generalized & thoracolumbar origin & arise from superior cervical ganglion - dilator - blood vessels - lacrimal gland (vessels)

specific & crainiosacral origin & arise from Edinger-Westphal nucleus - CN III - CN VII (facial) - ciliary ganglion & muscles - lacrimal gland

a agonist (mainly a1) - decongestant - mydriasis

Packet 1: Autonomic NS / A & B receptors Flashcards by Megan Fabisch

SNS overview

generalized & thoracolumbar origin & arise from superior cervical ganglion

dilator
blood vessels
lacrimal gland (vessels)

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PNS overview

specific & crainiosacral origin & arise from Edinger-Westphal nucleus

CN III
CN VII (facial)
ciliary ganglion & muscles
lacrimal gland

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PNS receptors:

ACH

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SNS receptors:

a1, a2, b1, b2 (NE and EPI)

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ciliary body receptors:

b1, b2 or a2

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blood vessels (conj)

a1 or b2

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sphincter muscle

muscarinic

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ciliary muscle

muscarinic

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adrenergic agents do what 3 things?

mydriatic - a1 agonist
anti glaucoma - a1, a2 or b2 agonists
vasoconstrictor/ decongestion - a1 agonist

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reactive hyperemia:

1st the decreased ability of the tissues to get blood and O2, and then 2nd blood vessels dilate greatly after long contraction = reactive hyperemia

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Phenylephrine - other name

neo-synephrine

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phenylephrine:

a agonist (mainly a1)

decongestant
mydriasis

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max effects of phenyl at ____?

60 minutes

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what is the most common adrenergic mydriatic?

phenylepherine

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what concentrations does phenyl come in?

1/8% OTC
2.5% (Rx)
10% (Rx)

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Do we use ephipherine for treating glaucoma?

no, because of toxcicites

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Does phenylephrine block the light reflex?

no, you need an antimuscarinic to block that

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can you use phenylephrine on a pt. with open angle glaucoma?

yes

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can you use phenylephrine on a pt with closed angle glaucoma?

no, not even 1/8%

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what else can we use phenyl to treat?

miotic cysts
ptosis
diagnosis of horner (71% definitive)
breaking posterior synechiae

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drug interactions with phenyl

tricyclic antidepressants, MAO inhibitors, guanethidine, reserpine

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systemic effects of phenyl:

CNS stimulation, headache, hypertension, tachycardia, reflex bradycardia, blanching of the skin, arrhythmias, subarachnoid heme.

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Apraclonidine - other name

Iopidine

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Apraclonidine concentrations:

.5% & 1%

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Apraclonidine:

a agonist: inhibit adenylate cyclase = dec. cAMP = decreased aqueous = DECREASE IOP - also INCREASE uveal scleral outflow

does apraclonidine have selectivity for a2?

only some

Which has higher chance of allergic reactions: apraclonidine or brimonidine?

APRACLONIDINE (20-50%)

Apraclonidine: diagnosis of horners: what happens?

the dilator muscle is super sensitive, so with that, the horners eye dilates more

Apraclonidine: effects

1. a1 agonist: mydriasis 2. lid retration 3. conj blanching (decongestion) 4. dry mouth, fatigue, lethargy, headache etc.

Brimonidine: other name

Alphagan (P)

Brimonidine: receptor

adrenergic receptor agonist : a2

Is brimonidine selective for a1? or a2?

highly selective for a2

Brimonidine: MOA

decrease aqueous like apraclonidine: inhibit adenylate cyclase = dec. cAMP = decrease production ALSO increase in uveal scleral outflow BUT NOT REMODELING (like apraclonidine)

which adrenergic agonist is neuroprotective?

brimonidine

what is the most frequent toxicity with brimonidine?

hyperemia - excess blood in the vessls

Combigan

Brimonidine .2% & Timolol .5%

Simbrinza

Brimonidine .2% & Brinzolamide 1%

naphazoline: receptor?

direct acting a1 agonist

tetrahydrozoline: receptors?

direct acting a1 agonist

oxymetazoline: receptors?

direct acting a1 agonist

naphazoine: concentrations?

.0125 & .03 (OTC) | .1% (Rx)

Tetrahydrozoline: concentrations?

.05% (OTC)

Oxymtazoline: concentrations?

.025% (OTC)

what is visine?

tetrahyrozoline

what sympathomimetic could you use with an OTC antihistamine to treat minor allergic conjunctivitis?

naphazoline with anti histamine

Paremyd: what is it?

Hydroxyamphetamine 1% & Tropicamide .25%

Hydrozyamphetamine 1%

stimulates release of NE, blocks reuptake | INDIRECT ACTING

Hydroxyamphetamine 1%: what happens in horner's pt

no dilation in post-ganglionic lesion | - widely dilated with central or preganglionic (usually 5 year prognosis)

hydroxyamphetamine: onset and duration = similar to ___?

phenylepherine

Cocaine: MOA

INDIRECT ACTING: block NE reuptake - mydriaysis - vasoconstriction - anesthesia

Cocaine: horner's diagnosis

dilation is reduced or absent in Horner's eye regardless of location of lesion

Dapiprazole: other name

Rev eyes

Dapriprazole: concentration

.5%

Dappiprazole: receptor

a-blocker

what do we need to be concerned with when using a-blockers?

floppy iris syndrome - especially when pt wants cataract surgery

Dapiprazole: uses?

reverse PHENYLEPHERINE mydriasis | - some actions on tropicamide induced mydriasis

what is the major toxicity seen with Dapiprazole?

conjunctival hyperemia (80%) and burning (50%)

which is better to use for the least risk of pupillary block? pilocarpine or dapiprazole?

.5% dapiprazole is better than pilocarpine since less risk of pupillary block (lens forward and iris back)

When do dark irises respond the same as light irises?

B-blockers

Timolol: other names

Timoptic, Timoptic-XE

Timolol : concentrations

.25% and .5%

Timolol: receptors

non-selective B blockers/ decreased aqueous production | - 7x more potent than propranolol

Does timolol affect pupil size, accommodation or aqueous production?

ONLY DECREASE IN PRODUCTION | no effect on pupil size and accommodation

what is pt most likely to have symptoms of myasthenia symptoms (diplopia, ptosis eom paresis) with?

B-blockers, timolol.

Levovunolol: other names & concentrations

Betagan .5% or .25%

Levobunolol: receptors

non selective b blocker

Metipranolol: other names and concentrations

optipranolol .3%

Metipranolol: receptors

non-selective b blockers

advantage to metipranolol?

cheaper b blockers

Betaxolol: other names and concentrations

Betoptic - S .25%

Betaxolol: receptors

SELECTIVE B1 blockers: we need B2 so we just get some blockage from "spill-over effect" but to as effective on decreasing IOP

Advantage to betaxolol?

better for patients with asthma or heart conditions

Carteolol: other names and concentrations

Ocupress 1%

which b blocker comes in a suspension?

Betaxolol

Carteolol: receptor

non selective b blocker

Advantage to Carteolol?

Intense Sympathomimetic Activity = not a b blocker but partial agonist, but DOES NOT DISRUPT the lipid profile as much as other b blockers

Best interocular pressure control: b blockers

just avoid betaxolol

Chronic pulmonary disease or asthma: for b blockers

use betaxolol

hypercholestemia: (use of b blockers)

carteolol

pregnancy: use of b blockers:

avoid ALL: contraindicated with all

Packet 1: Autonomic NS / A & B receptors Flashcards

(80 cards)