Eye pharmacology Flashcards

(38 cards)

1
Q

Opsin receptors in rod and cone cells

A

Opsin receptors:

Rods-

Rod cells are stimulated by light over a wide range of intensities and are responsible for perceiving the size, shape, and brightness of visual images. They do not perceive colour and fine detail, tasks performed by the other major type of light-sensitive cell, the cone.

  • Rhodopsin- A biological pigment containing protein that sits in organelle membranes called discs.

Made up of a protein called an opsin and a photosensitive chemical called a chromophore derived from vitamin A- 11-cis-retinaldehyde.

Cones- come in different types reflecting the varying quantities of long, medium or short-wave sensitive opsins.

Long wave sensitive opsin 1- red cones

Medium wave sensitive opsin - green cones

Short wave sensitive opsin 1- blue cones

  • Rhodopsin= apoprotein* (AKA opsin) + *chromophore (11 cis-retinal)
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2
Q

11-cis-retinal response to light with and without apoprotein opsin present

A

without opsin- In solution, 1 photon can induce isomerisation of 11-cis-transretinal to all-trans-retinal (structural change ) with an efficiency of 1/3.

In rhodopsin***, 1 photon can induce the same change with an ***efficiency of 2/3.

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3
Q

Signalling involved in light transduction

A

Transducin (Gt) is comprised of 3 subunits:

  • a-GTPase

binds GDP in inactive state

Binds GTP in active state

Linked to membrane

C-terminal interacts with rhodopsin

B and y G subunits form a single regulatory functional unit

Rhodopsin activates transducin

Light activation results in release of GDP* and *binding of GTP to Gta

GTP bound Gta* is then f_ree to activates downstream signalling methods_* cGMP phosphodiesterase

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4
Q

Ga subunits and their effects

Gas

Ga1/0

Gaq/11

which one does transudcin have?

A

Gas- increases adenylate cylase –> increase cAMP –> incresae PKA

Ga1/0- decreases adenylate cyclase “”””

Gaq/11- increases phospholipase CB causing cGMP phosphodiesterase and decreased cGMP

Tansducin has a Ga subunit causing increased cGMP phosphodiesterase and decreased cGMP causing increased visual perception.

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5
Q

Term for large pupils?

term for constricted pupils?

A

mydriasis

miosis

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6
Q

Radial muscle

innervation

neurotransmitter

receptor

signalling proteins

function

A
  • innervation- sympathetic
  • neurotransmitter- Noradrenaline
  • receptor- a1 receptor
  • signalling proteins- Gq –> increase PLCB –> increase IP3–> increase Ca2+i
  • function- contraction
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7
Q

Circular muscle

A

innervation- parasympathetic

neurotransmitter- acetylcholine

receptor- M3

signalling proteins- Gq –> increase PLCB–> increase IP3 –> increase Ca2+i

function- contraction- constriction of eye

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8
Q

Atropine

A

CLASS- antimuscarininc/ parasympatholytic

CHEM- natural

PHARM- target: muscarininc GPCR receptors effect: non-selective competitive antagonist

PHYS- mydriasis, cycloplegia

CLIN- lazy ey, anterior uveitits

symp> para –> blocks this:

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9
Q

Cyclopentolate

A

CLASS: antimuscarinic/ parasympatholytic

CHEM: synthetic

PHARM: target: muscarinic receptors (GPCR)

Action: non-selective, competitive antagonist

PHYS: multiple effects; myadriasis, cycloplegia (paralysis of ciliary body- can’t convex lens)

CLIN: used in eye examination

BLOCKS THIS

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10
Q

Tropicamide

A

CLASS: antimuscarinic/ parasympatholytic

CHEM: synthetic

PHARM: target: muscarinic receptors (GPCR)

Action: non-selective, competitive antagonist

PHYS: mydriasis, cycloplegia

CLIN: eye examination

blocks this vvvvvv

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11
Q

Phenylephrine

A

CLASS: sympathomimetic

CHEM: synthetic, adrenaline derivative

PHARM: target- a1 receptors

Action: full agonist

PHYS: mydriasis, vasoconstriction

CLIN: eye examination and surgery

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12
Q

oTHER drugs that can cause mydriasis

A

Hyoscine butylbromide— anticholinergic

L-dopa- precursor of adrenaline

Mydriasis reduced by carbidopa

Cocaine- sympathomimetic, drug abuse

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13
Q

opiates- diamorphine

A

CLASS: opiate

CHEM: semi-synthetic, morphine derivative

PHARM: target: u receptors (GPCR)

Action: full agonist

PHYS: stimulates oculomotor nerve  miosis (constriction) among other things

CLIN: analgesic…

Para on

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14
Q

Pyridostigmine

A

CLASS: cholinesterase inhibitor

CHEM: synthetic

PHARM: target: acetylcholinesterase (enzyme)

Action: competitive reversible inhibitor

PHYS: increase [Ach] at cholinergic synapses  increase niconitic activity at NMJ (myasthesia gravis) in overdose

 increases muscarinic activity

CLIN: myasthesia gravis

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15
Q
A
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16
Q

Ciliary muscles are caused to contract by what innervation?

receptors?

signalling?

A

parasympathetic

M3- acetylcholine contraction . B2- adrenaline relax

M3 in iris- Gq- increased Ca2+i

B2 Gs–> increased AC– increased cAMP

17
Q

Gq Smooth muscle contraction pathway of signalling

A

Gq is the key pathway that can be coupled to multiple kinds of receptors (M3, a1, H1).

Gaq can be activated by things like opsins,,,,,,,,,

Calmodulin binds to elevated levels of calcium.

This complex activates MLC kinase, which in turn ohosphorylates MLC, which then triggers muscle contraction

18
Q

Gas activation to cause smooth muscle relaxation

19
Q

Glaucoma

A

Visual impairment

Progressive optic neuropathy, optic nerve cupping

Classification:

Primary/ secondary, acute/ chornic, open angle/ closed

IOP increased

IOP regulated by production and drainage of aqueous humor

impaired drainage through the trabecular meshwork (canal of Schlemm)

20
Q

production of aqueous humor

A

Ciliary body synthesises aqeous humour

Flow path:

INFLOW: ciliary body –> posterior chamber –> pupil –> anterior chamber 

OUTFLOW: 90% trabecular meshwork –> Schlemm’s canal –> scleral and episcleral veins. (pressure sensitive)

UVEOSCLERAL ROUTE (PRESSURE insensitive)

21
Q

production of aqueous humor by 3 methods

A
  1. Passive diffusion of solutes down pressure gradient
  2. Filtration of fluid from fenestrated capillaries into interstitium of ciliary stroma (passive)
  3. Active secretion of solutes against gradient 80-90%)

2 important biochemical mechanisms

sodium potassium ATPase pump

Carbonic anhydrase

22
Q

Drugs for galucoma work by:

increasing aqueous drainage:

x

x

x

reducing aqueous production:

xxx

A

increasing drainage

  • Fc receptor agonists (-prost) –> via uveoscleral route
  • cholimemtics –> via trabecular/ schlemm route

reducing aqueous production

  • B blockers -olol
  • carbonic anhydrase inhinbitors -zolamide
  • A2 adrenergic agonists -onidine
    *
24
Q

Prostaglandin

A

CHEM- all prodrug analogues of PGF2a

Free acid forms are most active (esters and amide)

PHARM- target- FP receptor (GPCR)

Action- agonist

1* signalling- Gq/11

PHYS-

Increase permeability of sclera

Increase aqueous outflow via the uveoscleral route

No effect on aqueous production

CLIN- 1st line treatment for glaucoma in many cases

Topical application

25
trepostinil
Synthetic analogue of PGI2 IP receptor agonist Vasodilation Pulmonary art hypertension
26
B blockers
CLASS: B blockers (-olol) CHEM: all small molecules PHARM: all competitive antagonists PHYS: decrease sympathetic tone of ciliary body Decrease aqueous humour formation (decrease inflow) CLIN: chronic open-angle glaucoma, ocular hypertension
27
apraclinidine
CLASS: sympathomimetic CHEM: synthetic PHARM: target- a2-adrenergic receptor GPCR Action- full agonist 1\* signalling- Gi/o PHYS: Decreased sympathetic tone (pre-synaptic)  decreased aqeous formation Increased uveoscleral drainage causing increased outflow Also: mydriasis, disruption of accommodation CLIN: glaucoma
28
clonidine
CLASS: sympathomimetic CHEM: synthetic PHARM: Target- a2-adrenergic receptor (GPCR) Action- partial agonist 1\* signalling: Gi/o PHYS: Can enter CNS Direct action on ventral medulla Pre-synaptically  decreases cAMP  decreases Ca2+ influx and NA release Decreases sympathetic tone CLIN:Hypertension
29
adrenoreceptor classification and signalling
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30
acetolazamide
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31
carbonic anhydrase in ciliary processes
Carbonic anhydrase in ciliary processes Ca --\> increases [HCO3-]I --\> more Na+ transport Formation of intracellular HCO3- by CA contributes to the movement of Na+ into the cell, ensuring Na+i is sufficiently high to supply sodium pump with substrate. HCO3- also enters via the co-transporter with Na+. CA facilitates rapid transport/ diffusion of HCO3- as CO2 between epithelial layers. HCO3- passes into aqueous.
32
dorzolamide
CLASS: carbonic anhydrase inhinbitor CHEM: synthetic PHARM: target- carbonic anhydrases Action- competitive inhibitor PHYS: Decreases [HCO3-] in ciliary epithelia Decreased HCO3  decreased Na+  substrate for NA+/K+-ATPase “ decreases pH  decreases action of NA+/K+-ATPase “ decreases co-transport into aqueous with Na+  decreased aqueous formation CLIN: open-angle glaucoma
33
pilocarpine
CLASS: parasympathomimetic CHEM: natural small molceule PHARM: Target- muscarinic receptors (GPCR) Action- non-selective, partial agonist 1\* signalling: M1, 3, 5 PHYS: M3 on ciliary muscle  contraction of LCM  opening of trabecular meshwork/Schlemm’s canal decreases outflow resistance  increases ocular aqueous outflow Miosis, disruption of accommodation, headache CLIN: acute closed angle glaucoma
34
Age related macular degneration
Progressive degeneration of central retinal cells --\> vision loss ***_Classification_*** Dry (non-neovascular): degeneration without formation of new blood vessels Wet (neovascular): new vessels form and damage retina Active- may benefit from treatment Inactive- changes probably irreversible- unlikely to benefit from treatment ***_Available drugs all target VEGF pathway_***
35
VEGF-A -- vascaulr endothelial growth factor
CHEM: homodimer PHARM: binds to VEGF receptors- receptor tyrosine kinase PHYS: Endothelial cell proliferation Promotes cell migration Inhibits cell migration Inhinits apoptosis Induces permeabilization of blood vessels CLIN: ANTI-VEGF used in tumours, AMD and diabetic eye disease
36
Bevacizumab
CLASS: angiogenesis inhibitor CHEM: IgG PHARM: target- VEGF-A Action- blocking PHYS: VEGF promotes angiogenesis Decreased blood vessel formation slows degeneration of retina CLIN: Wet-type age related macular degeneration
37
Ranibizumab
CLASS: angiogenesis inhibitor CHEM: fab fragment of bevacizumab PHARM: target- VEGF-A Action- binding/ blocking PHYS: VEGF promotes angiogenesis Decreased blood vessel formation slows degeneration of retina CLIN: Wet-type age related macular degeneration
38
Aflibercept
CLASS: angiogenesis inhibitor CHEM: fusion protein of human IgG Fc and ligand binding domain of VEGRF-1 and VEGRF-2 receptors PHARM: Target- VEGF-A and B growth factors Action- binding/ blocking PHYS: VEGF promotes angiogenesis Decreased blood vessel formation slows degeneration of retina CLIN: Wet-type age related macular degeneration