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Abbey MSII Unit 3 > Pharm U3 optho. > Flashcards

Pharm U3 optho. Flashcards

1
Q

what allows transmission of central light rays through the pupil?

A

iris

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2
Q

pupillary aperture is controlled by what?

A

dilator and sphincter muscles

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3
Q

what is the lens?

A

pliant bag filled with protein

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4
Q

what is the lens thickness controlled by?

A

muscular fibers within the ciliary body via tension on the zones

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5
Q

accommodation

A

ability to alter the focal point

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6
Q

where does production of aqueous happen?

A

ciliray body

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7
Q

what is aqueous

A

source of nutrition for the lens, cornea, and trabecular meshwork

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8
Q

gluacoma

A

when intraocular pressure rises causing damage to the optic nerve due to aqueous production being more than aqueous outflow

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9
Q

angle closure glaucoma

A

flow of aqueous is prevented from draining into the trabecular meshwork by bowing forward of the iris

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10
Q

trabecular meshwork

A

located at the peripheral edge of the anterior chamber

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11
Q

how to test for predisposition of angle closure glaucoma

A

penlight - if both temporal and nasal iris are illuminated similarly - anterior chamber is deep. if nasal iris has a shadow over it, then the anterior chamber may be shallow due to bowing forward of the iris

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12
Q

sympathetic system causes what of the eye?

A

dilation of pupil

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13
Q

what syndromes demonstrate pupils not constricting to bright light but constricting when focusing?

A

parinaud’s syndrome (pineal tumor), argyll robertson syndrome (syphilis), Adie syndrome (benign parasympathetic deficit)

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14
Q

parasympathetic system causes what?

A

pupillary constriction

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15
Q

what controls modification of lens thickness and aqueous production

A

ciliary body

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16
Q

how is sympathetic innervation of the eye transmitted?

A

adrenergic receptors via NE - alpha and beta receptors

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17
Q

how is parasympathetic innervation transmitted?

A

cholinergic receptors via acetylcholine

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18
Q

what receptors are present in the eye for parasympathetic innervation

A

muscarinic and nicotinic

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19
Q

muscarinic receptors are block by what?

A

atropine

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20
Q

nictonic receptors are blocked by what?

A

d-tubocurarine

21
Q

nicotinic receptors on the eye are found where?

A

extraocular muscles

22
Q

muscarinic receptors for the eye are found where?

A

ciliary body and iris

23
Q

muscarinic receptors action on eye

A

iris sphincter constrict pupil, circular fibers of ciliary muscle to constrict pupil, and longitundinal fibers of ciliary muscle to place tension on trabecular meshwork

24
Q

Muscarinic agonists and their effects

A

acetylchoine, carbachol, methacholine, pilocarpine. cause pupillary constriction and increased aqueous outflow

25
Q

when are muscarinic agonists used

A

cataract surgery and glaucoma treatment

26
Q

muscarinic antagonists and their effects

A

atropine, scopolamine, tropicamide. pupillary dilatation and paralysis of ciliary body

27
Q

when are muscarinic antagonists used

A

cycloplegia for eye exams and to improve comfort during active eye inflammation (uveitis)

28
Q

what are the ACE inhibitors

A

echothiophate (irreversible) and physostigmine

29
Q

what is the nicotinic agonist? when is it used

A

edrophonium - used to diagnose myasthenia gravis

30
Q

describe the path of the sympathetic system from origin to eye

A

hypothalamus -> brainstem -> synapse to become second order and ascend with paravertebral sympathetic chain -> synapse at superior cervical ganglion to become third order neurons -> run with carotid plexus and run with ciliary nerve (V) to reach ciliary body and dilator muscle of the iris

31
Q

what are the direct sympathetic agonists? what receptor do they effect?

A

phenylephrine (mimic NE alpha 1- dilation of pupil); bromondine tartrate (selective a-2 agonist which suppresses aqueous humor production); clonidine (alpha-adrenergic agonist - lowers intraocular pressure through CNS effects)

32
Q

what are the indirect sympathetic agonists? what effect do they have

A

cocaine (prevent reuptake of NE) and hydroxyamphetamine (paradrine - releases NE)

33
Q

what are the sympathetic antagonists? what receptor do they effect?

A

beta blockers (-olol) timolol (non-specific beta 1 and 2) and betaxolol (beta 1 blocker, avoiding pulmonary symptoms)

34
Q

which drug reverses action of tropic amide and phenylephrine?

A

dapiprazole

35
Q

what are the first line medications for glaucoma?

A

timolol (non-specific beta-blocker), Latanaprost (prostaglandin), brimondine (alpha 2 agonist), dorzolamide hydrochloride (carbonic anhydrase inhibitor)

36
Q

carbonic anhydrase inhibitor mechanism and drug used

A

dorzolamide hydrochloride - topical - interfere with the active transport of Na through Na-K-ATPase pump

37
Q

what is the mechanism of prostaglandin analogs? drug used?

A

increase uveoscleral outflow without any effect on aqueous flow or trabecular outflow facility - Latanoprost (effective in reducing intraocular pressure)

38
Q

How is Horner’s syndrome diagnosis confirmed?

A

cocaine - if sympathetic system is dysfunctional, pupillary dilatation will not occur

39
Q

how is the location of the abnormality in horner’s syndrome confirmed?

A

paredrine (hydroxyamphetamine) - if the pupil does not dilate with paredrine, then the 3rd order neuron is dysfunctional (benign)

40
Q

What does loss of parasympathetic innervation cause?

A

disruption of the balance with the sympathetic system effecting pupillary innervation resulting in dilatation of the pupil

41
Q

which syndromes cause pupillary dilatation through loss os parasympathetic innervation in the eyes?

A

intracranial aneurysms, Adie’s syndrome, pharmacologic blockade

42
Q

how does internal carotid aneurysm result in pupillary dilatation?

A

trauma to the 3rd nerve from the aneurysm with associated extra ocular muscle palsies and ptosis, also occur with headaches

43
Q

Adie’s syndrome

A

damage to ciliary ganglion - characterized by dilated pupil with sector palsies of the pupillary sphincter - benign (due to viral infection/trauma)

44
Q

How to tell the difference between Adie’s syndrome and internal carotid aneurysm

A

a small dose of Ach will stimulate a chronically denervated nerve in Adie’s but not a traumatized nerve (aneurysm). normal eye needs 1% pilocarpine or 10% methacholine to cause constriction. In adie’s - only need 1/8% pilocarpine or 2.5% methacholine to cause pupillary constriction

45
Q

how can you tell if pupillary dilation is due to pharmalogic blockade? which drugs cause this?

A

pilocarpine 1% does not constrict pupil - caused by cycloplegic agents (muscarinic antagonists blocking action of actylcholine)

46
Q

beta blockers adverse effects

A

cardio (bradycardia, hypotension, syncope, CHF) resp (bronchospasm) neurologic (confusion, depression, fatigue, hallucinaions)

47
Q

adrenergics adverse effects

A

cardio (extrasystoles, palpitation, hypertension, MI) along with tremblinc, paleness, sweating

48
Q

cholinergic/anticholinesterases adverse effects

A

respiratory (bronchospasm), GI (salivation, nausea, vomiting, diarrhea, ab pain) also lacrimation and sweating

49
Q

anticholinergic adverse effects

A

neuro (ataxia, nystagmus, restlessness, confusion, hallucination, aggressive behavior) and also insomnia, photophobia, urinary retention

Abbey MSII Unit 3 (36 decks)

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