Pupil drugs Flashcards
Cholinergic Agonist MOA and drug
Parasympathetic agonist. Will result in pupil constriction and increased accommodation. Both of these causes an increase in aqueous outflow.
Pilocarpine.
Pilocarpine is used to tx
POAG and Ocular HTN (rare to use for tx now)
Acute angle closure glaucoma. Except when IOP is our 50.
PDS
Pilocarpine is used to Dx
Aide’s Tonic pupil, 3rd nerve palsy, pharmacologic dilation.
*Similar in action to Ach (parasympathetic) and will cause constriction of Aide’s
When pilocarpine is used to tx POAG and Ocular HTN, there is a ___% decrease in IOP
15-25%
Rarely used as Tx now
Pilocarpine adverse effects
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.
Pilocarpine
Caution
Contra
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.
Cholinergic Antagonist MOA and drugs
Parasympathetic antagonist.
Prevents pupil constriction and accommodation.
Cycloplegia.
Atropine Homatropine Cyclopentolate Tropicamide Scopolamine
What cycloplegic drop comes as a solution and ointment?
Atropine.
Clinical use for atropine
Anterior uveitis or K injury
Posterior synechiae
Cyclo refraction for suspected accommodative isotope.
Myopia control
Occlusion therapy for amblyopia.
Clinical uses for homatropine
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)
Clinical uses for cyclopentolate
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.
Clinical uses for tropicamide
Drug of choice for dilation.
Minimal cyclo. Especially with 0.5%
Paremyd
0.25% tropicamide and 1% hydroxyamphetamine is paremyd.
Does a higher concentration (more drops) of tropicamide improve mydriasis?
NO.
DM patients may be resistant to this drop unless phenylephrine is added.
Tropiciamide.
Ocular side effects of cyclo drops
Stings
SPK
Transient increase in IOP (always check IOP before!)
Conj hyperemia.
Systemic side of effects of cyclo
Tx with?
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
Caution and contra for cyclo drugs
Caution in down syndrome and pregnant
Contra in narrow angles.
Adrenergic Agonists MOA and drug
Sympathetic agonist. Stimulates dilator muscle.
No cyclo effect
phenylephrine
Indirect adrenergic agonists:
Hydroxyamphetamine
Cocaine
Phenylephrine clinical use
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.
Phenylephrine ocular and systemic side effects (most with 10%)
Ocular- sings, photophobia, release pigmented granules from iris into aqueous.
Systemic- Cardiovascular. Increase in BP, MI, tachycardia, and arrhythmia.
Caution and contra with phenylephrine
Caution- pts with cardiovascular disease, pts under 5, pts with hyperthyroidism, narrow angles.
Contraindicated- HTN, thyrotoxicosis, less than 1 year.
Why might a pt come in with a dilated eye after using visine?
Visine’s active ingredient is phenylephrine, an adrenergic agonist (sympathetic agonist)
can cause conj vasoconstriction and pupil dilation.
Which drugs are indirect adrenergic agonists and how do they work?
Hydroxyamphetamine
Cocaine
Prevent the reuptake of NE. Also release more NE into the synapse= increased sympathetic response.
How can hydroxyamphetamine be used to locate lesion in horners?
Pupil dilates? pre gang .
No dilation? Post gang,
How can you use cocaine to help with the dx of horners?
Will dx the horner’s eye, not the location of the lesion.
Eye that does not dilate- horners.
What two drops can you use to dx horners eye?
Cocaine and apraclonidine.
Cocaine- horners pupil does not dilate.
Apraclonidine- horners pupil dilates.
What two drops can you use to dx the location of lesion in horner’s syndrome?
Hydroxyamphetamine and phenylephrine
Hydroxyamphetamine:
Dilation? Lesion pre gang.
Phenylephrine:
Dilation? Lesion post gang
Adrenergic antagonist MOA and drug
Dapiprazole
Sympathetic antagonist.
Prevents dilation- causes mitosis.
Dilation reversal.
Better when used with phenyl or hydroxyamphetamine, not tropicamide.
Can cause eye irritation (red)
