viernes, 31 de diciembre de 2010

Manejo general y en medicina extrahospitalaria de...

Maximo Cuadros Chavez posted in cibermedicos.Maximo Cuadros Chavez2:55am Jan 1

Manejo general y en medicina extrahospitalaria de los síndromes alérgicos

Debido a la alta prevalencia de las enfermedades alérgicas, éstas constituyen una causa muy frecuente de consulta en los distintos niveles asistenciales. Es el médico de familia el que se plantea inicialmente la valoración de la sintomatología, las pruebas complementarias y el seguimiento, cuándo derivar al paciente al especialista y cómo modificar las dosis de los fármacos utilizados para el tratamiento de los distintos síndromes según su evolución. Estos aspectos del manejo general y extrahospitalario del paciente con enfermedad alérgica son los que vamos a comentar a continuación.

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Epinephrine and its use in anaphylaxis: current...


Maximo Cuadros Chavez posted in cibermedicos.Maximo Cuadros Chavez2:13am Jan 1

Epinephrine and its use in anaphylaxis: current issues
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antileukotriene therapy



 

Recent advances in antileukotriene therapy.

Pharmacotherapy and evidence based medicine

Current Opinion in Allergy & Clinical Immunology. 10(4):370-376, August 2010.
Scadding, Guy W a; Scadding, Glenis K b

Abstract:
Purpose of review: Despite profound effects of leukotrienes in experimental models, clinical responses to antileukotriene drugs are highly heterogeneous. This review discusses recent advances concerning the molecular mechanisms of antileukotrienes as well as their efficacy in various clinical scenarios and patient groups.

Recent findings: Appreciation of the role of leukotriene E4 and the existence of its distinct receptors may explain the limited efficacy of current leukotriene receptor antagonists. Pharmacogenetic studies highlight the influence of several leukotriene pathway genes on clinical responsiveness. Benefits of addition of antileukotrienes to inhaled corticosteroids in chronic adult asthmatics have been shown, but their role in acute asthma is unclear. Evidence suggests they are not a first-line treatment for allergic rhinitis or urticaria, but may provide useful additional therapy. In children antileukotrienes provide symptomatic benefit in preschool wheezers, but have no clear role in bronchiolitis or acute asthma. Adherence to montelukast appears superior to inhaled corticosteroids. Use in sleep-disordered breathing and eosinophilic gastroenteropathies warrants further investigation. Despite recent concerns thorough analysis of existing data suggests antileukotrienes are well tolerated drugs. The possible link with Churg-Strauss syndrome requires further investigation.

Summary: The leukotriene pathway remains an attractive target in asthma and allergic disease, particularly in light of renewed appreciation of the role of leukotriene E4. Clarification of the clinical role of antileukotrienes is needed.

(C) 2010 Lippincott Williams & Wilkins, Inc.


jueves, 30 de diciembre de 2010

Las plantas medicinales (primera parte)...

Maximo Cuadros Chavez posted in cibermedicos.Maximo Cuadros Chavez3:53pm Dec 30

Las plantas medicinales (primera parte)
http://www.facebook.com/l/0259cjJ8p5znJy0Zy4CiwKuy-kw;www.slan.org.ve/publicaciones/completas/plantas_medicinales_1.asp
Las plantas medicinales (segunda parte)
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No son tan inofensivas como parecen

Dra. Nubilde Martínez
Farmaceuta. Especialista en toxicología clínica. Doctorado en Ciencias de la
Educación.Trabajo original en el Boletín de Nutrición Infantil CANIA. Año 4,
Nro. 8. noviembre de 2003

Atte.
Dr.Máximo Cuadros Chávez
Celular 99199698 – Movistar - rpm #800515

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UNYK: 245 HRP

----------

Trastornos nutricionales

 
Trastornos nutricionales
 
Obesidad. Concepto. Clasificación. Implicaciones fisiopatológicas. Complicaciones asociadas. Valoración clínica
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Tratamiento de la obesidad. Medidas de estilo de vida y régimen alimentario. Tratamiento farmacológico. Tratamiento quirúrgico
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Desnutrición. Hipovitaminosis
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Estimación de requerimientos nutricionales. Nutrición en situaciones específicas
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Suplementos nutricionales. Clasificación. Indicaciones. Contraindicaciones. Valoración de la respuesta. Efectos secundarios
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Protocolo de valoración del estado nutricional
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Protocolo diagnóstico de la obesidad
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Protocolo terapéutico y de seguimiento de la obesidad
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Protocolo diagnóstico de la sospecha de astenia de origen endocrino
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Indicaciones y contraindicaciones de la nutrición enteral y parenteral
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Protocolo terapéutico de los estados de desnutrición

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martes, 28 de diciembre de 2010

A Meta-Analysis of the Efficacy and Tolerability of Interferon-􀁃 in Multiple Sclerosis, Overall and by Drug and Disease Type




Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069











martes, 14 de diciembre de 2010

domingo, 12 de diciembre de 2010

intoxicación por humo


 

Bases del manejo clínico de la intoxicación por humo de incendios «Docohumo Madrid 2010»
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__._,_.___

Tratamiento de la fibromialgia

 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: dom,12 diciembre, 2010 08:07
Asunto: Tratamiento de la fibromialgia

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No:343     

Diciembre 12, 2010
 Colores de Mexico

Estimad@ Maximo Jesus Cuadros Chavez:

Farmacoterapia de la fibromialgia: enfoque sobre duloxetina

Pharmacotherapy of  Fibromyalgia: Focus on Duloxetine
Eric Serra and Michel Andrejak
Amiens, France. Email: serra.eric@chu-amiens.fr
Clinical Medicine: Therapeutics 2009:1 1617-1627

 

Abstract
Context: Fibromyalgia syndrome (FMS) is a frequent medical condition characterized by chronic widespread pain and reduced pain threshold. Associated symptoms include fatigue, non restorative sleep, and psychological distress. As usual in medicine, even if the pathogenesis is unclear, some treatments are useful to help patients. Objectives: Tricyclic antidepressants were the first drugs used to treat FMS. More recently, among serotonin-norepinephrine reuptake inhibitors, duloxetine was approved by US Food and Drug Administration to treat FMS. Duloxetine is used for the management of major depressive disorder, neuropathic pain, generalized anxiety disorder, and stress incontinence. In the pharmacotherapy of  fibromyalgia, a focus is presented on the drug duloxetine. Results: Mechanism of action, metabolism and pharmacokinetic profile are presented. Clinical studies of Duloxetine showed an acceptable efficacy for this chronic condition: Number Need to Treat (NTT) of 4.7 to 9.9, through two 3-month placebo-controlled trials and two 6-month trials. Evaluation criteria are discussed. Safety of this medication has been found to be satisfactory, with nausea as the most common adverse event, in almost 20% of cases. Conclusion: Treatment algorithm for duloxetine is presented inside FMS treatment strategy. With duloxetine, it is important to start low and increase slowly to prevent or minimize adverse events: 30 mg/day up to 60 mg/day in the second week and if necessary up to 90-120 mg/day. It is possible to treat for 3 to 6 months, possibly up to 12 months. The drug could be decreased 2 to 4 weeks before stopping, with regular assessments during this time. International recommendations insist on multimodal treatments: drug and non drug. Also effective for anxiety and depression, duloxetine ranks among the first place drugs for FMS.
Keywords: duloxetine, fibromyalgia, pharmacotherapy.

 

Artí­culo en PDF 

 

Pregabalina y síndrome de fibromialgia: una opción terapéutica.

Pregabalin and Fibromyalgia Syndrome: A Treatment Option
Kim Lawson
Biomedical Research Centre, Sheffield Hallam University, City Campus, Sheffield, S1 1WB, UK. Email: k.lawson@shu.ac.uk
Clinical Medicine: Therapeutics 2009:1 809-824


Abstract: Fibromyalgia (FM) is a chronic complex pain disorder that is multidimensional and exhibits heterogeneity requiring a long-term multidisciplinary approach to management. Many of the drugs used in the treatment of FM have been focused to the management of single symptoms; often such drugs fail to demonstrate acceptable efficacy in the majority of the patient population. Pregabalin is an α2-δ ligand that regulates the release and postsynaptic actions of  neurotransmitters related to analgesic, anticonvulsant and anxiolytic properties. In randomized, double-blind, placebo-controlled studies, pregabalin has demonstrated an improvement in
pain, sleep and fatigue symptoms associated with FM, as well as offering an improvement in parameters related to quality of life. Although the positive outcomes obtained with pregabalin support its use as an option for the management of FM, the efficacy was restricted to a selected patient population outside of the usual care setting. Current data do not allow an explanation where there are any limitations of pregabalin as a treatment of patients with FM, as to whether this is a deficiency of the drug or the process of assessment (e.g. assessment tools of FM, clinical trial design).
Keywords: fibromyalgia, pregabalin, treatment, pain, fatigue, sleep

 

Artí­culo en PDF 

Atentamente
Anestesiología y Medicina del Dolor

martes, 7 de diciembre de 2010

Vestibular migraña

Se puede conseguir ???

Vestibular migraine.

Strupp M, Versino M, Brandt T.

Handb Clin Neurol. 2010;97:755-71.
GraciasAL

Enviado desde mi iPhone

El 07/12/2010, a las 12:56, Vicente Rey <vicente.rey@gmail.com> escribió:

2, 3, 4 = sent

2010/12/7 s a <doc.shipsaiims@gmail.com>
hi does anybody have access to any of these articles; i need them
urgently for an interview; thanking you in anticipation; i shall b v v
v v gr8ful!!!!

1.      Nayak A, Iyer VK, Agarwal S, Agarwala S. Fine Needle Aspiration
Cytology of Fetal Rhabdomyomatous and Teratoid Wilms Tumor. Acta Cytol
(Accepted for publication).

2.      Jha P, Agarwal S, Pathak P, Srivastava A, Suri V, Sharma MC,
Chosdol K, Srivastava T, Gupta D, Gupta A, Suri A, Sarkar C.
Heterozygosity status of 1p and 19q and its correlation with p53
protein expression and EGFR amplification in patients with astrocytic
tumors: novel series from India. Cancer Genet Cytogenet.
2010;198(2):126-34.
3.       Agarwal S, Gupta R, Iyer VK, Mathur SR, Ray R. Cytopathological
diagnosis of alveolar soft part sarcoma, a rare soft tissue neoplasm.
Cytopathology. 2010 Aug 22.
4.      Agarwal S, Iyer VK, Agarwala S, Mathur SR, Aron M, Gupta SD, Verma
K. Apoptotic protein expression in favorable histology Wilms tumor
correlates with tumor recurrence. Pediatric Surgery International.
2010 Sep.


--
Dr Shipra Agarwal
M.D. (Pathology)
Senior resident
Department of Pathology
All India Institute of Medical Sciences
New Delhi

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Anticoagulación oral...



domingo, 28 de noviembre de 2010

OCLUSION DE VENAS RETINALES

Teaching Topic
Retinal-Vein Occlusion
Clinical Practice
Retinal-Vein Occlusion
T.Y. Wong and I.U. Scott
     


Retinal-vein occlusion is a common cause of vision loss in older persons, and the second most common retinal vascular disease after diabetic retinopathy. In branch retinal-vein occlusion, the occlusion is at an arteriovenous intersection; in central retinal-vein occlusion, the occlusion is at or proximal to the lamina cribosa of the optic nerve, where the central retinal vein exits the eye.
Clinical Pearls
  How does branch retinal-vein occlusion present?
Patients with retinal-vein occlusion typically present with sudden, unilateral, painless loss of vision. The degree of vision loss depends on the extent of retinal involvement and on macular-perfusion status. Some patients with branch retinal-vein occlusion report only a peripheral visual-field defect.
  What are the major risk factors for branch retinal-vein occlusion?
The strongest risk factor for branch retinal-vein occlusion is hypertension, but associations have been reported for diabetes mellitus, dyslipidemia, cigarette smoking, and renal disease.
Figure 1. Branch Retinal-Vein Occlusion in the Superotemporal Quadrant of the Right Eye.
Morning Report Questions
Q. What is the recommended management of a patient with branch retinal-vein occlusion?
A. The authors suggest that first-line treatment of branch retinal-vein occlusion is grid laser photocoagulation, since longer-term data from clinical trials have shown improvement in visual acuity, lower rates of adverse effects, and lower costs with this treatment than with anti-VEGF therapy. Grid, or focal, laser photocoagulation is used for the treatment of macular edema resulting from branch retinal-vein occlusion. Treatment with a dexamethasone implant is another option, but evidence is lacking to demonstrate an improvement in visual acuity beyond 3 months.
Q. What is the recommended management of a patient with a central retinal-vein occlusion?
A. Whereas macular edema resulting from branch retinal-vein occlusion is susceptible to treatment with grid laser photocoagulation, that resulting from central retinal-vein occlusion is not. Ranibizumab and bevacizumab are widely used in the treatment of central retinal-vein occlusion, as well as in the treatment of branch retinal-vein occlusion, and have been demonstrated to improve vision. The study of intravitreal injection of dexamethasone through an implant showed that the intervention improved vision in patients with central retinal-vein occlusion.

Resucitación cardiopulmonar


 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,25 noviembre, 2010 12:51
Asunto: Resucitación cardiopulmonar

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No:327     

Noviembre 24, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

Aspectos destacados de las guías de la American Heart Association de 2010 para RCP y ACE

Mary Fran Hazinski, RN, MSN
© 2010 American Heart Association


La presente publicación "Aspectos destacados de las guías" resume las principales cuestiones y cambios de las Guías de la American Heart Association (AHA) de 2010 para reanimación cardiopulmonar (RCP) y atención cardiovascular de emergencia (ACE). Se ha desarrollado con el objetivo de que los proveedores de reanimación y los instructores de la AHA se enfoquen en la ciencia y en las recomendaciones que son más importantes, las que fueron más discutidas o las que resultarán en cambios en la aplicación de la reanimación o en el modo de entrenarse para ello. Además, se ofrecen los fundamentos de dichas recomendaciones.


Artículo en PDF

Atentamente
Enf. Rosario Camacho

Anestesiología y Medicina del Dolor


__._,_.___

Sedation of Ventilated Patients and Analgesia....


Maximo Cuadros Chavez posted in cibermedicos.
Sedation of Ventilated Patients and Analgesia.  Sandiumenge, Alberto MD, PhD One of every 3 patients admitted in an  intensive care unit undergoes mechanical  ventilation. Sedation and  analgesia are required to facilitate patient  tolerance to such an  aggressive procedure, diminishing stress response,  relieving pain and  anxiety, ensuring patient comfort, and facilitating nursing  care.  However, misuse of sedatives and analgesics may impact negatively on   critically ill patients. The recognition of the potential for enduring  effects  derived from sedative and analgesic misuse, the availability of  new agents, and  the growing emphasis on cost containment have led to  important changes in the  way that sedation and analgesia practices are  implemented. The aim of the  present review is to discuss the agents,  indications, complications, and most  important strategies to optimize  the sedation and analgesic practices in the  intensive care unit.  Clin Pulm Med 2010;17: 290–299 PDF (461 K) http://www.facebook.com/l/2b97azD73sIpFIAiod9tXCO69aQ;pt.wkhealth.com/pt/re/merck/pdfhandler.00045413-201011000-00006.pdf;jsessionid=MyJVCkcGDpK2bVR2MgTFHJPtx0T1hqG5fl4W1B7psyGb51GpGsym!1173397540!181195629!8091!-1  Atte. Dr.Máximo Cuadros Chávez Celular 99199698 – Movistar - rpm #800515  http://www.facebook.com/l/2b97avSIOYqlN8HF8or5Z3ojjKw;es.groups.yahoo.com/group/interno_residente_medico_PERU/ http://es-la.facebook.com/people/Maximo-Cuadros-Chavez/100001101314342 http://www.facebook.com/l/2b97aYBg96px6dDuOMoo9Juzsuw;medicalia.ning.com/ http://www.facebook.com/l/2b97aKWkCqFmXBdJtT7YPZFy5Pg;www.medsocial.org/ http://www.facebook.com/l/2b97arWz_PsRntUj8w9rxf1xfDg;medbook.ning.com/ UNYK: 245 HRP
Maximo Cuadros Chavez 8:46am Nov 28
Sedation of Ventilated Patients and Analgesia.
Sandiumenge, Alberto MD, PhD
One of every 3 patients admitted in an intensive care unit undergoes mechanical
ventilation. Sedation and analgesia are required to facilitate patient
tolerance to such an aggressive procedure, diminishing stress response,
relieving pain and anxiety, ensuring patient comfort, and facilitating nursing
care. However, misuse of sedatives and analgesics may impact negatively on
critically ill patients. The recognition of the potential for enduring effects
derived from sedative and analgesic misuse, the availability of new agents, and
the growing emphasis on cost containment have led to important changes in the
way that sedation and analgesia practices are implemented. The aim of the
present review is to discuss the agents, indications, complications, and most
important strategies to optimize the sedation and analgesic practices in the
intensive care unit.

Clin Pulm Med 2010;17: 290–299
PDF (461 K)
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Atte.
Dr.Máximo Cuadros Chávez
Celular 99199698 – Movistar - rpm #800515

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sábado, 27 de noviembre de 2010

Cannabis y dolor


 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,25 noviembre, 2010 13:06
Asunto: Cannabis y dolor

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No:328     

Noviembre 25, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

Cannabis fumada para el dolor neuropático crónico: un ensayo controlado aleatorizado

Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.
Ware MA, Wang T, Shapiro S, Robinson A, Ducruet T, Huynh T, Gamsa A, Bennett GJ, Collet JP.
Department of Anesthesia, McGill University, Montréal, Que.

CMAJ. 2010 Oct 5;182(14):E694-701. Epub 2010 Aug 30.


Abstract
BACKGROUND: Chronic neuropathic pain affects 1%-2% of the adult population and is often refractory to standard pharmacologic treatment. Patients with chronic pain have reported using smoked cannabis to relieve pain, improve sleep and improve mood. METHODS: Adults with post-traumatic or postsurgical neuropathic pain were randomly assigned to receive cannabis at four potencies (0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-day periods in a crossover trial. Participants inhaled a single 25-mg dose through a pipe three times daily for the first five days in each cycle, followed by a nine-day washout period. Daily average pain intensity was measured using an 11-point numeric rating scale. We recorded effects on mood, sleep and quality of life, as well as adverse events. RESULTS: We recruited 23 participants (mean age 45.4 [standard deviation 12.3] years, 12 women [52%]), of whom 21 completed the trial. The average daily pain intensity, measured on the 11-point numeric rating scale, was lower on the prespecified primary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v. 6.1, respectively; difference = 0.7, 95% confidence interval [CI] 0.02-1.4). Preparations with intermediate potency yielded intermediate but nonsignificant degrees of relief. Participants receiving 9.4% tetrahydrocannabinol reported improved ability to fall asleep (easier, p = 0.001; faster, p < 0.001; more drowsy, p = 0.003) and improved quality of sleep (less wakefulness, p = 0.01) relative to 0% tetrahydrocannabinol. We found no differences in mood or quality of life. The most common drug-related adverse events during the period when participants received 9.4% tetrahydrocannabinol were headache, dry eyes, burning sensation in areas of neuropathic pain, dizziness, numbness and cough. CONCLUSION: A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis three times daily for five days reduced the intensity of pain, improved sleep and was well tolerated. Further long-term safety and efficacy studies are indicated. (International Standard Randomised Controlled Trial Register no. ISRCTN68314063).

 

Lea el artículo completo en el siguiente enlace:


http://www.cmaj.ca/cgi/reprint/182/14/E694

 

El sistema endocannabinoide y el dolor

The endocannabinoid system and pain.
Guindon J, Hohmann AG.
Neuroscience and Behavior Program, Department of Psychology, University of Georgia, Athens, GA 30602-3013, USA.
CNS Neurol Disord Drug Targets. 2009 Dec;8(6):403-21.


Abstract
The therapeutic potential of cannabinoids has been the topic of extensive investigation following the discovery of cannabinoid receptors and their endogenous ligands. Cannabinoid receptors and their endogenous ligands are present at supraspinal, spinal and peripheral levels. Cannabinoids suppress behavioral responses to noxious stimulation and suppress nociceptive processing through activation of cannabinoid CB(1) and CB(2) receptor subtypes. Endocannabinoids, the brain's own cannabis-like substances, share the same molecular target as Delta(9)-tetrahydrocannabinol, the main psychoactive component in cannabis. Endocannabinoids serve as synaptic circuit breakers and regulate multiple physiological and pathological conditions, e.g. regulation of food intake, immunomodulation, inflammation, analgesia, cancer, addictive behavior, epilepsy and others. This review will focus on uncovering the roles of anandamide and 2-arachidonoylglycerol, the two best characterized endocannabinoids identified to date, in controlling nociceptive responding. The roles of anandamide and 2-arachidonoylglycerol, released under physiological conditions, in modulating nociceptive responding at different levels of the neuraxis will be emphasized in this review. Effects of modulation of endocannabinoid levels through inhibition of endocannabinoid hydrolysis and uptake is also compared with effects of exogenous administration of synthetic endocannabinoids in acute, inflammatory and neuropathic pain models. Finally, the therapeutic potential of the endocannabinoid signaling system is discussed in the context of identifying novel pharmacotherapies for the treatment of pain.

 

Artí­culo en PDF 

Novedades sobre las potencialidades terapéuticas del Cannabis y el sistema cannabinoide 

Marta Duran, Joan-Ramon Laporte y Dolors Capellà
Fundació Institut Català de Farmacologia. Hospitals Vall d'Hebron.
Universitat Autònoma de Barcelona. Barcelona. España.
Med Clin (Barc) 2004;122(10):390-8


Durante la última década una rica investigación básica ha permitido caracterizar el sistema cannabinoide. Comienzan a acumularse pruebas de que los cannabinoides podrían ser eficaces en el tratamiento de las náuseas y vómitos por quimioterápicos antineoplásicos, el dolor, la espasticidad y otros síntomas de la esclerosis múltiple y algunas alteraciones del movimiento. Hay que esperar la publicación de los resultados de los ensayos clínicos en curso con extractos de Cannabis por vía oral y sublingual para definir de manera precisa su lugar en terapéutica en estas y otras indicaciones. Actualmente se están desarrollando nuevas vías de administración como la rectal, sublingual o transdérmica para evitar los efectos perjudiciales del humo del
Cannabis fumado. Aunque el futuro inmediato parece basarse en medicamentos derivados directamente del Cannabis, la investigación actual tiende a desarrollar por un lado nuevos fármacos que actúen potenciando o inhibiendo los efectos de los cannabinoides endógenos y
por otro, fármacos sintéticos agonistas y antagonistas de los receptores cannabinoides.
Palabras clave: Sistema cannabinoide. Cannabis. Cannabinoides. Dolor. Espasticidad. Náuseas y vómitos. Eficacia. Efectos indeseados.

 

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Anestesiología y Medicina del Dolor


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