Systemic effects of medications used to treat glaucoma

Article Abstract:

Glaucoma is an eye disease characterized by an increase of pressure within the eye and resulting in damage to the optic nerve and eventually blindness. There are two types of glaucoma: primary, resulting from unknown causes, and secondary, resulting from other eye diseases. Drugs used to treat glaucoma may have effects at other sites within the body. These effects may not be detected in elderly patients, who tend to be chronically ill and are taking several other medications. Beta blocking agents used to treat glaucoma are generally safe, but can be absorbed into the circulation. Beta blockers have been shown to cause bronchospasm (increased contraction of the airways) and to worsen heart block, the interference with the electrical activity of the heart. They also can inhibit the physiologic mechanisms that compensate for congestive heart failure, and can have adverse effects on the central nervous system. Pilocarpine, a drug that constricts the pupil, has been shown to cause abnormalities of the heart when given in excessive amounts before surgery to repair glaucoma. Epinephrine, an agent whose effects mimic the action of the sympathetic nervous system when stimulated, can cause abnormal heart rhythms and attacks of abnormally high blood pressure. Almost 50 percent of patients taking carbonic anhydrase inhibitors, another type of agent used to treat glaucoma, discontinue their medications because of various side effects. Thus, drugs used to treat glaucoma may cause adverse effects on organs other than the eye, resulting in disorders that resemble primary disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Eye diseases, Ophthalmic agents, Glaucoma, Ophthalmic drugs

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The neglected medical history and therapeutic choices for abdominal pain: a nationwide study of 799 physicians and nurses

Article Abstract:

Concern has been raised in recent years about the rush to prescribe, rather than taking the time to obtain a complete history, that seems to exist in modern medical practice. To determine if this perception is accurate, 500 physicians and nearly 300 nurse practitioners were presented with a clinical vignette, and offered the options of merely prescribing drugs on the basis of the minimal history they had been given, or of asking for more information from the patient. A patient was described as experiencing abdominal pain, and having had a study performed a month previously that suggested he had gastritis, an inflammation of the stomach's lining, but did not have evidence of ulcer. When this hypothetical patient was further described as elderly, 39 percent of the physicians queried reported that they would immediately prescribe a particular drug. In contrast, only 19 percent of the nurse practitioners would have treated at this point, without further information. When asked what therapeutic interventions they would make with this patient, the physicians tended to choose drugs in a particular category known to treat ulcers effectively, but not proven to be of benefit in gastritis, while the nurse practitioners tended to start with non-drug methods, such as modifications in lifestyle, habits, etc. Given that the elderly are more likely to suffer side effects of the drugs that they are prescribed, the tendency of the physicians to start medications without obtaining further historical information is disturbing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Practice, Surveys, Nurse practitioners, Medical history taking, Dosage and administration, Physicians (General practice), General practitioners, Drug administration and dosage

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Cultural and Economic Factors That (Mis)Shape Antibiotic Use: The Nonpharmacologic Basis of Therapeutics

Article Abstract:

There are many reasons why doctors prescribe antibiotics. They may cave in to patient demands or feel that the visit is not productive unless the patient gets a prescription. The patient may also feel the same way. Managed care can affect the physician-patient relationship by encouraging the doctor to see more patients every day and therefore spend less time with each one. Patients need to be told that antibiotics will not cure a viral disease. Doctors need to be reminded that indiscriminate use of antibiotics causes drug resistance in bacteria.

Social aspects, Antibiotics, Physician and patient, Physician-patient relations, Prescription writing

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