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56 Cards in this Set

  • Front
  • Back
Production of aqueous humor is regulated by what system and receptor?
SYMPATHETIC - beta receptor
SYMPATHETIC nervous system uses which NT and receptors
NE - alpha and beta
PARASYMPATHETIC nervous system uses which NT and receptors
Ach - muscarinic (and nicotinic)
Radial muscle is innervated by _ and _ receptor
Sympathetic - alpha receptor
Sphincter (ciliary muscle) is innervated by _ and _ receptor
Parasympathetic - M3 receptor
Dilation of the pupil is called _
MIDRIASIS
Constriction of pupil is called _
MIOSIS
Relaxation of ciliary muscle is innervated by _ and _ receptor
Sympathetic - beta receptor
MYDRIASIS (pupillary dilation) can be achieved by stimulating _ receptor and inhibiting _ receptor
Alpha 1

M3
Relaxation/paralysis of ciliary muscle with loss of ability to accomodate for near vision is called _
CYCLOPLEGIA
How do you obtain cycloplegia?
Inhibiting M3 receptor
What are the indications for production of MYDRIASIS
- Fundoscopic exam
- Treatment of uveitis - preventing formation of synechiae
- Dilating pupil before intraocular surgery
- Red eye - available OTC
- Diagnosis of errors of refraction (used with cycloplegic)
- Other diagnostic procedures - angle block, retinoscopy
Adhesions between iris and lens are called _
Synechiae
Infection of iris, choroid and lens is called _
Uveitis
Which drug is alpha 1 agonist used to produce mydriasis
PHENYLEPHRINE
PHENYLEPHRINE CONTRAINDICATIONS

1. Phenylephrine is contraindicated in _

2. Phenylephrine should be taken with caution in people with _
1. Infants, aneurysms and narrow angle glaucoma (increase IOP)

2. Diabetes, hypertension, CV disease, hyperthyroidism (reports of fatal ventricular arrhythmias and MI in elderly patients with preexisting cardiac disease)
All muscarinic antagonists are used for both _ when both effects are indicated
Mydriasis and cycloplegia
Name topical ophthalmic muscarinic antagonists
Atropine
Scopolamine
Tropicamide
Which muscarinic antagonist has longest duration of action - 7-10 days
ATROPINE
Which muscarinic antagonist has shortest duration of action - 6 hours
TROPICAMIDE
Which drugs are not used for mydriasis unless cycloplegia is also indicated
Muscarinic antagonists
Where does atropine come from ?
Natural alkaloid found in Solanaceae plants
What are the adverse effects of atropine?
Dry mouth
Dry eyes
Blurred vision
Tachycardia - blocking vagal effect - unopposed sympathetic activation
Constipation
Anhidrosis
Increased intraocular pressure
Patients who are experiencing adverse effects of atropine run risk of _
Hyperthermia (because of anhidrosis)
Atropine is contraindicated in patients with _ and should be used with caution in patients _
GLAUCOMA - increases intraocular pressure
Patients predisposed to developing glaucoma (patients over 40)
Atropine causes _ CNS effects at therapeutic doses however causes _ at toxic doses and _ at extremely high doses
Mild excitatory - therapeutic doses

Hallucinations + delirium - toxic doses

Coma, respiratory arrest, death at extremely high doses
Atropine poisoning causes _
Marked excitement, irritability, hyperactivity and increase in body temperature (all CNS effects), coupled with anhidrosis - "ATROPINE FEVER" - potentially fatal
ATROPINE has additive adverse effects if combined with other antimuscarinic drugs - such as _

Also has additive CNS effects with _
Antihistamines
Phenothiazines
Tricyclic antidepressants
Amantadine
MAOI's


ALCOHOL
What kind of glaucoma is a medical emergency initially treated with drugs but eventually requiring surgical correction
Acute/angle closure glaucoma
Which type of glaucoma is most common type caused by lack of outflow of aqueous humor
Chronic/open angle glaucoma
Primary open angle glaucoma occurs due to degenerative changes in _
Trabecular meshwork and connective tissue of Schlemms canal
Primary angle closure glaucoma occurs due to anatomic or physiologic abnormalities of _ that predispose to _ often in patients with _ . Increased _ pressure also bows iris forward and occludes _
1. Tissue and anterior chamber

2. Blockage of outflow channel by iris root

3. Hyperopia

4. Posterior chamber

5. Trabecular meshwork
Which drugs considered first line treatment for glaucoma?

What is the mechanism of action
Beta blockers

Lower IOP by decreasing production of aqueous humor
Can beta blockers cause toxicity?
Can be absorbed in amounts sufficient to cause systemic effects (most important on heart and lungs)
Which topical beta blocker is used most for treatment of glaucoma
TIMOLOL
Epinephrine and Dipivefrin are indicated for treatment of _

What is the mechanism of action?

Which receptor mediates this?

Those drugs can be coupled with _
1. Open angle glaucoma

2. Decrease IOP by increasing drainage of aqueous humor

3. Alpha

4. Beta blocker
Prodrug form of EPI is called _

Is it often used?

It is highly _ soluble and readily penetrates cornea
DIPIVEFRIN

RARELY used

Lipid
Name two direct acting alpha 2 agonists

Mechanism of action?

What are they used for?

What are the side effects?
Apraclonidine

Brimonidine

2. Mechanism of action unclear

3. Short term treatment of refractory open angle glaucoma

4. Side effects - dry mouth, dry nose, headaches, others
MUSCARINIC AGONISTS IN GLAUCOMA TREATMENT

1. Cause _ by contracting iris sphincter muscles - decrease IOP, increase iris/cornea angle

2. Cause _ by contraction of ciliary muscle - decrease IOP - allow access of aqueous humor to canal of Schlemm
1. MIOSIS

2.ACCOMODATION for near vision
Which drug has been largely replaced by beta blockers in treatment of open angle glaucoma
PILOCARPINE
PILOCARPINE is indicated for _
Emergency treatment of acute narrow angle (angle-closure) glaucoma
MOA of PILOCARPINE
Produces miosis and ciliary muscle contraction - decrease IOP
Name two Ach esterase inhibitors
Physostigmine (reversible) and Ecothiophate (irreversible)
AchE inhibitors are indicated for treatment of _
Acute glaucoma
Are AchE inhibitor drug of choice for acute glaucoma
NOT drug of choice
Mechanism of action of AchE inhibitors in treatment of glaucoma?
Increase Ach --> cause miosis and ciliary muscle contraction --> decreases IOP
Adverse effects of AchE inhibitors
Cataracts with chronic use, at high doses causes CNS stimulation can lead to convulsions followed by respiratory and CV depression
In intial treatment of acute glaucoma combination of which drugs should be given?
Pilocarpine + Physostigmine
Name Ach agonists
Ach
Carbachol
Pilocarpine
CARBACHOL

1. What is it used for?

2. Is it selective towards muscarinic receptors?
1. Produces miosis for surgery (iridectomy)

2. NON selective - stimulates both muscarinic and nicotinic receptors
ACH

1. What is it used for?

2. Is it selective towards muscarinic receptors
- LIMITED USE to achieve miosis for ophthalmic surgery only - rapidly destroyed by cholinesterases
- NON SELECTIVE - stimulates both muscarinic and nicotinic receptors
Which drug is used in transdermal patch worn behind ear to prevent motion sickness
SCOPOLAMINE - gradual continuous release of drug within 3 days
1. What is the mechanism of action of SCOPOLAMINE

2. What are the side effects?
1. Possibly vomitting center in medulla or peripherally on vestibular apparatus

2. Significant SEDATION and dry mouth, potential withdrawal symptoms when removed especially if used for more then 3 days
HORNERS SYNDROME - typically unilateral interruption of _ and causes _

2. Nerve lesions cause nerve degeneration _ and leave _ intact
1. Sympathetic innervation of face - causes miosis, ptosis, anhidrosis on affected side

2. Distally - postganglionic intact
_ and _ (indirect sympathetic agonists) block reuptake of NE thus enhancing sympathetic effects
Cocaine and tricyclic antidepressants
In HORNERS SYNDROME if indirect sympathomimetics will not dilate abnormally constricted pupil but phenylephrine does this lesion is _

If lesion responds to both dilation by phenylephrinea and cocaine the lesion is _
POSTGANGLIONIC

PREGANGLIONIC - postganglionic fibers and their catecholamine stores are intact