12 Pharm of the Eye

Question 1

dipivefrin?

Answer 1

• mixed alpha, beta agonist

- prodrug metabolized to Epi

Question 2

epinephrine family?

Answer 2

mixed alpha, beta agonist

Question 3

apraclonidine family?

Answer 3

alpha 2 selective agonist

-Only use for extreme ocular cases

Question 4

betaxolol family, etc?

Answer 4

-B1 selective antagonist
-reduce aqueous humor production
-
-block B1 on ciliary body

Question 5

Carteolol family?

Answer 5

B non-selective antagonist

Question 6

levobunolol family?

Answer 6

B non-selective antagonist

Question 7

metipranolol family?

Answer 7

B non-selective antagonist

Question 8

timolol family?

Answer 8

B non-selective antagonist

Question 9

carbachol special info?

Answer 9

• cholinergic agonist (miotic)

- miotic, drain glaucoma by stim . M3 receptor on iris & ciliary body, improving uveoscleral outflow

Question 10

pilocarpine special info?

Answer 10

-cholinergic agonist (miotic)
-miotic, drain glaucoma by stim . M3 receptor on iris & ciliary body, improving uveoscleral outflow
[tears, saliva on your “pillow”]

Question 11

atropine class, clinic use, side effect, mech, bonus

Answer 11

-cholinergic antagonist
-Mydriasis (7-10 days)
-acute glaucoma!
-
-

Question 12

cyclopentolate family & length?

Answer 12

• cholinergic antagonist

- Mydriasis (1 day)

Question 13

homatropine family & length?

Answer 13

• cholinergic antagonist

- Mydriasis (1-3 days)

Question 14

scopolamine family & length?

Answer 14

• cholinergic antagonist

- Mydriasis (3-7 days)

Question 15

tropicamide family & length?

Answer 15

• cholinergic antagonist

- Mydriasis (1/4 day)

Question 16

acetazolamide family?

Answer 16

carbonic anhydrase inhibitor

Question 17

dichlorphenamide family?

Answer 17

carbonic anhydrase inhibitor

Question 18

dorzolamide family?

Answer 18

carbonic anhydrase inhibitor

Question 19

botulinum toxin A family?

Answer 19

miscellaneous agents

Question 20

Don’t forget picture of eye anatomy in your notes.

Answer 20

Yay, good job looking at it.

Question 21

Mydriasis is?

Answer 21

dilation

Question 22

Miosis is?

Answer 22

constriction

[think of cells undergoing meiosis constricting till they split in half]

Question 23

Consensual pupil response assesses?

Answer 23

“brain damage”

Question 24

What muscle does mydriasis?

Answer 24

-Radial smooth muscle contracts

Question 25

What happens to sympa/parasympa when mydriasis occurs? (2)

Answer 25

- inhibit para (M3 muscarinic antagonists in iris) [strong dilation] - stimulate sympa (alpha 1 agonists in iris) [weak dilation]

Question 26

What muscle does miois?

Answer 26

constrictor pupillae contracts

Question 27

What things happen with sympa/parasympa when miosis occurs? (3)

Answer 27

- stimulate para (M3 muscarinic agonists in iris) [strong contract] - inhibit symmpa (alpha 1 antagonist in iris) [weak contraction] - stimulate (agonist) opioid receptor in the CNS -> "pinhole" pupil [strong contraction]

Question 28

Of the things that affect refractive power, what are the 2 (of the multiple) ways we need to know?

Answer 28

- air:cornea interface | - lens curvature

Question 29

What suspends the lens?

Answer 29

"suspensory ligaments" (I think these are zonular fibers) attached to ciliary muscle.

Question 30

When ciliary muscle contracts what happens?

Answer 30

Relaxation of lens -> decreased radius -> see close up

Question 31

What receptor agonist contracts the ciliary muscle?

Answer 31

Muscarinic agonsits (carbachol & pilocarpine?)

Question 32

What is cyloplegia?

Answer 32

Blocked accomodation reflex. (muscarinic antagonists, ex atropine)

Question 33

Atropine side?

Answer 33

Acute glaucoma

Question 34

T/F Ciliary muscle is influenced by sympa?

Answer 34

F. No adrenergic receptors.

Question 35

What is presbyopia?

Answer 35

lens loses accomodation (flexibility) w/ age [12 diopter accomodation young adult, 1 diopter by age 50]

Question 36

What secretes aqueous humor?

Answer 36

blood vessels of ciliary body!

Question 37

What path does aqueous humor take?

Answer 37

thru anterior chamber/pupil, drains to: - trabecular meshwork -> - canal of Schlemm -> - Episcleral vein -> - Uveoscleral outflow

Question 38

What is carbonic anhydrase?

Answer 38

H2O and CO2 to HCO3 and H+

Question 39

What decreases aqueous humor production? (3)

Answer 39

- alpha 1 stim. (stimulation) (on blood vessels, reduces blood flow) [same as other vessels!] - alpha2 stim. (on ciliary body) - Carbonic anhydrase inhibitors [see "what increases?" flashcard for 1 more method of decreasing]

Question 40

How do carbonic anhydrase inhibitors reduce production of aqeous humor?

Answer 40

Reduce HCO3 procution -> | active transport of HCO3 & Na is req'd for making the humor.

Question 41

What increases aqueous humor production?

Answer 41

-B1 stim. (on ciliary body, by epinephrine) [Note antagonist would decrease] [recall B1's are also on the heart]

Question 42

What is the essential property for an ophthalmic drug?

Answer 42

-lipophilic/uncharged

Question 43

Eye color (melanin) has what affect on drugs?

Answer 43

Binds some drugs (atropine!) in darker eyes -> | slower onset, longer action, tendency to overdose to achieve effect quickly

Question 44

T/F local application to eye will not affect systemic function?

Answer 44

F. (side effects still possible, though minimized)

Question 45

Eye drop preservative side effect?

Answer 45

toxic/allergic (benzalkonium chloride!)

Question 46

T?F local anesthetic for cornea is effective?

Answer 46

T

Question 47

How would you detect a corneal lesion?

Answer 47

Fluorescent dye (taken up by injured cells)

Question 48

For muscarinic antagonist class, what receptor is acted on to produce mydriasis?

Answer 48

-M3 (on iris & ciliary muscle)

Question 49

How is drug choice determined for creating mydriasis?

Answer 49

Duration & cycloplegia or not

Question 50

Which class creates mydriasis but not cycloplegia?

Answer 50

Adrenoreceptor agonists

Question 51

Glaucoma is thought of as intraocular pressure over? What is normal?

Answer 51

21 mmHg (normal 12-20) [Note pressure is a result of production minus outflow, so affecting either can help glaucoma]

Question 52

Open angle glaucoma is a problem with?

Answer 52

Drainage into canal of Schlemm

Question 53

Which classes help reduce humor production? (3)

Answer 53

Beta antagonists, alpha agonists, carbonic anhydrase inhibitors (diuretic)

Question 54

Which class increases humor drainage?

Answer 54

miotics

Question 55

Mech. of how B antagonists reduce humor production?

Answer 55

block B1 receptors on ciliary body

Question 56

Mech. of how alpha agonists reduce humor production?

Answer 56

stim alpha2 on ciliary body &/or alpha1 on ciliary vessels

Question 57

Mech. of how miotics increase humor drainage?

Answer 57

stim M3 on iris & ciliary body, which may improve uveoscleral outflow

Question 58

Closed angle glaucoma is?

Answer 58

peripheral iris balloons forward against cornea, reduces flow

Question 59

Closed angle glaucoma acute treatment? (2)

Answer 59

systemic mannitol/glycerol to up blood osmolarity and thus down intraocular pressure -topical miotic, to tighten iris temporarily

Question 60

Closed angle glaucoma cure?

Answer 60

YAG laser to create a small hole in iris (iridectomy)

Question 61

Cautions about closed angle glaucoma?

Answer 61

-No mydriatics or cycloplegics.

Question 62

What does myasthenia gravis cause in eyes/lids?

Answer 62

fatigue-able, double vision, lid drooping (But pupil is always spared!!)

Question 63

How can squint & blepharospasm be treated?

Answer 63

botulinum toxin A (relaxes muscle for 3-6 wks) by blocking ACh vesicles from moving to nerve terminal to be released

Question 64

how is botulinum toxin A administered?

Answer 64

Needle under EMG (electromyography)

Question 65

How can myasthenia gravis LID problems be treated?

Answer 65

AChE (acetylcholine esterase) inhibitors | [note this is for lid problems, doesn't specify if effective for eye problems or not]