7b- Steroids Concepts Cont.

What is the minimum initial dosing pattern for a topical steroid?

QID

For mild-moderate inflammation, what is common dosage for a topical steroid?

QID x 7 days

For more severe symptoms, what is common dosage for a topical steroid?

pulse dose q1-2 hrs x 1-2 days before QID x5-6days

What is the initial dosage + med of topical steroids for uveitis?

q1h with PredForte

OR

q2h with Durezol

When do you need to taper a topical steroid?

if dose >QID or >10-14 days

When do you start to taper a topical steroid?

when you see improvement at follow up

How do you taper a topical steroid?

reduce dosage by MAX 50% of previous dosage (≤50%)

Example of uveitis treatment plan/taper with topical steroids? (assuming improvement)

Pred Forte:

q1h x 3 days

q2hr x 5d

QID x 5d

BID x 5d

What is the typical topical steroid dosage plan for post-op cataract?

Pred Forte:

TID x 2 weeks

BID x 2 weeks

QD x 2 weeks

What is an example of a dermatological topical steroid?

0.1% triamcinolone cream

What is 0.1% triamcinolone cream used for?

short term treatment of acute dermatitis of periocular adnexa

What is the dosage for 0.1% triamcinolone cream?

TID x 3d the BID x 3d

What is the only indication for oral steroids in Ohio?

allergic inflammation of conj, lids, and adnexa (contact dermatitis, allergic conjunctivitis/blepharitis)

What is the only steroid that can be Rx'd in ohio?

methylprednisolone

What are the side effects of chronic long term oral steroid use?

Cushing

adrenal suppression

osteoporosis

thinning and depigmentation of skin

steroid psychosis

What are the side effect of acute short term oral steroid use?

increase in blood sugar

peptic ulcers

problems with pregnancy

What is Dextenza?

intracanalicular insert that has sustained release of dexamethasone for 30d

What is Dextenza FDA approved for?

inflammation + pain following ocular surgery

allergic conjunctivitis

What is Kenalog (triamcinolone) injection used for?

chalazion

posterior uveitis

(diabetic) macular edema

temporal arteritis

What is Dexycu (9% dexamethasone) injection used for?

cataract post-op inflammation

What is Xipere (triamcinolone) injection FDA approved for?

macular edema associate with uveitis

Where is Xipere (triamcinolone) injected into?

suprachorodial space

What did the SCORE study show?

intravitreal injections work to treat CRVO patients, but do NOT help BRVO patients are result in bad side effects for them

Why do we not use intraocular steroid implants?

too many side effects