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Boards - Oc Pharm > Autonomic Drugs > Flashcards

Autonomic Drugs Flashcards

1
Q

Cholinergic agonist drugs

A

Direct:
Pilocarpine
Bethanechol
Carbachol
AcH

Indirect:

Edrophonium
Neostigmine
Echothiopate
Pyridostigmine
Isoflurophate
Donepezil

(Pralidoxime reverses AChE effects)

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2
Q

Pilocarpine: decrease aqueous production, increase uveoscleral outflow, or increase cornealscleral outflow?

A

Increase TM/corneoscleral outflow

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3
Q

PILOCARPINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Direct cholinergic agonist
  2. Accommodative esotropia, acute angle closure <40mmHg b4 LPI, glaucoma QID (rare), presbyopia, differentiating CN III palsy from sphincter tear, diagnosing Adie’s pupil
  3. Stimulates the longitudinal muscle of the CB which pulls posteriorly on the scleral spur which opens the trabecular spaces = increased outflow (corneoscleral)
  4. SE: Brow aches, headaches, myopic shift, cataracts (ASC), RD, secondary angle closure (pupillary block from lens moving anteriorly)
    CI: high myopia
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4
Q

___D of refractive error = ___mm axial length change

A

3, 1

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5
Q

Percentage of pilocarpine used to diagnose Adie’s

A

0.125%

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6
Q

Percentage of pilocarpine used for Vuity

A

1.25%

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7
Q

EDROPHONIUM

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Indirect cholinergic agonist (acts on AChE)
  2. Diagnosis of MG (Tensilon test)
  3. Resolves ptosis by increasing amt of AChE
  4. N/A
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8
Q

NEOSTIGMINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Indirect cholinergic agonist
  2. Dx or Tx MG
  3. Increases AcH at receptors by blocking AChE
  4. N/A
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9
Q

What do we rule out before prescribing Indirect cholinergic agonists?

A

Thymoma w/ chest x-ray

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10
Q

Tests to order to assess ACh levels

A

ACh Abs
-binding
-blocking
-modulating

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11
Q

ECHOTHIOPHATE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Indirect cholinergic agonist
  2. Dx and Tx of accomm. esotropia
  3. Increases AcH at receptors by blocking AChE
  4. N/A

IRREVERSIBLE

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12
Q

PYRIDOSTIGMINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Indirect cholinergic agonist
  2. TX OF MG
  3. Increases AcH at receptors by blocking AChE
  4. N/A
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13
Q

Drug used to reverse effects of AChE inhibitors - mostly from pesticide poisoning

A

Pralidoxime

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14
Q

Cholinergic antagonist drugs and MOA

A

Atropine
Scopolamine
Homatropine
Cyclopentolate
Tropicamide

Botulinumtoxin (Botox)

Block ACh at muscarinic receptor sites

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15
Q

SCOPOLAMINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist
  2. Motion sickness, anti-nausea
  3. Blocks AcH
  4. SE: CNS toxicity, hallucinations, amnesia, confusion, etc.
    CI: DOWN SYNDROME
  5. 5-7 days
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16
Q

TROPICAMIDE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist
  2. Dilation
  3. Blocks AcH
  4. Very safe :)
  5. 4-6 hours

Fastest onset and shortest duration for mydriasis

17
Q

ATROPINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist
  2. Uveitis/break PAS, tx of mild/moderate amblyopia
  3. Blocks AcH
  4. SE: Dry mouth, dry/flushed skin, faster HR, fever (effects on hypothalamus)
    CI: DOWN SYNDROME, <3yo, fever >100.4, incorrect dosage
  5. 7-12 days
18
Q

CYCLOPENTALATE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist
  2. Cycloplegic refractions, anterior uveitis
  3. Blocks ACh
  4. N/A
  5. 24 hours

Fastest onset and shortest duration of cycloplegia effects

19
Q

HOMATROPINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist
  2. Anterior uveitis (SOC),
  3. Blocks ACh, reduces pain by paralyzing the CB and sphincter, Stabilizes the blood- aqueous barrier to limit passage of blood contents
  4. Anticholinergic toxicity
  5. 1-3 days
20
Q

Botox

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Duration
A
  1. Cholinergic antagonist (Nicotinic receptors - skeletal muscle: orbicularis oculi, procerus, corrigator)
  2. Blepharospasm
  3. Blocks ACh release @ neuromuscular junction
  4. SE: ptosis
  5. A few months
21
Q

Adrenergic agonist drugs

A

Phenylephrine
Naphazoline/Tetrahydrozoline
Brimonidine
Apraclonidine
UPNEEQ

22
Q

PHENYLEPHRINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Adrenergic agonist
  2. DIlation w/o cycloplegia via radial muscle, palpebral widening, (muller’s muscle), blanches episcleritis, dx horner’s syndrome, breaks Post. synechiae (10%)
  3. Acts on receptors on iris dilator (a1), muller’s muscle, blood vessels (vasoconstriction), No effect on beta receptors
  4. SE: CV events (arrhythmia, hypertension)
    CI: PHENYL 10%: PTS TAKING MONOAMINE OXIDASE INHIBITORS, TRICYCLIC ANTIDEPRESSANTS, AND ATROPINE, GRAVES’ DISEASE
23
Q

NAPHAZOLINE/TETRAHYDROZOLINE(Visine)

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Adrenergic agonist
  2. Topical ocular decongestants
  3. Constrict conj. vessels (arteries)
  4. Fixed dilated pupil (alpha effects on radial muscle)

Greater alpha than beta effects, can depress CNS

24
Q

UPNEEQ

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Adrenergic agonist
  2. Blepharoptosis
  3. Stimulates alpha receptors on Muller’s muscle (1mm lift)
  4. Decreased BP, dilation
25
Q

Brominidine: decrease aqueous production, increase uveoscleral outflow, or increase cornealscleral outflow?

A

Decrease aqueous humor production
Increase uveoscleral outflow

26
Q

BRIMONIDINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Adrenergic agonist
  2. Glaucoma, neuroprotective properties
  3. Act on a2 (inhibitory) receptors on MACI (step on MACI) to decrease aqueous humor production and increase uveoscleral outflow
  4. SE: Follicular conjuctivitis, miosis, dry mouth
    CI: MOAIs, phenyl 10%
27
Q

APRACLONIDINE

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Adrenergic agonist
  2. acute IOP lowering, dx Horner’s syndrome
  3. Act on a2 (inhibitory) receptors on MACI (step on MACI)
  4. Tachyphylaxis after 8 days

Not effective as chronic therapy

28
Q

Adrenergic Antagonist drugs (Beta blockers)

29
Q

1 SE of beta blockers

A

Depression

30
Q

Other SEs of Beta Blockers

A

Bradycardia, Bronchospasm (asthma, COPD)
Erectile dysfunction

31
Q

Beta blockers: decrease aqueous production, increase uveoscleral outflow, or increase cornealscleral outflow?

A

Decrease aqueous prodution

32
Q

TIMOLOL

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
  5. Contraindications
A
  1. Beta Blocker
  2. Glaucoma
  3. blocks b2 receptors to decrease aqueous production
  4. SE: Masks symptoms of hypoglycemia, and hyperthyroidism, weakness in patients with MG, long-term drift
    CI: Patients with asthma or COPD

Morning dosage recommended to prevent nocturnal bradycardia

33
Q

COSOPT combination (BID)

A

timolol and dorzolamide

34
Q

COMBIGAN combination (BID)

A

timolol and brimonidine

35
Q

CARTEOLOL

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Beta blocker
  2. Modest reduction in cholesterol
  3. Blocks beta receptors
  4. Less SEs than other BBs

Reduces nocturnal bradycardia

36
Q

BETOXOLOL

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Beta blocker
  2. Glaucoma, neuroprotective
  3. Blocks beta receptors
  4. Can worsen congestive heart failure

b1 SELECTIVE, SAFE FOR LUNG ISSUES

37
Q

DONEPEZIL

  1. Drug type
  2. Indications
  3. MOA
  4. SEs and contraindications
A
  1. Indirect cholinergic agonist
  2. Alzheimer dementia
  3. Acetylcholinesterase inhibitor
  4. N/A

Boards - Oc Pharm (7 decks)

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