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II. Ocular Pharmacology > Anti-inflammatories, Steroids (M1) > Flashcards

Anti-inflammatories, Steroids (M1) Flashcards

1
Q

What are the major types of stimuli that cause inflammation?

A
  1. mechanical/trauma
  2. infection
  3. toxic (foreign substance)
  4. immunologic/hypersensitive
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2
Q

What is the ultimate goal of inflammation?

A

get as many WBC from bloodstream into tissues at site of injury

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3
Q

What is the physiological sequence of the inflammatory response?

A
  1. increase vasodilation
  2. increase vascular permeability of BV walls to get to tissues
  3. chemotaxis to get agents to proper site
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4
Q

What are the main signs and symptoms from the inflammatory response?

A
  1. rubor (redness)
  2. tumor (edema)
  3. calor (heat)
  4. dolar (pain)
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5
Q

What are the clinical implications of an aggressive or chronic inflammatory response?

A
  1. neovascularization
  2. tissue necrosis
  3. scar formation
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6
Q

What is the substance made by the body that is a platelet aggregator to control clotting?

A

thromboxane A2

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7
Q

What is the substance made by the body that increases the sensitivity of pain fibers?

A

PGE2

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8
Q

What is the substance made by the body that is the main prostaglandin of the eye? 1. What does it do? 2

A
  1. PGD2

2. inc vascular permeability and vasodilation

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9
Q

What is the prostaglandin that mediates the itch response?

A

PGI2

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10
Q

What do corticosteroids inhibit in the inflammatory response?

A

phospholipase A2 that transfers phospholipids to arachidonic acid

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11
Q

What are the mechanisms of actions of steroids to inhibit phospholipase A2?

A
  1. bind receptor, pass cell membrane
  2. bind cytoplasmic receptor
  3. enter nucleus to alter protein synthesis
  4. creates lipocortin-1 which inhibits phospholipase A2
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12
Q

What is the resultant effect of limiting arachidonic acid formation with steroids?

A
  1. dec redness
  2. dec swelling
  3. dec heat generation
  4. dec pain
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13
Q

What are the major clinical therapeutic effects of steroids?

A
  1. suppress inflammation
  2. inhibit neovascularization
  3. inhibit scar formation
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14
Q

What are the specific therapeutic effects of steroids that cause a reduction in scarring?

A
  1. inhibits fibroblast proliferation
  2. inhibits fibrin deposition
  3. inhibits collagen depostion
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15
Q

What are the steroid therapeutic effects that do NOT involve the arachidonic acid cycle or scar formation?

A
  1. dec circulating WBC’s and lymphocytes
  2. inhibits migration of neutrophils
  3. inhibits cell mediated response and cytokine synthesis
  4. inhibits mast cell and basophil degraulation
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16
Q

What are the ocular side effects of steroids?

A
  1. increase IOP
  2. Decrease wound healing
  3. formation of cataracts
  4. increase risk of infection
  5. mydriasis
  6. ptosis
17
Q

What amount of IOP increase constitutes a IOP spike as a result of a steroid? 1. What is the physiological cause? 2. What epidemiology increases the risk? 3

A
  1. > =8mmHg
  2. dec outflow of aqueous by altering TM proteoglycan matrix
  3. family history of glaucoma in primary family member
18
Q

What disease in a patient makes them more susceptible to decreased wound healing while taking steroids?

A

herpetic viruses

19
Q

What type of cataract is sometimes found in patients that take low dose steroids for a long time?

A

posterior subcapsular cataract

20
Q

What are contraindications of steroid use (and which are relative)?

A
  1. presence or suspicion of infection
  2. unsure of diagnosis
  3. contact lens use (while taking)
  4. epithelial defects (relative b/c if inflammation is cause then ok)
  5. glaucoma (relative)
21
Q

What is the anti-inflammatory efficacy of steroids determined by?

A
  1. lipophillicity
  2. receptor affinity
  3. rate at which drug is metabolized
22
Q

Which type of steroid has a lipophilic structure which leads to the greatest tissue absorption and corneal penetrance? 1. Which has intermediate penetrance? 2. Which has the least? 3

A
  1. “-ates”, acetates/etabonates/prednates
  2. alcohols
  3. sodium phosphates (NaPh)
23
Q

What are the guidelines for prescribing when off-label?

A
  1. make clinical sense
  2. some clinical judgement or support (case reports, etc)
  3. disclose to patient
24
Q

If a condition warrants steroid treatment, what should the minimum dosage be?

A

QID

25
Q

For mild to moderate inflammation, what is the common steroid dosage?

A

QID x 7 days

26
Q

For moderate to severe inflammation, what is the common steroid dosage?

A

pulse dose of q1-2h x 1-2 days then QID for 5-6 days

27
Q

What is the initial steroid dosage (with proper medication) for uveitis?

A

Q1h with Pred Forte or Q2h with Durezol

28
Q

When is steroid tapering necessary?

A
  1. high dosage (>QID)

2. long duration or treatment (>10 days)

29
Q

What is the proper amount to taper a patient off of steroids?

A

reduce dosage by

30
Q

What are the steps needed to taper a steroid initially dosed at q1hr x 5 days?

A
  1. dec to q2hr x 5d
  2. dec to QID x 5d
  3. dec to BID x 5d
31
Q

What type of medication must be shaken well: ointment, suspension, gel, solution, emulsion, cream?

A

suspension

32
Q

What are the concerns with chronic, long term use of systemic steroids?

A
  1. muscle wasting and altered fat (Cushing’s Syndrome)
  2. Suppress adreno-pituitary axis
  3. Osteoporosis
  4. thinning and depigmentation of skin
33
Q

What are the concerns with acute, short term use of systemic steroids?

A
  1. increase blood glucose (gluconeogenesis)
  2. Peptic ulcers
  3. Pregnancy
34
Q

What are optometrists able to treat systemic steroids with?

A

allergic inflammation of the conjunctiva, lids and adnexa

35
Q

What are the restrictions for prescribing oral steroids in Ohio for optometrists?

A
  1. at least 18 yo
  2. methylprednisolone only
  3. only a single course of therapy
  4. prescribed on basis of individuals particular episode of illness
36
Q

What did the SCORE study show?

A
  1. CRVO patients 5x’s more likely to improve VA with steroid (triamcinolone) injection (now standard of care)
  2. BRVO patients had no benefit is visual outcomes and higher rates of IOP spikes and cataract development (photocoagulation still standard)

II. Ocular Pharmacology (18 decks)

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