5. Steroids 17.pdf

Anti-Inflammatory Drugs: Steroids PharmII AntiInflammatory Drugs Steroids DIANE T. ADAMCZYK, OD Diane T. Adamczyk, OD Copyright © 2024 1 1 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Diane T. Adamczyk, OD Copyright © 2024 2 2 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Classic...

Anti-Inflammatory Drugs: Steroids PharmII AntiInflammatory Drugs Steroids DIANE T. ADAMCZYK, OD Diane T. Adamczyk, OD Copyright © 2024 1 1 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Diane T. Adamczyk, OD Copyright © 2024 2 2 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Classic symptoms of tissue inflammation ◦ Rubor - redness ◦ Calor - heat ◦ Tumor - swelling ◦ Dolor - pain Diane T. Adamczyk, OD Copyright © 2024 3 This is associated with inflammation When you have an inflammatory response, the area will get puffy and red and sometimes will be warm to the touch and you get swelling associated with it 3 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Inflammations etiology: ◦ Allergic ◦ Traumatic ◦ Infectious Diane T. Adamczyk, OD Copyright © 2024 4 Inflammation connected to a lot of etiologies 4 Anti-Inflammatory Drugs: Steroids PharmII Inflammation Treatment Steroids NSAIDs Immunosuppressants Diane T. Adamczyk, OD Copyright © 2024 5 Treat inflammation with steroids, NSAID, and immunosuppressants - like cyclosporine 5 Anti-Inflammatory Drugs: Steroids PharmII Steroids and Steroid Actions Diane T. Adamczyk, OD Copyright © 2024 6 6 Anti-Inflammatory Drugs: Steroids PharmII Steroids Anti-inflammatory effects: ◦ Nonspecific ◦ Does not correct disorder Diane T. Adamczyk, OD Copyright © 2024 7 Steroids are useful to make everything look and feel better Not great if they don’t go after the underlying etiology If you have an infection that results in an inflammatory response then it will make things look and feel better It is not specific but immune response wont go after a specific response btu it’s the general response the antiinflammatory will go after 7 Anti-Inflammatory Drugs: Steroids PharmII Anti-Inflammatory Agent: Steroid Actions Control inflammatory process and its effects: vImmune effect: ◦ Inhibit cell mediated immune responses ◦ Inhibit neutrophil ◦ Inhibit macrophage ◦ Interfere with lymphocyte Diane T. Adamczyk, OD Copyright © 2024 8 Going after cell mediated responses When all the cells come in and participate in the inflammatory response 8 Anti-Inflammatory Drugs: Steroids PharmII Anti-Inflammatory Agent: Steroid Actions Control inflammatory process and its effects: vInhibit degranulation of mast cells, basophils, neutrophils ◦ Inhibit mediator release ◦ histamine, ◦ bradykinin, ◦ platelet-activating factor Reduction of circulating eosinophils and monocytes Diane T. Adamczyk, OD Copyright © 2024 9 Mast cells are very involved in the allergic response Anti-inflammatory agents inhibits its release Does a lot of things that prevents the release of the mediators Mast cell is not the only mediator released but also bradykinin and histamine 9 Anti-Inflammatory Drugs: Steroids PharmII Anti-Inflammatory Agent: Steroid Actions Attenuation of bactericidal activity of macrophages and monocytes Affect tissue regeneration and repair: ◦ Decrease: ◦ Capillary and fibroblast proliferation ◦ Collagen deposition Above actions can potentially adversely affect infection control and tissue repair Diane T. Adamczyk, OD Copyright © 2024 10 Attenuates bactericidal activity of macrophages and monocytes which is why when you take an anti-inflammatory you are stopping the bodies way to fight an infection so a secondary infection can occur It affects tissue repair and regeneration 10 Anti-Inflammatory Drugs: Steroids PharmII Anti-Inflammatory Agent: Steroid Action Steroids Inhibit phospholipase A synthesis ◦ Arachidonic acid release ◦ Prevent synthesis of: Prostaglandins Thromboxane A Prostacyclin Leukotrienes Diane T. Adamczyk, OD Copyright © 2024 11 Start with phospholipids then enzyme comes in and you get arachidonic acid Then you have the lipoxygenase or cyclooxygenase legs The non-steroidals block the COX leg so no thromboxane, prostaglandin, or prostacyclin Corticosteroids come in earlier so it inhibits phospholipase A and inhibits the COX and LOX legs Corticosteroids come in early and prevent all the byproducts from occurring NSAIDs when compared have less side effects when compared to corticosteroids 11 Anti-Inflammatory Drugs: Steroids PharmII Steroids Protect ocular structures from effect of inflammation ◦ Hyperemia ◦ Cellular infiltration ◦ Vascularization ◦ Scarring ◦ Fibroblastic proliferation Diane T. Adamczyk, OD Copyright © 2024 12 Clinical manifestations of inflammation Cellular infiltration also can occur It can occur from many things like keratitis or infection on the cornea like trauma or acid The high will heal itself and in the process there is vascularization and will cause a decrease in vision There is scarring and fibroblastic proliferation and you can get a symblepharon from occurring It melts the conjunctiva away so there is an attachment b/w the bulbar and palpebral conj (symblepharon) 12 Anti-Inflammatory Drugs: Steroids Diane T. Adamczyk, OD Copyright © 2024 PharmII Inflammatory Effect Clinical Result Examples Steroid Protective Effect from Inflammation Vasodilation Cellular infiltration Hyperemia Cells, corneal infiltrates ↓Vasodilation ↓Capillary permeability ↓ Cellular exudation Immune effect Vascularization Corneal Vascularization Prevent vascularization ↓ Capillary proliferation Scarring Corneal scar Prevent scarring ↓Collagen deposit Fibroblastic proliferation Symblepharon ↓ Fibrosis/fibroblast proliferation 13 13 Anti-Inflammatory Drugs: Steroids PharmII Clinical Use of Steroids Diane T. Adamczyk, OD Copyright © 2024 14 14 Anti-Inflammatory Drugs: Steroids PharmII Clinical Use of Steroids Indications: ◦ Allergic reactions ◦ ◦ ◦ ◦ Vernal Allergic conjunctivitis Atopic keratoconjunctivitis Contact dermatitis ◦ Uveitis ◦ Episcleritis/scleritis ◦ Stromal herpes simplex ◦ Chemical burns ◦ Dry Eye Disease Diane T. Adamczyk, OD Copyright © 2024 15 When there are anterior segment problems You can use steroids for posterior segment and for fluid leakage and things like that 15 Anti-Inflammatory Drugs: Steroids PharmII Clinical Use of Steroids Indications: ◦ Surgery ◦ Aphakic/pseudophakic cystoid macular edema ◦ Graves’ ophthalmopathy ◦ Optic neuritis ◦ Retinal vasculitis Diane T. Adamczyk, OD Copyright © 2024 16 Steroids can be used for macular edema but non-steroidals are the better option b/w the two even though there is controversy using the topical 16 Anti-Inflammatory Drugs: Steroids PharmII Steroids: Drug Delivery and Administration Diane T. Adamczyk, OD Copyright © 2024 17 17