Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
110 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What % of American adults report using at least one prescription drug?
|
9 out of 10
|
|
|
|
Name 2 drugs containing Digoxin and what 3 conditions they are mainly used for
|
Lanoxin and Digitoxin - cardiac glycosides
* Supraventricular dysrhythmias * Atrial fibrillation * Congestive hear failure |
|
|
|
What % of patients taking Digoxin develop ocular complications?
|
95%
|
|
|
|
What are the 5 major complications of Digoxin Toxicity?
|
1. blurry vision
2. central scotomas (flickering or flashing lights, colored spots) 3. photophobia 4. altered color perception 5. optic neuritis (rare) Which complication is most common? |
Color vision disturbance
|
|
|
What is the mechanism of Digoxin Toxicity?
|
Levels exceed 2.0 ng/mL
Inhibition of the enzyme: Na+/K+ ATPase What does this affect in the eye? |
Photoreceptors, glial Muller cells, RPE
|
|
|
Why is the Na+/K+ ATPase enzyme important?
|
It plays a vital role in maintaining cone receptor fxn
|
|
|
|
What naturally occuring plants can also cause digoxin toxicity?
|
Foxglove Digitalis, Oleander, Lily of the Valley
Which two are used as herbal supplements? |
Oleander and Lily of the Valley
|
|
|
What must you examine closely in patients taking Amiodarone? Why?
|
The cornea
Patients can develop Corneal verticillata (Vortex keratopathy) What are the characteristics of Vortex keratopathy? |
Bilateral fine, golden brown or gray opacities
- whorl like pattern - subepithelium - glare, halos, foggy vision |
|
|
How long does it take for Amiodarone keratopathy to occur?
|
Can happen as early as 6 days
More commonly w/i 1-3 months |
|
|
|
What type of drug is Amiodarone?
|
antiarrhythmic agent
|
|
|
|
What are the char. of Amiodarone Keratopathy?
|
K+ channel blocker
Almost ALL pts develop keratopathy Resolves on cessation of therapy |
|
|
|
What are 2 other toxic effects of Amiodarone?
|
Ant. subcapsular cataracts and optic neuropathy
What is the mech. of action for cataract formation? |
Amiodarone acts as a photosensitizer --> lipid storage in the cornea and lens
|
|
|
What 6 things other than Amiodarone can cause Vortex Keratopathy?
|
Indomethacin
Meperidine Tamoxifen (breast cancer) Chloroquine/Hydroxychloroquine Phenothiazines Fabry dz |
|
|
|
What is Fabry Dz?
|
Lysosomal Storage Disorder --> is it acquired or genetic?
|
Genetic
|
|
|
What are the char. of a pt. who is a carrier of the trait for Fabry Dz?
|
They can still exhibit vortex keratopathy w/o having the neurological symptoms of the dz
|
|
|
|
Accupril
|
Headache
|
|
|
|
Altace
|
Anemic Retinopathy
|
|
|
|
Cardura
|
Color Vision
|
|
|
|
Cozaar
|
Eyelid swelling, cataracts
|
|
|
|
Hytrin
|
Blurred vision
|
|
|
|
Norvasc
|
Diplopia/Photophobia
|
|
|
|
Zestril
|
Diplopia/Photophobia
|
|
|
|
What are 4 major complications of systemic medications?
|
1. blurred vision
2. reduced acuity 3. color vision changes 4. visual field defects |
|
|
|
What are the major ocular S/E of Ritalin?
|
accommodative dysfxns and blurry vision
cataracts and glaucoma |
|
|
|
What types of pts is Ritalin contraindicated for? Why?
|
Glaucoma pts
Is a sympathomimetic --> can cause an acute angle closure or worsen chronic angle closure |
|
|
|
Name 2 anticonvulsants and their ocular side effects
|
Phenytoin (Dilantin) and Carbamazepine (Tegretol)
* Nystagmus, ataxia, and diplopia |
|
|
|
What is the biggest ocular complication of oral contraceptives?
|
Dry eye
|
|
|
|
What are other ocular complications of oral contraceptives?
|
Migraine headaches
Pseudotumor cerebri Retinal vascular occlusion |
|
|
|
What other types of drugs can cause dry eyes?
|
Antihistamines
Beta-blockers Antipsychotics Psychogenic meds |
|
|
|
Antihistamines: mech. of action and ocular side effects
|
H-1 blockers --> reduce mucous and tear secretion
Weak cholinergic antagonists --> mydriasis, anisocoria, decreased accommodation, blurred vision Angle closure glaucoma What other drug can cause angle closure glaucoma? |
Ritalin
|
|
|
Ocular side effects of beta blockers
|
reduce tear lysozyme levels (dry eye)
decrease IOP |
|
|
|
Antipsychotics: Mech. of action and ocular S/E
|
cholinergic antagonists
downbeat nystagmus Name 2 antipsychotics |
Lithium and Diazepam (Valium)
|
|
|
What is the most common drug rxed for depression in the US?
|
Prozac (fluoxetine hydrochloride)
Ocular S/E? |
blurred vision, dilated pupils, keratitis sicca, diplopia and ptosis
|
|
|
Ocular S/E of Zoloft (sertraline, Pfizer)
|
reduced accomm., diplopia and increased dry eyes
|
|
|
|
What is Xanax used for?
|
anxiety disorder
|
|
|
|
What is Gold (Ridaura) used for?
|
Rheumatoid Arthritis
What are the ocular S/E? |
dust like glittering granules on the cornea and conjunctival deposits --> does not affect vision
|
|
|
How long do the S/E of Gold (Ridaura) take to resolve?
|
3-6 mos when med discontinued
|
|
|
|
What is Flomax (tamsulosin) used for and what is the major ocular S/E?
|
Benign prostatic hyperplasia
IFIS (Intraoperative Floppy Iris Syndrome) = progressive miosis w/floppy iris during cataract extraction |
|
|
|
What are the most common ocular problems with Flomax?
|
iris trauma (hyphema), posterior capsule rupture, prolonged healing time assoc. w/complicated cataract extraction (IFIS)
What must you do for pts on Flomax needing cataract sx? |
D/c meds before sx
|
|
|
What other drugs besides Flomax can cause IFIS?
|
Hytrin and Cardura
|
|
|
|
What type of drug is Lupron (leuprolide) and what are the ocular S/E?
|
Prostate medication --> indicated for palliative txment of advanced prostate cancer and endometriosis
Temporary blurred vision for 1hr - 3 weeks after administration Pseudotumor cerebri What other systemic meds can cause pseudotumor cerebri? |
Amiodarone, oral contraceptives and certain antibiotics
|
|
|
What 4 major ocular S/E are the following antibiotics often assoc. with? :
Tetracycline hydrochloride (Achromycin) Doxycycline (Vibramycin) Minocycline hydrochoride (Minocin) |
1. Pseudotumor cerebri (Idiopathic Intracranial HTN = ICP)
2. Diplopia 3. Color vision defects 4. Photosensitivity |
|
|
|
What other medications can lead to ICP?
|
Isotretinoin
Trimethoprim-sulfamethoxazole Cimetidine Corticosteroids Tamoxifen Lithium Nitrofurantoin Levothyroxine |
|
|
|
What cat. of drugs do these fall under and what are the ocular S/E?
Amoxicillin trihydrate (Amoxil, Polymox, Trimox) Ceflacor (Ceclor) |
Antibiotics
Allergic rxn of eyelids or conj., photosensitivity, ptosis, diplopia, skin infxn |
|
|
|
What condition is characterized by a severe ocular rxn to antibiotics?
|
Steven Johnson Syndrome
|
|
|
|
What is Accutane and what are the ocular S/E?
|
a.k.a Isotretinoin
Form of Vit. A severe acne, psoriasis Dry eyes, papilledema, optic neuritis have been reported |
|
|
|
Lens opacities from cataracts are initially what type?
|
Post. subcapsular --> later ant. subcapsular region becomes affected
children or adults are more susceptible? |
children
|
|
|
What drugs besides steroids can cause cataracts?
|
Chlorpromazine --> causes deposition of fine, stellate, yellow-brown deposits on ant. lens capsule (usually not visually significant)
Allopurinol = used to tx gout |
|
|
|
What is the mech. by which Allopurinol leads to cataract formation?
|
Increases risk of cataract formation if cumulative dose exceeds 400g or duration exceeds 3 years
What types of cataracts can form? |
Cortical and subcapsular
|
|
|
Name 6 drugs/types of drugs that cause uveitis
|
Rifabutin
Cidofovir Beta-blockers Corticosteroids Pamidronic acid Sulfonamides |
|
|
|
What is Rifabutin (Mycobutin) used for and what are the ocular S/E?
|
Used to tx TB
MAC complex -- HIV infxn Unilateral acute uveitis * Hypopyon * vitritis What is the txment? |
Resolves when d/c meds
|
|
|
What is Cidofovir (Vistide) used for and what are the ocular S/E?
|
Used for CMV retinitis
Acute ant. uveitis and vitritis How is it txed? |
W/topical steroids and mydriatics
|
|
|
What types of meds are Chloroquine and Hydroxycholoroquine? (what are the other names for these 2 drugs?)
|
Antimalarial meds
Anti-inflammatory (Dz modifying anti-rheumatic drugs = DMARD) Chloroquine = Aralen Hydroxychloroquine = Plaquenil |
|
|
|
What autoimmune dzes are HCQ and CQ used for?
|
Systemic Lupus Erythematosus
Discoid Lupus Rheumatoid Arthritis Sjogren's Syndrome |
|
|
|
Which is less toxic/safer: Plauqenil (HCQ) or Aralen (CQ)? Why?
|
Plaquenil is safer
Plaquenil --> 200 mg tablets Aralen --> 250 mg tablets |
|
|
|
What are the ocular toxicities/S/Es of HCQ/CQ?
|
* melanotropic agents --> selective affinity for melanin esp. in RPE and Uveal tissue
** inhibition of critical enzymes/interference w/metabolic fxns of RPE and photoreceptors Ant. Seg = corneal verticillata (vortex keratopathy) Bull's Eye maculopathy |
|
|
|
** What are the 4 symptoms of Maculopathy?
|
1. Central visual loss
2. Reading difficulties 3. Reduced color vision 4. Central scotoma |
|
|
|
What is the goal of Plaquenil screening?
|
To detect toxicity before point of irreversible damage
|
|
|
|
What are the char. of low risk for Plaquenil toxicity?
|
Dosage = <6.5 mg/kg or <400 mg HCQ; <3 mg/kg or <250 mg CQ
Duration = <5 years Physique = lean or avg. weight Age = <60 yrs Renal/liver dz = none Concomitant retinal dz = none |
|
|
|
What are the char. of high risk for Plaquenil toxicity?
|
Dosage = >6.5 mg/kg or >400 mg HCQ; 3 mg/kg or >250 mg CQ
Duration = >5 yrs Physique = Obese and short - BMI > 25 Age = >60 yrs Renal/liver dz = present Concomitant retinal dz = present |
|
|
|
Which factor is more critical in ascertainig risk of plaquenil toxicity: daily or cumulative dosage?
|
Cumulative dosage
>1000g HCQ or 460g CQ HCQ = 400 mg/day (7 yrs) CQ = 250/day (5 yrs) |
|
|
|
When taking obesity and BMI into consideration for plaquenil toxicity, what should the dosage be based on?
|
The height of the pt.
Men = 50 kg + 2.3 kg/in. over 5 ft. Women = 45.5 kg + 2.3 kg/in over 5 ft. |
|
|
|
What were the 7 OLD screening procedures for Plaquenil toxicity?
|
1. Color vision (sensitivity & specificity)
2. Amsler grid (highly subjective) 3. Fundus photos 4. 10-2 VF 5. ERG 6. Time-Domain OCT 7. Fluorescein Angiography |
|
|
|
What are the 6 NEW screening procedures for Plaquenil toxicity?
|
1. Baseline exam --> DFE
2. Central VF (white 10-2) 3. Fundus photos 4. Spectral domain OCT 5. Fundus Autofluorescence 6. Multifocal ERG (mfERG) |
|
|
|
What type of VF is used in plaquenil screening and what is it useful for?
|
White 10-2
Useful for identifying fxnal vision loss |
|
|
|
Loss or presence of FAF is useful for assessment of RPE damage in various retinal disorders?
|
Loss of FAF
|
|
|
|
What is indicated by "reduced" autofluorescence? "increased" autofluorescence?
|
Reduced AF = subtle RPE defects
Increased AF = areas of early PR damage (accumulation of OS debris) |
|
|
|
What is Spectral Domain OCT used for?
|
Detects outer layer retinal abnormalites such as: perifoveal thinning, loss of inner/outer segment line and ovoid appearance of macular
|
|
|
|
Recent studies suggest that _______________ may be the most effective way of screening early HCQ toxicity (central 40 deg)
|
multifocal ERG
|
|
|
|
What are the signs of CQ and HCQ early toxicity?
|
localized paracentral ERG depression
|
|
|
|
What is the management for pts with Plaquenil toxicity?
|
Probable or clear toxicity
Co-manage w/PCP/rheumatologist to STOP immediately Goal is to minimize progression of vision loss if stopping is not possible (medication critical to manage underlying dz) --> close monitoring every 3 mo's to assess progression * MUST document that pt accepts risk of permanent vision loss |
|
|
|
What type of drug is Tamoxifen and what is it used for?
|
Selective Estrogen Receptor Modulator (SERM) w/both anti-estrogen and pro-estrogen activity
Imp. role in txment of early and advanced breast cancer --> reduces incidence of breast cancer up to _______% |
50%
|
|
|
What is seen in Tamoxifen Maculopathy?
|
White crystalline macular deposits in NFL and IPL of retina
|
|
|
|
What are the clinical char. of Tamoxifen Maculopathy?
|
* Occurs in 6% of pts w/i 6 mo's of low dose therapy (20mg)
* reversible early, not reversible later * white crystalline macular deposits * Decreased VA from foveal cyst formation * other ocular complication = PSC |
|
|
|
What is Niacin used for and what are the ocular complications?
|
Hypercholesterolemia --> lowers triglycerides and LDLs
Cystoid Macular Edema (CME) --> seen on OCT --> Absence of typical petaloid leakage on FA What is the txment? |
Resolves when med is stopped
|
|
|
What other meds cause CME?
|
Gilenya, Lipitor/Statins
|
|
|
|
What is Gilenya (fingolimod) and what is it used for? What is the major ocular side affect?
|
An immunosuppressant used for relapsing Multiple Sclerosis in adults
CME |
|
|
|
What are Lipitor/Statins and what conditions are they used for? Ocular complications?
|
Synthetic lipid-lowering agent used for Hypercholesterolemia, Atheroslcerosis, Stroke, heart attack and renal failure
Blurred vision and CME |
|
|
|
What is the most commonly Rxed cholesterol med?
|
Lipitor
|
|
|
|
What 2 other complications are Statins often assoc. with?
|
Type 2 diabetes and cataracts
|
|
|
|
What are Interferons and what conditions are they used to tx?
|
Anti-inflammatory, anti-tumor, anti-viral and immunomodulatory
MS, hepatitis, and other viral dzes What types of interferons are more frequently used? |
Pegulated interferon
- long acting form of interferon alpha - slower absorption |
|
|
What are the ocular side effects of Interferons?
|
Interferon Retinopathy:
* CWS near ONH * Hemorrhaging - retinal and subconj. * Macular edema - CME * Ischemic Optic Neuropathy What is the management? |
Retinopathy may be dose dependent
Common in pts with diabetes, HTN, and other vascular dz Retinopathy resolves SPONTANEOUSLY after cessation of txment |
|
|
What type of drug is Canthaxanthine, what is it used for and what are the ocular complications?
|
* Carotenoid
* OTC oral artificial tanning agent * Golden yellow crystalline deposits What is the txment? |
None --> maculopathy reverses once drug is stopped
|
|
|
What is another drug that can cuase crystalline maculopathy besides Canthaxanthine?
|
Nitrofurantoin
|
|
|
|
What type of drug is Nitrofurantoin and what are the ocular S/E?
|
Antibiotic used to tx UTI
Long term use can lead to crystalline deposition in superficial and deep retinal layers throughout the post. pole |
|
|
|
What is a major ocular side effect of Phenothiazines?
|
Retinopathy
|
|
|
|
Name 2 Phenothiazines and what they are used for? What is the mech. for ocular complications?
|
Thioridazine and Chlorpromazine
Used to tx schizophrenia Doses exceeding 800mg/day for a few weeks is sufficient to reduce vision and impair dark adaptation |
|
|
|
What are the 3 clinical signs of progressive retinotoxicity in patients taking Phenothiazines?
|
1. Salt and pepper pigmentary changes of the mid-periphery and post. pole
2. Pigment clumping and focal loss of the RPE 3. Diffuse loss of the RPE and choriocapillaris |
|
|
|
What types of drugs are Viagra, Levitra and Cialis? What is the mech. of action?
|
Erectile Dysfxn drugs
Phosphodiesterase 5 inhibitors Impact PDE 6 in the retina |
|
|
|
What is a major ocular complication of erectile dysfxn drugs?
|
Non-Arteritic Ischemic Optic Neuropathy (NAION) w/i 24-36 hours
"disc at risk" |
|
|
|
What are 4 Vascular risk factors for NAION assoc. with erectile dysfxn drugs?
|
1. Myocardical infarction = 10x risk of developing NAION
2. HTN = 7x risk 3. Hypercholesterolemia 4. Diabetes What is the mech. of action? |
An increase in nitrous oxide levels causing a decrease in blood pressure. The decrease in BP leads to hypoperfusion of an already at risk optic nerve
|
|
|
What are 2 other ocular S/E of erectile dysfxn drugs?
|
Changes in color perception common
Increased light sensitivity/photopsia Ocular side effects are or are not dose dependent? |
ARE dose dependent:
* Those taking 200mg of Viagra have a 50% chance of ocular side effects * Normal dose of 50 mg = less than 5% chance |
|
|
Dot-like precipitates and subretinal yellow material were seen in 65% of cases with _____________________ that also showed high reflectivity in pts on high doses of erectile dysfxn drugs
|
Idiopathic Central Serous Retinopathy
|
|
|
|
Increased risk of CSC assoc. with : Name 5 things
|
1. Phosphodiesterase-5 inhibitors
2. Pseudoepinephrine 3. Steroids 4. Cold meds 5. Diet pills |
|
|
|
What are the 2 proposed mechanisms by which ED drugs cause ocular complications?
|
1. PDE6 inhibition of polarization of photoreceptors
2. PDE5 inhibition increasing blood flow What are the potential side effects of each? |
1. Impaired color discrimination
Blue tinge Blurry vision 2. NAION CSC |
|
|
What are 3 other drugs that can cause optic neuropathy besides Viagra?
|
Ethambutol
Amiodarone Vigabatrin |
|
|
|
What is Ethambutol used for and what is the mech. of ocular complications?
|
* Used in combo w/isoniazid and rifampin in txment of TB
* Toxicity usually occurs b/ween 3-6 mos of starting txment * VF defects consist of central or centrocecal scotomas What is the prognosis upon cessation of meds? |
Usually good upon cessation, but a minority of pts develop permanent visual impairment
|
|
|
What % of pts on Amiodarone are affected by optic neuropathy?
|
1-2%
What is the prognosis? |
Prognosis is guarded b/c cessation of the drug may not restore vision
|
|
|
What type of drug is Vigabatrin and what are its ocular complications?
|
Anti-epileptic
Causes nonprogressive bilateral binasal VF defects Defects persist once txment is stopped but do not progress w/txment |
|
|
|
What is the mech. by which steroids can cause glaucoma?
|
Steroid induced IOP elevation typically occurs w/i a few weks of beginning steroid therapy
What are 3 drugs that do this? |
Inhalers
Nasalide flunisolide Vancenase beclomethasone |
|
|
What type of drug is Topamax (Topiramate), what is it used for and what ocular S/E does it have?
|
Anti-epileptic often used to tx migraines
Can cause "uveal effusion syndrome" with swelling of CB leading to pupillary block and angle closure glaucoma * Myopic shift can also be seen |
|
|
|
What types of drugs can cause Subconj. Hemes?
|
Gingko Biloba
Aspirin therapy Anticoagulation therapy |
|
|
|
Name 4 Aspirin type drugs that can cause Subconj. hemorrhaging
|
1. NSAIDS
2. Advil - ibuprofen 3. Indocin - indomethacin 4. Orudis - ketoprofen 5. Aleve - naproxen |
|
|
|
Name 3 drugs used for Anticoagulation therapy that can cause Subconj. hemes
|
1. Coumadin (Warfarin)
2. Heparin 3. Panwarfin Name 2 platelet inhibitors |
Plavix
Ticlid |
|
|
What can occur spontaneously in any pt on anticoagulant txment?
|
Spontaneous hyphema
|
|
|
|
Name 5 Herbal Supplements that have ocular complications
|
1. Nicotinic Acid
2. Canthaxanthine 3. Chamomille 4. Liquorice 5. Vit. A What are the ocular complications of each? |
1. Nicotinic acid = CME, Dry eyes, SPK
2. Canthaxanthine = crystalline retinopathy 3. Chamomille = allergic conjunctivitis 4. Liquorice = Visual loss assoc. w/migraine-like symptoms 5. Vit. A = Intracranial HTN |
|
|
Beta-carotene is a provitamin for what Vitamin?
|
Vitamin A
|
|
|
|
What is the assoc. b/ween beta carotene and smokers?
|
Beta carotene increases risk of lung cancer and Vitamin A toxicity
|
|
|
|
What are Lutein and Zeaxanthin used for?
|
Prevent free radical damage in the retina --> more effective than beta-carotene
|
|
|
|
What is the mech. of action of Lutein and Zeaxanthin?
|
Filters blue light
Selectively binds to tubulin: improves structure integrity and maintains eye health and quality of vision |
|
