Edrophonium - type of drug - MOA - use

Indirect cholinergic agonist (PNS) AChase inhibitor = incr ACh Diagnosis of Myasthenia Gravis - rapid onset (30-60s), short duration (10m) - if ptosis improves 1-2m after injection = (+) for MG

2 - Autonomic Drugs Flashcards by Elyse Kohl

Basics: SNS vs PNS

location of cell bodies
pre vs post ganglionic
receptor types

SNS: thoraco-lumbar, shorter pre-gang, releases epi/norepi, alpha/beta receptors

PNS: cranio-sacral, longer pre-gang, releases ACh, muscarinic receptors

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Cholinergic receptors in the eye

Iris sphincter (M3) = miosis

Ciliary muscle (M2/3) = accommodation

Lacrimal gland (M2/3) = tear production

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Adrenergic receptors in the eye

Iris dilator (a1) = dilation
TM (B2) = relaxation, incr outflow
Ciliary muscle (B2) = relaxation (opposes accomm)
NPCE (B2, some B1) = incr AH formation
CB vasculature (a2) = constricts, reducing AH formation

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Ocular cholinergic agonists

promote __ acitivity
3 main structures that rec’v this innerv
therapeutic uses

PNS

Sphincter, ciliary muscle, lacrimal g

Tx of glaucoma and accomm ET, less commonly for miosis prior to surgery or for pupillary testing

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Pilocarpine

type of drug
use and effectiveness

Direct cholinergic agonist (PNS)

Decr IOP, 30% reduction

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Pilocarpine

MOA
uses

Stimulate longitudinal muscle of CB -> pulls posteriorly on SS -> opens TM for incr corneoscleral outflow and decr IOP

After an angle closure attack (e.g. IOP is in low 20s)
Preparation for LPI
Fixed dilated pupil: 1% used to differentiate 3rd nerve palsy (will constrict) from sphincter tear
Acute dilated pupil: 0.125% diagnoses ADie’s (will constrict due to supersensitization)

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Pilocarpine

-main SE

Browache/HA and myopic shifts - a ton of accomm turned on
Miosis
Cataracts: long-term use
RDs: rare, due to retinal break -> detachment from ciliary muscle pulling on ora
Secondary angle-closure: contraction of ciliary m + secondary relaxation of lens zonules -> lens moves anteriorly
Pupillary block: combo of forward movement and myopic shift, etc.

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Edrophonium

type of drug
MOA
use

Indirect cholinergic agonist (PNS)

AChase inhibitor = incr ACh

Diagnosis of Myasthenia Gravis

rapid onset (30-60s), short duration (10m)
if ptosis improves 1-2m after injection = (+) for MG

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Neostigmine

type of drug
MOA
use

Indirect cholinergic agonist (PNS)

AChase inhibitor = incr ACh

Treatment of Myasthenia Gravis
-also limb strength eval in MG suspects

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Echothiophate

type of drug
MOA
use

Indirect cholinergic agonist (PNS)

Irreversible AChase inhibitor = incr ACh

Diagnosis/treatment of accommodative ET
Rarely used for glaucoma

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Pyridostigmine

type of drug
MOA
use

Indirect cholinergic agonist (PNS)

AChase inhibitor = incr ACh

Treatment of Myasthenia Gravis

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Recall ocular characteristics of Myasthenia Gravis

Ptosis - worse with BBs

Diplopia worse at end of the day

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Drug that’s administered IV to reverse effects of irreversible AChase inhibitors

Drug that’s administered to reverse muscarinic effects of reversible AChase inhibitors

Pralidoxime/Protopam

Atropine

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Ocular cholineric antagonists

mnemonic to remember all
mnemonic for order of cyclo and mydriatic effects
MOA for all
SE for all
toxicity

STop ACH

ASH CiTy

Bloch ACh at muscarinic sites in CB/iris

Dry eye, mydriasis, incr IOP

Hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat

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Scopolamine

type of drug
use
SE
contraindications

Cholinergic antagonist (decr PNS)

Similar to atropine, but rarely used due to severe SE

CNS toxicity (penetrates BBB)= hallucinations, amnesia, unconsciousness, confusion, incoherence, vomiting, urinary incontinence

Same as atropine

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Tropicamide

type of drug
use
SE
contraindications

Study These Flashcards

Cholinergic antagonist (decr PNS)

Dilation: fastest onset (25m) and shortest duration (6h), stronger mydriatic than cycloplegic
-cycloplegic effects are dose-dependent, mydriatic are not

Very safe overall

Atropine

type of drug
use
SE
contraindications

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Cholinergic antagonist (decr PNS)

Treatment of uveitis (homatropine better here)
Amblyopia penalization: mild-mod (acuity 20/100 or better)
Too prolonged for routine dilation: onset 60-180m, duration 7-12 days

Safe if correctly dosed
Toxicity = dry mouth (1st sign), dry flushed skin (vasoconstriction), rapid pulse, disorientation, fever (CNS hypothalamus effects)
-think SNS effects for toxicity

Special caution in pts with Down’s syndrome, small children, elderly

Cyclopentolate

type of drug
use

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Cholinergic antagonist (decr PNS)

Cycloplegia: fastest onset (45m) and shortest duration (24h)
-better than homatropine, similar overall effects to atropine
-mydriasis max at 45m
Tx of anterior uveitis + synechiae prevention

Homatropine

type of drug
use

Study These Flashcards

Cholinergic antagonist (decr PNS)

Standard for tx anterior uveitis

dilates pupil + keeps it mobile = prevents synechiae
paralyzes ciliary/sphincter m = reduces pain
constricts iris/ciliary vasculature = stabilizes BAB, limit cells/flare

Prolonged mydriatic and cycloplegic (weak cyclo)

Botulina toxin

type of drug/MOA
use

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Somatic drug, blocks ACh release at NMJ to inhibit muscle contraction

Blepharospasm treatment - temporary (few mo)
Strabismus correction - permanent

Phenylephrine

type of drug
MOA
uses (4)
10% use, SE, contraindications

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Adrenergic agonist (SNS)

Alpha1 agonist

Dilation of radial muscle without cycloplegia

2.5% used with tropicamide for routine dilation
in isolation cannot produce fixed dilation

Palpebral widening: acts on Mullers, good for BIO

Differentiate scleritis and episcleritis: blanching of conj vessels

Horners diagnosis: 1%

10% = Breaking posterior synechiae

limited due to adverse CV effects (HTN, arrhythmia)
contra: MAOIs, TCAs, atropine, Grave’s disease

Naphazoline

type of drug
MOA
use
SE

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Adrenergic agonist (SNS)

Alpha > beta effects

Topical ocular decongestant - constrict conj BVs

Potential to depress CNS

Tetrahydrozoline

type of drug
MOA
use
SE

Study These Flashcards

Adrenergic agonist (SNS)

Alpha > beta effects

Topical ocular decongestant - constrict conj BVs

Potential to depress CNS
Fixed dilated pupil due to alpha effects on radial muscle

Brimonidine

type of drug
MOA
use
SE
contraindications

Study These Flashcards

Adrenergic agonist (SNS)

Highly selective alpha2 agonist = decr AH production, incr uveoscleral outflow

Glaucoma (TID, short duration): IOP lowering + long-term use
-neuroprotective properties shown in crushed rat nerve model
Miosis: reduce glare, halos, other night vision symp post-refractive surgery

Follicular conj-itis: largely eliminated SE with Alphagan-P (purite preservative)
Systemic = dry mouth

MAOIs

Apraclonidine - type of drug - MOA - use - SE

Adrenergic agonist (SNS) Alpha2 agonist Weak alpha1 = only dilates if Horner’s Control IOP spikes before/after ocular surgery Acute angle closure attack: rapid, potent decr in IOP -IOP reduces 30-40% -onset 1h, peak 3-5h -not effective in chronic therapy due to SE Diagnosis of Horner’s Tachyphylaxis: loses efficacy over time Long-term use =allergic response

Horner’s diagnosis

1) cocaine = no dilation, apraclonidine = dilation | 2) hydroxyamphetamine = dilate if preganglionic, phenylephrine = no dilation if preganglionic

Beta-blocker effects - CNS - CV - pulmonary - GI - reproductive

Fatigue, disorientation, depression Bradycardia, arrhythmia, syncope Bronchoconstrict = dyspnea, wheezing, spasm Nausea, vomiting, diarrhea, ab pain Erectile dysfunction

MOA of beta adrenergic receptor blockers for glaucoma

Block B2 at NPCE to decr AH production

Timolol - type of drug - MOA - use - dosing - SE/pharmacokinetics - contraindications

Adrenergic antagonist (decr SNS) Non-selective BB Most effective at lowering IOP (~25%) - unstable - also available in gel form as timoptic xe 0.25% once daily in the morning ``` Crossover effect (unique!): reduces IOP in contralateral eye Long-term drift: extended use -> IOP gradually rises Short-term escape: IOP initially lowers, but returns to normal within weeks of starting therapy ``` Caution in diabetes (masks hypoglycemia), hyperthyroidism (masks signs/symp), and myasthenia gravis (exacerbate fatigue)

Timolol combo drugs available

Cosopt = timolol 0.5% + dorzolamide 2.0% Combigan = timolol 0.5% + brimonidine 0.2% Both dosed Q12h

Carteolol - type of drug - MOA - use - SE

Adrenergic antagonist (decr SNS) Non-selective BB Not used clinically, poor IOP reduction vs other BBs Intrinsic sympathomimetic activity: reduce nocturnal bradycardia, generally less stinging than timolol Modest reduction in cholesterol (very small) Potentially less SE than other BBs

Betaxolol - type of drug - MOA - use - SE

Adrenergic antagonist (decr SNS) Cardioselective B1 blocker -limits risk of respiratory effects Questionable neuroprotective qualities Overall less effective than timolol Can worsen CHF

Levobunolol - type of drug - MOA - use

Adrenergic antagonist (decr SNS) Non-selective BB Similar to timolol in effectiveness

Metipranolol - type of drug - MOA - use

Adrenergic antagonist (decr SNS) Non-selective BB Not used due to ineffectiveness vs other BBs

2 - Autonomic Drugs Flashcards

(34 cards)