Ocular side effects of Systemic medicine

What is pharmacokinetics?

What the body does the drug

What is pharmacodynamics?

What the drug does to the body

What are the alimentary routes of administration?

Sublingual

Oral

Rectal

What are the parenteral routes of administration?

Subcutaneous

Intramuscular

Intravenous

Which drugs can cause tear film problems?

Antihistamines

Antidepressants

Antiparkinsons

Antipsychotics

Antispasmodic

Which drugs can cause anterior chamber problems?

Topiramate

Which drugs can cause iris problems?

Alpha-1 adrenergic receptor antagonists

Which drugs can cause lens problems?

Corticosteroids

Allopurinol

Which drugs can cause foveal problems

Hydroxychloroquine

Taxoxifen

Pentosan

Fingolimod

Digoxin

Which drugs can cause optic nerve problems?

Amiodarone

PDE5 Inhibitors

Isotretinoin

Which allergy medications can disrupt the pupillary changes?

ZAC - Zytrec, Allergra, Claritin (H1 antihistamines)

What are the two main side effects of the 2nd generation H1 antihistamines?

Mydriasis (anisocoria, decreased accom, narrowed angle)

Decreased lacrimation (dry eye)

Which antidepressants can result in tear film disruption?

SNRIs - Serotonin-norepinephrine reuptake inhibitors

Tricyclic Antidepressants - Amitriptyline, Nortriptyline

MAOIs - Nardil, Parnate

What is the mechanism of action of tropicamide?

Dilation via parasympatholytic action

What is the mechanism of action of phenylephrine?

Dilates the pupil via alpha 1 agonist action on the iris dilator

Should SSRIs and opioids be taken together?

No, high risk for serotonin syndrome

Which antidepressants can cause unilateral ptosis?

Fluoxetine (Prozac) and Sertraline (Zoloft)

What drugs are used for Parkinson's disease?

Levodopa

Benztropine

Pramipexole

Schizophrenia is caused by an excess of which neurotransmitter?

Dopamine

What drugs are antipsychotics

Clozapine

Olanzapine

Quetiapine

Risperidone

Aripiprazole

What is the mechanism of action of anticholinergics?

Blockage of the muscarinic Ach receptors to inhibit the parasympathetic nervous system's effect

Which drug can affect the anterior chamber by causing angle closure glaucoma?

Topiramate (Topamax)

How does Topamax cause angle closure glaucoma?

Induced ciliochoroid effusion resulting in anterior rotation of the ciliary processes

What are the two side effects of Topamax?

Acute myopic shift (relaxation of zonular fibers)

Secondary angle closure glaucoma

What is the use of alpha-1 adrenergic antagonists?

Benign prostate hypertrophy

What are the side effects of tamsulosin (alpha-1 antagonist)?

Vasodilation due to blockage of alpha receptors in smooth muscle of arterioles, bladder and prostate gland

Intraoperative floppy iris syndrome (IFIS) (can’t keep pupil open during cataract surgery)

Which drugs can cause miosis?

Opiates

Anticholinesterases (neostigmine)

What is the number one drug that can cause a cataract?

Prednisone (posterior subcapsular cataract)

How do steroids affect the eye?

Alter lens metabolism and structure leading to protein aggregation and lens opacification (disruption of normal balance of ions and water)

What is the drug used for gout?

Allopurinol

What structure in the eye does allopurinol affect?

Lens

Why does allopurinol affect the lens?

Increased oxidative stress via reduced uric acid levels

Leads to accumulation of oxidative damage in lens proteins = PSC

What is the first structure that yellows in the lens?

Posterior cortex

Which drugs are used for lupus, RA, Sjogren’s, Juvenile idiopathic arthritis and anti-malarial

Chloroquine and hydroxychloroquine

Which type of maculopathy is caused by hydroxychloroquine?

Bulls eye maculopathy

When should a baseline test for bullseye maculopathy be done?

1st year

What is the use of tamoxifen?

Selective estrogen receptor modulator (SERM) to treat breast cancer

T/F Tamoxifen will deposit in the retina

True

What type of retinopathy does tamoxifen retinopathy fall under?

Crystalline retinopathy

Which drugs can cause crystalline retinopathy?

Talc

Tamoxifen

Canthaxanthin

Tamoxifen

What structure does Elmiron affect in the eye?

Retina

What can Elmiron cause?

PPS pigmentary maculopathy

Hyperpigmented macular spots - early

Patchy parafoveal RPE atrophy - late

What is Gilenya used for?

Multiple sclerosis

What is the main eye sign in MS?

Optic neuritis and INO (affecting the MLF)

What are the two ocular side effects of amiodarone?

Optic neuropathy after an average of 9 months of use (vision loss over time)

Vortex keratopathy

Which drugs does vortex keratopathy

Chloroquine

Amiodarone

Indomethacin

What are the ocular side effects of sildenafil?

Blue-ish tinge to vision

Hypersensitivity to light

Non-arteritic Ischemic Optic Neuropathy

What are the ocular side effects of estrogens and progesterone aka birth control pills?

Retinal vascular problems (vein occlusion and artery occlusion)

Pseudotumor cerebri

Decreased vision

Risk of glaucoma goes up

What ocular side effects are caused by hormone replacement therapy?

Dry eye

Corneal steepening

Disc edema/papilledema

What are the ocular side effects of warfarin?

Subconjunctival hemorrhage

Retinal hemorrhages

Age related macular degeneration patients can get the neovascularization to bleed

What should the INR be in patients with warfarin?

2.0-3.0

What ocular side effects are caused by bisphosphanates (fosamax)?

Anterior uveitis (with KPs and mutton fats KPs)

Episcleritis

Scleritis

Pain and irritation

What is the ocular side effect of interferon?

Cotton wool spots (ischemia in the nerve fiber layer)

Macular edema, vascular occlusion

What is cyclophosphamide (Cytoxan)

Chemo agent used for cancer patients as anti-rejection medication for organ transplants

What can vincristine and vinblastine cause (these are used for lymphomas, sarcomas, etc)

Epiphora

Which drugs can cause pseudotumor cerebri?

Tetracycline/Minocycline

Vitamin A (Accutane)

Steroid use

Ciprofloxacin

Naladixic acid

Which drugs can cause pigmented conjunctival deposits?

Tetracycline and minocycline

What should be administered alongside oral antibiotics?

Pre and probiotics

What is amiodarone used for?

Cardiac arrhythmias

What are the ocular side effects of amiodarone?

Optic neuropathy

Vortex keratopathy

What kind of cataract forms from a steroid?

PSC

What two drugs can cause cataract formation?

Allopurinol

Steroids

What does interferon cause?

Cotton wool spots/hemorrhages

What does the birth control pill cause?

Dry eye

Artery occlusion/vein occlusion