Efetividade e segurança da budesonida nebulizada no controle da crise aguda de sibilância em crianças menores de três anos não responsivas ao fenoterol

Pós-graduação em Pediatria - FMB

Avaliação da resposta ao broncodilatador em pacientes com DPOC

A resposta ao broncodilatador (BD) é tradicionalmente medida pela variação do volume expiratório forçado no primeiro segundo (VEF1). Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam pouca ou nenhuma resposta neste parâmetro. Outros parâmetros funcionais, medidos por pletismografia, podem ser úteis na avaliação da reversibilidade da obstrução em pacientes com DPOC. Com os objetivos de avaliar a freqüência de resposta ao BD no VEF1 em uma amostra de pacientes com DPOC; correlacioná-la com dados clínicos e avaliar a freqüência de resposta na capacidade vital forçada (CVF), capacidade vital lenta (CVL), capacidade inspiratória (CI), volume residual (VR), resistência das vias aéreas (RVA) e condutância específica das vias aéreas (GVA/VP), foi proposto este estudo. Sessenta e quatro pacientes com DPOC foram submetidos a pletismografia de corpo inteiro e medida a reversibilidade da broncoconstrição após 400μg de fenoterol. Dos 64 pacientes avaliados, 31,3% tiveram resposta no VEF1. A freqüência de pacientes com resposta ao BD, quando medida pelos outros parâmetros em estudo, foi de 50% na CVF, 46,9% no VR, 46,8% na GVA/VP, 37,1% na CVL, 34,4% na CI e 30,6% na RVA. Pacientes sem resposta no VEF1, apresentaram a seguinte freqüência de resposta: 47,5% no VR, 38,1% na GVA/VP, 35% na CI, 31,8% na CVF, 23,8% na CVL e 21,4% na RVA. Concluiu-se que volumes pulmonares estáticos e resistência / condutância das vias aéreas, quando incluídos na avaliação da resposta ao BD, além do VEF1, permitem avaliar com maior amplitude o número de pacientes com resposta funcional à prova farmacodinâmica. Estes resultados estão de acordo com a impressão clínica de que muitos pacientes com DPOC, mesmo sem melhora no VEF1 após BD, apresentam melhora clínica.

Atypical beta-adrenoceptor subtypes mediate relaxations of rabbit corpus cavernosum

This study was performed to characterize the beta-adrenoceptor population in rabbit isolated corpus cavernosum (RbCC) by using nonselective and selective beta-adrenoceptor agonists and antagonists in functional assays. Metaproterenol, ritodrine, fenoterol, and 8-hydroxy-5-[(1R)-1-hydroxy-2-[N-[(1R)-2-(rho-methoxy-phenyl)1-methylethyl] amino] ethyl] carbostyril (TA 2005) (3-100 nmol each) dose dependently relaxed the RbCC preparations. These relaxations were markedly reduced by N-omega-nitro-L-arginine methyl ester (L-NAME; 10 muM) and 1H-[1,2,4]-oxadiazolo-[4,3,-a]quinoxalin-1-one (ODQ) (10 muM), whereas the adenylyl cyclase inhibitor SQ 22,536 [9-(2-tetrahydrofuryl)adenine] (10 muM) had no effect. In contrast, neither L-NAME nor ODQ affected the isoproterenol-induced RbCC relaxations, but SQ 22,536 abolished this response. Sildenafil (1 muM) significantly potentiated the relaxations induced by beta(2)-agonists without affecting the isoproterenol-evoked relaxations. Rolipram (10 muM) enhanced the relaxations elicited by isoproterenol but had no effect on those induced by the selective beta(2) agonists. Propranolol and (+/-)-1-[2,3-(dihydro-7-methyl-1H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]-2-butanolhydrochloride (ICI 118,551) determined a rightward shift in the concentration-response curves to isoproterenol in a noncompetitive manner with a reduction of maximum response at the highest antagonist concentration, with the slope values significantly different from unity. Propranolol and ICI 118,551 had no effect on the relaxations elicited by fenoterol, TA 2005, metaproterenol, and ritodrine. Atenolol and 1-[2-((3-carbamoyl-4-hydroxy)phenoxy) ethylamino]-3-[4-(1-methyl-4-trifluoromethyl-2-imidazolyl)-phenoxy]2-propanol methanesulfonate (CGP 20712A) (0.1-10 muM) failed to affect the relaxations induced by all tested beta-adrenoceptor agonists. Our study revealed the existence of two atypical beta-adrenoceptors in the rabbit erectile tissue. Isoproterenol relaxes the rabbit cavernosal tissue by activating atypical beta-adrenoceptors coupled to adenylyl cyclase pathway, whereas the selective beta2-adrenoceptor agonists relax the RbCC tissue through another atypical beta-adrenoceptor subtype coupled to nitric oxide release from the sinusoidal endothelium.

Doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease (COPD) is an extremely common disorder that all primary care physicians should be able to manage. In this review we will define the entities incorporated in COPD and will present various aspects of the diagnoses and treatment. We could not cover every aspect of this broad topic even providing a detailed review of those areas but some facets of therapy like smoking cessation, drug therapy, oxygen therapy, nutrition, and respiratory rehabilitation will be described.

Doença pulmonar obstrutiva crônica

In this review the definition of COPD is presented and the epidemiology and risk factors for disease development are briefly discussed. Characteristics clinical features, pulmonary functions indices, radiologics signs and arterial blood gases alterations are presented and discussed. Classification of disease severity and components of COPD management are also described.

Doença pulmonar obstrutiva crônica

The chronic obstructive lung disease is reviewed with emphasys on its epidemiology and risk factors. The diagnosis, clinical aspects pulmonary, functional alterations and laboratorial findings are discussed. The treatment is also reviewed, based on the actual consensus, considering the following classes of approaches: bronchodilators, inhaled β-agonists, corticoids, methilxanthines, prolonged domiciliar-orygen therapy.

Doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease (COPD) is considered the forth cause of death in the world. The present review summarizes the epidemiologic and risk factors to the disease. Emphasizing the diagnostic, pulmonary function, radiological alterations and blood gases. According to the current guideline recommendations, the authors reviewed the classification and treatment. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Chiroptical properties of bioactive molecules: sensitivity to conformation and solvation

Chiroptical spectroscopies play a fundamental role in pharmaceutical analysis for the stereochemical characterisation of bioactive molecules, due to the close relationship between chirality and optical activity and the increasing evidence of stereoselectivity in the pharmacological and toxicological profiles of chiral drugs. The correlation between chiroptical properties and absolute stereochemistry, however, requires the development of accurate and reliable theoretical models. The present thesis will report the application of theoretical chiroptical spectroscopies in the field of drug analysis, with particular emphasis on the huge influence of conformational flexibility and solvation on chiroptical properties and on the main computational strategies available to describe their effects by means of electronic circular dichroism (ECD) spectroscopy and time-dependent density functional theory (TD-DFT) calculations. The combination of experimental chiroptical spectroscopies with state-of-the-art computational methods proved to be very efficient at predicting the absolute configuration of a wide range of bioactive molecules (fluorinated 2-arylpropionic acids, β-lactam derivatives, difenoconazole, fenoterol, mycoleptones, austdiol). The results obtained for the investigated systems showed that great care must be taken in describing the molecular system in the most accurate fashion, since chiroptical properties are very sensitive to small electronic and conformational perturbations. In the future, the improvement of theoretical models and methods, such as ab initio molecular dynamics, will benefit pharmaceutical analysis in the investigation of non-trivial effects on the chiroptical properties of solvated systems and in the characterisation of the stereochemistry of complex chiral drugs.

$\beta\sb2$-adrenergic receptor desensitization, internalization and phosphorylation in response to full and partial agonists

The objective of this study is to test the hypothesis that partial agonists produce less desensitization because they generate less of the active conformation of the $\beta\sb2$-adrenergic receptor ($\beta$AR) (R*) and in turn cause less $\beta$AR phosphorylation by beta adrenergic receptor kinase ($\beta$ARK) and less $\beta$AR internalization. In the present work, rates of desensitization, internalization, and phosphorylation caused by a series of $\beta$AR agonists were correlated with a quantitative measure, defined as coupling efficiency, of agonist-dependent $\beta$AR activation of adenylyl cyclase. These studies were preformed in HEK-293 cells overexpressing the $\beta$AR with hemagglutinin (HA) and 6-histidine (6HIS) epitopes introduced into the N- and C-termini respectively. Agonists chosen provided a 95-fold range of coupling efficiencies, and, relative to epinephrine, the best agonist, (100%) were fenoterol (42%), albuterol (4.9%), dobutamine (2.5%) and ephedrine (1.1%). At concentrations of these agonists yielding $>$90% receptor occupancy, the rate and extent of the rapid phase (0-30 min) of agonist induced desensitization of adenylyl cyclase followed the same order as coupling efficiency, that is, epinephrine $\ge$ fitnoterol $>$ albuterol $>$ dobutamine $>$ ephedrine. The rate of internalization, measured by a loss of surface receptors during desensitization, with respect to these agonists also followed the same order as the desensitization and exhibited a slight lag. Like desensitization and internalization, $\beta$AR phosphorylation exhibited a dependency on agonist strength. The two strongest agonists epinephrine and fenoterol provoked 11 to 13 fold increases in the level of $\beta$AR phosphorylation after just 1 min, whereas the weakest agonists dobutamine and ephedrine caused only 3 to 4 fold increases in phosphorylation. With longer treatment times, the level of $\beta$AR phosphorylation declined with the strong agonists, but progressively increased with the weaker partial agonists. The major conclusion drawn from this study is that the occupancy-dependent rate of receptor phosphorylation increases with agonist coupling efficiencies and that this is sufficient to explain the desensitization, internalization, and phosphorylation data obtained.^ The mechanism of activation and desensitization by the partial $\beta$AR agonist salmeterol was also examined in this study. This drug is extremely hydrophobic and its study presents possibly unique problems. To determine whether salmeterol induces desensitization of the $\beta$AR its action has been studied using our system. Employing the use of reversible antagonists it was found that salmeterol, which has an estimated coupling efficiency near that of albuterol caused $\beta$AR desensitization. This desensitization was much reduced relative to epinephrine. Consistent with its coupling efficiency, it was found to be similar to albuterol in its ability to induce internalization and phosphorylation of the $\beta$AR. (Abstract shortened by UMI.) ^

Evaluación del efecto broncodilatador de B2 Adrenérgico y anticolenérgico en E.P.O.C. tipo bronquitis crónica

Se trata de un estudio clínico comparativo en el que se busca evaluar la respuesta broncodilatadora del Bromuro de Ipratropia y del Bromhidrato de Fenoterol en pacientes con EPOC [Enfermedad pulmonar obstructiva]. tipo bronquitis crónica. El universo estuvo conformado por pacientes con su diagnóstico clínico que acudieron a consulta externa del Hospital Vicente Corral Moscoso de la ciudad de Cuenca. Se realizó la historia clínica y luego se procedió a realizar la espirografía de base y a los cinco y sesenta minutos después de ser administrados los fármacos en forma inhalatoria mediante sistema aleatorio. Para determinar el grado de respuesta broncodilatadora y comprobar la efectividad de los fármacos nos basamos en la expirometría basal que se confrontó con los valores de la segunda y tercera prueba, los parámetros estudiados fueron: Capacidad vital forzada [CVF], volumen espiratorio forzado en el primer segundo [VEF 1seg], Indice de Tiffeneau [VEF 1 seg/CVF] y los efectos colaterales presentados con la administración de los fármacos, que se identificaron mediante signos y síntomas de pacientes. En la investigación se determinó que al comparar a todos los pacientes con EPOC, que recibieron Bromuro de Ipratropio y Bromhidrato de Fenoterol, no se encuentran diferencias significativas [p mayor 0.05], la diferencia más grande encontrada es al comparar el VEF 1 seg. entre los dos grupos de estudio. En el tratamiento de la EPOC tipo bronquitis crónica los dos fármacos estudiados pueden ser utilizados indistintamente como broncodilatadores, sin embargo el Bromuro de Ipratropio tiene menos efectos secundarios