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The administration of medicines to children
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Whilst most extemporaneous preparations are for oral, rectal or topical administration, injections may also be prepared if appropriate facilities are available. Centralised preparation of injections for individual patients may reduce risk by presenting the appropriate dose in a suitable volume, but may also achieve economies by reducing wastage [72].
Anti-Diabetic Drugs
Published in Awanish Kumar, Ashwini Kumar, Diabetes, 2020
Apart from the conventional parenteral form of insulin available, the Mannkind Corporation has recently launched an inhaled insulin preparation named Afrezza®. It is a rapid-acting insulin formulation that needs to be taken at mealtimes. The inhaled formulation has several advantages as compared to the parenteral injectable insulin formulations. The first major advantage is patient compliance as regards the reduced need for painful injections. Secondly, it is much easier to carry while travelling as compared to insulin injections. Not forgetting the pharmacokinetic properties, Afrezza enters systemic circulation within 12 minutes and thus can quickly lower the elevated blood sugar. The peak effect is seen at 35 to 45 minutes after dosing. Afrezza comes in three dosage cartridges – 4 units, 8 units and 12 units. The most serious adverse event with Afrezza is possible severe bronchospasm in patients with chronic pulmonary disorders. As with other parenteral insulin formulations, hypoglycaemia still remains a serious adverse event with Afrezza. Other observed possible adverse events include a decline in pulmonary function, diabetic ketoacidosis and hyperkalaemia [5,6].
Surgical treatment of skin disorders
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Part of the distraction when giving an injection should be to hold the skin firmly – almost to the point of causing slight pain – because this stops the patient feeling the needle puncture, which should be delivered in a single, swift movement.
Biopredictive tools for the development of injectable drug products
Published in Expert Opinion on Drug Delivery, 2022
Mônica Villa Nova, Kennard Gan, Matthias G. Wacker
Injectable drug products cover a wide variety of potential injection sites involving different physiologies and formulations. Most frequently, intravenous, subcutaneous, intramuscular, and intradermal injections are being used. Additionally, there are several less common injection sites including the intracranial [46], intrathecal [47–49], intra-articular [50], or intraosseous [51] route of administration. A formulation-centric approach requires the material and quality attributes of the delivery system to be considered. Most injectables are liquids with the drug being dissolved or dispersed in a vehicle. Their absorption kinetics is affected by a variety of physiological parameters responsible for the distribution of the drug after the injection. They include the vascularization and structure of the injection site as well as the access to other tissues, such as the lymphatic system [52]. Regarding the subcutaneous route of administration, the preferred injection site varies between Asian and Western countries, leading to differences in the absorption rate as well [6].
What is the selection process for osteoarthritis pharmacotherapy?
Published in Expert Opinion on Pharmacotherapy, 2020
Shirley P. Yu, David J. Hunter
The use of exogenous intra-articular viscosupplements is based on the concept that it may restore the viscoelastic properties of the osteoarthritic joint with the added benefit of potential analgesic and anti-inflammatory properties [33]. The main issue with this therapy is that the apparent benefit is seen mainly in trials with a higher risk of bias. There are numerous comparative trials assessing viscosupplementation to that of placebo, corticosteroids, NSAIDS, platelet-rich-plasma and paracetamol. However, the evidence is conflicting. Viscosupplement have been shown to be superior to placebo, corticosteroids and NSAIDs, in terms of knee pain and function [34,35]. However, in general, meta-analysis of viscosupplements has shown that the overall effect size of this injection is small and not of clinical importance [36], and when assessing best-evidence randomized controlled trials, differences between hyaluronic acid and placebo were not observed [37]. In addition to the high cost per injection, there are potential harms ranging from minor side effects including injection site pain, local joint pain and swelling to more serious side effects such as the development of a pseudoseptic reaction, or a flare of crystalline arthritis [38].
Is insulin intoxication still the perfect crime? Analysis and interpretation of postmortem insulin: review and perspectives in forensic toxicology
Published in Critical Reviews in Toxicology, 2020
Charline Bottinelli, Nathalie Cartiser, Fabien Bévalot, Laurent Fanton, Jérôme Guitton
Insulin therapy is prescribed to diabetic patients as replacement for partial or total HI secretion deficiency or insulin resistance. There have been numerous studies and developments in administration route, but subcutaneous (SC) injection is still the most common. Injection can be performed by the patient with a syringe or insulin pen, or scheduled through an external insulin pump (Shahani and Shahani 2015). The injection site can be the arm, thigh, buttock, or abdomen, and must be changed regularly as repeated injection may cause local lipohypertrophy that could delay absorption (Batalis and Prahlow 2004) and then insulin could be released in a second time implying hyperinsulinemia. Intravenous (IV) administration is limited to emergency care. Individual insulin requirements are between 0.4 and 1.0 IU/kg/day (American Diabetes Association 2018) but could be potentially superior and adjusted for each patient, entailing regular follow-up with daily glycemic measurement (Idris et al. 2018).