Steroids

Question 1

Steroids have a _____ 4 ring, 17 carbon cholesterol backbone. They bind to ____ receptors. Insulin is a water soluble hormone and bind to ____ receptors

Answer 1

lipophilic; intracellular; extracellular

Question 2

what are the 3 major steroids produced in the cortex

Answer 2

1. mineralocorticoids; electrolyte balance
2. glucocorticoids; regulate homeostasis
3. sex hormones

Question 3

In the medulla there is _____ epinephrine and ____& norepinenphrine

Answer 3

80%; 20%

Question 4

What are the endogenous steroids

Answer 4

1. glucorticoids
2. mineralocorticoids
3. androgens; male sexual ch’s
4. progestins; preganancy hormones
5. estrogens: female sexual ch’s & preg hormones

Question 5

What is the steroid pathway

Answer 5

1. binding of steroid hormone to its receptor
2. translocation of steroid receptor complex to nucleus
3. binding of complex to DNA regulatory site
4. Transcription
5. Translation

Question 6

The HPA axis plays a key role in:

Answer 6

ANS activity, stress, mood, immunity and healing.

Question 7

What does the hypothalamus release? What does the anterior pituitary release?

Answer 7

corticotropin releasing hormone (CRH); adrenocortiotropic hormone (ACTH)

Question 8

What does adrenal gland release that has negative feedback on hypothalamus and pituitary

Answer 8

glucocorticoid

Question 9

Fight and flight response begins with release of:

Answer 9

ACTH

Question 10

Whats the effect of cortisol on the hypothalamus?

Answer 10

Inhibitory and causes reduction in the release of CRH

Question 11

When is diurnal cortisol levels the highest? When is it the lowest?

Answer 11

Highest: around 8 am
Lowest: middle of night (midnight)d

Question 12

what are the most potent steroids?

Answer 12

1. dexamethasone

2. betamethasone

Question 13

what is the most commonly prescribed ORAL steroid used in eyecare

Answer 13

prednisone

Question 14

Steroids help in:

Answer 14

1. radiation toxicity
2. mechanical trauma
3. chemical toxicity
4. infection
5. pronounced or exaggerated immune response

Question 15

Unlike NSAIDs, steroids act ____ through lipoprotein which leads to transcription and translation

Answer 15

indirectly

Question 16

PGI2 and TXA2 are physiologic_____

Answer 16

antagonists

Question 17

In regards to anti inflammation, Glucorticoids ____ T and B cells which inhibits macrophages and neutrophil migration. They also decrease fibrosblasts and phospholipase A2

Answer 17

decrease

Question 18

Glucocorticoids regulate CV system by _____ capillary permeability which increases HR and BP

Answer 18

decreases

Question 19

What does chronic oral streroid use result in

Answer 19

adrenal cortical atrophy (adrenal crisis) via ACTH supprssion

Question 20

We use steroid tapering bc:

Answer 20

discontinuing streoids abruptly can result in an exaggerated response by the HPA axis to restore lost steroid levels. Higher doses require longer tapering

Question 21

what are the different steroid preparations

Answer 21

1. oral
2. inhalation
3. local injection
4. IV
5. topical

Question 22

what are oral steroid indications

Answer 22

1. scleritis
2. temporal arteritis
3. endophtalmitis
4. ocular myasthenia gravis
5. graves opthalmosopathy
6. iodpathic incracranial hypertension (IIH)
7. Stevens johnson syndrome
8. posterior seg disease: vitiris, retinitis, chroiditis, papillitis

Question 23

Cortisol has a ____: ____ effect in terms of glucocorticoids and mineralocorticoids

Answer 23

1;1

Question 24

What are some general adverse effects of steroids

Answer 24

1. blurred vision
2. hair pattern changes
3. diabetic complications
4. peptic ulceration
5. HYPERTENSION
6. Delayed wound healing
7. adrenal insufficiency
8. growth inhibition
9. immunosuppression
10. cushing’s syndrome

Question 25

What are drug interactions with steroids

Answer 25

1. Enhanced steroid metabolism: - Barbiturates - Phenylbutazone - Phenytoin 2. Reduced anticoagulant effects: steroids may promote coagulation by reducing prostacyclin levels.

Question 26

what are steroid contraindications

Answer 26

1. active viral infection 2. tuberculosis positive 3. fungal infection 4. immunosuppresed 5. peptic ulcer history 6. osteporosis 7. psychosis 8. pregnancy

Question 27

____ based steroids have much less potential to cause cataracts/elevated IOP since ketone base steroids are not broken down by anterior chamber esterases

Answer 27

ester

Question 28

which is the only topical ester asked steroid used in eye care that is maximum strength

Answer 28

lotemax/loteprednol etabonate | -suspension, gel or PF ointment

Question 29

what is the only PF topical ophthalmic steroid in the US

Answer 29

Pred Forte/prenisolone acetate

Question 30

which is the only topical ester based steroid use in eyecare that is moderate strength

Answer 30

Alrex/Lotreprednol etabonate | suspension only

Question 31

what are topical steroid indications

Answer 31

1. corneal transplant, neovascularization, keratitis 2. bacterial infection/herpes zoster 3. immediate hypersensitivity rxn 4. conjunctivitis 5. chalazion 6. contact dermatitis and chemical burns 7. seasonal allergic conj 8. mooren's ulcer

Question 32

What are ocular adverse effects of topical steroids

Answer 32

1. transient ptosis 2. secondary infection 3. epithelial keratopathy/keratitis 4. mydriasis 5. uveitis 6. elevated IOP 7. PSC 8. corneal/sceleral thinning 9. retinal ischemia 10. retinal detachment 11. epiretinal membrane 12. optic nerve atrophy

Question 33

You get a ____% reduction when you give Pred Forte 1/min x 5 min/hr

Answer 33

72

Question 34

what are topical contraindications

Answer 34

1. steroid allergy 2. fungal infection 3. ACTIVE herpes simplex 4. recent cataract surgery 5. Ocular TB lesions 6. perforating corneal diathesis 7. acute purulent ocular bacterial infections.

Question 35

when should you precaution with topical steroids

Answer 35

1. diabetes 2. infectious disease 3. congestive heart failure 4. renal disease 5. hypertension 6. corneal abrasion 7. glaucoma 8. pseudophakic

Question 36

Cyclosprine-A is the first ___ to come o the market (restates)

Answer 36

immunosuppresant; targets only non activated T cells and inhibits mast cell degranulation. Phagocytic function is unaffected!

Question 37

What are adverse reactions of restates

Answer 37

1. burnging 2. redness 3. tearing 4. discharge 5. foreign body sensation 6. pruruitus 7. blur

Question 38

when is restates contraindicated

Answer 38

1. actuve ocular infection | 2. known hypersensitivity