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OCULAR PHARM > CYCLOPLEGICS > Flashcards

CYCLOPLEGICS Flashcards

1
Q

Catecholamines

A

Hormones including:
DOPAMINE
EPINEPHRINE
NORE-PINEPHRINE

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2
Q

COMT

A

Catechol-o-methyl Transferase

-an enzyme of catecholamine metabolism

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3
Q

MAO

A

An enzyme of catecholamine metabolism

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4
Q

CYCLOPLEGIA

A

Paralysis of the ciliary body musculature responsible for accommodation

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5
Q

What is ANAPHYLAXIS

A
  • Acute, systemic allergic hypersensitivity reaction to a previously sensitized allergen
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6
Q

EPI-PEN

A

Serious anaphylactic reactions develop within minutes (up to 2 hours) and require immediate emergency treatment with epinephrine

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7
Q

what are the dosage of EPIPEN ?

A

EpiPen 0.3mg
EpiPen Jr 0.15mg
Pregnancy category C

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8
Q

what diseases should you be cautious wit EPI-PEN

A

Caution in patients with heart disease or high blood pressure, Parkinson’s disease, diabetes, or a thyroid disorder

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9
Q

FIGHT OR FLIGHT

A

Regulated by the SYMPATHETIC or ADRENERGIC branch of the autonomic nervous system

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10
Q

REST AND DIGEST

A

Regulated by the PARASYMPETHETIC or CHOLINERGIC branch of the autonomic nervous system

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11
Q

Nicotininc Receptors are located in the ANS HOW?

A

using postganglionic in the ANS and terminally located in the somatic nervous system

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12
Q

Muscarinic receptors are associated with?

A

Terminal organs of postganglionic nerves in the cholinergic system

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13
Q

Norepinephrine (NE) are used?

A

NT used in sympathetic adrenergic system and its target receptors are ALPHA AND BETA

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14
Q

Presynaptic FOUND IN THE SYMPATHETIC PHARMACOLOGY

A

+α2 inhibition of signal propagation

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15
Q

VASCULAR

A

+α1 vasoconstriction; +β2 vasodilation

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16
Q

RESPIRATORY

A

+β2 bronchodilation

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17
Q

CARDIAC

A

+β1 ↑ contractility & conduction

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18
Q

HEPATIC

A

+β2 glucogenolysis

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19
Q

PANCREATIC

A

+β2 ↑ insulin release;

+α2 ↓ insulin release

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20
Q

IRIS

A

+α1 mydriasis

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21
Q

Ciliary BODY

A

+β2 relaxation & ↑ aqueous production

-β2 or +α2 ↓ aqueous production

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22
Q

What is Relative receptor Activity?

A

Epinephrine Vs Norepinephrine

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23
Q

when it comes to Alpha 1

A

Norepeinephrine (NE) - Neurogenic

it is NE> E (epinephrine)

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24
Q

What it comes to alpha 2

A

Epinephrine (greater than equal) to NE

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25
Q

When it comes beta 1

A

Epinephrine (equals) to NE

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26
Q

when it comes to beta 2?

A

epinephrine

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27
Q

What are ocular adrenergic Effects on Mydriasis?

A
  • Increase interpalpebral aperture (Müeller’s muscle)
  • Modulate aqueous generation
  • Receptors in lateral rectus modulate vascular tone
  • Receptors in trabeculum & Schlemm’s canal suppress accommodation
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28
Q

What is the standard care for all new patients when it comes do dilation?

A

Last to be performed in exam sequence

Bilateral under most every circumstance

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29
Q

What should be used to estimate the ocular angle?

A

Gonioscopy > Van Herick > shadow test

Commonly large in myopes and aphakes

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30
Q

what are the factors that affect when it comes to reduced sensitivity?

A 
Age-related miosis
 Unstable diabetes
 Post-op pupils
 Posterior synechiae
 Dark irides
 Pseudoexfoliation Syndrome
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31
Q

what is the factors that are affecting increased sensitivity?

A

Down syndrome

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32
Q

who are the poor dilation candidates?

A

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

33
Q

What is the angle closure within ususally?

A

IATROGENIC ANGLE CLOSURE GENERALLY

OCCURS 4-8 HRS POST INSTILLATION

34
Q

what are contraindictations when it comes to poor dilation candidates?

A
  • Iris supported intraocular lens
  • Subluxated lens or intraocular lens
  • Extremely narrow angle*
  • Angle closure history without peripheral iridotomy (PI)
35
Q

When do you do CYCLOPLEGIA?

A
  • Strabismus (especially esotropia)
  • Pseudomyopia (accommodative spasm)
  • Latent hyperopia
  • Anisometropia
  • Amblyopia, hysterical amblyopia
  • Functional deficits
  • Malingerers
  • Unexplained refractive error
  • Uncooperative, non-communicative, inconsistent patient
36
Q

CYCLOPLEGIA also known as

A

otherwise known as a ‘WET REFRACTION’

37
Q

what are the sympathetic Mydriatics?

A

Phenylephrine

Hydroxyamphetamine

38
Q

what is the activity of PHENYLEPHRINE

A

α1 selectivity

Some indirect effects via norepinephrine release

39
Q

what are the ACTIONS of Phenylephi?

A
  • Mydriasis in 45-60 min
  • Conjunctival blanching
  • Mild accommodation suppression ~2D
  • Lid retraction
  • IOP reduction
40
Q

what are the SPECIAL INDICATIONS OF PHENYL

A

Posterior synechiae breakage (10%)
Pre-LASIK vasoconstriction (10%)
Inhibition of iris cysts (caused by echothiophate*)
Horner’s evaluation (1%)

41
Q

what are ADVERSE EFFECTS OF PHNYELEPI?

A
  • Photophobia, blur, glare
  • Allergic dermatoconjunctivitis
  • Rebound miosis
  • Anterior chamber pigment liberation
  • Systemic hypertension → bradycardia
42
Q

who should you avoid PHENYLPHRINE

A
  • Avoid 10% in neonates/elderly
  • History of CVD or MI, DM1, aneurysm, advanced arteriosclerosis, ideopathic orthostatic hypotension
  • Atropine, TCAD, MAOI, reserpine, guanethidine, methyldopa
43
Q

what is HYDROXY-AMPHETAMINE

A

Indirect acting: promotes norepinephrine release from nerve terminals
Negligible direct α & β receptor stimulation

44
Q

what is the HYDROXY-AMPHETAMINE for 1%

A

No accommodation suppression

45
Q

what makes up the PAREMYD?

A

1% HYDROXYAMPHETAMINE
+
0.25% TROPICAMIDE

46
Q

What are the actions of PAREMYD?

A
  • Mydriasis independent of age or pigmentation
  • Faster recovery than phenylephrine/tropicamide combo thus better suited for a shallow angle
  • No benefit from pre-anesthetizing cornea
  • Differentiate pre/post-ganglionic dennervation
47
Q

what are the adverse effects PAREMYD?

A

Similar to phenylephrine except, systemic hypertension –> tachycardia

48
Q

what medications should you not use these PAREMYD on?

A

it is similar to phelephrine but

safer Similar to phenylephrine but safer in diabetes, ideopathic orthostatic hypotension, chemical sympathectomy agents

49
Q

what are the parasympathetic pharmacology?

A

M1, M2 AND M3

50
Q

which one VASCULAR binds to?

A

M3 salivary gland, vasodilation secretion

51
Q

whhich one RESPIRATORY binds to

A

M2 = M3 bronchoconstriction, secretion

52
Q

which one is CARDIAC binds to?

A

M2&raquo_space; M3 ↓ contractility & conduction

53
Q

which one is EMETIC binds to?

A

M3

54
Q

which one PANCREATIC binds to?

A

M2 = M3 acini secretion

55
Q

which one IRIS binds to?

A

M2 < M3 miosis

56
Q

which one CILIARY BODY binds to?

A

M2 < M3 contraction & ↑ aqueous outflow

57
Q

which one is CNS binds to?

A

M1 memory

M4 and M5 are also coming of interest for their role in CNS cognition

58
Q

what is Acetylcholine is broken into?

A

Acetate and Choline using ACHe

59
Q

what is AChE

A

= acetylcholinesterase is ubiquitously distributed throughout the body therefore metabolism is rapid

60
Q

what are ANTICHOLINERGIC AGENTS?

A 
Atropine
Scopolamine
Homatropme 2% and 5%
Tropicamide
Cyclopentolate 1%
Cyclomydril
61
Q

What is ATROPINE is selected for?

A

It is NON SELECTIVE Muscarinic and some are Nicotinic

62
Q

Scopolamine

A

are non selective

63
Q

Homatropme 2% and 5%

A

They are equivalent to 10% atropine potency

64
Q

Tropicamide

A

are Moderately M4 selective

65
Q

Cyclopentolate 1%

A

not given

66
Q

Cyclomydril

A

Which is 0.2% cyclopentolate + 1% phenylephrine

67
Q

What is ATROPINE used for?

A

Cycloplegia
Severe uveitis
amblyopia
Dianosis of Accommodative esotripia

68
Q

What is Scopolamine used for?

A

Travel sickness

has produced CNS effects

69
Q

What is Homatropine used for?

A

Modetrate uveitis
Corneal Abrasion
Mydriasis

70
Q

What is CYCLOPENTOLATE used for?

A

Cycloplegia
Moderate Uveitis
Corneal abrasion
** have CNS effects including hyperactivity, halucinations and psychosis

71
Q

What is TROPICCAMIDE used for?

A

Cycloplegia
Mydriasis
Mild uveitis

72
Q

what are ANTICHOLINERGICS adverse effects on OCULAR?

A

increase in IOP
Angle closure risk
Allergy

73
Q

What are ANTI-CHOLINERGICS systemic adverse effects?

A 
ABCDS
A = Anorexia
B= Blur
C = Constipation and Confusion
D = Dryness and sedation
S = Sedaton 
S = Stasis of urine
== you get thirst, tachycardia, hypertension, decrease glandular secretions:  SWEAT/BRONCHIAL/ SALIVA > heart, smooth muscle > GIT
74
Q

What are the adverse effects on CNS using Anticholinergics

A

CNS (MEDULLA)
decrease in Parkinson Tremor
Decrease in HR

75
Q

ATROPINE comes as

A

1.0% ointment or 0.5/1.0/2.0% solution

76
Q

what is ATROPINE used in?

A

Anterior Uveities: ciliary body spasm, posterior synechiae, lens advancement, vessels permeability

  • Myopic progression
  • Amblyopia :penalization
77
Q

WHAT IS TROPICAMIDE 0.5/ 1.0% solution used in?

A

Mydriasis
Dose dependent cycloplegia
Less pigment-sensitivity than cyclopentolate, homatropine and atropine
Best mydriasis as 0.25% with paremyd 1%

78
Q

what is CYCLOPENTOLATE 0.5/1.0/2.0% solution used in?

A

Delayed/ sustained effects in darkly pigmented
Less flushing and dryness than atropine
** AVOID 2% IN KIDS

OCULAR PHARM (4 decks)

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