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Class: Neuro > Eye Pharm > Flashcards

Flashcards in Eye Pharm Deck (32):
1

Which is a PDE inhibitor that affects vision?

Viagra

2

Name the 2 opposing muscles (IRIS) that control the opening of the pupil AND their receptors.

1) Pupillary Dilator - ALPHA adrenergic receptor
2) Pupillary Constrictor - muscarinic (M) receptor

3

Name the autonomic receptor on ciliary muscle that controls accommodation and facilitates aqueous humor outflow

Muscarinic (M) receptor

4

Name the autonomic receptor on ciliary epithelium (ciliary body- produces aqueous humor)

BETA adrenergic receptor

5

What two categories of drugs can be used to induce MYDRIASIS to facilitate an ophthalmic exam?

PHENYLEPHRINE (alpha agonist) - to act on pupillary dilator
TROPICAMIDE (anti-muscarinics) - to antagonize pupillary constrictor

6

What class of drugs is used to generate CYCLOPLEGIA (accommodation blockade)

Anti-muscarinics

7

What are the two classes of drugs that can be used to reduce intraocular pressure (IOP)?

MUSCARINIC Agonists - To facilitate AH outflow
CHOLINESTERASE Inhibitors - Same effect

8

Name the three anti-muscarinics
(1- prototype, 1- derivative)

1) ATROPINE - Prototype
2) SCOPOLAMINE - Derivative
3) TROPICAMIDE

9

Which of the anti-muscarinics can be used as a transdermal patch for motion sickness?

SCOPOLAMINE

10

Describe the pharmacokinetics (Absorption of ADME) of anti-muscarinics.

Both atropine and scopolamine are absorbed from the GUT and CONJUNCTIVA -> Antagonize the ciliary muscle + pupillary constrictor

11

Pneumonic for symptoms of ANTIMUSCARINIC EXCESS

Dry as a bone, Blind as a bat, Mad as a hatter, Hot as hell, Red as a beet, Full as a flask

12

ANTI-MUSCARINIC EXCESS 1:
Dry as a Bone

Decreased sweat, lacrimal gland secretion (tears), and salivary gland secretion (salivation)

13

ANTI-MUSCARINIC EXCESS 2:
Blind as a Bat

Cyclopegia (Ciliary Muscle Paralysis) - Eyes are fixed to far objects -> Can NOT accommodate lens to focus on near objects

14

ANTI-MUSCARINIC EXCESS 3:
Mad as a hatter

Decrease in Ach = CNS Excitation
Restlessness, Irritability, Disorientation, Delirium, Hallucination

15

ANTI-MUSCARINIC EXCESS 3:
Hot as hell

Decreased ability to sweat

16

ANTI-MUSCARINIC EXCESS 4:
Red as a Beet

Decreased ability to sweat -> Cutaneous vasodilation to try to facilitate heat dispersal

17

ANTI-MUSCARINIC EXCESS 5:
Full as a flask

Inability to contract bladder -> Urinary retention

18

How does anti-muscarinic excess affect adults and children?

ADULTS: Not life-threatening
CHILDREN: Life-threatening due to hyperthermia

19

TREATMENT (3) : Anti-muscarinic Excess

1) Cooling blankets
2) Benzodiazapines (DIAZEPAM) - Seizure Control
3) Cholinesterase Inhibitor (PHYSOSTIGIMINE)

20

Why is TROPICAMIDE used as a mydriatic, cyclopegic agent in ophthalmic exams rather than ATROPINE or SCOPOLAMINE?

Tropicamide's Duration of Effect is SHORTER (4 hrs) as opposed to atropine and scopolamine (7-10days, 3-7days). Do not have to worry about anti-muscarinic excess

21

What eye pathology is ATROPINE particularly useful for? Why?

AMBLYOPIA (Lazy Eye) - Longer Half-life
Induces cyclopegia in STRONGER eye so that brain is forced to use and strengthen the weaker eye

22

What is the ALTERNATIVE, Second line of treatment for amblyopia?

Scopolamine (Patch)

23

Name the two components of SECRETING and FACILITATING aqueous humor outflow.

1) Ciliary Body Epithelium (beta adrenergic receptors) - Secrete AH
2) Ciliary Muscle (M receptors) - Contraction puts tension on TRABECULAR MESHWORK -> Facilitates outflow through the canal of Schlemm

24

Name the two classes of drugs used to treat glaucoma.

1) BETA ADRENERGIC BLOCKERS - ANTAGONIZE AH production by ciliary epithelium
2) CHOLINESTERASE INHIBITORS - AGONIZE ciliary muscle contraction that puts tension on the trabecular meshwork -> Increase AH outflow -> Decrease IOP

25

What is the FIRST line of treatment for gluacoma?

LATANOPROST

26

What is the mechanism of action of LATANOPROST?

Prodrug for PGF2alpha
Acts on prostaglandin receptors -> Increases UVEOSCLERAL outflow of AH

27

What are three classes of drugs that DECREASE Aqueous humor production to combat glaucoma?

1) BETA BLOCKERS - Timolol
2) CARBONIC ANHYDRASE INHIBITORS - Brinzolamide
3) ALPHA-2 AGONISTS - Apraclonidine

28

What are the two classes of drugs that increase uveoscleral outflow to combat glaucoma?

1) LATANOPROST (PGF2alpha prodrug)
2) APROCLONIDINE (alpha-2 agonist)

29

Which two classes of drugs contract ciliary muscle fibers, thereby increasing aqueous humor outflow to combat glaucoma?

1) CHOLINERGIC AGONIST - Pilocarpine/Carbachol
2) CHOLINESTERASE INHIBITOR - Echothiophate, Physostigimine

30

Clarification on UVEOSCLERAL OUTFLOW

90% of aqueous humor drains through angle of the eye -> canal of schlemm -> Venous system
10% follows an unconventional pathway (UVEOSCLERAL OUTFLOW) - Fluid flows through the ciliary muscle -> Suprachoroidal space

31

Which class of drug is used for CLOSED ANGLE GLAUCOMA? Name the two (1 oral, 1 IV) drugs within this class.

OSMOTIC AGENT - Increases osmotic gradient between eye and circulating blood -> Increases fluid efflux
ORAL glycerol
IV mannitol
Acts within 10mins

32

How do topical eye drugs access the systemic circulation?

NASAL ABSORPTION - Lacrimal drainage -> Nose (highly vascular mucosal epithelium) -> Circulation