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Strengths and weaknesses of State-controlled wholesale distribution
Published in Carine Baxerres, Maurice Cassier, Understanding Drugs Markets, 2021
Stéphanie Mahamé, Roch Appolinaire Houngnihin, Adolphe Codjo Kpatchavi
In the pharmaceutical world, wholesale drug distribution has been described as subordinate to suppliers (manufacturers) and customers (pharmacies), which share the bulk of the sector's profits between them (Lomba, 2014). In Benin, however, where manufacturing is minimal, the pharmaceutical system is centered around importation and wholesale distribution by a very small number of actors: a mere five, as we will see. This wholesale distribution is based on the pharmacist's monopoly, which will be discussed in the next chapter. The monopoly is strictly controlled by the State and mobilizes significant capital, which affects the position of these actors and crystallizes economic and political challenges—challenges that have at times led to crises and redefined power relations. The current configuration of this wholesale distribution system, the result of a series of choices by political actors combined with various economic and ideological factors, will be discussed in this chapter.
Drug Design, Synthesis, and Development
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
Drug distribution is the next step in the pharmacokinetics of a drug. Once the drug has diffused into the capillaries, it is speedily distributed around the blood stream, and then more slowly distributed to various tissues and organs. Drug molecules do not have to cross cell membranes in order to leave the blood system and enter tissues. Capillaries contain small pores between cells through which drug-sized molecules can pass, but not important plasma proteins. If the drug target is an extracellular receptor, the drug can find the target, bind to it, and perform its function. Drugs that have targets within the cell, such as enzyme inhibiters, or drugs acting on nucleic acids, must leave the extracellular aqueous fluid and traverse cell membranes to access their targets. To do this, the drug must be sufficiently hydrophobic, or be able to utilise carrier proteins, or be taken in by pinocytosis. If a drug is excessively hydrophobic, it can become absorbed into fatty tissue, thus lowering the concentration available to bind to the target. Likewise, drugs that are ionised may be less available in the blood supply if they become bound to macromolecules; for example they can become irreversibly bound to blood plasma proteins.
Local Anesthetics and Additives
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Jean-Pierre Haberer, Bernard Jacques Dalens
Additional information on drug distribution is provided by measuring The blood/plasma drug concentration ratio, which is inversely related to plasma protein binding and can be calculated as follows: The free fraction of drug in whole blood (fb) and in plasma (fp)The distribution volume of free drug at steady state (VDSS1), which takes into account the degree of blood binding and depends (in part) upon the mean tissue affinities of the given agent
Patients with substance use disorders receiving continued care in skilled nursing facilities following hospitalization
Published in Substance Abuse, 2022
Shannon Gwin Mitchell, Courtney D. Nordeck, Elizabeth Lertch, Tyler E. Ross, Christopher Welsh, Robert P. Schwartz, Jan Gryczynski
The ability of sub-acute care facilities to dispense/administer controlled substances is a complicated matter at the federal and state levels. The ability of any facility or individual practitioner to be involved with the “closed system of drug distribution” established under the Comprehensive Drug Abuse Prevention and Control Act of 1970 (The Controlled Substances Act)(CSA) requires registration with the DEA.26 This registration is issued in accordance with the “business activity” of that entity. Acute care hospitals register as a “hospital/clinic” which allows them to store and administer controlled substances. Pertinent to the treatment of OUD, the CSA allows “a physician or authorized hospital staff to administer or dispense narcotic drugs in a hospital to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of conditions other than addiction…”10 Thus, the hospital is allowed to administer methadone to a patient with OUD already on an OTP (rather than requiring the program to deliver the doses) or give methadone to a patient not already on an OTP.
Potential application of mass spectrometry imaging in pharmacokinetic studies
Published in Xenobiotica, 2022
Chukwunonso K. Nwabufo, Omozojie P. Aigbogun
MSI is widely used for imaging spatial distribution of drug molecules and/or their metabolites due to its numerous advantages over traditional methods including higher sensitivity, better accuracy, reliance on m/z of analyte rather than labelling or staining, localisation of imaging compared to whole body imaging (Nilsson, Goodwin, Shariatgorji, et al. 2015; Goodwin et al. 2020; Spruill et al. 2022). Drug distribution is an important physiological process resulting in target tissue exposure to the drug. The knowledge of drug distribution is highly relevant to understanding the amount of drug available to produce action at the desired target site, the amount of drug involved in off-target action potentially leading to adverse drug reactions, and the loading dose of the drug (Raj and Raveendran 2019).
PEGylated drug delivery systems in the pharmaceutical field: past, present and future perspective
Published in Drug Development and Industrial Pharmacy, 2022
Eva Sanchez Armengol, Alexander Unterweger, Flavia Laffleur
In the field of polymer-drug conjugates, the design and development of stimuli-responsive systems will be gaining interest. For this, connections are integrated into blocks, reducing drastically side effects, and achieving as well desired pharmacokinetics and pharmacodynamics. Multifunctional polymeric carriers will be developed and studied as possible conjugates along polymer chains, changing their properties if needed by the addition of molecules such as targeting units. The properties of active ingredients will no longer be important for these systems, making them a potential candidate for many therapies. Nevertheless, hindrances such as drug interactions, heterogeneous drug distribution, and other unforeseen problems will arise. Promising therapies to overcome problems in the treatment of diseases will be based on dendrimers, polymer-small molecule drug conjugates or polymeric nanoparticles.