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Adverse actions can occur where
in the eye or organ systems
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Main goal
Identify early the ocular drug adverse reactions OADR's and report any OADR's to www.eyedrugregistry.com
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Determinants in Toxicology (8)
- Amounts of drug administered
- Nature of the drug
- Route of administration
- Pathophysiologic variables
- Age and Gender
- Multiple drug therapy
- Hx allergy to drugs
- Individual idiosyncrasy
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Adverse effects in the eyelids (5)
- Urticaria or angioedema
- Allergic contact dermatitis
- Cumulative deposition
- Melanotic hyperpigmentation or hypopigmentation
- Microbial imbalance
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Adverse effects in the Conjunctiva (5)
- Follicular irritative or toxic conjunctivitis
- Cumulative deposition
- Anaphylactic conjunctivitis
- Non-specific papillary irritative conjunctivitis
- Microbial imbalance
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Adverse effects on the Cornea (6)
- Anaphylactic karatitis
- Allergic contact keratitis
- Irritative or toxic keratitis
- Phototoxic keratitis
- Cumulative deposition
- Toxic calcific band keratopathy
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Adverse effects on the Uvea (4)
- Hypertophy of pupillary frill
- Iridocyclitis
- Iris sphincter atrophy
- Iris color changes
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Adverse effects in IOP (2)
- Elevation- steriods
- Reduction- prostaglandins
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Adverse effects on the Crystalline lens
- Anterior subscapsular opacification
- Posterior subscapsular opacification
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Adverse effects on the Retina (3)
- Detachment
- Cystoid macular edema
- Maculopathy
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Systemic Medications that cause Dry eyes
ODAAA
ocular diseases are anoying and agrivating
- Oral retinoid
- Diuretics
- Antihistamines
- Antocholinergics
- Anticholinergic effect
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Indication of Oral retinoid
Cystic acne
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Indication of Antihistamines
Allergic rhinitis/sinusitis
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Indication of Anticholinergics
Parkinsons disease
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Indication of Diuretics
Hypertension
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Indication of Anticholinergic effect
Psychosis, anxiety
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Systemic medicatons that cause Blepharoconjunctivitis
IAGRPM
I ate gold and redness proceeded monthly
- Isotretinoin
- Amioradone
- Gold salts
- Rifampin
- Potassium penicillin
- Methotrexate
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Indication of Isotretinoin
Cystic acne
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Indication of Amioradone
Cardiac arrhythmias
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Indication of Gold salts
Arthritis
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Indication of Methotrexate
Neoplastic disease/ Arthritis
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Indication os Potassium penicilin
Antibiotic
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Indications of Rifampin
Tuberculosis
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Drugs that cause corneal toxicity
CPA
corneal problems anytime
- Chloroquine/Hydroxychloroquine
- Phenothiazines/Chlorpromazine
- Amiodarone
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What is the drug that produces whorl-like epihelial deposits below the horizontal midline
Chloroquine/ Hydroxychloroquine
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What is the drug that causes endrothelial dusting
Phenothiazines/ Chloropromazine
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What is the drug that causes whorl-like epithelial deposits (periphery)
Amiodarone
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What are the drugs that affect the pupil
PCAACOA
pupils can annoy and carry ocular adversions
- Phenotiazides
- CNS stimulants (Amphetamines, Methylphenidate, cocaine)
- Anticholinergic agents
- Antihistamines
- CNS depresents (Barbituates, Anxiety agents)
- Opiates (Heroin, codeine, morphine)
- Anticholinesterase (neogistigmine)
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Which drugs cause Mydriasis
- Anticholinergic agents
- CNS stimulants (Amphetamines, Methylphenidate, Cocaine)
- CNS depressants (Barbituates and Anxiety agents)
- Antihistamine
- Phenothiazides
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Which drugs cause Miosis
- Opiates (heroin, codine, morphine)
- Anticholiestinerase (Neogistigmine)
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Drugs that induce refractive changes (all myopia but oral hypoglycemic)
CAN O HO
- Chorticosteroids
- Acetazolamide
- NSAIDS
- Oral hypoglycemic
- Hydrochlorothizide
- Oral controceptives
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Which drugs alter color perception
DALICI
Dogs are least in color intensity
- Digitalis gycosides
- Amioradone
- LSD/mescaline
- Isoniazid/ Ethambutol
- Chloroquine/Thioridazine
- Indomethacin
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What drugs case a Tritin defect (color anomaly)
Indomethacin and Chloroquine/Thioridazine
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Which drug gives a red-green defect
Isoniazid/ Ethambutol
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Which drug causes Xanthopsia
digitalis glycosides
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Which drug causes colored halos
Amioradone
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Which drug has variable color anomalys
LSD/mescaline
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Which drugs induce retinal changes
NACOI
Never a change of ideas
- NSAIDS
- Antineoplastics
- Chloroquine/Hydroxychloroquine
- Oral contraceptives
- Indomethacin/Phenothiazides
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What retinal changes does chloroquine/hydroxychloroquine cause
Bull's eye maculopathy
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What retinal changes does NSAIDs cause
Retinal hemmorhages
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What retinal changes does oral controceptives cause
Vascular occlusive disease
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What retinal changes does Antineoplastics cause
Exudates posterior pole
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What retinal changes does Indomethacin/Phenothiazides
Pigmentary retinopathy
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What drugs cause ocular nerve changes
LEEASOU
Let everybody eat anything satisfying oral erges
- Lithium
- Ethambutol/ Isonaxid
- Ethanol
- Amioradone
- Sildenafil (viagra)
- Oral contraceptives
- Estrogen therapy
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Which drugs cause Papilledema
- Lithium
- Oral contracetives
- Amioradone
- Estrogen therapy
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Which drugs cause Optic neurtits
- Ethambutol/Isonazid
- Sildenafil (viagra)
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Which drug causes oxic neuropathy
Ethanol
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What herbal and nutritional suppliments cause ocular side effects
NECGEC
Never eat chamomile going in expensive cars
- Niacin
- Echinocea pupura
- Camomile
- Ginkgo biloba
- Excess Vitamen A
- Canthaxantihn
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What does Canthaxantihn cause
Crystals macular region
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What do Camimule and Echinacea purpura cause
Conjunctivitis
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What does Ginko bilaba cause?
Hyphema, Retinal Hemorrhages
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What does Niacin cause?
Macular edema, lid edema and dicoloration
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What does Excess Vitamen A cause
DES, night blindness
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Detection and Provention
- Medical history
- Drug History
- Elderly
- Pregnancy
- Children
- Record any side effect observed
- Take immediate action
- Monitor patient closely
- If not previously reported, notify the FDA
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B andrenoreceptors antagonists
- B blockers
- Ocular hypotensive drugs
- -Glaucoma
- -Ocular hypertension
-
5 drugs used as adrenergic antagonists in the eye
- Timolol
- Levobutanolol
- Metipranolol
- Carteolol
- Betaxolol
-These stimulate the B blockers in the ciliary epithelium which decrease the aq humor
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Timolol Brand name
- Timoptic Timolol Maleate
- Timolol XE- Gelrite vehicle
- Timoptic Ocudose PF
- Betimol- Hemihydrate salt
- Istalol- Lipophilic action
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Pharm of Timolol
- Conc- .25 or .5%
- A non cardioselective B blocker
- Negative ISA
- B2 adrenoreceptor
- Decrease IOP 25% -7mm Hg
- Admin- 1drop bid or 1 drop d
- Max effect achieved in 3 weeks- Contralateral effect, Morning application
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Clinical uses of Timolol
- Primary Open Angle Glaucoma
- Ocular Hypertension
- Pre and Post surgery
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Ocular side effects of Timolol
- Blepharoconjunctivitis - Erythema and edema
- Decreased corneal sensitivity
- Dry eye - Superficial punctate keratopathy
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Systemic side effects of timolol
- Amnesia
- Alteration lipid plasma profile
- Bradycardia
- Bronchospasm
- CHF
- Diarrhea
- Elderly special consideration
- Heart block
- Hypoglycemia
- Systemic hypotension
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Contraindications of Timolol
- Bradycardia
- Bronchial asthma
- COPD
- Children and infants
- Overt cardiac failure
- Severe heart block
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Differences between Levobunolol and Timolol
- Brand name-Betagan
- Is cheaper
- Differ in metabolic action
- Ocular side effects- No DES, less allergic reactions
Use for pts with not as high IOP- lowers 3-5 mm Hg
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Differences between Metipranolol and Timolol
- Brand name- Optipranolol
- Conc- .1-.6 normal 0.3%
- Dose - 1 drop b/d
- Cheaper
Ocular side effects- 3 + Uveitis and preorbital dermatitis
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Carteolol
- Brand name- Ocupress
- Has + ISA
- Conc- 1%
- Clinical use for Ocular hypertension and POAG
- Ocular side effests, the 3 + increased cornal anesthesia
- Systemic- reduced side effects
- Bronchial effect
- Bocturnal bradycardia
- High density lipoprotein
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Betaxolol Pharm
- Name- Betoptic S
- Affinity for B1 receptors - Cardioselective
- Has some neuroprotective actions
- Suspension- conc 0.25%
- For ocular hypotension and POAG
- -Use for COPD and asthma patients
Ocular side effect- Discomfort
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Betaxolol systemic side effects
- Slight reduction in systolic blood pressure
- CHF
- Myocardial Infarction
- Some respiratory problems (caution in COPD)
- Sinus brady
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Betaxolol Contraindications
- Sinus brady
- First degree AV block
- Cardiogenic shock
- Cardiac failure
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Cosopt
Timolol maleate and Dorsolamide HCL
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Combigan
Timolol and Brimonidine
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Azarga
Timolol and Brinzolamide
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DuoTrav
Timolol and Travaprost
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B blocker selection guide
- Best IOP control- avoid Betaxolol
- Cost- Timolol or metipranolol
- Comfort- Carteolol
- Hypercholesteremia- Carteolol
- Allergies to preservative -Timoptic XE, or Ocudose
- COPD and asthma- Betaxolol
- Pregnancy - None
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