3 OS OUTROS TRATAMENTOS FARMACOLÓGICOS PARA O GPAA
3.4 OS ANÁLOGOS DAS PROSTAGLANDINAS E PROSTAMIDAS
Os equivalentes das prostaglandinas e, seguidamente, as prostamidas, foram os fármacos mais recentes para a terapêutica farmacológica do glaucoma. São originados da prostaglandina F2alfa. Agem elevando a ação das metaloproteinases, o que desencadeia mudanças na matriz extra-celular e, desta maneira, permite um fluxo maior do humor aquoso por meio da via úveo-escleral (ALLINGHAM, 2005).
Os três representantes essenciais dessa classe são a travoprosta e a latanoprosta, pois ambas são semelhantes as prostaglandinas, e a principal representante das prostamidas é a bimatoprosta (MAGALHÃES JR, 2013).
Essa classe de fármacos é a que possui a maior eficácia hipotensora na terapêutica dos enfermos portadores de glaucoma. É administrada em quantidade única noturna, pois grande parte das pesquisas evidenciam maior efeito do que a quantidade única matinal. Quando combinados com o maleato de timolol, são administrados igualmente em quantidade única noturna, com eficácia equivalente a utilização isolada de ambos os fármacos. Podem ser combinados a qualquer classe de fármacos, elevando o controle da PIO no enfermo glaucomatoso dado seu importante efeito (EINARSON et al., 2000; HEDMAN; ALM, 2000; ZHANG et al., 2001; BRON; EMMERICH, 2002; EISENBERG; TORIS; CAMRAS, 2002; VAN DER VALK et al., 2005; GOLDBERG; WALT, 2006; LI et al., 2006; WEBERS et al., 2006; APTEL; CUCHERAT; DENIS, 2008; COX et al., 2008; GUEDES; GUEDES; CHAOUBAH, 2008; STEWART et al., 2008; CHENG et al., 2009; EYAMO et al., 2009; HONRUBIA
et al., 2009; VAN DER VALK et al., 2009; VARMA; HWANG; GRUNDEN, 2009; GUEDES et al., 2010; LUU et al., 2010; ORME et al., 2010; WEBERS et al., 2010).
A primordial prostaglandina de utilização na terapia do glaucoma é a latanoprosta na concentração de 0,005%. É administrada em quantidade única noturna, reduzindo a PIO média em aproximadamente 30%. Similarmente ao seu efeito na terapêutica de pacientes com hipertensão ocular e com glaucoma, este medicamento foi avaliado em enfermos pediátricos e em enfermos com glaucoma primário de ângulo fechado, com evidências positivas em ambos os grupos. Demonstra efeito hipotensor igual à associação do timolol com a dorzolamida. A travoprosta na concentração de 0,004% é semelhante à latanoprosta, com algumas pesquisas propondo maior eficiência do primeiro fármaco na diminuição da PIO em pessoas de raça negra, comparando com as de raça branca. A bimatoprosta á 0,03% é similar à latanoprosta, ocorrendo menor surgimento de pigmentação iriana e cefaleia e maior hiperemia conjuntival (EINARSON et al., 2000; HEDMAN; ALM, 2000; ZHANG et al., 2001; BRON; EMMERICH, 2002; EISENBERG; TORIS; CAMRAS, 2002; VAN DER VALK et al., 2005; GOLDBERG; WALT, 2006; LI et al., 2006; WEBERS et al., 2006; APTEL; CUCHERAT; DENIS, 2008; COX et al., 2008; GUEDES; GUEDES; CHAOUBAH, 2008; STEWART et al., 2008; CHENG et al., 2009; EYAMO et al., 2009; HONRUBIA et al., 2009; VAN DER VALK et al., 2009; VARMA; HWANG; GRUNDEN, 2009; GUEDES et al., 2010; LUU et al., 2010; ORME et al., 2010; WEBERS et al., 2010).
Os fármacos equivalentes das prostaglandinas e das prostamidas são contraindicados para pacientes que apresentam intolerância ou hipersensibilidade aos componentes da fórmula (ALLINGHAM, 2005; KANSKI; BOWLING, 2011; MELLO; ALMEIDA; ALMEIDA, 2011).
Algum hipotensor pode ser retirado, se for obtido o controle da PIO e a não evolução da patologia, o mesmo que, campo visual estável e falha no nervo óptico mantida. Ao ser constatada a evolução da afecção, a terapia farmacológica deve ser reestabelecida (TIELSCH; SOMMER; KATZ, 1991; EGS, 2008; GIAMPANI et al., 2009; CG85, 2009; AAOGP, 2010).
23
CONSIDERAÇÕES FINAIS
O GPAA é o tipo de glaucoma mais comum que existe, com diagnóstico através da PIO maior que 21 mmHg associado ao defeito no nervo óptico ou a imperfeição do campo visual, sem cura, mas possui controle através de fármacos e intervenções cirúrgicas. Este glaucoma possui diversos fatores de risco, dentre eles a idade e o histórico familiar. Sua terapia pode ocasionar ameaça da qualidade de vida do paciente, tanto psicológica quanto financeira.
O tartarato de brimonidina é um fármaco agonista alfa-adrenérgico, que possui dois mecanismos de ação, um é atuando por meio da diminuição da síntese do humor aquoso e o outro, é elevando a drenagem pela via do escoamento uveoescleral. A terapia farmacológica (brimonidina) e a intervenção cirúrgica são eficientes no controle do GPAA, mas se por ventura o tratamento farmacológico não surtir efeito, é recomendada a cirurgia antiglaucomatosa, ou seja, a trabeculectomia.
Dentre as demais classes de fármacos que fazem parte da terapêutica farmacológica do GPAA, os inibidores da anidrase carbônica são os únicos que possuem restrições de associação. As outras classes podem ter associação de seus fármacos, sem interações medicamentosas.
Os medicamentos utilizados na terapêutica do GPAA, são indicados de acordo com a eficácia obtida no paciente, levando em consideração interações medicamentosas, intolerâncias e hipersensibilidades a componentes da fórmula. Tanto o tratamento farmacológico quanto o cirúrgico são paliativos, pois controlam a patologia, mas não curam. Dentre os tratamentos no geral, o mais eficaz e com maior duração é o cirúrgico, ou seja, a trabeculectomia seguida da esclerectomia.
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