Lecture 4 - Mydriatics and Cyclopegics

Question 1

What is an MAO and COMT?

Answer 1

An enzyme of catecholamine metabolism

Question 2

What is a catecholamine?

Answer 2

Hormones: Dopamine, EPI, NOR-EPI; produced from tyrosine in postganglionic fibers of the ANS and the Adrenal Medulla

Question 3

What is an anaphylaxis?

Answer 3

Acute, systemic hypersensitive reaction to an allergen

Question 4

What main Immunoglobulins is key in anaphylaxis?

Answer 4

IgE

Note: Goes into a bloodstream reacts with an antigen leading to histamine release from Mast cells

Question 5

What are three issues in regards to an emergent systemic anaphylaxis?

Answer 5

Swelling, Bronchoconstriction and vasodilation

Question 6

If you must administer an EPI pen, what pts. do you not want to administer this to?

Answer 6

Pts. who suffer from Heart Disease or High Blood Pressure, Parkinson’s disease (dopamine deprivation), diabetes or a thyroid disorder

Question 7

What are 2 sympathetic neurotransmitters used?

Answer 7

EPI (generated in the adernal and sent to the blood cells) and NOR-EPI (made by nerves and thrown into the synaptic cleft)

Question 8

What is the one neurotransmitter used for the parasympathetic system?

Answer 8

AcH

Question 9

What receptor is associated with the terminal organ of postganglionic nerves in the cholinergic system?

Answer 9

Muscarinic

Question 10

In sympathetic system, what analogs are stimulated for Presynaptic, Vascular, Respiratory, Cardiac, Hepatic, Pancreatic, Iris and Ciliary Body

Answer 10

Presynaptic: +α2 inhibition of signal propagation
Vascular: +α1 vasoconstriction; +β2 vasodilation*(Occurs in the skeletal system)
Respiratory: +β2 bronchodilation
Cardiac: +β1 ↑ contractility & conduction
Hepatic: +β2 glucogenolysis
Pancreatic: +β2 ↑ insulin release; +α2 ↓ insulin release
Iris: +α1 mydriasis
Ciliary body:
+β2 relaxation & ↑ aqueous production
-β2 or +α2 ↓ aqueous production

Question 11

What is greater in a1?

Answer 11

NE > E

Question 12

What is greater in a2 (inhibitory)?

Answer 12

E > or = NE

Question 13

What is greater in B1?

Answer 13

E = NE

Question 14

What is greater in B2?

Answer 14

E only.

Question 15

What do catecholamines rely on for creating its back bone?

Answer 15

Tyrosine

Question 16

Once tyrosine is reacted and creates Dopa, which then gets reacted with Ca+, what will this create?

Answer 16

Dopamine

Note: Dopamine can be stored and create NOR EPI

Question 17

What are 2 that are important for Catecholamine metabolism?

Answer 17

COMT and MAO’s

Question 18

What type of alpha molecules is reuptake in the pre-synaptic terminal?

Answer 18

a2

Note: MAo also reenters the presynaptic terminal

Question 19

What muscle in the eye modulates vascular tone?

Answer 19

Lateral Rectus

Question 20

What mechanism can cause adernegic effects that can suppress accommodation receptors?

Answer 20

Trabeculum and Schlemm’s canal

Question 21

Starting from the best to the least system, what method do you use use for angle estimation?

Answer 21

Gonioscopy > Van Herick > Shadow Test

Question 22

What anticholinergic agent blocks miotic response?

Answer 22

Tropicamide

Question 23

What two anticholinergic agents have similiar backbones to one another?

Answer 23

Atropine and Homatropine (semisynthetic)

Question 24

What Anticholinergic, can cause CNS effects, such as hyperactivity, halucinations and psychosis?

Answer 24

Cyclopentolate

Note: Lipophillic, thus it can readily cross the blood brain barrier much easier

Question 25

What is Anti-cholinergic is a perfect longterm usage for amblyopia?

Answer 25

Atropine

Question 26

By dilating the eye, the iris will give you pain but if someone has a corneal abrasion, what anticholinergic?

Answer 26

Homatropine

Question 27

Which type of ametropia, are okay with dilation?

Answer 27

Myopes

Question 28

What are the many adverse effects of anticholinergics?

Answer 28

ABCDs: Anorexia, Blur, Constipation & Confusion, Dryness, Sedation & Stasis of urine
Thirst, tachycardia, hypertension, ↓ glandular secretions: sweat/bronchial/saliva > heart, smooth muscle > GIT