Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

áCido Valproico

25.546 Aufrufe

Veröffentlicht am

Veröffentlicht in: Sport, Automobil
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

áCido Valproico

  1. 1. ÁCIDO VALPROICO<br />Rodolfo E. PezoaJares<br />R1 INPRF<br />
  2. 2. ESQUEMA<br />Introducción<br />Mecanismo de acción<br />Farmacocinética/farmacodinamia<br />Indicaciones<br />Dosis<br />Manejo<br />Efectos secundarios<br />Contraindicaciones<br />Interacciones medicamentosa<br />
  3. 3. INTRODUCCIÓN<br />Acido N-dipropilacetico<br />Ácido carboxilico de cadena simple ramificada<br />Los derivados comerciales son: 1) ácido valproico, 2) valpromida (Europa), 3) valproato de sodio inyectable, 4) divalproexsodico, 5) divalproexsodico de liberación prolongada<br />
  4. 4. MECANISMO DE ACCIÓN<br />GABA<br />Aumenta la síntesis a través de la activación de glutamatodecarboxilasa<br />Previene el catabolismo a través de la inhibición de GABA transaminasa<br />Liberación de GABA en respuesta a flujos de calcio<br />Activación postsinaptica del receptor GABA-A<br />
  5. 5. MECANISMO DE ACCIÓN<br />Monoaminas<br />Incrementa los niveles de serotonina<br />Reduce la captación presináptica de dópamina<br />Estimula la liberación de glutamato<br />Inhibe la acción de canales de sodio regulados por voltaje<br />
  6. 6. FARMACOCINÉTICA / FARMACODINAMIA<br />Todas las presentaciones se absorben rápidamente<br />Concentraciones pico en plasma 3-4 horas después de la administración oral<br />Vida media de 10 a 16 horas<br />Altamente ligada a proteínas, principalmente albúmina<br />Puede incrementar la fracción libre de otras drogas<br />
  7. 7. FARMACOCINÉTICA / FARMACODINAMIA<br />La fracción no ligada a proteínas es la farmacológicamente activa<br />Metabolismo hepático por 3 vías: <br />Glucoronización: 3-OH-valproato, 3-oxo-valproato, 2-en-valproato<br />Citocromo P450: 4-en-valproato, 2,4-en-valproato <br />Beta oxidación<br />
  8. 8. INDICACIONES<br />Epilepsia<br />Monoterapia o terapiaadyuvante de crisis complejasparciales con o sin otrostipos de convulsion<br />Monoterapia o terapiaadyuvante de crisis de ausencia simples o complejas<br />Terapiaadyuvanteparapacientes con múltiples crisis (incluidas crisis de ausencia)<br />Divalproexsodicotienelasmismasindicaciones, peroadicionalmenteparaprofilaxis de migraña<br />Maníaagudaasociada con trastorno bipolar<br />
  9. 9. INDICACIONES<br />Esquizofrenia<br />Trastorno esquizoafectivo<br />Abstinencia a alcohol<br />Ataques de pánico<br />Trastorno de estrés post-traumático<br />Trastorno de control de impulsos<br />Agitación de demencia<br />
  10. 10. DOSIS<br />Crisis de ausencia<br />Inicial: 15 mg/kg/dia<br />Incrementar 5-10 mg/kg/diasemanalmentehastaalcanzar NT<br />Maximo: 60 mg/kg/dia<br />Crisis parcialescomplejas<br />Inicial: 10-15 mg/kg/day<br />Incrementar5-10 mg/kg/diasemanalmentehastaalcanzar NT<br />Maximo: 60 mg/kg/dia<br />I.V.: Infusion de 60 minutos(≤20 mg/minute) con la mismafrecuenciaquepresentación oral<br />
  11. 11. DOSIS<br />Profilaxis de migraña<br />Inicial 250 mg cada 12 horas<br />Ajustardosisbasado en respuestaclinica<br />Máximo 1000 mg/dia<br />Liberaciónprolongada<br />Inicial: 500 mg/diapor 7 días<br />Incrementara 1000 mg/día<br />Ajustardosisbasado en respuestaclínica<br />
  12. 12. DOSIS<br />Mania<br />Inicial: 750 mg/dia en dosisdivididas<br />Ajustar la dosisconforme se alcancen NT y efectoclínicodeseado<br />Máximo60 mg/kg/day<br />Liberaciónprolongada<br />Inicial: 25 mg/kg/diaunavez al día<br />Ajustarla dosisconforme se alcancen NT y efectoclínicodeseado<br />Máximo60 mg/kg/day<br />
  13. 13. DOSIS<br />Status epilepticus: <br />Impregnación: I.V. 15-45 mg/kg administrados a ≤ 6 mg/kg/minute <br />Mantenimiento: I.V. 1-4 mg/kg/hour<br />
  14. 14. MONITOREO<br />Pruebas de función hepática, biometría hemática, perfil de coagulación, niveles de amonio, niveles de valproato<br />Rango terapéutico: 50-100 mcg/dL<br />Manía 85-125 mcg/dL<br />Toxicidad se ve a partir de 100-150 mcg/dL<br />
  15. 15. EFECTOS SECUNDARIOS<br />FDA Black Box Warning<br />Hepatotoxicidad<br />Pancreatitis <br />Hiperamonemia<br />Teratogenicidad<br />Somnolencia en ancianos<br />Trombocitopenia<br />
  16. 16. EFECTOS SECUNDARIOS<br />CNS: cefalea, somnolencia, mareo, insomnia, ansiedad<br />Dermatologico: alopecia<br />GI: nausea, vomito, diarrea, dolor abdominal, dispepsia, anorexia o hiperorexia<br />Hematologico: trombocitopenia<br />Muscular: tremor, debilidad<br />Oftalmo: diplopía, vision borrosa<br />Otros: sindrome gripal<br />
  17. 17. CONTRAINDICACIONES<br />Hipersensibilidad al valproato<br />Enfermedad hepática<br />Trastornos del ciclo de la urea<br />
  18. 18. INTERACCIONES<br />Alcohol:AVP aumenta la actividad depresora del alcohol sobre el SNC.<br />Ácido acetilsalicílico: AVP aumenta los niveles sericos de ASA<br />Felbamato:aumenta la concentración serica de AVP<br />Lamotrigina:Aumenta la vida media de AVP<br />Barbitúricos:AVP produce un aumento en los niveles séricos de fenobarbital<br />Topiramato: La administración concomitante de ácido valproico y topiramato ha sido asociada con hiperamonemia<br />Clonazepam: El uso simultáneo de ácido valproico y clonazepam puede producir un estado de ausencia.<br />
  19. 19. INTERACCIONES<br />Fenitoína:AVP aumenta niveles de fenitoina<br />Carbamazepina:AVP eleva niveles de carbamazepina.<br />Rifampicina:incremento en la depuración del valproato.<br />Meropenem:disminuye el nivel serico de AVP<br />Zidovudina:AVP disminuye su depuración<br />Warfarina: AVP Incrementa la fracción libre de warfarina.<br />

×