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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Anti-inflammatory Agents I - Week 6 > Flashcards

AED - Anti-inflammatory Agents I - Week 6 Flashcards

1
Q

List 7 kinds of anti-inflammatory agents used in Australia and give an example for each.

A 
Astringents - zince sulphate
Anti-histamines - antazoline
MCS - lodoxamide
Dual action MCS/AH - olopatadine
NSAIDs - ibuprofen
Corticosteroids - dexmethasone
Calcineurin/T-cell inhibitor - cyclosporine
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2
Q

Consider topical steroids. What is its potency and corneal penetration dependent on?

A

The formulation used - acetate vs phosphate vs alcohol

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3
Q

What kind of potency and penetration is ok for mild surface inflammation? What does this formulation minimise?

A

Low potency, low penetration

Minimises chance of steroid-induced IOP rise

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4
Q

High penetration and potency is essential for what eye disease? What formulation specifically?

A

Anterior uveitis

If required, write acetate on the Rx

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5
Q

Order the following by penetrance from highest to lowest:
Alcohol
Phosphate
Acetate

A

Acetate&raquo_space; alcohol > phosphate

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6
Q

What is the general guideline for the use of ocular lubricants (4)?

A

Mild ocular surface irritation (including SPK)
Neurotrophic keratitis
Adjunct in severe inflammation

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7
Q

What is the general guideline for the use of astringent eye drops (1)?

A

Mucoid discharge in allergic surface disease

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8
Q

What is the general guideline for the use of antihistamine eye drops (1)?

A

Allergic eye disease (type I hypersensitivity)

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9
Q

What is the general guideline for the use of MCS eye drops (1)?

A

Allergic eye disease (type I hypelsensitivity)

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10
Q

What is the general guideline for the use of dual action MCS/AH eye drops (1)?

A

Allergic eye disease (type I hypersensitivity)

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11
Q

What is the general guideline for the use of NSAIDs for ocular conditions (5)?

A

Mild/moderate allergic eye disease and other surface inflammation (episcleritis)
Intra-operative inhibition of miosis
Post-operative inflammation/analgaesia

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12
Q

What is the general guideline for the use of corticosteroid eye drops (5)?

A

All types of moderate to severe ocular surface inflammation
HSV and HZO keratitis (not epithelial)
Anterior uveitis
Endophthalmitis (intravitreal)

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13
Q

What is the general guideline for the use of cyclosporine eye drops (5)?

A 
Corneal graft
Uveitis
Scleritis
VKC
Dry eye
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14
Q

Are astringents safe in pregnancy, lactation, and children?

A

Yes to all three

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15
Q

Are antihistamines safe in pregnancy, lactation, and children?

A

Avoid use in pregnancy and lactation

Children are probably ok

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16
Q

Are MCS safe in pregnancy, lactation, and children?

A

Probably safe in all three

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17
Q

Are dual action MCS/AH safe in pregnancy, lactation, and children?

A

Probably safe in all three

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18
Q

Are NSAIDs safe in pregnancy, lactation, and children?

A

Caution/not recommended in pregnancy

Safe in lactation and children

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19
Q

Is cyclosporine safe in pregnancy, lactation, and children?

A

Caution/not recommended in pregnancy

Contraindicated in lactation

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20
Q

Are steroids safe in pregnancy, lactation, and children?

A

Safe in pregnancy and lactation

Not established in children

21
Q

What strength of steroid should pregnant women be prescribed?

A

The lowest potency required

22
Q

Why does prednisolone need to be shaken before use?

A

Acetate form is a suspension

23
Q

What is prednisolone used in the management of?

A

Uveitis

24
Q

Does prednisolone have low, moderate, or high strength?

A

High strength

25
Q

What formulation is prednisolone?

A

Acetate

26
Q

Compare fluoromethalones to prednisolone in terms of effectivity and IOP.

A

Fluoromethalones have less of an IOP spike but less effective than prednisolone

27
Q

What is a good rule of thumb when considering oral vs topical.

A

If inflammation no deeper than the iris / anterior ciliary body, topical therapy may be appropriate

28
Q

What is a general guideline if the iris or anterior ciliary body need to be targeted?

A

Better penetrance is required and more frequent administration may be needed for therapeutic dose

29
Q

What is a general guideline if structures deeper than the iris / anterior ciliary body need to be targeted (4)?

A

Oral / intraocular / sub-conj. / sub-Tenon’s injection may be required

30
Q

List 5 potential side effects of short-medium term steroid doses.

A 
IOP spike
Secondary/reactivation of infection
Masking clinical signs
Delayed wound healing
Transient discomfort
31
Q

List 2 potential side effects of long term steroid doses. Give percentages where possible (2).

A

IOP rise
Cataract - mainly posterior subcapsular
-33% after 12 months
-52% after 24 months

32
Q

List 5 mechanisms of action of glucocorticoids.

A

Blocks phospholipase A2 activity, decreasing cytokine produnction
Decreases cellular response
Prevents mast cell degranulation
Deregulates cellular DNA expression
Suppresses adrenal secretions of steroids

33
Q

Give 4 reasons why we wouls suppress inflammation.

A

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

34
Q

In how many days can peak steroid IOP response occur?

A

As little as 6 days

35
Q

Define Cushing’s syndrome.

A

Too much steroid

36
Q

What can occur in the eye with the use of NSAIDs (diclofenac specifically)?

A

Stromal lysis

37
Q

Can long-term steroid use be abruptly stopped?

A

No, it must be tapered

38
Q

Does stadard topical therapy using steroids require tapering?

A

Yes

39
Q

Does occasional short term / low dose steroid use require tapering?

A

No

40
Q

Why must steroid use sometimes be tapered?

A

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

41
Q

What is meant by pulse-dose?

A

High dose short bursts produce, which quicker therapeutic effect with shorter-lived side-effects

42
Q

In the eye, what is pulse dosing typically used for (2) and not used for (2)?

A

Commonly used in allergic / contact conjunctivitis

Not used in uveitis or HZO

43
Q

One requires caution when pulse-dosing?

A

The drug’s toxicity profile

44
Q

Consider a true allergic eye disease (type I). Is it immediate or delayed on second exposure to the allergen?

A

Immediate

45
Q

Consider delayed hypersensitivity (type IV). Can it be managed with MCS/AH?

A

No, need steroids

46
Q

Consider ocular inflammation due to topical drugs. Describe its occurence by type and percentage. Can the different types be told apart?

A

90% are due to direct toxicity

10% are a delayed immune response

47
Q

Do anti-histamines help with redness as well as itching? Explain.

A

no, just itching as its only a H1 antagonist

48
Q

What should be managed before treating for inflammation and why?

A

Steroids completely block the body’s natural defences against infection
Manage active infection before associated inflammation

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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