A atuação do farmacêutico no tratamento da hipertensão arterial sistêmica na atenção primária à saúde / The performance of the pharmacist in the treatment of hypertension in the primary care

A atuação multi-interdisciplinar no manejo da hipertensão é reconhecida e estimulada por diversos autores devido à complexidade de sua abordagem. A partir disso, as sociedades de cardiologia, hipertensão e nefrologia reconhecem a impôrtancia da participação do farmacêutico no tratamento e controle da hipertensão expresso no Consenso Brasileiro de Hipertensão Arterial. A contribuição desse profissional na atenção básica envolve principalmente atividades relacionadas ao gerenciamento dos medicamentos e à atenção farmacêutica. Esta última vem se desenvolvendo rapidamente no Brasil e no mundo e é considerada uma prática promissora para somar-se a outras, no sentido da adesão ao tratamento e controle dessa doença crônica. Esse artigo tem como objetivo delinear as atividades do farmacêutico na hipertensão bem como sugerir modos de realizá-las no contexto da atenção primária à saúde .

Reduction of glutamate uptake into cerebral cortex of developing rats by the branched-chain alpha-keto acids accumulating in maple syrup urine disease.

In the current study we investigated the effect of the branched-chain alpha-keto acids (BCKA) co-ketoisocaproic (KIC), alpha-keto-beta-methylvaleric (KMV), and alpha-ketoisovaleric (KIV) acids, which accumulate in maple syrup urine disease (MSUD), on the in vitro uptake of [3H]glutamate by cerebral cortical slices from rats aged 9, 21, and 60 days of life. We initially observed that glutamate uptake into cerebral cortex of 9- and 21-day-old rats was significantly higher, as compared to that of 60-day-old rats. Furthermore, KIC inhibited this uptake by tissue slices at all ages studied, whereas KMV and KIV produced the same effect only in cortical slices of 21- and 60-day-old rats. Kinetic assays showed that KIC significantly inhibited glutamate uptake in the presence of high glutamate concentrations (50 microM and greater). We also verified that the reduction of glutamate uptake was not due to cellular death, as evidenced by tetrazolium salt and lactate dehydrogenase viability tests of cortical slices in the presence of the BCKA. It is therefore presumed that the reduced glutamate uptake caused by the BCKA accumulating in MSUD may lead to higher extracellular glutamate levels and potentially to excitotoxicity, which may contribute to the neurological dysfunction of the affected individuals.

In vitro phosphorylation of cytoskeletal proteins from cerebral cortex of rats.

Procedures for the preparation of high- and low-salt Triton insoluble cytoskeletal fractions from rat brain suitable for studying in vitro phosphorylation by endogenous kinases and phosphatases are described. The high-salt Triton insoluble cytoskeletal fraction is enriched in neurofilament subunits (NF-H, NF-M and NF-L), vimentin and glial fibrillary acidic protein (GFAP), while the low-salt Triton insoluble cytoskeletal fraction contains detergent insoluble cytoskeletal elements such as intermediate filament subunits and tubulins. One of our approaches is to incubate cerebral cortex slices with [32P]orthophosphate before the cytoskeletal fraction extraction, which allows the in vitro phosphorylation of cytoskeletal constituents in an intact intracellular environment. On the other hand, we also incubate low- or high-salt cytoskeletal fractions previously prepared with [gamma(32)P]ATP. By doing so, we are able to study the direct effects of substances on the kinase and phosphatase activities associated with the cytoskeletal fraction. Moreover by using specific activators or inhibitors of protein kinases and phosphatases we can obtain more detailed information on the alterations provoked by these substances. These approaches are useful for the investigation of the neurotoxic effects of various drugs and metabolites affecting the cytoskeletal-associated phosphorylation system in the brain.