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Patient Controlled Epidural Analgesia
PCEA](https://image.slidesharecdn.com/nddsmy-160122173628/75/Newer-Drug-Delivery-Systems-30-2048.jpg)
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Newer Drug Delivery Systems
- 1.
- 2. Definition Therapeutic systems thatincorporate drugs in a dosage form that releases the medication • at a predetermined rate • over an extended period of time • from a single application
- 3. Demerits of conventional dosageforms Large amount of drug delivered Repeated dosage necessary Less patient compliance Fluctuation in drug concentration in blood
- 4. Aims of NDDS •Maintain constant blood levels for longer period of time • Decrease frequency of administration • Improves patient compliance • Reduce the GI S/E
- 5. Types of NDDS •Prolongedrelease parenteral preparations •Local Drug delivery systems •Targeted delivery systems •Some more NDDS
- 6. PROLONGED RELEASE PARENTERAL PREPARATIONS 1.Portablepumps 2.Implantable pumps 3.Pens 4.Pellets 5.Dermojet 6..Trandermal delivery system 7.Patient Controlled Analgesia(PCA)
- 7. Portable pumps Insulin Pump Releasessmall amount of insulin all day Steady glucose Batterypowered device
- 8. Parts of thepump Parts: Pump Insulin Reservoir Computer chip Infusion set
- 9. Insulin flows frompump Infusion set canula INSULIN PUMP
- 10. Recent Developments • Pumpsoftware • Alarms • Interface to computer • Bluetooth remote • Touch bolus
- 11. Implantable pumps Intrathecal pump Deliverdrug intrathecal space
- 12. Parts: Metal pump withreservoir to store drug and catheter to deliver drug
- 13. • Surgical procedure •Catheterspine PumpSubcutaneou s Drug delivered through catheter to intrathecal space
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- 15. • Indications: • Chronicpain • Cancer • Multiple sclerosis • Chronic pancreatitis • Drugs: • Morphine • Baclofen
- 16. Pens Insulin pens – Parts:Cartridge , dial, pen needle Injected S/C with needle
- 17. Pellets Eg: NORPLANT Contraceptive 6 siliconcapsules of 36mg levonorgestrel
- 18. Surgical procedure~15mnts IncisionInsert capsules subdermallyin fanlike shape Action in 24 hrs Removal: 2nd incision
- 19. Dermojet • Needle notused • High velocity jet of drug from microfine orifice • s/c tissue • Mass inoculation
- 20. Treatment of keloidsand hypertrophic scars with Intralesional dermojet injections of Bleomycin Dermojet treatment using Triamcinolone for alopecia areata
- 21. Transdermal drug delivery system •Adhesive patches • drugs delivered at constant rate into systemic circulation
- 22. • Layers: • Drugin reservoir • Occlusive backing film • Rate controlling micropore • Adhesive with priming dose • Protective peel off strip
- 24. Advantages Steady plasma conc BypassFirst pass metabolism Effect lasts for 1-7 days Convenient Less side effects
- 25. Disadvantages • Local irritation Erythema •Minimised by changing the site of application
- 26. DRUGS: • Hyoscine -1st used In motion sickness • GTN , fentanyl , nicotine , clonidine , estradiol
- 27. Sites Chest , abdomen,upper arm ,lower back, buttock, mastoid region
- 28. Patient Controlled Analgesia •To administer pain medications • Patient control dose and amount • Drugs: • Morphine • Bupivacaine • Indications:Post op pain, cancer pain
- 29.
- 30. ] Patient Controlled EpiduralAnalgesia PCEA
- 31. Local Drug deliverysystems
- 32. 1.Ocular drug Deliverysystems: Deliver steady concentration In ocular tissues Ocusert Lacrisert SODI
- 33. Ocusert • Consists of: •Central reservoir of Drug enclosed in microporous membrane
- 34. • Ocusert Pilocarpine: •First in the category • 2 types: • Pilo 20 and Pilo 40 • Pilocarpine alginate core sandwiched in Ethylene vinyl Acetate membranes
- 35. Placed under eyelid Pilocarpinedissolve In lacrimal fluid Released through rate controlling membrane Lasts 7 days
- 36. • Side effects •Miosis • Myopia • Drawback: • Non biodegradable • Require removal
- 37. • Lacrisert • Erodibleinsert • Used in dry eye syndrome Rod shaped Made of hydroxy propyl cellulose Inserted into inferior fornix
- 38. • Inserted intoinferior fornix • Imbibes water from conjunctiva Form a hydrophilic film which stabilise tear film Hydrates cornea
- 39.
- 40. SODI • Soluble OcularDug Insert • First developed for cosmonauts • Small oval thin film • Made of Acrylamide Vinyl Pyrolidene Ethylacrylate • Available for around 20 ophthalmology drugs • Ex:Ciprofloxacin
- 41. Progetasert • T shapedIUCD • progesterone at constant rate 65microgram/day * 1 yr
- 42. Drug Eluting Stents Metallicstents covered with drug Drug gradually released Prevent restenosis in MI Eg: Sirolimus,Paclitaxel
- 43. Targeted Drug Delivery Systems Selectivedelivery of drugs to specific regions Improve safety & efficacy Reduce s/e
- 44.
- 45. Vesicular Drug Delivery systems Highlyordered assemblies of lipid bilayer Can incorporate both hydrophilic and lipophilic drugs • Eg: • Liposomes • Niosomes
- 46. LIPOSOMES • Concentric shellsof Phospholipids in watery medium • Vehicle for targeted delivery
- 47. Spherical vesicles –2layers Pospholipid Cholesterol Size – nm to several mms Water soluble drugs- trapped in central aqueous compartment. Lipid soluble drugs- in lipid bilayer
- 48. • Examples: • Anticancerdrugs Doxorubicin • Antifungal drugs Amphotericin B
- 49. Multilamellar Vesicles (MLV) Several lipid bilayers Single Unilamellar Vesilces (SUV) Single lipid layer:25nm LargeUnilamellar vesicles (LUV) Single lipid layer:100nm CLASSIFICATION OF LIPOSOMES
- 50. Mechanism • Lipid bilayerfuse with cell membrane • Release contents cytoplasm
- 51.
- 53. Niosomes • Bilayer ofnon ionic surface active agents
- 54. Liposome • More expensive •Less stable • From phospholipids • Relatively more toxic Niosome • Cheaper • More stable • from uncharged surfactant • Relatively safer
- 55. Other vesicular drugdelivery systems Genosomes For cell specific gene transfer Hemosomes Hb containing liposomes to carry O2 Photosomes Photolyase incorporated liposomes for photodynamic therapy Ethosomes With polar core for water soluble drugs
- 56. MONOCLONAL ANTIBODIES • Antibodiesproduced by a single clone directed against single antigenic determinent • Hybridoma technologylarge scale production of Mab
- 57. • Hybridoma:by fusingB lymphocytes with myeloma cells • Myeloma cell grown in culture deficient in HGPRTenzyme • Prevent formation of Ig • Myeloma cell +B lymphocytesHybridoma Placed in HAT(Hypoxanthine Aminopterine Thymidine )medium and cloned Hybridomas survive and replicate Monoclonal antibodies formed are purified for clinical use
- 60. Name of Monoclonalantibody ends with mab Letter before mabsource
- 61. • Letter beforethe previous wordsTherapeutic use • Tutumor • Vivirus • Cicirculation Tu Tumour Vi Virus Ci Circulation
- 62. Examples Rituximab Chimeric Treat tumour-Hodgkins lymphoma PalivizumabHumanised RSV(virus)
- 63. NANOMEDICINE • Nanoparticles usedas drug delivery vehicles • Size< 100 nm • Taken up by cells more efficiently
- 64. • A nanometer =one billionth of a meter = 250 millionths of an inch. Different from properties of the bulk material.
- 65. Why Nanoparticles? • Caneasily reach tiny capillaries and secluded areas of body • High surface to volume ratiodissolution rate high • Eg: Nanosuspensions of Paclitaxel and Cyclosporine has better dissolution rate
- 66. • Targeted delivery-dependon particle size,charge preferentially absorb on certain organs and tissues
- 67. Passive targeting Spontaneous accumulationinleaky vasculature Physiology of diseased tissuepH,temperature Eg: Cancer cells—Pores,bloated gap junctionsEnhanced permeability and Retention effect(EPRE)Nanoparticles gather in tumor interstitium
- 68. Active targeting • Moietieslike Antibodies/lipids coupled to drug or delivery systems • Straps nanodevices to receptor expressed at target site
- 69. Advantages • Precision administration •Small dosagesLess side effects
- 70. Gold Nanoparticles Absorb Xrays Use:Contrast agenteffectiveRT Antibacterial therapyspecific Ab selectively kill bacteria
- 71. Nanoerythrosomes • Resealed erythrocytes used •Selective for liver and spleen • Use: • Liver disease,Enzyme disorders
- 72. NANOROBOTS Introduce into bodyto detect and repair damages Use ultrasonic signals and chemical sensors
- 73. • Uses ofnanorobots: • Atherosclerosis:Targeted at plaques • Cancer:Attack tumors using Ultrasonic signals • Deliver medicine directly to diseased organs • Diabetes and Hypertension:Nanorobots with sensors used
- 74. Quantum dots Photodetector device •Use: •Chemotherapyilluminating cancer cells •Surgeons can see glowing tumor and remove
- 75. Carbon Nanotubules • Cylindricalshape • Made of graphite,allotope of carbon • Use : • Cancer • Gene therapy • Bronchial Asthma
- 76.
- 77. Sustained release drugs Sustained release drugsProdrugsProdrugs Prolonged release oral preparationsProlonged release oral preparations
- 78. Sustained release preparation •Release medication in a predetermined manner over extended period of time • Eg:Diclofenac SR
- 80. Advantages • Therapeutic effectfor longer duration • Less frequency of administration • Less fluctuation • Lesser side effects
- 81.
- 82. Examples of Prodrug: To increase DOA Esters of Penicillin To cross BBB L-dopa in Parkinsonism For site specific actionMethanamine in UTI
- 83. Advantages : More stable Better bioavailability Less S/E Overcome bitter taste Improves Bioavailabilty
- 84. Newer Prodrugs Clostridia DirectedEnzyme Prodrug therapy(CDEPT) • Use Clostridia to convert prodrug to active form • Eg:Nitroreductase in chemotherapy Antibody directed Enzyme Prodrug therapy(ADEPT) • Use antibodies • Increase tumour selectivity • Eg:Azathioprine
- 85. Novel Colon DrugDelivery System • CODESTM • Uses Enteric coated Tablet • Covered with:Lactulosecoated with acid soluble Enteric coatingcoated with Enteric coated material
- 86. • Outermost layerprotects in stomachdissolves after gastric emptying • Second layerprotective in alkaline pH of Small Intestine • Colon:Bacterial flora lowers the pH by reacting with lactulosedrug released
- 87. Iontophoresis • Mild electriccurrent is applied for transport of drugs across skin • Eg:vasopressin,dexomethasone
- 88. • Dendrimer • 3Dstructure(like tree) • Nanoscale • Uses: • Gene delivery • Anticancer drugs • Nanoshells • Can absorb light to get heated up • Lethal to cells • Used in cancer treatment
- 89. Osmotic Drug Delivery System •GITS • Controlled delivery depending on Osmotic pressure of drug • Eg:Nifedipine GITS
- 90. Inhalable Insulin • Availablein Powdered form • Delivered with Nebuliser • Marketed by Pfizer in the name Exubera • And Mannkind in the name Alfrezza