Steroids Flashcards
what is the most commonly prescribed oral steroid?
Prednisone
steroids classically have ____ rings and ______ carbons
4 and 17
which vitamin is also a steroid?
vitamin D
ACTH and cortisol levels peak at what time of day?
morning (8am)
what has a negative feedback mechanism on the hypothalamus and pituitary?
glucocorticoids
what has a positive effect on the hypothalamus and pituitary?
epinephrine and norepinephrine
The hypothalamus releases ______ which causes the pituitary to release _________
corticotropin releasing hormone
ACTH
what is the mechanism of reduced healing caused by steroids?
glucocorticoids reduce fibroblast proliferation = reduces tissue regeneration and repair
at what level of the eye might you first choose a non-topical steroid?
anywhere from anterior uveitis and back
Cushing’s syndrome is caused by excess of what hormone?
ACTH
What is the only ester-based topical steroid?
loteprednol etabonate
how do steroids treat neovascularization?
they down-regulate VEGF synthesis
long term oral prednisolone causes what ocular side effects in patients?
PSC
if a patient is going to “respond” to steroids with an elevated IOP - when will it occur after therapy begins?
1-3 weeks
by how much do you reduce your oral steroid dose each day during tapering?
2-10mg until reaching 15-20mg total
how much hydrocotrisone (cortisol) and cortisone is released by the adrenal gland each day?
25 mg of hydrocortisone
5mg of cortisone
if you take a steroid - what type of pathway is stimulated in the HPA axis?
inhibitory feedback
what is the glucocorticoid mechanism that produces an anti-inflammatory effect?
decrease T and B cells, inhibit macrophages/neutrophil migration, inhibit fibroblasts and PLA2
what is the safest ophthalmic topical steroid?
lotepredonl etabonate
what is the difference between acetate and alcohols in terms of their affinities for lipophilic membranes vs. aqueous environments?
acetate is more lipophilic than alcohols
what is one of the strongest topical steroids?
pred forte (prednisolone acetate)
is it better to increase dosing frequency of pred forte within the first hour of treatment?
yes - 72% reduction of corneal inflammation vs. 11% when given q4h
how do adrenal glands become atrophic?
ACTH suppression (no capacity to generate steroids - seen in chronic steroid use)
what happens when you remove steroids abruptly?
HPA axis responds with outburst of steroids that will be highly excessive relative to normal physiological levels
Lotemax gel contains _____ less BAK than the suspension
70%
