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33 Cards in this Set
- Front
- Back
- 3rd side (hint)
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what is the only ester-based steroid?
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loteprednol
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acetates and alcohol steroidal formulations refer to what form of substance?
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ung or susp
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phosphate steroidal formulations refer to what form of substance?
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soln
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with a _______ epithelium, it is harder for solns (phosphates) to cross the cornea, easier for ung/susp (alcohols/acetates)
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intact
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with a _______ epithelium, it is easier for solns (phosphates) to cross the cornea, harder for ung/susp (alcohols/acetates)
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compromised
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the MOA of glucocorticoids:
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decrease/inhibit PLA2 activity
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this decreases the whole of the arachidonic acid pathway (decreases immune-response mediators such as prostaglandins, leukotrienes, thromboxanes, prostacyclins)
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a few of the SE of systemic steroid Tx are:
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susceptibility to infection, posterior subcapsular cataract, increase in IOP, hyperglycemia, muscle wasting, peptic ulcers, osteoporosis, psychosis
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as opposed to an abrupt cessation of antibiotic use, steroids are best truncated via ________
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tapering of Tx/dosage
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steroids are indicated for use in virtually all corneal and conjunctival infections/inflammations excluding:
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HSV (active virus), and any other ACTIVE viral etiology
glaucoma/closed angle Pts |
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steroids are indicated in these un-thought-of instances:
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pseudotumor, Grave's ophthalmopathy, ocular myasthenia gravis
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susp or soln
potent Gold Standard of ocular steroid (slide 3, trade names) |
prednisolone
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acetate: Pred Forte/Pred Mild, Omnipred
phosphate: Inflamase/Inflamase Mild, AK-Pred |
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alcohol or phosphate
potent greatest propensity to increase IOP (slide 3, trade names) |
dexamethasone
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alcohol: maxidex
phosphate: decadron, AK-Dex |
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What is the main difference between a generic steroid and brand name steroid?
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particle size and continuity in susp
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alcohol or acetate
relatively weak compared to dex and pred acetate trade name: Florex phosphate trade name (side 3) |
fluorometholone (FML)
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phosphate: FML forte, FML S.O.P.
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Tx of uveitis, post-op inflammation
weak compared to Pred/Dex/FML Trade name (side 3) |
rimexolone
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Vexol
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analog of prednisolone
soft drug ester-based (trade names on side 3) |
loteprednol etabonate
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Lotemax (0.5%)
Alrex (0.2%) |
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newest topical
emulsion (don't have to shake) FDA approved for management of pain and inflammation after intraocular surgery half the dosing freq of Pred Forte (trade name side 3) |
difluprednate
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Durezol
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very weak
less significant rise in IOP compared to the big 3 (dex, pred, FML) synthetic derivate of progesterone (side 3 trade name) |
medrysone
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HMS
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particle size in formulations is important because:
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it allows for better efficacy and better bioavailability)
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Big 3's potential to increase IOP (rank them)
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dex>pred>FML
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ocular SE of steroids
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increase IOP
posterior subcapsular cataracts infection (decreased immunological response) corneal problems (corneal melting, keratitis) |
PSC - P, D>FML>Medrysolone, Rimexolone
IOP - Dex>Pred>FML>Rim, Diflu, Medry |
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this steroid Tx is similar to Z-pack
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Medrol-dose pack (methylprednisolone pack), dosed for easy compliance by Pt
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when an increase in IOP occurs with steroid use, the % of normals that experience it is:
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Normals 5%
glaucomatous eyes: 95% |
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reasons behind an increase in IOP with steroid use:
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obstruction of aqueous outflow
increase in ECM by TM cells inhibition of proteases and TM endothelial phagocytosis |
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type of steroid used for intravitreal injection
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triamcinolone acetonide
(side 3) |
intravitreal triamcinolone acetonide - IVTA
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trade name for intravitreal implants of fluocinolone acetonide
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Retisert
lasts for 30 months monitor for inevitable increase in IOP |
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2 types of steroids most likely used for injections
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methylprednisolone
triamcinolone |
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contraindications for steroid therapy
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DM
infectious Dz chronic renal failure heart failure HTN |
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what should be monitored closely with systemic Tx of infections with steroids?
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systemic HTN, glaucoma, subcapsular cataracts, blood glucose (long term)
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________ have decreased effectivity with steroid Tx
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anticoagulants
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combination steroid/Ab or steroid/NSAIDs--why use?
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CL acute red eye
phlyctenule peripheral sterile corneal infiltrate (marginal ulcer) |
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Tobradex has what 2 drugs in it?
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dexamethasone and tobramycin
(side 3, what does Tobradex-ST stand for?) |
-ST for the decreased percentage of dexamethasone
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Zylet has what 2 drugs in it?
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loteprednol + tobramycin
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