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Medications
Published in Henry J. Woodford, Essential Geriatrics, 2022
Rather than defining polypharmacy by pill count alone, it can also be classified as ‘appropriate' or ‘inappropriate'. With appropriate polypharmacy, the potential benefits are greater than harms and it is in alignment with individual needs, goals and preferences. Inappropriate or ‘problematic' polypharmacy is when the desired outcomes are not being achieved.115 For example, hazardous or interacting drug combinations, ineffective drugs, unacceptable therapeutic burden, reduced adherence or prescribing cascades. It is possible to discover the co-prescription of agents that have directly opposing mechanisms of action, for example, pro-cholinergics and anticholinergics; dopamine agonists and antagonists; or furosemide and fludrocortisone.
Drug Analysis of Protein Microspheres: From Pharmaceutical Preparation to In Vivo Fate
Published in Neville Willmott, John Daly, Microspheres and Regional Cancer Therapy, 2020
Jeffrey Cummings, David Watson, John F. Smyth
Due to its low therapeutic index mitomycin C has been given both locally and in different forms, such as drug-dextran conjugates or absorbed onto activated carbon particles to reduce toxicity. Of particular interest, the drug has been incorporated into or admixed with a variety of microspherical drug delivery systems, such as ethylcellulose microparticles,36 biodegradable starch microspheres,37 albumin protein microspheres,38 and polylactic acid microcapsules.39 Despite having been microencapsulated for more than 10 years, little is known about the effect of the pharmaceutical process on the chemical and biological properties of the drug. This is more than likely due to the drug’s complex chemistry, pharmacology, and mechanism of action, which have proved surprisingly difficult to analyze comprehensively in vivo.
FDA Regulatory Acceptance of Bayesian Statistics
Published in Emmanuel Lesaffre, Gianluca Baio, Bruno Boulanger, Bayesian Methods in Pharmaceutical Research, 2020
For a pharmaceutical product, there is often little prior information derived from similar products since a similar pharmaceutical product often may have very different safety and efficacy profiles. The drug action is pharmacological and systemic and in contrast the device mechanism of action is usually physical, well-understood and local.
Pharmacological approaches to treat intestinal pain
Published in Expert Review of Clinical Pharmacology, 2023
Mikolaj Swierczynski, Adam Makaro, Agata Grochowska, Maciej Salaga
In this review, we focus on current and future pharmacological options for treatment of intestinal pain in the most significant intestinal pathologic conditions. We would like to elaborate on the drug’s mechanism of action, consider possible ways of reducing side effects and provide an expert opinion on the topic. The original studies discussed in this review were obtained from a literature search carried out by consulting 13 electronic scientific databases, including MEDLINE, SCOPUS, Web of Science, Directory of Open Access Journal electronic editorial networks, such as BMJ, Blackwell, Elsevier, Karger, Nature Publishing Group, Springer, literature distributors, such as OVID Journals and EBSCO, and clinical trials databases, such as CT and EU – CTR. The scientific papers were selected according to the time span ranging from 1987 to present.
Repeated low-dose caffeine ingestion during a night of total sleep deprivation improves endurance performance and cognitive function in young recreational runners: A randomized, double-blind, placebo-controlled study
Published in Chronobiology International, 2022
Amir Khcharem, Wajdi Souissi, Liwa Masmoudi, Zouheir Sahnoun
Several mechanisms of action of caffeine could be responsible for improving physical performance. The main mechanism of action is probably the activation of the central nervous system resulting from the blockade of adenosine receptors. Micromolar concentrations of caffeine in tissues block adenosine receptors (A1 and A2a), which can form a functional heteromer with dopamine receptors (D1 and D2) in different regions of the brain. Thus, caffeine indirectly increases dopamine levels and promotes its beneficial impact on psychomotor activity, which improves blood flow to the muscles and the heart (Ferré 2016). This improvement in blood circulation could be associated with a decrease in the sensation of muscle pain (Engels et al. 1999). Therefore, the administration of caffeine could help delay fatigue, which in turn improves physical performance (Doherty and Smith 2005).
Neuropathic ocular surface pain: Emerging drug targets and therapeutic implications
Published in Expert Opinion on Therapeutic Targets, 2022
Sneh Patel, Rhiya Mittal, Konstantinos D. Sarantopoulos, Anat Galor
Many individuals with chronic ocular surface pain have a central component and, in these individuals, oral neuromodulators are first-line therapies. These medications, overall, aim to suppress neuronal excitability and signal propagation to the CNS. Commonly used agents include α2δ ligands (gabapentin or pregabalin), tricyclic antidepressants (TCAs, nortriptyline, or amitriptyline), serotonin-norepinephrine reuptake inhibitors (SNRIs, duloxetine), and anti-convulsants/sodium channel blockers (carbamazepine, oxcarbazepine, or topiramate) [38,39]. These agents can be administered alone, but are often combined in cases where monotherapies fail to control symptoms. For example, α2δ ligands may be combined with TCAs (nortriptyline), SNRIs (duloxetine), and/or opioid-targeting agents [40]. Various mechanisms of action have been implicated. Specifically, gabapentin and pregabalin inhibit presynaptic voltage-gated calcium channels (thus resulting in reduced release of excitatory neurotransmitters at presynaptic terminals) and suppress synaptic propagation of pain signaling and neuronal excitability [41], antidepressants activate endogenous inhibitory analgesic pathways, while some antidepressants (amitriptyline) and anticonvulsants inhibit sodium channels and NMDA glutamate receptors [42,43].