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Ocular Pharm > Steroids > Flashcards

Steroids Flashcards

1
Q

Steroids have a _____ 4 ring, 17 carbon cholesterol backbone. They bind to ____ receptors. Insulin is a water soluble hormone and bind to ____ receptors

A

lipophilic; intracellular; extracellular

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2
Q

what are the 3 major steroids produced in the cortex

A
  1. mineralocorticoids; electrolyte balance
  2. glucocorticoids; regulate homeostasis
  3. sex hormones
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3
Q

In the medulla there is _____ epinephrine and ____& norepinenphrine

A

80%; 20%

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4
Q

What are the endogenous steroids

A
  1. glucorticoids
  2. mineralocorticoids
  3. androgens; male sexual ch’s
  4. progestins; preganancy hormones
  5. estrogens: female sexual ch’s & preg hormones
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5
Q

What is the steroid pathway

A
  1. binding of steroid hormone to its receptor
  2. translocation of steroid receptor complex to nucleus
  3. binding of complex to DNA regulatory site
  4. Transcription
  5. Translation
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6
Q

The HPA axis plays a key role in:

A

ANS activity, stress, mood, immunity and healing.

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7
Q

What does the hypothalamus release? What does the anterior pituitary release?

A

corticotropin releasing hormone (CRH); adrenocortiotropic hormone (ACTH)

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8
Q

What does adrenal gland release that has negative feedback on hypothalamus and pituitary

A

glucocorticoid

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9
Q

Fight and flight response begins with release of:

A

ACTH

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10
Q

Whats the effect of cortisol on the hypothalamus?

A

Inhibitory and causes reduction in the release of CRH

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11
Q

When is diurnal cortisol levels the highest? When is it the lowest?

A

Highest: around 8 am
Lowest: middle of night (midnight)d

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12
Q

what are the most potent steroids?

A
  1. dexamethasone

2. betamethasone

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13
Q

what is the most commonly prescribed ORAL steroid used in eyecare

A

prednisone

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14
Q

Steroids help in:

A
  1. radiation toxicity
  2. mechanical trauma
  3. chemical toxicity
  4. infection
  5. pronounced or exaggerated immune response
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15
Q

Unlike NSAIDs, steroids act ____ through lipoprotein which leads to transcription and translation

A

indirectly

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16
Q

PGI2 and TXA2 are physiologic_____

A

antagonists

17
Q

In regards to anti inflammation, Glucorticoids ____ T and B cells which inhibits macrophages and neutrophil migration. They also decrease fibrosblasts and phospholipase A2

A

decrease

18
Q

Glucocorticoids regulate CV system by _____ capillary permeability which increases HR and BP

A

decreases

19
Q

What does chronic oral streroid use result in

A

adrenal cortical atrophy (adrenal crisis) via ACTH supprssion

20
Q

We use steroid tapering bc:

A

discontinuing streoids abruptly can result in an exaggerated response by the HPA axis to restore lost steroid levels. Higher doses require longer tapering

21
Q

what are the different steroid preparations

A
  1. oral
  2. inhalation
  3. local injection
  4. IV
  5. topical
22
Q

what are oral steroid indications

A
  1. scleritis
  2. temporal arteritis
  3. endophtalmitis
  4. ocular myasthenia gravis
  5. graves opthalmosopathy
  6. iodpathic incracranial hypertension (IIH)
  7. Stevens johnson syndrome
  8. posterior seg disease: vitiris, retinitis, chroiditis, papillitis
23
Q

Cortisol has a ____: ____ effect in terms of glucocorticoids and mineralocorticoids

A

1;1

24
Q

What are some general adverse effects of steroids

A
  1. blurred vision
  2. hair pattern changes
  3. diabetic complications
  4. peptic ulceration
  5. HYPERTENSION
  6. Delayed wound healing
  7. adrenal insufficiency
  8. growth inhibition
  9. immunosuppression
  10. cushing’s syndrome
25
Q

What are drug interactions with steroids

A
  1. Enhanced steroid metabolism:
    - Barbiturates
    - Phenylbutazone
    - Phenytoin
  2. Reduced anticoagulant effects: steroids may promote coagulation by reducing prostacyclin levels.
26
Q

what are steroid contraindications

A
  1. active viral infection
  2. tuberculosis positive
  3. fungal infection
  4. immunosuppresed
  5. peptic ulcer history
  6. osteporosis
  7. psychosis
  8. pregnancy
27
Q

____ based steroids have much less potential to cause cataracts/elevated IOP since ketone base steroids are not broken down by anterior chamber esterases

A

ester

28
Q

which is the only topical ester asked steroid used in eye care that is maximum strength

A

lotemax/loteprednol etabonate

-suspension, gel or PF ointment

29
Q

what is the only PF topical ophthalmic steroid in the US

A

Pred Forte/prenisolone acetate

30
Q

which is the only topical ester based steroid use in eyecare that is moderate strength

A

Alrex/Lotreprednol etabonate

suspension only

31
Q

what are topical steroid indications

A
  1. corneal transplant, neovascularization, keratitis
  2. bacterial infection/herpes zoster
  3. immediate hypersensitivity rxn
  4. conjunctivitis
  5. chalazion
  6. contact dermatitis and chemical burns
  7. seasonal allergic conj
  8. mooren’s ulcer
32
Q

What are ocular adverse effects of topical steroids

A
  1. transient ptosis
  2. secondary infection
  3. epithelial keratopathy/keratitis
  4. mydriasis
  5. uveitis
  6. elevated IOP
  7. PSC
  8. corneal/sceleral thinning
  9. retinal ischemia
  10. retinal detachment
  11. epiretinal membrane
  12. optic nerve atrophy
33
Q

You get a ____% reduction when you give Pred Forte 1/min x 5 min/hr

A

72

34
Q

what are topical contraindications

A
  1. steroid allergy
  2. fungal infection
  3. ACTIVE herpes simplex
  4. recent cataract surgery
  5. Ocular TB lesions
  6. perforating corneal diathesis
  7. acute purulent ocular bacterial infections.
35
Q

when should you precaution with topical steroids

A
  1. diabetes
  2. infectious disease
  3. congestive heart failure
  4. renal disease
  5. hypertension
  6. corneal abrasion
  7. glaucoma
  8. pseudophakic
36
Q

Cyclosprine-A is the first ___ to come o the market (restates)

A

immunosuppresant; targets only non activated T cells and inhibits mast cell degranulation. Phagocytic function is unaffected!

37
Q

What are adverse reactions of restates

A
  1. burnging
  2. redness
  3. tearing
  4. discharge
  5. foreign body sensation
  6. pruruitus
  7. blur
38
Q

when is restates contraindicated

A
  1. actuve ocular infection

2. known hypersensitivity

Ocular Pharm (12 decks)

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