Ocular Flashcards
1
Q
ACh
A
- PS system
- direct muscarinic agonist
- pupillary constriction, increased aq outflow
- tx. cataract sx and glaucoma
- SE: SLUDGE
2
Q
Carbachol
A
- PS system
- direct muscarinic agonist
- pupillary constriction, increased aq outflow
- tx: cataract sx and glaucoma
- SE: SLUDGE
3
Q
pilocarpine
A
- PS system
- direct muscarinic agonist
- pupillary constriction, increased aq outflow
- tx: catarcts and glaucoma
- SE: SLUDGE
**Pile on the sweat, salive and tears
4
Q
atropine
A
antimuscarinic (PS system)
5
Q
scopolamine
A
- antimuscarinic (PS)
6
Q
tropicamide
A
antimuscarinic (PS system)
7
Q
homatropine
A
antimuscarinic
8
Q
cyclopentolate
A
antimuscarinic
9
Q
antimuscarinics: mech and use
A
- pupillary dilation, paralysis of ciliary body
- use: cycloplegia for eye exams and to improve comfort during uveitis
10
Q
SE of antimuscarinics/anticholinergics
A
- ataxia, nystagmus, restlessness, mental confusion, hallucinations, insomnia, photophobia, urinary retention
11
Q
location of muscarinic receptors
A
- iris sphincter (contstrict pupil)
- circular fibers of ciliary muscle (constrict pupil)
- longitiudinal fibers of ciliary muscle (place tension on trabecular meshwork)
** contraction of ciliary muscle and opening of trabecular meshwork decreases IOP
12
Q
edrophonium
A
- indirect agonist of nicotinic receptor
- destroys AChE
- used to dx Myasthenia Gravis
13
Q
PS system
A
- Edinger-Westphal nucleus sends fibers in the oculomotor nerve (CN III) that synapse in the ciliary ganglia –> innervate pupillary constrictor mm
- preganglionic lesions (before ciliary ganglion) are bad
14
Q
sympathetic system
A
- originates inteh hypothalamus –> fibers descend down the brainstem to thoracic spinal cord –> synapse –> 2nd order neurons exit SC and ascend with the paravertebral sympa chain –> synapse in the superior cervical ganglion –> 3rd order neurons run with the carotid plexus –> join opthalmic division of the CNV –> fibers pass with nasociliary nerve –> long ciliary nerve –> ciliary body and dilator muscles of iris
- preganglionic lesions (1st and 2nd order) are bad
15
Q
location of sympa ocular receptors
A
- iris dilator muscle
- superior palpebral muscle of Muller (lifts eyelid)
- ciliary epi (facilitates aqueous production)
- smooth mm of ocular BV (vasodilation)
- trabecular meshwork (increase aq outflow)
16
Q
phenylephrine
A
- sympa system
- mimic NE
- dilation of pupil
17
Q
L-epinephrine
A
dilate pupil (sympa system)
18
Q
dipivaly epinephrine
A
- prodrug of epi
- dilate pupil (sympa system)
19
Q
Bromondine tartrate
A
- alpha 2 agonist (sympa system)
- suppress aq humor production
- contraindication: use with MAOI can caused fatigue/drowsiness
- ** know this one
20
Q
clonidine
A
- alpha agonist (sympa system)
- lowers IOP via CNS effects
21
Q
apraclonidine
A
alpha agonist (sympa system)
derivative of clonidine that doesnt cross BBB and has minimal effect on BP
22
Q
cocaine
A
- inhibits reuptake of NE
- used to dx Horner’s syndrome (pupil fails to dilate)
23
Q
hydroxyamphetamine (Paradrine)
A
- releases NE
- used to dx pre vs postganglionic lesion in Horner’s
- dilation = 3rd neuron must be intact and lesion lies within 1st or 2nd order neuron –> CNS lesion, apical lung tumor or thoracic aortic aneurysm
24
Q
Dapiprazole
A
- reverses action of Tropicamide and Phenylephrine
- blockage of alpha-adrenergic receptors in smooth dilator muscle of iris
25
Q
beta blockers
A
- Timolol, Betaxolol, Metipranolol
- suppress aq production
- tx: glaucoma
- SE: bardycardia, hypotension, syncope, palpitation, CHF, bronchospasm
- contraindications: CHF, asthma
26
Q
Acetazolamide
A
- carbonic anhydrase inhibitor (oral)
- reduce production of aq via intereference with active transport of Na+
- tx: glaucoma
- but many SE (use topicals 1st)
27
Q
ethoxzolamide and methazolamide
A
carbonic anhydrase inhibs (oral)
tx: glaucoma
but many SE
28
Q
**Dorzolamide Hydrochloride
A
- carbonic anhydrase inhib (topical)
- decrease aq production via interference with active Na transport
- tx: glaucoma
- SE: allx to sulfonamides (red eyes and lid allx)
29
Q
brinzolamide
A
- carbonic anhydrase inhib (topical)
- tx glaucoma
- SE: red eyes and lid allx
30
Q
osmotic agents
A
- increase serum osmolarity and draw fluid from extravascular space into blood vessels
- tx glaucoma
- contraindicated in PTs with potential for heart failure due to increased intravascular volume
31
Q
Latanoprost
A
- prostaglandin (eye drop)
- increase uveoscleral outflow
- tx: glaucoma
- contraindications: cystoid macular edema, herpes
- SE: growth of eyelashes and change in color of iris
32
Q
bimatroprost, travoprost, unoprostone isopryl
A
- prostaglandins (eye drops)
- increase uveoscleral outflow
- tx glaucoma
- SE: eyelash growth, change of color of iris
33
Q
SE of adrenergics (epi, phenylephrine)
A
- palpitiation, HTN, MI, trembling, paleness, sweating
34
Q
1st line meds for glaucoma
A
- Timolol - beta blocker: decrease aq production
- Latanoprost- prostaglandin: increases uveoscleral outflow
- Brimondine - alpha 2 agonist: decrease aq production
- Dorzolamide HCl- carbonic anhydrase inhibitor: decreases aq production
35
Q
how to dx horner’s syndrome
A
- cocaine –> no dilation confifrms Horner’s
- Paredrine –> dilation = lesion at 1st or 2nd order neuron (3rd order neuron is intact but not recieving stimulus)
36
Q
how to dx Adie’s syndrome (tonic pupil)
A
- pilocarpine 1/8% or methacholine 2.5%
- pupil should constrict at this minimal dose because Ach will stimulate a chronically denervated nerve (due to hypersensitivity)
37
Q
how to dx pharmacologic blockade
A
- pilocarpine 1% or methacholine 10% –> no constriction
- pupil should constrict under any circumstances (even aneurysm bc the ciliary body is ok)
