Field Of Pharmacotherapy Research Articles

Biological and Medicinal Properties of Natural Chromones and Chromanones.

Emerging threats to human health require a concerted effort to search for new treatment therapies. One of the biggest challenges is finding medicines with few or no side effects. Natural products have historically contributed to major advances in the field of pharmacotherapy, as they offer special characteristics compared to conventional synthetic molecules. Interest in natural products is being revitalized, in a continuous search for lead structures that can be used as models for the development of new medicines by the pharmaceutical industry. Chromone and chromanones are recognized as privileged structures and useful templates for the design of diversified therapeutic molecules with potential pharmacological interest. Chromones and chromanones are widely distributed in plants and fungi, and significant biological activities, namely antioxidant, anti-inflammatory, antimicrobial, antiviral, etc., have been reported for these compounds, suggesting their potential as lead drug candidates. This review aims to update the literature published over the last 6 years (2018-2023) regarding the natural occurrence and biological activity of chromones and chromanones, highlighting the recent findings and the perspectives that they hold for future research and applications namely in health, cosmetic, and food industries.

Analysis of problems occurring in the care of a patient with liver cirrhosis

Introduction: Liver cirrhosis is a disease whose development is influenced by many factors, including those related to lifestyle. The disease causes disturbances in the functioning of not only the liver but also many other organs and systems. During the course of the disease, there are a number of complications that affect the patient's functioning in all areas. Patients with liver cirrhosis require constant and systematic treatment and comprehensive care, including care provided by nursing staff. Purpose of research: Analysis of problems occurring in the care of patients with liver cirrhosis Material and methods: The study included 103 patients with liver cirrhosis, hospitalized from October 10, 2022 to April 10, 2023. in the Observation and Infection Ward for Adults of the SPZOZ in Puławy. The method used in the work was a diagnostic survey, the technique was a survey, and the research tool was an original survey questionnaire developed for the needs of the research. Results: Patients with liver cirrhosis have many problems of a physical nature and related to non-compliance with medical recommendations, which may affect the inhibition of the progression of the disease, the prevention of complications and the improvement of the general condition. Conclusions: Patients with liver cirrhosis have a number of physical problems, the knowledge of which may affect the organization of work of nursing staff, facilitate the identification of problems, help determine the goal of care and plan nursing interventions. Not all respondents followed the specialist's recommendations, including: in the field of pharmacotherapy, dietary recommendations, performing check-ups, reporting for follow-up visits and physical activity. An important element in the care of a patient with liver cirrhosis is patient education and motivation to follow recommendations that are important in stopping the progression of the disease, preventing complications and improving the general condition.

Phytochemistry Profile, Antimicrobial and Antitumor Potential of the Methanolic Extract of Tabernaemontana catharinensis A DC and Eragrostis plana NEES.

Natural compounds that have the potential to act as antimicrobials and antitumors are a constant search in the field of pharmacotherapy. Eragrostis plana NEES (Poaceae) is a grass with high allelopathic potential. Allelopathy is associated with compounds generated in the primary and secondary metabolism of the plant, which act to protect it from phytopathogens. Tabernaemontana catharinensis A DC (Apocynaceae), a tree in which its leaves and bark are used for the preparation of extracts and infusions that have anti-inflammatory and antinociceptive effects, is attributed to its phytochemical constitution. The objective of this study was to elucidate the phytochemical constitution, the antibacterial potential, the toxicity against immune system cells, hemolytic potential, and antitumor effect of methanolic extracts of E. plana and T. catharinensis. The phytochemical investigation was carried out using the UHPLC-QTOF MS equipment. The antibacterial activity was tested using the broth microdilution plate assay, against Gram-negative and Gram-positive strains, and cytotoxicity assays were performed on human peripheral blood mononuclear cells (PBMC) and in vitro hemolysis. Antitumor activity was performed against the colon cancer cell line (CT26). Results were expressed as mean and standard deviation and analyzed by ANOVA. p < 0.05 was considered significant. More than 19 possible phytochemical constituents were identified for each plant, with emphasis on phenolic compounds (acids: vanillic, caffeic, and quinic) and alkaloids (alstovenine, rhyncophylline, amezepine, voacangine, and coronaridine). Both extracts showed antibacterial activity at concentrations below 500 µg/mL and were able to decrease the viability of CT26 at concentrations below 2000 µg/mL, without showing cytotoxic effect on PBMCs and in vitro hemolysis at the highest concentration tested. This is the first report of the activity of E. plana and T. catharinensis extracts against colon cancer cell line (CT26). Studies should be carried out to verify possible molecular targets involved in the antitumor effect in vivo.

Computational screening of benzophenone integrated derivatives (BIDs) targeting the NACHT domain of the potential target NLRP3 inflammasome

The NLRP3 inflammasome is a crucial component in the innate immune response, which regulates the caspase-1 activation for the production of proinflammatory cytokines IL-1 and IL-18. Hence, NLRP3/caspase-1/IL-β1 signaling pathway becomes responsible for the elevation of pathogenesis of several inflammatory disorders like Alzheimer's, cancer, and diabetes mellitus. Multiple molecular and cellular processes, including ionic flux, mitochondrial malfunction, reactive oxygen species generation, and lysosomal damage, have been shown to activate the NLRP3 inflammasome. We report benzophenone integrated derivative-3 (BID-3) as an effective inhibitor of NACHT domain of NLRP3 inflammasome through in silico studies, which involved molecular docking simulations, molecular dynamics simulations, binding free energy calculations as well as druglikeliness and pharmacokinetic analyses. Out of all the BIDs screened, BID-3 was predicted with higher binding efficiency, stability, and druglikeliness potential, in comparison with the MCC950 reference drug used. With the current scenario depicting no complete cure for NLRP3 inactivation, this investigation proves to be an initial breakthrough in the field of pharmacotherapy and drug-discovery. Results obtained from this study could be used as a prominent input for the in vitro and in vivo investigation of pharmacotherapeutic potential of BIDs against the above-mentioned health maladies targeting NLRP3 inflammasome.

Newer therapeutic agents for retinal diseases

ABSTRACT Introduction Last few decades in medical retina have encountered significant development in the field of pharmacotherapy. With better understanding of molecular mechanisms and disease pathophysiology, alternate pathways are being targeted in various clinical trials. Areas covered In this review, a comprehensive list of newer therapeutic agents in various retinal conditions like diabetic macular edema (DME), age-related macular degeneration (ARMD), inherited retinal diseases (IRDs) and non-arteritic ischemic optic neuropathy (NAION) have been elucidated. The review highlights alternate pathways involved in pathogenesis of DME and ARMD, and gives a brief summary of several phase I and phase II trials targeting these pathways. The review also briefly highlights the advancements in the field of gene therapy, stem cell transplantation, neuro-protection and retinal implants in IRDs. Lastly, available treatment options for NAION have been discussed. Expert opinion Evidence based medicine has allowed researches and vision scientists to explore newer drugs and target alternate disease pathways. Promising results with initial clinical trials will pave the pathway for larger studies and allow clinicians to overcome treatment burden presently associated with available treatment options.

Smart polymers for colon targeted drug delivery systems: a review

The colon targeted drug delivery has a number of important implications in the field of pharmacotherapy. Oral colon targeted drug delivery systems have recently gained importance for delivering a variety of therapeutic agents for both local and systemic administration. Targeting of drugs to the colon via oral administration to protect the drug from degradation or release in the stomach and small intestine. It also ensures abrupt or controlled release of the drug in the proximal colon. Various drug delivery systems have been designed that deliver the drug quantitatively to the colon and then trigger the release of the drug. This review will cover different types of polymers which can be used in the formulation of colon targeted drug delivery systems.

The impact of knowledge and effectiveness of educational intervention on readiness for hospital discharge and adherence to therapeutic recommendations in patients with acute coronary syndrome

Introduction: ESC guidelines emphasize the importance of educating patients after acute coronary syndromes aimed at familiarizing the patient with the essence of the disease, the principles of self-control and self-care as well as actions enhancing health maintenance. Aim: The aim of the study was to assess the impact of knowledge and effectiveness of educational intervention on readiness for discharge from the hospital and compliance with therapeutic recommendations six months after discharge. Material and methods: The study group consisted of 218 patients (28.9% women and 71.1% men) aged 31 to 90 years (63.0 ± 11.24) treated with coronary angioplasty for myocardial infarction. The effectiveness of educational intervention was assessed by comparing patients’ knowledge on the day of admission (1KE) and discharge from the hospital (2KE). Knowledge was assessed in 3 aspects: knowledge of symptoms, knowledge of the disease, and knowledge of prevention. Education was provided between 1KE and 2KE based on the brochure entitled “Myocardial Infarction”. The level of knowledge on the day of discharge and the increase in knowledge obtained after education (ΔKE) were referred to the level of Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and to the level of adherence in chronic diseases scale (ACDS). Results: As a result of the education carried out between 1KE and 2KE, a significant increase in knowledge was obtained (p < 0.05). There was no correlation between ΔKE and RHD-MIS. However, it was shown that a higher level of knowledge at discharge (2KE) was associated with a higher RHD-MIS result (R = 0.17; p = 0.01). The highest impact on the RHD-MIS result was due to the level of knowledge of disease symptoms in 2KE: 75.5 ± 19.5%, 76.4 ± 21.1%, 85.8 ± 16.4% for low, medium and high RHD-MIS results (p = 0.002) ; R = 0.15; p = 0.0003. Knowledge of the disease symptoms in 2KE was associated with the patient’s expectations in RHD-MIS - a higher level of knowledge was associated with higher patient expectations, respectively: 73.2 ± 21.7%, 80.0 ± 18.5%, 82.9 ± 19.2 for low, medium and high RHDMIS (p = 0.02); R = 0.19; p = 0.006. There was no correlation between ΔKE or 2KE and ACDS results 6 months after discharge. Conclusions: The educational brochure is an effective tool in improving patients’ level of knowledge. Better knowledge of the symptoms of coronary artery disease and myocardial infarction is associated with a higher degree of readiness for discharge from the hospital but does not affect the observance of therapeutic recommendations in the field of pharmacotherapy after 6 months.

Specification of drug administration in geriatric patients within the competences of the nurse

Aim. The study´s objective was to obtain the views of nurses on the application of competencies in the field of pharmacotherapy in geriatric patients in clinical practice. Subsequently, it attempted to identify the most common problems thatnurses encounter in relation to pharmacotherapy and safety of geriatric patients.Material and methods. The group consisted of 48 nurses working in a facility providing care for geriatric patients. A non-standardized questionnaire was used for data collection, which included two areas: the area of intervention of nurses in pharmacotherapy and the area of problems related to pharmacotherapy.Results. Nurses apply their competencies focused on pharmacotherapy, specially in the preparation and administration of drugs. The answers of nurses in the field of education (62%) and communication (58%) related to pharmacotherapy in the elderly can be considered insufficient. The most common problems that nurses encounter in clinical practice are non-cooperation of seniors, their distrust and negative attitude towards treatment. Nurses identified incorrect dosing and drug substitution as potential errors that could compromise the safety of the geriatric patient.Conclusions. Based on the results of our research, we can state that nurses actively apply their competencies in pharmacotherapy, taking into account the specifics of geriatric patient care. The shortcomings we have identified in the field of education and communication related to pharmacotherapy indicate the need to support the education and practical training of nurses’ skills. Further attention needs to be paid to the safety of the patient in pharmacotherapy.

Total Intravenous Anesthesia in Neurosurgery

AbstractIn recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.

Chemical structure and anti-inflammatory effect of polysaccharide extracted from Morinda citrifolia Linn (Noni)

Polysaccharides extracted from plants are very promising molecules in the field of pharmacotherapy. Knowing this, the aim of this study was to extract, characterize and evaluate the action of the polysaccharide of Morinda citrifolia Linn (Noni-PLS) in biological models of inflammatory processes. The characterization tests shown that sample refers to a heteropolysaccharide composed mainly of homogalacturonan and rhamnogalacturonan. This polysaccharide at dose of 10 mg/kg, when tested in our models of inflammation, showed significant activity in reducing carrageenan-induced paw oedema as well as all mediators edemas. This polysaccharide was able to inhibit the migration of leukocytes to the site of inflammation, and still reduced inflammatory nociception tests. This results, allows us to conclude that the polysaccharide extracted from Morinda citrifolia linn has anti-inflammatory potential since it reversed inflammatory parameters such as edema, leukocyte migration and nociception.

Study of the impact of implementing an electronic prescription with barcode scanning on the time of response to the patient's needs in the field of pharmacotherapy

Study of the impact of implementing an electronic prescription with barcode scanning on the time of response to the patient's needs in the field of pharmacotherapy

26.5 View From the Front Line: A 10-Year Exploration of Pharmacogenomics

The role of pharmacokinetic genes in the field of pharmacotherapy has been an area of interest and clinical investigation at the Institute of Living since 2005. This presentation will provide an overview of our clinical and research experience in an attempt to explore clinical applications of such testing. In addition, following such extensive experience, the possibility of using clinical probe questions to determine patients at risk for P450 vulnerabilities will be presented and further explored.

Implementation and Evaluation of Genetic Testing Seminars on Lifestyle-related Disease Prevention for Pharmacy Students

The field of pharmacotherapy has advanced to use molecular targeted agents, and pharmacists are now encouraged to focus on pharmacogenomics. A seminar titled "Implementation and evaluation of genetic testing of lifestyle-related disease genes" was presented to students at the Faculty of Pharmaceutical Sciences, Hiroshima University, describing the pharmacogenomic role of single nucleotide polymorphisms in obesity-related genes and alcohol metabolism-related genes. The seminar topic was selected first because pharmaceutical students were already familiar with some of the content, and secondly because we believe that pharmacists should be informed about the prevention of lifestyle-related diseases using genetic testing. We evaluated the usefulness of this seminar by administering a questionnaire before and after the seminar to participating students. Several points requiring improvement were identified, although 82% of students stated that the seminar was "very useful" or "useful". We conclude that this educational seminar was useful to students of pharmaceutical sciences.

Effect of different modes of therapy on vestibular and balance dysfunction in Parkinson’s disease

BackgroundPatients with Parkinson’s disease (PD) have difficulties in performing various motor tasks such as walking, writing and speaking, together with significant balance dysfunction. Despite gains made in the field of pharmacotherapy and deep brain stimulation, dopaminergic medications may produce a limited improvement in postural stability. Sustained improvement in motor skills can be achieved through physiotherapy. Aim of the workTo measure the effect of different modes of therapy in controlling vestibular and/or balance dysfunction in patients with PD. MethodologyThis study was conducted on 20 patients suffering from definite PD, subdivided into two subgroups according to the mode of therapy they followed. Subgroup I received medical treatment and physiotherapy, while subgroup II received medical treatment only. The control group consisted of 10 age- and sex-matched normal subjects. All participants were evaluated using video-nystagmography (VNG), Computerized Dynamic Posturography (CDP) including sensory impairment, automatic motor and voluntary motor assessment. In addition, patients were evaluated using functional limitation tests and were asked to fill the Freezing of Gait (FOG) questionnaire. ResultsThis research documents vestibular as well as balance dysfunction in patients with PD. Central vestibular disorders were more common than peripheral ones. The most prevalent balance abnormality was encountered in the sensory organization subtest, though patients showed significant affection in other domains; namely, autonomic motor, voluntary motor and functional limitation. In general, patients receiving both medication and physiotherapy showed better vestibular and balance function than those receiving medication only, and approached the normal values in many test parameters. ConclusionsSince patients with PD receiving physiotherapy in conjunction with medical treatment showed better control of their vestibular and balance functions, efforts should be directed to start physiotherapy including vestibular rehabilitation as early as possible in order to improve balance, thus increasing independence in daily life activities.

Off Label Use of Other CNS Drugs (e.g.psychostimulants, Anticonvulsants, Lithium): Pro's and Con's

Whether a drug is available in a particular country is based on a political decision motivated by scientific and other arguments. Some authorities may decide that available evidence regarding clinical efficacy, safety and tolerance of a certain drug is insufficient, and manufacturers may consider that the market in a particular country is too small for the introduction of a drug. On the other hand, on an international level, guidelines for the treatment of psychiatric disorders are established by authors, authorities in the field of pharmacotherapy. The recommendations are based on the evaluation of studies but also on the opinions of experts. According to the categories of evidence (A – F), recommendation grades (1 – 5) are defined, and therefore, this has also to be considered at least partly as a subjective approach. Moreover, the off-label use of drugs comprises the 4 ‘D”: diagnosis, drugs, doses, duration (of treatment) (cf Baldwin, Kosky, Adv. Psychiat. Treatment 13 (2007) 414). In particular, psychostimulants, anticonvulsants, lithium and thyroid hormones are widely prescribed in off-label conditions, e.g., psychostimulants are used as add-on medications in treatment resistant depression, lithium in psychiatric disorders presenting a chronobiological component (e.g. some forms of alcoholism), some anticonvulsants such as topiramate are considered to be helpful for the treatment of alcoholism or weight problems. Moreover, almost all neuropsychiatric agents are prescribed for personality disorders, but almost none of them is officially introduced for this indication. Finally, the baclofen – alcoholism story illustrates the conflicts existing in the field of off label prescriptions.

Emerging therapies for gait disability and balance impairment: Promises and pitfalls

Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention.

Geriatric management in medieval Persian medicine

In Iran, a large group of patients are elderly people and they intend to have natural remedies as treatment. These remedies are rooted in historical of Persian and humoral medicine with a backbone of more than 1000 years. The current study was conducted to draw together medieval pharmacological information related to geriatric medicine from some of the most often manuscripts of traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plants through a search of the PubMed, Scopus and Google Scholar databases. In the medieval Persian documents, digestible and a small amount of food such as chicken broth, honey, fig and plum at frequent intervals as well as body massage and morning unctioning are highly recommended. In the field of pharmacotherapy, 35 herbs related to 25 families were identified. Plants were classified as tonic, anti-aging, appetizer, memory and mood enhancer, topical analgesic and laxative as well as health improvement agents. Other than historical elucidation, this paper presents medical and pharmacological approaches that medieval Persian practitioners applied to deal with geriatric complications.

Non-Ribosomal Halogenated Protease Inhibitors from Cyanobacterial Isolates as Attractive Drug Targets

Cyanobacteria possess the ability to produce compounds with remarkable biological activity, and have thus attracted the attention of the pharmaceutical industry. Cyanopeptides acting as protease inhibitors have shown potential in the field of pharmacotherapy through regulation of abnormal physiological processes in the human body. Despite the already described cyanopeptide protease inhibitors, the search for new congeners is of considerable interest which may pave the way for more efficient molecules. In this study, the presence of the protease inhibitors aeruginosin and cyanopeptolin with non-, mono- and dichlorination and also genes coding for their synthetases was investigated in 90 cyanobacterial strains. Mass spectrometry analyses highlighted production of 91, 19 and 3 non-, mono- and dichlorinated congeners, respectively. The purified extract of Microcystis botrys SPC759 inhibited 61% of pepsin protease. PCR amplifications of aeruginosin and cyanopeptolin synthetase gene regions were observed in 41 and 28% of evaluated strains, respectively. The sequences obtained for the aerA-aerB (aeruginosin) and mcnC-mcnE (cyanopeptolin) gene regions grouped together with their homologues found in other cyanobacterial strains in the phylogenetic analyses with high bootstrap support. Antimicrobial activity assays performed using all intracellular extracts inhibited 31 and 26% of Gram-negative and Gram-positive pathogenic bacterial growth, respectively. The results of this study showed the production of aeruginosin and cyanopeptolin and the presence of their genes in several cyanobacterial genera for the first time besides the discovery of novel congeners.

ANITINERARY TO ACCESS THE COLON

Although oral delivery has become a widely accepted route of administration of therapeutic drugs, the gastrointestinal tract presents several formidable barriers to drug delivery. The delivery of drugs to the colon has a number of important implications in the field of pharmacotherapy. Drugs that are destroyed by the acidic environment of the stomach or metabolized by pancreatic enzymes are only slightly absorbed in the colon. Targeted delivery of drugs to the colon has attracted much interest recently for local treatment of a variety of colonic diseases such as irritable bowel syndrome (IBS), colorectal cancer and inflammatory bowel diseases (IBD), which includes both ulcerative colitis and crohn's disease. The colon is also receiving significant attention as a portal for the entry of drugs into the systemic circulation. A variety of delivery strategies and systems have been proposed for colonic targeting.This article shall review the diversestrategies used to target the drug to the colon.The various features of different approaches allowing locally restricted drug delivery to the inflamed colon are discussed including the main physiological issues and histological changes of the colon as its cancer develops.

Novel Antiplatelet Therapies

Advances in antiplatelet therapy have significantly improved outcomes in patients with ischemic heart disease. Thienopyridines remain a cornerstone of therapy along with aspirin. Recently, concerns have been raised about the use of clopidogrel due to its pharmacokinetic and pharmacogenetic interpatient variability. A third-generation thienopyridine, prasugrel, overcomes some of these problems by improving inhibition of platelet aggregation, but increasing the risk of peri-procedural bleeding. Other novel antiplatelet agents, such as ticagrelor, have shown improved efficacy in recent trials and require further investigations. The field of pharmacotherapy continues to rapidly evolve as newer agents, such as thrombin receptor antagonists, along with older agents, such as cilostazol and glycoprotein IIb/IIIa inhibitors, are being explored.