Mydriatics
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Mydriatic drugs work by blocking the muscarinic M3 receptors in the iris sphincter muscle and ciliary muscles, causing pupil dilation (mydriasis) and relaxation of accommodation (cycloplegia). Topical instillation in the eye results in mydriasis, abolition of the light reflex, and cycloplegia. Atropine is the most potent mydriatic drug, with slow onset but long duration of action lasting up to a week. Homatropine is less potent than atropine. Cyclopentolate has a more rapid onset of action but shorter duration of around one day, making it preferred for cycloplegia. Tropicamide has the quickest and brief
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Introduction to glaucoma
Anti glaucoma drugs/ anti glaucoma eye drops/ glaucoma medicines
- Classification
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- Contraindications
Summary
Mode of action of anti glaucoma drugs/anti glaucoma eye drops/ glaucoma medicines
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Introduction to glaucoma
Anti glaucoma drugs/ anti glaucoma eye drops/ glaucoma medicines
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- Indications
- Contraindications
Summary
Mode of action of anti glaucoma drugs/anti glaucoma eye drops/ glaucoma medicines
Beta blocker-decrease aqueous secretion
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Retinoscopy
Retinoscopy is an objective technique used to determine the refractive error of the eye using a retinoscope. There are two main types: static retinoscopy with relaxed accommodation and dynamic retinoscopy with active accommodation. The retinoscope projects a streak of light into the eye and the examiner observes the movement and characteristics of the reflected light to determine the refractive error. Common issues that can arise include an incorrect working distance, uncooperative accommodation, or ocular pathology. Retinoscopy provides an initial refractive estimate and is useful for populations that cannot communicate verbally.
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miotics and mydriatics presentation m&mm
Optometrists are well-acquainted with the two opposing muscles in the iris, the sphincter and the dilator, as we witness their effects daily in clinical practice. Pupil constriction (miosis) can either be stimulated by contraction of the iris sphincter or by relaxation of the iris dilator. On the other hand, pupil dilation (mydriasis) can either be stimulated by contraction of the iris dilator or by relaxation of the iris sphincter.
Miotic and mydriatic drops work by acting on these different muscles of the iris. The drops are able to control pupil size by targeting two parts of the autonomic nervous system: the sympathetic and parasympathetic systems. Let’s review their function and clinical role to better understand their present uses and why some of these agents are undergoing re-evaulation for potential new ones.
Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary nerves, synapsing to the iris dilator.1,2
Contrarily, the parasympathetic pathway is mainly responsible for pupil miosis.1,3 Pupil constriction starts when light enters the retina and activates the retinal ganglion cells—the beginning of the afferent arm—which then transmit their impulses into the optic nerve. This stimulus travels to the optic chiasm, through the optic tract and eventually reaches the pretectal nucleus. The impulses from the pretectal nucleus begin the efferent arm, which projects to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus gives rise to preganglionic fibers, which then synapse with postganglionic neurons in the ciliary ganglion. Postganglionic neurons leave the ciliary ganglion to innervate the iris sphincter.1,3
Tropicamide has a strong mydriatic effect.
Tropicamide has a strong mydriatic effect. Click image to enlarge.
Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary n
Cyclo Refraction.dider
Cycloplegia involves temporarily paralyzing the ciliary muscle using cycloplegic drugs like atropine and cyclopentolate. This allows for an objective determination of refractive error by relaxing accommodation. Cycloplegic refraction is indicated for pediatric patients and those with suspected refractive error anomalies. It involves instilling eye drops to paralyze the ciliary muscle for 30-60 minutes before performing retinoscopy. Key considerations include drug selection and dosage based on age, maximizing cycloplegia while minimizing side effects and post-treatment accommodation.
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Cycloplegia is the paralysis of the ciliary muscle resulting in the loss of accommodation. Cycloplegic agents cause cycloplegia by blocking the muscarinic receptors in the eye. Cyclopentolate is commonly used for routine cycloplegic refraction in children and adults due to its fast onset and relatively short duration. Cycloplegic refraction is used to objectively determine refractive error when accommodation is paralyzed, and is indicated for young children with suspected latent hyperopia or accommodative esotropia. Cycloplegia is considered complete for refraction when a dilated pupil and no residual accommodation is detected via push-up test.
Retinoscopy
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1. The definitions and main branches of pharmacology, including pharmacokinetics and pharmacodynamics.
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3. Classes of anti-inflammatory drugs used to treat ocular inflammation, such as glucocorticoids, NSAIDs, mast cell stabilizers, and antihistamines.
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Ocular hypotensive drugs are used to reduce intraocular pressure and treat glaucoma. There are several classes of ocular hypotensive drugs: 1) Prostaglandin analogues like latanoprost which increase outflow of aqueous humor, 2) Beta-blockers like timolol which reduce aqueous production, 3) Alpha-2 adrenergic agonists like brimonidine and apraclonidine which decrease aqueous production, 4) Carbonic anhydrase inhibitors like acetazolamide which suppress aqueous humor production, and 5) Cholinergic agonists or miotics like pilocarpine which contract the iris sphincter muscle and ciliary body to facilitate aqueous outflow. Hyper
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Similar to Mydriatics
miotics and mydriatics presentation m&mm
Optometrists are well-acquainted with the two opposing muscles in the iris, the sphincter and the dilator, as we witness their effects daily in clinical practice. Pupil constriction (miosis) can either be stimulated by contraction of the iris sphincter or by relaxation of the iris dilator. On the other hand, pupil dilation (mydriasis) can either be stimulated by contraction of the iris dilator or by relaxation of the iris sphincter.
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Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary nerves, synapsing to the iris dilator.1,2
Contrarily, the parasympathetic pathway is mainly responsible for pupil miosis.1,3 Pupil constriction starts when light enters the retina and activates the retinal ganglion cells—the beginning of the afferent arm—which then transmit their impulses into the optic nerve. This stimulus travels to the optic chiasm, through the optic tract and eventually reaches the pretectal nucleus. The impulses from the pretectal nucleus begin the efferent arm, which projects to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus gives rise to preganglionic fibers, which then synapse with postganglionic neurons in the ciliary ganglion. Postganglionic neurons leave the ciliary ganglion to innervate the iris sphincter.1,3
Tropicamide has a strong mydriatic effect.
Tropicamide has a strong mydriatic effect. Click image to enlarge.
Behind the Scenes
The sympathetic pathway, mainly responsible for pupil mydriasis, involves a three-neuron pathway.1,2 The first neuron begins in the hypothalamus and descends through the midbrain to synapse onto a specific area of the spinal cord, known as the ciliospinal center of Budge. This synapse is located between the C8 and T2 vertebrae. The second neuron, which is the preganglionic neuron, exits the spinal cord, ascends through the thorax and synapses near the apex of the lung into the superior cervical ganglion. The third postganglionic neuron travels to the cavernous sinus and enters the orbit through the short and long ciliary n
Cyclo Refraction.dider
Cycloplegia involves temporarily paralyzing the ciliary muscle using cycloplegic drugs like atropine and cyclopentolate. This allows for an objective determination of refractive error by relaxing accommodation. Cycloplegic refraction is indicated for pediatric patients and those with suspected refractive error anomalies. It involves instilling eye drops to paralyze the ciliary muscle for 30-60 minutes before performing retinoscopy. Key considerations include drug selection and dosage based on age, maximizing cycloplegia while minimizing side effects and post-treatment accommodation.
Cyclorefraction
Cycloplegia involves paralyzing the ciliary muscle through the use of cycloplegic drugs like atropine and cyclopentolate. This allows for an objective determination of refractive error by eliminating accommodation. Cyclorefraction is important for accurately diagnosing latent hyperopia in children, which if left uncorrected can cause vision problems. Cyclopentolate is generally the drug of choice for routine cyclorefraction due to its fast onset and relatively short duration of action. Completion of cycloplegia is determined through push-up testing to ensure no residual accommodation remains before performing refraction.
Ocular Therapeutics and Pharmacology Feb2nd2023.ppt
This document summarizes various ocular therapeutic agents including:
- Parasympathomimetics like pilocarpine and acetylcholine which constrict the pupil.
- Parasympatholytics like atropine which dilate the pupil and cause cycloplegia. They are used to treat uveitis, keratitis, and prevent synechiae formation.
- Sympathomimetics like phenylephrine which dilate the pupil. Beta blockers like timolol are used to treat glaucoma.
- Other antiglaucoma drugs include prostaglandin analogues, carbonic anhydrase inhibitors, osmotic agents, and anti-infl
OPTHALMIC DIAGNOSTIC AGENTS
This document discusses ophthalmic diagnostic agents used to facilitate eye examinations and diagnoses. It outlines various classes of diagnostic agents including cycloplegics, mydriatics, anesthetics, and dyes. Cycloplegics induce paralysis of the ciliary muscles while mydriatics dilate the pupil. Anesthetics reversibly block nerve impulses along sensory fibers. Common diagnostic dyes include fluorescein and rose bengal which help identify ocular structures. The document discusses the mechanisms, indications, and side effects of various ophthalmic diagnostic agents.
Anticholinergic drugs
Antimuscarinic agents act by blocking cholinergic receptors, specifically muscarinic receptors. They can block muscarinic receptors non-selectively or selectively at M1, M2, or M3 receptors. Atropine and scopolamine are examples of non-selective muscarinic antagonists. These agents have various therapeutic effects including pupil dilation, reduced secretions, and bronchodilation due to their antimuscarinic properties. They are used for conditions like mydriasis, secretions in respiratory diseases, and bradycardia. Common side effects include dry mouth, blurred vision, constipation, difficulty urinating, and tachycardia.
Spinal, dalal madam
Local anesthetics work by blocking sodium channels in nerve cell membranes, preventing the transmission of pain signals. There are two main classes of local anesthetics - aminoesters and aminoamides. Lignocaine is a commonly used local anesthetic with an intermediate duration of action. Bupivacaine is more potent but also more cardiotoxic than lignocaine. Spinal anesthesia involves injecting local anesthetic in the subarachnoid space to block pain signals from the lower body.
Cholinergic agent: Autonomic Drugs
Cholinergic agent: Autonomic Drugs
According to the M. Optom curriculum, we have prepared a concise presentation on Cholinergic or parasympathomimetic or cholinomimetic drugs
Vinayak atropine glyco
This document provides information about atropine and glycopyrrolate, including their structure, mechanisms of action, pharmacokinetics, clinical uses, and comparisons. Atropine is a competitive muscarinic receptor antagonist derived from plants. It has central nervous system and cardiovascular effects. Glycopyrrolate is a quaternary ammonium anticholinergic that does not cross the blood brain barrier, so it has fewer central effects. Both drugs are used preoperatively and to reverse neuromuscular blockade. Glycopyrrolate is preferred to atropine for premedication due to its more stable hemodynamic profile and lack of cognitive effects.
Cycloplegic refraction ppt
Cycloplegic refraction involves temporarily paralyzing the ciliary muscle with eye drops in order to determine a person's full refractive error. This is important for children who accommodate too much. Common cycloplegic agents include atropine, homatropine, and cyclopentolate. Cyclopentolate is often the drug of choice due to its faster onset and shorter duration. A cycloplegic refraction allows an accurate assessment of refractive error, especially in children and other patients where accommodation can affect results.
Pharmacology of MIOTICS, MYDRIATICS.pptx
Miotics are drugs that cause constriction of pupil.
The commonly used miotics belong to two groups
a) parasympathomimetics (contraction of circular fibres of iris)
b) sympatholytics (relaxing dilator pupillae muscle)
Mydriatics are drugs that dilate the pupil while cycloplegics are agents that cause paralysis of ciliary muscle (paralysis of accommodation)
The commonly used mydriatics belong to two groups
a) sympathomimetics
b) parasympatholytics
MIOTICS
Agents which cause constriction of pupil
These are used in the management of glaucoma and the treatment of esotropias and accommodation insufficiency.
Pilocarpine
Direct acting parasympathomimetic drug
Duplicates the muscarinic effects of acetylcholine (M3 receptor), but has no nicotinic effects.
It is effective in the treatment of glaucoma by decreasing intraocular tension
improves the aqueous humor outflow
Decreases aqueous secretion.
Onset of miosis occurs within 10-30 mins and lasts for 4-8 hours following topical application.
Indications and Usage
The control of intra-ocular pressure in angle closure glaucoma.
To reverse mydriasis caused by a cycloplegic agent.
In the treatment of accommodative strabismus.
Controversial role in the treatment of hyphaema.
After cataract extraction in cases of intra capsular cataract extraction
Adverse effects
Visual blurring
poor dark adaptation caused by the failure of the pupil to dilate in reduced illumination
Brow pain
Nausea
Diarrhoea
Sweating
Bronchospasm
Dosage and Administration
Pilocarpine nitrate, a sterile ophthalmic solution is available as 1%, 2% or 4% drops
To aid in emergency miosis, 1 to 2 drops of one of the higher concentrations should be used.
Carbachol
Carbachol is a direct acting parasympathomimetic that is used when allergy or resistance to pilocarpine develops
It has both nicotinic and muscarinic actions and also partially inhibits cholinesterase
Available as 0.75 % - 3 % drops.
Used for lowering intra-ocular pressure and pupillary constriction in the treatment of glaucoma.
When instilled into the eye, it mimics the effects of Ach, causing miosis and spasm of accommodation in which the ciliary muscle of the eye remains in a constant state of contraction.
Onset of action = 10-20min
Intraocular pressure is reduced for 4-8hrs.
Adverse effects
Little or no side effects occur due to lack of systemic penetration
Dosage and Administration
It is administered three to four times per day.
Physostigmine Sulphate
An indirectly acting parasympathomimetic agent which is reversible anticholine-esterase.
Given as 0.25% eye drops with 2% pilocarpine nitrate.
The mechanism of action involves inhibition of choline-esterase with consequent accumulation of acetylcholine at the neuromuscular junctions.
Topical application produces miosis which lasts for 6-24hrs.
Dosage and Administration
0.1-1% eye drops
It is administered every 4 to 6 hours
Adverse Reaction
Twitching
Irritation
allergic reaction
Depigmentation of the eye lid skin
Anticholinergics Drugs for Optometry
The document discusses various antimuscarnic agents used in ophthalmology including their classification, mechanisms of action, pharmacokinetics, uses, and side effects. It provides details on common agents like atropine, hyoscine, homatropine, cyclopentolate, and tropicamide. It explains that these agents act as parasympatholytics to cause mydriasis and cycloplegia. The document also provides comparisons of onset, duration of action, and residual accommodation for various agents and important clinical considerations for their use.
Atropine substitutes Pharmacology ppt
Many semisynthetic derivatives of belladonna
alkaloids and a large number of synthetic compounds have been introduced with the aim of
producing more selective action on certain
functions. Most of these differ only marginally
from the natural alkaloids, but some recent ones
appear promising.
Anticholinergic drugs
Anticholinergic drugs block the effects of acetylcholine at muscarinic receptors in the central and peripheral nervous system. Prototype anticholinergic is atropine, which is highly selective for muscarinic receptors. Anticholinergic drugs have many therapeutic uses including treatment of Parkinson's disease, motion sickness, respiratory disorders, ophthalmological disorders, and poisonings. However, they can cause adverse effects such as dry mouth, blurred vision, tachycardia, constipation, and delirium at high doses.
Anticholinergics[1]
This document discusses anticholinergic and mucolytic drugs. Anticholinergics work by blocking the action of acetylcholine at muscarinic receptors. Common anticholinergic drugs include atropine, hyoscine, and glycopyrrolate. Mucolytics are agents that can dissolve, digest, or liquefy mucus to reduce viscosity. Common mucolytics include N-acetylcysteine, sodium bicarbonate, bromhexine, and dornase alfa. N-acetylcysteine works by disrupting disulfide bonds in mucus while sodium bicarbonate increases mucus pH. These drugs are used to help clear mucus in conditions like
Cholinergic Drugs and Anticholinesterases in Optometry
Cholinergic Drugs and anticholinesterases play an important role in optometry, ophthalmology as well as medicine.
Parasympatholytics
Parasympatholytics are the drugs that block or inhibit the actions of acetylcholine at postganglionic nerve endings and cholinergic receptors. They are also referred to as anticholinergics or cholinergic blocking agents or antispasmodics.
Anticholinergic drugs include atropine and related drugs- atropine is the prototype. Atropine is obtained from the plant Atropa belladonna. Atropine and scopolamine (hyoscine) are the belladonna alkaloids. They compete with acetylcholine for muscarinic receptors and block this receptors-they are muscarinic antagonists.
Local anaesthetics by aga umar
This document provides information on various local anaesthetics, including their classification, mechanisms of action, durations of effect, concentrations used, metabolism and side effects. It discusses aminoester and aminoamide local anaesthetics such as procaine, lignocaine, mepivacaine, prilocaine, bupivacaine, levobupivacaine, ropivacaine and etidocaine. It also briefly mentions dibucaine as having the longest duration of action of any local anaesthetic.
Anti malarial drugs
The patient presented with recurrent fever and P. vivax parasitemia after initially being treated for P. vivax malaria.
The most likely cause of recurrence is relapse from latent hypnozoites in the liver, as chloroquine treats the blood stage infection but not hypnozoites.
For the second episode, she should be given the full treatment course of chloroquine again along with the full 14 day course of primaquine to treat the hypnozoites and prevent further relapses.
Primaquine should be continued as prescribed to clear the hypnozoites and prevent future relapses from this infection.
Parasympathetic (cholinomimetic ) drugs
These are drugs that acts on cholinoceptors. It includes their mode of action and he classes of cholinoceptor simulants.
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Ocular Therapeutics and Pharmacology Feb2nd2023.ppt
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Cholinergic Drugs and Anticholinesterases in Optometry
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Mydriatics
- 1. MYDRIATIC S By Dr Ketan Asawalle
- 2. HISTORY
- 3. Large pupils were considered a sign of beauty to instil drops of BELLADONNA extract active ingredient of Belladonna is ATROPINE
- 4. INTRODUCTION Classified under ANTICHOLINERGIC • Prototype drug- ATROPINE
- 5. muscle of the iris due to decrease in light DEFINITION
- 6. PARASYMPATHETIC SYMPATHETIC RECEPTORS INVOLVED = MUSCARINIC M3 and ADRENERGIC
- 8. RECEPTORS Pupillary dilators - Alpha 1 receptors Pupillary constrictors - M3 receptors Ciliary muscles M3 receptors
- 9. of Action mainly through blocking MUSCARINIC Alpha 1 Adrenergic Agonists also cause mydriasis
- 10. TOPICAL INSTILLATION IN EYE CAUSES • MYDRIASIS • ABOLITION OF LIGHT REFLEX • CYCLOPLEGIA
- 11. RESULTS • PHOTOPHOBIA • BLURRING OF VISION
- 12. USES pupil for the purpose of facilitating ophthalmoscopic its normal position when already prolapsed
- 13. USES ciliary muscle, and thus destroy the power of condition of the refractive media of the eye in cases Spasm of the ciliary muscle Unable voluntarily to relax the accommodation
- 14. MYDRIATIC DRUGS
- 15. ATROPINE • Potent Mydriatic • Slow Onset of Action • Long Lasting
- 16. ATROPINE • Pupils dilate in 30 to 40 minutes • Cycloplegia lasts for 1 to 3 hours • Effect lasts for 1 week
- 17. HOMATROPINE • Less potent • Onset of Action in 30 to 45 minutes • Mydriasis lasts for 1 to 3 days • Accommodation recovers in 1 to 2 days • Unsatisfactory cycloplegia
- 18. CYCLOPENTOLATE • Rapidly Acting • Onset of action for Mydriasis Cycloplegia 30 to 60 minutes • Action lasts for 1 day • Preferred for Cycloplegia
- 19. CYCLOPENTOLATE behavioural abnormalities due to absorption though • Uveitis • Iritis
- 20. TROPICAMIDE • QUICKEST and BRIEFEST Satisfactory for refraction testing and fundoscopy Action can be augmented by adding phenylephrine • Unreliable Cycloplegic
- 21. PHENYLEPHRINE • Used in combination with Tropicamide • Alpha 1 Adrenergic Agonist ciliary muscles to cause mydriasis but NO CYCLOPLEGIA
- 22. LIGNOCAINE and PROPARACAINE • Local anaesthetics • Used in combination with Tropicamide • Used during cataract surgeries • Mechanism of action UNDER RESEARCH
- 23. THANK YOU