Cardiovascular effects of commonly used ophthalmic medications

Shiuey, Yichieh; Eisenberg, M.P.H. Mark J.

doi:10.1002/clc.4960190104

Cited by 30 publications

(24 citation statements)

References 20 publications

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“…These criteria do not include drugs in common use in Brazil, such as antitussives, cinnarizine, diltiazem, piracetam, quinolones, xanthines, creams, pomades, and eyewashes that should be prescribed with caution to the elderly. As an example, we cite the pharmacological action of certain eyewashes, which may lead to cardiovascular changes and psychiatric disorders in elderly patients [43,44]. Thus, the prevalence of PIM use in this study, although extremely high, may still be underreported.…”

Section: Discussionmentioning

confidence: 97%

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

Lima

Garbín

et al. 2013

BMC Geriatr

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BackgroundThe use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study’s objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings.MethodsWe performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression.ResultsAmong the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404).ConclusionsThe results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.

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Section: Discussionmentioning

confidence: 97%

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

Lima

Garbín

et al. 2013

BMC Geriatr

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“…For example, the alpha receptor adrenergic stimulant, phenylephrine, can cause tachycardia and hypertension, the b blockers timolol and betaxolol can cause bradycardia, hypotension, and congestive heart failure, and tropicamide, an anticholinergic drug, can cause tachycardia, respiratory arrest in young children, and may also act as either a CNS depressant or stimulant (26)(27)(28). To date, it has been assumed that all systemic side effects of topically applied medications were due to drainage of these drugs from the eye into the conjunctival and nasal mucosal vessels, and their dissemination throughout the body.…”

mentioning

confidence: 99%

Accumulation of Porcine Insulin in the Rat Brain and Cerebrospinal Fluid Following Ocular Application

Koevary

Lam²,

Patsiopoulos³

et al. 2003

Journal of Ocular Pharmacology and Therapeutics

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We previously reported that insulin accumulated in the retina and optic nerve following ocular application. Since the optic nerve is surrounded by meninges and cerebrospinal fluid (CSF) and since it extends back to the thalamus, we examined whether the topical application of insulin eye drops also resulted in the accumulation of insulin in the CSF and brain. The data presented in this paper show that this is in fact the case. Following the ocular application of a 0.75% solution of porcine insulin, significant concentrations of insulin were demonstrable in the CSF extracted from the cisterna magnum, as well as in three brain regions. While it is not yet clear how insulin got into these target tissues, our data argue against a mechanism involving uptake from the blood (a fraction of topically applied compounds normally enters the vasculature through the conjunctiva and nasal mucosa). It is theorized that insulin may enter the CSF surrounding the optic nerve and by so doing, not only disseminate throughout the CSF space but also throughout the brain. The implications of these findings for central nervous system drug delivery are discussed.

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“…Topical ophthalmic medications bypass the first-pass metabolism by the gastrointestinal and hepatic systems by virtue of which they are directly absorbed into the systemic circulation 4. The immature cardiovascular and nervous systems compounded by the low body mass of premature infants makes them highly susceptible to the toxicity of these medications 5…”

Section: Discussionmentioning

confidence: 99%

Retinopathy of prematurity screening leading to cardiopulmonary arrest: fatal complication of a benign procedure

Agrawal¹,

Patri

Kalavakunta

et al. 2016

BMJ Case Reports

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A 6-week-old female infant born at 31 weeks of gestation was brought to the ophthalmology office for retinopathy of prematurity (ROP) screening. One drop of phenylephrine (2.5%) and tropicamide (1%) ophthalmic solution was instilled in each eye for ROP evaluation. She was breast fed about 5 min after receiving the medication. She was covered in a blanket and soon her mother could not feel her suckling. Cardiopulmonary resuscitation was initiated with return of spontaneous circulation in 1-2 min. She was admitted to the paediatric intensive care unit and monitored overnight. After an uncomplicated hospital course, she was discharged the following day. It was determined that the eye drops had induced cardiopulmonary arrest (CPA) as apnoea and bradycardia of prematurity resolve by 36 weeks and CPA occurred within minutes of the medication administration. Identification of CPA, prompt intervention and awareness of the offending agent is of prime importance in management of such complications.

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Cardiovascular effects of commonly used ophthalmic medications

Cited by 30 publications

References 20 publications

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

Accumulation of Porcine Insulin in the Rat Brain and Cerebrospinal Fluid Following Ocular Application

Retinopathy of prematurity screening leading to cardiopulmonary arrest: fatal complication of a benign procedure

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