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CYCLOPLEGICS Flashcards

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1
Q

Catecholamines

A

Hormones including:
DOPAMINE
EPINEPHRINE
NORE-PINEPHRINE

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2
Q

COMT

A

Catechol-o-methyl Transferase

-an enzyme of catecholamine metabolism

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3
Q

MAO

A

An enzyme of catecholamine metabolism

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4
Q

CYCLOPLEGIA

A

Paralysis of the ciliary body musculature responsible for accommodation

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5
Q

What is ANAPHYLAXIS

A
  • Acute, systemic allergic hypersensitivity reaction to a previously sensitized allergen
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6
Q

EPI-PEN

A

Serious anaphylactic reactions develop within minutes (up to 2 hours) and require immediate emergency treatment with epinephrine

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7
Q

what are the dosage of EPIPEN ?

A

EpiPen 0.3mg
EpiPen Jr 0.15mg
Pregnancy category C

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8
Q

what diseases should you be cautious wit EPI-PEN

A

Caution in patients with heart disease or high blood pressure, Parkinson’s disease, diabetes, or a thyroid disorder

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9
Q

FIGHT OR FLIGHT

A

Regulated by the SYMPATHETIC or ADRENERGIC branch of the autonomic nervous system

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10
Q

REST AND DIGEST

A

Regulated by the PARASYMPETHETIC or CHOLINERGIC branch of the autonomic nervous system

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11
Q

Nicotininc Receptors are located in the ANS HOW?

A

using postganglionic in the ANS and terminally located in the somatic nervous system

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12
Q

Muscarinic receptors are associated with?

A

Terminal organs of postganglionic nerves in the cholinergic system

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13
Q

Norepinephrine (NE) are used?

A

NT used in sympathetic adrenergic system and its target receptors are ALPHA AND BETA

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14
Q

Presynaptic FOUND IN THE SYMPATHETIC PHARMACOLOGY

A

+α2 inhibition of signal propagation

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15
Q

VASCULAR

A

+α1 vasoconstriction; +β2 vasodilation

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16
Q

RESPIRATORY

A

+β2 bronchodilation

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17
Q

CARDIAC

A

+β1 ↑ contractility & conduction

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18
Q

HEPATIC

A

+β2 glucogenolysis

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19
Q

PANCREATIC

A

+β2 ↑ insulin release;

+α2 ↓ insulin release

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20
Q

IRIS

A

+α1 mydriasis

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21
Q

Ciliary BODY

A

+β2 relaxation & ↑ aqueous production

-β2 or +α2 ↓ aqueous production

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22
Q

What is Relative receptor Activity?

A

Epinephrine Vs Norepinephrine

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23
Q

when it comes to Alpha 1

A

Norepeinephrine (NE) - Neurogenic

it is NE> E (epinephrine)

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24
Q

What it comes to alpha 2

A

Epinephrine (greater than equal) to NE

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25
When it comes beta 1
Epinephrine (equals) to NE
26
when it comes to beta 2?
epinephrine
27
What are ocular adrenergic Effects on Mydriasis?
- Increase interpalpebral aperture (Müeller’s muscle) - Modulate aqueous generation - Receptors in lateral rectus modulate vascular tone - Receptors in trabeculum & Schlemm’s canal suppress accommodation
28
What is the standard care for all new patients when it comes do dilation?
Last to be performed in exam sequence | Bilateral under most every circumstance
29
What should be used to estimate the ocular angle?
Gonioscopy > Van Herick > shadow test | Commonly large in myopes and aphakes
30
what are the factors that affect when it comes to reduced sensitivity?
``` Age-related miosis Unstable diabetes Post-op pupils Posterior synechiae Dark irides Pseudoexfoliation Syndrome ```
31
what is the factors that are affecting increased sensitivity?
Down syndrome
32
who are the poor dilation candidates?
Homocystinuria & Marfan’s syndrome: ectopia lentis risk Pregnancy: use Tropicamide; consult OB/GYN Pigmentary or exfoliative glaucoma; transient IOP elevation
33
What is the angle closure within ususally?
IATROGENIC ANGLE CLOSURE GENERALLY | OCCURS 4-8 HRS POST INSTILLATION
34
what are contraindictations when it comes to poor dilation candidates?
- Iris supported intraocular lens - Subluxated lens or intraocular lens - Extremely narrow angle* - Angle closure history without peripheral iridotomy (PI)
35
When do you do CYCLOPLEGIA?
- Strabismus (especially esotropia) - Pseudomyopia (accommodative spasm) - Latent hyperopia - Anisometropia - Amblyopia, hysterical amblyopia - Functional deficits - Malingerers - Unexplained refractive error - Uncooperative, non-communicative, inconsistent patient
36
CYCLOPLEGIA also known as
otherwise known as a ‘WET REFRACTION’
37
what are the sympathetic Mydriatics?
Phenylephrine | Hydroxyamphetamine
38
what is the activity of PHENYLEPHRINE
α1 selectivity | Some indirect effects via norepinephrine release
39
what are the ACTIONS of Phenylephi?
- Mydriasis in 45-60 min - Conjunctival blanching - Mild accommodation suppression ~2D - Lid retraction - IOP reduction
40
what are the SPECIAL INDICATIONS OF PHENYL
Posterior synechiae breakage (10%) Pre-LASIK vasoconstriction (10%) Inhibition of iris cysts (caused by echothiophate*) Horner’s evaluation (1%)
41
what are ADVERSE EFFECTS OF PHNYELEPI?
- Photophobia, blur, glare - Allergic dermatoconjunctivitis - Rebound miosis - Anterior chamber pigment liberation - Systemic hypertension → bradycardia
42
who should you avoid PHENYLPHRINE
- Avoid 10% in neonates/elderly - History of CVD or MI, DM1, aneurysm, advanced arteriosclerosis, ideopathic orthostatic hypotension - Atropine, TCAD, MAOI, reserpine, guanethidine, methyldopa
43
what is HYDROXY-AMPHETAMINE
Indirect acting: promotes norepinephrine release from nerve terminals Negligible direct α & β receptor stimulation
44
what is the HYDROXY-AMPHETAMINE for 1%
No accommodation suppression
45
what makes up the PAREMYD?
1% HYDROXYAMPHETAMINE + 0.25% TROPICAMIDE
46
What are the actions of PAREMYD?
- Mydriasis independent of age or pigmentation - Faster recovery than phenylephrine/tropicamide combo thus better suited for a shallow angle - No benefit from pre-anesthetizing cornea - Differentiate pre/post-ganglionic dennervation
47
what are the adverse effects PAREMYD?
Similar to phenylephrine except, systemic hypertension --> tachycardia
48
what medications should you not use these PAREMYD on?
it is similar to phelephrine but | safer Similar to phenylephrine but safer in diabetes, ideopathic orthostatic hypotension, chemical sympathectomy agents
49
what are the parasympathetic pharmacology?
M1, M2 AND M3
50
which one VASCULAR binds to?
M3 salivary gland, vasodilation secretion
51
whhich one RESPIRATORY binds to
M2 = M3 bronchoconstriction, secretion
52
which one is CARDIAC binds to?
M2 >> M3 ↓ contractility & conduction
53
which one is EMETIC binds to?
M3
54
which one PANCREATIC binds to?
M2 = M3 acini secretion
55
which one IRIS binds to?
M2 < M3 miosis
56
which one CILIARY BODY binds to?
M2 < M3 contraction & ↑ aqueous outflow
57
which one is CNS binds to?
M1 memory | M4 and M5 are also coming of interest for their role in CNS cognition
58
what is Acetylcholine is broken into?
Acetate and Choline using ACHe
59
what is AChE
= acetylcholinesterase is ubiquitously distributed throughout the body therefore metabolism is rapid
60
what are ANTICHOLINERGIC AGENTS?
``` Atropine Scopolamine Homatropme 2% and 5% Tropicamide Cyclopentolate 1% Cyclomydril ```
61
What is ATROPINE is selected for?
It is NON SELECTIVE Muscarinic and some are Nicotinic
62
Scopolamine
are non selective
63
Homatropme 2% and 5%
They are equivalent to 10% atropine potency
64
Tropicamide
are Moderately M4 selective
65
Cyclopentolate 1%
not given
66
Cyclomydril
Which is 0.2% cyclopentolate + 1% phenylephrine
67
What is ATROPINE used for?
Cycloplegia Severe uveitis amblyopia Dianosis of Accommodative esotripia
68
What is Scopolamine used for?
Travel sickness | has produced CNS effects
69
What is Homatropine used for?
Modetrate uveitis Corneal Abrasion Mydriasis
70
What is CYCLOPENTOLATE used for?
Cycloplegia Moderate Uveitis Corneal abrasion ** have CNS effects including hyperactivity, halucinations and psychosis
71
What is TROPICCAMIDE used for?
Cycloplegia Mydriasis Mild uveitis
72
what are ANTICHOLINERGICS adverse effects on OCULAR?
increase in IOP Angle closure risk Allergy
73
What are ANTI-CHOLINERGICS systemic adverse effects?
``` ABCDS A = Anorexia B= Blur C = Constipation and Confusion D = Dryness and sedation S = Sedaton S = Stasis of urine == you get thirst, tachycardia, hypertension, decrease glandular secretions: SWEAT/BRONCHIAL/ SALIVA > heart, smooth muscle > GIT ```
74
What are the adverse effects on CNS using Anticholinergics
CNS (MEDULLA) decrease in Parkinson Tremor Decrease in HR
75
ATROPINE comes as
1.0% ointment or 0.5/1.0/2.0% solution
76
what is ATROPINE used in?
Anterior Uveities: ciliary body spasm, posterior synechiae, lens advancement, vessels permeability - Myopic progression - Amblyopia :penalization
77
WHAT IS TROPICAMIDE 0.5/ 1.0% solution used in?
Mydriasis Dose dependent cycloplegia Less pigment-sensitivity than cyclopentolate, homatropine and atropine Best mydriasis as 0.25% with paremyd 1%
78
what is CYCLOPENTOLATE 0.5/1.0/2.0% solution used in?
Delayed/ sustained effects in darkly pigmented Less flushing and dryness than atropine ** AVOID 2% IN KIDS

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