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Central Nervous System Pathology > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Adragenrgic receptors of the Iris sphincter

cholinergic?

A

equal alpha and beta

muscarinic

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2
Q

Ciliary muscle:
adrenergic receptors
cholinergic receptors

A

some beta 1, few alpha

MUSCARINIC

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3
Q

Iris dilator
adrenergic receptors
cholinergic receptors

A

mostly alpha 1, few beta

no cholinergics

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4
Q

ciliary processes
adrangergics
cholinergics

A

mostly beta2, some alpha2, few beta1

muscarinic

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5
Q

mueller muscle
adrangergics
cholinergics

A

alpha 1

no cholinergics

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6
Q

used for mydriasis

diagnostic for dilated fundus exam

A

phenylephrine

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7
Q

primary therapeutic intervention of glaucoma until about 1978
what is the treatment now?

A

epinephrine

timolol (beta blocker)

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8
Q

why isn’t epinephrine effective to stimulate mydriasis?

what is the MOA of epinephrine in glaucoma

A
  • melanin of the iris binds and inhibits it
  • alpha and beta stimulation in ciliary processes, increases aqueous product
  • beta2 stimulation relaxes the trabecular meshwork
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9
Q

Epinephrine side effect in the eye

A

burning, irritation, rebound injection
pupil dilation and lid retraction (mueller’s muscle) via alpha 1 receptors
pigmentation of iris and lens (oxidized epinephrine deposits)
angle closure
increase IOP
cystoid macular edema: swelling of center portion of retina

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10
Q

direct alpha 1 agonist
synthetic sympathomimetic of epinephrine
used for pupil dilations
used for decongestion

A

phenylephrine

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11
Q

used to break posterior synechia to the lens due to uveitis

A

10% phenylephrine

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12
Q

does phenylephrine cause cycloplegia?

does the light reflex remain intact?

A

no

yes, need to add an anticholinergic to maintain dilation for eye exams and surgery

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13
Q

direct alpha agonist, some selectivity for alpha 2
derivative of clonidine
activated alpha 2 receptors on the presynaptic adraergic terminals to the ciliary processes, reducing NE release and decreasing aqueous product

A

apraclonidine

star wars clone wearing an apron, treats the eye after a laser attack

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14
Q

what are the MOAs of apraclonidine on the:

  • ciliary process epithelium
  • episcleral venous pressure
A
  • reduces cAMP, decreasing aqueous product

- decreases pressure in the ciliary processes allows more drainage into the uveoscleral venous system

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15
Q

apraclonidine use for pre and post op glaucoma sx

A

prevents IOP spike from inflammation

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16
Q

usually first line for normal tension glaucoma

highly selective for alpha 2 receptors

A

brimonidine

bro money thinks he’s the alpha dog (hence the alpha 2)

17
Q

differentiaties pre or post ganglionic horner’s syndrome

A

hydroxyamphetamine

18
Q

preganglionic horners, give pt hydroxyamphetamine

A

pupil dilates

19
Q

postganglionic horners, give pt hydrocyamphetamine

A

no pupil dilation

20
Q

alpha blocker aka Rev eyes
reverses mydriasis caused by phenylephrine
causes hyperemia and mild ptosis (name the organs affected)

A

dapiprazole
da paper sole, blocks alpha receptors
conjunctival vessels and mueller’s mm have been antagonized

21
Q

nonselective beta blocker, prototype
no sympathomimetic activity
blocks beta receptors at the ciliary processes which reduces aqueous production

A

timolol

the time mole hates beta fish, replaced epinephrine as the gold standard for glaucoma tx

22
Q

MOA of levubunolol and metipranolol

A

nonselective beta blockers

levitating buns and mets pro are there to back the time mole up in his hatred of beta fish

23
Q 
which drug class causes bradycardia, respiratory distress, and exacerbates myasthenia graves?
what diseases are contraindicated
A

nonselective beta blockers

CHF and COPD

24
Q

selective beta1 blocker

good for COPD and asthma

A

betaxolol

betty the taxer, selects for 1 tax form at a time, lets the 2 lungs breathe though

25
Q

used to break angle closure glaucoma until laser iridotomy can be performed
direct cholinergic agonist

A

pilocarpine (topical)

pile of cars, releases IOP by opening the trabecular meshwork

26
Q

ocular side effects of pilocarpine

A

accommodative spasm

miosis

27
Q

long lasting mitosis

used in complicated cataracts surgery to maintain lens in posterior chamber

A

carbachol

the car bagel, keeps the windshield in the right place

28
Q

reversible antiacetylcholinesterases

A

physostigmine and neostigmine

the fist stigma and neo stigma from the matrix, punch acetylcholinesterase in the face

29
Q

irreversible acetylcholinesterase inhibitors

cause really bad side effects: iris cysts, GI symptoms, and accelerated cataracts

A

ecothiophate and isoflurophate
uncle wearing EKKO ultd. with a mask of isoflo before surgery. he’s laying on the ach esterase table, and won’t be getting up anytime soon

30
Q

how to cholinergic antagonists (antimuscarinics) work to promote:
mydriasis
cycloplegia
pain relief in uveitis

A
  • inhibit iris sphincter mm
  • inhibit ciliary mm
  • inhibition of iris and ciliary mm relieves pain, reducing risk of posterior synechia
31
Q

antimuscarinic used for mydriasis
used with phenylephrine in standard DFE
no good for cycloplegia

A

tropicamide

the tropicana lady is so hot that your pupils dilate to take her in

32
Q

antimuscarinic used for mydriasis
used in ocular sx
not used for standard DFE because it lasts 24 hours
good for cycloplegia

A

cyclopentolate

cyclops with a really dilated pupil, is pissed because he can’t see anything for about a day. he’s also paralyzed btw

33
Q

antimuscarinic used for mydriasis and cycloplegia up to 48 hours
used in inflammatory conditions
relieves pain by reducing the amount of inflammatory markers that get forced out during contraction

A

homatropine

homatrope kind of sounds like cannabalism. this guy likes to abduct people for 2 days at a time

34
Q

antimuscarinic with extreme mydriasis and cycloplegia, lasts 7-12 days
used in infants and children under 5 years for DFE
never used in down syndrome

A

atropine
a trooper that catches children, works for weeks at a time without taking a break. must be a lot of kids to catch out there.

35
Q

which antimuscarinic is safe for glaucoma pts?

A

tropicamide

36
Q

what do you give a patient with a unilateral dilated pupil?

no history of trauma

A

give pilocarpine, if dilates than its Adie’s tonic pupil
if no dilation, increase the dose
if it dilates, they need imagine
if no dilation then its pharmacologic

Central Nervous System Pathology (5 decks)

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