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Neuro 2 > Ocular Pharmacology > Flashcards

Ocular Pharmacology Flashcards

1
Q

Where is dilator smooth muscle and how is it orientated?

A

anterior to the pigmented epithelium and is oriented radially

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2
Q

Where in the pupil constrictor (sphincter) smooth muscle and how is it orientated?

A

pupillary margin and is organized in a circular band

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3
Q

What nervous system causes pupil dilation? Via what receptor?

A

Sympathetic

Alpha-1

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4
Q

What other effects does the sympathetic nervous system have on the eye? Via what receptors?

A 
Aqueous humor production (alpha-2/beta-2)
Lacrimal secretions (alpha-1)
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5
Q

What nervous system causes pupil constriction? Via what receptor?

A

Parasympathetic

M3

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6
Q

What other effects does the parasympathetic nervous system have on the eye? Via what receptors?

A

lacrimal secretions (M2/M3)

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7
Q

Where are the three places where ocular (topical) drugs can have systemic effects?

A
  • Cheeks
  • GI tract (post lacrimal drainage)
  • General circulation (via ocular blood vessels)
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8
Q

True or false: the eye contains metabolic enzymes.

A

TRUE (ex. esterases, peptiases, MOA, etc.)

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9
Q

What is the role of the metabolic enzymes contained within the eye during drug therapy?

A

can convert more penetrative pro-drugs to their active form once they have entered the eye (improved therapy and diminished toxicity)

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10
Q

List the muscarinic antagonists used on the eye.

A 
CHATS
Cyclopentolate
Homotropine
Atropine
Tropicamide
Scopolamine
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11
Q

List the muscarinic agonists used in the eye.

A

Carbachol
Pilocarpine
Aceylcholine HCl

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12
Q

List the AchE inhibitor used in the eye.

A

Echothiopate

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13
Q

List the sympathomimetics used in the eye

A 
Dipivefrin
Phenylephrine
Apraclonidine
Brimonidine
Naphazoline
Tetrahydrozoline
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14
Q

List the PG analogs used in the eye.

A

Latanoprost
Travoprost
Bimatoprost

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15
Q

List the beta-adrenergic antagonists used in the eye.

A

Timolol Maleate
Levobunolol
Metipranolol
Carteolol

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16
Q

List the carbonic anhydrase inhibitors used in the eye.

A

Dorzolamide

Brinzolamide

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17
Q

What drug class is used for:
Dilation of eye (mydriasis) for exam
Treatment of isis/uveal tract inflammation?

A

Muscarinic antagonists

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18
Q 
What drug class is used for:
Constriction (miosis); Glaucoma?
A

Muscarinic agonists

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19
Q

What are AchE inhibitors used for?

A

glaucoma

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20
Q

Sympatheticomimetic used in glaucoma only?

A

dipivefrin

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21
Q

Sympatheticomimetic used for Mydriasis, decongestant, vasoconstriction?

A

phenylephrine

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22
Q

Sympatheticomimetic used in glaucoma AND ocular HTN?

A

Brimonidine

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23
Q

Sympatheticomimetic used in ocular HTN only?

A

apraclonidine

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24
Q

Sympatheticomimetics used as decongestants only?

A

naphazoline

tetrahydrozoline

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25
Q

What drug class is first line treatment for glaucoma?

A

PG analogs

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26
Q

What drug classes are used as alternative or adjunctive to PG analog for glaucoma?

A

Beta-adrenergic antagonists

Carbonic Anhydrase Inhibitors

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27
Q

MOA: Block M receptors in cornea, lacrimal glands, and iris sphincter and ciliary muscles

A

Muscarinic antagonists

28
Q

Muscarinic antagonists found in Angel’s Trumpets?

A

atropine

scopolamine

29
Q

MOA: Constrict the pupil to encourage flow of aqueous humor and improve glaucoma.

A

Muscarinic agonists

AchE inhibitor

30
Q

MOA: epinephrine pro drug.

A

dipivefrin

31
Q

MOA: alpha-2 stimulation which leads to decreased IOP by increasing outflow of aqueous humor

A

apraclonidine

brimonidine

32
Q

MOA: alpha stimulation which leads to decreased IOP by increasing outflow of aqueous humor

A

Phenylephrine
Naphazoline
Tetrahydrozoline

33
Q

MOA: Possibly facilitate aqueous outflow via accessory uveoscleral outflow pathway

A

PG analogs:
Latanoprost
Travoprost
Bimatoprost

34
Q

What is interesting about the pharmacokinetics of PG analogs?

A

Prodrug→ in situ hydrolysis

35
Q

MOA: Block ciliary body and blood vessel β2 receptors to decrease aqueous humor production (cAMP-PKA stimulation) OR decrease ocular blood flow and ultrafiltration that produces the humor.

A 
beta-adrenergic antagonists:
TImolol Maleate
Levobunolol
Metipranolol
Carteolol
36
Q

MOA: Blockage of catalyzes conversion of CO2 to HCO3- (by Zn containing metalloprotein= CA2) whih reduces fluid transport and decreases IOP

A

carbonic anhydrase inhibitors:
Dorzolamide
Brinzolamide

37
Q

Muscarinic antagonists are contraindicated in what conditions?

A

glaucoma

sulfite allergy

38
Q

List some local toxicities of muscarinic antagonists.

A

Myadriasis, cytoplegia and photophobia; Increases ICP, stings/burns

39
Q

List some systemic toxicities of muscarinic antagonists.

A

dry mouth, tachy-cardia, palpitations, somnolence, patients iwth increased risk of retinal detachment

40
Q

Muscarinic agonists should be used with caution in what conditions?

A

CV failure, asthma, peptic ulcer

41
Q

Muscarinic agnoists are contraindicated in what conditions?

A

iritis, uveitis, inflammation of anterior chamber

42
Q

Why do young patients tend to stop taking muscarinic agonists as prescribed?

A

visual blurring (myopia)

43
Q

Echothiopate can cause cataracts in what patients?

A

’phakic patients”

44
Q

Which is more toxic, a muscarinic agonist or an AchE inhibitor?

A

AchE inhibitor

45
Q

Echothiopate is contraindicated in what condition?

A

Closed-Angle Glaucoma due to  ICP

46
Q

Echotiopate should NOT be taken with what drugs?

A

carbamate/ phosphate insecticides

47
Q

What drug class causes photosensitivity, conjunctival hyperemia, hypersensitivity but has RARE systemic effects?

A

Sympathomimetics

48
Q

Sympathomimetics should be used with caution in what conditions?

A

HTN, hyperthyroidism, diabetes, arteriosclerosis, and asthma

49
Q

What are the acute toxicities of PG analogs?

A

blurred vision, burning, stinging, itching of eyes

50
Q

What is the strange systemic toxicity of PG analogs?

A

Lengthens and thickens eyelashes (hypotrichosis), permanent brown pigmentation of iris/eyelids

51
Q

What drug class is co-formulated with preservatives (benzalkonium chloride) that can damage soft contact lenses?

A

Beta-adrenergic antagonists

52
Q

What drug class is known for historical bacterial contamination?

A

carbonic anhydrase inhibitors

53
Q

What is a systemic adverse effect of carbonic anhydrase inhibitors?

A

dysgeusia (bitter taste from inhibiting CA2 in mouth)

54
Q

In what condition are carbonic anhydrase inhibitors contraindicated?

A

sulfa allergy

55
Q

What is the average IOP?

A

10-21 mm Hg

56
Q

What is the condition in which drainage of the aqueous humor is impaired, the pressure within the eye increases, compression of the retina occurs and damage the optic nerve results?

A

glaucoma

57
Q

What are the goals for treatment of open angle glaucoma?

A

decrease aqueous humor production and/or increase aqueous outflow

58
Q

What is the treatment for closed angle glaucoma?

A

surgical iridectomy; short-term medical management to decrease IOP and clear cornea before surgery

59
Q

Name the IV VEGF decoy receptor.

A

Aflibercept

60
Q

Name the IV VEGF antagonist.

A

Pegaptanib

61
Q

Name the IV VEGF mAb’s.

A

Ranibizumab

Bevacizumab

62
Q

Name the IV non-thermal laster activator that generates free radicals.

A

verteporfin

63
Q

How does verteporfin work?

A

Free radicals lead to vessel damage and subsequent platelet activation, thromosis, and occlusion of the choroidal neovascularization

64
Q

What are the risks of VEGF mAbs, antagonists, and decoy receptors?

A

Arterial thromboembolic events like TE, nonfatal stroke, nonfatal MI, or vascular death

65
Q

What do you advise patients of who get verteporfin for their macular degeneration treatment?

A

they will get temporary photosensitization (avoid direct sun for 5 days)

66
Q

How do opioids cause pinpoint pupils?

A

depressant effect on an inhibitory neuron (which then allows unregulated and spontaneous cholinergic stimulation from pupilloconstrictor neurons in the E-W nucleus) and is affected very minimally by the peripheral sympathetic dilator muscle.

Neuro 2 (11 decks)

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