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Drugs _ ophthalmology - hind

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					 Drugs & ophthalmology

       Girls work from
Dr.Sameer jamal lectures records
              2010
)‫(ممكن تجي سؤال عشان كده كتبتها ههههه‬   ‫العين مرآة الجسم‬

                                  Eye Drugs




      Eyes side                                 Systemic
       effect                                  side effect



                                   Systemic
                                    Drugs
• Eye drops can help or kill the patient
• There are well known systemic drugs that has
  a serious effects on the eye. So , as a GP u
  have to be aware of them and refer the pt. to
  ophthalmologist from the beginning.
• Systemic medications side effects on the eye
  usually bilateral blindness.
• You should ask about the eye drops when you
  take a drugs history from the pt.
                                         Drugs category:
1- Parasympathomimetics
2- Parasympatholytics.
3- sympathomimetics
4- sympatholytics
5- Antibiotic, antiviral, anti fungus
6- NSAID
7- Steroid
8- Antiglaucoma , antiallergic.
9- Decongested: as prozolin
-   it’s off counter medications and it’s a vasoconstrictor, it just will treat the sign not the
    problem .
-   So as a GP never prescribe it for your pt. and never prescribe any vasoconstrictors drops
    it’s the ophthalmologist job.
-    ‫مثال لو المريضة سهرانة طول الليل وعينها محمرة تحط القطرة يروح االحمرار الن الدوا يعمل انقباض للعظلة بعدين انبساط يعني زي كان رياضة‬
    ‫لعضالت االوعية الدموية ومع االستمرارية ممكن المريضة تحط القطرة والعضلة تنبسط وماترجع تنقبض ابدا ويسير المريض عندو احمرار مزمن‬
     ‫طول الحياة‬
    Chronic red eye for life.
Parasympathomimetics: it constrict the
                          pupils
Drugs             Uses                   Side Effect

1-pilocarpine     1- glaucoma            1- GIT upset
                  2- pupil constrictor   2- lacrimation and salivation
                  3-accommodative        3- anesthesia apnea: in anesthesia
                  esotropia              we use succinilcoline as muscle
2-Echothiophate                          relaxant and the esterase enzyme
                                         break it but if the pt. was on
                                         Echothiophate his body will not
                                         respond to the esterase enzyme so
                                         the apnea will be prolonged and
                                         the pt. will die.
                                         Because of that u have to take a
                                         good drugs history before any
                                         operations. Especially in pts. With
                                         Glaucoma
                   Parasympatholytics
Drugs                         Uses                         Side Effect

1- Atropin                    1- pupil dilator              1- Dizziness
-homatropine                                                2- fever
2-cyclogyl                    2- refraction: to identify    3- nausea
3- Mydriacyl                  the power of the patient’s 4- vomiting
( tropicamide) is the only    glasses correctly in < 20     5- hallucinations
one can be prescribed by a    years pt.                     6- AACA
GP because it has less side                                 (Acute angel closure
effects                       3- uveitis: coz iris stick to glaucoma)
                              the lens it will give         - Any drugs can dilate the
                              irregular pupil so we dilate pupil could induce AACG so
                              the pupil to prevent it from don’t induce dilatation
                              stickness                     unless u have to
                                                            7- tachycardia
                   sympathomimitics
Drugs                      Uses                       Side Effect

-Phenylephrine             -Pupil dilatations         -Acute MI
                                                      - acute hypertension.
                                                      - arrhythmias
- Alphagan:is an epinephrin - treatment of Glaucoma
derivative
              Sympatholytics
Drugs            Uses              Side Effect
- timolol        -Glaucoma         -Hypotension
-                                  - arrhythmias

                                   ‫نفس االثار الجانبية حق البيتا‬
                                    ‫بلوكر‬



• Every eye medications can cause any problems
It may ( vascular , respiratory , Gastric, Brain ant
   … ect.)
                   For a GP Don’t :
1- dilate the pupil unless you have to: if you want to use just use
   Mydriacyl and one drop in each eye.
2- use combination antibiotics drops:
- because if the patient develop sensitivity you will not know from
   witch one.
3- use antibiotics with steroid
4- Use steroid: topical steroid is not for GP it’s the job of
   ophthalmologist because the complications is a lot.
5- Use decongestant.
NB:
- Drops on eye is like an IV.
- Ask your pt. what eye medications he is on.
- The most common ocular condition the GP treated is Acute
   conjunctivitis ttt by topical antibiotics qid.
    Systemic toxicity to the eye form
         systemic medications
• Steroid complications :
- Cataract
- Glaucoma
NB: it’s just a matter of time, the longer the pt. on
   steroid the more likely he is going to develop
   cataract and glaucoma.
- If the pt. is going to use steroid for more than 4
   weeks so he must see the ophthalmologist , but
   for short term use (3-4) days it doesn’t matter.
          Ethamabutolo: it’s anti Tb
• A lot of pt. loss their vision permanently form it , so any pt. is
  going to start with antituberculous .He must have a full eye
  examination from the beginning and follow up with the
  ophthalmologist
• Toxic it can cause Optic Neuropathy
• It’s Dose related
   Dose                Incidence (pt. may develop optic Neuropathy)
   15mg/kg/day         <1%
   25mg/kg/day         5%
   50mg/kg/day         25 %

• it can improved and it can be permanent.
• INH is anti tb drugs but it has less side effect than
  Ethamabutolo.
     Systemic anti cancer agents
• Tamoxifen citrate (Nolvadex)
• Cyclosporine
They can cause maculopathy and interfere with
   vision.
 - their side effects are reversible
Chloroquine: is anti malaria and it’s used also
      in ttt of Rheumatoid arthritis and SLE
• Macular toxicity
• Bull’s eye maculopathy
- Cumulative dose is:
300 g total dose
- Daily dose:
250 mg / day
• Irreversible
• The pt. must be seen by the ophthalmologist
  before he start these drugs because it’s dose
  related.
                   Digitalis
• Symptoms of digitalis toxicity that you have to
  counsel the pt. about them are :
- Xanthopsia ‫كل شئ يشوفو اصفر‬
- Blurred vision
- White halos
- Flash lights
NB: digitalis toxicity it doesn’t cause permanent
  visual loss.
                   OCP
• It can cause :
 - Vascular eye and brain occlusion
- Migrain
- Ischemic optic neuropathy
- Pseudotumor cerebri:it’s the most common
   complication associated with oral
   contraceptive pills.
• Amiodarone is an antiarrhythmic agent.
- It affect cornea and ON and it can cause optic
  neuropathy.

• Antipsychotics: can affect the vision by
  involving the macula.

• Phenytoin (diphenylhydantoin) is antiepileptic
  drugs. Is the commenst one can cause
  ophthalmoplegia and nystagmus.

				
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posted:11/23/2012
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