Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
INFLAMMATION, NSAIDs & STEROIDS
What is Inflammation? |
Response to repair damage by an inflammatory agent (Biological, chemical, physical or allergic)
Reaction us. involves; hyperaemia, oedema, loss of function and pain Body Inflam reaction can continue to cause damage after inflam agent has been removed |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Inflammatory Response Cascade |
Increased Prostaglandins & Leukotrines (mediated by cyclooxygenase; COX)
--> Chemical Release (Histamine) --> Incr blood flow, itch, redness, BV permeability --> Attraction of leukocytes --> Fibroblastic Activity; Wound repair and scar formation |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Cyclosporin What is it? Concentration Use |
S4
Anti-inflammatory immunosupressive; inhibits cytokine production, alters action of helper T-Cells Compounding pharmacy; 0.05% restasis emulsion, burns on instillation Use: Scleritis, graft rejection prevention, sympathetic ophthalmitis Systemic administration; nephrotoxicity, hypertension |
|
|
INFLAMMATION, NSAIDs & STEROIDS
NSAID mechanism |
Interfere with synthesis of prostaglandins and/or leukotrines in arachidonic acid pathway, COX-1 and COX-2 inhibition
Reduce signs and pain associated with inflammation COX-2 Selective have less GI SE's |
|
|
INFLAMMATION, NSAIDs & STEROIDS
NSAID's vs Steroids |
NSAID's; safer
Steroids improve effectivity of NSAIDs |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Oral NSAIDs SE's of Non-Selective and COX-2 Selective Inhibitors |
Non-selective - GI problems; nausea, vomiting, gastric damage, skin reaction, renal insufficiency (nephropathy), liver disorders
COX-2 Selective - Increased rate of vascular events (myocardial infarction, stroke), decreased prostaglandin: excess clot, higher BP |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Ocular NSAIDs Uses |
Control corneal pain and photophobia; corneal abrasions, recurrent erosions, bullous-keratopathy
Post refractive surgery and prophylaxis; cataract surgery, macular oedema, inflammation Mild-Inflammation; episcleritis, allergies (treat itch) |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Ocular NSAIDs Ketorolac (Acular) |
S4
Prostaglandin D2 inhibitor Use: relief of itching in Seasonal Allergic Conjunctivitis, no effect on hyperaemia Contraindications: Aspirin/NSAID sensitivity, peptic ulcers Caution: Pregnant, lactation Adverse: Stinging/burning on instil, may delay wound healing (decr inflame response) Dose: 0.5% 4 x day 2-4 weeks, bottle Questionable efficacy |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Ocular NSAIDs Diclofenac (Voltaren Ophtha) |
S4
COX inhibitor, analgesic properties Use: Corticosteroid sparing agent, episcleritis, post-operative inflammation and pain, allergic conjunctivitis, cystoid macular oedema Contra: Aspirin/NSAID sensitivity, peptic ulcers Caution: pregnancy, lactation Adverse: Delay wound healing Dose: 0.1%, 1 drop, 3-5 times/day, bottle |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Ocular NSAIDs Flurbiprofen (Ocufen) |
S4
Use: corticosteroid sparing agent - post-op inflam, induced miosis, allergic conj., episcleritis Contra: Aspirin/NSAID sensitivity, peptic ulcers Caution: Pregnancy, lactation Adverse: Delay wound healing Dose: 0.03% 1 drop, 3-5 times/day, bottle and minims |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Ocular NSAIDs Adverse Effects |
Delayed epithelial growth and impaired wound healing
Potential for epithelial toxicity Corneal melting (rare) |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Mechanism |
Inhibit Phospholipase A2 --> Prevent release of arachidonic acid --> inhibit prostaglandin production --> inhibit cellular migration --> stabilise MC's, reduce histamine release, decr fibroblast proliferation, reduce vasodilation, prevent oedema, decr scar formation
|
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Natural vs synthetic |
Natural (eg. glucocorticoids, corticosterone, hydrocortisone) fluid (Na) retention
Synthetic; lower fluid (Na) retention |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Early stage vs Late Stage |
Early stage; reduce heat, swelling, pain, redness
Late stage: inhibit wound healing and repair Need to taper for high/long-term dose; continue at low dose after signs/symptoms have disappeared, avoids relapse --> recurrent and serious |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids General Uses |
Treat acute inflammatory episodes
Prevent scarring and neovascularisation eg. VKC, chemical burns, post keratoplasty, HZK, corneal infiltrates, ocular rosacea, anterior and posterior uveitis, sympathetic ophthalmitis, scleritis, episcleritis, retinal vascularitis, optic neuritis, Graves ophthalmology, myasthenia gravis |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Ocular Corticosteroids; Order by strength |
Acetate versions are more effective phosphate forms worst, Higher concentrations aren't more effective
Weakest; FML, Flucon (alcohol form), Flarex (acetate), Maxidex (acetate), prednisolone minims, prednefrine forte Hycor ung used for skin |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Fluoromethalone (FML, Flarex, Flucon) |
Relatively non-penetrating corticosteroid
Flarex is acetate form Contra: Viral and fungal infections, TB Caution: Prolonged use, corneal thinning, pregnancy, children Adverse: Glaucoma, cataract, superinfection, less IOP increase than others Dose: 0.1% suspension (shake), 1-2 drops, 2-4 times/day, increase to 2 drops/hour if necessary, taper |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Dexamethasone (Maxidex) |
Corticosteroid, alcohol derivatives stronger than phosphate
Use: Inflammatory and allergic eye disease Contra: Infection Caution: Prolonged use, corneal thinning, pregnancy, children Adverse: Glaucoma, cataract, superinfection, highest propensity to increase IOP Dose: 0.1%, severe inflam: 1-2 drops/hour, decr as inflam subsides. Mild inflam: 1-2 drops/4-6 hours, punctal occlusion, taper |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Prednisolone (Prednefrin Forte Minims) |
Strong corticosteroid, acetate form - used for AC penetration
Systemic oral form; asthma and COPD Contra: Infection, glaucoma Caution: Pregnancy, lactation, children Adverse: Incr IOP, cataract, corneal thinning Dose: 1% 1-2 drops, 2-4xday, taper, punctal occlusion |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Hydrocortisone (Hycor) |
Largely superseded, topical skin treatment
Use: Inflammatory eye disease (incl HZK) Contra: Infections, TB, fungal, viral Caution: prolonged use, cataract, diabetes, glaucoma, pregnancy, children <2 yrs Mineralocorticoid properties affect electrolyte imbalance - caution with polymedicine Adverse: Incr IOP, delayed healing, cataract Dose: 0.5%, 1% drops and ointment, 2-4 times/day, punctal occlusion, taper |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Ocular SE's |
-Cataract: bilateral, PSCC, diab and children more susceptible, dose and duration specific, irreversible
-IOP elevation; individual variation to susceptibility, duration and dose specific (worst for dexamethasone and betamethasone), IOP is reversible, glaucoma i s not -Superinfection; reduced immune defence mechanisms, more susceptible to infection -Mydriasis -Ptosis -Transient Ocular discomfort -Keratitis -Steroid Uveitis -Corneal and Scleral Thinning -Inhibit Wound healing |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Systemic SE's of Oral Corticosteroids |
-Imbalance in electrolyte levels
-Exacerbate peptic ulcers -Incr appetite, weight gain -Alter fat deposition, moon face -Osteoporosis -Hypertension -Inhibited growth (children) -Muscle weakness or atrophy -Diabetes mellitus -Delay in wound healing -Activation of infection -Mood changes |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Contraindications |
-Glaucoma
-Diabetes -Heart Conditions -Renal Disease -Osteoporosis -Psychosis -Drugs: Anticoagulants, metabolism enhancing drugs -Professional sports people |
|
|
INFLAMMATION, NSAIDs & STEROIDS
Steroids Indications for Ocular Steroids |
Non-infectious corneal infiltrates
Corneal Graft Episcleritis Scleritis Superior Limbic Keratoconjunctivitis Iritis |
