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Ocular Pharma # 9
Steroids and NSAIDS
Question | Answer |
---|---|
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 |