Ocular effects of systemic medications Flashcards
What drug causes Intraoperative Floppy Iris Syndrome
Tamsulosin
Drugs that cause maculopathy
Hydroxychloroquine
Drugs that cause angle closure
Topiramate
Drugs that cause Whorl Keratopathy
Chloroquine Hydroxychloroquine Amiodarone Indomethacin Tamoxifen
Drugs that cause mydriasis by a1 stimulation at iris dilator
(bad for narrow AC angle)
Epinephrine, norepinephrine Phenylephrine Oxymetazoline Pseudoephedrine Cocaine Methamphetamine Methylphenidate Bromocriptine, Amantadine (increase dopamine)
Drugs causing mydriasis by M3 inhibition at iris sphincter (anti-cholinergics)
Atropine Ipratropium & tiotropium Tolterodine Glycopyrrolate Anti-histamines 1st gen STRONG: diphenhydramine & promethazine Anti-depressants STRONGL amitriptyline, imipramine Anti-anxiety & sleep aids Anti-psychotics Muscle relaxant STRONG: cyclobenzaprine
Drugs causing miosis by a1 inhibition at iris dilator
Tamsulosin, terazosin, doxazosin, prazosin
Drugs causing miosis by indirect stimulation at iris sphincter
Acetylcholinesterase inhibitors:
Donepezil, edrophonium, pyridostigmine, neostigmine, isofluorophate
Opioids causing miosis by M3 stimulation at iris sphincter
heroin, hydrocodone, oxycodone, buprenorphine, methadone, tramadol
Drug causing miosis by direct M3 stimulation
pilocarpine
Drugs causing dry eye by a1 stimulation @ lacrimal gland
Epinephrine, norepinephrine Phenylephrine Oxymetazoline Pseudoephedrine Cocaine Methamphetamine Methylphenidate Bromocriptine, Amantadine (increase dopamine)
Drugs causing dry eye by M# inhibition @ lacrimal gland
Atropine Ipratropium & tiotropium Tolterodine Glycopyrrolate Anti-histamines 1st gen STRONG: diphenhydramine & promethazine Anti-depressants STRONGL amitriptyline, imipramine Anti-anxiety & sleep aids Anti-psychotics Muscle relaxant STRONG: cyclobenzaprine
Drugs increasing tears by a1 inhibition at lacrimal gland
None clinically relevant
Drugs increasing tears by M2, M3 stimulation (direct & indirect)
Direct: pilocarpine
Indirect: acetylcholinesterase inhibitors: donepezil, edrophonium, pyridostigmine, neostigmine, isofluorophate
Dry eye causing drugs unrelated to anti-cholinergic effects
Isotretinoin (meibomian gland loss) Cytotoxic chemotherapy drugs dupilumab (for auto-immune atopic dermatitis, asthma & allergic rhinitis reduced mucin secretion from goblet cells Estrogens & Diuretics
Drugs that increase IOP by B2>B1 stimulation on NPCE of ciliary body (increased aq.)
Epinephrine Isoproterenol Albuterol Levalbuterol Salmeterol Formoterol Pseudoephedrine Cocaine Methylphenidate Increase dopamine: bromocriptine and amantadine
Drugs that increase IOP by decreasing TM outflow
Prednisone Methylprednisone Dexamethasone fluticasone beclomethasone budesonide hydrocortisone
Drugs that decrease IOP by a2 stimulation NPCE
adrenergic agonists: Epinephrine, norepinephrine, clonidine
drugs that decrease IOP by B2>B1 inhibition at NPCE (adrenergic antagonists)
B1 selective: Metoprolol, atenolol
Non-selective: propranolol, labetalol, carvedilol
drugs decrease IOP by M2, M3 stimulation ciliary muscle cholinergic agonist
Direct: pilocarpine Indirect: Acetylcholinesterase inhibitors Donepezil Edrophonium Pyridostigmine, neostigmine Isofluorophate
What are the adverse effects of glucocorticoid drugs (steroids) on the eyes
PSC cataract, papilledema, TM resistance–>high IOP, glaucoma, and immunosuppression
adverse systemic effects of glucocorticoids
high blood sugar, HTN, osteoporosis, striae, decreased growth in children, increased risk of infection, peptic ulcer, peripheral edema, hypokalemia, emotional disturbances
