Safe Administration Route Research Articles

A Pilot Study of Physician Assistant Student and Alumni Attitudes, Awareness, and Perceptions of Medical and Recreational Marijuana

Objectives: In this study, we aimed to explore current physician assistant (PA) student and alumni attitudes, knowledge, and perceptions towards recreational and medical marijuana. Methods: We conducted a cross-sectional study with PA students and alumni (N = 62) from a mid-sized university in the southeastern United States. We used an online QualtricsTM survey of 40 questions pertaining to both medical and recreational marijuana. Results: When asked about counseling patients on medical marijuana only 50.8% felt comfortable. Even fewer were comfortable with discussing drug interactions (39%). Participants felt that edibles were the safest route of administration (46.8%). The majority felt patient counseling should be incorporated into health sciences courses (79.7%). There was a statistically significant association between their knowledge and their comfort in answering questions about marijuana (p < .001) and between their knowledge and their comfort in addressing drug interactions (p = .005). Conclusion: Our results align with previous research concluding that a greater amount of marijuana education should be incorporated into healthcare professionals’ curricula.

Latest Advances in Hydrogel-Based Drug Delivery Systems for Optimization of Metabolic Syndrome Treatment.

Drug delivery systems such as hydrogels have become relevant in cardiovascular and metabolic therapies due to their sustained and controlled release properties of drugs, versatile polymer structures, safety, and biodegradability. The literature presented demonstrates that a hydrogel-based controlled release system increases the therapeutic efficacy in different components of the metabolic syndrome. Hypertension has been the most explored component with advances in in vitro and murine models. However, clinical evidence in humans is scarce, and more translational studies are needed. Hydrogel-based systems for diabetes, obesity, and dyslipidemia have been little explored. Observations mainly demonstrated an increase in therapeutic efficacy, in vitro and in vivo, for the use of insulin, leptin, and natural components, such as epigallocatechin gallate. In all cases, the hydrogel systems achieve better plasma levels of the loaded compound, higher bioavailability, and low cytotoxicity compared to conventional systems. Also, the evidence existing suggests that the development of an injectable hydrogel system for controlled release of drugs or therapeutic compounds is presented as an attractive option for MeS treatment, and due to the possibility of sustained pharmacological release, there is no need for repeated doses and a safe administration route. The following review aims to evaluate the use of the hydrogel systems in the therapy of diabetes, obesity, hypertension, and dyslipidemia, which are the main components of metabolic syndrome.

Formulation And Evaluation Of Buccoadhesive Films of Lidocaine Hydrochloride

Buccal delivery is considered the most suitable, easy, and safest route of administration. So it can be used as an alternative route to the peroral route for the systemic administration of drugs. Oral films (OFs) are used as a unique approach, because it dissolves quickly in the mouth and directly reaches to the systemic circulation. The aim of this study is to formulate and evaluate OF of an anaethetic drug lidocaine (LH) and improve its local effect. Oral films were prepared by using chitosan and polyvinylpyrolidone. OFs were assessed for compatibility studies, surface pH, swelling properties, In-Vitro bioadhesion, mechanical properties, disintegration time, dissolution time and in- vitro drug release. It was found that actual LH content in the prepared patch was in the range of 95-105% of the claimed content. The addition of propylene glycol as a plasticizer gave good mechanical properties in concentration of 40%. The prepared oral films swelled and reached an Equilibrium state of swelling. The prepared polymeric films showed good adhesion and acceptable pH. It could be concluded that the release of LH is higher from films contain 1% chitosan. Increasing chitosan concentration to 2% resulted in decreasing the initial dissolution rate. The combination of chitosan (2%) , PVP(10%) and PG at 40% w/w gave a reasonable LH release.

Ozone Therapy: Overview of its Potential Utility in Male Reproduction

Ozone (O3), a highly water-soluble inorganic molecule, is a gas made of three atoms of oxygen (O) with a cyclic structure. Ozone can be produced by medical generators from pure oxygen after passing through a high voltage gradient. Ozone therapy (OT) can be given in medical practice via several routes that include transdermal, intramuscular, rectal, nasal, oral, vaginal, intravenous, intra-arterial, intraperitoneal, intra-pleural, topical, dental, intra-discal and by auto-hemotherapy. Because ozone, a highly reactive molecule, is a potent oxidant and anti-inflammatory agent, it has strong bactericidal, antiviral, anti-fungal and anti-protozoal actions as well as therapeutic effects on the immune system. With its multifaceted route of administration, OThas been used to treat several pathologies that involve the immune system such as cancers, sepsis, abscesses and chronic wounds, skin problems (such as eczema and psoriasis), HIV infection, asthma, arthritis, urologic problems, osteomyelitis and many others. The purpose of this review article is to evaluate the role of OT in the male reproductive system. We performed a review of all available basic science, experimental animal studies and clinical peer-reviewed articles published in PubMed and Google Scholar until November 2018. The literature so far retrieved shows that most studies pertaining to the effect of OT on male reproduction were performed in animals. Results to date show that OT, via improving the immune system, significantly protects testicular function in the setting of testicular torsion/ischemia, protects against the effect of gonadotoxic agents and treats bacterial infections in the semen. This article calls for a need for at least pilot studies in humans using OT in its safest route of administration, which is probably the transdermal one. This would be significant especially considering that male factor infertility constitutes up to one third of couple infertility and it is very common that poor semen parameters are irreversible with medical or surgical treatment, such as varicocele repair or vasectomy reversal.

Formulation and in Vivo Evaluation of Granisetron HCl mouth Dissolving films in Healthy Human Volunteers

Fast dissolving drug delivery systems such as mouth dissolving films (MDF) are novel dosage forms that disintegrate or dissolve within the oral cavity and it is considered the most convenient, easy, safest route of administration. Present work aimed at preparing quick onset of action of Graniserton HCl which is beneficial in emesis, aiding in the enhancement of bioavailability and is very convenient for administration without the problem of swallowing and using water. Present mouth dissolving films were prepared by the solvent-casting method using a combination of different polymers, HPMC E3, HPMC E5 and HPMC E15, along with Propylene glycol as a plasticizer. Mouth dissolving films were evaluated for physical characteristics such as thickness, folding endurance, drug content, surface pH, percentage elongation and tensile strength and results were found to be satisfactory. The Fourier-transform infrared study and scanning electron microscopy for the drug-polymer interaction was carried out. The formulations were subjected to disintegration, in-vitro drug release test. The in vitro disintegration time of the optimized batch F14 was found to be 9 sec and drug release was found to be very fast i.e. 99.69±6.27% of within 7min. In vitro and in vivo evaluation of the films confirmed their potential as an innovative dosage form to improve bioavailability and quick onset of action of Graniserton HCl in the management of chemotherapy induced vomitings.

Intranasal delivery of ciprofloxacin to rats: A topical approach using a thermoreversible in situ gel

Intranasal administration of antibiotics is an alternative and attractive delivery approach in the treatment of local infections such as chronic rhinosinusitis. This topical route has the advantage of delivering high drug concentrations directly to the site of infection when trying to eradicate the highly resistant bacterial biofilms. The purpose of this study was to assess and compare the pharmacokinetic parameters of ciprofloxacin following intranasal and intravenous administrations to rats in plasma, olfactory bulb and nasal mucosa of two different nasal regions. For intranasal administration a thermoreversible in situ gel was used to increase drug residence time in nasal cavity. Ciprofloxacin concentration time-profile in nasal mucosa of the studied anterior region (at naso- and maxilloturbinates level) was markedly higher after intranasal administration (0.24mg/kg) than that following intravenous administration (10mg/kg), while in nasal mucosa of the more posterior region (at ethmoidal turbinates level) ciprofloxacin concentrations were found to be higher after intranasal administration when the different dose administered by both routes is taken into account. A plateau in ciprofloxacin concentration was observed in nasal mucosa of both studied regions after intranasal administration, suggesting a slow delivery of the drug over a period of time using the nasal gel formulation. In plasma and olfactory bulb, concentration of ciprofloxacin was residual after intranasal administration, which demonstrates this is a safe administration route by preventing systemic and particularly central nervous system adverse effects. Dose-normalized pharmacokinetic parameters of ciprofloxacin exposure to nasal mucosa revealed higher values after intranasal delivery not only in the anterior region but also in the posterior nasal region. In conclusion, topical intranasal administration appears to be advantageous for delivering ciprofloxacin to the biophase, with negligible systemic and brain exposure using a 41.7-fold lower dose than intravenous administration. Therefore, it may represent a promising approach in the drug management of chronic rhinosinusitis.

Eyedrop Vaccination Induced Systemic and Mucosal Immunity against Influenza Virus in Ferrets.

We investigated eyedrop vaccination (EDV) in pre-clinical development for immunological protection against influenza and for potential side effects involving ocular inflammation and the central nervous system (CNS). Live attenuated influenza EDV, CA07 (H1N1), PZ-4 (H1N2) and Uruguay (H3N2), induced both systemic and mucosal virus-specific antibody responses in ferrets. In addition, EDV resulted in a clinically significant protection against viral challenge, and suppression of viral replication in nasal secretion and lung tissue. Regarding safety, we found that administered EDV flow through the tear duct to reach the base of nasal cavity, and thus do not contact the olfactory bulb. All analyses for potential adverse effects due to EDV, including histological and functional examinations, did not reveal significant side effects. On the basis of these findings, we propose that EDV as effective, while being a safe administration route with minimum local side effects, CNS invasion, or visual function disturbance.

Application of sustained delivery microsphere of cyclosporine A for preventing posterior capsular opacification in rabbits.

To explore the inhibitory effect of a sustained cyclosporin A (CsA) delivery microsphere (CsA-MS) on posterior capsular opacification (PCO) in rabbit eyes after cataract extraction. Twenty New Zealand white rabbits accepted cataract extraction plus intraocular lens implantation and their left eyes were intraoperatively injected CsA-MS prepared using polymer polylactioglycolic acid (PLGA) as a carrier and their right eyes were injected with empty MS. The changes in cornea, anterior chamber reaction, intraocular pressure, PCO and CsA concentration in aqueous humor were examined postoperatively and all the eyes were enucleated 3 months after surgery for histopathological and morphological examination with light microscopy and electron microscopy. Conjunctival hyperemia, corneal edema, intraocular pressure and anterior chamber response of experimental and control eyes were similar, while PCO in CsA-MS injected eyes was greatly improved compared with that in control eyes. Posterior capsules in CsA-MS injected eyes were smooth and lens epithelial cells (LEC) did not proliferate significantly (P>0.05), while LEC in posterior capsule of control eyes had different degrees of proliferation and cortical regeneration. LEC in CsA-MS injected eyes were not functionally active and underwent apoptosis, whereas LEC in control eyes were functionally active (F-test, P=0.025). In addition, the corneal ultrastructure showed no differences between CsA-MS and MS injected eyes. CsA-MS has high bioavailability in rabbit eyes and could inhibit postoperative PCO occurrence and development during the study period, suggesting that CsA-MS may be a promising, effective and safe administration route to prevent PCO in clinic.

神経難病における在宅栄養管理；ALS患者の在宅ケア・終末期ケアを中心として

Nutritional intervention in neurological diseases including amyotrophic lateral sclerosis (ALS) has drawn attention in recent years. Malnutrition or progressive weight loss in the early stage of ALS has been reported as a predictor of poor survival prognosis. Percutaneous endoscopic gastrostomy (PEG) is recommended in the early stage of ALS to stabilize the body weight and possibly to improve patients' quality of life (QOL) or survival prognosis. Clinicians should be precisely aware of clinical significance and purposes, and optimal timing of PEG in ALS. PEG should be performed in the stages with preserved respiratory function (forced vital capacity > 50%, and arterial carbon dioxide pressure < 45 mmHg), to avoid early death after PEG and to maintain QOL with nutritional intervention through PEG. Although appropriate amount of energy to be administered is yet to be established, high calorie diet is expected to be effective for potential improvement of survival. PEG is also necessary as a safe administration route of opioids for palliative and end-of-life care.

The Application of Thermosensitive Gel Nano-Material in Neurosurgery

Thermo-sensitive gel is a kind of macromolecular material with temperature sensibility character. It is liquid under room temperature, and it can be changed to semisolid gel under animal body temperature. Then the medicament in the gel can be released gradually, to gain the sustained-release. We can make use of this character. The makeup of thermo-sensitive gel has a lot of ways, and recently the most in common use is PNIPA. It can be used in tumor cavity’s coating sustained-release chemotherapy after surgical operation, all use methods including：1. Brain glioma re-growing always be happened in tumor local site after neurosurgery operation, and inosculate the chemotherapy medicament into chitosan nanospheres slow-releasing particulates. Then mix into the thermosensitive gel , to be made to spray. During neurosurgical operation, after the surgical treatment for tumor, we spray it in the brain parenchyma cave remain after cutting tumor. When the thermosensitive gel meets the animal temperature, it is changed to membrane-wise glue attached to the tumor cave face. Then after surgical it can absorb moisture nearby, and gel membrane and chitosan nanospheres will release medicament continually. After glioma surgical treatment, the chemotherapy is slowly released partially. 2. Stereotactic surgery injection release interstitial chemotherapy. Under stereotactic apparatus inject gel into the centre of tumor, then the gel changes to colloid from liquid, and then the gel no outflow from tumor. The stereotactic technology offers the effective biopsy, diagnose and accurate and safe administration route for malignant glioma in brain’s depth which cannot be surgical treatment. 3. Embolization chemotherapy in tumor vasculature. Inject the thermosensitive gel into tumor artery, and some parts of gel curdle gradually, then it can embolize tumor capillary network, to interdict the blood to tumor, to control tumor’s growth. In the meantime medicament in gel release gradually, to win the chemotherapy. 4. Cerebral aneurysms and cerebral arteriovenous malformation embolization. Thermosensitive gel makes use of the difference between room temperature and animal heat to make embolism.

New Prospectives in the Delivery of Galantamine for Elderly Patients Using the IntelliDrug Intraoral Device: In Vivo Animal Studies

The transbuccal delivery of drugs could assist several categories of chronic, especially elderly, patients in adhering to a correct dosage regimen. In particular, patients suffering from dementia have several difficulties in following the prescribed dosage, in addition to problems associated with swallowing tablets. Galantamine is currently used for treating patients with mild to moderate Alzheimer's-type dementia. The transbuccal delivery of this drug could be an interesting non- invasive and safe administration route. Several studies have been performed in vitro and ex vivo within the framework of a European Commission funded Project (IntelliDrug-FP6), aimed at developing a device which would be fitted for controlled delivery of drugs by an electronic and software-driven system. The primary objective of this study was to evaluate the efficacy of a prototype of the IntelliDrug device in vivo on 6 pigs, following a single Galantamine dose to be delivered through the buccal mucosae, as compared to intravenous drug injection. The secondary objectives were: a) to verify Galantamine bioavailability through buccal delivery; b) to evaluate the permeation enhancement effect of iontophoresis; and, finally, c) to assess any histomorphological changes in the buccal mucosae after transbuccal delivery. The results suggested that transbuccal delivery has the potential to cause long-lasting and controlled blood levels of Galantamine. The latter crosses the entire buccal mucosae, reaching systemic circulation after about 30 minutes and its plasmatic peak approximately 120 minutes after administration. The histological analysis of the buccal mucosae did not reveal any evidence of flogosis or tissue injury. Our results have clearly confirmed that the buccal delivery of Galantamine is a reliable tool with which to overcome the drawbacks associated with the conventional administration route. In general, transbuccal drug delivery has been shown to be an interesting, non-invasive and safe administration route for delivering systemically-acting drugs.