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Cetamina, substância ilícita ou terapêutica
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Abstract(s)
A cetamina é um medicamento utilizado em múltiplas indicações terapêuticas, atuando pelo bloqueio dos recetores N-metil-D-aspartato (NMDA). As suas principais utilizações na prática clínica encontram-se associadas aos seus efeitos anestésicos, analgésicos e antidepressivos, podendo ser utilizada em adultos e crianças. Este medicamento torna-se numa opção terapêutica vantajosa não apenas pelo seu vasto
número de indicações terapêuticas, mas também pelo seu rápido início de ação e margem terapêutica alargada. Este medicamento destaca-se dos restantes anestésicos disponíveis no mercado pela sua capacidade de não comprometer o sistema cardiorrespiratório, assim como pela sua capacidade de induzir um efeito anestésico dissociativo, sendo muito útil nos serviços de urgência. Adicionalmente, apresenta características químicas que permitem a sua administração por diversas vias, incluindo vias menos invasivas, como a via intranasal. A cetamina apresenta um vasto número de efeitos, apesar dos mecanismos
responsáveis ainda não serem conhecidos na totalidade, podendo ser utilizada como anestésico, sedativo, anti-inflamatório, analgésico, antidepressivo e, mais recentemente, tem sido estudada a sua utilização no tratamento de dependência de substâncias de abuso, como a heroína e o álcool, e no tratamento de exacerbações da asma. No entanto, a maioria desta utilizações terapêuticas ainda se encontra a ser estudada, pelo que a sua utilização permanece em off-label. Assim, apesar de todas as suas vantagens terapêuticas, a cetamina é caracterizada pelos seus efeitos psicomiméticos, como alucinações, delírios
e dissociação, sendo esta a principal causa para a limitação da sua utilização. Estes efeitos encontram-se também associados a um potencial significativo para o seu uso recreativo, tornando-se numa potencial substância de abuso. O uso recreativo de cetamina tem sofrido um aumento, embora pouco significativo, especialmente nos Estados Unidos da América e na Ásia. Contudo continua a não ser considerada um narcótico pela maioria das organizações internacionais, pelo que este problema não apresenta um impacto
epidemiológico muito significativo.
Ketamine is a drug used in multiple therapeutic indications, which acts by the blockage of the N-methyl-D-aspartate receptors (NMDA). Its principal uses in clinical practice are associated with its anesthetic, analgesic and antidepressant effects, which can be used both in adults and children. This drug becomes a valuable therapeutic option, not only for its multiple therapeutic indications, but also for its rapid onset of action and wide therapeutic window. This medicine stands out from the other anesthetics available on the market for its ability of not compromising the cardiorespiratory system, as well as for its ability for inducing a dissociative anesthetic effect, which makes it very useful in emergency departments. Additionally, it presents chemical properties that enable the administration of this drug by a various number of routes, including less invasive route, such as the intranasal route. Ketamine presents a various number of effects, although its mechanisms are still unknown, which makes it able to be used as anesthetic, sedative, anti-inflammatory, analgesic, antidepressant, and more recently, it has been studied its use in the treatment of substance dependence, such as heroin and alcohol, and in the treatment of asthma exacerbations. However, most of these therapeutic uses are still being studied, which means it is still used in off-label. Therefore, although it presents many clinical advantages, ketamine is characterized for its psychomimetic effects, such as hallucinations, delirium and dissociation, which is the main cause for its limited use. These effects are also associated with a high potential for recreational use, which makes it a potential abuse drug. The abuse of ketamine has been rising, although it is not very significant, especially in the United States and Asia. Nevertheless, it is still not considered a narcotic by most of the international organizations, so this problem does not present a significant epidemiologic impact.
Ketamine is a drug used in multiple therapeutic indications, which acts by the blockage of the N-methyl-D-aspartate receptors (NMDA). Its principal uses in clinical practice are associated with its anesthetic, analgesic and antidepressant effects, which can be used both in adults and children. This drug becomes a valuable therapeutic option, not only for its multiple therapeutic indications, but also for its rapid onset of action and wide therapeutic window. This medicine stands out from the other anesthetics available on the market for its ability of not compromising the cardiorespiratory system, as well as for its ability for inducing a dissociative anesthetic effect, which makes it very useful in emergency departments. Additionally, it presents chemical properties that enable the administration of this drug by a various number of routes, including less invasive route, such as the intranasal route. Ketamine presents a various number of effects, although its mechanisms are still unknown, which makes it able to be used as anesthetic, sedative, anti-inflammatory, analgesic, antidepressant, and more recently, it has been studied its use in the treatment of substance dependence, such as heroin and alcohol, and in the treatment of asthma exacerbations. However, most of these therapeutic uses are still being studied, which means it is still used in off-label. Therefore, although it presents many clinical advantages, ketamine is characterized for its psychomimetic effects, such as hallucinations, delirium and dissociation, which is the main cause for its limited use. These effects are also associated with a high potential for recreational use, which makes it a potential abuse drug. The abuse of ketamine has been rising, although it is not very significant, especially in the United States and Asia. Nevertheless, it is still not considered a narcotic by most of the international organizations, so this problem does not present a significant epidemiologic impact.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Cetamina Depressão major Psicoestimulantes Substância de abuso