Ans. b (Chloroquine). (Ref. KD Tripathi Pharmacology 5th ed. 239)CHLOROQUINE# Chloroquine is also found to induce remission in up to 50% patients of Rheumatoid arthritis. It is found to reduce monocyte interleukin I, consequently inhibiting B lymphocytes.# Chloroquine/hydroxychloroquine are employed in milder nonerosive disease in case methotrexate or sulfasalazine cannot be used, especially when only one or a few joints are involved.Chloroquine accumulates in tissues and produce toxicity, most disturbing of which is retinal damage (Bull's eye' maculopathy) and corneal opacity.# This is less common and reversible in case of hydroxychloroquine, which is preferred over chloroquine.# Other adverse effects are:- Rashes,- Graying of hair,- Irritable bowel syndrome,- Myopathy and- Neuropathy.Chloroquine has marked, rapid schizontocidal and gametocidal activity against blood forms of P. ovale and Plasmodi- um malariae and against susceptible strains of P. vivax and P. falci- parum. It is not active against intrahepatic forms (P. vivax and P. ovale).Systemic medications for treating infectionIndicationsOcular effects and side effectsSystemic side effectsChloramphenicolSevere bacterial infections such as abdominal typhus, Haemophilus influenzae mening it isDecreased visual acuity, vilsual field changes (scotomas or initation) optic neuritis or retrobulbar optic neuritis, local allergic reactions.Aplastic anemia, gastrointestinal dysfunction, fever, gray syndrome.Chloroquine and hydroxychloroquineMalaria.AmebiasisRheulmatoidArthritisDeposits on the cornea, changes in the retinal pigment epithelium (bull's eye maculopathy), visual field changesNausea, headache, bleaching of the hair, blood count changes.QuinineMalaria infectionDecreased visual acuity including toxic amblyopia, mydriasis, retinal damage (edema or vascular constriction), optic disc edema, scotomas.Hemolytic anemia, allergic reactions, hearing loss.EthambutolTuberculosisOptic neuritis, visual field changes, color vision defects.Hyperuricemia, nauseaIsoniazidTuberculosisOptic neuritis, atrophy of the optic nerve, visual field changes, optic disc edema, colorvision defects.Polyneuropathy (vitamin B6 metabolic dysfunction) allergic reactions, liver damage.PenicillinBacterial infectionsMydriasis, depressed accommodation, diplopia, optic disc edema with cerebral pseudotumor (secondary).Nausea, allergic reactions.RifampicinTuberculosisConjunctival hyperemia, blepharo conjunctivitis, color change (orange) of fluid is possible.Liver dysfunction, nausea, allergic reactions, hepatic enzyme inductionStreptomycinTuberculosisNystagmus, decreased visual acuity, toxic amblyopia, color vision defect, atrophy of the optic nerveOtotoxicity, nephrotoxicity, allergy.SulfonamidesBacterial infectionsMyopia, unspecific irritationAllergic reactions, nausea, photosensitivity.TetracyclineBacterial infectionsMyopia, optic disc edema with cerebral pseudotumor, decreased visual acuity, diplopia.Nausea, allergic reactions, liver damage.Gold saltsBase medication in rheumatoid arthritisDeposits on the eyelids, conjunctiva cornea (chrysiasis) and lens (rare) ptosis, nystagmus, and diplopia are rare.Blood count changes, nephrotoxicity, mucous membrane damage.Educational table:ADVERSE EFFECTS OF AN MALARIAL DRUGSDrugSide EffectsContraindications and cautionsChloroquine, hydroxy- chloroquineGI distress, pruritus, headache, dizziness, hemolysis, ocular dysfunctionAvoid in psoriasisMefloquineNVD, dizziness, syncope, extrasystoles, CNS effects (rare)Avoid in seizures, psychiatric disorders, and in cardiac conduction defectsPrimaquineGI distress, headache, dizziness, neutropenia, hemolysisAvoid in pregnancy, G6PD deficiency, and autoimmune disordersQuinineGI distress, cinchonism, CNS effects, hemolysis, hematotoxicityAvoid in pregnancy