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Ocular Pharmacology > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

Define Autonomic Nervous System (ANS)

A

Functional division of nervous system that is not voluntarily controlled

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2
Q

Define Somatic Nervous System

A

Functional division of nervous system that is voluntarily controlled

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3
Q

Define Sympathetic Nervous system

A

Branch of autonomic nervous system that opposes effects of parasympathetic division

Endogenous sympathetic nervous system neurotransmitter: NE, DA, EPI

Receptors of SNS: Alpha, Beta

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4
Q

Define parasympathetic nervous system

A

Branch of autonomic nervous system that opposes effects of sympathetic division

Endogenous parasympathetic neurotransmitter: Acetylcholine

Receptors of PNS: Muscarinic, Nicotinic

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5
Q

Catecholamines are:

A
  • Biogenic amines derived from tyramine including dopamine, epinephrine, norepinephrine
  • Produced from tyrosine in adrenal medulla and postganglionic fibers of sympathetic nervous system
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6
Q

Function of Autonomic nervous system

A

Deals primarily with control and visceral functions necessary for life (non-voluntary)

  • cardiac output
  • Blood flow and distribution
  • Digestion
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7
Q

Autonomic nervous system comprised of two branches:

A

Sympathetic nervous system(adrenergic) -Fight & flight

Parasympathetic (Cholinergic) - Res and digest

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8
Q

Stimulation of Sympathetic and parasympathetic nervous system results in effect on:
eyes
salivation
skin
respiration
heart
digestion
adrenal glands

A

pic 2 parasympathetic

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9
Q

What are the neurotransmitters of the SNS

A

Epinephrine, Norepinephrine, Dopamine

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10
Q

Dopamine of a precursor of

A

Norepinephrine and ephedrine

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11
Q

Where is most NE secreted

A

Synaptic clefts
NE is also found in bloodstream, normally exists in concentrations 3x greater than epinephrine

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12
Q

Where is most epinephrine produced

A

Adrenal glands (80%), rest by brain

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13
Q

What neurotransmitter is found in the PNS

A

Acetylcholine

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14
Q

Receptors (alpha,beta and DA), where are they located and result of stimulation

A

pic receptor

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15
Q

What effect will Beta2 stimulation have on the ciliary muscle

A

Relaxation (suppresses accomodation)
Increased aqueous production (IOP)
(alpha2 stimulation decreases IOP)

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16
Q

Mydriasis results from stimulation of which receptor

A

Alpha 1

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17
Q

Alpha1 receptors are more sensitive to NE or E?

A

NE (also stimulated by high doses of D)

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18
Q

Alpha 2 receptors are more sensitive to NE or E

A

E more than or equal to NE

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19
Q

Beta2 receptors more sensitive to NE or E

A

E is a lot morethan NE

20
Q

What is the t1/2 of catecholamines

A

1-3minutes
85% of synaptic NE is non-enzymatically inactivated by reuptake

21
Q

direct acting sympathomimetic drugs

A

Bind to and stimulate same receptor as the endogenous neurotransmitter eg phenylephrine

22
Q

Beta1 receptors more sensitive to NE or E

A

Equal (also stimulated by high doses of D)

23
Q

Indirect acting sympathomimetics

A
  • Stimulate release of neurotransmitter from a nerve terminal eg amphetamine
  • Block the reuptake of neurotransmitter from the synapse, prolonging effect eg cocaine
24
Q

Sympathomimetic adverse effects regarding CVS

A

Increased heart rate
Arrhythmia
Elevated blood pressure

25
Q

Ocular sympathomimetic side effects

A

Mydriasis & suppression of accommodation leading to light sensitivity
Reduced depth of focus and near blur

26
Q

Sympathomimetic adverse effects regarding CNS

A

Hemorrhagic stroke
Anxiety
Fear
Headache
Tremor

27
Q

Hepatic sympathomimetic adverse effect

A

Elevated blood sugar

28
Q

Immune system and respiratory sympathomimetic adverse effect

A

Immunosuppression
Pulmonary edema

29
Q

Effect of M3 stimulation on eyes

A

Miosis
Cilliary muscle contraction and increased aqueous outflow
Increase in ocular gland secretion

30
Q

Ocular anticholinergic side effects

A

Increased IOP
Angle closure risk
Alergy

31
Q

Systemic anticholinergic side effects

A

ABCDss
-Anorexia
-Blur
-Constipation
-Dryness
-Sedation
_Stasis of urine

Thirst, tachycardia. hypertension, decreased glandular secretions(sweat/bronchial/saliva) > heart/smooth muscle > GIT

32
Q

CNS anticholinergic side effects

A

Decreased parkinson tremor
Decreased heart rate

33
Q

What is the anticholinergic toxidrome

A

Blind as a bat (blur)
Hot as desert (hyperthermia)
Mad as a hatter (Confusion)
Dry as a bone (Dry mouth,urinary retention)
Red as beet (flushed skin)

Tachycardia
absent bowel sounds
shaking
dilated pupils

34
Q

How do neuromuscular blocking agents work

A

Act on motor neurons where they block Acetylcholine-based contraction of muscle fibres
(Nicotinic acid ACh receptors are ligand gated, stimulation leads to Na+ influx and generation of action potential that results in contraction

35
Q

How do botox and tetanus produce muscle paralysis

A

Inhibiting degranulation of ACh vesicles in the presynaptic neuron
Blocking ACh release

36
Q

Acetylcholine is broken down into…

A

Acetate + choline by Acetylcholinesterase (AChE) and Butyrylcholinesterase (BChE) (enzymes)

37
Q

Atropine is an antidote to which receptor effects

A

Muscarinis, not the nicotinic(muscular) effects

38
Q

OCULAR ADRENERGIC EFFECTS

A
  • Mydriasis (radial iris muscle contraction)
  • increase interpalpebral aperture (Müeller’s smooth muscle)
  • Modulate aqueous generation by the ciliary body
  • Suppress accommodation thru receptors in the trabeculum &
    Schlemm’s canal
39
Q

DILATION

A

Standard of care for ALL new patients
• Last to be performed in exam sequence
• Bilateral under most every circumstance
• May be sectoral*: i.e. create a keyhole pupil

Angle Estimation
• Gonioscopy > Van Herick > shadow test
• Commonly large in myopes and aphakes

40
Q

FACTORS AFFECTING DILATION

A

Reduced Sensitivity
• Age-related miosis
• Unstable diabetes
• Post-op (traumatized) pupils
• Posterior synechiae
• Dark irides
• Pseudo-exfoliation syndrome

Increased Sensitivity
• Down syndrome

41
Q

POOR DILATION CANDIDATES

A

Caution
• Homocystinuria & Marfan’s syndrome: ectopia lentis risk
• Pregnancy: use Tropicamide; consult OB/GYN
• Pigmentary or exfoliative glaucoma; transient IOP elevation

*Iatrogenic angle closure generally occurs 4-8 hrs post instillation

42
Q

DILATION CONTRAINDICATIONS

A
  • Iris supported/anterior chamber intraocular lens
  • Subluxated lens or posterior chamber intraocular lens (PCIOL)
  • Extremely narrow angle*
  • Angle closure history without laser peripheral iridotomy (LPI)
43
Q

ADRENERGIC AGONISTS

A

Sympathomimetic Amines used for Dilation

  • Phenylephrine
  • Hydroxyamphetamine (an amphetamine metabolite and a component drug of Paremyd®)

OTC Drops for Red Eye Relief (Imidazolines)

In contrast to biogenic amines, the imidazolines lack a saturated benzene ring, enhancing selectivity for ɑ1 receptors

  • Oxymetazoline (Visine LR® 0.025% ) α1 agonist and α2 partial agonist (Upneeq® 0.1%)
  • Naphazoline (Clear Eyes® & Naphcon®)
  • Tetrahydrozoline (Visine®)

• Brimonidine 0.025% LumifyTM an α2 agonist

44
Q

30

A
45
Q
A

Ocular Pharmacology (10 decks)

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