Friday, 6 March 2015

Holi in medical field..

Holi in medical field..
[Courtesy by : - Dr. Prem Nyati ( Professor Pharmac ,MGM Medical College , Indore )

A ) Drugs affecting colour vision:
Digitalis can produce blurring of vision and white vision (inability to see red and green colour), border of white colour appears around dark objects. There can be Chromatopsia (Yellow vision), transient amblyopia (decreased vision) and scotomas (isolated areas of loss of vision).
Ethambutol can reduce visual acuity and loss of ability to differentiate red from green; hence it may produce green vision.
Sildenafil can produce visual disturbances due to Phosphodiasterae-6 inhibition that impairs the colour vision. Object may appear blue.

B ) Drugs colouring the tears & contact lens:
Rifampin gives an orange red color to different secretions like urine, faeces, saliva, sputum, tears, and sweat. Beside rifampin few other drugs such as tetracycline, nitrofurantoin, phenazopyridine, etc can change the colour of tears. Contact lenses can absorb this colouring permanently and thus there may be change in the colour of the lenses.

C ) Red man or red neck syndrome ;
Vancomycin can produce extreme flushing in face and neck region, which is referred as red man or red neck syndrome. It is due to massive release of histamine by rapid i/v infusion and can be prevented by antihistamines and slow infusion.

D ) Purple toe syndrome ;
Warfarin can produce a reversible, painful, blue tingled discoloration of plantar surfaces and side of toes, known as purple toe syndrome. It is due to release of cholesterol emboli from atheromatous plaque.

E ) Gray baby syndrome
Chloramphenicol can lead to Gray baby syndrome in premature neonates due to reduced conjugation and excretion. This has a high mortality, initiates with poor feeding, irregular breathing, cyanosis and CV collapse.

F ) Drugs affecting urine & stool colour -
Phenolphthalein- about 15% is absorbed and eliminated by kidney so urine becomes pink or red if it is alkaline.
Methocarbamol, amitryptiline and nitazoxanide may colour the urine with a green tinge.
Furazolidine can give black colour to urine.
Triamterine and methylne blue can colour the urine blue.
Orange to red coloured urine and stool is seen with rifampin.
Riboflavin and tetracyclines can colour the urine yellow.
Black coloured stool can be seen with iron & bismuth

G ) Drugs colouring the teeth ;
Tetracyclines are deposited in the calcified tissues like bones and teeth perhaps because of chelation and formation of tetra calcium orthophosphate complex. There is yellowish brown discoloration of teeth due to ultraviolet absorbing effect. This may be a permanent discoloration. The period of greatest risk is from mid pregnancy to six months of postnatal period for deciduous anterior teeth and from six months to five years of age for permanent anterior teeth.
Chlorhexidine can also lead to brownish discoloration of teeth.
Iron elixir contact can produce gray- black staining of teeth (putting the solution on the back of tongue by a dropper minimizes the risk).
Silver sulphide containing dental amalgam can also impart gray-black colour to teeth.

H ) Drugs affecting skin colour -
Clofazimine can produce red brown discoloration of skin.
Phenothiazines, chloroquine, gold salts, bleomycin, busulfan, cyclophosphamide, amiodarone can produce bluish-grey pigmentation
There may be dark brown patches on face by phenytoin, estrogens (cholasma)

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