KMK pharmacology

Question 1

Parasympathetic

Answer 1

• First cell body is located at the craniosacral region of the spinal cord
• Release ACH at the pre and postganglionic neuron
• Binds to site of action
  
  • Ciliary muscle
  • Sphincter muscle
  • Lacrimal gland
• M1, M2, M3 (Muscarinic receptors)
  
  • M2 & M3 highest likelihood to be at the SOA
• Rest and digest, bronchoconstriction/miosis, SLUD (salivation, lacrimation, urination, defecation)

Question 2

What enzyme breaks down ACH?

Answer 2

Acetylcholinesterase

Question 3

What increases ACH?

Answer 3

Acetylcholine inhibitors

Question 4

Sympathetic

Answer 4

• Preganglionic neuron starts at the thoracolumbar region → release a neurotransmitter
  
  • ACH in preganglion
  • epinephrine and norepinephrine (adrenaline) in postganglionic
• Fight/flight, bronchodilator, mydriasis, dry

Question 5

What inhibits epinephrine?

Answer 5

Monoaminoxidase (MAO)

Question 6

What is an example of an MAOI

Answer 6

Phenelzine (Antidepressant)

Causes tachycardia

Question 7

What does tropicamide do?

Answer 7

Stops ACH to dilate the pupil

Question 8

What receptor is on the dilator

Answer 8

alpha 1 (ex. phenylephrine)

Question 9

What is the MOA of cocaine?

Answer 9

blocks the reuptake of norepinephrine → dilate pupils

Question 10

MOA of pilocarpine

Answer 10

increase corneoscleral outflow

Pulls on the ciliary muscle → pulls on scleral spur → opens the TM

Question 11

What are the 3 drugs that increase outflow?

Answer 11

Prostaglandins

Pilocarpine

Alpha 2 agonist

Question 12

Cholinergic Agonist (Direct)

Answer 12

• Direct
  
  • pilocarpine (rx after angle closure causing squishy iris) - makes iris tight
    
    • After LPI
    • ADies tonic pupil .125% → like water, will constrict the pupil

Question 13

Adies tonic pupil is a lesion in the _____.

Answer 13

Ciliary ganglion - starves the sphincter muscle which is why it reacts to .125% pilo

Question 14

Where does thing edinger westphal start at?

Answer 14

midbrain (also CN 3 & 4 start here)

Question 15

What are the side effects of pilocarpine?

Answer 15

• Has to be dosed QID - causing brow aches, myopic shift
• Create a TON of accommodation

Question 16

Cholinergic Agonist (indirect)

Answer 16

• Myasthenia gravis
  
  • neostigmine
  • pyridostigmine (get rid of MG)
  • Edrophonium (ed diganosis)
  • Echothiophate (irreversible side effects)
  • Donepezil (tx alzheimbers/dementia)
• Increase cholinergic or parasympathetic activity
• Increase Ach
• ALL decrease IOP

Question 17

2 major ocular side effects of myasthenia gravis

Answer 17

• Ptosis
• Diplopia (most common SE)
• Worse at the end of the day

Question 18

What can exacerbate the effects of myasthenia gravis?

Answer 18

B-blockers

Question 19

Cholinergic Antagonist MOA

Answer 19

Decrease Ach

• ASH CT
• Antidepressants, Antipsychotic, Antihistamine (ANTI, ANTI, ANTI)

Question 20

List longest to shortest duration of cycloplegic effects

Answer 20

ASH CT

• Atrophine
• Scopolamine
• Homatropine
• Cyclopentolate
• Tropicamide

Question 21

Penetrates the BBB the strongest?

Answer 21

Scopolamine

• Amnesia
• Confusion
• Hallucination
• Can be used for motion sickness (patch)

Question 22

Atropine should be avoided in which pts?

Answer 22

Down syndrome but overall safe drug

Question 23

Shortest duration of mydriatic affects

Answer 23

Tropicamide - very safe drug

• Adverse reaction rare

Question 24

Max effect of tropicamide

Answer 24

25 mins

Question 25

Define penalization

Answer 25

Dilating the good eye with atropine

Question 26

Cyclopentolate affects last how long?

Answer 26

24 hours - fastest onset and shortest effect for cycloplegic refraction

Question 27

Max effect of cylopentolate starts at __ mins

Answer 27

45

Question 28

Tight junction in 3 spots

Answer 28

* Schlemm's canal * Iris stroma - minor circle * NPCE on pars plicata

Question 29

Adrenergic Agonist

Answer 29

* Alpha 1 * Alpha 2 * Beta 1 * Beta 2

Question 30

Which 2 receptors causes glaucoma?

Answer 30

Alpha 1 & Beta 2 (active secretion)

Question 31

Alpha 1 drug

Answer 31

Phenyl (crappy dilation) does not allow fixed dilation and no cyclo Best friend during BIO (lift muellers muscle 3mm)

Question 32

Alpha 2 drugs

Answer 32

apraclonidine & brimonidine

Question 33

Nonspecific adrenergic agonist

Answer 33

Naphazoline Tetrahydrozoline (visine) - ocular decongestant, takes red out, acts on alpha 1 → dilated pupil

Question 34

What can you use to break PS? When is it contraindicated?

Answer 34

10% phenyl - increase BP, think about the heart Avoid in TCA and graves disease, and if taking phenelzine (MAOI)

Question 34

What can you use to break PS? When is it contraindicated?

Answer 34

10% phenyl - increase BP, think about the heart Avoid in TCA and graves disease, and if taking phenelzine (MAOI)

Question 35

3 MOA of TCA

Answer 35

Increase epinephrine and norepinephrine increase anticholinergic activity Increase serotonin

Question 36

Apraclonidine

Answer 36

Has weak alpha 1 - no dilation If the eye the eye does dilate with this drop then consider horner's syndrome Think ACUTE - acts within an hour and awesome reduction in IOP Not good for longterm because it can cause **tachyphylaxis**

Question 37

Brimonidine

Answer 37

* Alphagan 0.2% * can cause follicular conunctivitis - red eye * Alphagan P .10% * has purite & a preservative * causes miosis

Question 38

If you bind to alpha 2 receptor

Answer 38

shut down sympathetic affects - which is why alphagan P causes miosis

Question 39

Which receptors are on the lungs and eyes?

Answer 39

B2

Question 40

Which receptors are on the heart?

Answer 40

B1