Fármacos Antianémicos

OBJETIVOS DEL TEMA

1.-mas adecuado = para tratar una anemia

2.-de la absorci= on del hierro en su eficacia clinica y efectos .

3.-accion de la = B12 y Folico como fármacos.

4.- Asumir su inutilidad en neuropatias no relacionadas con FARMACOLOGIA DE LA SANGRE
FARMACOS ANTIANEMICOS

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FARMACOS ANTIANEMICOS
EFICACES EN ANEMIAS FERROPENICAS=

<= /v:shape>

•ANEMI= AS FERROPENICAS:

• - ANEMIAS POR DEFICIENCIA DE HIERRO.

• - DISMINUCION PATOLOGICA DEL

•      NUMERO DE HEMATIES.

• - REDUCCION DE= SU VOLUMEN MEDIO

•         (MICROCITICAS). <= /span>

• - REDUCCION CONTENIDO HEMOGLOBINA
•        (HIPOCROMICAS).

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PREPARADOS DE HIERRO
CLASIFICACION=

•PREPA= RADOS DE HIERRO FERROSO:

•S= ALES DE HIERRO:

•+ SULFATO FERRO= SO: BARATO.CONOCIDO

•+ GLUCONATO, GLUTAMATO Y LACTATO.

•DE LIBERACION RETARDADA: NO UTIL. <= /span>

•Q= UE AUMENTAN LA ABSORCION:&= #13;

•         + ASCORBATO FERROSO.

•         + SULFATO DE FERROGLICINA.

•         + MAS REACCIONES ADVERSAS.

•PREPA= RADOS DE HIERRO FERRICO:

•    - BIODISPONIBILIDAD MAS BAJA.

•    - FERRICITRATO DE COLINA.

•TRATA= MIENTO PARENTERAL:

•- RESPUESTA ANTIANEMICA: SIMILAR AL

•   TRATAMIENTO ORAL.

•- VENTAJA: CREA RESERVA= S DE Fe CON

•    RAPIDEZ. <= /div>
•- DESVENTAJAS: ANAFILAX= IA POTENCIAL-

•        MENTE MORTAL. DE ULTIMA ELECCION

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PREPARADOS DE HIERRO
FARMACOCINETICA 1

•A= BSORCION:

•- DUODENO Y PAR= TE ALTA DEL YEYUNO.

•- CAPTACION MUC= OSA INTESTINAL.

•- OXIDACION Fe = FERROSO A FERRICO.

•- UNION A FERRITINA SATURABLE: <= /div>
•     + INTERCAMBIO C= ON EL PLASMA,

•        SI RESERVAS CORPORALES BAJAS.

•     + DEPOSITO FERRITINA CELS. INTEST.,

•        SI RESERVAS CORPORALES ALTAS.

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PREPARADOS DE HIERRO
FARMACOCINETICA 2

•- DOSIS PROMEDI= O:

•        200 mg/dia EN 3-4 TOMAS

•- ABSORCION ESPERADA:

•<= span style=3D'mso-spacerun:yes'> 35 mg/dia -- 40 % ABSORBIDA -- 0.7 g/l Hb

•100 m= g/dia -- 25 % ABSORBIDA -- 1.4   ”

•200 m= g/dia -- 18 % ABSORBIDA -- 1.9   ”

•400 m= g/dia -- 12 % ABSORBIDA -- 2.2 ”

•- BUSCAR EQUILI= BRIO EFICACIA / EFEC. AD.

mg/dia

Hb
<= b>g/l

100

200

300

400

500

1.5

0.5

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= PREPARADOS DE HIERRO
ACC.FARMACOLOGICAS Y R.ADVERSAS

•ACCIO= NES FARMACOLOGICAS:

•- NORMALIZA EL Nº Y MORFOLOGIA DE LOS

• HEMATIES Y LAS CIFRAS DE HEMOGLO-=

• BINA.

•-= TARDA = 1 O 2 MESES SEGUN GRAVEDAD

• DE LA ANEMIA.

•- RESTAURA RESERVAS DE HIERRO:

• + REQUIERE MUCHOS MESES (3-= 4).

•

•REACC= IONES ADVERSAS:

•- EN EL 25% = DE LOS PACIENTES CON DOSIS

• = ; &n= bsp; NORMALES.

•- NAUSEAS Y DOLOR GASTRICO:

• + AUMENTAN CON = LA DOSIS.

•- PIROSIS, DIARREA O ESTREÑIMIENTO:

• + NO AUMENTAN C= ON LA DOSIS.

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FARMACOS ANTIANEMICOS
EFICACES EN ANEMIAS MEGALOBLASTICAS

•ANEMI= AS MEGALOBLASTICAS:

• - ANEMIAS POR DEFICIT DE VIT. B12 Y/O

• AC.FOLICO

• - DISMINUCION PATO= LOGICA DEL

• Nº= ; DE HEMATIES.

• - AUMENTO DE SU VOLUMEN = MEDIO

• = ; (MACROCITICAS). = ;

• - HEMOGLOBINIZACION CORRECTA

• = ; (NORMOCROMICAS). &#= 13;

• - SINTESIS DEFECTUOSA DE DNA Y

• PROTREINAS.

• - TEJIDOS MAS AFECTADOS:

• + LOS DE MAYOR TASA = DE

• = ; REPRODUCCION CELULAR.

• + S. HEMATOPOYETICO MUY SENSIBLE.

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VIT. B12 Y ACIDO FOLICO
MECANISMO DE ACCION=

HOMOCISTEINA

MET= ILCOBALAMINA

METIL-THF

<= b>MTHF

METIONINA

COB= ALAMINA

THF

SINTESIS DE &= #13;

PROTE= INAS

B12

-CH= 3

-CH3

SINTESIS =

DE DN= A

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R0lGODlhJwAnAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAn ACYAggAAAJkAAM0AAP8AAP8yMv9mZgECAwECAwPAWLTc/jCSUJS8uAVas48b133kFFZo6YUbmqoS 27oj7MgzPex87/89nMgFLBoHQlrlyAzilIWmNKmUNqk666aIJU5DwC7qy/qJl0xhwHeOOrfvtflZ jbPBcxn0DueV8yx7doN8gXV+eIh9cSeHO3+KcoWNWZGFYXSVj2qQjDlenjJcmaChi5OfY6OJq4aa Vph6jrCAlKW0qEOquLWpaLy5SgLDxMXGx8ekBcjMzcayFc7Szq7T1syN19rJFNvexQEJADs= ------=_NextPart_01C7842C.EFBF2F20 Content-Location: file:///C:/E31BBA37/sangre3_2006-07_archivos/slide0030.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Fármacos Antianémicos

VITAMINA B12
OTRAS CONSECUENCIAS DE SU DEFICIT

•- LEUCOPENIA Y TROMBOCITOPENIA.

•- ALTERACIONES EN SISTEMA NERVIOSO:

• + CAUSA: * DESMIELINIZACION NEURONAS

• = ; &n= bsp; MEDULA Y CORTEZA.

• = ; * DEGENERACION AXONAL.

• + SINTOMAS:

• * INICIALMENTE: PARESTESIAS.

• * ATAXIA, HIPO O HIPERREFLEXIA.

• * CONFUSION, MALHUMOR, AMNESIA.

• * CEGUERA CENTRAL, DEMENCIA.

• * PUEDEN SER IRREVERSIBLES.

•- ALTERACIONES DIGESTIVAS:

• + LESION DE LA MUCOSA ORAL Y G.I. <= /span>

• + POR SU RAPIDA RENOVACION CELULAR

• + GLOSITIS, METEOR= ISMO, PESADEZ,

• DIARREA.

•- PUEDEN APARECER SIN ANEMIA.

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VITAMINA B12
CLASIFICACION

•

• - FARMACOS:

•

•<= span style=3D'mso-spacerun:yes'> = ; + CIANOCOBALAMINA ( SINTETICO ).

•

• = ; + HIDROXICOBALAMINA ( NATURAL ).

•

•<= span style=3D'mso-spacerun:yes'> - FORMAS ACTIVAS COMO COENZ= IMAS:

•

•<= span style=3D'mso-spacerun:yes'> = ; + METIL-COBALAMINA.

•

• = ; + 5-DESOXI-ADENOSIL-COBALAMINA.

•

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VITAMINA B12
FARMACOCINETICA

•ABSOR= CION:

•V= IAS DE ADMINISTRACION.: =

• = + I.M., S.C.,V.O. O SUBLINGUAL. NO I.V.

•EN ESTOMAGO SE UNE A FACTOR =

• INTRINSECO DE CASTLE (F.I.C.)

•M= UCOSA DEL ILEON:

•+ TRANSPORTE ACTIVO:

• - UNION A RECEPTORES ESPECIFICOS

• = PARA EL COMPLEJO VIT B12 + F.I.C.

• - VIT B12 ABSORBIDA Y F.I.C. A HECES.

•+ DIFUSION PASIVA: NO REQUIERE F.I.C.

•<= span style=3D'mso-spacerun:yes'> - INEFICAZ PARA ABSORCION B12 = DIETA.

• - SOLO TIENE UTILI= DAD CLINICA CON B12

• A DOSIS MUY ALTAS.

•M= UCOSA SUBLINGUAL:

•<= span style=3D'mso-spacerun:yes'> = ; = DIF. PASIVA DOSIS ALTAS

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VITAMINA B12
ACCIONES FARMACOLOGICAS

•

•- NORMALIZA EL Nº Y MORFOLOGIA DE

• LOS HEMATIES. =

•- NORMALIZA LEUCOPENIA Y

• TROMBOCITOPENIA.

•- CORRIGE ALTERACIONES DIGESTIVAS.

•- MEJORIA CLINICA EN 10 O 20 DIAS.

•- ALTERACIONES NEUROLOGICAS:

• + PUEDEN TAR= DAR MESES EN REVERTIR.

• + PUEDEN NO HACERLO NUNCA.

• + IMPORTANCI= A DE LA DETECCION

• &n= bsp; PRECOZ.

•- ABSOLUTAMENTE INUTIL:

• + EN NEUROPATIAS DE OTRO ORIGEN.

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ACIDO FOLICO
CLASIFICACION

•

•- FARMACOS:

•<= span style=3D'mso-spacerun:yes'> + ACIDO FOLICO =

• &n= bsp; (ACIDO PTEROIL-GLUTAMICO).

• + ACIDO FOLINICO:

• = ; - FACTOR CITROVORUM O

• = ; LEUCOVORINA.

• = ; - 5-FORMIL-TETRAHIDROFOLICO.

•

•-= FORMA ACTIVA COMO COENZIMA:

•<= span style=3D'mso-spacerun:yes'> + ACIDO TETRAHIDROFO= LICO

• &n= bsp; (THF O FH4).

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ACIDO FOLICO
FARMACOCINETICA

•ABSOR= CION:

•<= span style=3D'mso-spacerun:yes'> - VIAS DE ADMINISTRACION:

• &n= bsp; + ORAL Y PARENTERAL.

•<= span style=3D'mso-spacerun:yes'> - EN DUODENO Y YEYUNO:

•<= span style=3D'mso-spacerun:yes'> + TRANSPORTE ACTIVO.=

•METAB= OLISMO Y ELIMINACION:

•- CONVERSION HEPATICA EN M-THF.

•- MINIMO DEPOSITO HEPATICO DE M-THF

•- M-THF FORMA PRINCIPAL DE FOLATO EN

• SANGRE.

•- CONVERSION EN LOS TEJIDOS DE M-THF<= span style=3D'font-size:150%;color:lime'>

• EN THF (FH4) FORMA ACTIVA.

•- EL ACIDO THF ES UTILIZADO EN:

• + SINT= ESIS DE PROTEINAS Y DNA.

• + ADEC= UADA MULTIPLICACION CELULAR

•

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ACIDO FOLICO
ACC.FARMACOLOGICAS Y R.ADVERSAS

•- RESERVAS DE FOLATO SON LIMITADAS.

•- PUEDEN BASTAR 2 MESES DE BALANCE = 3;

• NEGATIVO PARA DESARROLLAR ANEMIA<= span style=3D'font-size:150%;color:blue;mso-color-index:3;display:none'>

•- NIVELES EN SANGRE MUY SENSIBLES:

• + TANT= O A HIPERDEMANDA.

• + COMO= A ALTERACIONES ABSORCION.

- NORMALIZA EL Nº Y MORFOLOGIA

DE LOS HEMATIES. =

- EN 48 HORAS DESAPARECEN LAS <= /span>

FORMAS MACROCITICAS.

- EN 2-3 SEMANAS EL HEMATOCRITO =

VUELVE A LA NORMALIDAD.

REACCIO= NES ADVERSAS:

- CARECE DE EFECTOS ADVERSOS.

- INCLUSO A DOSIS MUY ELEVADAS.

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=

=

=

1.- EL SULFATO FERROSO ES EL PREPARADO DE HIERRO DE PRIMERA ELECCION .

2.- BUSCAR EQUILIBRIO ENTRE DOSIS SUFICIENTE DE HIERRO Y EFECTOS ADVERSOS MINIMOS O NULOS.

3.- LAS ALTERACIONES NEUROLOGICAS Y DIGESTIVAS SOLO APARECEN POR = DEFICIT DE B12.

4.- LA ANEMIA POR DEFICIT DE FOLICO PUEDE APARECER EN POCAS SEMANAS.

FARMACOS ANTIANEMICOS
RESUMEN=

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=

=

1.- J.Flórez <= /div>
Farmacologia Humana

4ª Edic= ion 2003.

FARMACOS ANTIANEMICOS
BIBLIOG= RAFIA

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g_HLinkArray.length; ii++) { coordsStr=3D""; imaObj =3D g_HLinkArray[ii]; for ( jj=3D0; jj < imaObj.coords.length-1; jj++ ) coordsStr +=3D (imaObj.coords[jj]*factor) + ","; coordsStr +=3D (imaObj.coords[jj]*factor); imaObj.areaObj.coords =3D coordsStr; } } function ParseCoords( coordsStr ) { var numArray =3D new Array(); var i =3D curPos =3D commaPos =3D 0; while ( ( commaPos =3D coordsStr.indexOf(",", curPos) ) !=3D -1 ) {=20 numArray[i++] =3D parseInt( coordsStr.substr( curPos, commaPos ) ); curPos =3D commaPos + 1; } numArray[i] =3D parseInt( coordsStr.substr( curPos ) ); return numArray; } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { =09 if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 1, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"Fin de la presentación, haga clic para salir.", = SCREEN_MODE=3D"Frames", gIsEndShow=3D0, NUM_VIS_SLDS=3D17, SCRIPT_HREF=3D"s= cript.js", FULLSCR_HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0042.htm",1,-1,1),new hrefList(= "slide0022.htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1),new hrefList("= slide0045.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("s= lide0020.htm",1,-1,1),new hrefList("slide0027.htm",1,-1,1),new hrefList("sl= ide0029.htm",1,-1,1),new hrefList("slide0030.htm",1,-1,1),new hrefList("sli= de0031.htm",1,-1,1),new hrefList("slide0046.htm",1,-1,1),new hrefList("slid= e0035.htm",1,-1,1),new hrefList("slide0037.htm",1,-1,1),new hrefList("slide= 0047.htm",1,-1,1),new hrefList("slide0040.htm",1,-1,1),new hrefList("slide0= 043.htm",1,-1,1),new hrefList("slide0044.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Siguiente",sPrev=3D"Anterior",sEnd=3D"Fin de la presentaci&oac= ute;n",sFont=3D"Arial",sArrow=3D"Flecha",sFreeform=3D"Forma libre",sRect=3D= "Rectángulo",sOval=3D"Óvalo" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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1	FARMACOLOGIA DE = LA SANGRE FARMACOS ANTIANEMICOS=
2	FARMACOS ANTIANE= MICOS EFICACES EN ANEMIAS FERROPENICAS ANEMIAS FERROPENICAS: - ANEMIAS POR DEFICIEN= CIA DE HIERRO. - DISMINUCION PATOLOGI= CA DEL NUMERO DE HEMATIES. - REDUCCION DE SU VOLU= MEN MEDIO = ; (MICROCITICAS). - REDUCCION CONTENIDO HEMOGLOBINA (HIPOCROMICAS).
3	PREPARADOS DE HI= ERRO CLASIFICACION PREPARADOS DE HIERRO FERROSO: SALES DE HIERRO: + SULFATO FERROSO: BARATO.CONOCIDO + GLUCONATO, GLUTAMATO Y LACTATO. DE LIBERACION RETARDADA: NO UTIL. QUE AUMENTAN LA ABSORCION: = ; + ASCORBATO FERROSO. = ; + SULFATO DE FERROGLICINA. = ; + MAS REACCIONES ADVERSAS. PREPARADOS DE HIERRO FERRICO: - BIODISPONIBILIDAD MAS BAJA. - FERRICI= TRATO DE COLINA. TRATAMIENTO PARENTERAL: - RESPUESTA ANTIANEMICA: SIMILAR AL TRATAMIENTO ORA= L. - VENTAJA: CREA RESERVAS DE Fe CON RAPIDEZ.<= /li> - DESVENTAJAS: ANAFILAXIA POTENCIAL- MENTE MORTAL. DE ULTIMA ELECCION
4	PREPARADOS DE HIERRO FARMACOCINETICA 1 ABSORCION: - DUODENO Y PARTE ALTA DEL YEYUNO. - CAPTACION MUCOSA INTESTINAL. - OXIDACION Fe FERROSO A FERRICO. - UNION A FERRITINA SATURABLE: + INTERCAMBIO CON EL PLASMA, SI RESERVAS CORPORALES BAJAS. + DEPOSITO FERRITINA CELS. INTEST., SI RESERVAS CORPORALES ALTAS.
5	PREPARADOS DE HI= ERRO FARMACOCINETICA 2 - DOSIS PROMEDIO: 200 mg/dia EN 3-4 TOMAS - ABSORCION ESPERADA: 35 mg/dia -- 40 % ABS= ORBIDA -- 0.7 g/l Hb 100 mg/dia -- 25 % ABSORBIDA -- 1.4 ” 200 mg/dia -- 18 % ABSORBIDA -- 1.9 ” 400 mg/dia -- 12 % ABSORBIDA -- 2.2= ” - BUSCAR EQUILIBRIO EFICACIA / EFEC. AD.
6	PREPARADOS DE HI= ERRO ACC.FARMACOLOGICAS Y R.AD= VERSAS ACCIONES FARMACOLOGICAS: - NORMALIZA EL Nº Y MORFOLOGIA DE LOS HEMATIES Y LAS CIFRAS= DE HEMOGLO- BINA. - TARDA 1 O 2 MESES SEGUN GRAVEDAD DE LA ANEMIA. - RESTAURA RESERVAS DE HIERRO: + REQUIERE MUCHOS MESES (3-4). REACCIONES ADVERSAS: - EN EL 25% DE LOS PACIENTES CON DOSIS = ; &n= bsp; NORMALES. - NAUSEAS Y DOLOR GASTRICO: + AUMENTAN CON LA DOSIS. - PIROSIS, DIARREA O ESTREÑIMIENTO: + NO AUMENTAN CON LA DOSIS.
7	FARMACOS ANTIANE= MICOS EFICACES EN ANEMIAS MEGALOBLASTICAS ANEMIAS MEGALOBLASTICAS: - ANEMIAS POR D= EFICIT DE VIT. B12 Y/O AC.= FOLICO - DISMINUCION PATOLOGICA DEL N&o= rdm; DE HEMATIES. - AUMENTO DE SU VOLUM= EN MEDIO = ; (MACROCITICAS). - HEMOGLOBINIZA= CION CORRECTA = ; (NORMOCROMICAS). - SINTESIS DEFE= CTUOSA DE DNA Y PROTREINAS. - TEJIDOS MAS AFECTADOS: + LOS DE MAYOR TASA DE = ; REPRODUCCION CELULAR. + S. HEMATOPOYETICO MUY SENSIBLE.
8	VIT. B12 Y ACIDO= FOLICO MECANISMO DE ACCION
9	VITAMINA B12 OTRAS CONSECUENCIAS DE SU DEFICIT - LEUCOPENIA Y TROMBOCITOPENIA. - ALTERACIONES EN SISTEMA NERVIOSO: + CAUSA: * DESMIELINI= ZACION NEURONAS = ; &n= bsp; MEDULA Y CORTEZA. = ; * DEGENERACION AXONAL. + SINTOMAS: = ; * INICIALMENTE: PARESTESIAS. = ; * ATAXIA, HIPO O HIPERREFLEXIA. = ; * CONFUSION, MALHUMOR, AMNESIA. = ; * CEGUERA CENTRAL, DEMENCIA. = ; * PUEDEN SER IRREVERSIBLES. - ALTERACIONES DIGESTIVAS: + LESION DE LA = MUCOSA ORAL Y G.I. + POR SU RAPIDA RENOVACION CELULAR + GLOSITIS, METEORISMO, PESADEZ, DIARREA. - PUEDEN APARECER SIN ANEMIA.
10	VITAMINA B12 CLASIFICACION<= /div> - FARMACOS: = ; + CIANOCOBALAMINA ( SINTETICO ). = ; + HIDROXICOBALAMINA ( NATURAL ). - FORMAS ACTIVA= S COMO COENZIMAS: = ; + METIL-COBALAMINA. = ; + 5-DESOXI-ADENOSIL-COBALAMINA.
11	VITAMINA B12 FARMACOCINETICA ABSORCION: VIAS DE ADMINISTRACION.: + I.M., S.C.,V.O. O SUBLINGUAL. NO I.V. EN ESTOMAGO SE UNE A FACTOR = ; INTRINSECO DE CASTLE (F.I.C.) MUCOSA DEL ILEON: + TRANSPORTE ACTIVO: - UNION A RECEPTORES ESPECIFICOS PARA EL COMPLEJO VIT B12 + F.I.C. - VIT B12= ABSORBIDA Y F.I.C. A HECES. + DIFUSION PASIVA: NO REQUIERE F.I.C. - INEFICAZ PARA ABSORCION B12 DIETA. - SOLO TIENE UT= ILIDAD CLINICA CON B12 A DOSIS MUY ALTAS. MUCOSA SUBLINGUAL: = ; DIF. PASIVA DOSIS ALTAS
12	VITAMINA B12 ACCIONES FARMACOLOGICAS - NORMALIZA EL Nº Y MORFOLOGIA DE LOS HEMATIES. - NORMALIZA LEUCOPENIA Y TROMBOCITOPENIA. - CORRIGE ALTERACIONES DIGESTIVAS. - MEJORIA CLINICA EN 10 O 20 DIAS. - ALTERACIONES NEUROLOGICAS: + PUEDEN = TARDAR MESES EN REVERTIR. + PUEDEN = NO HACERLO NUNCA. + IMPORTA= NCIA DE LA DETECCION PRECOZ. - ABSOLUTAMENTE INUTIL: + EN NEUROPATIAS DE OTRO ORIGEN.
13	ACIDO FOLICO CLASIFICACION<= /div> - FARMACOS: + A= CIDO FOLICO (ACIDO PTEROIL-GLUTAMICO). + A= CIDO FOLINICO: = ; - FACTOR CITROVORUM O = ; LEUCOVORINA. = ; - 5-FORMIL-TETRAHIDROFOLICO. - FORMA ACTIVA COMO COENZIMA: + A= CIDO TETRAHIDROFOLICO (THF O FH4).
14	ACIDO FOLICO FARMACOCINETICA ABSORCION: - VIAS DE ADMINISTRACION: + ORAL Y PARENTERAL. - EN DUODENO Y YEYUNO: + TRANSPORTE ACTIVO. METABOLISMO Y ELIMINACION: - CONVERSION HEPATICA EN M-THF. - MINIMO DEPOSITO HEPATICO DE M-THF - M-THF FORMA PRINCIPAL DE FOLATO EN SANGRE. - CONVERSION EN LOS TEJIDOS DE M-THF EN = THF (FH4) FORMA ACTIVA. - EL ACIDO THF ES UTILIZADO EN: + SINTESIS DE PROTEINAS Y DNA. + ADECUADA MULTIPLICACION CELULAR
15	ACIDO FOLICO ACC.FARMACOLOGICAS Y R.AD= VERSAS - RESERVAS DE FOLATO SON LIMITADAS. - PUEDEN BASTAR 2 MESES DE BALANCE NEGATIVO PARA DESARROLLAR ANEMIA - NIVELES EN SANGRE MUY SENSIBLES: + T= ANTO A HIPERDEMANDA. + C= OMO A ALTERACIONES ABSORCION.
16	FARMACOS ANTIAN= EMICOS RESUMEN
17	FARMACOS ANTIAN= EMICOS BIBLIOGRAFIA

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