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102 Cards in this Set
- Front
- Back
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When activated alpha 1 receptors causes...
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1. mydriasis
2. vasoconstriction 3. decrease aqueous outflow thus increased IOP |
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When activated alpha 2 receptors causes...
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decreased IOP via:
1. decrease AH production 2. increase TM spacing |
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When activated beta 2 receptors causes...
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1. increase IOP
2. relaxation of accommodation |
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When activated beta 1 receptors causes...
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not significant in the eye
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Name sympathomimetic agents
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1. cocaine
2. hydroxyamphetamine 3. phenylephrine |
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What receptors do sympathomimetic agents work on?
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alpha agonists
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Cocaine
Class Mechanism of action |
alpha agonist & anesthetic
blocks NE causing mydriasis |
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Cocaine is used in the diagnosis of what disease?
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Horner's syndrome
dilates normal eyes and causes no dilation of Horner's pupil thereby telling you there is a lesion |
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Hydroxyamphetamine
class mechanism |
alpha agonist
release NE and reduced NE reuptake causes dilation and relaxation of acc |
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Hydroxyamphetamine is used in the diagnosis of what disease?
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Horner's syndrome
locates the lesion, tells if its preganglionic or postganglionic |
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Hydroxyamphetamine causes what to a 1st and 2nd degree preganglionic lesion?
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dilation
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Hydroxyamphetamine causes what to a 3rd degree postganglionic lesion?
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does not dilate the eye
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Phenylephrine
class mechanism |
alpha agonist
causes vasoconstriction and acts on radial muscle of iris causing dilation |
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clinical uses of phenylephrine
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decongestant
vasoconstriction mydriasis prior to sx breaks posterior synechiae |
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systemic effects of phenylephrine
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palpitation
tachycardia arrhythmia HTN occipital HA rupturing aneurysms |
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What is the major concern when using phenylephrine?
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may cause rise in bp in 10% of patients - rare
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Who is at most risk for the systemic effects of phenylephrine and what concentration should be avoided in these patients?
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elderly and small kids
patients with cardio issues, aneurysms, of insulin dep DM 10% |
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What is the mechanism of action of parasympatholytics?
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STOP AcH
block effects of Ach at muscarinic receptors thereby causing mydriasis and cycloplegis |
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What are the side effects of parasympatholytics?
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Mydriasis and Cycloplegia
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Name parasympatholytic drugs from weakest to stronges
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Tropicamide
Cyclopentolate Homatropine Scopolamine Atropine |
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What is the most potent and longest acting mydriatic and cycloplegic agent available?
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Atropine
mydriasis - 7-10 days cycloplege - 7-12 days |
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Name the clinical uses of atropine
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cycloplegic refractions
amblyopia therapy tx inflammation of iris/uvea |
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What are the systemic effects of atropine?
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dry mouth/skin
hallucinations tachycardia respiratory depression death |
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What drug is used to treat atropine overdose?
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phyostogimine
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Duration of cyclopentolate
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mydriasis - 1 day
cycloplege - 0.25 day |
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What are they systemic effects of cyclopentolate?
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Greater CNS effects than atropine such as hallucinations, drowsiness, ataxia, psychosis, dysphagia
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Clinical use of homatropine
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uveitis
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duration of homatropine
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1-3 days
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scopolamine uses
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uveitis
pre & postop iridocyclitis tx cycloplegic refraction |
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duration of scopolamine
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mydriasis 3-7 days
cycloplegia 5-7 days |
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duration of tropicamide
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depends on dose - 6 hrs
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what recovers first, mydriasis or cycloplegia, if tropicamide is used?
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accommodation
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drug of choice for DFE
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tropicamide
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Name and alpha antagonist and its mechanism of action
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Dapirazole (Rev Eyes)
blocks alpha receptors causing decrease in IOP and MIOSIS |
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Dosage of dapirazole
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2 drops followed 5 min later by 2 more drops
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Shelf life of dapiprazole
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it is reconstittuted by doctor and should be used by 3 weeks
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Describe the mechanism of action of topical ocular anesthetics.
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acts on cell membrane of nerves tissue by blocking transient increase in membrane permeability to sodium ions
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Why are topical anesthetics used prior to dilation?
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1. numb the stinging effect
2. decrease tear & blinking to increase contact time 3. creates temporary keratopathy that increases absorption |
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Name the anesthetic who's sole clinical use is for tonometry
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benoxinate
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benoxinate (flurress) contains
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.4% benoxinate AND .25% Na flourescein
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mechanism of action of cocaine
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blocks initiation and conduction of nerve impulses & causes vasoconstriction
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uses of cocaine
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horner's syndrome dx
forced duction testing debridement |
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what is the main ocular side effect of cocaine?
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significant corneal epithelial defects, clouding, ulceration AND dilation
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what are the systemic side effects of cocaine?
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with 20mg dose:
rapid irregular pulse bradychardia nausea vomitting HA respiratory arrest death |
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CI of cocaine use
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HTN
Adrenergic agonists tricyclic antidepressants methyldopa MAOI |
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tetracaine comes in what forms
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drops and ung
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ocular side effects of tetracaine
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> corneal epithelial compromise than proparacaine
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systemic side effects of tetracaine
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CNS involvement with doses over 1.5mg/kg of body wt
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All ocular anesthetics are what type; esters or amides?
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esters
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Mechanism of action of NSAIDs
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blocks COX pathway thereby preventing the production of prostaglandins which mediate pain & inflammation
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Action of NSAIDs
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anti-inflammatory
anti-pyretic analgesis |
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Name the 2 most common topical NSAIDs
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Voltaren (diflofenac)
Acular (ketorolac) |
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Diclofenac sodium
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voltaren
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Ketorolac tromethamine
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acular
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common dosing schedule for NSAIDs
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TID or QID
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Most common use of NSAIDs
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treatment of post-op inflammation (CME)
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clinical use of diclofenac (voltaren)
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post-op inflammation after cataract sx
photophobia after refractive sx |
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Off label use of voltaren
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anti-inflamatory post ALT
tx of seasonal allergic conjunctivitis tx of pain post RK & PRK |
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clinic use of acular
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FDA approved for post-op inflammation & allergy
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off label use of acular
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GPC
Vernal KC |
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age approval for acular
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3+
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bromfenac
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xibrom
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bromfenac use
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FDA approved for post-op inflammation
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nepafenac
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nevanac
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mechanism of nevanac
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converted to amfenac sodium which inhibits COX
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use of nevanac
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FDA approved for post-op inflammation
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off label use of nevanac
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diabetic macular edema
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flurbiprofen
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ocufen
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ocufen use
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inhibits miosis
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off label use of ocufen
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uveitis
post-op inflammation |
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what pathway is not blocked by NSAIDs?
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lipoxygenase pathyway --> leukotrienes
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Function of corticosteroids
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suppress pain, redness, and swelling
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CI of corticosteroids
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infectious processes
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Mechanism of action of corticosteroids
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block COX and LIPOXYGENASE pathways thus inhibiting prostaglandins and leukotrienes
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clinical uses of corticosteroids
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any condition causing inflammation
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which conditions should steroids not be used in?
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HSV keratitis if epithelium is involved
fungal, viral, and bacterial diseases of cornea |
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for what type of HSV can steroids be used?
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stromal HSV but must be used with antiviral
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can steroids be used to tx infective conjunctivitis?
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only if benefits outweigh the risk
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why are steroids used in tx of chemical, radiation, or thermal burns of the cornea?
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reduces scarring
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the initial dosage of steroids should be?
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high enough to suppress inflammation, can refine when reevaluate
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which steroid increases IOP the most?
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dexamethasone
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Flarex (fluoromethalone acetate)
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moderate inflammation
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FML ( flouromethalone alcohol)
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mild to moderate inflammation
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Lotemax (loteprednol 0.5%)
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post-op inflmmation
moderate-severe inflammation highly potent but metabolized fast so less side effects |
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Alrex (loteprednol 0.2%)
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allergic conjunctivitis
highly potent but metabolized fast so less side effects |
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Pred Forte/Pred Mild (Prednisolone Acetate)
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greates anti-inflammatory agent
penetrates cornea and AC well tx AC rxn and moderate/severe inflammation |
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prednisolone sodium phosphate
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moderate/severe infammation
doesnt penetrate cornea well |
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Vexol (rimexalone)
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moderate to severe inflammation
post-op doesnt increase IOP as much |
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which type of steroids penetrate the cornea the best and are most potent?
suspensions vs sol |
suspensions
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suspensions are derivatives of...
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acetate and alcohol
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solutions are derivatives of...
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phosphate
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Typical dosing of severe inflammation
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1 drop every 1-2 hrs for 1-2 days then TID-BID
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ocular side effects of steroids
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PSC
increase IOP infection corneal and sclera thinning causing perforation |
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PSC develop mostly after systemic or ocular tx?
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systemic
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when do PSC typically develop?
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after 1 yr of tx in adults
earlier in children |
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is the chance of developing PSC dose related?
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yes
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Who is most likely to develop PSC following steroid use?
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diabetics
hispanics |
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Do PSC regress after D/C steroid use?
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NO
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Elevated IOP is seen after topical vs systemic use of steroids?
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Topical, periocular, & systemic
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which mode of administration is less likely to cause increase IOP?
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systemic
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Does IOP go back to normal after D/C steroid use?
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yes ater 3 weeks
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Which patients will have a greater increase in IOP when using steroids?
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POAG pts and their chiildren
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