Ocular side effects of Systemic medications Flashcards
What are the factors that contribute to the likelihood of ADRs occurring?
Older age
Very young age
Female gender
Increased weight
Poor general/ocular health
Genetic factors
Dose and duration of meds
Interactions with other meds
What are the types of anti-depressants?
Tricyclines
MonoAmine Oxidase Inhibitors (MAOIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Give an example of a Trycycline
Amitriptyline
Clomipramine
When are tricyclines contraindicated?
Angle-closure risk
Glaucoma
What are the ADRs for antidepressants?
Mydriasis - all
Photophobia - MAOIs and SSRIs
Blurred vision - tricyclic and MAOIs
Cycloplegia - tricyclic only
Dry eye - tricyclic and SSRIs
Increased IOP - tricyclic only
What is the mechanism of antidepressants?
Anticholinergic
When are MAOIs contraindicated?
Mydriatics
Careful with certain foods (e.g. cheese)
When are SSRIs contraindicated?
Poorly controlled epilepsy
Manic phase
What can oral contraceptives be used for in addition to contraception?
Control of heavy bleeding and menstrual pain, menstrual cycle control, anaemia prevention
What are the types of oral contraception? Give an example of each
Combined (oestrogen and progesterone) e.g. ethinyloestradiol/norethisterone
Progesterone only e.g. norethisterone
What are the ADRs of oral contraceptives?
Systemic: DVT
Ocular: Reduced tear quality/quantity (dry eye, CL intolerance), retinal vein occlusion
Give two examples of Anti-Tuberculosis drugs
Ethambutol
Rifampicin
What are the contraindications for Ethambutol?
Optic Neuritis
Poor vision
What are the ADRs for Ethambutol?
Reduced VA
Optic neuritis: axial (central VA reduction, CV loss) or paraxial (VF constriction)
What are the contraindications for Rifampicin?
Jaundice
What are the ADRs for Rifampicin?
Discolouration of soft CLs - pink
What are the other categories of drugs which can cause ocular side effects?
Anti-inflammatories - NSAIDs and corticosteroids
Anti-infectives
Anti-cancer
Erectile dysfunction agents
Anti-convulsive
Anti-psychotics
Hypnotics
Cardiovascular agents
Antihistamines
Anti-hypertensives
Antimalarials
Bronchodilators
Anti-Parkinson’s
What are some ADRs of anti-infectives?
Give an example of a drug.
e.g. doxycycline
diplopia
blurred vision
VF loss
What are some ADRs of anti-hypertensives?
Give an example of a drug.
e.g. timolol
reduced VA
IOP changes
photophobia
visual disturbances
conjunctival and palpebral changes
What are some ADRs of cardiovascular agents?
Give an example of a drug.
e.g. amiodarone
CV changes
hazy vision
haloes
corneal deposits
lens opacities
optic neuropathy
What are some ADRs of anti-malarials?
Give an example of a drug.
e.g. chloroquine
Bull’s eye maculopathy
corneal deposits
blurred vision
CV defects
VF loss
What are some ADRs of bronchodilators?
Give an example of a drug.
e.g. ventolin
ocular pain
mydriasis
What are some ADRs of anti-inflammatories?
Give an example of a drug.
e.g. ibuprofen, prednisolone
NSAIDs: dry eye, CV changes, rx changes
Corticosteroids: steroidal glauc/cats, corneal thinning, increased IOP, immunosuppression
What are some ADRs of anti-psychotics?
Give an example of a drug.
e.g. chlorprozamine
blurred vision
mydriasis
reduced accom
reduced lacrimation (so dry eye)
corneal, lens and conjunctival deposits
What are some ADRs of hypnotics?
Give an example of a drug.
e.g. diazepam
reduced accom
EOM dysfunction
diplopia
allergic conjunctivitis
What are some ADRs of anti-Parkinson’s?
Give an example of a drug.
e.g. levodopa
mydriasis
ptosis
hallucinations
blurred vision
What are some ADRs of anti-convulsants?
Give an example of a drug.
e.g. vigabatrin
diplopia
blurred vision
VF constriction
reduced VA and CV
What are some ADRs of antihistamines?
Give an example of a drug.
e.g. ceritzine, loratadine
reduced lacrimation (so dry eye)
increased corneal and conjunctival staining
blurred vision
mydriasis
What are some ADRs of erectile dysfunction agents?
Give an example of a drug.
e.g. Viagra
increased light senstivity
blurred vision
conjunctival hyperaemia
pain
CV change
NAION
What are some ADRs of anti-cancer drugs?
Give an example of a drug.
Tamoxifen:
crystalline retinopathy
VF changes
CV changes
whorl corneal opacities
posterior subcapsular cataracts
