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68 Cards in this Set
- Front
- Back
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Systemic side effects result from ocular drugs eing absorbed into systemic circulation by way of the
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conj
muscous membranes |
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T/F local ocular inflammation INCREASES the possibility of systemic side effects from ocular aplllication
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TRUE
it increases available blood supply for absorption |
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Signs of anticholinergict toxicity
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hot as a hare
red as a beet dry as a bone blind as a bat mad as a hatter |
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Anticholinergic agents include
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Tropicamide
Scopolamine Homatropine Atropine Cyclopentolate |
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Avoid using anticholinergics in _____ temperatures and ______ humidity
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High
High |
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___ is used to control anticholinergic toxicity
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Physostimine
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ocular cholinergic agonists are typically used to treat
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glaucoma and esotropia.
(pilocarpine, echothiophate) |
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Contraindication for cholinergic agonists
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asthma
examples: (pilocarpine, echothiophate) |
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Phenylephrine is an __________ and should be avoided in patients with
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adrenergic agonist
insulin dependent diabetes, cardiac disease, ypertension, thyrotoxicois, aneurysms, advancedarteriosclerois avoid in patients taking MAO inhibitors |
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Two ocular drugs that are adrenergic alpha 2 agonists that bind to receptors on POSTganglionic sympathetic nerve terminals
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Iopidine and Alphagan
both are used to treat glaucoma results in release of norepinephrine |
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Adrenergic antagonists include
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timolol levobunolol betaxolol
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Most common adrenergic anatagonist side effects
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CNS
Cardio Respiratory Skin |
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Key notes about Timolol
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*Autonomic Nervous system beta-adrenergic agonist (Miotic)
*Non selective blocker similar to propanolol *Anti-arrhymic, anti-angina, anti-hypertensive properties *Ophthalmic solution .25% & .5% *Topical gel *Oral prep used to treat cardiac dxfn *1 drop b.i.d *Gel q.d *Bronchospasm *COPD *Asthma *Pregnancy *Pulmonary edema *AV block *Raynaud’s disease *Pediatric use??? *Depresses cardiovascular system *Anti-glaucoma *Applied topically to reduce IOP both in elevated and normal pressures *No pupil constriction *No adverse accommodation or VA effect *Very rapid ocular penetrance |
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Key notes about Levobunolol
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Autonomic Nervous system beta-adrenergic agonist
*Anti-glaucoma *Non selective blocker *Ophthalmic solution .25% & .5% *1-2 drops 1-2X daily *Px with cardiac dxfn * May mask symptoms of hypoglycemia * May precipitate thyroid storm in Px with hyperthyroidism |
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Key notes about Betaxolol
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Beta 1 selective adrenergic blocking agent
*10-20mg tablets *Ophthalmic solution .25% & .5% *Dose 1 qtt BID for max effect *5-10mg 2X daily 20mg daily max *Angle closure *AV block *Cardiogenic shock * *Anti-glaucoma *Anti-hypertensive *for intraocular HTN *Chronic open-angle glaucoma *Safer for Asthma patients |
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Key notes about Carteolol
Ocupress Carteolol HCL |
*Autonomic Nervous system beta-adrenergic agonist
*Intrinsic sympathomimetic activity *Ophthalmic solution 1% *1 drop b.i.d *Px with cardiac dxfn *Anti-glaucoma |
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Key notes about Metipranolol
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*Autonomic Nervous system beta-adrenergic agonist
*Anti-glaucoma *Non selective blocker *Available .3%solution |
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Overdose of local anesthetics have resulted in
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convulsions and arrhythmias.
Avoide oding with patients with liver/kidney disease or hypersensitivity to other drugs. |
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Sustained convulsions resulting from anesthetics are treated with
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diazepan, barbitautes, succinylcholine. However, most convulsions are typically self liminted
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Drugs Affecting the
Cornea and Lens |
Chloroquine and hydroxychloroquine
Chlorpromazine NSAIDs Photosensitizing drugs Gold salts Corticosteroids Amiodarone |
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Chloroquine &
Hydroxychloroquine Systemic uses and ocular side effects |
Collagen diseases: arthritis, lupus
Ocular signs and symptoms -Corneal epithelial -yellow-green deposits More likely with chloroquine -Decrease or disappear with reduction or discontinuation of drug -No loss of visual acuity -Decreased or absent corneal sensitivity -Halos around lights, glare & photophobia |
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Chlorpromazine Systemic use and ocular side effects
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Psychiatric disorders
Ocular signs and symptoms (dose related) -Anterior capsular lens opacities and corneal endothelial and Descemet’s membrane pigment Deposits fade after dose reduced or drug stopped -Reduced VA (rare), glare, halos around lights and hazy vision |
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Non Steroidal Anti-inflammatory Agents side effects
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Ocular signs and symptoms (rare)
Corneal opacities similar to chloroquine Opacities diminish with dose reduction or cessation of therapy Mild light sensitivity to frank photophobia |
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Photosensitizing Drugs
(Psoralen compounds) •Systemic use and ocular effects |
–PUVA therapy •Absorb UV & visible light undergoing reaction which modifies nearby molecules of tissue
•Ocular signs and symptoms –Cataracts in phakic patients –Retinal damage in aphakic patients |
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Gold Salts Systemic use and ocular effects
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Rheumatoid arthritis
Ocular signs and symptoms (Chrysiasis) Corneal stromal and anterior lens capsule and anterior lens suture gold deposits Occurs after prolonged use of metal Color yellow brown to violet and red No visual or ocular symptoms -Conjunctivitis •Eyelid exfoliative dermatitis •Irregular brownish conjunctival deposits |
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Corticosteroids
•Ocular signs and symptoms |
–PSC after prolonged use –Elevated IOP do to decreased aq outflow
–Reactivation of ocular infectious diseases –Infection – suppression of immune system •Management –Monitor for ocular changes and reduce steroids or change to NSAIDs if possible depending on systemic condition |
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Amiodarone systemic use and ocular side effects
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–Atrial and ventricular arrhythmias
•Ocular signs and symptoms –Epithelial deposits anterior to Bowman’s membrane •Deposits start as fine horizontal lines and progress to whorl-like pattern •Severity related to drug dosage and duration •Resolution 6-18 months after drug stopped •Severe keratopathy can cause blur, glare, halos and photophobia –Anterior lens capsule opacities can also occur •No symptoms |
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Drugs Affecting the Conjunctiva and Lids
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Tetracycline
Minocycline Amiodarone Isotretinoin Chlorpromazine Sulfonamides Gold compounds |
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Isotretinoin•Systemic use and ocular sidgns and symptoms
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–Analog of vit. A (Accutane) used to treat recalcitrant cystic acne and other keratinizing dermatoses •Ocular signs and symptoms (dose related) –Blepharoconjunctivitis, dry eye, CL intolerance & subepithelial corneal opacities
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Chlorpromazine conj side effects
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used for
Psychiatric disorders Slate blue discoloration (melanin deposits) of bulbar conjunctiva, sclera and skin after prolonged use (1-6 years with dosing between 500 to 3000mg daily) |
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Sulfonamides Ocular side effects
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Lid edema
Conjunctivitis Chemosis |
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Tetracycline & Minocycline ocular side effects
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•Epinephrine like conjunctival deposits
–Dark brown to black granules located in palpebral conjunctiva –Granules located in cysts |
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Drugs that decrease aqueous tears and tear constituents
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–Anticholinergics, antihistamines, isotretinoin, beta blockers, oral contraceptives and miscellaneous drugs
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•Drugs that increase aqueous tears and tear film constituents
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Certain systemic cholinergic, adrenergic and antihypertensive drugs
–Certain antimicrobial agents can enter tears |
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T/F Anticholinergies increase tear solution
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FALSE!!
decrease |
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T/F •Antihistamines Reduce aqueous and mucin production
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T
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T/F Isotretinoin reduces TBUT and causes dry eye symptoms as well as reduces lipid production
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T
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T/F Beta blockers (examples, timolol, practolol, propranolol)cause dry eye
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T
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Oral contraceptives may _______tear secretion
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reduce
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anticholinergic actions including phenothiazines, antianxiety agents, tricyclic antidepressants are all associated with causing _________
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dry eye
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This drug can discolor tears orange, pink or red
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Rifampin
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Neostigmine, ephedrine, reserpine, hydralazine and diazoxide reported to increase _______
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lacrimation
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•Atropine, ephedrine, timolol and propranolol increase __________
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lysozyme production
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Drugs Causing Mydriasis
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•Anticholinergics (also can cause cycloplegia)
–Atropine, scopolamine and other anticholinergics •CNS stimulants –Amphetamines and cocaine can stimulate adrenergics causing mydriasis •CNS depressants –Barbiturate poisoning causes sluggish light response –Antianxiety drugs can sometimes cause mydriasis Miscellaneous agents –Antihistamines and antipsychotic drugs with anticholinergic effects –Dried seed pods of jimson weed •Contains belladonna alkaloids |
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Drugs Causing Miosis
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•Opiates –Heroin, morphine, codeine act on CN III •Anticholinesterase agents –Insecticides
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Drugs causing diplopia
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Phenothiazines, anti-anxiety and antidepressant drugs
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T/F Sulfonamindes, diuretics and CAIs can cause acute myopic shifts up to 7 Diopters
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True
Mechanism –Edema of ciliary body causes zonules to relax |
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Retinal effects of Chloroquine and Hydroxycholorquine
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Ocular sings and symptoms –Starts with fine pigment mottling of macula –“Bull’s Eye” macular lesion eventually develops –Arteriolar attenuation, disc pallor and macular edema –Peripheral changes similar in appearance to retinitis pigmentosa –Bilateral and symmetric –Central, paracentral and pericentral field defects
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T/F Hydroxychloroquine less likely to cause retinopathy than chloroquine
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T
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Thioridazine systemic use and ocular signs
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Antipsychotic drug
•Ocular signs and symptoms –Retinopathy resulting in reduced VA, abnormal color vision and dark adaption –Fundus appears normal, then fine pigment change ultimately pigmented and non pigmented retinal lesions |
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Thioridzaine symptoms start ______ days after starting drug and you do not see any retinopathy if daily dose is below _______
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30-90 days
––No retinopathy if daily dose below 800 mg |
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Thioridazine effects retina because it binds to
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uveal pigment which may damage choriocapillaris
–Drug may inhibit oxidation of retinol |
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Quinine Systemic use and ocular effects
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–As an anti-parasitic drug against malaria –To relieve muscle cramping or tightness in myotonia congenita
•Ocular signs and symptoms –Various visual complaints from slight VA reduction, distortion, color vision defects, photophobia, hallucinations to complete loss of vision (no light perception) with non reactive pupils –Ptosis, paralysis of EOM function, diplopia and nystagmus –Fundus changes including papilledema!!!, optic atrophy, retinal vascular and pigment changes |
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Quinine causes ocular side effects because it has direct toxic effect on _______
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photoreceptors and ganglion cells
–Curare like neuromuscular blocking effect |
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Talc systemic uses include ______
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A filler for oral medications –Cutting cocaine and heroin
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Ocular side effects to Talc useage
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–Multiple tiny yellow white particles scattered throughout retinal vessels
–May have macular edema, venous engorgement, hemorrhage, neovascularization, vitreous hemorrhage and retinal detachment –All levels of visual disturbance can be present |
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memory aid for pupils
"MorPHINE: Fine. AmPHETamine: Fat" |
Morphine overdose: pupils constricted (fine)
Amphetamine overdose: pupils dilated (fat) |
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Cholinergics effects
If you know these, you will be "LESS DUMB" |
Lacrimation
Excitation of nicotinic synapses Salivation Sweating Diarrhea Urination Micturition Bronchoconstrictio |
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Fluorescein Dye basic info
(Flourscein sodium, chlorobutanol, polysorbate 80, boric acid, potassium chloride, sodium carbonate) |
*Yellow acid dye of xanthenes series
*Used as sodium salt *Affected by pH *Available in impregnated filter paper *Used to assess corneal epithelium lesions, ulcerations or abnormalities |
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Fluorescein Dye exits at ______ and emits at ______ when stimulated with cobalt blue
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*Excited at 490nm wavelength
*Emits 525 nm light (green color) when stimulated w cobalt blue light |
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Fluorescein Dye is available in
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*2% solution used
* 1, 2, 15ml amounts for topical use *10-25% solution used forinjection |
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Using fluorescein dy can cause
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*Irritation of cornea
*Fainting *Discoloration of soft contact lens * Temporary yellow skin discoloration |
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Fluress causes anethesia in ___ secs and lasts ___ minutes
Fluress (Flourscein sodium, chlorobutanol, benoxiate hydrochloride) |
*Anesthesia 15 sec
*Duration 15 min |
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Fluress
is used for |
*Used for Goldman tonometry and FB assessment
*Used to assess corneal lesions/ulcerations |
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Fluress is administered _____ and can cause
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2 drops OU for 3 installations @ 5 min intervals
*Stinging/burning *Conjunctiva redness *Possible severe hyper allergic response with intense epithelial keratitus |
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Fluorescein
(Injection) Used to assess |
vascular and abnormalities of fundus and iris
*10-13 seconds from injection until dye appears in the CRV *20 seconds to appear in iris |
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Fluorescein
(Injection) is administered |
* 10ml of 5% solution
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Fluorescein
(Injection) takes how long to appear? |
*10-13 seconds from injection until dye appears in the CRV
*20 seconds to appear in iris |
