Lecture 5 Steroids 87.pdf

Anti-Inflammatory Drugs: Steroids Pharm II Dextenza (dexamethasone ophthalmic insert) 0.4 mg DEXTENZA (dexamethasone ophthalmic insert): ◦ Adverse Reactions: ◦ ADR non ocular (both surgery and allergic conjunctivitis): Headache 1% ◦ Following Ophthalmic Surgery: ◦ Anterior chamber inflammation (10%)...

Anti-Inflammatory Drugs: Steroids Pharm II Dextenza (dexamethasone ophthalmic insert) 0.4 mg DEXTENZA (dexamethasone ophthalmic insert): ◦ Adverse Reactions: ◦ ADR non ocular (both surgery and allergic conjunctivitis): Headache 1% ◦ Following Ophthalmic Surgery: ◦ Anterior chamber inflammation (10%); ◦ IOP increase (6%), ◦ VA reduced (2%); ◦ CME (1%); corneal edema (1%); ◦ Associated with Allergic conjunctivitis: ◦ Increased IOP (3%), ◦ increased lacrimation (1%), discharge (1%), VA reduced (1%) Diane T. Adamczyk, OD Copyright © 2024 80 80 Anti-Inflammatory Drugs: Steroids Pharm II Dexamethasone Insert Treatment: Post Cataract Surgery and Allergy Treatment Inflammation and Pain Post Cataract Surgery: Treatment Allergic Conjunctivitis: Patients experienced rapid, early onset of pain and inflammation relief lasting through 45 day With favorable safety profile Potential for relief of ocular itching for up to 4 weeks Significant improvement noted as early as Day 2 (flare and pain) and Day 4 (cells) Only 1 (0.2%) IOP increase J Cataract Refract Surg 2019; 45:204–212 Diane T. Adamczyk, OD Copyright © 2024 Am J Ophthalmol 2021;229: 288– 300. 81 -2 studies that look at the dexamethasone insert ; one is looking at the treatment of allergic conjunctivitis and one is looking at its use after cataract surgery -remember that the plug lasts 30 days but pt feels extended relief of 45 days post cataract surgery 81 Anti-Inflammatory Drugs: Steroids Pharm II Steroid: Dexamethasone (Ozurdex) Dexamethasone intravitreal implant (Ozurdex) ◦ Solid polymer sustained release ◦ Dissolvable ◦ For inflammation and macular edema (diabetic or VO) ◦ Duration of the effect is 1-3 months Diane T. Adamczyk, OD Copyright © 2024 82 -this form of dexamethasone is an implant à used for macular edema/inflammation associated to diabetes or vein occlusion -remember that steroids are going to help with decrease in neovascularization and linkage from BV so by injecting this implant you’re getting closer to the area in the macula 82 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Fluorometholone Structurally related to progesterone Ketone based Alcohol, acetate Relatively low potential for elevating IOP ◦ ^ 0.1% to 0.25% does enhance tendency to ^IOP Diane T. Adamczyk, OD Copyright © 2024 83 -FML à abbreviation -not related to cortisol like the other steroids but related to progesterone -doesn’t get into the eye and stays on the ocular surface so it’s a good drop for DE pt esp if they have inflammation bc IOP doesn’t really rise 83 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Fluorometholone Anti-inflam: ◦ Acetate > alcohol ◦ Fluorometholone alcohol < dexamethasone alcohol and prednisolone acetate ◦ ^ Alcohol derivative (FML) from 0.1% to 0.25% ◦ does not significantly ^ anti-inflammatory activity; ◦ IOP ? Diane T. Adamczyk, OD Copyright © 2024 84 -not as strong of an anti-inflammatory compared to dexamethasone and prednisolone 84 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Anti-Inflammatory Efficacy Anti-InflamEfficacy (%) Steroid Epithelium: Intact Pred acetate 1% Pred phosphate 1% Fluorometholone acetate 0.1% Fluorometholone alcohol 0.25% Fluorometholone alcohol 0.1% Dexamethasone acetate 0.1% Dexamethasone alcohol 0.1% Dexamethasone phosphate 0.1% Absent 51 53 28 47 48 35 31 37 55 60 40 42 19 22 Diane T. Adamczyk, OD Copyright © 2024 85 -acetate has better effect compared to the alcohol 85 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Fluorometholone Fluorometholone alcohol ◦ Suspension 0.1%, 0.25% ◦ 0.1%: FML ◦ 0.25%: FML Forte Fluorometholone acetate ◦ Suspension 0.1% ◦ Flarex Diane T. Adamczyk, OD Copyright © 2024 86 -both come in as suspensions so you have to shake it 86 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Medrysone Synthetic derivative of progesterone Weakest ophthalmic steroid Limited corneal penetration Ketone based Low affinity for glucocorticoid receptor Use: ◦ Superficial ocular inflammations (eg. allergic conjunctivitis) ◦ Poor response intraocular inflammation -No longer available US: Medrysone Alcohol 1.0% (suspension) Diane T. Adamczyk, OD Copyright © 2024 87 -included for completion bc no longer available in the US 87 Anti-Inflammatory Drugs: Steroids Pharm II Steroids: Loteprednol Analog of prednisolone ◦ Transformed to inactive metabolite in anterior chamber ◦ Site specific/Soft drug à get to receptor site and does the job but doesn’t cause rise in IOP ◦ Ketone group at position 20 is absent ◦ Esther-based à possibly the reason why there is a low chance of increase in IOP Approximate (or