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SS - Exam 4 > Pharm For Skin 2 > Flashcards

Pharm For Skin 2 Flashcards

1
Q

Uses for inflammatory /auto immune conditions

A

Atopy
Flea allergy
Food allergy
Culicoides hypersensitivity
Pemphigus

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2
Q

Glucocorticoids doses

A

Immunosuppressive does higher than anti inflammatory/anti allergic dose
- prednisolone: 2.5-6.6mg/kg
- dexamethasone: 0.2-0.5mg/kg vs 0.1-0.2mg/kg

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3
Q

GC’s

A

Standard treatment for inflammatory /auto immune
Highly effective
Work at multiple sites of cascade
Can cause transactivation of anti inflammatory genes and treansrepression of pro inflame genes

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4
Q

Major ADR of corticosteroids

A

Derm:
Cushingoid appearence
Skin thinning
Alopecia
Hirsutism
Hypertrichosis

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5
Q

Alternatives for GC’s - allergic

A

Allergic/inflammatory
- cyclosporine
- oclacitinib
- lokivetmab
- antihistamines

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6
Q

Alternatives for GC’s - auto immune

A

Auto immune:
- azathioprine
- chlorambucil
- cyclophosphamide
- mycophenolate mofetil

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7
Q

Cyclosporine

A

Used locally on the eye in all species
- KCS, anterior uveitis, immune mediated keratitis
- FDA approved for dogs

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8
Q

Use in cyclosporine

A

Systemic use is mainly for Tx of atopic dermatitis
- dogs & cats
- FDA approved for dogs & cats
Use in immune-mediated disease require higher doses
- response varies
- used in perianal fistulas

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9
Q

Bioavailability of cyclosporine

A

Greatly affected by formulation & feeding
FDA approved formulations are microemulsions
- capsules for dogs, solution for cats
- smaller particle sizes increase absorption

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10
Q

Metabolism of cyclosporine

A

EXTENSIVELY metabolized by CYP450 enzymes
- drugs that INHIBIT cyp450 INCREASE CsA conc.
- drugs that INDUCE cyp450 DECREASE CsA conc.

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11
Q

Cyclosporine p-glycoprotein efflux pumps

A

Substrate for p-glycoprotein efflux pumps
- drugs that INHIBIT p-Gp INCREASE CsA conc.
- drugs that INDUCE p-gp DECREASE CsA conc.

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12
Q

Ketoconazole inhibits

A

CYP450
P-glycoproteins
Decreases metabolism of CsA

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13
Q

Cyclosporine & ketoconazole

A

Almost doubles plasma & skin CsA concentrations
Cuts cost of CsA almost in half - cheaper

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14
Q

Contradictions for cyclosporine

A

Use with history of NEOPLASIA
Systemic immunosuppressant
- increase the susceptibility to development of neoplasia
- exacerbate sub clin neoplasic conditions

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15
Q

precautions of cyclosporine

A

Should be used with caution in animals w RENAL insufficiency

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16
Q

Precautions of cyclosporines

A

GI problems
Gingival hyperplasia @inital dose
May cause hirsuitsm in dogs
Killed vaccines are recommended

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17
Q

Diabetes and cyclosporines

A

Affects glucose metabolism
- decreased insulin secretion
- increased insulin resistance
PK are altered in diabetic dogs = decreased concentrations

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18
Q

Length of effect

A

Several weeks
After Initial dosing period, every other day may be effective

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19
Q

Oclacitinib

A

NIB = inhibit kinases
JAK 1,3 kinase inhibitor
Blocks signal for cytokine transduction
Inhibits IL-31 mediated pruritis

20
Q

IL and oclacitinib

A

Inhibits
IL-31 med pruritis
IL involve in allergies, 2,4

21
Q

Apoquel in dogs

A

Tx for atopic dermatitis & itch in allergic dermatitis
Safe in other species

22
Q

Apoquel in cats

A

Used for NON flea, NON food induced hypersensitivity dermatitis

23
Q

Apoquel in horses

A

Culicoides hypersensitivity, asthma
Anecedontal evidence only

24
Q

PK of oclacitinib

A

Well absorbed EVEN in horses
Moderately /widely distributed
HIGHLY metabolized - eliminated by metabolism
No effects on CYP450 enzymes
Eating does not affect absoption

25
Q

PD of oclacitinib

A

Controls itch within 4 hours
Lasts for 24 hours after dosing
No effects on CYP450 enzymes
Feeding does not affect absorption

26
Q

ADR of oclacitinib

A

Generally safe
- V/D most common
Transient leukopenia
Pododermatitis
Papillomas
Aggression

27
Q

Lokivetmab

A

FDA approved for Atopy in dogs - Cytopoint
1st vet monoclonal antibody
cIL-31 inhibitor - stops itch cycle to brain

28
Q

Monoclonal antibodies PK

A

NOT orally absorbed - admin IV, IM, SC
Absorbed via lymphatics
Binds to target receptor cells

29
Q

Metabolism and admin of monoclonal antibodies

A

Met by peptides & amino acids - circulated by phagocytic target cells
Admin xxx can trigger an immune response
- form anti drug antibodies
- rapid destruction
- decreased efficiency

30
Q

ADR of lokivetmab

A

Lasts <3 days
Can cause urinary incontinence, pain at inj site hyper-excitability, somewhat expensive

31
Q

Dosing oclacitinib

A

Range 0.4-0.6mg/kg
Tablets: 3.6mg, 5.4mg, 16mg

32
Q

Dosing lokivetmab

A

2mg/kg
1mL vials at 10mg, 20mg, 30mg, 40mg concentrations

33
Q

Antihistamines

A

Not as effective
Lower role in skin disease in vet species
First and second gen

34
Q

First gen antihistamines

A

Diphenhydramine - Benadryl
Hydroxzyine
Chlorpheniramine

35
Q

Second generation antihistamines

A

Loratadine - Claritin
Cetirizine - Zyrtec
Fexofenadine - Allegra

36
Q

ADR of antihistamines

A

Relatively safe
Sedation+/-
Mild GI
Anti muscarinic effects (dry mouth, urine retention, constipation)
Topical cal cause local allergic reactions
Sever overdose = CNS & convulsions

37
Q

Claritin vs Claritin D

A

Need formulation without decongestion
- can cause behavior changes, panting, tachy, hypertension
H1 receptor blocker

38
Q

Oddball drugs

A

Azathioprine
Chlorambucil
Mycophenolate mofetil

39
Q

azathioprine

A

Purine antagonist - affects RNA/DNA
Decreases antibody production - pemphigus**
NOT safe in cats - Myelosuppression
Hepatotoxicity common in dogs
Safe in horses

40
Q

ADR of azathioprine

A

GI - v/d
Pancreatitis
Skin eruptions
Poor hair growth
^ susceptibility to infection
Teratogenic in rats, mice, humans

41
Q

Drug/drug interactions - azathioprine

A

Allopurinol - weird drug, used for leishmania
- risk of Myelosuppression
CsA
GC’s

42
Q

Chlorambucil

A

Alkylating agent - cross linking DNA
Targets B cells
Onset is slow - 2 weeks for activity

43
Q

ADR of chlorambucil

A

Myelosuppression - mild, reversible, 7-14d of initial therapy
GI toxicity
Reversible neurotoxicity (myoclonus) w overdose
Safer than azathioprine for cats

44
Q

Mycophenolate mofetil

A

MPA inhibits inosine monophosphate dehydrogenate
- suppresses lymphocyte proliferation
- decreases antibody production

45
Q

Mycophenolate mofetil absorption

A

Variable absorption & elimination dogs
Commonly combined w GC’s
Reduced Hepatotoxicity & cytotoxicity vs azathioprine
GI ADR are common in dogs

SS - Exam 4 (28 decks)

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