This document discusses implantable drug delivery systems. It describes how implantable pellets or capsules can continuously release drugs over long periods of time to treat conditions without frequent injections or hospital visits. Ideal properties of implants include biocompatibility and controlled drug release. Various types of implants are described, including biodegradable polymer matrices and osmotic pumps, which use osmotic pressure to precisely deliver drugs. Applications include cancer treatment and osteoporosis. Advantages are continuous dosing and patient compliance, while disadvantages include need for minor surgery and inability to easily stop therapy.
Application Of Polymer In Controlled Release FormulationAnindya Jana
Polymers are becoming increasingly important in the field of drug delivery. The pharmaceutical applications of polymers range from their use as binders in tablets to viscosity and flow controlling agents in liquids, suspensions and emulsions. Polymers can be used as film coatings to disguise the unpleasant taste of a drug, to enhance drug stability and to modify drug release characteristics.
As a consequence, increasing attention has been focused on methods of giving drugs continually for a prolonged time periods and in a controlled fashion.
This technology now spans many fields and includes pharmaceutical, food and agricultural applications, pesticides, cosmetics, and household products.
Mucoadhesive drug delivery system interact with the mucus layer covering the mucosal epithelial surface, & mucin molecules & increase the residence time of the dosage form at the site of the absorption.
Mucoadhesive drug delivery system is a part of controlled delivery system.
Since the early 1980,the concept of Mucoadhesion has gained considerable interest in pharmaceutical technology.
combine mucoadhesive with enzyme inhibitory & penetration enhancer properties & improve the patient complaince.
MDDS have been devloped for buccal ,nasal,rectal &vaginal routes for both systemic & local effects.
Hydrophilic high mol. wt. such as peptides that cannot be administered & poor absorption ,then MDDS is best choice.
Mucoadhesiveinner layers called mucosa inner epithelial cell lining is covered with viscoelasticfluid
Composed of water and mucin.
Thickness varies from 40 μm to 300 μm
General composition of mucus
Water…………………………………..95%
Glycoproteinsand lipids……………..0.5-5%
Mineral salts……………………………1%
Free proteins…………………………..0.5-1%
The mechanism responsible in the formation of mucoadhesive bond
Step 1 : Wetting and swelling of the polymer(contact stage)
Step 2 : Interpenetration between the polymer chains and the mucosal membrane
Step 3 : Formation of bonds between the entangled chains (both known as consolidation stage)
Electronic theory
Wetting theory
Adsorption theory
Diffusion theory
Fracture theory
Advantages over other controlled oral controlled release systems by virtue of prolongation of residence of drug in GIT.
Targeting & localization of the dosage form at a specific site
-Painless administration.
-Low enzymatic activity & avoid of first pass metabolism
If MDDS are adhere too tightlgy because it is undesirable to exert too much force to remove the formulation after use,otherwise the mucosa could be injured.
-Some patient suffers unpleasent feeling.
-Unfortunately ,the lack of standardized techniques often leads to unclear results.
-costly drug delivery system
Video Lecture is available at https://www.youtube.com/watch?v=DXu_CLgB4q0
Introduction, terminology/definitions and rationale, advantages, disadvantages, selection of drug candidates. Approaches to design-controlled release formulations based on diffusion, dissolution and ion exchange principles. Physicochemical and
biological properties of drugs relevant to controlled release formulations.
Application Of Polymer In Controlled Release FormulationAnindya Jana
Polymers are becoming increasingly important in the field of drug delivery. The pharmaceutical applications of polymers range from their use as binders in tablets to viscosity and flow controlling agents in liquids, suspensions and emulsions. Polymers can be used as film coatings to disguise the unpleasant taste of a drug, to enhance drug stability and to modify drug release characteristics.
As a consequence, increasing attention has been focused on methods of giving drugs continually for a prolonged time periods and in a controlled fashion.
This technology now spans many fields and includes pharmaceutical, food and agricultural applications, pesticides, cosmetics, and household products.
Mucoadhesive drug delivery system interact with the mucus layer covering the mucosal epithelial surface, & mucin molecules & increase the residence time of the dosage form at the site of the absorption.
Mucoadhesive drug delivery system is a part of controlled delivery system.
Since the early 1980,the concept of Mucoadhesion has gained considerable interest in pharmaceutical technology.
combine mucoadhesive with enzyme inhibitory & penetration enhancer properties & improve the patient complaince.
MDDS have been devloped for buccal ,nasal,rectal &vaginal routes for both systemic & local effects.
Hydrophilic high mol. wt. such as peptides that cannot be administered & poor absorption ,then MDDS is best choice.
Mucoadhesiveinner layers called mucosa inner epithelial cell lining is covered with viscoelasticfluid
Composed of water and mucin.
Thickness varies from 40 μm to 300 μm
General composition of mucus
Water…………………………………..95%
Glycoproteinsand lipids……………..0.5-5%
Mineral salts……………………………1%
Free proteins…………………………..0.5-1%
The mechanism responsible in the formation of mucoadhesive bond
Step 1 : Wetting and swelling of the polymer(contact stage)
Step 2 : Interpenetration between the polymer chains and the mucosal membrane
Step 3 : Formation of bonds between the entangled chains (both known as consolidation stage)
Electronic theory
Wetting theory
Adsorption theory
Diffusion theory
Fracture theory
Advantages over other controlled oral controlled release systems by virtue of prolongation of residence of drug in GIT.
Targeting & localization of the dosage form at a specific site
-Painless administration.
-Low enzymatic activity & avoid of first pass metabolism
If MDDS are adhere too tightlgy because it is undesirable to exert too much force to remove the formulation after use,otherwise the mucosa could be injured.
-Some patient suffers unpleasent feeling.
-Unfortunately ,the lack of standardized techniques often leads to unclear results.
-costly drug delivery system
Video Lecture is available at https://www.youtube.com/watch?v=DXu_CLgB4q0
Introduction, terminology/definitions and rationale, advantages, disadvantages, selection of drug candidates. Approaches to design-controlled release formulations based on diffusion, dissolution and ion exchange principles. Physicochemical and
biological properties of drugs relevant to controlled release formulations.
Various approaches to Targeted Drug Delivery Systems (TDDS) in its formuation and evaluation in a pharmaceutical industry and research is outlined in this presentation.
The device which is used in the intrauterine drug delivery system is known as an Intrauterine device (IUD) (2). IUDs or intrauterine devices are small artificial objects or devices inserted into the uterus to prevent the occurrence of pregnancy by disrupting the fertilization process as a result of sexual intercourse. They have gained popularity in recent times and are one of the most effective methods of birth control in terms of long-term contraception. It can be easily installed and is flexible. These devices are usually small in size and inserted through the cervix. IUDs reduce the need for abortion with unwanted pregnancies by preventing the effective movement of eggs and sperm. However, it cannot confirm the spread of STIs or STDs such as HIV, gonorrhoea, etc
Topics covered
Introduction
Advantages
Disadvantages
Development of intra uterine devices (IUDs)
Applications
References
Gastro retentive drug delivery system (GRDDS)Shweta Nehate
Oral route is the most acceptable route for drug administration. Apart from conventional dosage forms several other forms were developed in order to enhance the drug delivery for prolonged time period and for delivering drug to a particular target site. Gastro-retentive drug delivery system (GRDDS) has gainned immense popularity in the field of oral drug delivery recently. it is a widely employed approach to retain the dosage form in the stomach for an extended period of time and release the drug slowly that can address many challenges associated with conventional oral delivery, including poor bioavailability. different innovative approaches are being applied to fabricate GRDDS. Gastroretentive drug delivery is an approach to prolong gastric residence time, there by targeting site-specific drugs release in the upper gastrointestinal tract (GIT) for local or systemic effects. It is obtained by retaining dosage form into stomach and by releasing the in controlled manner.
‘Targeted drug delivery system is a special form of drug delivery system where the medicament is selectively targeted or delivered only to its site of action or absorption and not to the non-target organs or tissues or cells.’
Mucoadhesive drug delivery system has gained interest among pharmaceutical scientists as a means of promoting dosage form residence time as well as improving intimacy of contact with various absorptive membranes of the bio- logical system
Various approaches to Targeted Drug Delivery Systems (TDDS) in its formuation and evaluation in a pharmaceutical industry and research is outlined in this presentation.
The device which is used in the intrauterine drug delivery system is known as an Intrauterine device (IUD) (2). IUDs or intrauterine devices are small artificial objects or devices inserted into the uterus to prevent the occurrence of pregnancy by disrupting the fertilization process as a result of sexual intercourse. They have gained popularity in recent times and are one of the most effective methods of birth control in terms of long-term contraception. It can be easily installed and is flexible. These devices are usually small in size and inserted through the cervix. IUDs reduce the need for abortion with unwanted pregnancies by preventing the effective movement of eggs and sperm. However, it cannot confirm the spread of STIs or STDs such as HIV, gonorrhoea, etc
Topics covered
Introduction
Advantages
Disadvantages
Development of intra uterine devices (IUDs)
Applications
References
Gastro retentive drug delivery system (GRDDS)Shweta Nehate
Oral route is the most acceptable route for drug administration. Apart from conventional dosage forms several other forms were developed in order to enhance the drug delivery for prolonged time period and for delivering drug to a particular target site. Gastro-retentive drug delivery system (GRDDS) has gainned immense popularity in the field of oral drug delivery recently. it is a widely employed approach to retain the dosage form in the stomach for an extended period of time and release the drug slowly that can address many challenges associated with conventional oral delivery, including poor bioavailability. different innovative approaches are being applied to fabricate GRDDS. Gastroretentive drug delivery is an approach to prolong gastric residence time, there by targeting site-specific drugs release in the upper gastrointestinal tract (GIT) for local or systemic effects. It is obtained by retaining dosage form into stomach and by releasing the in controlled manner.
‘Targeted drug delivery system is a special form of drug delivery system where the medicament is selectively targeted or delivered only to its site of action or absorption and not to the non-target organs or tissues or cells.’
Mucoadhesive drug delivery system has gained interest among pharmaceutical scientists as a means of promoting dosage form residence time as well as improving intimacy of contact with various absorptive membranes of the bio- logical system
Implantable drug delivery systems are designed to be placed under the skin and
release drugs into the blood circulation without repetitive insertion of needles.
Therefore, IDDS is defined as “a sterile drug delivery device for subcutaneous
implantation having the ability to deliver drugs at a controlled rate over a
prolonged time period, comprising a rod -shaped polymeric inner matrix
with an elongated body and two ends”.
University Institute of Pharmaceutical Sciences is a flag bearer of excellence in Pharmaceutical education and research in the country. Here is another initiative to make study material available to everyone worldwide. Based on the new PCI guidelines and syllabus here we have a presentation dealing with the types of parenteral formulation including the types of parenteral route for administration along withcomponents of parenteral formulation.
Thank you for reading.
Hope it was of help to you.
UIPS,PU team
Implantable Drug Delivery Systems: Delivering Medication on Demand
Implantable drug delivery systems (IDDS) are miniature devices surgically placed under the skin or inside tissues to deliver a sustained and controlled release of medication directly to the target site. This targeted approach offers several advantages over traditional oral or injectable medications:
Benefits:
Improved treatment compliance: Eliminates the need for frequent dosing, improving adherence to treatment plans.
Enhanced efficacy: Delivers drugs directly to the site of action, maximizing their therapeutic effect.
Reduced side effects: Minimizes systemic exposure to the drug, potentially reducing unwanted side effects.
Controlled release: Offers precise control over the release rate and duration of medication delivery, optimizing treatment effectiveness.
Long-term therapy: Can provide continuous medication delivery for months or even years, ideal for chronic conditions.
Types of IDDS:
Biodegradable implants: Made from materials that naturally degrade over time, releasing the drug at a predetermined rate.
Non-biodegradable implants: Composed of materials that remain in the body after the drug is released, requiring surgical removal.
Reservoir implants: Contain a pre-filled reservoir of medication released through a controlled mechanism.
Pump implants: Use a micro-pump to deliver the medication at specific intervals or in response to external stimuli.
Applications:
Pain management: Chronic pain, post-surgical pain, arthritis
Hormonal therapy: Contraception, hormone replacement therapy
Cancer treatment: Localized chemotherapy, targeted drug delivery
Psychiatric disorders: Depression, schizophrenia
Neurological disorders: Parkinson's disease, epilepsy
Challenges and considerations:
Surgical implantation: Requires a minor surgical procedure, carrying associated risks and potential complications.
Cost: The devices and implantation procedure can be expensive.
Limited drug suitability: Not all medications are compatible with IDDS technology.
Device failure: Mechanical malfunctions or material degradation can occur over time.
Future of IDDS:
Advancements in materials science, miniaturization, and biocompatibility are paving the way for more sophisticated IDDS with:
Closed-loop systems: Sensors monitoring disease markers and adjusting drug release in real-time.
Multifunctional capabilities: Combining drug delivery with other functionalities like disease monitoring or biostimulation.
Personalized medicine: Tailored IDDS designed for individual patient needs and genetic profiles.
Implants- B.Pharm SEM 7- Novel Drug Delivery Systemvedanshu malviya
Implantable drug delivery device classification is not a straightforward task as there are a number of complex implants that will fall into hybrid categories. Nevertheless, implantable drug delivery devices can be broadly classified in two main groups: passive implants and active implants. The first group includes two main types of implants: biodegradable and non-biodegradable implants. On the other hand, active systems rely on energy dependent methods that provide the driving force to control drug release. The second group includes devices such as osmotic pressure gradients and electromechanical drives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. ABSTRACT
Implantable drug delivery systems are being
developed to release drugs to the blood stream
continuously as well as free patients from being
hospitalized to receive intravenous infusions or
frequent injections. One technique is implantation of
a pellet in the subcutaneous tissue so the pellet may
be released by erosion. Drugs are also diffused
through silicone rubber capsules but only poly
acrylamide is able to release large molecules .
Contraceptive rings containing progesterone and
placed in the uterus or vagina and implanted silicone
rubber capsules use these principles.
3. INTRODUCTION
Implants are intended for implantation in the
body(usually subcutaneously) for the purpose of providing
continuous release of the drug over long period of time.
Implants are administered by means of a suitable special
injection or surgical incision.
These are developed with a view to transmit drugs and
fluids into the blood stream with out the repeated insertion
of needles.
These systems are particularly suited to the drug delivery
requirements of insulin, steroids, chemotherapeutics,
antibiotics, analgesics, trial parenteral nutrition and heparin.
4. IDEAL PROPERTIES OF IMPLANTS:
Bio-stable
Bio-compatible
Easily removable
Non toxic and non-carcinogenic
Minimum surface area and smooth texture
Rate controlled release of the drug
Non-irritant
Non-antigenic
Non-thrombogenic
Should be long reservoir
Better life
Easy programmable
5. ENVIRONMENTALLY STABLE :
Should not breakdown under the influence of heat, light, air
and moisture.
BIO-STABLE :
Should not undergo physicochemical degradation when in
contact with bio-fluids.
BIO-COMPATIBLE :
Should neither stimulate immune responses (otherwise the
implant will be rejected) nor thrombosis and fibrosis
formation.
NON-TOXIC AND NON-CARCINOGENIC :
It’s degradation products or leached additives must be
completely safe.
6. ADVANTAGES
Unattended continuous delivery within the
therapeutic window.
Avoids the highly variable peak and trough
concentrations.
Enhanced drug efficacy.
Minimized side effects.
Termination of therapy as and when required.
Patient compliance is also a benefit of continuous
dosing with these implants as they operate for a long
period of time once implanted.
7. DISADVANTAGES
Mini surgery is needed (painful).
Uneasy to simple discontinue the therapy.
Local reactions.
Inadequate release.
The reaction between host and implant.
Implantation procedure is difficult in the case of larger
implants
Requires small surgery for large implantation and painful.
8. APPLICATIONS:
CANCER TREATMENT:
GLIADEL WAFER: Delivers carmustine for the
treatment of brain tumors directly at the site of tumor to
prevent re-occurence of tumors.
DEPOCYTE: Cytarabine releasing implantable drug
delivery system used to treat acute leukemia.
DUROS OSMOTIC PUMP: Non bio degardable drug
delivery system used to (treat acute)deliver leoprolide
acetate in the treatment of prostate cancer.
9. OSTEOPOROSIS:
MICROCHIPS: This device made by ELI Lilly co
workers used to deliver for drug used to increase
bone density in patients suffering from severe
osteoporosis.
OCULAR DISEASE:
LACRIMEDICS: These are collagen implants used
to treat eye syndrome by partially blocking tear
removing canals and they dissolve within 7-10 days.
10. LIMITATIONS OF IMPLANTS
Possible toxicity.
Need for microsurgery to implant the system.
Possible pain.
Difficulty in shutting off release if necessary.
11. CLASSIFICATION
I. IN-SITU DEPOT FORMING SYSTEM
a) In-situ precipitating implant.
b) In-situ microparticulate implant.
c) In-situ gels.
d) In-situ cross linked gels.
I. SOLID IMPLANTS
II. INFUSION IMPLANTS
12. IN-SITU DEPOT FORMING SYSTEM
In-situ depot forming system transform into semi-
solids upon injection and provide sustained release
of pharmacological agents.
Including small molecule drugs, peptides.
EXAMPLE :ATRIGEL(PLGA + water)
SABER(sucrose acetate isobutyrate
ALZAMER(PLGA + solvent)
13. IN-SITU PRECIPITATING IMPLANT
PREPARATION:
Polymeric solutions of 20%,30% and 40% dissolved in
PLGA,DMSO by shaking in an environment shaker at a
room temperature for up to 72hrs.
A clear polymeric solution was obtained and 300 mg of
MK was added to a calibrated amber glass vial and 3 ml
polymeric solution measured by 3ml syringe and added to
vial.
drug is completely dissolved in polymeric solution
volume was adjusted to 3ml calibration mark and mix well
after 24hrs.
14. ADVANTAGES :
Reduces the side effects.
Improved patient compliance.
DISADVANTAGES:
Need for reconstitution before injection.
Inability to remove the dose once injected.
Relatively complicated manufacturing procedures to
produce a sterile,stable.
15. IN-SITU MICROPARTICULATE
IMPLANT
A polymeric solution of 30% PLGA in NMP
was prepared this polymeric phase was emulsified
into an external peanut oil phase at three different
polymer to oil phase ratios of 1:1,1:2 and 1:4.
The emulsification process was achieved by probe
sonication using branson sonifier 250 at output of
250w
16. Frequency of 20KHZ for 30s under ice cooling
Pluronic F6s based on the amount of the total
formulation was dissolved in the polymer phase and
aluminum monosterate in the oil phase to increase
the stability of the emulsion.
DISADVANTAGES
High injection force.
Local irritation at the injection site.
17. IN-SITU GELS
A proprietary parenteral in-situ gel delivery system
is ATRIGEL system.
Used for both parenteral and site specific drug
delivery.
Liquid formulations generating a semisolid depot
after adminstration into the body are attractive
delivery system.
When the liquid polymer system is placed in the
body using standard needles and syringes.
18. In-situ gels are drugs delivery systems that are in
solution form before administration in the body but
once administered undergo gelation in situ to form a
gel.
In-situ routes for in situ gels :
oral, ocular, rectal, vaginal, injectable and intra-
peritoneal routes.
19. IN-SITU CROSS LINKED GELS
Gel site polymer is a natural acidic polysaccharide.
Extracted and purified from the aloe plant.
The polymer in an aqueous solution forms a gel in
the presence of calcium.
When injected subcutaneously or intramuscularly
thus entrapping a water soluble drug in the solution
and providing sustained release.
20. SOLID IMPLANTS
Implants are cylindrical , monolithic devices of mm
or cm dimensions .
Implanted by a minor surgical incision or injected
through a large bone needle into the subcutaneously.
Subcutaneous tissue is an ideal location because of
its poor perfusion.
Slow drug absorption.
21. The drug in implants may be dissolved or dispersed
in a matrix of polymer or waxes that control release
by dissolution, bioerosin or biodegradation.
Polymers used are silicone elastomers ,
polymethacrylates, polycaprolactone.
While waxes include glycerol monostearate.
22. INFUSION DEVICES
These are implantable devices but are
versatile in the sense that they are intrinsically
powered to release the medicament at a zero order
rate and the drug reservoir can be replenished from
time to time . Depending upon the mechanism by
which these implantable pumps are powered to
release the contents,they are classified into
following types:
23. I. OSMOTIC PRESSURE ACTIVATED DRUG
DELIVERY SYSTEM.
II. VAPOUR PRESSURE ACTIVATED DRUG
DELIVERY SYSTEM.
III. BATTERY POWERED DRUG DELIVERY
SYSTEM.
OSMOTIC PRESSURE POWERED SYSTEM
a) ALZET osmotic pump.
b) DUROS infusion pump.
24. ALZET OSMOTIC PUMP
It is a miniaturized system that provides zero order
delivery of biologically active molecules and has
been extensively used in animal studies by
researchers throughout the world.
25. The ALZET pumps are capsular in shape and made
in a variety of sizes. the pump is made of three
concentric layers.
1. The innermost drug reservoir contained in a
collapsible impermeable polyester bag(which is
open to the exterior via a single portal).
2. An intermediate sleeve of dry osmotic energy
source(sodium chloride).
3. The outer most rigid , rate controlling semi
permeable membrane fabricated from substituted
cellulosic polymers.
EXAMPLE : Ionized drugs , macromolecules ,
steroids and peptides.
26. A rigid polymeric plug is used to form a leak proof
seal between the drug reservoir and the semi
permeable housing.
An additional component , the flow modulator
,comprising of a cap and a tube made of stainless
steel is inserted into the body of osmotic pump after
filling.
After implantation water from the surrounding tissue
fluids is imbibed through the semi permeable
membrane at a controlled rate that dissolves the
osmogent creating an osmotic pressure differential
across the membrane.
The osmotic sleeve thus expands and since the outer
wall is rigid it squeezes the inner flexible drug
reservoir and the drug solution is expelled in a
constant volume per unit time.
27. DUROS INFUSION IMPLANT
The duros osmotic implant is a non-biodegradable ,
miniature titanium cylinder intended to enable
systemic or tissue specific therapy for small
molecule drugs , peptides, proteins, DNA and other
bioactive molecules.
The implant which is inserted subcutaneously and
retrieved at the end of the treatment duration is
designed to precisely and the continuously deliver
drugs for periods ranging from one month to more
than a year.
EXAMPLE :Leuprolide acetate implant.
28. In a DUROS system , a protein or peptide is
formulated into a stable solution or suspension
which is protected by the water resistant , non
erodible , ,sterilized drug reservoir .
29. The outer titanium alloy cylinder is capped by a
semi-permeable membrane at one end and by an exit
port at the other end.
Within the DUROS system is implanted in the
human body , water from surrounding tissue enters
one end of the cylinder through the semi permeable
membrane causing the osmotic engine to swell.
This osmotic engine displaces a piston which in turn
causes the drug formulation to be released from a
port at the other end of the system.
30. VAPOUR PRESSURE POWRERED
PUMP
This device is based on the principle that at a given
temperature a liquid in equilibrium with its vapour
phase exerts a constant pressure that is independent
of enclosing pump.
31. The disc shaped devices consists of two chambers.
An infusate chamber containing the drug solution
which is separated by a freely movable flexible
bellow from the vapor chamber containing
inexhaustible vaporizable fluid such as flurocarbons.
After implantation the volatile liquid vaporizes at
the body temperature and creates a vapor pressure
that compresses the bellows and expels the infusate
through a series of flow regulators at a constant rate.
EXAMPLE: Insulin for diabetics
Morphine.
32. BATTERY POWERED PUMPS
Two types of battery powered implantable
programmable pumps used to deliver insulin are
PERISTALTIC PUMP AND SOLENOID DRIVEN
RECIPROCATING PUMP.
Both with electronic controls.
The systems can be programmed to deliver the drug
at desired rates.
Their design is such that the drug moves towards the
exit and there is no backflow of infusate.