Ocular Pharm- Steroids

Rank the topical steroid formulations from most to least absorbance into the eye?

1. -ates

2. alcohols

3. sodium phosphates (NaPh)

Which drug is considered the DOC for uveitis?

Pred Forte (1.0% prednisolone acetate)

For which ocular condition must we write DAW on the script when prescribing Pred Forte?

Uveitis

Why is Pred Forte considered the gold standard?

has the highest efficacy (great absorption + receptor affinity, slow metabolism)

What ocular problems is Pred Forte commonly used for?

uveitis

keratitis

post-op inflammation

moderate-severe ocular surface inflammation

What is the FDA indication of Pred Forte?

open indication to treat ocular inflammation

What is the generic version of Pred Forte?

1.0% prednisolone acetate

What is the FDA indication for 1.0% prednisolone NaPh?

open indication for ocular inflammation

What is the formulation of Pred Forte (1.0% prednisolone acetate)?

suspension

What is 1.0% prednisolone NaPh commonly used for?

external diseases of the conjunctiva

What is the formulation of 1.0% prednisolone NaPh?

solution

What is the formulation of Durezol (0.05% difluprednate)?

emulsion

What is the formulation of generic 0.05% difluprednate?

suspension

What must you make sure when prescribing Durezol?

the generic is a suspension, so make sure to write DAW or make sure the patient knows to shake before each use if pharmacy switches it to a generic

Compare Durezol and Pred Forte?

equal efficacy and side effects, Durezol dosed half as often

What is Durezol FDA indicated for?

uveitis

post-op inflammation

What is a potential use of Durezol?

treat anterior scleritis

What is the only ester based topical steroid?

loteprednol

Compare loteprednol etabonate to Pred Forte?

near equal efficacy, loteprednol has much lower risk of IOP spike

Name all the brand names of loteprednol etabonate

Lotemax

Alrex

Inveltys

Eysuvius

Name all the formulations of Lotemax

Lotemax suspension

Lotemax gel

Lotemax SM gel

Lotemax ointment

What is the FDA indication for lotemax suspension (0.5% loteprednol etabonate)?

open indication for ocular inflammation

What is the FDA indication for Lotemax gel, Lotemax SM gel, and Lotemax ointment?

post-op ocular surgery

What are all Lotemax products (except the ointment) preserved with?

BAK

What is the dosage and generic name of Lotemax gel?

0.5% loteprednol etabonate

What is the dosage and generic name of Lotemax SM gel?

0.38% loteprednol etabonate

What is the dosage and generic name of Lotemax ointment?

0.5% loteprednol etabonate

What is the dosage and generic name of Alrex?

0.2% loteprednol etabonate

What is the FDA indication of Alrex?

allergic conjunctivitis

What is the dosage and generic name of Inveltys?

1.0% loteprednol etabonate

What is the formulation of Alrex?

suspension

What is the formulation of Inveltys?

suspension

What is the FDA indication for Inveltys?

post-op inflammation

What is the technology used in Inveltys + Eysuvius to increased drug delivery?

AMMPlify: mucus penetrating particles

What is the dosage and generic name of Eysuvius?

0.25% loteprednol etabonate

What is the FDA indication of Eysuvius?

short term treatment of signs and symptoms of dry eye

What is the DOC when needing to use a topical steroid for a long period of time?

loteprednol etabonate

What are the common uses of loteprednol etabonate?

dry eye

inflammatory keratitis

post-op inflammation

GPC

VKC

episcleritis (esp nodular)

allergic conjunctivitis

any inflammatory condition requiring long term therapy

What is the DOC for GPC and VKC?

loteprednol etabonate

What is the dosage and generic name of Maxidex?

0.1 dexamethasone alcohol

What is the formulation of Eysuvius?

suspension

What is the formulation of Maxidex?

suspension

What is the FDA indication for Maxidex?

open indication for ocular inflammation

What topical steroid has the largest IOP spike?

Maxidex

Why do we never use Maxidex as a stand-alone steroid?

low efficacy and high IOP spike

What is the FDA indication for generic 0.1% fluorometholone alcohol?

open indication for ocular inflammation

What are the common uses of 0.1% fluorometholone alcohol?

episcleritis

superficial inflammation

thygeson's keratitis

often preferred drug on insurance formularies

What is the dosage and generic name of FML Forte?

0.25% fluorometholone alcohol

What is the FDA indication for FML Forte?

open indication for ocular inflammation

What is the dosage and generic name of Flarex?

0.1% flurometholone acetate

What is the formulation of Flarex?

suspension

What is the FDA indication for Flarex?

open indication for ocular inflammation

What is the difference in IOP spike between Durezol and Pred Forte?

have the same risk of an IOP spike, but when they do cause a spike, Durezol causes a bigger spike, and usually in younger patients