Opthomology Drugs

Question 1

open angle glaucoma

Answer 1

angle between iris and cornea is 45 degrees or more. you need to give medication to lower the pressure

Question 2

narrow angle glaucoma

Answer 2

space between the cornea and iris is less than 20 degrees. you have to use a laser to open the iris to allow for release of pressure

Question 3

pupil action under sympathetic innervation

Answer 3

Norepi is the neurotransmitter. alpha 1a AR subtype is in the iris dilator muscle. Alpha 1 b causes iris arteriolar contraction. superior palpebral muscle of muller lifts eyelid, ciliary epithelium does aqueous production, increases outflow of aqueous

Question 4

pupil action under parasymp innervation

Answer 4

contraction of the pupils. uses ACh as neurotransmitter. muscarinic M3 receptors in ciliary body and iris contract the iris sphincter and circular fibers of ciliary muscle. contract fibers of ciliary body opening trabecular meshwork

Question 5

in order to read you must have

Answer 5

accommodation: thickening of lens moving focal point closer to the eye. convergence of the eyes. miosis of the pupils. start to lose this ability at age 45

Question 6

presynaptic vs. postsynaptic lesions

Answer 6

presynaptic are serious, can come from tumor, MS, vascular accident. postsynaptic are benign: Aidies syndrome, pharmacologic blockade

Question 7

phenylephrine

Answer 7

mimics NE alpha 1 (dilates eye). sympathetic agonist

Question 8

parasympathetic muscarinic agonist

Answer 8

pilocarpine, echothiopate, physostigmine

Question 9

cocaine

Answer 9

prevents reuptake of NE. indirect sympathetic system agonist

Question 10

hydroxyamphetamine (paredrine)

Answer 10

releases NE. indirect sympathetic agonist

Question 11

timolol and betaxolol

Answer 11

beta blockers. timo is nonspecific, betaxo is B1 specific

Question 12

prostaglandin analogs

Answer 12

increase uveoscleral outflow

Question 13

carbonic anhydrase inhibitors

Answer 13

reduce aqueous production

Question 14

horner’s syndrome

Answer 14

sympathetic paresis. miosis, ptosis, anhidrosis. preganglionic: CNS lesions, lung tumors, thoracic aortic aneurysms. Postganglionic: migraine equivalent

Question 15

cocaine in horner’s syndrome

Answer 15

if sympathetic system is dysfunctional, pupil will not dilate

Question 16

separating 1st or 2nd order from 3rd order horner’s

Answer 16

if third order neuron intact but not stimulated then paredrine will cause pupillary dilation (bad). if pupil does not respont to paredrine then 3rd order lesion. (good)

Question 17

parasympathetic paresis

Answer 17

loss of parasympathetic function leads to pupillary dilation. ptosis and loss of eye movement. worst headache of life could mean an aneurysm.

Question 18

Adie’s syndrome

Answer 18

parasympathetic dysfunction leading to large pupil. damage to ciliary ganglion. accommodation is present

Question 19

how to separate adie’s syndrome from aneurysm

Answer 19

denervation hypersensitivity. use small dose of methacholine or pilocarpine. pupillary constriction will happen if Adie’s syndrome

Question 20

pharmacologic blockade

Answer 20

bad headache, pupil not responding to light or accommodation. give low dose of muscarinic agonist. should be no pupil change. give high dose. if still no pupil change, then pharm blockade.

Question 21

side effects of beta blockers

Answer 21

bradycardia, hypotension, syncope, palpitation, bronchospasm, mental confusion, depression, fatigue, hyperkalemia

Question 22

adrenergic side effects

Answer 22

extrasystoles, palpitations, hypertenstion, trembling, paleness, sweating

Question 23

cholinergic side effects

Answer 23

bronchospasm, salvation, nausea, vomiting, diarrhea, ab pain, lacrimation, sweating

Question 24

anticholinergic effects

Answer 24

ataxia, nystagmus, restlesness, mental confusion, aggressive behavior, insomnia, photophobia, urinary retention

Question 25

what 3 things can cause pupil to respond to accommodation but not light?

Answer 25

adie’s syndrome (young females with no patellar reflex)
parinaud’s syndrome (young kids with midbrain tumor (pineal))
argyll-robertson (tertiary syphillis)