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Ocular Pharma # 9

Steroids and NSAIDS

Corticosteroids block the formation of __________ and effect the production of ______________. Arachadonic acid / Prostaglandins, cytokines, and other inflammatory agents.
What other actions do corticosteroids perform to prevent inflammation? Decreased blood vessels dilation and permeability, decreases white blood cell proliferation and mast cell degranulation and histamine release.
NSAID's block the formation of _____________. Prostaglandins by blocking the breakdown of COX (cylooxygenase)
What are the four cardinal signs of inflammation? Redness, swelling, heat, pain
What are the three main OCULAR side effects of corticosteriods? Cataracts, glaucoma, and activation of herpes virus. Also, can mask underlying disease
Corticosteroids are contraindicated in what type of herpes? Epithelial herpes (dendritic ulcer) simplex
Corticosteroids may be indicated in what type of herpes? Stromal (interstitial) herpes simplex and herpes zoster
How many systemic side effects of systemic corticosteroids can you name? Moon face, buffalo hump, adrenal gland suppression, activation infections, gastric ulcers, psychoses, muscle and bone weakness, growth retardation in the young, fluid and electrolyte imbalance
After how many days of corticosteroid treatment should the drug be tapered when discontinuing? 5-7
What five instructions do you give to a patient who is starting steroids? Punctal occlussion instructions, use drug ONLY as directed, keep your appointment, do not stop drug w/out consulting your MD, and that glaucoma and cataracts are a risk as well as activation of an inactive herpes virus.
Which are the three strongest (most effective) topical steroids? Difluprednate (Durazol®), Prednisone acetate (Pred forte®), Dexamethasone (Decadron®)
Which are the two weakest steroids with the fewest side effects? Weakest in order: Medrysone (HMS®), Fluorometholone (FML®), and Loteprednol 0.2% (Alrex®)
Which prednisone is strongest, the phosphate or the acetate? Acetate (which is also a suspension and requires a lot of shaking)
How many disorders can you name that may be treated with topical steroids? Blepharitis, OSD, Severe allergic blepharitis, Phlyctentules, Stromal herpes simplex, Herpes Zoster, Corneal transplant immune reaction, Post-operative cataract and glaucoma surgeries, Uveitis, Scleritis, Chemical burns
Which of the following are NOT side effects of topical steroids? Glaucoma / Activation of Herpes Virus / Delayed wound healing / Lash pigmentation / Posterior subcapsular cataracts Lash Pigmentation
Which topical steroid is an emulsion, is very effective, and does not have to be shaken? Diflupednate (Durezol®)
Can you name two topical steroids, which have a low incidence of increasing IOP? Medrysone and Flurometholone.
Which topical steroid has the weakest effect? Medrysone
What is a popular new combined steroid-antibiotic, which has reduced the strength of steroid to reduce the side effects and is very useful in the treatment of blepharitis? Tobradex-­‐ST® (Tobramycin and Dexamethasone)
Can you name the new once a day topical NSAID? Bromfenac (Bromday®)
How many NSAID's can you name? See the slides. Most common ones used are probably Ketorolac (Acular®) and Nefafenac (Nevanac®) and Bromfenac (Bromday®). Note similarities of generic names.
How many indications for topical NSAID's can you name? Probably main use is prophylactically in all cataract surgeries to prevent clinical CME. Also helps reduce miosis & inflammation. Reduction of corneal pain in refractive surgery. Ketorolac (Acular®) is approved to treat alleric conjunctiviits.
What are the side effects of topical NSAID's? Eye irritation and burning, along with hyperemia. May delay corneal healing (if used prolonged), which can lead to thinning, perforation, and erosions.
What are the side effects of systemic NSAID's and which are the most common? GI bleeding and gastric ulcers are main complications. Other uncommon possiblities are making asthma worse and kidney dysfunction.
Where do NSAID's block the inflammatory process? Inhibits COX and prevents conversion of arachidonic acid to prostaglandins.
Can NSAID's be used to treat an allergy? Yes
Can NSAID's be used to treat dry eye? New studies show that NSAIDs may be of value as adjunct Rx in dry eyed.
When should topical NSAID's be used with caution? Hyphemas
When is acetaminophen contraindicated and why? Alcoholics – can cause liver failure.
What type of agents are Methotrexate and Cyclosporine? Immunosuppresive
Can you name an ocular disorder that Methotrexate and Cyclosporine are used to treat? Auto immune disorders which affect the eye: Uveitis, Sjogrens, RA
Is aspirin a NSAID? Yes
What is aspirin contraindicated? Adolescents or teenagers with flu-­like syndrome. May lead to Reye’s syndrome.
Does acetaminophen have any anti-­inflammatory properties? No. Is used to reduce fever and pain
Created by: Leequa