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OPTOM345 > 8,10 - Ocular Side Effects of Systemic Drugs > Flashcards

8,10 - Ocular Side Effects of Systemic Drugs Flashcards

1
Q

Accutane

A

Indications: This retinoid (a form of vitamin A) is used to treat psoriasis, cystic acne, and various other skin conditions.
Ocular Side Effects:
- Dry eye
- Optic neuritis
- Night vision decrease
- Transitory myopia.
Comments: Annual eye exam recommended.

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2
Q

Amiodarone (Cordarone or Pacerone)

A
  • Na+ and K+ blocker, increased refractory period. Reversible.
    Indications: Antiarrhythmic
    Ocular Side Effects:
  • Whorl keratopathy (a.k.a. vortex keratopathy = blur + halo)
  • Optic neuropathy
  • Photophobia.
    Comments: Seen with 400-1,400 mg/d. DDX: Fabry’s disease, indomethacin, chlorpromazine
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3
Q

Avandia/Actos (rosiglitazone maleate)

A

Indications: Diabetes. Increases sensitivity to insulin.
Ocular Side Effects:
- Macular edema
Comments: DDx from Clinically Significant Macular Edema (CSME); Cardiovascular events are also seen.

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4
Q

Contraceptives (estrogen and/or progesterone)

A

Indications: Pregnancy prevention and Menopausal Hormone Therapy (HRT).
Ocular Side Effects:
- Optic neuritis
- Pseudotumor cerebri
- Dry eyes
Comments: retinal thrombosis, cardiovascular events

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5
Q

Coumadin (warfarin sodium)

A

Also Aspirin, they are anti-coagulants.
Indications: Prevents clot formation in atrial
fibrillation and thrombosis.
Ocular Side Effects:
- Retinal + subconjunctival hemorrhage. Also seen with ginkgo use. Comments: INR > 5 prone to bleed (normal 1-3)

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6
Q

Crack cocaine/drug abuse

A

Indications: Illicit drugs
Ocular Side Effects:
- Talc retinopathy
- Epithelial defects. Both symptoms also seen with canthaxanthine.
Comments: Talc are “fillers” in cocaine & abused drugs along with things like flour, laxatives, sugar, and local anesthetics among other precipitates.

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7
Q

Digoxin (Digitek)

A

Indications: Congestive heart failure
Ocular Side Effects:
- Red-green color defects
- Flickering or flashes of light
- Colored spots.
- Snowy, hazy, or dimming vision.
- Yellow-tinged vision (xanthopsia) is also reported with this drug. Comments: Visual changes are reversible.

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8
Q

Ethambutol (Myambutol)

A
  • It binds/chelates copper -> reduces copper availability -> impairs mitochondria -> reduces axonal transport -> optic neuropathy
    Indications: Tuberculosis.
    Ocular Side Effects:
  • Optic neuropathy
    Comments: Monthly exam is suggested for doses >15mg/kg/day, elderly, children, and diabetics. Baseline exam should include VF, color vision, and optic nerve analysis.
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9
Q

Flomax (tamsulosin)

A
  • Relaxes bladder + prostate muscles -> urinate easier
    Indications: Benign prostate hypertrophy
    Ocular Side Effects:
  • Loss of tone in iris dilator smooth muscle causing poor pupil dilation (Floppy iris syndrome)
  • Prolapse during cataract surgery.
    Comments: Selective alpha-1A antagonist
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10
Q

Fosamax

A
  • Binds preferably to calcium and accumulates at bones to increase strength + density
    Indications: Osteoporosis treatment/prevention
    Ocular Side Effects:
  • Hyperemia
  • Anterior uveitis
  • Blurred vision
  • Episcleritis + scleritis.
    Comments: A thorough dilated exam is recommended due to the multiple side effects that may occur.
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11
Q

Interferons (Intron A/Avonex/Pegasys)

A
  • Modulates immune system
    Indications: Used to treat hepatitis & MS
    Ocular Side Effects:
  • Ocular pain
  • Conjunctivitis
  • Cotton wool spots
  • Optic neuritis
  • Pronounced dry eye.
    Comments: Eye exam prior to treatment and 2-4 weeks after treatments.
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12
Q

Levothyroxine (Synthroid)

A
  • Binds to nuclei of most cells, controlling DNA -> control metabolism
    Indications: Replaces thyroxin not produced by thyroid
    Ocular Side Effects:
  • Diplopia
  • Ptosis
  • Paralysis of EOMs.
    Comments: Patient may experience symptoms similar to myasthenia with excess hormone.
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13
Q

Lipitor/Zocor (atorvastatin/simvastatin)

A
  • Binds to HMG-CoA reductase which prevents cholesterol production
    Indications: Hyperlipidemia
    Ocular Side Effects:
  • Pseudo-cystoid macular edema
    Comments: Most commonly occurs in men between the ages of 30-50. Also seen with Niacin (vitamin to lower cholesterol).
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14
Q

Phenothiazines (Thorazine, Mellaril)

A
  • Dopamine antagonist
    Indications: Treats depression and anxiety. Also schizophrenia and pyschosis.
    Ocular Side Effects:
  • Night blindness (Nyctalopia),
  • Anterior subcapsular cataract
  • Salt/pepper fundus.
  • Hyperpigmentation of conj, cornea, lens, retina, choroid, and macula
  • “Brown vision”
    Comments: Doses around 800 mg/d increase risk of toxicity.
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15
Q

Plaquenil (hydroxychloroquine)

A
  • High affinity for melanin in iris, RPE, and choroid
    Indications: Treats malaria, rheumatoid arthritis, and lupus erythematosis.
    Ocular Side Effects:
  • Bull’s-eye maculopathy
  • Corneal deposits
    Comments: Baseline eye exam including HVF-10, Amsler grid, and color vision. Yearly thereafter.
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16
Q

Prednisone (steroids)

A

Indications: Lupus, rheumatoid arthritis, and other immune-mediated conditions.
Ocular Side Effects:
- Posterior subcapsular cataract
- High IOP
- Exacerbation of hepatic keratitis
Comments: 25-80 mg/d; intravitreal injections and implants need regular monitoring.

17
Q

Prozac/antidepressants (fluoxetine/SSRIs)

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs) increas serotonin levels
    Indications: Antidepressant
    Ocular Side Effects:
  • Dry eye
  • Blurred vision
  • Mydriasis
  • Photophobia
  • Ptosis
  • Diplopia
  • Conjunctivitis
    Comments: Commonly prescribed generic drugs in US.
18
Q

Tamoxifen citrate (Nolvadex)

A
  • Binds to estrogen receptors of tumour cells to reduce DNA synthesis
    Indications: Breast cancer (or prophylatic Tx of breast cancer)
    Ocular Side Effects:
  • Crystalline retinopathy
    Comments: Normal dosage levels (20 mg/d) are unlikely to induce retinopathy.
19
Q

Topamax (topiramate)

A

Indications: Seizures. Also off label for migraine headaches.
Ocular Side Effects:
- Acute myopia, bilateral
- Angle closure glaucoma
Comments: Ultrasonography has also shown choroidal effusion, choroidal detachment, and ciliary body edema.

20
Q

Viagra/Levitra/Cialis (sildenafil)

A
  • Inhibits phosphodiesterase-5 (PDE-5) for vasodilation and inhibits phototransduction pathway
    Indications: Erectile dysfunction
    Ocular Side Effects:
  • Bluish tinge to vision (cyanopsia)
  • NAION
  • Macular edema
    Comments: Visual side effects occur in 11% of men taking 100-mg doses.

OPTOM345 (32 decks)

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