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Impacto clínico da monitorização farmacocinética de gentamicina, amicacina e vancomicina e a sua relação com a função renal
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Abstract(s)
Com o desenvolvimento dos campos de atuação do farmacêutico, surgiu uma crescente
necessidade da existência de um serviço de farmacocinética clínica nos hospitais.
A monitorização da terapêutica farmacológica foi uma das principais funções atribuídas ao
farmacêutico, permitindo a otimização da terapêutica, a diminuição dos efeitos adversos a ela
associados, assim como a diminuição de resistências bacterianas.
Esta monografia aborda de uma forma geral, os mecanismos de ação, de resistência, as
indicações clínicas, possíveis efeitos adversos, assim como a importância de considerar os dois
aspetos fundamentais desde que o fármaco é administrado até exercer o seu efeito terapêutico:
farmacodinamia e farmacocinética. Um dos objetivos consiste na análise do perfil
farmacocinético da vancomicina, gentamicina e amicacina e os diferentes fatores que os
influenciam, tais como fatores patológicos.
Para além disso, são discutidos alguns casos clínicos reais provenientes do Hospital Garcia
de Orta (HGO) com o intuito de avaliar o contributo clínico que a monitorização
farmacocinética de gentamicina, amicacina e vancomicina terá para o sucesso terapêutico de
doentes sob antibioterapia, tendo igualmente em vista a caracterização do impacto que fármacos
nefrotóxicos ou com mecanismos sinérgicos, administrados concomitantemente, poderá
exercer a nível da função renal.
Neste âmbito, também foi necessário caracterizar a necessidade de administrações em
regime de doses múltiplas diárias assim como doses únicas diárias e, aparentemente este último
regime revela-se mais vantajoso.
Tendo em vista todos estes aspetos, é imprescindível a presença de um farmacêutico no
campo da farmacocinética clínica tanto na monitorização da terapêutica com estes agentes
antimicrobianos, como no auxílio médico para a definição das respetivas posologias.
With the development of the fields of pharmaceutical activity emerged a growing need for the existence of a clinical pharmacokinetic service in hospitals. The therapeutic drug monitoring was one of the main duties assigned to the pharmacist, allowing the therapy optimization, adverse effects reduction, as well as the decrease of bacterial resistance. This monography broadly approaches the mechanisms of action and resistance, clinical indications and possible adverse effects, focusing on the two fundamental issues since the drug is administered until it exerts its therapeutic effect: the pharmacodynamics and the pharmacokinetics. One of its goals consists on analyzing the vancomycin, gentamicin and amikacin pharmacokinetic profile and the different factors that influence them, such as pathological factors. Moreover, some real clinical cases from Hospital Garcia de Orta (HGO) are also discussed in order to evaluate the clinical contribution of therapeutic drug monitoring of gentamicin, amikacin and vancomycin will have for the therapeutic success of patients on antibiotic therapy, in addition to characterize the impact of concomitantly administered nephrotoxic drugs or with synergistic mechanisms may have on renal function. In this context, it was also necessary to characterize the need for administrations in a multiple and once-daily dose regimens and apparently, the latter is more advantageous. In view of all these aspects, the presence of a pharmacist in the field of clinical pharmacokinetics is essential not only for the therapeutic monitoring of these antimicrobial agents, but also for the medical assistance to define their dosages
With the development of the fields of pharmaceutical activity emerged a growing need for the existence of a clinical pharmacokinetic service in hospitals. The therapeutic drug monitoring was one of the main duties assigned to the pharmacist, allowing the therapy optimization, adverse effects reduction, as well as the decrease of bacterial resistance. This monography broadly approaches the mechanisms of action and resistance, clinical indications and possible adverse effects, focusing on the two fundamental issues since the drug is administered until it exerts its therapeutic effect: the pharmacodynamics and the pharmacokinetics. One of its goals consists on analyzing the vancomycin, gentamicin and amikacin pharmacokinetic profile and the different factors that influence them, such as pathological factors. Moreover, some real clinical cases from Hospital Garcia de Orta (HGO) are also discussed in order to evaluate the clinical contribution of therapeutic drug monitoring of gentamicin, amikacin and vancomycin will have for the therapeutic success of patients on antibiotic therapy, in addition to characterize the impact of concomitantly administered nephrotoxic drugs or with synergistic mechanisms may have on renal function. In this context, it was also necessary to characterize the need for administrations in a multiple and once-daily dose regimens and apparently, the latter is more advantageous. In view of all these aspects, the presence of a pharmacist in the field of clinical pharmacokinetics is essential not only for the therapeutic monitoring of these antimicrobial agents, but also for the medical assistance to define their dosages
Description
Keywords
Farmacocinética clínica Monitorização Farmacocinética Nefrotoxicidade Minoglicosídeos/vancomicina Função renal Monitorização terapêutica de