This document provides information about small volume parenterals (SVPs), which are injections packaged in containers of 100ml or less. It discusses the formulation, ingredients, containers, sterilization, and manufacturing of SVPs. Specifically, it describes that SVPs can be aqueous or non-aqueous solutions administered intravenously. It also outlines various additives used in SVP formulations, including vehicles, solvents, buffers, and preservatives. The document discusses sterilization methods like heat, filtration, and radiation. It provides details on terminal sterilization and blow-fill-seal technology for SVP production.
Proteins and peptides have received increased interest in the current drug therapies
Recently, approved recombinant protein therapeutics have been developed to treat a wide variety of clinical indications, including cancers, exposure to infectious agents, autoimmunity/ inflammation and genetic disorders.
Their high potency and selectivity.
Their low accumulation in tissues.
They have potentially lower toxicity than the small drug molecules.
Provide abroad range of targets, which could represent a basis for personalized medication.
Proteins and peptides have received increased interest in the current drug therapies
Recently, approved recombinant protein therapeutics have been developed to treat a wide variety of clinical indications, including cancers, exposure to infectious agents, autoimmunity/ inflammation and genetic disorders.
Their high potency and selectivity.
Their low accumulation in tissues.
They have potentially lower toxicity than the small drug molecules.
Provide abroad range of targets, which could represent a basis for personalized medication.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
2. According to USP : “ an injection that is packaged in containers
labelled as containing 100 ml or less”.
All the sterile products packaged in vials, ampoules, cartridges,
syringes, bottles or any other container that is 100ml or less fall
under the class of SVP.
SVP aqueous solutions can be administered by intravenous route
because of local irritation. Small volume parenteral products can be
formulated and packaged in several ways and include a wide variety
of products like :
Small Volume Parenteral (SVP)
3. Advantages:
It provides rapid onset of action
It provides immediate therapeutic action
It can be administered accurate dose.
It can be given to patients who cannot take oral
medication.
It minimize the first pass effect.
It provides more bioavailability
4. Disadvantages:
Pain upon injection.
Generally need medical help for administration (like physician or
nurse usually in hospital or clinic)/Trained person is required.
It requires strict adherence to aseptic procedures in production,
packaging and administration.
Chances of improper dosing are more.
Danger of blood clot formation is there.
Drug can not be recovered in adverse conditions.
More expensive than other dosage forms.
Traumatic injury from the insertion of needle.
Impossible to retrieve if adverse reaction occurs
5. Formulation of SVP :
Aqueous vehicle :
Types:- purified water, WFI, sterile WFI,
bacteriostatic WFI, sterile WF Irrigation.
Preparation :- Distillation , ion exchange or reverse
osmosis.
Except purified water all are pyrogen free
Non aqueous vehicle :
Because of safety
purity
biocompatibility
6. Several SVPs are marketed as oily solutions.
The oil must be vegetable in origin (sesame, olive, or
cottonseed oil).
Product USP Oil
Ampicillin(suspension) Vegetable
Diethyl stilbestrol Sesame, Cotton
Epinephrine(suspension) Sesame
Penicillin G procaine Vegetable
(suspension)
Co solvents :-
Are used to increase the stability of poorly soluble drug in
water and prevent drug chemical degradation by hydrolysis
Ex propylene glycol or in combination with ethanol and
polyethylene glycol.
7. INGREDIENTS OR ADDTIVES
The USP includes in this category all substances added to a
preparation to improve or safeguard its quality. An added
substance may:
Increase and maintain drug solubility.
Provide patient comfort by reducing pain and tissue irritation.
Enhance the chemical stability of a solution.
Enhance the chemical and physical stability
Minimize protein interaction with inert surfaces, such as glass
and rubber and plastic.
Protect a preparation against the growth of microorganisms.
8. It must be non toxic in quantity administered to the patient.
It should not interfere with therapeutic efficacy nor with the
assay of active therapeutic compound.
It must be prevented from adversely affecting the product
Antioxidants
Stabilizers
Buffers
Chelating agent
Protectants
Solubilizing agent
Surfactants
Tonicity adjusting
Cryoprotectants and Lyoprotectants
Note : LVP is not contain bactericide so from vehicle
part exclude BWFI and Anti-microbial agent.
9. Containers & closures
1.Glass
2.Plastic
3.Rubber closure with Aluminium caps
Small volume parenterals: less than 100ml
Large volume parenterals : more than 100ml
E,g.
Ampoules( single dose )
Vials( multiple dose)
Cartridges
Automatic injector
10. Packaging materials: Glass ,Plastic, Rubber
Sealing Ampoules are unique in that the primary and
secondary seal are the same.
Ampoules are sealed by melting a portion of glass in a
flame.
Pull seal – Slow, Reliable, powder or other types with
wide opening Roll or Tip seal
Packaging :
11. STERILIZATION
Steam sterilization
Dry heat sterilization
Sterilization by filtration
Gas sterilization
Sterilization by ionizing radiation
12. Moist Heat Sterilization
Bacterial death by moist heat is due to denaturation and
coagulation of essential protein molecules (enzymes)
and cell constituents.
It can be used for a large number of injections,
ophthalmic solutions etc.
Methods used:
Autoclave
Tyndallization
13. Autoclaving used to sterilize anything, which is not injured by
steam and high temperature of sterilization. These include
aqueous parenteral solutions e.g. distilled water, saline
solutions etc.
Tyndallisation essentially consists of heating the substance to
boiling point (or just a little below boiling point) and holding it
there for 15 minutes, three days in succession. After each
heating, the resting period will allow spores that have survived
to germinate into bacterial cells; these cells will be killed by
the next day's heating.
14. Dry Heat Sterilization
The killing of microorganisms by heat is a function of the time-
temperature combination used. If the temperature is increased then
the time required for killing all the bacteria will be decreased.
The vital constituents of cells such as proteins (enzymes) and
nucleic acids are denatured by oxidation.
Cycles recommended as per BP 1988 are:
A minimum of 1800C for not less than 30 minutes.
A minimum of 1700 C for not less than 1 hour.
A minimum of 1600 C for not less than 2 hours.
Dry heat is used to sterilize glass ware ( e.g., glass syringes etc.
15. Gas sterilization
This process involves exposure of materials to
sterilizing gases such as ethylene oxide, formaldehyde,
glutaraldehyde, propylene oxide.
Ethylene oxide is the only gas that is successfully
used on a large scale of industrial and medical
applications. It works by alkylation.
16. Different types of radiation used for sterilization are:
Ultraviolet radiation
Gamma radiation
Infrared radiation
X-rays
Alpha and beta radiation
Only a narrow range of wavelength (220 to 280 nm) of UV is
effective in killing micro-organisms, and wavelengths close to
253.7 nm are the most effective.
Radiation from the radioactive isotope of Cobalt 60, is used as a
source of gamma emission.
Radiation sterilization causes damage to DNA and results in cell
death.
Sterilization by Radiation
17. This method is used for sterilizing thermo-labile solutions,
which will otherwise be degraded by other conventional heating
methods.
The drug solutions are passed through the sterile bacteria proof
filter unit and subsequently transferring the product aseptically
into the sterile containers which are then sealed.
Different types are :
Sintered glass filter
Seitz filter
Ceramic filter
They are suitable for sterilizing aqueous and oily solutions but
not for organic solvents such as alcohol, chloroform etc.
Sterilization by filtration
18. Terminal Sterilization
Product is sterilize in final container
It refer that the finished product should withstand with
steam sterilization cycle for 15 minutes.
Terminal Sterilization help to assure the sterility of the
finished product.
LVP : Moist and dry heat sterilization process are preferred.
19. Blow Fill Seal Technology.
It is most widely used and accepted by US FDA.
Polypropylene granules are heated at 2000C to form tube
shaped prison.
Prison reaches the mould forming container by the sterile
compressed air
Fill nozzle known as mandrel fills the liquid in the
container.
Followed by sealing neck and filled container is resealed
from the mould.
It takes 10-15 sec of time to produce one container.
20. Manufactured facilities of parenterals
The production area where the parenteral preparation are
manufactured can be divided into five sections:
Clean-up area
Preparation area
Aseptic area
Quarantine area
Finishing & packaging area
21. Parenteral suspension is a dispersed, multi-phased,
heterogeneous system of insoluble solid particles intended
principally for intramuscular and subcutaneous injection.
Because a delicate balance of variables is required in order
to formulate a suitable product, a suspension is one of the
most difficult parenteral forms to prepare.
Such a product must not cake during shipping and storage
and should be easy to suspend and inject through an 18 to
21 gause needle throughout its shelf life.
Suspension
22. To achieve these goals it is necessary to control the
crystallization, particle size reduction and sterilization of the
drug substance.
Suspension give prolong drug release particle size of drug
should be small and uniform.
Suspension require following additives wetting agent,
suspending agent, buffering agent, preservative, antioxidant,
ionicity agents
23. Example of ingredients used in aqueous
parenteral suspensions
Suspending agent
Gelatin, mannitol, povidone
Surfactants
Lecithin, polysorbate 80.
Solubilizing agents
Propylene glycol
PH adjustment
Citric acid, sodium citrate.
24. Two basic method are used to prepare parenteral
suspension:
Sterile vehicle and powder are combined aseptically.
Sterile solutions combined and crystal formed in
situ.
Problem encountered in suspension formulation are:
Settling and caking.
Polymorphic transformation.
Crystal growth.
25. An emulsion is a heterogenous dispersion of one immiscible
liquid in another.
This inherently unstable system is made possible through the use
of an emulsifying agent, which prevent coalescence of the
dispersed droplet.
Parenteral emulsion are rare because it is necessary (and difficult)
to achieve stable droplet of less than 1micron meter to in prevent
emboli in blood vessels and it is not usually necessary to achieve
an emulsion for drug administration.
Formulation options are severely restricted through a very limited
selection of stabilizers and emulsifiers primarily due to the dual
constraints of autoclave sterilization and parenteral injection.
EMULSIONS
26. Parenteral emulsions are used for several purposes, including :
Water-in-oil emulsions of allergenic extracts
Oil-in-water sustained-release depot preparations
Oil in-water nutrient emulsion.
27. It is also known as lyophilization i.e. system is made solvent
loving for removing the same.
Principle:
In freeze drying, water is removed from the frozen state by
sublimation, i.e., direct change of water from solid into vapour
without conversion to a liquid phase.
Solid-liquid- vapour equilibrium phase diagram of water is
useful to decide the experimental conditions.
The drying is achieved by subjecting material to temperature
& pressure below the triple point.
Under this conditions, any heat transferred is used as latent
heat & ice sublimes directly into vapour state.
Freeze drying
28. Construction :
Freeze dryer consist of
Drying chamber in which trays are locked
Heat supply in the form of radiation source heating coils
Vapour condensing or adsorption system
Vacuum pump or steam ejector or both.
29. Working:
The working of freeze dryer consist of following steps.
Preparation & pretreatment:
The volume of solution introduced into the container is limited by
its capacity. Therefore pretreatment is essential. The solutions are
preconcentrated under the normal vacuum tray drying. This
reduces the actual drying by 8 to 10 times.
Prefreezing to solidify water:
Vials, ampoules or bottles in which the aqueous solution is
packed are frozen in cold shelves (- 50ᵒC). The normal cooling
rate is about 1 to 3 Kelvin/ minute so that large ice crystals with
relatively large holes are formed on sublimation of ice. This is
also responsible for giving a porous product.
30. The freeze drying is achieved by subjecting material to
temperature & pressure below the triple point of water at
which solid, liquid and vapour all co-exist in equilibrium.
31. Primary Drying:
Removing the solvent (ice) from the product, by evacuating
the chamber, usually below 100 μm Hg, and subliming the
ice onto a cold, condensing surface at a temperature below
that of the product, the condensing surface being within the
chamber or in a connecting chamber.
It means sublimation of ice under vacuum. The temp. &
pressure should be below the triple point of water i.e.
0.0098ᵒC & 4.58 mmHg for sublimation, when water is alone
present.
32. When a solution of a solid is dried, the depression of freezing
point of water occurs. Hence, it is essential that the temperature be
brought below the eutectic point.
The pressure & temp. at which the frozen solid vaporizes without
conversion to liquid is referred to as the eutectic point.
Depending on the drug substances dissolved in water, the eutectic
point is determined. The usual range is from -10ᵒC to -30ᵒC.
Heat (About 2900 kilojoules/ Kg) is supplied which transfer as
latent heat & ice sublimes directly into vapour state.
As the drying proceeds, thickness of dried solids increases.
Primary drying stage removes easily removable water, about 98%
to 99%.
33. Secondary Drying:
It is removable of residual moisture or bound water under high
Vacuum. The temp. of solid is raised to as high as 50 to 60ᵒC but
vacuum is lowered below that is used in primary drying. The rate
of drying is very low .
The temperature for secondary drying should be as high as
possible, without causing any chemical degradation of the active
ingredient.
34. Advantages of Freeze-Dried Products
Product is stored in dry state-few stability problems.
Product is dried without elevated temperatures.
Good for oxygen and/or air-sensitive drugs
Rapid reconstitution time
Constituents of the dried material remain homogenously
dispersed.
Product is process in the liquid form.
Sterility of product can be achieved and maintained
35. Disadvantages of Freeze-Dried Products
Volatile compounds may be removed by high vacuum
Single most expensive unit operation
Stability problems associated with individual drugs
Some issues associated with sterilization and sterility
assurance of the dryer chamber and aseptic loading of
vials into the chamber