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A Reação De Michael Na Preparação De Esteróides Potencialmente

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A Reação De Michael Na Preparação De Esteróides Potencialmente UNIVERSIDADE DA BEIRA INTERIOR Ciências da Saúde A reação de Michael na preparação de esteróides potencialmente bioativos Experiência Profissionalizante na vertente de Farmácia Comunitária, Hospitalar e Investigação Miguel Fernando Magalhães da Silva Peixoto Relatório de Estágio para obtenção do Grau de Mestre em Ciências Farmacêuticas (Ciclo de estudos Integrado) Orientador: Prof. Doutor Samuel M. Silvestre Covilhã, Outubro 2013 ii “Joga todo o teu ser na breve ideia que incerta entre o corrente te procura pra lá do que banal te prende e enleia e pelo destacá-la emerge pura. Fazê-lo é dar-lhe já o que perdura. Porque a banalidade que a medeia como à pedra vulgar por entre a areia esquece o que em tomá-la a rareia. Ser homem é escolher o que o oriente e ser-lhe o mais a margem que lhe mente.” Virgílio Ferreira iii iv Dedicatória Dedico esta tese ao meu pai, Joaquim Fernando Magalhães dos Santos, que apesar de já ter partido, continua sempre presente na minha memória. v vi Agradecimentos Em primeiro lugar ao Professor Doutor Samuel Silvestre, orientador desta tese, expresso aqui o meu reconhecimento pela disponibilidade que sempre demonstrou, pela paciência com que sempre me recebeu, por todo o seu saber e conhecimentos transmitidos. Agradeço sinceramente todos os conselhos e o modo como sempre me apoiou e motivou. Finalmente quero também agradecer as sugestões e a revisão crítica do presente texto. Deixo aqui o meu agradecimento à minha orientadora de estágio em Farmácia Hospitalar, Doutora Cláudia Neto e a toda a equipa dos Serviços Farmacêuticos do Centro Hospitalar Vila Nova de Gaia/Espinho, pela forma como me receberam e por todos os conhecimentos e experiências partilhados. Do mesmo modo, desejo agradecer à minha orientadora de estágio em Farmácia Comunitária, Doutora Patrícia Pais, e à restante equipa da Farmácia Popular, pelos conhecimentos transmitidos. Agradeço à minha mãe por todo o incentivo e apoio incondicional que sempre me transmite, pela paciência e grande amizade com que sempre me ouve. Expresso aqui um profundo agradecimento à minha namorada, Ana Rita, pelo inestimável apoio em todos os momentos e sobretudo pela paciência e compreensão nos momentos mais difíceis. Quero também deixar um agradecimento especial a todos os meus amigos e colegas, por todo o apoio e amizade demonstrado ao longo destes anos. Por fim, agradeço também à Faculdade de Ciências da Saúde a oportunidade para a elaboração desta tese e a todos aqueles que de alguma forma contribuíram para a sua concretização. vii viii Resumo O trabalho apresentado neste documento encontra-se dividido em três capítulos, que correspondem às três vertentes abordadas no decurso do estágio final do Mestrado Integrado em Ciências Farmacêuticas. O primeiro capítulo refere-se à experiência profissional desenvolvido no Centro Hospitalar Vila Nova de Gaia/Espinho. Neste capítulo, tendo por base o Manual de Boas Praticas e considerando a legislação em vigor, estão descritas as atividades realizadas e as competências adquiridas no decurso do estágio realizado nas diversas áreas dos serviços farmacêuticos. No segundo capítulo é abordada a experiência profissional adquirida durante o estágio curricular realizado na Farmácia Popular, situada na localidade do Tortosendo, concelho da Covilhã. De um modo semelhante, procede-se à descrição das atividades efetuadas e de todos os conhecimentos e competências adquiridas durante o estágio. No terceiro capítulo encontra-se descrito o trabalho de investigação desenvolvido no Centro de Investigação em Ciências da Saúde durante o último ano. Este envolveu a síntese e a avaliação biológica de esteróides da série pregnano com potencial atividade antiproliferativa. Neste âmbito, explorou-se a reação de Michael obtendo-se um novo processo reacional, utilizando micro-ondas e o catalisador Bi(OTf)3, que permitiu obter a 5α- indoleprogesterona. Após alguns estudos sobre a reatividade da reação, avaliou-se o efeito antiproliferativo do produto obtido e da progesterona. Palavras-chave Farmácia hospitalar; Farmácia comunitária; Esteróides; Reação de Michael; Micro- ondas; Bi(OTf)3; Atividade antiproliferativa; Estudos computacionais; ix x Abstract The work presented in this paper is divided into three chapters, which correspond to the three aspects discussed during the final stage of the Master degree in Pharmaceutical Sciences. The first chapter refers to the experience developed in the Centro Hospitalar Vila Nova de Gaia/Espinho. In this chapter, based on the Manual of Good Practices and considering the legislation, are described the activities and skills acquired during the training held in various areas of the pharmaceutical service. The second chapter discussed the experience acquired during the internship held in Farmácia Popular, located in Tortosendo, municipality of Covilhã. Similarly, the activities carried out as well as all the knowledge and skills acquired during the internship in the community pharmacy are described in this chapter. The third chapter describes the research work lead at the Center for Research in Health Sciences during the last year. This involved the synthesis and biological evaluation of steroids from the pregnane series with potential antiproliferative activity. In this context, we explored the Michael reaction resulting in a new reaction process, using microwave and the catalyst Bi(OTf)3, to obtain 5α-indoleprogesterona. After a few studies about the reactivity of the reaction, the antiproliferative effect of the product and progesterone was evaluated. Keywords Hospital pharmacy; Community pharmacy; Steroids; Michael reaction; Microwave; Bi(OTf)3; Antiproliferative activity; Computational studies; xi xii Índice CAPÍTULO 1: RELATÓRIO DE ESTÁGIO EM FARMÁCIA HOSPITALAR ........................... 1 1. Introdução .................................................................................... 1 1.1. Centro Hospitalar Vila Nova de Gaia/Espinho .................................... 1 1.2. Os Serviços Farmacêuticos ........................................................... 2 2. Organização e gestão dos Serviços Farmacêuticos .................................... 3 2.1. Aprovisionamento ..................................................................... 3 2.2. Sistemas e critérios de seleção ..................................................... 4 2.2.1. Formulário Hospitalar Nacional Medicamento ............................... 4 2.3. Sistemas e critérios de aquisição ................................................... 5 2.3.1. Catálogo de aprovisionamento público da Administração Geral do Sistema de Saúde (ACSS) ............................................................................. 5 2.3.2. Ajustes diretos/Negociação com consulta prévia/Concurso Público ..... 5 2.3.3. Aquisição a farmácias comunitárias e pedidos de empréstimo ........... 5 2.3.4. Aquisição de medicamentos que necessitam de autorização de utilização especial (AUE) ............................................................................. 6 2.3.5. Aquisição de medicamentos contendo estupefacientes e psicotrópicos 6 2.4. Receção e conferência de produtos adquiridos .................................. 7 2.5. Armazenamento ....................................................................... 7 3. Sistemas de distribuição de medicamentos ............................................. 9 3.1. Sistema de Distribuição Individual Diária em Dose Unitária (SDIDDU) ........ 10 3.2. Distribuição Clássica ou Tradicional ................................................. 11 3.2.1. Distribuição de medicamentos por reposição de stocks por níveis (Armazéns Avançados) .............................................................................. 12 3.3. Pyxis Medstation® ...................................................................... 12 3.4. Distribuição de medicamentos a doentes em regime de ambulatório ........ 13 3.4.1. Sistema de Identificação por Radiofrequência (RFID) ...................... 15 3.5. Distribuição de Medicamentos sujeitos a controlo especial ..................... 16 3.5.1. Distribuição de medicamentos contendo estupefacientes e psicotrópicos ............................................................................................. 16 3.5.2. Distribuição de derivados do Plasma humano ................................ 17 3.5.3. Distribuição de medicamentos extra formulário ............................. 18 4. Produção e controlo de medicamentos .................................................. 18 4.1. Manipulação galénica não estéril .................................................... 18 4.2. Manipulação galénica estéril ......................................................... 20 4.2.1. Misturas para Nutrição Parentérica ............................................ 20 4.2.1.1. Validação de Prescrições Médicas de Nutrição Parentérica .......... 22 4.2.1.2. Manipulação de Nutrição Parentérica .................................... 23 xiii 4.2.2. Fármacos Citotóxicos ............................................................. 24 4.2.2.1. Unidade de Preparação de Citotóxicos ................................... 25 4.2.2.2. Validação das Prescrições .................................................. 25 4.2.2.3. Preparação dos Medicamentos Citotóxicos .............................. 26 4.2.3. Preparações Extemporâneas Estéreis .......................................... 27 4.2.4. Reembalagem ......................................................................... 28 5.Ensaios Clínicos ..............................................................................
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