Efectividad del tratamiento del dolor irruptivo oncológico con comprimido bucal de Fentalilo (CBF). Revisión bibliográfica de su farmacocinética, seguridad y empleo en situaciones clínicas especiales / Effectiveness of fentanyl buccal tablet for the treatment of breakthrough cancer pain. review on pharmacokinetics, safety and clinical use in special situations

Varios estudios han mostrado que la prevalencia del dolor irruptivo en pacientes oncológicos es elevada y que se trata de un problema no completamente resuelto. El tratamiento del dolor irruptivo oncológico (DIO) requiere un fármaco con características específicas siendo probablemente de elección fentanilo, que se presenta en diversas formulaciones. En este trabajo se ha realizado una revisión de los ensayos clínicos publicados sobre el comprimido bucal de fentanilo para valorar la evidencia disponible en relación a su efectividad en el tratamiento del dolor irruptivo oncológico y aspectos relacionados con su farmacocinética, seguridad y particularmente su empleo en condiciones especiales como la mucositis. La evidencia revisada muestra que el comprimido bucal de fentanilo es eficaz en términos de alivio del dolor en el tratamiento de los episodios de DIO, incluyendo los pacientes con mucositis. Se ha revisado también la bioequivalencia entre la administración bucal (entre la encía y la mejilla) y sublingual (bajo la lengua) del preparado)

Several studies have shown that the prevalence of breakthrough pain in cancer patients is high and it is a problem not fully solved. Treatment of breakthrough cancer pain requires a drug with specific characteristics and probably the most useful drug is fentanyl, that is available in several formulations. This paper presents a review of published clinical trials on fentanyl buccal tablet to assess the evidence available regarding its effectiveness in the treatment of breakthrough cancer pain, issues related to its pharmacokinetics, safety and its use in special conditions such as mucositis. Evidence shows that fentanyl buccal tablet is effective for relieving pain in the treatment of episodes in breakthrough pain, including patients with mucositis. The bioequivalence of buccal (between the gum and cheek) and sublingual (under the tongue) administration has been also reviewed

Synthesis of novel 6-enaminopurines.

Two different approaches have been used for the synthesis of 6-enaminopurines 6 from 5-amino-4-cyanoformimidoyl imidazoles. In the first approach imidazoles 1 were reacted with ethoxymethylenemalononitrile or ethoxymethylenecyanoacetate under mild experimental conditions and this led to 9-substituted-6-(1-amino-2,2-dicyanovinyl) purines 6a-f or 9-substituted-6-(1-amino-2-cyano-2-methoxycarbonylvinyl) purines 6g-k. These reactions are postulated to occur through an imidazo-pyrrolidine intermediate 7, which rapidly rearranges to the 6-enaminopurine 6. In the second approach 6-methoxyformimidoyl purines 3, prepared in two efficient steps from 5-amino-4-cyanoformimidoyl imidazoles 1, were reacted with malononitrile and methylcyanoacetate with a mild acid catalysis (ammonium acetate or piperidinium acetate) to give 6-enaminopurines 6a, 6d, 6f, 6g and 6k in very good yields. Only low yields were obtained for the 6-enaminopurine 6j, as competing nucleophilic attack on C-8 of either 3d or 6jcauses ring opening with formation of pyrimido-pyrimidines 11 and 10a respectively.

Necrolisis tóxica epidérmica / Toxic epidermal necrolysys

Se presenta una paciente portadora de necrolisis tóxica epidérmica provocada por la penicilina y que fue salvada en el hospital "Enrique Cabrera", de Altahabana. Se reportan como complicaciones: Simblefaron, conjuntivitis, forunculosis y sinequia vaginal. Se realiza breve revisión bibliográfica(AU)