Critérios para ajuste posológico de medicamentos anti-hipertensivos e antihiperglicemiantes em indivíduos com insuficiência renal
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Data
2021-12-17
Autores
Yokoo, Beatriz Aparecida Cabral
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Universidade Estadual Paulista (Unesp)
Resumo
O declínio na função renal é caracterizado pela diminuição da capacidade dos rins em realizar de maneira eficaz a filtração dos produtos finais do metabolismo de biomoléculas e xenobióticos, sais e líquidos do sangue. Consequentemente, níveis tóxicos de diversos metabólitos podem ser alcançados. A diminuição da função renal é comum em pacientes hospitalizados; logo, necessitam de cuidados intensivos. Assim sendo, faz-se necessária a avaliação constante de biomarcadores laboratoriais relacionados à função renal, incluindo os níveis séricos de creatinina e ureia e o clearance da creatinina. Analisando o Manual do Farmacêutico de 2021/2022 da Fundação Osvaldo Cruz, observamos mais de 200 medicamentos que possuem indicação de diminuição da dose usual e/ou de aumento no intervalo de administração e/ou que devem ser suspensos no caso de pacientes com insuficiência renal, medicamentos estes que em sua maioria são eliminados através da urina principalmente após filtração glomerular. O farmacêutico exerce um papel fundamental na promoção da saúde, contribuindo na identificação de problemas relacionados ao uso de medicamentos e na otimização do regime posológico de indivíduos mediante diversas condições, incluindo insuficiência renal. Este trabalho de conclusão de curso de graduação revisou a literatura disponível na busca por evidências que possam auxiliar na tomada de decisão do ajuste posológico dos medicamentos mais utilizados pelos pacientes, incluindo os antihiperglicemiantes e os anti-hipertensivos, assim como buscou avaliar se os manuais farmacêuticos de duas instituições, como um aplicativo médico, são úteis para auxiliar nesta função do farmacêutico.
The decline in the renal function is characterized by a decrease in the ability of the kidneys to effectively filter out the metabolismo end products of biomolecules and xenobiotics, salts and blood fluids. As a consequece, toxic levels of several metabolites can be reached. Decreased kidney function is common in hospitalized patients; therefore, they need intensive care. Therefore, it is necessary to constantly evaluate the laboratory biomarkers related to the renal function, including the serum levels of creatinine and urea and the creatinine clearance. Analyzing the Osvaldo Cruz Foundation's 2021/2022 Pharmacist Manual, it can be observed more than 200 drugs that have indication for a decrease in the usual dose and/or an increase in the administration interval and/or that should be discontinued in the case of patients with renal failure, these drugs are mostly eliminated through the urine, mainly after glomerular filtration. The pharmacist plays a key role in the health promotion, by reviewing the pharmacotherapeutic profile in an atempt to identify problems related to the use of medications, evaluating the adequacy of the therapeutic regimen and monitoring laboratory biomarkers, in order to obtain parameters that allow the adjustment and/or optimization of the dosage regimen of individuals under various conditions, including renal failure. This graduation course conclusion work reviewed the available literature in the search of evidence that can help in decision making about the dose adjustment of the drugs most used by patients, including antihyperglycemic and antihypertensive drugs, as well as seeking to assess whether the pharmaceutical manuals of two institutions, such as a medical app, are useful to assist in this role of the pharmacist.
The decline in the renal function is characterized by a decrease in the ability of the kidneys to effectively filter out the metabolismo end products of biomolecules and xenobiotics, salts and blood fluids. As a consequece, toxic levels of several metabolites can be reached. Decreased kidney function is common in hospitalized patients; therefore, they need intensive care. Therefore, it is necessary to constantly evaluate the laboratory biomarkers related to the renal function, including the serum levels of creatinine and urea and the creatinine clearance. Analyzing the Osvaldo Cruz Foundation's 2021/2022 Pharmacist Manual, it can be observed more than 200 drugs that have indication for a decrease in the usual dose and/or an increase in the administration interval and/or that should be discontinued in the case of patients with renal failure, these drugs are mostly eliminated through the urine, mainly after glomerular filtration. The pharmacist plays a key role in the health promotion, by reviewing the pharmacotherapeutic profile in an atempt to identify problems related to the use of medications, evaluating the adequacy of the therapeutic regimen and monitoring laboratory biomarkers, in order to obtain parameters that allow the adjustment and/or optimization of the dosage regimen of individuals under various conditions, including renal failure. This graduation course conclusion work reviewed the available literature in the search of evidence that can help in decision making about the dose adjustment of the drugs most used by patients, including antihyperglycemic and antihypertensive drugs, as well as seeking to assess whether the pharmaceutical manuals of two institutions, such as a medical app, are useful to assist in this role of the pharmacist.
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Palavras-chave
insuficiência renal, ajuste posológico, farmacocinética, diabetes mellitus, hipertensão, renal failure, dose adjustment, pharmacokinetics,, hypertension