<div id="pf1" class="pf w0 h0" data-page-no="1"><div class="pc pc1 w0 h0"><img class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/13632904-319a-4ffd-bdf7-f5bb5c330981/bg1.png"><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls4 ws1">Excreção das Drogas </div><div class="t m0 x2 h3 y2 ff2 fs1 fc0 sc0 ls4 ws1">As principais modalid<span class="_0 blank"></span>ades pelas quais as d<span class="_0 blank"></span>rogas deixam o <span class="_0 blank"></span>organismo são: <span class="_0 blank"></span>excreção renal, </div><div class="t m0 x2 h3 y3 ff2 fs1 fc0 sc0 ls4 ws1">excreção biliar (fez<span class="_0 blank"></span>es) e excreção <span class="_0 blank"></span>pulmonar (anestésicos ga<span class="_0 blank"></span>sosos por <span class="_0 blank"></span>exemplo). </div><div class="t m0 x2 h3 y4 ff2 fs1 fc0 sc0 ls4 ws1">Outras vias de excr<span class="_0 blank"></span>eção são representa<span class="_0 blank"></span>das pelo suor, lágrima<span class="_0 blank"></span>s<span class="_1 blank"> </span><span class="ff3">, leite matern<span class="_0 blank"></span>o<span class="ff2">, fezes, </span></span></div><div class="t m0 x2 h3 y5 ff2 fs1 fc0 sc0 ls4 ws1">secreção nasal <span class="_0 blank"></span>etc. </div><div class="t m0 x2 h3 y6 ff2 fs1 fc0 sc0 ls4 ws1">Algumas drogas <span class="_0 blank"></span>secretadas na bile pelo fí<span class="_0 blank"></span>gado são reabsorvida<span class="_0 blank"></span>s no intestino, no cicl<span class="_0 blank"></span>o </div><div class="t m0 x2 h3 y7 ff2 fs1 fc0 sc0 ls4 ws1">enterro-hepático (<span class="_0 blank"></span>após sofrerem reações <span class="_0 blank"></span>pela flora inte<span class="_0 blank"></span>stinal). </div><div class="t m0 x2 h3 y8 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h4 y9 ff4 fs1 fc1 sc0 ls4 ws0">\uf076<span class="ff5 ls0 ws1"> <span class="ff3 ls4">A via Renal cons<span class="_0 blank"></span>titui a principal via de e<span class="_0 blank"></span>xcreção </span></span></div><div class="t m0 x0 h3 ya ff3 fs1 fc1 sc0 ls4 ws1">de drogas </div><div class="t m0 x2 h3 yb ff2 fs1 fc0 sc0 ls4 ws1">Substancias lipofíli<span class="_0 blank"></span>cas (<span class="ff5 fs2 fc2">tem afinidade e<span class="_0 blank"></span> é solúvel<span class="_0 blank"></span> em lipídios) </span></div><div class="t m0 x2 h3 yc ff2 fs1 fc0 sc0 ls4 ws1">não são eficiente<span class="_0 blank"></span>mente excretadas pelo<span class="_0 blank"></span>s rins. <span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h3 yd ff2 fs1 fc0 sc0 ls4 ws1">Por este motivo as dr<span class="_0 blank"></span>ogas lipofílicas são <span class="_0 blank"></span>metabolizadas<span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h3 ye ff2 fs1 fc0 sc0 ls4 ws1">em metabólitos <span class="_0 blank"></span>hidrofílicos/ polare<span class="_0 blank"></span>s que são mais<span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h3 yf ff2 fs1 fc0 sc0 ls4 ws1">facilmente excretad<span class="_0 blank"></span>os pela urina devido <span class="_0 blank"></span>a sua baixa<span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h3 y10 ff2 fs1 fc0 sc0 ls4 ws1">permeabilidade tubul<span class="_0 blank"></span>ar e portanto, <span class="_0 blank"></span>baixa ou ausente<span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h3 y11 ff2 fs1 fc0 sc0 ls4 ws1">taxa de reabsorção.<span class="_0 blank"></span><span class="ff5 fs2 fc2"> </span></div><div class="t m0 x2 h5 y12 ff5 fs2 fc2 sc0 ls4 ws1"> </div><div class="t m0 x0 h4 y13 ff4 fs1 fc0 sc0 ls1">\uf0e8<span class="ff5 ls4 ws1"> <span class="_2 blank"></span><span class="ff2">Assim, as drogas ex<span class="_0 blank"></span>cretadas pelos rins </span></span></div><div class="t m0 x4 h3 y14 ff2 fs1 fc0 sc0 ls4 ws1">apresentam variação<span class="_0 blank"></span> na percentagem de </div><div class="t m0 x4 h3 y15 ff2 fs1 fc0 sc0 ls4 ws1">excreção devido trê<span class="_0 blank"></span>s processos: </div><div class="t m0 x3 h4 y16 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">Filtração glomeru<span class="_0 blank"></span>lar; </span></span></div><div class="t m0 x3 h4 y17 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">Secreção ou reabsor<span class="_0 blank"></span>ção tubulares at<span class="_0 blank"></span>ivas; </span></span></div><div class="t m0 x3 h4 y18 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">Difusão passiva atr<span class="_0 blank"></span>avés do epitélio tub<span class="_0 blank"></span>ular (lipofílicas). </span></span></div><div class="t m0 x2 h3 y19 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x2 h3 y1a ff2 fs1 fc0 sc0 ls4 ws1">Na <span class="ff3">FILTRAÇÃO GLO<span class="_0 blank"></span>MERULAR<span class="ff2"> (cápsula d<span class="_0 blank"></span>e Bowman) apenas m<span class="_0 blank"></span>oléculas de drogas com baixo </span></span></div><div class="t m0 x2 h3 y1b ff2 fs1 fc0 sc0 ls4 ws1">peso molecular <span class="_0 blank"></span>atingem o filtrado glo<span class="_0 blank"></span>merular, sendo portant<span class="_0 blank"></span>o apenas 20% do fluxo </div><div class="t m0 x2 h3 y1c ff2 fs1 fc0 sc0 ls4 ws1">plasmático filtrado <span class="_0 blank"></span>pelos glomérulos. </div><div class="c x5 y1d w2 h6"><div class="t m0 x6 h7 y1e ff7 fs3 fc0 sc0 ls4 ws1">Se o túbulo é livremente permeável </div><div class="t m0 x6 h7 y1f ff7 fs3 fc0 sc0 ls4 ws1">ás moléculas de droga, a </div><div class="t m0 x6 h7 y20 ff7 fs3 fc0 sc0 ls4 ws1">concentração da droga no filtrado se </div><div class="t m0 x6 h7 y21 ff7 fs3 fc0 sc0 ls4 ws1">aproxima da concentração </div><div class="t m0 x6 h7 y22 ff7 fs3 fc0 sc0 ls4 ws1">plasmática da droga e cerca de 99% </div><div class="t m0 x6 h7 y23 ff7 fs3 fc0 sc0 ls4 ws1">da droga filtrada é reabsorvida </div><div class="t m0 x6 h7 y24 ff7 fs3 fc0 sc0 ls4 ws1">passivamente. As drogas que </div><div class="t m0 x6 h7 y25 ff7 fs3 fc0 sc0 ls4 ws1">possuem elevada lipossolubilidade, o </div><div class="t m0 x6 h7 y26 ff7 fs3 fc0 sc0 ls4 ws1">que significa elevada permeabilidade </div><div class="t m0 x6 h7 y27 ff7 fs3 fc0 sc0 ls4 ws1">tubular, são, portanto, lentamente </div><div class="t m0 x6 h7 y28 ff7 fs3 fc0 sc0 ls4 ws1">excretadas. </div><div class="t m0 x6 h7 y29 ff7 fs3 fc0 sc0 ls4 ws1">Se a droga é altamente polar, </div><div class="t m0 x6 h7 y2a ff7 fs3 fc0 sc0 ls4 ws1">portanto, tem baixa permeabilidade </div><div class="t m0 x6 h7 y2b ff7 fs3 fc0 sc0 ls4 ws1">tubular, a droga filtrada permanece </div><div class="t m0 x6 h7 y2c ff7 fs3 fc0 sc0 ls4 ws1">no túbulo e sua concentração na </div><div class="t m0 x6 h7 y2d ff7 fs3 fc0 sc0 ls4 ws1">urina se eleva cerca de 100x mais </div><div class="t m0 x6 h7 y2e ff7 fs3 fc0 sc0 ls4 ws1">que no plasma. </div></div></div><div class="pi" data-data='{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}'></div></div> <div id="pf2" class="pf w0 h0" data-page-no="2"><div class="pc pc2 w0 h0"><img class="bi x7 y2f w3 h8" alt="" src="https://files.passeidireto.com/13632904-319a-4ffd-bdf7-f5bb5c330981/bg2.png"><div class="t m0 x2 h3 y30 ff2 fs1 fc0 sc0 ls4 ws1">Obs. A albumina <span class="_0 blank"></span>plasmática (proteína ma<span class="_0 blank"></span>is abundante <span class="_0 blank"></span>do plasma) não é <span class="_0 blank"></span>filtrada. Se a drog<span class="_0 blank"></span>a </div><div class="t m0 x2 h3 y31 ff2 fs1 fc0 sc0 ls4 ws1">se liga a esta proteín<span class="_0 blank"></span>a em nível elevad<span class="_0 blank"></span>o, sua concentraçã<span class="_0 blank"></span>o no filtrado glomeru<span class="_0 blank"></span>lar é menor </div><div class="t m0 x2 h3 y32 ff2 fs1 fc0 sc0 ls4 ws1">que a concentração p<span class="_0 blank"></span>lasmática. </div><div class="t m0 x2 h3 y33 ff2 fs1 fc0 sc0 ls4 ws1">O restante 80% do <span class="_0 blank"></span>fluxo sanguíneo, com ce<span class="_0 blank"></span>rca de 80% també<span class="_0 blank"></span>m da droga irá passar par<span class="_0 blank"></span>a os </div><div class="t m0 x2 h3 y34 ff2 fs1 fc0 sc0 ls4 ws1">capilares peritubular<span class="_0 blank"></span>es do túbulo proximal<span class="_0 blank"></span>. Neste, as moléculas <span class="_0 blank"></span>da droga são tra<span class="_0 blank"></span>nsferidas </div><div class="t m0 x2 h3 y35 ff2 fs1 fc0 sc0 ls4 ws1">para a luz <span class="_0 blank"></span>tubular por meio de transporte <span class="_0 blank"></span>ativo, podendo reduz<span class="_0 blank"></span>ir a concentração pla<span class="_0 blank"></span>smática </div><div class="t m0 x2 h3 y36 ff2 fs1 fc0 sc0 ls4 ws1">da droga. Temos <span class="_0 blank"></span>assim a <span class="ff3">SECREÇÃO TUBU<span class="_0 blank"></span>LAR<span class="ff2">, principal mecani<span class="_0 blank"></span>smo de eliminação d<span class="_0 blank"></span>a droga </span></span></div><div class="t m0 x2 h3 y37 ff2 fs1 fc0 sc0 ls4 ws1">por excreção renal<span class="_0 blank"></span>. </div><div class="t m0 x2 h3 y38 ff2 fs1 fc0 sc0 ls4 ws1">O grau de ligação pro<span class="_0 blank"></span>teica plasmática d<span class="_0 blank"></span>essas </div><div class="t m0 x2 h3 y39 ff2 fs1 fc0 sc0 ls4 ws1">drogas não influen<span class="_0 blank"></span>cia significativa<span class="_0 blank"></span>mente na </div><div class="t m0 x2 h3 y3a ff2 fs1 fc0 sc0 ls4 ws1">secreção tubular, <span class="_0 blank"></span>pois a célula tub<span class="_0 blank"></span>ular renal é </div><div class="t m0 x2 h3 y3b ff2 fs1 fc0 sc0 ls4 ws1">capaz de separar a <span class="_0 blank"></span>proteína plasmática a fi<span class="_0 blank"></span>m de </div><div class="t m0 x2 h3 y3c ff2 fs1 fc0 sc0 ls4 ws1">excretar a drog<span class="_0 blank"></span>a. </div><div class="t m0 x2 h3 y3d ff2 fs1 fc0 sc0 ls4 ws1">Estas drogas depois d<span class="_0 blank"></span>e secretadas pelo<span class="_0 blank"></span>s túbulos e filtradas pelos glom<span class="_0 blank"></span>érulos caem na <span class="_0 blank"></span>luz </div><div class="t m0 x2 h3 y3e ff2 fs1 fc0 sc0 ls4 ws1">tubular e podem seg<span class="_0 blank"></span>uir dois caminhos: </div><div class="t m0 x0 h4 y3f ff4 fs1 fc0 sc0 ls1">\uf0e8<span class="ff5 ls4 ws1"> <span class="_2 blank"></span><span class="ff2">Excretadas na urina<span class="_0 blank"></span> ou Reabsorvidas </span></span></div><div class="t m0 x2 h3 y40 ff2 fs1 fc0 sc0 ls4 ws1">Estes processo<span class="_0 blank"></span>s dependem da ionização <span class="_0 blank"></span>das drogas secretada<span class="_0 blank"></span>s, se encontra-se em maior </div><div class="t m0 x2 h3 y41 ff2 fs1 fc0 sc0 ls4 ws1">parte ionizada, <span class="_0 blank"></span>não será reabsorvida, ma<span class="_0 blank"></span>s se encontra-se não </div><div class="t m0 x2 h3 y42 ff8 fs1 fc0 sc0 ls4 ws2">\ue374<span class="ff2 ws1"> ionizada será reabs<span class="_0 blank"></span>orvida. </span></div><div class="t m0 x2 h3 y43 ff2 fs1 fc0 sc0 ls4 ws1">O glomérulo renal fi<span class="_0 blank"></span>ltra ambas as parte<span class="_0 blank"></span>s, tanto ionizad<span class="_0 blank"></span>a como </div><div class="t m0 x2 h3 y44 ff2 fs1 fc0 sc0 ls4 ws1">não <span class="ff8 ws2">\ue374</span> ionizada. P<span class="_0 blank"></span>orém, muitas drogas por<span class="_0 blank"></span> serem ácido<span class="_0 blank"></span>s e </div><div class="t m0 x2 h3 y45 ff2 fs1 fc0 sc0 ls4 ws1">bases fracos altera<span class="_0 blank"></span>m sua ionização com o <span class="_0 blank"></span>pH, afetando <span class="_0 blank"></span>assim </div><div class="t m0 x2 h3 y46 ff2 fs1 fc0 sc0 ls4 ws1">a excreção renal. </div><div class="t m0 x3 h4 y47 ff4 fs1 fc0 sc0 ls5">\uf0fc<span class="ff5 ls6 ws1"> <span class="ff2 ls4">Uma droga básica é <span class="_0 blank"></span>mais rapidamente <span class="_0 blank"></span>excretada em uma urin<span class="_0 blank"></span>a ácida porque <span class="_0 blank"></span>o baixo </span></span></div><div class="t m0 x0 h3 y48 ff2 fs1 fc0 sc0 ls4 ws1">pH no túbulo favorec<span class="_0 blank"></span>e a ionização, inibind<span class="_0 blank"></span>o a reabsorção. Drog<span class="_0 blank"></span>as ácidas portanto <span class="_0 blank"></span>são </div><div class="t m0 x0 h3 y49 ff2 fs1 fc0 sc0 ls4 ws1">mais rapidament<span class="_0 blank"></span>e excretadas se a urina<span class="_0 blank"></span> é alcalina. </div><div class="t m0 x3 h3 y4a ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h3 y4b ff2 fs1 fc0 sc0 ls4 ws1">Ex. No plasma co<span class="_0 blank"></span>m pH 7,4, o <span class="_0 blank"></span>ASS se encontra em sua maior par<span class="_0 blank"></span>te sobre a forma ion<span class="_0 blank"></span>izada </div><div class="t m0 x3 h3 y4c ff2 fs1 fc0 sc0 ls4 ws1">e hidrossolúvel. O glo<span class="_0 blank"></span>mérulo renal filtra<span class="_0 blank"></span> ambas as par<span class="_0 blank"></span>tes, tanto a ionizad<span class="_0 blank"></span>a como a não <span class="ff8 ws2">\ue374</span> </div><div class="t m0 x3 h3 y4d ff2 fs1 fc0 sc0 ls4 ws1">ionizada. Na acidif<span class="_0 blank"></span>icação normal da urina <span class="_0 blank"></span>a ionização do ASS di<span class="_0 blank"></span>minui, aumentando a </div><div class="t m0 x3 h3 y4e ff2 fs1 fc0 sc0 ls4 ws1">fração não ionizada <span class="_0 blank"></span>lipossolúvel que será <span class="_0 blank"></span>reabsorvida. Se a urina<span class="_0 blank"></span> for alcalinizada, a </div><div class="c x8 y4f w4 h9"><div class="t m0 x6 h3 y50 ff2 fs1 fc0 sc0 ls4 ws1">Obs. A reabsorção oc<span class="_0 blank"></span>orre: </div><div class="t m0 x9 h4 y51 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">túbulo distal </span></span></div><div class="t m0 x2 h4 y52 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">alça de Henle </span></span></div><div class="t m0 xa h4 y53 ff6 fs1 fc0 sc0 ls2">\uf0b7<span class="ff5 ls3 ws1"> <span class="ff2 ls4">túbulo coletor.<span class="_0 blank"></span> </span></span></div></div><div class="c xb y54 w5 ha"><div class="t m0 x6 h3 y55 ff2 fs1 fc0 sc0 ls4 ws1">PROBENECIDA </div><div class="t m1 xc hb y55 ff4 fs4 fc0 sc0 ls4">\uf0e0</div><div class="t m0 xd h3 y55 ff2 fs1 fc0 sc0 ls4 ws1"> Atua bloquea<span class="_0 blank"></span>ndo </div><div class="t m0 x6 h3 y56 ff2 fs1 fc0 sc0 ls4 ws1">proteínas de transpor<span class="_0 blank"></span>te ativo </div><div class="t m0 x6 h3 y57 ff2 fs1 fc0 sc0 ls4 ws1">afetando assi<span class="_0 blank"></span>m a secreção e retendo </div><div class="t m0 x6 h3 y58 ff2 fs1 fc0 sc0 ls4 ws1">portanto aníons e <span class="_0 blank"></span>cátions no </div><div class="t m0 x6 h3 y59 ff2 fs1 fc0 sc0 ls4 ws1">sangue. </div></div></div><div class="pi" data-data='{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}'></div></div> <div id="pf3" class="pf w0 h0" data-page-no="3"><div class="pc pc3 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y5a w6 hc" alt="" src="https://files.passeidireto.com/13632904-319a-4ffd-bdf7-f5bb5c330981/bg3.png"><div class="t m0 x3 h3 y30 ff2 fs1 fc0 sc0 ls4 ws1">ionização do ASS <span class="_0 blank"></span>será aumentada, diminu<span class="_0 blank"></span>indo sua reabsorç<span class="_0 blank"></span>ão e aumentando <span class="_0 blank"></span>sua </div><div class="t m0 x3 h3 y31 ff2 fs1 fc0 sc0 ls4 ws1">excreção. </div><div class="t m0 x3 h3 y5b ff2 fs1 fc0 sc0 ls8 ws3">Ex<span class="ls9 ws1">. <span class="ff8 ls4 ws2">\ue059\ue1b5\ue102\ue176\ue11a\ue17d\ue003<span class="_0 blank"></span>\ue15a\ue104\ue003\ue15d\ue176\ue19a<span class="_0 blank"></span>\ue17d\ue1c6\ue15d\ue110<span class="_0 blank"></span>\ue102\ue115\ue106\ue17d\ue003<span class="_0 blank"></span>\ue189\ue11e\ue16f\ue17d\ue003\ue128\ue11e\ue176\ue17d\ue10f\ue102\ue18c\ue10f\ue15d\ue19a<span class="_3 blank"></span>\ue102\ue16f\ue003\ue37e\ue104\ue110\ue15d\ue11a\ue17d\ue003\ue128\ue18c\ue102\ue110\ue17d\ue37f<span class="lsa ws4">\ue355\ue003<span class="_0 blank"></span><span class="ls4 ws2">\ue102\ue003\ue102\ue16f\ue110\ue102\ue16f\ue15d\ue176\ue15d<span class="ff2 ls7">-</span>\ue003\ue1cc<span class="_3 blank"></span>\ue102\ue115\ue106\ue17d\ue003\ue11a\ue102\ue003\ue1b5\ue18c\ue15d\ue176\ue102\ue003\ue110\ue17d\ue175\ue003</span></span></span></span></div><div class="t m0 x3 hd y33 ff8 fs1 fc0 sc0 ls4 ws2">\ue17d\ue003\ue1b5\ue190\ue17d\ue003\ue11a\ue11e\ue003\ue10f\ue15d\ue110\ue102\ue18c\ue10f<span class="_0 blank"></span>\ue17d\ue176\ue102\ue19a\ue17d\ue003<span class="_0 blank"></span>\ue11a\ue11e\ue003\ue190\ue17f\ue11a\ue15d\ue17d\ue003\ue1c0\ue102\ue15d\ue003\ue189\ue18c\ue17d\ue1c0<span class="_3 blank"></span>\ue17d\ue110\ue102\ue18c\ue003\ue175\ue102\ue15d\ue17d\ue18c\ue003\ue11e\ue1c6<span class="_3 blank"></span>\ue110\ue18c\ue11e\ue115\ue106\ue17d\ue003\ue11a\ue17d\ue003\ue128<span class="_3 blank"></span>\ue11e\ue176\ue17d\ue10f\ue102\ue18c\ue10f\ue15d\ue19a<span class="_0 blank"></span>\ue102\ue16f<span class="ls9 ws5">\ue358\ue003<span class="lsb">\ue04b\ue003</span></span></div><div class="t m0 x3 h3 y34 ff8 fs1 fc0 sc0 ls4 ws2">\ue128\ue11e\ue176\ue17d\ue10f\ue102\ue18c\ue10f\ue15d\ue19a<span class="_3 blank"></span>\ue102\ue16f<span class="lsa ws4">\ue355\ue003</span>\ue189\ue17d\ue18c\ue003\ue190\ue11e\ue18c\ue003\ue104\ue110\ue15d\ue11a\ue17d\ue003\ue128\ue18c\ue102\ue110\ue17d<span class="_0 blank"></span><span class="ff2 ws1">, quando em meio alcalin<span class="_0 blank"></span>o se ioniza <span class="_0 blank"></span>ainda mais. </span></div><div class="t m0 x3 h3 y35 ff8 fs1 fc0 sc0 ls4 ws2">\ue02f\ue17d\ue176\ue15d\ue1cc<span class="_0 blank"></span>\ue102\ue176\ue11a\ue17d<span class="ff2 ls7">-</span><span class="lsc ws6">\ue190\ue11e<span class="lsa ws4">\ue355\ue003</span></span><span class="ws7">\ue11e\ue16f\ue11e\ue003<span class="_0 blank"></span>\ue190\ue11e\ue003\ue19a\ue17d\ue18c\ue176\ue102\ue003<span class="_0 blank"></span>\ue175\ue102\ue15d\ue190\ue003\ue15a\ue15d\ue11a\ue18c\ue17d\ue190\ue190\ue17d\ue16f\ue1b7\ue1c0\ue11e\ue16f\ue003<span class="_0 blank"></span>\ue11e\ue003\ue175\ue11e\ue176\ue17d\ue190\ue003\ue16f\ue15d\ue189\ue17d\ue190\ue190\ue17d\ue16f\ue1b7\ue1c0\ue11e\ue16f<span class="lsa ws4">\ue355\ue003</span><span class="ws2">\ue11e\ue003\ue11e\ue176\ue19a<span class="_3 blank"></span>\ue106\ue17d\ue003\ue176\ue106\ue17d\ue003\ue189\ue17d\ue11a\ue11e\ue18c\ue104\ue003</span></span></div><div class="t m0 x3 h3 y36 ff8 fs1 fc0 sc0 ls4 ws2">\ue102\ue19a\ue18c\ue102\ue1c0\ue11e\ue190\ue190\ue102\ue18c\ue003\ue17d\ue003\ue11e\ue189\ue15d\ue19a<span class="_3 blank"></span>\ue120\ue16f\ue15d\ue17d\ue003\ue19a\ue1b5\ue10f\ue1b5\ue16f\ue102\ue18c<span class="lsa ws4">\ue355\ue003<span class="lsd ws8">\ue18b\ue1b5\ue11e</span>\ue355\ue003</span>\ue110\ue17d\ue175\ue17d\ue003\ue10f\ue102\ue18c\ue18c<span class="_0 blank"></span>\ue11e\ue15d\ue18c\ue102\ue003\ue10f\ue15d\ue17d\ue16f\ue17f\ue150\ue15d\ue110\ue102<span class="lsa ws4">\ue355\ue003</span>\ue19a\ue11e<span class="_0 blank"></span>\ue175\ue003\ue110\ue17d\ue176\ue190<span class="_0 blank"></span>\ue19f\ue19a\ue1b5\ue15d\ue115\ue106\ue17d\ue003<span class="_0 blank"></span>\ue16f\ue15d\ue189\ue17d\ue189\ue18c\ue17d<span class="ff2 ls7">-</span>\ue003</div><div class="t m0 x3 h3 y37 ff8 fs1 fc0 sc0 ls4 ws2">\ue19a\ue11e\ue15d\ue110\ue102<span class="ls9 ws5">\ue358\ue003<span class="_3 blank"></span><span class="ls4 ws2">\ue04b\ue003\ue128\ue11e\ue176\ue17d\ue10f\ue102\ue18c\ue10f\ue15d\ue19a<span class="_3 blank"></span>\ue102\ue16f<span class="lsa ws4">\ue355\ue003</span>\ue176\ue106\ue17d\ue003\ue189\ue17d\ue11a\ue11e\ue176\ue11a\ue17d\ue003\ue190\ue17d\ue128\ue18c\ue11e\ue18c\ue003\ue18c\ue11e\ue102\ue10f<span class="_0 blank"></span>\ue190\ue17d\ue18c\ue115\ue106\ue17d\ue003\ue19a\ue1b5\ue10f\ue1b5\ue16f\ue102\ue18c<span class="ff2 ws1">, <span class="_0 blank"></span>permanec<span class="ff8 ws2">\ue11e\ue003\ue176\ue102\ue003\ue1b5\ue18c\ue15d\ue176\ue102\ue003\ue11e\ue003\ue120\ue003</span></span></span></span></div><div class="t m0 x3 h3 y5c ff2 fs1 fc0 sc0 ls4 ws1">eliminado. </div><div class="t m0 x2 h3 y39 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x2 h3 y5d ff2 fs1 fc0 sc0 ls4 ws1">Assim, as <span class="ff3 fc3">alterações <span class="_0 blank"></span>da ionização com o p<span class="_0 blank"></span>H<span class="ff2"> <span class="fc0">atuam da seguinte forma: </span></span></span></div><div class="t m0 x2 h3 y5e ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h4 y5f ff4 fs1 fc0 sc0 ls5">\uf0fc<span class="ff5 ls6 ws1"> <span class="ff2 ls4">Drogas ácidas </span></span></div><div class="t m1 xe hb y5f ff4 fs4 fc0 sc0 ls4">\uf0e0</div><div class="t m0 xf h3 y5f ff2 fs1 fc0 sc0 lse ws1"> <span class="ls4">maior eliminação e<span class="_0 blank"></span>m urina alcalina. (<span class="_0 blank"></span>Ionização) </span></div><div class="t m0 x2 h3 y60 ff2 fs1 fc0 sc0 ls4 ws1">Em casos de intoxica<span class="_0 blank"></span>ção com drogas á<span class="_0 blank"></span>cidas portanto <span class="_0 blank"></span>devemos alcalinizar a <span class="_0 blank"></span>urina para maior </div><div class="t m0 x2 h3 y61 ff2 fs1 fc0 sc0 ls4 ws1">excreção. </div><div class="t m0 x2 h3 y62 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h4 y63 ff4 fs1 fc0 sc0 ls5">\uf0fc<span class="ff5 ls6 ws1"> <span class="ff2 ls4">Drogas básicas </span></span></div><div class="t m1 x10 hb y63 ff4 fs4 fc0 sc0 ls4">\uf0e0</div><div class="t m0 x11 h3 y63 ff2 fs1 fc0 sc0 ls4 ws1"> maior eliminação e<span class="_3 blank"></span>m<span class="_1 blank"> </span> urina <span class="_0 blank"></span>ácida. (Ionização) </div><div class="t m0 x2 h3 y64 ff2 fs1 fc0 sc0 ls4 ws1">Em casos de intoxica<span class="_0 blank"></span>ção com drogas bá<span class="_0 blank"></span>sicas portanto devemo<span class="_0 blank"></span>s acidificar a urina<span class="_0 blank"></span> </div><div class="t m0 x2 h3 y65 ff2 fs1 fc0 sc0 ls4 ws1">promovendo uma <span class="_0 blank"></span>maior taxa de ionização <span class="_3 blank"></span>e aumentando assim a excreção. </div><div class="t m0 x2 h3 y66 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x2 h3 y67 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h4 y68 ff4 fs1 fc1 sc0 ls4 ws0">\uf076<span class="ff5 ls0 ws1"> <span class="ff3 ls4">EXCREÇÃO BIL<span class="_0 blank"></span>IAR </span></span></div><div class="t m0 x2 h3 y69 ff2 fs1 fc0 sc0 ls4 ws1">Fármacos metaboliza<span class="_0 blank"></span>dos no fígado são <span class="_0 blank"></span>muitas vezes lançados <span class="_0 blank"></span>na bile por tra<span class="_0 blank"></span>nsporte ativo e </div><div class="t m0 x2 h3 y6a ff2 fs1 fc0 sc0 ls4 ws1">passam para o intesti<span class="_0 blank"></span>no podendo ser elimi<span class="_0 blank"></span>nados nas fezes ou re<span class="_0 blank"></span>absorvidos no intestino. </div><div class="t m0 x2 h3 y6b ff2 fs1 fc0 sc0 ls4 ws1">CICLO ÊNTERO-HEPÁ<span class="_0 blank"></span>TICO (ELEVADO COEF<span class="_0 blank"></span>ICIENTE DE <span class="_0 blank"></span>SOLUBILIDADE </div><div class="t m1 x12 hb y6b ff4 fs4 fc0 sc0 ls4">\uf0e0</div><div class="t m0 x13 h3 y6b ff2 fs1 fc0 sc0 ls4 ws1"> ÓLEO/ÁGUA<span class="_0 blank"></span>) </div><div class="t m0 x2 h3 y6c ff2 fs1 fc0 sc0 ls4 ws1">Assim, algumas drog<span class="_0 blank"></span>as são secretadas na <span class="_0 blank"></span>bile pelo fígado, e a maioria <span class="_0 blank"></span>delas são </div><div class="t m0 x2 h3 y6d ff2 fs1 fc0 sc0 ls4 ws1">reabsorvidas pelo int<span class="_0 blank"></span>estino devido a sua li<span class="_0 blank"></span>possolubilidade. </div><div class="t m0 x2 h3 y6e ff2 fs1 fc0 sc0 ls4 ws1">Principais candidatos<span class="_0 blank"></span> a serem eliminados <span class="_3 blank"></span>pela bile:<span class="_1 blank"> </span> drogas de p<span class="_0 blank"></span>eso molecular elevad<span class="_0 blank"></span>o, </div><div class="t m0 x2 h3 y6f ff2 fs1 fc0 sc0 ls4 ws1">polares, e os ionizad<span class="_0 blank"></span>os no intestino </div><div class="t m1 x14 hb y6f ff4 fs4 fc0 sc0 ls4">\uf0e0</div><div class="t m0 x15 h3 y6f ff2 fs1 fc0 sc0 ls4 ws1"> fezes. </div><div class="t m0 x2 h3 y70 ff2 fs1 fc0 sc0 ls4 ws1"> </div><div class="t m0 x3 h4 y71 ff4 fs1 fc1 sc0 ls4 ws0">\uf076<span class="ff5 ls0 ws1"> <span class="ff3 ls4">EXCREÇÃO RES<span class="_0 blank"></span>PIRATÓRIA </span></span></div></div><div class="pi" data-data='{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}'></div></div> <div id="pf4" class="pf w0 h0" data-page-no="4"><div class="pc pc4 w0 h0"><div class="t m0 x2 h3 y30 ff2 fs1 fc0 sc0 ls4 ws1">A taxa de perda <span class="_0 blank"></span>de gases depende princip<span class="_0 blank"></span>almente da frequênci<span class="_0 blank"></span>a cardíaca e do fluxo </div><div class="t m0 x2 h3 y72 ff2 fs1 fc0 sc0 ls4 ws1">sanguíneo pulmonar<span class="_0 blank"></span>. </div><div class="t m0 x2 h3 y73 ff2 fs1 fc0 sc0 ls4 ws1">Ex. anestésicos <span class="_0 blank"></span>gasosos, etanol (excr<span class="_0 blank"></span>etado muito lentamente)<span class="_0 blank"></span>. </div><div class="t m0 x2 h3 y74 ff2 fs1 fc0 sc0 ls4 ws1"> </div></div><div class="pi" data-data='{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}'></div></div>
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