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45 Cards in this Set

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Two divisions of ANS
Sympathetic / Adrenergic and parasympathetic / cholinergic
Parasympathetic neurotransmitter
Acetylcholine
Sympathetic neurotransmitter
Norepinephrine
Stimulates epinephrine release from Adrenal medulla
parasympathetic stimulation causes
Miosis of pupil (constriction)
sympathetic stimulation causes
Mydriasis of pupil (dilation)
parasympathomimetic
cholinergic agonist
mimics effects of Ach
Constricts
(pilocarpine)
parasympatholytic
cholinergic antagonist
blocks Ach
Dilates
Sympathomimetic
adrenergic agonist
blocks Ach
Dilates
(phenylephrine)
Sympatholytic
adrenergic antagonist
mimics effects of Ach
(rev eyes)
Direct acting drugs
occupy the receptor site
indirect acting drugs
works without physically attaching to the receptor site
sympathomimetics
Mydriatics only (pupil dilation only)
stimulates dilator muscle only
(Red caps)
parasympatholytics
mydriatics and cycloplegics (dilate and cycloplege)
inhibit sphincter and ciliary muscle
(red caps)
phenylephrine
2.5% - 10%
max dilation in 40 min, lasts 3-6 hours
Direct adrenergic agonist
can slightly increase BP
10% used to break posterior synechia
no cycloplegia
not increase IOP
Hydroxyamphetamine
safer in HTN patients
good for diabetics who are hard to dilate
no increase in IOP
distinguishes between pre and post ganglionic Horners
enhances release of norepinephrine
ephedrine
4% and 5%
max dilation 30 min, lasts 3 hours
primarily used as topical decongestant
cocaine
1% - 4%
max dilation 40 min, lasts 6 hours
stimulates CNS
Prevents re-uptake of norepinephrine
diagnose Horners
Atropine
1%
Most potent mydriatic / cycloplegic available
max dilation 30-40 min, lasts ~ 2 weeks
blocks action of Ach on end plates
management of anterior uveitis
Fatal if swallowed
can raise IOP
homatropine
2% - 5%
similar to atropine
max dilation 40 min, lasts 2-3 days
management of anterior uveitis
can raise IOP
cyclopentolate
.5%, 1%, 2%
max dilation 15-30 min, lasts 8-24 hours
drug of choice for cycloplegic refraction
2% may cause CNS disturbances in children
can raise IOP
tropicamide
.5% - 1%
max dilation 20-30 min, lasts 4 hours
max cycloplegia 30-45 min, lasts 4 hours
can raise IOP
drug of choice for routine dilation
.5% safest dilating agent for pregnant patients
Paremyd
combo of 1% hydroxyamphetamine and .25% tropicamide
max dilation 60 min, lasts 6-8 hours
cycloplegia lasts 3 hours
don't use w/ flashes, floaters, vision loss, on diabetic patients, or children
When should you dilate?
routine exam, flashes / floaters, VA not 20/20, decrease in VA, unexplained VF loss, intermittent blurred vision, diabetes, myopia > 6D, ocular injury, pain or redness, APD, cataract, opacities, lattice degeneration, retinal holes, retinal detachment, metastatic tumors, unexplained headaches, drug use
When should you cycloplege?
infants and preverbal children, hyperactive children, non communicative patients, illiterate patients, latent hyperopes, accommodative esotropes, mentally handicapped (caution with down syndrome pts and infants)
contraindications of pupillary dilation
iris supported IOL, extreme narrow or closed chamber angle, subluxated lens, pregnancy or lactation, allergies to meds
post dilation complications
large pupil - glare
accommodative paresis - blurred near vision
light sensitivity - bad in cataract pts
acute angle closure glaucoma
acute angle closure glaucoma
obstruction of trabecular meshwork in anterior chamber by peripheral iris
ALWAYS evaluate the AC angle before dilation
-pain, photophobia, blurred vision, halos, headaches, nausea
-conjunctival injection, corneal edema, mid dilated fixed pupil, decreased VA, increased IOP
pilocarpine
.5% - 10%
Direct acting cholinergic agonist
max constriction 10 min, lasts 4-6 hours
used in open and closed angle glaucoma to lower IOP
.125% to diagnose Adie's Tonic Pupil
(green caps)
physostigmine
.25% - .5%
Indirect acting cholinergic agonist
max constriction 30 min, lasts 12-36 hours
2x the effect of pilocarpine
(green caps)
dapiprazole
(reveyes).5%
used for reversal of mydriasis produced by phenylephrine
causes injection (30-45 min)
2 drops -> 2 more 5 min apart
mix new bottle every 3 weeks
to speed up reversal of dilation use
paramyd and rev-eyes
b/c low [tropicamide] and sympathomimetic so reverses easier
tetracaine
.5% - 1%
onset 9-26 sec, lasts 10-25 min
may cause allergic rxn and corneal epithelial damage
significant stinging when dropped
proparacaine
.5%
onset 6-20 sec, lasts 10-20 min
less allergic rxn and corneal epithelial damage
commonly used with fluorescein strip for Goldmann
benoxinate
.4%
onset 6-20 sec, lasts 10-20 min
stings more than proparacaine
no reported allergic rxn
the anesthetic in fluress
cocaine
1% - 4%
max anesthetic in 20 sec, lasts 20 min
can cause marked epithelial damage
-facilitates entrance of mydriatic drugs through cornea
fluress
combo of .4% benoxinate + .25% fluorescein
effective in 15 sec, lasts 15-20 min
topical anesthetics
used for: tonometry, gonioscopy, and FB removal
are: toxic if swallowed
prolonged use can retard corneal epithelial healing
aid in absorption of mydriatics
topical anesthetics toxicity
stinging / burning
punctate keratitis - can decrease VA
NEVER GIVE as TREATMENT
when not to use anesthetics
known hypersensitivity
before staining with fluoroscein or rose bengal
before scraping for culture
NEVER GIVE for PAIN
Fluorescein
use cobalt blue filter
shows breaks in continuity of epithelial cells of cornea or conjuntiva
Doesn't stain healthy cells
measures TBUT and openess of lacrimal system (Jones test)
Rose bengal
use white light
stains devitalized cells bright RED
diagnoses dry eye or herpetic lesions
lissamine green
stins dead / degenerate cells and mucous
useful when red dye is not desirable or using multiple dyes
stain lasts longer than rose bengal
saline
salt solution that is isotonic to tear film
must have preservative
used to rinse gonio lens, irrigate eyes, wet FL and RB stips
celluvisc
1% carboxymethylcellulose
clear viscous artificial tears solution
No preservative
used w/ 3 mirror gonio
goniosol
2.5% hydroxypropylmethylcellulose
better image optically than celluvisc
-no air bubbles, good suction
toxic to cornea - expect SPK
used in all laser procedures