Reações adversas na cavidade oral em decorrência do uso de medicamentos / Side effects in oral cavity in consequent of medication use

Introdução: as reações adversas a medicamentos constituem um problema importante na prática do profissional da área da saúde, já que essas reações são causas de hospitalização, aumento no tempo de permanência hospitalar e da morbimortalidade. Muitas das reações adversas aos fármacos apresentam-se na cavidade oral. Objetivo: descrever os principais medicamentos com potencial de efeitos colaterais na cavidade oral, agrupando os que causam efeitos adversos semelhantes. Método: trata-se de estudo bibliográfico e descritivo por meio de utilização de estudos originais e atualizados a partir dos bancos de dados oficiais SciELO, PUBMED e LILACS. Priorizaram-se artigos em língua portuguesa, inglesa e espanhola, que incluíam revisões bibliográficas, meta-análises e relatos de casos publicados entre 2000 e 2015. Foram utilizados como descritores os termos: manifestações orais e medicamentos, lesões orais e medicamentos, mucosa oral e medicamentos e reação medicamentosa na cavidade oral. Resultados e Discussão: dezenove artigos foram analisados detalhadamente e mostram predominância de relatos de caso. Vários medicamentos foram associados com alterações patológicas nos tecidos orais, sobretudo os medicamentos utilizados em oncologia e medicamentos com ação no sistema nervoso central. As reações adversas às drogas dependem do fármaco e são bastante variáveis, e dentre as encontradas destacam-se ulceração de mucosa, hiperplasia gengival, xerostomia e diminuição do fluxo salivar. Conclusão: algumas lesões são comuns a diferentes medicamentos e, dessa forma, é fundamental a observação correta da possibilidade de sequela associada à terapia medicamentosa. Uma anamnese adequada com um levantamento do histórico médico completo do paciente é essencial para o profissional de saúde estar apto a fazer o diagnóstico das alterações e concluir o tratamento adequado para a solução do problema. (AU)

Introduction: adverse drug reactions are an important problem in the practice of health professionals, since these reactions may cause hospitalization, increase in length of hospital stay and morbidity and mortality. Many adverse drug reactions occur in the oral cavity. Objective: to describe the main drugs with potential side effects in the oral cavity, grouping those that cause similar adverse effects. Methods: bibliographic and descriptive study through use of original studies from three databases: SciELO, PubMed and LILACS. Selected papers were in Portuguese, English and Spanish, which included literature reviews, meta-analysis and case reports published between 2000 and 2015. The terms used were: oral medications and manifestations, oral lesions and medicines, oral mucosa and drugs and adverse drug reaction in the oral cavity. Results and Discussion: nineteen articles were analyzed in detail and case reports were predominant. Several drugs have been associated with pathological changes in oral tissue, in particular drugs used in oncology and those acting on the central nervous system. Adverse drug reactions depend on the medication and are quite variable. Among the found reaction are: ulcerative mucosa, gingival hyperplasia, xerostomia and decreased salivary flow. Conclusion: some lesions are common to different drugs, making critical the proper observation of possible sequelae associated with drug therapy. Detailed anamnesis with a complete medical history of the patient is essential for the proper diagnosis and a better therapeutic decision. (AU)

Pharmacological characterization of venoms from three theraphosid spiders: Poecilotheria regalis, Ceratogyrus darlingi and Brachypelma epicureanum

BackgroundTarantulas (Theraphosidae) represent an important source of novel biologically active compounds that target a variety of ion channels and cell receptors in both insects and mammals. In this study, we evaluate and compare the pharmacological activity of venoms from three taxonomically different theraphosid spiders bred in captivity: Poecilotheria regalis, an aggressive arboreal tarantula from southeastern India; Ceratogyrus darlingi, an aggressive tarantula from southern Africa; and Brachypelma epicureanum, a docile tarantula from the Yucatan dry forest of Mexico. Prior to this study, no research had been conducted with regard to the composition and pharmacological activity of these venoms.MethodsThe pharmacological characterization of the venoms was described for the first time by the assessment of their toxicity in crickets (LD50) along with their nociceptive (by using the formalin test), hyaluronidase, phospholipase A2, edematogenic and caseinolytic activity.ResultsP. regalis and B. epicureanum venoms induced a similar lethal effect on crickets (LD50 = 5.23 ± 3.1 and 14.4 ± 5.0 μg protein/g 48 h post-injection, respectively), whereas C. darlingi venom (119.4 ± 29.5 μg protein/g 48 h post-injection) was significantly less lethal than the other two venoms. All three venoms induced similar edematogenic activity on rats but did not induce nociceptive behavior. The assessment of enzymatic activity indicated that P. regalis venom induces significantly higher hyaluronidase activity (27.6 ± 0.9 TRU/mg) than both C. darlingi (99.7 ± 1.9 TRU/mg) and B. epicureanum (99.6 ± 1.6 TRU/mg); these latter venoms did not display phospholipase A2or caseinolytic activity.ConclusionsThis study demonstrates that these theraphosid spiders of different habitats produce venoms with different activities. P. regalis venom displays a high level of hyaluronidase activity, which may be associated with its potentially medically significant bite.(AU)