ADRs of systemuc drugs

Routes of administration

Alimentary:

Sublingual

Oral

Rectal

Parenteral:

Subcutaneous

Intramuscular

Intravenous

Other:

Inhalation

Topical

Pharmokinetics

What the body does to the drug

Pharmodynamics

what the drug does to the body

Pregancy category A and B

ok

Category C

probably ok

make me nervous

Pregnancy D and X

not ok

What is the most critical trimester for development?

first trimester

ALWAYS ASK ARE YOU OR COULD YOU BE PREGNANT OR NURSING

Visual axis starts in the ____ and ends in the ____

tear film

occipital lobe

You can not get an APD beyond

LGN

Drugs that affect the TF/cornea

Anticholinergics

antihistamines

antidepressants

anti parkinson

antipsychotics

antispasmodics

Anti allergy medications (Claratin, Allergra, Zyrtec, benadryl) are what kind of receptors

H1 antihistamine

Allergy med ocular side effects

mydriasis

- decrease accomodation

decreased lacrimation

belpharospasm

weak atropine-like action that can cause pupillary changes

Antidepressants: SNRIs

Venlafaxine

Duloxetine

Desvenlafaxine

Levomilnacipran

Antidepressants: TCAs

Amitriptyline (Elavil)

Nortripyline

Monoamine Oxidase Inhibitors (MAOIs)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Do not give SSRI's with

opioids!

Seretonin syndrome

Antidepressants he mentions

Fluoxetine hydochloride (prozac)

Sertaline (zoloft)

Fluoxetine hydochloride (prozac)

Sertaline (zoloft)

can cause

Blurred vision

myrdiasis

photophobia

keratitis sicca

unilateral ptosis************

Antiparkinson's agents

levodopa

Benztropine

Pramipexole

Antipsychotics

Clozapine

Olanzapine

Quietiapine

Risperione

Aripiprazole

anticholinergi mechanism

block muscarnic Ach receptors

inhibit the parasympathetic nervous system's effects

leads to decreased tear production

What drug can put someone into angle closure

Topiramate

Topiramate uses

Migraine prophylaxis

Epilepsy

Weight loss - off label

neuropathic pain - off label

Topiramate THINK

angle closure

worse risk with hyerope

we will see a myoic shift as well W

Topiramate Mechanism of ocular side effect

induced ciliochoroidal effusion resulting in anterior roation of the ciliar processes

pharmacological stimulation of prostaglandin release leading to vasodilation anc increase permeability of the CB

What drugs affect the iris

alpha 1 adrenergic receptor antagonist --> benign prostate hypertrophy, HTN

Tamsulin (Flomax)

alpha 1 adrenergic receptor antagonist MOA

blockage of alpha 1 adrenergic receptors found in smooth muscle tissue of arterioles, bladder, and prostate gland

results in vasodialtion

alpha 1 adrenergic receptor antagonist affect the eye by

intraoperative floppy iris syndrome IFIS

Cataract surgery

Drugs that cause mydriasis

Anticholinergics

CNS stimulants

CNS depressants

Antihistamines

Phenothiazines

drugs that cause miosis

*opiates*, anticholinesterases

Drugs that cause IFIS

Genitourinary (tamsulin)

Corticosteroids cause

Posterior subcapsular cataracts

Steroid mechanism of ocualr se

alter the metabolism and structure of lens proteins leading to protein aggregation and lens opacification

disrupts normal balance of ions and water in the lens

Allopurinol

Treatment of gout and certain kidney stones

causes cataract formation

Gout

accumulation of urate crystals in joints causing inflamamtin

Allopurinol mechanism of ocular side effect

indirect relationship

increased oxidative stress via reduced uric acid levels

leads to accumulation of oxidative damge in lens proeins

Chloroquine based drugs affect the

retina

Chloroquine drugs used for

anti-malarial

autoimmune conditions

- RA, lupus (collagen vaclar disease), Sjorgrens, Juvenile idioathic arthritis

Hydroxychloroquine will cause

Bull's eye maculopathy

binding to melanin in RPE

inhibits RPE lysosome activity

PR loss and RPE atrophy

In asian patients on hydroxychloroquine must look in

pericentral fovea

order 30-2

Tamoxifen (Nolvadex, Soltamozx)

Selective estrogen receptor modulator SERM

Tamoxifen causes

retinal toxicity

Crystalline Retinopathies

Tacl - intravenous durg use

Tamoxifen - used in treating breast cancer

Canthazanthin - used as an oral tanning agent

Pentosan Polysulfate (Elmiron)

semisynthtic sulfated polysaccharide

uused for interstitial cystitis or bladder pain syndrome

Pentosan Polysulfate (Elmiron) causes

PPS pigmentary maculopathy

Fingolimod (Gilenya)

sphingosine 1-phosphate receptor modulator --> prevents accumulatio of T and B cells from lympathic system into systemic circualtion --> reduced demyleination

Ued for MS

Fingolimod (Gilenya) will cause

cystoid macualr edema

Amiodarone

Class 3 antiarrhytmic agent

Amiodarone ocular side effect

Optic neuropathy

Vortex Keratopathy

Corneal depostis

Conj yellow-brown deposts

Anterir subcapsular yellow -white opacities

thryoid dysfunction

What drugs can cause Vortex Keratopahy

Chloroquinolone

indomethacin

Amiodorone

Sildenafil citrate (Viagra)

Bluish tinge to the patients vision

Hypersensitivity to light

Anterior ischemic optic neuropathy

NAION

PDE5 inhibitors cause

NAION

Isotretinoin (Accutane) can cause

ocular surface disease, decreased dark adaptation, reduced vision, myopia, intracranial HTN

Oral Antibiotics 5 main classes

Penicilins

Cephalosporins

Fluoroquinolines

tetracyclines

Most common side effect

Antibiotic associated diarhhea

17% fatal

17% of cases

fatal

Must take ___ with antibitic

probitic

antibiotic allergy

5%

from degraded beta lactam

Penicillins are category

B

Estrogen and Progestrogens include

orthocyclen

orthonovum

Mircette

medroxyprogesterone

Estrogen and progesteron uses

BC

Amenhorrhea

premenstral problems

Estrogen and progesteron causes

decreased vision

Retinal vascular probelms

Pseudotuor cerebri, hypercoaguable state

Arterial dissection, intracranial occlusice dx

contact lens intolerance

Hormone replacement and Birthcontrol can cause

Dry eye**

Optic neuritis

Disc edema/ papilledema

retinal thrombosis**

Corneal steepening

Phenothiazine Toxicity

Chlorpromazine

Thrioridazine

Prochlorpezaine

used for psychiatric disorders

Chlorpromazine

cronea and lesn pigmentary deposits

Thrioridazine

retinal pigmentary changes

Warfarin (Coumadin)

prevention of clot fomarin in patients with atrial fibrillation and treatment of thombosis

massice retinal hemorrhages

age related macular dengernation patients

INR

More Vitamin K (e.g., eating extra leafy greens or starting a supplement): Lowers your INR, making your blood clot faster and raising your risk for a blood clot. [1, 2]

Bilateral subconjunctical heme

Aledronate (Fosamax)

Bone disorder agent

Causes

Antier Uveitis

Episcleritis

Scleritis

Neoplastic agents: Interferons

treatment

Hepatitis B and C

MS

interferons cause

cotton wool spots

retinal hemorrhaes

retinal edema

vascular occlusions

Radiation causes

Dry Eye

Radiatin retinopathy

trichiasis

epiphora

ectropion

iritis

cataract

Cyclophasphamide

chemo agent

severe dry eye!

Drugs that cause Pseudotumor Cerebri

Tetracycline/minocycline (doxy)

Vitamin A (accutane)

Steroid use

Ciprofloxin

Naladixic acid

tetracycline ocualr side effects

photosensitivity

pigmented conj deposits

disc edme/papillodema