Ocular Pharm Mt 1: Mydriatics + Cycloplegics

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Are you an optician or a student aspiring to be an optician and need help to revise and test your knowledge on ocular pharmacy? The quiz below tests the mydiatrics and cycloplegic conditions of the eye.


Questions and Answers
  • 1. 

    Mydriatics stimulate what division of the ANS?

    • A.

      Cholinergic

    • B.

      Adrenergic

    • C.

      Neither

    • D.

      Both depending on the dosage

    Correct Answer
    B. Adrenergic
    Explanation
    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.

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  • 2. 

    Choose the indications for use of a mydriatic.

    • A.

      Cycloplegia

    • B.

      Pupillary dilation

    • C.

      Testing for Horner's Syndrome

    • D.

      Contstriction of ocular blood vessels (ocular decongestant)

    Correct Answer(s)
    B. Pupillary dilation
    C. Testing for Horner's Syndrome
    D. Contstriction of ocular blood vessels (ocular decongestant)
    Explanation
    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.

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  • 3. 

    Cycloplegis are ______ which are used in the eye to inhibit ____.

    • A.

      Anti-cholinergics; accommodation

    • B.

      Anti-cholinergics; pupillary constriction

    • C.

      Adrenergic agonists; accommodation

    • D.

      Adrenergic agonists; pupillary constriction

    Correct Answer
    A. Anti-cholinergics; accommodation
    Explanation
    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.

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  • 4. 

    Choose the indications for use of cycloplegics.

    • A.

      Uveitis

    • B.

      Wet refractions

    • C.

      DFEs

    • D.

      Gonioscopy

    Correct Answer(s)
    A. Uveitis
    B. Wet refractions
    C. DFEs
    Explanation
    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.

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  • 5. 

    Phenylephrine (a mydriatic) acts equally on alpha1 and beta receptors, since it is a non-selective adrenegic agonist.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Phenyl acts primary on alpha1 receptors (eye) and has little effect on beta receptors

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  • 6. 

    What is the generally recommened concentration of phenyl for infants and elderly?

    • A.

      0.12%

    • B.

      1%

    • C.

      2.5%

    • D.

      10%

    Correct Answer
    C. 2.5%
    Explanation
    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.

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  • 7. 

    What is the 0.12% phenyl used for?

    • A.

      Ocular decongestant

    • B.

      Dx of Horner's

    • C.

      For children

    • D.

      More than one of the above

    Correct Answer
    A. Ocular decongestant
    Explanation
    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.

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  • 8. 

    Which concentration of phenyl is used for Horner's syndrome?

    • A.

      0.12%

    • B.

      1%

    • C.

      2.5%

    • D.

      10%

    Correct Answer
    B. 1%
    Explanation
    Significant mydriasis can occur in the eye with a postganglionic lesion as compared with one with normal innervation

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  • 9. 

    To break posterior synechiae and for peripheral corneal vessels vasoconstriction during LASIK, what concentration of phenyl is used?

    • A.

      0.12%

    • B.

      1%

    • C.

      2.5%

    • D.

      10%

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

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  • 10. 

    What is a rare but potential systemic side effect of phenyl?

    Correct Answer
    increased BP
    Explanation
    alpha-adrenetic effects

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  • 11. 

    For what situations would be phenyl be contraindicated?

    • A.

      Narrow angle glc

    • B.

      Narrow angles in general

    • C.

      Low birth weight infants

    • D.

      Elderly with atherosclerotic CVD

    • E.

      Cerebrovascular dz

    • F.

      Allergies to tropicamide

    • G.

      Pts with low BP

    Correct Answer(s)
    A. Narrow angle glc
    B. Narrow angles in general
    C. Low birth weight infants
    D. Elderly with atherosclerotic CVD
    E. Cerebrovascular dz
    Explanation
    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.

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  • 12. 

    Indicate the contraindicatesion for 10% phenyl.

    • A.

      Type I diabetes

    • B.

      Type II diabetes

    • C.

      Orthostatic hypotension

    • D.

      Advanced ASHD

    • E.

      IOL

    • F.

      Past refractive surgery

    Correct Answer(s)
    A. Type I diabetes
    C. Orthostatic hypotension
    D. Advanced ASHD
    E. IOL
    Explanation
    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

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  • 13. 

    Strong action of 2.5% and 10% solutions on dilator muscle in older patients may result in what 30-45 minutes after use?

    • A.

      Transient pigment floaters in AH

    • B.

      Lens dislodgement

    • C.

      Narrower angles

    • D.

      Permanent mydiasis

    Correct Answer
    A. Transient pigment floaters in AH
    Explanation
    flaters usually disappear within 12-24 hours
    * may mimic anterior uveitis or microscopic hyphema

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  • 14. 

    Mydfrin is a geneic name for 10% phenyl

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    2.5% and 10% = phenyl HCL, AK-Dilate, Neofrin

    2.5% = mydrifin

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  • 15. 

    What is the proper regiment for cycloplegic refraction in adults?

  • 16. 

    Pheynl is rarely used alone for mydriasis.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    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.

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  • 17. 

    Cholinergic receptors in the tissue of the iris sphincter and CB are nicotinic in type.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    MUSCARINIC --> mostly M3

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  • 18. 

    Synechiea between the iris and the lens is one of the most common indications for use of cyclos.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    CONTRAINDICATIONS

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  • 19. 

    Indicate all the contraindications for cyclo use.

    • A.

      Primary glc

    • B.

      Hypersensitivity to belladonna alkaloids

    • C.

      Adhesions between the iris and lens

    Correct Answer(s)
    A. Primary glc
    B. Hypersensitivity to belladonna alkaloids
    C. Adhesions between the iris and lens
    Explanation
    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.

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  • 20. 

    Anticholinegics can cause psychotic reactions and behavioral disturbances

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Ataxia, incoherent speech, restlessness, hallucinations, hyperactivity, seizures, disorientation

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  • 21. 

    What is the max concentration of cyclos that should be used in small infants?

    • A.

      0.25%

    • B.

      0.3%

    • C.

      0.5%

    • D.

      1%

    Correct Answer
    C. 0.5%
    Explanation
    Increased susceptiblity to cyclopentolate has been reported in infants and children with spastic paralysis and brain damage.

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  • 22. 

    What cyclo may cause CNS disturbances that may be dangerous in infants and children?

    • A.

      Tropicamide

    • B.

      Cyclopentolate

    • C.

      Homatropine

    • D.

      Atropine

    • E.

      All of the above

    • F.

      2 of the above

    Correct Answer
    F. 2 of the above
    Explanation
    TROP + CYCLOPENTOLATE can cause CNS disturbances in infants + children

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  • 23. 

    In Down syndrome pts and children with brain damage, cyclos (esp atropine) may not produce enough of a pupil response

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    cyclos can cause a HYPERREACTIVE pupillary response

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  • 24. 

    Indicate the ocular side effects of anti-chols.

    • A.

      Blurry vision

    • B.

      Photophobia

    • C.

      Visual hallucinations

    • D.

      Conjunctivitis

    • E.

      Sub conj heme with over use

    Correct Answer(s)
    A. Blurry vision
    B. Photophobia
    C. Visual hallucinations
    Explanation
    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.

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  • 25. 

    Indicate the potential systemic side effects of anti-chols.

    • A.

      Dryness of mouth and skin

    • B.

      Tachycardia

    • C.

      Headache

    • D.

      Somnolence

    • E.

      Nausea and vomiting

    • F.

      Facial sweating

    Correct Answer(s)
    A. Dryness of mouth and skin
    B. Tachycardia
    C. Headache
    D. Somnolence
    Explanation
    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.

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  • 26. 

    Severe reactions to anti-chols is manifested by hypotension and progressive respiratory depression

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    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

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  • 27. 

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

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Cyclos are indicated in dx procedures and in ACUTE inflammatry conditions of the iris and uveal tract

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  • 28. 

    The ophthalmic formulations for atropine come in what %?

    • A.

      0.25%

    • B.

      0.5%

    • C.

      1%

    • D.

      2.5%

    Correct Answer
    C. 1%
    Explanation
    0.5% may not be readily available, may need to be compounded

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  • 29. 

    Cyclopentolate usually has complete recovery in ___ hours

    Correct Answer
    24
    Explanation
    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.

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  • 30. 

    Which is the DOC for cyclo refractions due to the faster onset and shorter duration of action?

    • A.

      Atropine

    • B.

      Scopolamine

    • C.

      Cyclopentolate

    • D.

      Homotropine

    Correct Answer
    C. Cyclopentolate
    Explanation
    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.

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  • 31. 

    2% and repeated doses of 1% cyclopentolate should be avoided in infants and children due to increased CNS effects.  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    1% and 2% solutions contraindicated in infants, young children and children with spastic paralysis and brain damage

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  • 32. 

    Most patients in whom cyclopentolate has been administred have sufficient recovery of accomm amp to be able to read in ___-___ hours.

    Correct Answer
    6-12
    Explanation
    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.

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  • 33. 

    What cyclo does this describe: non-ionized drug molecules penetrate the corneal epithelium easily, and can reach a higher concentration level at muscarinic receptor sites than other cyclos.  

    • A.

      Atropine

    • B.

      Homatropine

    • C.

      Cyclopentolate

    • D.

      Tropicamide

    Correct Answer
    D. Tropicamide
    Explanation
    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.

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  • 34. 

    What cyclo does this describe: Greater drug diffusability compared to other anti-chols provides faster onset of action and shorter duration of action.

    • A.

      Homatropine

    • B.

      Cyclopentolate

    • C.

      Atropine

    • D.

      Tropicamide

    Correct Answer
    D. Tropicamide
    Explanation
    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.

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  • 35. 

    What is the drug of choice for dx mydriasis?

    • A.

      Tropicamide

    • B.

      Homotropine

    • C.

      Atropine

    • D.

      Scopolamine

    Correct Answer
    A. Tropicamide
    Explanation
    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.

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  • 36. 

    Tropicamide is the preferred drug to tx uvieitis

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Trop has a short duration of action and is therefore is NOT USED IN UVEITIS

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  • 37. 

    What concentrations are available for ophthalmic use of tropicamide?

    • A.

      0.25%

    • B.

      0.5%

    • C.

      1%

    • D.

      2%

    Correct Answer(s)
    B. 0.5%
    C. 1%
    Explanation
    0.5%: Mydral, Tropicacyl
    1%: Mydral, Tropicacyl, Mydriacyl

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  • 38. 

    Which drugs are used in combo to make Cyclomydril?

    • A.

      0.2% cyclopentolate HCl

    • B.

      0.5% cyclopentolate HCl

    • C.

      1% phenylephrine

    • D.

      0.5% tropicamide

    Correct Answer(s)
    A. 0.2% cyclopentolate HCl
    C. 1% phenylephrine
    Explanation
    1 drop into eye every 5-10 mins, not to exceed 3 times

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  • 39. 

    What is the max amount of administrations that should be used with Cyclomydril?

    • A.

      1x

    • B.

      2x

    • C.

      3x

    • D.

      As often as needed to produce results

    Correct Answer
    C. 3x
    Explanation
    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.

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