6.1.15 Recognises adverse ocular reactions to medication. Flashcards
Antidepressants
Examples
* Sertraline
* Citalopram
* Fluoxetine
Condition
* Depression
* Anxiety
ADR’s
* ADDE
* Reduced accomm
* Light sensitivity
Betablockers
Examples
* Atenolol
* Propranolol
* (topical: Timolol for POAG)
Condition
* Hypertension
* Anxiety
* Angina
* Migraines
ADR’s
* ADDE
Post-menopausal
Examples
* HRT
Condition
* Menopause
ADR’s
* ADDE
Anti-coagulants
Examples
* Warfarin
* Aspirin
Condition
* Blood thinners – prevent stroke/heart attack
ADR’s
* Sub conj haem
* Vitreous/retinal haem
Anti-rheumatic / malarial
Examples
* Hydroxychloroquine
Condition
* Rheumatoid Arthritis
ADR’s
* Blurred vision
* Bull’s eye Maculopathy
* Hydroxychloroquine
Steroids
(long term over 10mg daily = chronic dose = risks higher)
Examples
* Prednisolone
* Dexamethasone
Condition
* Reduce inflammation
ADR’s
* Increase in IOP
* Cataract
* Exophthalmos
Prostaglandin Analogues (topical)
Examples
* Bimatoprost (Lumigan), latanoprost (Xalatan)
Condition
* POAG
ADR’s
* Ocular irritation
* Conj hyperaemia
* Iris hyperpigmentation
* Increase in lash length, thickness & pigmentation
* Increase in lid skin pigmentation
* CMO - RARE
* AU – RARE
HRT – hormone replacement therapy
Condition
Menopause
ADR’s
Studies show can make dry eye worse – 15% elevation in clinically diagnosed dry eye
Reporting Scheme
- using yellow cards at rear of BNF or download from MHRA website
- BNF - Symbol T – suspected reactions to new meds, nverted black triangle = intensely monitoring
Tamoxifen
- Crystalline retinopathy
- Whorl-like corneal opacities
- Posterior subcapuslar opacities
- VF & CV changes
Tamsulosin
- Floppy iris syndrome
- Photophobia, visual disturbance
Amiodarone
- Corneal deposits - vortex keratopathy
- Len deposits - white-yellow punctates
- Optic neuropathy - rare!
Reporting Schemes
- You should use reporting schemes for adverse drug reactions . There are two reporting schemes, operated by the MHRA. These are:
1. the yellow card scheme which covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medication
2. the Medical Devices Reporting Form which covers adverse incidents mainly relating to contact lenses and care products, including contact lens comfort drops
More about the Yellow Card Scheme:
- For reporting suspected adverse drug reactions
- Reports from health professionals and general public
- Run by:
- the Commission on Human Medicines (CHM) - Independent advisory body
- the Medicines and Healthcare products Regulatory Agency (MHRA) - Government agency
- To monitor the safety of medicines on the market
What if a patient had an angle closure attack after dilation?
Where the IOP is 40mmHg or higher and the patient is not vomiting, give a single dose of oral acetazolamide (Diamox) 500mg (not slow release formulation). (NB: Diamox may be hazardous in an elderly frail patient.) Then refer as an emergency to ophthalmologist. (In view of potential unwanted effects of this treatment, patient should be accompanied by a carer or relative)
What if patient had severe corneal melt after local anaesthetic use?
Emergency referral. Px should wear eye protection getting to appt
