Ophthalmology

Question 1

Adragenrgic receptors of the Iris sphincter

cholinergic?

Answer 1

equal alpha and beta

muscarinic

Question 2

Ciliary muscle:
adrenergic receptors
cholinergic receptors

Answer 2

some beta 1, few alpha

MUSCARINIC

Question 3

Iris dilator
adrenergic receptors
cholinergic receptors

Answer 3

mostly alpha 1, few beta

no cholinergics

Question 4

ciliary processes
adrangergics
cholinergics

Answer 4

mostly beta2, some alpha2, few beta1

muscarinic

Question 5

mueller muscle
adrangergics
cholinergics

Answer 5

alpha 1

no cholinergics

Question 6

used for mydriasis

diagnostic for dilated fundus exam

Answer 6

phenylephrine

Question 7

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

Answer 7

epinephrine

timolol (beta blocker)

Question 8

why isn’t epinephrine effective to stimulate mydriasis?

what is the MOA of epinephrine in glaucoma

Answer 8

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

Question 9

Epinephrine side effect in the eye

Answer 9

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

Question 10

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

Answer 10

phenylephrine

Question 11

used to break posterior synechia to the lens due to uveitis

Answer 11

10% phenylephrine

Question 12

does phenylephrine cause cycloplegia?

does the light reflex remain intact?

Answer 12

no

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

Question 13

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

Answer 13

apraclonidine

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

Question 14

what are the MOAs of apraclonidine on the:

• ciliary process epithelium
• episcleral venous pressure

Answer 14

• reduces cAMP, decreasing aqueous product

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

Question 15

apraclonidine use for pre and post op glaucoma sx

Answer 15

prevents IOP spike from inflammation

Question 16

usually first line for normal tension glaucoma

highly selective for alpha 2 receptors

Answer 16

brimonidine

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

Question 17

differentiaties pre or post ganglionic horner’s syndrome

Answer 17

hydroxyamphetamine

Question 18

preganglionic horners, give pt hydroxyamphetamine

Answer 18

pupil dilates

Question 19

postganglionic horners, give pt hydrocyamphetamine

Answer 19

no pupil dilation

Question 20

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

Answer 20

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

Question 21

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

Answer 21

timolol

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

Question 22

MOA of levubunolol and metipranolol

Answer 22

nonselective beta blockers

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

Question 23

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

Answer 23

nonselective beta blockers

CHF and COPD

Question 24

selective beta1 blocker

good for COPD and asthma

Answer 24

betaxolol

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

Question 25

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

Answer 25

pilocarpine (topical) | pile of cars, releases IOP by opening the trabecular meshwork

Question 26

ocular side effects of pilocarpine

Answer 26

accommodative spasm | miosis

Question 27

long lasting mitosis | used in complicated cataracts surgery to maintain lens in posterior chamber

Answer 27

carbachol | the car bagel, keeps the windshield in the right place

Question 28

reversible antiacetylcholinesterases

Answer 28

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

Question 29

irreversible acetylcholinesterase inhibitors | cause really bad side effects: iris cysts, GI symptoms, and accelerated cataracts

Answer 29

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

Question 30

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

Answer 30

- inhibit iris sphincter mm - inhibit ciliary mm - inhibition of iris and ciliary mm relieves pain, reducing risk of posterior synechia

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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.

Question 35

which antimuscarinic is safe for glaucoma pts?

Answer 35

tropicamide

Question 36

what do you give a patient with a unilateral dilated pupil? | no history of trauma

Answer 36

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