Ocular steroid potency chart

Glucocorticoids are potent anti-inflammatories, regardless of the inflammation's cause; their primary anti-inflammatory mechanism is lipocortin-1 (annexin-1) synthesis. Lipocortin-1 both suppresses phospholipase A2 , thereby blocking eicosanoid production, and inhibits various leukocyte inflammatory events ( epithelial adhesion , emigration , chemotaxis , phagocytosis , respiratory burst , etc.). In other words, glucocorticoids not only suppress immune response, but also inhibit the two main products of inflammation, prostaglandins and leukotrienes . They inhibit prostaglandin synthesis at the level of phospholipase A2 as well as at the level of cyclooxygenase /PGE isomerase (COX-1 and COX-2), [29] the latter effect being much like that of NSAIDs , potentiating the anti-inflammatory effect.

An Alternative Treatment

Decreased tear meniscus in dry eye.
As an alternative to steroids—or as an adjunctive therapy—topical cyclosporine can also be used to control inflammation in dry eye disease. While cyclosporine does not demonstrate the rapid anti-inflammatory effect of steroids, it carries fewer risks and is safe for long-term use.
Because of their complementary efficacy and safety profiles, many practitioners often begin dry eye treatment by prescribing both topical steroids and cyclosporine. Following the recommendation of the Asclepius Panel, the use of combination therapy is instituted with the topical corticosteroid, Lotemax (loteprednol etabonate ophthalmic suspension %, Bausch + Lomb) and Restasis (cyclosporine ophthalmic emulsion %, Allergan). 24 The Asclepius Panel recommends practitioners begin early treatment with an anti-inflammatory agent (such as Lotemax) four times a day to improve symptoms and to prevent disease progression. After two weeks, the frequency of the corticosteroid is reduced to twice daily and supplemented with Restasis twice a day. Treatment with loteprednol was stopped after day 60, while cyclosporine treatment is continued.

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone, or methylprednisolone in pediatric patients whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses. It is further recommended that short course, or "burst" therapy, be continued until the patient achieves a peak expiratory flow rate of 80% of his or her personal best or until symptoms resolve. This usually requires 3 to 10 days of treatment, although it can take longer. There is no evidence that tapering the dose after improvement will prevent a relapse.

A study in HUVEC cells (endothelial) with the leaves of Morus Alba at 400mcg/mL (deemed a physiologically relevant dose citing this study [87] ) is able to inhibit the expression of P‐selectin and fractalkine induced by resistin, with similar potency to 20uM Curcumin (both fully abolishing the effects of resistin) thought to be related to attenuating NADPH oxidase activity (abolished with Morus Alba, reduced to 30% of control with Curcumin). [88] Resistin induces P-Selection and fractalkine expression in endothelial cells, which increases monocyte adhesion and may be pro-artherosclerotic [89] and in HUVEC cells Morus Alba was shown to inhibit monocyte binding to a potency correlating greatly with NADPH oxidase activity. [88]

Relatively little published work on the use of ACH during treatment though what is available is not encouraging. Rodent studies showed that combining ACH and antibiotic therapy (using penicillin) in the acute treatment of infection can have negative effects – the ACH seemingly has no effect at all and can even reduce the potency of the antibiotic leading to decreased patient outcomes.
One human case reported was a gravely ill patient with leptospirosis and severe hypoxaemia. There was diffuse alveolar haemorrhage and myositis thus a bolus of corticosteroids was used over the first 24 hours complementary to the traditional treatment. Outcome was good though the paper does not indicate the effect ACH therapy may have had on the antibiotic agents as there was only one patient.
ACH therapy for chronic infection is a difficult area to draw conclusions on. For a patient with a significant leptospiral residency who is still receiving antibiotic therapy the addition of ACH could reduce the existing treatment effectiveness as described above. For patients suffering from post-infection pathologies there is a case for ACH treatment. As an example, some patients can develop parainfectious encephalomyelitis after an infection of leptospira. In one reported case the progressive course of this condition was reversed rapidly with eventual full recovery after corticosteroid therapy. In cases such as this the leptospiral cause of the condition can in effect be forgotten when treating the pathologies.

Ocular steroid potency chart

ocular steroid potency chart

A study in HUVEC cells (endothelial) with the leaves of Morus Alba at 400mcg/mL (deemed a physiologically relevant dose citing this study [87] ) is able to inhibit the expression of P‐selectin and fractalkine induced by resistin, with similar potency to 20uM Curcumin (both fully abolishing the effects of resistin) thought to be related to attenuating NADPH oxidase activity (abolished with Morus Alba, reduced to 30% of control with Curcumin). [88] Resistin induces P-Selection and fractalkine expression in endothelial cells, which increases monocyte adhesion and may be pro-artherosclerotic [89] and in HUVEC cells Morus Alba was shown to inhibit monocyte binding to a potency correlating greatly with NADPH oxidase activity. [88]

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