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65 Cards in this Set
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SIDE EFFECTS
From Topical Ocular Therapy Anticholinergic Agents (Mydriatics) |
Dry mouth, flush, CNS Toxicity, Angle Closure
Use less potent drug as DPA Advise: Photophobia, ACG, accommodative effects Manage; Discontinue drug, watch until symptoms subside, manage IOP increase |
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SIDE EFFECTS
From Topical Ocular Therapy Cholinergic Agents (Miotics) |
Headache, browache, nausea, vomiting, bronchospasm, hypotension, muscle weakness, GI disturbance
Manage; discontinue, if life threatening; IV atropine |
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SIDE EFFECTS
From Topical Ocular Therapy Adrenergic Agonists (Phenylephrine) |
Acute hypertension, paleness, faint, headache, trembling, perspiration
Manage; lower BP, avoid those at risk of SE (diabetic, cardiac disease, v old, v young) Use lower dose when required |
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SIDE EFFECTS
From Topical Ocular Therapy Anti-Infective Agents |
Chloramphenicol; bone marrow suppression, avoid if family history of hematopoietic failure
Sulfonamides; allergic disorders, renal and liver failure, blood dyscrasias Aminoglycosides; nephrotoxicity, ototoxicity, limit systemic absorption |
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SIDE EFFECTS
From Topical Ocular Therapy Anti-Allergy Agents |
Decongestants; rebound hyperaemia, see alpha agonists
Manage; cease use, lubricants Avoid; Narrow angles Anti-histamines; possible drowsiness, some have anti-cholinergic effects, avoid driving and alcohol |
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SIDE EFFECTS
From Topical Ocular Therapy Anti-Inflammatory Agents |
NSAIDs; decr wound healing, allergies, GI effects, monitor cornea, avoid if past reaction to NSAIDs or peptic ulcer
Steroids; glaucoma, cataract, infection, monitor cornea, IOP, lens, taper, instigate IOP Tx, avoid viral and fungal keratitis |
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SIDE EFFECTS
From Topical Ocular Therapy Glaucoma Agents |
B-Blockers; CNS, cardiovascular, pulmonary, GI, masks hypoglycaemia symptoms
Manage; discontinue drug, cardiac arrhythmia, or respiratory symptoms Avoid; asthmatics, COPD, congestive heart failure, diabetes Prostaglandins; Inflammation, increase lash and iris pigmentation Avoid uveitic glaucoma and monocular use |
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SIDE EFFECTS
Predisposing factors to Systemic reaction |
Prior topical LA use; thin corneal epithelium
Conjunctival break/haemorrhage; increased systemic absorption Hyperaemic conjunctiva; incr systemic absorption High BP, heart disease, thyroid problems Multiple applications; systemic or topical |
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SIDE EFFECTS
Reduce Risk of Systemic Reaction |
Wipe excess solution/ointment from lids/lashes
Use lowest concentration and least frequent dose Advise patient on techniques to reduce systemic absorption; punctal occlusion, closed eyes, head down, concurrent vasoconstrictor |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Why Eye is predisposed? |
Rich blood supply for small volume
Many tissue types; avascular (diff to remove toxins), binding (melanin), transmitters, autonomic control mechanisms |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Significance of Ocular SE's |
Initial changes are subtle, but can be reversed
Progression can cause irreversible damage Eye may exhibit first sign of general drug toxicity |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Probability of Ocular Response |
Condition (chronic vs acute)
Patient (age, history, etc) Drug (dose, mechanism, administration route) |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Top 10 Problem Drugs |
Amiodarone
Prednisolone B-Blockers Amitriptyline Benzodiazepines Carbanazepine Tamoxifen Conjugated Oestrogens Thiazide Diuretics Indomethacin |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Chloroquine |
Use: Malaraia (tx and prophylaxis), gouty and rheumatoid arthritis, SLE
Toxic dose: 250mg+/day Hydrochloroquine - safer alternative Ocular Effects; Glare, haloes, photophobia, corneal deposits, diffuse punctate/epithelial verticillata, bulls-eye pigmented maculopathy (irreversible), melanin binding (excrete slowly) |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Corneal Verticillata/Vortex-Keratopathy |
Phenothiazines (Chlorpromazine), chloroquine/hydroxychloroquine, indomethacin, amiodarone, tamoxifen, Fabry's disease
{More from Diseases notes} |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Prednisone |
Corticosteroid for inflam and autoimmune diseases
Ocular Effects; PSCC, incr IOP (-> glaucoma), Posterior Open Angle Glaucoma (POAG) -> incr resistance to outflow and incr aqueous production |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Amiodarone: Aratac |
Similar to thyroxine; reversible thyroid abnormality (hypo/hyper)
Use: Cardiac arrhythmia (last resort med) Ocular effects: Glare, haloes, photophobia (rare), Vortex-K, anterior lens opacities, dry eye, optic neuropathy, purple skin, blurred vision |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Tamoxifen: Tamoxen |
Non-steroidal anti-oestrogen, used to reduce incidence of breast cancer
Toxic Dose: 180+mg/day Ocular Effects; White/yellow refractile particles, crystalline retinopathy due to axonal degenerations, denser at macula (irreversible), macula oedema (rare), corneal verticillata, optic neuritis |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Isoretinoin; Roaccutane |
Severe cystic acne
Ocular Effects: Blepharoconjunctivitis, corneal opacities, dry eye, lens opacities, impaired dark adaptation, glare sensitive, abnormal ERG Most are reversible |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Vigbatrin: Sabril |
Epilepsy drug
Ocular Effects: VF loss, colour vision deficits, loss of VA, GABA accumulates in retina |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Talc |
Filler in IV drugs (cocaine, heroin)
Ocular effects: embolises in retinal circulation, builds up in chronic use, Nerve Fibre Layer defects, macular ischaemia, post. pole - tiny yellow/white glistening particles |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Chlorpromazine |
Phenothizine derivative, dopamine antagonist for schizophrenia and psychiatric disorders
Ocular Effects: anterior stellate lens opacities, endothelial brown corneal deposit (reversible), conjunctival, scleral and skin discolouration, oculogyric crises; eyes deviated and fixed |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Thioridazine |
Phenothiazine derivative, schizophrenia
Ocular Effects: Transient blurred vision (anticholinergic effect; pupil and accommodation), pigment binding, retinal pigmentary disruption with high doses |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Biphosphonates (Fosamax) |
Prevent osteoporosis, reduce loss of bone mass, risk of fracture, cancer
Ocular effects: Ocular inflammation (non-specific conjunctivitis, episcleritis, uveitis, scleritis), Reversible |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Dry Eye |
Diuretics, B-blockers, anti-cholinergics, psychotropics, anti-histamines, oral acne medications, oral contraceptives
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Corneal Deposits |
Amiodarone, Chloroquine/hydroxychloroquine, isoretinoin, indomethacin
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Lens Changes |
Corticosteroids, Chlorpromazine, Amiodarone
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Mydriasis |
Antimuscarinics, CNS stimulants, CNS depressants, Phenothiazines, anti-histamines
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Cycloplegia |
Antimuscarinics, antihistamines, phenothiazines, axiolytics, tricyclic antidepressants, chloroquine derivatives
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Miosis |
Opiates, anticholinesterases
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Myopia |
Sulfonamides, CAI's, diuretics, aspirin
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy IOP |
Increased by corticosteroids
Decreased by B-blockers, alcohol, cardiac glycosides Acute Closed Angle Glaucoma; anti-muscarinics, antihistamines, phenothiazines, tricyclic antidepressants |
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Retinal Changes |
Chloroquine/hydroxychloroquine, thioridazine, quinine (vascular attenuation, fields), vigabatrin: sabril, cardiac glycosides, isoretinoin, tamoxifen
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Optic Nerve |
Ethambutol, Chloramphenicol, tetracyclines, oral contraceptives, corticosteroids, amiodarone
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SIDE EFFECTS
Ocular Side Effects from Systemic Therapy Effects on EOM |
Nystagmus; salicylates, phenytoin, antihistamines, lithium
Diplopia; phenothiazines, anti-anxiety, anti-depressants Impaired Versions; alcohol |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Pregnancy Categories |
A: Taken by preg women, appear safe
B1: Taken by limited preg women, appear safe, animals - no evidence of harm B2: Taken by limited preg women, appear safe, animals - inadequate info B3: Taken by limited preg women, appear safe, animals - increase foetal damage, uncertain significance C: Drugs have caused harm or suspected harm to foetus without malformations D: Drugs have or suspected to have caused increased human foetal malformations or irreversible damage X: Drugs are such high risk, should not be used in pregnancy or if there is a possibility of pregnancy |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Pregnancy Prescribing for Lactating Women |
Feed 1st, Drug 2nd
Drug may suppress lactation, toxic effects to infant, inhibit suckling reflex |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these Ocular Drugs? Aminoglycosides, chloramphenicol, tetracyclines, atropine, corticosteroids (dexamethasone, FML, hydrocortisone, prednisolone), LA's, fluorescein and rose bengal |
A - safe for pregnancy and lactation
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these Ocular Drugs? Quinolones, aciclovir, alpha-agonists (apraclonidine), prostaglandins, CAI, brinzolamide, dorzolamide, antihistamines (AH), levocabastine, AH + MCS (ketotifen, olopatadine) |
B3 - no data, avoid use
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these Ocular Drugs? Brimonidine, MCS, lomide |
B1
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these Ocular Drugs? Beta-Blockers, cholinergics (pilocarpine), NSAIDs (diclofenac, keterolac) |
C - foetal bradycardia
Neonatal hypothermia, restlessness, seizures, diaphoresis Short term, low dose NSAIDs okay |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category is this Ocular Drug? Cyclopentolate |
B2 - safe to use
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Paracetemol, codeine, cephalosporins, erythromycin, penicillins, ethambutol, nystatin, sympathomimetics, thyroxine, antacids, corticosteroids, older sedating AH's |
A
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Cephalosporins, penicillins, azithromycin, H2 antagonists, newer less sedating AH's |
B1
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Cephalosporins, penicillins, newer less sedating AH's |
B2
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Quinolones, amphotericin, aciclovir, PPI's, tamoxifen, botox |
B3
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Aspirin, opioid analgesics, loop and thiazide diuretics, B-blockers, Ca-channel blockers, vasodilators, HMG-CoA reductase inhibitors, sulphonylureas, NSAIDs, Tricyclic Antidepressants, benzodiazepines |
C
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category are these systemic Drugs? Aminoglycosides, tetracyclines, streptomycin, ACE inhibitors, barbituates |
D
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What category is this systemic Drug? Retinoids |
X
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Aminoglycosides and Chloramphenicol |
Safe; prefer tobramycin to gentamycin
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Cholinergics |
Infrequent; iris cysts or nodular excrescences with prolonged use, rarely affect vision
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Beta-Blockers |
not safe, apnoea in neonates, bradycardia in children
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Corticosteroids |
Increased risk of hypertension and cataracts
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Anticholinergics |
Extreme caution; spastic paralysis or brain damage, one drop 0.5% atropine - systemic effects
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Children Risk of Phenylephrine |
Incr risk systemic adverse effects (hypertension, intraventricular bleeding), DO NOT USE 10%
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Risks with Elderly |
Polypharmacy, non-compliance and increased SE's
Altered pharmaco-kinetics & -dynamics; decr renal function, incr sensitivity, target receptor and organ response changes. Prescribe lowest dose (systemic) Prescribe smallest number and simplest dose regimen (topical) |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Issues with Compliance |
Poor/complex instructions
Ocular irritation Multiple doses and polypharmacy Systemic SE's Lack of symptoms (glauc) or relief (MCS) Compliance decreases with tx duration |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
What is the "Usefulness Product" Concept? |
% Effectiveness x % Compliance
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Adverse Drug Reactions |
Important to report if you think an adverse reaction has been caused by an ocular drug
Type of reaction; anaphylaxis vs delayed hypersensitivity |
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Hypersensitivity |
Allergic reaction; Prior exposure has produced IgE antibodies --> Immune response
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Supersensitivity |
Hypersensitivity due to increased receptor numbers and/or affinity, enhanced response
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Tolerance |
Body becomes accustomed to therapeutic effect, require higher dose
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Tachyphylaxis |
Rapid tolerance, sudden decrease in response to drug
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Idiosyncratic Reactions |
Unusual/unpredictable response
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DRUGS IN PREGNANCY, ELDERLY & CHILDREN
Altered Responsiveness Placebo Effects |
Anticipated responses due to patient's expectations NOT DRUG
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