Ocular Flashcards
Acetylcholine
Class: Direct muscarinic agonist
Mech: Pupillary constriction
Thera: Used in cataract surgery to constrict pupil intraoperatively
Tox: Bronchospasm, SLUDGE, sweating
Pilocarpine
Class: Direct muscarinic agonist
Mech: Pupillary constriction, increased aqueous outflow
Thera: Treatment of glaucoma (both open and acute closed angle); used less today due to SEs
Tox: Bronchospasm, SLUDGE, sweating
Decreased vision when patient has cataracts due to miosis and headache
Requires frequent dosage
Carbachol
Class: Direct muscarinic agonist
Mech: Pupillary constriction, increased aqueous outflow
Thera: Treatment of glaucoma (both open and acute closed angle); used less today due to SEs
Tox: Bronchospasm, SLUDGE, sweating
Decreased vision when patient has cataracts due to miosis and headache
Echothiophate iodide
Class: Indirect muscarinic agonist.
Mech: Irreversibly binds cholinesterase
Thera: Treatment of glaucoma (both open and acute closed angle); used less today due to SEs
Bronchospasm, SLUDGE, sweating
Atropine
Class: Antimuscarinic
Mech: Pupillary dilatation, paralysis of ciliary body
Thera: Improve discomfort during active eye inflammation
Tox: Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent/aggressive behavior, insomnia, photophobia, urinary retention
Misc: Very long acting so not used unless severe inflammation
Scopolamine
Class: Antimuscarinic
Mech: Pupillary dilatation, paralysis of ciliary body
Thera: Improve discomfort during active eye inflammation
Tox: Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent/aggressive behavior, insomnia, photophobia, urinary retention
Homatropine
Class: Antimuscarinic
Mech: Pupillary dilatation, paralysis of ciliary body
Thera: Cycloplegia for eye exams, improve discomfort during active eye inflammation (uveitis)
Tox: Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent/aggressive behavior, insomnia, photophobia, urinary retention
Cyclopentolate
Class: Antimuscarinic
Mech: Pupillary dilatation, paralysis of ciliary body
Thera: Cycloplegia for eye exams, improve discomfort during active eye inflammation (uveitis)
Tox: Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent/aggressive behavior, insomnia, photophobia, urinary
Tropicamide
Class: Antimuscarinic
Mech: Pupillary dilatation, paralysis of ciliary body
Thera: Most commonly used cycloplegia for eye exams
Tox: Ataxia, nystagmus, restlessness, mental confusion, hallucination, violent/aggressive behavior, insomnia, photophobia, urinary
Epinephrine
Class: Direct adrenergic agonist
Mech: Dilation of episcleral vessels which allows for increased aqueous outflow.
Tox: Extrasystoles, palpitation, hypertensio, MI, trembling, paleness, sweating.
Dipivefrin HCl
Class: Direct adrenergic agonist
Mech: Prodrug of Epi
Thera: Treatment of glaucoma
Hydroxyamphetamine
Class: Indirect adrenergic agonist
Mech: Release NE
Thera: Separates 1st and 2nd from 3rd order neuron dysfunction in Horner’s; positive dilation means 1st or 2nd order which is an ominous sign
Cocaine
Class: Indirect adrenergic agonist
Mech: Prevent reuptake of NE
Thera: Use initially to confirm the diagnosis of Horner’s
Apraclonidine
Class: Direct alpha agonist
Mech: Amino derivative of clonidine; does not cross BBB therefore has a minimal effect on BP
Thera: Treatment of open angle glaucoma
Phenylephrine
Class: Direct alpha1 agonist
Thera: Dilate pupil for eye exam and cataract surgery
Tox: Extrasystoles, palpitation, HTN, MI, trembling, paleness, sweating
Misc: Caution in elderly patients; at 10% can cause cardiac SEs
Clonidine
Class: Direct alpha2 agonist
Mech: Lowers intraocular pressure through CNS SEs
Brimondine tartrate
Class: Direct alpha2 agonist
Mech: Suppresses aqueous humor production through action of cAMP in non-pigmented ciliary epithelium
Thera: Primary agent for treatment of glaucoma.
Misc: May cause follicular conjunctivitis; use with MAOi can cause fatigue and drowsiness
Dapiprazole
Class: Alpha antagonist
Mech: Blocks alpha adrenergic receptors in smooth dilator muscle of iris
Thera: Reverses topicamide, phenylephrine
Misc: Not currently available
Tamsulosin
Class: Alpha1 antagonist
Thera: BPH
Tox: Floppy iris syndrome
Misc: Blocks iris dilator muscle, making cataract surgery much more difficult and with a much higher incidence of complications
Timolol
Levobunolol
Metipranolol
Carteolol
Class: Beta blocker
Mech: Reduce intraocular pressure by reducing aqueous production at the ciliary process
Thera: Second line treatment for glaucoma
Tox: Bradycardia, hypotension, syncope, palpitation, CHF, bronchospasm, mental confusion, depression, fatigue, light-headedness, hallucinations, memory impairment, sexual dysfunction, hyperkalemia
Misc:
Timolol: Contraindicated in CHF, asthma, bradycardia, may cause bradycardia over time
Metipranolol: Only beta blocker that doesn’t follow the rule
Betaxolol
Class: Beta1 blocker
Mech: Reduce intraocular pressure by reducing aqueous production at the ciliary process
Thera: Second line treatment for glaucoma
Latanoprast
Travoprost
Bimatoprost
Class: Prostaglandin analog
Mech: Increase uveoscleral outflow
Thera: Primary agent for treatment of glaucoma
Tox: Eyelash growth, change in iris color, intraocular inflammation
Misc: May cause cystoid macular edema in cataract surgery and activate herpes
Travoprost: more effective in African Americans
Unoprostone
Class: Prostaglandin analog
Mech: Increase uveoscleral outflow
Thera: glaucoma
Tox: Eyelash growth, change in iris color, intraocular inflammation
Misc: Least effective overall
Nifedipine
Class: Ca-channel blocker
Mech: Increases ocular perfusion at nervehead
Thera: May aid in treatment of low tension glaucoma by systemic meds; not widely used
Dorzolamide HCl
Brinzolamide
Class: Carbonic anhydrase inhibitor
Mech: Reduce aqueous production via interference with the active transport transport of Na through Na-K-ATPase pump
Thera: Second line glaucoma
Tox: Red eyes, lid allergies
Misc: Dorzolamide HCl is contraindicated in sulfonamide allergies; these are drops
Acetazolamide
Class: Carbonic anhydrase inhibitor
Mech: Reduce aqueous production via interference with the active transport transport of Na through Na-K-ATPase pump
Thera: Oral agent used for advanced glaucoma and with cataract surgery
