Pharmaceutical services in primary health care: dissatisfaction among users, managers and pharmacists

Abstract To assess the performance indicators for pharmaceutical services (PS) in primary health care (PHC), the level of satisfaction with pharmacy services among users and managers / pharmacists' impressions in relation to the findings were evaluated. The study used mixed methods, including a retrospective and descriptive study of the performance indicators for PS in PHC, an observational study on the level of satisfaction and a qualitative study of users' perception of pharmacy services at Health Units. Managers and pharmacists' impressions of the study results were also collected. Only 44.4% of pharmacies had a full-time pharmacist. From the establishments visited, 5.3% did not have an air-conditioned environment, and only 33.3% of the items essential to the Good Practices of Storage of Medicines and Supplies criteria were fulfilled. Although 77.9% of the prescribed medicines were dispensed, it did not reach the 80% standard. The satisfaction level of users was 3.2±0.6, indicating dissatisfaction with pharmacies' services. By means of an evaluation of each item within the questionnaire, it was possible to observe that variables related to pharmaceutical care presented low scores in relation to other domains, thus evidencing the fragility of the pharmaceutical- patient relationship in users' perception. Managers and pharmacists suggested that these results were related to the inadequate physical infrastructure of pharmacies, work overload, lack of recognition and undervaluation of pharmacists, lack of interaction within the PHC team, high turnover of pharmacists, and lack of PS prioritization by the administration. PS in PHC has structural and organizational weaknesses that require changes. In general, users are dissatisfied with pharmacies' services, especially with pharmaceutical care.

Long-acting insulin in a public health system: analysis of compliance with clinical protocol in public pharmacies / Insulina de ação prolongada no sistema público de saúde: análise da adesão ao protocolo clínico em farmácias públicas

Abstract Diabetes mellitus (DM) is a chronic disease marked by elevated blood glucose levels. Controlling DM involves adequate diet, physical exercises, medicines and monitoring the blood glucose and glycated hemoglobin (HbA1c) levels. This was a retrospective study of the process of dispensing long-acting insulin analogues to users with diabetes (types 1 and 2) who were registered at high-cost public pharmacies in public health system in a southeast state of Brazil, that sought to evaluate the fulfillment of the criteria of all the clinical protocol to provide these analogs. Of the 987 users registered in the health service, 315 met the inclusion criteria for the study. The evaluation of the dispensing processes of the long-acting insulin analogues revealed that the inclusion, exclusion, and suspension criteria of the protocol related with these insulin analogues were in some extend only partially fulfilled. Additionally, there was no difference between the initial and final fasting glycemic and HbA1c levels. It is concluded that the established criteria for dispensing long-acting insulin analogues were partly fulfilled by pharmacies, compromising the rational use of these analogues. It can directly impact the cost of maintaining the public health service and users' health.

Resumo Diabetes mellitus (DM) é uma doença crônica marcada por níveis sanguíneos elevados de glicose. O controle do DM envolve dieta adequada, exercícios físicos, medicamentos e monitoramento dos níveis sanguíneos de glicose e de hemoglobina glicada (HbA1c). Trata-se de um estudo retrospectivo do processo de dispensação de análogos de insulina de ação prolongada a usuários com diabetes (tipos 1 e 2) cadastrados em farmácias públicas de alto custo do sistema público de saúde de um estado do Sudeste do Brasil, que buscou avaliar o cumprimento dos critérios do protocolo clínico para fornecimento desses análogos. Dos 987 usuários cadastrados no serviço de saúde, 315 preencheram os critérios de inclusão. A avaliação dos processos de dispensação dos análogos de insulina de ação prolongada revelou que os critérios de inclusão, exclusão e suspensão do protocolo dos análogos de insulina eram parcialmente cumpridos. Além disso, não houve diferença entre os níveis inicial e final de glicemia em jejum e HbA1c. Conclui-se que os critérios estabelecidos para dispensação de análogos de insulina de ação prolongada foram parcialmente cumpridos pelas farmácias, comprometendo o uso racional dos análogos. Os achados podem impactar diretamente no custo de manutenção do serviço público de saúde e na saúde do usuário.

Nephroprotective activity of the enriched polyphenol extract of Euterpe edulis Martius

Contrast-induced nephropathy (NIC) is directly related to increased morbidity and mortality, and its treatment and prevention might be achieved by the administration of antioxidant products. The juçara palmetto (Euterpe edulis Martius) has fruits rich in phenolic compounds, which are known for their antioxidant activity. This work aimed to evaluate the nephroprotective activity of E. edulis pulp in the NIC animal model. The collected fruits were pulped, their contents of polyphenols and anthocyanins were quantified, and their antioxidant activity were evaluated. The nephroprotective effects were determined based on iodine contrast induction and evaluated by biochemical and histological analyses. The results showed that E. edulis pulp was rich in polyphenols (811 ± 16.7 mg EAG/g) and anthocyanins (181.25 mg/100 g) and had very strong antioxidant activity, as demonstrated by the DPPH (2,2-diphenyl-1-picryl-hydrazyl) method, which revealed an antioxidant activity index (AAI) of 3.4, and the 2,29-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) method, which revealed an IC50 of 0.59 ± 0.03 mg/mL. In the in vivo experiments, E. edulis pulp tended to provide renal protection and reduce renal dysfunction and tubular morphological lesions in mice after the induction of NIC, and these effects were obtained through the antioxidant activities of the polyphenols in the pulp.

Finasteride promotes worsening of the cardiac deleterious effects of nandrolone decanoate and protects against genotoxic and cytotoxic damage

Metabolism of anabolic androgenic steroids is important for its physiological effects. The aim was to investigate the effects of finasteride (a 5α-reductase inhibitor - 5αR) on cardiac and mutagenic effects promoted by ND. Male Wistar rats were separated into three groups: CONT, received the vehicles of ND and finasteride (Peanut oil+Saline); DECA group, received ND (20 mg.kg.week-1, i.m.), and DECAF received ND and finasteride (100 µg.kg-1, i.p.), for four weeks. After, hypertrophy, cytokines and Angiotensin Converting Enzyme (ACE) activity was determined in heart. Bone marrow was used for micronucleus evaluation. Treatment with ND promotes increase in cardiac hypertrophy, ACE activity and disbalance among pro- and anti-inflammatory cytokines, and combination with finasteride worsened those effects. Association with finasteride ameliorates the toxic effects of ND on bone marrow cells, as was observed by a normalization of the number of micronucleate polychromatic erythrocytes and the mitotic index. Our data demonstrates that deleterious effects promoted by ND are depend, at least in part, of its metabolization. Also, inhibition of 5αR by finasteride present variated effects dependent on organ studied. It can promote increase on cardiac damage and a reduction on mutagenic effects of ND, which demonstrated that dehydronandrolone has diverse role on ND effects..

Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil / Satisfaction levels of users and verification of the knowledge of pharmacists in public pharmacies in the State of Espírito Santo, Brazil

Resumo O objetivo do presente estudo foi determinar o nível de satisfação dos usuários de farmácias públicas e verificar o conhecimento dos farmacêuticos com relação à dispensação de medicamentos. Trata-se de um estudo descritivo, realizado em municípios de uma mesma região, no interior do Estado do Espírito Santo, no período de maio a agosto de 2013. Os dados foram coletados por meio de questionário estruturado. Para a análise estatística, foi utilizado o Software SPSS20. Para os dados que apresentaram distribuição normal foram aplicados o teste t student ou ANOVA, enquanto que para os demais foram aplicados os testes Mann-Whitney ou Kruskal -Wallis. A correlação de Spearman foi utilizada para avaliar a satisfação do paciente em relação ao tempo de atendimento e ao tempo de espera. O nível de significância adotado para os testes foi de 5%. Os principais resultados obtidos foram o alto nível de insatisfação por parte dos usuários e a correlação com o tempo de espera até o atendimento. Além disso, o conhecimento dos farmacêuticos em relação à dispensação foi classificado como satisfatório/regular. Conclui-se que são necessárias medidas na gestão de serviços farmacêuticos para atender as expectativas dos usuários na dispensação de medicamentos.

Abstract The scope of this study was to determine the satisfaction levels of users of public pharmacies and verify the knowledge of pharmacists in relation to dispensing of medicines. This is a descriptive study, conducted in municipalities in the State of Espírito Santo, in the period from May to August 2013. Data were collected using a structured questionnaire and SPSS20 software was used for statistical analysis. The Student t or ANOVA test was used for data with normal distribution, while the Mann-Whitney or Kruskal-Wallis test was applied for data without normal distribution. The Spearman correlation was used to evaluate patient satisfaction with the service time and the waiting time. The significance level for the tests was 5%. The main results obtained were the high level of dissatisfaction among users and the correlation with the waiting time to be attended. Apart from this, the knowledge of pharmacists in relation to the medication dispensed was classified as satisfactory/regular. The conclusion drawn is that actions are necessary in the management of pharmaceutical service to address the expectations of users in the dispensation of drugs.

Level of satisfaction of clients of public pharmacies dispensing high-cost drugs in Espírito Santo, Brazil

ABSTRACT The aim of this study was to evaluate the level of satisfaction of pharmaceutical services and to determine the socioeconomic profile of public pharmacy clients. This is a cross-sectional observational study using a quantitative approach. The sample was calculated from the monthly number of patients seen in pharmacies and was stratified for each pharmacy. Data were analysed using SPSS 11.5 software and by observing the simple relative frequencies for qualitative variables. For the quantitative variables, the analysis of variance (ANOVA) and post-hoc Fisher tests were performed. Data are expressed as mean ± standard deviation (SD). The results show that, in general, patients at "Farmácias cidadãs" are satisfied with the services. However, when stratified, we found that the greatest satisfaction was related only to structural and organizational aspects, while the pharmaceutical services are unsatisfactory. When relating satisfaction to the socioeconomic characteristics, a difference between waiting time (39.07 ± 19.53), attendance by pharmacist (8.91 ± 5.14) and education was observed. It is concluded that users are satisfied with the services of state "Farmácias cidadãs" of Espírito Santo, but there should be improvements in relation to pharmaceutical services and the interpersonal relationships between health professionals and users of the public health system in Brazil.

RESUMO O objetivo do presente estudo foi avaliar o nível de satisfação dos serviços farmacêuticos e a determinação do perfil socioeconômico de clientes de farmácias públicas. Trata-se de um estudo observacional transversal com abordagem quantitativa. A amostra foi calculada através de dados da quantidade mensal de pacientes atendidos nas farmácias e estratificada para cada unidade do Estado. Os dados foram analisados por meio programa SPSS 11.5, observando-se as frequências relativas simples para as variáveis qualitativas. Para as variáveis quantitativas efetuaram-se análise de variância de uma via (ANOVA) e teste post-hoc de Fisher. Os dados foram expressos como a média ± desvio padrão (DP). Os resultados revelam que, em geral, os usuários atendidos nas farmácias cidadãs estão satisfeitos com os serviços, porém, quando estratificado por pergunta, avaliou-se que a maior satisfação está relacionada apenas aos aspectos estruturais e organizacionais e que o serviço farmacêutico é insatisfatório. Quando relacionada à satisfação com as características socioeconômicas, observou-se diferença entre tempo de espera (39.07 ± 19.53), de atendimento pelo farmacêutico (8.91 ± 5.14) e escolaridade. Conclui-se que os usuários estão satisfeitos com os serviços das farmácias cidadãs estaduais do Espírito Santo, porém deve haver melhora em relação ao atendimento farmacêutico e à relação interpessoal entre profissionais de saúde e usuários do sistema público de saúde brasileiro.

Hypotensive effect and endothelium-dependent vascular action of leaves of Alpinia purpurata (Vieill) K. Schum

The aims of this study were to evaluate the chemical profile, vascular reactivity, and acute hypotensive effect (AHE) of the ethanolic extract of leaves of Alpinia purpurata (Vieill) K. Schum (EEAP). Its chemical profile was evaluated using HPLC-UV, ICP-OES, and colorimetric quantification of total flavonoids and polyphenols. The vascular reactivity of the extract was determined using the mesenteric bed isolated from WKY. AHE dose-response curves were obtained for both EEAP and inorganic material isolated from AP (IAP) in WKY and SHR animals. Cytotoxic and mutagenic safety levels were determined by the micronucleus test. Rutin-like flavonoids were quantified in the EEAP (1.8 ± 0.03%), and the total flavonoid and polyphenol ratios were 4.1 ± 1.8% and 5.1 ± 0.3%, respectively. We observed that the vasodilation action of EEAP was partially mediated by nitric oxide (·NO). The IAP showed the presence of calcium (137.76 ± 4.08 μg mg-1). The EEAP and IAP showed an AHE in WKY and SHR animals. EEAP did not have cytotoxic effects or cause chromosomic alterations. The AHE shown by EEAP could result from its endothelium-dependent vascular action. Rutin-like flavonoids, among other polyphenols, could contribute to these biological activities, and the calcium present in EEAP could act in a synergistic way.

Os objetivos deste estudo foram avaliar o perfil químico de folhas de Alpinia purpurata K. Schum (AP), assim como a reatividade vascular e o efeito hipotensor agudo (EHA) do extrato etanólico de folhas de AP (EEAP). Avliou-se o perfil químico utilizando-se HPLC-UV, ICP-OES e quantificação colorimétrica de flavonoides e polifenóis totais. A reatividade vascular foi determinada utilizando leito mesentérico isolado de ratos WKY. Curvas dose-resposta do EEAP e do material inorgânico da AP (IAP) foram realizadas em animais SHR e WKY. Determinaram-se a segurança citotóxica e mutagênica pelo teste de micronúcleos. Flavonoides tipo rutina foram quantificados no EEAP (1,8±0,03%) e flavonoide total e polifenóis foram de 4,1±1,8% e 5,1±0,3%, respectivamente. Observou-se ação vasodilatadora do EEAP, mediada parcialmente pelo óxido nítrico (·NO). O IAP revelou a presença de cálcio (137,76±4.08 μg.mg-1 de Ca). O EEAP e IAP apresentaram EHA em animais WKY e SHR. Não se observaram efeitos citotóxicos e alterações cromossômicas provocadas pelo EEAP. O EEAP mostrou um EHA que poderia resultar de ação vascular dependente do endotélio. Rutina, entre outros polifenóis e flavonoides, poderia estar contribuindo para essas atividades biológicas e o cálcio presente no EEAP, poderia agir de maneira sinérgica.

Estudo comparativo entre hábitos vocais, sedentarismo e qualidade de vida em idosos frequentadores da unidade de saúde Vila Nova / Comparative study between vocal habits, sedentarism and quality of life in elderly frequent health unit Vila Nova

OBJETIVO:Verificar se as orientações sobre a saúde vocal e a prática de atividade física oferecem melhores formas de prevenção, retardando o envelhecimento vocal precoce e melhorando a qualidade de vida.MÉTODOS:Participaram deste estudo 30 idosos, de ambos os sexos, com faixa etária entre 60 e 83 anos, sendo 10 fisicamente ativos e 20 sedentários. Os idosos foram separados em três grupos, a saber: GSS: Grupo sedentário, sem orientação de saúde vocal; GSC: Grupo sedentário, com orientação de saúde vocal e GFAC: Grupo fisicamente ativo, com orientação de saúde vocal. Aplicaram-se dois questionários, um com questões do tipo fechadas e outro com questionário de qualidade de vida em voz (QVV).RESULTADOS:Os grupos sedentários apresentaram valores dos escores total do QVVmenores e uma porcentagem maior de problemas de saúde quando comparados com os fisicamenteativos, porém sem impactar na qualidade de vida.CONCLUSÃO:O estilo de vida saudável e a práticaregular de atividade física ajudam a reduzir a ocorrência de problemas de saúde, no entanto não houve diferença estatisticamente significante entre os grupos quanto à orientação sobre a saúde vocal, não se mostrando uma medida preventiva importante quando isolada. É possível que outros fatoresconcorram de forma mais significante para o retardo do envelhecimento vocal e melhoria na qualidade de vida, sendo necessárias mais pesquisas para identificá-los e colocá-los em prática.

OBJECTIVE:To assess whether vocal health guidance and physical activity offer better ways of preventing and slowing down early vocal aging and improving the overall quality of life.METHODS:A group of 30 elderly people, male and female, aged between 60 and 83 years, 10 physically active and 20 sedentary, were divided into three groups: GSS: sedentary without vocal health guidance; GSC: sedentary with vocal health guidance and GFAC: physically active with vocal health guidance. To each elderly person was applied two questionnaires, the first one was consisted of closed-type questionscreated by the researchers and the second one was the questionnaire of quality of life in voice (QVV).The data collected were analyzed and the results submitted to statistical analysis using the statisticalpackage GraphPad Prism version 4.0.RESULTS:The sedentary group presented smaller overall scores on the QVV and a larger percentage of health problems compared with physically active but without causing any impact on the quality of life.CONCLUSION:A healthy lifestyle and regular physical activity can help reduce the occurrence of health problems although there was no statistically significantdifference between the groups regarding vocal health guidance, therefore vocal health guidance didnot prove to be an important preventive measure when applied isolated. It is possible that other factorscontribute more significantly to the retardation of vocal aging and improvement in the overall quality oflife and more research is needed to identify them and put them into practice.

Scientific production in pharmaceutical care: comparison between Brazil, USA and Spain

The aim of this study was to estimate the evolution of the field of Pharmaceutical Care (PC) by measuring the quality and quantity of the scientific production on the topic of PC in Brazil compared to two pioneering countries in the field, the United States of America (USA) and Spain. The databases Web of Science, Scopus, Medline, Lilacs and SciELO were used as sources for the literature search. Pharmaceutical Care, or the appropriate translations, was used as the search term for the literature search, which was limited to articles published between 1990 and 2009. A score of quality (SQ) was calculated using variables such as impact factor and the frequency of the citations. We included 3265 articles published in 544 journals. We found that there was a steady increase in scientific production since 1990 and that the USA had a higher quality of scientific production than Spain, whereas the Spain produced the highest quantity of articles. In comparison, the Brazilian production of scientific publications on PC is low in terms of both quality and quantity but has increased steadily since 2002. Nevertheless, Brazil has not yet reached the level of the USA or Spain. In conclusion, Brazil's scientific production has evolved over the second decade studied in this work, with particularly high levels of production in the last five years. However, an increase in the quantity and quality of the publications should be encouraged.

O objetivo deste estudo foi estimar a evolução da área de atenção farmacêutica (AF) através da medição da qualidade e quantidade da produção científica na área de AF no Brasil, comparando-a com os países pioneiros no ramo: Estados Unidos da América (EUA) e Espanha. Os bancos de dados Web of Science, Scopus, Medline, Lilacs e SciELO foram usados como fontes para a pesquisa. AF ou as respectivas traduções foram usadas como descritor para a pesquisa bibliográfica sendo incluídos artigos publicados no período de 1990 a 2009. A pontuação da qualidade (PQ) foi calculada, utilizando variáveis como fator de impacto e frequência das citações. Foram cincluídos 3.265 artigos publicados em 544 revistas. Verificou-se um aumento constante na produção científica desde 1990 sendo que os EUA possuíam maior qualidade, enquanto a maior quantidade de artigos foi produzida na Espanha. Em comparação, a produção brasileira na AF é baixa em qualidade e quantidade, mas tem aumentado desde 2002. Apesar disso, o Brasil ainda não atingiu o nível dos EUA ou Espanha. Em conclusão, o Brasil apresentou expressiva evolução na última década com maior desenvolvimento nos últimos cinco anos. Entretanto, melhoria na quanitdade e qualidade das publicações deve ser incentivada.

Hepatitis C in prisoners and non-prisoners in Colatina, Espírito Santo, Brazil

The aim of the present work was to compare hepatitis C prevalence, genotypes, and risk factors between prisoners and non-prisoners in the city of Colatina, Espírito Santo, Brazil. This cross-sectional study involved approximately 1,600 residents and 730 prisoners, all of whom were living in Colatina. The percentage of individuals who tested positive for anti-HCV was 0.1% (2/1,600) in the non-prisoner group and 1.0% (7/730) in the prisoner group, confirming a higher risk of hepatitis C in the latter group. The percentage of subjects who progressed to HCV-RNA negative was 11.1% (1/9), confirming the high probability of evolution to chronicity. Genotype 1 was the most predominant genotype found. Factors associated with increased risk of hepatitis C were being male, being institutionalized, having an income of less than three minimum wages, having low educational attainment, and using injected drugs. Alcohol use, pain in the liver, migraine, and reported history of hepatitis were markedly associated with hepatitis C. The prison population tested positive for anti-HCV at a higher rate than the non-prison population.

O objetivo do presente trabalho foi comparar a prevalência, os genótipos e fatores de risco da hepatite C entre a população em geral e os presos na cidade de Colatina, Espírito Santo, Brasil. O presente estudo é transversal e comparou cerca de 1.600 moradores e 730 prisioneiros, todos eles vivendo em Colatina. A prevalência de anticorpos anti-HCV positivo foi de 0,1% (2/1.600), na população em geral, e de 1,0% (7/730) entre os presos, o que confirma o elevado risco nesse grupo. A percentagem de indivíduos que apresentam RNA-HCV negativo foi de 11,1% (1/9), confirmando a alta taxa de evolução para a cronicidade. O genótipo predominante foi o I. Fatores associados ao aumento do risco de hepatite C foram do sexo masculino, sendo institucionalizado, com renda de até três salários mínimos, baixa escolaridade e uso de drogas injetáveis. O uso de álcool, dor no fígado, enxaqueca e relato de histórias de hepatite apresentaram associação significativa com a hepatite C. A população carcerária teve maiores taxas de positividade para o anti-HCV do que a população não-prisional pesquisada.

In vivo hypotensive effect and in vitro inhibitory activity of some Cyperaceae species

In 1820, French naturalist August Saint Hillaire, during a visit in Espírito Santo (ES), a state in southeastern Brazil, reported a popular use of Cyperaceae species as antidote to snake bites. The plant may even have a hypotensive effect, though it was never properly researched. The in vitro inhibitory of the angiotensin converting enzyme (ACE) activity of eigth ethanolic extracts of Cyperaceae was evaluated by colorimetric assay. Total phenolic and flavonoids were determined using colorimetric assay. The hypotensive effect of the active specie (Rhychonospora exaltata, ERE) and the in vivo ACE assay was measured in vivo using male Wistar Kyoto (ERE, 0.01-100mg/kg), with acetylcholine (ACh) as positive control (5 µg/kg, i.v.). The evaluation of ACE in vivo inhibitory effect was performed comparing the mean arterial pressure before and after ERE (10 mg/kg) in animals which received injection of angiotensin I (ANG I; 0,03, 03 and 300 µg/kg, i.v.). Captopril (30 mg/kg) was used as positive control. Bulbostylis capillaris (86.89 ± 15.20%) and ERE (74.89 ± 11.95%, ERE) were considered active in the in vitro ACE inhibition assay, at 100 µg/mL concentration. ACh lead to a hypotensive effect before and after ERE's curve (-40±5% and -41±3%). ERE showed a dose-dependent hypotensive effect and a in vivo ACE inhibitory effect. Cyperaceae species showed an inhibitory activity of ACE, in vitro, as well as high content of total phenolic and flavonoids. ERE exhibited an inhibitory effect on both in vitro and in vivo ACE. The selection of species used in popular medicine as antidotes, along with the in vitro assay of ACE inhibition, might be a biomonitoring method for the screening of new medicinal plants with hypotensive properties.

Em 1820, o naturalista francês August Saint Hillaire, durante uma visita ao Espírito Santo (ES), Estado do sudeste do Brasil, relatou o uso popular de espécies de Cyperaceae como antídoto para picadas de cobra. As espécies podem possuir efeito hipotensor, embora nunca tenham sido devidamente pesquisadas. A inibição in vitro da atividade da enzima conversora da angiotensina (ECA) de oito extratos etanólicos de Cyperaceae foi avaliada por ensaio colorimétrico. Totais de fenólicos e flavonóides foram determinados utilizando ensaio colorimétrico. O efeito hipotensor da espécie ativa (Rhychonospora exaltata, ERE) no ensaio de ECA in vitro foi avaliada in vivo utilizando-se machos Wistar Kyoto (ERE, 0.01-100 mg/kg), com a acetilcolina (ACh), como controle positivo (5 µg/kg, iv). A avaliação do efeito inibidor da ECA in vivo foi realizado comparando-se a pressão arterial média, antes e após ERE (10 mg/kg) nos animais que receberam injeção de angiotensina I (Ang I, 0,03, 03 e 300 µg/kg, iv). Captopril (30 mg/kg) foi utilizado como controle positivo. Bulbostylis capillaris (86,89±15,20%) e ERE (74,89±11,95%, ERE) foram considerados ativas no ensaio de inibição da ECA in vitro, na concentração de 100 µg/mL. A ACh gerou um efeito hipotensor, antes e depois da curva de ERE (-40 ± 5% -41 ± 3%). ERE apresentou efeito hipotensivo dependente da dose e um efeito inibidor da ECA in vivo. As espécies de Cyperaceae mostraram uma atividade inibidora de ACE in vitro, bem como elevado conteúdo de substâncias fenólicas e flavonóides. ERE exibiu um efeito inibidor da ECA tanto in vitro como in vivo. A seleção das espécies utilizadas na medicina popular como antiofídicos, juntamente com o ensaio in vitro de inibição da ECA, pode ser um método de biomonitoramento para a seleção de novas plantas medicinais com propriedades hipotensores.