Packet 1: Autonomic NS / A & B receptors Flashcards

(80 cards)

1
Q

SNS overview

A

generalized & thoracolumbar origin & arise from superior cervical ganglion

  • dilator
  • blood vessels
  • lacrimal gland (vessels)
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2
Q

PNS overview

A

specific & crainiosacral origin & arise from Edinger-Westphal nucleus

  • CN III
  • CN VII (facial)
  • ciliary ganglion & muscles
  • lacrimal gland
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3
Q

PNS receptors:

A

ACH

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4
Q

SNS receptors:

A

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

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5
Q

ciliary body receptors:

A

b1, b2 or a2

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6
Q

blood vessels (conj)

A

a1 or b2

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7
Q

sphincter muscle

A

muscarinic

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8
Q

ciliary muscle

A

muscarinic

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9
Q

adrenergic agents do what 3 things?

A
  1. mydriatic - a1 agonist
  2. anti glaucoma - a1, a2 or b2 agonists
  3. vasoconstrictor/ decongestion - a1 agonist
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10
Q

reactive hyperemia:

A

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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11
Q

Phenylephrine - other name

A

neo-synephrine

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12
Q

phenylephrine:

A

a agonist (mainly a1)

  • decongestant
  • mydriasis
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13
Q

max effects of phenyl at ____?

A

60 minutes

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14
Q

what is the most common adrenergic mydriatic?

A

phenylepherine

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15
Q

what concentrations does phenyl come in?

A
  1. 1/8% OTC
  2. 2.5% (Rx)
  3. 10% (Rx)
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16
Q

Do we use ephipherine for treating glaucoma?

A

no, because of toxcicites

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17
Q

Does phenylephrine block the light reflex?

A

no, you need an antimuscarinic to block that

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18
Q

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

A

yes

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19
Q

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

A

no, not even 1/8%

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20
Q

what else can we use phenyl to treat?

A
  1. miotic cysts
  2. ptosis
  3. diagnosis of horner (71% definitive)
  4. breaking posterior synechiae
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21
Q

drug interactions with phenyl

A

tricyclic antidepressants, MAO inhibitors, guanethidine, reserpine

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22
Q

systemic effects of phenyl:

A

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

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23
Q

Apraclonidine - other name

A

Iopidine

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24
Q

Apraclonidine concentrations:

A

.5% & 1%

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25
Apraclonidine:
a agonist: inhibit adenylate cyclase = dec. cAMP = decreased aqueous = DECREASE IOP - also INCREASE uveal scleral outflow
26
does apraclonidine have selectivity for a2?
only some
27
Which has higher chance of allergic reactions: apraclonidine or brimonidine?
APRACLONIDINE (20-50%)
28
Apraclonidine: diagnosis of horners: what happens?
the dilator muscle is super sensitive, so with that, the horners eye dilates more
29
Apraclonidine: effects
1. a1 agonist: mydriasis 2. lid retration 3. conj blanching (decongestion) 4. dry mouth, fatigue, lethargy, headache etc.
30
Brimonidine: other name
Alphagan (P)
31
Brimonidine: receptor
adrenergic receptor agonist : a2
32
Is brimonidine selective for a1? or a2?
highly selective for a2
33
Brimonidine: MOA
decrease aqueous like apraclonidine: inhibit adenylate cyclase = dec. cAMP = decrease production ALSO increase in uveal scleral outflow BUT NOT REMODELING (like apraclonidine)
34
which adrenergic agonist is neuroprotective?
brimonidine
35
what is the most frequent toxicity with brimonidine?
hyperemia - excess blood in the vessls
36
Combigan
Brimonidine .2% & Timolol .5%
37
Simbrinza
Brimonidine .2% & Brinzolamide 1%
38
naphazoline: receptor?
direct acting a1 agonist
39
tetrahydrozoline: receptors?
direct acting a1 agonist
40
oxymetazoline: receptors?
direct acting a1 agonist
41
naphazoine: concentrations?
.0125 & .03 (OTC) | .1% (Rx)
42
Tetrahydrozoline: concentrations?
.05% (OTC)
43
Oxymtazoline: concentrations?
.025% (OTC)
44
what is visine?
tetrahyrozoline
45
what sympathomimetic could you use with an OTC antihistamine to treat minor allergic conjunctivitis?
naphazoline with anti histamine
46
Paremyd: what is it?
Hydroxyamphetamine 1% & Tropicamide .25%
47
Hydrozyamphetamine 1%
stimulates release of NE, blocks reuptake | INDIRECT ACTING
48
Hydroxyamphetamine 1%: what happens in horner's pt
no dilation in post-ganglionic lesion | - widely dilated with central or preganglionic (usually 5 year prognosis)
49
hydroxyamphetamine: onset and duration = similar to ___?
phenylepherine
50
Cocaine: MOA
INDIRECT ACTING: block NE reuptake - mydriaysis - vasoconstriction - anesthesia
51
Cocaine: horner's diagnosis
dilation is reduced or absent in Horner's eye regardless of location of lesion
52
Dapiprazole: other name
Rev eyes
53
Dapriprazole: concentration
.5%
54
Dappiprazole: receptor
a-blocker
55
what do we need to be concerned with when using a-blockers?
floppy iris syndrome - especially when pt wants cataract surgery
56
Dapiprazole: uses?
reverse PHENYLEPHERINE mydriasis | - some actions on tropicamide induced mydriasis
57
what is the major toxicity seen with Dapiprazole?
conjunctival hyperemia (80%) and burning (50%)
58
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)
59
When do dark irises respond the same as light irises?
B-blockers
60
Timolol: other names
Timoptic, Timoptic-XE
61
Timolol : concentrations
.25% and .5%
62
Timolol: receptors
non-selective B blockers/ decreased aqueous production | - 7x more potent than propranolol
63
Does timolol affect pupil size, accommodation or aqueous production?
ONLY DECREASE IN PRODUCTION | no effect on pupil size and accommodation
64
what is pt most likely to have symptoms of myasthenia symptoms (diplopia, ptosis eom paresis) with?
B-blockers, timolol.
65
Levovunolol: other names & concentrations
Betagan .5% or .25%
66
Levobunolol: receptors
non selective b blocker
67
Metipranolol: other names and concentrations
optipranolol .3%
68
Metipranolol: receptors
non-selective b blockers
69
advantage to metipranolol?
cheaper b blockers
70
Betaxolol: other names and concentrations
Betoptic - S .25%
71
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
72
Advantage to betaxolol?
better for patients with asthma or heart conditions
73
Carteolol: other names and concentrations
Ocupress 1%
74
which b blocker comes in a suspension?
Betaxolol
75
Carteolol: receptor
non selective b blocker
76
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
77
Best interocular pressure control: b blockers
just avoid betaxolol
78
Chronic pulmonary disease or asthma: for b blockers
use betaxolol
79
hypercholestemia: (use of b blockers)
carteolol
80
pregnancy: use of b blockers:
avoid ALL: contraindicated with all