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Pharm Flashcards

1
Q

What was the 1st glaucoma drug invented?

A

Pilocarpine

NOTE: short half life so need frequent admin (QID). Reduces pressures by 30%

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2
Q

MOA of Pilocarpine?

A

(+) longitudinal muscles of CB (corneo-scleral pathway) –> pulls posteriorly on scleral spur & secondarily opens up trabecular spaces for INC outflow & DEC IOP

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3
Q

Pilocarpine is considered what kind of drug?

A

Direct cholinergic agonist

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4
Q

Uses for pilocarpine?

A
  1. After an angle closure attack in prep for LPI
  2. 1% –> DDx 3rd nerve palsy from sphincter tear in pt w fixed, dilated pupil - 3rd nerve palsy WILL constrict
  3. 0.125% DDx Adie’s Tonic Pupil (acute dilated pupil); iris sphincter is super sensitized
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5
Q

ADEs of pilocarpine?

A
  1. Browaches, HA, myopic shift (pt will INC their accom bc it is paralyzed causing shift)
  2. Miosis
  3. Cataracts
  4. Retinal Detachments
  5. Secondary angle closure
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6
Q

Neostigmine, edrophonium, echothiophate, and pyridostigmine are considered what kind of medications?

A

Indirect Cholinergic Agnoists: Anti-cholinesterase agents

NOTE: this is considered “indirect” bc it inhibits AchE which is the enzyme that breaks down ACh

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7
Q

Which is the most dangerous cholinergic antagonist?

A

Scopolamine

NOTE: similar clinical indications as atropine but rarely used side effects

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8
Q

ADEs of scopolamine?

A

Hallucinations, amnesia, unconsciousness, confusion, restlessness, incoherence, vomiting, urinary incontinence

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9
Q

Major actions of parasympathetic nervous system?

A
  1. Broncho-constriction
  2. Miosis
  3. Rest and digest
  4. INC in secretions (SLUD): salivation, lacrimation, urination, defecation
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10
Q

Major actions of sympathetic nervous system?

A
  1. Broncho-DILATION
  2. Mydriasis
  3. Fight or flight
  4. Overall DEC in secretions (anti-SLUDGE)
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11
Q

What receptors are on the iris sphincter?

A

M3

Effect = miosis

RECALL: the iris muscles develop from NEURAL ECTODERM

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12
Q

What receptors are located on the ciliary muscle?

A

M2, M3

Effect = accommodation

RECALL: ciliary muscles develop from the neural crest. Abnormal neural crest development –> irregular iridocorneal adhesions

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13
Q

What receptors are located on the lacrimal gland?

A

M2, M3

Effect = tear production

RECALL: lacrimal gland is derived from surface ectoderm. Surface ectoderm gives rise to “surface” structures.

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14
Q

What receptor is located on the iris dilator?

a. Alpha 1
b. Alpha 2
c. Beta 1
d. Beta 2
e. M2
f. M2 & M3

A

a. Alpha 1

RECALL:
Alpha 2 --> CB vasculature
Beta 1 /2 --> NPCE
Beta 2 + M2/M3 --> Ciliary muscles, TM
M3 --> Iris sphincter
M2/M3 --> Lacrimal gland
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15
Q

What receptors are located on the Ciliary Muscles & Trabecular meshwork?

A

Ciliary Muscles: M2/M3 + Beta 2

Trabecular Meshwork: Beta 2

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16
Q

Beta 2 agonists cause what to the TM & CM & NPCE?

A

RELAXATION

INC outflow & DEC Accommodation & INC IOP

17
Q

Which cholinergic antagonist works the fastest and has the shortest duration of MYDRIATIC effect?

A

Tropicamide

18
Q

What are the ADEs of Atropine?

A

1 is DRY MOUTH

Dry skin

Rapid pulse

Disorientation

Fever due to CNS effects of hypothalamus

NOTE: do NOT give to pts w DOWN’s SYNDROME, small children, and elderly

19
Q

Which anti-cholinergic antagonist has the fastest onset & shortest duration of CYCLOPLEGIC effects?

A

Cycloplentolate

NOTE: this drug is the standard for cycloplegia in clinic

20
Q

Which anti-cholinergic antagonist is the standard for Treating ANTERIOR Uveitis?

A

Homatropine

  1. Keeps iris MOBILE (DEC likelihood of posterior synechiae formation)
  2. REDUCES pain by paralyzing CM & sphincter
  3. Stabilizes the BAB by constricting the iris & ciliary body vasculature to limit passage of blood contents into the aqueous humor
21
Q

Which medication is a SOMATIC drug that blocks the release of ACh at the neuromuscular junction, inhibiting muscle contractions?

A

Botulin A Toxin (Botox)

Single injections have been effective in providing permanent correction for strabismus; cosmetic wrinkles

Used in blepharospasm Tx but effects only laast a couple hours

22
Q

What are the uses of adrenergic agonists?

A
  1. Promote SYMPATHETIC activity
  2. Used in dilation, conj constriction, & management of minor allergic conditions
  3. Temporary control of IOP spikes (post Sx, angle closure glaucoma, Tx POAG)
23
Q

What receptors does Norepinephrine act on?

A

A1 (dilator)
A2 (CB vasculature)
B1 (NPCE + heart)

NOT B2

24
Q

What receptors does Epinephrine act on?

A

A1 (dilator)
A2 (CB vasculature)
B1 (NPCE + heart)
B2 (Lungs)

25
Q

MOA of Phenylephrine (neo-synephrine)?

A

Alpha-1 Agonist!!!!

ONLY dilates. Not effect on Beta receptors so NO cycloplegic effect

Alpha-1 receptors are MAINLY on SMOOTH MUSCLE & blood vessels (will cause constriction and INC BP)

NOTE: muller’s muscle contains alpha-2 receptors and some alpha 1 receptors so it will retract potentially w phenyl use

26
Q

Other uses for Phenylephrine other than to help dilation?

A
  1. DDx scleritis vs episcleritis (blanch = epi)
  2. Horner’s syndrome
  3. 10% to break PS but has adverse CV effects (HTN)
27
Q

CI of phenylephrine?

A

MAOIs

TCAs

Grave’s Dz

28
Q

What medications is this description describing?

  • Topical ocular decongestants
  • Alpha&raquo_space; Beta effects (potential to depress the CNS)
  • Fixed dilated pupil potentially
A
  1. Naphazoline (Naphcon)
  2. Tetrahydrozoline (Visine)

Visine may cause fixed dilated pupil

Naphcon-A is a popular OTC combines the reduction of hyperemia & anti-histamine for itch relief

29
Q

What are the two main alpha-2 topical adrenergic agonist used for glaucoma?

A
  1. Brimonidine (Alphagan 0.20%)

2. Apraclonidine (Iopidine)

30
Q

Which ocular glaucoma medication fits this profile:
- Highly selective alpha-2 agonist (30X more selective than the other in its class)

  • Neuroprotective properties
  • 30% Follicular conjunctivitis
  • TID due to short duration
  • Miosis ADE (helps w post-refractive LASIK, PRK complaints)
  • Systemic dry mouth (MC) and CI of MAOIs
A

Brimonidine (Alphagan 0.20%)

31
Q

Which ocular glaucoma medication fits this profile:
- BEST eye drop to drop IOP in acute situations

  • Used: control IOP spike before & after Sx, laser iridotomy, trabeculoplasty, posterior capsulotomy
  • Also used for Acute Angle Closure; rapid potent DEC IOP
  • 30 to 40% IOP reduction
  • Onset: 1 hour, peak 3-5
  • Tx: tachyphylaxis
  • Dx Horner’s
A

Apraclonidine (Iopidine)

32
Q

What are the pharmacological tests for Horner’s Syndrome?

A
  1. Cocaine
  2. Apraclonidine
  3. Hydroxyamphetamine
  4. Phenylephrine 1% (Adrenergic receptors are sensitized)

Part 1 (31 decks)

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