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Skin Midterm > Pruritus, Xerosis, Urticaria, Wounds > Flashcards

Pruritus, Xerosis, Urticaria, Wounds Flashcards

1
Q

what is another word of pruritus

A

itching

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2
Q

how would pruritus on diseased skin be described as

A

itch related to skin condition

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3
Q

What are the two groups of pruritus

A
  1. diseased skin

2. non-diseased skin

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4
Q

what is the classification of pruritus on diseased skin

A

prurioceptive itch

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5
Q

What are some potential causes of pruritus on diseased skin

A
  1. dermatitis
  2. xerosis
  3. urticaria
  4. psoriasis
  5. scabies
  6. fungal infections
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6
Q

what are the 3 types of pruritus on non-diseased skin

A
  1. neurogenic itch
  2. neuropathic itch
  3. psychogenic itch
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7
Q

what is neurogenic itch

A

itch originating from the nervous system WITHOUT neural damage

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8
Q

what are some potential causes of neurogenic itch

A
  1. renal failure
  2. Cirrhosis
  3. hyperthyroidism
  4. pregnancy
  5. medications (opiods)
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9
Q

what is neuropathic itch

A

itch caused by DAMAGE to afferent nerves

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10
Q

what are some potential causes of neuropathic itch

A
  1. nerve damage

2. neuralgia

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11
Q

what is psychogenic itch

A

itch related to psychological illness

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12
Q

what are some potential causes of psychogenic itch

A
  1. anxiety
  2. depression
  3. OCD
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13
Q

Described the pathophysiology of pruritus

A
  1. Itch stimulus - afibers send signals to the brain “hey scratch”
  2. Scratch - stops itch
  3. transmits signals through A-fibers which inhibit C-fiber signals
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14
Q

which receptor does histamine cause itch through

A

H1; through H2 to a much more limited degree

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15
Q

what is histamine mostly responsible for

A

allergic type itch

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16
Q

what type of peptide may cause vasodilation and intensify itch

A

neuropeptides (substance P)

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17
Q

what type of drugs causes an itch centrally or peripherally

A

opioids

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18
Q

Is pruritus typically a sign or symptom

A

symptom of an underlying cause

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19
Q

what are some non-pharm treatments for pruritus

A
  1. keep skin hydrated - emollients and barrier creams
  2. use mild soaps
  3. take cooler, shorter showers
  4. avoid irritants
  5. use of cooling antipruritic lotions (camphor/menthol)
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20
Q

For a histamine induced itch what type of medication should you use

A

antihistamines

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21
Q

what type of antihistamines are preferred to use in patients who have pruritus

A

second generation

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22
Q

why are second generation histamines preferred

A

they are non sedating and uses scheduled doses

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23
Q

what are the second generation antihistamine

A
  1. fexofenadine (Allegra)
  2. loratadine (Claritin)
  3. cetirizine (Zyrtec)
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24
Q

what are topical steroids used for

A

only for inflammatory skin causes

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25
Q

what is capsaicin best used for

A

counter irritant may be helpful in well localized itch

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26
Q

what is doxepin cream (antidepressant with H1 and H2 antagonistic properties) most useful for

A

small areas of intact skin

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27
Q

what are some other agents for non-histamine induced itch

A
  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
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28
Q

what is xerosis

A

dry skin

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29
Q

what layer of the epidermis is is dehydrated

A

stratum corneum

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30
Q

what population is more common to get xerosis

A

elderly

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31
Q

where does xerosis commonly effect

A

lower extremities and forearms

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32
Q

what will the skin look like if they had xerosis

A

scales, cracks, and fissures

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33
Q

What are some factors that lead to xerosis

A
  1. Family tendency
  2. seasonal changes
  3. aging (decreases in epidermal free fatty acids)
  4. environment
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34
Q

What are preventative measures you can take to prevent xerosis

A
  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
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35
Q

What should you do if there is existing dryness after treatment

A
  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
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36
Q

T/F ointments are water free and highly fat soluble

A

true

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37
Q

what is urticaria

A

hives

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38
Q

what is urticaria characterized by

A

wheals and/or angioedema

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39
Q

what are wheals

A
  • central swelling usually surrounded by erythema
  • itching and sometimes burning
  • usual duration of 1 - 24 hours
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40
Q

what is angioedema

A
  • 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
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41
Q

what is acute urticaria

A

< 6 weeks in duration

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42
Q

what is chronic urticaria

A

> 6 weeks in duration

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43
Q

what is it called when you do not know if its a disease

A

idiopathic

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44
Q

what is adrenergic urticaria

A

related to emotional stress

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45
Q

what is exercise induced urticaria

A

triggered by exercise

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46
Q

what is cold contact urticaria

A

symptoms occur after skin is exposed to cold

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47
Q

what is delayed pressure urticaria

A

symptoms occur 3-6 hour after skin has been under sustained pressure

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48
Q

what is dermographic urticaria

A

shearing forces; “skin writing”; common

49
Q

what is heat contact urticaria

A

symptoms occur after skin is exposed to heat

50
Q

what is solar urticaria

A

caused by exposure to UV rays

51
Q

what is vibratory urticaria

A

occur after exposure to vibrations - across the back

52
Q

what is aquagenic urticaria

A

caused by exposure to water

53
Q

what is cholinergic urticaria

A

related to increase in body temperature

54
Q

what is contact urticaria

A

caused by contact or exposure to a specific trigger; +/- IgE mediated; may include foods or drugs

55
Q

what is the pathophysiology of urticaria

A
  • 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
Q

If someone has acute urticaria is extensive diagnostic tests recommended

A

No

57
Q

How is urticaria assessed

A

urticaria activity score (UAS-7)

58
Q

How does the UAS-7 worl

A
  • 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
Q

what are the treatment goals of urticaria

A
  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
Q

what is the first step for treating urticaria according to the European guidelines

A

2nd generation H1 antihistamine SCHEDULED

61
Q

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

A

increased dose of 2nd generation dose up to 4x

62
Q

If inadequate control: after increasing 2nd generation antihistamines what should you try next according to the European guidelines

A

add a second generation antihistamine to omalizumab (Xolair), cyclosporine (sandimmune), montelukast (singulair) then re-evaluate therapy every 6 months

63
Q

For severe exacerbations after step 3, a short course (3-7days) of what medication may be considered according to the European guidelines

A

glucocorticoid ( ex: prednisone)

64
Q

According to the American guidelines what is the first step in treating someone with urticaria

A

2nd generation H1 antihistamine SCHEDULED

65
Q

If insufficient control when using a 2nd gen antihistamine what should you use next according the American guidelines

A
  • 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
Q

If insufficient control with one of the add ons from step 2 of the American guidelines what is the 3rd step

A

add high potency antihistamine hydroxyzine or doxepin and titrate as tolerated

67
Q

If insufficient control from step 3 of the American guidelines what is step 4

A

consider referrals for immunomodulatory therapy such as omalizumab (Xolair) or cyclosporine (Sandimmune)

68
Q

If symptoms are severe after step 3 in the American guidelines what should be considered

A

prednisone 0.5 to 1 mg/kg/day and may be added to steps 1,2,3

69
Q

What is the MOA of antihistamines

A

decreased capillary permeability and decreased histamine mediated exocrine secretions

70
Q

what generation of histamines has lower lipophilicity

A

2nd generation

71
Q

what are some contraindications of first-generation antihistamines?

A
  • hypersensitivity to antihistamines
  • narrow angle glaucoma
  • peptic ulcers
  • symptomatic BPH
72
Q

what are contraindications for 2nd gen antihistamines

A

hypersensitivity to antihistamines

73
Q

what are some warnings of first gen antihistamine

A
  • COPD, asthma
  • anticholinergic (drying effects) - thickened secretions and decreased expectoration
  • sedative effects, especially with concomitant CNS medications
74
Q

what are some warnings with 2nd gen antihistamines

A

sedative effects, especially with concomitant CNS medications

75
Q

What is the most sedating 2nd gen antihistamine

A

cetirizine

76
Q

what 2nd gen antihistamine does not affect nor is affected by CYP

A

desloratadine (Clarinex)

77
Q

Which 2nd gen antihistamine is most likely to decreased medication compliance and why

A

fexofenadine (Allegra) because it is taken twice daily

78
Q

what are the four different phases of wound healing

A
  1. coagulation
  2. inflammatory
  3. proliferative and migratory phase (tissue formation)
  4. remodeling phase
79
Q

What is the primary mediator of the coagulation phase

A

platelets

80
Q

what are the primary mediators of inflammatory phase

A

neutrophils, monocytes, macrophages

81
Q

What is the proliferative and migratory phase (tissue formation)

A
  • 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
Q

what is the remodeling phase of wound healing

A
  • 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
Q

what are the treatment goals of wound care

A
  • prevent complications such as infection

- prevent sores from growing larger

84
Q

If a person has excessive exudates what type of dressing should they use

A
  1. foams
  2. alginates
  3. hydro-fibers
85
Q

what is the benefit of using foams, alginates, and hydrofibers

A

highly absorbent

86
Q

what is the disadvantage of using foams, alginates, and hydrofibers

A

may dry wound

87
Q

what is the common use for foams, alginates, and hydrofibers

A

heavy exudates

88
Q

what common brands are used for alginates

A
  • curasorb

- kalginate

89
Q

what common brands are used for foams

A
  • curafoam

- hydrosorb

90
Q

what are common brands for hydrofibers

A

aquacel

91
Q

what type of dressing is used for dry wounds

A

gels or hydrogels

92
Q

what is the benefit of using hydrogels

A

provides moisture; may be used infections; soothing; auto-debridement

93
Q

what is the disadvantage of hydrogels

A

needs secondary dressing; do not use in gangrene; may cause maceration

94
Q

what is the common use of hydrogels

A

dry, sloughing wounds; necrotic tissue

95
Q

what are the common brand names for hydrogels

A
  • curasol

- elasto-gel

96
Q

what type of dressings should you use if a person has moderate exudate

A

films or hydro-colloids

97
Q

what is the benefit of using films or hydro-colloids

A

auto-debridement (out body has enzymes that constantly break down parts of wound to have continually healing. Helps prevent scar formation)

98
Q

what common brand name film is used

A

Tegaderm

99
Q

what are so topically formulations you can use for a wound

A
  1. silver sulfadiazine 1% cream

2. Becaplermin (Regranex) gel

100
Q

what is silver sulfadiazine cream do

A

disrupts cell wall and cell membranes

101
Q

what does becaplermin do

A
  • platelet derived growth factor

- only for use in combination with standard wound care

102
Q

what are pressure sores

A

bed sores

103
Q

where does pressure sores generally occur

A

over a body prominence

104
Q

In what patient population does pressure sores most commonly occur in

A

elderly

105
Q

what increases the likelihood and severity of pressure sores

A

moisture

106
Q

what are the most common locations a pressure sore can appear

A
  • sacrum and ischial tuberosities
  • greater trochanter (hip)
  • back of head
  • elbows
  • heels
107
Q

what are some preventative measures you can take to prevent pressure sores

A
  • skin surveillance
  • proper and frequent repositioning
  • pressure relief mattresses and devices
  • keep area clean and dry
108
Q

how long should a seated patient be repositioned if they have a pressure sore

A

every 15-60 minutes

109
Q

what layer of the skin in stage 1 deep tissue injury is affected

A

`epidermis

110
Q

what layer of the skin in stage 2 deep tissue injury is affected

A

`thinning dermis

111
Q

what is affected in stage 3 of deep tissue injury

A

full tissue loss; subcutaneous fat is visible

112
Q

what is affected in stage 4 of deep tissue injury

A

full loss of thickness; exposed bone, tendon or muscle

113
Q

What is unstageable deep tissue injury

A

covered by slough and/or eschar

114
Q

For stage 1 and 2 deep tissue injury what is the treatment option

A

medical treatment first

115
Q

what is the treatment option for stage 3 and 4

A

likely will require surgical intervention

116
Q

what are the prevention and treatment options for an infection of deep tissue injury

A

topical antibiotics (silver sulfadiazine or triple antibiotic)

117
Q

what type of antibiotics should be given if a patient has cellulitis, sepsis, bacteremia, or osteomyelitis

A

systemic antibiotics

118
Q

For pain management of deep tissue injury what can a patient use

A
  • topical lidocaine and prilocaine may be applied around the wound
  • consider systemic therapy

Skin Midterm (4 decks)

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