Packet 2: Cholinergic Agents

Question 1

ACH

Answer 1

DIRECT acting Cholinergic (Muscarinic):biotic

Question 2

Intracameral injection of ACH

Answer 2

Miochol

Question 3

intracameral injection of Carbachol

Answer 3

Miostat

Question 4

Carbachol: other name

Answer 4

Carcholin

Question 5

Carbachol

Answer 5

DIRECT acting Cholinergic Muscarinic - miotic

Question 6

which is used intra-op or pre-op to prevent increased IOP

Answer 6

Carbachol

Question 7

Pilocarpine:

Answer 7

DIRECT acting cholinergic muscarinic: miotic

Question 8

Pilocarpine: treats?

Answer 8

POAG and closed angle 2%

Question 9

should you use pilo to reverse mydriasis?

Answer 9

no, risk of pupilary block

Question 10

what is the most popular cholingeric agonist? (miotic)

Answer 10

Pilocarpine

Question 11

Ocular response to Pilocarpine:

Answer 11

increase accommodation, and increase aqueous outflow

Question 12

does Pilo have pigment binding?

Answer 12

Yes, so dark irides will respond less

Question 13

Do B-blockers have pigment binding?

Answer 13

No, they bind the same

Question 14

Does latanoprost have pigment binding?

Answer 14

No, no effect on iris color or pigment

Question 15

Indications for mydriasis?

Answer 15

cycloplegia, inflammation of the urea, myopia, amblyopia

Question 16

what are contraindications for atropine?

Answer 16

glaucoma, and downs syndrome
-closed and open angle
downs syndrome is more sensitive to reactionstropine

Question 17

physostigmine is an antidote to what?

Answer 17

atropine

Question 18

what is atropine’s antidote?

Answer 18

physostigine

Question 19

what does physostigmine do?

Answer 19

blocks ACH metabolism: so increase ACH (could be mitotic) and have those toxicities as well.

Question 20

cyclopentalate: other name

Answer 20

cyclogyl

Question 21

when would you not use cyclopentalate?

Answer 21

accommodative esotropia and latent hyperopia

Question 22

drug of choice for 7-8 y.o and older?

Answer 22

cyclopentalate

Question 23

max effects for cyclopentalate?

Answer 23

30-40 minutes

Question 24

duration for cyclopentalate?

Answer 24

2-4 hours

Question 25

side effects of cyclopentalate?

Answer 25

irritation and lacrimation, conj hyperemia, allergic bleph, increased IOP, drowsiness and ataxia

Question 26

paradoxical effects of cyclopentalate?

Answer 26

disorientation, incoherent speech, restlessness, visual hallucinations

Question 27

what moves into the cornea fastest?

Answer 27

nonionized.

Question 28

tropic amide: other name

Answer 28

mydriacyl

Question 29

what is the max mydriasis for tropic tropicamide:

Answer 29

20-30 minutes

Question 30

pka of tropicamide?

Answer 30

5.4 (base) so becomes non ionized when moved into the tears

Question 31

systemic effects of tropicamide:

Answer 31

there are very minimal systemic side effects with tropicamide.

Question 32

what do you want in a cyclo drop?

Answer 32

most mydriasis with least cycloplegia

Question 33

what gives us the best mydyasis and least cyclo?

Answer 33

paremyd

Question 34

what is paremyd?

Answer 34

.25% trop and 1% hydroxyamp.

Question 35

cyclomydril:

Answer 35

1% pheny & .2% cyclopentolate

Question 36

peds department cycloplegia spray concentrations:

Answer 36

- 10 ml of 1% tropicamide - 5 ml of 10% phenylephrine - 5 ml of 2% cyclopentolate

Question 37

peds department for dilation

Answer 37

-10 ml of 1% tropicamide -5 ml of 10% phenylephrine 5 ml of saline

Question 38

which cyclo drop last too long for normal use:

Answer 38

homatrophine and atropine

Question 39

Ecothiophate: other name

Answer 39

Phospholine 0.125% solution

Question 40

Ecothiopahte: MOA

Answer 40

INDIRECT Parasympathomimetics: inhibit AchE | -therefore increase ACH and could cause the same toxicities that direct acting choingeric agents can

Question 41

Pralidoxime: MOA

Answer 41

reactivates AchE

Question 42

Pralidoxime: other name

Answer 42

Protopam 2-PAM

Question 43

What is protopam?

Answer 43

Pralidoxime: inhibit AchE at both muscarinic and nicotinic sites

Question 44

when do we use indirect acting parasympathomimetics?

Answer 44

1. glaucoma- no longer used because of toxicities | 2. accommodative esotropia

Question 45

Major Ocular Effects of Miotics:

Answer 45

- accommodative spasm - allergic bleh - anterior sub capsular cataract - pupillary block - band keratopath - miotic cysts - conj. injection - follicular conjuntivitis - retinal detachment - lid myopkmia

Question 46

what are contraindications for Miotics?

Answer 46

- cataracts - under 40: because pilo can mess with accommodating - neovascularization - RD - Asthma: bronchoconstriction is bad for asthma - Phakic eyes: ONLY WITH ECHOTHIOPHATE