Pupil drugs

Question 1

Cholinergic Agonist MOA and drug

Answer 1

Parasympathetic agonist. Will result in pupil constriction and increased accommodation. Both of these causes an increase in aqueous outflow.

Pilocarpine.

Question 2

Pilocarpine is used to tx

Answer 2

POAG and Ocular HTN (rare to use for tx now)

Acute angle closure glaucoma. Except when IOP is our 50.

PDS

Question 3

Pilocarpine is used to Dx

Answer 3

Aide’s Tonic pupil, 3rd nerve palsy, pharmacologic dilation.

*Similar in action to Ach (parasympathetic) and will cause constriction of Aide’s

Question 4

When pilocarpine is used to tx POAG and Ocular HTN, there is a ___% decrease in IOP

Answer 4

15-25%

Rarely used as Tx now

Question 5

Pilocarpine adverse effects

Answer 5

Miosis
Accommodative spasm –> blur at distance.
Browache/HA !!!!!!!!
Retinal detachment
Shallowing of the AC
Breakdown of the blood aqueous barrier. More things can get into the eye.

Question 6

Pilocarpine
Caution
Contra

Answer 6

Caution-
High myopes. Watch for retinal detach.
Pts with uveitis.
Older pts may have accommodative spasm.

Contra-
Pts with angle closure secondary to lens induced mechanism or aqueous misdirection.

Question 7

Cholinergic Antagonist MOA and drugs

Answer 7

Parasympathetic antagonist.
Prevents pupil constriction and accommodation.
Cycloplegia.

Atropine
Homatropine 
Cyclopentolate 
Tropicamide 
Scopolamine

Question 8

What cycloplegic drop comes as a solution and ointment?

Answer 8

Atropine.

Question 9

Clinical use for atropine

Answer 9

Anterior uveitis or K injury

Posterior synechiae

Cyclo refraction for suspected accommodative isotope.

Myopia control

Occlusion therapy for amblyopia.

Question 10

Clinical uses for homatropine

Answer 10

it is the drug of choice for anterior uveitis or K injury (off label)

-Prevents PS
-Pain relief
Reduces cells and flare (decreases vessel permeability)

Question 11

Clinical uses for cyclopentolate

Answer 11

Drug of choice for cyclo refraction.
1 drop 1% or 2 drops 0.5% 5 mins apart.

Residual accommodation is 1-1.75D
Also could help mild anterior uveitis.

Question 12

Clinical uses for tropicamide

Answer 12

Drug of choice for dilation.

Minimal cyclo. Especially with 0.5%

Question 13

Paremyd

Answer 13

0.25% tropicamide and 1% hydroxyamphetamine is paremyd.

Question 14

Does a higher concentration (more drops) of tropicamide improve mydriasis?

Answer 14

NO.

Question 15

DM patients may be resistant to this drop unless phenylephrine is added.

Answer 15

Tropiciamide.

Question 16

Ocular side effects of cyclo drops

Answer 16

Stings
SPK
Transient increase in IOP (always check IOP before!)
Conj hyperemia.

Question 17

Systemic side of effects of cyclo

Tx with?

Answer 17

Decrease in parasympathetic system.
Decrease GI movement, dry skin and mucous membranes, tachycardia, fever, and urinary incontinence.

CNS disturbances in young patients = ataxia, incoherent speech, and seizures.

Tx with physostigmine given in ER

Question 18

Caution and contra for cyclo drugs

Answer 18

Caution in down syndrome and pregnant

Contra in narrow angles.

Question 19

Adrenergic Agonists MOA and drug

Answer 19

Sympathetic agonist. Stimulates dilator muscle.
No cyclo effect

phenylephrine

Indirect adrenergic agonists:
Hydroxyamphetamine
Cocaine

Question 20

Phenylephrine clinical use

Answer 20

Reduces redness (conj vasoconstriction)
*Can get rebound redness. 

Differentiate scleritis from episcleritis.

Palpebral widening. Improve ptosis because sympathetic innervation to mullers

Break posterior synechiae with 10%

Determine lesion in horners.

• Dilate? Lesion post gang.
• No dilation? Lesion pre gang.

Question 21

Phenylephrine ocular and systemic side effects (most with 10%)

Answer 21

Ocular- sings, photophobia, release pigmented granules from iris into aqueous.

Systemic- Cardiovascular. Increase in BP, MI, tachycardia, and arrhythmia.

Question 22

Caution and contra with phenylephrine

Answer 22

Caution- pts with cardiovascular disease, pts under 5, pts with hyperthyroidism, narrow angles.

Contraindicated- HTN, thyrotoxicosis, less than 1 year.

Question 23

Why might a pt come in with a dilated eye after using visine?

Answer 23

Visine’s active ingredient is phenylephrine, an adrenergic agonist (sympathetic agonist)

can cause conj vasoconstriction and pupil dilation.

Question 24

Which drugs are indirect adrenergic agonists and how do they work?

Answer 24

Hydroxyamphetamine
Cocaine

Prevent the reuptake of NE. Also release more NE into the synapse= increased sympathetic response.

Question 25

How can hydroxyamphetamine be used to locate lesion in horners?

Answer 25

Pupil dilates? pre gang .

No dilation? Post gang,

Question 26

How can you use cocaine to help with the dx of horners?

Answer 26

Will dx the horner’s eye, not the location of the lesion.

Eye that does not dilate- horners.

Question 27

What two drops can you use to dx horners eye?

Answer 27

Cocaine and apraclonidine.
Cocaine- horners pupil does not dilate.
Apraclonidine- horners pupil dilates.

Question 28

What two drops can you use to dx the location of lesion in horner’s syndrome?

Answer 28

Hydroxyamphetamine and phenylephrine

Hydroxyamphetamine:
Dilation? Lesion pre gang.

Phenylephrine:
Dilation? Lesion post gang

Question 29

Adrenergic antagonist MOA and drug

Answer 29

Dapiprazole
Sympathetic antagonist.
Prevents dilation- causes mitosis.
Dilation reversal.

Better when used with phenyl or hydroxyamphetamine, not tropicamide.

Can cause eye irritation (red)