peds ezcema part 2 Flashcards by amanda kastel

when are wet wraps used

for areas liquenified and not healing

How well did you know this?

Not at all

Perfectly

when using a wet wrap, when should it be applied

bath, drug, then moisturizer, then wet wrap

How well did you know this?

Not at all

Perfectly

why are wet wraps used?

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?

Not at all

Perfectly

explain how wet wraps should be applied and for how long

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?

Not at all

Perfectly

when may CS side effects be more pronounced?

if applied to thin skin like face/neck/groin

How well did you know this?

Not at all

Perfectly

name some skin-related side effects of topical CS

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

How well did you know this?

Not at all

Perfectly

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

cataracts
glaucoma
intraocular HTN

How well did you know this?

Not at all

Perfectly

name 3 VERY RARE systemic adverse effects of CS

adrenal suppression
growth retardation
reduced bone density

How well did you know this?

Not at all

Perfectly

when is there a risk of flare relapse?

if the steroid is ABRUPTLY discontinued

How well did you know this?

Not at all

Perfectly

TRUE OR FALSE

CS tends to be more effective then calcineurin inhibitors

FALSE —- efficacy is same

How well did you know this?

Not at all

Perfectly

TCIs are _____ agents.
how do they work?

immunosuppressive

suppress T cell activation and cytokine production

How well did you know this?

Not at all

Perfectly

how often are TCIS applied

like CS - BID

How well did you know this?

Not at all

Perfectly

true or false

TCIs are immunosuppressives

true

How well did you know this?

Not at all

Perfectly

how long do TCIs take to work

within 3 days of starting

How well did you know this?

Not at all

Perfectly

Tacrolimus 0.1% ointment

who is it FDA approved for

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

How well did you know this?

Not at all

Perfectly

tacrolimus 0.03% ointment
pimecrolimus 1% cream

who is it FDA approved for?

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

How well did you know this?

Not at all

Perfectly

which is more effective - pimecrolimus or tacrolimus?

tacrolimus

How well did you know this?

Not at all

Perfectly

name some adverse effects of TCIs and how to avoid them

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

roseacea, contact dermatitis

How well did you know this?

Not at all

Perfectly

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

tacrolimus

How well did you know this?

Not at all

Perfectly

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

what is an advantage of TCI over CS?

they cause less skin atrophy and ocular AE

How well did you know this?

Not at all

Perfectly

name 3 disadvantages of TCIs

more expensive
burning and stinging
BBW: malignancy

How well did you know this?

Not at all

Perfectly

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

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?

Not at all

Perfectly

TCIs are ________ line therapy for AD

2nd line - when others not effective or tolerated

How well did you know this?

Not at all

Perfectly

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

considered off label

How well did you know this?

Not at all

Perfectly

what to counsel pts on getting TCI

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

TCIs should be avoided in ____ persons

immunocompromised because they suppress T cells

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

FALSE - short term should not be used continuoisly typically used for mod-severe -- but can be milkd-mod (lower doses)

besides CS and TCI what is another treatment for AD flares

topical PDE4 inhibitors

name a topical PDE4 inhibitor

Crisaborole

who is indicated for treatment with crisaborole

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

how does crisaborole work in managins AD flares

decreases cytokine production by inhibiting PDE4

true or false crisaborole is applied twice a day

true

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

AROUND 8 DAYS AFTER STARTING TCS/TCI is 3 days

name some adverse effects of crisaborole

burning and stinging at the application site

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

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

phototherapy is a ____ agent for severe, refractory AD

systemic

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

takes a LOT of treatments, and done 3x a week has anti inflammatory effecs, dec cytokine production, and antimicrobial effects by decreasing staph colonization

in what age is phototherapy avoided

children and young adults - bc skin cancer risk

what are some AE of phototherapy

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

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

phototherapy

when are SYSTEMIC corticosteroids used for AD?

for exacerbations that havent responded to topical therapy

why are systemic corticosteroids not recommended to be taken long term

toxicity rebound flares -- when you come off you may flare up

what is allergen specific immune therapy

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

what is cyclosporine A

a systemic agent for refractory (keeps coming back) AD

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

suppresses inflammatory cytokine gene transcription in T cells

what are some AE of cyclosporine A

GI headache hephrotixic dont use more than 1 year - malignancy concern

name 3 systemic agents that inhibit murine synthesis

azathioprine mycophenolate methotrexate

what is interferon gamma

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

what is an issue with systemic agents for refractory AD

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

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

monoclonal -- dupilumab JAK inhibitors - baricitinib abrocitinib upadacitinib

biologic therapies are specific to the _________ of AD

pathophysiology

explain the MOA of bupilumab (dupixent)

inhibits signaling of IL4 and IL13 tH2 cytokine pathways

in what age/severity is dupilumab indicated for

children greater than or equal to 6 months moderate to severe AD - when other therapies not effective or cant be used

dupilumab is usually administered with what?

a topical corticosteroid -- response may be improved

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

2-3 weeks other systemics are much longer at aorund 14 weeks

does dupilumab have good efficacy?

yes 63-82&

explain how dupixent works to help AD pts

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

name some adverse effects of dupilumab

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

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?

unresponsive to topical anti inflammatories may be due to malassezia (fungus) may be responsive to anti fungals or decrease dose or dicontinue dupilumab

name 3 advantages of JAK inhibitors over biologics

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

JAK inhibitors are indicated for what patients?

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

generic for rinvoq What class is it?

JAK inhibitor upadacitinib

upadacitinib is FDA approved for what age and what population?

12 years old and older and adults refractory moderate-severe AD that is unresponsive to systemic medications

compare the efficacy of dupulimab and upadacitinib

upadacitinib has lower efficacy than the injectable

upadacitinib should not be co administered with what

other JAK inhibitors (like tofacitinib) any immunosuppressant DMARDS (adalimumab, infliximab)

name some AE of upadacitinib (rinvoq)

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

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

greater than 12 years and adults refractory, mod-severe AD that is unresponsive to oral and systemic

abrocitinib should not be coadministered with what

other JAK inhibitors any immunosuppressant DMARDS

Major AE of abrocitinib

risk for CV event, thrombosis

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

probiotics

name 3 oils that can be used topically for AD

olive oil coconut oil sunflower seed oil

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

olive oil

_______ is at the heart of AD therapy

EDUCATION