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Lecture 4: Ocular Pharmacology
Terms in this set (84)
The circular muscles of the iris are controlled by what?
The radial muscles of the iris are controlled by what
This part of ANS controls normal body function It's nerves are cranial-sacral and it goes to glands/muscles (smooth muscle, cardiac muscle and glands).
The parasympathetic nervous system has what neurotransmitter (NT) at 1st AND 2nd site? Receptors include muscarinic, somatic-skeletal, and nicotinic.
This part of the ANS controls "fight or flight". It has thoraco-lumbar nerves that go to vital organs (heart, BV, and skeletal muscle). It will cause pupil dilation
The sympathetic nervous system has what NT at it's 1st site? 2nd site?
T/F. Most organs have dual innervation of SNS and PNS
This enzyme breaks down excess AcH in the synapse of the nerve terminal.
These drugs cause pupil dilation
These drugs cause cycloplegia
These drugs cause miosis.
These drugs are used to treat glaucoma
These drugs are vasoconstrictors (VISINE)
These drugs decrease aqueous formation (X2)
2. Beta blocker
T/F. When bright light is shown in the eye AcH is released and reacts on muscarinic receptors causing constriction, but the dilator doesn't really respond to light.
This drug class causes "wet". (Think: SLUG BAM).
Direct Parasympathomimetics act where?
Indirect Parasympathomimetics act where? (x2)
1. Release of NT
2. Inhibit ACHe
Cholinergic drugs cause what two things to occur in the eye?
1. Pupil Constriction
2. Decreased IOP
What are three contraindications for the use of cholinergic drugs?
Peptic ulcer disease
Severe Cardiac disease
Anti-Cholinergics prevent the action of AcH and only block muscarinic receptors. Is the binding reversible or irreversible?
This anti-cholinergic drug is used to treat bradycardia, bronchoconstriction, and cholinergic poisoning. It is also the drug of choice for CYCLOPLEGIC refractions.
This drug is the most potent mydriatic and cycloplegic available.
What is a contraindication of atropine?
Down's syndrome patients (because causes hyperactivity)
What are two patients that may benefit from atropine use?
Accommodative esotropes (children)
Amblyopes (child alternative to patching)
This anti-cholinergic drug is not the drug of choice in cycloplegic refractions but is useful in anterior uveitis cases.
This anti-cholinergic is a NON-SELECTIVE antagonist. It is used in Sea Sickness and in atropine sensitive patients. What is a big contraindication of this drug?
CNS toxicity (crosses BBB easily)
This sympatholytic is the drug of choice for ophthalmoscopy. It has the fastest onset and shortest duration. Least amount of side effects.
Tropicamide: Are the mydriatic or cycloplegic effects greater?
What is the most common drug added to phenylephrine?
Dicylomine (Bentyl), Hydroscyamine (Levisin) and Propantheline (Pro-Banthine) are anti-cholinergics used in IBC and GI spasms. What is a common side effect?
This drug is an anti-cholinergic that acts as a nebulizer for asthma patients by inducing bronchodilation.
What are two ocular adverse effects of anti-cholinergics?
What is an ocular contraindication of anti-cholinergics?
T/F. Anti-cholinergics are used in Parkinson's Disease treatment.
This drug is a neuromuscular blocking agent that is often used in intubation. It should NOT be used in a lacerated eye and can affect IOP.
There are two types of ACHe in the body (a "True" and a "non-discriminating"). Why is this important?
Because any exogenous AcH added to the body is eliminated almost immediately
Botox: Prevents the release of AcH and is not permanent. What are two ocular conditions it can be used for?
Blepharospasm (paralyzes muscle)
Strabismus (paralyzes muscle)
Indirect Cholinergic Drug act how?
Inhibit ACHe, so more AcH remains in synapse.
Donepezil (Aricept), Rivastigmine (Exelon), and Tacrine (Cognex) are all CHOLINERGIC drugs that are used in what patients?
These CHOLINERGICs work at the neuromuscular junction and are used in myasthenia gravis to allow AcH to hang around longer in the synapse.
Sympathomimetics constrict arterioles and veins (Reduce bleeding), allow for slow diffusion of drugs, can be used as decongestants, and do what to aqueous humor formation?
Decrease it (decrease IOP)
These drugs can produce a sympathomimetic response. Metabolism occurs via monoamine oxidase (A- NE, B-Dopamine). Name four of these.
Dopamine, Epi, Norepi, and dobutamine (synthetic)
Norepinephrine is found where?
Epinephrine is found where?
Dopamine is found where?
Brain, kidney, GI
T/F. SNS controls BP through constant partial vasoconstriction.
What type of sympathetic drugs are used to treat HTN?
What are four ways that adrenergic receptors can be activated?
Promote NE release
Inhibit NE uptake
Inhibit NE inactivation
These alpha receptors are found postsynaptically at effector cells.
These alpha receptors are found presynaptically at the nerve terminal and participate in NT control.
Alpha agonists produce what two main effects?
Beta-1 Receptors are found where?
Beta-2 receptors are found where?
Direct adrenergic drugs stimulate the receptor. Give three examples of this type of drug.
Indirect adrenergic drugs stimulate norepinephrine release. Give an example of this type of drug.
Mixed action adrenergic drugs can either effect the receptor or NT release. Name two drugs that do this.
What are the two main effects of adrenergic drugs in the eye?
This is an alpha-1 blocker that causes vasodilation and orthostatic hypotension (used to treat HTN)
This is a beta-blocker that decreases heart rate and blood pressure and can cause fatigue.
Metropolol (Toprol XL)
Adrenergic drug use: vasoconstrictive properties are used in what? Other uses: treat cardiac arrest, treat asthma, treat ADHD, diet pills.
Anti-Adrenergics decrease sympathetic tone in blood vessels and thus decrease TPR and BP. They are used to treat what?
Raynaud syndrome (And HTN)
This is a alpha-1 agonist that works on the dilator muscle in the eye. It produces MINIMAL/NO cycloplegia.
What are five other uses of phenylephrine clinically?
1. Widen palpebral fissure in ptosis
2. Decrease IOP
3. 10% can break posterior synechia
4. Differentiate scleritis and episcleritis
5. Help diagnose horners (dilate supersensitivity)
T/F. You should not use phenylephrine in Grave's disease, pregnancy or cardio patients.
T/F. Even with the use of phenylephrine, the pupil will still be reactive to light.
This is an indirect acting adrenergic agonist that produces vasoconstriction and mydriasis. It is cautioned because it can cause an increase in BP.
Hydroxyamphetamine: what is a big USE for this?
Differentiate between post/pre/central Horner's lesion
Thymoxamine and Dapiprazole are alpha-1 adrenergic antagonists. They are used for what?
Dilation reversal (no effect on accommodation because muscle still paralytic)
Why do we use a topical anesthetic when dilating patients? (x2)
1. Increase corneal permeability to drug
2. Decrease irritation = Decrease Lacrimation = Decrease Dilution
The pupil has both SNS and PNS innervation, but which is predominate?
Does the dilator muscle have more alpha or beta receptors?
What drug class can cause CM spasm, vasodilation and increased lacrimation?
What drug class can cause CM paralysis and decreased lacrimation?
What drug class can blanch blood vessels in the eye?
Which drug class can cause and eye lid twitch and CM spasm?
Dilator has what receptor? Response?
TM has what receptor? Response?
CM has what receptor? Response?
Nonpigmented ciliary epithelium has what receptor? Response?
Beta 1 and 2
Increase aqueous formation
Ciliary Body Vessels have what receptor? Response?
Decrease aqueous formation
Sphincter has what receptor? Response?
Ciliary muscle has what receptor? Response?
Lacrimal gland has what receptor? Response?
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