Steroids Flashcards
Steroids have a _____ 4 ring, 17 carbon cholesterol backbone. They bind to ____ receptors. Insulin is a water soluble hormone and bind to ____ receptors
lipophilic; intracellular; extracellular
what are the 3 major steroids produced in the cortex
- mineralocorticoids; electrolyte balance
- glucocorticoids; regulate homeostasis
- sex hormones
In the medulla there is _____ epinephrine and ____& norepinenphrine
80%; 20%
What are the endogenous steroids
- glucorticoids
- mineralocorticoids
- androgens; male sexual ch’s
- progestins; preganancy hormones
- estrogens: female sexual ch’s & preg hormones
What is the steroid pathway
- binding of steroid hormone to its receptor
- translocation of steroid receptor complex to nucleus
- binding of complex to DNA regulatory site
- Transcription
- Translation
The HPA axis plays a key role in:
ANS activity, stress, mood, immunity and healing.
What does the hypothalamus release? What does the anterior pituitary release?
corticotropin releasing hormone (CRH); adrenocortiotropic hormone (ACTH)
What does adrenal gland release that has negative feedback on hypothalamus and pituitary
glucocorticoid
Fight and flight response begins with release of:
ACTH
Whats the effect of cortisol on the hypothalamus?
Inhibitory and causes reduction in the release of CRH
When is diurnal cortisol levels the highest? When is it the lowest?
Highest: around 8 am
Lowest: middle of night (midnight)d
what are the most potent steroids?
- dexamethasone
2. betamethasone
what is the most commonly prescribed ORAL steroid used in eyecare
prednisone
Steroids help in:
- radiation toxicity
- mechanical trauma
- chemical toxicity
- infection
- pronounced or exaggerated immune response
Unlike NSAIDs, steroids act ____ through lipoprotein which leads to transcription and translation
indirectly
PGI2 and TXA2 are physiologic_____
antagonists
In regards to anti inflammation, Glucorticoids ____ T and B cells which inhibits macrophages and neutrophil migration. They also decrease fibrosblasts and phospholipase A2
decrease
Glucocorticoids regulate CV system by _____ capillary permeability which increases HR and BP
decreases
What does chronic oral streroid use result in
adrenal cortical atrophy (adrenal crisis) via ACTH supprssion
We use steroid tapering bc:
discontinuing streoids abruptly can result in an exaggerated response by the HPA axis to restore lost steroid levels. Higher doses require longer tapering
what are the different steroid preparations
- oral
- inhalation
- local injection
- IV
- topical
what are oral steroid indications
- scleritis
- temporal arteritis
- endophtalmitis
- ocular myasthenia gravis
- graves opthalmosopathy
- iodpathic incracranial hypertension (IIH)
- Stevens johnson syndrome
- posterior seg disease: vitiris, retinitis, chroiditis, papillitis
Cortisol has a ____: ____ effect in terms of glucocorticoids and mineralocorticoids
1;1
What are some general adverse effects of steroids
- blurred vision
- hair pattern changes
- diabetic complications
- peptic ulceration
- HYPERTENSION
- Delayed wound healing
- adrenal insufficiency
- growth inhibition
- immunosuppression
- cushing’s syndrome
What are drug interactions with steroids
- Enhanced steroid metabolism:
- Barbiturates
- Phenylbutazone
- Phenytoin - Reduced anticoagulant effects: steroids may promote coagulation by reducing prostacyclin levels.
what are steroid contraindications
- active viral infection
- tuberculosis positive
- fungal infection
- immunosuppresed
- peptic ulcer history
- osteporosis
- psychosis
- pregnancy
____ based steroids have much less potential to cause cataracts/elevated IOP since ketone base steroids are not broken down by anterior chamber esterases
ester
which is the only topical ester asked steroid used in eye care that is maximum strength
lotemax/loteprednol etabonate
-suspension, gel or PF ointment
what is the only PF topical ophthalmic steroid in the US
Pred Forte/prenisolone acetate
which is the only topical ester based steroid use in eyecare that is moderate strength
Alrex/Lotreprednol etabonate
suspension only
what are topical steroid indications
- corneal transplant, neovascularization, keratitis
- bacterial infection/herpes zoster
- immediate hypersensitivity rxn
- conjunctivitis
- chalazion
- contact dermatitis and chemical burns
- seasonal allergic conj
- mooren’s ulcer
What are ocular adverse effects of topical steroids
- transient ptosis
- secondary infection
- epithelial keratopathy/keratitis
- mydriasis
- uveitis
- elevated IOP
- PSC
- corneal/sceleral thinning
- retinal ischemia
- retinal detachment
- epiretinal membrane
- optic nerve atrophy
You get a ____% reduction when you give Pred Forte 1/min x 5 min/hr
72
what are topical contraindications
- steroid allergy
- fungal infection
- ACTIVE herpes simplex
- recent cataract surgery
- Ocular TB lesions
- perforating corneal diathesis
- acute purulent ocular bacterial infections.
when should you precaution with topical steroids
- diabetes
- infectious disease
- congestive heart failure
- renal disease
- hypertension
- corneal abrasion
- glaucoma
- pseudophakic
Cyclosprine-A is the first ___ to come o the market (restates)
immunosuppresant; targets only non activated T cells and inhibits mast cell degranulation. Phagocytic function is unaffected!
What are adverse reactions of restates
- burnging
- redness
- tearing
- discharge
- foreign body sensation
- pruruitus
- blur
when is restates contraindicated
- actuve ocular infection
2. known hypersensitivity
