Drug interactions
Chloroquine has a number of drug–drug interactions that might be of clinical concern:
Ampicillin- levels may be reduced by chloroquine;
Antacids- may reduce absorption of chloroquine;
Cimetidine- may inhibit metabolism of chloroquine; increasing levels of chloroquine in the body;
Cyclosporine- levels may be increased by chloroquine; and
Mefloquine- may increase risk of convulsions. Overdose
Chloroquine, in overdose, has a risk of death of about 20%. It is rapidly absorbed from the gut with an onset of symptoms generally within an hour. Symptoms of overdose may include sleepiness, vision changes, seizures, stopping of breathing, and heart problems such as ventricular fibrillation and low blood pressure. Low blood potassium may also occur.While the usual dose of chloroquine used in treatment is 10 mg/kg, toxicity begins to occur at 20 mg/kg, and death may occur at 30 mg/kg. In children as little as a single tablet can cause problems.Treatment recommendations include early mechanical ventilation, cardiac monitoring, and activated charcoal. Intravenous fluids and vasopressors may be required with epinephrine being the vasopressor of choice. Seizures may be treated with benzodiazepines. Intravenous potassium chloride may be required, however this may result in high blood potassium later in the course of the disease. Dialysis has not been found to be useful. Pharmacology
Absorption of chloroquine is rapid and primarily happens in the gastrointestinal tract. It is widely distributed in body tissues. Protein binding in plasma ranges from 46% to 79%. Its metabolism is partially hepatic, giving rise to its main metabolite, desethylchloroquine. Its excretion is ≥50% as unchanged drug in urine, where acidification of urine increases its elimination.
This conjunctivoplasty surgery to correct Conjunctivochalasis typically involves resection of an ellipse-shaped segment of conjunctiva just inferior to the lower lid margin, and is usually followed either by suturing or amniotic membrane graft transplantation to close the wound.Further techniques have been developed such as the Reservoir Restoration which aim to replace the degenerated Tenon’s, deepen the inferior fornix to restore the normal anatomy and physiology, and facilitate restoration of the normal tear film. In this surgical procedure, a crescent-shaped area of the conjunctiva is recessed along a limbal peritomy with a maximum anterior-posterior width no more than 3 mm. Diseased and dissolved Tenon’s are undermined leaving a large bare scleral defect. Cryopreserved amniotic membrane is slid over the scleral bed with fibrin glue and tucked under the conjunctiva to recreate the fornix. Immediately postop, the surgeon should note an improved anatomical definition and deepening of the inferior fornix. References


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