for

A

children greater than or equal to 6 months

moderate to severe AD - when other therapies not effective or cant be used

54
Q

dupilumab is usually administered with what?

A

a topical corticosteroid – response may be improved

55
Q

what is the approximate onset of action of dupilumab?
compare this to the other systemic agents

A

2-3 weeks

other systemics are much longer at aorund 14 weeks

56
Q

does dupilumab have good efficacy?

A

yes
63-82&

57
Q

explain how dupixent works to help AD pts

A

downregulate inflamm mediators
upregulation of genes involved with barrier
reduction in skin infection
downregulation of markers of epidermal proliferation

58
Q

name some adverse effects of dupilumab

A

GI upset
injection site reactions
conjunctivitis/blepharitis/dry eye
oral herpes
facial edema
skin papilloma

59
Q

as mentioned, dupilumab can cause facial edema

it is unresponsive to what meds? it is responsive to what meds? what may the edema be due to?

A

unresponsive to topical anti inflammatories

may be due to malassezia (fungus)

may be responsive to anti fungals or decrease dose or dicontinue dupilumab

60
Q

name 3 advantages of JAK inhibitors over biologics

A

given by mouth
predictable pharmacokinetics
less immunogenicity (ability to cause an immune response)

61
Q

JAK inhibitors are indicated for what patients?

A

who have not had disease control with topical and/or phototherapy

62
Q

generic for rinvoq

What class is it?

A

JAK inhibitor

upadacitinib

63
Q

upadacitinib is FDA approved for what age and what population?

A

12 years old and older and adults

refractory moderate-severe AD that is unresponsive to systemic medications

64
Q

compare the efficacy of dupulimab and upadacitinib

A

upadacitinib has lower efficacy than the injectable

65
Q

upadacitinib should not be co administered with what

A

other JAK inhibitors (like tofacitinib)

any immunosuppressant

DMARDS (adalimumab, infliximab)

66
Q

name some AE of upadacitinib (rinvoq)

A

NVD
increased risk of infection and tb activation
retinal detachment
dec WBC
malignancy risk

67
Q

Abrocitinib (cibinqo) is FDA approved for what age and population

A

greater than 12 years and adults

refractory, mod-severe AD that is unresponsive to oral and systemic

68
Q

abrocitinib should not be coadministered with what

A

other JAK inhibitors
any immunosuppressant
DMARDS

69
Q

Major AE of abrocitinib

A

risk for CV event, thrombosis

70
Q

what is a drug that may benefit pts in controlling AD?

A

probiotics

71
Q

name 3 oils that can be used topically for AD

A

olive oil
coconut oil
sunflower seed oil

72
Q

of the 3 oils, for which is there a concern of contact dermatitis

A

olive oil

73
Q

_______ is at the heart of AD therapy

A

EDUCATION

74
Q
A

Intro to D&D Midterm (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions