L9

Question 1

What is the innervation to the dilator muscle of the iris? What is the result? What is the NT and receptor?

Answer 1

Sympa -> dilate

NE on alpha 1 receptor

Question 2

If you have an ocular sympathetic lesion, what would you see?

Answer 2

Normal = dilate
Lesion = miosis (Horner's)

Question 3

What is the innervation to the sphincter muscle of the iris? What is the result? What is the NT and receptor?

Answer 3

Para -> constrict

ACh on M3 receptors

Question 4

If you have an ocular para lesion, what would you see?

Answer 4

Blown pupil (dilation)

Question 5

What drug do you use to dilate pupil for lazy eyes?

Answer 5

Atropine

Question 6

What would the effect of alpha1 agonist eyedrops be? What is the drug?

Answer 6

Phenylephrine

- Activate sympa –> dilation

Question 7

What would the effect of a cholinergic antagonist be? What is the drug?

Answer 7

Tropicamide

Antagonize sphincter muscle activation - prevent miosis

Question 8

Drugs that dilate your eyes

Answer 8

Atropine = muscarinic antagonist
Phenylephrine = a1 agonist
Tropicamide = cholinergic antagonist

Question 9

What drug do you use to reverse dilation you just cause via drugs?

Answer 9

Dapiprazole = alpha blocker

Question 10

What are the SC of sympathetic overload?

Answer 10

“Mad as a hatter, dry as a bone”
Dry skin, mouth + constipation + urine retention
Irritable, delirious
Tachycardia

Question 11

1 blown pupil differential

Answer 11

Intracranial pathology

Or you accidentally touched your eye with dilator

Question 12

Define glaucoma

Answer 12

Optic disc atrophy due to death of ganglion cells

Question 13

What is the only treatable risk factor for glaucoma?

Answer 13

↑IOP

Question 14

4 types of glaucoma

Answer 14

1. Open angle - dilation makes better
2. Angle closure - dilation causes acute angle closure attack
3. Secondary
4. Childhood

Question 15

Where is this angle we’re talking about

Answer 15

Bet iris & cornea

Question 16

Describe open angle patho

Answer 16

Due to increase aqueous production (maybe… unclear)

Treat to ↓production or ↑outflow

Question 17

Describe closed angle patho

Answer 17

Narrow angle means can’t drain –> pressure builds up

Question 18

4 drug classes to treat glaucoma and specific drugs for each

Answer 18

Beta antagonists
- Timolol (non-selective)
A2 agonist
- Brimonidine
- Apraclonidine
Cholinergic agonists - rarely used
- Pilocarpine
- Caramylcholine
Cholinergic antagonist 
- Tropicamide

Question 19

Where do cholinergic agonists work to treat glaucoma

Answer 19

Trabecular meshwork
Constrict pupil –> increase angle
Better outflow

Question 20

Where do B antagonists and A agonists work to treat glaucoma

Answer 20

Ciliary body

↓aqueous production

Question 21

Which drugs might cause acute angle closure attack

Answer 21

Anti-cholinergics

If on these meds and naturally have narrow angle

Question 22

Why is the goal to target B1 > B2 receptors for antagonists?

Answer 22

B2 antagonism = potential pulm SE

B1 is cardio-selective

Question 23

What are the potential SE from BBs?

Answer 23

“Feel slower” - CNS depression, ↓BP

Question 24

Symptoms of Horner’s sydrome

Answer 24

Ptosis, miosis, anhydrosis

Question 25

1st step in Horner’s diagnosis - explain mechanism

Answer 25

"Is this Horner's"
Cocaine
Increases NE in synapse b/c X NET reuptake
Normal = see dilation
Horner's = maintained constriction

Question 26

2nd step in Horner’s diagnosis - explain mechansim

Answer 26

"Localize the lesion"
Amphedamine 
Pre-synaptically releases NE
See dilation = 1st or 2nd order neuron lesion
Still constricted = 3rd order lesion

Question 27

Which drug could you use instead of amphedamine

Answer 27

Apriclonidine = A2 selective agonist w/ weak A1 effect
Normal pts won’t see dilation
Horner’s pts - hypersensitive to A1 b/c A2 isn’t working –> dilate