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Ocular Pharmacology > Packet 1: Autonomic NS / A & B receptors > Flashcards

Packet 1: Autonomic NS / A & B receptors Flashcards

1
Q

SNS overview

A

generalized & thoracolumbar origin & arise from superior cervical ganglion

  • dilator
  • blood vessels
  • lacrimal gland (vessels)
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2
Q

PNS overview

A

specific & crainiosacral origin & arise from Edinger-Westphal nucleus

  • CN III
  • CN VII (facial)
  • ciliary ganglion & muscles
  • lacrimal gland
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3
Q

PNS receptors:

A

ACH

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4
Q

SNS receptors:

A

a1, a2, b1, b2 (NE and EPI)

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5
Q

ciliary body receptors:

A

b1, b2 or a2

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6
Q

blood vessels (conj)

A

a1 or b2

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7
Q

sphincter muscle

A

muscarinic

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8
Q

ciliary muscle

A

muscarinic

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9
Q

adrenergic agents do what 3 things?

A
  1. mydriatic - a1 agonist
  2. anti glaucoma - a1, a2 or b2 agonists
  3. vasoconstrictor/ decongestion - a1 agonist
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10
Q

reactive hyperemia:

A

1st the decreased ability of the tissues to get blood and O2, and then 2nd blood vessels dilate greatly after long contraction = reactive hyperemia

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11
Q

Phenylephrine - other name

A

neo-synephrine

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12
Q

phenylephrine:

A

a agonist (mainly a1)

  • decongestant
  • mydriasis
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13
Q

max effects of phenyl at ____?

A

60 minutes

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14
Q

what is the most common adrenergic mydriatic?

A

phenylepherine

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15
Q

what concentrations does phenyl come in?

A
  1. 1/8% OTC
  2. 2.5% (Rx)
  3. 10% (Rx)
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16
Q

Do we use ephipherine for treating glaucoma?

A

no, because of toxcicites

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17
Q

Does phenylephrine block the light reflex?

A

no, you need an antimuscarinic to block that

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18
Q

can you use phenylephrine on a pt. with open angle glaucoma?

A

yes

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19
Q

can you use phenylephrine on a pt with closed angle glaucoma?

A

no, not even 1/8%

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20
Q

what else can we use phenyl to treat?

A
  1. miotic cysts
  2. ptosis
  3. diagnosis of horner (71% definitive)
  4. breaking posterior synechiae
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21
Q

drug interactions with phenyl

A

tricyclic antidepressants, MAO inhibitors, guanethidine, reserpine

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22
Q

systemic effects of phenyl:

A

CNS stimulation, headache, hypertension, tachycardia, reflex bradycardia, blanching of the skin, arrhythmias, subarachnoid heme.

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23
Q

Apraclonidine - other name

A

Iopidine

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24
Q

Apraclonidine concentrations:

A

.5% & 1%

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25
Q

Apraclonidine:

A

a agonist: inhibit adenylate cyclase = dec. cAMP = decreased aqueous = DECREASE IOP
- also INCREASE uveal scleral outflow

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26
Q

does apraclonidine have selectivity for a2?

A

only some

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27
Q

Which has higher chance of allergic reactions: apraclonidine or brimonidine?

A

APRACLONIDINE (20-50%)

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28
Q

Apraclonidine: diagnosis of horners: what happens?

A

the dilator muscle is super sensitive, so with that, the horners eye dilates more

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29
Q

Apraclonidine: effects

A
  1. a1 agonist: mydriasis
  2. lid retration
  3. conj blanching (decongestion)
  4. dry mouth, fatigue, lethargy, headache etc.
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30
Q

Brimonidine: other name

A

Alphagan (P)

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31
Q

Brimonidine: receptor

A

adrenergic receptor agonist : a2

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32
Q

Is brimonidine selective for a1? or a2?

A

highly selective for a2

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33
Q

Brimonidine: MOA

A

decrease aqueous like apraclonidine: inhibit adenylate cyclase = dec. cAMP = decrease production
ALSO increase in uveal scleral outflow BUT NOT REMODELING (like apraclonidine)

34
Q

which adrenergic agonist is neuroprotective?

A

brimonidine

35
Q

what is the most frequent toxicity with brimonidine?

A

hyperemia - excess blood in the vessls

36
Q

Combigan

A

Brimonidine .2% & Timolol .5%

37
Q

Simbrinza

A

Brimonidine .2% & Brinzolamide 1%

38
Q

naphazoline: receptor?

A

direct acting a1 agonist

39
Q

tetrahydrozoline: receptors?

A

direct acting a1 agonist

40
Q

oxymetazoline: receptors?

A

direct acting a1 agonist

41
Q

naphazoine: concentrations?

A

.0125 & .03 (OTC)

.1% (Rx)

42
Q

Tetrahydrozoline: concentrations?

A

.05% (OTC)

43
Q

Oxymtazoline: concentrations?

A

.025% (OTC)

44
Q

what is visine?

A

tetrahyrozoline

45
Q

what sympathomimetic could you use with an OTC antihistamine to treat minor allergic conjunctivitis?

A

naphazoline with anti histamine

46
Q

Paremyd: what is it?

A

Hydroxyamphetamine 1% & Tropicamide .25%

47
Q

Hydrozyamphetamine 1%

A

stimulates release of NE, blocks reuptake

INDIRECT ACTING

48
Q

Hydroxyamphetamine 1%: what happens in horner’s pt

A

no dilation in post-ganglionic lesion

- widely dilated with central or preganglionic (usually 5 year prognosis)

49
Q

hydroxyamphetamine: onset and duration = similar to ___?

A

phenylepherine

50
Q

Cocaine: MOA

A

INDIRECT ACTING: block NE reuptake

  • mydriaysis
  • vasoconstriction
  • anesthesia
51
Q

Cocaine: horner’s diagnosis

A

dilation is reduced or absent in Horner’s eye regardless of location of lesion

52
Q

Dapiprazole: other name

A

Rev eyes

53
Q

Dapriprazole: concentration

A

.5%

54
Q

Dappiprazole: receptor

A

a-blocker

55
Q

what do we need to be concerned with when using a-blockers?

A

floppy iris syndrome - especially when pt wants cataract surgery

56
Q

Dapiprazole: uses?

A

reverse PHENYLEPHERINE mydriasis

- some actions on tropicamide induced mydriasis

57
Q

what is the major toxicity seen with Dapiprazole?

A

conjunctival hyperemia (80%) and burning (50%)

58
Q

which is better to use for the least risk of pupillary block? pilocarpine or dapiprazole?

A

.5% dapiprazole is better than pilocarpine since less risk of pupillary block (lens forward and iris back)

59
Q

When do dark irises respond the same as light irises?

A

B-blockers

60
Q

Timolol: other names

A

Timoptic, Timoptic-XE

61
Q

Timolol : concentrations

A

.25% and .5%

62
Q

Timolol: receptors

A

non-selective B blockers/ decreased aqueous production

- 7x more potent than propranolol

63
Q

Does timolol affect pupil size, accommodation or aqueous production?

A

ONLY DECREASE IN PRODUCTION

no effect on pupil size and accommodation

64
Q

what is pt most likely to have symptoms of myasthenia symptoms (diplopia, ptosis eom paresis) with?

A

B-blockers, timolol.

65
Q

Levovunolol: other names & concentrations

A

Betagan .5% or .25%

66
Q

Levobunolol: receptors

A

non selective b blocker

67
Q

Metipranolol: other names and concentrations

A

optipranolol .3%

68
Q

Metipranolol: receptors

A

non-selective b blockers

69
Q

advantage to metipranolol?

A

cheaper b blockers

70
Q

Betaxolol: other names and concentrations

A

Betoptic - S .25%

71
Q

Betaxolol: receptors

A

SELECTIVE B1 blockers: we need B2 so we just get some blockage from “spill-over effect” but to as effective on decreasing IOP

72
Q

Advantage to betaxolol?

A

better for patients with asthma or heart conditions

73
Q

Carteolol: other names and concentrations

A

Ocupress 1%

74
Q

which b blocker comes in a suspension?

A

Betaxolol

75
Q

Carteolol: receptor

A

non selective b blocker

76
Q

Advantage to Carteolol?

A

Intense Sympathomimetic Activity = not a b blocker but partial agonist, but DOES NOT DISRUPT the lipid profile as much as other b blockers

77
Q

Best interocular pressure control: b blockers

A

just avoid betaxolol

78
Q

Chronic pulmonary disease or asthma: for b blockers

A

use betaxolol

79
Q

hypercholestemia: (use of b blockers)

A

carteolol

80
Q

pregnancy: use of b blockers:

A

avoid ALL: contraindicated with all

Ocular Pharmacology (6 decks)

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