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Ocular Pharm Flashcards

1
Q

Name 4 things in anterior segment of the eye

A
  1. lens
  2. ciliary body
  3. cornea
  4. iris
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2
Q

Describe the cornea (4 characteristics)

A
  1. tough
  2. transparent
  3. avascular
  4. dome shaped
    (covers front of the eye)
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3
Q

Describe the iris (3)

A
  1. pigmented tissue

2. allows light rays through the pupil

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4
Q

What controls the pupillary aperture?

A

iris dilator and sphincter muscles

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5
Q

Lens description?

A

pliant bag of protein

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6
Q

How does the lens work?

A

changes thickness and in doing so alters the focal point of the eye

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7
Q

How is lens thickness controlled?

A

muscular fibers within the ciliary body put tension on the zonules that connect the lens to the ciliary body

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8
Q

Why is the lens imp in accommodation?

A

b/c ability to change focal point is intrinsic in accommodation.

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9
Q

Where is aqueous produced?

A

ciliary body

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10
Q

What is the function of AQUEOUS?

A

source of nutrition for cornea, lens and trabecular meshwork.

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11
Q

How does aqueous cause glaucoma?

A
  1. aqueous production must match riddance

2. when aqueous builds up in anterior chamber, increased pressure affects optic nerve and glaucoma develops.

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12
Q

How does aqueous leave?

A

through the trabecular meshwork on edge of anterior chamber. drained through collector channels before leaving.

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13
Q

Angle closure glaucoma: formation?

A

bowing forward of the iris prevents aqueous from draining into the trabecular meshwork

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14
Q

Test for predisposition to angle closure glaucoma?

A

shine light on temporal side of eye. If both the temporal and nasal iris light up similarly, pt ok. If the nasal portion has shadow, predisposed to developing angle closure glaucoma (anterior chamber shallow bc iris bowed out)

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15
Q

3 things involved in accommodation?

A
  1. convergence of eyes
  2. pupillary constriction
  3. thickening of the lens
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16
Q

Accommodation but pupil doesn’t constrict…3 conditions?

A
  1. Argyll Robertson-Tertiary syphilis
  2. Adie Syndrome- damaged ciliary ganglion
  3. Parinaud’s Syndrome- pineal tumor
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17
Q

Parasympathetic innervates what in the eye?

A
  1. iris sphincter muscle
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18
Q

Parasympa innervation in the eye: what blocks muscarinic receptors vs. nicotinic?

A
  1. muscarinic blockade=atropine

2. nicotinic blockade=d-tubocurarine

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19
Q

Location of muscarinic and nicotinic receptors in the eye?

A

muscarinic-on ciliary muscle and iris

nicotinic-on extraocular muscles

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20
Q

Preganglionic para problem: 3 on the differential?

A
  1. Meningitis
  2. Ischemic infarct
  3. compression of nerve
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21
Q

POSTGANGLIONIC para problem: 3 on differential?

A
  1. Adie’s syndrome
  2. pharm blockade
  3. acute glaucoma
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22
Q

Neurotransmitter: Ach
Receptor: Muscarinic
Location of these receptors in eye and specific function?

A
  1. iris sphincter: CONSTRICT PUPIL
  2. circular fibers of ciliary muscle: CONSTRICT PUPIL
  3. longitudinal fibers of ciliary muscle: TENSION ON TRABECULAR MESHWORK
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23
Q

DIRECT MUSCARINIC AGONISTS OF THE EYE (4)

A
  1. Ach
  2. Methacholine
  3. Pilocarpine
  4. Carbachol
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24
Q

FUNCTION OF DIRECT MUSCARINIC AGONISTS in the eye?

A
  1. pupillary constriction

2. increase aqueous flow

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25
CONDITIONS muscarinic agonists used to treat/used in?
1. cataract surgery | 2. glaucoma
26
MUSCARINIC ANTAGONISTS OF THE EYE IN ORDER OF BEST FOR MYDRIASIS AND CYCLOPEGIA(paralysis of ciliary muscle) ? (5)
1. Tropicamide (recovery 1/4 day) 2. Cyclopentolate 3. Homatropine 4. scopolamine 5. Atropine
27
Nicotinic agonist? Only 1 in opthamology
Edrophonium (Achesterase inhibitor)
28
SYMPATHETIC SYSTEM: 1 order neurons
fibers coming down from hypothalamus to the brainstem
29
SYMPA: 2 order neurons
after synapse of first order in spinal cord, ascend with paravertebral sympa chain to superior cervical ganglion
30
SYMPA: 3 order neurons
after synapsing now third order neurons run with carotid plexus and join V1 (opthal division of CN5). Fibers pass with 1. nasociliary nerve and 2. long ciliary nerve to reach the ciliary body and dilator muscle of the iris.
31
REVIEW SYMPA RECEPTORS
1. alpha 1: smooth muscle contraction 2. alpha 2: feedback inhibition of presynaptic sympa 3. beta 1: increase heart rate 4. beta 2: smooth muscle and bronchi dilation
32
ocular receptor functions?
1. Iris dilator muscle- dilate pupil 2. superior palpebral muscle of Mueller-lifts eyelid 3. ciliary epithelium- aqueous production 4. trabecular meshwork- aqueous outflow 5. ocular smooth muscle blood vessel-dilates blood vessels
33
DIRECT SYMPA AGONISTS (6)
1. Phenylephrine 2. clonidine 3. apraclonidine 4. L-epinephrine 5. Dipivalyl epinephrine 6. Bromondine Tartrate
34
phenylephrine?
alpha 1-pupil dilation
35
L-epinephrine?
alpha and beta
36
Dipivalyl epinephrine?
pro-drug of epinephrine
37
Clonidine?
alpha adrenergic agonist | lowers intraocular pressure through CNS effects
38
Apraclonidine
``` alpha agonist (derivative of clonidine that does not cross the BBB, has minimal effect on systemic BP) ```
39
Bromondine tartrate
selective alpha 2 agonist | suppresses aqueous humor production
40
INDIRECT NE AGONISTS? (2)
1. COCAINE- prevents NE re-uptake | 2. hydroxyamphetamine- releases NE
41
NE ANTAGONISTS? (6)
1. Dapiprazole 2. Timolol 3. Betaxolol 4. Carteolol 5. Levobunolol 6. Metipranolol
42
DAPIPRAZOLE?
1. Reverses action of Tropicamide and Phenylephrine | 2. Blocks alpha adrenergic receptor in smooth dilator muscle of iris
43
TIMOLOL
non-specific beta 1 and 2 blocker
44
Betaxolol
beta 1 blocker
45
Carteolol
non-specific beta 1 and 2 blocker
46
Levobunolol
beta 2 blocker
47
Metipranolol
1. non-selective beta 1 and 2 blocker 2. no significant intrinsic sympathomimetic activity 3. weak membrane stabilizing activity 3. weak myocardial depressant
48
Glaucoma Treatment: 3 ways to Rx increased intraocular pressure?
1. Increase aqueous outflow by dilating episcleral vessels (Epi) 2. Decrease aqueous production (beta blockers) 3. Increase aqueous outflow through trabecular meshwork (Ach agonists)
49
Epinephrine compounds include?
1. epinephrine borate 2, epinephrine bitartrate 3. prodrug DPE
50
Beta blockers that decrease aqueous production?
1. Timolol 2. Betaxolol 3. Levobunalol
51
parasympas?
pilocarpine, carbachol, echothiophate
52
Carbonic anhydrase inhibitors?
treat glaucoma reduce production of aqueous affect Na transport in Na/K pump
53
Oral carbonic anhydrases? Effective but lots of systemic SE
1. acetazolamide 2. methazolamide 3. ethoxzolamide
54
Topical carbonic anhydrases?
1. brinzolamide 2. dorzolamide hcl cause red eyes, lid allergies
55
beta blocker timolol + dorzolamide?
Cosopt | 2nd line for glaucoma
56
Osmotic agents: function?
increase osmolarity by interfering with the passive transport of fluid into the ciliary body. Increase intravascular volume, can cause heart failure so need to be montored closely. Only short periods of time.
57
Osmotic agents examples?
Glycerol, sorbitol, (oral) mannitol and urea 9IV)
58
Prostaglandins: 1st line therapy: MOA?
increase uveoscleral outflow w/o any effect on trabecular or aqueous flow.
59
Prost examples: 4?
1. Latanoprost 2. Bimatoprost 3. Travoprost 4. Unoprostone isopryl
60
Latanoprost
1. most common, first 2. stored in firdge 3. can cause intraocular inflammation 4. may exacerbate cystoid macular edema after cataract surgery 5. cause eyelashes longer and change iris color (all prosts do this)
61
Travoprost
most effective in african americans
62
Unoprostone isopryl
least effective one
63
Nifedipine
Ca channel blocker. effective in glaucoma treatment. doesn't act on ciliary body or trabecular meshwork.
64
First line treatments?
1. Timolol 2. Latanoprost 3. Brimondine 4. Dorzolamide
65
Timolol
1. beta blocker non-specific | 2. CI in CHF, asthma, bradycardia over time can cause tachyphylaxis
66
latanoprost
1. prostaglandin 2. eyelash and iris change CI in 3. cystoid macular edema & 4. herpes
67
Brimondine
alpha 2 agonist | CI in use with MAOI -cause faitgue/drowsiness, follicular conjunctivits
68
Dorzolamide
carbonic anhydrase inhibitor | allergies to sulfonamides
69
Confirm Horner's dx: with what?
Use cocaine. It will NOT cause pupillary dilatation with Horners
70
Horner's 1st, 2nd or, 3rd order? With what and how?
1. Use Paradrine 1%. 2. If 3rd nearon intact will dialte with Paredrine so signifies a 1st or 2nd order dysfunction=very serious 3. If 3rd neuron not intact, no dilation with Paredrine so 3rd neauron prob=benign
71
See lecture for cases**************
indeed

Pharm (2 decks)

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