Opthalmic drugs & systemic effects Flashcards by hassan gonzales

Name the five category of drugs used to treat the eye

Mydriatic agents
Cycloplegic agents
Glaucoma agents
Intraocular agents
Local anesthetic agents

How well did you know this?

Not at all

Perfectly

Mydriatic agents cause

pupillary dilation on the dilator muscle of the iris

How well did you know this?

Not at all

Perfectly

Name two mydriatic drugs

phenylephrine

tropicamide

How well did you know this?

Not at all

Perfectly

Phenylephrine’s MOA includes

pupillary dilation and capillary decongestion due to alpha-1 agonism without cycloplegic effects

How well did you know this?

Not at all

Perfectly

Phenylephrine’s SE includes

Bradycardia
Hypertension
Tremors
HA

How well did you know this?

Not at all

Perfectly

Tropicamide exerts its effects as an

antimuscarinic

How well did you know this?

Not at all

Perfectly

Cycloplegic agents are classified as ——— that exert its effects by

parasympatholytic compounds

temporary paralysis’ ciliary muscles and muscles of accommodation

*used frequently in phacoEmulsificaton procedures

How well did you know this?

Not at all

Perfectly

Name three cycloplegic agents

Homoatropine
Atropine
Cyclopentolate

How well did you know this?

Not at all

Perfectly

Atropine causes both

mydriasis and cyclopegia

How well did you know this?

Not at all

Perfectly

Atropine SE include

Irritability and delirium (crosses BBB)
Tachycardia
Flushing
Dry skin
Thirst

How well did you know this?

Not at all

Perfectly

Atropine should be used with caution in which patient population

Narrow-angle glaucoma

How well did you know this?

Not at all

Perfectly

Glaucoma agents are further classified as

cholinergic agonists (miotics)
adrenergic agents
carbonic anhydrase inhibitors
prostaglandin F2a analogues

How well did you know this?

Not at all

Perfectly

cholineric agonists used to tx glaucoma are subdivided into

direct-acting
vs.
indirect-acting

How well did you know this?

Not at all

Perfectly

Name two direct-acting cholinergic agonists

Pilocarpine

Carbachol

How well did you know this?

Not at all

Perfectly

Name two indirect-acting cholinergic agonsists

physostigmine
echothiophate

*AKA anticholinesterases

How well did you know this?

Not at all

Perfectly

What is the MOA of pilocarpine

Miosis via contraction of the iris sphincter and stimulation of ciliary muscle which opens the trabecular meshwork and facilitates the outflow of aqueous humor and decreases aqueous production…Net effect is to lower intraocular pressure.

*causes loss of accomodation

How well did you know this?

Not at all

Perfectly

Does pilocarpine cross the BBB

Yes because it is a tertiary amine

Carbachole is a cholinomimetic agent that

reduces intraocular pressure

Physostigmine is an indirect-acting cholinergic agonist that causes

contraction of the sphincter muscle of the iris wihich opens the trabecular meshwork and facilitates the outflow of aqueous humor.

Does physostigmine cross the BBB

Yes bc it is a tertiary amine

Echothiophate is an indirect-acting cholinergic agent that irreversibly inhibits

acetylcholinesterase

*Takes 4-6 weeks required for activity to recover after stopping of echothiophate therapy

What effect does echothiophate have after systemic absorption through the lacrimal apparatus

it covalently bonds with pseudocholinesterases and inhibits its activity.

*prolongs the activity of succinylcholine, mivacurium, and LA ester compounds

What anesthetic agent should be avoided in patients taking echothiophate

Succinylcholine

What effect does echothiophate have as a gluacoma drug

produces miosis, increased outflow of aqueous humor and decreased intraocular pressure

The are two Major SE assocciated with echothiophate

BRONCHOSPASM and Paralysis r/t elevated achetylcholine levels

Name the classification of the adrenergic AGENTS used to treat glaucoma

Dipiverine (epi deriviative) B-adrenergic antagonists (timolol, betaxolol) A-adrenergic agonists (apraclonidine, brimonidine)

Timolol is a nonselective beta antagonist that

decreases the production of aqueous humor which decreases intraocular pressure *Significant conjunctival absorpton so CAUTION in RAD, HF, hypotension

Alpha-adrenergic agonists exerts its effect on glaucoma patients by

postsynaptic alpha-2 binding which decreases aqueous humor production

Does the a-adrenergic agonist Apraclonidine cross the BBB

NO, highly ionized at physiologic pH

Name four carbonic-anhydrase inhibitors

AcetazolAmide MethazolAmide DorzolAmide BrinzolAmide

What are carbonic-anhydrase inhibitors used for

glaucoma and production of mild diuretic

What is the MOA of carbonic Anhydrase Inhibitors

decreases secretion of aq. humor by the ciliary body which decreases intraocular pressure *inhibits the conversion of carbon dioxide and water to bicarbonate and hydrogen ion, and affects sodium and fluid transport

Name the prostaglandin F2a analogues

IatanoPROST TrasoPOST BimatoPROST UnoPROStone

What is the MOA of the Prostaglandin F2a drugs

Deceases intraocular pressure by increasing uveoscleral outflow of aqueous humor *Doesn't have systemic effects so replaced b-adrenergic antagonists

List three intraocular medications

Acetylcholine Epinephrine Sulfur hexafluoride/perfluorocarbons

Acetylcholine is used for what purpose in the eye room

used intraocularly after LENSs extraction to produce pupillary constriction

Epinephrine is used for what purpose in the eye room

placed in irrigating soln to provide continuous mydriasis

Sulfur hexafluoride/perfluorocarbons are used for what purpose in the eye room

bubble of sulfar hexa...injected into posterior chamber during vitreous surgery for insufflation of vitreous cavity or tamponade of a detached retina

15 minutes prior to intraocular gas injection what must be done

discontinue nitrous oxide

Nitrous oxide must be avoided for ----days after air bubble injection

Nitrous oxide must be avoided for ----days after sulfur hexafluride injection

Nitrous oxide must be avoided for ----days after perfluorocarbons injection