tag:blogger.com,1999:blog-5108237181258088362024-03-19T05:47:25.561-07:00SINOPSE PEDIÁTRICALuiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-510823718125808836.post-75362672436832025672017-01-23T06:17:00.001-08:002017-01-23T06:17:39.980-08:00FEBRE AMARELA<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FEBRE AMARELA</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Guia de Vigilância em Saúde – Ministério da Saúde</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-X:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> A95</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO SILVESTRE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> O ciclo silvestre é endêmico nas regiões tropicais da África e das Américas. Geralmente se apresenta sob a forma de surtos com intervalos de tempo que variam de 3 a 7 anos, alternados por períodos com menor número de casos. Em geral, na população humana, o aparecimento de casos tem sido precedido de epizootias de primatas não humanos (PNH).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="331" src="https://lh5.googleusercontent.com/8anG5cRrt7Kr_YHJhEyJmSRvgnxlHWLBgjRDA-YYRWfoUmuxzp2RysnG8xEkxepDe_-4t5EMC1YWB6dEzKR6D9kq7CjQ5lzYgX2mFRJ0a9ilhrbzZaZRZYoD7DLx_P9DpD7W_gM0" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="389" /></span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura1: Áreas com e sem recomendação de vacina contra febre amarela no Brasil, 2012. Área com recomendação da vacina (ACRV): áreas anteriormente consideradas endêmicas e de transição, com a inclusão do sul de Minas Gerais, até então considerada “área indene de risco potencial”. Área sem recomendação de vacina (ASRV): áreas indenes, incluindo também o sul da Bahia e o norte do Espírito Santo, que antes eram consideradas “áreas indenes de risco potencial”.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">AGENTE ETIOLÓGICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A febre amarela é causada por uma arbovírus do gênero </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Flavivirus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, da família </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Flaviviridae</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 13.59px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HOSPEDEIROS E RESERVATÓRIOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HOSPEDEIROS:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO SILVESTRE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> primatas não-humanos. Homem é hospedeiro acidental.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO URBANO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> homem.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RESERVATÓRIOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Mosquitos</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> são os reservatórios do vírus da febre amarela. Uma vez infectados, permanecem assim por toda a vida. Apenas a fêmea transmite o vírus, pois o repasto sanguíneo tem como intuito prover nutrientes essenciais para a maturação dos ovos e completude do ciclo gonotrófico. A transmissão também ocorre de forma vertical, onde as fêmeas dos mosquitos transferem os vírus para suas proles.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MODO DE TRANSMISSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O vírus é transmitido pela </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">picada dos mosquitos transmissores infectados</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Não há transmissão de pessoa a pessoa.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO URBANO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> a transmissão ocorre a partir de vetores urbanos (</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Aedes aegypti</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">) infectados.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO SILVESTRE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> os transmissores são mosquitos com hábitos estritamente silvestres (gêneros </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Haemagogus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sabethes</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, na América Latina). No Brasil, os principais vetores são das espécies </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Haemagogus janthinomys</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (mais frequentemente) e </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Haemagogus leucocelaenus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Participam de forma secundária na transmissão as espécies: </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Haemagogus albomaculatus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sabethes glaucodaemon</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sabethes chloropterus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sabethes cynaeus</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sabethes soperi</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="281" src="https://lh4.googleusercontent.com/C6zauDleaqYXNidFCVSjLtU3mhiERpfMxfSE7Vop6b_UqTqWbPxxcmJUXruTn5MH65neXoInTvU-a6ljfR5zFZl51a4jJGoGP43tSrwL5VpKX7RFlb6FPd1pu0-fwVTx8wwixeC8" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="504" /></span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura2: Ciclos epidemiológicos (silvestre e urbano) da febre amarela no Brasil.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PERÍODO DE INCUBAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">período de incubação da febre amarela</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> varia de </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">3 a 6 dias</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, podendo se estender até 15 dias.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PERÍODO DE TRANSMISSIBILIDADE</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O período de transmissibilidade compreende dois ciclos: intrínseco (que ocorre no homem) e extrínseco (que ocorre no vetor).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO INTRÍNSECO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> a </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">viremia</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> humana dura, no máximo, </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">7 dias</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, e vai </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">de 24-48 horas antes do aparecimento dos sintomas até 3 a 5 dias após o início da doença</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, período em que o homem pode infectar os mosquitos transmissores.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CICLO EXTRÍNSECO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> No mosquito, após um repasto com sangue infectado, o vírus migra para as glândulas salivares, onde se multiplica depois de 8 a 12 dias de incubação. A partir desse momento, a fêmea do mosquito passa a ser capaz de transmitir o vírus amarílico até o final de sua vida (6 a 8 semanas).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUSCETIBILIDADE E IMUNIDADE</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUSCETIBILIDADE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> universal.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IMUNIDADE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> a infecção confere imunidade duradoura. Os filhoS de mães imunes podem apresentar imunidade passiva e transitória durante os primeiros 6 meses de vida.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tipicamente, a febre amarela caracteriza-se por manifestações de insuficiência hepática e renal, tendo geralmente apresentação bifásica, com um período inicial prodrômico (infecção) e um toxêmico (que surge após uma aparente remissão e, em muitos casos, evolui para óbito em aproximadamente uma semana).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PERÍODO DE INFECÇÃO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> dura cerca de 3 dias, tendo início súbito de sintomas inespecíficos como febre, calafrios, cefaleia, lombalgia, mialgias generalizadas, prostração, náuseas e vômitos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REMISSÃO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> ocorre declínio da temperatura e diminuição dos sintomas, provocando uma sensação de melhora no paciente. Dura poucas horas e, no máximo, um a dois dias.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PERÍODO TOXÊMICO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> reaparece a febre, diarreia e vômitos com aspecto de borra de café. Instala-se quadro de insuficiência hepatorrenal caracterizado por icterícia, oligúria, anúria e albuminúria, acompanhado de manifestações hemorrágicas (gengivorragia, epistaxe, otorragia, hematêmese, melena, hematúria, sangramentos em locais de punção venosa), prostração intensa e comprometimento do sensório, com obnubilação mental e torpor, com evolução para coma e morte. O pulso torna-se mais lento apesar da temperatura elevada (sinal de Faget – dissociação pulso-temperatura).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES ESPECÍFICOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SOROLOGIA PELO MÉTODO DE CAPTURA DE ANTICORPOS IgM (MAC-ELISA):</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Método de escolha. Deve ser analisado conjuntamente com os dados clínicos e epidemiológicos, considerando reações cruzadas e inespecíficas;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SOROLOGIA PELO TESTE DE INIBIÇÃO DA HEMAGLUTINAÇÃO EM AMOSTRAS PAREADAS:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> análise de amostras coletadas com intervalo de 15 dias da primeira para a segunda amostra. Depende dos dados clínicos e epidemiológicos para conclusão diagnostica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SOROLOGIA IgG-ELISA:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> depende dos dados clínicos e epidemiológicos para conclusão diagnostica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PESQUISA VIRAL EM CULTURA CELULAR:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> empregado na fase inicial da doença, para isolamento viral ou detecção do genoma viral pela técnica de reação em cadeia da polimerase de transcrição reversa (RT-PCR), em amostras de sangue ou tecido, conservados em temperaturas ultrabaixas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IMUNO-HISTOQUÍMICA:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> detecção de antígeno viral pode ser realizado em amostras de tecidos (principalmente o fígado) conservadas em temperatura ambiente, em formalina tamponada a 10%.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAME HISTOPATOLÓGICO DO FÍGADO:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> necrose médio-lobular ou médio-zonal e a presença dos </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">corpúsculos acidófilos de Coulcilman</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES INESPECÍFICOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROVAS DE FUNÇÃO HEPATICA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BILIRRUBINA TOTAL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): 0,3-1,2 mg/100mL sangue;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Encontra-se elevada na lesão intensa dos hepatócitos, caracterizando-se pela presença de icterícia nas mucosas e/ou pele.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BILIRRUBINA DIRETA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): 0,1-0,3 mg/100mL sangue;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Encontra-se elevada na lesão intensa dos hepatócitos, caracterizando-se pela presença de icterícia nas mucosas e/ou pele.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">AMINOTRANSFERASES:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ASPARTATO AMINOTRANSFERASE (AST) ou TRANSAMINASE GLUTÂMICA OXALACÉTICA (TGO):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): < 40 U/L;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Valores > 1000 U/L indicam doença associada com lesão extensa do tecido hepático, como ocorre nos casos graves de febre amarela.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALANINA AMINOTRANSFERASE (ALT) ou TRANSAMINASE GLUTÂMICA PIRÚVICA (TGP):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): < 30 U/L;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Valores > 1000 U/L indicam doença associada com lesão extensa do tecido hepático, como ocorre nos casos graves de febre amarela.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROVAS DE FUNÇAO RENAL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">URÉIA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): 10-45 mg/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CREATININA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal (adulto): 0,6-1,3 mg/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Valores superiores a 1,5 mg/dL podem indicar complicações e/ou doença renal.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento é </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">sintomático</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, com cuidadosa assistência ao paciente que, sob hospitalização, deve permanecer em repouso, com reposição de líquidos e das perdas sanguíneas, quando indicado. Nas </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">formas graves</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, o paciente deve ser atendido em </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Unidade de Terapia Intensiva (UTI)</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">NOTIFICAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A febre amarela é de </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">notificação compulsória</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A notificação deve ser registrada por meio do preenchimento da</span><a href="http://www.saude.mt.gov.br/arquivo/809" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: blue; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Ficha de Investigação da Febre Amarela</span></a><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> do Sistema de Informação de Agravos de Notificação (SINAN).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MEDIDAS DE PREVENÇÃO E CONTROLE</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IMUNIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">vacina contra a febre amarela (VFA)</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> é a medida mais importante e eficaz para prevenção e controle da doença. É constituída por vírus atenuados da cepa 17DD, derivada de uma amostra africana do vírus amarílico. Apresenta eficácia acima de 95%.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia da vacina VFA: 0,5 mL, via subcutânea.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Indicações da vacina:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Residentes ou viajantes para as áreas com recomendação da vacina (todos os estados das regiões Norte e Centro Oeste, Minas Gerais e Maranhão, alguns municípios dos estados do Piauí, Bahia, São Paulo, Paraná, Santa Catarina e Rio Grande do Sul) devem ser vacinados pelo menos 10 dias antes da viagem, no caso de pessoas que nunca foram vacinadas ou sem comprovante de vacinação. Em caso de revacinação, esse prazo não se aplica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pessoas que se deslocam para países em situação epidemiológica de risco, conforme as recomendações do</span><a href="http://www.anvisa.gov.br/hotsite/viajante/Regulamento_Sanitario_Internacional_vers%C3%A3o%20para%20impress%C3%A3o.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: blue; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Regulamento Sanitário Internacional (RSI)</span></a><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A vacinação é indicada para toda a população a partir dos 9 anos de idade, com a administração de dose de reforço aos 4 anos de idade.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Algumas particularidades devem ser destacadas:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em pessoas a partir de 5 anos de idade, que receberam uma dose da vacina antes de completar 5 anos de idade, administrar uma única dose de reforço, com intervalo mínimo de 30 dias entre as doses.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pessoas a partir de 5 anos de idade que nunca foram vacinadas ou sem comprovante de vacinação: administrar a primeira dose da vacina e 1 dose de reforço, 10 anos após a administração dessa dose.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pessoas a partir dos 5 anos de idade que receberam 2 doses da vacina: considerar vacinado e não administrar nenhuma dose.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pessoas com 60 anos ou mais, que nunca foram vacinados ou sem comprovante de vacinação, o médico deverá avaliar o beneficio/risco da vacinação, levando em conta o risco da doença e o risco de eventos adversos nessa faixa etária e/ou decorrentes de comorbidades.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Para gestantes, independentemente do estado vacinal, a vacinação está contraindicada. Na impossibilidade de adiar a vacinação, como em situações de emergência epidemiológica, vigência de surtos, epidemias ou viagem para área de risco de contrair a doença, o médico deverá avaliar o beneficio/risco da vacinação.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Para as mulheres que estejam amamentando crianças com até 6 meses de idade, independentemente do estado vacinal, a vacinação não está indicada, devendo ser adiada até a criança completar 6 meses de vida. Na impossibilidade de adiar a vacinação (situações de emergência epidemiológica, vigência de surtos, epidemias ou viagem para área de risco de contrair a doença), o médico deverá avaliar o benefício/risco da vacinação. Em caso de mulheres que estejam amamentando e que receberam a vacina, o aleitamento materno deve ser suspenso, preferencialmente, por 28 dias após a vacinação (com um mínimo de 15 dias).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em pacientes com imunodeficiência, a administração da vacina deve ser condicionada à avaliação médica individual de benefício/risco e não deve ser realizada em caso de imunodepressão grave.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em crianças com menos de 2 anos de idade nunca vacinadas com VFA, não administrar essa vacina simultaneamente com a vacina tríplice viral ou tetra viral. O intervalo mínimo entre as vacinas é de 30 dias, salvo em situações especiais que impossibilitem manter o intervalo indicado. Se a criança recebeu anteriormente as vacinas tríplice viral e febre amarela, não deve haver interferência na imunogenicidade entre elas, as duas poderão ser administradas simultaneamente ou sem intervalo mínimo entre as doses. Se a criança recebeu apenas uma das vacinas (tríplice viral ou febre amarela), estabelecer preferivelmente o intervalo mínimo de 30 dias entre as doses.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em situações de suspeita de surto, epizootia ou confirmação da circulação viral em vetores silvestres, a dose inicial deve ser antecipada para 6 meses de idade e essa dose não será considerada válida para fins de cobertura de rotina. Revacinar aos 9 meses e aos 4 anos de idade.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nos casos de doenças agudas febris moderadas ou graves, recomenda-se adiar a vacinação até a resolução do quadro, com o intuito de não se atribuir à vacina as manifestações da doença em curso.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes que tenham desencadeado doença neurológica de natureza desmielinizante (Síndrome de Guillain-Barré, encefalomielite disseminada aguda e esclerose múltipla) no período de 6 semanas após a aplicação de dose anterior de VFA, deve receber a vacina após avaliação médica.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paciente transplantados de células-tronco hematopoiéticas (medula óssea) devem ser avaliados caso a caso, considerando o risco epidemiológico. Caso se decida pela vacinação, deve ser respeitado o prazo mínimo de 24 meses após o transplante.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IMUNIDADE:</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> os anticorpos protetores aparecem entre o 7° e o 10° dia após a vacinação. O paciente deve receber a vacina 10 dias antes de ingressar na área de transmissão.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CONTRA-INDICAÇÕES:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças menores de 6 meses de idade;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indivíduos com história de reação anafilática relacionada a substâncias presentes na vacina (gelatina bovina, ovo de galinha e seus derivados, por exemplo);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com alguma das condições abaixo:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Infectados pelo HIV com imunossupressão grave, com a contagem de células CD4 < 200 células/mm</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> ou menos de 15% do total de linfócitos para crianças menores de 6 anos.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em tratamento com drogas imunossupressoras (corticosteroides, quimioterapia, radioterapia e imunomoduladores);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Submetidos a transplante de órgãos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Imunodeficiência primária;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Imunodepressão de qualquer natureza;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Neoplasia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">História pregressa de doenças do timo (miastenia gravis, timoma, casos de ausência de timo ou remoção cirúrgica).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EVENTOS ADVERSOS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dor local, mal-estar, cefaleia, dores musculares e febre baixa, que ocorrem por volta do 5° ao 10° dia pós-vacinal e duram de 1 a 2 dias.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reações de hipersensibilidade imediata (erupção, urticária, angioedema e choque anafilático) podem ocorrer de 30 minutos até 2 horas após a administração da vacina.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença neurológica aguda associada à VFA (DNA-VFA): encefalite (mais frequente em menores de 6 meses), meningite, doenças autoimunes com envolvimento do sistema nervoso central e periférico.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença viscerotrópica aguda associada à VFA (DVA-FVA): evento adverso de maior letalidade decorrente da disseminação do vírus vacinal para diversos órgãos, com choque, derrame pleural, ascite e falência de múltiplos órgãos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CONTROLE VETORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Evitar o acesso dos mosquitos transmissores ao doente mediante utilização de tela no seu local de permanência.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adotar ações emergenciais de eliminação do A. aegypti, principalmente nos locais em que os casos estão internados.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fortalecer as ações de combate vetorial nos municípios situados próximos às áreas de transmissão.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://www.rio.rj.gov.br/dlstatic/10112/6385405/4170293/GUIADEVS2016.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: blue; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">BRASIL. MINISTÉRIO DA SAÚDE. SECRETARIA DE VIGILÂNCIA EM SAÚDE: Guia de vigilância em saúde: 1° edição atualizada, 2016: 399-416.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-6385767694434332972016-12-28T04:05:00.000-08:002017-01-05T07:24:39.749-08:00SÍNDROME DE TURNER<div style="text-align: justify;">
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SINOPSE</h3>
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<strong><span style="font-family: Calibri;"></span></strong> </div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Protocolo Clínico e Diretrizes Terapêuticas</span></div>
</b></span><h2 style="text-align: center;">
SÍNDROME DE TURNER</h2>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Portaria SAS/MS n° 223, de 10 de maio de 2.010.</span></div>
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CID-X:</h3>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b style="font-weight: normal;"><ul>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.0: Cariótipo 45,X;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.1: Cariótipo 46,X isso;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.2: Cariótipo 46,X com cromossomo sexual anormal, salvo isso;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.3: Mosaicismo cromossômico 45,X/46, XX ou XY;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.4: Mosaicismo cromossômico 45,X/outras linhagens celulares com cromossomo sexual anormal;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Q96.8: Outras variantes da síndrome de Turner.</span></h3>
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DIAGNÓSTICO</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CARIÓTIPO;</span></div>
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CRITÉRIOS DE INCLUSÃO:</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com diagnóstico de síndrome de Turner, confirmado pelo cariótipo, que apresentarem:</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade: 2 a 12 anos;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estatura: inferior ao percentil 5, conforme as curvas da Organização Mundial da Saúde (< 5 anos) ou do <em>National Center for Health Statistics</em> (≥ 5 anos).</span></div>
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CRITÉRIOS DE EXCLUSÃO</h3>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença neoplásica ativa: nos casos de doença neoplásica, o tratamento com somatropina somente poderá ser utilizado após liberação documentada por oncologista, decorridos 2 anos do tratamento e remissão completa da doença;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anomalias congênitas renais e cardiovasculares não corrigidas: o tratamento com somatropina deverá ser protelado ou interrompido pelo tempo necessário para que as correções sejam realizadas e a paciente se recupere;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença aguda grave: nos casos de doenças agudas graves, o tratamento não poderá ser iniciado ou deverá ser interrompido por 1-2 meses ou até que haja a recuperação da paciente;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipertensão intracraniana benigna;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Retinopatia diabética proliferativa ou pré-proliferativa;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade ou intolerância ao medicamento ou a um de seus componentes.</span></div>
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TRATAMENTO</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">SOMATROPINA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação (3 UI = 1 mg):</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Frasco-ampola: 4 U; 12 U;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Somatropina: 0,135-0,15 UI/Kg/dia (0,045-0,050 mg/Kg/dia ou 0,3-0,375 mg/Kg/semana), SC, à noite, 6-7 vezes/semana.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ajustar a dose pela aferição da IGF-1 sérica que deve se encontrar dentro dos limites da normalidade. Valores elevados de IGF-1 requerem redução da dose de somatropina. Valores reduzidos de IGF-1 indicam a necessidade de avaliar a adesão do paciente ao tratamento e, se estiver adequada, aumentar a dose de somatropina.</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeitos Adversos:</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Intolerância à glicose;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipertensão intracraniana benigna;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Escoliose;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deslizamento da epífise femoral;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pancreatite;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Neoplasia: controverso;</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ruptura de aorta: controverso.</span></div>
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TEMPO DE TRATAMENTO</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento com SOMATROPINA deverá ser interrompido:</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Falha de resposta ao tratamento:</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumento da velocidade de crescimento no primeiro ando de tratamento inferior a 50% da velocidade de crescimento prévia; ou</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Velocidade de crescimento < 2 cm/ano, desde que a paciente esteja em vigência de, pelo menos, 1 ano de tratamento efetivo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IDADE ÓSSEA ≥ 14 anos.</span></div>
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MONITORIZAÇÃO</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ESTATURA (Utilizar a curva de altura de Lyon): a cada 6 meses;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PESO: a cada 6 meses;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">GLICEMIA DE JEJUM: anualmente;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TSH: anualmente;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IGF-1: anualmente;</span></h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IDADE ÓSSEA: anualmente;</span></h3>
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TERMO DE ESCLARECIMENTO E RESPONSABILIDADE – TER</h3>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É obrigatória a informação à paciente ou a seu responsável legal dos potenciais riscos, benefícios e efeitos adversos relacionados ao uso do medicamento preconizado neste protocolo. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="735" src="https://lh4.googleusercontent.com/G6i8tDNSOXWkgaZ09kPnm4a_0-NNSw1AFXSlUFAzy8ASjTHGCM3SoWucLH49lM0c5OaNUuazpYK0dor4qw30ud_HFMsqXI0Vnn7Dj_u_mOmmsCSRQ4w9-3HpupMUjpbt0yUiIqfw" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="501" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="717" src="https://lh5.googleusercontent.com/JuhkDkygouyAkltaMWCKebK4Kp1t4sJUTV4Kq5jT1h2oNgtN1_mwq9pby8JqnXpsjBwYvxsc84e5Iidnw34HMBbdr4WTlY170rUaNxs3glikXHylHHoN_xnoaxuDjsTw35ZIMsko" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="569" /></span></div>
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REFERÊNCIA BIBLIOGRÁFICA</h3>
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<a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/03/pcdt-sindrome-de-turner-livro-2010.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #0563c1; font-family: "calibri"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">MINISTÉRIO DA SAÚDE - Consultores: SCHWARTZ, I.V.D., ELNECAVE, R.H.; KRUG, B.C. & AMARAL, K.M.. Editores: PICON, P.D.; GADELHA, M.I.P. & BELTRAME, A.: Protocolo Clínico e Diretrizes Terapêuticas - Síndrome de Turner. Portaria SAS/MS n° 223, de 10 de maio de 2.010.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-87015546263419778512016-12-22T03:54:00.000-08:002016-12-22T03:54:47.517-08:00HIPOVITAMINOSE D EM PEDIATRIA<div style="text-align: justify;">
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<b><a href="http://www.luizhorta.com/" target="_blank"><img alt="http://www.luizhorta.com/" border="0" height="58" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfDoo2q9FURyhFfKO7gu2ogJe-8sRCxNT55GLzQe4k8QqlodoJkS_-dsDvZpl11eiTH_bcvKUQhB7ompsstEV3puGToV6705cLCMAvd3fQi-geCVkBGyvmWKNeJg_14SNoOftkJjPnh7A/s400/profluizhorta.jpg" width="400" /></a></b></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIPOVITAMINOSE D EM PEDIATRIA: RECOMENDAÇÕES PARA O DIAGNÓSTICO, TRATAMENTO E PREVENÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sociedade Brasileira de Pediatria </span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FONTES DA VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exposição solar:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Responde por 90% da síntese de vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não expor diretamente ao sol lactentes menores de 6 meses e limitar a exposição solar em crianças maiores;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Na primavera, outono e verão, 10-15 minutos de exposição ao sol entre 10:00 e 15:00 horas é suficiente para a síntese de vitamina D em indivíduos de pele clara.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fontes alimentares:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: FONTES DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALIMENTOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(1µg = 40 UI)</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Óleo de fígado de bacalhau (1 colher de chá)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">600-1000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sardinha enlatada (100 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">300 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atum (90 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">230 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Salmão selvagem (100 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">600-1000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Salmão criado em fazendas de piscicultura (100 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">100-250 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fígado de boi (100 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Iogurte (100 g)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">90 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gema de ovo (1 unidade)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fórmulas lácteas fortificadas (1 litro)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">400 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Leite materno (1 litro)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">20-40 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Leite de vaca (1 litro)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">40 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td colspan="2" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da transferência materno-fetal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gestantes com hipovitaminose D;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prematuridade;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da síntese cutânea:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exposição solar inadequada;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pele escura;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Protetor solar;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Roupas que cubram quase todo o corpo;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poluição atmosférica;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Latitude</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da ingestão de vitamina D:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aleitamento materno exclusivo;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes que ingerem menos de 1 litro de fórmula láctea por dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dieta pobre em vitamina D;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dieta vegetariana;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da absorção intestinal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndromes de má absorção intestinal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença celíaca;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença inflamatória intestinal;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fibrose cística;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome do intestino curto;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cirurgia bariátrica;</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da síntese de vitamina D:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hepatopatia crônica;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefropatia crônica;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sequestro da vitamina D no tecido adiposo:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamentos:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticonvulsivantes: fenobarbital, fenitoína, carbamazepina, oxcabamazepina, primidona;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Corticosteróides;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antifúngicos azólicos: cetoconazol;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antirretrovirais;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Colestiramina;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Orlistat;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Rifampicina.</span></div>
</li>
</ul>
</ul>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Necessidade aumentada de vitamina D:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Períodos de crescimento acelerado do esqueleto:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes entre 0-12 meses de idade;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adolescentes entre 9 e 18 anos;</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência enzimática:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência da enzima 25-hidroxilase (mutação do CYP2R1);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência da 1-alfa-hidroxilase (mutações do CYP27B1);</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Resistência à ação da vitamina D (mutações do receptor de vitamina D – VDR).</span></div>
</li>
</ul>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crescimento deficiente;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atraso no desenvolvimento;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irritabilidade;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dores ósseas;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Raquitismo (criança):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crescimento deficiente;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atraso no desenvolvimento motor;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atraso na erupção dentária;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irritabilidade;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sudorese;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alterações dentárias;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fronte olímpica;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atraso no fechamento das fontanelas;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crânio tabes;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Rosário raquítico (alargamento das junções costocondrais);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alargamento dos punhos e tornozelos (alargamento metafisário);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sulco de Harrison (atrofia diafragmática);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deformidades de membros inferiores (geno varo, geno valgo).</span></div>
</li>
</ul>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Osteomalácia (adolescentes e adultos)</span></div>
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</ul>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRIAGEM PARA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A triagem para deficiência de vitamina D está recomendada apenas nos indivíduos com fatores de risco:</span></div>
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<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="210"></col><col width="274"></col></colgroup><tbody>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: FATORES DE RISCO PARA DEFICIÊNCIA DE VITAMINA D</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuição da transferência materno-fetal</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 36pt; margin-top: 0pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gestantes com hipovitaminose D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prematuridade.</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuição da síntese cutânea</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 36pt; margin-top: 0pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exposição solar inadequada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pele escura;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Protetor solar;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Roupas que cubram quase todo o corpo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poluição atmosférica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Latitude.</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuição da ingestão de vitamina D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aleitamento materno exclusivo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes que ingerem menos de 1 litro de fórmula láctea por dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dieta pobre em vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dieta vegetariana.</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuição da absorção intestinal</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndromes de má absorção: doença celíaca, doença inflamatória intestinal, fibrose cística, síndrome do intestino curto, cirurgia bariátrica.</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuição da síntese</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hepatopatia crônica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefropatia crônica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sequestro de vitamina D no tecido adiposo</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamentos</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticonvulsivantes: fenobarbital, fenitoína, carbamazepina, oxcarbamazepina, primidona;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Corticosteróides;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antifúngicos azólicos: cetoconazol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antirretrovirais;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Colestiramina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Orlistat;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Rifampicina.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCIDIOL (25-OH-VITAMINA D):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Método:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Métodos padrão-ouro:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cromatografia de alta performance (HPLC);</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Espectro-cromatografia líquida de massa (LC-MS);</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Métodos rotineiros:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Imunoensaios</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Radioimunoensaios.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="121"></col><col width="121"></col><col width="121"></col><col width="121"></col></colgroup><tbody>
<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL DO ESTADO NUTRICIONAL DE VITAMINA D EM CRIANÇAS E ADOLESCENTES</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICOS</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Consensus on Prevention and Management of Nutritional Rickets (2016)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Endocrine Society Clinical Practice Guideline (2011)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">American Academy of Pediatrics (2008)</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
</td><td colspan="3" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">25-OH-D sérica (ng/mL*)</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Suficiência</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 20</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">30-100</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">21-100</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Insuficiência</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12-20</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">21-29</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">16-20</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Deficiência</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 12</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 20</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 15</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Toxicidade</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 100</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 100</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 150</span></div>
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<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">*: 1 ng/mL = 2,5 nmol/L</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
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</tbody></table>
</div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quando o nível de 25-OH-VITAMINA D for inferior a 20 ng/ml, avaliar a possibilidade de raquitismo, dosando:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO SÉRICO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÓSFORO SÉRICO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MAGNÉSIO;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FOSFATASE ALCALINA;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PROTEÍNAS TOTAIS E FRAÇÕES;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PARATORMÔNIO (PTH).</span></div>
</li>
</ul>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="188"></col><col width="101"></col><col width="101"></col><col width="93"></col></colgroup><tbody>
<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: ESTÁGIOS DA DEFICIÊNCIA DA VITAMINA D</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTÁGIO 1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTÁGIO 2</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTÁGIO 3</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Cálcio sérico</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal ou </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal ou </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯¯</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Fósforo sérico</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal ou </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯¯</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Fosfatase alcalina sérica</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Paratormônio sérico</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">25-OH-vitamina D sérica</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯¯</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯¯¯</span></div>
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<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: aumentado; </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">¯</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: diminuído.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
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</div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Para os pacientes com diagnóstico clínico e laboratorial de raquitismo, devemos solicitar:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RADIOGRAFIA DE MÃOS E PUNHOS OU JOELHOS, em AP; e RADIOGRAFIA DE TÓRAX em PA e P: os achados radiológicos no raquitismo são:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alargamento das metáfises com perda de seus contornos, principalmente em punhos e tornozelos;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alargamento das junções costocondrais;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fraturas em “galho verde”;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Geno varo ou geno valgo;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deformidades torácicas.</span></div>
</li>
</ul>
</ul>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO DA HIPOVITAMINOSE D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento da hipovitaminose D é indicado para todos os pacientes com deficiência de vitamina D, sintomáticos ou não. Pacientes com insuficiência da vitamina D podem ser tratados, caso pertençam a grupos de risco para hipovitaminose D e as medidas gerais (adequação na dieta e atividade ao ar livre) não possam ser efetuadas.</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">COLECALCIFEROL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamento de escolha;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCITRIOL (1,25-OH-vitamina D):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal crônica;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Raquitismo dependente de vitamina D tipo 1 ou tipo 2;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndromes de má absorção intestinal grave.</span></div>
</li>
</ul>
</ul>
</ul>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="121"></col><col width="121"></col><col width="121"></col><col width="121"></col></colgroup><tbody>
<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: TRATAMENTO DA HIPOVITAMINOSE D</span></div>
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<tr style="height: 0px;"><td rowspan="2" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FAIXA ETÁRIA</span></div>
</td><td colspan="2" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO COM VITAMINA D*</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(1 mcg = 40 UI)</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOSE DE MANUTENÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOSE DIÁRIA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOSE SEMANAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Global Consensus Recommendations on Prevention and Management of Nutritional Rickets (2016)</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">< 1 ano</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2000 UI, por 12 semanas</span></div>
</td><td rowspan="3" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não há recomendação específica sobre doses semanais</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pelo menos 400 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1 – 12 anos</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3000-6000 UI, por 12 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pelo menos 600 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">> 12 anos</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">6000 UI, por 12 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pelo menos 600 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Endocrine Society Clinical Practice Guidelines (2011)</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">< 1 ano</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2000 UI, por 8 a 12 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50.000 UI, por 6 a 8 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">400-1000 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1-18 anos</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2000 UI, por 8 a 12 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50.000 UI, por 6 a 8 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">600-1000 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">> 18 anos</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">6000 UI, por 6 a 8 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50.000 UI, por 6 a 8 semanas</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1500-2000 UI/dia</span></div>
</td></tr>
<tr style="height: 0px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">* Ingerir a qualquer hora do dia, com ou sem jejum.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose cumulativa é mais importante que a frequência das doses.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Regra básica: 100 UI de vitamina D suplementada eleva em 0,7-1,0 ng/mL os níveis séricos de vitamina D.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 8pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="242"></col><col width="242"></col></colgroup><tbody>
<tr style="height: 0px;"><td colspan="2" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: PREPARAÇÕES COMERCIAIS DE COLECALCIFEROL</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PRODUTO</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">APRESENTAÇÃO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Addera D3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 3 gotas = 400 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DePura</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DePura Kids</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 500 UI</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 1000 UI; 2000 UI; 7000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Doranguitos</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos mastigáveis: 200 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DoseD</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Doss</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cápsulas 1000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DPrev</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 1000 UI; 2000 UI; 5000 UI; 7000 UI e 50000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FontD</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI;</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cápsulas 200 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Maxxi D3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SanyD</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 1000 UI; 2000 UI; 7000 UI; 50000 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SupraD</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Vitax D3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI;</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cápsulas 200 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ViterSol D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gotas: 1 gota = 200 UI;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cápsulas 200 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERAPIA COM DOSES ELEVADAS DE VITAMINA D (STOSS-THERAPY)</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É a terapia, usada em situações especiais, com administração de doses elevadas de vitamina D, VO ou IM, por curtos períodos de tempo, repetindo-se o tratamento, se necessário, a cada 3 meses.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O uso de soluções orais de vitamina D contendo propilenoglicol em doses elevadas pode resultar em intoxicação.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Critérios de indicação da terapia com doses elevadas de vitamina D (Global Consensus on Nutritional Rickets):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crainças < 3 meses: não usar;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças entre 3 e 12 meses: 50.000 UI, VO, dose única; seguida de manutenção de 400 UI/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças entre 12 meses e 12 anos: 150.000 UI, VO, dose única; seguida de manutenção de 600 UI/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças maiores de 12 anos: 300.000 UI, VO, dose única, seguida de manutenção de 600 UI/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO DE CÁLCIO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicações:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Raquitismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ingestão de cálcio insuficiente.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CARBONATO DE CÁLCIO (1 g de carbonato de cálcio = 400 mg de cálcio elementar):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia: 30-80 mg de cálcio elementar/Kcal/dia, VO, 8/8 horas, nas refeições. Administrar por 2 a 4 semanas, reavaliando em seguida.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CITRATO DE CÁLCIO (1 g de citrato de cálcio = 211 mg de cálcio elementar):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com acloridria;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de inibidores da bomba de prótons.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">30-80 mg de cálcio elementar/Kcal/dia, VO, 8/8 horas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">GLUCONATO DE CÁLCIO (1 g de gluconato de cálcio = 90 mg de cálcio elementar):</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicações:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tetania ou convulsão.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">10-20 mg/Kcal/dose, EV, lento, em 5-15 minutos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25-OH-VITAMINA D: dosada a cada 3 meses até atingir valores superiores a 20-30 ng/mL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO SÉRICO: em casos de raquitismo, dosar a cada 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÓSFORO SÉRICO: em casos de raquitismo, dosar a cada 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MAGNÉSIO: em casos de raquitismo, dosar a cada 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FOSFATASE ALCALINA: em casos de raquitismo, dosar a cada 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PARATORMÔNIO: em casos de raquitismo, dosar a cada 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RX DE MÃOS E PUNHOS ou DE JOELHOS: em casos com lesões ósseas, após 1-3 meses de iniciado o tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INTOXICAÇÃO POR VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico laboratorial:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25-OH-VITAMINA D: > 100 ng/ml (> 250 nmol/L);</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO SÉRICO: elevado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCIÚRIA: presenta;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PARATORMÔNIO: suprimido.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fatores de risco para intoxicação por vitamina D:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças granulomatosas: tuberculose, infecções fúngicas crônicas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Linfomas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome de Williams;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Vitamina manipulada (erro de dosagem).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quadro Clínico da intoxicação por vitamina D:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Náusea;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Vômito;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dor abdominal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poliúria;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Polidipsia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Constipação intestinal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Calcificação ectópica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefrolitíase;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Depressão do sistema nervoso central.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento da Hipervitaminose D:</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suspensão da reposição de vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidratação venosa;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diuréticos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Corticosteróides.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREVENÇÃO DA HIPOVITAMINOSE D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: PREVENÇÃO DA HIPOVITAMINOSE D EM CRIANÇAS E ADOLESCENTES</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Gestantes</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suplementar 25-OH-vitamina D, com 600-2000 UI/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Lactantes</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suplementar as mulheres em aleitamento materno com 25-OH-vitamina D, com 600-2000 UI/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Crianças e Adolescentes</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suplementar 25-OH-vitamina D, com 400 UI/dia (< 1 ano) e 600 UI/dia (> 1 ano), em:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças em aleitamento materno exclusivo:</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RN termo: iniciar logo após o nascimento;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RN prematuro: iniciar quando peso > 1500 g e tolerância para ingestão oral;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças em uso de fórmula láctea fortificada com vitamina D que ingerem volume de leite < 1000 mL/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças e adolescentes que ingerem < 600 UI de vitamina D/dia na dieta;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças e adolescentes que não se exponham ao sol regularmente.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Grupos de Risco</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suplementar 25-OH-vitamina D, com 600-1800 UI/dia, nos seguintes grupos de risco:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dieta estritamente vegetariana;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hepatopatia crônica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefropatia crônica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Má absorção intestinal: doença celíaca, doença de Crohn, fibrose cística, cirurgia bariátrica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperparatireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças granulomatosas: tuberculose, sarcoidose, histoplasmose;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de medicamentos:</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticonvulsivantes: fenobarbital, fenitoína, carbamazepina, oxcarbamazepina;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Corticosteróides;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antifúngicos azólicos: cetoconazol;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antirretrovirais;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Colestiramina;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Orlistat;</span></div>
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<span style="background-color: transparent; color: black; font-family: "Courier New"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Rifampicina.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estimular a prática de atividades ao ar livre</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estimular o consumo de alimentos ricos em vitamina D</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Observações:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças com fatores de risco para hipovitaminose D devem manter a suplementação enquanto perdurar o risco;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">· </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Preparação de escolha: colecalciferol (vitamina D3).</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: SBP, 2016.</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">SOCIEDADE BRASILEIRA DE PEDIATRIA. DEPARTAMENTO CIENTÍFICO DE ENDOCRINOLOGIA. ALVES, C.A.D.; GARGNIN, K.R.N.; PAULA, L.C.C.; GARCIA, L.S.; COLLET-SOLERG P.F.; LIBERATORE JR, R.D.R.; PINTOM R.M. & ARRAIS, R.F.: Hipovitaminose D em Pediatria: recomendações para o diagnóstico, tratamento e prevenção. Nov/2016.</span></div>
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<a href="http://www.ans.gov.br/prevencao-e-combate/combate-ao-mosquito-aedes-aegypti#" target="_blank"></a><br />Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-1304270762556742742016-12-21T12:19:00.000-08:002016-12-21T12:19:49.459-08:00SÍNDROME DE OVÁRIOS POLICÍSTICOS E HIRSUTISMO/ACNE<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><b style="font-weight: normal;"><div dir="ltr" id="docs-internal-guid-661b2b3e-2309-dabc-cb1d-eba5fb577345" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 0.153pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROTOCOLO CLÍNICO E DIRETRIZES TERAPÊUTICAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SÍNDROME DE OVÁRIOS POLICÍSTICOS E HIRSUTISMO/ACNE</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Portaria SAS/MS n° 1.321, de 25 de novembro de 2013.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-X:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E28.0: Excesso de estrógeno;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E28.2: Síndrome dos ovários policísticos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">L68.0: hirsutismo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEFINIÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome de ovários policísticos (SOP) caracteriza-se por manifestações de hiperandrogenismo (hirsutismo, acne, alopécia) e ciclos menstruais irregulares.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prevalência da síndrome de ovários policísticos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em mulheres com idade reprodutiva: 4-6,8%.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A SOP tem herança autossômica dominante.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O hiperandrogenismo presente na síndrome de ovários policísticos pode resultar em secreção adequada porém acíclica de estrogênios e em secreção deficiente de progesterona. Ocorre hiperplasia endometrial e sangramento intermitente e disfuncional. O estímulo mitogênico e hiperplasia endometrial confere risco 3 vezes maior de neoplasia de endométrio em pacientes com SOP em comparação com a população geral.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alguns casos de SOP apresentam amenorréia prolongada e atrofia endometrial.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres com SOP têm níveis elevados de hormônio luteinizante (LH) e aumento da frequência e amplitude dos pulsos de LH, podendo ocorrer anormalidades no eixo reprodutivo hipotálamo-hipofisário. A concentração de hormônio folículo-estimulante (FSH) é normal ou diminuída, resultando em aumento da relação LH/FSH. A prolactina pode estar moderadamente elevada, decorrente do estímulo estrogênico ou do aumento dos androgênios adrenais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Patologia: Macroscopicamente, o ovário aumentado, policístico, com cápsula espessada e esbranquiçada. Histologicamente, o córtex é espessado e esclerótico.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres com SOP apresentam infertilidade, porém podem apresentar ovulações esparsas, com possibilidade de gravidez e abortamento precoce.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Embora a resistência insulínica e a hiperinsulinemia sejam mais frequentes nas mulheres obesas, ocorrem também nas pacientes com SOP e peso normal.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irregularidade menstrual: o hiperandrogenismo promove secreção em quantidade adequada, mas acíclica, de estrogênios e deficiência na secreção de progesterona, resultando em oligo ou anovulação e, consequentemente, oligomenorréia ou amenorréia. Estas alterações hormonais pode resultar em hiperplasia endometrial e sangramento intermitente e disfuncional (sangramento menstrual frequente ou anormalmente abundante tipicamente associado à anovulação). Em algumas pacientes com SOP, pode ocorrer amenorréia prolongada e atrofia endometrial. Esses distúrbios menstruais iniciam-se na peripuberdade, fazendo com que a menarca seja normal ou levemente atrasada seguida de ciclos irregulares. Algumas iniciam com ciclos regulares e evoluem para irregularidade associada a ganho de peso. Mulheres obesas podem apresentar melhora na regularidade dos ciclos com pequenas perdas de peso, provavelmente relacionada à melhora na sensibilidade à insulina.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperandrogenismo: pode manifestar-se com hirsutismo, acne e alopecia, mas não costuma estar associada a sinais de virilização (aumento da massa muscular, voz grossa e aumento do clitóris);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hirsutismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É o aumento da quantidade de pelos com uma distribuição masculina (sobre os lábios, no mento e ao longo da linha alba no abdome inferior).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diferencia-se da hipertricose (presença de pelos em regiões não dependentes de hormônios, como antebraços e pernas, geralmente com pelos finos. Decorre da hereditariedade, medicamentos, inanição ou excesso de uso de glicocorticóides, e não se associa ao desbalanço de hormônios sexuais).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O hirsutismo deve ser quantificado pelo escore de Ferriman e Gallwey, o qual permite o diagnóstico e a avaliação semiquantitativa para acompanhamento do tratamento. Este escore pontua de 0 (ausência de pelos) a 4 (completamente coberta de pelos) 9 áreas do corpo sensíveis aos andrógenos. A soma desta pontuação resulta no escore de Ferriman-Gallwey. Hirsutismo ocorre quando o escore for superior a 8 (5% das mulheres pré-menopáusicas tem escore superior a 8).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anormalidades hipotálamo-hipofisárias;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ovários policísticos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade: ocorre em 50 das pacientes com SOP;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Resistência insulínica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES LABORATORIAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HORMÔNIO LUTEINIZANTE (LH) sérico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> elevado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HORMÔNIO FOLÍCULO-ESTIMULANTE (FSH) sérico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> normal ou diminuído;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RELAÇÃO LH/FSH:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> aumentada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTOSTERONA sérica:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> elevada.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulher adulta: < 80 ng/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">USG PÉLVICA TRANSVAGINAL DE ALTA FREQUÊNCIA:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> a SOP tipicamente apresenta ovário aumentado, policístico e com cápsula espessada. O padrão morfológico típico da SOP não é necessário nem suficiente para o diagnóstico da doença, tendo em vista que estas características estão presentes em:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">80-100% das mulheres com SOP;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">92% das mulheres com hirsutismo idiopático;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">87% das mulheres com oligomenorréia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">82% das mulheres pré-menopáusicas com diabetes mellitus tipo 2;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">83% das mulheres com hiperplasia adrenal congênita;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">40% das mulheres com história de diabetes mellitus gestacional;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">26% das mulheres com amenorréia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3% das mulheres saudáveis.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">17-HIDROXIPROGESTERONA sérica:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 3px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -7px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulher Adulta:</span></div>
</li>
</ul>
</ul>
</ul>
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -55px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fase folicular: 0,2-1,8 ng/mL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -55px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fase lútea: 0,2-4,7 ng/mL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -55px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fase pós-menopáusica: 0,2-1,7 ng/mL;</span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROLACTINA sérica:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de prolactinoma;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -16px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulher adulta: 4,8-23,3 ng/mL;</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GLICEMIA DE JEJUM:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de síndrome metabólica;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal: < 100 mg/dL;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTE DE TOLERÂNCIA ORAL À GLICOSE:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicado para mulheres obesas ou com história familiar de diabetes mellitus;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Administra-se 75 g de glicose e dosa-se glicemia após 2 horas;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal: < 140 mg/dL;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SULFATO DE DEHIDROEPIANDROSTERONA (DHEA-S):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de tumor adrenal;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulher adulta:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">19 a 30 anos de idade: 30-780 mcg/dL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">31 a 50 anos de idade: 10-380 mcg/dL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pós-menopausa: 30-260 mcg/dL;</span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HORMÔNIO TIREOESTIMULANTE (TSH):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de hipotireoidismo;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal: 0,3-4,2 mcU/mL;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 4px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">COLESTEROL TOTAL, HDL COLESTEROL E TRIGLICERÍDEOS:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de síndrome metabólico;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -17px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Colesterol total: < 200 mg/dL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -17px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">HDL colesterol: > 40 mg/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Triglicérides: < 150 mg/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DIAGNÓSTICOS DO NATIONAL INSTITUTE OF HEALTH - NIH - 1990:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irregularidade menstrual devido a oligo ou anovulação; e</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperandrogenismo diagnosticado:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Clinicamente: hirsutismo, acne, alopécia androgênica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Laboratorialmente: androgênios séricos elevados.</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DIAGNÓSTICOS DO CONSENSO DE ROTTERDAM (2003):</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> presença de pelo menos 2 dos 3 critérios abaixo, após a exclusão de outras causas conhecidas de androgenismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Disfunção ovulatória;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperandrogenismo clínico ou laboratorial; ou</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aparência policística dos ovários à ultrassonografia pélvica (volume ovariano > 10 cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> ou presença de 12 ou mais folículos com 0,2-0,9 cm).</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DIAGNÓSTICOS DA ANDROGEN EXCESS & PCOS SOCIETY:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperandrogenismo clínico ou laboratorial; associado a:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anovulação; ou</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ovários policísticos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO DIFERENCIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Outras causas de hiperandrogenismo feminino:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Hiperplasia adrenal:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">17-hidroxiprogesterona sérica basal: elevada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Teste da cortrosina: 17-hidroxiprogesterona sérica elevada 60 minutos após a administração intravenosa de 250 mg de corticotropina.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Tumores secretores de androgênios:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quadro clínico de início abrupto, com hirsutismo rapidamente progressivo, sinais de virilização e amenorréia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Testosterona sérica: geralmente > 150 ng/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exames de imagem adrenal ou ovariana: presença de lesão.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Hiperprolactinemia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poucos sinais de hiperandrogenismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prolactina sérica: elevada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Disfunção tireoidiana;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Uso de medicamentos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Critérios que sugerem causas raras de hirsutismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Início abrupto, curta duração (tipicamente inferior a 1 ano) ou piora repentina e progressiva do hirsutismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Início após a 3° década de vida;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sinais ou sintomas de virilização, incluindo calvície frontal, acne, clitoromegalia, aumento de massa muscular e engrossamento da voz.</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE INCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SÍNDROME DOS OVÁRIOS POLICÍSTICOS:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Utilizar os critérios de diagnóstico de SOP do NIH:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irregularidade menstrual: associada a:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sinais clínicos de hiperandrogenismo (hirsutismo, alopécia, acne); ou</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperandrogenemia: níveis séricos aumentados de testosterona);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIRSUTISMO IDIOPÁTICO com ciclos regulares e ovulatórios, hirsutismo isolado e ausência de ovários policísticos à ultrassonografia pélvica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIPERPLASIA ADRENAL COM MANIFESTAÇÕES DE HIRSUTISMO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> poderão ser tratados com este protocolo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Outras doenças que causem hirsutismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tumores produtores de androgênios;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperprolactinemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome de Cushing;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tireopatias;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de medicamentos associados com hirsutismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes gestantes;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade aos medicamentos do protocolo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IRREGULARIDADE MENSTRUAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">As irregularidades menstruais devem ser tratadas para evitar o desenvolvimento de hiperplasia e neoplasia endometrial.</span></div>
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<span style="background-color: transparent; color: black; font-family: "Times New Roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ANTICONCEPCIONAIS ORAIS (ACO)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento de primeira linha para as pacientes com irregularidades menstruais e alterações dermatológicas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reavaliar a paciente após 3 meses de tratamento para determinar a eficácia clínica e os níveis de androgênios;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento deve ser mantido até o amadurecimento ginecológico completo (5 anos após a menarca) ou a perda do excesso de peso. Após o amadurecimento ginecológico ou a perda do excesso de peso, interrompe-se o tratamento por alguns meses para avaliar a persistência da irregularidade menstrual e a necessidade de manutenção do tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sangramento uterino disfuncional:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento agudo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ACO com Estrogênio (dose alta) + Progesterona: 1 cp, VO, 3-4 vezes ao dia (paciente deve ser orientada sobre a possibilidade de ocorrência de grande sangramento e cólicas quando o tratamento for interrompido); ou</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Progesterona</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento crônico:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ACO cíclicos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contra-indicações do uso de ACO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninas na pré-menarca com baixa estatura que ainda apresentem as epífises ósseas abertas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Risco de trombose venosa (usar com cautela);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipertensão arterial sistêmica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipertrigliceridemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diabetes mellitus.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Desvantagens do tratamento com anticoncepcionais orais:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Maior dificuldade para a perda de peso;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crença pela paciente de que se encontra curada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não seguimento do acompanhamento médico;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Impossibilidade de gestação;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Desconhecimento das consequências do tratamento a longo prazo sobre a fertilidade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROGESTOGÊNIOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Usados para controlar os sintomas relacionados aos ciclos anovulatórios (não normalizam os níveis de androgênios, nem tratam adequadamente o hirsutismo);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Acetato de Medroxiprogesterona:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Administrado por 10-12 dias por mês;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento da irregularidade menstrual de mulheres sexualmente maduras.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Utilizado em pacientes que não toleram ou tenham contraindicação ao uso de anticoncepcionais orais;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Resultam em sangramentos de privação regulares alguns dias após a administração de progestogênio cíclico.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">METFORMINA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Segunda opção no tratamento do distúrbio menstrual nas pacientes com contraindicação ao uso de anticoncepcionais orais e alterações metabólicas, isoladas ou associadas ao progestogênio.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIRSUTISMO E ACNE/ALOPÉCIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTOS DERMATOLÓGICOS:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Depilação (física ou química);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Epilação (uso de ceras);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Destruição da papila dérmica (elétrica ou a laser);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inibição do crescimento capilar.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO ENDOCRINOLÓGICO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Resumo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicado para as pacientes que não tiveram resposta satisfatória com o tratamento dermatológico ou quando a queixa principal for irregularidade menstrual;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento farmacológico deve ser realizado em associação com o dermatológico;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A melhora do hirsutismo com tratamento endocrinológico somente é evidenciada após 6-12 meses de tratamento, pois apenas interrompe a estimulação de crescimento de novos folículos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento inicial do hirsutismo deve ser feito com anticoncepcionais orais enquanto a paciente não desejar engravidar.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quando não houver resposta adequada após 6 meses, pode-se associar anticoncepcional oral com espironolactona.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quando a associação anticoncepcional oral com espironolactona não apresentar efeito desejado a longo prazo, pode-se substituir um dos componentes (anticoncepcional oral ou antiandrogênico) por molécula diferente do mesmo grupo terapêutico (ex.: trocar espironolactona por ciproterona).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sempre estimular a redução de peso em pacientes com sobrepeso ou obesidade (mudanças no estilo de vida: dieta e atividade física);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">METFORMINA: indicada para pacientes que apresentam sinais de resistência insulínica ou síndrome metabólica;</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ANTICONCEPCIONAIS ORAIS E PROGESTOGÊNIOS:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efetivo em pacientes com SOP típica (onde o hiperandrogenismo é de origem predominantemente ovariana), sendo a primeira opção terapêutica hormonal;</span></div>
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<br /><br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ANTICONCEPCIONAIS ORAIS:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atuam reduzindo os níveis plasmáticos de testosterona por:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reduzirem os níveis de gonadotrofinas séricas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumentarem a globulina ligadora de gonadotrofinas (globulina ligadora da testosterona);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diminuírem modestamente os níveis de sulfato de deidroepiandrostestosterona;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Previnem a transformação de unidades pilossebáceas em pelos terminais;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeitos:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reduz a testosterona sérica e sulfato de deidroepiandrostestosterona após 3 semanas;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reduz a acne após 3 meses;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Melhora o hirsutismo após 6 a 9 meses;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Formulações de anticoncepcionais orais com dosagem de estrogênios de 30 a 35 mcg são mais adequados para suprimir a produção androgênica;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÁRMACOS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETINILESTRADIOL + LEVONORGESTREL:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -122px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -152px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 0,03 mg + 0,15 mg.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -122px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -152px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 cp/dia por 21 dias/mês.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -152px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sangramento disfuncional</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (doses elevadas): 3-4 cp/dia e decrescentes por 4 a 5 dias.</span></div>
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</ul>
</ul>
</ul>
</ul>
</ul>
</ul>
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<br /><br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: square; margin-left: -82px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROGESTOGÊNICOS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">DESOGESTREL;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">GESTODENO;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">NORGESTIMATO;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">DROSPIRENONA;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ACETATO DE CIPROTERONA:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -122px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticoncepcionais orais com acetato de ciproterona é útil em pacientes com SOP por melhorarem a acne, hirsutismo e transtornos menstruais associados e disfunção no tecido adiposo em obesas;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -102px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÁRMACOS:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; margin-left: -122px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ACETATO DE MEDROXIPROGESTERONA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -141px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -170px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 10 mg;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -141px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -170px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">10 mg/dia por 10-12 dias do ciclo;</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; margin-left: -122px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">NORETISTERONA:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -141px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -170px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 0,35 mg</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -141px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia: </span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: -26px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0,35 mg/dia por 21 dias/mês;</span></div>
</li>
</ul>
</ul>
</ul>
</ul>
<br /><br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; margin-left: -34px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ANTIANDROGÊNICOS:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; margin-left: -54px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Resumo:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eficazes na redução do hirsutismo e da acne e, em menor intensidade, da alopecia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atuam revertendo a transformação da unidade pilossebácia a pelo terminal induzida por androgênios;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeito ocorre após 9 a 12 meses de tratamento;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Geralmente administrados conjuntamente com anticoncepcionais orais (para evitar concepção em mulheres com idade fértil e vida sexual ativa);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESPIRONOLACTONA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Agente de primeira escolha;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Um dos mais potentes e seguros agentes antiandrogênicos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inibe a ligação de testosterona a seus receptores;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Início de resposta em 2 meses e pico de efeito em 6 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeito colateral:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Irregularidade menstrual: Controlada por:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Coadministração de anticoncepcionais orais; ou</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso cíclico em 21 dias por mês;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimido: 25 mg; 100 mg;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50 mg ou 100 mg, VO, 1-2 vezes ao dia, até o máximo de 200 mg/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ACETATO DE CIPROTERONA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Agente de segunda escolha;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Progestogênio com atividade antiandrogênica (liga-se ao receptor androgênico, inibindo a biossíntese de androgênios; também inibe a secreção de gonadotrofinas;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: -74px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Administrado isoladamente ou associado a anticoncepcionais orais;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos 50 mg;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12,5 mg a 50 mg/dia, VO, do 5° ao 25° dia do ciclo menstrual; ou</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25 mg a 50 mg/dia< VO, no esquema 21/7 (21 dias com medicação e 7 dias para o período menstrual); ou</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -93px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">100 mg do 1° ao 10° dia do ciclo menstrual em associação com anticoncepcionais orais no esquema 21/7.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FLUTAMIDA;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FINASTERIDA.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OBESIDADE E RESISTÊNCIA INSULÍNICA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A redução de peso melhora a resistência insulínica, a hiperandrogenemia e a ovulação em pacientes com SOP;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Orientar mudanças no estilo de vida: dieta e atividade física regular;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">METFORMINA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eleva a sensibilidade à ação da insulina, diminuindo a produção hepática de glicose e aumentando sua captação periférica;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicado nas pacientes com evidências de resistência insulínica ou síndrome metabólica;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reduz o hiperandrogenismo e a irregularidade menstrual das pacientes com SOP;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Seus efeitos são mais significativos nas pacientes que reduzem seu peso;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alternativa terapêutica para mulheres com distúrbios menstruais e contraindicação metabólica para anticoncepcionais orais;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: -6px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Com a utilização de metformina pode ocorrer ovulação e gravidez, sendo importante garantir a anticoncepção nestes casos, principalmente se houver associação com antiandrogênicos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos 500 mg e 850 mg.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Iniciar com 425 mg ou 500 mg, VO, antes do jantar. Aumentar 425 mg ou 500 mg por semana até o máximo de 1,7 a 2,550 g/dia. Dividir a dose em 2 a 3 vezes ao dia para melhorar a tolerância.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TEMPO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento deve ser contínuo, devendo ser suspenso para engravidar.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BENEFÍCIOS ESPERADOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Regularização dos ciclos menstruais (verificado nos primeiros meses de tratamento);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução do volume e distribuição de pelos e outras manifestações androgênicas (após 6 meses de tratamento);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução do peso e melhora das manifestações de resistência insulínica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EFEITOS ADVERSOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sintomas gastrintestinais (diarreia e náuseas): melhoram gradativamente;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeitos cardiovasculares mínimos (ciproterona e estrógeno);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeitos no sistema nervoso central mínimos (ciproterona e estrógeno);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tensão nas mamas e galactorréia (ciproterona e estrógeno);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Elevação das transaminases e hepatite, eventualmente fatal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da libido (ciproterona e estrógeno).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">POTÁSSIO SÉRICO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> quando do uso de espironolactona (hipercalemia);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CREATININA SÉRICA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CLEARENCE DE CREATININA:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> avaliar anualmente quando do uso de metformina. Suspender a metformina se o clearence for < 30 mL/Kg/min;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALT/TGP e AST/TGO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> dosar antes e a cada 3-6 meses após a introdução de acetado de ciproterona. Em caso de elevação, reavaliar/suspender a medicação;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BILIRRUBINAS:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> dosar antes e a cada 3-6 meses após a introdução de acetado de ciproterona. Em caso de elevação, reavaliar/suspender a medicação;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 14px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GLICEMIA:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> avaliar a cada 3-6 meses quando do uso de metformina</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span><br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE – TER</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É obrigatória a informação ao paciente ou a seu responsável legal dos potenciais riscos, benefícios e efeitos adversos relacionados ao uso do medicamento preconizado neste protocolo. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/03/pcdt-sindr-ovarios-polic-hirsutismo-acne-livro-2013.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">MINISTÉRIO DA SAÚDE. Consultores: COSTA, A.F.; SPRITZER, P.M.; KRUG, B.C.; GONÇALVES, C.B.T.; AMARAL, K.M.; SCHNEIDERS, R.E.; BERNARDE, H.D. & RONSONI, R.M.. Editores: PICON, P.D.; GADELHA, M.I.P & ALEXANDRE, R.F.: Síndrome de ovários policíclicos e hirsutismo/acne. Protocolos Clínicos e Diretrizes Terapêuticas. Portaria SAS/MS n° 1.321, de 25 de novembro de 2.013.</span></a></div>
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<a href="http://www.ans.gov.br/prevencao-e-combate/combate-ao-mosquito-aedes-aegypti#" target="_blank"></a><br />Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-28665408601590507062016-12-16T17:13:00.000-08:002016-12-16T17:13:14.910-08:00METFORMINA<div style="text-align: justify;">
<b><br /></b></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
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<a href="https://www.blogger.com/null" name="_GoBack"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 18pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">METFORMINA,
Cloridrato</span></b></a><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">CATEGORIA TERAPÊUTICA</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></div>
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<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l6 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Biguanida - antidiabético oral<sup><span style="font-size: x-small;">1</span></sup>.<o:p></o:p></span></span></li>
</ul>
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span><br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">MECANISMO DE AÇÃO<o:p></o:p></span></b></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="mso-tab-count: 1;"> </span>A
metformina reduz a produção hepática de glicose, diminui a absorção intestinal
de glicose e melhora a sensibilidade à insulina, aumentando a captação e
utilização periférica de glicose</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">FARMACOLOGIA<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Início de
ação: dentro de alguns dias, com efeito máximo geralmente dentro de 2 semanas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Redução
na glicemia de jejum média em crianças > 10 anos e adultos: 60-70 mg/dl</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Meia-vida:
3-6 horas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Tempo
para o pico de concentração sérica:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l4 level2 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Formulação
de liberação imediata: 2-4 horas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l4 level2 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Formulação
de liberação prolongada: 4-8 horas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Eliminação:
renal (secreção tubular; excreção inalterada de 90%)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l4 level1 lfo10; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diálise:
clearence até 170 ml/minuto</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">INDICAÇÕES</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></div>
<br />
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diabetes
mellitus tipo 2:</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> como monoterapia quando não controlado
com dieta e exercício físico, ou associado a sulfoniluréia ou insulina<sup><span style="font-size: x-small;">1</span></sup>;<o:p></o:p></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Resistência
insulínica nos pacientes com síndrome dos ovários policísticos (SOP):</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> Seu
uso pode inclusive restaurar a ovulação espontânea<sup><span style="font-size: x-small;">1</span></sup>.<o:p></o:p></span></span></li>
</ul>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">GESTAÇÃO </span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></div>
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<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l3 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Fator de risco B<sup><span style="font-size: x-small;">1</span></sup>;<o:p></o:p></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l3 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">O uso de metformina deve ser evitado durante a
gestação (diabetes mellitus gestacional ou diabetes mellitus tipo 2),
devendo o tratamento ser realizado com insulinoterapia neste período<sup><span style="font-size: x-small;">1</span></sup>.<o:p></o:p></span></span></li>
</ul>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">LACTAÇÃO</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></div>
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<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 0pt; mso-list: l0 level1 lfo4; tab-stops: list 36.0pt; text-align: justify; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Não recomendado (a metformina passa para o
leite materno)<sup><span style="font-size: x-small;"> 1</span></sup>.<o:p></o:p></span></span></li>
</ul>
<br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">CONTRA-INDICAÇÕES<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hipersensibilidade
à metformina ou qualquer de seus componentes</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Doença ou
insuficiência renal<sup>1,2</sup> (Creatinina sérica </span></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">≥1,5 mg/dL</span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> em homens e ≥1,4 mg/dL em
mulheres; ou Clearence de Creatinina alterado (que pode ser resultante de
condições clínicas como colapso cardiovascular, insuficiência respiratória,
infarto do miocárdio agudo, insuficiência cardíaca congestiva aguda e
septicemia; acidose metabólica aguda ou crônica com ou sem coma (incluindo
cetoacidose diabética)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;"> 1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Doença ou
insuficiência hepática</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cetoacidose
diabética<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Pré-coma
diabético<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Situações
agudas com potencial para afetar a função renal:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Desidratação<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Febre<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Infecção
grave<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Choque<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Administração
intravascular de contrastes iodados<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Doenças
agudas ou crônicas capazes de provocar hipóxia tecidual:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Insuficiência
cardíaca<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Insuficiência
respiratória<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l5 level2 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Infarto
do miocárdio recente<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Intoxicação
alcoólica aguda ou etilismo<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cirurgia
eletiva de grande porte<sup>2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">REAÇÕES ADVERSAS<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cardiovascular:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dor
torácica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Flushing</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Palpitação</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hematológicas:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Vasculite
leucocitoclástica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Anemia
megaloblástica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Sistema
nervoso central:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Calafrios</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Tontura</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cefaleia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Fotofobia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dermatológico:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Rash</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Alterações
ungueais</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Eritema<sup>2</sup>;<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Prurido<sup>2</sup>;<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Urticária<sup>2</sup>;<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Endocrinometabólico:
<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">hipoglicemia
(embora rara, pode decorrer de baixa ingestão calórica, exercício extenuante ou
associação com outros hipoglicemiantes)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;"> 1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Acidose
láctica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">: suspeitar de acidose láctica em todo paciente em uso de metformina que
apresentar cãibras musculares com perturbações digestivas (dor abdominal,
astenia grave), dispneia acidótica, hipotermia e coma</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. Laboratoriamente, encontra-se acidose
metabólica e lactato elevado (> 5 mmol/l), com aumento do ânion-gap e da
relação lactato/piruvato</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. Na suspeita de acidose metabólica, suspender a metformina<sup><span style="font-size: x-small;">2</span></sup></span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Gastrointestinal:<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dor
abdominal</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Distensão
abdominal</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Fezes
anormais</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inapetência<sup>2</sup>;
<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Constipação</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diarreia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dispepsia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Flatulência</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Azia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Indigestão</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Náusea</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Alteração
na sensação gustativa</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Vômitos</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hepatite<sup>2</sup>
ou alteração da função hepática<sup>2</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Neuromuscular
e esqueléticas:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Mialgia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Fraqueza</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Sistema respiratório:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dispnéia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Infecção
do trato respiratório superior</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Pneumonite</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Miscelânea:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Redução
dos níveis de vitamina B<sub>12</sub></span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Síndrome
flu-like</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l10 level2 lfo8; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diaforese
aumentada</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">INTERAÇÕES MEDICAMENTOSAS<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l9 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina aumenta os
níveis/efeitos de:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dalfampridina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dofetilide</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l9 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Mediamentos que aumentam os
níveis/efeitos da Metformina:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inibidores
da anidrase carbônica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cefalexina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cimetidina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Glicopirrolato</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Agentes
contrastantes iodados</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Lamotrigina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Pegvisomant</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Trimetoprim</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l9 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina reduz os níveis/efeitos
de:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Trospium</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l9 level1 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Medicamentos que reduzem os
níveis/efeitos da Metformina:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Corticosteróides
(oralmente inalado, sistêmico)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;"> 1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Análogos
do hormônio liberador do hormônio luteinizante</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Somatropina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l9 level2 lfo9; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diuréticos
tiazídicos</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span><br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">POSOLOGIA<o:p></o:p></span></b></span></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Diabetes mellitus tipo 2 em
pacientes não tratados previamente ou tratados com sulfoniluréia:<o:p></o:p></span></b></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">10-16
anos de idade: <o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inicial: 500 mg/dose, VO, 12/12hs,
nas refeições</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1 </span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">(café-da-manhã e jantar)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. <o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumento da dose deve ser feito
semanalmente, com acréscimos de 500 mg, divididos nas duas tomadas, até um
total diário de 2000 mg</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> (1000 mg no café-da-manhã e 1000 mg no jantar)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> 2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dose alternativa: <o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inicial:
850 mg/dose, VO, 24/24 horas, no café-da manhã<sup>1,2</sup>.<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumentar
a dose a cada 2 semanas em 500 mg até a dose máxima diária de 2550 mg/dia (850
mg no café, 850 mg no almoço e 850 mg no jantar)<sup> 2</sup>.<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">≥ 17 anos
de idade e adultos: <o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inicial: 500 mg/dose, VO, 12/12
horas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1 </span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">(café-da-manhã e jantar)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumento da dose deve ser feito
semanalmente, com acréscimos de 500 mg, divididos nas duas tomadas, até um
total diário de 2500 mg</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> (1000 mg no café, 500 mg no almoço e 1000 mg no jantar)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> 2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. Doses diárias superiores a 2000
mg/dia podem ser administradas de 8/8 horas</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1 </span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">(1000 mg no café da manhã, 1000 mg no
almoço e 1000 mg no jantar)</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> 2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dose alternativa: <o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dose
inicial: 850 mg/dose, VO, 24/24 horas, no café-da-manhã</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumento
da dose deve ser feito semanalmente, com acréscimos de 850 mg, passando para
12/12 horas, até um total diário de 2550 mg</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1 </span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">(850 mg no café, 850 mg no almoço
e 850 mg no jantar)<sup> 2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina XR (liberação
prolongada): <o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inicial:
500 mg/dose, VO, 24/24 horas, no jantar</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,3</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 144pt; mso-add-space: auto; mso-list: l7 level4 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumento
da dose deve ser feito semanalmente, com acréscimos de 500 mg, 24/24 horas, até
um total diário de 2000 mg</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,3</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> (as doses devem ser somadas em administradas sempre no jantar. Se essa
tomada única não tiver resposta, podemos dividir a dose máxima de 2000 mg em 2
tomadas ao dia: 1000 mg no café-da-manhã e 1000 mg no jantar)<sup><span style="font-size: x-small;">3</span></sup></span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. Se
houver necessidade de dose > 2000 mg/dia, mudar para a metformina de
liberação regular e ajustar a dose até o máximo de 2550 mg/dia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina associada ao
tratamento insulínico:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">≥ 17 anos
de idade e adultos: <o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Inicial: adicionar 500 mg de
metformina ou metformina XR, VO, 24/24 horas, à dose habitual de insulina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumentar a dose de metformina
semanalmente em 500 mg até o máximo de 2500 mg de metformina ou 2000 mg de
metformina XR</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Reduzir a dose de insulina<span style="mso-spacerun: yes;"> </span>em 10-25% quando a glicemia de jejum ficar
< 120 mg/dl</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina no tratamento da
resistência insulínica na Síndrome dos Ovários Policísticos:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Iniciar:
500 mg/dia, VO, 24/24 horas<sup>2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumentar
a dose gradualmente até atingir a posologia desejada<sup>2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dose
habitual: 1000-1500 mg/dia, VO, 8/8 horas (500 mg no café-da-manhã e 500 mg no
jantar ou 500 mg no café-da-manhã, 500 mg no almoço e 500 mg no jantar)<sup> 2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Em alguns
casos, a dose final poderá ser de 2250 mg/dia (850 mg, 2 a 3 vezes ao dia, nas
refeições)<sup> 2</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina
XR:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Iniciar: 500 mg/dose, VO, 24/24
horas, no jantar<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Aumentar semanalmente a dose em
500 mg até a dose desejada<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dose usual: 1000-1500 mg/dia, VO,
24/24 horas. (uma única tomada no jantar)<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><strong>Metformina
no tratamento do Diabetes Mellitus tipo 1 (dependentes de insulina):<o:p></o:p></strong></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">A
metformina não substitui a insulinoterapia, mas permite a redução da dose
diária de insulina e melhor estabilização da glicemia<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">A dose
adequada será obtida mediante o controle seriado da glicemia capilar<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Se
insulina < 40 U/dia:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina XR: 500 mg/dose, VO,
12/12 horas (500 mg pela manhã e 500 mg à noite), aumentando para 1500 mg/dia,
se necessário<sup>3</sup>. A dose de insulina é, simultaneamente, reduzida em
2-4 unidades a cada 2 dias<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l7 level2 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Se
insulina > 40 U/dia:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hospitalizar o paciente para
efetuar a associação de metformina<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l7 level3 lfo11; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Metformina é administrada na dose
de 1000 mg/dia, aumentando para 1500 mg/dia, se necessário<sup>3</sup>.
Simultaneamente, a dose de insulina é reduzida, a partir do primeiro dia, em
30-50%<sup>3</sup>. Os valores de glicemia capilar orientarão a redução
ulterior progressiva das doses de insulina<sup>3</sup>.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">APRESENTAÇÕES<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cloridrato de Metformina de
liberação regular:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
500mg: Cloridrato de Metformina<sup>4</sup>; Dimefor<sup>4</sup>; Formet<sup>4</sup>;
Glifage<sup>4</sup>; Glucoformin<sup>4</sup>; Triformin<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
850 mg: Cloridrato de Metformina<sup>4</sup>; Diaformin<sup>4</sup>; Dimefor<sup>4</sup>;
Formet<sup>4</sup>; Glifage<sup>4</sup>; Gliformil<sup>4</sup>; Glucoformin<sup>4</sup>;
Triformin<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
1 g: Cloridrato de Metformina<sup>4</sup>; Glifage<sup>4</sup>; Gliformil<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Cloridrato de Metformina de liberação
prolongada:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
500 mg: Glifage XR<sup>4</sup>; Metta SR<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
750 mg: Glifage XR<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
1 g: Glifage XR;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Glimepirida +
Cloridrato de Metformina de liberação regular:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glimepirida 1 mg + Cloridrato de Metformina 500 mg: Amaryl Flex 1mg/500mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glimepirida 2 mg + Cloridrato de Metformina 500 mg: Amaryl Flex 2mg/500mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Glimepirida +
Cloridrato de Metformina de liberação prolongada:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glimepirida 2 mg + Cloridrato de Metformina 1 g: Meritor 2/1000mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glimepirida 4 mg + Cloridrato de Metformina 1 g: Meritor 4/1000mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Vildagliptina + Cloridrato
de Metformina de liberação regular:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Vildagliptina 50 mg + Cloridrato de Metformina 500 mg: Galvus met<sup>4</sup>;
Jalra met 50mg/500 mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Vildagliptina 50 mg + Cloridrato de Metformina 850 mg: Jalra met 50mg/850 mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Vildagliptina 50 mg + Cloridrato de Metformina 1 g: Jalra met 50mg/1 g<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Glibenclamida +
Cloridrato de Metformina de liberação regular:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glibenclamida 1,25 mg + Cloridrato de Metformina 250 mg: Glucovance 1,25mg/250mg;
<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glibenclamida 2,5 mg + Cloridrato de Metformina 500 mg: Glibeta 2,5mg/500mg<sup>4</sup>;
Glucovance 2,5 mg/500 mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glibenclamida 5 mg + Cloridrato de Metformina 500 mg: Glibeta 5 mg/500 mg<sup>4</sup>;
Glucovance 5 mg/500 mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Glibenclamida 5 mg + Cloridrato de Metformina 1 g: Glucovance 5mg/1g<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Sitagliptina +
Cloridrato de Metformina de liberação regular:<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Sitagliptina 50 mg + Cloridrato de Metformina 500 mg: Janumet 50mg/500mg<sup>4</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Sitagliptina 50 mg + Cloridrato de Metformina 850 mg: Janumet 50mg/850mg<sup>4</sup>;<o:p></o:p></span></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Sitagliptina 50 mg + Cloridrato de Metformina 1 g: Janumet 50mg/1g<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Saxagliptina +
Cloridrato de Metformina de liberação prolongada:<o:p></o:p></span></b></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Saxagliptina 5 mg + Cloridrato de Metformina de liberação prolongada 500 mg:
Kombiglyze XR 5mg/500mg<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Saxagliptina 5 mg + Cloridrato de Metformina de liberação prolongada 1 g: Kombiglyze
XR 5mg/1g<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Saxagliptina 2,55 mg + Cloridrato de Metformina de liberação prolongada 1 g:
Kombiglyze XR 2,5mg/1g<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Associação Nateglinida +
Cloridrato de Metformina de liberação regular:<o:p></o:p></span></b></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Nateglinida 120 mg + Cloridrato de Metformina 500 mg: Starform 120/500mg<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l8 level2 lfo12; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Comprimidos
Nateglinida 120 mg + Cloridrato de Metformina 850 mg: Starform 120/850mg<sup>4</sup>;<o:p></o:p></span></span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">CUIDADOS<o:p></o:p></span></b></span></div>
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<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Suspender o tratamento com
metformina:<o:p></o:p></span></b></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="mso-spacerun: yes;"> </span>Nas condições clínicas que predispõem à
acidose láctica</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">:<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l11 level3 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hipoxemia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l11 level3 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Desidratação</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l11 level3 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hipoperfusão</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 108pt; mso-add-space: auto; mso-list: l11 level3 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">§<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Sepse</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Pacientes
com insuficiência cardíaca congestiva que requeira tratamento farmacológico</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Pacientes
com função renal inferior ao limite normal para a idade</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Procedimentos
cirúrgicos</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">: a metformina deve ser suspensa 48 horas antes do procedimento
cirúrgico e reintroduzida somente 48 horas após o procedimento se a função
renal for reavaliada e se encontrar normal</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Estudos
radiológicos envolvendo a administração intravenosa de contraste iodado</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">: a metformina deve ser suspensa 48
horas antes da administração do contraste iodado ou na ocasião do exame e
reintroduzida somente após a função renal ter sido reavaliada e se apresentar
normalizada</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">2</span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Função
hepática anormal</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Uso agudo
ou crônico excessivo de álcool</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Transferência da terapia com
clorpropamida a metformina:</span></b></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"> monitorar o paciente nas
primeiras duas semanas pelo risco de hipoglicemia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">. Se o paciente não responder ao
tratamento em 4 semanas com dosagem máxima, considerar a adição gradual de
sulfoniluréia, mesmo que o tratamento primário ou secundário com esta não tenha
sido efetivo. Mantenha a metformina na dose máxima</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">MONITORAMENTO<o:p></o:p></span></b></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dosar
antes de iniciar o tratamento:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Creatinina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Uréia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Clearence
de creatinina<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Glicemia
de jejum<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">ALT/AST<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">No início
do tratamento:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Glicemia
de jejum: para ajuste da dose terapêutica;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dosar a
cada 3 meses:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Hemoglbina
glicada<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dosar
anualmente durante o tratamento (ou mais frequentemente, se necessário):<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Creatinina</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1,2</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Uréia</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Clearence
de creatinina<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">ALT/AST<sup>2</sup>;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 36pt; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Glicemia
alvo:<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Jejum e
pré-prandial: 80-120 mg/dl</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">;<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l11 level2 lfo7; text-align: justify; text-indent: -18pt;">
<span style="mso-bookmark: _GoBack;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; mso-fareast-font-family: "Courier New"; mso-fareast-language: PT-BR;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Ao dormir:
100-140 mg/dl</span></span><span style="mso-bookmark: _GoBack;"><sup><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><span style="font-size: x-small;">1</span></span></sup></span><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0pt; text-align: justify;">
<span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p> </o:p></span></span></div>
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"></span></b></span><br />
<span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">REFERÊNCIAS BIBLIOGRÁFICAS</span></b></span><span style="mso-bookmark: _GoBack;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></b></span><br />
<br />
<ol start="1" type="1">
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 8pt; mso-list: l1 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">TAKEMOTO, C.K.; HODDING, J.H. & KRAUS,
D.M.: Pediatric & neonatal dosage handbook. Lexcomp, 20° edition,
2.013.<o:p></o:p></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 8pt; mso-list: l1 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"></span><a href="http://www.medicinanet.com.br/bula/144/glifage.htm"><span style="color: #0563c1;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Bula:
Glifage.</span></span><span style="mso-bookmark: _GoBack;"></span></span></a><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;"><o:p></o:p></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 8pt; mso-list: l1 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"></span><a href="http://www.medicinanet.com.br/bula/145/glifage_xr.htm"><span style="color: #0563c1;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Bula:
Glifage XR</span></span><span style="mso-bookmark: _GoBack;"></span></span></a><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">.<o:p></o:p></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin: 0cm 0cm 8pt; mso-list: l1 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; vertical-align: baseline;"><span style="mso-bookmark: _GoBack;"><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: PT-BR;">Dicionário de Especialidades Farmacêuticas
2014. Rio de Janeiro, EPUC, 2013.<o:p></o:p></span></span></li>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-55965932453953312412016-11-17T10:08:00.001-08:002016-11-17T10:08:36.389-08:00DEFICIÊNCIA DE VITAMINA D<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOCUMENTO CIENTÍFICO - SOCIEDADE BRASILEIRA DE PEDIATRIA (SBP)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A vitamina D é um pró-hormônio (secosteróide), havendo duas formas disponíveis:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Vitamina D2 (ergocalciferol): derivada de plantas e fungos</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Vitamina D3 (colecalciferol): é sintetizada por animais (peixes, aves e vertebrados) e na pele humana a partir do 7 dehidrocolesterol (7-DHC), por ação dos raios ultravioleta (UVB). Está presente na natureza como na gordura de peixes marinhos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quantidades inferiores a 10% de vitamina D são provenientes da dieta. A vitamina D é absorvida no intestino delgado, na dependência de gordura na dieta, e excretada predominantemente pela bile. No fígado, ocorre a hidroxilação pela enzima 25-hidroxilase,formando 25-hidroxivitamina D (25-OH-D), principal forma circulante da vitamina D. A 25-OH-D é transportada para o rim, sofrendo hidroxilação pela enzima 1α-hidroxilase,gerando a forma biologicamente ativa do hormônio 1,25 diidroxivitamina D (1,25-OH</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">-D - calcitriol). O 1,25-OH</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">-D aumenta as concentrações séricas de cálcio e fósforo por estimular a absorção destes minerais no intestino delgado, por mobilizar cálcio do osso e pelo aumento da reabsorção de cálcio nos túbulos renais distais. O aumento nas concentrações de cálcio e vitamina D levam a uma redução na produção de paratormônio (PTH).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALIMENTOS FONTES DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alimentos que contêm vitamina D: óleo de fígado de peixe, peixes (sardinha, salmão, atum), gema de ovo e fígado.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CONTEÚDO DE VITAMINA D:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Leite materno: 22 UI/L;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fórmulas infantis: 10 mg/L (400 UI/L).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FATORES DE RISCO PARA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças amamentadas ao seio sem suplementação/exposição solar adequada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pele escura;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Limitada exposição ao sol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Necessidade de rigorosa fotoproteção;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Má-absorção de gorduras;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome nefrótica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">uso de drogas: rifampicina, isoniazida e anticonvulsivantes (fenitoína e fenobarbital)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade: há sequestro de parte da vitamina D no tecido adiposo</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">AVALIAÇÃO LABORATORIAL </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25-OH-D sérica: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Melhor indicador do estado nutricional relativo à vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Interpretação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência: < 50 nmol/L (20 ng/dL)(independentemente do método laboratorial empregado).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO sérico: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência de vitamina D: hipocalcemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÓSFORO sérico:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência de vitamina D: hipofosfatemia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FOSFATASE ALCALINA sérica;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1,25-OH2-D: não é indicado para a avaliação do estado nutricional relativo à vitamina D em virtude de sua meia-vida curta e de não ser regulado pela ingestão de vitamina D, mas por outros fatores como o paratormônio (PTH). Suas concentrações podem ser normais ou mesmo elevadas na deficiência de vitamina D (devido ao hiperparatireoidismo secundário).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paratormônio (PTH):</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Raquitismo associado à deficiência de vitamina D: elevado.</span></div>
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<br /> </div>
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="76"></col><col width="80"></col><col width="77"></col><col width="69"></col><col width="40"></col><col width="66"></col><col width="90"></col><col width="90"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="8" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: ALTERAÇÕES BIOQUÍMICAS NOS DIFERENTES ESTÁGIOS DA DEFICIÊNCIA DE VITAMINA D</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Deficiência de </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Vitamina D</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Cálcio plasmático</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Fósforo plasmático</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Fosfatase Alcalina</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PTH</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">25-OH-D</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1,25-OH</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 6.39px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: sub;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">-D</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Alterações radiológicas</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">LEVE</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">normal ou ↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">normal ou ↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">normal</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">osteopenia</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MODERADA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">normal ou ↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">alterações raquíticas moderadas</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GRAVE</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑↑↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑↑↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↓↓↓</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">normal, ↓ ou ↑</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">alterações raquíticas graves</span></div>
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<tr style="height: 24px;"><td colspan="8" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">↑: aumentado; ↓: diminuído.</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO DA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">As manifestações clínicas da deficiência de vitamina D são relacionadas ao metabolismo do cálcio e podem demorar meses para aparecer na dependência da velocidade de crescimento da criança, do grau de deficiência desta vitamina e do conteúdo de cálcio na dieta.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Na deficiência de vitamina D pode ocorrer hipocalcemia, hipofosfatemia, tetania, osteomalácia e raquitismo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O Raquitismo manifesta-se por comprometimento do crescimento pondero-estatural, atraso no desenvolvimento motor, palidez, irritabilidade, sudorese, crânio tabes, fronte olímpica, atraso no fechamento das fontanelas, irregularidade na erupção dentária, alargamento das junções condrocostais (rosário raquítico), cintura diafragmática (sulco de Harrison), deformidades torácicas, alargamento epifisário (principalmente punho e tornozelos), encurvamento da diáfise (genu varum) e fraturas (principalmente em galho verde).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A deficiência de vitamina D com apresentação clínica de convulsões ou tetania, por hipocalcemia, é mais frequente em lactentes e adolescentes, em períodos de crescimento acelerado.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRIAGEM PARA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A triagem para deficiência de vitamina D deve ser feita pela aferição de 25-OH-D sérica somente nos pacientes com fatores de risco para esta deficiência:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças amamentadas ao seio sem suplementação/exposição solar adequada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pele escura;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Limitada exposição ao sol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Necessidade de rigorosa fotoproteção;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Má-absorção de gorduras;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome nefrótica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">uso de drogas: rifampicina, isoniazida e anticonvulsivantes (fenitoína e fenobarbital);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obesidade.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREVENÇÃO DA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">NECESSIDADE NUTRICIONAL DE VITAMINA D (</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">adequate intake</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"> - </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Institute of Medicine</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">, 2011):</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 1 ano de idade: 400 UI/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 a 18 anos de idade: 600 UI/dia (RDA).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO PROFILÁTICA DE VITAMINA D (SBP):</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 semana a 1 ano de idade: 400 UI/dia (inclusive para crianças com aleitamento materno exclusivo, independentemente da região do país);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12 a 24 meses de idade: 600 UI (inclusive para crianças com aleitamento materno exclusivo, independentemente da região do país);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Recém-nascidos pré-termos: a suplementação oral de vitamina D (400 UI/dia) deve ser iniciada quando o peso for superior a 1500g e houver tolerância plena à nutrição enteral.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Grupos de risco: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose mínima diária de 600 UI de vitamina D, monitorando as concentrações séricas de 25-OH-D sempre que possível e, se necessário, reajustando a dose.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXPOSIÇÃO AO SOL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tempo de exposição:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Primeiro ano de vida: 30 minutos de exposição solar semanal (ou 6 a 8 minutos de exposição solar por dia, 3 vezes por semana) usando apenas fraldas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes com vestimentas (apenas face e mãos expostas): 2 horas semanais (17 minutos por dia).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Horário de exposição:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não há um horário ideal que promova com segurança uma boa produção de vitamina D. Por esse motivo, nos lactentes é necessária a reposição de vitamina D.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Como o horário das 10:00hs às 15:00hs está associado ao risco de câncer de pele, recomenda-se o horário de antes das 10:00hs e após as 15:00hs, mesmo que essa exposição seja insuficiente em virtude do ângulo de incidência luminosa ser mais oblíquo (como ocorre no inverno) e com pouca produção de vitamina D na pele.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Filtros solares: o filtro solar somente reduz significativamente a síntese de vitamina D pela pele quando aplicado sob condições de estrita fotoproteção (> 2 mg/cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">). O uso habitual de filtro solar não resulta em insuficiência de vitamina D, especialmente devido à aplicação inadequada (< 2 mg/cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">) praticada pela maior parte dos indivíduos. Mais do que o filtro solar, o comportamento de fotoproteção (evitar ao máximo a exposição ao sol, utilizar mangas longas e bonés, etc.).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO DE VITAMINA D: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com deficiência de vitamina D (concentração sérica de 25-OH-D < 20 ng/ml ou 50 nmol/litro), sintomáticos ou não, devem ser tratados com suplementação de vitamina D. Essa suplementação pode ser realizada em doses diárias ou semanais de vitamina D (D2 - ergocalciferol ou D3 - colecalciferol), combinada com a suplementação de cálcio, quando este não for suprido pela dieta. Pode ser realizado o tratamento com doses altas de vitamina D, por menor período de tempo e com repetições a cada 3 meses, desde que tomado o cuidado com o propilenoglicol encontrado em algumas preparações orais de vitamina D, que pode ser tóxico em altas doses.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: TRATAMENTO DA DEFICIÊNCIA DE VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO COM DOSE DIÁRIA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Tratamento:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">> 1 mês:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 1.000 UI/dia, VO, por 2 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1 a 12 meses de idade:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 1.000 a 5.000 UI/dia, VO, por 2 a 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">> 12 meses: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">5.000 UI/dia, VO, por 2 a 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Manutenção</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 400 a 1.000 UI/dia, VO.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO COM DOSE SEMANAL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">0 a 1 ano de idade:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Tratamento:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 50.000 UI, VO, 1 vez por semana, por 6 semanas até atingir concentrações séricas de 25-OH-D superiores a 30 ng/dL;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Manutenção: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">100-1.000 UI/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1 a 18 anos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Tratamento:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 50.000 UI, VO, 1 vez por semana, por 6 semanas até atingir concentrações séricas de 25-OH-D superiores a 30 ng/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Manutenção:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 600-1.000 UI/dia, VO. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO COM ALTAS DOSES:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Tratamento:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 100.000 a 600.000 UI, VO, por 1 a 5 dias, podendo ser repetida a cada 3 meses;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Manutenção:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 400 a 1000 UI/dia, ou 50.000 UI, VO, 1 vez por semana, por 8 semanas (adolescentes e adultos).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: SUPLEMENTOS MEDICAMENTOSOS CONTENDO VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MEDICAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">APRESENTAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">D-Fort</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cápsula gelatinosa: 230 mg = 200 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">D-Pura (colecalciferol)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução oral: 5600 UI/mL (1 gt = 220 UI)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">D-Pura Kids (colecalciferol)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução oral: 5600 UI/mL (1 gt = 220 UI)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Vitamina D3 (colecalciferol)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Minicápsula: 2000 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DeSol (colecalciferol)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução oral: 1 gt = 200 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Addera D3 (colecalciferol)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução oral: 1 gt = 132 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimido revestido: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">10 mg = 1.000 UI;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">70 mg = 7.000 UI;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">500 mg = 50.000 UI</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Ad-Til (colecalciferol e acetato de retinol)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução oral: 1 gt = 1250 UI de vitamina A + 250 UI de vitamina D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO DE CÁLCIO: pacientes com baixa ingestão de cálcio devem ser suplementados. Formas mais comuns de suplementação de cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de Cálcio: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Forma mais efetiva;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deve ser ingerida com a refeição.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Citrato de Cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pode ser ingerido sem alimento;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É a primeira opção para pacientes com acloridria ou em uso de bloqueador H2 e inibidor de bomba de prótons.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactato de Cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Menos absorvido.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gluconato de Cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Menos absorvido.</span></div>
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<table style="border-collapse: collapse; border-image: none; border: currentColor; width: 590px;"><colgroup><col width="*"></col><col width="*"></col></colgroup><tbody>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: RECOMENDAÇÕES DE CÁLCIO PARA CRIANÇAS E ADOLESCENTES</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IDADE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RECOMENDAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Lactentes:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">0 a 6 meses:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">6 a 12 meses:</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">200 mg/dia*;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">260 mg/dia*.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Crianças e adolescentes:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">1 a 3 anos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">4 a 8 anos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">9 a 13 anos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">14 a 18 anos:</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">700 mg/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1.000 mg/dia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1.300 mg/dia;</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1.300 mg/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">*: <em>Adequate intake</em> - <em>AI</em>.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O máximo do elemento Cálcio por dose deve ser 500mg e o limite superior tolerado é de 2500 mg/dia em pacientes maiores de 1 ano de idade. O limite máximo (upper limit - UL) ou a dose máxima diária de ingestão de vitamina D é de:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0 a 6 meses: 1000 UI/dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">6 a 12 meses: 1500 UI/dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 a 3 anos: 2500 UI/dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">4 a 8 anos: 3000 UI/dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 9 anos: 4000 UI/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORAMENTO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">25-OH-D sérico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Uma vez que o tratamento seja iniciado, a dosagem sérica de vitamina D na forma de 25-OH-D deve ser feita a cada 3 meses, até que os valores adequados sejam atingidos.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CÁLCIO sérico: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">deve ser realizado após 1 mês e 3 meses do início do tratamento.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FÓSFORO sérico: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser realizado após 1 mês e 3 meses do início do tratamento.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FOSFATASE ALCALINA sérica:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser realizado após 1 mês e 3 meses do início do tratamento.</span></div>
</li>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MAGNÉSIO sérico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser realizado após 3 meses do início do tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PARATORMÔNIO (PTH) sérico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> necessário nos casos de raquitismo. Deve ser realizado após 3 meses do início do tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RAZÃO CÁLCIO URINÁRIO/CREATININA:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser realizado após 3 meses do início do tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RX CRÂNIO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> necessário nos casos de raquitismo. Deve ser realizado após 3 meses do início do tratamento nos casos com alterações ósseas iniciais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RX OSSOS LONGOS: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">necessário nos casos de raquitismo. Deve ser realizado após 3 meses do início do tratamento nos casos com alterações ósseas iniciais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: EXAMES PARA MONITORAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 mês após início do tratamento: Cálcio, Fósforo e Fosfatase Alcalina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3 meses após início do tratamento: Cálcio, Fósforo, Magnésio, Fosfatase Alcalina, 25-OH-D, PTH, Razão cálcio urinário/creatinina, Radiografia (no caso de alterações ósseas iniciais);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">a cada 3 meses até níveis séricos normais: 25-OH-D.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INTOXICAÇÃO POR VITAMINA D</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quadro Clínico:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipercalcemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Depressão do sistema nervoso central;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Calcificação ectópica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipercalciúria;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefrocalcinose;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nefrolitíase</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico Laboratorial:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">25-OH-D sérico: > 100 ng/mL (250 nmol/L);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio sérico: elevado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Calciúria: elevada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ultrassonografia renal: nefrocalcinose e/ou nefrolitíase.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://www.sbp.com.br/src/uploads/2015/02/vitamina_d_dcnutrologia2014-2.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Sociedade Brasileira de Pediatria: Documentos Científicos - Deficiência de vitamina D em crianças e adolescentes. Outubro 2014.</span></a></div>
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<br /></b><a href="http://direitomed.com/" target="_blank"><img alt="Site de Legislação em Saúde no Brasil" border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqxr41GLDzhWqeORWXCBkMd3mtrfeYL0MHtxV5DTEVG8wmulOzAPB1Dbhqfvw0tlghK8iZCFWZ72KzumYovaLP_CL3D93NrmsSFJbGbGg1xfU6DyDglNKY7FNH5HrwJZezrnBcaxIupE8/s200/direitomedico_blogger.jpg" title="www.direitomed.com" width="200" /></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-63185623166965466942016-11-10T01:43:00.000-08:002016-11-10T01:43:23.235-08:00OSTEOPOROSE<div style="text-align: justify;">
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<b><a href="http://www.luizhorta.com/" target="_blank"><img alt="http://www.luizhorta.com/" border="0" height="58" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfDoo2q9FURyhFfKO7gu2ogJe-8sRCxNT55GLzQe4k8QqlodoJkS_-dsDvZpl11eiTH_bcvKUQhB7ompsstEV3puGToV6705cLCMAvd3fQi-geCVkBGyvmWKNeJg_14SNoOftkJjPnh7A/s400/profluizhorta.jpg" width="400" /></a></b></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OSTEOPOROSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Portaria SAS/MS n° 451, de 9 de junho de 2.014, republicada em 09 de junho de 2.014 e retificada em 18 junho de 2.014.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-X: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.8: Osteoporose pós-menopáusica com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.1: Osteoporose pós-ooforectomia com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.2: Osteoporose de desuso com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.3: Osteoporose por má absorção pós-cirúrgica com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.4: Osteoporose induzida por drogas com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.5: Osteoporose idiopática com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M80.8: Outras osteoporoses com fratura patológica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.0: Osteoporose pós-menopáusica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.1: Osteoporose pós-ooforectomia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.2: Osteoporose de desuso;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.3: Osteoporose devido à má absorção pós-cirúrgica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.4: Osteoporose induzida por drogas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.5: Osteoporose idiopática;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.6: Osteoporose localizada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M81.8: Outras osteoporoses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M82.0: Osteoporose na mielomatose múltipla;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M82.1: Osteoporose em distúrbios endócrinos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M82.8: Osteoporose em outras doenças classificadas em outra parte.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEFINIÇÕES</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OSTEOPOROSE:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">segundo a OMS: presença de densidade mineral óssea inferior ou igual a 2,5 desvios-padrão abaixo do pico de massa óssea encontrada no adulto jovem;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">segundo a National Osteoporosis Foundation (NOF): presença de densidade mineral óssea inferior ou igual a 2,5 desvios-padrão abaixo do pico de massa óssea encontrada no adulto jovem, acompanhada de, pelo menos, uma fratura por fragilidade óssea.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OSTEOPENIA ou BAIXA MASSA ÓSSEA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (segundo a OMS): presença de densidade mineral óssea entre 1 a 2,5 desvios-padrão abaixo do pico de massa óssea encontrada no adulto jovem.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cerca de 50% das mulheres e 20% dos homens com idade ≥ 50 anos sofrerão uma fratura de osteoporótica ao longo da vida. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">EUA: 5% dos indivíduos que sofrem fratura do quadril morrem durante a internação hospitalar, 12% morrem nos 3 meses subsequentes e 20% morrem no ano seguinte ao da fratura. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Brasil: 23,6% dos pacientes que sofrem fratura de fêmur morrem nos 3 meses subsequentes.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Recife: Prevalência de osteoporose em mulheres com idade ≥ 50 anos foi de 28,8 na coluna lombar e 18,8% no colo do fêmur. Prevalência de fraturas vertebrais, sintomáticas ou não, foi de 20% entre mulheres com idades entre 50 e 59 anos e se elevou para 81,8% entre 80 e 89 anos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Brasil: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prevalência global de osteoporose no sexo masculino com idade superior a 50 anos é de 19,5%.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Incidência de fratura de quadril em idosos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sexo feminino: 27,5/10.000 habitantes;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sexo masculino: 13/10.000 habitantes.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cerca de 80% das fraturas por fragilidades ósseas ocorrem em pacientes com escore T superior a -5,5 desvios-padrão.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fatores de risco para fratura osteoporótica:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fratura osteoporótica prévia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Baixo peso, baixo índice de massa corporal ou perda de peso;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de glicocorticóide: dose superior a 5 mg de prednisona/dia ou equivalente por período igual ou superior a 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de anticonvulsivantes: por interferência no metabolismo da vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sedentarismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperparatireoidismo primário;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anorexia nervosa;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gastrectomia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anemia perniciosa;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipogonadismo masculino;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Menopausa precoce: risco moderado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">História familiar de fratura osteoporótica: risco moderado.;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fatores de risco para uma segunda fratura de quadril:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quedas prévias: mais de 90% das fraturas de quadril são decorrentes de quedas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Déficit cognitivo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Longo período de internação em instituição;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença de Parkinson;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Perda ponderal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade avançada;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência da mobilidade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tontura;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Conceito negativo da própria saúde.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOPATOGENIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O pico de massa óssea é atingido no final da adolescência e mantido até a quinta década pela ingestão alimentar adequada de cálcio e vitamina D e pela prática de exercício físico. A partir de então, ocorre perda progressiva de massa óssea, acentuando-se em mulheres na pós-menopausa.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CLASSIFICAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Com base em sua etiologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Primária: forma mais comum, diagnosticada na ausência de doenças ou relacionada a outras condições que levem à diminuição da massa óssea;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Secundária: quando a diminuição da massa óssea é decorrente de outra doença (tabela 1) ou relacionada ao uso de medicamentos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA 1 - AGRAVOS ASSOCIADOS À OSTEOPOROSE SECUNDÁRIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOENÇAS ENDÓCRINAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipogonadismo, hiperparatireoidismo, hipertireoidismo, hipercortisolismo, hiperprolactinemia</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOENÇAS GASTROINTESTINAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças inflamatórias intestinais, doença celíaca, cirrose biliar primária, cirurgias de </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">bypass</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> gástrico, gastrectomias</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OUTRAS DOENÇAS CRÔNICAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Artrite reumatóide, espondilite anquilosante, lúpus eritematoso sistêmico, doença pulmonar obstrutiva crônica, acidose tubular renal, hipercalciúria idiopática, mieloma múltiplo, doença metastática, mastocitose sistêmica, desordens hereditárias do tecido conjuntivo, osteogênese imperfeita, síndrome de imunodeficiência adquirida</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DESORDENS NUTRICIONAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência ou insuficiência de vitamina D, deficiência de cálcio, ingestão excessiva de álcool, anorexia nervosa, nutrição parenteral</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OUTRAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Transplante de órgãos</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA 2 - MEDICAMENTOS ASSOCIADOS À OSTEOPOROSE SECUNDÁRIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CATEGORIA DE RISCO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MEDICAMENTOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Com risco bem definido:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Glicocorticóides;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticonvulsivantes: fenobarbital, fenitoína, carbamazepina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">*</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e ácido valpróico</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">*</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Agentes imunossupressores: ciclosporina, tacrolimo, micofenolato;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anticoagulantes: heparina não-fracionada, heparina de baixo peso molecular</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">* e **</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Agentes hormonais e anti-hormonais: medroxiprogesterona de depósito, tamoxifeno</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">***</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, inibidores da aromatase</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">****</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, agonistas do GnRH, hormônio tireoidiano</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">+</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, pioglitazona, rosiglitazona, etc.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Com risco possível:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lítio, antipsicóticos, inibidores seletivos da recaptação da serotonina, topiramato e inibidores da bomba de prótons.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">*</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: em menor escala; </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">**</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: a longo prazo; ***: nas mulheres em pré-menopausa; </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">****</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: nas mulheres em pós-menopausa; </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">+</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: em dose supressiva;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FATORES DE RISCO PARA FRATURA OSTEOPORÓTICA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fratura osteoporótica prévia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Baixo peso, baixo índice de massa corporal ou perda de peso;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de glicocorticóide: dose superior a 5 mg de prednisona/dia ou equivalente por período igual ou superior a 3 meses;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de anticonvulsivantes: por interferência no metabolismo da vitamina D;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sedentarismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperparatireoidismo primário;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anorexia nervosa;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gastrectomia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anemia perniciosa;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipogonadismo masculino;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Menopausa precoce: risco moderado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">História familiar de fratura osteoporótica: risco moderado.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Diagnóstico Clínico:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> indivíduo com fatores de risco e fratura osteoporótica;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DENSITOMETRIA MINERAL ÓSSEA POR DMO POR ÁREA (AREAL) PELA TÉCNICA DE ABSORCIOMETRIA POR RAIOS-X COM DUPLA ENERGIA (DXA): </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A densidade mineral óssea (DMO) é expressa em termos de grama de mineral/cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> analisado (g/cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">). Quando a DMO do indivíduo é comparada à de adultos jovens normais do mesmo sexo, obtém-se o escore T (Tabela 3); quando comparada com a esperada para pessoas normais na mesma idade e sexo,obtém-se o escore Z. A diferença entre a DMO do indivíduo e o padrão normal é expressa por desvios-padrão acima ou abaixo do valor comparado. Geralmente um desvio-padrão equivale a 10-15% do valor da DMO em g/cm</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Indicações para realização de Densitometria Mineral Óssea:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres com idade ≥ 65 anos e homens com idade ≥ 70 anos, independentemente da presença de fatores de risco;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres na pós-menopausa e homens com idade entre 50 e 69 anos com fatores de risco para fratura;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres na perimenopausa, se houver fatores de risco específicos associados a um risco aumentado de fratura, tais como baixo peso corporal, fratura prévia por pequeno trauma ou uso de medicamentos de risco bem definido;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos que sofrerem fratura após os 50 anos de idade;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indivíduos com anormalidades vertebrais radiológicas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos com condições associadas a baixa massa óssea, como artrite reumatóide ou uso de glicocorticóide na dose de 5 mg de prednisona/dia ou equivalente por período igual ou superior a 3 meses.</span></div>
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<a href="http://www.shef.ac.uk/FRAX/tool.aspx?country=55" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Frature Risk Assessment Tool</span><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;"> (FRAX)</span></a><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: ferramenta que tem como objetivo calcular o risco de ocorrência de fratura de quadril ou outra fratura osteoporótica relevante (vértebra, quadril, antebraço ou úmero) nos próximos 10 anos. O FRAX calcula o risco de fratura osteporótica com base na validação internacional de fatores individuais de risco, incluindo idade, sexo, peso, altura, ocorrência de fratura prévia, história de fratura de quadril em mãe ou pai, tabagismo atual, uso de glicocorticóides (5 mg de prednisona/dia ou equivalente por período igual ou superior a 3 meses), artrite reumatóide, outras condições clínicas associadas a osteoporose (hipogonadismo, doença hepática crônica, menopausa precoce), ingesta alcoólica de 3 ou mais doses/dia e DMO de colo femoral. Esse instrumento ainda não está validado para uso na população brasileira. Estudo recente mostrou que a utilização dos dados de idade e o escore T são tão efetivos quanto o complexo modelo FRAX na identificação de pacientes em risco de fraturas.</span></div>
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<table style="border-collapse: collapse; border-image: none; border: currentColor; width: 590px;"><colgroup><col width="*"></col><col width="*"></col></colgroup><tbody>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA 3 - CRITÉRIOS DENSITOMÉTRICOS DA ORGANIZAÇÃO MUNDIAL DA SAÚDE (OMS)*</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CATEGORIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESCORE T</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Normal</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Até -1</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Osteopenia</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Entre -1 e -2,5</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Osteoporose</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Igual ou inferior a -2,5</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Osteoporose estabelecida</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Igual ou inferior a -2,5 associada a fratura por fragilidade óssea</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">*: Critérios estabelecidos para coluna lombar, colo do fêmur ou terço médio do rádio.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES SUBSIDIÁRIOS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">HEMOGRAMA;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VELOCIDADE DE HEMOSSEDIMENTAÇÃO (VHS);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO SÉRICO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ALBUMINA SÉRICA;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CREATININA SÉRICA;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÓSFORO SÉRICO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FOSFATASE ALCALINA SÉRICA;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">AMINOTRASFERASES/TRANSAMINASES SÉRICAS;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCIÚRIA EM 24 HORAS;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MARCADORES BIOQUÍMICOS DE REMODELAÇÃO ÓSSEA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Interligadores de colágeno:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dosagem no soro e urina:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Piridinolonas totais;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Piridinolina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deoxipiridinolina livre;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">N-telopeptídeo (NTx);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">C-telopeptídeo (C-CTx).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">São mais utilizados em protocolos de pesquisas clínicas, não devendo ser usados rotineiramente na prática médica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RADIOGRAFIA DE COLUNA VERTEBRAL: diagnóstico diferencial e detecção de fraturas sintomáticas ou não.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE INCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres na pós-menopausa e homens com idade ≥ 50 anos que apresentarem pelo menos uma das condições abaixo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fratura de baixo (decorrentes de queda da própria altura ou inferior) impacto de fêmur, quadril ou vértebra (clínica ou morfométrica), comprovada radiologicamente;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exame densitométrico com escore T igual ou superior a -2,5 no fêmur proximal ou coluna vertebral;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Baixa massa óssea (escore T entre -1,5 e -2,5 no fêmur proximal ou coluna) em paciente com idade ≥ 70 anos e “caidor” (2 ou mais quedas nos últimos 6 meses).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com plano de início e manutenção de tratamento com glicocorticóides em dose superior a 5 mg de prednisona/dia ou equivalente, por período igual ou superior a 3 meses.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade, contra-indicação ou intolerância a medicamento preconizado neste protocolo.</span></div>
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<br /><br /> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><strong>TRATAMENTO</strong></span></h3>
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<br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><strong>TRATAMENTO NÃO-MEDICAMENTOSO:</strong></span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXERCÍCIO FÍSICO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: exercício físico regular de resistência para fortalecimento muscular.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREVENÇÃO DE QUEDAS</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Como as fraturas osteoporóticas ocorrem frequentemente em decorrência de quedas, principalmente na população idosa, é de suma importância considerar os fatores de risco para quedas. Os fatores mais importantes para quedas são:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alterações do equilíbrio;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alterações visuais;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiências cognitivas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Declínio funcional;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de medicamentos psicoativos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de anti-hipertensivos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idoso “caidor”: história de quedas ≥ 2 vezes nos últimos 6 meses.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cuidados:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Rever medicamentos psicoativos e outros associados ao risco de quedas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Avaliar problemas neurológicos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Correção dos distúrbios visuais e auditivos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medidas de segurança ambiental: protocolos de prevenção de quedas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DESENCORAJAR TABAGISMO E INGESTÃO EXCESSIVA DE ÁLCOOL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO MEDICAMENTOSO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO DE CÁLCIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ingestão diária de cálcio: 1.200-1.500 mg de cálcio elementar/dia, principalmente por meio de dieta;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CARBONATO DE CÁLCIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: comprimidos de 1.250 mg;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CARBONATO DE CÁLCIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 500-2.000 mg/dia, VO.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUPLEMENTAÇÃO DE VITAMINA D</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ingestão diária de vitamina D: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos com ≥ 50 anos de idade: 800-1.000 UI de vitamina D/dia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alimentos ricos em vitamina D: leite fortificado, cereais, ovos, peixe de água salgada e fígado.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exposição solar da face, tronco e braços antes das 10 horas ou após as 16 horas por, no mínimo, 15 minutos, 2-4 vezes por semana, salvo por contra-indicação dermatológica.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reposição de vitamina D:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">COLECALCIFEROL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CARBONATO DE CÁLCIO + COLECALCIFEROL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: comprimidos 500 mg/400UI; 600 mg/400UI.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">COLECALCIFEROL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 800-1.000 UI/dia, VO.</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITRIOL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITRIOL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">cápsulas de 0,25 mcg;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITRIOL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 0,25 mcg/dose, VO, 12/12 horas.</span></div>
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</ul>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO DE PRIMEIRA LINHA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BIFOSFONADOS</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento de primeira linha:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamentos:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALENDRONATO DE SÓDIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Primeira opção de tratamento</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contra-indicação:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal grave (Depuração de creatinina endógena < 30 mL/min.);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade ao alendronato ou a qualquer componente da fórmula;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">hipocalcemia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">gravidez e lactação;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inabilidade de o paciente sentar ou ficar em pé por, pelo menos, 30 minutos.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cuidados:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com insuficiência renal leve-moderada pré-existente: monitorar função renal a cada 1-3 meses.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALENDRONATO DE SÓDIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: comprimidos de 10 e 70 mg.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALENDRONATO DE SÓDIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 10 mg/dia ou 70 mg/1 vez por semana, VO. Deve ser ingerido em jejum pelo menos 1 hora antes da primeira refeição e de outros medicamentos com um copo de água (200 mL). Após a ingestão, o paciente deve ficar sentado ou em pé por, pelo menos, 30 minutos.</span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RISENDRONATO DE SÓDIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contra-indicações:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade ao risendronato ou a qualquer componente da fórmula;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gravidez e lactação;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal grave (DCE < 30 mL/min.);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inabilidade de o paciente sentar ou ficar em pé por, pelo menos, 30 minutos.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cuidados:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com insuficiência renal leve-moderada pré-existente: monitorar função renal a cada 1-3 meses.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RISENDRONATO DE SÓDIO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos de 5 e 35 mg.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RISENDRONATO DE SÓDIO: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">5 mg/dia ou 35 mg/1 vez por semana, VO. Deve ser ingerido em jejum pelo menos meia hora antes da primeira refeição e de outros medicamentos com um copo de água (200 mL). Após a ingestão, o paciente deve ficar sentado ou em pé por, pelo menos, 30 minutos.</span></div>
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</ul>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PAMIDRONATO DISSÓDICO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alternativa de tratamento para pacientes com intolerância ao bifosfonado de administração oral;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PAMIDRONATO DISSÓDICO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">pó liofilizado para solução injetável de 30 mg e 60 mg.</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PAMIDRONATO DISSÓDICO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">60 mg/dose, IV, a cada 3 meses. Após reconstituição, deve-se diluir o fármaco em 500 mL de soro fisiológico. A duração mínima da infusão é de 2 horas.</span></div>
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</ul>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Duração do tratamento: 5 anos, estendendo por mais 5 anos em pacientes com piora da massa óssea à DMO após o início do tratamento ou com escore T inferior a -3,5.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cuidados: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Evitar o decúbito por 30 minutos após a ingestão do medicamento (prevenção do risco de ulceração esofágica).</span></div>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO DE SEGUNDA LINHA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RALOXIFENO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ação: modulador seletivo do receptor de estrógeno;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento da osteoporose em mulheres na pós-menopausa;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não usar concomitantemente com estrógenos sistêmicos (aumento do risco de eventos tromboembólicos);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RALOXIFENO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: comprimidos de 60 mg.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RALOXIFENO</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: 60 mg/dia, VO.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTRÓGENOS CONJUGADOS</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Devido aos riscos potenciais (acidente vascular encefálico, câncer de mama, tromboembolia venosa) constituem alternativa para as pacientes no climatério que apresentam sintomas vasomotores com osteoporose e comprometimento da qualidade de vida.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deve ser empregada dose individualizada e por menor tempo possível.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cuidados:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atentar para os antecedentes pessoal e familiar de neoplasias dependentes de estrogênios;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Realizar exame ginecológico e geral completos, considerando as contraindicações e advertências de uso;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres não histerectomizadas necessitam fazer uso de associação com progesterona.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
</li>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTRÓGENOS CONJUGADOS</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos de 0,3 mg.</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTRÓGENOS CONJUGADOS</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> dose individualizada, VO.</span></div>
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</ul>
</ul>
</ul>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITONINA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alternativa para pacientes com intolerância ou contraindicação aos bifosfonados, estrógenos conjugados e raloxifeno.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contra-indicação:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade aos componentes da fórmula.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITONINA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Spray nasal com 200 UI/dose;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução injetável de 30 mg e 60 mg.</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CALCITONINA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via tópica nasal: 200 UI/dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via subcutânea: 100 UI/dia.</span></div>
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</ul>
</ul>
</ul>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TEMPO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento da osteoporose deve ser mantido por 5 anos. Para pacientes com uso de alendronato, com piora da massa óssea à DMO ou com escore T até -3,5, pode ser estendido por mais tempo, porém não há evidências clínico-epidemiológicas consistentes nesse sentido a individualização da conduta.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Verificar a adesão ao tratamento;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Densitometria Mineral Óssea (DMO);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Marcadores bioquímicos não devem ser usados para monitorização.</span></div>
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<br /><br /> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE - TER</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É obrigatória a informação ao paciente ou a seu responsável legal dos benefícios, potenciais riscos e efeitos adversos relacionados ao uso dos medicamentos preconizados neste protocolo. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica.</span></div>
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<a href="http://www.luizhorta.com/html/endocrino_clinica/osso/ficha_farmacoterapeutica_osteoporose.pdf" target="_blank"><strong>FICHA FARMACOTERAPÊUTICA</strong></a></div>
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<strong><a href="http://www.luizhorta.com/html/endocrino_clinica/osso/ter_osteoporose.pdf" target="_blank">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE - TER</a></strong></div>
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<strong><a href="http://www.luizhorta.com/html/endocrino_clinica/osso/guia_orientacao_paciente_osteoporose.pdf" target="_blank">CARTILHA DE ORIENTAÇÃO AO PACIENTE</a></strong></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FLUXOGRAMA DE TRATAMENTO DA OSTEOPOROSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img alt="fluxograma_osteoporose.jpg" height="765" src="https://lh3.googleusercontent.com/beOHBARPiyT_yo1vx6iSyK6Erm3Fa8qy8QwiFJua83PW0TJwZyIxvXgCglODouTXo71xvsjWEZl6Xt6vcBcc3vP4gwFOSOg01PEoDYlAixb6FRrfojXuLlKyOrcEae8NW9UKBhg_" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="518" /></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FLUXOGRAMA DE DISPENSAÇÃO DE MEDICAMENTOS (ALENDRONATO, CARBONATO DE CÁLCIO, COLECALCIFEROL E ESTRÓGENOS CONJUGADOS)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img alt="fluxograma_dispensacao_osteoporose.jpg" height="672" src="https://lh6.googleusercontent.com/St6biWEgTlE8JFEWPX5MkPqN1Nsx7iErkg5M7qHKv3c-bCwP33jPuZ4Pp4FOFOayb-k6hs7TFWOeyl8-duYZ-7w1en5khcqCMYncMglGquEDnGRdRvXgZNSFvxsHBuJ_DzZ-IAw-" style="-webkit-transform: rotate(0.00rad); border-image: none; border: currentColor; transform: rotate(0rad);" width="500" /></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://portalsaude.saude.gov.br/images/pdf/2014/dezembro/15/Osteoporose.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">BUKSMAN, S.; FERREIRA, M.A.P.; KRUG, B.C; GONÇALVES, C.B.T.; AMARAL, K.M.; XAVIER, L.C.; RONSONI, R.M.; SCHNEIDERS, R.E. e colaboradores: Osteoporose. Protocolo Clínico e Diretrizes Terapêuticas. Portaria SAS/MS n° 451, de 9 de junho de 2.014, republicada em 09 de junho de 2.014 e retificada em 18 de junho de 2.014.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com2tag:blogger.com,1999:blog-510823718125808836.post-23507510833182165242016-10-28T05:50:00.000-07:002016-10-28T17:06:28.756-07:00INSUFICIÊNCIA ADRENAL PRIMÁRIA - DOENÇA DE ADDISON<div style="text-align: justify;">
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<b style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></b></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INSUFICIÊNCIA ADRENAL PRIMÁRIA</span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(DOENÇA DE ADDISON)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Portaria SAS/MS n° 1.170, de 19 de novembro de 2.015</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID X: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E27.1 - Insuficiência adrenocortical primária;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E27.4 - Outras insuficiências adrenocorticais e as não especificadas.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prevalência: 0,45-11,7 casos por 100.000 habitantes.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adrenalite auto-imune (39%);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paracoccidioidomicose (28%);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tuberculose (11%); </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adrenoleucodistrofia (7,3%);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Outras: infecções virais, histoplasmose, neoplasias malignas metastáticas, hemorragia adrenal, medicamentos e hiperplasia adrenal congênita.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FORMA AGUDA (CRISE ADDISONIANA):</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Decorre da falha aguda na síntese de esteróides adrenais (cortisol e aldosterona), desencadeada por um fator estressante (infecções, trauma, cirurgia, etc.).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manifesta-se por:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência mineralocorticóide:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotensão ou choque hipotensivo (depleção de sódio e volume plasmático);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoglicemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Respiração fraca e curta;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Febre;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Taquicardia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Náusea;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dor abdominal inespecífica;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diarréia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Desidratação;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipovolemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obnubilação;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sonolência;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotensão refratária a fluidoterapia e vasopressores;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inconsciência e coma.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FORMA CRÔNICA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manifestações mais sutis e inespecíficas:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência mineralocorticóide:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotensão postural;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperpotassemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiponatremia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Acidose metabólica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dor abdominal;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fraqueza;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Emagrecimento;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperpigmentação cutânea;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eosinofilia.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CORTISOL SÉRICO BASAL:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> reduzido (na presença de elevação de ACTH, cortisol sérico basal inferior a 3 mcg/dL é diagnóstico de insuficiência adrenal. Níveis superiores a 16 mcg/dL excluem o diagnóstico);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HORMÔNIO ADRENOCORTICOTRÓFICO (ACTH):</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> elevado;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTE DE ESTÍMULO COM ACTH: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aplica-se 250 mcg de ACTH, via intravenosa ou intramuscular, e dosa-se cortisol sérico nos tempos 30 e 60 minutos após a injeção.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal: cortisol sérico após o medicamento superior a 18 mcg/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ATIVIDADE DA RENINA PLASMÁTICA: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">aumentada;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ALDOSTERONA SÉRICA:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> reduzida;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SÓDIO SÉRICO: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">reduzido;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">POTÁSSIO SÉRICO:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> elevado;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CÁLCIO SÉRICO:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> elevado (10-20% dos casos).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE INCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com diagnóstico laboratorial de insuficiência adrenal:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cortisol sérico < 3 mcg/dL e ACTH > 45 pg/mL; ou</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cortisol sérico < 18 mcg/dL após teste de estímulo com 250 mcg de ACTH (IV ou IM); ou</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Renina plasmática > valor de referência e Aldosterona no limite inferior ou abaixo do valor de referência.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pacientes com dosagem de cortisol sérico < 3 mcg/dL, com ACTH < 45 pg/mL ou sem dosagem de ACTH concomitante;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contraindicação ou intolerância aos medicamentos especificados.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO DA CRISE AGUDA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Hidrocortisona:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Solução injetável de 100 e 500 mg.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose de ataque: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Recém-nascido: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: 20 mg/dose, IV;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes e Pré-escolares: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: 50 mg/dose, IV;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Escolares, adolescentes e adultos: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: 100 mg/dose, IV.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose de manutenção:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: 50-100 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> de superfície corporal/ dia, IV, em administração contínua.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> 12-18 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia, IM ou IV, 12/12 ou 6/4 horas;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estresse ou crise adrenal: 60-100 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia, IM ou IV, 12/12 ou 6/6 horas.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal: 20 mg/dia, IM ou IV, 12/12 ou 6/6 horas;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estresse ou crise adrenal: 200-300 mg/dia, IM ou IV, 12/12 ou 6/6 horas. </span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidratação intravenosa.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Após a melhora clínica, com adequada hidratação e perfusão periférica, a reposição do glicocorticóide deverá ser administrada por via oral, iniciando-se a reposição mineralocorticóide.</span></div>
</li>
</ul>
</ul>
<span style="font-family: arial;"><span style="font-size: 14.66px;"><br /></span></span><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.66px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO CRÔNICO:</span></div>
</li>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Reposição Glicocorticóide:</span></div>
</li>
</ul>
</ul>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Preferir Prednisona ou Prednisolona e utilizar menor dose possível (cerca de 2,5-3,75 mg/dia).</span></div>
</li>
</ul>
</ul>
</ul>
<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisona ou Prednisolona: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisona:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças: 2,5-4 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia, VO, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos: 2,5-7,5 </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">mg/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia, VO, 1 vez ao dia.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisolona:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças: 2-3 </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia, VO, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos: 2,5-7,5 mg/dia, VO, 1 vez ao dia.</span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dexametasona:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças: 0,27 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">/</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, VO, IM ou IV, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos: 0,25-0,75 mg/dia, VO, IM ou IV, 1 vez ao dia.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Dose de estresse:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> duplicar a dose habitual quando ocorrer febre (temperatura axilar ≥38,5 °C), gastroenterite com desidratação, parto normal ou cesariana, cirurgia acompanhada de anestesia geral e grandes traumas.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisona: comprimidos de 5 mg e 20 mg;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisolona: solução oral de 1,34 mg/mL de fosfato sódico de prednisolona (equivalente a 1 mg de prednisolona base) e 4,02 mg/mL de fosfato sódico de prednisolona (equivalente a 3 mg de prednisolona base).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dexametasona: elixir de 0,1 mg/mL; comprimido de 4 mg; solução injetável de 4 mg/mL.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.66px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Reposição Mineralocorticóide:</span></div>
</li>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fludrocortisona: comprimido de 0,1 mg.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças: 0,1 mg/dia (podendo variar de 0,05-0,3 mg/dia), VO, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos: 0,1 mg/dia (podendo variar de 0,05-0,4 mg/dia), VO, 1 vez ao dia.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.66px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Cuidados especiais:</span></div>
</li>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Evitar jejum durante as doenças agudas. Se necessário, suplementar glicose e eletrólitos.</span></div>
</li>
</ul>
</ul>
</ul>
<span style="font-family: arial;"><span style="font-size: 14.66px;"><br /></span></span><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.66px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GESTANTES:</span></div>
</li>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Utilizar prednisona, prednisolona ou hidrocortisona;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prednisona ou Prednisolona: cerca de 7,5 mg/dia.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Somente para pacientes que não conseguem a administração por via oral;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose: 20 mg/dia, IV ou IM.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">DOSE DE ESTRESSE NA INDUÇÃO DO PARTO: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hidrocortisona: 200-300 mg/dia, IV ou IM, 12/12 ou 6/6 horas.</span></div>
</li>
</ul>
</ul>
</ul>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br />
</div>
<div dir="ltr" style="font-weight: bold; margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="186"></col><col width="145"></col><col width="81"></col><col width="177"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: POTÊNCIAS BIOLÓGICAS RELATIVAS DOS ESTERÓIDES SINTÉTICOS EM RELAÇÃO AO CORTISOL</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESTERÓIDE</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ATIVIDADE ANTI-INFLAMATÓRIA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RETENÇÃO SALINA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SUPRESSÃO DO EIXO HIPOTÁLAMO-HIPOFISÁRIO</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CORTISOL/HIDROCORTISONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FLUDROCORTISONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">125</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREDNISONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0,8</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">4</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREDNISOLONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0,8</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">4</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEXAMETASONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">26</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">17</span></div>
</td></tr>
<tr style="height: 28px;"><td colspan="4" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Obs.: A produção diária de cortisol é estimada em 7-9 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.39px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> em neonatos, 6-7 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.39px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> em crianças e adolescentes e 10-15 mg em adultos.</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br />
</div>
<div dir="ltr" style="font-weight: bold; margin-left: 0pt;">
<table style="border-collapse: collapse; border-image: none; border: currentColor;"><colgroup><col width="134"></col><col width="117"></col><col width="109"></col><col width="53"></col><col width="71"></col><col width="104"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="6" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TABELA: GLICOCORTICÓIDES USADOS NO TRATAMENTO DA INSUFICIÊNCIA ADRENAL PRIMÁRIA</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Esteróide</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Dose-equivalente em crianças (mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.39px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">/dia)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Dose-equivalente em adultos (mg/dia)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Doses ao dia</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meia-vida (horas)</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Vias de administração</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIDROCORTISONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12-18</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">20</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2-4</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IV, IM</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREDNISONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2,5-4</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2,5-7,5</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12-36</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREDNISOLONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2-3</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2,5-7,5</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12-36</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEXAMETASONA</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0,27</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0,25-0,75</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">>48</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IV, IM, VO</span></div>
</td></tr>
<tr style="height: 24px;"><td colspan="6" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IV = intravenoso; IM = intramuscular; VO = via oral.</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br />
</div>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"><span style="font-size: 18.66px;">TEMPO DE TRATAMENTO</span></span></div>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento deve ser mantido por toda a vida.</span></div>
</li>
</ul>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br />
</div>
<div dir="ltr" style="font-weight: bold; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
<ul style="font-weight: bold; margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Intervalo entre consultas: 2 a 6 meses;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Monitorizar: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reposição Mineralocorticóide:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dosar:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RENINA PLASMÁTICA;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">SÓDIO SÉRICO;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">POTÁSSIO SÉRICO.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Objetivo do tratamento: normalizar os níveis de sódio (135-145 mEq/L) e potássio (3,5-5,5 mEq/L) e não suprimir a Renina, mantendo a pressão arterial sistêmica normal. Supressão da renina ou hipertensão arterial sistêmica são indícios de excesso de mineralocorticóide.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reposição Glicocorticóide:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deve ser monitorizada por sinais clínicos:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sinais de excesso glicocorticóide: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fragilidade capilar;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gibosidade;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estrias violáceas;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fácies de lua cheia;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fraqueza muscular proximal; e</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipertensão.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não deve ser monitorizada por meio de exames complementares, como ACTH ou cortisol séricos.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">OBSERVAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O paciente deve portar consigo identificação (pulseira, corrente ou cartão) que informe a sua condição e que contenha contatos de emergência.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE - TER</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É obrigatória a informação ao paciente ou ao seu responsável legal, dos potenciais riscos, benefícios e eventos adversos relacionados ao uso dos medicamentos preconizados neste protocolo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O TER é obrigatório ao se solicitar o fornecimento de medicamento do Componente Especializado de Assistência Farmacêutica (CEAF).</span></div>
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<a href="http://www.luizhorta.com/html/endocrinoped/insuficiencia_adrenal/ter_insuficiencia_adrenal_primaria.pdf" target="_blank">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE</a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://www.luizhorta.com/html/endocrinoped/insuficiencia_adrenal/insuficiencia_adrenal_primaria_diretrizes_2016.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">MINISTÉRIO DA SAÚDE: Protocolo Clínico e Diretrizes Terapêuticas - Insuficiência Adrenal Primária - Doença de Addison. Portaria SAS/MS n° 1.170, de 19 de novembro de 2.015.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-15092977248864342642016-10-26T14:52:00.000-07:002016-10-26T17:59:53.124-07:00HIPOTIREOIDISMO CONGÊNITO<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Protocolo Clínico e Diretrizes Terapêuticas</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HIPOTIREOIDISMO CONGÊNITO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Portaria SAS/MS n° 1.161, de 18 de novembro de 2.015</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CID-X: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">E03.0 - Hipotireoidismo congênito com bócio difuso;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">E03.1: Hipotireoidismo congênito sem bócio.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DEFINIÇÃO DE HIPOTIREOIDISMO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotireoidismo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> é a diminuição ou ausência de hormônios tireoidianos, caracterizado pela diminuição dos níveis séricos de tiroxina (T4) e triiodotironina (T3).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CLASSIFICAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotireoidismo primário: decorrente da incapacidade parcial ou total da glândula tireóide em produzir hormônios tireoidianos.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Central: decorrente da falta do hormônio tireoestimulante (TSH) hipofisário ou do do hormônio liberador do hormônio tireoestimulante (TRH) hipotalâmico.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Incidência:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Grécia: 1:1.800 nascidos-vivos;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">França: 1:10.000 nascidos-vivos;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Brasil: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotireoidismo: 1:2.595 a 1:4.795 nascidos vivos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotireoidismo central: 1:25.000 a 1:100.000 nascidos-vivos.</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ETIOLOGIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nas regiões não deficientes de iodo, as causas mais comuns de hipotireoidismo congênito são:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ectopia tireoidiana (6%);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Agenesia tireoidiana (15%); </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deficiência na síntese hormonal (15%).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotireoidismo transitório:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Decorrente do uso pelas mães durante a gestação de iodetos, substâncias antitireoidianas ou iodo radioativo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">QUADRO CLÍNICO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O hipotireoidismo congênito costuma ser assintomático ou oligossintomático logo após o nascimento. Posteriormente, pode se manifestar por:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipotonia muscular;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dificuldade respiratória;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cianose;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Icterícia prolongada;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Constipação;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Bradicardia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anemia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sonolência excessiva;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Livedo retitcularis;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Choro rouco;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hérnia umbilical;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alargamento de fontanelas;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mixedema;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sopro cardíaco;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Macroglossia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dificuldade na alimentação;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crescimento deficiente pôndero-estatural;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Atraso na dentição;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pele seca e sem elasticidade;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Atraso no desenvolvimento neuropsicomotor e retardo mental.</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRIAGEM NEONATAL (TESTE DO PEZINHO): </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Estratégia 1:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Aferição do TSH em amostra de sangue coletada em papel de filtro (teste do pezinho), seguida da medida do T4 (total ou livre) em amostra de soro quando o TSH for superior a 20 mUI/L por radioimunoensaio ou superior a 15 mUI/L por ensaios imunométricos.</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Coleta da amostra: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recém-nascidos a termo sem comprometimento clínico: deve ser realizada a coleta entre o 3° e o 7° dias de vida (Os níveis de TSH em crianças não afetadas pelo hipotireoidismo congênito são mais elevados nos primeiros 3 dias de vida, podendo, nesse período, resultar em testes com diagnósticos falso-positivos);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recém-nascidos prematuros ou criticamente doentes: a coleta deve ser realizada aos 7 dias de vida.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Estratégia 2: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aferição de T4 em amostra de papel filtro (normal: > 6 mcg/dL), coletada entre o 3° e o 7° dia de vida, seguida da aferição de TSH quando os níveis de T4 estiverem baixos.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Programa Nacional de Triagem Neonatal:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> os resultados de rastreamento positivos devem ser seguidos da dosagem de T4 (total e livre) e TSH em amostra de sangue venoso, obtida com a maior brevidade possível para a confirmação diagnóstica. O ponto de corte de TSH adotado pelo protocolo é de 10 mUI/L no teste do pezinho.</span></div>
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</ul>
</ul>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ULTRASSONOGRAFIA CERVICAL: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Permite diagnosticar a etiologia do hipotireoidismo congênito.</span></div>
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</ul>
</ul>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CINTILOGRAFIA DE TIREÓIDE: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Permite diagnosticar a etiologia do hipotireoidismo congênito.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizado após o exame de ultrassonografia cervical, quando este não consegue determinar a etiologia do hipotireoidismo congênito.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deve ser realizado após 3 anos de idade para não postergar o início da terapia de reposição hormonal.</span></div>
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</ul>
</ul>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TESTE FUNCIONAL DE ESTÍMULO COM TRH:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Utilizado para o diagnóstico etiológico de hipotireoidismo congênito central.</span></div>
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</ul>
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<br /></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IDADE ÓSSEA: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">atraso na maturação óssea.</span></div>
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</ul>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CRITÉRIOS DE INCLUSÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com diagnóstico laboratorial de hipotireoidismo congênito:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TSH sérico: > 10 mUI/L;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">T4 total ou livre: normal-baixo. </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CRITÉRIOS DE EXCLUSÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HipoTBGnemia: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com dosagem sérica TSH normal, T4 total sérico inferior ao valor de referência e valores de proteína carreadora de hormônios tireoidianos (thyroxine-binding globulin, TBG) inferiores ao valor de referência, devem ser submetidos à dosagem de T4 livre sérico:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">T4 livre sérico normal: diagnóstico de hipoTBGnemia, não devendo ser o paciente incluído no protocolo de tratamento de hipotireoidismo congênito.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">T4 livre sérico reduzido: diagnóstico de hipotireoidismo congênito. Paciente deve ser incluído no protocolo de tratamento.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com intolerância ao uso do medicamento empregado na reposição hormonal.</span></div>
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</ul>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CENTROS DE REFERÊNCIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O Programa Nacional de Triagem Neonatal prevê que “os Serviços de Referência em Triagem Neonatal/Acompanhamento e Tratamento de Doenças Congênitas Tipo I, II e III - grupo em que se inclui o hipotireoidismo congênito - são os responsáveis pela realização da triagem dos pacientes, assim como por seu tratamento e acompanhamento”.</span></div>
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</ul>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRATAMENTO</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">APRESENTAÇÃO:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Levotiroxina sintética: comprimidos de 25, 50 e 100 mcg.</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">POSOLOGIA:</span></div>
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<table style="border-collapse: collapse; border: none; width: 590px;"><colgroup><col width="*"></col><col width="*"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="2" style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TABELA: POSOLOGIA DE REPOSIÇÃO HORMONAL COM LEVOTIROXINA</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IDADE</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DOSE (mcg/Kg/dia)</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">0 a 28 dias</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">10 - 15</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1 a 6 meses</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">7 - 10</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">7 a 11 meses</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">6 - 8</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1 a 5 anos</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">4 - 6</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">6 a 12 anos</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3 - 5</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">13 a 20 anos</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3 - 4</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1 - 2</span></div>
</td></tr>
<tr style="height: 28px;"><td colspan="2" style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nas crianças que não conseguem ingerir o comprimido, o mesmo deve ser macerado e dissolvido em pequena quantidade de água.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deve ser administrada em dose única diária e contínua.</span></div>
</li>
</ul>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TEMPO DE TRATAMENTO:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O tratamento deve ser mantido por toda a vida.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nos casos de suspeita de hipotireoidismo transitório, a medicação deve ser suspensa após 3 anos de idade por curto período de tempo como o objetivo de reavaliar a função tireoidiana. Esses casos incluem pacientes sem etiologia definida por exame de imagem (especialmente se for demonstrada tireóide normal à ecografia), pacientes com quadro clínico e laboratorial inicial duvidoso e pacientes que não precisaram de aumento de dose de tiroxina durante o seguimento.</span></div>
</li>
</ul>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MONITORIZAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes devem ser monitorizados quanto:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li>Desenvolvimento pôndero-estatural;</li>
<li>Desenvolvimento neuropsicomotor;</li>
<li>Laboratorialmente:</li>
<ul>
<li>TSH: manter o TSH dentro dos valores de referência (idealmente entre 0,5-2,0 mUI/L).</li>
</ul>
</ul>
</ul>
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<br /></div>
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<br /></div>
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border: none; width: 590px;"><colgroup><col width="*"></col><col width="*"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="2" style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TABELA: MONITORIZAÇÃO LABORATORIAL DO TRATAMENTO DO HIPOTIREOIDISMO CONGÊNITO</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MOMENTO</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FREQUÊNCIA DE DOSAGEM DO TSH</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Logo após iniciado o tratamento com levotiroxina</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2 a 4 semanas após início da medicação</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Primeiros 6 meses de vida</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">a cada 1-2 meses</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">De 6 meses a 3 anos de idade</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">a cada 3-4 meses</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Após 3 anos de vida</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">a cada 6-12 meses</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Após qualquer alteração de dosagem</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">após 4 semanas do ajuste de dosagem</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
<span id="docs-internal-guid-ea5d0683-02f9-0c05-792c-755cd0adafdb"></span><br />
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<a href="http://portalsaude.saude.gov.br/images/pdf/2015/novembro/26/Hipotiroidismo-congenito---PCDT-Formatado--.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Portaria SAS/MS n° 1.161, de 18 de novembro de 2015: Protocolo Clínico e Diretrizes Terapêuticas - Hipotireoidismo Congênito.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-65088026160098190682016-10-24T10:52:00.000-07:002016-10-24T10:52:30.073-07:00HIPERPROLACTINEMIA<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIPERPROLACTINEMIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(Portaria SMS/MS n° 208, de 23 de Abril de 2.010)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-10: </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E22.1 (Hiperprolactinemia)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Etiologia Fisiológica:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gravidez;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Amamentação;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamentosa:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Neurolépticos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fenotiazinas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Butirofenonas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Risperidona;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sulpirida.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antidepressivos tricíclicos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Amitriptilina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Clomipramina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inibidores da monoaminoxidase;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anti-hipertensivos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Verapamil;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reserpina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Metildopa.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Domperidona;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Metoclopramida;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inibidores seletivos da captação de serotonina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contraceptivos orais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prolactinomas e adenomas hipofisários produtores de prolactina: Em mulheres, mais de 90% dos prolactinomas são tumores intrasselares pequenos que raramente aumentam de tamanho. Em homens e crianças, geralmente são macroadenomas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotireoidismo: Hiperprolactinemia é encontrada em 40% dos pacientes com hipotireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome dos ovários policísticos (SOP): hiperprolactinemia está presente em 30% dos casos de SOP. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença de Addison;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cirrose hepática;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperprolactinemia idiopática;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Macroprolactinemia: resulta da ligação anômala da prolactina a imunoglobulinas circulantes, formando um complexo de alto peso molecular. Essa ligação reduz a atividade biológica da prolactina, apresentando-se com hiperprolactinemia assintomática. Para diagnosticá-la deve ser realizada pelo TESTE DE PRECIPITAÇÃO ou CROMATOGRAFIA LÍQUIDA EM COLUNA DE FILTRAÇÃO POR GEL.;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">“Efeito gancho”: caracteriza-se pela leitura de valores falsamente baixos de prolactina em casos de macroprolactinomas que secretam grandes quantidades de hormônio. Deve ser suspeitado em indivíduos com macroadenomas hipofisários e valores não muito elevados de prolactina (< 200 ng/mL). Para excluí-lo, deve ser realizada a dosagem da PROLACTINA DILUÍDA.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CLASSIFICAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Microadenomas: < 10 mm de diâmetro;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Macroadenomas: ≥ 10 mm de diâmetro.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Galactorréia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Distúrbios menstruais (oligomenorréia e amenorréia);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Impotência, disfunção erétil, infertilidade e diminuição da libido nos homens.;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Redução da densidade mineral óssea;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeito de massa tumoral:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipopituitarismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manifestações neurológicas:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">cefaléia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manifestações oftalmológicas:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">alteração nos campos visuais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO DIFERENCIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Macroadenomas hipofisários;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pseudoprolactinomas: lesões selares ou perisselares que provocam aumento da prolactina sérica por compressão da haste hipofisária e não por aumento da produção de prolactina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência hepática;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PROLACTINA SÉRICA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (ensaio de quimioluminescência e imunorradiométrico):</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Normal:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Homens: < 20 ng/mL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres: < 25 ng/mL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alterado:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 100 ng/mL: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de medicamentos psicoativos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso de estrógenos;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idiopático;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Microprolactinomas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 200 ng/mL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prolactinomas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 250 ng/mL:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Macroprolactinomas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTE DA PRECIPITAÇÃO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> diagnostica a presença de macroprolactinemia, baseando-se na insolubilidade das imunoglobulinas após exposição a concentrações definidas de polietilenoglicol (PEG). Após o procedimento, recuperações menores que 30% da prolactina estabelecem o diagnóstico de macroprolactinemia, enquanto recuperações maiores que 65% o afastam. Valores de recuperação entre 30 e 65% devem ser submetidos à CROMATOGRAFIA LÍQUIDA EM COLUNA POR FILTRAÇÃO POR GEL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CROMATOGRAFIA LÍQUIDA EM COLUNA POR FILTRAÇÃO POR GEL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: indicada para o diagnóstico de macroprolactinemia quando o TESTE DA PRECIPITAÇÃO encontrar uma taxa de recuperação entre 30 e 65%.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DOSAGEM DE PROLACTINA DILUÍDA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: utilizada para o diagnóstico do “efeito gancho”. Nos pseudoprolactinomas (lesões selares e perisselares que provocam hiperprolactinemia por compressão da haste hipofisária e não por produção excessiva de prolactina pela lesão), a prolactina diluída não mostrará valores elevados. Nos macroprolactinomas com “efeito gancho”, a diluição da amostra resultará em valores elevados de prolactina sérica.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">EXAMES COMPLEMENTARES:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TSH, T4 livre</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TGO, TGP;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uréia, Creatinina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES DE IMAGEM</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RESSONÂNCIA MAGNÉTICA NUCLEAR DE HIPÓFISE: pesquisar prolactinoma. O resultado normal não afasta a possibilidade de microprolactinoma.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TOMOGRAFIA COMPUTADORIZADA DE HIPÓFISE: é menos efetiva que a RMN para a identificação de tumores, particularmente dos microprolactinomas, mas pode ser útil na impossibilidade ou contraindicação da realização da RMN, particularmente na suspeita de macroprolactinoma.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE INCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CRITÉRIO OBRIGATÓRIO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Prolactina sérica: superior ao limite de normalidade para o método de dosagem utilizado;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CRITÉRIOS ADICIONAIS (presença de, pelo menos, 1 desses critérios):</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ressonância Magnética Nuclear ou Tomografia Computadorizada de hipófise demonstrando macroprolactinoma;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ressonância Magnética Nuclear de hipófise demonstrando microprolactinoma associado à clínica de hiperprolactinemia ou hipogonadismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ressonância Magnética Nuclear de hipófise normal, associada à clínica de hiperprolactinemia ou hipogonadismo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotireoidismo primário como causa da hiperprolactinemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperprolactinemia secundária a medicamento;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gravidez como causa de hiperprolactinemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência renal ou hepática;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade aos medicamentos preconizados;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperprolactinemia por compressão da haste hipofisária (pseudoprolactinoma).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIPERPROLACTINEMIA MEDICAMENTOSA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suspender ou substituir o medicamento por fármaco alternativo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quando se tratar de neurolépticos ou antidepressivos, deve-se discutir com o psiquiatra a possibilidade da troca por um outro medicamento que não cause hiperprolactinemia, ou a redução da dose administrada do medicamento em questão. O uso de agonista dopaminérgico deve se limitar a casos bem específicos, quando não há alternativas terapêuticas, sempre de comum acordo e acompanhamento com o psiquiatra.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Para pacientes sintomáticos, em que o medicamento não pode ser suspenso, uma alternativa a ser considerada é a reposição de estrógeno/progestestona ou, ainda, bifosfonado, se houver osteoporose, de acordo com o </span><a href="http://portalsaude.saude.gov.br/images/pdf/2014/dezembro/15/Osteoporose.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Protocolo Clínico e Diretrizes Terapêuticas da Osteoporose.</span></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MICROPROLACTINOMA ou HIPERPROLACTINEMIA IDIOPÁTICA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Assintomáticos; mulheres com menstruação regular, galactorréia leve e prole constituída; e mulheres menopausadas com galactorréia leve:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Geralmente não necessitam tratamento, apenas acompanhamento com monitorização frequente da prolactinemia para detectar aumento de massa, a cada 6 meses nos primeiros 2 anos e, após, anualmente;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sintomáticos:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Objetivo: restaurar a função gonadal e sexual por meio da normalização da prolactinemia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TRATAMENTO DE ESCOLHA DOS MICROPROLACTINOMAS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento medicamentoso com agonista dopaminérgico:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">BROMOCRIPTINA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso reservado para mulheres hiperprolactinêmicas com infertilidade e desejo de engravidar (maior experiência com uso do medicamento em gestantes);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial: 1,25 mg/dose,VO, após o jantar ou na hora de dormir, 1 vez ao dia, durante 1 semana. Após 1 semana, aumentar a dose para 1,25 mg/dose, VO, 2 vezes ao dia (depois do café da manhã e depois do jantar/hora de dormir). Incrementos da dose de 2,5 mg podem ser realizados a cada 3-7 dias, até chegar à dose desejada, que varia de 5-15 mg/dia (geralmente não ultrapassa 7,5 mg/dia);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manutenção: 2,5-15 mg/dia (geralmente < 7,5 mg/dia), VO, 2-3 vezes ao dia.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 2,5 mg.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeitos adversos: náusea, vômitos, cefaléia, tontura e hipotensão postural.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CABERGOLINA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Agonista específico do receptor D2 da dopamina;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Medicamento de primeira escolha para a maioria dos pacientes (menos efeitos colaterais)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose inicial: 0,25 mg/dose, VO, 2 vezes por semana ou 0,5 mg, VO, 1 vez por semana. Incrementos de 0,5-1,0 mg, com intervalo de no mínimo 4 semanas, conforme necessidade, podem ser realizados. Após o incremento, a dose deve ser administrada 2 vezes por semana.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manutenção: 1-2 mg/semana (eventualmente > 3 mg/semana até máximo de 4,5 mg/semana), VO, 2 vezes por semana.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 0,5 mg.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MACROPROLACTINOMA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Objetivo: controle hormonal e redução com controle tumoral.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TRATAMENTO DE ESCOLHA PARA OS MACROPROLACTINOMAS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento medicamentoso com agonista dopaminérgico (mesmo tratamento descrito acima).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Durante o tratamento medicamentoso, após normalizados os níveis de prolactina sérica por pelo menos 2 anos e o tumor reduzido em mais de 50% do tamanho inicial, a dose do agonista dopaminérgico pode ser reduzida gradativamente até a menor dose possível. Se o paciente apresentar níveis normais de prolactina após 3 anos de uso do agonista dopaminérgico, associado a marcante redução tumoral, pode-se tentar a suspensão do fármaco. Após a suspensão do fármaco, a dosagem da prolactina sérica deve ser realizada a cada 3 meses no primeiro ano de suspensão do agonista e, após, anualmente.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MACROPROLACTINOMAS MAIORES E MAIS INVASIVOS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento de primeira escolha é o medicamentoso (mesmo tratamento descrito acima);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MACROPROLACTINOMAS QUE NÃO RESPONDEM AO TRATAMENTO MEDICAMENTOSO (Ausência de redução da sintomatologia, da hiperprolactinemia ou sem melhora do déficit visual (10%):</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento cirúrgico</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TUMORES AGRESSIVOS OU PROLACTINOMAS MALIGNOS NÃO RESPONSIVOS AOS AGONISTAS DOPAMINÉRGICOS E À CIRURGIA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento radioterápico.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DEMAIS CASOS:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Somente necessitam de tratamento os pacientes com sintomatologia decorrente de hiperprolactinemia (infertilidade, galactorréia relevante, alterações do desenvolvimento puberal ou hipogonadismo de longa data).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mulheres com hiperprolactinemia leve, ciclos menstruais regulares e desejo de engravidar necessitarão também de tratamento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO EM SITUAÇÕES ESPECIAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GESTANTES:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Todas as gestantes, independentemente do agonista dopaminérgico em uso, devem ser expostas ao menor tempo de uso, principalmente no primeiro trimestre da gestação.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">GESTANTES COM MICROPROLACTINOMA OU HIPERPROLACTINEMIA IDIOPÁTICA: o agonista dopaminérgico deve ser suspenso quando confirmada a gravidez.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">GESTANTES COM MACROPROLACTINOMAS: manter o tratamento com agonista dopaminérgico (bromocriptina preferivelmente à cabergolina) nos tumores com maior chance de crescimento ou suspender o medicamento e monitorizar cuidadosamente a paciente (principalmente em relação aos sintomas de expansão tumoral: cefaléia ou defeito de campo visual). </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TEMPO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tempo mínimo de tratamento dopaminérgico é de, pelo menos, 2 anos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A suspensão do medicamento pode ser segura em pacientes com longo tempo de normalização da prolactina sérica e sem evidência de tumor na Ressonância Magnética Nuclear.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MICROPROLACTINOMA OU HIPERPROLACTINEMIA IDIOPÁTICA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PROLACTINA SÉRICA: uma vez normalizado os níveis séricos de prolactina, a dosagem de controle é anual. Se os níveis de prolactina sérica não se normalizar, deve-se aumentar a dose do agonista dopaminérgico prescrito e, na ausência de resposta, substituí-lo por outro agonista dopaminérgico.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MACROPROLACTINOMA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A redução tumoral pode ser vista em 1-2 semanas após introdução do agonista dopaminérgico (mas pode ser mais tardia em alguns pacientes);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PROLACTINA SÉRICA: dosar 2-3 meses após iniciado o tratamento com agonista dopaminérgico e repetir periodicamente de acordo com a evolução do paciente. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RESSONÂNCIA MAGNÉTICA NUCLEAR: deve ser realizada 2-3 meses após iniciado o tratamento com agonista dopaminérgico e repetir periodicamente de acordo com a evolução do paciente.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">APÓS A SUSPENSÃO DO TRATAMENTO COM AGONISTA DOPAMINÉRGICO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PROLACTINA SÉRICA: deve ser dosada a cada 3 meses no primeiro ano de suspensão do agonista e, após, anualmente.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">RESSONÂNCIA MAGNÉTICA NUCLEAR DA HIPÓFISE: após a suspensão do agonista dopaminérgico, deve ser realizada a Ressonância Magnética Nuclear se os níveis de prolactina sérica voltarem a ficar acima do limite superior da normalidade.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ECOCARDIOGRAMA TRANSTORÁCICO:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser realizado antes do início do tratamento com </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">CABERGOLINA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e durante o seguimento, a critério médico, visando detectar valvopatias, calcificação valvar aórtica e regurgitação tricúspide.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE (TER)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">É obrigatório informar ao paciente ou a seu responsável legal dos potenciais riscos, benefícios e efeitos adversos relacionados ao uso dos medicamentos preconizados neste protocolo. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica (CEAF).</span></div>
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<br /><a href="http://www.luizhorta.com/html/endocrinoped/hiperprolactinemia/ter_bromocriptina_cabergolina.pdf" target="_blank">Termo de Esclarecimento e Responsabilidade</a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://portalsaude.saude.gov.br/images/pdf/2016/fevereiro/04/Hipeprolactinemia---PCDT-Formatado--.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Protocolo Clínico e Diretrizes Terapêuticas: Hiperprolactinemia. Portaria SAS/MS n° 1.160, de 18 de novembro de 2.015.</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-10780081038267350822016-10-24T10:45:00.000-07:002016-10-24T10:45:58.828-07:00HIPOPARATIREOIDISMO<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">SINOPSE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HIPOPARATIREOIDISMO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(Portaria SAS/MS n°450, de 29 de Abril de 2.016)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-10: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E20.0: hipoparatireoidismo idiopático;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E20.1: pseudohipoparatireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E20.8: outro hipoparatireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E89.2: hipoparatireoidismo pós-procedimento.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Trauma cirúrgico em cirurgia de tireóide, paratireóide e neoplasias da cabeça e pescoço: É a causa mais comum de hipoparatireoidismo. No trauma cirúrgico em cirurgia da tireóide, o hipoparatireoidismo costuma ser transitório (20 vezes mais frequente que o hipoparatireoidismo definitivo).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças auto-imunes da paratireóide: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Segunda causa mais comum de hipoparatireoidismo;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Formas:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome poliglandular autoimune tipo I:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Associação de: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência adrenal;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Candidíase mucocutânea; e</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças genéticas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças infiltrativas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doenças de depósito;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lesão por irradiação;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo funcional: decorrente de hipo ou hipermagnesemia e reversível com a correção dos distúrbios do magnésio;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pseudohipoparatireoidismo: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Decorrente da resistência tecidual à ação do paratormônio (PTH);</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença hereditária rara;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quadro Laboratorial: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paratormônio: normal ou elevado.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idiopático.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Decorrentes da hipocalcemia aguda: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Espasmos musculares;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tetania;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Parestesias;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Convulsões;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sinal de Trousseau: positivo. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprime-se o braço com esfigmomanômetro insuflado 20 mmHg acima da pressão sistólica por 3 minutos. O sinal de positividade é o espasmo carpal, ou seja, a flexão do pulso e articulações metacarpofalangeanas, extensão das articulações interfalangeanas distais e proximais, e adução do polegar e dedos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sinal de Chvostek: positivo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ocorre em 15% das pessoas normocalcêmicas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Percute-se o nervo facial na região zigomática. O sinal de positividade consiste no desencadeamento de espasmos musculares faciais.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Histórico pregresso de cirurgia cervical ou cicatriz de tireoidectomia no pescoço: hipoparatireoidismo pós-cirúrgico.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Insuficiência adrenal e candidíase mucocutânea crônica: síndrome poliglandular autoimune tipo I.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo crônico:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Catarata;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sintomas extrapiramidais e retardo mental (calcificação dos núcleos da base no sistema nervoso central)</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES LABORATORIAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ELETROCARDIOGRAMA:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Alterações da repolarização ventricular.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumento do intervalo QT.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CÁLCIO TOTAL ou IÔNICO SÉRICO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio total deve ser corrigido para a albumina no soro: para cada 1g/dL de albumina abaixo de 4 g/dL, deve-se adicionar 0,8 mg/dL à medida do cálcio total.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio total corrigido para albumina: baixo (<8 mg/dL).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio iônico: baixo (< 4 mg/dL).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PARATORMÔNIO (PTH) SÉRICO: reduzido ou indetectável (< 15 pg/mL).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">FÓSFORO SÉRICO: aumentado (> 5,0 mg/dL).</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MAGNÉSIO SÉRICO: hiper ou hipomagnesemia podem resultar em hipoparatireoidismo funcional.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCIÚRIA EM 24 HORAS.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE INCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio total corrigido para albuminemia séricos: < 8 mg/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio iônico sérico: < 4 mg/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paratormônio (PTH) sérico: < 30 pg/mL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pseudohipoparatireoidismo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio total corrigido para albuminemia séricos: < 8 mg/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fósforo sérico: > 5 mg/dL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Taxa de filtração glomerular estimada (TFGe) > 60 mL/min/1,73m</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">; e</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Paratormônio (PTH) sérico: normal ou elevado.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipoparatireoidismo transitório ou funcional que tenham a função das paratireóides normalizadas;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipo ou hipermagnesemia;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade ou intolerância aos medicamentos preconizados neste Protocolo.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">HIPOCALCEMIA GRAVE</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Os pacientes com hipocalcemia grave (tetania, convulsões ou prolongamento do intervalo QT no eletrocardiograma) devem ser tratados emergencialmente a nível hospitalar.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gluconato de Cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gluconado de Cálcio 10%: ampola com 10 mL;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">IV;</span></div>
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<br /></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MANUTENÇÃO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentações:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de Cálcio: comprimidos 500 mg cálcio;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de cálcio + Colecalciferol: comprimidos 500 mg cálcio + 200 UI colecalciferol;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de cálcio + Colecalciferol: comprimidos 500 mg cálcio + 400 UI colecalciferol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de cálcio + Colecalciferol ou Fosfato de Cálcio Tribásico + Colecalciferol: comprimidos 600 mg cálcio + 400 UI colecalciferol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gluconato de Cálcio ou Cloreto de Cálcio: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipocalcemia grave: Preferentemente Gluconado de Cálcio, 1000 mg/dose, IV, em 10-25 minutos.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Carbonato de cálcio:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manutenção: 2-6 g/dia, VO, 2-6 vezes ao dia (preferencialmente 3 ou mais vezes ao dia, associado às refeições).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Observação: se só estiver disponível as formulações com colecalciferol, utilizar a com menor dose de colecalciferol.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Vitamina D sintética alfa hidroxilada: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">ALFACALCIDOL (1-alfa-hidroxivitamina D</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Transporte ligado a proteínas: 99,9%;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Início do efeito: 1-2 dias após administração;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Duração do efeito: 3-5 dias;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação: cápsulas 0,25 mcg e 1 mcg;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inicial: 0,5 mcg/dose, VO, 1 vez ao dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ajuste: ajustar com base na calcemia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manutenção: 0,5-6 mcg/dia, VO, 1-2 vezes ao dia</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VO;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CALCITRIOL (1,25-diidroxivitamina D</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">): </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Transporte ligado a proteínas: 99,9%;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Efeito: 1-2 dias após administração;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Duração do efeito: 3-5 dias;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Apresentação: cápsulas 0,25 mcg.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Inicial: 0,25 mcg/dose, VO, 1 vez ao dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ajuste: ajustar de acordo com a calcemia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manutenção: 0,25-3 mcg/dia, VO, 1-2 vezes ao dia.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">REDUÇÃO DA INGESTÃO DE SÓDIO: pode, conjuntamente com a redução nas doses de cálcio e vitamina D sintética, reduzir a calciúria induzida por esses medicamentos.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">DIURÉTICO TIAZÍDICO: pode, conjuntamente com a redução nas doses de cálcio e vitamina D sintética, reduzir a calciúria induzida por esses medicamentos.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">HIPERCALCIÚRIA PERSISTENTE:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipercalciúria: calciúria > 300 mg/24 horas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span> </div>
<div dir="ltr" style="background-color: transparent; color: black; font-size-adjust: none; font-stretch: normal; font: 400 14.66px/1.38 Arial; list-style-type: circle; margin-bottom: 0pt; margin-top: 0pt; text-align: justify; text-decoration: none; vertical-align: baseline;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"></span> </div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">AJUSTE DA MEDICAÇÃO:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Se Cálcio sérico baixo:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumentar a dose de carbonato de cálcio ou calcitriol/alfacalcidol;</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Se Cálcio sérico elevado:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Reduzir a dose de carbonato de cálcio ou calcitriol/alfacalcidol.</span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GESTAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento de mulheres com hipoparatireoidismo durante a gestação deve ser cuidadoso para evitar o desenvolvimento de hiperparatireoidismo secundário e desmineralização óssea no feto. A vitamina D sintética 1-alfa-hidroxilada com maior experiência de uso em gestantes é o calcitriol. Ao longo da gestação, há necessidade de aumento da dose de calcitriol para a manutenção dos níveis de cálcio no limite inferior da normalidade. Após o parto, as necessidades de calcitriol retornam para o patamar pré-gestacional.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TEMPO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O tratamento deve ser mantido por toda a vida. </span></div>
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<br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"></span> </div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dosar CÁLCIO e FÓSFORO SÉRICOS, CREATINÚRIA e CALCIÚRIA EM URINA DE 24 HORAS: inicialmente a cada 7-14 dias, espaçando progressivamente até ajuste adequado, quando o controle passa a ser a cada 3-6 meses.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Objetivo do tratamento:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Manter: </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cálcio total corrigido com albuminemia séricos: entre 8 e 8,5 mg/dL.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Calciúria < 300 mg/24 horas ou < 4 mg/Kg peso/24 horas.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE - TER</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deve-se informar ao paciente ou a seu responsável legal sobre os potenciais riscos, benefícios e efeitos colaterais relacionados ao uso dos medicamentos preconizados neste Protocolo, levando-se em consideração as informações contidas no TER.</span></div>
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<a href="http://www.luizhorta.com/html/endocrinoped/hipoparatireoidismo/ter_hipoparatireoidismo.pdf" target="_blank">Termo de Esclarecimento e Responsabilidade</a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<a href="http://portalsaude.saude.gov.br/images/pdf/2016/maio/02/Portaria-450-de-29-04-2016-Hipoparatireoidismo-ATUALIZA----O.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">SECRETARIA DE ATENÇÃO À SAÚDE/MINISTÉRIO DA SAÚDE: HIPOPARATIREOIDISMO. Portaria SAS/MS n° 450, de 29 de abril de 2.016).</span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-49349463656225900132016-09-29T19:27:00.001-07:002016-09-29T19:27:32.348-07:00HIPERPLASIA ADRENAL CONGÊNITA (HAC)<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
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<b id="docs-internal-guid-a062e4d4-78ea-217b-f53f-f1605f187442" style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Protocolo Clínico e Diretrizes Terapêuticas</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HIPERPLASIA ADRENAL CONGÊNITA (HAC)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(Portaria SAS/MS n° 16, de 15 de janeiro de 2.010)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CID-10:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> E25.0 (transtornos adrenogenitais congênitos associados à deficiência enzimática)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ETIOLOGIA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deficiências enzimáticas na síntese dos esteróides adrenais:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deficiência da 21-hidroxilase (CYP21A2): > 95% dos casos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deficiência de 11-beta-hidroxilase (CYP11B1): </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">5% dos casos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acúmulo dos precursores pregnenolona e progesterona, aumentando a síntese de desoxicorticosteróide (mineralocorticóide), resultando em hipertensão arterial.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">20,22-desmolase (CYP11A1): rara;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-alfa-hidroxilase (CYP17): </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rara;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acúmulo dos precursores pregnenolona e progesterona, aumentando a síntese de desoxicorticosteróide (mineralocorticóide), resultando em hipertensão arterial.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3-beta-hidroxiesteróide-desidrogenase (HSD3B2): rara;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aldosterona sintase (CYP11B2): rara;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperplasia lipóide (StAR): rara.</span></div>
</li>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">QUADRO CLÍNICO</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FORMAS CLÍNICAS:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FORMA CLÁSSICA PERDEDORA DE SAL:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Forma mais comum de HAC clássica (60% dos casos);</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RN do sexo feminino: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Virilização da genitália externa (aumento do clitóris, fusão labial e formação do seio urogenital);</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RN do sexo masculino: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">genitália externa masculina.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Todos os RNs:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Geralmente apresentam crise adrenal nos primeiros dias de vida: depleção de volume, desidratação, hipotensão, taquicardia, vômitos, perda de peso, letargia, hiponatremia e hiperpotassemia.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FORMA CLÁSSICA NÃO PERDEDORA DE SAL (VIRILIZANTE SIMPLES):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RN sexo feminino: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Virilização da genitália externa;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RN sexo masculino:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Genitália externa masculina. Diagnosticados em idade tardia por sinais de hiperandrogenismo: pubarca precoce, velocidade de crescimento aumentada, maturação óssea acelerada ou puberdade precoce.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FORMA NÃO-CLÁSSICA (DE INÍCIO TARDIO):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Forma 15 vezes mais frequente que a forma clássica de HAC;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">São assintomáticos ou apresentam sintomas tardiamente na infância ou adolescência.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sexo feminino: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperandrogenismo: aumento de clitóris, pubarca precoce, ciclos menstruais irregulares e hirsutismo.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sexo masculino:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Geralmente assintomático.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eventualmente, há presença de tecido adrenal ectópico em testículo, com aumento de volume testicular e oligospermia.</span></div>
</li>
</ul>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FORMAS COM EXCESSO DE SÍNTESE MINERALOCORTICÓIDE:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DEFICIÊNCIA DE 11-BETA-HIDROXILASE:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertensão;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipopotassemia.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-ALFA-HIDROXILASE:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertensão;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; margin-left: 48px; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipopotassemia.</span></div>
</li>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO LABORATORIAL</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO LABORATORIAL DA HAC FORMA CLÁSSICA:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TESTE DO PEZINHO (Dosagem de 17-OH-progesterona):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">No RN, os valores de 17-OH-progesterona dependem da idade gestacional ao nascimento, da idade da coleta do material para exame, do peso ao nascimento e do sexo. </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O uso materno de glicocorticóide pode reduzir a concentração de 17-OH-progesterona e dar resultado falso-negativo.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Valor de referência para ponto de corte para rastreamento de HAC varia de 15-40 ng/mL.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Teste do pezinho positivo deve ser confirmado com dosagem de 17-OH-progesterona em sangue periférico.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona em sangue periférico:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RN: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona < 10 ng/mL = afasta diagnóstico de HAC por deficiência de 21 hidroxilase;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona > 35 ng/mL = sugere fortemente o diagnóstico de HAC por deficiência de 21-hidroxilase;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona > 100 ng/mL = diagnóstico de HAC forma clássica por deficiência de 21-hidroxilase.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Resultados de 17-OH-progesterona basal em sangue periférico indeterminado:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Teste de estímulo com ACTH;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Análise por biologia molecular.</span></div>
</li>
</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO LABORATORIAL DA HAC FORMA NÃO-CLÁSSICA:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona basal em sangue periférico:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona > 0,8 ng/mL = sugere diagnóstico de HAC por deficiência de 21-hidroxilase;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mulheres adultas:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona (fase folicular do ciclo menstrual): > 2 ng/mL = sugere o diagnóstico de HAC por deficiência de 21-hidroxilase.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Teste de estímulo com ACTH (250 mg):</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona > 10 ng/mL = sugere o diagnóstico de HAC por deficiência de 21-hidroxilase.</span></div>
</li>
</ul>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EXCLUSÃO DO TRATAMENTO:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com resultado de teste do pezinho positivo, sem exame de 17-OH-progesterona em sangue periférico confirmatório;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Contraindicação ou intolerância aos medicamentos especificados;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes do sexo masculino com HAC forma não clássica e assintomáticos;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes com sexo feminino e forma não clássica devem ser tratadas conforme o </span><a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/03/pcdt-sindr-ovarios-polic-hirsutismo-acne-livro-2013.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Protocolo Clínico e Diretrizes Terapêuticas da Síndrome dos Ovários Policísticos.</span></a></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRATAMENTO DA HAC</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">GLICOCORTICÓIDES:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÃO:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HAC clássica perdedora ou não-perdedora de sal:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona em sangue periférico basal ou após estímulo com ACTH > 100 ng/mL.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MEDICAMENTOS GLICOCORTICÓIDES:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dexametasona: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apresentações:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elixir de 0,1 mg/mL;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprimido: 4 mg;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Solução injetável: 4 mg/mL.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: 0,27 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">/dia, VO ou IV, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: 0,25-0,75 mg/dia, VO ou IV, 1 vez ao dia.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dose: a dose deve ser ajustada para a menor dose possível para manter controlados os níveis de andrógenos.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prednisona:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apresentações:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprimidos: 5 e 20 mg;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: 2,5-4,0 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">/dia, VO, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: 2,5-7,5 mg/dia, VO, 1 vez ao dia.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dose: a dose deve ser ajustada para a menor dose possível para manter controlados os níveis de andrógenos.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prednisolona: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apresentação:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Solução oral: 1,34 mg/mL;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: 2-3 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">/dia, VO, 1 vez ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: 2,5-7,5 mg/dia, VO, 1 vez ao dia.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dose: a dose deve ser ajustada para a menor dose possível para manter controlados os níveis de andrógenos.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hidrocortisona:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apresentação: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Solução injetável: 100 e 500 mg.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: 12-18 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">/dia (em estresse ou crise adrenal: 60-100 mg/m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">/dia), VO ou IV, 2-4 vezes ao dia;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: 20 mg/dia (em estresse ou crise adrenal: 200-300 mg/dia), VO ou IV, 2 a 4 vezes ao dia.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dose: a dose deve ser ajustada para a menor dose possível para manter controlados os níveis de andrógenos. Manter nível de </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> entre 4-12 ng/mL e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">androstenediona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">testosterona total</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> em valores pouco acima do limite superior do valor de referência.</span></div>
</li>
</ul>
</ul>
</ul>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="128" src="https://lh6.googleusercontent.com/4G3ht3sm6I2qGc477ScqTheI9Z9lOxQyelr81EYmtBjIIvayrjo3Qr41pORujxwNhO001PViVu_4_j6R4UN98tHRWvWvW1Y3FQ4MuytVUN1hFWCIdHjzpXzSR38lAsSS9DILYav8" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: DORA et al, 2.010.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MINERALOCORTICÓIDES:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÃO:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HAC perdedora de sal com </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona em sangue periférico basal ou após estímulo com ACTH > 100 ng/mL; associado com</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiponatremia (sódio sérico < 135 mEq/L) e Hiperpotassemia (Potássio sérico > 5,5 mEq/L); associado com</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Renina plasmática > valor de referência e Aldosterona < valor de referência.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MEDICAMENTO MINERALOCORTICÓIDE:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fludrocortisona:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apresentação: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprimido: 0,1 mg.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças < 6 meses: ≥ 0,1 mg/dia, (associada a 1-3 g de sal suplementar),VO, 1 vez ao dia.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças 6-12 meses: reduzir a dose gradualmente até atingir a dose de 0,1 mg/dia, VO, 1 vez ao dia.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: 0,1 mg/dia (variação: 0,05-0,3 mg/dia), VO, 1 vez ao dia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: 0,1 mg/dia (variação: 0,05-0,4 mg/dia), VO, 1 vez ao dia.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O ajuste da dosagem é feita com o objetivo de normalizar a volemia e corrigir os distúrbios do sódio e potássio.</span></div>
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<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="159" src="https://lh5.googleusercontent.com/eKoprG__iPotnr4bOORJk267pSn6NDuauayJHTiJCwHjdrwWvZZ74RxlXvihcGC-xsEoJjW55kx8eqKE7nVDwsHDNHZ932U77lld4knwZkgeH_vNJ5T0Mu0RkI27OmdBwWU47mPv" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: DORA et al, 2.010.</span></div>
<b style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MONITORIZAÇÃO</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O acompanhamento deve ser feito a cada 3 meses no primeiro ano de vida e, em crianças com tratamento adequado, a cada 4-6 meses.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AJUSTE DA DOSE DE GLICOCORTICÓIDE:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosar </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Androstenediona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Testosterona total</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> a cada 3 meses no primeiro ano de vida e a cada 4-6 meses nas crianças com tratamento adequado. Manter nível de </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">17-OH-progesterona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> entre 4-12 ng/mL e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">androstenediona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">testosterona total</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> em valores pouco acima do limite superior do valor de referência.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Avaliar sinais clínicos de hipercortisolismo: fragilidade capilar, giba, estrias violáceas, fácies de lua cheia, fraqueza muscular proximal e hipertensão.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Avaliar velocidade de crescimento e maturação óssea (Rx de mãos e punhos para avaliação da idade óssea deve ser realizado anualmente).</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AJUSTE DA DOSE DE MINERALOCORTICÓIDE:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosar Renina plasmática, sódio e potássio séricos a cada 3 meses no primeiro ano de vida e a cada 4-6 meses em crianças com tratamento adequado.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Objetivo: normalizar o sódio sérico (135-145 mEq/L) e o potássio sérico (3,5-5,5 mEq/L) e não suprimir a renina plasmática, mantendo a pressão arterial normal. Supressão da renina plasmática e hipertensão arterial indicam excesso de mineralocorticóide, sendo necessária a revisão da dose de fludrocortisona.</span></div>
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<b style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TEMPO DE TRATAMENTO</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O tratamento com glicocorticóides e mineralocorticóides deve ser feito por toda a vida em pacientes com HAC forma clássica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OBSERVAÇÕES</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes diagnosticados com HAC forma clássica devem portar consigo identificação (pulseira, corrente ou cartão) que informe sua condição e que contenha instruções de medidas a serem tomadas.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes com HAC adequadamente tratados atingem estatura final cerca de 1,5 desvio-padrão (aproximadamente 10 cm) abaixo da estatura prevista.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE - TER</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">É obrigatória a informação ao paciente ou a seu responsável legal dos potenciais riscos, benefícios e efeitos adversos relacionados ao uso dos medicamentos preconizados neste protocolo. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FLUXOGRAMA DE TRATAMENTO DA HAC</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="729" src="https://lh3.googleusercontent.com/nuOwS00o9-UnNynJ3CslvfNZEJztZsniHHJoIOa8DIG8VGbwfn0XkcHSigs1piC1-lZoG_ZtBzvzuJYXuxYTw7G3MbCvqXvJhEGuvzNCjsv-dlyiousJGOD1rYZ34h650s7CMP2n" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="573" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FLUXOGRAMA DE DISPENSAÇÃO DE FLUDROCORTISONA</span></div>
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<h2 align="center" style="font-weight: bolder; margin-top: 0px; padding-left: 15px; padding-right: 15px;">
LINKS ÚTEIS</h2>
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<span style="text-decoration: none;"><a class="nav" href="http://www.luizhorta.com/html/endocrinoped/ppc/instrucoes_preenchimento_lme_16_12_11.pdf" style="text-decoration: none;" target="new" title="IMPRESSÕES - PREENCHIMENTO DO IME">INSTRUÇÕES - PREENCHIMENTO DO IME</a></span></div>
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<span style="text-decoration: none;"><a href="http://www.luizhorta.com/html/endocrinoped/ppc/lme_formulario_impressao_16_12_11.pdf" style="text-decoration: none;" target="new" title="IME - FORMULÁRIO DE IMPRESSÃO">IME - FORMULÁRIO DE IMPRESSÃO</a></span></div>
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<br /></div>
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<span style="text-decoration: none;"><a href="http://www.luizhorta.com/html/endocrinoped/ppc/lme_formulario_preenchimento_online_16_12_11.pdf" style="text-decoration: none;" target="new" title="IME - FORMULÁRIO ON LINE">IME - FORMULÁRIO ON LINE</a></span></div>
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<br /></div>
<div style="font-weight: bolder; padding-left: 15px; padding-right: 15px;">
<span style="text-decoration: none;"><a href="http://www.luizhorta.com/html/endocrinoped/hcsr/ter_fludrocortisona.pdf" style="text-decoration: none;" title="TERMO DE CONSENTIMENTO E RESPONSABILIDADE">TERMO DE CONSENTIMENTO E RESPONSABILIDADE</a></span></div>
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<br /></div>
<div style="font-weight: bolder; padding-left: 15px; padding-right: 15px;">
<span style="text-decoration: none;"><a href="http://www.luizhorta.com/html/endocrinoped/hcsr/orientacao_ao_paciente_fludrocortisona.pdf" style="text-decoration: none;" target="new" title="CARTILHA DE ORIENTAÇÃO AO PACIENTE">CARTILHA DE ORIENTAÇÃO AO PACIENTE</a></span></div>
<span style="font-weight: normal;"></span><br />
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<br /></div>
<div style="font-weight: bolder; padding-left: 15px; padding-right: 15px;">
<span style="text-decoration: none;"><a href="http://www.luizhorta.com/html/endocrinoped/hcsr/ficha_farmacoterapeutica_hac.pdf" style="text-decoration: none;" target="new" title="FICHA FARMACOTERAPÊUTICA">FICHA FARMACOTERAPÊUTICA</a></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">REFERÊNCIA BIBLIOGRÁFICA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/02/pcdt-hiperplasia-adrenal-congenita-livro-2010.pdf" style="text-decoration: none;">DORA, J.M.; ELNECAVE, R.H.; KRUG, B.C. & AMARAL, K.M.: Hiperplasia adrenal congênita. Protocolo Clínico e Diretrizes Terapêuticas (Portaria SAS/MS n° 16, de 15 de janeiro de 2.010)</a>.</span></div>
</li>
</ol>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-2389146029766818952016-09-15T13:16:00.000-07:002016-09-15T13:21:20.030-07:00ACROMEGALIA<div style="text-align: justify;">
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<b><a href="http://www.luizhorta.com/" target="_blank"><img alt="http://www.luizhorta.com/" border="0" height="58" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfDoo2q9FURyhFfKO7gu2ogJe-8sRCxNT55GLzQe4k8QqlodoJkS_-dsDvZpl11eiTH_bcvKUQhB7ompsstEV3puGToV6705cLCMAvd3fQi-geCVkBGyvmWKNeJg_14SNoOftkJjPnh7A/s400/profluizhorta.jpg" width="400" /></a></b></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">SINOPSE:<o:p></o:p></span></b></div>
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<b><span style="font-size: 18.0pt; line-height: 107%;">Protocolo Clínico e
Diretrizes Terapêuticas<o:p></o:p></span></b></div>
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<b><span style="font-size: 28.0pt; line-height: 107%;">ACROMEGALIA<o:p></o:p></span></b></div>
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(Portaria SAS/MS n° 199,
de 25 de fevereiro de 2.013, republicada em 22 de novembro de 2.013)<o:p></o:p></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">CID-X:</span></b> E22.0<o:p></o:p></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">ETIOLOGIA</span></b></div>
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<ul>
<li style="text-align: justify;">Cerca
de 90% dos casos de acromegalia são decorrentes de somatotropinomas [adenomas
hipofisários secretores de hormônio de crescimento (GH)]. Cerca de 2% são
decorrentes de secreção eutópica ou ectópica de hormônio liberador de hormônio
do crescimento (GHRH). Raramente, a causa é a secreção ectópica de GH.</li>
</ul>
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<b><span style="font-size: 14.0pt; line-height: 107%;">EPIDEMIOLOGIA<o:p></o:p></span></b></div>
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<ul>
<li style="text-align: justify;">A
acromegalia tem uma incidência de 3 casos por milhão de pessoas por ano e
prevalência de 40 a 70 casos por milhão de habitantes.</li>
<li style="text-align: justify;">O
pico de incidência da acromegalia ocorre entre os 30 e 50 anos de idade.
Pacientes mais jovens em geral exibem tumores mais agressivos.</li>
</ul>
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<b><span style="font-size: 14.0pt; line-height: 107%;">CLASSIFICAÇÃO<o:p></o:p></span></b></div>
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<ul>
<li style="text-align: justify;">Em
relação ao tamanho do tumor:</li>
<ul>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;"><b>Microadenomas:</b> tamanho menor que 1 centímetro;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;"><b>Macroadenomas:</b> tamanho igual ou superior a 1
centímetro. Respondem por mais de 70% dos casos.</span></li>
</ul>
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<b><span style="font-size: 14.0pt; line-height: 107%;">QUADRO CLÍNICO<o:p></o:p></span></b></div>
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<ul>
<li style="text-align: justify;">É
uma doença insidiosa de modo que o diagnóstico geralmente atrasa em 7 a 10
anos. Clinicamente, manifesta-se:</li>
<ul>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">pelo efeito de massa do tumor: distúrbios
visuais, paralisia de nervos cranianos por invasão do seio cavernoso e
cefaleia; ou</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">pelo excesso de GH e IGF-1:</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">crescimento excessivo: macrognatia, crescimento
dos pés e das mãos, hipertrofia de tecidos moles, macroglossia. Em pacientes
jovens que ainda não tiveram o fechamento da cartilagem de crescimento, ocorre
crescimento estatural excessivo e gigantismo;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">por complicações musculoesqueléticas: artalgias,
síndrome do túnel do carpo, miopatia;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">por complicações sistêmicas: hipertensão
arterial sistêmica (30%), diabete melito, cardiopatia, hipertrofia do
ventrículo esquerdo e apnéia do sono;</span></li>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">aumento da incidência de neoplasias,
especialmente de cólon (controverso);</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">por hiperprolactinemia: alterações menstruais e
galactorréia no sexo feminino; e impotência, sintomas de hipogonadismo e
galactorréia no sexo masculino.</span></li>
</ul>
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<b><span style="font-size: 14.0pt; line-height: 107%;">DIAGNÓSTICO<o:p></o:p></span></b></div>
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<b style="text-indent: 18pt;"><span style="font-size: 12.0pt; line-height: 107%;"><br /></span></b></div>
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<b style="text-indent: 18pt;"><span style="font-size: 12.0pt; line-height: 107%;">DIAGNÓSTICO LABORATORIAL:</span></b></div>
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</div>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">GH sérico
basal:</b><span style="text-indent: -18pt;"> elevado (maioria dos casos). Um valor muito baixo de GH (< 0,4
ng/mL) exclui o diagnóstico de acromegalia, principalmente se associado a nível
sérico de IGF-1 normal;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">IGF-1
sérico basal:</b></li>
<ul>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">Acromegalia: elevado (maioria dos casos);</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">A dosagem de IGF-1 sérico basal, juntamente com
o teste de supressão do GH com sobrecarga de glicose, serve para o diagnóstico
e avaliação da resposta ao tratamento.</span></li>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">GH após
sobrecarga de glicose:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Dosagem de GH nos tempos 0, 30, 60, 90 e 120
minutos após a administração de 75g de glicose, VO.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Normal: níveis de GH caem para níveis inferiores
a 0,4 ng/mL em pelo menos uma das dosagens (supressão do GH).</span></li>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">Pacientes com acromegalia: ausência de supressão
dos valores de GH em relação ao basal.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Esse teste, juntamente com o IGF-1 sérico basal,
pode ser usado no diagnóstico e para avaliar a resposta ao tratamento.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Esse teste é contra-indicado em pacientes
portadores de diabete melito. Para esses pacientes, o valor basal de GH e o
mesmo ponto de corte de 0,4 ng/mL devem ser adotados para caracterizar a
não-supressão.</span></li>
</ul>
</ul>
<div style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="text-indent: 35.4pt;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="text-indent: 35.4pt;">Outros exames
a serem solicitados na avaliação do paciente com acromegalia:</span></div>
<div class="MsoNormal" style="text-align: justify;">
</div>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Glicemia
de jejum:</b><span style="text-indent: -18pt;"> frequentemente encontra-se elevada nos pacientes com acromegalia;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Avaliação da função adenohipofisária de paciente
com acromegalia:</span></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Cortisol
sérico basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">TSH
sérico basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">T4 livre
sérico basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Prolactina
sérica basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><u style="text-indent: -18pt;">Homens</u><span style="text-indent: -18pt;">:</span></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">LH sérico
basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">FSH
sérico basal</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Testosterona
total</b><span style="text-indent: -18pt;">;</span></li>
</ul>
<li style="text-align: justify;"><u style="text-indent: -18pt;">Mulheres</u><span style="text-indent: -18pt;">: a avaliação dos ciclos
menstruais é suficiente para avaliação gonadal.</span></li>
</ul>
</ul>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
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<o:p></o:p></div>
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<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<o:p> </o:p><span style="text-indent: 35.4pt;">Observação:
durante o tratamento e a monitorização da doença, é importante que sejam
utilizados os mesmos métodos de dosagem dos níveis séricos de GH e IGF-1.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="text-indent: 35.4pt;"><span style="font-size: 12.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="text-indent: 35.4pt;"><span style="font-size: 12.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="text-indent: 35.4pt;"><span style="font-size: 12.0pt; line-height: 107%;">DIAGNÓSTICO POR EXAME DE IMAGEM:</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
</div>
<ul>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">RESSONÂNCIA
MAGNÉTICA DE SELA TÚRCICA:</b><span style="text-indent: -18pt;"> todos os pacientes devem ser avaliados por RMN
de sela túrcica. Os pacientes com contra-indicação para esse exame, devem ser
submetidos a </span><b style="text-indent: -18pt;">TOMOGRAFIA COMPUTADORIZADA
DE SELA TÚRCICA</b><span style="text-indent: -18pt;">.</span></li>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-align: left;">Os pacientes com diagnóstico clínico e laboratorial de acromegalia que apresentarem RMN ou TC de sela túrcica normal devem ser investigados para tumor ectópico produtor de GH e submetidos a:</span></li>
</ul>
<div style="text-align: justify;">
<br /></div>
<ul><ul>
<li><span style="text-indent: -18pt;"><b style="text-align: justify; text-indent: -18pt;">TOMOGRAFIA COMPUTADORIZADA DE TÓRAX</b><span style="text-align: justify; text-indent: -18pt;">;</span></span></li>
<li><b style="text-align: justify; text-indent: -18pt;">TOMOGRAFIA
COMPUTADORIZADA DE ABDOME</b><span style="text-align: justify; text-indent: -18pt;">.</span></li>
</ul>
</ul>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<o:p></o:p></div>
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<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 35.4pt;">
Outros exames
a serem realizados nos pacientes com acromegalia:<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
</div>
<ul>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">ECOCARDIOGRAFIA</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">AVALIAÇÃO
DE DISTÚRBIOS DO SONO</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">COLONOSCOPIA</b><span style="text-indent: -18pt;">;</span></li>
<li style="text-align: justify;"><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><b style="text-indent: -18pt;">CAMPIMETRIA
VISUAL</b><span style="text-indent: -18pt;">.</span></li>
</ul>
<div style="text-align: justify;">
<!--[if !supportLists]--><o:p></o:p><br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
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<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<o:p><br /></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14.0pt; line-height: 107%;">TRATAMENTO<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
O
tratamento pode ser considerado primário (primeiro tratamento utilizado para
controlar a doença a longo prazo) ou secundário (visa controlar a doença nos
pacientes não compensados após a realização do tratamento primário).<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
</div>
<ul>
<li style="text-align: justify;"><b><span style="font-size: 12.0pt; line-height: 107%;">TRATAMENTO PRIMÁRIO</span></b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">TRATAMENTO
CIRÚRGICO:</b></li>
<ul>
<li style="text-align: justify;"><u style="text-indent: -18pt;">Para a maioria dos pacientes, o tratamento
primário de escolha para acromegalia é cirúrgico</u><span style="text-indent: -18pt;">.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">É o tratamento de escolha para os microadenomas
(taxa de sucesso de 75-95%), macroadenomas não invasivos (taxa de sucesso de
40-68%) e tumores que provocam sintomas
compressivos.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Tumores com
extensão para seio cavernoso ou outras características de maior invasão:
tem baixa probabilidade de cura cirúrgica, porém o tratamento cirúrgico leva a
uma melhor resposta ao tratamento posterior.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Complicações: fístula liquórica, infecções
(meningite e sinusite), hipopituitarismo e diabete insípido.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Não requer tratamento pré-operatório com
análogos da somatostatina.</span></li>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">TRATAMENTO
MEDICAMENTOSO</b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">TRATAMENTO
COM ANÁLOGOS DA SOMATOSTATINA:</b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Tratamento
primário:</b><span style="text-indent: -18pt;"> </span><u style="text-indent: -18pt;">reservado apenas para os pacientes com contraindicação ao
tratamento cirúrgico e sem sintomas compressivos secundários ao tumor</u><span style="text-indent: -18pt;">.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Mecanismo de ação: estimulam o receptor de
somatostatina, diminuindo a secreção de GH e a proliferação dos somatotrofos.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Os pacientes respondedores e sem efeitos
adversos na fase run in apresentam as mais elevadas taxas de resposta. A taxa
de resposta em pacientes não selecionados é de 40%. A redução tumoral ocorre em
75% dos pacientes, com redução tumoral em média de 50% do volume da massa
tumoral.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Efeitos colaterais: desconforto e cólicas
abdominais (melhoram em cerca de 8-10 semanas após o início do tratamento, com
a manutenção do tratamento), litíase biliar, colecistite (rara), pancreatite,
piora de estados hiperglicêmicos.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Contraindicação: gestação.</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">OCTREOTIDA:</b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Octreotida
de curta duração:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Utilizada para avaliar a tolerabilidade do
paciente à medicação, antes de iniciar o uso da formulação de longa duração;</span></li>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">Apresentação: ampola de 0,1 mg/mL.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Posologia: 100 mcg, via subcutânea, dose única.</span></li>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Octreotida
de longa duração:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Mais utilizada para o tratamento a longo prazo.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">OCTREOTIDA LAR (long acting release):</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Propicia níveis plasmáticos efetivos por
aproximadamente 28 dias após injeção muscular única.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Apresentação: ampola de 10, 20 e 30 mg/mL.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Posologia:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Iniciar com 20 mg, IM, 28/28 dias;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Ajuste: a dose deve ser ajustada em intervalos
de 3-6 meses, baseando-se nos níveis séricos de GH e IGF-1. Sem resposta:
aumentar para 30 mg, IM, 28/28 dias. Com resposta: reduzir para 20 mg, IM,
28/28 dias ou 30 mg, IM, 6/6 semanas.</span></li>
</ul>
</ul>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">LANREOTIDA:</b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">LANREOTIDA
SOLUÇÃO INJETÁVEL DE LIBERAÇÃO PROLONGADA:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Administrada a cada 28-56 dias, via subcutânea;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Apresentação: seringa preenchida de 60, 90 e 120
mg.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Posologia:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Iniciar com 90 mg, via subcutânea, 1 vez ao mês.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Ajuste: Reavaliar após 3 meses, considerando a
resposta pelos níveis séricos de GH e IGF-1. Se os sintomas se mostrarem
estáveis e os níveis hormonais normais, reduzir a dose para 60 mg, via
subcutânea profunda, 1 vez ao mês. Se os sintomas e os níveis de IGF-1
estiverem normais, e o GH basal > 1-2,5 ng/mL, a dose é mantida em 90 mg, via
subcutânea profunda, mensalmente. Se o paciente apresentar sintomas
não-controlados ou níveis elevados de GH ou IGF-1, a dose deverá ser aumentada
para 120 mg, via subcutânea profunda, 1 vez por mês (dose máxima).</span></li>
</ul>
</ul>
</ul>
</ul>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">TRATAMENTO
COM AGONISTAS DA DOPAMINA:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Indicação:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Como monoterapia: apenas como substituição nos
casos de intolerância aos análogos de somatostatina.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Tratamento primário reservado apenas para os
pacientes com contraindicação ao tratamento cirúrgico e sem sintomas
compressivos secundários ao tumor.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Terapia associada aos análogos de somatostatina:
para os pacientes que não apresentaram resposta ao tratamento com análogos de
somatostatina.</span></li>
</ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Medicamento agonista da dopamina indicado pelo
protocolo:</span></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">CABERGOLINA:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Apresentação: comprimido de 0,5 mg.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Posologia:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Iniciar com 1,0 mg, VO, semanalmente.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Ajuste da dose: Aumentar a dose até 3,5 mg, VO,
semanalmente conforme a resposta baseada nos níveis séricos de GH e IGF-1 em
intervalos de 3-6 meses.</span></li>
</ul>
</ul>
</ul>
</ul>
</ul>
</ul>
<div style="text-align: justify;">
<br /></div>
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<o:p></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<o:p><br /></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 12.0pt; line-height: 107%;">TRATAMENTO SECUNDÁRIO</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
</div>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">TRATAMENTO
MEDICAMENTOSO:</b></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">ANÁLOGOS
DA SOMATOSTATINA ou AGONISTAS DA DOPAMINA:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Indicação:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Resposta parcial ou sem resposta após o
procedimento cirúrgico; ou</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Antes de obter o efeito pleno do tratamento
radioterápico.</span></li>
</ul>
</ul>
</ul>
</ul>
<div style="text-align: justify;">
<br /></div>
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<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 12.0pt; line-height: 107%;">TRATAMENTO DE TERCEIRA
LINHA</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
</div>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Utilizado nos pacientes que não atingiram
controle da doença após o tratamento cirúrgico e medicamentoso;</span></li>
<li style="text-align: justify;"><b style="text-indent: -18pt;">RADIOTERAPIA:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Resultados:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Normalização de GH e IGF-1:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">50-60% dos pacientes em 5-10 anos;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">65-87% dos pacientes em 15 anos;</span></li>
</ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Controle do crescimento tumoral:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">90-100% dos casos logo após o tratamento
radioterápico.</span></li>
</ul>
</ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Complicações: Hipopituitarismo, defeitos
visuais, tumores secundários, eventos cerebrovasculares e alterações cognitivas
a longo prazo.</span></li>
</ul>
</ul>
<div style="text-align: justify;">
<br /></div>
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<br /></div>
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<o:p><br /></o:p></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 12.0pt; line-height: 107%;">TEMPO DE TRATAMENTO
MEDICAMENTOSO</span></b></div>
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</div>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Os pacientes em tratamento medicamentoso para
acromegalia que apresentarem resposta adequada, podem ter a suspensão do
tratamento somente quando:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">tiverem sido submetidos à radioterapia;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">tiverem sido submetidos a tratamento cirúrgico
adicional</span></li>
</ul>
</ul>
<b><span style="font-size: 14.0pt; line-height: 107%;"></span></b><br />
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-size: 14.0pt; line-height: 107%;"><b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></span></b></div>
<b><span style="font-size: 14.0pt; line-height: 107%;">
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<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">MONITORIZAÇÃO DO
TRATAMENTO</span></b></div>
</span></b><br />
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</div>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">O tratamento da acromegalia visa:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Controlar a secreção de GH e IGF-1;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Controle do tumor e dos sinais de excesso de GH
e IGF-1;</span></li>
<li style="text-align: justify;"><span style="font-family: "courier new"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;"> </span></span><span style="text-indent: -18pt;">Diminuição das complicações da acromegalia;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Diminuição dos sintomas relacionados ao
crescimento do tumor e suas complicações;</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Diminuição da mortalidade.</span></li>
</ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">A </span><b style="text-indent: -18pt;">MONITORIZAÇÃO</b><span style="text-indent: -18pt;">
é feita:</span></li>
<ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Após o
tratamento cirúrgico:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;"><b>Dosagem de GH e IGF-1 após sobrecarga de glucose:
</b>deve ser realizado 3-6 meses depois do procedimento. Não deve ser realizado em
pacientes diabéticos (nestes pacientes, deve ser realizada a dosagem sérica basal
de GH e IGF-1).</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;"><b>Ressonância magnética nuclear de sela túrcica:</b>
6-12 meses após o procedimento cirúrgico. A periodicidade posterior dependerá
da resposta do paciente ao tratamento, devendo ser realizada imediatamente sempre
que aparecerem sinais clínicos ou laboratoriais de recorrência.</span></li>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Durante
tratamento com análogos da somatostatina ou agonista dopaminérgico:</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;"><b>Dosar GH e IGF-1 sérico basal </b>a cada 3-6 meses.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;"><b>Ressonância magnética nuclear de sela túrcica:</b></span></li>
</ul>
<li style="text-align: justify;"><b style="text-indent: -18pt;">Acompanhamento
pós-tratamento (mesmo pacientes considerados curados):</b></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Avaliações clínicas e laboratoriais trimestrais
no primeiro ano e, após, anualmente. Essa periodicidade pode ser modificada
pela presença de alterações clínicas ou laboratoriais.</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Avaliar também: hipertensão, diabete melito,
cardiopatia acromegálica.</span></li>
</ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">RESULTADOS ENCONTRADOS:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Acromegalia controlada:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">Dosagem de GH e IGF-1 após sobrecarga de
glicose:</span></li>
<ul>
<li style="text-align: justify;"><span style="text-indent: -18pt;">IGF-1 dentro do nível normal; e</span></li>
<li style="text-align: justify;"><span style="text-indent: -18pt;">GH: nadir de GH <0,4 ng/mL.</span></li>
</ul>
</ul>
</ul>
</ul>
</ul>
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<b><span style="font-size: 14.0pt; line-height: 107%;"><br /></span></b></div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">TERMO DE ESCLARECIMENTO
E RESPONSABILIDADE – TER</span></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
É
obrigatória a informação ao paciente ou a seu responsável legal dos benefícios,
potenciais riscos e efeitos colaterais relacionados ao uso dos medicamentos
preconizados neste protocolo. O TER é obrigatório ao se prescrever medicamento
do Componente Especializado da Assistência Farmacêutica.</div>
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<b><span style="font-size: 14.0pt; line-height: 107%;">REFERÊNCIA
BIBLIOGRÁFICA:</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
</div>
<ol>
<li style="text-align: justify;"><a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/02/pcdt-acromegalia-livro-2013.pdf" style="text-indent: -18pt;">Protocolo
Clínico e Diretrizes Terapêuticas: Acromegalia (Portaria SAS/MS n° 199, de 25
de fevereiro de 2.013, republicada em 22 de novembro de 2.013).</a></li>
</ol>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-21566257323510458142016-07-18T17:56:00.000-07:002016-07-18T17:56:29.555-07:00SINVASTATINA<div style="text-align: justify;">
<b><br /></b></div>
<div class="separator" style="clear: both; text-align: center;">
<b><a href="http://www.luizhorta.com/" target="_blank"><img alt="http://www.luizhorta.com/" border="0" height="58" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfDoo2q9FURyhFfKO7gu2ogJe-8sRCxNT55GLzQe4k8QqlodoJkS_-dsDvZpl11eiTH_bcvKUQhB7ompsstEV3puGToV6705cLCMAvd3fQi-geCVkBGyvmWKNeJg_14SNoOftkJjPnh7A/s400/profluizhorta.jpg" width="400" /></a></b></div>
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<br /></div>
<div dir="ltr" id="docs-internal-guid-1a08ad35-06b6-2325-1c4a-2a1c24dde83e" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<div style="text-align: center;">
<br /></div>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SINVASTATINA</span></div>
<b id="docs-internal-guid-15905a60-00a9-5365-48a1-cd9c48343cd4" style="font-weight: normal;"><br /></b>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTRODUÇÃO</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipolipemiante do grupo das estatinas inibidor da HMG-CoA resutase</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MECANISMO DE AÇÃO</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A Sinvastatina inibe a HMG-CoA redutase, reduzindo o LDL, apo B e triglicérides e elevando o HDL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Sinvastatina é um derivado metilado da lovastatina que age por inibição competitiva da 3-hjidroxi-3-metilglutaril-coenzima A (HMG-CoA) redutase, enzima marca-passo da biosíntese de colesterol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Início de ação: > 3 dias</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Efeito máximo: após 2 semanas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica (reduzir colesterol total, LDL-C e apo B): se, após dietoterapia adequada, LDL-C ≥ 190 mg/dL ou ≥ 160 mg/dL com histórico familiar de doença cardiovascular prematura, ou presença de ≥ 2 fatores de risco cardiovascular (idade ≥ 10 anos; meninas somente após a menarca)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia primária (heterozigota, familial ou não familial) ou Dislipidemia mista (Fredrickson tipos IIa e IIb): para reduzir colesterol total, LDL-C, apo B e triglicérides (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertrigliceridemia (Fredrickson tipo IV)(adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disbetalipoproteinemia primária (Fredrickson tipo III) (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar homozigótica (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prevenção secundária dos eventos cardiovasculares em pacientes hipercolesterolêmicos com doença coronariana estabelecida ou com elevado risco de doença coronariana (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">APRESENTAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CLINFAR, SINVASMAX, SINVASTACOR, </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SINVASTATINA</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: comprimidos 5 mg, 10 mg, 20 mg, 40 mg e 80 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CORDIRON: comprimidos 5 mg e 10 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">LIPISTATINA, MEVILIP, SINVALIP, SINVASCOR, VASTATIL, ZOCOR: 10 mg, 20 mg, 40 mg e 80 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">LIPTRAT: comprimidos 10 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SINVASTON: comprimidos 10 mg e 20 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VASLIP: comprimidos 10 mg, 20 mg e 40 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ASSOCIAÇÕES:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIOCOMB SI (VALSARTANO 80 mg ou 160 mg + SINVASTATINA 20 mg)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PREVENCOR (ÁCIDO ACETILSALICÍLICO 100 MG + SINVASTATINA 10 mg, 20 mg ou 40 mg)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VYTORIN (EZETIMIBE 10 mg + SINVASTATINA 10 mg, 20 mg, 40 mg e 80 mg)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ZETSIM (EZETIMIBE 10 mg + SINVASTATINA 10 mg, 20 mg e 40 mg)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">POSOLOGIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pode ser ingerido à noite, com ou sem alimentos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Para a administração por sonda, o comprimido pode ser disperso em água e utilizado imediatamente em separado da dieta enteral</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em caso de esquecimento da dose, orientar o paciente que a tome assim que lembrar, exceto se estiver próximo do horário da dose seguinte, quando deve ser pulada a dose esquecida, não dobrando a dose para compensar o esquecimento</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PEDIATRIA: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças e adolescentes > 10 anos de idade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (meninas: >1 ano após a menarca)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica: 10 mg/dia, VO, 1 vez por dia, à noite. Ajustar dose em intervalos de 4 semanas ou mais até a dose máxima de 40 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperlipidemia:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças < 10 anos:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: 5 mg/dia, VO, 1 vez ao dia, à noite; Aumentar para 10 mg/dia, VO, 1 vez ao dia, à noite, após 4 semanas; e para 20 mg/dia, VO, 1 vez ao dia, à noite, após mais 4 semanas, se tolerado</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças > 10 anos: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: 10 mg/dose, VO, 1 vez ao dia, à noite; Aumentar para 20 mg/dia, VO, 1 vez ao dia, à noite, após 6 semanas; e para 40 mg/dia, VO, 1 vez ao dia, à noite, se tolerado</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">10-17 anos: Iniciar com 10 mg/dia, VO, 1 vez ao dia, à noite e aumentar a dose a cada 4 semanas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">> 17 anos: iniciar com 20-40 mg/dia, VO, 1 vez ao dia, à noite e aumentar a dose em intervalos de 4-8 semanas até atingir o nível-alvo para o LDL-C</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajustar a dose segundo o LDL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ADULTOS:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A dose deve ser ajustada segundo o LDL-C a cada 4 semanas ou mais</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A dose de 80 mg/dia de sinvastatina está limitada aos pacientes que já estejam utilizando essa dose por > 12 meses consecutivos sem evidência de miopatia e sem uso concomitante de uma medicação com interação medicamentosa que contraindique a associação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Se o paciente se encontra em uso de sinvastatina 40 mg/dia sem alcançar a meta de LDL-C, não há indicação de aumentar a dose para 80 mg/dia, mas substituir a sinvastatina por outro redutor de LDL-C com maior poder de redução</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Deve ser administrada à noite: no jantar ou antes de dormir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familial homozigótica: 40 mg/dia,1 vez ao dia, à noite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prevenção de eventos cardiovasculares, hiperlipidemias:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">10-20 mg/dia, VO, 1 vez ao dia, à noite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Moderada redução de LDL-C: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: 5-10 mg,VO, 1 vez ao dia, à noite. Ajuste até alcançar a meta do LDL-C>2.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Redução > 40% do LDL-C:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: 40 mg/dL/dia, VO, 1 vez ao dia, à noite. Ajuste a dose até alcançar a meta do LDL-C</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paciente com doença coronariana ou elevado risco de doença cardiovascular (diabetes, doença vascular periférica, história de acidente vascular encefálico ou outra doença cerebrovascular): </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: 40 mg/dia, VO, 1 vez ao dia, à noite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste na insuficiência renal:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leve a moderada: não necessita ajuste;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Grave (Cl</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">Cr</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> < 30 mL/minuto): Dose inicial: 5 mg/dia, VO, 1 vez ao dia, à noite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência hepática: contra-indicado o uso de sinvastatina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose máxima: 80 mg/dia, VO, melhor usar de forma fracionada nas refeições 20 mg + 20 mg + 40 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em associação com drogas que aumentam o risco de rabdomiólise, usar 10-20 mg/dia, no máximo</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dosagem:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Função renal:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TFG < 10 mg/min: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cl</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">Cr</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> < 30 mL/minuto: iniciar com 5 mg/dia, VO, 1 vez ao dia, à noite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
</ul>
</ul>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EFEITOS COLATERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distúrbios psíquicos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ansiedade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anorexia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Depressão</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Redução da libido</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção erétil / Impotência</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cefaléia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vertigem</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tremor</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tontura</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alteração na gustação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Secura da pele e membrana mucosa</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Catarata</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Neuropatia periférica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paresia facial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Parestesia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fotossensibilidade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprometimento da musculatura ocular extrínseca</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oftalmoplegia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paralisia de nervos periféricos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Polimialgia reumática</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paralisia facial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ginecomastia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor abdominal</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Constipação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gastrite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Náusea</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vômitos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dispepsia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Flatulência</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diarréia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatoma</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Icterícia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Icterícia colestática</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cirrose</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fígado gorduroso</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Necrose hepática fulminante</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das bilirrubinas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das transaminases (> 3 vezes o valor superior da normalidade)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência hepática fatal ou não-fatal: ocorre raramente com hiperbilirrubinemia, sintomas clínicos de hepatotoxicidade e icterícia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência renal (secundária à rabdomiólise)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção tireoidiana</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Erupção cutânea</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vasculite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Urticária</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Flushing</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eczema</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reações de hipersensibilidade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anafilaxia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prurido</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Púrpura</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rash</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descoloração da pele</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Angioedema</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dermatomiosite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Urticária</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alopécia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eritema multiforme</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alterações ungueais</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nódulos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome de Stevens Johnson</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome lúpus eritematoso sistêmico- like</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Necrólise epidérmica tóxica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pancreatite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vasculite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Epidermólise</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mal-estar</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gripe e resfriado</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Calafrios</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Bronquite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Infecção das vias aéreas superiores</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dispnéia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ginecomastia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Impotência</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção tireoidiana</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anemia hemolítica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leucopenia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eosinofilia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Plaquetopenia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da fosfatase alcalina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aumento da velocidade de hemossedimentação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da hemoglobina glicada (HbA1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">C</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da glicemia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ANA positivo</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Espasmos musculares</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fraqueza muscular</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mialgia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Polimialgia reumática</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miopatia (elevação da CPK)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da CPK (> 3 vezes o limite superior da normalidade)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">elevação da gama-glutamiltransferase (GGT)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor muscular</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Artalgia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Artrite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fibrilação atrial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Doença pulmonar intersticial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Edema</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise (sintomas: dor muscular, fraqueza muscular, aumento de CPK. Risco é maior se associado a genfibrozila, macrolídeo, diltiazen, fluvoxamina, antirretrovirais, verapamil, amiodarona, azólicos, ciclosporina, etc.) e insuficiência renal aguda</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miopatia autoimune-mediada (IMNM): ocorre raramente com o uso de inibidores da HMG-CoA redutase. Apresenta-se com fraqueza muscular proximal e níveis elevados de CPK (que persistem após a suspensão da droga). Biópsia muscular: miopatia necrotizante com inflamação limitada. Tratamento: terapia imunossupressora (corticosteróides, azatioprina)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da HbA1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">C</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> ou da glicemia de jejum (essa elevação não justifica a suspensão do medicamento quando a vantagem do efeito hipolipemiante compensar o efeito adverso</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Piora cognitiva reversível: ocorre raramente, com confusão mental, esquecimento, amnésia e perda da memória). Pode ocorrer 1 dia ou anos início do tratamento e são reversíveis após descontinuação do mesmo (geralmente dentre de 3 semanas)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CONTRA-INDICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gravidez (teratogenicidade)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1, 2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lactação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipersensibilidade à sinvastatina ou seus componentes</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Transaminases persistentemente elevadas sem etiologia conhecida</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso concomitante de sinvastatina com: inibidores fortes da CYP3A4 (boceprevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, claritromicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, eritromicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, antirretrovirais inibidores de protease do HIV</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, itraconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, cetoconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, nefazodona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, posaconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, telaprevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, telitromicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, voriconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">), ciclosporina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, danazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, gemfibrozila</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> e suco de toranja</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatopatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Associação com genfibrozila</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTERAÇÕES MEDICAMENTOSAS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar uso concomitante de sibutramina com: bocepevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ciclosporina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidor de CYP3A4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, eritromicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ácido fusídico</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, gemfibrozila</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, mifepristona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidores de protease</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, arroz fermentado vermelho (red yeast rice)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, telaprevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinvastatina aumenta níveis/efeitos de: aripiprazole</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, daptomicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, diltiazen</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, pazopanib</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, trabectedin</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, antagonistas da vitamina K</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os níveis/efeitos da sinvastatina podem ser elevados por: amiodarona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, amlodipina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, benzafibrato</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, bocepevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, colchicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ciclosporina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidores da CYP3A4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ciproterona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, danazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, posaconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, risperidona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, voriconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, dasatinib</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, diltiazen</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, dronedarone</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, eltrombopag</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, eritromicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fenofibrato</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ácido fenofíbrico</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fluconazol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ácido fusídico</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, gemfibrozila</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, suco de toranja</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, chá verde</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, imatinibe</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ivacaftor</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, lomitapide</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, antibióticos macrolídeos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, mifepristona</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, niacina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, niacinamida</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidores de protease</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, quinino</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ranolazine</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, arroz fermentado vermelho</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, sildenafil</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, telaprevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ticagrelol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, verapamil</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinvastatina pode reduzir os níveis/efeitos de: lanthanum</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, levotiroxina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os níveis/efeitos de sinvastatina podem ser diminuídos por: antiácidos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, carbamazepina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, oxcarbamazepina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, bosentan</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, indutores de CYP3A4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, dabrafenid</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, deferasirox</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, efavirenz</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, etravirine</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fosfenitoína</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fenitoína</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, derivados da rifamicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, rifampicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, erva de São João (St Johns wort)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, tocilizumab</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MONITORIZAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pediatria:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Basal: ALt, AST, CPK, colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">4 semanas após início da terapia: ALT e AST</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Se não houver sinais de miopatia ou alterações laboratoriais: dosar ALT, AST e colesterol total e frações a cada 4 meses no primeiro ano e a cada 6 meses a partir de então</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Basal: CPK, ALT, AST, colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinais ou sintomas de miopatia: dosar novamente CPK a qualquer momento e suspender terapia com sinvastatina de CPK marcadamente elevada)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Dosar CPK antes, 2 meses após introdução do medicamento e, a seguir, a cada 6 meses</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ALT ou AST elevados: repetir a dosagem para confirmar e monitorizar frequentemente. Se ALT/AST ficar persistentemente > 3 vezes o valor superior da normalidade, suspender a sinvastatina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Colesterol total e frações: dosar a cada 6-8 semanas após início da terapia até alcançar a meta. Após alcançar a meta, dosar a cada 4-6 meses</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CUIDADOS GERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Afastar as causas de hiperlipidemia secundária antes da introdução de sinvastatina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pode causar tontura: evitar dirigir ou outras atividades que requeiram estado de alerta</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recomendar uso de protetor solar e evitar exposição ao sol para prevenir reações de fotossensibilidade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O regime de dose de manutenção deve ser reduzido em pacientes com propensão a miopatia (descendentes de chineses) ou no uso concomitante de outros hipolipemiantes (niacina, derivados do ácido fíbrico), amiodarona, amlodipina, diltiazem, dronedarona, ranolazine, verapamil</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes em tratamento com inibidores da HMG-CoA redutase podem desenvolver rabdomiólise com ou sem insuficiência renal e/ou miopatia, principalmente em doses de sinvastatina superiores a 80 mg/dia, uso concomitante de outros inibidores da HMG-Coa redutase, outros hipolipemiantes (derivados do ácido fíbrico ou niacina em doses > 1 g/dia), inibidores potentes da CYP3A4 ou grandes quantidades de suco de toranja</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reduzir a dose de sinvastatina quando da associação desta com: verapamil, diltiazen, dronedarona, amiodarona, amlodipina, lomitapide e ranolazine</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes chineses com uso de doses de 80 mg/dia de sinvastatina tem maior risco de miopatia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar o uso de sinvastatina se o paciente apresentar níveis de CPK > 10 vezes o limite superior da normalidade ou sinais de miopatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar o uso de sinvastatina quando o paciente for submetido a cirurgia maior eletiva, condições clínicas e cirúrgicas agudas ou em condições com risco de insuficiência renal (sepse, hipotensão, trauma, convulsões não-controladas)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Sinvastatina deve ser mantida no período perioperatório a menos que seus riscos suplantem os benefícios cardioprotetores</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Usar sinvastatina com cuidado em pacientes com insuficiência renal, hipotireoidismo não compensado, em uso de drogas com potencial para miopatia (colchicina), pelo elevado risco de miopatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes devem ser orientados a reportar dores musculares inexplicadas, fraqueza ou urina marrom</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Usar sibutramina com cuidado em pacientes com história de etilismo ou doença hepática prévia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">REFERÊNCIAS BIBLIOGRÁFICAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OLIVEIRA, R.G.: Blackbook Pediatria. Belo Horizonte, Blackbook Editora, 4° edição: 51, 2011.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TAKEMOTO, C.K.; HODDING, J.H. & KRAUS, D.M.: Pediatric & neonatal dosage handbook. Lexicomp, 20th edition: 1556-1559, 2013.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CARVALHO, P.R.A.; CARVALHO, C.G.; TORRIANI, M.S.; SANTOS, L.; BARROS, E. et al.: Medicamentos de A a Z - Pediatria - 2011/2012.Porto Alegre, Artmed: 842-844, 2012.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">BARROS, E. (org): Medicamentos de A a Z - 2014/2015. Porto Alegre, Artmed: 662-663, 2014.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DICIONÁRIO DE ESPECIALIDADES FARMACÊUTICAS 2014. Rio de Janeiro, Editora Publicações Científicas, 2013.</span></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-5629670665433705892016-07-14T17:55:00.001-07:002016-07-14T17:55:22.884-07:00PRAVASTATINA<div style="text-align: justify;">
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<span style="font-family: Arial; font-size: 24px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">PRAVASTATINA</span></div>
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<b id="docs-internal-guid-51b80654-ec0f-47a7-4dd1-2169faf8af1f" style="font-weight: normal;"><br /></b>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTRODUÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipolipemiante inibidor da HMG-CoA resutase</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MECANISMO DE AÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A Pravastatina inibe a HMG-CoA redutase, reduzindo o LDL, apo B e triglicérides e elevando o HDL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Pravastatina é um inibidor seletivo competitivo da 3-hidroxi-3-metilglutaril-coenzima A (HMG-CoA) redutase, enzima marca-passo da síntese de colesterol</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Início de ação: 2 semanas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Efeito máximo: após 4 semanas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÕES</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes ≧ 8 anos de idade como terapia coadjuvante quando LDL-C ≧ 190 mg/dL ou se ≧ 160 mg/dL com história familiar de doença cardiovascular prematura ou ≧ 2 riscos cardiovasculares</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia primária (heterozigota, familial e não familial) e Dislipidemia mista (Fredrickson tipos IIa e IIb):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adjuvante da terapia dietética para reduzir o colesterol total e LDL-C, apolipoproteína B (apo B) e triglicérides e aumentar os níveis de HDL-C (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertrigliceridemia isolada (Fredrickson tipo IV)(adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disbetalipoproteinemia primária (Fredrickson tipo III) (adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prevenção primária e secundária da doença cardiovascular em pacientes de alto risco (Alto Risco: ≧ 55 anos, tabagista, hipertensão, HDL-C baixo, história familiar de doença cardiovascular precoce; prevenção secundária para reduzir o risco de infarto agudo do miocárdio, choque, procedimento de revascularização e angina em pacientes com evidencia de doença arterial coronariana)(adultos)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">APRESENTAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">LENITRAL: comprimido 10 mg, 20 mg e 40 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PRAVASTATINA: comprimido 10 mg, 20 mg e 40 mg</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">POSOLOGIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A posologia deve ser individualizada de acordo com o nível basal de LDL-C, a meta terapêutica e a resposta do paciente</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Ajustes devem ser feitos com intervalos de 4 semanas</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pode ser administrado com ou sem alimentos em qualquer horário do dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Esquecimento de dose: tomar a dose assim que lembrar; no entanto, se estiver próximo ao horário da dose seguinte, pular a dose esquecida e tomar a do horário normal</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PEDIATRIA: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças e adolescentes:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperlipidemia ou hipercolesterolemia heterozigótica familiar ou não familiar: </span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Iniciar o tratamento se, após dieta adequada, paciente mantiver LDL-C ≥ 190 mg/dL ou LDL-C permanecer ≥ 160 mg/dL com história familiar positiva para doença cardiovascular precoce ou alcançar a classificação NCEP. A terapia pode ser considerada para as crianças de 8 a 9 anos de idade que prefassam os critérios acima ou para crianças com diabetes melito e LDL-C ≥ 130 mg/dL</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">8 a 13 anos de idade: 20 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">14 a 18 anos de idade: até 40 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ADULTOS:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperlipidemias, prevenção primária de eventos coronarianos, prevenção secundária de eventos cardiovasculares:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose inicial: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;"><ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OLIVEIRA (2011): 10-20 mg/dia, VO, 1 vez ao dia (Dose habitual: 20-40 mg/dia) (Dose máxima: 80 mg/dia)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TAKEMOTO et al (2013): 40 mg/dia, VO, 1 vez ao dia. Ajustar a dose segundo a resposta (dose habitual: 10-80 mg/dia)(Dose máxima: 80 mg/dia)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção renal ou hepática (não administrar em doença hepática instalada</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">) ou risco aumentado de miosite: Iniciar com 10 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Dose habitual: 10-20 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EFEITOS COLATERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cefaléia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fadiga</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tonteira</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Redução da memória</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Neuropatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise e insuficiência renal aguda</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Erupção cutânea (Rash)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descoloração da pele</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fotossensibilização</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anafilaxia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Angioedema</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Epidermólise</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eritema multiforme</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Náusea</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vômito</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diarréia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pirose</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Icterícia colestática</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cirrose</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção dos nervos cranianos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dermatomiosite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da velocidade de hemossedimentação (VHS)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Necrose hepática fulminante</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ginecomastia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Anemia hemolítica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatoma</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alteração da libido</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome lúpus eritematoso-like</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das transaminases</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatopatia: se ocorrer hepatotoxicidade com sintomatologia, hiperbilirrubinemia ou icterícia, suspender a pravastatina. Se uma etiologia alternativa não for encontrada, não retornar a usar a pravastatina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência hepática (rara)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pancreatite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Visão borrada</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Opacidade corneana e do cristalino</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mialgia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fraqueza muscular</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Neuropatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Parestesia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paralisia de nervo periférico</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Polimialgia reumática</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ANA positivo</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome de Stevens-Johnson;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distúrbio da gustação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tremor</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vasculite</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vertigem</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tosse</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da glicemia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Depressão</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diabetes melito (início recente)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dispneia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eosinofilia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção erétil</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paresia facial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aumento da hemoglobina glicosilada (HbA1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">C</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprometimento da musculatura ocular extrínseca</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Impotência</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Doença pulmonar intersticial</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leucopenia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mal-estar</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ofatmoplegia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Neuropatia periférica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fotossensibilidade</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distúrbios psíquicos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Palidez</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trombocitopenia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunção tireoidiana</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Necrólise epidérmica tóxica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gripe</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miopatia autoimune-mediada (IMNM): complicação rara, caracterizada por fraqueza muscular proximal com níveis elevados de CPK, que persistem após suspensão da pravastatina. Biópsia muscular pode revelar miopatia necrosante com inflamação limitada. Tratamento com terapia imunossupressiva (costicosteróides, azatioprina)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprometimento cognitivo reversível (confusão, esquecimento, amnésia e perda da memória) podem raramente ocorrer com o uso de inibidores da HMG-CoA redutase, após 1 dia a anos do início do tratamento e mantendo-se cerca de 3 semanas após sua suspensão</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor torácica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CONTRA-INDICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lactação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gestação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipersensibilidade à pravastatina ou qualquer componente</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Doença hepática ativa</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das transaminases persistente sem explicação</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MONITORIZAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pediatria:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Basal: ALT, AST, CPK, colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Repetir após 4 semanas de terapia: ALT, AST</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Se não houver sintomas de miopatia ou anormalidades laboratoriais:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Repetir a cada 3-4 meses durante o primeiro ano: ALT, AST e colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Após o primeiro ano, repetir a cada 6 meses: ALT, AST e colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos:</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Basal: CPK, ALT, AST e colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A cada 6-8 semanas até a dose adequada: colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Após a dose adequada, a cada 4-6 meses: colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosar novamente CPK se sinais de miopatia (Suspender a medicação se marcadamente elevado)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosar novamente ALT e AST se houver os valores basais estiverem elevados ou houver sinais de hepatopatia (suspender a terapia se transaminases persistentemente > 3 vezes o limite superior normal)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTERAÇÕES MEDICAMENTOSAS</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar uso concomitante de pravastatina com: ácido fusídico, gemfibrozila; pimozida, Arroz fermentado vermelho</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pravastatina aumenta os níveis/efeitos de: aripiprazole, ciclosporina, daptomicina, limitapide, paroxetina, pazopanib, pimozide, trabectedin, antagonistas da vitamina K</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os níveis/efeitos de pravastatina são elevados por: bezafibrato, Boceprevir, conchicina, ciclosporina, darunavir, eltrombopag, fenofibrato, ácido fenofíbrico, ácido fusídico, gemfibrozila, itraconazol, niacina, niacinamida, inibidores da P-glicoproteína/ABCB1, arroz fermentado vermelho, telaprevir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pravastatina reduz os níveis/efeitos de: lanthanum</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os níveis/efeitos da pravastatina são reduzidos por: antiácidos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, sequestradores de ácidos biliares</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, efavirenz</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fosfenitoína</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, nelfinavir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, indutores da P-glicoproteína/ABCB1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fenitoína</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, derivados da rifamicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, saquinavir</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, antagonistas da vitamina K</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, agentes antifúngicos</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ciclosporina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fenofibrato</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, rifampicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidores da protease</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, daptomicina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, colestiramina (administrar pravastatina 1 hora antes ou 4 horas após a resina)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CUIDADOS GERAIS</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Afastar causas de hiperlipidemia secundária antes de iniciar a pravastatina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mulheres em idades férteis devem ser aconselhadas a usar 2 métodos anticoncepcionais concomitantes</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O aumento da concentração sérica de hemoglobina glicada e a elevação da glicemia de jejum não justificam a suspensão da pravastatina quando os benefícios hipolipemiantes superarem a alteração glicêmica</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Usar pravastatina com cuidado nos pacientes que usam drogas que reduzem a esteroidogênese (cetoconazol, espironolactona, cimetidina)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosar CPK antes, 2 meses após introdução do medicamento e, a seguir, a cada 6 meses</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Inibidores da HMG-CoA redutase podem desenvolver rabdomiólise com ou sem insuficiência renal aguda e/ou miopatia, principalmente em uso concorrente de medicações hipolipemiantes (derivados do ácido fólicoou niacina em doses > 1 g/dia)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reduzir a dose de pravastatina quando uso concorrente de eritromicina, claritromicina ou ciclosporina</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar o uso de pravastatina se os níveis de CPK forem marcadamente elevados (> 10 vezes o limite superior normal) ou se houver sinais de miopatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar o uso de pravastatina temporariamente nos procedimentos cirúrgicos maiores eletivos, condições cirúrgicas ou clínicas agudas ou em situações de risco para insuficiência renal (sepse, hipotensão, trauma, convulsões não controladas)</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Use pravastatina com cuidado em pacientes com comprometimento renal, hipotireoidismo descompensado e em uso de drogas que predispõem à miopatia (colchicina) pelo risco de miopatia</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os pacientes devem ser orientados a procurar assistência médica na presença de dor muscular, fraqueza ou urina marrom</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">REFERÊNCIAS BIBLIOGRÁFICAS</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OLIVEIRA, R.G.: Blackbook Pediatria. Belo Horizonte, Blackbook Editora, 4° edição: 51, 2011.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TAKEMOTO, C.K.; HODDING, J.H. & KRAUS, D.M.: Pediatric & neonatal dosage handbook. Lexicomp, 20th edition: 1556-1559, 2013.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CARVALHO, P.R.A.; CARVALHO, C.G.; TORRIANI, M.S.; SANTOS, L.; BARROS, E. et al.: Medicamentos de A a Z - Pediatria - 2011/2012.Porto Alegre, Artmed: 774-775, 2012.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">BARROS, E. (org): Medicamentos de A a Z - 2014/2015. Porto Alegre, Artmed: 662-663, 2014.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DICIONÁRIO DE ESPECIALIDADES FARMACÊUTICAS 2014. Rio de Janeiro, Editora Publicações Científicas, 2013.</span></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-36506894775061761062016-07-14T17:52:00.000-07:002016-07-18T17:57:21.312-07:00ROSUVASTATINA<div style="text-align: justify;">
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<span style="font-family: "arial"; font-size: 24px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">ROSUVASTATINA</span></div>
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<b id="docs-internal-guid-9a7b7bc5-ec0c-6814-e732-f9aabd14a488" style="font-weight: normal;"><br /></b>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTRODUÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rosuvastatina é uma agente hipolipemiante inibidor da HMG CoA redutase</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MECANISMO DE AÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rosuvastatina é um inibidor da HMG CoA redutase</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A rosuvastatina age como inibidor seletivo e competitivo da 3-hidroxi-3-metilglutaril-coenzima A (HMG-CoA) redutase, enzima marca-passo da biossíntese de colesterol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">FARMACODINÂMICA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Início de ação: 1 semana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Efeito máximo: 4 semanas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">APRESENTAÇÕES</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CRESTOR: comprimidos 5 MG, 10 mg, 20 mg e 40 mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PLENANCE, ROSTATIN, ROSUCOR, ROSUSTATIN, RUSOVAS, TREZOR: comprimidos 10 mg e 20 mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VIVACOR: comprimidos 5 mg, 10 mg e 20 mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ROSUVASTATINA: comprimidos 10 mg e 20 mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÕES</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica: como adjuvante da terapia dietética para reduzir o colesterol total, LDL-C e apo. Pediatria: 10 a 17 anos (meninas: > 1 ano após a menarca)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia primária (Hiperlipidemia de Fredrickson tipo IIa, IIb e IV): para reduzir o colesterol total, LDL-C, apo B, Colesterol não-HDL e triglicérides. Adultos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertrigliceridemia (adultos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disbetalipoproteinemia (Hiperlipidemia de Fredrickson tipo III)(aduiltos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar homozigótica: para reduzir a progressão da aterosclerose e adjunto da dieta para reduzir o colesterol total e LDL-C (adultos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">POSOLOGIA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Administram com ou sem alimentos em qualquer horário do dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em caso de esquecimento da dose, ingerir o medicamento assim que lembrar, mas, se estiver próximo do horário da dose seguinte, pular a dose esquecida e tomar a do horário normal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PEDIATRIA: </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar heterozigótica: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">10-17 anos: 5-20 mg/dose, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Regular dose a cada 4 semanas. Dose máxima: 20 mg/dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar homozigota: </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">≧ 8 anos e ≧ 32Kg: início: 20 mg/dia, VO, 1 vez ao dia. Regular dose a cada 6 semanas até 40 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adolescentes: dose inicial: 10 mg/dia, VO, 1 vez ao dia. Ajustar a dose em intervalos de 2-4 semanas até atingir os níveis-alvo. Dose máxima: 40 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ADULTOS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hiperlipidemia, dislipidemia mista, hipertrigliceridemia, disbetalipoproteinemia primária, lentificação do processo de aterosclerose: Inicial: 10 mg/dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (20 mg/dia se LDL >190 mg/dL ou tratamento mais agressivo), VO, 1 vez ao dia. Após 2 semanas, a dose pode ser aumentada em 5-10 mg, VO, 1 vez ao dia. Dose de manutenção: 5-40 mg/dia, VO, 1 vez ao dia. Dose máxima: 40 mg/dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Dose de manutenção para os pacientes com tratamento menos agressivo ou com predisposição à miopatia (descendentes asiáticos, etc.): 5 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipercolesterolemia familiar homozigótica: Dose inicial: 20 mg/dia, VO, 1 vez ao dia. Dose máxima: 40 mg/dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose habitual: 10-20 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dose máxima: 40 mg/dia, VO, 1 vez ao dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ajuste de dose:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Função hepática: não indicado em pacientes com sinais de hepatopatia ou aumento das transaminases > 3 vezes o limite superior normal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Função renal: se Cl</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">Cr</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> < 30 mL/min, não exceder 10 mg/dia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MONITORIZAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pediatria:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosagem basal: ALT, AST, CPK, Colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Após 1 mês de tratamento: ALT, AST</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Na ausência de sinais de miopatia ou anormalidades laboratoriais: dosar colesterol total e frações, ALT e AST a cada 3-4 meses durante o primeiro ano e a cada 6 meses após</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dosagem basal: ALT, AST, CPK, colesterol total e frações</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Colesterol total e frações: 6-8 semanas após o basal e após ajuste de dosagem até alcançar a dose adequada. Após, repetir a cada 4-6 meses</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">International normalizes ratio (INR) nos pacientes em uso de warfarina (rosuvastatina eleva significativamente o INR quando associado a warfarina): antes do início do tratamento e frequentemente durante a terapia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Proteinúria: rosuvastatina pode causar proteinúria, necessitando redução da dosagem</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hematúria: rosuvastatina pode causar hematúria, necessitando redução da dosagem</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hb A1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: pode ser elevada pelo uso de rosuvastatina. Os benefícios da rosuvastatina podem compensar essa elevação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Glicemia de jejum: pode ser elevada pelo uso de rosuvastatina. Os benefícios da rosuvastatina podem compensar essa elevação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EFEITOS COLATERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cefaléia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distúrbio de memória</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insônia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pesadelos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tontura</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Astenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vertigem</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Náusea</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vômito</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor abdominal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pancreatite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Artralgia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da CPK</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Constipação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miodite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mialgia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fraqueza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miopatia autoimune mediada (MMM): raramente reportada, apresentando-se com fraqueza muscular proximal e elevação da CPK, que persistem após a descontinuação da rosuvastatina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A biópsia muscular pode revelar miopatia necrotizante com inflamação limitada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Tratamento: terapia imunossupressora (corticosteróides, azatioprina)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mioglobinúria</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hematúria (microscópica) e proteinúria, geralmente associada a dose de 40 mg/dia de rosuvastatina, transitória e não associada a redução da função renal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Considerar redução da dosagem da rosuvastatina se hematúria ou proteinúria inexplicadas persistirem</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência renal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hepatite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Icterícia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Insuficiência hepática não-fatal ou fatal: rara, acompanhada de hiperbilirrubinemia ou icterícia durante o tratamento com rosuvastatina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Interromper a terapia com rosuvastatina, somente reintroduzindo a terapia após descartar a medicação como causa da insuficiência hepática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Angioedema</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Prurido</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">rash cutâneo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Exantema</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Urticária</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alteração nos exames de função tireoidiana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aumento das transaminases (> 3 vezes superior ao limite normal)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da fosfatase alcalina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das bilirrubinas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da glicemia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diabetes melito (início recente)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da hemoglobina glicosilada (Hb A1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação da gama-glutamiltransferase (GGT)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Catarata</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ginecomastia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hematúria (microscópica)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome de hipersensibilidade: anafilaxia, angioedema, artralgia, eritema multiforme, eosinofilia, anemia hemolítica, miopatia necrotizante imune mediada (IMNM), doença pulmonar intersticial, lúpus, fotossensibilidade, polimialgia reumática, ANA positivo, púrpura, síndrome de Stevens-Johnson, necrólise epidérmica tóxica, urticária e vasculite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comprometimento cognitivo (confusão mental, esquecimento, amnésia e perda de memória) podem ocorrer durante a terapia (iniciando-se em um dia ou anos após início da terapia) de forma reversível (geralmente dentro de 3 semanas)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CONTRA-INDICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gestação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lactação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipersensibilidade à rosuvastatina ou algum de seus componentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Doença hepática aguda</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Elevação das transaminases inexplicada e persistente (> 3 vezes acima do limite normal)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar uso concomitante de rosuvastatina com: ácido fusídico, gemfibrozila, arroz fermentado vermelho (red yeast rice)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INTERAÇÕES MEDICAMENTOSAS</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rosuvastatina aumenta os níveis/efeitos de: daptomicina, trabectedin, antagonistas da vitamina K</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aumentam os níveis/efeitos de rosuvastatina: amiodarona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, benzafibrato</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, boceprevir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, colchicina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ciclosporina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, dronedarone</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fenofibrato</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ácido fenofíbrico</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ácido fusídico</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, gemfibrozila</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, itraconazol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, niacina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, niacinamida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, inibidores de protease</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, arroz fermentado vermelho</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, telaprevir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, atanazavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, darunavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, fluconazol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; fosamprenavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, lopinavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, nelfinavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, ritonavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, saquinvi</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rosuvastatina diminui os níveis/efeitos de: lanthanum</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os níveis/efeitos de rosuvastatina são diminuídos por: antiácidos (hidróxido de alumínio, hidróxido de magnésio)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,3,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, erva de São João</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, carbonato de cálcio</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; óxido de magnésio</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, hypericum</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CUIDADOS GERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Causas secundárias de hiperlipidemia devem ser descartadas antes da instituição da terapia com rosuvastatina</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Risco de rabdomiólise com ou sem insuficiência renal e/ou miopatia aumentam com o uso concomitante de rosuvastatina com outras medicações hipolipemiantes (fibratos ou niacina em doses > 1 g/dia) ou grandes quantidades de suco de toranja)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reduzir a dose de rosuvastatina quando em associação com ciclosporina, lopinavir/ritonavir ou atanazavir/ritonavir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar o uso de rosuvastatina quando níveis de CPK elevarem-se (> 10 vezes o limite normal) ou houver sinais de miopatia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Descontinuar a medicação quando de cirurgia eletiva, condições médicas ou cirúrgicas agudas, situações de risco de insuficiência renal aguda (sepse, hipotensão, trauma, convulsões não controladas)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Usar rosuvastatina com cautela em pacientes com comprometimento renal, hipotireoidismo não compensado, uso de drogas associadas a miopatia (colchicina), por aumentarem o risco de miopatia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cuidado ao associar rosuvastatina com condições ou medicações que reduzem a esteroidogênese (cetoconazol, espironolactona, cimetidina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OLIVEIRA, R.G.: Blackbook Pediatria. Belo Horizonte, Blackbook Editora, 4° edição: 51, 2011.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TAKEMOTO, C.K.; HODDING, J.H. & KRAUS, D.M.: Pediatric & neonatal dosage handbook. Lexicomp, 20th edition: 1676-1678, 2013.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CARVALHO, P.R.A.; CARVALHO, C.G.; TORRIANI, M.S.; SANTOS, L.; BARROS, E. et al.: Medicamentos de A a Z - Pediatria - 2011/2012.Porto Alegre, Artmed: 826-827, 2012.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">BARROS, E. (org): Medicamentos de A a Z - 2014/2015. Porto Alegre, Artmed: 714-715, 2014. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DICIONÁRIO DE ESPECIALIDADES FARMACÊUTICAS 2014. Rio de Janeiro, Editora Publicações Científicas, 2013.</span></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-46912473332402244242016-04-27T20:28:00.000-07:002016-06-02T06:08:47.112-07:00INFLUENZA<div style="text-align: justify;">
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<span style="font-family: "arial"; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">HORTA, L.S.G</span><span style="font-family: "arial"; font-size: 24px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CID-X: J11</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SINONÍMIA:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Gripe; influenza humana; influenza sazonal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A influenza é uma doença sazonal, de ocorrência anual, com predominância, em regiões de clima temperado, no outono e inverno</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Na faixa temperada do hemisfério Norte, gripe ocorre no inverno, nos meses de outubro a abril de cada ano, com pico de incidência entre dezembro e março</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Na faixa temperada do hemisfério Sul, a atividade do vírus também ocorre no outono-inverno, de abril a setembro</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Nos países de clima tropical, a gripe influenza pode ocorrer em qualquer época do ano, porém as epidemias têm tendência a ocorrer após mudanças nos padrões climáticos, como estação de chuvas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. É uma infecção viral aguda que afeta o sistema respiratório de elevada transmissibilidade, com tendência a fácil disseminação, causando epidemias sazonais e, eventualmente, pandemias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="451" src="https://lh3.googleusercontent.com/wswUqVXpF_JmQAFmybibAS-J1QxmvF_kbUieel-BLMgZvujgyUGexpY2Us3pjm3EG9fvfkY9f4EJoQMHGjFq73K_MxeR823xVipDrNszjy9l1UjO45BgbyU86pBwAS653PTHdw92" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Distribuição mensal de casos de influenza nas regiões brasileiras. Há uma onda anual de influenza em direção ao sul (zonas equatoriais, tropicais e subtropicais, sucessivamente). Na região norte, há maior incidência de novembro a maio, com um pico maior em março e um menor em novembro. Na região nordeste, há maior incidência de maio a agosto. No sudeste, há predomínio entre maio e agosto, com pico em maio e casos esporádicos o ano todo. Na região sul, ha predomínio entre maio e outubro, com pico em junho.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Globalmente, estima-se que a influenza acometa 5 a 10% dos adultos e 20 a 30% das crianças, causando 3 a 5 milhões de casos graves e 250.000 a 500.000 óbitos anuais</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As complicações são mais frequentes em idosos, crianças, gestantes e pessoas com comorbidades (cardiomiopatias e pneumopatias)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uma pandemia de influenza pode ocorrer quando um vírus não humano ganha a habilidade de transmissão inter-humana de forma eficiente e sustentada, espalhando-se globalmente. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vírus da gripe com potencial pandêmico: são os vírus da gripe que têm o potencial para causar uma pandemia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Ex.: influenza aviária A (H5N1) e da gripe aviária (H7N9)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Quando surgem cepas pandêmicas, para as quais a população apresenta pouca imunidade, a gravidade da doença é maior, com altas taxas de hospitalização e mortes durante algumas estações</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Epidemias de influenza de gravidade variável têm ocorrido de maneira sistemática a cada 1 a 3 anos, predominantemente no inverno</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. As pandemias tem ocorrido de forma irregular, geralmente com intervalos de 30 a 40 anos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">HISTÓRICO:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">412 a.C: Hipócrates descreveu a primeira epidemia conhecida de influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1733: Na Itália, Cagliarde cunhou a palavra influenza, que significava influência, desastres do céu</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1918-20: Gripe espanhola</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: 50% da população mundial infectada e 30 milhões de óbitos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1918: No Brasil, o desembarque no Recife de marinheiros contaminados oriundos de Dakar resultou em epidemia que disseminou-se por outros estados seguindo a faixa litorânea atingindo aproximadamente 65% da população e resultando em 35.240 óbitos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1933: Isolamento do vírus influenza A por Wilson Smith e seus colaboradores, Chirstopher Andrews e Patrick Laidlaw</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1939: Isolamento do vírus influenza B por Francis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1947: Organização Mundial de Saúde (OMS) desenvolveu um sistema de vigilância epidemiológica de influenza em todos os continentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1950: Isolamento do vírus influenza C por Taylor</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1957-60: Gripe asiática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: foi causada pelo vírus A/Singapura/1/57 (H2N2), coom emergência de Hemaglutinina e Neuraminidase diferentes de todos os tipos que circulavam previamente, resultando na morte de 1 milhão de pessoas em todo o mundo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1968-72: Gripe de Hong Kong</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: resultou em 1 milhão de óbitos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2009: Primeira pandemia do século XXI pelo vírus influenza A (H1N1) pdm09, envolvendo mais de 190 países</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRANSMISSIBILIDADE</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Meios de Transmissão:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Secreções das vias respiratórias da pessoa contaminada ao falar, tossir, espirrar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pelas mãos, levando o vírus à boca, olhos e nariz</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Por objetos contaminados por secreções: os vírus sobrevivem em diversas superfícies (madeira, aço e tecidos) por 8 a 48 horas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Duração da transmissibilidade:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos: a transmissibilidade ocorre principalmente 24 horas antes do início dos sintomas e dura até 3 dias após o final da febre</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, geralmente até 7 dias após o início dos sintomas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças: pode durar em média 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, podendo alcançar 2 semanas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes imunossuprimidos: a transmissibilidade pode se prolongar por mais de 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, podendo chegar até a meses</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A transmissão é muito elevada no ambiente domiciliar, creches, escolas e em ambiente fechados ou semi-fechados (aviões, navios e meios de transporte coletivo)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SITUAÇÃO EPIDEMIOLÓGICA NO ESTADO DE SÃO PAULO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="451" src="https://lh5.googleusercontent.com/FUf5Li_JKTNPd-vhqpVAcjcdHYm8YUICLPtjrl4VDeFPexAbu5KZ64BkFlJnZhCndLK-4h9ZTUbOxz67Bq3ZSRULGtBSn4UCrTof0hYebkYxhaZmCQp8f-RUtya55qws6_HRaSY4" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Distribuição dos caos de SRAG, segundo agente etiológico e SE do início dos sintomas. Há um aumento de casos notificados de SRAG no Estado de São Paulo e dos casos confirmados para o vírus influenza.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="260" src="https://lh3.googleusercontent.com/d95MM3I3FQmv76m_TFZ67xhOrW5OXQZGEUooQvZZs2w5om0p8skDleFCeDXWpeVSpCajZ1ntLCDHJriT6lVXQa06RISoQflMa0hPXLvO3uJ5bQAn4wLtIXB68vOvbV2EmKn8XMuL" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Distribuição percentual de casos e óbitos confirmados para o vírus influenza, segundo subtipo.O vírus influenza A (H1N1) pdm09 foi o mais frequentemente identificado, seguido pelo influenza A (não subtipado) e influenza B.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="259" src="https://lh5.googleusercontent.com/0pplvVSGWDDnGo5rdhtKQyyZXhuh-6IoaEzrqExFIBxK7hYCqdJz_46Sxrd0-kvnZQUMRNyOOCWdZMJSt-LXrqWhWdJnX_vcZCGpwhHIeH6OPS6k5DefxOEYI2RVgXb6hfutqih8" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Número de casos e óbitos de SRAG, confirmados para o vírus influenza.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="399" src="https://lh4.googleusercontent.com/_26He9EKSR-iRLGekWc88LERqRlVdapZCM10bpXkIwHrgKAYPnmRN77ggR4SAczULhZJOdr25OCL2M72IN93JDc9avjseWDwMvGoGgbdrDsu1OaxDoujEn2_pK9qIrvqrkDZ_Xju" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Distribuição geográfica dos casos de SRAG confirmados para o vírus influenza, segundo município de residência. Os casos de SRAG por influenza A (H1N1)pdm09 estão distribuídos em 121 (18,7%) municípios.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="403" src="https://lh6.googleusercontent.com/aiLWBWQWG3RWGBKYTXZV1x7vxWR25f041iNO6uGbY8HuPLeuKvTd5VMhOtt0UlCy9ESa4-qoxYeayAkJXMzzrNXJXUaF_DYKPvyWY0aI4LLJC01haD5KTN4EJrFHXC3ZEwNX66yO" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Distribuição geográfica dos óbitos de SRAG confirmados paa o vírus influenza, segundo o município de residência. Os casos de SRAG por influenza A (H1N1)pdm09 estão distribuídos em 121 (18,7%) municípios, sendo que 354 (49,5%) casos e 47 (51,6%) óbitos ocorreram na Grande São Paulo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="393" src="https://lh5.googleusercontent.com/u2ZLwalWS_8qojFn5SALe4HqYWcGeRpnq3QlAzN47YnhTfwO3s4DYYEk2ziZm1cmLA79z-dHZHjzZmPB9ATccUhV-NpgeqtRncM9i7mvzdiUv0HmIbPfMSGUR0SsLTrm-zjtPb0E" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: SRAG por influenza A (H1N1)pdm09, número de casos e de óbitos, por faixa etária A faixa etária com maior proporção de casos foi a de 45 a 59 anos (mediana de 51 anos).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="415" src="https://lh6.googleusercontent.com/sV1o3IvUDwGbURgcsJu8rShTn4TBwpohMlujSFf_esVBODkVtT3dw92Fjthn2VTue7aWKGDVzk9R0ch-8pk3JpZionA0s_KJ2UMLMs71QqasqO1GewX8fY7osk7AO6vyS0QLh7G8" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Frequência de comorbidades apresentadas pelos óbitos de SRAG confirmados para o vírus influenza A (H1N1) pdm09. Comorbidade foi identificada em 355 casos (49,7%) e em 65 óbitos (71,4%), sendo as mais frequentes diabetes mellitus, doença cardiovascular crônica e obesidade.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Boletim Epidemiológico Semanal - SE 14/2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AGENTE ETIOLÓGICO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O vírus influenza é um RNA vírus envelopado pertencente à família </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orthomyxoviridae</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, gênero </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Influenzavirus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, possui RNA de hélice única e polaridade negativa</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os vírus influenza se subdividem em três tipos antigenicamente distintos: A, B e C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A antigenicidade baseia-se nas diferenças antigênicas da nucleoproteína (NP) e da proteína matriz (M1)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vírus tipo A: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O vírus tipo A é mais suscetível às variações antigênicas e, periodicamente, sofre alterações em sua estrutura genômica, apresentando-se em diversos subtipos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. São responsáveis pela maioria das epidemias de influenza (75% das infecções</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">) e classificados de acordo com os tipos de proteínas que se localizam em sua superfície</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: hemaglutinina (H) e neuraminidase (N)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A proteína H está associada à infecção das células do trato respiratório superior, onde o vírus se multiplica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, enquanto a proteína N facilita a saída das partículas virais do interior das células infectadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Esse vírus infecta o homem, suínos, cavalos mamíferos marinhos e aves</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os vírus influenza A causam infecção em várias espécies de vertebrados, tendo como origem filogenética na aves aquáticas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A cepa do vírus A (H5N1) está circulando de forma epidêmica desde 1997 entre as aves domésticas da Ásia, sendo altamente contagiosa e grave e resultando na morte de milhares de aves</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A exposição direta a aves infectadas, às suas fezes e à água ou terra contaminada pelas fezes pode resultar na infecção humana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A gripe aviária é resultado de um inesperado vírus epizoótico altamente patogênico com capacidade de ser transmitido entre espécies</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vírus tipo B:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> o vírus tipo B infecta exclusivamente humanos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Sofre menos variações antigênicas e está associado a epidemias mais localizadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Em algumas temporadas, há predomínio de cepas B</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vírus tipo C:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> o vírus tipo C infecta humanos e suínos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. É antigenicamente estável, provocando doença subclínica e não ocasionando epidemias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Raramente causa doença grave</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="280" src="https://lh5.googleusercontent.com/ff6dxAnfQDs3F4262xFYeYcBkNcW3pUSSFXaTnDPMi7qYknbYuqa_TOIGWa0AToCnc9M7wsnd8FRjBqpjJpcI7mhl2tPpE-3GGrIKvLTnEIwVXy2bdjpakWk0epOR4N4fakYHFNq" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Diferenças entre os vírus influenza tipos A, B e C.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os genomas dos vírus influenza A e B contêm um complexo de transcrição/replicação viral formado pelas proteínas PB1, PB2 e PA, associado à extremidade de cada segmento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A nucleoproteína é composta pelo conjunto formado pelo RNA, NP, PB1, PB2 e PA</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O envelope viral é formado por uma dupla camada lipídica, contendo projeções proeminentes formadas pelas glicoproteínas HA, NA e proteína M2, e cobrindo a proteína M1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Os principais determinantes antigênicos dos vírus influenza A e B são as glicoproteínas hemaglutinina (HA) e neuraminidase (NA)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Nas aves aquáticas, há 16 diferentes HA (H1 a H16) e 9 NA (N1 a N9)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Os vírus influenza que acometem o homem, apresentam somente três tipos de HA (H1, H2 e H3) e dois NA (N1 e N2)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="435" src="https://lh3.googleusercontent.com/9_dNunjm--v4EWUNz-auoeFwwT99N65wv7sprk97yzxS3EGTRGI3A_BhylLAfrD48jNqSGuChbSxYJIPEAkfnYAENoGysXjEjpdQWqmuxugywktFkIZgau6e9uHs8z65AWzbZuty" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Estrutura do vírus influenza A. (PB2: polimerase B2; PB1-F2 e PB1: polimerase B1; PA: polimerase A; HA: hemaglutinina; NP: nucleocapsídeo; NA: neuraminidase; M1 e M2: proteína matriz; NS: proteína não-estrutural; NEP/NS2: proteína de exportação nuclear.)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A hemaglutinina (HA) é o principal antígeno viral contra a qual são dirigidos a maioria dos anticorpos neutralizantes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. É responsável pale fixação da partícula viral ao receptor celular, o ácido siálico, permitindo a fusão entre as membranas viral e celular com consequente penetração das proteínas e genoma virais na célula hospedeira</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="509" src="https://lh6.googleusercontent.com/8MeywrH4PAMpOlRbWmuIXgtzoaVnbBH7zVeWeZ3ge7p5q8MYDciEyrlqw43ZxntQbxXskRHcVrRxMBrly4Kai4ssqYG9XaL9QrIEND3zyL6DSPvVeFFFJ_yXjG2WAUzuS2_O0yvE" style="border: none; transform: rotate(0rad);" width="560" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Ciclo replicativo do vírus influenzae. (C) O vírus influenzae liga-se à superfíce da célula hospedeira através da ligação da hemaglutinina ao ácido siálico da membrana celular; (D - H) entra na célula e inicia a replicação, usando o material celular. (I) Os vírus recém formados saem da célula; (J) os vírus são liberados pela neuraminidase viral, permitindo que o ciclo infeccioso continue.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A neuraminidase (NA) tem uma ação enzimática que cliva o ácido siálico presente nas glicoproteínas e glicolipídeos da superfície celular, na hemaglutinina (HA) e na própria neuraminidase</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A clivagem do ácido siálico pela neuraminidase impede que as partículas virais neoformadas que brotam na célula infectada se fixem e aglutinem na superfície celular, clivando o ácido siálico e disseminando o vírus no meio extracelular para a infecção de novas células</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A neuraminidase também pode sofrer variação antigênica menor por mutação e substituição de algum de seus resíduos aminoácidos, resultando em resistência viral aos inibidores da neuraminidase</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mutações nos sítios antigênicos da hemaglutinina (HA) diminuem ou inibem a ligação de anticorpos neutralizantes, permitindo o surgimento de novas cepas virais que se disseminam na população por escaparem da imunidade desenvolvida por infecção ou vacinação prévia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Variação antigênica menor (antigenic drift): é o mecanismo de variabilidade genética decorrente do acúmulo de mutações pontuais, responsável pelas epidemias sazonais de gripe</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="818" src="https://lh6.googleusercontent.com/rTDfe1CMd1QwMbc_c3A5yp0GTeZdMgsxKVTGKC9Na0MpxhBayGlndbj6IJkrgisn009n4RtA4C8O91euv8UfOS54Fbg7F4PH3Q5jy2TsYR_3FnXfdhd5FIX2H66g_Cnqqzey7RVz" style="border: none; transform: rotate(0rad);" width="559" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Variação antigênica menor (antigenic drift).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Variação antigênica maior (</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">antigenic shift</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">): mecanismo de variação antigênica que que surge um vírus de tipo A com HA e/ou NA diferentes daquelas presentes nos vírus circulantes na população</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Decorre da introdução na população de um vírus de outra espécie animal ou quando ocorre rearranjo genético entre dois vírus de espécies animais diferentes que co-infectam a mesma célula</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Há a formação de um vírus híbrido cujas glicoproteínas são trocadas. Resultam no surgimento de um vírus híbrido com novas HA e/ou NA desconhecidas da população contra as quais não possui anticorpo com grande potencial pandêmico se adaptável à espécie humana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="897" src="https://lh4.googleusercontent.com/_-8F1-SYQOfIIK84qxangkh4MxkSAfFKxb0TrAW9EGq8rHNonG6Uxl8FRqeP4GcqSS4kgsNAgLfH9-byPrtB26y5Or06em56sblclKQsmYv7RW-T6e86Sbb5orpHAnYFkMmnYjqR" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Variação antigênica maior (Antigenic shift).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os vírus influenza tem habilidade de causar epidemias anuais recorrentes e pandemias, devido a sua elevada variabilidade genética e capacidade de adaptação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. O genoma viral é fragmentado, favorecendo os fenômenos de rearranjo entre os diferentes segmentos de dois ou mais vírus que infectam uma mesma célula</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A natureza RNA do genoma viral induz altas taxas de mutação durante a fase de replicação, mormente nos genes codificadores das glicoproteínas de superfície viral: hemaglutinina (HA) e neuraminidase (NA)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Essas mutações habitualmente resultam no surgimento de novas variantes virais contra as quais a população não apresenta imunidade, resultando em pandemias com elevada mortalidade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Embora as cepas possam acometer qualquer idade, no Brasil, há uma predominância da cepa do vírus influenza A (H1N1)pdm09 em adultos (40-60 anos), a cepa A (H3N2) em idosos e as cepas B em crianças, adolescentes e adultos jovens</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 9.6px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RESERVATÓRIO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os principais reservatórios são: homem, suínos, equinos, focas e aves</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. As aves migratórias, principalmente as aquáticas e as silvestres, desempenham importante papel na disseminação natural da doença entre distintos pontos do globo terrestre</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MODO DE TRANSMISSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A transmissão ocorre, geralmente, dentro de uma mesma espécie, exceto entre os suínos, cujas células possuem receptores para os vírus humanos e aviários</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Transmissão direta </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(pessoa a pessoa): é a mais comum e ocorre por meio de gotículas, expelidas pelo indivíduo infectado com o vírus influenza ao falar, espirrar e tossir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. As gotículas respiratórias provocadas pela tosse, espirro ou fala possuem > 5 μm de espessura, não se propagam por mais que 1 metro da fonte e relacionam-se à transmissão de contato de gotícula com mucosa da boca ou nariz ou conjuntiva dos olhos de indivíduo suscetível</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Eventualmente, pode ocorrer transmissão pelo ar, pela inalação de partículas residuais, que podem ser levadas a distâncias maiores que 1 metro </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Transmissão indireta</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (contato com a secreção de outros doentes): as mãos são o principal veículo, ao propiciarem a introdução de partículas virais diretamente nas mucosas oral, nasal e ocular</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PERÍODO DE TRANSMISSIBILIDADE:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Indivíduos adultos saudáveis infectados transmitem o vírus entre 24 e 48 horas antes do início dos sintomas, porém em quantidades mais baixas do que durante o período sintomático</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Durante o período sintomático, o pico de excreção viral ocorre principalmente entre as primeiras 24 a 72 horas do início da doença e declina até níveis indetectáveis por volta do 5° dia após o início dos sintomas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pessoas com alto grau de imunodepressão podem excretar vírus por semanas ou meses</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As crianças também excretam vírus mais precocemente, com maior carga viral e por período mais longo que os adultos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SUSCETIBILIDADE E IMUNIDADE:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A suscetibilidade é geral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A imunidade aos vírus influenza é adquirida a partir da infecção natural ou por meio de vacinação, sendo que esta garante imunidade apenas em relação aos vírus homólogos da sua composição</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Período de incubação:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1 a 4 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Infecção aguda das vias aéreas (Síndrome Gripal - SG):</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">cursa com quadro febril (temperatura ⩾37,8°C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, geralmente alta: 38-40°C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">), com a temperatura declinando após 2 a 3 dias e normalizando em torno do 6° dia de evolução</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A febre geralmente é mais acentuada em crianças</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Pode se acompanhar de calafrios, mal-estar, cefaléia, mialgia, dor de garganta, artralgia, prostração, rinorréia, tosse seca, diarréia, vômito, fadiga, rouquidão e hiperemia conjuntival</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Infecções de mucosas (otite, sinusite) e o agravamento das crises de asma e bronquite crônica são comuns</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As queixas respiratórias, com exceção da tosse, tornam-se mais evidentes com a progressão da doença e mantêm-se, em geral, por 3 a 4 dias após o desaparecimento da febre</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A rouquidão e a linfadenopatia são mais comuns em crianças</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A tosse, a fadiga e o mal-estar frequentemente persistem por 1 a 2 semanas e, raramente, passam de 6 semanas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Geralmente tem resolução espontânea em aproximadamente 7 dias, embora a tosse, o mal estar e a fadiga possam permanecer por algumas semanas e, em alguns casos (mormente em indivíduos com fatores e/ou condições de risco), podem evoluir para a síndrome respiratória aguda grave (SRAG)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Em crianças com menos de 2 anos, também é considerada síndrome gripal (SG): febre de início súbito (mesmo que referida) e sintomas respiratórios (tosse, coriza, obstrução nasal), na ausência de outro diagnóstico específico</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="421" src="https://lh3.googleusercontent.com/fwjsKvuzIFG65yzLAmdkWPQkkoEN4FMujxo3TCPU7cEDs5tmpJDoK4RkBfcuw_fsZTe6wPT4V4nbDejZWcULvK-Un5BPR_QgSHS6kLGlFjeRVXWzftTk1YpswUuxMtxaK5IRKiNK" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Manifestações da influenza em crianças.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinais de agravamento do estado clínico:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Aparecimento de dispnéia, taquipnéia ou hipoxemia (saturação de O</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> < 95%)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Persistência ou aumento da febre por mais de 3 dias (podem indicar pneumonite primaria pelo vírus influenza ou secundária a uma infecção bacteriana)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Exacerbação da doença preexistente (doença pulmonar obstrutiva crônica, cardiopatia, etc.)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Disfunções orgânicas graves (insuficiência renal aguda)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miosite (com elevação da creatinofosfoquinase - CPK - superior a 2 a 3 vezes o normal)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alteração do sensório</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Exacerbação dos sintomas gastrointestinais em crianças</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Desidratação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CLASSIFICAÇÃO DAS FORMAS CLÍNICAS</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SÍNDROME GRIPAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Febre de início súbito, mesmo que referida, acompanhada de tosse ou dor de garganta e, pelo menos, um dos seguintes sintomas: cefaléia, mialgia, artralgia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em crianças menores de 2 anos de idade: Febre de início súbito (mesmo que referida) e sintomas respiratórios (tosse, coriza, obstrução nasal)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SÍNDROME RESPIRATÓRIA AGUDA GRAVE</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos de qualquer idade, com sintomas da síndrome gripal, associada a dispnéia ou os seguintes sinais de gravidade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Saturação de oxigênio < 95% em ar ambiente</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinais de desconforto respiratório ou aumento de frequência respiratória</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Piora nas condições clínicas da doença de base</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hipertensão em relação à pressão habitual do paciente</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ou</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduo de qualquer idade com quadro de insuficiência respiratória aguda durante o período sazonal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ALTERAÇÕES LABORATORIAIS</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hemograma:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> leucocitose, leucopenia ou neutrofilia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Enzimas musculares:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> elevadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Enzimas hepáticas:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> elevadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO LABORATORIAL DA INFLUENZA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pesquisa do vírus influenza na secreção da nasofaringe:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> a amostra deve ser colhida preferentemente até o 7° dia do início dos sintomas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A técnica da coleta de amostra pode ser encontrada no link: </span><a href="http://www.cve.saude.sp.gov.br/htm/resp/2014/IAL14_PROTOCOLO_LAB_VIRUS_RESP.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">PROTOCOLO LABORATORIAL PARA A COLETA DE AMOSTRAS BIOLÓGICAS PARA INVESTIGAÇÃO DOS VÍRUS RESPIRATÓRIOS</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A amostra é processada por:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cultura viral:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> padrão ouro mas demorado e com limitação prática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Biologia molecular pela </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">técnica de reação em cadeia da polimerase de transcrição reversa (RT-PCR em tempo real)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Método do ensaio imunoenzimático (EIA): </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">muito fácil de ser realizado, permitindo diagnóstico rápido, sendo a chave para a instituição do tratamento e profilaxia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Método da imunofluorescência indireta (IFI):</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> que utiliza um painel de soros que detecta, além das influenzas A e B, outros vírus respiratórios de interesse (vírus sincicial respiratório, parainfluenza 1, 2, 3 e adenovírus)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Indicado para os laboratórios que não dispõem da RT-PCR</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. De forma complementar e para controle de qualidade, utilizam-se as técnicas de biologia molecular e isolamento viral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Testes rápidos para detecção de influenza A e B:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> menor sensibilidade que a cultura, mas com resultados em até 30 minutos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Testes sorológicos:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> não têm utilidade prática pois requerem duas amostras com intervalo de 15 a 21 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Teste de sensibilidade aos antivirais:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> realizado pelos laboratórios de referência</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Caracterização genética:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> realizado pelos laboratórios de referência</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Caracterização antigênica: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">realizado pelos laboratórios de referência</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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</ul>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="256" src="https://lh3.googleusercontent.com/FE27NQVZ1E22u4IcCUFPwAlvFY5hhydWpAfpQTH9Bl3tYXAbAMhB6eLEqxosUDPQh-KlCjwhBDoyfK7opjHGxrdQ3uPM9r6yYF6jyVhgrejKbV1ms6eomTmy2Qu-iZ3aFWMAuSxv" style="border: none; transform: rotate(0rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Testes Rápidos para diagnóstico de influenza. (*: disponíveis no Brasil)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DIAGNÓSTICO DIFERENCIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Apesar de os sintomas sistêmicos da síndrome gripal da influenza serem mais intensos que nas demais infecções virais, o quadro clínico é semelhante, dificultando o diagnóstico diferencial. Utiliza-se do algoritmo de diagnóstico laboratorial de vírus respiratórios:</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="348" src="https://lh6.googleusercontent.com/7t9ohj5fYGdN-iPRGmgNr4ifruofXzo6EkjFR76vHzeQ3hP2aOb_ptN8o8K2xBj5AJX0z7jL5bR0Lxqw5EC1aPIZIyIDmkMnSObEiKH0Ae3bY3rsZMvsgjDEjuNP4HwqgvlTtWmG" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="590" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Algoritmo de diagnóstico laboratorial para influenza e outros vírus respiratórios</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: GUIA DE VIGILÂNCIA EM SAÚDE/MS, 2014.</span></div>
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<table style="border-collapse: collapse; border: none; width: 590px;"><colgroup><col width="*"></col><col width="*"></col><col width="*"></col></colgroup><tbody>
<tr style="height: 28px;"><td colspan="3" style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Diferenças entre influenza e resfriado comum</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SINTOMAS</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INFLUENZA</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RESFRIADO COMUM</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ocorrência</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sazonal: outono, inverno</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ano todo</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Início</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Súbito</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gradual</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Febre</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Geralmente alta, por 3 a 4 dias</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Incomum</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cefaléia</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Intensa</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Incomum</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fadiga</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dura de 2 a 3 semanas</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leve</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dores</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Frequente e intensa</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leve ou inexistente</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Exaustão</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Precoce e intensa</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Ausente</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Obstrução nasal</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Às vezes</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Muito comum</span></div>
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<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor de garganta</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Às vezes</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comum</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tosse</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Presente</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Incomum</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor no peito</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Comum</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Leve</span></div>
</td></tr>
<tr style="height: 0px;"><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Complicações</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pneumonia</span></div>
</td><td style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinusite</span></div>
</td></tr>
<tr style="height: 28px;"><td colspan="3" style="border-bottom: solid #000000 1px; border-left: solid #000000 1px; border-right: solid #000000 1px; border-top: solid #000000 1px; padding: 7px 7px 7px 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ALTERAÇÕES EM EXAMES DE IMAGEM</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Radiografia de tórax: infiltrado intersticial localizado ou difuso ou presença de área de condensação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">COMPLICAÇÕES</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A influenza (gripe) pode, mormente em indivíduos com doença crônica, idosos e crianças menores de 2 anos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, evoluir com complicações, como:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pneumonia bacteriana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> e por outros vírus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: é a complicação que mais frequentemente leva à hospitalização e à morte</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinusite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Otite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Desidratação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Agravamento de doenças crônicas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: cardiovasculares, pulmonares (DPOC, asma), metabólicas (diabetes mellitus)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Infarto do miocárdio</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acidente vascular cerebral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miocardite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pericardite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Miosite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rabdomiólise</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pneumonia primária por influenza (predominantemente em cardiopatas - doença reumática com estenose mitral - e mulheres grávidas)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manifestações neurológicas:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Convulsão</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Encefalite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome de Guillain Barré</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Condições e fatores de risco para complicações:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Grávidas em qualquer idade gestacional</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Puérperas até duas semanas após o parto (incluindo as que tiveram aborto ou perda fetal)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adultos ⩾ 60 anos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças < 5 anos (com maior risco de hospitalização em menores de 2 anos de idade, especialmente menores de 6 meses, com maior taxa de mortalidade)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">População indígena aldeada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos menores de 19 anos de idade em uso prolongado de ácido acetilsalicílico (risco de síndrome de Reye)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos que apresentem:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pneumopatias (asma, etc.)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com tuberculose de todas as formas (evidência de maior complicação e possibilidade de reativação)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cardiovasculopatias (excluindo hipertensão arterial sistêmica)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nefropatias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Doenças hematológicas (anemia falciforme, etc.)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Distúrbios metabólicos (diabetes mellitus, etc.)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Transtornos neurológicos e do desenvolvimento que podem comprometer a função respiratória ou aumentar o risco de aspiração (disfunção cognitiva, lesão medular, epilepsia, paralisia cerebral, síndrome de Down, acidente vascular encefálico ou doenças neuromusculares)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Imunossupressão (medicamentos, neoplasias, HIV/Aids, etc.)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Obesidade (especialmente aqueles com IMC ⩾ 40 em adultos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRATAMENTO</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SÍNDROME GRIPAL EM PACIENTES COM CONDIÇÕES E FATORES DE RISCO PARA COMPLICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Medicamentos sintomáticos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hidratação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oseltamivir (Tamiflu): mandatório, mesmo após 48 horas de evolução da doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SÍNDROME GRIPAL EM PACIENTES SEM CONDIÇÕES E FATORES DE RISCO PARA COMPLICAÇÕES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Medicamentos sintomáticos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hidratação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oseltamivir (Tamiflu): a indicação deve ser baseada em julgamento clínico, preferencialmente nas primeiras 48 horas após início da doença. Em caso de piora clínica, o emprego do oseltamivir é mandatório</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">SÍNDROME RESPIRATÓRIA AGUDA GRAVE (SRAG)</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Internação hospitalar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Terapêutica de suporte:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Hidratação venosa</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oxigenioterapia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Monitoramento clínico</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oseltamivir (Tamiflu): iniciar imediatamente,independentemente da coleta de material para exame laboratorial</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Coletar amostras de secreções respiratórias para exame laboratorial, preferencialmente antes do início do tratamento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indicações para Unidade de Terapia Intensiva:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Instabilidade hemodinâmica persistente após reposição volêmica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sinais e sintomas de insuficiência respiratória (hipoxemia com necessidade de suplementação de oxigênio para manter saturação arterial de oxigênio superior a 90%)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evolução para outras disfunções orgânicas (insuficiência renal aguda, insuficiência hepática, disfunção neurológica)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">GESTANTES COM INFLUENZA</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">GESTANTES COM SINAIS DE AGRAVAMENTO (SpO</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: sub; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> < 95%, etc.):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Internação hospitalar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oxigenioterapia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Monitorização contínua</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Oseltamivir (Tamiflu): indicado para todas as gestantes com suspeita de influenza, mesmo sem agravamento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Radiografia de tórax em gestante: pode ser realizada na suspeita de pneumonia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRATAMENTO DA INFLUENZA COM ANTIVIRAIS</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Existem duas classes de agentes antivirais disponíveis para tratamento e profilaxia da influenza:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Inibidores dos canais de íon M2 (Rimantadina e Amantadina): atem inibindo a proteína M2 necessária para a liberação do material genético viral dentro das células. Ativos apenas contra a influenza A (pois o tipo B não tem a proteína M2) e aprovados para crianças acima de 1 ano de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. O desenvolvimento de resistência aos inibidores de canais de íons M2 são as maiores limitações do uso destes agentes e decorre de um único ponto de mutação em determinadas posições da proteína M2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Ocorre em até ⅓ dos pacientes tratados, geralmente dentro dos 3 primeiros dias de tratamento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Efeitos adversos: manifestações gastrointestinais (náusea, boca seca, diarréia) e do sistema nervoso central (insônia, ansiedade, nervosismo, irritabilidade, cefaléia), fadiga</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Inibidores da neuraminidase (INA) (Oseltamivir e Zanamivir): inibem as moléculas de NA presentes na superfície dos vírus influenza A e B, indispensáveis para a liberação dos vírus recém-formados nas células infectadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Ativos também contra o vírus aviário</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Oseltamivir é aprovado para tratamento e profilaxia em crianças maiores de 1 ano de idade. Zanamivir é aprovado para tratamento em crianças maiores de 7 anos de idade e profilaxia, acima de 5 anos de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">7</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O fosfato de oseltamivir (Tamiflu) e o zanamivir (Relenza) são antivirais inibidores de neuraminidase. Seus efeitos no tratamento da influenza são mais efetivos quando administrados até 48 horas após o início da doença, porém ainda apresentam efeito quando administrados posteriormente, mormente até 4 a 5 dias do início da doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O tratamento com oseltamivir iniciado antes de 48 horas do início dos sintomas proporciona redução da ocorrência de casos graves e complicações da infecção pelo vírus influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O oseltamivir e o zanamivir são aviados em receituário simples</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="422" src="https://lh3.googleusercontent.com/rr5XC7UQG8MXCmxfQeXW5O6-l95YEPUghlqw5mNAIxd49LvekeWcvm-alMnmnPJYBktirw4wE0RM2Xrqvyj4FnNxkEavJIhXFGFbBr13KwVxl3Or2X35g0VP8VLTcSJh6gjCbR6D" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="532" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Posologia do oseltamivir e do zanamivir para influenza.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: MINISTÉRIO DA SAÚDE, 2015.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify; text-indent: 36pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Posologia do Fosfato de Oseltamivir no Período Neonatal:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recém-nascido pré-termo: 1 mg/Kg/dose, VO, 12/12 horas até 38 semanas de idade, por 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Período neonatal:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IG < 38 semanas de idade: 1 mg/Kg/dose,VO, 12/12 horas, por 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IG Entre 38 e 40 semanas: 1,5 mg/Kg/dose, VO, 12/12 horas, por 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IG > 40 semanas: 3,0 mg/Kg/dose, VO, 12/12 horas, por 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TRATAMENTO COM ZANAMIVIR:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Meia vida plasmática curta;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Via de administração: inalatória</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O zanamivir está indicado somente em casos de:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Intolerância gastrointestinal grave ao fosfato de oseltamivir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alergia ao fosfato de oseltamivir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Resistência ao fosfato de oseltamivir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Zanamivir é contraindicado:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em menores de 5 anos de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Paciente com doença respiratória crônica, pelo risco de broncoespasmo severo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes sob ventilação mecânica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">AJUSTE DE DOSE DE FOSFATO DE OSELTAMIVIR E ZANAMIVIR EM PACIENTES COM INSUFICIÊNCIA RENAL:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="544" src="https://lh6.googleusercontent.com/W5s34oKkXgVhD72ruVKmEDG50S998E0kOQjrRgaZ7R3KuzbP6aqmneclA_6jR4Ixf9fn3bBIitpwsCfdouTBmIta1s5D2WsgXFZYfX5PW8zqYOiNGrXJrTo_mx7jVGduMzcXN8Tu" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="539" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Ajuste da dosagem do fosfato de oseltamivir e zanamivir na insuficiência renal.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: MINISTÉRIO DA SAÚDE, 2015.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em hemodiálise, a dose deve ser 30 mg após cada sessão de hemodiálise e, em diálise peritoneal, a dose deve ser de 30 mg, uma vez por semana</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">DURAÇÃO DO TRATAMENTO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Geralmente, a duração do tratamento com fosfato de oseltamivir e zanamivir é de 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes com doença grave ou prolongada e imunossuprimidos, podem ter seu tratamento prolongado por período superior a 5 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OBSERVAÇÕES EM RELAÇÃO AO TRATAMENTO</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pacientes que vomitam o medicamento até uma hora após a ingestão do medicamento deve ser administrado uma dose adicional</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">QUIMIOPROFILAXIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A quimioprofilaxia com antivirais não é recomendada se o período após a última exposição (ou seja, contato com caso suspeito ou confirmado para influenza) a uma pessoa com infecção pelo vírus for maior que 48 horas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Para que a quimioprofilaxia seja efetiva, o antiviral deve ser administrado durante a potencial exposição à pessoa com influenza e continua por mais 7 dias após a última exposição conhecida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÕES DE QUIMIOPROFILAXIA PARA INFLUENZA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pessoas com risco elevado de complicações, não vacinadas ou vacinadas há menos de duas semanas, após exposição a caso suspeito ou confirmado de influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças com menos de 9 anos de idade, primovacinadas, necessitam de segunda dose da vacina com intervalo de um mês para serem consideradas vacinadas. Aquelas com condições ou fatores de risco, que foram expostas a caso suspeito ou confirmado no intervalo entre a primeira e a segunda dose ou com menos de duas semanas após a segunda dose, deverão receber quimioprofilaxia se tiverem comorbidades</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pessoas com graves deficiências imunológicas (exemplos: pessoas que usam medicamentos imunossupressores; pessoas com Aids com imunodepressão avançada) ou outros fatores que possam interferir na resposta à vacinação contra a influenza, após contato com pessoa com infecção</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Profissionais de laboratório, não vacinados ou vacinados a menos de 15 dais, que tenham manipulado amostras clínicas de origem respiratória que contenham o vírus </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">influenza </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">sem uso adequado de EPI</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trabalhadores de saúde, não vacinados ou vacinados a menos de 15 dias, e que estiveram envolvidos na realização de procedimentos invasivos geradores de aerossóis ou na manipulação de secreções de caso suspeito ou confirmado de </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">influenza </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">sem o uso adequado de EPI</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Residentes de alto risco em instituições fechadas e hospitais de longa permanência, durante surtos na instituição</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">QUIMIOPROFILAXIA EM INSTITUIÇÕES FECHADAS E HOSPITAIS DE LONGA PERMANÊNCIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Instituição fechada e hospitais de longa permanência: aqueles com pernoite de residente e trabalhador (ex.: asilos, orfanatos, presídios, hospitais psiquiátricos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Surto em instituições fechadas ou hospitais de longa permanência: ocorrência de dois casos suspeitos ou confirmados para influenza com vínculo epidemiológico</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A quimioprofilaxia para todos os residentes ou internos é recomendada para controlar surtos somente se a instituição ou hospital de longa permanência for destino para pessoas com condições e fatores de risco para complicações</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Recomendações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em surto suspeito ou confirmado de influenza nesses ambientes, é recomendado o uso de quimioprofilaxia antiviral para todos os expostos residentes ou internados, independente da situação vacinal. para trabalhadores e profissionais de saúde, é recomendado somente para os não vacinados ou vacinados há menos de duas semanas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">É recomendável a quimioprofilaxia com antiviral na instituição por, no mínimo, duas semanas e até, pelo menos, sete dias após a identificação do último caso</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">POSOLOGIA ANTIVIRAL NA QUIMIOPROFILAXIA</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="514" src="https://lh4.googleusercontent.com/kZn8Ga3WdSCa9sJvHLUescLBQa4Js_Ngq9uAvWAVRYVqRrUPzf4rqQlVNvVh8ZE0HtxknEAoEb11dCAI2RXpp7PhPzsZa1kv7ylLFmwpM2ReismQEHb1V_B3LqDfreDCzdUlND0f" style="border: none; transform: rotate(0rad);" width="538" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Posologia de antivirais na quimioprofilaxia.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: MINISTÉRIO DA SAÚDE, 2015.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Quimioprofilaxa para Crianças com menos de 1 ano de idade:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">< 3 meses: não é recomendado o uso de antiviral (fosfato de oseltamivir), a menos que a situação seja julgada crítica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">0 - 8 meses: 3 mg/Kg/dose, VO, 1 vez ao dia, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">> 1 ano: a dose varia de acordo com o peso:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">< 15 Kg: 30 mg/dose, VO, 1 vez ao dia, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">15 a 23 Kg: 45 mg/dose, VO, 1 vez ao dia, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">23 a 40 Kg: 60 mg/dose, VO, 1 vez ao dia, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">> 40 Kg: 75 mg/dose, VO, 1 vez ao dia, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MEDIDAS PREVENTIVAS</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PRECAUÇÃO PADRÃO:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Higienização das mãos antes e após contato com o paciente</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de equipamentos de proteção individual (EPI) ao contato com sangue ou secreções: avental e luvas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de óculos e máscara se houver risco de respingos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fazer o descarte adequado de resíduos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PRECAUÇÕES CONTRA GOTÍCULAS:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de máscara cirúrgica ao entrar no quarto, a menos de 1 metro do paciente e substituí-la a cada contato com o paciente</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Higienização das mãos antes e depois de cada contato com o paciente (água e sabão ou álcool gel)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de máscara cirúrgica no paciente durante o transporte</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Limitar procedimentos indutores de aerossóis (intubação, sucção, nebulização)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de dispositivos de sucção fechados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manter paciente preferencialmente em quarto privativo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Quando em enfermaria, respeitar a distância mínima de 1 metro entre os leitos durante o tratamento com fosfato de oseltamivir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PRECAUÇÕES NAS SITUAÇÕES EM QUE HAJA GERAÇÃO DE AEROSSÓIS:</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nos casos de procedimentos que gerem aerossóis (partículas < 5 μm de espessura, que podem ficar suspensas no ar por longos períodos de tempo (ex.: intubação, sucção, nebulização), recomenda-se:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de equipamentos de proteção individual (EPI) pelo profissional de saúde durante o procedimento de assistência ao paciente: avental, luvas, óculos, máscara [respirador] tipo N95, N99, PFF2 ou PFF3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manter paciente preferencialmente em quarto privativo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de máscara [respirador] tipo N95, N99, PFF2 ou PFF3 pelo profissional ao entrar no quarto</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de máscara cirúrgica no paciente durante transporte</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">LIMPEZA E DESINFECÇÃO DE SUPERFÍCIES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Remoção de sujidades com água e sabão ou detergente</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Limpeza com solução de hipoclorito de sódio em pisos e superfícies dos banheiros</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fricção de outras superfícies e objetos com álcool a 70%</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Uso de equipamento de proteção individual (EPI) adequado</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fazer descarte adequado de resíduos, conforme </span><a href="http://portal.anvisa.gov.br/wps/wcm/connect/10d6dd00474597439fb6df3fbc4c6735/RDC+N%C2%BA+306,+DE+7+DE+DEZEMBRO+DE+2004.pdf?MOD=AJPERES" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Resolução da Diretoria Colegiada da ANVISA - RDC n° 306/04</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">PRECAUÇÕES GERAIS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Higienização das mãos frequentemente, principalmente antes de consumir alimentos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Utilizar lenço descartável para higiene nasal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cobrir nariz e boca quando espirrar ou tossir</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar tocar mucosas de olhos, nariz e boca</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Higienizar as mãos após tossir ou espirrar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Não compartilhar objetos de uso pessoal, como talheres, pratos, copos ou garrafas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manter os ambientes bem ventilados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar contato próximo a pessoas que apresentem sinais ou sintomas de influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar sair de casa em período de transmissão da doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar aglomerações e ambientes fechados (procurar manter os ambientes ventilados)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adotar hábitos saudáveis (alimentação balanceada e ingestão de líquidos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orientar o afastamento temporário (trabalho, escola, etc.) até 24 horas após cessar a febre</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MANEJO DO RECÉM-NASCIDO FILHO DE MÃE COM SUSPEITA OU DIAGNÓSTICO DE INFLUENZA</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">MÃE COM SINTOMAS DE INFLUENZA E RN CLINICAMENTE ESTÁVEL:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manter a mãe e o RN em quarto privativo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manter distância mínima do berço do RN e mãe de 1 metro</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orientar e realizar etiqueta respiratória</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orientar a higienização das mãos imediatamente após tocar nariz, boca e sempre antes do cuidado com o RN</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orientar o uso de máscara cirúrgica pela mãe durante o cuidado e amamentação do RN</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Profissional de saúde deve seguir as orientações de precaução padrão de gotículas quando atender a puérpera e RN</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A mãe deve usar máscara ao circular nas áreas comuns do hospital</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CRIANÇA HOSPITALIZADA COM SINTOMAS DE INFLUENZA:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Utilizar preferencialmente quarto privativo ou distância mínima entre leitos de 1 metro</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em Unidade Neonatal, o quarto privativo poderá ser substituído pelo uso de incubadora mantendo as demais orientações quanto à distância entre leitos e à adesão às precauções por gotículas e padrão por profissionais da saúde</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Orientar pais ou acompanhante a higienizar as mãos antes e após tocar na criança ou após tocar no espaço perileito</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Caso o acompanhante apresente sintomas respiratórios, orientar etiqueta respiratória, com higienização das mãos, utilizar máscara cirúrgica em áreas compartilhadas por outros pacientes ou profissionais da saúde</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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</ul>
<b style="font-weight: normal;"><br /></b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">IMUNIZAÇÃO</span></div>
<b style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacina contra influenza é capaz de promover imunidade contra a doença durante o período de circulação sazonal do vírus influenza, reduzindo o agravamento da doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacinação contra influenza é reservada para grupos-alvos definidos pelo Ministério da Saúde, mesmo que já tenham recebido a vacina na temporada anterior em virtude da queda de anticorpos protetores</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacina contra influenza é constituída de vírus mortos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em 2016, desenvolve-se a 18° Campanha Nacional de Vacinação contra a Influenza no período de 30 de abril a 20 de maio de 2016, sendo o dia 30 de abril o dia de mobilização nacional</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">TIPOS DE VACINAS</span></div>
<b style="font-weight: normal;"><br /></b>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Existem diversas vacinas contra influenza que diferem quanto a sua composição (tipo e quantidade de antígenos, presença de adjuvantes e conservantes) e que podem ter diferentes indicações, conforme a faixa etária</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify; text-indent: 36pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As vacinas utilizadas nas campanhas nacionais de vacinação contra a influenza do Programa Nacional de Imunizações (PNI) são vacinas trivalentes que contém os antígenos purificados de duas cepas do tipo A e uma do tipo B (</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">vacina tipo Split</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">), sem adição de adjuvantes e sua composição é determinada pela Organização Mundial de Saúde para o hemisfério sul, de acordo com as informações da vigilância epidemiológica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacinação pode reduzir entre 32-45% o número de hospitalizações por pneumonias, de 39-75% a mortalidade global e em aproximadamente 50%, nas doenças relacionadas à influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VACINA CONTRA INFLUENZA -TEMPORADA 2016</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacina influenza trivalente da temporada de 2016 para o hemisfério sul (OMS) é composta de cepas do vírus </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Myxovirus influenzae</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> inativados, fragmentados e purificados, correspondente aos antígenos hemaglutinina (HA)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A/California/7/2009 (H1N1) pdm09</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A/Hong Kong/4891/2014 (H3N2)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">B/Brisbane/60/2008 (linhagem Victoria)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="598" src="https://lh6.googleusercontent.com/xGJlMmD0N37JDtUwc6FmMdKYIDJU6KvnNyEHPdQowz9qWZK145YIs-VdS7iYWVT9rOquvO1nwPCltsKA9I7tz6pgftU8NLWnL3PH04JHFbd6W1B6tuijqA85SWJi8M7NBFtz1A8y" style="border: none; transform: rotate(0rad);" width="578" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tabela: Especificações da vacina influenza da temporada 2016.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Informe Técnico - Campanha Nacional de Vacinação contra a Influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">INDICAÇÃO DA IMUNIZAÇÃO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos com 60 anos ou mais de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">População privada de liberdade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Funcionários do sistema prisional</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Povos indígenas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Crianças entre 6 meses e 5 anos de idade (4 anos, 11 meses e 29 dias)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Profissionais de saúde</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adolescentes e jovens de 12 a 21 anos de idade sob medidas socioeducativas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Gestantes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Puérperas (até 45 dias após o parto)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pessoas portadoras de doenças crônicas não transmissíveis e outras condições clínicas especiais (conforme listagem definida pelo Ministério da Saúde com Sociedades Científicas)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: os pacientes devem apresentar no posto de vacinação prescrição médica especificando o motivo da indicação da vacina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="520" src="https://lh4.googleusercontent.com/62Du3BulUasgGVjFEMK7D5QOqvcJYV5yY-2METibE6FvddRznEk2fy1-DQ-0rWS7KGy6fgKTk3co1ogMvQMGkcfS12PkOQqiE4hmrsT22k3oTKLVCPWmjTXDJ2t2ICrZNW6MTutC" style="border: none; transform: rotate(0rad);" width="581" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Categorias de risco clínico com indicação da vacina influenza sazonal.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Informe Técnico - Campanha Nacional de Vacinação contra a Influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CONTRAINDICAÇÃO DA IMUNIZAÇÃO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Menores de 6 meses de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos com história de reação anafilática prévia ou alergia grave relacionada ao ovo de galinha e seus derivados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indivíduos que, após recebimento de qualquer dose anterior, apresentarem hipersensibilidade imediata (reação anafilática)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VIA DE ADMINISTRAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Preferentemente via intramuscular para a vacina Butantan e Sanofi Pasteur/França e exclusivamente intramuscular para a vacina Sanofi Pasteur/EUA</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2,6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacina Butantan e Sanofi Pasteur/França poderá ser administrada por via subcutânea em pessoas que apresentam discrasias sanguíneas ou estejam utilizando anticoagulantes orais</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ESQUEMA DE VACINAÇÃO CONTRA INFLUENZA - TEMPORADA 2016</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">População não Indígena:</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="239" src="https://lh4.googleusercontent.com/wN_QqrB3VKyCsdhezPoDUecWLpngZuw7RgieHB6yruFum42PV2nLtGnwo7DNKOo4lqpoJPIzimusH--aKzTXrsSM0AD8C8yrsskF4mT0otx2k8lSFVzZ4bWVBwVLO3Fdfkc1W-H7" style="border: none; transform: rotate(0rad);" width="573" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figura: Esquema vacinal contra a influenza.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fonte: Informe Técnico - Campanha Nacional de Vacinação contra Influenza - 2016</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 6.3999999999999995px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">São recomendadas 2 doses da vacina influenza sazonal em primovacinados com idade entre 6 meses e 8 anos, 11 meses e 29 dias, e uma dose nos anos subsequentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">População indígena:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A população indígena deverá ser vacinada em sua totalidade acima de 6 meses de idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EFEITOS ADVERSOS DA IMUNIZAÇÃO</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manifestações locais:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Dor e sensibilidade local, eritema e enduração com resolução em cerca de 48 horas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Abscessos são raros e decorrentes de infecção secundária ou erros na técnica de aplicação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manifestações sistêmicas (iniciam-se em 6-12 horas e desaparecem em 1-2 dias):</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Febre;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mal-estar;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mialgia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reações de hipersensibilidade:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reações anafiláticas: raras;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Manifestações neurológicas:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Síndrome de Guillain-Barré (SGB): manifesta-se clinicamente como polirradiculoneurite inflamatória com lesão de desmielinização, parestesias e déficit motor ascendente de intensidade variável</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Os sintomas geralmente aparecem entre 7 e 21 dias (no máximo até 42 dias - 7 semanas) após a vacinação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. A imunização contra influenza dos indivíduos com histórico de SGB anterior devem levar em consideração os riscos e benefícios, pelo risco de recorrência da SGB</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Narcolepsia: descrito alguns casos nos países nórdicos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Encefalite aguda disseminada (ADEM)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Neurite óptica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mielite transversa</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">EFICÁCIA DA VACINAÇÃO CONTRA INFLUENZA</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Em adultos saudáveis, a detecção de anticorpos protetores dá-se entre 2 e 3 semanas após a vacinação e apresenta duração de 6 a 12 meses</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. O pico máximo de anticorpos ocorre após 4 a 6 semanas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A imunogenicidade em crianças varia de 30 a 90%, sendo diretamente proporcional à idade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Cerca de 40 a 80% das crianças menores de 6 anos de idade apresentam soroconversão após uma única dose da vacina, enquanto crianças maiores de 6 anos apresentam soroconversão após uma única dose em 70 a 100% dos casos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacinação da gestante, além de proteger a mãe, promove proteção nos primeiros 6 meses de vida a 60 % dos conceptos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CUIDADOS EM RELAÇÃO À IMUNIZAÇÃO CONTRA A INFLUENZA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A vacina influenza pode ser administrada na mesma ocasião de outras vacinas ou medicamentos, porém com seringas e localizações anatômicas diferentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Tratamento com imunossupressores ou radioterapia podem reduzir ou anular a resposta imunológica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Corticoterapia de reposição ou em tratamento sistêmico de curto prazo ou sem causar imunossupressão não comprometem a eficácia da vacina contra influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Os doadores de sangue ou hemoderivados devem ficar inaptos para a doação por um período de 48 horas após a imunização</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">6</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">CONDUTAS FRENTE A SURTOS/EVENTOS</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RECOMENDAÇÕES PARA INSTITUIÇÕES FECHADAS E HOSPITAIS DE LONGA PERMANÊNCIA</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vacinar anualmente todos os residentes e funcionários</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizar coleta de amostra para diagnóstico de caso suspeito, até que se tenham, no mínimo, dois casos confirmados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizar busca ativa diária até, pelo menos, uma semana após a identificação do último caso</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizar quimioprofilaxia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Implementar medidas de prevenção - precaução padrão e precaução de gotículas aerossóis - para todos os residentes e internados com suspeita ou confirmação de influenza por 7 dias após o início dos sintomas ou até 24 horas após o desaparecimento da febre e sintomas respiratórios</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Isolamento em quarto privativo ou, quando não disponível, isolamento de coorte (pessoas com sintomas compatíveis)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar visitas. Caso ocorram, usar EPI</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Outras medidas:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Residentes sintomáticos devem ser mantidos, na medida do possível, em seus quartos. Caso circulem, usar máscara cirúrgica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Limitar aglomeração, considerando a possibilidade de servir refeição no quarto</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Restringir movimentação dos profissionais que atuam em áreas onde há doentes para áreas não atingidas pelo surto</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar novas admissões ou transferências de sintomáticos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RECOMENDAÇÕES PARA ESCOLAS OU CRECHES</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Não há indicação de quimioprofilaxia para comunidade escolar, exceto nas indicações citadas, devendo somente receber quimioprofilaxia individual pessoas consideradas com condições e fator de risco para complicações por influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alunos, professores e demais funcionários que adoecerem devem permanecer em afastamento temporário por 48 horas na suspeita clínica de influenza, podendo ser liberado o retorno à escola se clinicamente estável, sem uso de antitérmico e sem febre por 24 horas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adotar as seguintes medidas preventivas:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cobrir o nariz e a boca com lenço ao tossir ou espirrar, e descartar o lenço no lixo após o uso</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lavar as mãos com água e sabão após tossir ou espirrar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">No caso de não haver disponibilidade de água e sabão, usar álcool gel</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar tocar olhos, nariz ou boca</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar contato próximo com pessoas doentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">RECOMENDAÇÕES PARA POPULAÇÃO PRIVADA DE LIBERDADE</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vacinar anualmente a população privada de liberdade (carcerária)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Não há indicação de quimioprofilaxia para a população carcerária em caso de surto, por eta não se tratar de população de risco de complicação para influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O caso suspeito ou confirmado deverá ser mantido em cela individual</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar trânsito de profissionais entre alas com e sem doentes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizar coleta de amostra para diagnóstico de influenza em caso suspeito até que haja no mínimo dois casos confirmados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Realizar busca ativa diária até, pelo menos, uma semana após a identificação do último caso</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Outras medidas preventiva:</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cobrir o nariz e a boca com lenço ao tossir ou espirrar, e descartar o lenço no lixo após o uso</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">; </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lavar as mãos com água e sabão após tossir ou espirrar</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">No caso de não haver disponibilidade de água e sabão, usar álcool gel;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Evitar tocar nos olhos, nariz ou boca</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
</li>
</ul>
</ul>
<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VIGILÂNCIA EPIDEMIOLÓGICA</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">NOTIFICAÇÃO</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Todo o caso de síndrome respiratória aguda grave (SRAG) hospitalizado deve ser notificado (Sinan influenza Web)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Nos casos de surtos, a vigilância epidemiológica local deverá ser prontamente notificada/informada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O Brasil possui uma rede de unidades sentinelas para vigilância da influenza, distribuídas em serviços de saúde, em todas as unidades federadas do País, que monitoram a circulação do vírus influenza através de casos de síndrome gripal (SG) e síndrome respiratória aguda grave (SRAG)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">OBJETIVOS DA VIGILÂNCIA EPIDEMIOLÓGICA</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Monitorar as cepas dos vírus influenza circulantes no Brasil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Avaliar o impacto da vacinação contra a doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acompanhar a tendência da morbidade e mortalidade associadas à doença</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Identificar grupos e fatores de risco para influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Responder a situações inusitadas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Detectar e oferecer resposta rápida à circulação de novos subtipos que poderiam estar relacionados à pandemia de influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Produzir e disseminar informações epidemiológicas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Estudar a resistência dos antivirais</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<b style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">VIGILÂNCIA SENTINELA DA INFLUENZA</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Rede Sentinela em Influenza</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Unidades sentinelas para registro de informação de casos de SG e SRAG: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">unidades ou serviços de saúde já implantados e cadastrados no Cadastro Nacional de Estabelecimentos de Saúde (CNES) e Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), que atuam na identificação, registro, investigação e diagnóstico de casos suspeitos e confirmado</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Portaria n° 183, de 30/01/2014: a rede sentinela em influenza é composta por unidades de saúde definidas pelos gestores e técnicos dos municípios, estados e Distrito Federal, sendo habilitados por processo de pactuação no respectivo Colegiado de Gestão, segundo fluxo estabelecido pelas Secretarias Municipais de Saúde e Secretarias Estaduais de Saúde</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sítios sentinelas para a vigilância da influenza: estão distribuídos em unidades de saúde de todas as Unidades Federadas (UFs) e têm como objetivo principal identificar os vírus da influenza circulantes no Brasil, para</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Contribuir com a composição da vacina contra influenza</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Isolar espécimes virais para o envio ao Centro Colaborador de Influenza referência nas Américas para a OMS</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Conhecer a patogenicidade e virulência do vírus influenza circulante em cada período sazonal, visando à orientação terapêutica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Garantir a representatividade mínima da circulação viral em todas as UFs do país, tanto de casos graves como de casos leves</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Identificar a situação inusitada e precoce de possível novo subtipo viral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O registro de casos de SG e SRAG deverá ser feito pelas unidades sentinelas e inserido no SIVEP-Gripe, conforme fluxo estabelecido e organizado em cada UF</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Os casos identificados nas unidades sentinelas deverão ser notificados pelos técnicos no SIVEP-Gripe</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super; white-space: pre-wrap;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></div>
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<a href="ftp://ftp.cve.saude.sp.gov.br/doc_tec/RESP/pdf/INFLU15_PROTOCOLO_ATUALIZADO.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">BRASIL. MINISTÉRIO DA SAÚDE. SECRETARIA DE VIGILÂNCIA DAS DOENÇAS TRANSMISSÍVEIS: PROTOCOLO DE TRATAMENTO DE INFLUENZA, 2015.</span></a></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://portalsaude.saude.gov.br/images/pdf/2014/novembro/27/guia-vigilancia-saude-linkado-27-11-14.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">BRASIL. MINISTÉRIO DA SAÚDE. SECRETARIA DE VIGILÂNCIA EM SAÚDE: GUIA DE VIGILÂNCIA EM SAÚDE: 13-35, 2014.</span></a></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://www.cve.saude.sp.gov.br/htm/resp/2014/IAL14_PROTOCOLO_LAB_VIRUS_RESP.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">SÃO PAULO (BRASIL). SECRETARIA DE ESTADO DA SAÚDE DE SÃO PAULO. COORDENADORIA DE CONTROLE DE DOENÇAS. INSTITUTO ADOLFO LUTZ: Protocolo laboratorial para a coleta de amostras biológicas para investigação dos vírus respiratórios (10/06/2014).</span></a></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://www.cve.saude.sp.gov.br/htm/resp/pdf/srag16_boletim_se14.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">SÃO PAULO (BRASIL). SECRETARIA DE ESTADO DA SAÚDE DE SÃO PAULO. COORDENADORIA DE CONTROLE DE DOENÇAS. CENTRO DE VIGILÂNCIA EPIDEMIOLÓGICA: Boletim epidemiológico semanal – SE 14/2016, Síndrome Respiratória Aguda Grave – SRAG/INFLUENZA.</span></a></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://portal.anvisa.gov.br/wps/wcm/connect/10d6dd00474597439fb6df3fbc4c6735/RDC+N%C2%BA+306,+DE+7+DE+DEZEMBRO+DE+2004.pdf?MOD=AJPERES" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA (ANVISA): RESOLUÇÃO DA DIRETORIA COLEGIADA - RDC Nº 306, DE 7 DE DEZEMBRO DE 2004:Dispõe sobre o regulamento técnico para o gerenciamento de resíduos de serviços de saúde.</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://portalsaude.saude.gov.br/images/pdf/2016/marco/11/informe-tecnico-campanha-vacinacao-influenza-2016.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">BRASIL. MINISTÉRIO DA SAÚDE: INFORME TÉCNICO - CAMPANHA NACIONAL DE VACINAÇÃO CONTRA A INFLUENZA, 2016.</span></a></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<a href="http://www.sbp.com.br/PDFs/conseso_influenza.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">BRASIL. SOCIEDADE BRASILEIRA DE PEDIATRIA. ALMEIDA, F..J.; BEREZIN, E.N.; FARHAT, C.K.; CINTRA, O.A.; STEIN, R.T.; BURNS, D.A.R.; ARNS, C.; LOMAR, A.V.; TONIOLO NETO, J. & MEDEIROS, R.: Consenso para o tratamento e profilaxia da influenza (gripe) no Brasil. </span></a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-43283550023827549232016-04-10T12:45:00.002-07:002016-04-10T12:45:38.752-07:00CALENDÁRIO DA CAMPANHA DE IMUNIZAÇÃO CONTRA A GRIPE/INFLUENZA NA GRANDE SÃO PAULO<div style="text-align: justify;">
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Na Grande São Paulo, a campanha de vacinação contra gripe H1N1 iniciou-se na semana passada com a primeira etapa, visando imunizar os profissionais da área da saúde. Amanhã, dai 11 de abril, iniciará a segunda etapa com a vacinação de crianças (entre 6 meses e 5 anos de idade), gestantes, idosos (acima de 60 anos de idade) e indígenas. No dia 18 de abril, iniciará a 3° etapa, com a vacinação de pessoas com doenças crônicas, que deverão apresentar receita médica para receber a imunização, mulheres que deram à luz há menos de 45 dias e pacientes com síndromes genéticas (como síndrome de down).<br />
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O grupo de risco para complicações e óbito por influenza H1N1 são idosos, pessoas com diabetes, doença cardiovascular crônica, obesidade, imunodeficiência/imunodepressão e doença neurológica crônica.<br />
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Fonte: <a href="http://www1.folha.uol.com.br/cotidiano/2016/04/1759330-inicio-da-vacinacao-publica-exclui-grupo-com-mais-mortes-por-gripe.shtml" target="_blank">Folha de São Paulo</a><br />
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Neste ano, houve 76 óbitos decorrentes de complicações relacionadas à influenza, sendo que 75% destes pacientes apresentaram fatores de risco. . <br />
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Fonte: <a href="http://www1.folha.uol.com.br/cotidiano/2016/04/1759330-inicio-da-vacinacao-publica-exclui-grupo-com-mais-mortes-por-gripe.shtml" target="_blank">Folha de São Paulo</a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-64250971297265777732016-04-05T06:15:00.000-07:002016-04-05T09:32:28.265-07:00SP ANTECIPA A VACINAÇÃO CONTRA A GRIPE PARA PROFISSIONAIS DA SAÚDE<div style="text-align: justify;">
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Desde a segunda-feira passada (04/03/2016) os profissionais da saúde da região metropolitana de São Paulo começaram a ser vacinados contra a gripe. A vacina contra os vírus H1N1, H3N2 e um tipo genético de influenza B deverá ser aplicada em mais de 532 mil funcionários de hospitais públicos e privados desta região.</div>
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A campanha de vacinação contra a gripe foi antecipada em virtude do elevado número de casos ocorridos ainda no verão. Foram notificadas 59 mortes por gripe e 465 casos de síndrome respiratória aguda. Desse total, 372 casos e 55 mortes foram relacionados ao vírus da gripe A (H1N1).</div>
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A imunização dos profissionais da saúde ocorrerá ao longo desta semana, passando a ser ampliada, a partir do dia 11 de abril, para crianças gestantes e idosos. O dia D para campanha a nível nacional iniciará em 30 de abril.<br />
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Fonte: <a href="http://g1.globo.com/sao-paulo/noticia/2016/04/sp-comeca-vacinacao-antecipada-de-profissionais-da-saude-contra-gripe.html" target="_blank">G1</a></div>
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Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-1861099093807773782016-03-29T19:47:00.000-07:002016-04-05T10:11:01.346-07:00CLARITROMICINA<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CLARITROMICINA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GRUPO FARMACOLÓGICO:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">antimicrobiano Macrolídeo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RECEITUÁRIO: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Receita de Controle Especial C (branca), em 2 vias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">POSOLOGIA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Neonatologia: eficácia e segurança não estabelecidos para recém-nascidos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pediatria (USO OFF-LABEL</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">) (>6 meses</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">):</span></div>
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<li><span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">VIA ORAL: 15 mg/Kg/dia (máximo = 500 mg/dose), VO, 12/12 horas</span><span style="font-family: Arial; font-size: 8.8px; text-align: justify; vertical-align: super; white-space: pre-wrap;">3</span><span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">; </span></li>
<li><span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">VIA INTRAVENOSA: </span><span style="background-color: white; font-family: Arial; font-size: 14.6667px; line-height: 1.38; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">7,5mg/kg/dose (máximo = 500 mg/dose), IV, 12/12 horas</span><span style="background-color: white; font-family: Arial; font-size: 8.8px; text-align: justify; vertical-align: super; white-space: pre-wrap;">3;</span><span style="background-color: white; font-family: Arial; font-size: 14.6667px; line-height: 1.38; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">;</span></li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Otite, amigdalite, sinusite, pneumonia, piodermite: 15 mg/Kg/dia (suspensão 250mg/5mL: 0,15 mL/Kg/dose, até 10 mL/dose </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">), VO, 12/12hs, por 7 a 14 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Coqueluche: 15 mg/Kg/dia (máximo=500 mg/dose), VO ou IV, 12/12hs, por 7 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Bartonelose (tratamento ou profilaxia para recurrência frequente ou severa em paciente HIV exposto/positivo: 15 mg/Kg/dia (máximo=500 mg/dose), VO, 12/12hs</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Endocardite (profilaxia): 15 mg/Kg/dose única (máximo=500 mg/dose única), VO, 30-60 minutos antes do procedimento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Infecção pelo estreptococo do grupo A; febre reumática, prevenção primária e tratamento da tonsilofaringite extreptocócica: 15 mg/Kg/dia (máximo=250 mg/dose), VO, 12/12 horas, por 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença de Lyme: 15 mg/Kg/dia (máximo=500 mg/dose), VO, 12/12hs, por 14-21 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Infecção por </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Micobacterium avium complex</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (MAC): </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Lactentes e crianças:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Profilaxia: 15 mg/Kg/dia, VO ou IV, 12/12hs de acordo com o CD4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">< 12 meses: se CD4 menor que 750 cel/mm</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">1 a 2 anos: se CD4 menor que 500 cel/mm</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">2 a 5 anos: se CD4 menor que 75 cel/mm</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 6 anos: se CD4 menor que 50 cel/mm</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Recorrência: 15 mg/Kg/dia (máximo=500 mg/dose), VO, 12/12hs em combinação com etambutol com ou sem rifabutin</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tratamento no HIV exposto/positivo: 15-30 mg/Kg/dia (máximo=500 mg/dose), VO, 12/12hs em combinação com etambutolç e rifabutin</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pneumonia adquirida na comunidade; pneumonia atípica (M. pneumoniae, C. pneumonniae, C. trachomatis):</span></div>
</li>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">> 3 meses, lactentes, crianças e adolescentes: 15 mg/Kg/dia, (máximo=500 mg/dose), VO, 12/12hs</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Um antibiótico beta lactâmico deve ser adicionado se houver suspeita de pneumonia bacteriana típica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
</li>
</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adolescentes: profilaxia e tratamentodo HIV exposto/positivo: 500 mg/dose, VO, 12/12hs com etambutol e rifabutin.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Doença ulcerosa péptica, erradicação do Helicobacter pylori: 15 mg/Kg/dia (máximo=500 mg/dose), VO, 12/12hs, associado a combinação dupla ou tripla (subsalicilato de bismuto, amoxicilina, metronidazol) e antagonista do receptor H</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> ou inibidor de bomba protônica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adolescentes: 250-500 mg, VO ou IV, de 12/12hs</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Coqueluche: 500 mg, VO ou IV, 12/12hs, por 7 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Adultos:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">250 - 500 mg/dose, VO ou IV, 12/12hs, por 7-14 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Bronquites e sinusites: 500 mg/dose, VO, 12/12hs, por 7-14 dias;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Helicobacter: 250-500 mg/dose, VO, 12/12hs a 8/8hs</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span></div>
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</ul>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ajuste de dose:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Função hepática: não há necessidade de ajuste de dose</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Função renal: se Cl</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: sub;">Cr</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> < 30 mL/min, administrar metade da dose a cada 12 ou 24 horas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diálise: não há necessidade de ajuste de dose adicional para pacientes em diálise</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
</li>
</ul>
</ul>
<br />
<br />
<div dir="ltr" style="margin-left: 0pt;">
<table style="border-collapse: collapse; border: none;"><colgroup><col width="136"></col><col width="45"></col><col width="57"></col><col width="57"></col><col width="109"></col><col width="77"></col><col width="110"></col></colgroup><tbody>
<tr style="height: 0px;"><td colspan="4" style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #777777; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ajuste da dose pelo</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #777777; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">clearance de creatinina </span></div>
</td><td colspan="3" style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #777777; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose em diálise </span></div>
</td></tr>
<tr style="height: 0px;"><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Dose/intervalo</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">>80</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">80-50</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">50-10</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><10 (anúria)</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">após HD</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">diária em DP</span></div>
</td></tr>
<tr style="height: 0px;"><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">250-500mg q12h</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12h</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">12h</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">24h</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">250mg q24h</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">250mg</span></div>
</td><td style="background-color: #f8f8f8; border-bottom: solid #c6c6c6 1px; border-left: solid #c6c6c6 1px; border-right: solid #c6c6c6 1px; border-top: solid #c6c6c6 1px; padding: 7px 5px 7px 5px; vertical-align: top;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: #f8f8f8; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Clcr<10</span></div>
</td></tr>
</tbody></table>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: white; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fonte: Manual Farmacêutico - HIAE</span><span style="background-color: white; color: #585858; font-family: "arial"; font-size: 7.199999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: white; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: white; color: #585858; font-family: "arial"; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
<br />
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">APRESENTAÇÕES:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimidos: 250mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, 500mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Comprimido UD: 500mg</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Suspensão: 125mg/5mL</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">; 250mg/5ml</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Frasco-ampola: 500mg/10mL</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
</li>
</ul>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESPECTRO:</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ATIVA CONTRA:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> gram positivos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e negativos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: pneumococo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Streptococcus pyogenes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Staphylococcus </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">sensível a oxacilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">H. influenzae</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">M. catarrhalis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, gonococo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, meningococo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, Campylobacter</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Legionella sp.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, Mycoplama</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mycoplasma pneumoniae</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Chlamydia sp.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Chlamydia tracomatis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Borrelia burgdoferi</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,V</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Mycobacterium avium complex</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Heliobacter pilory</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, B. pertussis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e parapertussis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ATIVIDADE MODERADA:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Haemophilus sp.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">; </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Neisseria sp</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RESISTENTE:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> S. aureus resistente a oxacilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Staphylococcus sp. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">resistentes à oxacilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INDICAÇÕES:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Infecções do trato respiratório superior e inferior (otite média aguda, pneumonia adquirida na comunidade)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Infecções de pele</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e partes moles</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">; </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Micobacterioses atípicas (</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mycobacterium avivium</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> complex disease</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">) em pacientes com AIDS (associadas a outros fármacos)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Profilaxia da endocardite infecciosa em procedimentos dentários em pacientes alérgicos à penicilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Profilaxia pós-exposiçaõ e tratamento da coqueluche</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CONTRA-INDICAÇÕES:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Uso concomitante com derivados do ergot</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, pimozida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, cisaprida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, astemizole</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, terfenadina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, colchicina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, lovastatina, sinvastatina;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Icterícia colestática ou disfunção hepática em uso prévio de claritromicina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipersensibilidade à claritromicina ou seus componentes, eritromicina ou outro antibiótico macrolídeo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">QT longo ou arritmia ventricular (incluindo torsade de pointes);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Evitar uso em pacientes com hipocalemia ou hipomagnesemia não corrigida, pacientes em uso de antiarritmicos classe IA (quinidina, procainamida) ou classe III (amiodarona, dofetilide, sotalol).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MODO DE ADMINISTRAÇÃO:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via oral: pode ser administrado com ou sem alimentos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via sonda: a suspensão oral pode ser administrada via sonda após diluir a dose em 10-20 mL de águia destilada para diminuir a osmolaridade do líquido e facilitar a administração</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Administrar separadamente da dieta enteral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via intravenosa: Não administrar em bolus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A dose deve ser diluída para a concentração de 2 mg/mL para pacientes sem restrição de volume</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Para crianças e pacientes com restrição de volume, deve-se diluir a dose na concentração máxima de 10 mg/mL, administrando em 1 hora</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A diluição pode ser feita com soros fisiológico, glicosado, glicofisiológico ou Ringer-Lactato</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A concentração final deve estar entre 4 e 10 mg/mL</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Via intramuscular: não</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESQUECIMENTO DE DOSE:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ingerir a dose assim que lembrar até o máximo de atraso de 1 hora, quando deverá suspender a dose e esperar a próxima dose</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INTERAÇÃO MEDICAMENTOSA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Reduz a concentração sérica: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">clopidogrel</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Não associar Claritromicina com: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nilotimibe</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, salmeterol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tioridazina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, topotecano</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, terfenadina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aztemisol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e cisaprida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Claritromicina aumenta a concentração sérica (toxicidade) desses medicamentos: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">fluconazol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, benzodiazepínicos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, buspirona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, carbamazepina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, digoxina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, clozapina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, colchicina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, ciclosporina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, ergotamina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, fentanil</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, sinvastatina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, pravastatina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, nilotinibe</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, sertralina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, citalopram</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, sirolimus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, teofilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,4</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tacrolimus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tioridazina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, ziprazidona</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Não administrar claritromicina na mesma via de infusão com:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> aminofilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, ceftazidima</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, cefuroxima</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, furosemida</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, heparina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, fenitoína</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GESTAÇÃO:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Fator de risco C</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">LACTAÇÃO: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Usar com precaução</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EFEITOS ADVERSOS: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Náusea</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, anorexia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, dispepsia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, dor abdominal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, vômitos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, diarreia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, colite por </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Clostridium difficile</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, gosto anormal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, colite pseudomembranosa</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, dor abdominal</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, cefaleia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tonturas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, perda auditiva</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, dor no sítio de infusão</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, flebite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, hepatotoxicidade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, rash</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, prurido</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, trombocitopenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento de transaminases</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento de bilirrubinas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, hepatite colestática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento no tempo de protrombina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, elevação de BUN</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento da uréia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento da creatinina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, elevação da fosfatase alcalina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, reação de hipersensibilidade aguda (grave)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, anafilaxia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, síndrome de Stevens-Johnson</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, necrólise epidérmica tóxica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, ansiedade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, alteração do comportamento</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, confusão, despersonalização</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, depressão</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, desorientação</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tontura</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, rash medicamentoso com eosinofilia e sintomas sistêmicos (DRESS)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento de gama glutaritransferase</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, glossite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> alucinações</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, perda auditiva (reversível)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, hemorragia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, púrpura de Henoch-Scönlein (vasculite IgA)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, disfunção e falência hepática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, hipoglicemia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, insônia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, nefrite intersticial</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, icterícia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, leucopenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, aumento DHL</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, mania</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, mialgia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, neutropenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, pesadelos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, monilíase oral</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, pancreatite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, psicose</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, prolongamento QT</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, rabdomiólise</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, convulsão</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, redução do olfato</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, estomatite</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tinitus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, descoloração da língua</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, descoloração dental</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, torsade de pointes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tremor</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, urticária</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, taquicardia ventricular</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, arritmia ventricular</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, vertigem</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, leucopenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> hematológica</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e hepática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INTERAÇÃO MEDICAMENTOSA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Claritromicina aumenta a concentração/efeito de: Budesonida (nasal, oral, sistêmica, inalatória)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, corticosteróides (oral, sistêmico, inalatório)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, sinvastatina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, tacrolimus (sistêmico, tópico),</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> terfenadina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, teofilina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, antagonistas da vitamina K</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, zidovudina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Níveis/efeitos da claritromicina são elevados por: antifúngicos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Claritromicina diminui a concentração/efeito de: BCG</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, clopidogrel</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, zidovudina</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Níveis/efeitos da claritromicina são reduzidos por: inibidores da protease</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MECANISMO DE AÇÃO:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A claritromicina inibe a síntese protéica bacteriana RNA-dependente por se ligar à subunidade 50S do ribossomo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. O metabólito 14-hidroxi da claritromicina é duas vezes mais ativo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.799999999999999px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">5</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.666666666666664px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIAS BIBLIOGRÁFICAS:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">CARVALHO, P.R.A.; CARVALHO, C.G.; TORRIANI, M.S.; SANTOS, L. & BARROS, E.: :MEDICAMENTOS DE A a Z: PEDIATRIA. 2012-2013. Editora ARTMED, 2012: 278-80.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">OLIVEIRA, R.G.: Blackbook - Pediatria. Belo Horizonte, Editora Blackbook, 3° edição, 2005.</span></div>
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<a href="https://aplicacoes.einstein.br/manualfarmaceutico/Paginas/RelacaoMedicamentos.aspx?tipo=principio_ativo&filtro=%22%22&busca=claritromicina&itemID=CLARITROMICINA#boxDetalhe" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">MANUAL FARMACÊUTICO - HOSPITAL ISRAELITA ALBERT EINSTEIN - acesso em 21/03/2016.</span></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">MACHADO, A. & BARROS, E.: Antimicrobianos e pediatria - Consulta rápida.Porto Alegre, Editora Artmed, 2007: 189.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">TAKEMOTO, C.K.; HODDING, J.H. & KRAUS, D.M.: Pediatric & neonatal dosage handbook. Lexicomp, 20th edition, 2013: 442-445.</span></div>
</li>
</ol>
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<a href="http://www.ans.gov.br/prevencao-e-combate/combate-ao-mosquito-aedes-aegypti#" target="_blank"></a>Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-64482836547751800412016-02-25T18:19:00.000-08:002016-03-29T19:43:15.237-07:00CUIDADOS PARA COMBATER O AEDES E EVITAR A DENGUE, CHIKUNGUNYA E ZIKA EM CASA<div style="text-align: justify;">
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<span style="font-size: large;"><b>CUIDADOS PARA COMBATER O AEDES E EVITAR A DENGUE, CHIKUNGUNYA E ZIKA EM CASA</b></span></div>
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<h3>
<b>CUIDADOS GERAIS</b></h3>
<div style="text-align: center;">
<img alt="montagem cuidados" class="img-responsive pull-left img-margin-right-ans" src="http://www.ans.gov.br/images/stories/aedes/box_408_200_montagem_cuidados_cinza_verm.png" style="margin-right: 1.5em;" width="200" /> </div>
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<h4>
<b>Prevenção/Proteção</b></h4>
</div>
<ul>
<li>Utilize telas em janelas e portas, use roupas compridas - calças e blusas - e, se vestir roupas que deixem áreas do corpo expostas, aplique repelente nessas áreas;</li>
<li>Fique, preferencialmente, em locais com telas de proteção, mosquiteiros ou outras barreiras disponíveis. </li>
</ul>
<h4>
<b>Cuidados:</b></h4>
<ul>
<li>Caso observe o aparecimento de manchas vermelhas na pele, olhos avermelhados ou febre, procure um serviço de saúde para atendimento;</li>
<li>Não tome qualquer medicamento por conta própria;</li>
<li>Procure orientação sobre planejamento reprodutivo e os métodos contraceptivos nas Unidades Básicas de Saúde.</li>
</ul>
<h4>
<b>Informação:</b></h4>
<ul>
<li>Utilize informações dos sites institucionais, como o Ministério da Saúde e das Secretarias Estaduais e Municipais de Saúde;</li>
<li>Se desejar engravidar, busque orientação com um profissional da saúde e tire todas as dúvidas para avaliar sua decisão;</li>
<li>Se não desejar engravidar, busque orientação médica sobre métodos contraceptivos. </li>
</ul>
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" 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" 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<b> Denuncie os focos do Aedes aegypti:</b><br />
<a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><br />
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<a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=510823718125808836" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a>Quando o foco do mosquito é detectado e não pode ser eliminado pelos moradores, como em terrenos baldios ou lixo acumulado na rua, a Secretaria Municipal de Saúde de sua cidade deve ser acionada para remover os possíveis criadouros. Veja aqui como entrar em contato. (<a href="http://www.saude.sp.gov.br/ses/sites-de-interesse/secretariasestaduais-%20e-municipais-de-saude)" target="_blank">http://www.saude.sp.gov.br/ses/sites-de-interesse/secretariasestaduais- e-municipais-de-saude)</a><br />
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<a href="http://www.ans.gov.br/images/stories/noticias/pdf/Cartilha_Zika_revisada.pdf" target="_blank">CARTILHA COM ORIENTAÇÕES GERAIS AO PÚBLICO SOBRE O ZIKA VÍRUS</a><br />
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Fonte: <a href="http://www.ans.gov.br/prevencao-e-combate/combate-ao-mosquito-aedes-aegypti#" target="_blank">ANS</a>Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-14921048230243475122016-02-21T18:03:00.001-08:002016-02-25T17:44:06.999-08:00PUBERDADE PRECOCE<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PUBERDADE PRECOCE</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Sinopse:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Protocolo Clínico e Diretrizes Terapêuticas</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">(Portaria SAS/MS n° 111, de 23 de abril de 2010)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 21.33px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PUBERDADE PRECOCE</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-X:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">E22.8</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CONSIDERAÇÕES INICIAIS</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Puberdade precoce</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> é o aparecimento de caracteres sexuais secundários antes dos 8 anos em meninas e 9 anos em meninos.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Puberdade precoce central ou verdadeira</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> é aquela dependente de gonadotrofinas, cursando com a ativação precoce do eixo hipotárlamo-hipófise-gonadal e desenvolvendo quadro semelhante á puberdade normal. Inicialmente, apresenta aumento do volume mamário em meninas e aumento do volume testicular em meninos (> 4 mL). Geralmente, a secreção prematura dos hormônios esteroides promove a aceleração do crescimento e fusão precoce das cartilagens de crescimento, resultando em comprometimento da estatura final. Nos casos em que não há aceleração da idade óssea, há possibilidade de não se instituir o tratamento nos estágios iniciais da puberdade, mormente em meninas entre 6 e 87 anos de idade.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A puberdade precoce central é 10 a 23 vezes mais frequente em meninas, sendo a maioria dos casos idiopática. Nos meninos, 2/3 dos casos são decorrentes de anormalidades neurológicas e, destas, 50% são tumores.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Etiologia da puberdade precoce central: tumores do sistema nervoso central, hamartomas hipotalâmicos, hidrocefalia, doenças inflamatórias ou infecções do sistema nervoso central.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Puberdade precoce periférica ou pseudopuberdade</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> precoce: decorre da produção de esteroides sexuais e não depende de gonadotrofinas, não havendo liberação do eixo hipotálamo-hipófise-gonadal. Há aparecimento de caracteres sexuais secundários, aceleração da velocidade de crescimento e avanço na idade óssea.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Etiologia da puberdade precoce periférica: tumores ou cistos ovarianos, tumores testiculares, hiperplasia adrenal congênita, tumores adrenais, síndrome de McCune Albright, hipotireoidismo grave.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Telarca precoce:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> desenvolvimento isolado das mamas. É uma forma de precocidade sexual que não caracteriza puberdade precoce, mas pode, em 18-20% dos casos configurar sintoma inicial de puberdade precoce.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Pubarca precoce:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> desenvolvimento isolado dos pelos pubianos. É uma forma de precocidade sexual que não caracteriza puberdade precoce, mas pode, em 18-20% dos casos configurar sintoma inicial de puberdade precoce.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninas:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> presença de mamas com ou sem desenvolvimento de pelos pubianos ou axilares antes de 8 anos de idade.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninos:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> aumento do volume testicular ( > 4 mL) e presença ou não de pelos pubianos ou axilares antes de 9 anos de idade.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Puberdade precoce central:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninos: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">LH basal:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> > 0,2 UI/L (ensaio imunoquiminulométrico - ICMA)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> > 0,6 UI/L (ensaio imunofluorimétrico - IFMA).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninas:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Teste de estímulo com GnRH ou teste de estímulo com agonista do GnRH (leuprorrelina): </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">pico de LH superior a 5,0 a 8,0 UI/L.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTE DE ESTÍMULO COM GnRH:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Método padrão–ouro para diagnóstico de puberdade precoce central tanto em meninos como em meninas com mais de 3 anos de idade.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Metodologia: Administra-se 100 µg de análogo do GnRH. IV e dosa-se LH nos tempos 0, 30 e 60 minutos.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de puberdade precoce:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> pico de LH superior a 5,0 a 8,0 UI/L em ambos os sexos e ensaios acima referidos.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TESTE COM ESTÍMULO DE ANÁLOGO DO GnRH (LEUPRORRELINA)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Exame alternativo utilizado na impossibilidade de realizar o teste de estímulo com GnRH.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Metodologia: Administra-se Leuprorrelina 3,75 mg/dose única, IM e dosa-se LH após 2 horas.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico de puberdade precoce:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">pico de LH > 10,0 UI/L.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RELAÇÃO ENTRE LH/FSH basais:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Puberdade: Relação LH/FSH: > 1,0.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Auxilia na diferenciação da puberdade precoce central progressiva e não progressiva.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EXAMES DE IMAGEM</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IDADE ÓSSEA:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> deve ser avaliada a idade óssea segundo o método de Greulich & Pyle:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">avanço puberal: idade óssea 1 ano superior à idade cronológica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ULTRASSONOGRAFIA PÉLVICA:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicada no sexo feminino, mormente em meninas com menos de 3 anos de idade;</span></div>
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<span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estímulo estrogênico persistente:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tamanho uterino: > 35 mm de comprimento;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Volume uterino: > 2,0 mL;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aspecto uterino piriforme.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Estimulação gonadotrófica persistente:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Volume ovariano: > 1,0 cm</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 35pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">RESSONÂNCIA MAGNÉTICA NUCLEAR:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Indicada:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Todos os meninos com puberdade precoce central;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninas com idade inferior a 6 anos com puberdade precoce central;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninas com idades entre 6 a 8 anos com puberdade precoce central e sinais clínicos de alteração neurológica do SNC.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">INDICAÇÃO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">·</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninas:</span></div>
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<span style="background-color: transparent; color: black; font-family: "courier new"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">< 3 anos de idade:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> com sinais clínicos de puberdade rapidamente progressiva, idade óssea avançada, avanço da velocidade de crescimento, LH em níveis puberais, USG com aumento do tamanho ovariano e uterino;</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 107pt; margin-top: 0pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: transparent; color: black; font-family: "courier new"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">3 a 6 anos de idade:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> com sinais clínicos de puberdade, idade óssea avançada, aumento da velocidade de crescimento. LH basal ou no teste de estímulo em nível puberal, USG com aumento do tamanho ovariano e uterino;</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 107pt; margin-top: 0pt; text-align: justify; text-indent: -18pt;">
<span style="background-color: transparent; color: black; font-family: "courier new"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">6 a 8 anos de idade:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> sinais clínicos de puberdade rapidamente progressiva, idade óssea avançada, aumento da velocidade de crescimento, comprometimento da estatura final (abaixo do alvo familiar), LH no teste de estímulo em nível puberal, USG com aumento de tamanho ovariano e uterino.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">·</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninos:</span></div>
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<span style="background-color: transparent; color: black; font-family: "courier new"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">o</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">< 9 anos de idade: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">sinais clínicos de puberdade, aumento da velocidade de crescimento, idade óssea avançada, comprometimento da estatura final, LH basal ou no teste de estímulo em nível puberal.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE EXCLUSÃO DO TRATAMENTO:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Serão excluídos de tratamento os pacientes que apresentarem pelo menos uma das seguintes situações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Pubarca precoce isolada;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Telarca precoce isolada;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Produção de esteroides não estimulados por gonadotrofinas:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tumores ou cistos ovarianos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tumores testiculares;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hiperplasia adrenal congênita;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Tumores adrenais;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome de McCune-Albright;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Puberdade precoce lentamente progressiva, sem comprometimento da estatura final em meninas de 6 a 8 anos de idade;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade óssea:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninas: > 12 anos;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Meninos: > 13 anos.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Contra-indicação ou intolerância aos medicamentos especificados.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Crianças pequenas para a idade gestacional (PIG);</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Autistas;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em tratamento quimioterápico;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Baixa estatura idiopática;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Deficiência de GH;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Hipotireoidismo severo.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MEDICAMENTOS:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">GOSSERRELINA:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3,6 mg/dose, implante subcutâneo, a cada mês;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">10,8 mg/dose, implante subcutâneo, a cada 3 meses.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">LEUPRORRELINA:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3,75 mg/dose, IM, a cada mês;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">11,25 mg/dose, IM, a cada 3 meses.</span></div>
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</ul>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRIPTORRELINA:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3,75 mg/dose, IM, a cada mês;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">11,25 mg/dose, IM, a cada 3 meses.</span></div>
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</ul>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Observações:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não há superioridade terapêutica entre o uso trimestral sobre o mensal;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Quando constatado o bloqueio incompleto, pode-se indicar redução do intervalo entre as doses ou aumento das mesmas.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TEMPO DE TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> O tratamento deve ser iniciado ao diagnóstico e suspenso:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninas:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;"> idade óssea entre 12 e 12,5 anos </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">e idade cronológica normal para o desenvolvimento da puberdade com expectativa de altura final dentro do alvo familiar.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">Meninos:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;"> idade óssea entre 13 e 13,5 anos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e idade cronológica normal para o desenvolvimento da puberdade com expectativa de altura final dentro do alvo familiar.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">MONITORIZAÇÃO:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A cada 3 meses: estadio puberal, crescimento linear e tolerância medicamentosa;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Idade óssea: anualmente;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nos primeiros 3 a 6 meses de tratamento:</span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: circle; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Antes da dose seguinte, deve ser realizado teste de estímulo com GnRH ou Leuprorrelina:</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">30 minutos após GnRH: LH < 2,3 UI/L (IFMA) ou < 2,0 UI/L (ICMA);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: square; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">60 minutos após Leuprorrelina: < 6,6 UI/L (IFMA)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EFEITOS ADVERSOS</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Sangramento vaginal (após a primeira administração);</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cefaléia;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fogachos;</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Abscessos estéreis;</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: justify;">
<span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Anafilaxia.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TERMO DE ESCLARECIMENTO E RESPONSABILIDADE – TER</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> É obrigatória a informação ao paciente ou a seu responsável legal dos potenciais riscos, benefícios e efeitos adversos. O TER é obrigatório ao se prescrever medicamento do Componente Especializado da Assistência Farmacêutica.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FLUXOGRAMA DE TRATAMENTO DA PUBERDADE PRECOCE CENTRAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">REFERÊNCIAS BIBLIOGRÁFICAS</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">·</span><span style="background-color: transparent; color: black; font-family: "times new roman"; font-size: 9.33px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><a href="http://portalsaude.saude.gov.br/images/pdf/2014/abril/02/pcdt-puberdade-precoce-central-livro-2010.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">PICON, P.D.; GADELHA, M.I.P. & BELTRAME, A.: Protocolo Clínico e Diretrizes Terapêuticas – Puberdade Precoce Central. Portaria SAS/MS n° 111 de 23 de abril de 2010</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<br />Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-9201081392459858512016-02-20T01:37:00.001-08:002016-02-25T17:43:34.377-08:00ZIKA VÍRUS (ZIKAV)<div style="text-align: justify;">
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 24px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ZIKA VÍRUS (ZIKAV)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CID-X:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> A92.8 (outras febres virais especificadas transmitidas por mosquitos)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ETIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O Zika vírus (ZICAV) é um arbovírus (vírus transmitido por artrópodes) RNA vírus do gênero Flavivirus, família Flaviviridae. Há duas linhagens do vírus: Africana e Asiática</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O ZIKAV foi isolado pela primeira vez em 1947, a partir de macacos Rhesus utilizados como sentinelas para detecção de febre amarela na floresta de Zika, em Uganda</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">HISTÓRICO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Embora a primeira evidência de infecção humana pelo ZIKAV remonte 1952 em amostras de soro humano do leste da África, o ZIKAV somente chamou a atenção a partir de 2007, após um surto na ilha de Yap e em outras ilhas próximas dos Estados Federados da Micronésia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Durante o surto, cerca de 70% dos habitantes da ilha de Yap foram afetados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Entre outubro de 2013 e 7 de fevereiro de 2014, 8.264 casos suspeitos de febre pelo ZIKAV foram notificados na Polinésia Francesa e, entre 764 amostras analisadas, 53,1% foram positivas para esse vírus por biologia molecular</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Foram identificados 38 casos de síndrome de Guillain-Barré (SGB) após infecção pelo ZIKAV, 25 pacientes tiveram complicações neurológicas (encefalite, meningoencefalite, parestesia, paralisia facial e mielite) e 7 pacientes tiveram outras complicações (4 apresentaram trombocitopenia; 2, complicações oftalmológicas; e 1, complicação cardíaca)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em 2013, foram detectados casos de febre pelo ZIKAV na Nova Caledônia, importados da Polinésia Francesa, ocorrendo os primeiros casos autóctones em meados de janeiro de 2014. No início de fevereiro de 2014, foi declarado um surto com um total de 1385 casos confirmados laboratorialmente, incluindo 35 casos importados</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em 28 de fevereiro de 2014, foi identificado o primeiro caso de ZIKAV no Chile, em uma criança de 11 anos, residente da Ilha de Páscoa</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EPIDEMIOLOGIA</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O ZIKAV é endêmico no leste o oeste do continente Africano</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Em 1966, o vírus de disseminou para o continente asiático</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Atualmente, há circulação esporádica de ZIKAV na África (Nigéria, Tanzânia, Egito, África Central, Serra Leoa, Gabão, Senegal, Costa do Marfim, Camarões, Etiópia, Quênia, Somália e Burkina Faso), Ásia (Malásia, Índia, Paquistão, Filipinas, Tailândia, Vietnã, Camboja, Índia, Indonésia) e Oceania (Micronésia, Polinésia Francesa, Nova Caledônia/França e Ilhas Cook)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Casos importados de febre pelo vírus Zika foram descritos no Canadá, Alemanha, Itália, Japão, Estados Unidos, Austrália e Chile</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="247" src="https://lh4.googleusercontent.com/8fu9Uq9oEzIBB0_QFQYo5NJCeV25ujVOAo6BB0HYO_rcRDTVqnICuoH8ZCQv4hlWHwgKyA4zm8Ncxsl0l8DczEr0GSL_Zq5I4d2GAfjVkg80x2bXBTN71KQFAns7Hmaf3MbBkKXe" style="-webkit-transform: rotate(0.00rad); border: currentColor; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura 1: Distribuição do ZIKAV no mundo</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Epidemiologia da Epidemia de ZIKAV na Polinésia Francesa (2013-2014):</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="317" src="https://lh3.googleusercontent.com/aGOLKWJ1X0iDePXmLt-uz5XvxE7tVNlUzYLNFNC9MDhioPAJSnSOEDFQ_pbNLSooU3duUbIGUgriS1m8OqQZZsA0_CODbL_J_Xwbr_8oZn-p6ia51Wm1CYp42AQMsczxOdyGoW8B" style="-webkit-transform: rotate(0.00rad); border: currentColor; transform: rotate(0rad);" width="530" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura 2: Evolução semanal do número de suspeitos de infecção por ZICAV na Polinésia Francesa de 30/10/2013 a 14/02/2014 (Epidemia ainda em atividade)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura 3:Número de casos com complicações neurológicas por dia de admissão hospitalar na Polinésia Francesa de 2013-2014 (n=73)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRANSMISSÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Os primatas não humanos são considerados reservatórios silvestres do ZIKAV</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Na África Oriental, o vírus é mantido em ciclo silvestre nas florestas tropicais, com ciclo de epizootia envolvendo primatas não humanos e mosquitos do gênero </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aedes spp</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Na África Ocidental e no sudeste Asiático, além de o vírus ter sidoisolado em macacos (</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cercopithecus aethiops</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Erytrocebus patas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">), circula em várias espécies de animais vertebrados (orangotangos, elefantes, zebras, búfalos e roedores)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O ZICAV é transmitido por vetores, acidentes em laboratório, transmissão vertical (perinatal), via sexual e via transfusional</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Os principais vetores para o ZIKAV são os mosquitos da família Culicidae e do gênero </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aedes</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> (transmissão silvestre ou urbana)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2,3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">: Aedes </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">aegypti </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">(transmissão urbana), Aedes </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">polynensiensis</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, Aedes </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">albopictus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">, Aedes </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">hensilli</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">África: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A. africanus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> e outros;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Malásia: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A. aegypti</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Polinésia Francesa: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A. aegypti </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">(vetor urbano)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gabão: </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A. albopictus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Período de incubação extrínseco para ZIKAV em mosquitos: 10 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">QUADRO CLÍNICO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Período de incubação: 3 a 12 dias</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mais de 80% das pessoas infectadas não desenvolvem manifestações clínicas (forma assintomática)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Forma sintomática: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Síndrome dengue-like: artralgia, edema de extremidades, febre leve, cefaléia,dor retro-orbital, hiperemia conjuntival, exantema maculopapular com progressão descendente da face aos membros e frequentemente pruriginosa, vertigem, mialgia e manifestações gastrointestinais</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A doença febril aguda é autolimitada, com duração de 3 a 7 dias, geralmente sem complicações graves</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Há surgimento de exantema maculopapular pruriginoso, febre intermitente, hiperemia conjuntival não purulenta e não pruriginosa, artralgia (que pode persistir por aproximadamente um mês), mialgia e cefaléia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Menos frequentemente, há edema, dor de gargante, tosse, vômitos e hematospermia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Em sua forma mais grave, pode ocorre síndrome de Guillain-Barré (SGB), principalmente em locais com circulação simultânea do vírus da dengue</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">1,2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em relação às manifestações clínicas de outras doenças exantemáticas (dengue, chikungunya e sarampo), a febre pelo ZIKAV apresenta mais exantema e hiperemia conjuntival e menor alteração nos leucócitos e trombócitos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="289" src="https://lh4.googleusercontent.com/UyKj3YHXBpR0a0Fxf9hqLbUMZsXkegpZhGT-7qtipCVRCh6tjLHPT8YY7pVbRFSe-JL0LMrzs8iMroFwu6McFMrtq0jvxl0J1NxW9yINVXgIDClq6UBbpmPpIcpWz--52-ZWJFwz" style="-webkit-transform: rotate(0.00rad); border: currentColor; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura 2: diagnóstico diferencial entre dengue, chikungunya e Zika vírus</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">DIAGNÓSTICO LABORATORIAL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">HEMOGRAMA: discreta a moderada leucopenia e trombocitopenia</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Desidrogenase láctica sérica (DHL): ligeiramente aumentada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Gama glutamiltransferase (gama-GT): ligeiramente aumentada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Proteína C reativa: ligeiramente aumentada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fibrinogênio: ligeiramente aumentado</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ferritina: ligeiramente aumentada</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Diagnóstico laboratorial específico do ZIKAV: detecção do RNA viral a partir de espécimes clínicos</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O período virêmico é curto, permitindo a detecção direta do vírus em até 3 a 5 dias após o início dos sintomas: a amostra deve ser coletada até o 4° dia após início dos sintomas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">os ácidos nucléicos do vírus foram detectados em humanos entre 1 e 11 dias após o início dos sintomas e o vírus foi isolado em primata não humano até 9 dais após inoculação experimental</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">No Brasil, o diagnóstico é feito pela Reação em Cadeia da Polimerase via Transcriptase Reversa (RT-PCR)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Testes sorológicos (Elisa ou imunofluorescência): CDC desenvolveu uma técnica de ELISA para detectar anticorpos específicos IgM anti ZIKAV, porém apresenta frequentemente reação cruzada com outros flavivírus (dengue e febre amarela), dificultando o diagnóstico. Além disso, na fase aguda, tanto IgM quanto IgG estão em baixas concentrações, de modo a dificultar a confirmação diagnóstica. Pode ser utilizada uma técnica complementar de soroneutralização (Teste de Neutralização em Redução de Placas - PRNT) que amplifica em 4 vezes a titulação de anticorpos inicial</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Não há kits comerciais disponíveis para a detecção de anticorpos contra o ZIKAV</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><img height="197" src="https://lh4.googleusercontent.com/2yn5XU5HVg7hP3sDlMt8BOaTihym9iB1saNvpWdByk2gHG2rEOWs90PPlx9rAn2ZnzSfl5UwGxcJmkczfw9wajpQpyxMFYQSY6r39kt1b6HZo4InCL9l9Bms0mp68XUBzse3hKQu" style="-webkit-transform: rotate(0.00rad); border: currentColor; transform: rotate(0rad);" width="590" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Figura 3: Oportunidade de detecção do ZIKAV segundo a técnica laboratorial (isolamento viral, reação em cadeia da polimerase via transcriptase reversa (RT-PCR) e sorologia (IgM/IgG)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">TRATAMENTO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não existe tratamento específico. A dor e a febre devem ser controlados com o uso de acetaminofeno (paracetamol) ou dipirona. As erupções pruriginosas podem ser tratadas com antihistamínicos. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não usar ácido acetilsalicílico ou outros antiinflamatórios.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">“Diante da inexistência de </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">kits </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">comerciais para realização de sorologia específica para ZIKAV no Brasil, como ocorre com a dengue, é importante destacar que, neste momento, as realizações dos diagnósticos clínico e diferencial com dengue e febre de chikungunya são as principais ações a serem adotadas. Os casos suspeitos devem ser tratados como dengue, devido à sua maior gravidade.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">”</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">IMUNIZAÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Não há vacina para prevenir infecção pelo ZIKAV</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">PREVENÇÃO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">A prevenção da infecção pelo ZIKAV depende da proteção individual contra picadas e da erradicação dos mosquitos vetores (prevenção anti-vetorial)</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. A prevenção em nível comunitário consiste na redução do número de mosquitos pela redução dos locais de postura dos ovos (pires de vasos de plantas, fossas, reservatórios de água, pneus abandonados, etc.), secando-os, isolando-os ou tratando-os com inseticidas</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Deltametrina é o único inseticida com resultado satisfatório em aplicação aerossol</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">3</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Proteção individual inclui: vestes longas e com cores claras, repelentes de pele e mosquiteiros nas camas (protegendo bebês e pacientes acamados).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">NOTIFICAÇÃO</span></div>
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<span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Os casos confirmados de Zika vírus devem ser comunicados/notificados em até 24 horas, conforme </span><a href="http://www.direitomed.com/medicina/legislacao_complementar/portarias/portaria_1271_2014_ms.html" style="text-decoration: none;" target="_blank"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline;">Portaria MS nº 1.271, de 6 de junho de 2014</span></a><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">. Reforça-se que a notificação realizada pelos meios de comunicação não isenta o profissional ou serviço de saúde de realizar o registro dessa notificação nos instrumentos estabelecidos, utilizando a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde – CID A92.8 (acesso a cópia da ficha de notificação/conclusão individual: </span><a href="http://dtr2004.saude.gov.br/sinanweb/novo/Documentos/SinanNet/fichas/Ficha_conclusao.pdf" style="text-decoration: none;"><span style="background-color: transparent; color: blue; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">http://dtr2004.saude.gov.br/sinanweb/novo/Documentos/SinanNet/fichas/Ficha_conclusao.pdf</span></a><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">)</span><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">4</span><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Em caso de dúvida, entre em contato com a Vigilância Epidemiológica das Secretarias Estaduais ou Municipais de Saúde</span><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 8.79px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: super;">4</span><span style="background-color: transparent; color: #333333; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 18.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">FONTE: </span></div>
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<li><a href="http://www.luizhorta.com/html/pediatria/zikav.html" target="_blank">SITE: PROFESSOR LUIZ HORTA</a></li>
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<br />Luiz Hortahttp://www.blogger.com/profile/04688738606876114760noreply@blogger.com0tag:blogger.com,1999:blog-510823718125808836.post-39894718103621949662016-02-19T17:51:00.001-08:002016-02-25T17:44:36.009-08:00NOVOS CRITÉRIOS PARA O DIAGNÓSTICO DE FEBRE REUMÁTICA<div style="text-align: justify;">
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<b>NOVOS CRITÉRIOS PARA O DIAGNÓSTICO DE FEBRE REUMÁTICA</b></h2>
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A febre reumática é uma doença multissistêmica que acomete 3% dos pacientes que desenvolvem faringite por estreptococo beta-hemolítico do grupo A (37% das faringites são causadas por esse agente. Estima-se que, no Brasil, ocorram cerca de 30.000 novos casos de febre reumática, sendo que 15.000 desses casos evoluem com lesões cardíacas que podem ser irreversíveis.</div>
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A cardiopatia reumática crônica é responsável por 233.000 óbitos prematuros por ano e é a maior causa de mortalidade cardiovascular em crianças e adultos jovens em países em desenvolvimento. A faixa etária mais acometida situa-se entre 5 e 14 anos de idade. <b><br /></b></div>
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O tratamento da faringite (profilaxia primária) visa reduzir a exposição antigênica do paciente ao estreptococo e impedir a propagação de cepas reumatogênicas na população, além de prevenir as complicações agudas. A prevenção da febre reumática baseia-se no tratamento adequado da farnigoamigdalite estreptocócica, preferencialmente com a penicilina G banzatina. o risco de alergia á droga é mínimo e passível de ser resolvido com medicação. A <a href="http://www.direitomed.com/medicina/legislacao_complementar/portarias/portaria_3161_2011_ms.html" target="_blank">Portaria do Ministério da Saúde n° 3.161 de 27/12/2011 </a>d<span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><b><span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ispõe sobre a administração da penicilina nas unidades de Atenção Básica à Saúde, no âmbito do Sistema Único de Saúde (SUS).</span></span></b></div>
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<b><span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">O</span></span><span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> tratame</span></span><span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">nto da faringite</span></span><span style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> com antibióticoterapia deve ser baseado no Escore de Centor Modificado<b> </b>(figura 1). Deve-se somar os pontos do escore, havendo indicação para tratamento antibiótico para faringite sempre que o valor for > 3 pontos. O encontro de 2 pontos no escore indica a realização do teste rápido. Na impossibilidade da realização deste teste, o tratamento está indicado em populações de médio e alto risco com escore de 2 pontos.</span></span></b></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">ESCORE DE CENTOR MODIFICADO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">3 - 14 anos</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">+1</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">15 - 44 anos</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">≥ 45 anos</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">+1</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Edema ou exsudato tonsilar</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">+1</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Linfoadenomegalia</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">+1</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Ausência de tosse</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">+1</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Presença de tosse</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">0</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adultis in the emergency room. Med Decis Making. 1981; 1(3):239-46.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical Validation of Guidelines for the Management of Pharyngits in Children and Adults. JAMA. 2004; 291 (13):1587-1595. doi:10.1001/jama.291.13.1587.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Fine AM, Nizet V, Mandl KD. Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Strepcococcal Pharyngitis. Arch Intern Med. 2012 Jun 11; 172(11): 847-852.</span></div>
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O diagnóstico de Febre Reumática baseia-se nos Critérios de Jones, que foram revisados pela American Heart Association em 2015, segundo tabela 2:</div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS DE JONES MODIFICADOS</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">POPULAÇÕES DE BAIXO RISCO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">POPULAÇÕES DE ALTO RISCO</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS MAIORES</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cardite</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poliartrite</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poliartrite (somente)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Mono ou poliartrite ou poliartralgia</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Coréia</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Coréia</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Coréia</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nódulos subcutâneos</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nódulos subcutâneos</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Nódulos subcutâneos</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eritema marginado</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eritema marginado</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Eritema marginado</span></div>
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<tr style="height: 28px;"><td colspan="3" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">CRITÉRIOS MENORES</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Febre</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Febre</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Febre</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Artralgia</span></div>
</td><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Poliartralgia</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Monoartralgia</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Provas de atividade inflamatória elevadas</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VHS ≥60mm e/ou </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PCR ≥3,0 mg/dL</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">VHS ≥30mm e/ou </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"><br class="kix-line-break" /></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">PCR ≥3,0 mg/dL</span></div>
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<tr style="height: 0px;"><td style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumento de PR no ECG</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumento de PR no ECG</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Aumento de PR no ECG</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline;">EVIDÊNCIAS DE ESTREPTOCOCCIA RECENTE</span></div>
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<tr style="height: 28px;"><td colspan="3" style="border: 1px solid rgb(0, 0, 0); padding: 7px; vertical-align: top;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Cultura positiva da orofaringe para estreptococo β-hemolítico do grupo A</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Títulos elevados de ASO ou outro anticorpo estreptocócico;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Teste rápido para antígenos do estreptococo;</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;"> Escarlatina recente</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">O diagnóstico será positivo para FEBRE REUMÁTICA se houver a presença de dois critérios maiores ou de um critério maior e dois menores, se acompanhados de evidência de infecção estreptocócica anterior.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.66px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline;">Revision of the Jones Criteria for the diagnosis of fheumatic fever in the era of Dopples echocardiography: a scientific statement from the American Heart Association. Circulation; 13(20): 1806-18, 2015 May 19.</span></div>
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O tratamento da febre reumática visa: </div>
<ul>
<li>erradicação do estreptococo;</li>
<li> controle dos fenômenos inflamatórios e cicatriciais; </li>
<li>controle sintomático;</li>
<li>tratamento das demais complicações da febre reumática aguda (cardite, poliartrite e coréia).</li>
</ul>
<div style="text-align: justify;">
A erradicação do estreptococo é feita com a penicilina G benzatina (600.000 a 1.200.000 UI) em dose única. As outras opções (amoxicilina, penicilina V e ampicilina) tem resultados menos satisfatórios. nos pacientes alrgicos à penicilina, recomenda-se eritromicina<b>´</b>(20-40 mg/Kg/dia, durante 10 dias), azitromicina ou clindamicina.<b><br /></b></div>
<div style="text-align: justify;">
Para evitar novos surtos de doença, indica-se profilaxia secundária com penicilina G benzatina na mesma dose:</div>
<ul>
<li> nos pacientes sem doença cardíaca: a cada 21 dias até 21 anos de idade ou até 5 anos após o último surto; </li>
<li>nos pacientes com febre reumática com cardite prévia, insuficiência mitral residual ou resolução da lesão valvar: até 25 anos ou 10 anos após o último surto;</li>
<li>nos pacientes com lesão valvar residual moderada a severa: profilaxia deverá ser mantida até a quarta década de vida ou por toda a vida.</li>
</ul>
<div style="text-align: justify;">
A sulfadiazina é utilizada nos pacientes alérgicos (500 mg/dia em pacientes até 30 Kg e 1000 mg/dia nos pacientes com > 30 Kg).<b> </b>Nos casos de pacientes alérgicos à penicilina e à sulfa, utiliza-se eritromicina (250 mg de 12/12 horas).</div>
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A febre reumática provável e a febre reumática possível devem ser reconhecidas como categorias diagnóticas, sendo realizada a profilaxia com penicilina pelo menos até a revisão do acompanhamento.</div>
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<b>Fonte: <a href="http://www.sbp.com.br/src/uploads/2012/12/Novos-critrios-para-Febre-Reumtica-Site-003.pdf" target="_blank">Sociedade Brasileira de Pediatria</a></b></div>
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