Topical therapies for glaucoma: what family physicians need to know.
Medication classes historically used in the management of glaucoma include beta blockers, miotics, sympathomimetics and carbonic anhydrase inhibitors. Because topically applied medications are more site specific, they are preferred in the treatment of glaucoma. Compared with oral medications, topical agents are associated with a decreased incidence of systemic side effects. With topical administration, conjunctival and localized skin allergic reactions are relatively common, whereas severe reactions, including death, are rare. Recently introduced topical agents for glaucoma therapy include dorzolamide and brinzolamide, the first topical carbonic anhydrase inhibitors; brimonidine and apraclonidine, more ocular-specific alpha agonists; and latanoprost, a prostaglandin analog, which is a new class of glaucoma medication. Latanoprost has the unique side effect of increasing iris pigmentation. Like their predecessors, the newer agents lower intraocular pressure by a statistically significant degree. Preservation of visual field, the more substantial patient-oriented end point, continues to be studied. (+info)
Effect of sodium cloprostenol and flunixin meglumine on luteolysis and the timing of birth in bitches.
At birth, the physiological role of prostaglandins in bitches is unclear. Bitches were treated before parturition with either saline, the prostaglandin analogue, sodium cloprostenol, or the prostaglandin synthetase inhibitor, flunixin meglumine. The animals were examined regularly to determine the onset of parturition and a series of blood samples were taken to define the hormonal profiles before, during and after birth. Animals treated with cloprostenol whelped earlier than did controls. In addition, the prostaglandin F2 alpha metabolite surge and decrease in plasma progesterone concentration and rectal temperature were earlier than in controls. Flunixin meglumine disrupted the normal 13,14-dihydro-15-keto prostaglandin F2 alpha profile but did not abolish prostaglandin synthesis completely or delay the onset of labour in treated animals. This study confirms that prostaglandins induce luteolysis and the onset of labour in the bitch. However, the partial inhibition of prostaglandin synthesis does not prevent parturition. (+info)
Release of GM-CSF and G-CSF by human arterial and venous smooth muscle cells: differential regulation by COX-2.
In addition to their traditional contractile function, vascular smooth muscle cells can be stimulated under inflammatory conditions to release a range of potent biological mediators. Indeed, we and others have shown that human vascular smooth muscle release the colony stimulating factors (CSF) granulocyte macrophage-CSF (GM-CSF) and granulocyte-CSF (G-CSF) as well as large amounts of prostaglandins following the induction of cyclo-oxygenase-2 (COX-2), when stimulated with cytokines. Here we demonstrate, for the first time, that co-induced COX-2 activity simultaneously suppresses GM-CSF release and potentiates G-CSF release by human vascular cells. Moreover, the differential regulation of GM-CSF and G-CSF release by COX-2 was mimicked by the prostacyclin (PGI(2)) mimetic, cicaprost. These observations suggest that PGI(2), released following the induction of COX-2, differentially regulates the release of GM-CSF (suppresses) and G-CSF (potentiates) from human vascular cells. (+info)
Effects of some isoprostanes on the human umbilical artery in vitro.
1. Cumulative concentration-effect curves for the selective prostanoid TP receptor agonist U46619 and six isoprostanes were constructed in the human isolated umbilical artery. 2. All compounds except 8-iso-PGF3 alpha produced concentration-dependent contractions. The contractile response to the isoprostanes increased with each cumulative addition up to a point, after which subsequent addition reduced the contraction below the previous level. This 'downturn' in the concentration-effect curve did not occur with U46619. 3. The potencies of the compounds tested were as follows (pEC50 +/- s.e.mean): U46619, 6.7 +/- 0.2; 8-iso-PGE2, 6.5 +/- 0.1; 8-iso-PGF2 alpha, 5.8 +/- 0.2; 8-iso-PGE1, 5.4 +/- 0.1; 8-iso-PGF1 alpha, 5.0 +/- 0.1; 8-iso-PGF2 beta > 4.8; 8-iso-PGF3 alpha >> 4.8 (n = 4-17). Neither 8-iso-PGF2 beta nor 8-iso-PGF3 alpha at 44 microM had a significant effect on cumulative concentration-effect curves to U46619. 4. The selective TP receptor antagonist GR32191 (0.1 microM) caused rightward shifts in the concentration-effect curves to all the active compounds. pA2 values for GR32191 against U46619, 8-iso-PGE2, 8-iso-PGF2 alpha, 8-iso-PGE1 were 7.6 +/- 0.2, 9 +/- 1, 8.2 +/- 0.3 and 7.7 +/- 0.3, respectively (n = 4). 5. Neither N omega-nitro-L-arginine methyl ester (100 microM) nor the selective DP receptor antagonist BW A868C (50 nM) affected the complex concentration-effect curve to 8-iso-PGE2 (n = 3). 6. Stable contractions to U46619 (1-3 microM) were unaffected by anandamide at concentrations up to 60 microM. (+info)
Affinities, selectivities, potencies, and intrinsic activities of natural and synthetic prostanoids using endogenous receptors: focus on DP class prostanoids.
The prostanoid receptor-subtype binding affinities, selectivities, potencies, and intrinsic activities of four natural prostanoids and six synthetic DP class prostanoids were determined using binding and functional assays with endogenous receptors. SQ27986 exhibited the highest affinity for the human platelet DP receptor and the best DP receptor selectivity profile. Prostaglandin (PG)D(2) was the least DP receptor-selective. The rank order of compound affinities at the DP receptor was SQ27986 (K(i) = 10 +/- 2 nM) > RS93520 = ZK110841 = BW245C (K(i) = 23-26 nM) > ZK118182 (K(i) = 50 +/- 9 nM) > PGD(2) (K(i) = 80 +/- 5 nM). DP receptor agonists produced cAMP in embryonic bovine tracheal fibroblasts with different potencies (EC(50) values in nM): ZK118182 (18 +/- 6), RS93520 (28 +/- 6), SQ27986 (29 +/- 7), ZK110841 (31 +/- 7), BW245C (53 +/- 16), and PGD(2) (98 +/- 10). BW245C was more efficacious and RS93520 was less efficacious than PGD(2). ZK110841 and ZK118182 exhibited a relatively high potency at the adenylyl cyclase-coupled EP(2) receptor in human nonpigmented ciliary epithelial cells but were partial agonists. None of the DP class agonists showed any EP(4) receptor functional activity in Chinese hamster ovary cells. The DP receptor antagonist BWA868C competitively antagonized the PGD(2)-induced cAMP accumulation in embryonic bovine tracheal fibroblast cells (pA(2) = 7.83 +/- 0.08). The dissociation constants for BWA868C antagonizing PGD(2)-, BW245C-, and ZK118182-induced cAMP production were quite similar (apparent -log K(b) = 7.9-8.2, n = 5-9). The pharmacological properties of some natural and numerous DP class synthetic prostanoids have been determined using endogenous receptors. (+info)
Effects of glaucoma medications on the cardiorespiratory and intraocular pressure status of newly diagnosed glaucoma patients.
AIMS: To evaluate the short term cardiovascular, respiratory, and intraocular pressure (IOP) effects of four glaucoma medications in newly diagnosed glaucoma patients. METHODS: 141 newly diagnosed glaucoma patients were recruited and underwent a full ocular, cardiovascular, and respiratory examination, including an electrocardiogram (ECG) and spirometry. They were prescribed one of four topical glaucoma medications and reviewed 3 months later. One eye of each patient was randomly chosen for analysis, performed using analysis of variance and the chi(2) test. RESULTS: Latanoprost had the greatest mean IOP lowering effect in both the primary open angle glaucoma (POAG) (p = 0.005) and the "presumed" normal tension glaucoma (NTG) groups (p = 0.33), reducing the IOP by 8.9 mm Hg and 4.1 mm Hg respectively. Timolol was associated with lowered pulse rates and reductions in the spirometry measurements. 41% of patients using brimonidine complained of systemic side effects and over 55% of patients using betaxolol complained of ocular irritation. 28% of patients required an alteration in their glaucoma management. CONCLUSIONS: Latanoprost appears to be a useful primary treatment for glaucoma patients, in view of superior IOP control and a low incidence of local and systemic side effects. Timolol causes a reduction in measurements of respiratory function, a concern in view of the potential subclinical reversible airways disease in the elderly glaucoma population. Brimonidine is associated with substantial, unpredictable systemic side effects and betaxolol causes ocular irritation and weak IOP control. Spirometry is advised in all patients receiving topical beta blocker therapy to control their glaucoma. (+info)
Preparation of the cervix for surgical termination of pregnancy in the first trimester.
Worldwide, surgical vacuum aspiration is the method of choice of terminating first trimester unwanted pregnancy. Cervical priming prior to surgical evacuation reduces the risks of cervical injury by making the cervix softer and easier to dilate. Over the years, a number of effective methods of cervical priming have became available: osmotic dilators; antiprogesterone and prostaglandins. Of these, prostaglandins remain the most widely used method of cervical preparation. However many of the natural and synthetic analogues of prostaglandins are either expensive or associated with troublesome side-effects. More recently, misoprostol, a synthetic 15-deoxy-16 hydroxy 16-methyl analogue of naturally occurring prostaglandin E, used in the management of peptic ulcers, has established a lead for cervical priming in terms of availability, ease of administration, cost and effectiveness. In fact it appears that both oral and vaginal misoprostol given at dosages of 400 microg are effective for cervical priming when administered 3 h prior to surgical vacuum aspiration. Now that the use of misoprostol for cervical priming has been validated, its widespread use in gynaecological practice is expected. (+info)
Vasoconstrictor actions of isoprostanes via tyrosine kinase and Rho kinase in human and canine pulmonary vascular smooth muscles.
1. We examined the effects of several E-ring and F-ring isoprostanes on mechanical activity in pulmonary artery and vein. 2. 8-iso PGE(2) and 8-iso PGF(2 alpha) were powerful spasmogens in human vasculature and in canine pulmonary vein. 8-iso PGE(1) and 8-iso PGF(2 beta) also exhibited moderate spasmogenic activity in canine pulmonary vein; 8-iso PGF(1 alpha), 8-iso PGF(1beta), and 8-iso PGF(3 alpha) were generally ineffective. Canine pulmonary arteries did not exhibit excitatory responses to any of the isoprostanes. 3. The spasmogenic effects of 8-iso PGE(2) were markedly attenuated by the TP-receptor blocker ICI 192605 and by the EP-receptor blocker AH 6809 (-log K(B)=8.4 and 5.7, respectively). PGE(2) was a very weak agonist ( approximately 100 fold less so than 8-iso PGE(2)). 4. In the presence of ICI 192605 (10(-6) M), 8-iso PGE(1) evoked modest dose-dependent relaxations in human and canine pulmonary vein, and in canine pulmonary artery, but not in the human pulmonary artery. The other isoprostanes were generally ineffective as vasodilators in the pulmonary vasculature of both species. 5. The spasmogenic effects of 8-iso PGE(2) and 8-iso PGF(2 alpha) did not involve elevation of [Ca(2+)](i). 6. 8-iso PGE(2)-evoked contractions were blocked by inhibitors of tyrosine kinase (genistein) and Rho kinase (Y 27632 and HA 1077), but not by inhibitors of protein kinase C (calphostin C or chelerythrine), mitogen-activated protein kinase kinase (PD 98059) or p38-kinase (SB 203580). 7. The actions of 8-isoprostanes in the lungs are compound-, species- and tissue-dependent. Several isoprostanes evoke vasoconstriction: in the case of 8-iso PGE(2), this involves activation of TP-receptors, tyrosine kinases and Rho kinases. 8-iso PGE(1) is also able to cause vasodilation. (+info)