Ocular Pharm Mt 1: Mydriatics + Cycloplegics

1% and 2% solutions contraindicated in infants, young children and children with spastic paralysis and brain damage

Tropicamide is the drug of choice for diagnosing mydriasis. Mydriasis refers to the dilation of the pupil, and tropicamide is a medication that can be used to induce this dilation for diagnostic purposes. It works by blocking the action of the parasympathetic nervous system, which normally constricts the pupil. Tropicamide has a rapid onset and short duration of action, making it ideal for diagnostic procedures. Homotropine, atropine, and scopolamine are also drugs that can cause mydriasis, but tropicamide is preferred due to its shorter duration and fewer side effects.

Cyclopentolate is the DOC (drug of choice) for cyclo refractions due to its faster onset and shorter duration of action compared to other options such as atropine, scopolamine, and homotropine. This means that cyclopentolate can quickly and effectively dilate the pupil and relax the ciliary muscle, allowing for accurate refraction measurements to be taken.

Ataxia, incoherent speech, restlessness, hallucinations, hyperactivity, seizures, disorientation

MUSCARINIC --> mostly M3

Cycloplegics are drugs that are used in the eye to inhibit accommodation. Accommodation refers to the ability of the eye to change its focus from near to far objects. Anti-cholinergics are a type of drug that blocks the action of acetylcholine, a neurotransmitter involved in various bodily functions, including accommodation. Therefore, anti-cholinergics inhibit accommodation in the eye.

Increased susceptiblity to cyclopentolate has been reported in infants and children with spastic paralysis and brain damage.

Phenyl is rarely used alone for mydriasis, meaning it is not commonly used as a standalone medication for dilating the pupil. This suggests that phenyl is typically used in combination with other drugs or treatments for mydriasis.

Toxic manifestations of anti-chols: skin rash, drowsiness, fever, vasodilation, urinary retention, slowed GI motility, decreased salivary and sweat gland production, decreased secretions in pharynx/bronchi/nasal passages, coma, medullary paralysis, death

Phenyl acts primary on alpha1 receptors (eye) and has little effect on beta receptors

Trop has a short duration of action and is therefore is NOT USED IN UVEITIS

Cyclopentolate is a medication commonly used to dilate the pupils for eye examinations. It works by temporarily paralyzing the muscles in the eye that constrict the pupil. The effects of cyclopentolate typically last for several hours, with complete recovery occurring within 24 hours. During this time, the pupil will gradually return to its normal size and the paralysis of the muscles will wear off. Therefore, the correct answer is 24.

Tropicamide is the cyclo described in the question. It has greater drug diffusability compared to other anti-chols, which leads to a faster onset of action and a shorter duration of action. This means that tropicamide will start working more quickly and its effects will wear off faster compared to the other options.

0.5% may not be readily available, may need to be compounded

CONTRAINDICATIONS

cyclos can cause a HYPERREACTIVE pupillary response

10% should generally be minimized bc of a greater risk of significant ocular, cardiovascular, and other systemic side effects

Mydriatics are drugs that cause pupil dilation. The dilation of the pupil is controlled by the iris muscles, which are innervated by the autonomic nervous system (ANS). The ANS is divided into two main divisions: the sympathetic division (adrenergic) and the parasympathetic division (cholinergic). In this case, mydriatics stimulate the sympathetic division (adrenergic) of the ANS to cause pupil dilation. Therefore, the correct answer is adrenergic.

2.5% and 10% = phenyl HCL, AK-Dilate, Neofrin

2.5% = mydrifin

0.5%: Mydral, Tropicacyl
1%: Mydral, Tropicacyl, Mydriacyl

Phenyl is used as an ocular decongestant. It helps to relieve redness and congestion in the eyes by constricting blood vessels. This can provide temporary relief for symptoms such as itching, watering, and irritation. The concentration of 0.12% indicates the strength of the phenyl solution, which is suitable for use as an ocular decongestant. Therefore, the correct answer is ocular decongestant.

flaters usually disappear within 12-24 hours
* may mimic anterior uveitis or microscopic hyphema

The generally recommended concentration of phenyl for infants and elderly is 2.5%. This concentration is considered safe and effective for these age groups. Higher concentrations may be too strong and potentially harmful, while lower concentrations may not provide the desired effect. Therefore, a concentration of 2.5% is commonly recommended to ensure the appropriate balance of effectiveness and safety for infants and elderly individuals.

Significant mydriasis can occur in the eye with a postganglionic lesion as compared with one with normal innervation

Tropicamide is the cyclo described in the given statement. It is a non-ionized drug that can easily penetrate the corneal epithelium and reach a higher concentration at muscarinic receptor sites compared to other cyclos. This indicates that tropicamide is more effective in binding to muscarinic receptors and exerting its pharmacological effects than the other options listed.

Compress the lacrimal sac by digital pressure during and for up to 2-3 minutes after instillation

The correct answer is 3x. This means that Cyclomydril should be administered up to three times as often as needed to produce the desired results. This suggests that the frequency of administration can vary depending on the individual and their response to the medication. It is important to follow the instructions of a healthcare professional and use the medication as directed to ensure its effectiveness and safety.

The contraindications for cyclo use include primary glc, hypersensitivity to belladonna alkaloids, and adhesions between the iris and lens. These conditions are considered contraindications because they can potentially worsen the symptoms or cause adverse reactions when using cyclo. Primary glc refers to primary glaucoma, a condition characterized by increased pressure in the eye, which can be exacerbated by cyclo. Hypersensitivity to belladonna alkaloids means that individuals who are allergic or have a severe reaction to these substances should avoid using cyclo. Adhesions between the iris and lens can interfere with the proper functioning of cyclo and may cause complications.

TROP + CYCLOPENTOLATE can cause CNS disturbances in infants + children

not good for ppl with IOL bc risk of dislodging the lens

DM --> can increase blood glucose levels

**neonates have shown issues with RETINAL TOXICITY

Phenyl would be contraindicated in situations where there is narrow angle glaucoma, narrow angles in general, low birth weight infants, elderly patients with atherosclerotic cardiovascular disease, and patients with cerebrovascular disease. This is because phenyl can potentially worsen these conditions or cause adverse effects in these specific patient populations. Additionally, patients with allergies to tropicamide and those with low blood pressure should also avoid phenyl.

The given answer lists the ocular side effects of anti-chols as blurry vision, photophobia, and visual hallucinations. These side effects can occur as a result of taking anti-cholinergic medications, which block the action of acetylcholine in the body. Blurry vision refers to a loss of sharpness or clarity in vision, photophobia is a sensitivity to light that causes discomfort or pain in the eyes, and visual hallucinations are seeing things that are not actually there. These side effects can potentially occur when using anti-cholinergic drugs.

Cyclos are indicated in dx procedures and in ACUTE inflammatry conditions of the iris and uveal tract

Cyclopentolate is a medication used to dilate the pupils and temporarily paralyze the muscles that control the focusing of the eyes. After administration, most patients experience a recovery of their accommodation amplitude within 6-12 hours, meaning they regain the ability to focus and read. This suggests that the effects of cyclopentolate are temporary and wear off within this time frame.

Cycloplegics are medications that paralyze the ciliary muscles in the eye, causing temporary paralysis of accommodation and dilation of the pupil. This makes them useful in various clinical situations. Uveitis is an inflammation of the uvea, the middle layer of the eye, and cycloplegics can help relieve pain and prevent complications in uveitis patients. Wet refractions refer to refractive error measurements in patients with conditions like cataracts or corneal irregularities, and cycloplegics can help obtain accurate measurements in these cases. DFEs (Dilated Fundus Examinations) involve examining the back of the eye, and cycloplegics can be used to dilate the pupil for a better view. Therefore, uveitis, wet refractions, and DFEs are all valid indications for the use of cycloplegics.

1 drop into eye every 5-10 mins, not to exceed 3 times

Mydriatics are used to dilate the pupil, which can be beneficial in various situations. Pupillary dilation is necessary for certain eye examinations, such as fundoscopy or retinal examination, as it allows for a better view of the back of the eye. Testing for Horner's Syndrome also requires pupillary dilation to assess the response of the pupil to certain stimuli. Additionally, mydriatics can be used as ocular decongestants to constrict ocular blood vessels, which can help reduce redness and swelling in the eye. Therefore, the indications for use of a mydriatic include pupillary dilation, testing for Horner's Syndrome, and constriction of ocular blood vessels.

alpha-adrenetic effects

The potential systemic side effects of anti-chols include dryness of the mouth and skin, tachycardia (rapid heartbeat), headache, somnolence (drowsiness), and nausea and vomiting. These side effects can occur as a result of the medication's action on the body's cholinergic receptors, which can lead to decreased saliva production, increased heart rate, and changes in blood flow to the brain. Additionally, the medication may also affect the autonomic nervous system, leading to excessive sweating on the face.