Visual side effects

The most common visual side effects are blurring, dimness of vision, flickering or flashing lights, color vision (yellow, green, red, and white), cycloplegia, and diplopia. 

Clomiphene citrate (Clomid) is an orally administered nonsteroidal agent widely used for treatment of infertility. Visual side effects associated with clomiphene therapy include nonspecific blmring of vision and various entop-tic phenomena, including flashes of light, scintillations, heat waves, and prolonged afterimages. The symptoms can occur as early as several days after treatment is started and usually disappear within several days to several weeks after treatment is discontinued. Cases have been reported, however, in which patients remained symptomatic from 2 to 7 years after discontinuing the medication. 

The authors concluded that health care professionals should be aware of hydroxocobalamin s mechanism of action, as well as its stunning visual side effect which has the potential to interfere with therapy. 

Although side effects are usually mild, treatment with brimonidine tartrate includes oral dryness, ocular hyperemia, burning and stinging, headache, visual blurring, foreign body sensation, fatigue drowsiness, ovular allergic reactions, and ocular pruritus. 

Response fluctuations occur with disease progression as the patient s dopamine reserves are depleted in the brain and as a complication of PD treatment. Motor fluctuations include delayed peak response, early wearing off, random unpredictable on-off, and freezing. Dyskinesias include chorea, dystonia, and diphasic dyskinesia. Wearing off can be visualized by imagining the therapeutic window of dopamine narrowing over time. The therapeutic window is defined as the minimum effective concentration of dopamine required to control PD symptoms (on without dyskinesia) and the maximum concentration before experiencing side effects from too much dopamine (on with dyskinesia). Early in the disease, a dose of... 

Additional side effects have been noted in some women. Women with contact lenses may have visual changes and more disturbances with lenses. If normal saline eye drops do not help, referral to an ophthalmologist is recommended. Melasma and chloasma can occur secondary to estrogen stimulation of melanocyte production. Women with darker pigmentation are more susceptible. The melasma may not be... 

Flutamide is an androgen receptor antagonist that achieves peak concentrations approximately 2 to 4 hours after an oral dose. Flutamide is metabolized extensively, with a terminal half-life of about 8 hours. Bicalutamide achieves peak concentrations approximately 6 hours after the dose, with a terminal half-life of 6 to 10 days. Bicalutamide undergoes stereospecihc metabolism, where the S-enantiomer is cleared more rapidly by the liver than the -enantiomer. Nilutamide achieves peak serum concentrations between 1 to 4 hours after an oral dose and has a terminal half-life of 38 to 60 hours. Nilutamide is metabolized extensively, with less than 2% excreted as unchanged drug by the kidney. Side effects common to these agents are hot flashes, gynecomastia, and decreased libido. Flutamide tends to be associated with more diarrhea and requires three-times-daily administration, whereas bicalutamide is dosed once daily. Nilutamide may cause interstitial pneumonia and is associated with the visual disturbance of delayed adaptation to darkness. 

The answer is c. (Hardman, pp 156-158.) A wide variety of clinical conditions are treated with antimuscarinic drugs. Dicyclomine hydrochloride and methscopolamine bromide are used to reduce Gl motility, although side effects—dryness of the mouth, loss of visual accommodation, and difficulty in urination—may limit their acceptance by patients. Cyclopentolate hydrochloride is used in ophthalmology for its mydriatic and cycloplegic properties during refraction of the eye. Trihexyphenidyl hydrochloride is one of the important antimuscarinic compounds used in the treatment of parkinsonism. For bronchodilation in patients with bronchial asthma and other bronchospastic diseases, ipratropium bromide is used by inhalation. Systemic adverse reactions are low because the actions are largely confined to the mouth and airways. 

The major clinical study underpinning product approval was a randomized, double blind study in which 71 CTCL patients were administered the product at one of two dosage levels (9 or 18 [tg kg 1 day ) overall, 30 per cent of patients experienced an objective tumour response. Serious side effects potentially associated with product administration include acute hypersensitivity-type reactions, vascular leak syndrome and visual impairment. Additional adverse reactions include flu-like symptoms, headache, hyper- or hypo-tension, as well as digestive upset. Ontak is manufactured by Seragen Inc. and is distributed by Ligand Pharmaceuticals. 

Initially, anxious patients should be monitored once to twice weekly for reduction in anxiety symptoms, improvement in functioning, and side effects. The Visual Analog Scale may assist in the evaluation of drug response. 

Phenytoin is an anti-epileptic drug. Patients taking anti-epileptic drugs are advised to take the medicine routinely, as directed, to stabilise and to avoid epileptic attacks as much as possible. Phenytoin has a narrow therapeutic index so it is important to identify side-effects. It may cause blood disorders. Patients are therefore advised to report immediately any symptoms of bruising or unexplained bleeding. Visual symptoms as a result of phenytoin do not commonly occur. Their occurrence may indicate overdosage. 

Ivabradine is used in the treatment of angina in patients in normal sinus rhythm. It acts on the sinus node resulting in a reduction of the heart rate. It is contraindicated in severe bradycardia (heart rate lower than 60 beats/ minute), cardiogenic shock, acute myocardial infarction, moderate-to-severe heart failure, immediately after a cerebrovascular accident, second and third-degree heart block and patients with unstable angina or a pacemaker. Side-effects include bradycardia, first-degree heart block, ventricular extrasystoles, headache, dizziness and visual disturbances, including blurred vision. 

Nalorphine was the first compound used for narcotic (heroin in particular) overdose treatment however, it exhibits a number of side effects such as visual hallucinations, and therefore its use is prohibited in some countries. The most popular synonym for this drug is narkan. 

The major toxicity associated with ethambutol use is retrobulbar neuritis impairing visual acuity and red-green color discrimination this side effect is dose related and reverses slowly once the drug is discontinued. Mild GI intolerance, allergic reaction, fever, dizziness, and mental confusion are also possible. Hyperuricemia is associated with ethambutol use due to a decreased renal excretion of urates gouty arthritis may result. 

While its detailed mechanism of action is unknown, it is an effective blood schizonticide that is, it acts against the form of the parasite responsible for chnical symptoms. Orally administered mefloquine is well absorbed and has an absorption half-hfe of about 2 hours the elimination half-hfe is 2 to 3 weeks. Among its side effects are vertigo, visual alterations, vomiting, and such CNS disturbances as psychosis, hallucinations, confusion, anxiety, and depression. It should not be used concurrently with compounds known to alter cardiac conduction or prophylactically in patients operating dangerous machinery. It should not used to treat severe malaria, as there is no intravenous formulation. 

Side effects occasionally include gastrointestinal distress, urticaria, and dizziness. Neurological symptoms of ataxia, hypotonia, visual disturbances, and exacerba-... 

The major side effect is myelosuppression, which contributes to fevers and infections in as many as half of treated patients. Nausea and vomiting are mild. Occasional neurotoxicity has been noted at higher doses, with agitation, confusion, and visual disturbances. 

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