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Neuro 2 > Pharm: Ocular > Flashcards

Pharm: Ocular Flashcards

1
Q

muscarinic antagonists

A 
effect: cycloplegia and mydriasis
Tx: iritis, uveitis, eye exam
AE: increased intraocular pressure, stinging
systemic AE: xerostomia, tachycardia
CI: glaucoma, sulfite allergy
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2
Q

muscarinic agonists

A

direct acting miotic
increase aqueous humor flow
Tx: glaucoma
AE: sting, tears, decreased night vision
CI: iritis, uveitis, inflammation of anterior chamber
caution: pts with cholinergic mediated medical conditions (CV failure, asthma, ulcer, GI spasm)

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3
Q

AChE inhibitors

A

more potent and longer acting that direct miotics
AE more common
additive effects with: CARBAMATE and ORGANOPHOSPHATE toxicity
Tx: glaucoma
CI: CLOSE ANGLE GLAUCOMA

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4
Q

sympathomimetics

A 
produce mydriasis 
act on alpha receptors
outflow of aqueous humor
Tx: glaucoma, ocular HTN, decongestant 
caution: hyperthyroid, HTN, DM, asthma, arteriosclerosis
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5
Q

PG analogs

A

FIRST LINE
-prost
prodrug activated by esterase
PGF2alpha analog: increase aqueous outflow via accessory uveoscleral outflow pathway
2 hours to onset
Tx: glaucoma
AE: blurry vision, stinging, itching, BROWN stain (iris, eyelid, eyelash); EYELASH growth

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6
Q

beta-adrenergic antagonists

A

-olol
1. decrease aqueous humor production by decreased cAMP
2. decrease ocular blood flow and ultrafiltration producing humor
RAPID and SUSTAINED action
can be found in systemic circulation
Tx: glaucoma
AE: damage soft contact lenses, systemic effects

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7
Q

carbonic anhydrase inhibitors

A

-zolamide
reduce bicarb secretion and fluid transport
Tx: glaucoma
AE: TASTE disturbance, stinging, blurry vision, lacrimation, dry eye
CI: SULFONAMIDE ALLERGY
can get BACTERIAL CONTAMINATION

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8
Q

drugs for macular degeneration

A

intravitreal injection
VEGF interruption: decrease vascular growth
AE: arterial thromboembolic event

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9
Q

atropine

A

muscarinic antagonist

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10
Q

cyclopentolate

A

muscarinic antagonist

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11
Q

homotropine

A

muscarinic antagonist

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12
Q

scopolamine

A

muscarinic antagonist

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13
Q

tropicamide

A

muscarinic antagonist

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14
Q

carbachol

A

muscarinic agonist

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15
Q

pilocarpine

A

muscarinic agonist

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16
Q

acetylcholine HCl

A

muscarinic agonist

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17
Q

echothiophate

A

AChE inhibitors

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18
Q

dipivefrin

A

sympathomimetic
pro drug of epinephrine
alpha and beta agonist

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19
Q

phenylephrine

A

sympathomimetic

20
Q

apraclonidine

A

sympathomimetic

21
Q

brimonidine

A

sympathomimetic

22
Q

naphazoline

A

sympathomimetic

23
Q

tetrahydrozoline

A

sympathomimetic

24
Q

latanoprost

A

PG analog

25
Q

travoprost

A

PG analog

26
Q

bimatoprost

A

PG analog

Tx: eyelash hypotrichosis

27
Q

timolol maleate

A

beta-adrenergic antagonist

28
Q

levobunolol

A

beta-adrenergic antagonist

29
Q

metipranolol

A

beta-adrenergic antagonist

30
Q

carteolol

A

beta-adrenergic antagonist

31
Q

dorzolamide

A

carbonic anhydrase inhibitor

32
Q

brinzolamide

A

carbonic anhydrase inhibitor

33
Q

aflibercept

A

VEGF decoy receptor

Tx: macular degeneration

34
Q

pegaptanib

A

VEGF antagonist

Tx: macular degeneration

35
Q

ranibizumab

A

VEGF mAb

Tx: macular degeneration

36
Q

bevacizumab

A

VEGF mAb

Tx: macular degeneration

37
Q

verteporfin

A 
IV non-thermal laser activator
free radical production damages vessels
AE: visual disturbance, photosensitive, headache
AVOID BRIGHT LIGHT
Tx: macular degeneration
38
Q

ciliary body

A
  1. accommodation

2. aqueous humor secretion

39
Q

Receptor actions

  1. M3
  2. alpha 1
  3. alpha 2 and beta 2
  4. beta 2
A
  1. miosis, accomodati, lacrimal secretion
  2. mydriasis, lacrimal secretion
  3. aqueous production
  4. ciliary relaxation
40
Q

How can a drug cause unilateral mydriasis?

A
  1. direct contamination

2. nasolacrimal duct

41
Q

Gardener’s Eye

A

unilateral dilated pupil and blurred vision
due to Datura or Angel’s Trumpets (contains scopolamine and atropine)
cannot be reversed with pilocarpine

42
Q

MoA of opioid pinpoint pupils

A

act on Edinger-Westphal nucleus

block inhibitory neurons that allow pupil to dilate

43
Q

How can topical eye drugs become systemic

A
  1. spill on cheeks: skin discoloration and vasoconstriction
  2. lacrimal drainage and absorption in GI
  3. ocular blood vessels
44
Q

Tx of close vs. open angle glaucoma

A

close: Sx iridectomy
open: meds to decrease aqueous humor production or increase outflow

45
Q

Drugs to Tx glaucoma

A
  1. AChE inhibitor

2. miosis therapy

46
Q

considerations when choosing miotics vs. AChE inhibitor in glaucoma Tx

A
  1. young patients intolerant, preferred in phakic, caution in patient with increased risk for retinal detachment
  2. promote cataract formation in phakic patient

Neuro 2 (10 decks)

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