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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
Q

What effect does iris color have on phenylephrine?

A

Darker irises tend to decrease effect ad vice versa

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26
Q

How can you use phenylephrine in ptosis?

A

Treats it if due to sympathetic deinnervation

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27
Q

Can you use phenylephrine to diagnose Horner’s?

A

Yes, but not that accurate

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28
Q

What other uses does phenylephrine have?

A

Breaking posterior synechiae

Treat miotic cysts caused by an ACh-esterase inhibitor

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29
Q

What is phenylephrine’s major contraindication?

A

Thyrotoxicosis (Thyroid storm)
Coronary Artery Disease
Untreated Hypertension

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30
Q

What drugs can phenylephrine interact with?

A

Tricyclic antidepressants
MAO inhibitors
Guanethidine Reserpine

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31
Q

What toxicities can you see with phenylephrine?

A

CNS stimulation, headache, hypertension, subarachnoid hemorrhage, ventricular arrhythmias, tachycardia, reflex bradycardia, blanching skin

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32
Q

What are some local/ocular toxicities with phenylephrine?

A

Transient pain/lacrimation
Keratitis
Liberation of iris pigment into anterior chamber
Post-dilation miosis in elderly
Rebound congestion and conjunctival hypoxia
ANGLE CLOSURE

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33
Q

What is apraclonidine’s commerical name?

A

Oopidine

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34
Q

What doses does apraclonidine/oopidine come in?

A

0.5% and 1%

35
Q

Describe apracolindine/oopidine

A

Adrenergic agonist. mostly A2

36
Q

Describe the mechanism of action associated with A2 receptors in the eye

A

Inhibit adenylate cyclase, lower cAMP, decreases aqueous production and more uveoscleral outflow

37
Q

What is 1% apracolindine/oopidine used for?

A

Argon laser trabeculoplasty

38
Q

What is 0.5% apracolindine/oopidine used for?

A

Long term treatment of primary open angle glaucoma (lowers IOP)

39
Q

Can you use apracolindine to diagnosis horners?

A

Yes, but not great

40
Q

What are some toxicities with apracolindine/oopradine?

A

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
Q

What is one of the commercial names for Brimonidine?

A

Alphagan P (purite as a preservative)

42
Q

Describe Brimonidine/Alphagan

A

A HIGHLY selective A2 adrenergic agonist

43
Q

What is the method of action for brimonidine’s antiglaucoma action?

A

A2 activation to lower cAMP and decrease aqueous production

44
Q

What are the most frequent side effects with Brimonidine/alphagan?

A 
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
Q

What are some OTC sympathomimetics?

A

Naphazoline (0.0125%, 0.03% OTC); Rx 0.1%
Tetrahydrozoline (0.05%) OTC
Oxymetazoline (0.025%)

46
Q

What is hydroxyamphetamine’s commercial name?

A

Paradrine

47
Q

What is paramyd?

A

1% hydroxyamphetamine and .25% tropcamide

48
Q

Describe the method of action for hydroxyamphetamine

A

Indirect; causes release of NE from nerve endings for simple dilation effect.

49
Q

What three drugs can be used to diagnose Horner’s and which is the very best?

A

Phenylephrine/Neo-synephrine
Apracolindine/Oopindine
Hydroxyamphetamine (Best)

50
Q

How does hydroxyamphetamine diagnose Horners?

A

Causes dilation if horners is central/preganglionic (This is very serious)
No dilation if issue is postganglionic

51
Q

Hydroxyamphetamine’s mydriatic effect mimicks what drug?

A

Phenylephrine/Neo-synephrine

52
Q

Describe Cocaine

A 
Indirect NE release (adrenergic)
Highly controlled
Causes mydriasis, vasoconstriction and some anesthesia
Can be used to diagnose horners
Can debrade corneal epithelium
53
Q

Describe the use of cocaine in Horner’s

A

Can detect/confirm presence of Horners but cannot localize the lesion like hydroxyamphetamine

54
Q

What is Daplprazole’s commercial name?

A

Rev-Eyes

55
Q

What is daplprazole/rev-eyes?

A

Adrenergic antagonist

56
Q

Describe dalprazole/rev-eyes

A

Alpha blocker that was discontinued

Meant to undo dilation caused by phenylephrine by blocking the alpha receptors

57
Q

What toxicities are seen with daplprazole/rev-eyes?

A 
Conjunctival hyperemia
Burning
Corneal edema
Ptosis/lid edema
Erythema
58
Q

What is Propranolol’s commercial name?

A

Timoptic, Timoptic-XE and Timolol

59
Q

Describe Propranolol/Timolol/Timoptic/Timoptic-XE

A

Prototypical beta blocker; still the most popular. Non-selective
Decreases aqueous production and is the choice glaucoma drug

60
Q

Does propranolol/timolol’s efficacy change in iris color?

A

No, doesn’t really get bound to pigment

61
Q

Does propranolol/timolol affect the pupil/CNS?

A

No changes to pupil size or accommodation

Few CNS effects

62
Q

What glaucoma can you treat propranolol/timolol?

A

Open angle glaucoma, not good for chronic narrow angle glaucoma

63
Q

How dos propranolol compare to pilocarpine?

A

Less irritation and drop out, less frequent administration and fewer dosings. Less acute ocular toxicities
Use unless there is a contraindication

64
Q

What toxicities are associated with Propranolol/Timolol?

A

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
Q

What is escape/tolerance in both short and long term when treated with propranolol/timolol?

A

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
Q

What is Raynaud’s Phenomenon?

A

Pain in extremities due to reflex vasoconstriction caused by the vasodilation the propranolol/timolol

67
Q

Describe some other things possible with beta blockers?

A

Unmasking myasthenia gravis
Migraine prophylaxis
Eliminating ability to detect hypoglycemia (that’s a sympathetic response)

68
Q

What are the contraindications for beta blockers/propranolol/timolol

A

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
Q

What is Lebobunolol’s commercial name?

A

Betagan

70
Q

How does lebobunolol/betagan compare to propranolol/timolol?

A

Longer duration of action, can use once a day

71
Q

What is metipranolol’s commercial name?

A

Optipranolol

72
Q

How does metipranololo/optipranolol compare to propranolol/timolol?

A

Non-selective beta blocker, pretty much the same as propranolol

73
Q

What is the commercial name for betaxolol suspension?

A

Betoptic

74
Q

How does betaxolol/betoptic compare to propranolol/timolol?

A

Relatively selective B1 blocker that tries to avoid the pulmonary toxicities, but not as effective as timolol

75
Q

A glaucoma patient that does have COPD would require what drug to treat their glaucoma?

A

Betaxolol/betaoptic

76
Q

What is Carteolol’s commercial name?

A

Ocupress

77
Q

Describe carteolol/ocupress

A 
Partial agonist (intrinsic sympathomimetic activity)
Doesn't slow heart rate as much as timolol, can allow a glaucoma patient to exercise
78
Q

What are the combination products for beta blockers?

A

Combigan (brimonidine 0.2% and timolol 0.5%)

Cosopt (dorzolamide 2.0% and timolol 0.5%)

79
Q

Which beta blockers are best for controlling IOP?

A

Generic timolol
Metipranolol
Timolol hemihydrate

80
Q

Which beta blocker should not be used for strict IOP control?

A

Betaxolol; not as effective as others unless contraindicated

81
Q

Which beta blocker would you select for patient comfort and if they were hypercholesteremic?

A

Carteolol; Some beta activity left due to being partial agonist

82
Q

What beta blocker would you use if the patient is allergic to preservatives?

A

Timoptic XE, Timoptic in ocudose
Alphagan P
Travatan Z

83
Q

What beta blocker would you use for a patient with COPD?

A

Betaxolol

84
Q

What beta blocker would you use for a pregnant patient?

A

NONE

Pharmacology II (10 decks)

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