Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
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 |
