Diabetes as a risk factor of acute kidney injury in vancomycin users: an observational and prospective study

Diabetes was investigated as a risk factor for nephrotoxicity induced by vancomycin. In the present study, the drug's nephrotoxic effect was indirectly evaluated by Glomerular Filtration Rate, albuminuria and serum levels of creatinine and urea on the 1st, 7th and 14th days of vancomicyn therapy in a group of diabetic and non-diabetic patients, with and without previous nephropathy. The correlations between investigated variables (including the population's epidemiological profile and hospital care) were measured by the Spearman test. The sample consisted of 132 patients, predominantly male diabetic patients with previous nephropathy, over 40 years, receiving ≥ 10 grams of vancomycin for the treatment of infectious diseases and showing satisfactory clinical outcomes. A risk of vancomycin drug interaction with potential nephrotoxic outcome was observed in 36.4% of patients who used multiple drugs. Furthermore, 80% of patients had an increase of at least 0.5 mg.dL-1 in baseline serum levels of creatinine and urea at the end of the study. This was more common among the diabetic patients with previous nephropathy, showing higher albuminuria and a reduction in the Glomerular Filtration Rate. Therefore, it has been recommended that the use of vancomycin in diabetic patients should be in careful dosages and that kidney functioning be monitored.

Crisis sintomáticas agudas y epilepsia en niños y adolescentes en época de COVID-19 / Acute symptomatic crisis and epilepsy in children and adolescents in times of COVID-19

Objetivo: Describir los aspectos de mayor relevancia en niños y adolescentes con crisis sintomáticas agudas o diagnóstico de epilepsia, en tiempo de pandemia de la COVID-19. Métodos: La información se obtuvo de las bases de datos PubMed/Medline, Scielo, y Clinical Key utilizando palabras clave incluidas en el Descriptor de Ciencias de la Salud en idioma inglés o español, sin límite de tiempo, y todo tipo de publicación; se seleccionaron los artículos relacionados con epilepsia, crisis epilépticas, y COVID-19. Resultados: En la literatura se justifica la ocurrencia de crisis epilépticas por varias causas en enfermos con la COVID-19 y se insiste en la conducta terapéutica y la necesidad de vigilancia de las interacciones farmacológicas entre los medicamentos indicados para la prevención de recurrencia de las crisis epilépticas y los específicos para esta nueva enfermedad. Basado en estos criterios, presentamos una propuesta para la conducta a seguir en cada situación. Consideraciones finales: Esta comprobada la posibilidad de que ocurran complicaciones neurológicas en pacientes con la COVID-19 y específicamente en las crisis epilépticas y la epilepsia. El uso de interferón y lopinavir/ritonavir, en caso de estar indicado en los protocolos de actuación, y el mantenimiento del tratamiento previo con los medicamentos para prevenir la recurrencia de crisis en los epilépticos, considerando las posibles interacciones y la vigilancia requerida en cada caso, parece ser la mejor opción en la mayoría de los niños y adolescentes con COVID-19(AU)

Objective: To describe the most outstanding aspects in children and adolescents with acute symptomatic crisis or diagnosis of epilepsy in times of the COVID-19 pandemic. Methods: The information was collected in PubMed/Medline, Scielo and Clinical Key databases using the keywords included in the Descriptor of Health Sciences in English or Spanish language, with not time limit, and looking for all kind of publications. There were selected articles related to epilepsy, epileptic seizures and COVID-19. Results: In the consulted literature, it was justified the occurrence of epileptic seizures due to different causes in patients with COVID-19 and it is highlighted the therapeutic behaviour and the need of surveillance of the pharmacologic interactions among the drugs indicated for the prevention of epileptic seizures and the specific of this new disease. Based in these precepts, we present a final proposal for the behaviour to follow in each situation. Final considerations: It is proved the possibility of neurologic complications in patients with COVID-19 and specifically in the epileptic seizures and epilepsy. The use of interferon and lopinavir/ritonavir, in case of being indicated in the action protocols, and to keep the previous treatment with the drugs to prevent the recurrence of crisis in epileptic patients considering the possible interactions and the required surveillance in each case, seems to be the best option in most of the children and adolescents with COVID-19(AU)

Reacciones adversas causadas por quimioprofilaxis con doxiciclina / Adverse reactions caused by chemoprophylaxis with doxicicline

Se realizó un estudio descriptivo y prospectivo de 86 trabajadores del Puerto Guillermón Moncada de Santiago de Cuba, quienes recibieron tratamiento quimioprofiláctico con doxiciclina y presentaron reacciones adversas asociadas a dicho tratamiento, en noviembre del 2015, con vistas a caracterizarles y determinar la relación de causalidad existente entre la administración del medicamento, la aparición de efectos indeseables y las posibles interacciones farmacológicas. En esta serie, las reacciones adversas resultaron leves y no graves; las relaciones de causalidad, definitivas en la mayoría de los afectados (65,1 por ciento), aunque se determinaron algunas como probables y posibles, en tanto, las reacciones más frecuentes se presentaron en la esfera gastrointestinal

A descriptive and prospective study of 86 workers from Guillermón Moncada Port was carried out in Santiago de Cuba. They received chemoprophylactic treatment with doxicicline and presented adverse reactions associated with this treatment, in November, 2015, aimed at characterizing them and determining the relationship of causation existing between the administration of medication, emergence of undesirable effects and possible pharmacological interactions. In this series, the adverse reactions were light and no severe; the causation relationships, were definitive in most of the affected patients (65.1 percent), although some were determined as probable and possible, while, the most frequent reactions were presented in the gastrointestinal sphere

Detecção e avaliação das interações medicamentosas potencialmente prejudiciais em idosos: projeto Bambuí / Detection and evaluation of interactions for potentially harmful drug Elderly: Bambuí Project

O presente trabalho teve como objetivo determinar a prevalência e os fatores associados a interações medicamentosas potencialmente prejudiciais (IMPPs) entre idosos (60 + anos de idade) residentes na cidade de Bambuí, bem como identificar os princípios ativos mais frequentemente envolvidos nesses eventos e caracterizar essas interações quanto à gravidade. Participaram do estudo 1.132 idosos que utilizaram dois ou mais medicamentos simultaneamente. Esses participantes eram predominantemente do sexo feminino (68,6%), com idade entre 60-69 anos (54,8%),e 84,2% apresentavam pelo menos uma das doenças crônicas pesquisadas. Foram consumidos em média 4,2 medicamentos por participantes, e a prevalência do uso de cinco ou mais fármacos foi de 36,1%. A prevalência de IMPPs foi de 11,9%, das quais 13,2% foram classificadas como maiores e 66,5% moderadas...

Os medicamentos mais frequentemente envolvidos em IMPPs foram diclofenaco(10,2%) e efedrina (9,8%) e a associação mais comum foi a de teofilina + efedrina(18,2%). As classes terapêuticas com atuação sobre o aparelho cardiovascular(36,8%) e sistema músculo esquelético (27,8%) foram as mais frequentes. A ocorrência de IMPPs foi mais frequente entre os usuários de polifarmácia, entre aqueles submetidos à hospitalização e a um maior número de consultas médicas,mas somente a polifarmácia permaneceu independentemente associada ao evento(OR= 4,49; IC 95% 2,93- 6,87). Na análise multivariada, as chances de exposição ao risco de IMPPs foram menores entre aqueles que apresentavam uma ou duas das condições crônicas investigadas, em comparação àqueles livres delas. O estudo constitui uma importante contribuição para a melhoria da qualidade de prescrição,integrando os esforços despendidos para reforçar as ações de farmacovigilância,especialmente na população idosa, em que os riscos no uso de medicamentos são agravados pela própria fisiologia do envelhecimento. Além disso, vem ajudar a preencher a carência de produção científica sobre o tema em populações idosas residentes em comunidade, em um cenário distinto do serviço de saúde,especialmente o hospitalar...

Detecção e avaliação das interações medicamentosas potencialmente prejudiciais em idosos: projeto Bambuí

O presente trabalho teve como objetivo determinar a prevalência e os fatores associados a interações medicamentosas potencialmente prejudiciais (IMPPs) entre idosos (60 + anos de idade) residentes na cidade de Bambuí, bem como identificar os princípios ativos mais frequentemente envolvidos nesses eventos e caracterizar essas interações quanto à gravidade. Participaram do estudo 1.132 idosos que utilizaram dois ou mais medicamentos simultaneamente. Esses participantes eram predominantemente do sexo feminino (68,6%), com idade entre 60-69 anos (54,8%),e 84,2% apresentavam pelo menos uma das doenças crônicas pesquisadas. Foram consumidos em média 4,2 medicamentos por participantes, e a prevalência do uso de cinco ou mais fármacos foi de 36,1%. A prevalência de IMPPs foi de 11,9%, das quais 13,2% foram classificadas como maiores e 66,5% moderadas.

Os medicamentos mais frequentemente envolvidos em IMPPs foram diclofenaco(10,2%) e efedrina (9,8%) e a associação mais comum foi a de teofilina + efedrina(18,2%). As classes terapêuticas com atuação sobre o aparelho cardiovascular(36,8%) e sistema músculo esquelético (27,8%) foram as mais frequentes. A ocorrência de IMPPs foi mais frequente entre os usuários de polifarmácia, entre aqueles submetidos à hospitalização e a um maior número de consultas médicas,mas somente a polifarmácia permaneceu independentemente associada ao evento(OR= 4,49; IC 95% 2,93- 6,87). Na análise multivariada, as chances de exposição ao risco de IMPPs foram menores entre aqueles que apresentavam uma ou duas das condições crônicas investigadas, em comparação àqueles livres delas. O estudo constitui uma importante contribuição para a melhoria da qualidade de prescrição,integrando os esforços despendidos para reforçar as ações de farmacovigilância,especialmente na população idosa, em que os riscos no uso de medicamentos são agravados pela própria fisiologia do envelhecimento. Além disso, vem ajudar a preencher a carência de produção científica sobre o tema em populações idosas residentes em comunidade, em um cenário distinto do serviço de saúde,especialmente o hospitalar.

Interações medicamentaosas: definições e mecanismos / Drug interactions: definitions and mechanisms

Com mudanças na expectativa de vida, comorbidades edisponibilidade de novos fármacos, aumentou a ocorrênciade interações medicamentosas por mecanismos farmacocinéticose farmacodinâmicos. Para a biotransformação dosmedicamentos, os organismos desenvolveram sistemas enzimáticoscapazes de metabolizar e excretar esses produtos.Os polimorfismos genéticos dessas enzimas condicionamsua eficiência em metabolizar determinados medicamentos.A conjugação com moléculas solúveis em água, adicionadasao medicamento, facilitam sua excreção. Os transportadoresdesempenham importante papel no influxo, efluxo e na excreçãode medicamentos através dos sistemas biliar e urinário.O tratamento de doenças cardiovasculares frequentementeenvolve uso de múltiplos fármacos, principalmente nos pacientesidosos e portadores de comorbidades. Nesse sentido, éimportante o conhecimento dessas interações medicamentosas,frequentemente responsáveis pelos insucessos terapêuticos epela ocorrência de efeitos adversos...

With changes in life expectancy, co-morbidities and theavailability of new drugs, the occurrence of drug interactionsby pharmacokinetic and pharmacodynamic mechanisms hasincreased. For the bio-transformations of medications theorganisms have developed enzymatic systems able to metabolizeand excrete these products. The genetic polymorphisms ofthese enzymes affect their efficiency in metabolizing certaindrugs. The combination with water-soluble molecules addedto the medication facilitates the excretion. Transporters playan important role in the inflow, outflow and the excretion ofmedications through the biliary and urinary systems. Thetreatment of cardiovascular diseases often involves the useof multiple drugs especially in elderly patients and patientswith co-morbidities. In this sense, it is very important theknowledge about these drugs interactions which are oftenresponsible for the therapeutic failure and for the occurrenceof adverse effects...

Gender differences, polypharmacy, and potential pharmacological interactions in the elderly

OBJECTIVE: This study aims to analyze pharmacological interactions among drugs taken by elderly patients and their age and gender differences in a population from Porto Alegre, Brazil. METHODS: We retrospectively analyzed the database provided by the Institute of Geriatric and Gerontology, Porto Alegre, Brazil. The database was composed of 438 elderly and includes information about the patients' disease, therapy regimens, utilized drugs. All drugs reported by the elderly patients were classified using the Anatomical Therapeutic and Chemical Classification System. The drug-drug interactions and their severity were assessed using the Micromedex® Healthcare Series. RESULTS: Of the 438 elderly patients in the data base, 376 (85.8 percent) used pharmacotherapy, 274 were female, and 90.4 percent of females used drugs. The average number of drugs used by each individual younger than 80 years was 3.2±2.6. Women younger than 80 years old used more drugs than men in the same age group whereas men older than 80 years increased their use of drugs in relation to other age groups. Therefore, 32.6 percent of men and 49.2 percent of women described at least one interaction, and 8.1 percent of men and 10.6 percent of women described four or more potential drug-drug interactions. Two-thirds of drug-drug interactions were moderate in both genders, and most of them involved angiotensin-converting enzyme inhibitor, non-steroidal anti-inflammatory, loop and thiazide diuretics, and β-blockers. CONCLUSION: Elderly patients should be closely monitored, based on drug class, gender, age group and nutritional status.

Hipertensión arterial resistente: [revisión] / Resistant hypertension: [review]

Resistant hypertension, defined as a persistent blood pressure over 140/90 mmHg despite the use of three antihypertensive drugs including a diuretic, is unusual. The diagnosis requires ruling out initially pseudoresistance and a lack of compliance with treatment. Ambulatory blood pressure recording allow the recognition of white coat hypertension. When there is a clinical or laboratory suspicion, secondary causes of hypertension should be discarded. Excessive salt intake, the presence of concomitant diseases such as diabetes mellitus, chronic renal disease, obesity, and psychiatric conditions such as panic attacks, anxiety and depression, should also be sought. The presence of target organ damage requires a more aggressive treatment of hypertension. Recent clinical studies indicate that the administration of aldosterone antagonists as a fourth therapeutic line provides significant additional blood pressure reduction, when added to previous antihypertensive regimens in subjects with resistant hypertension. The possible blood pressure lowering effects of prolonged electrical activation of carotid baroreceptors is under investigation.

Agonistic-like responses from the torus semicircularis dorsalis elicited by GABA A blockade in the weakly electric fish Gymnotus carapo

Findings by our group have shown that the dorsolateral telencephalon of Gymnotus carapo sends efferents to the mesencephalic torus semicircularis dorsalis (TSd) and that presumably this connection is involved in the changes in electric organ discharge (EOD) and in skeletomotor responses observed following microinjections of GABA A antagonist bicuculline into this telencephalic region. Other studies have implicated the TSd or its mammalian homologue, the inferior colliculus, in defensive responses. In the present study, we explore the possible involvement of the TSd and of the GABA-ergic system in the modulation of the electric and skeletomotor displays. For this purpose, different doses of bicuculline (0.98, 0.49, 0.245, and 0.015 mM) and muscimol (15.35 mM) were microinjected (0.1 æL) in the TSd of the awake G. carapo. Microinjection of bicuculline induced dose-dependent interruptions of EOD and increased skeletomotor activity resembling defense displays. The effects of the two highest doses showed maximum values at 5 min (4.3 ± 2.7 and 3.8 ± 2.0 Hz, P < 0.05) and persisted until 10 min (11 ± 5.7 and 8.7 ± 5.2 Hz, P < 0.05). Microinjections of muscimol were ineffective. During the interruptions of EOD, the novelty response (increased frequency in response to sensory novelties) induced by an electric stimulus delivered by a pair of electrodes placed in the water of the experimental cuvette was reduced or abolished. These data suggest that the GABA-ergic mechanisms of the TSd inhibit the neural substrate of the defense reaction at this midbrain level.

A pharmacoepidemiologic study of drug interactions in a Brazilian teaching hospital / Um estudo farmacoepidemiológico de interações medicamentosas em um hospital universitário brasileiro

PURPOSE: Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital. METHODS: From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex® DrugReax® System. Patients'records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions. RESULTS: From the 1785 prescriptions examined, 1089 (61 percent) were from the male adult ward. Patients' average age was 52.7 years (SD = 18.9; range, 12-98). The median number of drugs in each prescription was 7 (range, 2-26). At least 1 drug-drug interactions was present in 887 (49.7 percent) prescriptions. Regarding the severity of the clinical result, the interactions were classified as minor (20; 2.3 percent), moderate (184; 20.7 percent), major (30; 3.4 percent), and undetermined because of an incidence of more than 1 interaction in a single patient (653; 73.6 percent). From the 30 patients with major interactions, 17 (56.7 percent) presented adverse drug reactions induced by exposure to a major drug-drug interaction. CONCLUSIONS: Patients did suffer adverse drug reactions from major drug-drug interactions. Many physicians may be unaware of drug-drug interactions. Education, computerized prescribing systems and drug information, collaborative drug selection, and pharmaceutical care are strongly encouraged for physicians and pharmacists.

INTRODUÇÃO: Embora as interações medicamentosas constituam uma pequena parcela das reações adversas a medicamentos, elas geralmente são previsíveis e às vezes podem ser evitadas. As prevalências de interações medicamentosas em hospitais são escassas no Brasil. OBJETIVO: Avaliar a prevalência de interações medicamentosas em prescrições hospitalares e seu significado clínico em pacientes de um hospital universitário brasileiro. MÉTODOS: Uma amostra de 1785 prescrições de enfermaria de adultos foi coletada de um total de 11.250 aviadas no período de janeiro a abril de 2004. As interações medicamentosas foram identificadas pelo Micromedex. Prontuários de pacientes com interações medicamentosas graves foram examinados por um médico e uma farmacêutica a busca de resultados laboratoriais que confirmassem a ocorrência da interação medicamentosa. RESULTADOS: As prescrições eram de pacientes masculinos (1089; 61 por cento) em sua maioria. A idade média dos pacientes foi de 52,7 anos (DP=18,9; variação de 12 a 98 anos). Cada paciente recebeu em média 7 medicamentos (variando de 2 a 26). Ao menos 887 (49,7 por cento) das prescrições continham interação medicamentosa. As prescrições continham interação medicamentosa classificadas como leve (55; 3.1 por cento), moderada (421; 23.6 por cento) e grave (90; 5.0 por cento). Em 321 (17.9 por cento) prescrições foram encontradas mais de uma interação medicamentosa, cujo resultado clínico é desconhecido. Uma amostra de 33 prontuários com interações medicamentosas graves foram avaliadas, destes, 17 (51.5 por cento) apresentaram reações adversas a medicamentos induzida por uma interação medicamentosa grave. CONCLUSÃO: Um grande número de pacientes sofre reações adversas a medicamentos como resultado de interações medicamentosas graves. Acreditamos que a maioria dos médicos desconheça a ocorrência de interações medicamentosas. Educação continuada, sistema computadorizado para prescrição, seleção de medicamentos em parceria com farmacêuticos...

Effects of calcium, strontium, and barium on isolated phrenic nerve-diaphragm preparation of rat and their interactions with diltiazem and nifedipine.

Calcium (Ca2+), strontium (Sr2+), and barium (Ba2+) are expected to exert similar chemical and pharmacological effects. The effects of barium, strontium and calcium were studied on the contractions of rat phrenic nerve-diaphragm preparations, following electrical stimulation and their interactions with nifedipine (nif) and diltiazem (DZM) were also studied. Low doses of strontium chloride (SrCl2), barium chloride (BaCl2) and calcium chloride (CaCl2) were able to increase the force of contraction of the rat diaphragm when actively stimulated. Diltiazem inhibited the stimulant effects of Sr2+, Ba2+, and Ca2+. On the other hand, nifedipine blocked the effects of Sr2+ and Ca2+ but potentiated the effects of Ba2+. Strontium, barium, and calcium restored the contractility of the muscle following electrical stimulation when the tissue was in biological fluid absolutely depleted of calcium. These findings suggest that Sr2+ and Ba2+ may be able to substitute Ca2+ in the rat diaphragm for its contractions and nifedipine and diltiazem may follow different mechanisms of actions or channels in their blocking effects.

Epilepsia y anticonceptivos / Epilepsy and contraceptives

La epilepsia es una enfermedad neurológica que puede afectar a la mujer en edad fértil. Es conocido que las terapias anticonvulsivantes pueden disminuir la efectividad de los anticonceptivos hormonales. Los principales mecanismos son una mayor estimulación del sistema enzimático hepático de la citocromo P450 y el aumento de los niveles de la globulina transportadora de hormonas sexuales. Como consecuencia se produce una disminución de los niveles disponibles de los anticonceptivos hormonales, debiendo ajustar las dosis y en algunas oportunidades utilizar otros métodos.

The interaction of ryanoids with individual ryanodine receptor channels

Ryanodine binds with high affinity and specificity to a class of Ca2+-release channels known as ryanodine receptors (RyR). The interaction with RyR results in a dramatic alteration in function with open probability (Po) increasing markedly and rates of ion translocation modified. We have investigated the features of ryanodine that govern the interaction of the ligand with RyR and the mechanisms underlying the subsequent alterations in function by monitoring the effects of congeners and derivatives of ryanodine (ryanoids) on individual RyR2 channels. While the interaction of all tested ryanoids results in an increased Po, the amplitude of the modified conductance state depends upon the structure of the ryanoid. We propose that different rates of cation translocation observed in the various RyR-ryanoid complexes represent different conformations of the channel stabilized by specific conformers of the ligand. On the time scale of a single channel experiment ryanodine binds irreversibly to the channel. However, alterations in structure yield some ryanoids with dissociation rate constants orders of magnitude greater than ryanodine. The probability of occurrence of the RyR-ryanoid complex is sensitive to trans-membrane voltage, with the vast majority of the influence of potential arising from a voltage-driven alteration in the affinity of the ryanoid-binding site.

Pharmacological control of cough.

Cough constitutes an important medical problem in all ages. Although treatment of underlying pathologies, e.g., bronchial asthma, upper respiratory tract infection, etc. is well justified to cure cough, non-specific therapy in the form of a number of antitussive agents like, codeine, dextromethorphan, etc. is widely practiced to suppress it. Most of these agents are efficacious and well-tolerated. Nevertheless, CNS toxicities may occur in new-borns, especially those with immature metabolic profile. Some recent reports about interactions (involving hepatic cytochrome P450 enzymes) between dextromethorphan and other drugs are also noteworthy.

Interacción entre relajantes musculares y fármacos usados en anestesia intravenosa / Interaction between muscle relaxants and drugs used in intravenous anesthesia

Los fármacos usados en anestesia general intravenosa tienen estructura química muy diferente entre sí, y la interacción de los relajantes musculares con ellos no es la misma. El tiopental sódico, los opiáceos y el propofol no manifiestan interacción con los relajantes no despolarizantes o la succinilcolina, salvo condiciones especiales con esta última droga. Las benzodiazepinas pueden prolongar el bloqueo neuromuscular por galamina y aumentar la potencia del vecuronio (desvío de la curva dosis-respuesta a la izquierda), pero sin magnitud importante de la interacción, mientras pueden disminuir ligeramente la magnitud de las fasciculaciones musculares por succinilcolina. La ketamina puede prolongar tanto el bloqueo despolarizante como no despolarizante, sin afectar el potencial de membrana, aunque interfiere con las corrientes propias de los potenciales de acción de la sinapsis y músculo. A dosis menores aumenta la fuerza muscular en forma directa. La procaína administrada por infusión intravenosa es el fármaco de mayores interacciones con los relajantes musculares. Prolonga la duración de la succinilcolina por competencia enzimática, inhibe las fasciculaciones, no modifica los tiempos de presentación de la taquifilaxia y el bloqueo Fase II y III, pero disminuye las dosis acumuladas del relajante necesarias para dichos fenómenos. Su comportamiento en el bloqueo no despolarizante es variable dependiendo de cual sea el relajante. Disminuye la DE50 de la d-tubocurarina. Modifica las pendientes de las curvas dosis-respuesta a la d-tubocurarina y galamina inclinándolas a la izquierda. Demora la fase inicial de recuperación (Duración Clínica) de la galamina y pancuronio, así como su índice de Recuperación. También disminuye la actividad de la butirilcolinestarasa, más con el pancuronio que con los demás, y no tiene interacción alguna con el alcuronio. Las interacciones con los relajantes de duración intermedia o corta, si se presentan, son de menor magnitud.

Interacciones entre dopamina y glutamato en esquizofrenia / Interactions between dopamine and glutamate in schizophrenia

La hipótesis glutamatérgica de la esquizofrenia, que está recién en sus inicios, plantea que existe una alteración de la neurotransmisión glutamatérgica en esta enfermedad. La hipótesis se basa en los efectos psicoticomiméticos de la fenciclidina (PCF) y en las evidencias de actividad glutamatérgica anormal en pacientes esquizofrénicos. En este artículo se discute la posibilidad de que una deficiencia en la actividad de vías glutamatérgicas corticoestriatales pueda tener un papel fisiopatológico importante en la esquizofrenia. Se analizan las estrategias terapéuticas que se derivan de la hipótesis, como el empleo de agonistas glutamatérgicos y otros fármacos que pueden corregir la anormalidad planteada