Corticosteroids

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  1. Dexamethasone conc
    0.1%
  2. prednisolone acetate conc
    1% and 0.12% phenylephrine
  3. prednisolone minim conc
    0.5%
  4. fluorometholone acetate conc
    0.1%
  5. fluorometholone conc
    0.1%
  6. hydrocortisone conc
    1% - ointment
  7. corticosteroid contraindication
    • active ocular infection
    • especially HSK or fungal keratitis
  8. corticosteroid precautions
    • h/p HSK
    • glaucoma, OHTN, narrow angles, h/o steroid response
  9. corticosteroids and children
    increased susceptibility to raised IOP + cataract
  10. corticosteroids and pregnancy/breastfeeding
    safe
  11. Types of corticosteroid base
    • acetate: lipid soluble, enhanced corneal penetration
    • salts: e.g. sodium phosphate. hydrophilic, limited penetration
  12. corticosteroid common >1% adverse effects
    • OHTN
    • retarded corneal healing
    • rebound inflammation
    • PSC
  13. OHTN as a side effect of corticosteroids is dependent on:
    • dosage
    • potency
    • penetration
    • treatment
  14. PSC as a side effect of corticosteroid occurs with
    • long-term use >1yr
    • high dose
  15. mechanism underlying PSC as a side effect of corticosteroids
    • not fully understood
    • glucocorticoids enter lens fibre cells --> reacts with lens crystallins --> alters  protein conformations and bonds
  16. corticosteroid MOA
    upregulates lipocortins --> inhibits lipophosphase A2 --> inhibits inflammatory cascade, fibrocyte + keratocyte activity in stroma
  17. Prostaglandins are associated with what signs of inflammation
    • pain
    • fever
    • vasodilation
  18. Leukotrienes are associated with what signs of inflammation
    • increased vascular permeability
    • chemotaxis
    • WBC recruitment
  19. corticosteroid adverse effect infrequent 0.1-1%
    opportunistic infection
  20. Why do some steroids cause more IOP rise?
    • not fully understood
    • possible factors:
    • penetration
    • shorter half life
    • susceptibility to metabolism (fluorometholone + hydrocrtisone metaolised > prednisolone + dexamethasone)
    • site of administration
  21. MOA for IOP rise with corticosteroids
    • steroid inhibits beta receptor --> alpha overactivitiy --> ECM overproduction
    • inhibits ECM degradation mechanism
    • accumulation of ECM + debris 
    • actin cross-linking --> stronger blockage
    • inhibits TM cell phagocytosis

Card Set Information

Author:
ijesc
ID:
335875
Filename:
Corticosteroids
Updated:
2017-11-10 07:32:07
Tags:
thera
Folders:
thera
Description:
thera finals
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