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Ocular Pharm > Mydriatics Cylcloplegics > Flashcards

Mydriatics Cylcloplegics Flashcards

1
Q

Catecholamines are biogenic amines derived from tyramine. What do they include?

A
  1. dopamine
  2. epinephrine
  3. norepinephrine
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2
Q

what are enzymes of catecholamine metabolism

A

catechol o methyl transferase and monamine oxidase

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3
Q

what refers to paralysis of the ciliary body musculature responsible for accommodation

A

cyclopegia

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4
Q

what are the sympathetic NS neurotransmitters

A
  1. epinephrine (blood borne)

2. norepinephrine ( neuronal)

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5
Q

Only ____ is secreted at synaptic clefts

A

norepinephrine

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6
Q

What is the neurotransmitter for the parasympathetic NS

A

acetylcholine

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7
Q

What are the released NT for the sympathetic adrenergic system and what do they target

A

norepinephrine; target tissues

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8
Q

what are the terminal receptors for the sympathetic adrenergic sytem

A

alpha and beta

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9
Q

what is the NT for the sympathetic cholinergic autonomic system and what do they target?

A

acetylcholine; target sweat glands and some vessels

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10
Q

what are the terminal receptors of the sympathetic cholinergic system

A

muscarinic

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11
Q

alpha ___ receptor is antagonistic and is the built in inhibitor of the sympathetic NS

A

2

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12
Q

beta ___ is associated with the heart only

A

1

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13
Q

what is a precursor for tyrosine and melanin

A

phenylalanine

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14
Q

describe the sympathetic nerve activity

A

Tyrosine gets absorbed by the nerve which transfers it to inferior of nerve –> Dopa –> dopamine –> packaged into vesicles within nerve terminal. –> dopamine gets converted to norepinephrine –> calcium enters nerve terminal –> vesicles fuse with nerve terminal wall and release contents to exterior –> NE diffuses and enters inferior of nerve –> COMT destroys NE –> NE stimulates pos synaptic alpha receptors, beta receptors and alpha 2 presynaptic receptors

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15
Q

what are ocular adrenergic effects

A
  1. mydriasis
  2. increase in interpalpebral aperture (mueller smooth muscle)
  3. modulate aqueous generation by the ciliary body
  4. suppress accommodation thru receptors in the trabeculum and schemes canal
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16
Q

stimulation of ____ 2 increases AH production

A

beta

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17
Q

Myopes and ___ have large angles

A

aphaks

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18
Q

What are some factors that affect dilation and cause reduced sensitivity

A
  1. age related miosis
  2. unstable diabetes
  3. post op pupils
  4. posterior synechiae
  5. dark irides
  6. pseudoexfoliation syndrome
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19
Q

what factor affects dilation that causes increased sensitivity

A

down syndrome

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20
Q

Who are poor dilation candidates

A
  1. homocysinuria and marfans sydndrome patients: ectopia lentis risk; zonules break and there is an increased risk of fibers being stretched and torn and les dislodging
  2. pregnant women
  3. pigmentary or exfoliative glaucoma; transient IOP elevation
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21
Q

what are contraindications of dilation

A
  1. iris supported intraocular lens
  2. subluxated lens
  3. extremely narrow angle
  4. angle closure history w.o peripheral iridotomy
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22
Q

When does iatrogenic angle closure generally occur

A

4-8 hours post instillation

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23
Q

what are sympathetic mydriatics

A
  1. phenylphrine

2. hydroxyamphetamine

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24
Q

alpha 1 has _____ response

A

mydriatic

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25
Q

what does phenylephrine do

A

has alpha receptor selectivity and causes contraction of iris radial muscles by indirectly causing NE vesicles to fuse with presynpatic neuronal membrane and release those vesicle in the cleft.

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26
Q

what is common solution % of phenylephrine that is used

A

2.5% and 10%

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27
Q

what are common indications of phenylephrine

A

1 .mydriasis in 45-60 min

  1. conjunctival blanching
  2. mild accommodation suppresion - 2D
  3. Lid retraction
  4. IOP reduction
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28
Q

what are special uses of pheynlephrine

A
  1. posterior synechiea breakage
  2. pre lasik vasoconstriction
  3. inhibition of iris cysts
  4. horners eval
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29
Q

Which drugs enhance phenylephrine effects

A
  1. MAOI’s
  2. TCAD’s
  3. atropine
30
Q

what drugs reduce effect of phenylephrine

A
  1. methyldopa

2. beta blockers

31
Q

What are some adverse effects of phenylephrine

A
  1. photophobia, blur, glare
  2. allergic dermoconjuntivitis
  3. rebound miosis & congestion
  4. anterior chamber pigment liberation
  5. systemic hypertension –>bradycardia
32
Q

what are contraindications of phenylephrine

A
  1. avoid 10% in neonates and elderly

2. history of CVD, MI, uncontrolled DM1, aneurysm, advanced arteriosclerosis, idiopathic orthostatic hypotension

33
Q

In contrast to phenylephrine, hydroxyamphetamine is ____ acting; promotes NE release from nerve terminals

A

indirect

34
Q

There is no accommodation suppression with 1% formulation of _____

A

hydroxyamphetamine

35
Q

Muscarinic receptors deal with the _____ NS

A

parasympathetic

36
Q

What is ubiquitosly found at nerve terminals

A

acetylcholinesterase

37
Q

what circulates in the plasma

A

butrylcholinesterase

38
Q

what is key catecholamine of sympathetic ns

A

dopamine

39
Q

Describe the parasympathetic nerve activity

A

go over this

40
Q

What are some anticholinergic agents

A
  1. Atropine; non selective M
  2. scopolamine: non selective
  3. homatropine
  4. tropicamide
  5. cyclopentolate
  6. cyclomydril
41
Q

which anti cholinergic agent is kind of used like a patch

A

atropine

42
Q

what is atropine used for

A

cycloplegia, severe uveitis, amblyopia, esotropia, myopic progression, posterior synechiae

43
Q

what is used for travel sickness

A

scopolamine

44
Q

what is used for modetarate uveitis, corneal abrasion and mydriasis

A

homatropine

45
Q

What are some adverse ocular effects of anticholinergics

A
  1. Inc IOP
  2. angle closure risk
  3. allergy
46
Q

What are some systemic adverse effects of anticholinergics

A

ABCDs

  1. Anorexia
  2. Blur
  3. constipation & confusion
  4. dryness
  5. Sedation and stasis of urine
47
Q

what are CNS adverse effects of anticholinergics

A

Decreases in parkinson tremor and decreases HR

48
Q

What are synergistic exaggerated anticholinergic drug interaction effects

A
  1. classic antihistaminics
  2. tricyclic antidepressants
  3. antipsychotics
  4. botox
  5. opiods (constipiation)
  6. potassium supplements (gastric ulceration)
49
Q

what are contraindications of anticholinergics

A
  1. angle closure glaucoma & narrow anterior chamber angles
  2. open angle glaucoma
  3. down syndrome
  4. albinism
  5. cerebral palsy
  6. spastic paryalysis
  7. iris supported anterior intraocular lens
50
Q

What are classic indications of tropicamide

A
  1. mydriasis
  2. dose dependent cyclopegia
  3. less pigment sensitivity than cyclopentolate, homatropine and atropine
  4. best mydriasis as 0.25% with paremyd 1%
51
Q

Cyclopentolate is highly lipophilic and has delayed/sustained effects in darkly pigmented people. But there is less flushing and dryness than _____

A

atropoine

52
Q

what is known as wet refraction

A

cyclopegic refraction;

53
Q

Which cyclopegic drops act the quickest

A
  1. cyclopentolate; 20-45 min onset and lasts 6-24 hours

2. tropicamide; 20-35 min onset and lasts 6 hours

54
Q

What is paremyd composed of

A

hydroxyamphetamine and tropicamide

55
Q

____ is combined with tropicamide and is applied before administering tropicamide in order to vasoconstrictor and reduce systemic absorption

A

phenylephrine

56
Q

what is an adverse effect of paremyd

A

systemic hypertension –> TACHycardia

57
Q

When should you caution with using the epipen

A

patients with heart disease, high blood pressure, parkinson disease, diabetes or a thyroid disorder.

58
Q

which anticholinergic agents are non selective for M

A

atropine

scopolamine

59
Q

Binding of M ___ and M ___ causes an increase in the activity of the cell. Binding of M___

A

1 and 3. 2

60
Q

M2 = M3 in the ___ system as well as the ____ system.

A

respiratory; bronchoconstriction, secretion

pancreatic; acini secretion

61
Q

Which anticholinergic drugs are concerned with pigmentation

A
  1. cyclopentolate
  2. atropine
  3. homatropine
62
Q

what are indications for cyclopegia

A
  1. strabismus
  2. pseudomyopia
  3. latent hyperopia
  4. anisometropia
  5. amblyopia
  6. malingerrs
  7. uncooperative, non communicative, inconsistent patient
63
Q

____ is not affected by age or iris pigmentation and you get no benefit from preanestheizing the cornea. Mydriasis happens in ___ to 30 mins

A

Paremyd; 20

64
Q

In anaphylaxis you get bronchnconstriction, reduced blood pressure (vasodilation) and ____

A

swelling

65
Q

what does alpha 1 do

A

increases vasoconstriction and increases mydriasis

66
Q

what does beta 1 do

A

increases contractility and conduction in the heart

67
Q

what does beta 2 do

A

increases vasodilation, glucugenolysis, insulin release, relaxation and aqueous production

68
Q

when is the only time that norepinehprine is predominant?

A

at alpha 1

69
Q

when is epinephrine equal to norepinephrine

A

beta 1

70
Q

what are the sympathetic mydriatics

A
  1. pheynlephrine

2. hydroxyamphetamine (paremyd)

71
Q

What are the sympathetic mydriatics that are OTC imidazolines for red eye relief

A
  1. oxymetazoline
  2. naphzoline (clear eyes)
  3. tetrahydrozoline (visine)

Ocular Pharm (12 decks)

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