This study compared the efficacy of international and local simvastatin products in lowering lipid levels in patients with primary hyperlipidemia. Fifty patients were divided into two groups, with one group receiving the international simvastatin product and the other receiving the local product, both at 10 mg per day for 4 weeks. Lipid levels including total cholesterol, triglycerides, HDL, and LDL were measured before and after treatment. Both products significantly lowered total cholesterol, triglycerides, and LDL levels with no significant changes in HDL. The international product lowered total cholesterol by 23 mg/dL and LDL by 3.76 mg/dL, while the local product lowered total cholesterol by 13 mg/dL and LDL by 5.52
Drug-Induced Gingival Overgrowth in Hypertensive Patients on Calcium Channel ...Hasanain Alani
The document describes a case-control study that assessed 103 patients taking calcium channel blockers (CCBs) for hypertension and their risk of developing drug-induced gingival overgrowth (GO). The study found that 89 patients developed GO, with 75 requiring treatment, and that the type and dosage of CCB impacted the frequency and severity of GO. The aim was to evaluate how CCB medication influences GO occurrence, treatment responses, and additional costs.
In this document, there is all the information about TDM and its relation with pharmacogenetics and pharmacokinetics
TDM can be looked at as a new area in pharmacokinetics that will lead to better patient's outcomes.
Hope you enjoy it.
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING.docxfestockton
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG
C
Nephrotoxicity
Evidence in patients receiving cisplatin therapy
Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP
CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic
agent for many different cancers, including ovarian, testicular, lung, cervical,
and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016;
Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose-
limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect
(Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, &
Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction
of the kidneys after exposure to medications, other treatments, or toxins
(Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accu-
mulation of metabolites in the renal proximal tubule cells of the kidneys,
where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al.,
2016). Accumulation of these metabolites causes direct inflammation; the
production of reactive oxygen species, which leads to oxidative cell damage;
and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are
available to measure kidney function and define nephrotoxicity or acute
kidney injury (see Table 1).
Most patients receiving cisplatin experience acute impairment of glo-
merular and tubular function in varying degrees. Toxicity is dependent on
individual cisplatin pharmacokinetics and is usually more severe with high
total cisplatin doses and when other potential nephrotoxic medications are
given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one
study, children aged 10 years or older at treatment had a lower glomerular
filtration rate 10 years after therapy compared to children aged younger than
10 years at treatment (Skinner et al., 2009).
Nephrotoxicity can be reversible, but for some individuals, it can result
in permanent kidney injury, chronic progressive renal failure, or renal tubule
function impairment (Skinner et al., 2009). Chronic and severe reductions
of renal function have several sequelae. The immediate impact may be dose
reduction or cessation of potentially lifesaving nephrotoxic chemotherapy,
thereby increasing the risk of relapse or progression of the cancer. In the
event of a disease relapse or progression, changes to renal function may limit
enrollment in phase 1 or 2 clinical trials because of inclusion parameters
related to baseline renal function.
Hydration and diuretics have been used in conjunction with cisplatin
administration for decades to improve the excretion of cisplatin and reduce
the incidence of nephrotoxicity. One method of promoting this excretion is
through osmotic diuresis with mannitol (Morgan et al., 2014). However, the
amount ...
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
This document discusses modified release drug products, including extended release and delayed release dosage forms. It defines modified release as altering the timing and/or rate of drug release. Extended release aims for twice daily dosing by providing continuous drug levels while delayed release releases the drug at a time other than promptly after administration. The document discusses various extended release drug delivery technologies like coated beads, multilayer tablets, microencapsulation, embedding in eroding matrices, plastic matrices, complexation, and osmotic pumps. It emphasizes the importance of in vitro-in vivo correlations and bioequivalence studies in evaluating these modified release products.
This guideline from the ASGE addresses the management of antithrombotic agents for patients undergoing GI endoscopy. It discusses balancing the risks of bleeding from endoscopic procedures against the risks of thromboembolic events if antithrombotic therapy is interrupted. It provides tables classifying the bleeding risks of different endoscopic procedures and the thromboembolic risks of different patient conditions. The guideline aims to help endoscopists consider procedure risks, patient risks, and effects of antithrombotic drugs on bleeding when deciding whether antithrombotic therapy should be continued or interrupted for a given patient undergoing a specific endoscopic procedure.
Formulation and Evaluation of Sublingual Tablet of Enalapril Maleate By 32 Fu...PRASANTAKUMARMOHAPAT3
The aim of this work was to formulate and evaluate sublingual tablets of Enalapril maleate for
rapid management of Hypertension. In the present work, the metallic taste of Enalapril maleate
was masked by using Kyron T-114 in 1:2 ratio. The Drug-Resin Complex was formulated as
sublingual tablets using Cross Povidone (X1) and Avicel PH102 (X2) by direct compression
method. The sublingual tablets were evaluated such as thickness, hardness, % Friability, Wetting
time, disintegration time, Water absorption ratio and % CDR. In this study, the fast release of
tablets depends on the concentration of Cross Povidone (X1) and Avicel PH102 (X2). The
selected formulation showed the fastest release of the tablets in 45 s. Stability study was
performed by taking an optimized formulation and it was observed stable. The sublingual tablets
showed acceptable results in all studies. The results indicate that the formulation can be used for
rapid management of Hypertension. Also, Enalapril maleate’s bioavailability may be increased
by selecting sublingual route of administration.
This study compared the efficacy of international and local simvastatin products in lowering lipid levels in patients with primary hyperlipidemia. Fifty patients were divided into two groups, with one group receiving the international simvastatin product and the other receiving the local product, both at 10 mg per day for 4 weeks. Lipid levels including total cholesterol, triglycerides, HDL, and LDL were measured before and after treatment. Both products significantly lowered total cholesterol, triglycerides, and LDL levels with no significant changes in HDL. The international product lowered total cholesterol by 23 mg/dL and LDL by 3.76 mg/dL, while the local product lowered total cholesterol by 13 mg/dL and LDL by 5.52
Drug-Induced Gingival Overgrowth in Hypertensive Patients on Calcium Channel ...Hasanain Alani
The document describes a case-control study that assessed 103 patients taking calcium channel blockers (CCBs) for hypertension and their risk of developing drug-induced gingival overgrowth (GO). The study found that 89 patients developed GO, with 75 requiring treatment, and that the type and dosage of CCB impacted the frequency and severity of GO. The aim was to evaluate how CCB medication influences GO occurrence, treatment responses, and additional costs.
In this document, there is all the information about TDM and its relation with pharmacogenetics and pharmacokinetics
TDM can be looked at as a new area in pharmacokinetics that will lead to better patient's outcomes.
Hope you enjoy it.
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING.docxfestockton
APRIL 2018, VOL. 22 NO. 2 CLINICAL JOURNAL OF ONCOLOGY NURSING 175CJON.ONS.ORG
C
Nephrotoxicity
Evidence in patients receiving cisplatin therapy
Elizabeth A. Duffy, DNP, RN, CPNP, Wendy Fitzgerald, RN, MSN, PPCNP-BC, CPON®, Kelley Boyle, MSN, RN, PCNS-BC, and Radha Rohatgi, PharmD, BCOP
CISPLATIN IS A PLATINUM COMPOUND THAT HAS BEEN USED as a chemotherapeutic
agent for many different cancers, including ovarian, testicular, lung, cervical,
and bladder cancers (Ruggiero, Rizzo, Trombatore, Maurizi, & Riccardi, 2016;
Santoso, Lucci, Coleman, Shafer, & Hannigan, 2003). The primary dose-
limiting toxicity of cisplatin is nephrotoxicity, a well-known side effect
(Jones, Spunt, Green, & Springate, 2008; Miller, Tadagavadi, Ramesh, &
Reeves, 2010). Nephrotoxicity involves glomerular or tubular dysfunction
of the kidneys after exposure to medications, other treatments, or toxins
(Skinner, 2011). Nephrotoxicity associated with cisplatin is related to accu-
mulation of metabolites in the renal proximal tubule cells of the kidneys,
where about 90% of cisplatin undergoes urinary excretion (Ruggiero et al.,
2016). Accumulation of these metabolites causes direct inflammation; the
production of reactive oxygen species, which leads to oxidative cell damage;
and cell death (Miller et al., 2010; Ruggiero et al., 2016). Many methods are
available to measure kidney function and define nephrotoxicity or acute
kidney injury (see Table 1).
Most patients receiving cisplatin experience acute impairment of glo-
merular and tubular function in varying degrees. Toxicity is dependent on
individual cisplatin pharmacokinetics and is usually more severe with high
total cisplatin doses and when other potential nephrotoxic medications are
given concurrently (Skinner, 2011; Womer, Pritchard, & Barratt, 1985). In one
study, children aged 10 years or older at treatment had a lower glomerular
filtration rate 10 years after therapy compared to children aged younger than
10 years at treatment (Skinner et al., 2009).
Nephrotoxicity can be reversible, but for some individuals, it can result
in permanent kidney injury, chronic progressive renal failure, or renal tubule
function impairment (Skinner et al., 2009). Chronic and severe reductions
of renal function have several sequelae. The immediate impact may be dose
reduction or cessation of potentially lifesaving nephrotoxic chemotherapy,
thereby increasing the risk of relapse or progression of the cancer. In the
event of a disease relapse or progression, changes to renal function may limit
enrollment in phase 1 or 2 clinical trials because of inclusion parameters
related to baseline renal function.
Hydration and diuretics have been used in conjunction with cisplatin
administration for decades to improve the excretion of cisplatin and reduce
the incidence of nephrotoxicity. One method of promoting this excretion is
through osmotic diuresis with mannitol (Morgan et al., 2014). However, the
amount ...
1) The study compared the effects of dexamethasone, tranexamic acid, and a combination of both on post-rhinoplasty edema and ecchymosis in 60 patients who underwent primary open rhinoplasty.
2) Patients were divided into 4 groups: dexamethasone only, tranexamic acid only, combination, and placebo. Medications were given intravenously before and after surgery.
3) Edema and ecchymosis were evaluated on a scale of 0-4 on postoperative days 1, 3, and 7. The dexamethasone, tranexamic acid, and combination groups had significantly lower edema and ecchymosis ratings compared to the placebo
This document discusses modified release drug products, including extended release and delayed release dosage forms. It defines modified release as altering the timing and/or rate of drug release. Extended release aims for twice daily dosing by providing continuous drug levels while delayed release releases the drug at a time other than promptly after administration. The document discusses various extended release drug delivery technologies like coated beads, multilayer tablets, microencapsulation, embedding in eroding matrices, plastic matrices, complexation, and osmotic pumps. It emphasizes the importance of in vitro-in vivo correlations and bioequivalence studies in evaluating these modified release products.
This guideline from the ASGE addresses the management of antithrombotic agents for patients undergoing GI endoscopy. It discusses balancing the risks of bleeding from endoscopic procedures against the risks of thromboembolic events if antithrombotic therapy is interrupted. It provides tables classifying the bleeding risks of different endoscopic procedures and the thromboembolic risks of different patient conditions. The guideline aims to help endoscopists consider procedure risks, patient risks, and effects of antithrombotic drugs on bleeding when deciding whether antithrombotic therapy should be continued or interrupted for a given patient undergoing a specific endoscopic procedure.
Formulation and Evaluation of Sublingual Tablet of Enalapril Maleate By 32 Fu...PRASANTAKUMARMOHAPAT3
The aim of this work was to formulate and evaluate sublingual tablets of Enalapril maleate for
rapid management of Hypertension. In the present work, the metallic taste of Enalapril maleate
was masked by using Kyron T-114 in 1:2 ratio. The Drug-Resin Complex was formulated as
sublingual tablets using Cross Povidone (X1) and Avicel PH102 (X2) by direct compression
method. The sublingual tablets were evaluated such as thickness, hardness, % Friability, Wetting
time, disintegration time, Water absorption ratio and % CDR. In this study, the fast release of
tablets depends on the concentration of Cross Povidone (X1) and Avicel PH102 (X2). The
selected formulation showed the fastest release of the tablets in 45 s. Stability study was
performed by taking an optimized formulation and it was observed stable. The sublingual tablets
showed acceptable results in all studies. The results indicate that the formulation can be used for
rapid management of Hypertension. Also, Enalapril maleate’s bioavailability may be increased
by selecting sublingual route of administration.
Formulation and Evaluation of Stavudine Controlled Release Matrix TabletSunil Vadithya
The document presents a study on the formulation and evaluation of controlled release matrix tablets of Stavudine. Stavudine was selected as a model drug due to its short half-life. Hydroxypropyl methylcellulose (HPMC) and Carbopol 934 were used as release retarding polymers to develop sustained release matrix tablets. Tablets were prepared by direct compression method and evaluated for physical parameters, drug content, swelling index and in-vitro drug release up to 8 hours. The results showed that formulations containing higher proportions of polymers released the drug in a controlled manner for an extended period of time.
Salon a 14 kasim 09.00 10.15 arzu topeli̇ i̇ski̇t-ingtyfngnc
This document summarizes updates in sepsis epidemiology, diagnosis, and management based on recent guidelines and studies. It notes that sepsis affects millions worldwide each year and is a leading cause of death in hospitals. While guidelines over the past decade have aimed to increase early diagnosis and treatment, compliance remains low and an expected decrease in mortality has not been observed. Ongoing research continues to investigate new diagnostic tools and therapeutic agents for sepsis.
Dr. K.V.G.S. Murty discloses his interests in herbal research companies and formulations including Cardorium Plus. Cardorium Plus is manufactured by Alakananda Herbals and marketed by Ayurveda One to address vascular endothelial dysfunction. World health statistics show increases in conditions like hypertension, diabetes and obesity globally that are associated with endothelial dysfunction. An interim report discusses an ongoing clinical trial of Cardorium Plus that shows improvements in endothelial function markers like augmentation pressure and augmentation index in subjects taking Cardorium Plus compared to placebo after 3 months. The report concludes Cardorium Plus may benefit those with conditions like hypertension, heart disease and diabetes by improving endothelial function.
The best medical treatment of venous insufficiency in 2013uvcd
This document summarizes the best medical treatment of venous insufficiency in 2013. It discusses the epidemiology, etiology, socioeconomic aspects, and management of chronic venous disorders. It provides details on medical therapeutic methods, including venoactive drugs, compression therapy, and lifestyle adaptations. It evaluates the efficacy of various venoactive drugs like calcium dobesilate, MPFF, and hydroxyethyl rutosides in treating symptoms and venous leg ulcers based on clinical trials and meta-analyses. It also explains the effects of drugs on the macrocirculation, microcirculation, and leukocyte-endothelium interaction in attenuating venous inflammation.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Ph-responsive Hydrogel Loaded With Insulin As A Bioactive Dressing For Enhanc...Snehankit Gurjar
The multifunctional hydrogel is composed of N-carboxyethyl chitosan (N-chitosan) and adipic acid dihydrazide (ADH), which are crosslinked in situ by hyaluronic acid–aldehyde (HA-ALD).
Such self-healing and injectable properties are particularly appealing for skin wound repair because they help reduce gel fragmentation and integrate ruptured gels at the target site, even after external mechanical destruction, and hence can continuously support skin wound healing.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
Homeostasis & Steroids - Dr. Shweta Yadav - Oral and Maxillofacial SurgeryDr. Shweta Yadav
This document provides an overview of homeostasis and steroids. It discusses the history of steroids, defines homeostasis, and classifies steroids based on function and duration of action. The document outlines the biosynthesis, basal secretion, and components of the homeostatic system. It describes the mechanisms of action of glucocorticoids, including their effects on carbohydrate and fat metabolism, calcium levels, and the inflammatory response. The document also discusses the hypothalamic-pituitary-adrenal axis and negative feedback mechanism, adverse effects of steroids, contraindications, and the rule of two for dental treatment. It concludes by listing some uses of steroids in oral and maxillofacial surgery.
This document is the February 2015 issue of the UTSW Internal Medicine Journal Watch. It contains summaries of recent articles across various specialties, including endocrinology, rheumatology, health care improvement, general internal medicine, nephrology, infectious diseases, hepatology, and cardiology. There is also an EKG challenge case. The endocrinology section highlights updates to diabetes screening and treatment guidelines from the American Diabetes Association, including changes to blood glucose and blood pressure targets. The health care improvement section discusses a study finding that some health plans are using adverse drug tiering to discourage enrollment by patients with high-cost conditions like HIV.
1) The study measured blood levels of anandamide, an endogenous cannabinoid, in patients undergoing general anesthesia with either sevoflurane or propofol.
2) Anandamide levels significantly declined over time in patients who received sevoflurane, but remained stable in patients who received propofol.
3) This suggests that general anesthesia influences the endocannabinoid system in a drug-dependent manner, which may explain differences in side effects between volatile and intravenous anesthetics.
This document discusses the history and products of J.B. Mody Chemicals and Pharmaceuticals Limited, an Indian pharmaceutical company. It focuses on their cardiovascular products including Nicardia, Rantac, Metrogyl, and Cilacar. The document outlines their expansion over the decades and major milestones. It then discusses their current focus on hypertension, diabetes, heart failure, and related conditions. Slides provide information on managing difficult hypertension, the benefits of cilnidipine and telmisartan combination therapy, and trials supporting cilnidipine's renoprotective effects. Physicians answer multiple choice questions related to these topics in the treatment of hypertensive patients.
This document discusses how complementary and alternative medicines (CAMs) are increasingly being used by patients and can impact cardiopulmonary bypass. It presents two case studies of patients taking specific CAMs (Sovaldi/Ribavirin and Saw Palmetto) who experienced bleeding issues during bypass surgery. The document advocates for perfusionists to be aware of CAMs patients are taking and create discontinuation plans in advance to improve outcomes and decrease blood product usage and costs.
This document discusses uremic toxins and their classification, effects, and approaches for removal. It begins by classifying uremic toxins into small water-soluble compounds like urea and guanidines, and protein-bound toxins like indoxyl sulfate and p-cresol. Protein-bound toxins are associated with cardiovascular and other diseases. Therapeutic strategies discussed include reducing protein intake, manipulating gut flora, increasing dialytic removal through high flux dialysis or HDF, adsorption techniques, and kidney transplantation.
Dr. Yugal kishor discusses corticosteroids in his document. He begins with an introduction to corticosteroids and the three main types produced by the adrenal cortex: glucocorticoids, mineralocorticoids, and sex hormones. He then covers the functional anatomy and classes of corticosteroids. Applications in dentistry are also reviewed such as supplementing patients with adrenal insufficiency during dental procedures to prevent adrenal crisis. Topical corticosteroids are discussed for treating various oral conditions like recurrent aphthous stomatitis.
1. The document discusses hypertension and its progression to heart failure if left uncontrolled over long periods of time. It notes various clinical trials that have shown cilnidipine to be effective in reducing blood pressure and protecting organs like the kidneys compared to other treatments.
2. The document contains questions and answers about managing hypertension in diabetic patients, noting that early and dual reno-protective therapy with cilnidipine and telmisartan is preferred to control blood pressure and reduce organ damage long-term.
3. It discusses the benefits of the cilnidipine-telmisartan combination in consistently lowering blood pressure and sympathetic overactivity while protecting kidney function, based on the multiple mechanisms
This document provides guidelines for the inpatient management of hyponatremia (sodium <130 mmol/L) at Norfolk and Norwich University Hospital. It was authored by several doctors and approved by medical committees. The guidelines outline procedures for assessing patients, determining the cause of hyponatremia, and prescribing appropriate treatment depending on whether patients present with euvolaemic, hypovolemic, or hypervolemic hyponatremia. The objectives are to safely and effectively treat hyponatremia while avoiding risks like overly rapid sodium correction.
The document summarizes a presentation on the formulation and evaluation of a novel anti-inflammatory transdermal drug delivery system. It includes an introduction, literature review, aim and objectives, rationale for the study, proposed plan of work including formulation development and evaluation, and expected outcomes. The literature review covers previous research on transdermal delivery approaches, permeation enhancers, and examples of marketed transdermal products. The objectives are to prepare and evaluate anti-inflammatory transdermal patches and conduct in-vitro and stability testing.
This document discusses potential drug interactions with contrast media used in medical imaging. It describes several categories of interactions, including drugs that may be retained in the body if contrast media causes reduced renal function, drugs that can enhance the renal or allergic effects of contrast media, drugs that can alter the hematological or cardiac effects, and how contrast media may interfere with isotope studies and drugs acting on the central nervous system. Precautions are recommended when administering certain drugs before or after contrast media injection.
Formulation and Evaluation of Stavudine Controlled Release Matrix TabletSunil Vadithya
The document presents a study on the formulation and evaluation of controlled release matrix tablets of Stavudine. Stavudine was selected as a model drug due to its short half-life. Hydroxypropyl methylcellulose (HPMC) and Carbopol 934 were used as release retarding polymers to develop sustained release matrix tablets. Tablets were prepared by direct compression method and evaluated for physical parameters, drug content, swelling index and in-vitro drug release up to 8 hours. The results showed that formulations containing higher proportions of polymers released the drug in a controlled manner for an extended period of time.
Salon a 14 kasim 09.00 10.15 arzu topeli̇ i̇ski̇t-ingtyfngnc
This document summarizes updates in sepsis epidemiology, diagnosis, and management based on recent guidelines and studies. It notes that sepsis affects millions worldwide each year and is a leading cause of death in hospitals. While guidelines over the past decade have aimed to increase early diagnosis and treatment, compliance remains low and an expected decrease in mortality has not been observed. Ongoing research continues to investigate new diagnostic tools and therapeutic agents for sepsis.
Dr. K.V.G.S. Murty discloses his interests in herbal research companies and formulations including Cardorium Plus. Cardorium Plus is manufactured by Alakananda Herbals and marketed by Ayurveda One to address vascular endothelial dysfunction. World health statistics show increases in conditions like hypertension, diabetes and obesity globally that are associated with endothelial dysfunction. An interim report discusses an ongoing clinical trial of Cardorium Plus that shows improvements in endothelial function markers like augmentation pressure and augmentation index in subjects taking Cardorium Plus compared to placebo after 3 months. The report concludes Cardorium Plus may benefit those with conditions like hypertension, heart disease and diabetes by improving endothelial function.
The best medical treatment of venous insufficiency in 2013uvcd
This document summarizes the best medical treatment of venous insufficiency in 2013. It discusses the epidemiology, etiology, socioeconomic aspects, and management of chronic venous disorders. It provides details on medical therapeutic methods, including venoactive drugs, compression therapy, and lifestyle adaptations. It evaluates the efficacy of various venoactive drugs like calcium dobesilate, MPFF, and hydroxyethyl rutosides in treating symptoms and venous leg ulcers based on clinical trials and meta-analyses. It also explains the effects of drugs on the macrocirculation, microcirculation, and leukocyte-endothelium interaction in attenuating venous inflammation.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Ph-responsive Hydrogel Loaded With Insulin As A Bioactive Dressing For Enhanc...Snehankit Gurjar
The multifunctional hydrogel is composed of N-carboxyethyl chitosan (N-chitosan) and adipic acid dihydrazide (ADH), which are crosslinked in situ by hyaluronic acid–aldehyde (HA-ALD).
Such self-healing and injectable properties are particularly appealing for skin wound repair because they help reduce gel fragmentation and integrate ruptured gels at the target site, even after external mechanical destruction, and hence can continuously support skin wound healing.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
Homeostasis & Steroids - Dr. Shweta Yadav - Oral and Maxillofacial SurgeryDr. Shweta Yadav
This document provides an overview of homeostasis and steroids. It discusses the history of steroids, defines homeostasis, and classifies steroids based on function and duration of action. The document outlines the biosynthesis, basal secretion, and components of the homeostatic system. It describes the mechanisms of action of glucocorticoids, including their effects on carbohydrate and fat metabolism, calcium levels, and the inflammatory response. The document also discusses the hypothalamic-pituitary-adrenal axis and negative feedback mechanism, adverse effects of steroids, contraindications, and the rule of two for dental treatment. It concludes by listing some uses of steroids in oral and maxillofacial surgery.
This document is the February 2015 issue of the UTSW Internal Medicine Journal Watch. It contains summaries of recent articles across various specialties, including endocrinology, rheumatology, health care improvement, general internal medicine, nephrology, infectious diseases, hepatology, and cardiology. There is also an EKG challenge case. The endocrinology section highlights updates to diabetes screening and treatment guidelines from the American Diabetes Association, including changes to blood glucose and blood pressure targets. The health care improvement section discusses a study finding that some health plans are using adverse drug tiering to discourage enrollment by patients with high-cost conditions like HIV.
1) The study measured blood levels of anandamide, an endogenous cannabinoid, in patients undergoing general anesthesia with either sevoflurane or propofol.
2) Anandamide levels significantly declined over time in patients who received sevoflurane, but remained stable in patients who received propofol.
3) This suggests that general anesthesia influences the endocannabinoid system in a drug-dependent manner, which may explain differences in side effects between volatile and intravenous anesthetics.
This document discusses the history and products of J.B. Mody Chemicals and Pharmaceuticals Limited, an Indian pharmaceutical company. It focuses on their cardiovascular products including Nicardia, Rantac, Metrogyl, and Cilacar. The document outlines their expansion over the decades and major milestones. It then discusses their current focus on hypertension, diabetes, heart failure, and related conditions. Slides provide information on managing difficult hypertension, the benefits of cilnidipine and telmisartan combination therapy, and trials supporting cilnidipine's renoprotective effects. Physicians answer multiple choice questions related to these topics in the treatment of hypertensive patients.
This document discusses how complementary and alternative medicines (CAMs) are increasingly being used by patients and can impact cardiopulmonary bypass. It presents two case studies of patients taking specific CAMs (Sovaldi/Ribavirin and Saw Palmetto) who experienced bleeding issues during bypass surgery. The document advocates for perfusionists to be aware of CAMs patients are taking and create discontinuation plans in advance to improve outcomes and decrease blood product usage and costs.
This document discusses uremic toxins and their classification, effects, and approaches for removal. It begins by classifying uremic toxins into small water-soluble compounds like urea and guanidines, and protein-bound toxins like indoxyl sulfate and p-cresol. Protein-bound toxins are associated with cardiovascular and other diseases. Therapeutic strategies discussed include reducing protein intake, manipulating gut flora, increasing dialytic removal through high flux dialysis or HDF, adsorption techniques, and kidney transplantation.
Dr. Yugal kishor discusses corticosteroids in his document. He begins with an introduction to corticosteroids and the three main types produced by the adrenal cortex: glucocorticoids, mineralocorticoids, and sex hormones. He then covers the functional anatomy and classes of corticosteroids. Applications in dentistry are also reviewed such as supplementing patients with adrenal insufficiency during dental procedures to prevent adrenal crisis. Topical corticosteroids are discussed for treating various oral conditions like recurrent aphthous stomatitis.
1. The document discusses hypertension and its progression to heart failure if left uncontrolled over long periods of time. It notes various clinical trials that have shown cilnidipine to be effective in reducing blood pressure and protecting organs like the kidneys compared to other treatments.
2. The document contains questions and answers about managing hypertension in diabetic patients, noting that early and dual reno-protective therapy with cilnidipine and telmisartan is preferred to control blood pressure and reduce organ damage long-term.
3. It discusses the benefits of the cilnidipine-telmisartan combination in consistently lowering blood pressure and sympathetic overactivity while protecting kidney function, based on the multiple mechanisms
This document provides guidelines for the inpatient management of hyponatremia (sodium <130 mmol/L) at Norfolk and Norwich University Hospital. It was authored by several doctors and approved by medical committees. The guidelines outline procedures for assessing patients, determining the cause of hyponatremia, and prescribing appropriate treatment depending on whether patients present with euvolaemic, hypovolemic, or hypervolemic hyponatremia. The objectives are to safely and effectively treat hyponatremia while avoiding risks like overly rapid sodium correction.
The document summarizes a presentation on the formulation and evaluation of a novel anti-inflammatory transdermal drug delivery system. It includes an introduction, literature review, aim and objectives, rationale for the study, proposed plan of work including formulation development and evaluation, and expected outcomes. The literature review covers previous research on transdermal delivery approaches, permeation enhancers, and examples of marketed transdermal products. The objectives are to prepare and evaluate anti-inflammatory transdermal patches and conduct in-vitro and stability testing.
This document discusses potential drug interactions with contrast media used in medical imaging. It describes several categories of interactions, including drugs that may be retained in the body if contrast media causes reduced renal function, drugs that can enhance the renal or allergic effects of contrast media, drugs that can alter the hematological or cardiac effects, and how contrast media may interfere with isotope studies and drugs acting on the central nervous system. Precautions are recommended when administering certain drugs before or after contrast media injection.
Similar to Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate Controlling Polymers (20)
ALPHA LOGARITHM TRANSFORMED SEMI LOGISTIC DISTRIBUTION USING MAXIMUM LIKELIH...BRNSS Publication Hub
The document discusses the alpha logarithm transformed semi-logistic distribution and its maximum likelihood estimation method. It introduces the distribution, provides its probability density function and cumulative distribution function. It then describes generating random numbers from the distribution and outlines the maximum likelihood estimation method to estimate the distribution's unknown parameters. This involves deriving the likelihood function and taking its partial derivatives to obtain equations that are set to zero and solved to find maximum likelihood estimates of the location, scale, and shape parameters.
AN ASSESSMENT ON THE SPLIT AND NON-SPLIT DOMINATION NUMBER OF TENEMENT GRAPHSBRNSS Publication Hub
This document summarizes research on the split and non-split domination numbers of tenement graphs. It defines tenement graphs and provides basic definitions of domination, split domination, and non-split domination. Formulas for the split and non-split domination numbers of tenement graphs are presented based on the number of vertices. Theorems are presented stating that the mid vertex set of a tenement graph is always a split dominating set, but its size is not always equal to the split domination number.
This document summarizes research on generalized Cantor sets and functions where the standard construction is modified. It introduces Cantor sets defined by an arbitrary base where the intervals removed at each stage are not all the same length. It also defines irregular or transcendental Cantor sets generated by transcendental numbers like e. The key findings are:
1) There exists a unique probability measure for generalized Cantor sets that generates the cumulative distribution function.
2) The Holder exponent of generalized Cantor sets is shown to be logn/s where n is the base and s is the number of subintervals.
3) Lower and upper densities are defined for the measure on generalized Cantor functions and their properties are
SYMMETRIC BILINEAR CRYPTOGRAPHY ON ELLIPTIC CURVE AND LIE ALGEBRABRNSS Publication Hub
1) The document discusses symmetric bilinear pairings on elliptic curves and Lie algebras in the context of cryptography. It provides an overview of the theoretical foundations and applications of combining these areas.
2) Key concepts covered include the Weil pairing as a symmetric bilinear pairing on elliptic curves, its properties of bilinearity and non-degeneracy, and efficient computation. Applications of elliptic curves in cryptography like ECDH and ECDSA are also summarized.
3) The security of protocols like ECDH and ECDSA relies on the assumed difficulty of solving the elliptic curve discrete logarithm problem (ECDLP). The document proves various mathematical aspects behind symmetric bilinear pairings and their use in elliptic curve cryptography.
SUITABILITY OF COINTEGRATION TESTS ON DATA STRUCTURE OF DIFFERENT ORDERSBRNSS Publication Hub
This document summarizes research investigating the suitability of cointegration tests on time series data of different orders. The researchers used simulated time series data from normal and gamma distributions at sample sizes of 30, 60, and 90. Three cointegration tests (Engle-Granger, Johansen, and Phillips-Ouliaris) were applied to the data. The tests were assessed based on type 1 error rates and power to determine which test was most robust for different distributions and sample sizes. The results indicated the Phillips-Ouliaris test was generally the most effective at determining cointegration across different sample sizes and distributions.
Artificial Intelligence: A Manifested Leap in Psychiatric RehabilitationBRNSS Publication Hub
Artificial intelligence shows promise in improving psychiatric rehabilitation in 3 key ways:
1) AI can help diagnose and treat mental health issues through virtual therapists and chatbots, improving access and reducing stigma.
2) Technologies like machine learning and big data allow personalized interventions and more accurate diagnoses.
3) The COVID-19 pandemic has increased need for mental health support, and AI may help address gaps by providing remote services.
A Review on Polyherbal Formulations and Herbal Medicine for Management of Ul...BRNSS Publication Hub
This document provides a review of polyherbal formulations and herbal medicines for treating peptic ulcers. It discusses how peptic ulcers occur due to an imbalance between aggressive and protective factors in the gastrointestinal tract. Common causes include H. pylori infection and NSAID use. While synthetic medications are available, herbal supplements are more affordable and have fewer side effects. The review examines various herbs that have traditionally been used to treat ulcers, including their active chemical constituents. It defines polyherbal formulations as combinations of two or more herbs, which can enhance therapeutic effects while reducing toxicity. The document aims to summarize recent research on herb and polyherbal formulation treatments for peptic ulcers.
Current Trends in Treatments and Targets of Neglected Tropical DiseaseBRNSS Publication Hub
This document summarizes current trends in treatments and targets of neglected tropical diseases. It begins by stating that neglected tropical diseases affect over 1.7 billion people globally each year and are caused by a variety of microbes. The World Health Organization is working to eliminate 30 neglected tropical diseases by 2030. The document then discusses several specific neglected tropical diseases in more detail, including human African trypanosomiasis, Chagas disease, leishmaniasis, soil-transmitted helminths, and schistosomiasis. It describes the causative agents, transmission methods, symptoms, affected populations, and current treatment options for each of these diseases. Overall, the document aims to briefly discuss neglected infectious diseases and treatment
Evaluation of Cordia Dichotoma gum as A Potent Excipient for the Formulation ...BRNSS Publication Hub
This document summarizes a study that evaluated Cordia dichotoma gum as an excipient for oral thin film drug delivery. Films were prepared with varying ratios of the gum, plasticizers (methyl paraben and glycerine), and the model drug diclofenac sodium. The films were evaluated for properties like thickness, folding endurance, tensile strength, water uptake, and drug release kinetics. The results found that a film with 10% gum, 0.2% methyl paraben and 2.5% glycerine (CDF3) exhibited the best results among the formulations tested. Stability studies showed the films were stable for 30 days at different temperatures. Overall, the study demonstrated that C.
Assessment of Medication Adherence Pattern for Patients with Chronic Diseases...BRNSS Publication Hub
This study assessed medication adherence and knowledge among rural patients with chronic diseases in South Indian hospitals. 1500 hypertensive patients were divided into intervention and control groups. The intervention group received education from pharmacists at various times, while the control group did not. A questionnaire evaluated patients' medication knowledge at baseline and several follow-ups. The intervention group showed improved medication knowledge scores after education compared to the control group. Female gender, lower education, and income were linked to lower knowledge. The study highlights the need to educate rural patients to improve medication understanding and adherence.
This document proposes a system to hide information using four algorithms for image steganography. The system first encrypts data using a modified AES algorithm. It then encrypts the encrypted data using a modified RSA algorithm. Next, it uses a fuzzy stream algorithm to add ambiguity. Finally, it hides the encrypted data in the least significant bits of cover images using LSB steganography. The document evaluates the proposed system using metrics like PSNR, MSE, and SSIM to analyze image quality and the ability to hide data imperceptibly compared to other techniques. It selects four color images as cover files and tests the system on them.
The document discusses Goldbach's problems and their solutions. It summarizes that the ternary Goldbach problem, which states that every odd number greater than 7 can be represented as the sum of three odd primes, was solved in 2013. It also discusses Ramare's 1995 proof that any even number can be represented as the sum of no more than 6 primes. The document then provides proofs for theorems related to representing numbers as sums of primes and concludes there are an infinite number of twin primes.
The document summarizes research on k-super contra harmonic mean labeling of graphs. It defines k-super Lehmer-3 mean labeling of a graph as an injective vertex labeling such that the induced edge labels satisfy certain properties. It proves that several families of graphs admit k-super Lehmer-3 mean labeling for any positive integer k, including triangular snakes, double triangular snakes, alternative triangular snakes, quadrilateral snakes, and alternative quadrilateral snakes. The document introduces the concept of k-super Lehmer-3 mean labeling and investigates this property for these families of graphs.
The document summarizes research on using various iterative schemes to solve fixed-point problems and inequalities involving self-mappings and contractions in Banach spaces. It defines concepts like non-expansive mappings, mean non-expansive mappings, and rates of convergence. The paper presents two theorems: 1) an iterative scheme for a sequence involving a self-mapping T is shown to converge to a fixed point of T, and 2) an iterative process involving a self-contraction mapping T is defined and shown to converge. Limiting cases are considered to prove convergence as the number of iterations approaches infinity.
This document summarizes research on analyzing and simulating the accuracy and stability of closed-loop control systems. It discusses various techniques for evaluating accuracy and stability, including steady-state error analysis, stability analysis, and simulation. Factors that can affect accuracy and stability are also identified, such as sensor noise, model inaccuracies, and environmental disturbances. The paper provides an overview of closed-loop control systems and their uses in various engineering fields like manufacturing, chemical processes, vehicles, aircraft, and power systems.
This document presents some results from a research paper on defining and investigating properties of a new triple Laplace transform. The paper introduces definitions of conformable partial fractional derivatives and the new triple Laplace transform. Several theorems are proven, including properties of the new triple Laplace transform and its relation to conformable partial fractional derivatives of functions. The new triple Laplace transform could provide a way to study nonlinear partial fractional differential equations involving functions of three variables.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
2. Chouhan, et al.: Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate
Controlling Polymers
IJPBA/Jan-Mar-2024/Vol 15/Issue 1 28
which releases the medication into the bloodstream
at a predefined pace. These solutions assisted in
overcoming the multidose therapy-related negative
effects of the traditional drug system. For a variety
of reasons, the development of technology that uses
the skin as a port of entry to release drugs into the
systemic circulation at a controlled rate has gained
popularity (Keleb et al., 2010).
Adhesive drug-containing devices with a specific
surface area, known as transdermal drug delivery
systems (TDDS), apply a predetermined dosage of
medication to intact skin at a preprogrammed rate.
Transdermal delivery has grown in significance in
the past few years. Potential benefits of the TDDS
include avoiding hepatic first-pass metabolism,
sustaining stable blood levels for an extended
period of time, which can reduce the need for
frequent doses, enhanced bioavailability, less
gastrointestinal discomfort, and increased patient
compliance (Gaikwad et al., 2013).
Transdermal patch dosage form of transdermal
therapeutic system (TTS) has been commercially
available since the early 1980s. Comparing this
approach to alternative traditional systems, there are
numerous important clinical advantages. As a result,
the TTS has special clinical importance in the long-
term management and prevention of chronic illnesses
such as hypertension. While certain antihypertensive
medications have already been developed and tested
as transdermal patches, the majority are still untested.
In the near future, transdermal formulation of
antihypertensive drugs is a promising development
(Rastogi and Yadav, 2012).
A transdermal patch is an adhesive patch with
medication that is applied topically to transfer a
predetermined amount of medication through the
skin and into the bloodstream. This frequently
encourages the body’s wounded area to mend.
Compared to other methods of medication delivery,
suchasoral,topical,intravenous,andintramuscular,
a transdermal drug delivery route has the advantage
of allowing for controlled medication release into
the patient through the patch. This is typically
achieved by either a porous membrane covering
a reservoir of medication or by body heat melting
thin layers of medication embedded in the adhesive
(Wokovich et al., 2006).
The commonly used drug for hypertension is
nitrendipine. Nitrendipine is a Calcium Channel
Blocker (CCB) with a vasodilator properties. It is
a moderately natriuretic agent instead of sodium
retentive, which sets it apart from other CCBs.
It is also an excellent antihypertensive agent.
Nitrendipine prevents the inflow of extracellular
calcium across the smooth muscle cell membranes
of the heart and blood vessels by rupturing the
channel, blocking ion-control gating mechanisms,
and/or interfering with the release of calcium
from the sarcoplasmic reticulum. Reduction of
intracellular calcium causes myocardial smooth
muscle cell contractile processes to be inhibited,
which dilates coronary and systemic arteries,
increases oxygen delivery to the myocardial tissue,
reduces total peripheral resistance, lowers systemic
blood pressure, and reduces afterload (Santiago
and Lopez, 1990; Scriabine, 1984).[1-10]
MATERIALS AND METHODS
Nitrendipine was obtained as a gift sample from
the pharmaceutical industry. Chemicals such
as Eudragit RLPO and RSPO, chloroform, and
methanol with PEG 600, HPMC, Ethyl Cellulose,
and Glycerin were obtained from Loba Chemie
Pvt. Ltd. Mumbai.
Preparation of Blank Patches
Accurately weighed polymers were taken in
combination and dissolved in respective solvents
(chloroform and methanol in the ratio of 1:1 v/v)
then poured in Petri dish with glycerin on the plain
surface. Then film was dried overnight at room
temperature.
Preparation of Rate Controlling Membrane
Eudragit RLPO and RSPO were used for the
preparation of rate-controlling membranes.
Polymers were dissolved in chloroform and
methanol with PEG 600 as plasticizer (Table 1).
Then, solution was then poured into a glass Petri
dish. The solvent was allowed to evaporate under
room temperature for 24 h (Prajapati et al., 2011).
3. Chouhan, et al.: Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate
Controlling Polymers
IJPBA/Jan-Mar-2024/Vol 15/Issue 1 29
Preparation of Matrix Type Transdermal
Patches
Transdermal patches are composed of different
polymers HPMC, ethyl cellulose, Eudragit RLPO,
and Eudragit RSPO (Madishetti et al., 2010).
The polymers were dissolved in chloroform and
methanol along with plasticizer (Table 2). Then,
the solution was poured into a glass Petri dish
containing glycerin. The solvent was allowed to
evaporate under room temperature for 24 h. The
polymers (total weight: 500 mg) and drug (20 mg)
were weighed in requisite ratios and dissolved
in 10 mL of chloroform and methanol and PEG
400. After vortexing, the solution was poured on
glycerin placed in a glass Petri dish and dried at
room temperature for 24 h.
Dose Calculations
Width of the plate = 5 cm, length of the
plate = 12 cm, No. of 2.5 × 2.5 cm2
wafers present
whole plate = 12, each wafer contains 10 mg of
drug, 12 no. of wafers contains mg of drug= 20×12
= 240 mg, the amount of drug added in each plate
was approximately equal to 240 mg.
Evaluation Parameters
The prepared transdermal patches were evaluated
for the following parameters (Table 3):
Microscopic Evaluation
An optical microscope (Olympus-Cover-018) with
a camera attachment (Minolta) was used to observe
the shape of the prepared transdermal patch for all
formulations.[11]
Table 2: Evaluation parameters
S.
No.
Formulation
code
Thickness*
(µm)
Folding
Endurance* (times)
% Moisture
content*
% Moisture
uptake*
Tensile strength
(kg/cm2
)
% Drug
content
1 F1 92±5 185±8 5.58±0.15 3.45±0.15 0.45±0.03 96.65±0.15
2 F2 89±2 225±7 5.12±0.22 3.12±0.32 0.48±0.05 99.12±0.23
3 F3 96±3 186±2 5.69±0.32 3.85±0.14 0.52±0.04 97.85±0.22
4 F4 98±6 205±6 5.48±0.15 3.96±0.23 0.58±0.03 96.65±0.18
5 F5 95±5 178±5 5.36±0.16 3.47±0.25 0.49±0.02 98.12±0.16
6 F6 97±4 165±8 5.47±0.22 3.65±0.36 0.52±0.04 97.66±0.15
*Average of three determinations (n=3, mean±S.D.)
Table 1: Preparation of matrix‑type transdermal patches
Formulation
Code
Drug
(mg)
HPMC
(mg)
RLPO
(mg)
RSPO
(mg)
Ethyl
cellulose (mg)
Total polymer
weight (mg)
Plasticizer
% w/w
Permeation
Enhancer % w/w
F1 240 250 150 ‑ 100 500 0.5 10
F2 240 300 100 ‑ 100 500 0.5 10
F3 240 350 50 ‑ 100 500 0.5 10
F4 240 250 ‑ 150 100 500 0.5 10
F5 240 300 ‑ 100 100 500 0.5 10
F6 240 350 ‑ 50 100 500 0.5 10
Plasticizer % w/w of total polymer PEG 6000 (mL). Permeation Enhancer % w/w of total polymer (Methanol, chloroform) mL
Table 3: In vitro % permeation profile of nitrendipine in
formulation F1‑F6
Time
(h)
% of drug release
F1 F2 F3 F4 F5 F6 Pure
drug
0.5 26.65 24.45 22.32 36.65 32.25 30.25 46.65
1 43.32 36.65 30.25 48.85 43.32 42.12 69.98
2 68.85 53.32 45.65 59.98 53.32 50.36 96.65
4 76.65 68.85 55.56 68.85 63.32 60.32 ‑
6 83.32 76.65 63.32 89.98 85.45 83.32 ‑
8 98.12 89.98 74.45 96.65 93.36 90.32 ‑
10 99.12 94.45 88.85 98.85 98.78 98.85 ‑
12 99.45 99.15 93.32 99.12 99.19 99.45 ‑
4. Chouhan, et al.: Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate
Controlling Polymers
IJPBA/Jan-Mar-2024/Vol 15/Issue 1 30
Thickness
The thickness of the patch was measured by
Vernier calipers. The thickness of patches was
measured at three different places and an average
of three readings was taken with standard deviation
(Tanwar et al., 2007).[12]
Folding Endurance
This was determined by repeatedly folding one film
at the same place until it had broken. The number
of times the film could be folded at the same
place without breaking/cracking gave the value of
folding endurance (Shivaraj et al., 2010).[13]
Tensile Strength
Cut the patch at the center having 2 cm length and
2 cm breadth. Patch was hanged on the top and
lower side of the instrument, then start the switch,
and note the reading on the screen. The thickness
and breadth of strips were noted at three sites and
the average value was taken for calculation. The
tensile strength was calculated by dividing applied
force by cross-sectional area (Alka et al., 2012).[14]
Percentage of Moisture Content
The prepared patches were weighed individually
and kept in desiccators containing activated silica
at room temperature for 24 h (Amish et al., 2012).
Individual patches were weighed. The percentage
of moisture content was calculated as the difference
between the final and initial weight with respect to
the initial weight.[15]
Percentage of Moisture Uptake
First, weighed the patches and then kept in a
desiccator at room temperature for 24 h and then
its exposed to 84% RH (A saturated solution of
potassium chloride) in a desiccator. The % of
moisture uptake was calculated by the difference
between the final and initial weight with respect to
the initial weight (Kriplani et al., 2018).[16]
Drug Content Analysis
The patches (n = 3) of a specified area (6.16 cm2
)
were taken into a 10 mL volumetric flask and
dissolved in methanol (10 mL) with the help
of shaker. After the vortex, the solution was
filtered and prepared subsequent dilutions and
analyzed by UV spectrophotometer at 222 nm
(Teja et al., 2012).[17]
In Vitro Skin Permeation Study
The in vitro skin permeation study was done using
a Franz diffusion cell (receptor compartment
capacity: 80 mL: surface area: 3.14 cm2
. The egg
membrane was separated and used for in vitro
study (Table 4). The receiver compartment was
filled with 40 mL of phosphate buffer, pH = 7.4.
The transdermal patch was firmly pressed onto the
center of the egg membrane and then the membrane
Table 4: In vitro drug release data for optimized formulation F2
Time (h) Square root of
time (h) 1/2
Log time Cumulative*
% drug release
Log cumulative
% drug release
Cumulative
Drug remaining
Log cumulative
% Drug remaining
0.5 0.707 −0.301 24.45 1.388 75.55 1.878
1 1 0 36.65 1.564 63.35 1.802
2 1.414 0.301 53.32 1.727 46.68 1.669
4 2 0.602 68.85 1.838 31.15 1.493
6 2.449 0.778 76.65 1.885 23.35 1.368
8 2.828 0.903 89.98 1.954 10.02 1.001
10 3.162 1 94.45 1.975 5.55 0.744
12 3.464 1.079 99.15 1.996 0.85 −0.071
Table 5: Regression analysis data of nitrendipine
transdermal patches
Batch Zero order First order
r²
F2 0.91 0.921
5. Chouhan, et al.: Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate
Controlling Polymers
IJPBA/Jan-Mar-2024/Vol 15/Issue 1 31
was mounted on the donor compartment (Vidyavati
and Jithan, 2010). The donor compartment was
then placed in a position such that the surface of the
membrane just touches the receptor fluid surface.
The whole assembly was kept on a magnetic stirrer
with suitable rpm throughout the experiment using
magnetic beads. The temperature of the receptor
compartment was maintained at 37 ± 0.5°C.[18,19]
RESULTS AND DISCUSSION
In total, six formulations of transdermal patches
were prepared and they were evaluated for various
parameters. The thickness of the patch ranged
from 89 ± 2 to 98 ± 6 µm. The folding endurance
was observed to be extended from 178 ± 5 to
225 ± 7. The concentration of polymers also affects
folding durability, which can result in outstanding
fold qualities. The purpose of plasticizers in
transdermal patches is to enhance the film’s look
and film-forming capabilities. The PEG 6000
in patches provides more flexibility at higher
plasticizer concentrations. The % moisture content
varied from 5.12 ± 0.22 to 5.69 ± 0.32% while the
moisture uptake ranged from 3.12 ± 0.32 to 3.96 ±
0.23%.
Studies on the moisture content and moisture
uptake of the patches showed a direct relationship
between the concentration of hydrophilic polymer
and the patches’ increased moisture content and
moisture uptake. The produced formulations had a
low moisture content, which may have contributed
to their stability and decreased brittleness after
extended storage. In addition, the formulations’low
moisture uptake may have reduced their bulkiness
and shielded them from microbial contamination.
In addition, the tensile strength was estimated
as 0.45 ± 0.03 to 0.58 ± 0.03 kg/cm2
. The %
drug content was found to be maximum for F2
formulation which is about 99.12 ± 0.23% and
lowest in the case of F1 formulation which is about
96.65 ± 0.15%. The in vitro % drug release was
noticed to be 99.45% in F1 and F6 formulations
(Figure 1). Although the % drug release is better
for F1 and F6, the F2 formulation is considered to
be more superior and ideal by comparing between
above-mentioned parameters.
The findings showed that as HPMC concentration
rises, so does the medication release from the
patches. In a 12-h period, the total percentage
of drug release was recorded. It was discovered
that when the hydrophilic polymer concentration
in the polymer matrix increased, so did the drug
release. This is because the creation of gelatinous
holes is caused by the dissolution of a water-
soluble component of the polymer matrix. When
such pores are formulated, the mean diffusion path
length of the drug molecules that are released into
the diffusion medium decreases, increasing the
release rate.
Further, the regression analysis of nitrendipine
transdermal patches was carried out. Mainly the
zero-order and first-order kinetics were in focus
(Table 5). The zero-order kinetic model is a
mathematical representation used to analyze drug
release kinetics. It is characterized by a linear
relationship between time and drug release, with a
constant release rate. In this analysis, Batch F2 has
an r² value of 0.910 for the zero-order model. The
first-order kinetic model is another mathematical
model used to describe drug release kinetics.
It assumes that the drug release rate is directly
proportional to the amount of drug remaining to
be released. Batch F2 has an r² value of 0.921 for
the first-order model. Thus, it can be clearly seen
that the transdermal patch follows the first-order
release kinetics.
CONCLUSION
The preparation technique for the transdermal
nitrendipine patches used in this study is
Figure 1: Percentage of drug release of nitrendipine
transdermal patches
6. Chouhan, et al.: Formulation and Evaluation of Transdermal Patches of Nitrendipine Eudragit RLPO and RSPO Using Rate
Controlling Polymers
IJPBA/Jan-Mar-2024/Vol 15/Issue 1 32
straightforward. Excellent physicochemical
qualities were also demonstrated by every
formulation in terms of thickness, weight
fluctuation, drug content, flatness, folding
durability, moisture content, and moisture uptake.
Still, the F2 formulation was considered as best.
The in vitro release results demonstrated that
the kinds and concentrations of polymers had
an impact on the drug release from the patch
formulation. Drug penetration in vitro has been
examined in relation to the impact of penetration
enhancers such as methanol and chloroform. These
investigations showed that medication permeability
increased with penetration enhancer concentration.
The results of this study showed that putting
nitrendipine topically in the form of a transdermal
patch can alleviate the issues associated with its
oral administration, such as limited absorption due
to dissolution rate and gastrointestinal side effects
so quite helpful in the treatment of patients with
hypertension.
REFERENCES
1. Verma A, Verma B, Prajapati S, Tripathi K. Formulation
and evaluation of transdermal therapeutic system
of matrix type clonidine hydrochloride. Pharm Lett
2012;4:1137-42.
2. Amish AD, Zankhana PS, Joshi J. Formulation and
evaluation of transdermal ondansetron hydrochloride
matrix patch: In vitro skin permeation and irritation
study. Int J Pharm Res Allied Sci 2012;2:26-34.
3. Arguedas JA, Perez MI, Wright JM. Treatment blood
pressure targets for hypertension. Cochrane Database
Syst Rev 2009;2009:CD004349.
4. Chiang BN, Perlman LV, Epstein FH. Overweight and
hypertension. A review. Circulation 1969;39:403-21.
5. Gaikwad AK. Transdermal drug delivery system:
Formulation aspects and evaluation. Compr J Pharm Sci
2013;1:1-0.
6. KelebE,SharmaRK,MosaEB,AljahwiAA.Transdermal
drug delivery system-design and evaluation. Int J Adv
Pharm Sci 2010;1:201-11.
7. Kriplani P, Sharma A, Pun P, Chopra B, Dhingra A, et
al. Formulation and evaluation of transdermal patch
of diclofenac sodium. Glob J Pharm Pharm Sci
2018;4:555647.
8. Madishetti SK, Palem CR, Gannu R,
Thatipamula RP, Panakanti PK, Yamsani MR.
Development of domperidone bilayered matrix type
transdermal patches: Physicochemical, in vitro and ex
vivo characterization. Daru 2010;18:221-9.
9. Oparil S, Schmieder RE. New approaches in the
treatment of hypertension. Circ Res 2015;116:1074-95.
10. Prajapati ST, Patel CG, Patel CN. Formulation and
evaluation of transdermal patch of repaglinide. ISRN
Pharm 2011;2011:651909.
11. Rastogi V, Yadav P. Transdermal drug delivery system:
An overview. Asian J Pharm 2012;6:161.
12. Santiago TM, Lopez LM. Nitrendipine: A new
dihydropyridine calcium-channel antagonist for the
treatment of hypertension. DICP 1990;24:167-75.
13. Schiffrin EL. A critical review of the role of endothelial
factors in the pathogenesis of hypertension. J Cardiovasc
Pharmacol 2001;38:S3-6.
14. Scriabine A, Garthoff B, Kazda S, Rämsch KD,
Schlüter G, Stoepel K. Nitrendipine. Cardiovasc Drug
Rev 1984;2:37-50.
15. Shivaraj A, Selvam RP, Mani TT, Sivakumar T. Design
and evaluation of transdermal drug delivery of ketotifen
fumarate. Int J Pharm Biomed Res 2010;1:42-7.
16. Tanwar YS, Chauhan CS, Sharma A. Development
and evaluation of carvedilol transdermal patches. Acta
Pharm 2007;57:151-9.
17. Allena RT,Yadav HK, Sandina S, Prasad MS. Preparation
and evaluation of transdermal patches of metformin
hydrochloride using natural polymer for sustained
release. Int J Pharm Pharm Sci 2012;4:297-302.
18. SankavarapuV,AukunuruJ.Developmentandevaluation
of zero order sustained release matrix type transdermal
films of ibuprofen. J Glob Pharm Technol 2010;2:51-8.
19. Wokovich AM, Prodduturi S, Doub WH, Hussain AS,
Buhse LF. Transdermal drug delivery system (TDDS)
adhesion as a critical safety, efficacy and quality
attribute. Eur J Pharm Biopharm 2006;64:1-8.