wk8: AED - Anti-inflammatories [DG] Flashcards
What are the 7 categories of anti-inflammatories in Australia? Provide an example for each category
Astringents - zinc sulphate Anti-histamines - levocabastine MCS - sodium cromoglycate Dual action MCS/AH - olopatadine NSAIDS - diclofenac Corticosteroids - fluoromethalone Calcineurin/T-cell inhibitor - cyclosporine (not available in aus.)
How do astringents work?
break down mucus production, reduce leakiness
How long do MCSs take to start working? Knowing this, what do we clinicians like to do?
2-4 week period. So we like to use dual action MCS/Anti-histamines like patanol or zatadin 2 x day
List the topical multi-use (preserved) eye drops available in Australia (5)
all anti-histamines all MCSs all dual action MCS/AHs all NSAIDS all corticosteroids (except prednisolone phosphate)
List the topical single-use (non-preserved) eye drops available in Australia (5)
most lubricant bases phenylephrine (in albalon relief) ketotifen (zatiden single dose) flurbiprofen (in ocufen) prednisolone phosphate (minims)
List the topical eye ointments available in Australia (2)
lubricants (but as paraffin)
hydrocortisone
How do topical steroid formulations differ? (2)
different potencies
different corneal penetration
What type of inflammation is low potency, low penetration steroids good for? Why?
ok for mild surface inflammation (minimises chances of steroid-induced pressure rise)
When are high potency, high penetrative steroids essential? If they are required, what should you write on the Rx?
for anterior uveitis. If this level of steroid is required, write ACETATE on the Rx
Which has the greater corneal penetrance: alcohol based steroids or acetate based steroids?
acetate based steroids
What is the treatment goal for inflammation?
Rapid control of inflammation to minimize complications (drug and disease)
What is a “loading dose”?
an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.
Is a loading dose always required for steroid use?
Some argue for some argue against it. Though you honestly don’t have to reach therapeutic window as fast as antibiotics (because you don’t have to deal with exponentially dividing bacteria). Darryl Guest - “I don’t think loading dose matters too much for steroids”
Do you use a loading dose for antibiotics? And if so, do you finish the course early or go through the entire course of antibiotics?
Yes. Still go through the whole course
How does steroid potency differ from antibiotic potency?
Different steroids vary in potency. Different antibiotics don’t vary in potency because potency is determined by what you are trying to kill
What are the 3 levels of lists on the OBA website for optometry drugs
- Drugs you are allowed to use
- TGA list - what’s available
- PBS list - what’s subsidised
Name 6-8 anti-inflammatories found in the OBA
Cyclosporin Dexamethasone Diclofenac Fluoromethalone Flurbiprofen Hydrocortisone Ketorolac Prednisolone
For a steroid to have an adequate effect in the anterior chamber, what 2 things will it need?
Needs both potency and penetration
Describe the following drugs for their potency, penetration and capacity to raise IOP (when in ant. chamber):
- Hydrocortisone alcohol
- Hydrocortisone acetate
- Flouromethalone alcohol
Potency Penetr. IOP
Hy.Al v. low - ++
Hy.Ac low ++ ++
Fl. Al. mid - +++
Describe the following drugs for their potency, penetration and capacity to raise IOP (when in ant. chamber):
- prednisolone phosphate
- fluorometholone acetate
- prednisolone acetate
- dexamethasone alcohol
poten. pen. IOP Pr.Ph mid + +++ Fl.Ac high ++ +++ Pr.Ac. high +++ ++++ D.Al high ++ ++++
How do acetates, alcohols and phosphate steroids compare in terms of penetration? Rank them from highest penetrance to lowest
acetate»_space; alcohol > phosphate
What are the 2 main side effects of steroid use? Give an example of a patient where one of these side effects won’t be a concern
increase in IOP
increase risk of steroid cataract
- note: patients who have already had cataract surgery and are wearing IOLs will not have to worry about the cataract side effect
As a general guideline for anti-inflammatory usage:
- What should ocular lubricants be used for? (4)
mild ocular surface irritation (inc. SPK)
dry eye
neurotrophic keratitis
adjunct in severe inflammation
As a general guideline for anti-inflammatory usage:
- What should astringents be used for? (1)
- what is a limitation of astringents? (1)
mucoid discharge in allergic surface disease
but not as readily available as other options
As a general guideline for anti-inflammatory usage:
- What should anti-histamines be used for? (1)
- What should MCSs be used for? (1)
- What should dual action MCS/AH be used for?(1)
All 3 of these are used for allergic eye disease (type 1 hypersensitivity)
As a general guideline for anti-inflammatory usage:
- What should NSAIDs be used for? (5)
mild/moderate allergic eye disease
other surface inflammation (e.g. epicleritis)
intra-operative inhibition of miosis
post-operative inflammation/analgesia
“my main use is cystic oedema associated with cataract surgery” - Darryl Guest
As a general guideline for anti-inflammatory usage:
- What should corticosteroids be used for? (4)
all types of moderate-severe ocular surface inflammation
HSV and HZO keratitis (NOT epithelial)
anterior uveitis
endophthalmitis (intravitreal)
