8 - Toxicology

Question 1

Cornea

-whorl keratopathy (5 drugs, 1 systemic dz)

Answer 1

CHAI-T
Chloroquine
Hydroxychloroquine
Amiodarone
Indomethacin (gout)
Tamoxifen

Systemic dz: Fabry’s

Question 2

Cornea

-dry eye disease

Answer 2

All drugs preserved with BAK, incl topical ophthalmic glaucoma meds

Question 3

Cornea

-SPK (2)

Answer 3

Isotretinoin: severe dryness (MGs)

Topical ophthamic aminoglycosides: TobraGent = ocular surface disease

Question 4

Cornea

-endothelial/descemet’s membrane pigmentation (3)

Answer 4

ChlorpromaZINE
ThioridaZINE
PromethaZINE (1st gen antihistamine)

Question 5

Cornea

-stromal gold deposits

Answer 5

Gold salts

-can result in visual asymptomatic yellow-brown deposits within posterior stroma/descemet’s (ocular chrysiasis)

Question 6

Cornea

-delayed corneal healing

Answer 6

Topical ophthalmic and oral corticosteroids

Question 7

Amiodarone

• use
• ocular SEs (3)

Answer 7

Anti-arrhythmic

Whorl K
Anterior subcapsular lens deposits
NAION (1-2%)

Question 8

Lens

-anterior subcapsular effects (4)

Answer 8

“May Trigger Anterior Cataracts”
Miotics (vacuoles)
Thioridazine
Amiodarone
Chlorpromazine

Question 9

Lens

-posterior subcapsular cataracts

Answer 9

Corticosteroids

-dose-dependent, irreversible, Hispanics at highest risk

Question 10

Conj and Lids

-blepharoconj-itis, dryness, lid edema

Answer 10

Isotretinoin (MGs + Zeis)

Question 11

Conj and Lids

-subconj hemorrhage (1 drug, 2 other)

Answer 11

NSAIDs/blood thinners (warfarin, clopidogrel, dipyradimole)

Valsalva

Clotting dz

Question 12

Conj and Lids

-Steven-Johnson syndrome, lid edema (rare)

Answer 12

Sulfonamides

Question 13

Conj and Lids

-pigmented cysts on conj

Answer 13

Tetracyclines

Question 14

Conj and Lids

-subconj hemorrhage, conj hyperemia

Answer 14

Sildenafil (vasodilates)

Question 15

Conj and Lids

-conj hyperemia, incr growth of lashes, incr periorbital pigmentation

Answer 15

PGAs

Question 16

Conj and Lids

-conj-itis in 1% of pts

Answer 16

Tamiflu

Question 17

Lacrimal system

-decr tear secretion (6 categories)

Answer 17

Anticholinergic effects (decr PNS): ANTI-cholinergics, ANTI-depressants, ANTI-histamines, ANTI-psychotics

Isotretinoin

Beta blockers (doesn’t make sense, just know it)

Hormone therapies: oral contraceptives, replacement therapies

ADHD meds: methylphenidate, dextroamphetamine

Diuretics: HCTZ, chlorothiazide, furosemide, triamterene

Question 18

Pupil size

-mydriasis

Answer 18

Anticholinergic effects (decr PNS): ANTI-cholinergics, ANTI-depressants, ANTI-histamines, ANTI-psychotics

*watch for angle closure with narrow angles

Question 19

Pupil size

-miosis (3)

Answer 19

Opiates: morphine, heroine, cocaine

AChase inhibitors (indirect cholin agonists)

Pilocarpine

Question 20

EOMs/eye movements

-nystagmus (3)

Answer 20

Phenytoin (“funnytoin”)

Phenobarbital

Salicylates (NSAIDs)

Question 21

EOMs/eye movements

-diplopia (3)

Answer 21

Phenytoin

Anti-depressants

Anti-anxiety

Question 22

EOMs/eye movements

-smooth pursuit impairment

Answer 22

Alcohol

Question 23

EOMs/eye movements

-oculogyric crisis (2)

Answer 23

Phenothiazines

Cetirizine

*oc = EOMs undergo spastic, abnorm musc contractions that leave the eye in abnorm positions (esp elev)

Question 24

Sclera and uvea

-intraoperative floppy eyelid syndrome

Answer 24

Alpha1 blockers (for BPH): tamsulosin, terazosin, prazosin

Question 25

Sclera and uvea | -blue sclera (2)

Answer 25

Corticosteroids Minocycline (tetracycline)

Question 26

Sclera and uvea | -secondary angle closure (1)

Answer 26

Topiramate - choroidal swelling -> iris forward into apposition with TM - also myopic shift

Question 27

Optic nerve | -retrobulbar optic neuritis, B/Y defects, entopic phenomena

Answer 27

Digoxin

Question 28

Optic nerve | -optic neuritis (4 + 2 unlikely)

Answer 28

Ethambutol = retrobulbar, bilateral Chloramphenicol Streptomycin Sulfonamides Unlikely: isoniazid, methotrexate

Question 29

Optic nerve | -NAION (4)

Answer 29

``` VIAgra Viagra Vardenafil Imitrex Amiodarone ```

Question 30

Optic nerve | -optic neuritis, papilledema, pseudotumor cerebri

Answer 30

Oral contraceptives

Question 31

Retina | -bull’s eye maculopathy

Answer 31

Chloroquine >>> hydroxy

Question 32

Retina | -CME (esp topical ophthalmic in aphakic eyes)

Answer 32

Epinephrine

Question 33

Retina | -white/yellow crystalline deposits (esp macula), +/- macular edema

Answer 33

Tamoxifen

Question 34

Retina | -pigementary retinopathy (may app similar to bull’s eye) (3)

Answer 34

ThioridaZINE ChlropromaZINE PromethaZINE

Question 35

Retina | -retinal hemorrhage, pigmentary changes (mottling, esp macular)

Answer 35

Indomethacin (gout, also whorl K)

Question 36

Retina | -retinopathy: white, shiny emboli w/in arterioles

Answer 36

Talc

Question 37

Retina | -loss of color vision, nyctalopia

Answer 37

Isotretinoin

Question 38

Retina | -retinal hemorrhage

Answer 38

NSAIDs

Question 39

Retina | -vasculopathy (incl A/V occlusions), retinal hemorrhage

Answer 39

Oral contraceptives

Question 40

Retina | -macular edema

Answer 40

Zidovudine

Question 41

Intracranial hypertension (6)

Answer 41

``` CATS Contraceptives Accutane, vit A Tetracycline Synthroid, steroids ```

Question 42

IOP | -systemic that decr (4)

Answer 42

BB Cardiac glycosides (digoxin) Alcohol Cannabinoids

Question 43

IOP | -systemic that incr (4 categories)

Answer 43

Anticholinergics: ANTIs, atropine, scopolamine Short-acting B2 agonists (albuterol, levalbuterol, terbutaline) Pseudophedrine Corticosteroids