5 - Anti-Inflammatory Flashcards
Corticosteroids
-background on natural release of cortisol
During “fight or flight” condns, ACTH is released from anterior pituitary -> acts on adrenal cortex -> secretes cortisol (body’s endogenous glucocorticoid)
Corticosteroids
- MOA
- overall effects
- SE
Inhibits phospholipase A2 (thus stops arachidonic acid pathway)
-note: hydroxy/chloroquine also works here
Anti-inflamm, immunosuppression
- decr inflammatory mediators + decr capillary permeability = significant reduction in immune response
- decr in fibroblast + collagen formation = prevents healing
Risk of secondary infxn (e.g. HSV)
PSC cataract: irreversible, dose-dependent
Glaucoma: incr IOP by decr corneoscleral outflow (interfere with phagocytosis of debris in Schlemm’s, incr [] of glycosoaminoglycans within TM)
Prednisolone 1% Acetate
- type of drug
- about
Potent steroid
Penetrates well, needs to be shaken
Rimexolone
-type of drug
Potent steroid
Difluprednate
- type of drug
- about
Potent steroid
Highest steroid response (“I gave diflupred and the IOP ‘flu’ up”)
Dose half of what you would give of pred acetate
Dexamethasone
- type of drug
- about
Potent steroid
Dex of tobradex
Fluorometholone
-type of drug
Soft steroid
Loteprednol
- type of drug
- about
Soft steroid
Only ester-based = safest/least SE
NSAIDs
- MOA
- clinical uses
- SE
Block Cox 1 + 2 -> decr inflamm by inhibiting conversion of arachadonic acid into PGs and thromboxanes
Post-op cataract (Irvine-Gass)
RCEs, corneal abrasians, allergic conj-itis
Corneal toxicity (melting) Stinging upon instillation
Diclofenac sodium
- type of drug
- use/dosing
- SE
NSAID
QID
Withdrawn from market due to corneal melting
Ketorolac tromethamine
- type of drug
- use/dosing
- SE
NSAID
QID, only NSAID approved for topical tx of seasonal allergic conj-itis
Avoid use if corneal involvement
Nepafenac
- type of drug
- use/dosing
NSAID
BID
Bromfenac
- type of drug
- use/dosing
- SE
NSAID
Xibrom = BID, preserved with BAK + sodium sulfate (sulfa allergy) Bromday = DQ (only topical NSAID)
Flurbiprofen
- type of drug
- use/dosing
- SE
NSAID
Prior to ocular surgery (1 gtt every 30 min, starting 2h before)
Contains thimerosal as a preservative
