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Pharmacology > Ocular > Flashcards

Ocular Flashcards

1
Q

Miosis (pupillary constriction) occurs via what muscle and what limb of the NS?

A

Pupillary sphinctor muslce of the iris via PNS (M3)

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2
Q

Mydriasis (pupillary dilation) occurs via what muscle and what limb of the NS?

A

Radial dilator muscle of the iris via SNS (alpha)

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3
Q

Accomodation occurs via what muscle and what limb of the NS?

A

Ciliary muscle via PNS (M3), specifically, the circular fibers

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4
Q

Secretion of aqueous humor occurs via what structure and what limb of the NS?

A

Ciliary body epithelium via SNS (beta)

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5
Q

In the eye, muscarinic receptors (PNS) are found where? What about nicotinic receptors (PNS) ?

A

Muscarinic: Ciliary body, Iris. Nicotinic: Extraocular muscles

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6
Q

In the eye, what is the major endogenous NT of the PNS? What is the major receptor? What does it do?

A

Ach. Muscarinic. Constrict pupil (pupillary sphinctor m. of the iris + circular fibers of the ciliary muscle), Place tension on trabecular meshwork (longitudinal fibers of ciliary muscle)

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7
Q

Ach class?

A

Direct muscarinic agonist

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8
Q

Pilocarpine class?

A

Direct muscarinic agonist

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9
Q

Carbachol class?

A

Direct muscarinic agonist

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10
Q

Methacholine class?

A

Direct muscarinic agonist

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11
Q

Direct muscarinic agonists used in ocular treatment?

A

Acetylcholine, Pilocarpine, Carbachol, Methacholine

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12
Q

Major effects and uses of muscarinic agonists in the eye?

A

Pupillary constriction, Increased aqueous outflow. Used for cataract surgery and treatment of glaucoma.

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13
Q

Ach for?

A

Pupillary constriction – used in cataract surgery

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14
Q

Pilocarpine for?

A

Pupillary constriction, increased aqueous outflow – tx of glaucoma

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15
Q

Carbachol for?

A

Pupillary constriction, increased aqueous outflow – tx of glaucoma

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16
Q

Side effects of direct muscarinic agonists?

A

Lacrimation, sweating, bronchospasm, salivation, N/V/D, abdominal pain, tenesmus

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17
Q

Muscarinic antagonists used in ocular treatment?

A

Atropine, Scopolamine, Homatropine, Cyclopentolate, Tropicamide

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18
Q

Major effects and uses of muscarinic antagonists in the eye?

A

Pupillary dilation, Paralysis of ciliary body. Used for cycloplegia for eye exams and to improve comfort during active eye inflammation (for example, uveitis)

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19
Q

Atropine class?

A

Antimuscarinic

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20
Q

Scopolamine class?

A

Antimuscarinic

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21
Q

Homatropine class?

A

Antimuscarinic

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22
Q

Cyclopenolate class?

A

Antimuscarinic

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23
Q

Tropicamide class?

A

Antimuscarinic

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24
Q

Atropine for?

A

Pupillary dilation, paralysis of ciliary body – Improve comfort during active eye inflammation

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25
Q

Atropine timing?

A

VERY long acting: Maximal strength in 30-40 minutes, with recovery lasting 7-10 days

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26
Q

Scopolamine for?

A

Pupillary dilation, paralysis of ciliary body – Improve comfort during active eye inflammation

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27
Q

Homatropine for?

A

Pupillary dilation, paralysis of ciliary body – Cycloplegia for eye exams, Improve comfort during active eye inflammation

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28
Q

Cyclopentolate for?

A

Pupillary dilation, paralysis of ciliary body – Cycloplegia for eye exams, Improve comfort during active eye inflammation

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29
Q

Tropicamide for?

A

Pupillary dilation, paralysis of ciliary body – Most commonly used for eye exams

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30
Q

Tropicamide timing?

A

Maximal strength in 20-40 minutes, with recovery lasting less than 1/4 of a day

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31
Q

Edrophonium class?

A

Acetylcholinesterase Inhibitor: Indirect nicotinic agonist

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32
Q

Edrophonium for?

A

Differentiate myasthenia gravis from an acute acetyl choline crisis

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33
Q

Side effects of antimuscarinics?

A

Anhidrosis, urinary retention, ataxia, nystagmus, photophobia, mental confusion, hallucination, violent/aggressive behavior, insomnia

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34
Q

In the eye, what is the major endogenous NT of the SNS? What is the major receptor? What does it do?

A

NE. Alpha & Beta. Dilate pupil (radial dilator m. of the iris), Aqueous production (ciliary body epithelium), Increase outflow of aqueous (trabecular meshwork), lift eyelid (superior palpebral m.), dilate blood muscles (smooth muscle of ocular blood vessels)

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35
Q

Phenylephrine class?

A

Direct alpha1 agonist

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36
Q

Phenylephrine for?

A

Pupillary dilation – eye exam, cataract surgery

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37
Q

Epinephrine class?

A

Direct adrenergic agonist

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38
Q

Epinephrine for?

A

Dilation of episcleral vessels – Increased aqueous outflow

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39
Q

Dipvalyl class?

A

Direct adrenergic agonist (prodrug of epinephrine)

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40
Q

Dipvalyl for?

41
Q

Brimonidine tartrate class?

A

Direct alpha2 agonist

42
Q

Brimonidine tartrate for?

A

Suppress aq humor production –Glaucoma

43
Q

Apraclonidine class?

A

Direct alpha agonist

44
Q

Apraclonidine for?

45
Q

Apraclonidine is useful why?

A

Does not cross BBB, minimal effects on BP

46
Q

Clonidine class?

A

Direct alpha2 agonist

47
Q

Clonidine for?

A

Lower intraocular pressure through CNS effects – glaucoma

48
Q

Hydroxyamphetamine class?

A

Indirect adrenergic agonist, release NE

49
Q

Hydroxyamphetamine for?

A

Separates 1st/2nd from 3rd order neuron dysfunction in Horner’s – Positive dilation means 1st/2nd order (more ominous lesion)

50
Q

Cocaine class?

A

Indirect adrenergic agonist, prevents NE reuptake

51
Q

Cocaine for?

A

Use initially to confirm diagnosis of Horner’s

52
Q

Dapiprazole class?

A

Alpha antagonist

53
Q

Dapiprazole for?

A

Blcok alpha-adrenergic receptors in smooth muscle of the eye, Reverse tropicamide & phenylephrine in particular

54
Q

How do epinephrine compounds help glaucoma?

A

Increase aqueous outflow by dilating episcleral vessels

55
Q

How do beta-blockers help glaucoma?

A

Reduce intraocular pressure by reducing aqueous production at the ciliary processes

56
Q

How do parasympathomimetics help glaucoma? What are drugs used?

A

Lower intraocular pressure by contracting the ciliary muscles and contracting the trabecular meshwork. Used is pilocarpine, carbachol.

57
Q

Echothiophate class?

A

Indirect muscarinic agonist, irreversible acetylcholine esterase inhibitor

58
Q

Echothiophate for? Is it used still?

A

Glaucoma. Less used because of topical side effects.

59
Q

Timolol class?

A

Beta-blocker

60
Q

Timolol for?

A

Reduce intraocular pressure by reducing aq production at the ciliary process – glaucoma

61
Q

Levobunolol class?

A

Beta-blocker

62
Q

Levobunolol for?

A

Reduce intraocular pressure by reducing aq production at the ciliary process – glaucoma

63
Q

Betaxolol class?

A

B1 blocker

64
Q

Betaxolol for?

A

Reduce intraocular pressure by reducing aq production at the ciliary process – glaucoma

65
Q

Carbonic anydrase inhibitors? Which are oral and which are topical?

A

Acetazolamide, Ethoxzolamide, Methazolamide (oral); Dorzolamide, Brinzolamide (topical)

66
Q

How do carbonic anhydrase inhibitors help glaucoma?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production

67
Q

Acetazolomide class?

A

Carbonic anhydrase inhibitor

68
Q

Acetazolomide for?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production – Oral for glaucoma

69
Q

Ethoxzolamide class?

A

Carbonic anhydrase inhibitor

70
Q

Ethoxzolamide for?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production – Oral for glaucoma

71
Q

Methazolamide class?

A

Carbonic anhydrase inhibitor

72
Q

Methazolamide for?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production – Oral for glaucoma

73
Q

Dorzolamide class?

A

Carbonic anhydrase inhibitor

74
Q

Dorzolamide for?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production – Topical for glaucoma

75
Q

Brinzolamide class?

A

Carbonic anhydrase inhibitor?

76
Q

Brinzoloamide for?

A

Interfere with active transport of Na through Na-K-ATPase in order to reduce aqueous production – Topical for glaucoma

77
Q

Side effects of topical carbonic anhydrase inhibitors?

A

Lid allergies, Red eyes

78
Q

How do osmotic agents help with glaucoma?

A

Interfere with passive transportation of fluid in the ciliary body. Increase serum osmolarity, draw fluid fro the extravasc to intravasc space. Can only be used short term due to risk of heart failure.

79
Q

Examples of osmotic agents? How are they administered?

A

Glycerol, sorbitol (oral), Mannitol, urea (IV)

80
Q

How do prostaglandin analogs help with glaucoma?

A

Increase uveoscleral outflow (without any effect on aqueous flow or trabecular outflow facility)

81
Q

Latanoprost class?

A

Prostaglandin analog

82
Q

Travoprost class?

A

Prostaglandin analog?

83
Q

Bimatoprost class?

A

Prostaglandin analog?

84
Q

Unoprostone isopropyl class?

A

Prostaglandin analog?

85
Q

Prostaglanding analogs?

A

Latanoprost, Travoprost, Bimatoprost, Unoprostone isopropyl

86
Q

Latanoprost for?

A

Increase uveoscleral outflow – Glaucoma

87
Q

Latanoprost side effects?

A

Intraocular inflammation, eyelash growth, iris color change, exacerbate cystoid macular edema after cataract surgery, can activate herpes

88
Q

Most commonly used prostaglandin analog?

A

Latanoprost

89
Q

Travoprost mxn?

A

Increase uveoscleral outflow – Glaucoma

90
Q

Bimatoprost mxn?

A

Increase uveoscleral outflow – Glaucoma

91
Q

Unoprostone isopropyl mxn?

A

Increase uveoscleral outflow – Glaucoma

92
Q

Least effect overall of prostaglandin analogs?

A

Unoprostone isopropyl

93
Q

All prostaglandin analogs can cause?

A

Eyelash growth, change in iris color

94
Q

Nifedipine class?

A

Ca-channel blocker

95
Q

Nifedipine for?

A

Increase ocular perfusion at nervehead – Low-tension-glaucoma

96
Q

What are the 4 first-line treatments for glaucoma? Say their class, frequency & contraindications.

A

Timolol (non-spec beta blocker; once/day; CHF, asthma, bradycardia, tachyphylazxis with time), Latanaprost (prostaglandin; once/day; cystoid macular edema, herpes, iris color change, eyelash growth, intraocular inflammation), Brimondine (alpha2 agonist, 3/day, use with MAOI cna cause fatigue/drowsiness & follicular conjunctivitis), Dorzolamide HCL (carbonic anhydrase inhibitor, 3/day, allergies to sulfonamides)

97
Q

How can you distinguish Horner’s from non-Horner’s and preganglionic from postganglionic? Give drug, abnormal response, normal response.

A

Cocaine 10%, fail to dilate, dilate (normal – No Horner’s). Paredrine 1%, dilate, dilate (so both dilate with a preganglionic lesion). Paredrine 1%, fail to dilate, dilate (so a failure to dilate with paredrine 1% indicates a postganglionic lesion).

98
Q

How can you distinguish a tonic pupil? Give drug, abnormal response, normal response.

A

Pilocarpine 1/8%, constrict, no rxn (normal). Methacholine 2.5%, constrict, no rxn (normal).

99
Q

How can you pick out a pharmacologic ocular problem (possible self-induced?

A

Pilocarpine 1%, no constriction, constriction (normal).

Pharmacology (46 decks)

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