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NBEO Part 2 > KMK pharmacology > Flashcards

KMK pharmacology Flashcards

1
Q

Parasympathetic

A
  • First cell body is located at the craniosacral region of the spinal cord
  • Release ACH at the pre and postganglionic neuron
  • Binds to site of action
    • Ciliary muscle
    • Sphincter muscle
    • Lacrimal gland
  • M1, M2, M3 (Muscarinic receptors)
    • M2 & M3 highest likelihood to be at the SOA
  • Rest and digest, bronchoconstriction/miosis, SLUD (salivation, lacrimation, urination, defecation)
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2
Q

What enzyme breaks down ACH?

A

Acetylcholinesterase

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3
Q

What increases ACH?

A

Acetylcholine inhibitors

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4
Q

Sympathetic

A
  • Preganglionic neuron starts at the thoracolumbar region → release a neurotransmitter
    • ACH in preganglion
    • epinephrine and norepinephrine (adrenaline) in postganglionic
  • Fight/flight, bronchodilator, mydriasis, dry
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5
Q

What inhibits epinephrine?

A

Monoaminoxidase (MAO)

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6
Q

What is an example of an MAOI

A

Phenelzine (Antidepressant)

Causes tachycardia

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7
Q

What does tropicamide do?

A

Stops ACH to dilate the pupil

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8
Q

What receptor is on the dilator

A

alpha 1 (ex. phenylephrine)

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9
Q

What is the MOA of cocaine?

A

blocks the reuptake of norepinephrine → dilate pupils

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10
Q

MOA of pilocarpine

A

increase corneoscleral outflow

Pulls on the ciliary muscle → pulls on scleral spur → opens the TM

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11
Q

What are the 3 drugs that increase outflow?

A

Prostaglandins

Pilocarpine

Alpha 2 agonist

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12
Q

Cholinergic Agonist (Direct)

A
  • Direct
    • pilocarpine (rx after angle closure causing squishy iris) - makes iris tight
      • After LPI
      • ADies tonic pupil .125% → like water, will constrict the pupil
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13
Q

Adies tonic pupil is a lesion in the _____.

A

Ciliary ganglion - starves the sphincter muscle which is why it reacts to .125% pilo

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14
Q

Where does thing edinger westphal start at?

A

midbrain (also CN 3 & 4 start here)

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15
Q

What are the side effects of pilocarpine?

A
  • Has to be dosed QID - causing brow aches, myopic shift
  • Create a TON of accommodation
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16
Q

Cholinergic Agonist (indirect)

A
  • Myasthenia gravis
    • neostigmine
    • pyridostigmine (get rid of MG)
    • Edrophonium (ed diganosis)
    • Echothiophate (irreversible side effects)
    • Donepezil (tx alzheimbers/dementia)
  • Increase cholinergic or parasympathetic activity
  • Increase Ach
  • ALL decrease IOP
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17
Q

2 major ocular side effects of myasthenia gravis

A
  • Ptosis
  • Diplopia (most common SE)
  • Worse at the end of the day
18
Q

What can exacerbate the effects of myasthenia gravis?

A

B-blockers

19
Q

Cholinergic Antagonist MOA

A

Decrease Ach

  • ASH CT
  • Antidepressants, Antipsychotic, Antihistamine (ANTI, ANTI, ANTI)
20
Q

List longest to shortest duration of cycloplegic effects

A

ASH CT

  • Atrophine
  • Scopolamine
  • Homatropine
  • Cyclopentolate
  • Tropicamide
21
Q

Penetrates the BBB the strongest?

A

Scopolamine

  • Amnesia
  • Confusion
  • Hallucination
  • Can be used for motion sickness (patch)
22
Q

Atropine should be avoided in which pts?

A

Down syndrome but overall safe drug

23
Q

Shortest duration of mydriatic affects

A

Tropicamide - very safe drug

  • Adverse reaction rare
24
Q

Max effect of tropicamide

A

25 mins

25
Q

Define penalization

A

Dilating the good eye with atropine

26
Q

Cyclopentolate affects last how long?

A

24 hours - fastest onset and shortest effect for cycloplegic refraction

27
Q

Max effect of cylopentolate starts at __ mins

A

45

28
Q

Tight junction in 3 spots

A
  • Schlemm’s canal
  • Iris stroma - minor circle
  • NPCE on pars plicata
29
Q

Adrenergic Agonist

A
  • Alpha 1
  • Alpha 2
  • Beta 1
  • Beta 2
30
Q

Which 2 receptors causes glaucoma?

A

Alpha 1 & Beta 2 (active secretion)

31
Q

Alpha 1 drug

A

Phenyl (crappy dilation)

does not allow fixed dilation and no cyclo

Best friend during BIO (lift muellers muscle 3mm)

32
Q

Alpha 2 drugs

A

apraclonidine & brimonidine

33
Q

Nonspecific adrenergic agonist

A

Naphazoline

Tetrahydrozoline (visine) - ocular decongestant, takes red out, acts on alpha 1 → dilated pupil

34
Q

What can you use to break PS? When is it contraindicated?

A

10% phenyl - increase BP, think about the heart

Avoid in TCA and graves disease, and if taking phenelzine (MAOI)

34
Q

What can you use to break PS? When is it contraindicated?

A

10% phenyl - increase BP, think about the heart

Avoid in TCA and graves disease, and if taking phenelzine (MAOI)

35
Q

3 MOA of TCA

A

Increase epinephrine and norepinephrine

increase anticholinergic activity

Increase serotonin

36
Q

Apraclonidine

A

Has weak alpha 1 - no dilation

If the eye the eye does dilate with this drop then consider horner’s syndrome

Think ACUTE - acts within an hour and awesome reduction in IOP

Not good for longterm because it can cause tachyphylaxis

37
Q

Brimonidine

A
  • Alphagan 0.2%
    • can cause follicular conunctivitis - red eye
  • Alphagan P .10%
    • has purite & a preservative
    • causes miosis
38
Q

If you bind to alpha 2 receptor

A

shut down sympathetic affects - which is why alphagan P causes miosis

39
Q

Which receptors are on the lungs and eyes?

A

B2

40
Q

Which receptors are on the heart?

A

B1

NBEO Part 2 (3 decks)

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