Os AINE\'s são frequentemente empregados para o tratamento da dor aguda em gatos, porém, podem ser contraindicados pela propensão em causar efeitos adversos. A dipirona é um antigo analgésico não-opioide extensamente utilizado cujo mecanismo de ação ainda não foi completamente elucidado. O presente estudo prospectivo, randomizado e cego teve como objetivo avaliar o efeito analgésico e o mecanismo de ação via cicloxigenases (COX-1 e 2) da administração por via intravenosa (IV) de dipirona (12,5 mg/kg a cada 12 horas D12,5 ou 25 mg/kg a cada 24 horas D25) ou de meloxicam (0,1 mg/kg a cada 24 horas M) em gatas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Trinta gatas (13 ± 5 meses e 2,7 ± 0,5 kg) foram avaliadas durante 24 horas após o início do tratamento a partir de ferramentas objetivas e subjetivas da dor. Medicação resgate com cloridrato de tramadol (2 mg/kg, IV) foi instituída quando escores ≥ 5 pela Escala Glasgow. A atividade das COX-1 e 2 foi avaliada a partir da mensuração das concentrações de tromboxano B2 (TXB2) e prostaglandina E2 (PGE2). Efeitos adversos foram registrados e exames laboratoriais, incluindo concentrações séricas de dimetilarginina simétrica (SDMA), foram realizados. As análises estatísticas foram efetuadas com o software GraphPad Prism versão 7.03. O grau de significância estabelecido para os testes foi de 5% (P < 0,05). Mudanças nos parâmetros fisiológicos cardiovasculares não foram clinicamente relevantes, porém as gatas do grupo M apresentaram aumento de frequência cardíaca em relação ao basal (P = 0,0331). A temperatura retal reduziu no momento T1h em todos os grupos (P = 0,0001). Houve um aumento da glicemia no momento T4h no grupo D25 (P = 0,0178) e em T1h no grupo M (P = 0,0205). Apesar de os escores de dor e sedação 9 não diferirem entre grupos, a escala analógica visual revelou aumento em T4h em relação ao basal no D12,5 (P = 0,0415) e os escores de sedação em T1h foram superiores ao basal em todos os tratamentos (P < 0,0001). Não houve diferença quanto ao resgate analgésico, porém duas gatas dos grupos D12,5 (20%) e M (20%) e quatro do D25 necessitaram de medicação resgate. As concentrações de TXB2 foram superiores no grupo M em relação ao D12,5 e D25 em T4h (P = 0,0032 e P < 0,0001, respectivamente) e T24h (P = 0,0070 e 0,0111, respectivamente). Houve redução muito significativa em T1/2h, T4h e T24h quando comparados ao T0h em todos os grupos (P < 0.0001) e ocorreu aumento entre T1/2h e T4h no grupo M (P = 0,0004). As concentrações de PGE2 estimulada por lipopolisacarídeos (LPS) foram superiores em D25 em relação ao M em T4h (P = 0,0479). No grupo D12,5, em T1/2h, esta foram inferiores as de T0h (P = 0,0001) e T4h (P = 0,0112). O mesmo ocorreu no grupo D25 em T0h, T4h e T24h (P < 0,0001, P = 0,001 e 0,0004, respectivamente) enquanto que no M, os momentos T1/2h e T4h apresentaram valores inferiores ao T0h (P = 0,0016 e 0,0075). As concentrações séricas de SDMA do grupo D25 reduziram em T24h quando comparadas as de T0h (P = 0,0322), porém apenas uma gata do grupo M apresentou concentração acima do limite para a espécie. A partir dos resultados observados conclui-se que os protocolos analgésicos instituídos foram efetivos para o controle da dor pós-operatória neste contexto, apresentando inibição não seletiva COX-2 sem causar efeitos adversos e alterações hematológicas, na atividade das enzimas hepáticas e na taxa de filtração glomerular. / NSAIDs are often used for treatment of acute pain in cats, but it may be contraindicated for propensity to cause adverse effects. Dipyrone ia a widely used non-opioid analgesic whose mechanism of action has not yet been fully elucidated. The present prospective, randomized, blind study aimed to evaluate the analgesic effect and mechanism of action of inhibition of cycloxigenases (COX-1 and 2) of intravenous (IV) administration of dipyrone (25 mg/kg q 24 hours or 12.5 mg/kg q 12 hours) or meloxicam (0.1 mg/kg q 24 hours) in cats underwent elective ovariohysterectomy. Thirty cats (13 ± 5 months and 2,7 ± 0,5 kg) were evaluated for 24 hours after surgical procedure using objective and subjective pain tools. Rescue medication with tramadol hydrochloride (2 mg/kg IV) was administrated when scores ≥ 5 by the Glasgow scale. The activity of COX-1 and 2 was assessed by measuring the concentrations of thromboxane B2 (TXB2) and prostaglandin E2 (PGE2). Adverse effects were recorded and laboratory tests, including serum concentrations of symmetrical dimethylarginine (SDMA), were performed. Data was analyzed with GraphPad Prism version 7.03. Values of P < 0.05 were considered significant. Changes in cardiovascular parameters were not clinically relevant, but the M group presented higher heart rate than basal (P = 0.0331). The rectal temperature reduced at time T1h in all groups (P = 0.0001). There was an increase in blood glucose at time T4h in group D25 (P = 0.0178) and in T1h in group M (P = 0.0205). Although pain and sedation scores did not differ between groups, the visual analogue scale 11 showed an increase in T4h over baseline in D12.5 (P = 0.0415) and sedation scores in T1h were higher than baseline in all treatments (P < 0.0001). There was no difference in the analgesic rescue, but two cats of D12.5 (20%) and M (20%) groups and four from the D25 required rescue medication. The concentrations of TXB2 were higher in M group compared to D12.5 and D25 at T4h (P = 0.0032 and P < 0.0001, respectively) and T24h (P = 0.0070 and 0.0111, respectively) and there was a very significant reduction in T1/2h, T4h and T24h when compared to T0h in all groups (P < 0.0001) and there was an increase between T1/2h and T4h in group M (P = 0.0004). Concentrations of lipopolysaccharide-stimulated PGE2 (LPS) were higher in D25 compared to M in T4h (P = 0.0479). Those in the D12.5 group, in T1/2h, were lower than in T0h (P = 0.0001) and T4h (P = 0.0112). The same occurred in group D25 at T0h, T4h and T24h (P <0.0001, P = 0.001 and 0.0004, respectively) whereas in M, T1/2h and T4h moments presented values lower than T0h (P = 0.0016 and 0.0075). Serum concentrations of SDMA of D25 group decreased in T24h when compared to T0h (P = 0.0322) and only one cat (group M) showed serum concentration above the feline cut-off. In conclusion, the analgesic protocols were effective for the control of postoperative pain in this context, presenting COX-2 non-selective inhibition without causing adverse effects and hematological, liver enzyme activity and glomerular filtration rate alterations.

Submitted by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-06-12T13:58:59Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) ROCHELLE GORCZAK.pdf: 1606847 bytes, checksum: bc8c2f487df26334b0352b162fbe2aac (MD5) / Approved for entry into archive by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-06-12T13:59:15Z (GMT) No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) ROCHELLE GORCZAK.pdf: 1606847 bytes, checksum: bc8c2f487df26334b0352b162fbe2aac (MD5) / Made available in DSpace on 2017-06-12T13:59:15Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) ROCHELLE GORCZAK.pdf: 1606847 bytes, checksum: bc8c2f487df26334b0352b162fbe2aac (MD5) Previous issue date: 2017-03-30 / A dipirona é um analgésico eficaz para o manejo da dor pós-operatória moderada ou grave, podendo ser utilizado isoladamente em dores leves ou associado a outros analgésicos em qualquer tipo de dor, gerando diversos benefícios ao paciente. O presente estudo teve como objetivo avaliar os parâmetros cardiorrespiratórios no transoperatório, além da analgesia no período trans e pós-operatório de cadelas que receberam infusão contínua (IC) de dipirona. Para o estudo, 20 cadelas foram submetidas ao procedimento de Ovariohisterectomia eletiva. A medicação pré-anestésica foi composta pela associação de acepromazina e morfina, seguida da indução com propofol e manutenção com isofluorano. Posteriormente, os animais foram alocados, aleatoriamente, em dois grupos: dipirona (GD), que receberam bolus de dipirona (25 mg/kg) seguido da IC do fármaco na taxa de 10 mg/kg/h, e grupo controle (GC), cujos animais receberam o bolus e IC de solução de NaCl 0,9%, ambos os grupos na velocidade de 5 mL/kg/h. Variáveis paramétricas foram analisadas pela ANOVA seguida pelo teste de Tukey (p<0,05) e comparadas entre os grupos pelo teste t pareado. Variáveis não paramétricas foram analisadas pelo teste de Friedman seguido pelo teste de Dunn’s. Entre os grupos, essa avaliação foi realizada pelo teste de Mann-Whitney (p<0,05). Foram observadas diferenças estatísticas entre os momentos em ambos os grupos em relação à FC, f, PAS, PAM, PAD, PPT, glicemia, neutrófilos segmentados e linfócitos. Entre os grupos, houve apenas diferenças nos valores basais de PAM, número de eosinófilos, de neutrófilos segmentados e tempos cirúrgicos. No entanto, a maioria dos valores manteve-se dentro da faixa considerada fisiológica para a espécie. As avaliações da analgesia pós-operatória foram realizadas por um período de 24h, utilizando a Escala Composta de Dor de Glasgow e a Escala da Universidade de Melbourne, não sendo observadas diferenças entre os grupos. A utilização do fármaco como adjuvante a anestesia não alterou os parâmetros cardiorrespiratórios, nem os exames hematológicos realizados. A analgesia pós-operatória foi semelhante entre os grupos. / Dipyrone is an effective analgesic for the management of moderate or severe postoperative pain, can be used alone in mild pain or associated with other analgesics in any type of pain, generating several benefits to the patient. The present study aimed to evaluate cardiorespiratory parameters in the intraoperative period, and analgesia in the trans and postoperative period, in dogs receiving constant rate infusion (CRI) of dipyrone. For the study, 20 canine females were submitted to elective ovariohysterectomy procedure. The preanesthetic medication was composed by the association of acepromazine and morphine, followed by induction with propofol and maintenance with isoflurane. Afterwards, the animals were divided randomly into two groups: dipyrone (GD), who received dipyrone boluses (25 mg/kg) intravenous, followed by the CRI of the drug at the rate of 10 mg/kg/h, and control group (CG), whose animals received the bolus and IC of 0.9% NaCl solution, both groups at a rate of 5 mL/kg/h. Variables with normal distribution were evaluated by ANOVA followed by the Tukey test (p<0,05) and compared between groups by paired t-test. Non-parametric variables were analyzed by Friedman test followed by Dunn's test. Among the groups, this evaluation was performed by the Mann-Whitney test (p<0,05). Statistical differences were observed between time points in both groups regarding HR, f, SBP, MBP, DBP, PPT, glycaemia, segmented neutrophils and lymphocytes. Among these two groups, there were only differences in baseline MBP, number of eosinophils, segmented neutrophils and surgical times. However, most values remained within the physiological range considered for the species. The postoperative analgesia assessments were performed for a period of 24 hours, using Glasgow Composite Pain Scale and Range of the University of Melbourne, no differences were observed between groups. The use of the drug as an adjunct to anesthesia did not alter the cardiorespiratory parameters, Nor haematological examinations performed. Postoperative analgesia was similar between the groups.

Os AINE\'s são frequentemente empregados para o tratamento da dor aguda em gatos, porém, podem ser contraindicados pela propensão em causar efeitos adversos. A dipirona é um antigo analgésico não-opioide extensamente utilizado cujo mecanismo de ação ainda não foi completamente elucidado. O presente estudo prospectivo, randomizado e cego teve como objetivo avaliar o efeito analgésico e o mecanismo de ação via cicloxigenases (COX-1 e 2) da administração por via intravenosa (IV) de dipirona (12,5 mg/kg a cada 12 horas D12,5 ou 25 mg/kg a cada 24 horas D25) ou de meloxicam (0,1 mg/kg a cada 24 horas M) em gatas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Trinta gatas (13 &#177; 5 meses e 2,7 &#177; 0,5 kg) foram avaliadas durante 24 horas após o início do tratamento a partir de ferramentas objetivas e subjetivas da dor. Medicação resgate com cloridrato de tramadol (2 mg/kg, IV) foi instituída quando escores &ge; 5 pela Escala Glasgow. A atividade das COX-1 e 2 foi avaliada a partir da mensuração das concentrações de tromboxano B2 (TXB2) e prostaglandina E2 (PGE2). Efeitos adversos foram registrados e exames laboratoriais, incluindo concentrações séricas de dimetilarginina simétrica (SDMA), foram realizados. As análises estatísticas foram efetuadas com o software GraphPad Prism versão 7.03. O grau de significância estabelecido para os testes foi de 5% (P &lt; 0,05). Mudanças nos parâmetros fisiológicos cardiovasculares não foram clinicamente relevantes, porém as gatas do grupo M apresentaram aumento de frequência cardíaca em relação ao basal (P = 0,0331). A temperatura retal reduziu no momento T1h em todos os grupos (P = 0,0001). Houve um aumento da glicemia no momento T4h no grupo D25 (P = 0,0178) e em T1h no grupo M (P = 0,0205). Apesar de os escores de dor e sedação 9 não diferirem entre grupos, a escala analógica visual revelou aumento em T4h em relação ao basal no D12,5 (P = 0,0415) e os escores de sedação em T1h foram superiores ao basal em todos os tratamentos (P &lt; 0,0001). Não houve diferença quanto ao resgate analgésico, porém duas gatas dos grupos D12,5 (20%) e M (20%) e quatro do D25 necessitaram de medicação resgate. As concentrações de TXB2 foram superiores no grupo M em relação ao D12,5 e D25 em T4h (P = 0,0032 e P &lt; 0,0001, respectivamente) e T24h (P = 0,0070 e 0,0111, respectivamente). Houve redução muito significativa em T1/2h, T4h e T24h quando comparados ao T0h em todos os grupos (P &lt; 0.0001) e ocorreu aumento entre T1/2h e T4h no grupo M (P = 0,0004). As concentrações de PGE2 estimulada por lipopolisacarídeos (LPS) foram superiores em D25 em relação ao M em T4h (P = 0,0479). No grupo D12,5, em T1/2h, esta foram inferiores as de T0h (P = 0,0001) e T4h (P = 0,0112). O mesmo ocorreu no grupo D25 em T0h, T4h e T24h (P &lt; 0,0001, P = 0,001 e 0,0004, respectivamente) enquanto que no M, os momentos T1/2h e T4h apresentaram valores inferiores ao T0h (P = 0,0016 e 0,0075). As concentrações séricas de SDMA do grupo D25 reduziram em T24h quando comparadas as de T0h (P = 0,0322), porém apenas uma gata do grupo M apresentou concentração acima do limite para a espécie. A partir dos resultados observados conclui-se que os protocolos analgésicos instituídos foram efetivos para o controle da dor pós-operatória neste contexto, apresentando inibição não seletiva COX-2 sem causar efeitos adversos e alterações hematológicas, na atividade das enzimas hepáticas e na taxa de filtração glomerular. / NSAIDs are often used for treatment of acute pain in cats, but it may be contraindicated for propensity to cause adverse effects. Dipyrone ia a widely used non-opioid analgesic whose mechanism of action has not yet been fully elucidated. The present prospective, randomized, blind study aimed to evaluate the analgesic effect and mechanism of action of inhibition of cycloxigenases (COX-1 and 2) of intravenous (IV) administration of dipyrone (25 mg/kg q 24 hours or 12.5 mg/kg q 12 hours) or meloxicam (0.1 mg/kg q 24 hours) in cats underwent elective ovariohysterectomy. Thirty cats (13 &#177; 5 months and 2,7 &#177; 0,5 kg) were evaluated for 24 hours after surgical procedure using objective and subjective pain tools. Rescue medication with tramadol hydrochloride (2 mg/kg IV) was administrated when scores &ge; 5 by the Glasgow scale. The activity of COX-1 and 2 was assessed by measuring the concentrations of thromboxane B2 (TXB2) and prostaglandin E2 (PGE2). Adverse effects were recorded and laboratory tests, including serum concentrations of symmetrical dimethylarginine (SDMA), were performed. Data was analyzed with GraphPad Prism version 7.03. Values of P &lt; 0.05 were considered significant. Changes in cardiovascular parameters were not clinically relevant, but the M group presented higher heart rate than basal (P = 0.0331). The rectal temperature reduced at time T1h in all groups (P = 0.0001). There was an increase in blood glucose at time T4h in group D25 (P = 0.0178) and in T1h in group M (P = 0.0205). Although pain and sedation scores did not differ between groups, the visual analogue scale 11 showed an increase in T4h over baseline in D12.5 (P = 0.0415) and sedation scores in T1h were higher than baseline in all treatments (P &lt; 0.0001). There was no difference in the analgesic rescue, but two cats of D12.5 (20%) and M (20%) groups and four from the D25 required rescue medication. The concentrations of TXB2 were higher in M group compared to D12.5 and D25 at T4h (P = 0.0032 and P &lt; 0.0001, respectively) and T24h (P = 0.0070 and 0.0111, respectively) and there was a very significant reduction in T1/2h, T4h and T24h when compared to T0h in all groups (P &lt; 0.0001) and there was an increase between T1/2h and T4h in group M (P = 0.0004). Concentrations of lipopolysaccharide-stimulated PGE2 (LPS) were higher in D25 compared to M in T4h (P = 0.0479). Those in the D12.5 group, in T1/2h, were lower than in T0h (P = 0.0001) and T4h (P = 0.0112). The same occurred in group D25 at T0h, T4h and T24h (P &lt;0.0001, P = 0.001 and 0.0004, respectively) whereas in M, T1/2h and T4h moments presented values lower than T0h (P = 0.0016 and 0.0075). Serum concentrations of SDMA of D25 group decreased in T24h when compared to T0h (P = 0.0322) and only one cat (group M) showed serum concentration above the feline cut-off. In conclusion, the analgesic protocols were effective for the control of postoperative pain in this context, presenting COX-2 non-selective inhibition without causing adverse effects and hematological, liver enzyme activity and glomerular filtration rate alterations.

Adverse drug reactions (ADRs) constitute a major problem in society and in drug therapy. They are a common cause of short-term hospitalization, prolonged hospitalization and death. Spontaneous reporting of ADRs remains one the most effective methods for detecting new and serious drug reactions. In Sweden physicians are legally required to report fatal and serious ADRs. We know from previous studies that there is a substantial degree of under-reporting of ADRs also in Sweden. Attitudes towards reporting of ADRs among physicians in the northern region of Sweden were investigated using a questionnaire. The most important factor for not reporting ADRs among physicians and general practioners in our region was that the reaction was considered to be well known. However, their attitudes could also allow for a considerable rate of under-reporting. The effect on the reporting rate when nurses received instruction and were encouraged to report ADRs was studied. During a 12-month study period, 18 ADR reports with a total number of 22 ADRs were sent in by the nurses participating in the study to test nurses as reporters of ADRs. Using the Swedish ADR database, we calculated the risk of agranulocytosis associated with the use of metamizole by using consumption data from the case records of scrutinized patients’ and stored prescriptions. Over the period from 1996 to 1999, ten cases of agranulocytosis during treatment with metamizole were reported to SADRAC. Metamizole was prescribed to 666 (19%) inpatients during the 3-month study period and 112 prescriptions were identified at the participating pharmacies. Thirty-eight percent of them indicated treatment for more than 15 days. Making certain assumptions, the calculated risk of agranulocytosis was one out of every 31 000 inpatients and one out of every 1400 outpatients. The degree of under-reporting of serious ADRs was studied in five hospitals. More than 1300 case records were scrutinized and among these we found 107 cases that according to current rules for ADR reporting, should have been reported. Only fifteen of these were found in the SADRAC database, indicating a under-reporting rate of 86%.The effect on the reporting rate of ADRs was studied in an intervention study in which a small economical inducement was given to those who reported ADRs. The effect of a small economical stimulation to increase the reporting rate was studied. From the intervention area we received 62 suspected ADRs compared with 50 from the control area. The increase in the number of reports was 59% compared with an unchanged reporting rate from the control area. The physicians in northern Sweden have a relatively good knowledge of the existing rules for ADR reporting. Nurses could play an important role in detecting and reporting suspected ADRs. The risk of developing an metamizole induced agranulocytosis is considerably increased if metamizole is given to patients for a longer time than recommended. The rate of reported ADRs is very low, also for serious and fatal reactions. An increase in the reporting rate of suspected ADRs was observed during study period.