Ophthalmology Monograph 13 - Glaucoma Medical Therapy: Principles and Management

Author: Tyree Carr
Published: January 1999
Publisher: American Academy of Ophthalmology
ISBN: 1560551712
Paperback Book
Number of Pages: 288

Click to compare book prices for Ophthalmology Monograph 13 - Glaucoma Medical Therapy: Principles and Management

Ophthalmologists from the Duke University Eye Center, the University of Wisconsin, and other US institutions provide information about glaucoma medical therapy to colleagues in practice or in training and to other practitioners who may have clinical contact with glaucoma patients. The information here on medical management complements the surgical orientation of the Academy's , Second Edition 1998. A form, examination, and answer sheet are included to apply for continuing medical education credit.

Table of Contents
Preface xv
Acknowledgments xvii
Chapter 1 Ocular Pharmacology 1
1-1 Bioavailability in Ocular Compartments 2
1-1-1 Drug Transfer Rate and Concentration 2
1-1-2 Drug Absorption 4
1-2 Tear Film Dynamics 7
1-3 Drug Formulation 8
1-3-1 Solution Versus Suspension 8
1-3-2 Buffering and pH 9
1-3-3 Osmolality and Tonicity 9
1-3-4 Viscosity 10
1-3-5 Preservatives 10
1-4 New Drug Delivery Vehicles 11
1-4-1 Emulsions 11
1-4-2 Gels 11
1-5 Drug Delivery Systems 12
1-5-1 Ocusert 12
1-5-2 Liposomes 14
1-5-3 Implantable Reservoirs 17
References 20
Chapter 2 Beta Blockers 25
2-1 General Pharmacology 26
2-2 Mechanism of Action 26
2-3 Indications 27
2-4 Contraindications 27
2-5 Treatment Regimen 28
2-6 Side Effects 28
2-6-1 Local Adverse Effects 28
2-6-2 Systemic Adverse Effects 29
2-6-3 Central Nervous System Adverse Effects 29
2-6-4 Cardiovascular System Adverse Effects 30
2-6-5 Pulmonary Adverse Effects 31
2-6-6 Metabolic Adverse Effects 31
2-7 Drug-Drug Interactions 32
2-8 Drug-Disease Interactions 33
2-9 Specific Ocular Beta Blockers 34
2-9-1 Nonselective Beta Blockers 34
2-9-1-1 Timolol 34
2-9-1-2 Carteolol 37
2-9-1-3 Levobunolol 37
2-9-1-4 Metipranolol 38
2-9-2 Selective Beta Blocker 38
2-9-2-1 Betaxolol 38
2-9-3 Combination Drugs 39
2-10 Conclusion 39
References 39
Chapter 3 Adrenergic Agents 47
3-1 Adrenergic Physiology in the Eye 47
3-2 Pharmacology 49
3-3 Nonselective Agonists 49
3-3-1 Epinephrine 49
3-3-2 Dipivefrin 51
3-4 Alpha-Selective Agonists 51
3-4-1 Clonidine 52
3-4-2 Apraclonidine 52
3-4-2-1 Pharmacology 52
3-4-2-2 Mechanism of Action 53
3-4-2-3 Safety 54
3-4-2-4 Indications 57
3-4-3 Brimonidine 64
3-4-3-1 Pharmacology 64
3-4-3-2 Mechanism of Action 65
3-4-3-3 Efficacy 65
3-4-3-4 Safety 66
3-4-3-5 Indications 67
3-5 Conclusion 69
References 70
Chapter 4 Cholinergic Drugs 77
4-1 Mechanism of Action 77
4-2 Contraindications 82
4-3 Indications and Treatment 83
4-4 Side Effects 84
4-5 Drug Interactions 87
4-6 Results of Clinical Trials 89
4-7 Direct, Short-Acting Drugs 89
4-7-1 Pilocarpine 89
4-7-2 Carbachol 91
4-8 Indirect, Long-Acting Drugs 92
4-8-1 Echothiophate 92
References 93
Chapter 5 Carbonic Anhydrase Inhibitors 99
5-1 Oral Agents 99
5-2 Topical Agents 104
5-2-1 Dorzolamide 104
5-2-2 Brinzolamide 109
References 109
Chapter 6 Prostaglandin Analogs 113
6-1 Mechanism of Action 113
6-2 Indications 116
6-3 Contraindications 116
6-4 Treatment Regimen 117
6-5 Side Effects 117
6-5-1 Iris and Eyelash Color Change 117
6-5-2 Uveitis 118
6-5-3 Cystoid Macular Edema 120
6-5-4 No Systemic Side Effects 121
6-6 Drug Interactions 121
6-7 Results of Clinical Trials 121
6-8 Clinical Studies on Additivity 124
6-8-1 Beta Blockers 124
6-8-2 Oral Carbonic Anhydrase Inhibitors 125
6-8-3 Cholinergic Agents 125
6-8-4 Adrenergic Agents 126
6-9 Other Prostaglandin Analogs 127
References 127
Chapter 7 Osmotic Drugs 133
7-1 Mechanism of Action 133
7-2 Indications 136
7-3 Contraindications 136
7-4 Treatment Regimen 136
7-5 Side Effects 138
7-6 Drug Interactions 140
7-7 Clinical Use 140
7-7-1 Angle-Closure Glaucoma 140
7-7-2 Secondary Glaucomas 141
7-7-3 Aqueous Misdirection 141
7-7-4 Perioperative Use 141
7-8 Oral Osmotic Drugs 142
7-8-1 Glycerol 142
7-8-2 Isosorbide 143
7-8-3 Other Oral Osmotic Drugs 143
7-9 Intravenous Osmotic Drugs 144
7-9-1 Mannitol 144
7-9-2 Urea 144
7-9-3 Other Intravenous Osmotic Drugs 145
References 145
Chapter 8 Systemic Drugs and Intraocular Pressure 149
8-1 Drugs for Systemic Hypertension 149
8-1-1 Beta-Adrenergic Antagonists 149
8-1-2 Central Sympatholytics 152
8-1-3 Calcium Channel Blockers 153
8-1-4 Angiotensin-Converting Enzyme Inhibitors 156
8-1-5 Other Hypertensive Medications 156
8-2 Marijuana 157
8-3 Alcohol 158
References 159
Chapter 9 Initial Medical Treatment 163
9-1 Patient History and Risk Factors 163
9-2 Glaucoma Treatment Trials 164
9-3 To Treat or Not to Treat 168
9-4 Target Intraocular Pressure 168
9-5 Initial Treatment Modality 170
9-6 Initial Medical Management 171
9-7 Patient Followup 173
9-8 Glaucoma Suspects 174
References 175
Chapter 10 Combination Medical Therapy 179
10-1 Adjunctive Therapy 179
10-2 Combination Therapy 180
10-3 Addition or Substitution of Drugs 180
10-4 Additivity of Medications 181
10-5 Progression to Maximum Medical Therapy 182
10-6 Improvement of Compliance 183
10-7 Enhancement of Surveillance 185
10-8 High Intraocular Pressure on Initial Presentation 185
10-9 When Medical Therapy Fails 187
10-10 Conclusion 189
References 190
Chapter 11 Special Therapeutic Situations 193
11-1 Angle-Closure Glaucoma 193
11-1-1 Acute Angle-Closure Glaucoma 195
11-1-2 Chronic Angle-Closure Glaucoma 198
11-2 Discrete Glaucomas 199
11-2-1 Pigmentary Glaucoma 199
11-2-2 Exfoliation Syndrome 202
11-2-3 Corticosteroid-Induced Glaucoma 202
11-2-4 Neovascular Glaucoma 203
11-2-5 Iridocorneal Endothelial Syndrome 203
11-3 Trauma and Glaucoma 204
11-3-1 Hyphema 204
11-3-2 Angle-Recession Glaucoma 204
11-3-3 Inflammation 204
11-3-4 Foreign Bodies 205
11-3-5 Chemical Burns 205
11-4 Other Special Situations 205
11-4-1 Infants and Children 205
11-4-2 Prepresbyopic Adults 206
11-4-3 Patients With Cataracts 207
11-4-4 Panallergic Patients 207
References 207
Chapter 12 Compliance with Medications 213
12-1 Prevalence of Noncompliance 214
12-2 Clinical Features of Noncompliance 214
12-3 Reasons for Noncompliance 216
12-3-1 Patient 216
12-3-2 Disease 217
12-3-3 Regimen 218
12-3-4 Physician-Patient Relationship 219
12-3-5 Clinical Environment 219
12-4 Detection of Noncompliance 219
12-5 Improvement of Compliance 220
12-5-1 Memory Aids 220
12-5-2 Simplification of Regimen 221
12-5-3 Improvement of Physician-Patient Relationship 222
12-5-4 Patient Education 222
References 223
Epilog: From Medical to Surgical Therapy 227
E-1 Maximum Medical Therapy 227
E-2 Optic Nerve and Target Intraocular Pressure 228
E-3 Laser Surgery 229
E-4 Sequence of Laser Surgery and Trabeculectomy 229
E-5 Surgical Contraindications 230
E-6 Concluding Comment 230
References 230
CME Credit 231
Answer Sheet 232
Self-Study Examination 233
Index 247

Click to compare book prices for Ophthalmology Monograph 13 - Glaucoma Medical Therapy: Principles and Management Ophthalmology Monograph 13 - Glaucoma Medical Therapy: Principles and Management

Compare Shop Books - Help - About - Book Links - Book Coupons