Anti-inflammatories, NSAIDs and Immunosuppressives (M1)

Question 1

What is the mechanism of action of NSAIDs?

Answer 1

cyclo-oxygenase inhibitors

Question 2

What are the physiological effects of NSAIDs?

Answer 2

1. Inhibition of PG’s to dec vasodilation and for pain mediation
2. analgesic to manage pain
3. NO lymphocyte or fibroblast effect

Question 3

What are the therapeutic effects of NSAIDs (along with the specific inhibited mediator for each)?

Answer 3

1. analgesia (PGE2 formation prevention)
2. anti-inflammatory (PGD2 formation prevention)
3. anti-platelet (thromboxane A2 formation prevention)
4. antipyretic (inhibit bacterial pyrogens)

Question 4

What are the reasons that NSAIDs are used for post-op cataract surgery?

Answer 4

1. management of pain and inflammation

2. prevention and treatment of cystoid macular edema

Question 5

What are the advantages of direct application of NSAIDs for ocular trauma?

Answer 5

1. mechanism of action takes place in the peripheral nervous system
2. limits systemic side effects

Question 6

What are the therapeutics used following PRK (photorefractive keratectomy)?

Answer 6

1. Voltaren
2. steroids
3. bandage CL

Question 7

What are the off-label uses for topical NSAIDs?

Answer 7

1. Post PRK/refractive surgery
2. Corneal abrasion/erosion/Post FB removal
3. Bullous keratopathy
4. pre/post Betadine Tx
5. GP contact lens adaptation
6. Allergic conjunctivitis
7. cystoid macular edema (CME) prevention/Tx

Question 8

What is cystoid macular edema (CME) following cataract surgery called? 1. Why are NSAIDs used to prevent this? 2

Answer 8

1. Irvine Gass Syndrome

2. one of few topicals that can reach the posterior vitreous

Question 9

What is the indication where oral NSAIDs are indicated as the Tx of choice?

Answer 9

scleritis

Question 10

What are the oral NSAIDs used (and their dosage) in the Tx of scleritis?

Answer 10

1. Naproxen (500 mg BID)
2. Indomethacin (25mg TID)
3. Ibuprofen (400-600mg QID)

Question 11

What are the oral NSAIDs used (and their dosage) for pain?

Answer 11

1. Ibuprofen (400-600mg QID; max is 2400mg/24hrs)
2. ketoprofen (50mg q6-8h)
3. Naproxen (up to 250-500mg BID)

Question 12

What are the advantages of Restasis for the treatment of dry eye?

Answer 12

1. creates aqueous production from your own lacrimal gland
2. decreases inflammation to inc quality of life with less artificial tear use and comfort
3. compliance improves and CL wearers can use it

Question 13

What are the disadvantages of Restasis for the treatment of dry eye?

Answer 13

1. cost is high b/c no competition and insurance doesn’t cover
2. continuous treatment for the rest of life
3. no immediate response

Question 14

What is an alteration in management of prescribing Restasis with the example?

Answer 14

1. steroid trial to see if inflammatory so Lotemax QID x 2wk

2. dose with steroid and taper off steroid eventually BID x 2wks then D/C