Steroids and NSAIDS
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| Corticosteroids block the formation of __________ and effect the production of ______________. | Arachadonic acid / Prostaglandins, cytokines, and other inflammatory agents.
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| 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.
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| NSAID's block the formation of _____________. | Prostaglandins by blocking the breakdown of COX (cylooxygenase)
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| What are the four cardinal signs of inflammation? | Redness, swelling, heat, pain
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| What are the three main OCULAR side effects of corticosteriods? | Cataracts, glaucoma, and activation of herpes virus. Also, can mask underlying disease
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| Corticosteroids are contraindicated in what type of herpes? | Epithelial herpes (dendritic ulcer) simplex
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| Corticosteroids may be indicated in what type of herpes? | Stromal (interstitial) herpes simplex and herpes zoster
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| 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
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| After how many days of corticosteroid treatment should the drug be tapered when discontinuing? | 5-7
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| 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.
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| Which are the three strongest (most effective) topical steroids? | Difluprednate (Durazol®),
Prednisone
acetate
(Pred
forte®),
Dexamethasone
(Decadron®)
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| Which are the two weakest steroids with the fewest side effects? | Weakest in order: Medrysone
(HMS®),
Fluorometholone
(FML®),
and
Loteprednol
0.2%
(Alrex®)
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| Which prednisone is strongest, the phosphate or the acetate? | Acetate
(which
is
also
a
suspension
and
requires
a
lot
of
shaking)
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| 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
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| 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
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| Which topical steroid is an emulsion, is very effective, and does not have to be shaken? | Diflupednate
(Durezol®)
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| Can you name two topical steroids, which have a low incidence of increasing IOP? | Medrysone
and
Flurometholone.
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| Which topical steroid has the weakest effect? | Medrysone
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| 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)
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| Can you name the new once a day topical NSAID? | Bromfenac
(Bromday®)
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| 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.
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| 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.
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| 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.
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| 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.
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| Where do NSAID's block the inflammatory process? | Inhibits
COX
and
prevents
conversion
of
arachidonic
acid
to
prostaglandins.
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| Can NSAID's be used to treat an allergy? | Yes
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| Can NSAID's be used to treat dry eye? | New
studies
show
that
NSAIDs
may
be
of
value
as
adjunct
Rx
in
dry
eyed.
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| When should topical NSAID's be used with caution? | Hyphemas
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| When is acetaminophen contraindicated and why? | Alcoholics
–
can
cause
liver
failure.
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| What type of agents are Methotrexate and Cyclosporine? | Immunosuppresive
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| Can you name an ocular disorder that Methotrexate and Cyclosporine are used to treat? | Auto
immune
disorders
which
affect
the
eye:
Uveitis,
Sjogrens,
RA
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| Is aspirin a NSAID? | Yes
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| What is aspirin contraindicated? | Adolescents
or
teenagers
with
flu-like
syndrome.
May
lead
to
Reye’s
syndrome.
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| Does acetaminophen have any anti-inflammatory properties? | No.
Is
used
to
reduce
fever
and
pain
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