A. Derek. Principia College.
Long-term therapy with acetyl- salicylic acid reduces the risk of having another stroke discount 10 mg maxalt overnight delivery. Antplatelet and thrombolytc drugs are not used in the management of haemorrhagic stroke discount maxalt 10mg amex, as they may exacerbate bleeding buy generic maxalt 10 mg. Acetylsalicylic acid is normally given for at least one year afer coronary artery bypass surgery. It is also given to patents with prosthetc heart valves who have had cerebral embolism despite warfarin treatment. Contraindicatons Surgery within 10 days, including organ biopsy, puncture of noncompressible vessels, serious trauma, cardiopulmonary resuscitaton, actve bleeding, serious gastrointestnal bleeding within 3 months, previous cerebrovascular accident or actve intracranial process, thrombocytopenia, severe uncontrolled hypertension, aortc dissecton, acute pericardits. Precautons Monitor platelet count for thrombocytopenia; interactions (Appendix 6c); pregnancy (Appendix 7c). Dose Oral Adult-Prophylaxis of cerebrovascular disease or myocardial infarcton: 75 to 100 mg daily. Adverse Efects Bronchospasm;gastrointestnalhaemorrhage (rarely, major); also other haemorrhage (for example subconjunctval); urtcaria; hepatomegaly. Alteplase Pregnancy Category-C Schedule H Indicatons Acute myocardial infarcton, acute massive pulmonary embolism, acute ischaemic stroke. Dose Intravenous Acute myocardial infarcton Adult: The recommended total dose is 100 mg. Heparin therapy to be insttuted or reinsttuted near the end of or immediately following the alteplase infusion when the partal thromboplastn tme returns to twice normal or less. Acute ischemic stroke Adult: Use recommended within frst 3 h of onset of the symptoms. Caution in recent surgery or invasive procedures, diabetic hemorrhagic retinopathy, severe hepatic and renal impairment, pregnancy (Appendix 7c), lactation, children, elderly, interactions (Appendix 6c). Adverse Efects Hemorrhage including intracranial, gastrointestnal or genitourinary bleeding, transient hypotension, reperfusion dysrythmias, cerebral edema, seizures, allergic-type reactons, nausea, vomitng. Storage Store protected from heat, light and moisture at room temperature (<30°C) or under refrigeraton. Clopidogrel* Pregnancy Category-B Schedule H Indicatons Prophylaxis in thromboembolic disorders including myocardial infarcton, peripheral arterial disease and stroke, acute coronary syndrome. Contraindicatons Hypersensitvity, actve pathological bleed- ing such as peptc ulcer or intracranial hem- orrhage, coagulaton disorders, lactaton. Precautons Patient with increased risk of bleeding from trauma, surgery or other pathological conditions, ulcers, renal impairment, hepatic impairment, history of bleeding or haemostatic disorder, pregnancy (Appendix 7c); interactions (Appendix 6c). Adult- Thrombosis: 2,50,000 units over 30 min, followed by 1,00,000 units every h for 12 to 72 h according to conditon with monitoring of clotng parameters. Contraindicatons Recent haemorrhage; surgery (including dental); parturiton; trauma; heavy vaginal bleeding; haemorrhagic stroke; history of cerebrovascular disease (especially recent or if residual disability); coma; severe hypertension; coagulaton defects; bleeding diatheses; aortc dissecton; risk of gastrointestnal bleeding such as recent history of peptc ulcer; oesophageal varices; ulceratve colits; acute pancreatts; severe liver disease; acute pulmonary disease with cavitaton; previous allergic reactons; pregnancy (Appendix 7c). Precautons Risk of bleeding from any invasive procedure; including injecton; external chest compres- sion; abdominal aneurysm or where throm- bolysis may give rise to embolic complica- tons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and sub- sequent embolizaton); diabetc retnopathy (small risk of retnal haemorrhage); recent or concurrent antcoagulant treatment; platelet count; fbrinogen level; thrombin and pro- thrombin tme. Storage Store in a sealed container protected from light in refrigerator (2 to 8⁰C). Urokinase* Pregnancy Category-C Schedule H Indicatons Acute myocardial infarcton; pulmonary embolism; deep vein thrombosis; peripheral vascular thrombosis; peripheral arterial thromboembolism; arterial thrombosis. Dose Intravenous infusion Deep vein thrombosis: 4,400 units/kg body weight in 15 ml Sodium Chloride (0. Contraindicatons In recent haemorrhage; trauma; or surgery (including dental extracton); coagulaton defects; bleeding diatheses; aortc dissecton; coma; history of cerebrovascular disease especially recent events or with any residual disability; recent symptoms of possible peptc ulceraton; heavy vaginal bleeding; severe hypertension; actve pulmonary disease with cavitaton; acute pancreatts; pericardits; bacterial endocardits; severe liver disease and oesophageal varices. They should also be used with cauton in external chest compression; pregnancy (Appendix 7c); elderly; hypertension; abdominal aneurysm or other conditons in which thrombolysis might give rise to embolic complicatons such as enlarged lef atrium with atrial fbrillaton (risk of dissoluton of clot and subsequent embolisaton); diabetc retnopathy (very small risk of retnal bleeding) and recent or concurrent use of drugs that increase the risk of bleeding; hematocrit platelet count; thrombin and prothrombin tme. Bleeding is usually limited to the site of injecton; but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontnuaton of the thrombolytc and may require administraton of coagulaton factors and antfbrinolytc drugs (aprotnin or tranexamic acid). Rarely, further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). It causes allergic reactons (including rash; fushing and uveits) and anaphylaxis has also been reported. Storage Store in a sealed container protected from light in refrigerator (2 to 8⁰C). The container should be sterile, tamper evident and sealed so as to exclude micro-organisms. They are rarely, needed when shock is due to Sodium and water depleton as, in these circumstances, the shock responds to water and electrolyte repleton.
Controlled release from the device involves no moving parts with release from the individual reservoirs being initiated by applying an electric potential between the anode membrane and a cathode discount maxalt 10mg fast delivery. The anode membrane undergoes electrochemical dissolution causing the release of solid maxalt 10mg online, liquid or gel from the reservoir buy 10mg maxalt fast delivery. The proof-of-principle release studies have demonstrated the controlled, pulsatile release of chemical substances from the device. Future integration of this technology with microchip-based bioanalytical technologies should facilitate the development of microchips in which a microbiosensor controls the release of drug in response to a biological stimulus, allowing both controlled pulsatile release and bioresponsive drug release from the same device. It is anticipated that the disease could be treated by introducing the enzyme-coding gene into bone marrow progenitors. Recent advance in genetic engineering technology has made it possible to regulate gene expression including transcription and translation in a variety of cell types. Such success has led to development of a second-type gene therapy making use of “surrogate” cells. Genetic modification of heterologous cells, rather than impaired cells, by viral or nonviral vectors endows the surrogate cells with a missionary function to provide the body with necessary proteins. Examples of the cells that are used include fibroblasts, endothelial cells, lymphocytes, keratinocytes, glial cells and mammary cells. These genetically modified cells may be housed in a polymeric implantable device for implantation into the patient. However, to make such a therapy reality, concerns over cell viability inside the implantable device have to be adequately addressed. The implant’s polymer composition and morphology would have to be optimized in order to maximize the life-span of the cells and to minimize host immune responses. The vascularization of the implant would be another determinant that plays an important role regarding cell viability because it enables the implant to receive nutrients necessary for their survival, to eliminate metabolic by-products and to provide the systemic entrance of therapeutic proteins. The disulfide bond is cleaved by electrons resulting from glucose transformation to gluconic acid by glucose oxidase. As drug delivery and targeting technologies advance, the requirements for the next generation of advanced drug delivery systems grows increasingly more demanding, forcing the development of more sophisticated systems. Previous technologies of sustained or zero-order release alone are not adequate to treat diseases requiring long-term care. Effective bioresponsive, modulated advanced drug delivery systems are now the “Holy Grail” of workers in this field. Fortunately the recent advancement of chemistry and biology provides the pharmaceutical scientist with the tools to develop more effective drug delivery systems which target the site-of-action of the drug and address the challenges of chronopharmacology. The future of drug delivery and targeting will rely on the integration of these disciplines and a wider appreciation of the need to address the challenges of drug delivery and targeting at an earlier stage in the drug discovery process. As a consequence, advanced drug delivery research will require a new generation of multidisciplinary pharmaceutical scientists to address these challenges in this new millennium. Explain the potential uses of (i) temperature-sensitive and (ii) pH-sensitive hydrogels in advanced drug delivery. Give examples of credible matrix systems which may have application in the bioresponsive delivery of insulin. Describe the role of genetically engineered cell implants in bioresponsive drug delivery. Thus at the pH of the small intestine, the drug is much less ionized than in the stomach and is therefore more readily absorbed. The amount3 of steroid passing from the reservoir through the membrane in 4 hours is 40 µg. Provided that the drug release rate be constant, calculate the flux (F) that is defined as the amount of a solute flowing through a membrane per unit time. The effective surface area, permeability coefficient, thickness, and osmotic reflection coefficient of the semi-permeable membrane used for the pump are 3. Initially, the pump has a reservoir compartment with a drug4 2 having Cd of 100mg/ml, and the observed ∆π is 100 atm. Now, consider that we have changed the reservoir medium and osmotic agent to increase Cd of the drug from 100 to 300mg/ml and to increase ∆π from 100 to 300 atm, by how much will the release rate of the drug be increased? Solution As dV/dt is proportional to ∆π increasing both Cd and ∆π by 3 fold will result in an overall 9 fold increase in release rate of the drug. This book or any part thereof must not be reproduced in any form without the written permission of the publisher, except for any purpose of the United States Government. Bower, director of the Bureau, generously gave his time and talents to this project. The work of the editors was greatly facilitated by representatives of the Air Force, particularly Major Leo N. Dies mag vielen wehe, manchen wol getan haben, beides nicht meine Schuld und nicht mein Verdienst. Sigmund Freud in a letter to Romain Rolland, May 13 1926 * Introduction — manipulations of human behavior In recent years, concern has been expressed, in both scholarly and popular literature, about the dangers of scientific developments that could be used to control and manipulate human behavior.
Drugs used in the treatment of glaucoma lower the intra- ocular pressure by a variety of mechanisms including reduc- ton in secreton of aqueous humour by the ciliary body buy 10 mg maxalt free shipping, or increasing the outlow of the aqueous humour by opening of the trabecular network maxalt 10 mg discount. Antglaucoma drugs used include topical applicaton of a beta-blocker (beta-adrenoceptor antagonist) order 10 mg maxalt with amex, a miotc, or a sympathomimetc such as epine- phrine; systemic administraton of a carbonic anhydrase inhib- itor may be used as an adjunct. Timolol is a non-selectve beta-blocker that reduces the secre- ton of aqueous humour. A beta-blocker is usually the drug of choice for inital and maintenance treatment of chronic open- angle glaucoma. If further reducton in intra-ocular pressure is required a miotc, a sympathomimetc or a systemic carbonic anhydrase inhibitor may be used with tmolol. Since systemic absorpton can occur, an ophthalmic beta- blocker should be used with cauton in certain individuals. A miotc such as pilocarpine, through its parasympatho- mimetc acton, contracts the iris sphincter muscle and the ciliary muscle, and opens the trabecular network. It is used in chronic open-angle glaucoma either alone or, if required, with a beta-blocker, epinephrine or a systemic carbonic anhydrase inhibitor. Pilocarpine is used with systemic acetazolamide in an acute atack of angle-closure glaucoma prior to surgery; however, it is not advisable to use pilocarpine afer surgery because of a risk of posterior forming. Systemic absorpton of topically applied pilocarpine can occur producing muscarinic adverse efects. Epinephrine is usually used with a miotc, a beta-blocker or a systemic carbonic anhydrase inhibitor in the treatment of chronic open-angle glaucoma; however, because epinephrine is also a mydriatc, it is contraindicated for angle-closure glau- coma unless an iridectomy has been carried out. Acetazolamide, by reducing carbonic anhydrase in the eye, reduces the producton of aqueous humour and so reduces intra-ocular pressure. It is used systemically as an adjunct in chronic open-angle glaucoma unresponsive to treatment with topically applied antglaucoma drugs. Prolonged therapy with acetazolamide is not normally recommended, but if treatment is unavoidable blood count and plasma electrolyte concentra- ton should be monitored. Acetazolamide is also used as part of emergency treatment for an acute atack of angle-closure glaucoma; however it should not be used in chronic angle-clo- sure glaucoma as it may mask deterioraton of the conditon. Acetazolamide* Pregnancy Category-C Schedule H Indicatons As an adjunct in the treatment of chronic open-angle glaucoma; secondary glaucoma; as part of pre-operatve treatment of acute angle-closure glaucoma. Contraindicatons Hypersensitvity to sulfonamides; chronic angle-closure glaucoma (may mask dete- rioraton); hypokalaemia, hyponatraemia, hyperchloraemic acidosis; renal impairment (Appendix 7d), severe hepatc impairment; renal hyperchloremic acidosis, addison’s dis- ease. Precautons Elderly; lactaton; diabetes mellitus; pulmonary obstructon; monitor blood count and electrolytes if used for long periods; interactons (Appendix 6b, 6c); pregnancy (Appendix 7c); severe respiratory acidosis. May impair ability to perform skilled tasks, for example operatng machinery, driving. Contraindicatons Systemic absorpton may follow topical applicaton to the eyes, therefore they are contraindicated in patents with bradycardia, heart block, or uncontrolled heart failure; hypersensitvity. Precautons Avoid in asthma, poor cardiac reserve, hepatc impairment; not for injecton; pregnancy (Appendix 7c). Adverse Efects Ocular stnging, burning, pain, itching, erythema, dry eyes and allergic reactons including anaphylaxis and blepharoconjunctvits; occasionally corneal disorders have been reported; crusty taste, photophobia, corneal punctuate staining, decreased corneal sensitvity, keratts, anisocoria; headache; sleep disturbances. Precautons Patents with coronary insufciency; interactons (Appendix 6a, 6c), pregnancy (Appendix 7c). Latanoprost Pregnancy Category-C Schedule H Indicatons To lower intraocular pressure in open angle glaucoma or ocular hypertension. Precautons Patents with a history of intraocular infammaton (irits/uveits) or actve intraocular infammaton, with torn posterior lens capsule, britle or severe asthma, infammatory, angle closure or congenital glaucoma, pregnancy (Appendix 7c), lactaton, interactons (Appendix 6c). Adverse Efects Conjunctval hyperaemia, iris pigmentaton; upper respiratory tract infecton; cold, fu; darkening and thickening of eyelashes, eyelid skin darkening; intraocular infammaton, ocular irritaton and pain; exacerbaton of asthma; blepharits. Physostgmine Pregnancy Category-C Schedule H Indicatons Glaucoma in conjuncton with other drugs and not alone (as it is very potent). Adverse Efects Twitching lids, myopia, ocular and periorbital pain, cilliary and conjuctval congeston. Dose Instllaton into the eye Adult- Chronic open-angle glaucoma before surgery: 1 drop (2% or 4 %) up to 4 tmes daily. Acuteangle closure glaucoma before surgery: 1 drop (2%) every 10 min for 30 to 60 min, then 1 drop every 1 to 3 h untl intra-ocular pressure subsides. Contraindicatons Acute irits, acute uveits, anterior uveits, some forms of secondary glaucoma; acute infammaton of anterior segment; not advisable afer angle-closure surgery (risk of posterior synechiae). Precautons Retnal disease, conjunctval or corneal damage; monitor intra-ocular pressure in chronic open-angle glaucoma and in long-term treatment; cardiac disease, hypertension; asthma; peptc ulceraton; urinary-tract obstructon; Parkinson’s disease; stop treatment if symptoms of systemic toxicity develop; ulcer; hyperthyroidism; seizures. Do not carry out skilled tasks, for example operatng machinery or driving untl vision is clear, pregnancy (Appendix 7c). Adverse Efects Eye pain, blurred vision, ciliary spasm, lacrimaton, myopia, browache; conjunctval vascular congeston, superfcial keratts, vitreous haemorrhage and increased pupillary block; lens opacites have occurred following prolonged use; rarely, systemic efects including hypertension, tachycardia; bronchial spasm, pulmonary oedema; salivaton; sweatng; nausea, vomitng, diarrhoea; fushing, rhinits, chills, middle ear disturbances.
Peptide drugs are generally perceived as large molecules and would have diffculty crossing membranes order maxalt 10 mg with visa. Most researchers correlate molecular size with molecular weight order 10mg maxalt overnight delivery, and have set out the general rule of thumb that orally bioavailable drugs should be less than 500 g/mol discount maxalt 10 mg with amex. This description has been further refned by others to orally bioavailable drugs with a molecular weight between 160 to 480 g/mol . As we have described in Chapter 5 we noticed that most orally bioavailable peptide drugs are comprised of three to fve residues that fts into three to fve subsites of the active site. An aspect of our work on β-secretase inhibitors and Alzheimer’s disease will be used to illustrate methods of reducing the molecular size of a peptide design. The subse- quent aggregation of these peptide amyloid β-peptide fragments leads to the pathol- ogy of the disease. In the frst method, we synthesized compounds in which one amino acid was systematically removed at a time from the N-terminal, then from the C-terminal. A nearly complete loss of inhibitory activity on the removal of a residue indicated that the position of the residue was important for active site recognition. Because glycine does not have a side-chain, any near loss of β-secretase inhibition suggested that the interactions between the side-chain of the residue and its associated subsite were important at the affected position. The resulting pentapeptide was optimized at the two end-terminals Universal Free E-Book Store... A wonderful discovery of a potent non-peptide inhibitor of β-secretase by another research group  inspired us to shift our focus on non-peptides. As an overall measure of lipophilicity, the log P value can be experimentally determined or esti- mated by calculations, where the partition coeffcient, P, is a ratio of concentrations of an unionized compound between n-octanol and water . As it pertains to passive diffusion across membranes, only the unionized form of the compound will traverse the membrane. Lipinski’s calculated log P rule, in which a drug would most likely be orally bioavailable, was elaborated to a range of −0. This range suggests that lipophilic compounds are expected to exhibit improved membrane permeability when compared to hydrophilic compounds. One should note that there are several methods of estimating log P, and Lipinski’s rule relies on the calculated log P method. As a characteristic that is needed for oral bioavailability, the most relevant measure of lipophilicity with regard to oral absorption by passive diffusion is the compound’s log D value . The distribution coeffcient, D, is the ratio of the sum of the con- centrations of all forms of the compound between n-octanol and water. Thus, while log P only considers the unionized form of the compounds, log D takes into account both ionized and unionized forms of the compound. It is noteworthy that, as with log P values , pKa values  can also be mathematically predicted. Once the drug enters the bloodstream, it encounters a differ- ent pH environment of about 7. To account for acidic and basic compounds, the difference between the fractions of the neutral form at pH 6. Compounds with positive Δlog D values are acidic, whereas compounds with negative values are basic. Acidic compounds tend to have better bioavailability characteristics, because in the acidic pH 6. In other words, acidic compounds have a lower risk than basic compounds of entering the liver and being degraded. As another beneft for slightly acidic drugs, highly ionized drugs, either acidic or basic, may also cause patient discomfort due to direct irritation of the gastrointesti- nal lining. Taken together what we have discussed, slightly acidic drugs are favored for improved gastrointestinal absorption, less frst-pass metabolism, and less mucosal irritation. In general, hydrophobic compounds are often favored for pharmacological activity over hydrophilic compounds due to desolvation entropy . Simply put, a hydropho- bic compound is more entropically favored to release water molecules before binding to the often hydrophobic active site of the target biological substance. Hydrophobic compounds need to spend less energy to part with water because they have fewer interactions with water. Interestingly, compounds with high hydrogen bond poten- tials can interact with water and would thus exhibit unfavored desolvation entropy. Hence, lipophilicity is pre- ferred in both pharmacodynamics and pharmacokinetics. One of the goals of rational drug design is to optimize lipid solubility for membrane permeation while retaining a signifcant pharmacological activity.