Different Categories Of Drugs Research Articles

New anticoagulants, reversal agents, and clinical considerations for perioperative practice.

There are several new anticoagulants on the market that will impact perioperative care, including the use of these anticoagulant drugs in the setting of regional anesthesia. The ideal pharmacological agent would prevent pathological thrombosis and allow for a normal response to vascular injury to limit bleeding. At present, all antithrombotic agents have increased bleeding risk as their main side effect. We describe the different categories of drugs, e.g., antiplatelet, anticoagulant, and thrombolytic, with particular emphasis on the new drugs that have been introduced into the market. These agents can be evaluated by a number of methods including low-, medium-, or high-risk procedures and guidelines and best practice standards that have been published regarding the amount of time to wait after stopping the medication and before performing a procedure, e.g., the American Society of Regional Anesthesia and Pain Medicine recommendations. The present investigation will also describe new reversal agents for anticoagulants and the implications of all these drugs for regional anesthesia.

HPMC-Eudragit-Based Gastro-retentive Hydrodynamically Balanced System—Suitable for Sparingly Soluble and Freely Soluble Drugs: an In Vitro Study

In this study HPMC-eudragit based hydrodynamically balanced capsules of two model drugs; propranolol HCl and ofloxacin were prepared with the aim to have the gastric retention of the systems for longer periods of time with desired sustained/ controlled drug release. Gastro-retentive capsules were prepared by simple physical blending of various low density polymers and filling into capsules. These capsules were subjected to in vitro buoyancy/ matrix integrity and dissolution studies. Weight variation, content uniformity test, UV spectral analysis and placebo interaction studies were also performed. Preliminary studies revealed that high soluble drug required higher polymer ratios to sustain drug release and maintain matrix integrity/ buoyancy than low soluble drug. In both the cases, with increase in HPMC and eudragit S100 levels there was an increase in matrix integrity and decrease in drug release rate, however much higher levels of eudragit S100 decreased matrix integrity and buoyancy. Lactose (release rate modifier) decreased matrix integrity, buoyancy and increased drug release. Mechanism of release in the both cases was found to be anomalous "non-fickian". From this research and the literature available on the eudragit and HPMC matrix systems, it is evident that different categories of drugs (suitable for gastric retention), ranging from freely soluble to sparingly soluble can be suitably formulated as HPMCeudragit based GR HBS capsules with desired drug release characteristics, provided no chemical instability/ incompatibility occurs between the drug and the polymers.

Chitosan and its Derivatives as Chemical Drug Delivery Carriers

Background: Chitosan (CS) is a nontoxic and biocompatible natural polysaccharide with great development potential in the delivery of chemical drugs. However, further applications of CS are limited due to its inherent insolubility in neutral solution. Objective: The chemical modification of CS is of great significance for drug carriers, and the modification would not alter its fundamental skeleton but affords new or improved properties for drug delivery systems. Method: This review is designed to afford an overview of CS and CS derivatives used as drug delivery carriers, with a special stress on chemical modifications of CS to attain specific biomedical purpose. Results: The chemical modification of CS is generally carried out on the primary amine group or on the hydroxyl group. A variety of modifications such as quaternization, acylation, sulfonation, phosphorylation, thiolation, hydrophobization, hydrophilization afford extensive derivatives with improved properties for specific applications in pharmaceutical, biomedical and biotechnological fields. Conclusion: Various drug delivery systems and delivery of different categories of drugs based on CS and CS derivatives have also been illustrated. Keywords: Aminopolysaccharide, chitosan, chitosan derivatives, drug delivery system, chemical modification.

Quality control of hydrochlorothiazide tablets marketed in Sinop-MT

The thiazide diuretics are of the classes of drugs most frequently used for the treatment of hypertension. Hydrochlorothiazide is the representative of this class and is found in tablet form in doses of 25 and 50 mg. It is marketed in three different categories of drugs: reference, similar and generic. According to the regulator in Brazil, the National Health Surveillance Agency (ANVISA), before pharmaceuticals are released for use, the pharmaceutical industry must meet product quality specifications, but the consumption of counterfeit drugs, contraband or without registration with government laws It is growing in Brazil, which affect the entire drug production chain affecting the health of those who use these medicines. In view of the reported problems about the quality of marketed drugs and being the state of Mato Grosso considered a fake gateway drug, due to its proximity to Bolivia, this study aimed to assess the quality of tablets containing hydrochlorothiazide is already one of the most widely used drugs in the treatment of hypertension in Sinop-MT municipality according local search. Samples from five laboratories that produce hydrochlorothiazide tablets at a dose of 25 mg, and the most market in the municipality of Sinop / MT were analyzed as stablished in the Brazilian Pharmacopoeia. It was found that four of the five samples of drugs in Mato Grosso, performed all the requirements for approval in quality testing, with the exception of a product that has lower hardness values than recommended, which can lead to problems drug presentation as well as directly affect the absorption, bioavailability and action of the therapeutic drug. It was concluded that medicinal products containing hydrochlorothiazide showed adequate quality, ensuring their effectiveness.

Assessment of prescription pattern of cataract patients in the ophthalmology department at a tertiary health care institution

Background: Evaluation of the current prescription pattern of cataract patients in the Ophthalmology Department to find out utilization of drugs per prescription that reflects possibilities of drug interaction and patient compliance and to suggest measures for rational prescriptions.Methods: The study was carried out in the Ophthalmology Department at Gauhati Medical College and Hospital, Guwahati for a period of 6 months after obtaining permission from the Institutional Human Ethics Committee. This was a retrospective, observational hospital based study. The present study included patients of any age group and both the sexes (male/female) who were diagnosed as having cataract and who were prescribed different categories of drugs. A total of 156 prescriptions were collected, analysed and classified during the study period (both outdoor and indoor patients).Results: Our study found that maximum numbers of patients were encountered in the age group of 45-65 years and around 48.4% of cases for IOL implantation were having immature senile cataract. Topical eye drops are most commonly used account for 56.3% in preoperative cases. Overall 564 drugs were prescribed on discharge in 156 prescriptions; So on an average 3.6 drugs were prescribed per prescription. Overall antimicrobials (51.80%) are most commonly prescribed group followed by anti-inflammatory (25.10%), anxiolytic, steroid etc.Conclusions: Our study showed a significant awareness to avoid polypharmacy by keeping average number of drugs per prescription as low as possible to avoid increased cost of the therapy, therapeutic failure, and adverse drug reactions and hence for better patient compliance.

Evaluation of Prosopis africana Seed Gum as an Extended Release Polymer for Tablet Formulation.

In the present work, an attempt has been made to screen Prosopis africana seed gum (PG), anionic polymer for extended release tablet formulation. Different categories of drugs (charge basis) like diclofenac sodium (DS), chlorpheniramine maleate (CPM), and ibuprofen (IB) were compacted with PG and compared with different polymers (charge basis) like xanthan gum (XG), hydroxypropyl methyl cellulose (HPMC-K100M), and chitosan (CP). For each drug, 12 batches of tablets were prepared by wet granulation technique, and granules were evaluated for flow properties, compressibility, and compactibility by Heckel and Leuenberger analysis, swelling index, in vitro dissolution studies, etc. It has been observed that granules of all batches showed acceptable flowability. According to Heckel and Leuenberger analysis, granules of PG-containing compacts showed similar and satisfactory compressibility and compactibility compared to granules of other polymers. PG showed significant swelling (P < 0.05) compared to HPMC, and better than CP and XG. Differential scanning calorimetry (DSC), X-ray diffraction (XRD), and Fourier transform infrared (FTIR) study showed no interaction between drugs and polymers. From all PG-containing compacts of aforesaid drugs, drug release was sustained for 12h following anomalous transport. Especially, polyelectrolyte complex formation retarded the release of oppositely charged drug (CPM-PG). However, extended release was noted in both anionic (DS) and nonionic (IB) drugs, maybe due to swollen gel. All compacts were found to be stable for 3-month period during stability study. This concludes that swelling and release retardation of PG has close resemblance to HPMC, so it can be used as extended release polymer for all types of drugs.

Assessment of various second-line medications in addition to inhaled corticosteroid in asthma patients: a randomized controlled trial.

Many patients with persistent asthma cannot achieve the treatment goal for asthma with a single controller medication. The aim of the present study was to assess lung function and rescue medication use in asthma patients receiving four different categories of drugs in combination with an inhaled corticosteroid. Patients recruited to the study were randomized into four groups to receive budesonide with either formoterol, doxofylline, montelukast or tiotropium for a period of 3 months. Lung function (i.e. forced expiratory volume in 1 s (FEV1 )) and rescue medication use were determined at baseline and on Day 15, 30, 45, 60 and 90 of treatment. A total of 297 patients completed the study. At baseline, no significant differences (P > 0.05) were observed in any of the outcome measures. Significant within-group improvement in FEV1 was observed in all groups. On Day 90, between-group differences showed that the improvement in FEV1 was significantly (P < 0.05) higher for patients receiving budesonide + formoterol, followed by budesonide + montelukast and budesonide + doxofylline, and least for those receiving budesonide + tiotropium. Similarly, within- and between-group comparisons showed significant (P < 0.05) reductions in rescue medication use in all groups. However, the magnitude of the decrease was greater in the budesonide + formoterol group, followed by the budesonide + montelukast, budesonide + doxofylline and budesonide + tiotropium groups. Based on our findings, among the second-line treatment regimens, budesonide with either montelukast or doxofylline was found to be better than budesonide + tiotropium in patients with mild-to-moderate persistent asthma. Further studies with a longer duration are likely to be useful.

Pulmonary Drug Delivery System: A Novel Approach for Drug Delivery

In present study authors review all aspects of pulmonary drug delivery system; including need of drug delivery, different approaches for drug delivery and recent advancement in pulmonary drug delivery system. Review deals with drug targeting to pulmonary region for the treatment of various diseases such as chronic obstructive pulmonary disease, lung cancer, cystic fibrosis, tuberculosis, asthma, etc. All these disorders are difficult to be effectively cured through conventional modes of dosage system rather novel delivery systems have been developed which proved to be more site specific and less toxic. Apart from various formulations, different delivery devices such as metered dose inhalers (MDI), dry powder inhalers (DPI), nebulizers, aerosolizers, etc. have also improved drug targeting efficacy and reduced dose size in a more efficient manner. This review contains mainly the tabulated description of different categories of drugs and devices recently available in the market which makes it easily accessible for the researchers. Proteins, other biologicals and different marketed products are also successfully available to be delivered through pulmonary route for the better patient management. It can be concluded from whole study that different pulmonary delivery system possesses certain specificity for dosage formulations and serves as an important tool to deliver drugs to the target site. Keywords: Pulmonary drug delivery, targeted drug delivery, delivery devices, protein and peptide delivery, Micronization, Spray freeze drying, Supercritical Fluid Crystallization, Nanoparticles, Insulin, Nanosuspensions

Angiotensin II-Receptor Blockers: their Relevance in Clinical Practice

The implication of the renin angiotensin system (RAS) and specifically angiotensin II in the pathogenesis of essential hypertension, cardiac, cerebrovascular and renal disease is well established. Among the different categories of drugs that manage hypertension, angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are notably effective in the downregulation of RAS. Whereas ACEIs achieve RAS inhibition by constraining the conversion of angiotensin I to angiotensin II, they can display adverse effects, such as cough and angioedema that result from the increased production of bradykinin and prostaglandin. The direct antagonistic action of ARBs on angiotensin II receptors has proved to be very well tolerated. Achieving rapid blood pressure reduction and twenty-four hour hypertension control, they are superior to other antihypertensive agents in the regression of left ventricular hypertrophy, new onset diabetes and stroke and in the delay of renal dysfunction. The combination of ARBs with other drug categories, such as diuretics or calcium channel blockers, can provide additive effects, favouring their recommendation and use for the clinical management of hypertension and cardiovascular diseases. Meta-analyses of clinical trials have provided evidence that ARBs are comparable with other drugs against cardiovascular and all-cause mortality.

A side effect resource to capture phenotypic effects of drugs

The molecular understanding of phenotypes caused by drugs in humans is essential for elucidating mechanisms of action and for developing personalized medicines. Side effects of drugs (also known as adverse drug reactions) are an important source of human phenotypic information, but so far research on this topic has been hampered by insufficient accessibility of data. Consequently, we have developed a public, computer-readable side effect resource (SIDER) that connects 888 drugs to 1450 side effect terms. It contains information on frequency in patients for one-third of the drug–side effect pairs. For 199 drugs, the side effect frequency of placebo administration could also be extracted. We illustrate the potential of SIDER with a number of analyses. The resource is freely available for academic research at http://sideeffects.embl.de.

Epilepsy and sudden death: Personal reflections and call for global action

To solve the mystery of sudden unexpected death in persons with epilepsy (SUDEP), a global focus is needed to identify persons at risk, develop treatment regimens, and prevent its occurrence. A world wide network of professionals must focus on basic scientific research programs and clinical and epidemiology studies. Team work among different multidisciplinary professionals in clinical settings and within and among laboratories should address the global issues of SUDEP. If the correct term ‘SUDEP’ is used on autopsy reports and if verbal autopsies postmortem are conducted when needed, the true incidence of SUDEP may be found to be much higher than previously thought and the market for new antiepileptics and other drugs to prevent SUDEP will be larger. Symposia should discuss new data and lessons learned from the last 20 to 30 years to be applied by scientists and clinicians worldwide to gain a better understanding of SUDEP. ‘Think out of the box’ when evaluating an established animal model with potential for modification(s) to study mechanism(s) of SUDEP. Multiple relevant animal models are needed to understand the pathophysiology of SUDEP, hypothesize about effective treatments, develop small pilot studies in persons with epilepsy, and conduct confirmatory large-scale clinical trials. The fields of pharmacology, clinical pharmacology, and cardiology have much to offer as we work to improve compliance, develop new antiepileptic drugs, and apply different categories of drugs to resolve the mystery of SUDEP. Ambulatory simultaneous EKG and EEG telemetry monitoring of patients at risk for sudden death will help identify cardiac vs. brain epileptogenic triggers for treatment to decrease risk of SUDEP. Respiratory function monitoring is also needed. Academic fellowships and competitions for medical students, postdoctoral fellows, residents and faculty will attract medical and graduate trainees to work on SUDEP. Grant funding is essential to move the SUDEP knowledge base forward. Leaders must solve the global mystery of SUDEP using a leadership philosophy foundation that provides innovative vision and approaches for SUDEP research and teaching programs. The interaction of teaching and research is essential: while a student is learning how to conduct research he must simultaneously learn to become a teacher. Medical and graduate leaders must provide vision and a fertile environment to teach students of today to become the self learners and leaders of tomorrow to find solutions for SUDEP.

Reasons for response differences seen in the V15-32, INTEREST and IPASS trials

The first phase III study to assess the effect of gefitinib and docetaxel on the survival of Japanese patients with non-small-cell lung cancer who received previous treatment with platinum doublets, the V15-32 trial, did not establish noninferiority of gefitinib over docetaxel in terms of the effect on overall survival, despite the results showing a twofold higher response rate to gefitinib. The overall survival favored docetaxel for the first 18 months and gefitinib thereafter. The INTEREST trial, which compared docetaxel and gefitinib, demonstrated noninferiority of gefitinib, and the survival curves were completely superimposed. In this trial, patients had been recruited from 24 countries from Europe, Asia, and North and South America. Results of the IPASS trial showed superior progression-free survival for gefitinib compared with the combination of carboplatin and paclitaxel as first-line treatment in Asian patients who were nonsmokers and had adenocarcinoma histology. In this Review, we discuss the reasons for the differences in the effects of molecular-targeted drugs and cytotoxic antineoplastic agents observed in these trials. We also highlight the magnitude of the antitumor activity of these two different categories of drugs, and discuss how this could affect future clinical trial design and analysis.

Education and drug use in Sweden—a nationwide register‐based study

To analyse educational variations in prescriptions dispensed in Sweden. A better knowledge of the use of drugs in the population, including socioeconomic distribution, is a prerequisite in efforts to estimate whether drugs are being prescribed and used according to need. This knowledge may also facilitate the identification of selection or confounding factors when analysing outcome or adverse side effects of drug treatment. All prescriptions dispensed during 2006 for 22 different categories of drugs were analysed in the Swedish Prescribed Drug Register. Each prescription was linked by a unique personal identification number (PIN) to the National Education Register. In total, analyses covered 1,557,740 men and 1,568,175 women aged 45-74. Those with low education were generally at higher risk of having drugs, odds ratios (ORs) varying from 1.2 to 2. Most differences appeared to be of the same magnitude as those found in studies of the relation between education and disease incidence and prevalence, that is drugs may be prescribed and dispensed according to need. However, there are some drugs, such as antibiotics, sildenafil, hormone replacement drugs, anti-migraine drugs and angiotensin receptor blockers (ARB), where people with higher education have higher consumption than is expected from incidence and prevalence data. There are rather large differences in drug utilization between groups of different educational levels. Mostly these disparities seem to reflect differences in need, but there are examples of inequalities in drug use.

Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials

Objective To determine the average reduction in blood pressure, prevalence of adverse effects, and reduction in risk of stroke and ischaemic heart disease events produced by the five main categories...

Co-occurrence of abuse of different drugs in men: the role of drug-specific and shared vulnerabilities.

Previous research has demonstrated genetic and environmental influences on abuse of individual substances, but there is less known about how these factors may influence the co-occurrence of abuse of different illicit drugs. We studied 3372 male twin pairs from the Vietnam Era Twin Registry. They were interviewed using the Diagnostic Interview Schedule, Version III, Revised to investigate the extent to which the abuse of different categories of drugs occurs together within an individual, as well as the possibility that genetic and environmental factors are responsible for observed co-occurrence. Co-occurrence was quantified using odds ratios and conditional probabilities. Multivariate biometrical modeling analyses were used to assess genetic and environmental influences on co-occurrence. Abusing any category of drug was associated with a marked increase in the probability of abusing every other category of drugs. We found evidence for a shared or common vulnerability factor that underlies the abuse of marijuana, sedatives, stimulants, heroin or opiates, and psychedelics. This shared vulnerability is influenced by genetic, family environmental, and nonfamily environmental factors, but not every drug is influenced to the same extent by the shared vulnerability factor. Marijuana, more than other drugs, was influenced by family environmental factors. Each category of drug, except psychedelics, had genetic influences unique to itself (ie, not shared with other drug categories). Heroin had larger genetic influences unique to itself than did any other drug. There are genetically and environmentally determined characteristics that comprise a shared or common vulnerability to abuse a range of illicit drugs.

Freedom of Exchange in Marketing versus Protection for Drug Consumers

For many years critics in the popular press have peri- odically suggested that the FDA is overly aternalistic and inflexible and that the American public is ill-sewed g y the FDA's reluctance to make decisions. As a result, they claim, Americans are being denied drugs that are available to Europeans and the FDA is fostering a medical monopoly by restricting most drugs to rescri tion status. A , comparison was made of the pertinent laws o ! Cana c! a, Great Brit- ain, Germany, and Third World, developing countries to see if there is a trend developing toward enactment of consumer protection leg- islation for drug roducts and the extent to which consumers are allowed or den~e the freedom to purchase different categories of drugs. B

Freedom of Exchange in Marketing versus Protection for Drug Consumers

For many years critics in the popular press have periodically suggested that the FDA is overly aternalistic and inflexible and that the American public is ill-sewed g y the FDA's reluctance to make decisions. As a result, they claim, Americans are being denied drugs that are available to Europeans and the FDA is fostering a medical monopoly by restricting most drugs to rescri tion status. A , comparison was made of the pertinent laws o ! Cana c! a, Great Britain, Germany, and Third World, developing countries to see if there is a trend developing toward enactment of consumer protection legislation for drug roducts and the extent to which consumers are allowed or denied the freedom to purchase different categories of drugs.

Effects of calcium, calcium entry blockers and calmodulin inhibitors on atrioventricular conduction disturbances induced by hypoxia.

Effects of hypoxia on atrioventricular conduction were investigated in the Langendorff-perfused isolated heart of the rabbit with various extracellular calcium concentrations ([Ca2+]) as well as in the presence of verapamil, nifedipine, N-(6-aminohexyl)-5-chloro-1-naphthalenesulphonamide (W-7) and chlorpromazine. The prolongation of the atrio-His (AH) interval by hypoxia for 7 min was greater with increasing [Ca2+]o ranging from 1.2 to 5.2 mM. At [Ca2+]o of over 3.2 mM under hypoxic conditions, AH block of the Wenckebach type was observed in some cases. Verapamil (5 X 10(-8) M) and nifedipine (5 X 10(-8) M) caused a significant prolongation of AH intervals before hypoxia. However, the intensity of AH prolongation due to hypoxia was significantly attenuated in the presence of the calcium entry blocker, and AH block was not induced even at 3.2 mM [Ca2+]o. W-7 (5 X 10(-6) M) and chlorpromazine (10(-6) M) did not affect the AH intervals before hypoxia. The hypoxia-induced prolongation of the AH interval or AH block was prevented in the presence of these drugs. W-5, a chlorine-deficient derivative of W-7, showed no protection against hypoxia-induced AV nodal conduction disturbances. These findings suggest that hypoxia-induced AV nodal conduction disturbance is explained, at least in part, by the electrical uncoupling of nodal cells, probably due to the calcium overload. This conduction disturbance is protected by calcium entry blockers or by calmodulin inhibitors, but the mode of protective action is not the same for these different categories of drugs.

Epidemiology of drugs taken by pregnant women: drugs that may affect the fetus adversely.

The epidemiology of drug consumption during pregnancy has been studied retrospectively in 911 randomly selected mothers. The drugs used, the proportions of pregnant women taking them, the duration and timing of drug administration were ascertained. Excluding iron, drugs were prescribed for 82 % of women during pregnancy and the average number of drugs prescribed for these women was 4. Self‐medicated drugs were taken by 65% of mothers and the average number of drugs taken by these was 1.5. The proportion of mothers taking different categories of drugs ranged from 82% to 1.2%. The mean duration of drug therapy for the various categories of drugs ranged from 125 to 10 days. The duration of treatment with individual drugs was also ascertained. Some drugs tended to be administered early, some late, and some throughout pregnancy. A drug “consumption in pregnancy” factor has been calculated by which the over‐all consumption of a drug can be measured and comparisons made of the consumption of one drug relative to another. Drugs that may carry a risk of teratogenicity if administered early in pregnancy are listed, as are those drugs that, if administered later in pregnancy, may adversely affect fetal functioning or the functioning of the newborn infant at or after birth.