Fracionamento biomonitorado de fração isolada do extrato hexânico de Pterodon polygalaeoflorus

O gênero Pterodon compreende algumas espécies largamente distribuídas sobre a região central do Brasil. Seus frutos são comercialmente disponíveis no mercado da flora medicinal sendo amplamente utilizados pelas suas propriedades farmacológicas como antirreumático, anti-inflamatório e analgésicas. O objetivo deste trabalho foi biomonitorar o fracionamento do extrato hexânico de Pterodon polygalaeflorus Benth. (ExPpg), utilizando modelos de inflamação aguda (edema de pata e bolha de ar). O fracionamento/sub-fracionamento foi realizado por cromatografia em coluna de sílica e as amostras analisadas por cromatografia em camada fina e cromatografia gasosa acoplada a espectrômetro de massas. O edema de pata foi induzido em camundongos SW por injeção (s.c.) de carragenina. Uma hora antes da inoculação de carragenina os animais foram tratados v.o. com veículo (EtOH 15%, 1,25% Tween-20), indometacina (10 mg/kg p.c.) ou ExHPpg/frações/sub-frações de Ppg. No modelo bolha de ar, a cavidade foi desenvolvida em camundongos SW através da injeção de ar estéril (s.c.) no dorso e a inflamação induzida por carragenina. Uma hora antes de inocular a carragenina os animais foram tratados (v.o) com o veículo, indometacina (10 mg/kg) ou ExHPpg/Fr2Ppg/sub-frações. Após 4 h o exsudato da bolha foi coletado para contagem total e diferencial de leucócitos (Panótico rápido) e dosagem de proteínas (biureto), e a pele referente à bolha foi removida para análises macroscópica e histológica (HE). Também foi realizado estudo de migração de neutrófilos pelo ensaio do transwell. Após demonstração do efeito antiedematogênico do ExHPpg, este foi fracionado em quatro frações. A fração Fr2Ppg, mais ativa no modelo de edema de pata, também inibiu os diferentes parâmetros inflamatórios avaliados no modelo de bolha de ar, com a menor dose testada, e foi sub-fracionada em cinco sub-frações. Destas, as SF2.1 e SF2.2 foram as que mostraram melhor efeito anti-inflamatório pelo modelo da bolha de ar. Em relação ao grupo controle com carragenina, o ExHppg, Fr2Ppg, SF 2.1 e SF 2.2, na dose 0,02 mg/kg, exerceram inibições de 70,6%, 62,8%, 54,7% e 79% no número total de células no exsudato, reduções de 76,8%, 76,9%, 71,1% e 73,3% na concentração de proteína, respectivamente. Com a dose de 0,2 mg/kg, foram observadas inibições apenas para ExHPpg e SF 2.1, com intensidades menores, na leucometria total (62,9% e 48,62%, respectivamente), e na concentração de proteína para SF 2.1 e SF 2.2 (reduções de 68,2% e 30,4%, respectivamente). As análises macroscópica e histológica mostraram redução importante da vasodilatação e do infiltrado inflamatório pelo tratamento com o ExHppg, Fr2Ppg, SF 2.1 e SF 2.2. No ensaio de transwell a Fr2Ppg exibiu 31,4% de inibição na migração de neutrófilos. As sub-frações SF2.1 e SF2.2 foram avaliadas por GC-MS, identificando-se de diversos compostos majoritários. Em resumo, este trabalho confirma o potencial anti-inflamatório da espécie Pterodon polygalaeflorus e mostra um fracionamento efetivo do ExHPpg quanto à composição e ação anti-inflamatória.

Influência dos receptores opioides no efeito hipotensor arterial do propofol em humanos

O propofol é uma droga hipnótico-sedativa, amplamente utilizada em anestesiologia, devido à sua elevada eficácia hipnótica e ao seu despertar rápido e praticamente isento de efeitos residuais. A depressão cardiovascular, que é o efeito adverso mais importante e indesejável do propofol, parece estar intimamente relacionada à dose administrada, à velocidade de injeção do medicamento, à idade e ao estado físico dos pacientes, assim como, às condições de volemia e de reserva cardiovascular dos mesmos, podendo ser intensificada, ainda, pela associação de uma droga opioide ao propofol. A hipotensão arterial induzida pelo propofol parece possuir uma origem multifatorial, pois já foi evidenciada a participação de diversos sistemas nos efeitos produzidos pelo propofol, inclusive, a participação da via opioide no efeito antinociceptivo da droga. Portanto, o objetivo desse estudo foi investigar a participação dos receptores opioides no efeito hipotensor arterial do propofol. A pesquisa foi do tipo randomizada, transversal, aberta e comparativa. Foram estudados 40 pacientes estado físico ASA 1, submetidos a anestesia geral para cirurgias eletivas. Os desfechos avaliados neste estudo foram as pressões arteriais sistólica (PAS), diastólica (PAD) e média (PAM), a pressão venosa central (PVC) e a frequência cardíaca (FC). Portanto, após a monitorização contínua dos pacientes com cardioscopia com análise de ST, pressão arterial invasiva, pressão venosa central, oxicapnometria, análise eletroencefalográfica bispectral (BIS) e gasimetrias arteriais e venosas, estes foram divididos aleatoriamente através de programa de distribuição aleatória gerada por computador, de acordo com os 5 grupos existentes (n = 8 para todos os grupos). Foram 3 grupos de pacientes pré-medicados intravenosamente (iv) com naloxona 1 μg/Kg (PN1) ou 3 μg/Kg (PN3), ou com salina para controle (CP), 2 minutos antes da administração iv de propofol (2,5 mg/Kg). Outros 2 grupos controle da naloxona foram pré-medicados com naloxona 1 μg/Kg (CN1) ou 3 μg/Kg (CN3), mas não receberam propofol. Os resultados demonstraram que há mais de um mecanismo envolvido no efeito hipotensor arterial do propofol, que é composto por uma rápida redução inicial da PAM opioide-independente e uma lenta redução final da PAM, que foi dependente, ao menos parcialmente, de ação opioide. O propofol, na dose de 2,5 mg/Kg, reduziu a PAS, PAD e PAM de forma significativa e independente do efeito hipnótico do anestésico, dos valores iniciais de PVC e de modificações na FC dos pacientes, apesar de ter sido evidenciada a inibição do baroreflexo induzida pelo anestésico. A hipotensão induzida pelo propofol pôde ser parcialmente reduzida, de forma significativa e dose-dependente, pela prévia administração iv de naloxona de 3 μg/Kg, menor dose efetiva. Este efeito da naloxona ocorreu, principalmente, através de um aumento significativo da PAD, sem importar em modificações significativas da PAS, FC, PVC, BIS ou do ECG. Foi concluído que a hipotensão arterial induzida pelo propofol possui uma origem multifatorial, sendo produzida parcialmente por um mecanismo que é opioide-dependente e sensível ao pré-tratamento dos pacientes com a naloxona. Nosso estudo não recebeu nenhum financiamento externo.

One new flavanoid and Anti-HIV active constituents from boussingaultia gracilis miers var. pseudobaselloides bailey

Boussingaultia gracilis Miers var. pseudobaselloides Bailey (Basellaccae) is a folk medicine used as an analgesic and supplements, only a few research was reported on the chemical constituents of this plant. This paper presented its chemical and anti-HIV

丁香和升麻的化学成分研究

本论文由三部分共四章组成。第一部分介绍丁香化学成分的研究成果，第二部分为升麻的化学成分研究，第三部分综述了环菠萝蜜烷三萜结构和活性关系的研究现状。 第一部分包括第一和第二章。第一章介绍了丁香（Eugenia caryophyllataThunb.）花蕾的化学成分和结构鉴定。采用正、反相硅胶柱层析等各种分离方法，从其乙醇提取物的乙酸乙酯萃取物和正丁醇萃取物中共分离出34 个化合物，它们的结构类型分属黄酮、三萜、鞣质等。其中1 个为新的酚苷类化合物，其结构经波谱分析鉴定为2-O-(6'-O-没食子酰基)-b-D-葡萄糖基苯甲酸甲酯（24），另外还有12 个化合物为首次从该植物中分离得到。第二章介绍了丁香挥发油的气相色谱- 质谱联用（ GC-MS ）和正丁醇萃取物的高效液相色谱- 质谱联用（HPLC-MS/MS）分析，尝试简单快速地检测丁香挥发油及极性部分的主要化学成分的方法。 第二部分为第三章。本章介绍了传统中药升麻（Cimicifuga foetida L.）根部乙醇提取物化学成分的分离纯化和结构鉴定。通过正、反相硅胶柱层析等分离纯化方法和MS、NMR 等波谱解析技术，共分离鉴定了20 个化合物，主要为环菠萝蜜烷三萜，其中5 个新三萜化合物分别鉴定为cimicidol-3-one（38）、3'-O-乙酰基升麻苷H-1（41）、2'-O-乙酰基升麻苷H-1（42）、(3b,12b,16b)-12-乙酰氧-16,23-环氧-9,19-环羊毛甾烷-22-烯-24-酮3-O-b-D-吡喃木糖苷（44）和升麻碱（54）。新化合物54 为结构新颖的环菠萝蜜烷三萜皂苷生物碱，这是首个发现的具有环菠萝蜜烷三萜骨架的生物碱，也是从升麻属植物中发现的第一个三萜生物碱，它的结构通过多种波谱解析，特别是2D-NMR 的充分应用，并结合化学降解和反应得到证实。此外，还介绍了分离得到的一种具有明显抑制破骨细胞活性的化合物(QS29)的体外活性研究。 第三部分即第四章，综述了升麻属植物中环菠萝蜜烷三萜与其生物活性的构效关系研究现状。 This dissertation consists of three parts. In the first and the second parts, thechemical constituents from the flower buds of Eugenia caryophyllata and therhizomes of Cimicifuga foetida were reported. The third part is a review on astructure-activity relationship of the cycloartane triterpenoid from Cimicifuga species. The first part is composed of two chapters. The chapter 1 is about the isolationand identification of the chemical constituents from the flower buds of E.caryophyllata. A new phenolic glucoside gallate, methyl 2-O-(6’-O-galloyl)-b-D-glucopyranosylbenzoate (24), together with thirty-three known compounds has beenisolated from the ethanol extract of the flower buds of E. caryophyllata throughrepeated column chromatography on normal and reversed phase silica gel. Thestructure of the new compound was elucidated on the basis of spectral and chemicalevidence. Those kno wn compounds were belonged to flavone, triterpenoid, tannin andsome simple compounds. Among them, 12 compounds were isolated from the titleplant for the first time. The second chapter describes the capillary GC-MS analysis ofthe volatile components and the HPLC-MS/MS analysis of the polar constituents fromthe flower buds of E. caryophyllata, in order to detect the main constituents in thecrude extract rapidly and precisely. The third chapter is about the chemical constituents of the rhizomes C. foetida, atraditional Chinese medicine which was used as anti-inflammatory, analgesic andantipyretic agents. Our investigation of the bioactivities constituents of the rhizomesof C. foetida led to the isolation of five new cycloartane triterpenoids, which werecharacterized as cimicidol-3-one (38), 3'-O-acetyl cimicifugoside H-1 (41),2'-O-acetyl cimicifugoside H-1 (42), (3b,12b,16b)-12-acetoxy-16,23-epoxy-9,19-cyclolanost-22-ene-24-one 3-O-b-D-xylopyranoside (44) and cimicifugadine (54),along with fifteen known compounds through repeated column chromatography onnormal and reversed phase silica gel. Among them, 54 is a novel cycloartanealkaloid and first discovered as a new type alkaoid from nature. The structures ofthese compounds were elucidated on the basis of spectral and chemical evidence, andcimicidol-3-one was confirmed by X-ray crystallography analysis. Moreover, onecompound exhibited strong anti-osteoporosis activity in vitro experiment. The fourth part is a review on a structure-activity relationship analysis of thecycloartane triterpenoid from Cimicifuga species.

Short-capillary electrophoresis with electrochemiluminescence detection using porous etched joint for fast analysis of lidocaine and ofloxacin

Fast analysis of ofloxacin and lidocaine, as bactericide and analgesic or anesthetics, is of clinic importance for understanding the patient's medical process. This paper presented a high throughput, simple analysis method of lidocaine and ofloxacin by capillary electrophoresis coupled with electrochemiluminescence (ECL) using porous etched joint. To shorten the analysis time and to improve the analytical performance, a capillary with 10 cm in length was used as the separation channel. The cyclic voltammograms of Ru(bpy)(3)(2+) with different capillary length at same field strength showed that the porous etched joint eliminated the effect of electrophoretic current on the ECL detection. Following micro total analysis systems (muTAS), some advantages of which this approach has, the fabrication of channel in chip was not needed. Compared with capillary electrophoresis with 40-cm-long capillary, the high sample throughput and low zone broadening may be the main advantage of the present system. Under optimal condition, the detection limits of lidocaine and ofloxacin based on peak height were 3.0 x 10(-8) and 5.0 x 10(-7) mot L-1 and a 60 h(-1) of sampling frequency was obtained.

Simultaneous determination of tramadol and lidocaine in urine by end-column capillary electrophoresis with electrochemiluminescence detection

Tramadol and lidocaine, used as analgesic and local anesthetic in surgery, are partly excreted by kidney. For the first time, we developed a simple and sensitive method, based on capillary electrophoresis with electrochemiluminescence (ECL) detection by end column mode without joint to monitor tramadol and lidocaine in urine. To eliminate the influence of ionic strength of urine sample, analytes were extracted by ether. Tripropylamine (TPA) was used as internal standard. ne recoveries of tramadol and lidocaine were between 94% and 97% at different levels. The method exhibited the linear range for the tramadol and lidocaine from 1.0 X 10(-7) to 1.0 X 10(-4) mol/L with correlation efficient of 0.998. The relative standard deviation (RSD) was 2.9% and 2.7% (n = 8) for tramadol and lidocaine, respectively. The limit of detection (LOD) was 6.0 x 10(-8) mol/L and 4.5 x 10(-8), mol/L (S/N = 3) for tramadol and lidocaine, respectively. The application for detecting tramadol and lidocaine in urine of patients showed that the method was valuable in clinical and biochemical laboratories for detecting tramadol, lidocaine and other tertiary amine pharmaceuticals for various purpose, such as metabolism investigation.

迁移性安慰剂效应的多模态机制 ：从痛觉到情绪的行为、ERP和fMRI研究

Although studies on placebo effect proved the placebo expectation established by pain-alleviating treatment could significantly alleviate later pain perception, or the placebo expectation established by anxiety-reducing treatment could significantly reduce the intensity of induced negative feelings, it is still unclear whether or not the placebo effect can occur in a transferable manner. That is, we still don’t know if the placebo expectation derived from pain-alleviating can significantly reduce later negative emotional arousal or not. Experiment 1: We compared the effect of the verbal expectation (purely verbal induction and without pain-alleviating reinforcement) with the reinforced expectation (building the belief in the placebo’s ataractic efficiency on unpleasant picture processing by secret reduction of the intensity of the pain-evoking stimulus) on the negative emotion. The results showed that the expectation, which was reinforced by actual analgesia, was transferable and could produce significant placebo effect on negative emotional arousal. However, the expectation that was merely induced by verbal instruction did not have such power. Experiment 2 both examined the direct analgesic effect of the placebo on the sensory pain (how strong is the pain stimulus) and emotional pain (how disturbing is the pain stimulus) and the transferable ataractic effect of the placebo on the negative emotion (how disturbing is the emotional picture stimulus), and further proved that the placebo expectation that was established from pain-reducing reinforcement not only induced significant placebo effect on pain, but also significant placebo effect on unpleasant feeling. These results support the viewpoint that the reduction of affective pain based on the conditioning mechanism plays an important role in the placebo analgesia, but can’t explain the transferred placebo effect on visual unpleasantness. Experiment 3 continued to use the paradigm of the reinforced expectation group and recorded the EEG activities, the data showed that the transferable placebo treatment was accompanied with decreased P2 amplitude and increased N2 distributed, and significant differences between the transferable placebo condition and the control condition (i.e., P2 and N2) were observed within the first 150-300 ms, a duration brief enough to rule out the possibility that differences between the two conditions merely reflect a bias “to try to please the investigator. In Experiment 4, we selected the placebo responders in the pre-experiment and let them to go through the formal fMRI scan. The results found that the transferable placebo treatment reduced the negative emotional response, emotion-responsive regions such as the amygdala, insula, anterior cingulate cortex and the thalamus showed an attenuated activation. And in the placebo condition, there was an enhanced activation in the subcollosal gyrus, which may be involved in emotional regulation. In conclusion, the transferable placebo treatment induced the reliable placebo effect on the behavior, EEG activity and bold signal, and we attempted to discuss the pychophysiological mechanism based on the positive expectancy.

Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature

Cryotherapy is widely used in rehabilitation; however, its effectiveness after anterior cruciate ligament (ACL) reconstruction remains uncertain. To investigate the effectiveness and safety of cryotherapy following ACL reconstruction through a systematic review, randomized and quasi-randomized clinical trials were searched in the databases: MEDLINE, EMBASE, CENTRAL PEDro, SportDiscus, CINAHL, LILACS (June 2013). the primary outcomes measures were pain, edema and adverse events; the secondary outcomes were knee function, analgesic medication use, range of motion, blood loss, hospital stay, quality of life and patient satisfaction. the methodological quality of studies was evaluated using the Cochrane Collaboration risk-of-bias tool. Ten trials (a total of 573 patients) were included. Results of meta-analysis showed that the use of cold compression devices produced a significant reduction in pain scores 48 h after surgery (p < 0.00001), compared to no cryotherapy. the risk for adverse events did not differ between patients receiving cryotherapy versus no treatment (p = 1.00). the limited evidence currently available is insufficient to draw definitive conclusions on the effectiveness of cryotherapy for other outcomes. There is a need for well designed, good quality randomized trials to answer other questions related to this intervention and increase the precision of future systematic reviews. (C) 2014 Elsevier B.V. All rights reserved.

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time

Efeito dos salicilatos em Salmo trutta fario

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Laserterapia em Implantologia

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Paracetamol metabolism in postoperative patients

Introduction: Despite being available for more than 50 years, there is still much to learn about paracetamol. Postoperative analgesic regimens that maintain good pain control while minimising exposure to opiates are beneficial and paracetamol has had a resurgence in this role since an IV formulation came to market. However there is evidence to suggest currently licensed doses are sub-therapeutic, especially when administered orally or rectally. Higher, unlicensed doses are now being advocated but, prior to this study, there was little evidence of their safety in surgical patients. When assessing drug safety in surgical patients a number of surgery and patient related factors influence results, and these must be considered. Methods: Major and intermediate surgical patients were recruited from two hospitals in Ireland. They were administered IV paracetamol at either 9g or 4g daily doses. In addition they received daily sub therapeutic doses of four other medicines to indicate the activity of their CYP450 enzymes that are involved in paracetamol metabolism. Urine and blood samples were collected to determine paracetamol pharmacokinetics, CYP450 activity, inflammatory cytokine concentration and for evidence of hepatotoxicity. Results: There were 33 patients that participated in the study. There was no evidence of clinically significant hepatotoxicity occurring in any patient during the study period, but there could have been changes following this time. Paracetamol disposition was shown to change, however half-life remained relatively constant. There were a number of changes to the way paracetamol was metabolised following surgery that maintained this rate of elimination. Conclusion: Doses of up to 9g per day given to major surgical patients for up to five days postoperatively produced no evidence of hepatotoxicity. Further research is warranted to determine the clinical utility of these higher doses

Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: Side-effects of standard pain medications can limit their use. Therefore, nonpharmacologic pain relief techniques such as auriculotherapy may play an important role in pain management. Our aim was to conduct a systematic review and meta-analysis of studies evaluating auriculotherapy for pain management. DESIGN: MEDLINE,(®) ISI Web of Science, CINAHL, AMED, and Cochrane Library were searched through December 2008. Randomized trials comparing auriculotherapy to sham, placebo, or standard-of-care control were included that measured outcomes of pain or medication use and were published in English. Two (2) reviewers independently assessed trial eligibility, quality, and abstracted data to a standardized form. Standardized mean differences (SMD) were calculated for studies using a pain score or analgesic requirement as a primary outcome. RESULTS: Seventeen (17) studies met inclusion criteria (8 perioperative, 4 acute, and 5 chronic pain). Auriculotherapy was superior to controls for studies evaluating pain intensity (SMD, 1.56 [95% confidence interval (CI): 0.85, 2.26]; 8 studies). For perioperative pain, auriculotherapy reduced analgesic use (SMD, 0.54 [95% CI: 0.30, 0.77]; 5 studies). For acute pain and chronic pain, auriculotherapy reduced pain intensity (SMD for acute pain, 1.35 [95% CI: 0.08, 2.64], 2 studies; SMD for chronic pain, 1.84 [95% CI: 0.60, 3.07], 5 studies). Removal of poor quality studies did not alter the conclusions. Significant heterogeneity existed among studies of acute and chronic pain, but not perioperative pain. CONCLUSIONS: Auriculotherapy may be effective for the treatment of a variety of types of pain, especially postoperative pain. However, a more accurate estimate of the effect will require further large, well-designed trials.

Effect of ritonavir-induced cytochrome P450 3A4 inhibition on plasma fentanyl concentrations during patient-controlled epidural labor analgesia: a pharmacokinetic simulation.

BACKGROUND: Ritonavir inhibition of cytochrome P450 3A4 decreases the elimination clearance of fentanyl by 67%. We used a pharmacokinetic model developed from published data to simulate the effect of sample patient-controlled epidural labor analgesic regimens on plasma fentanyl concentrations in the absence and presence of ritonavir-induced cytochrome P450 3A4 inhibition. METHODS: Fentanyl absorption from the epidural space was modeled using tanks-in-series delay elements. Systemic fentanyl disposition was described using a three-compartment pharmacokinetic model. Parameters for epidural drug absorption were estimated by fitting the model to reported plasma fentanyl concentrations measured after epidural administration. The validity of the model was assessed by comparing predicted plasma concentrations after epidural administration to published data. The effect of ritonavir was modeled as a 67% decrease in fentanyl elimination clearance. Plasma fentanyl concentrations were simulated for six sample patient-controlled epidural labor analgesic regimens over 24 h using ritonavir and control models. Simulated data were analyzed to determine if plasma fentanyl concentrations producing a 50% decrease in minute ventilation (6.1 ng/mL) were achieved. RESULTS: Simulated plasma fentanyl concentrations in the ritonavir group were higher than those in the control group for all sample labor analgesic regimens. Maximum plasma fentanyl concentrations were 1.8 ng/mL and 3.4 ng/mL for the normal and ritonavir simulations, respectively, and did not reach concentrations associated with 50% decrease in minute ventilation. CONCLUSION: Our model predicts that even with maximal clinical dosing regimens of epidural fentanyl over 24 h, ritonavir-induced cytochrome P450 3A4 inhibition is unlikely to produce plasma fentanyl concentrations associated with a decrease in minute ventilation.

Low Molecular Weight Opioid Peptide Esters Could be Developed as a New Class of Analgesics.

Low molecular weight opioid peptide esters (OPE) could become a class of analgesics with different side effect profiles than current opiates. OPE may have sufficient plasma stability to cross the blood brain barrier (BBB), undergo ester hydrolysis and produce analgesia. OPE of dipeptides, tyr-pro and tyr-gly conjugated to ethanol have a structure similar to the anesthestic agent, etomidate. Based upon the analgesic activity of dipeptide opioids, Lipinski's criteria, and permeability of select GABA esters to cross the BBB, opioid peptides (OP) conjugated to ethanol, cholesterol or 3-glucose are lead recommendations. Preliminary animal data suggests that tyr-pro-ethyl ester crosses the BBB and unexpectedly produces hyperalgesia. Currently, there are no approved OP analgesics available for clinical use. Clinical trials of good manufacturing practice OP administered to patients suffering from chronic pain with indwelling intrathecal pumps could resolve the issue that OP may be superior to opiates and may redirect research.