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Ocular Pharmacology > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

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1
Q

Define Autonomic Nervous System (ANS)

A

Functional division of nervous system that is not voluntarily controlled

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2
Q

Define Somatic Nervous System

A

Functional division of nervous system that is voluntarily controlled

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3
Q

Define Sympathetic Nervous system

A

Branch of autonomic nervous system that opposes effects of parasympathetic division

Endogenous sympathetic nervous system neurotransmitter: NE, DA, EPI

Receptors of SNS: Alpha, Beta

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4
Q

Define parasympathetic nervous system

A

Branch of autonomic nervous system that opposes effects of sympathetic division

Endogenous parasympathetic neurotransmitter: Acetylcholine

Receptors of PNS: Muscarinic, Nicotinic

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5
Q

Catecholamines are:

A
  • Biogenic amines derived from tyramine including dopamine, epinephrine, norepinephrine
  • Produced from tyrosine in adrenal medulla and postganglionic fibers of sympathetic nervous system
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6
Q

Function of Autonomic nervous system

A

Deals primarily with control and visceral functions necessary for life (non-voluntary)

  • cardiac output
  • Blood flow and distribution
  • Digestion
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7
Q

Autonomic nervous system comprised of two branches:

A

Sympathetic nervous system(adrenergic) -Fight & flight

Parasympathetic (Cholinergic) - Res and digest

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8
Q

Stimulation of Sympathetic and parasympathetic nervous system results in effect on:
eyes
salivation
skin
respiration
heart
digestion
adrenal glands

A

pic 2 parasympathetic

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9
Q

What are the neurotransmitters of the SNS

A

Epinephrine, Norepinephrine, Dopamine

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10
Q

Dopamine of a precursor of

A

Norepinephrine and ephedrine

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11
Q

Where is most NE secreted

A

Synaptic clefts
NE is also found in bloodstream, normally exists in concentrations 3x greater than epinephrine

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12
Q

Where is most epinephrine produced

A

Adrenal glands (80%), rest by brain

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13
Q

What neurotransmitter is found in the PNS

A

Acetylcholine

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14
Q

Receptors (alpha,beta and DA), where are they located and result of stimulation

A

pic receptor

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15
Q

What effect will Beta2 stimulation have on the ciliary muscle

A

Relaxation (suppresses accomodation)
Increased aqueous production (IOP)
(alpha2 stimulation decreases IOP)

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16
Q

Mydriasis results from stimulation of which receptor

A

Alpha 1

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17
Q

Alpha1 receptors are more sensitive to NE or E?

A

NE (also stimulated by high doses of D)

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18
Q

Alpha 2 receptors are more sensitive to NE or E

A

E more than or equal to NE

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19
Q

Beta2 receptors more sensitive to NE or E

Study These Flashcards
A

E is a lot morethan NE

20
Q

What is the t1/2 of catecholamines

Study These Flashcards
A

1-3minutes
85% of synaptic NE is non-enzymatically inactivated by reuptake

21
Q

direct acting sympathomimetic drugs

Study These Flashcards
A

Bind to and stimulate same receptor as the endogenous neurotransmitter eg phenylephrine

22
Q

Beta1 receptors more sensitive to NE or E

Study These Flashcards
A

Equal (also stimulated by high doses of D)

23
Q

Indirect acting sympathomimetics

Study These Flashcards
A
  • Stimulate release of neurotransmitter from a nerve terminal eg amphetamine
  • Block the reuptake of neurotransmitter from the synapse, prolonging effect eg cocaine
24
Q

Sympathomimetic adverse effects regarding CVS

Study These Flashcards
A

Increased heart rate
Arrhythmia
Elevated blood pressure

25
Ocular sympathomimetic side effects
Mydriasis & suppression of accommodation leading to light sensitivity Reduced depth of focus and near blur
26
Sympathomimetic adverse effects regarding CNS
Hemorrhagic stroke Anxiety Fear Headache Tremor
27
Hepatic sympathomimetic adverse effect
Elevated blood sugar
28
Immune system and respiratory sympathomimetic adverse effect
Immunosuppression Pulmonary edema
29
Effect of M3 stimulation on eyes
Miosis Cilliary muscle contraction and increased aqueous outflow Increase in ocular gland secretion
30
Ocular anticholinergic side effects
Increased IOP Angle closure risk Alergy
31
Systemic anticholinergic side effects
ABCDss -Anorexia -Blur -Constipation -Dryness -Sedation \_Stasis of urine Thirst, tachycardia. hypertension, decreased glandular secretions(sweat/bronchial/saliva) \> heart/smooth muscle \> GIT
32
CNS anticholinergic side effects
Decreased parkinson tremor Decreased heart rate
33
What is the anticholinergic toxidrome
Blind as a bat (blur) Hot as desert (hyperthermia) Mad as a hatter (Confusion) Dry as a bone (Dry mouth,urinary retention) Red as beet (flushed skin) Tachycardia absent bowel sounds shaking dilated pupils
34
How do neuromuscular blocking agents work
Act on motor neurons where they block Acetylcholine-based contraction of muscle fibres (Nicotinic acid ACh receptors are ligand gated, stimulation leads to Na+ influx and generation of action potential that results in contraction
35
How do botox and tetanus produce muscle paralysis
Inhibiting degranulation of ACh vesicles in the presynaptic neuron Blocking ACh release
36
Acetylcholine is broken down into...
Acetate + choline by Acetylcholinesterase (AChE) and Butyrylcholinesterase (BChE) (enzymes)
37
Atropine is an antidote to which receptor effects
Muscarinis, not the nicotinic(muscular) effects
38
OCULAR ADRENERGIC EFFECTS
* Mydriasis (radial iris muscle contraction) * increase interpalpebral aperture (Müeller’s smooth muscle) * Modulate aqueous generation by the ciliary body * Suppress accommodation thru receptors in the trabeculum & Schlemm’s canal
39
DILATION
Standard of care for ALL new patients • Last to be performed in exam sequence • Bilateral under most every circumstance • May be sectoral\*: i.e. create a keyhole pupil Angle Estimation • Gonioscopy \> Van Herick \> shadow test • Commonly large in myopes and aphakes
40
FACTORS AFFECTING DILATION
Reduced Sensitivity • Age-related miosis • Unstable diabetes • Post-op (traumatized) pupils • Posterior synechiae • Dark irides • Pseudo-exfoliation syndrome Increased Sensitivity • Down syndrome
41
POOR DILATION CANDIDATES
Caution • Homocystinuria & Marfan’s syndrome: ectopia lentis risk • Pregnancy: use Tropicamide; consult OB/GYN • Pigmentary or exfoliative glaucoma; transient IOP elevation \*Iatrogenic angle closure generally occurs 4-8 hrs post instillation
42
DILATION CONTRAINDICATIONS
* Iris supported/anterior chamber intraocular lens * Subluxated lens or posterior chamber intraocular lens (PCIOL) * Extremely narrow angle\* * Angle closure history without laser peripheral iridotomy (LPI)
43
ADRENERGIC AGONISTS
Sympathomimetic Amines used for Dilation * Phenylephrine * Hydroxyamphetamine (an amphetamine metabolite and a component drug of Paremyd®) OTC Drops for Red Eye Relief (Imidazolines) In contrast to biogenic amines, the imidazolines lack a saturated benzene ring, enhancing selectivity for ɑ1 receptors * Oxymetazoline (Visine LR® 0.025% ) α1 agonist and α2 partial agonist (Upneeq® 0.1%) * Naphazoline (Clear Eyes® & Naphcon®) * Tetrahydrozoline (Visine®) • Brimonidine 0.025% LumifyTM an α2 agonist
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Ocular Pharmacology (10 decks)

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