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146 Referências Bibliográficas 1 Palella, F.J. Jr; Delaney KM, Moorman AC, e col. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl. J. Med. 1998; 338: 853-860. 2 Egger. M, May M, Chene G, e col. «Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies.» Lancet. 2002; 360: 119-129. 3 Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999; 131: 81-87. 4 Casado JL, Perez-Elias MJ, Antela A, e col. Predictors of long-term response to protease inhibitor therapy in a cohort of HIV-infected patients. AIDS. 1998; 12: F131-135. 5 Piketty C, Race E, Castiel P, e col. «Efficacy of a five-drug combination including ritonavir, saquinavir and efavirenze in patients who failed on a convetional triple-drug regimen: phenotypic resistance to protease inhibitors predicts outcome of therapy.» AIDS. 1999; 13: F71-77. 6 Marzolini C, Telenti A, Decosterd LA, Grub G, iollaz J, Buclin T. «Efavirenz plasma levels can predict treatment failure and central nervous system side effects in HIV-1-infected patients.» AIDS. 2001; 15: 71-75. 7 Clevenbergh P, Garraffo R, Durant J, Dellamonica P. PharmaAdapt; a randomized prospective study to evaluate the benefit of therapeutic drug monitoring of protease inhibitors: 12 week results. AIDS, 2002; 16: 2311-2315. 8 Malllas J, Blanco JL, Sarasa M, e col. Dose-finding study of once-daily indinavir/ritonavir plus zidovudine and lamivudine in HIV-infected patients. J Acquir Immune Defic Syndr. 200, 25: 229-235. 9 Casado JL, Moreno A, Sabido R, e col. A clinical study of the combination of 100 mg ritonavir plus 800 mg indinavir as salvage therapy: influence of increased plasma drug levels in the rate of response. HIV Clin Trials. 2000; 1: 13-19. 10 Seminari E, Maggiolo F, Villani P, e col. Efavirenze, nelfinavir, and stavudine rescue combination therapy in HIV-1-positive patients heavlily pretreated with nucleoside analogues and protease inhibitors. J Acquir Immune Defic Syndr. 1999; 22: 453-460. 11 Barry MG, Merry C, Lloyd J, e col. Variability in trough plasma saquinavir concentrations in HIV patients – a case for therapeutic drug monitoring. Br J Clin Pharmacol. 1998; 45: 501--502. 12 Back D, Gatti G, Fletcher C, e col. Therapeutic drug monitoring in HIV infection: current status and future directions. AIDS. 2002, 16 (suppl 1): S5-37. 13 Stein DS, Fish DG, Bilello JA, Preston SL, Martineau GL, Drusano GL. A 24-week open-label phase I/II evaluation of the HIV protease inhibitor MK-639 (indinavir). AIDS. 1996; 10: 485-492. 14 Burger DM, Hoetelmans RM, Hugen PW, e col. Low plasma concentrations of indinavir are related to virological treatment failure in HIV-1-infected patients on indinavir-containing triple therapy. Antivir Ther. 1998, 3: 215-220. 15 Havlir D, Cheeseman SH, McLaughlin M, e col. High-dose nevirapine: safety, pharmacokinetics, and antiviral effect in patients with immunodeficiency virus infection. J Infect Dis. 1995; 171: 537-545. 16 Dieleman JP, Gyssens IC, van der Ende ME, de Marie S, Burger DM. Urological complaints in relation to indinavir plasma concentrations in HIV-1-infected patients. AIDS. 1999; 13: 473-478.
17 Bean P. HIV´s pharmacokinetics, pharmacodynamics, pharmacogenetics, and pharmacogenomics. Am Clin Lab. 2000 Nov-Dec;19(9):12. 18 Munk B. The ups and downs of drug levels. In http://www.thebody.com/content/art1062. html. May/June 2001. 19 Kappelhoff BS, Crommentuyn KM, de Maat MM, Mulder JW, Huitema AD, Beijne JH. Practical guidelines to interpret plasma concentrations of antiretroviral drugs. Clin Pharmacokinet. 2004; 43(13): 845-53. 20 la Porte CJL, Back DJ, Blaschke T, e col. Updated guidelines to perform therapeutic drug monitoring for antiretroviral agents. Antivir Ther. 2006, 3: 3-14. 21 Cruz, JP. Farmacologia dos anti-retrovíricos in “Manual sobre SIDA”, 2ª edição, 2004, 251-68. Terapêutica Farmacológica 147
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Boas Práticas de Farmácia Hospita
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Boas Práticas de Farmácia Hospita
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Introdução
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aconselhando os doentes sobre a sua
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Enquadramento da Farmácia Hospital
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A farmácia de ambulatório deve es
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3.1. Normas gerais: > > > > Os prof
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4. Estabelecimento de Funções 4.1
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1.2. Enquadramento Legal A publica
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> Aos beneficiários de um sistema
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Terapêutica Farmacológica 2
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arsenal terapêutico, surgiu em 199
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2.2 Fármacos Anti-Retrovíricos Ta
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Tabela 1 - Classes e Sub-Classes de
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DCI/ Nome genérico INNTR Abreviatu
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DCI/ Nome genérico Abreviatura Mar
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DCI Soluções orais Abacavir +Lami
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Nelfinavir Ritonavir DCI Soluções
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Dose diária recomendada IR IH Cáp
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Dose diária recomendada IR IH Adul
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Dose diária recomendada IR IH Adul
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Dose diária recomendada IR IH Admi
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Dose diária recomendada IR IH IH l
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Activo contra VIH-2 Classe Mecanism
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Tabela 5 - ADME dos ARV Eliminaçã
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Eliminação Tempo semi-vida Metabo
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Eliminação Tempo semi-vida Metabo
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Tabela 6 - Efeitos Adversos dos ARV
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FTC d4T 3TC INTR e INtTR Nota: não
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EFV NVP Etravirina INNTR > 10% SNC:
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fAPV IDV IP Dislipidémia (hipercol
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RTV IP Dislipidémia (hipercolester
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ENF MVC Inibidores da fusão > 10%
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Lamivudina Lopinavir/ ritonavir Mar
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Tabela 8 - ARV e Gravidez; ARV e Am
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Tabela 9 - ARV: Indutores, Substrat
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Tabela 10 - Interacções e Contra-
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ABC ddI FTC 3TC d4T TDF ZDV EFV NVP
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Cocaína Codeína Fenciclidina (PCB
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Meperidina / Peptidina Metadona Int
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Oxicodona Cetamina Tetrahidro- Cana
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Fármacos ABC ddI FTC 3TC D4T TDF Z
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Fármacos ABC ddI FTC 3TC D4T TDF Z
Page 97 and 98: Tabela 13 - Interacções INNTR VS
Page 99 and 100: Antimicobacterianos Antifúngicos T
Page 101 and 102: Tabela 15 - Interacções IP VS IP
Page 103 and 104: ARV fAPV ATV LPV/r DRV NFV IDV RTV
Page 109 and 110: Tabela 16 - Interacções IP e Fár
Page 111 and 112: IDV LPV/r NFV SQV TPV/r DRV300-400
Page 129 and 130: LPV/r 400 mg/ 100 mg BID (MVC 300 m
Page 131 and 132: Cetoconazol 400 mg QD (MVC 100 mg B
Page 133 and 134: Tabela 18 - Interacções Inibidore
Page 135 and 136: Tabela 18.2 - Interacções Elviteg
Page 137 and 138: Referências Bibliográficas Breaki
Page 139 and 140: No entanto, os efeitos do fármaco
Page 141 and 142: 2.1. Conceito de quociente inibitó
Page 143 and 144: 3. Monitorização Sérica da Terap
Page 145 and 146: 4.2. Colheita da amostra de sangue
Page 147: 5. Conclusão As várias caracterí
Page 152 and 153: 150 3. Aconselhamento ao Doente 3.1
Page 154 and 155: 152 > Factores relacionados com o d
Page 156 and 157: 154 3.2 Adesão à Terapêutica A a
Page 158 and 159: 156 > > > > tomar medicamentos pres
Page 160 and 161: 158 3.1.2. Marcadores biológicos:
Page 162 and 163: 160 3.2.2 Avaliação clínica A av
Page 164 and 165: 162 Quadro 1 - Métodos de Monitori
Page 166 and 167: 164 Advoga-se a utilização de mai
Page 168 and 169: 166 Factores relacionados com o doe
Page 170 and 171: 168 Referências Bibliográficas 1
Page 172 and 173: 170 3.3 Seguimento Farmacoterapêut
Page 174 and 175: 172 7 - O doente não recebe o medi
Page 176 and 177: 174 2.3. Conceitos do Terceiro Cons
Page 178 and 179: 176 2.4. Conceitos actuais de Cuida
Page 180 and 181: 178 3. Método de Dáder de Seguime
Page 182 and 183: 180 3.1. Oferta do serviço O farma
Page 184 and 185: 182 Também se anotam outros dados,
Page 186 and 187: 184 Quadro 4 - Estado de Situação
Page 188 and 189: 186 Os aspectos mais importantes a
Page 190 and 191: 188 3.5. Fase de avaliação O obje
Page 192 and 193: 190 3.6. Fase de intervenção A in
Page 194 and 195: 192 Figura 8 - Fluxograma da Fase d
Page 196 and 197: 194 intervenções farmacêuticas r
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196 5. Considerações Finais O SFT
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198 3.4. Suporte Nutricional 1. Des
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200 Além da dor, as náuseas e os
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202 A intervenção dietética/nutr
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204 Fármaco Classificação Dose D
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206 Fármaco Classificação Dose O
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208 Aporte calórico diário: 35-45
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210 3.2.1.2. Vias de administraçã
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212 Figura 1 - Terapêutica Nutrici
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214 4. Interacções entre Fármaco
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216 Fármaco Interacção fármaco/
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218 Fármaco Interacção fármaco/
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220 Referências Bibliográficas 1
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222 31 Merritt R, DeLegge MH, Holco
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224 4. Ensaios Clínicos 1. Introdu
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226 em curso. É também recomendad
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228 Figura 1 - Fluxograma dos Ensai
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230 Os aspectos organizacionais ess
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232 5.1.4. Procedimentos de trabalh
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234 5.1.4.6. Administração da med
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236 Referências Bibliográficas 1
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238 5. Aspectos Farmacoeconómicos
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240 Nas análises de custo-efectivi
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242 2.1 Aplicação da Farmacoecono
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244 3. Conclusão A infecção por
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Padrões de Qualidade Assistencial
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2. Actualização da Informação >
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Referências Bibliográficas 1 Birk
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254 Conclusão Os serviços farmac
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