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Pharmacology II > Autonomic Nervous System - Beta Blockers > Flashcards

Autonomic Nervous System - Beta Blockers Flashcards

1
Q

The SNS has what origin?

A

Thoracolumbar origin

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2
Q

In the orbit what is the associated SNS ganglion and what structures are innervated?

A 
Superior Cervical Ganglion
Dilator Muscle
Blood vessels in uveal tract
Smooth muscles
Lacrimal gland vessels
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3
Q

The PNS has what origin?

A

Craniosarcal origin

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4
Q

In the orbit what structures are associated with the PNS?

A 
Edinger-Westphal
CN III and CNVII
Ciliary Ganglion
Spinchter Muscles
Ciliary muscles
Lacrimal Gland
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5
Q

What neurotransmitter is associated with PNS?

A

Acetylcholine (Muscarinic)

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6
Q

What neurotransmitter is associated with the SNS?

A

Norepinephrine and Epinephrine
Alpha 1 and Alpha 2
Beta 1 and Beta 2

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7
Q

What neurotransmitter is located at ganglion receptors?

A

Nicotine, affects both PNS and SNS

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8
Q

The dilator is under which system and what neurotransmitter?

A

SNS; A1

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9
Q

The sphincter is under which system and what neurotransmitter?

A

PNS; acetylcholine

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10
Q

The ciliary body is under which system and what neurotransmitter?

A

SNS; A2, B1, B2

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11
Q

The Ciliary body muscle is under which system? (mostly)

A

PNS; acetylcholine

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12
Q

Conjunctival blood vessels are under which system?

A

SNS; A1 and B2

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13
Q

The Lacrimal gland is under which system (and the vessels are under which system?)

A

The gland is PNS; acetylcholine

The vessels are SNS

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14
Q

The muller’s smooth muscles are under which system?

A

SNS; A1

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15
Q

An A1 agonist would be what?

A

A mydriatic

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16
Q

Describe uses for norepinephrine

A

Actually, little clinical use
Affects A1/2 and B1 receptors
Good systemic vasoconstrictor

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17
Q

Describe epinephrine and its uses

A

Prototypical adrenergic agent
Very potent vasoconstrictor
But a weak mydriatic
Decreases IOP

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18
Q

What is phenylephrine’s generic name?

A

Neo-synephrine

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19
Q

What concentrations can phenylephrine come in?

A

1/8% OTC

2.5 and 10% are Rx only

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20
Q

Phenylephrine and ANY mydriatic agent can cause what in a patient with wht condition?

A

Narrow angle closure; patients with a narrow angle

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21
Q

What are some clinical uses for phenylephrine/Neo-synephrine

A

Decongestant - Vasoconstriction
Mydriasis - Duh
Max effect in 1 hour, lasts 6-7 hours

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22
Q

What effect does applying a local anesthetic have on the dilation produced by phenylephrine?

A

LA before phenylephrine greatly improves the dilating effect

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23
Q

Can you use phenylephrine for a cycloplegic exam?

A

No, no effect on the ciliary muscle (very low)

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24
Q

In the elderly, what may happen with the administration of phenylephrine to the eye?

A

May have decreased sympathetic tone making them more sensitive to the mydriatic effect

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25
What effect does iris color have on phenylephrine?
Darker irises tend to decrease effect ad vice versa
26
How can you use phenylephrine in ptosis?
Treats it if due to sympathetic deinnervation
27
Can you use phenylephrine to diagnose Horner's?
Yes, but not that accurate
28
What other uses does phenylephrine have?
Breaking posterior synechiae | Treat miotic cysts caused by an ACh-esterase inhibitor
29
What is phenylephrine's major contraindication?
Thyrotoxicosis (Thyroid storm) Coronary Artery Disease Untreated Hypertension
30
What drugs can phenylephrine interact with?
Tricyclic antidepressants MAO inhibitors Guanethidine Reserpine
31
What toxicities can you see with phenylephrine?
CNS stimulation, headache, hypertension, subarachnoid hemorrhage, ventricular arrhythmias, tachycardia, reflex bradycardia, blanching skin
32
What are some local/ocular toxicities with phenylephrine?
Transient pain/lacrimation Keratitis Liberation of iris pigment into anterior chamber Post-dilation miosis in elderly Rebound congestion and conjunctival hypoxia ANGLE CLOSURE
33
What is apraclonidine's commerical name?
Oopidine
34
What doses does apraclonidine/oopidine come in?
0.5% and 1%
35
Describe apracolindine/oopidine
Adrenergic agonist. mostly A2
36
Describe the mechanism of action associated with A2 receptors in the eye
Inhibit adenylate cyclase, lower cAMP, decreases aqueous production and more uveoscleral outflow
37
What is 1% apracolindine/oopidine used for?
Argon laser trabeculoplasty
38
What is 0.5% apracolindine/oopidine used for?
Long term treatment of primary open angle glaucoma (lowers IOP)
39
Can you use apracolindine to diagnosis horners?
Yes, but not great
40
What are some toxicities with apracolindine/oopradine?
Allergic reactions in 20-50% A1 stimulation Mydriasis Lid retraction Conjunctival blanching (constricting vessels) Systemic effects (Dry mouth, fatigue, lethargy, headache, symptoms of head cold) High dropout rate
41
What is one of the commercial names for Brimonidine?
Alphagan P (purite as a preservative)
42
Describe Brimonidine/Alphagan
A HIGHLY selective A2 adrenergic agonist
43
What is the method of action for brimonidine's antiglaucoma action?
A2 activation to lower cAMP and decrease aqueous production
44
What are the most frequent side effects with Brimonidine/alphagan?
``` Hyperemia (too much blood in vessels) Stinging, burning, blurry vision and FBS Alelrgic reaction Dry mouth, fatigue, headache, lethargy, drowsiness No blanching or mydriasis ```
45
What are some OTC sympathomimetics?
Naphazoline (0.0125%, 0.03% OTC); Rx 0.1% Tetrahydrozoline (0.05%) OTC Oxymetazoline (0.025%)
46
What is hydroxyamphetamine's commercial name?
Paradrine
47
What is paramyd?
1% hydroxyamphetamine and .25% tropcamide
48
Describe the method of action for hydroxyamphetamine
Indirect; causes release of NE from nerve endings for simple dilation effect.
49
What three drugs can be used to diagnose Horner's and which is the very best?
Phenylephrine/Neo-synephrine Apracolindine/Oopindine Hydroxyamphetamine (Best)
50
How does hydroxyamphetamine diagnose Horners?
Causes dilation if horners is central/preganglionic (This is very serious) No dilation if issue is postganglionic
51
Hydroxyamphetamine's mydriatic effect mimicks what drug?
Phenylephrine/Neo-synephrine
52
Describe Cocaine
``` Indirect NE release (adrenergic) Highly controlled Causes mydriasis, vasoconstriction and some anesthesia Can be used to diagnose horners Can debrade corneal epithelium ```
53
Describe the use of cocaine in Horner's
Can detect/confirm presence of Horners but cannot localize the lesion like hydroxyamphetamine
54
What is Daplprazole's commercial name?
Rev-Eyes
55
What is daplprazole/rev-eyes?
Adrenergic antagonist
56
Describe dalprazole/rev-eyes
Alpha blocker that was discontinued | Meant to undo dilation caused by phenylephrine by blocking the alpha receptors
57
What toxicities are seen with daplprazole/rev-eyes?
``` Conjunctival hyperemia Burning Corneal edema Ptosis/lid edema Erythema ```
58
What is Propranolol's commercial name?
Timoptic, Timoptic-XE and Timolol
59
Describe Propranolol/Timolol/Timoptic/Timoptic-XE
Prototypical beta blocker; still the most popular. Non-selective Decreases aqueous production and is the choice glaucoma drug
60
Does propranolol/timolol's efficacy change in iris color?
No, doesn't really get bound to pigment
61
Does propranolol/timolol affect the pupil/CNS?
No changes to pupil size or accommodation | Few CNS effects
62
What glaucoma can you treat propranolol/timolol?
Open angle glaucoma, not good for chronic narrow angle glaucoma
63
How dos propranolol compare to pilocarpine?
Less irritation and drop out, less frequent administration and fewer dosings. Less acute ocular toxicities Use unless there is a contraindication
64
What toxicities are associated with Propranolol/Timolol?
Irritation and lacrimation Dry eye (all beta blockers) Allergic blepharoconjunctivitis Corneal anesthesia/superficial punctate keratitis Blurry vision with or without transient myopia Uveitis Myasthenic symptoms (Diplopia, nystagmus, ptosis)
65
What is escape/tolerance in both short and long term when treated with propranolol/timolol?
Short-term - IOP drops but starts to increase back to higher levels rapidly (Short-term escape) Long-term - Chronic use of timolol where you slowly see a return to higher IOP (may be disease progressing)
66
What is Raynaud's Phenomenon?
Pain in extremities due to reflex vasoconstriction caused by the vasodilation the propranolol/timolol
67
Describe some other things possible with beta blockers?
Unmasking myasthenia gravis Migraine prophylaxis Eliminating ability to detect hypoglycemia (that's a sympathetic response)
68
What are the contraindications for beta blockers/propranolol/timolol
Bronchial asthma (closing vessels) History of bronchial asthma Severe chronic obstructive pulmonary disease Bradycardia Severe heart block Overt cardiac failure (just barely maintaing BP) Children/infants
69
What is Lebobunolol's commercial name?
Betagan
70
How does lebobunolol/betagan compare to propranolol/timolol?
Longer duration of action, can use once a day
71
What is metipranolol's commercial name?
Optipranolol
72
How does metipranololo/optipranolol compare to propranolol/timolol?
Non-selective beta blocker, pretty much the same as propranolol
73
What is the commercial name for betaxolol suspension?
Betoptic
74
How does betaxolol/betoptic compare to propranolol/timolol?
Relatively selective B1 blocker that tries to avoid the pulmonary toxicities, but not as effective as timolol
75
A glaucoma patient that does have COPD would require what drug to treat their glaucoma?
Betaxolol/betaoptic
76
What is Carteolol's commercial name?
Ocupress
77
Describe carteolol/ocupress
``` Partial agonist (intrinsic sympathomimetic activity) Doesn't slow heart rate as much as timolol, can allow a glaucoma patient to exercise ```
78
What are the combination products for beta blockers?
Combigan (brimonidine 0.2% and timolol 0.5%) | Cosopt (dorzolamide 2.0% and timolol 0.5%)
79
Which beta blockers are best for controlling IOP?
Generic timolol Metipranolol Timolol hemihydrate
80
Which beta blocker should not be used for strict IOP control?
Betaxolol; not as effective as others unless contraindicated
81
Which beta blocker would you select for patient comfort and if they were hypercholesteremic?
Carteolol; Some beta activity left due to being partial agonist
82
What beta blocker would you use if the patient is allergic to preservatives?
Timoptic XE, Timoptic in ocudose Alphagan P Travatan Z
83
What beta blocker would you use for a patient with COPD?
Betaxolol
84
What beta blocker would you use for a pregnant patient?
NONE

Pharmacology II (10 decks)

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