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Ocular Pharm > mydriatics and cyclopegics > Flashcards

mydriatics and cyclopegics Flashcards

1
Q

what are MAO and COMT?

A

enzymes of catecholamine metabolism ( e.g. breakdown epinephrine and norepinephrine)

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2
Q

what are catecholamines?

A

biogenic amines derived from tyramine (important in sympathetic pathway)

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3
Q

what are three catecholamines?

A

dopamine, epinephrine, norepinephrine

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4
Q

the sympathetic branch is also known as the _________ branch

A

adrenergic

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5
Q

the parasympathetic branch of autonomics is also known as the ______ branch

A

cholinergic

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6
Q

what neurotransmitters are responsible for adrenergic branch of autonomics?

A

adrenaline, epinephrine, norepinephrine

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7
Q

what neurotransmitter is primarily responsible for cholinergic branch of autonomics?

A

acetylcholine

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8
Q

____ is a precursor of E and NE

A

dopamine

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9
Q

epinephrine (E) is secreted into the ____ by the _____ gland

A

bloodstream, adrenal

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10
Q

which sympathetic neurotransmitter is classically blood borne and which is classically neuronal?

A

epinephrine, NE respectively

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11
Q

because norepinephrine is _____, it is the primary catecholamine generated by nerves responsible for sympathetic nerve impulses

A

neuronal

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12
Q

_____ is also found in the blood stream in __x higher concentrations than epinephrine

A

norepinephrine, 3x

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13
Q

which sympathetic neurotransmitter is secreted at synaptic clefts?

A

norepinephrine

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14
Q

acetylcholine in parasympathetics is made of a ____ group and _____ molecule

A

acetate, choline

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15
Q

the autonomic nervous system has ___ branches which are?

A

sympathetic adrenergic, sympathetic cholinergic, and parasympathetic cholinergic

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16
Q

do somatic nerves leaving the spine synapse with ganglia?

A

no

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17
Q

somatic nerves are myelinated or unmyelinated?

A

myelinated

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18
Q

the target receptor of somatic nerves are mainly what?

A

skeletal muscle

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19
Q

parkinson’s is treated with _____ drugs

A

anticholinergic

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20
Q

does the autonomic nervous system have myelinated ganglion fibers?

A

no

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21
Q

ganglia acetylcholine (ACh) stimulates ___ receptors in autonomic system

A

nicotinic

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22
Q

at end terminal organ, ACh neurons stimulate __ receptors in somatic system

A

nicotinic

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23
Q

at end terminal organ, ACh for which two pathways stimulates M receptors?

A

parasympathetic cholinergic and sympathetic cholinergic

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24
Q

at the end terminal organ, __ stimulates __ receptors in the sympathetic adrenergic pathway?

A

NE, alpha and beta

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25
Q

what are two examples of target tissue for sympathetic cholinergic?

A

sweat glands, some vessels

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26
Q

sympathetic ganglia are closer to the ___ where as parasympathetic ganglia are closer to the _____

A

spine, terminal organ

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27
Q

what 2 effects does alpha 1 have on the body?

A

mydriasis, vasoconstriction in GI tract

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28
Q

what 3 effects does alpha 2 have on the body?

A

decrease in aqueous outflow, decrease in signals (signal inhibition), decrease in insulin release

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29
Q

what 2 effects does beta 1 have on the body?

A

increase contractility and conduction of heart. remember B1= heart

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30
Q

what 6 effects does beta 2 have on the body?

A

increase in aqueous production, increase insulin release, vasodilation, bronchodilation, glycogenesis, relaxation of ciliary body

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31
Q

norepinephrine is best at what three things and why?

A

mydriasis, vasoconstriction, cardiac contraction/conduction b/c NE predominates over E for alpha 1 and = to E for B1 effects

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32
Q

epinephrine is stronger than NE at ___ and ___ receptor ?

A

beta 2 and alpha 2 (E=NE for B1). beta 2 for epinephrine is strongest!!

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33
Q

E and NE can be metabolized by which two enzymes?

A

MAO and COMT

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34
Q

in sympathetic nerve activity, ___is absorbed by the nerve in the first step

A

tyrosine

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35
Q

in sympathetic nerve activity, once in the nerve terminal, tyrosine is converted to ___ which is then converted to ____

A

dopa, dopamine

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36
Q

the dopamine is packed into ____ and then some is converted to ____

A

vesicles, NE

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37
Q

once the NE vesicles accumulate, you get an _____ that triggers ___ to enter the nerve terminal and cause the fusing of vesicles with nerve wall and the ___ of NE neurotransmitters into the external environment

A

action potential, calcium, release

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38
Q

what are three things that NE can do once released into the external environment?

A
  1. go into post-synaptic nerve terminal and COMT degrades it
  2. NE can stimulate post synaptic alpha/beta receptors or alpha receptors on the presynaptic receptors-causing inhibitory signal (which thus blocks calcium dependent degranulation
  3. some NE remaining in the synaptic cleft will be reabsorbed by nerve that released it and broken down by MAO
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39
Q

what is the amino acid for stress hormones?

A

tyrosine

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40
Q

phenylalanine is a precursor for ____ and ____

A

tyrosine, melanin

41
Q

name 4 ocular adrenergic effects

A

mydriasis, increase in palpebral aperture (stimulation of meuller’s muscle), modulate aqueous generation by ciliary body, suppress accommodation

42
Q

list best to least effective ways to find angle estimation

A

gonioscopy > van herick > shadow test

43
Q

___ and ___ commonly have large angles

A

myopes and aphakes

44
Q

name 6 factors that cause REDUCED sensitivity to dilation

A

age-related miosis, unstable diabetes, posterior synechiae, post-op pupils, dark irides, pseudoexfoliation syndrome

45
Q

what is something that causes INCREASED sensitivity to dilation?

A

down syndrome

46
Q

4 poor dilation candidates are?

A

pregnant women, homocystinuria and marfan’s syndrome (have week fibers and lens can dislodge and fall into eye), pigmentary/exfoliative glaucoma (leads to transient IOP elevation)

47
Q

contraindications for dilation (4)?

A

very narrow angle, angle closure history, iris supported intraocular lens, subluxated lens or IOL

48
Q

phenylephrine is mainly selective for which receptor type?

A

alpha receptors

49
Q

phenylephrine activity includes what three things?

A

mydriasis, contraction of iris radial muscle, indirectly cause NE vesicles to fuse and release neurotransmitters

50
Q

what are 5 phenylephrine indications for use?

A

used for mydriasis, conjunctival blanching, mild accommodation (~2D), lid retraction and IOP reduction

51
Q

what are 4 special uses of phenylephrine?

A

posterior synechiae breakage (10% formula), pre-LASIK vasoconstriction (10% formula), inhibition of iris cysts caused by echothiophate, horner’s evaluation

52
Q

3 synergistic phenylephrine drug interactions?

A

MAOIs, TCADs, atropine

53
Q

2 antagonistic phenylephrine drug interactions?

A

methyldopa, beta blockers

54
Q

7 phenylephrine adverse effects?

A

photophobia, blur, glare, allergic dermatoconjunctivitis, rebound miosis and congestion, anterior chamber pigment liberation, bradycardia

55
Q

6 contraindications of phenylephrine?

A

avoid 10% in old/young, CVD, uncontrolled diabetes, aneurysm, advanced arteriosclerosis, idiopathic orthostatic hypotension

56
Q

hydroxyamphetamine activity?

A

indirectly promotes NE release, contraction of iris radial muscles indirectly

57
Q

M1 receptor in parasympathetic pathway is for what?

A

memory

58
Q

M2 receptor is greater than M3 for what?

A

cardiac: decreasing contractility and conduction in the heart

59
Q

M2=M3 receptor for what 2 things?

A

pancreatic acini/hormone secretion, respiratory increase in bronchoconstiction and secretion

60
Q

M3 is greater than M2 for what two things?

A

iris miosis, ciliary body contraction and increase in aqueous outflow

61
Q

M3 is the parasympathetic receptor that does what three functions?

A

emetic (vomiting), increase salivary gland secretion, vasodilation

62
Q

what two enzymes break down acetylcholine?

A

acetylcholinesterase and butyrylcholinesterase (BChE)

63
Q

where is BChE found?

A

circulating in plasma

64
Q

where is acetylcholinesterase found?

A

at nerve terminals

65
Q

what molecule in the parasympathetic nerve activity starts the process?

A

acetyl-CoA

66
Q

in parasympathetic nerve activity, acetyl-CoA first comes in and combines with ___ to make ____

A

choline, ACh

67
Q

ACh is packaged into vesicles and due to subsequent _____ entry into the nerve, it ___ with the membrane and ____ ACh into the external environment

A

calcium, fuses, releases

68
Q

what acts by inhibiting calcium dependent degranulation of ACh?

A

botox (used for muscle paralysis)

69
Q

how do anticholinergic agents function?

A

they block the parasympathetic response

70
Q

name 5 anticholinergics

A

atropine, scopalamine, homatropine, cyclopentolate, tropicamide

71
Q

is scopolamine a selective or nonselective drug used for _______?

A

non-selective, motion sickness

72
Q

atropine is selective or non selective for __-receptors?

A

non-selective, for M receptors

73
Q

homatropine is a semi-synthetic derivative of atropine meaning it is broken down ____ effectively and lasts ____ than atropine in the body

A

less, longer

74
Q

tropicamide is moderately ____ receptor selective

A

M4

75
Q

which is the most lipophilic anticholinergic?

A

cyclopentolate

76
Q

which anticholinergic is the safest to use in clinic and most common dilated agent you use?

A

tropicamide

77
Q

because atropine in non-selective for M receptors and some N receptors, it has less or more side effects?

A

more

78
Q

cyclomydril is ______ + _____

A

cyclopentolate, phenylephrine

79
Q

the cyclo drugs will _____ the ciliary muscle

A

paralyze

80
Q

which anticholinegic do you use to dilate pts with uveitis and why?

A

atropine b/c it’s potent with long lasting effect

81
Q

what anticholinergic is used as an alternative to patching in ametropic patients?

A

atropine

82
Q

what are 3 ocular adverse effects of anticholinergics?

A

increase in IOP, angle closure risk, allergy

83
Q

what are important systemic adverse effects of anticholinergics?

A

ABCDS: anorexia, blur, constipation, confusion, dryness, sedation, stasis of urine

84
Q

what are two CNS medulla effects of anticholinergics?

A

decrease in parkinson tremor and decreased heart rate

85
Q

4 synergistic drug interactions of anticholinergics? 2 others?

A

synergistic: anti-histaminics, tricyclic antidepressants, antipsychotics, botox
other: opioids, potassium supplements

86
Q

7 contraindications for anticholinergics?

A

angle closure glaucoma and narrow angles, open angle glaucoma, down syndrome, albinism, cerebral palsy, spastic paralysis, iris supported IOL

87
Q

3 classic indications for atropine?

A

anterior uveitis (for vasoconstriction b/c block parasympathetic actions), myopic progression (won’t accommodate and grow eye longer), amblyopia (penalizing good eye)

88
Q

which anticholinergic has less flushing and dryness than atropine?

A

cyclopentolate

89
Q

cyclopentolate can cause ____effects in darkly pigmented eyes

A

delayed/sustained effects that last longer

90
Q

PAREMYD is a combo of which two drugs?

A

hydroxyamphetamine (adrenergic) and tropicamide (anticholinergic)

91
Q

PAREMYD has a ____ recovery than phenylephrine+tropicamide and can be used for a ____ angle

A

faster, shallow

92
Q

Do you need to pre-anesthetize cornea before using PAREMYD?

A

no

93
Q

does age and iris pigmentation affect usage of PAREMYD?

A

no

94
Q

unique adverse effect of PAREMYD

A

tachycardia

95
Q

PAREMYD safer than tropicamide in what 3 situations?

A

diabetes, ideopathic orthostatic hypotension, chemical sympathectomy agents

96
Q

2 tropicamide uses?

A

mydriasis, dose-dependent cyclopegia (can ramp up dosing)

97
Q

which anticholinergic has less pigment-sensitivity than the others?

A

tropicamide

98
Q

does hydroxyamphetamine surpress accommodation?

A

no! (phenylephrine does)

Ocular Pharm (2 decks)

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