Steroids

Question 1

what is the most commonly prescribed oral steroid?

Answer 1

Prednisone

Question 2

steroids classically have ____ rings and ______ carbons

Answer 2

4 and 17

Question 3

which vitamin is also a steroid?

Answer 3

vitamin D

Question 4

ACTH and cortisol levels peak at what time of day?

Answer 4

morning (8am)

Question 5

what has a negative feedback mechanism on the hypothalamus and pituitary?

Answer 5

glucocorticoids

Question 6

what has a positive effect on the hypothalamus and pituitary?

Answer 6

epinephrine and norepinephrine

Question 7

The hypothalamus releases ______ which causes the pituitary to release _________

Answer 7

corticotropin releasing hormone

ACTH

Question 8

what is the mechanism of reduced healing caused by steroids?

Answer 8

glucocorticoids reduce fibroblast proliferation = reduces tissue regeneration and repair

Question 9

at what level of the eye might you first choose a non-topical steroid?

Answer 9

anywhere from anterior uveitis and back

Question 10

Cushing’s syndrome is caused by excess of what hormone?

Answer 10

ACTH

Question 11

What is the only ester-based topical steroid?

Answer 11

loteprednol etabonate

Question 12

how do steroids treat neovascularization?

Answer 12

they down-regulate VEGF synthesis

Question 13

long term oral prednisolone causes what ocular side effects in patients?

Answer 13

PSC

Question 14

if a patient is going to “respond” to steroids with an elevated IOP - when will it occur after therapy begins?

Answer 14

1-3 weeks

Question 15

by how much do you reduce your oral steroid dose each day during tapering?

Answer 15

2-10mg until reaching 15-20mg total

Question 16

how much hydrocotrisone (cortisol) and cortisone is released by the adrenal gland each day?

Answer 16

25 mg of hydrocortisone

5mg of cortisone

Question 17

if you take a steroid - what type of pathway is stimulated in the HPA axis?

Answer 17

inhibitory feedback

Question 18

what is the glucocorticoid mechanism that produces an anti-inflammatory effect?

Answer 18

decrease T and B cells, inhibit macrophages/neutrophil migration, inhibit fibroblasts and PLA2

Question 19

what is the safest ophthalmic topical steroid?

Answer 19

lotepredonl etabonate

Question 20

what is the difference between acetate and alcohols in terms of their affinities for lipophilic membranes vs. aqueous environments?

Answer 20

acetate is more lipophilic than alcohols

Question 21

what is one of the strongest topical steroids?

Answer 21

pred forte (prednisolone acetate)

Question 22

is it better to increase dosing frequency of pred forte within the first hour of treatment?

Answer 22

yes - 72% reduction of corneal inflammation vs. 11% when given q4h

Question 23

how do adrenal glands become atrophic?

Answer 23

ACTH suppression (no capacity to generate steroids - seen in chronic steroid use)

Question 24

what happens when you remove steroids abruptly?

Answer 24

HPA axis responds with outburst of steroids that will be highly excessive relative to normal physiological levels

Question 25

Lotemax gel contains _____ less BAK than the suspension

Answer 25

70%