AED - Anti-inflammatory Agents I - Week 6 Flashcards
List 7 kinds of anti-inflammatory agents used in Australia and give an example for each.
Astringents - zince sulphate
Anti-histamines - antazoline
MCS - lodoxamide
Dual action MCS/AH - olopatadine
NSAIDs - ibuprofen
Corticosteroids - dexmethasone
Calcineurin/T-cell inhibitor - cyclosporine
Consider topical steroids. What is its potency and corneal penetration dependent on?
The formulation used - acetate vs phosphate vs alcohol
What kind of potency and penetration is ok for mild surface inflammation? What does this formulation minimise?
Low potency, low penetration
Minimises chance of steroid-induced IOP rise
High penetration and potency is essential for what eye disease? What formulation specifically?
Anterior uveitis
If required, write acetate on the Rx
Order the following by penetrance from highest to lowest:
Alcohol
Phosphate
Acetate
Acetate»_space; alcohol > phosphate
What is the general guideline for the use of ocular lubricants (4)?
Mild ocular surface irritation (including SPK)
Neurotrophic keratitis
Adjunct in severe inflammation
What is the general guideline for the use of astringent eye drops (1)?
Mucoid discharge in allergic surface disease
What is the general guideline for the use of antihistamine eye drops (1)?
Allergic eye disease (type I hypersensitivity)
What is the general guideline for the use of MCS eye drops (1)?
Allergic eye disease (type I hypelsensitivity)
What is the general guideline for the use of dual action MCS/AH eye drops (1)?
Allergic eye disease (type I hypersensitivity)
What is the general guideline for the use of NSAIDs for ocular conditions (5)?
Mild/moderate allergic eye disease and other surface inflammation (episcleritis)
Intra-operative inhibition of miosis
Post-operative inflammation/analgaesia
What is the general guideline for the use of corticosteroid eye drops (5)?
All types of moderate to severe ocular surface inflammation
HSV and HZO keratitis (not epithelial)
Anterior uveitis
Endophthalmitis (intravitreal)
What is the general guideline for the use of cyclosporine eye drops (5)?
Corneal graft
Uveitis
Scleritis
VKC
Dry eye
Are astringents safe in pregnancy, lactation, and children?
Yes to all three
Are antihistamines safe in pregnancy, lactation, and children?
Avoid use in pregnancy and lactation
Children are probably ok
Are MCS safe in pregnancy, lactation, and children?
Probably safe in all three
Are dual action MCS/AH safe in pregnancy, lactation, and children?
Probably safe in all three
Are NSAIDs safe in pregnancy, lactation, and children?
Caution/not recommended in pregnancy
Safe in lactation and children
Is cyclosporine safe in pregnancy, lactation, and children?
Caution/not recommended in pregnancy
Contraindicated in lactation
Are steroids safe in pregnancy, lactation, and children?
Safe in pregnancy and lactation
Not established in children
What strength of steroid should pregnant women be prescribed?
The lowest potency required
Why does prednisolone need to be shaken before use?
Acetate form is a suspension
What is prednisolone used in the management of?
Uveitis
Does prednisolone have low, moderate, or high strength?
High strength
What formulation is prednisolone?
Acetate
Compare fluoromethalones to prednisolone in terms of effectivity and IOP.
Fluoromethalones have less of an IOP spike but less effective than prednisolone
What is a good rule of thumb when considering oral vs topical.
If inflammation no deeper than the iris / anterior ciliary body, topical therapy may be appropriate
What is a general guideline if the iris or anterior ciliary body need to be targeted?
Better penetrance is required and more frequent administration may be needed for therapeutic dose
What is a general guideline if structures deeper than the iris / anterior ciliary body need to be targeted (4)?
Oral / intraocular / sub-conj. / sub-Tenon’s injection may be required
List 5 potential side effects of short-medium term steroid doses.
IOP spike
Secondary/reactivation of infection
Masking clinical signs
Delayed wound healing
Transient discomfort
List 2 potential side effects of long term steroid doses. Give percentages where possible (2).
IOP rise
Cataract - mainly posterior subcapsular
-33% after 12 months
-52% after 24 months
List 5 mechanisms of action of glucocorticoids.
Blocks phospholipase A2 activity, decreasing cytokine produnction
Decreases cellular response
Prevents mast cell degranulation
Deregulates cellular DNA expression
Suppresses adrenal secretions of steroids
Give 4 reasons why we wouls suppress inflammation.
It may lead to cell/tissue loss
May lead to scarring and loss of function
May lead to collateral ocular surface disturbance
Improved patient comfort and surgical outcome
In how many days can peak steroid IOP response occur?
As little as 6 days
Define Cushing’s syndrome.
Too much steroid
What can occur in the eye with the use of NSAIDs (diclofenac specifically)?
Stromal lysis
Can long-term steroid use be abruptly stopped?
No, it must be tapered
Does stadard topical therapy using steroids require tapering?
Yes
Does occasional short term / low dose steroid use require tapering?
No
Why must steroid use sometimes be tapered?
With steroid use, natural cortisol levels decrease
If abruptly stopped, there is a delayed body response in which natural cortisol levels are low, which promotes rebound inflammation
What is meant by pulse-dose?
High dose short bursts produce, which quicker therapeutic effect with shorter-lived side-effects
In the eye, what is pulse dosing typically used for (2) and not used for (2)?
Commonly used in allergic / contact conjunctivitis
Not used in uveitis or HZO
One requires caution when pulse-dosing?
The drug’s toxicity profile
Consider a true allergic eye disease (type I). Is it immediate or delayed on second exposure to the allergen?
Immediate
Consider delayed hypersensitivity (type IV). Can it be managed with MCS/AH?
No, need steroids
Consider ocular inflammation due to topical drugs. Describe its occurence by type and percentage. Can the different types be told apart?
90% are due to direct toxicity
10% are a delayed immune response
Do anti-histamines help with redness as well as itching? Explain.
no, just itching as its only a H1 antagonist
What should be managed before treating for inflammation and why?
Steroids completely block the body’s natural defences against infection
Manage active infection before associated inflammation
