Estudo de indicadores de prescrição, interações medicamentosas e classificação de risco ao feto em prescrições de gestantes da cidade de Mirassol - São Paulo. / Study of indicators of prescription, drug interactions and classification of risk to the fetus in pregnant requirements of the city of Mirassol - Sao Paulo

O uso racional de medicamentos é indispensável para garantir a qualidade e eficácia de um tratamento medicamentoso. Diante disto, a utilização de medicamentos durante a gestação deve ser analisada e acompanhada minuciosamente para minimizar os riscos e possíveis conseqüências ao feto e à gestante. Foram analisadas 100 receitas medicamentosas para gestantes, internadas no Hospital e Maternidade Mãe do Divino Amor na Providência de Deus do município de Mirassol, SP, utilizando os indicadores de prescrição propostos pela OMS, análise de interação medicamentosa por programas informatizados e pela literatura, classificação dos medicamentos encontrados segundo a classificação da segurança do fármaco durante a gravidez prescrita pelo Food and Drug Administration (FDA) a Relação Nacional de Medicamentos Essenciais (RENAME) e a Classificação Anatomical Therapeutic Chemical (ATC). Na análise dos indicadores de prescrição, nas 100 receitas avaliadas, encontrou-se a média de 2,6 medicamentos por prescrição; 21,5% de medicamentos prescritos pelo nome genérico; 40% delas contendo antibiótico; 59,4% com pelo menos um medicamento injetável e 58 % de medicamentos prescritos, presentes na Lista de Medicamentos Padronizados. Quanto à análise de interações medicamentosas, observa-se a prescrição do antibiótico cefalexina com o antiinflamatório cetoprofeno. Portanto, considerando-se os resultados obtidos no estudo e na revisão da literatura, sugere-se que as prescrições de medicamentos neste hospital para gestantes sejam melhor avaliadas segundo risco benefício, visando à minimização dos efeitos adversos desnecessários, tanto maternos como fetais.

The racional usage of medicines is indispensable to warrant the quality and efficacy of a medical treatment. Considering this, the use of remedies during pregnancy must be examined and followed in details to minimize the risks to the fetus and to the pregnant. A hundred of prescriptions to pregnant women interned at the Hospital Mãe do Divino Amor na Providência de Deus, in Mirassol city, São Paulo State, were analysed and compared with the prescription index designated by the WHO (World Health Organization). This work shows too the analysis of medicines interaction by softwares and literature and the classification of remedies by FDA (Food and Drug Administration) risk to the fetus, Rename (National List of Essential Medicines) and ATC (Anatomical Therapeutic Chemical). In one hundred of prescriptions analysed, there is a average of 2,6 medicines per precept, 21,5% of remedies prescribed by the generic name, 40% of indications of antibiotics, 59,4% of instructions with at least one medicine ministered by injection and 58 % of substances quoted in Remune (Municipal List of Essential Medicines). There was find only one interaction between the medicines: an antibiotic that belongs to the group of celafosporin and non-steroidal antiinflamatory. Thus, considering the results of the study and literature review, is suggested that the prescription of drugs in this hospital to betaken by the pregnantes be better assessed for risks and benefits, to minimize unnecessaru harm to the mother and the fetus.

Correlation between arterial oxygen and carbon dioxide levels and response to almitrine bismesylate in normal dogs

The objectives of this study were: 1) to test the action of small doses of almitrine bismesylate (0.004 mg/Kg body weight/min) on the arterial blood gases and on pulmonary and systemic circulation during hypoventilation under controlled mechanical ventilation; and 2) to investigate possible correlations between arterial blood. O2 and CO3 levels and the response to the drug. Twenty one dogs divided into two groups were studied under controlled ventilation in a double-blind fashion: hypoventilation + placebo (HP) (seven dogs); hypoventilation + almitrine (HA) (fourteen dogs). The results showed no significant variations of the gas ex-change and hemodynamic varibles in the HP group. In the HP group, during almitrine bismesylate infusion, despite the lack of variation in the pulmonary ventilation, the PaO2 increased from 46.1 torr to 51.7 torr, the PaCO2 decreased from 61.9 torr to 57.7 torr. There were no significant variations of hemodynamic variables in the HA group. Thus we conclude that the drug improved arterial blood gases (PaO2 increased) with small increase in alveolar ventilation (PaCO2 decreased) despite the lack of changes in pulmonary ventilation, and that the drug has action on the arterial PO2 potentiated by hypoxemia and hypercapnia

Gas exchange during differential mechanical ventilation after unilateral lung injury induced by hydrochloric acid: experimental study in dogs

In order to test gas exchange in lungs with unilateral injury, when mechanical ventilation is needed, three groups (G-I, G-II, G-III) of seven dogs each were studied. Injury was induced in the left lung by injecting 0,lN, 1.0 ml per kg of body weight of hydrochloric acid, pH = 2.00. For groups I and II a conventional volumetric artificial ventilator was used. G-I was the control group. In group II a bilateral positive end-expiratory pressure (PEEP) was introduced during the last phase (phase 3) of the experiment, and in group III, a prototype of a volume cycled ventilator, with separated bellows, was used delivering tidal volumes separately to each lung through a Carlens' tube. In G-III, PEEP was introduced only to the injured lung in the last phase of the experiment. Phase l (Fl), basal phase, was similar in the three groups; phase 2 (F2) was the period after instillation of hydrochloric acid and phase 3 was the period after a 5 cmH2O bilateral PEEP was used in G-II, and a selective PEEP to the left lung was used in G-III. In each phase of the experiment, hemodynamic and gas exchange variables were obtained. Our results allowed the following conclusions: the differential lung ventilation technique maintained the alveolar ventilation of the dogs and the differential lung ventilation with unilateral PEEP was better for gas exchange (phase 3) than the conventional ventilation with bilateral PEEP (CPPB).