Pruritis Treatments

Question 1

Non-pharm Interventions (5)

Answer 1

1. Skin moisturization 2. Cool environment (cooling lotions work too) 3. Avoidance of skin irritants 4. Stress reduction 5. Physical interventions (occlusive dressing for itchy areas, short fingernails)

Question 2

Barrier repair

Answer 2

Creams, moisturizers & emollients Low pH products may be particularly useful

Question 3

Topical corticosteroids

Answer 3

Not directly anti-pruritic but may reduce inflammation associated with sx

Question 4

Topical calcineurin inhibitors

Answer 4

Useful in anogenital pruritus, may experience transient burning or stinging

Question 5

Doxepin

Answer 5

H1 antagonist? Avoid in children (20-25% risk of sedation)

Question 6

Menthol (MOA & uses)

Answer 6

MOA: binds & activates TRPM8 Useful in pts who report cooling as an alleviating factor

Question 7

Capsaicin (MOA, uses, adverse rxns)

Answer 7

MOA: activates transient release potential vanilloid-1 (TRPV1), an ion channel in cutaneous nerve fibers –> stimulates nerves to release and eventually deplete neuropeptides such as substance P (resp for itching) Uses: neuropathic itch, may experience transient burning (comes from hot peppers) ***Also induces lasting desensitization of neurons to a variety of stimuli***

Question 8

Salicylic acid (MOA, uses, & adverse rxns)

Answer 8

MOA: COX inhibitor and keratolytic, causes sheading of epidermal cells, has antibacterial properties, and opens clogged pores Uses: Lichen simplex chronicus, acne, dandruff avoid in acute inflammatory dermatoses and children Adverse rxns: photosensitivity (need sunscreen), salicylate toxicity, esp in children and those with poor kidney/liver fxn

Question 9

Local anesthetics

Answer 9

Pramoxine (useful for pruritis of face and associations with CKD) Lidocaine patch (useful in neuropathic pruritus)

Question 10

How do you prescribe topical steroids in terms of potency?

Answer 10

Use low-potency steroids on face, genitals, and skin folds Elsewhere, start high potency to gain control and titrate down for maintenance

Question 11

Antihistamines

Answer 11

Systemic treatment, no direct effect except in cases of urticaria

Question 12

Antidepressants

Answer 12

Mirtazapine: useful in nocturnal pruritus (adverse rxns: weight gain/inc. appetite) Sertraline: useful in cholestatic pruritus

Question 13

Mu-opioid receptor antagonists

Answer 13

Naltrexone: useful in pts with cholestatic and CKD-associated pruritus Adverse rxns: may cause n/v, drowsiness, reverse analgesia, and may precipitate acute withdrawl in pts recieving opoid analgesics

Question 14

kappa-opioid receptor agonists

Answer 14

butorphanol: useful in nocturnal and intractable pruritus, some potential for abuse bc weak mu opioid agonist

Question 15

Anticonvulsants

Answer 15

Gabapentin/pregabalin: useful in neuropathic pruritus

Question 16

Substance P antagonist

Answer 16

More commonly used to control n/v in chemo pts but has shown benefits in pts with intractable pruritus (ex. Sezary syndrome)

Question 17

Brimonidine

Answer 17

a2 adrenergic agonist applied as topical gel to treat rosacea MOA: vasoconstricts by stimulating post-synaptic vascular a2 receptors

Question 18

Oxymetazoline

Answer 18

Mixed a1a/a2 adrenergic agonist MOA: vasoconstrictor applied as topical cream to treat rosacea

Question 19

Naphazoline

Answer 19

Adrenergic receptor agonist to treat eye redness

Question 20

Tetrahydrozoline

Answer 20

Adrenergic receptor agonist to treat eye redness

Question 21

Phenylephrine

Answer 21

Adrenergic receptor agonist to treat eye redness

Question 22

Oxymetazoline

Answer 22

Adrenergic receptor agonist to treat eye redness