PHARMACOLOGY - Miosis and Mydriasis Flashcards
What are the effects of atropine - anti-muscarinic (2 ocular, 3 systemic)
Ocular
1. mydriasis via iris sphincter muscle paralysis
2. cycloplegia via ciliary body paralysis
Systemic
3. Sedatory effect
4. Delays gastric emptying
5. Reduces sweating
What are the mechanism of pilocarpine? (6)
DIRECT muscaranic agonist - acts on muscarinic / Ach receptor
- MIOSIS - iris sphincter contraction
- ACCOMODATION - ciliary muscle contraction (accomodative spasm)
- REDUCES IOP - ciliary muscle contraction increases tension of scleral spur by pulling is posteriorly and internally –> opening of trabecular meshwork (conventional route)
- MYOPIA - ciliary muscle contraction
- VASCULAR PERMEABILITY - increases so should be avoided in uveitis.
- REVERSAL OF MYDRIASIS - only ones caused by atropine, not phenylephrine.
Which drugs can reverse atropine mydriasis?
Which drugs can reverse phenylephrine mydriasis?
- Pilocarpine, thymoxamine (more effective)
What are the effects of apraclonidine? (3)
- Mydriasis
- Eyelid retraction
- Conjunctival blanching
What is the main ocular side effects of brimonidine / apraclonidine?
After 1 year - allergic conjunctivitis, follicular conjunctivitis
Which drugs are alpha-1 adrenergic agonists?
Which drugs are alpha-2 adrenergic agonists?
Alpha-1 : phenylephrine
Alpha-2: apraclonidine, brimonidine
Which drug relaxes the ciliary body?
Atropine
Which drugs are parasympathetic antagonists?
- Cyclopentolate
- Tropicamide
- Atropine
- Phenothiazine
What is the mechanism of action of phenylephrine?
Non selective alpha agonist
What is the mechanism of action of tropicamide?
It is a muscarinic antagonist - blocks parasympathetic pathway.
what are the side effects of tropicamide?
- precipitates angle closure
- exacerbates ataxic dysarthia
- cerebellar signs
- increases risk of seizure
In what instances are alpha-2-agonists contraindicated? (2)
- Potentiates hypertensive crisis with monoamine oxidase inhibitors
- WIth TCAs, its IOP effect is removed.
What is the effect of muscarinic agonists, example? (3)
Direct - pilocarpine
Indirect - carbachol - inhibits cholinesterase
- Miosis
- Accomodation
- Decreased intraocular pressure
What are the main muscarinic agonists and antagonists?
Musacrinic agonist - pilocarpine, carbachol
Muscarinic antagonist - tropicamide (short acting 6 hours), cyclopentolate (24 hours) atropine (7 days)
What is the order of potency for muscarinic antagonists?
atropine > cyclopentolate > homatropine > tropicamide