Pruritus, Xerosis, Urticaria, Wounds Flashcards
1
Q
what is another word of pruritus
A
itching
2
Q
how would pruritus on diseased skin be described as
A
itch related to skin condition
3
Q
What are the two groups of pruritus
A
- diseased skin
2. non-diseased skin
4
Q
what is the classification of pruritus on diseased skin
A
prurioceptive itch
5
Q
What are some potential causes of pruritus on diseased skin
A
- dermatitis
- xerosis
- urticaria
- psoriasis
- scabies
- fungal infections
6
Q
what are the 3 types of pruritus on non-diseased skin
A
- neurogenic itch
- neuropathic itch
- psychogenic itch
7
Q
what is neurogenic itch
A
itch originating from the nervous system WITHOUT neural damage
8
Q
what are some potential causes of neurogenic itch
A
- renal failure
- Cirrhosis
- hyperthyroidism
- pregnancy
- medications (opiods)
9
Q
what is neuropathic itch
A
itch caused by DAMAGE to afferent nerves
10
Q
what are some potential causes of neuropathic itch
A
- nerve damage
2. neuralgia
11
Q
what is psychogenic itch
A
itch related to psychological illness
12
Q
what are some potential causes of psychogenic itch
A
- anxiety
- depression
- OCD
13
Q
Described the pathophysiology of pruritus
A
- Itch stimulus - afibers send signals to the brain “hey scratch”
- Scratch - stops itch
- transmits signals through A-fibers which inhibit C-fiber signals
14
Q
which receptor does histamine cause itch through
A
H1; through H2 to a much more limited degree
15
Q
what is histamine mostly responsible for
A
allergic type itch
16
Q
what type of peptide may cause vasodilation and intensify itch
A
neuropeptides (substance P)
17
Q
what type of drugs causes an itch centrally or peripherally
A
opioids
18
Q
Is pruritus typically a sign or symptom
A
symptom of an underlying cause
19
Q
what are some non-pharm treatments for pruritus
A
- keep skin hydrated - emollients and barrier creams
- use mild soaps
- take cooler, shorter showers
- avoid irritants
- use of cooling antipruritic lotions (camphor/menthol)
20
Q
For a histamine induced itch what type of medication should you use
A
antihistamines
21
Q
what type of antihistamines are preferred to use in patients who have pruritus
A
second generation
22
Q
why are second generation histamines preferred
A
they are non sedating and uses scheduled doses
23
Q
what are the second generation antihistamine
A
- fexofenadine (Allegra)
- loratadine (Claritin)
- cetirizine (Zyrtec)
24
Q
what are topical steroids used for
A
only for inflammatory skin causes
25
what is capsaicin best used for
counter irritant may be helpful in well localized itch
26
what is doxepin cream (antidepressant with H1 and H2 antagonistic properties) most useful for
small areas of intact skin
27
what are some other agents for non-histamine induced itch
1. opioid antagonists (naltrexone) - for neurogenic itch
2. cholestyramine - for renal and liver diseases
3. gabapentin - for neuropathic itch
4. anti - depressants: for psychogenic itch
28
what is xerosis
dry skin
29
what layer of the epidermis is is dehydrated
stratum corneum
30
what population is more common to get xerosis
elderly
31
where does xerosis commonly effect
lower extremities and forearms
32
what will the skin look like if they had xerosis
scales, cracks, and fissures
33
What are some factors that lead to xerosis
1. Family tendency
2. seasonal changes
3. aging (decreases in epidermal free fatty acids)
4. environment
34
What are preventative measures you can take to prevent xerosis
1. relatively low room temperature; use of humidifiers
2. Bathing with warm (not hot water) no more than every 1 to 2 days
3. reduce excessive exposure to soap, solvents, and other drying agents
4. use emollients frequently - best results when applied to moist skin
35
What should you do if there is existing dryness after treatment
1. soak affected area for 5-10 minutes and then immediately apply water in oil type of medication
2. topical corticosteroid OINTMENT may be used for symptomatic xerosis, especially when associated with eczema
36
T/F ointments are water free and highly fat soluble
true
37
what is urticaria
hives
38
what is urticaria characterized by
wheals and/or angioedema
39
what are wheals
- central swelling usually surrounded by erythema
- itching and sometimes burning
- usual duration of 1 - 24 hours
40
what is angioedema
- sudden swelling of dermis and subcutaneous
- sometimes painful
- common involvement of the mucous membranes
- resolution that is slower than wheals (lasts for up to 72 hours)
- If occurring in respiratory, GI, nervous, or cardiac systems, may be anaphylaxis
41
what is acute urticaria
< 6 weeks in duration
42
what is chronic urticaria
> 6 weeks in duration
43
what is it called when you do not know if its a disease
idiopathic
44
what is adrenergic urticaria
related to emotional stress
45
what is exercise induced urticaria
triggered by exercise
46
what is cold contact urticaria
symptoms occur after skin is exposed to cold
47
what is delayed pressure urticaria
symptoms occur 3-6 hour after skin has been under sustained pressure
48
what is dermographic urticaria
shearing forces; "skin writing"; common
49
what is heat contact urticaria
symptoms occur after skin is exposed to heat
50
what is solar urticaria
caused by exposure to UV rays
51
what is vibratory urticaria
occur after exposure to vibrations - across the back
52
what is aquagenic urticaria
caused by exposure to water
53
what is cholinergic urticaria
related to increase in body temperature
54
what is contact urticaria
caused by contact or exposure to a specific trigger; +/- IgE mediated; may include foods or drugs
55
what is the pathophysiology of urticaria
- may also be related to autoimmunity and IgE release
| - most idiopathic but largely mediated by mast cell stimulation, histamine release and mediated through H1 receptors
56
If someone has acute urticaria is extensive diagnostic tests recommended
No
57
How is urticaria assessed
urticaria activity score (UAS-7)
58
How does the UAS-7 worl
- Patient adds score for wheals and pruritus for a daily score (0-6)
- Patient sums daily scores for 7 days to get severity (max is 42)
59
what are the treatment goals of urticaria
1. identify and relieve triggers and underlying cause
2. relieve symptoms
3. minimize nonspecific aggravating factors - avoid intense cold/heat
4. various treatment guidelines are available; similar except for several differences in step 2
5. once therapy has been initiated, re-evaluate the need for continued therapy every 3-6 months
60
what is the first step for treating urticaria according to the European guidelines
2nd generation H1 antihistamine SCHEDULED
61
if inadequate control: after 2-4 weeks of using 2nd generation H1 antihistamine and/or if symptoms are intolerable what is the next step according to the European guidelines
increased dose of 2nd generation dose up to 4x
62
If inadequate control: after increasing 2nd generation antihistamines what should you try next according to the European guidelines
add a second generation antihistamine to omalizumab (Xolair), cyclosporine (sandimmune), montelukast (singulair) then re-evaluate therapy every 6 months
63
For severe exacerbations after step 3, a short course (3-7days) of what medication may be considered according to the European guidelines
glucocorticoid ( ex: prednisone)
64
According to the American guidelines what is the first step in treating someone with urticaria
2nd generation H1 antihistamine SCHEDULED
65
If insufficient control when using a 2nd gen antihistamine what should you use next according the American guidelines
- titrate 2nd generation H1 antihistamine to 2-4 times normal dose
- add a different 2nd gen H1 antihistamine
- add H2 antihistamine (ranitidine, cimetidine)
- add 1st generation H1 antihistamine at night ( ex: diphenhydramine)
- add leukotriene receptor antagonist montelukast
66
If insufficient control with one of the add ons from step 2 of the American guidelines what is the 3rd step
add high potency antihistamine hydroxyzine or doxepin and titrate as tolerated
67
If insufficient control from step 3 of the American guidelines what is step 4
consider referrals for immunomodulatory therapy such as omalizumab (Xolair) or cyclosporine (Sandimmune)
68
If symptoms are severe after step 3 in the American guidelines what should be considered
prednisone 0.5 to 1 mg/kg/day and may be added to steps 1,2,3
69
What is the MOA of antihistamines
decreased capillary permeability and decreased histamine mediated exocrine secretions
70
what generation of histamines has lower lipophilicity
2nd generation
71
what are some contraindications of first-generation antihistamines?
- hypersensitivity to antihistamines
- narrow angle glaucoma
- peptic ulcers
- symptomatic BPH
72
what are contraindications for 2nd gen antihistamines
hypersensitivity to antihistamines
73
what are some warnings of first gen antihistamine
- COPD, asthma
- anticholinergic (drying effects) - thickened secretions and decreased expectoration
- sedative effects, especially with concomitant CNS medications
74
what are some warnings with 2nd gen antihistamines
sedative effects, especially with concomitant CNS medications
75
What is the most sedating 2nd gen antihistamine
cetirizine
76
what 2nd gen antihistamine does not affect nor is affected by CYP
desloratadine (Clarinex)
77
Which 2nd gen antihistamine is most likely to decreased medication compliance and why
fexofenadine (Allegra) because it is taken twice daily
78
what are the four different phases of wound healing
1. coagulation
2. inflammatory
3. proliferative and migratory phase (tissue formation)
4. remodeling phase
79
What is the primary mediator of the coagulation phase
platelets
80
what are the primary mediators of inflammatory phase
neutrophils, monocytes, macrophages
81
What is the proliferative and migratory phase (tissue formation)
- keratinocytes move to the site of injury through interactions with tissue matrix metalloproteinases (MMPs) and integrins
- extracellular matrix (ECM): structural proteins (collagen, elastin)
- keratinocyte migration and proliferation along with wound contraction helps to close open wounds
82
what is the remodeling phase of wound healing
- occurs 5-7 days after injury
- keratinocyte migration and proliferation result in increased epithelialization
- a robust ECM is no longer needed so it begins to get degraded
- Fibroblasts change into myofibroblasts: contract the wound; bring skin structures together that were separated by edema and inflammation
83
what are the treatment goals of wound care
- prevent complications such as infection
| - prevent sores from growing larger
84
If a person has excessive exudates what type of dressing should they use
1. foams
2. alginates
3. hydro-fibers
85
what is the benefit of using foams, alginates, and hydrofibers
highly absorbent
86
what is the disadvantage of using foams, alginates, and hydrofibers
may dry wound
87
what is the common use for foams, alginates, and hydrofibers
heavy exudates
88
what common brands are used for alginates
- curasorb
| - kalginate
89
what common brands are used for foams
- curafoam
| - hydrosorb
90
what are common brands for hydrofibers
aquacel
91
what type of dressing is used for dry wounds
gels or hydrogels
92
what is the benefit of using hydrogels
provides moisture; may be used infections; soothing; auto-debridement
93
what is the disadvantage of hydrogels
needs secondary dressing; do not use in gangrene; may cause maceration
94
what is the common use of hydrogels
dry, sloughing wounds; necrotic tissue
95
what are the common brand names for hydrogels
- curasol
| - elasto-gel
96
what type of dressings should you use if a person has moderate exudate
films or hydro-colloids
97
what is the benefit of using films or hydro-colloids
auto-debridement (out body has enzymes that constantly break down parts of wound to have continually healing. Helps prevent scar formation)
98
what common brand name film is used
Tegaderm
99
what are so topically formulations you can use for a wound
1. silver sulfadiazine 1% cream
| 2. Becaplermin (Regranex) gel
100
what is silver sulfadiazine cream do
disrupts cell wall and cell membranes
101
what does becaplermin do
- platelet derived growth factor
| - only for use in combination with standard wound care
102
what are pressure sores
bed sores
103
where does pressure sores generally occur
over a body prominence
104
In what patient population does pressure sores most commonly occur in
elderly
105
what increases the likelihood and severity of pressure sores
moisture
106
what are the most common locations a pressure sore can appear
- sacrum and ischial tuberosities
- greater trochanter (hip)
- back of head
- elbows
- heels
107
what are some preventative measures you can take to prevent pressure sores
- skin surveillance
- proper and frequent repositioning
- pressure relief mattresses and devices
- keep area clean and dry
108
how long should a seated patient be repositioned if they have a pressure sore
every 15-60 minutes
109
what layer of the skin in stage 1 deep tissue injury is affected
`epidermis
110
what layer of the skin in stage 2 deep tissue injury is affected
`thinning dermis
111
what is affected in stage 3 of deep tissue injury
full tissue loss; subcutaneous fat is visible
112
what is affected in stage 4 of deep tissue injury
full loss of thickness; exposed bone, tendon or muscle
113
What is unstageable deep tissue injury
covered by slough and/or eschar
114
For stage 1 and 2 deep tissue injury what is the treatment option
medical treatment first
115
what is the treatment option for stage 3 and 4
likely will require surgical intervention
116
what are the prevention and treatment options for an infection of deep tissue injury
topical antibiotics (silver sulfadiazine or triple antibiotic)
117
what type of antibiotics should be given if a patient has cellulitis, sepsis, bacteremia, or osteomyelitis
systemic antibiotics
118
For pain management of deep tissue injury what can a patient use
- topical lidocaine and prilocaine may be applied around the wound
- consider systemic therapy
