Isocratic HPLC Method for Simultaneous Determination of Amlodipine and Xipamide in Human Plasma
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Liquid Chromatography Tandem Mass Spectrometry Determination Of
The Pharma Innovation Journal 2018; 7(7): 57-61 ISSN (E): 2277- 7695 ISSN (P): 2349-8242 NAAS Rating: 5.03 Liquid chromatography tandem mass spectrometry TPI 2018; 7(7): 57-61 © 2018 TPI determination of prohibited diuretics and other acidic www.thepharmajournal.com Received: 01-05-2018 drugs in human urine: A Review Accepted: 05-06-2018 Anchal Sharma Anchal Sharma, Dr. Rajiv Tonk and Dr. Vivek Sharma M. Pharm Scholar, Delhi Pharmaceutical Sciences and Research University, New Delhi, Abstract India This paper reviews liquid chromatographic-mass spectrometric (LC-MS) procedures for the screening, identification and quantification of doping agents in urine and other biological samples and devoted to Dr. Rajiv Tonk drug testing in sports. Reviewed methods published approximately within the last five years and cited in Associate Professor, Delhi the PubMed database have been divided into groups using the same classification of the 2004 World Pharmaceutical Sciences and Anti-Doping Agency (WADA) Prohibited List. Together with procedures specifically developed for anti- Research University, New Delhi doping analysis, I.C-MS applications used in other fields (e.g., therapeutic drug monitoring, clinical and India forensic toxicology, and detection of drugs illicitly used in livestock production) have been included when considered as potentially extensible to doping control. Information on the reasons or potential Dr. Vivek Sharma abuse by athletes, on the requirements established by WADA for analysis, and on the WADA rules for Assistant Professor, Govt College of Pharmacy Rohru, Himachal the interpretation of analytical finding. The basis of human sports doping control is set by the World Pradesh. -
Extracts from PRAC Recommendations on Signals Adopted at the 9-12 March 2020 PRAC
6 April 20201 EMA/PRAC/111218/2020 Corr2,3 Pharmacovigilance Risk Assessment Committee (PRAC) New product information wording – Extracts from PRAC recommendations on signals Adopted at the 9-12 March 2020 PRAC The product information wording in this document is extracted from the document entitled ‘PRAC recommendations on signals’ which contains the whole text of the PRAC recommendations for product information update, as well as some general guidance on the handling of signals. It can be found here (in English only). New text to be added to the product information is underlined. Current text to be deleted is struck through. 1. Immune check point inhibitors: atezolizumab; cemiplimab; durvalumab – Tuberculosis (EPITT no 19464) IMFINZI (durvalumab) Summary of product characteristics 4.4. Special warnings and precautions for use Immune-mediated pneumonitis [..] Patients with sSuspected pneumonitis should be evaluated confirmed with radiographic imaging and other infectious and disease-related aetiologies excluded, and managed as recommended in section 4.2. LIBTAYO (cemiplimab) Summary of product characteristics 1 Expected publication date. The actual publication date can be checked on the webpage dedicated to PRAC recommendations on safety signals. 2 A footnote was deleted on 8 April 2020 for the signal on thiazide and thiazide-like diuretics (see page 3). 3 A minor edit was implemented in the product information of the signal on thiazide and thiazide-like diuretics on 5 June 2020 (see page 4). Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2020. -
Estonian Statistics on Medicines 2016 1/41
Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole -
Part 3 Hypertension Series
Clinical Pharmacology & Toxicology Pearl of the Week ~Part 3 - Hypertension Series: Thiazide and Thiazide-like Diuretics~ Thiazide and thiazide-like diuretics are a class of diuretics that predominantly operate at the distal convoluted tubule (DCT) - Thiazide diuretics: hydrochlorothiazide - Thiazide-like diuretics: chlorthalidone, metolazone, indapamide Indications: - Treatment of hypertension - Off-label: Edema, calcium nephrolithiasis, nephrogenic diabetes insipidus, augmented effect of loop diuretics (Lasix + metolazone) Mechanisms of action: Renin release is mediated by: Baro-receptors in afferent arteriole, Beta- 1 stimulation, and the macula densa (Senses distal convoluted tubule sodium-chloride concentration) Thiazide-induced inhibition of the sodium-chloride co-transporter (NaCC) in the distal convoluted tubule natriuresis and mild diuresis Mild diuresis and drop in the extra-cellular fluid volume (200-300cc) Typically offset by increase in Renin (RAAS) system Natriuresis: increases the slope of the pressure-natriuresis curve (see right) Impaired absorption of sodium and chloride due to thiazide higher sodium-chloride concentrations in distal convoluted tubule sensed by macula densa decreased renin-signal vasodilation + sustained natriuresis drop in blood pressure Promotes calcium reabsorption (increased calcium movement though the TRPV5 calcium channel in DCT) Other mechanisms (proposed): o Direct vessel vaso-dilation (inhibiting epithelial ATP, or potassium channels) o Weak carbonic anhydrase activity (promotes diuresis) How -
Heart Failure — Managing Newly Diagnosed and Decompensated
Clinical Guideline Heart failure: Managing newly diagnosed and decompensated patients admitted to hospital 1. Confirmation of Diagnosis Person with signs and symptoms suggesting heart failure Detailed history and clinical examination Consider aetiology for new diagnosis of heart Suspected diagnosis Confirmed failure or underlying cause for exacerbation of of heart failure diagnosis of heart chronic heart failure and exclude treatable Diagnosis has not failure causes. been confirmed by Diagnosis confirmed Arrange other investigations: echocardiogram by previous . CXR echocardiogram . ECG . FBC . U&Es and Creatinine . LFTs . TFTs . RBG . Cholesterol If current echocardiogram not Diagnosis confirmed by clinically relevant, echocardiogram, if possible Heart failure excluded so request repeat performed as an in-patient review diagnosis echo, if possible and adhering to Advancing performed as an in- Quality heart failure (AQHF) patient indicators Heart failure with preserved ejection Heart failure due to significant left ventricular fraction / diastolic dysfunction (EF systolic dysfunction (EF < 40%) >55%) • Update primary diagnosis on PCIS / -Update primary diagnosis on PCIS Cerner and document in casenotes /Cerner and document in casenotes. Proceed to Management of Confirmed Heart Failure Heart failure — managing newly diagnosed and decompensated patients in acute care — clinical guidelines, v1 Principal author: Dr P Saravanan Approved by Medicines Clinical Guideline Team: July 2013 Review by: July 2016 Page 1 of 27 2. Inpatient management Heart failure with preserved Heart failure due to left ventricular ejection fraction systolic dysfunction (EF < 40%) • Referral to heart failure specialist team. • Arrange admission to appropriate ward/unit Refer to Heart Failure Fluid balance: Drug management: Specialist Nurse for 1. Fluid restriction 1-2 litres in 24 1. -
Ш„ ^Гг Тііи CLINICAL PHARMACOLOGICAL STUDIES on TIENILIC ACID and FUROSEMIDE Promotores: Prof
D D π Ш π α π • Q ÛDD fDSDUO Q ^г^ ш„ ^гг тііи CLINICAL PHARMACOLOGICAL STUDIES ON TIENILIC ACID AND FUROSEMIDE Promotores: Prof. dr F. W. J. GRIBNAU Prof. dr С. Α. Μ. van GINNEKEN CLINICAL PHARMACOLOGICAL STUDIES ON TIENILIC ACID AND FUROSEMIDE PROEFSCHRIFT ter verkrijging van de graad van doctor in de Geneeskunde aan de Katholieke Universiteit te Nijmegen, op gezag van de rector magnificus Prof. dr J. H. G. I. Giesbers, volgens het besluit van het college van dekanen in het openbaar te verdedigen op donderdag 24 maart 1983 des namiddags te 2 uur precies door ADRIANUS LAMBERTUS MARIA KERREMANS geboren te Roosendaal И krips repro meppel The studies presented in this thesis were performed in - the Department of Internal Medicine - the Institute of Pharmacology of the University of Nijmegen, The Netherlands; and in - the Nursing home 'Irene" H. Landstichting - the Canisius-Wilhelmina Hospital Nijmegen Aan Mariette Jos, Sanne en Mechteld Aan mijn ouders CONTENTS Chapter I GENERAL INTRODUCTION AND PROBLEM STATEMENT page Chapter II DIURETICS 2.1 renal transport of sodium and chloride 2.2 renal transport of uric acid 2.3 site of action and mode of action of diuretics 2.4 tienilic acid 2.5 furosemide references Chapter III SOME FACTORS INFLUENCING DRUG RESPONSE 2 3.1 influence of age on pharmacokinetics and pharmacodynamics 3.2 influence of long-term treatment 3.3 congestive heart failure and its influence on sodium homoeostasis and on disposition and effect of diuretics 3.4 diuretic resistance in congestive heart failure references Chapter IV METHODS 4 4.1 HPLC 4.2 protein binding of drugs 4.3 pharmacokinetics 4.4 dose-response curves references Chapter V PHARMACOKINETIC AND PHARMACODYNAMIC STUDIES OF TIE- 6 NILIC ACID IN HEALTHY VOLUNTEERS Eur J Clin Pharmacol 1982, 22, 515-521. -
MELT-HF Metolazone As Early Add on Therapy for Acute Decompensated
MELT-HF MEtolazone as Early add on Therapy for acute decompensated Heart Failure. A single center pilot study. Muhammad A. Chaudhry, MD MELT-HF Protocol [Amendment 5.0; 17-Jan-2017] Page 1 of 10 INTRODUCTION Background Heart failure is a major source of morbidity, mortality and growing public health cost. In US, the number of congestive heart failure patients is more than 4 million with more than 550,000 new annually reported cases. The annual cost of heart failure management exceeds 35 billion dollars per year. The heart failure readmissions and average length of hospital stay cost approximately $11,000 per patient. Loop diuretics are used alone in the majority of cases to promote diuresis. An association of increased creatinine and increased risk of renal dysfunction, the cardiorenal syndrome, in the face of high dose loop diuretics has raised questions regarding the safety and toxicity of high dose loop diuretics. While the dose of diuretics is ubiquitous, little data exists to guide their use and many clinicians are uncertain as to when and how to initiate and limit therapy. In many cases, a “stepped approach” with oral loop diuretics advancing to intravenous and finally combination high dose diuretics is employed. PREVIOUS TRIALS DOSE( Diuretic strategies in patients with ADHF) Trial Prospective, randomized double blinded trial of 308 patients with ADHF. Showed that high dose diuretics (2.5 times the outpatient daily dose) were associated with improved urine output at 72 hours (3575± 2635 in low dose group vs. 4899±3479 in high dose group). There was no significant difference between the high and low dose groups in mean creatinine change (0.08±0.3 mg per deciliter in high-dose group as compared to 0.04±0.3 mg per deciliter in low-dose group, P=0.21. -
Azosemide Is More Potent Than Bumetanide and Various Other Loop
www.nature.com/scientificreports OPEN Azosemide is more potent than bumetanide and various other loop diuretics to inhibit the sodium- Received: 21 November 2017 Accepted: 14 June 2018 potassium-chloride-cotransporter Published: xx xx xxxx human variants hNKCC1A and hNKCC1B Philip Hampel 1,2, Kerstin Römermann1, Nanna MacAulay 3 & Wolfgang Löscher1,2 The Na+–K+–2Cl− cotransporter NKCC1 plays a role in neuronal Cl− homeostasis secretion and represents a target for brain pathologies with altered NKCC1 function. Two main variants of NKCC1 have been identifed: a full-length NKCC1 transcript (NKCC1A) and a shorter splice variant (NKCC1B) that is particularly enriched in the brain. The loop diuretic bumetanide is often used to inhibit NKCC1 in brain disorders, but only poorly crosses the blood-brain barrier. We determined the sensitivity of the two human NKCC1 splice variants to bumetanide and various other chemically diverse loop diuretics, using the Xenopus oocyte heterologous expression system. Azosemide was the most potent NKCC1 inhibitor (IC50s 0.246 µM for hNKCC1A and 0.197 µM for NKCC1B), being about 4-times more potent than bumetanide. Structurally, a carboxylic group as in bumetanide was not a prerequisite for potent NKCC1 inhibition, whereas loop diuretics without a sulfonamide group were less potent. None of the drugs tested were selective for hNKCC1B vs. hNKCC1A, indicating that loop diuretics are not a useful starting point to design NKCC1B-specifc compounds. Azosemide was found to exert an unexpectedly potent inhibitory efect and as a non-acidic compound, it is more likely to cross the blood-brain barrier than bumetanide. Te Na+–K+–2Cl− cotransporter NKCC1 (encoded by SLC12A2) plays an important role in Cl- uptake in neu- rons both in developing brain and in adult sensory neurons1,2. -
Optimal Diuretic Strategies in Heart Failure
517 Review Article on Heart Failure Update and Advances in 2021 Page 1 of 8 Optimal diuretic strategies in heart failure Sarabjeet S. Suri, Salpy V. Pamboukian Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA Contributions: (I) Conception and design: SS Suri; (II) Administrative support: SV Pamboukian; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Dr. Sarabjeet S. Suri, MD. University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL 35223, USA. Email: [email protected]. Abstract: Heart failure (HF) is one of the major causes of morbidity and mortality in the world. According to a 2019 American Heart Association report, about 6.2 million American adults had HF between 2013 and 2016, being responsible for almost 1 million admissions. As the population ages, the prevalence of HF is anticipated to increase, with 8 million Americans projected to have HF by 2030, posing a significant public health and financial burden. Acute decompensated HF (ADHF) is a syndrome characterized by volume overload and inadequate cardiac output associated with symptoms including some combination of exertional shortness of breath, orthopnea, paroxysmal nocturnal dyspnea (PND), fatigue, tissue congestion (e.g., peripheral edema) and decreased mentation. The pathology is characterized by hemodynamic abnormalities that result in autonomic imbalance with an increase in sympathetic activity, withdrawal of vagal activity and neurohormonal activation (NA) resulting in increased plasma volume in the setting of decreased sodium excretion, increased water retention and in turn an elevation of filling pressures. -
Presented By: Dr. Joohee Pradhan Assistant Professor Department of Pharmaceutical Sciences, MLSU, Udaipur
Presented By: Dr. Joohee Pradhan Assistant Professor Department of Pharmaceutical Sciences, MLSU, Udaipur OUTLINE • Introduction and Definition • Relevant Physiology of Urine Formation • Classification: different ways • Carbonic anhydrase inhibitors: Acetazolamide*, Methazolamide, Dichlorphenamide. • Thiazides: Chlorthiazide*, Hydrochlorothiazide, Hydroflumethiazide, Cyclothiazide, • Loop diuretics: Furosemide*, Bumetanide, Ethacrynic acid. • Potassium sparing Diuretics: Spironolactone, Triamterene, Amiloride. • Osmotic Diuretics: Mannitol 2 Introduction and Definition • Diuretics (natriuretics) are drugs which cause a net loss of Na+ and water in urine and hence increase the urine output (or) urine volume. • The primary action of most diuretics is the direct inhibition of Na+ reabsorption (increased excretion) at one or more of the four major sites along the nephron. • An increased Na+ excretion is accompanied by anion like Cl- Since NaCl is the major determinant of extracellular fluid volume; Diuretics reduce extracellular fluid volume (decrease in oedema) by decreasing total body NaCl content. 3 Introduction and Definition • Diuretics are very effective in the treatment of conditions like: o chronic heart failure o nephrotic syndrome o chronic hepatic diseases o hypertension o Pregnancy associated oedema o Cirrhosis of the liver. 4 Relevant Physiology of Urine Formation • Kidneys are the organs responsible for urine formation. Two important functions of the kidney are: o To maintain a homeostatis balance of electrolytes and water. o To excrete water soluble end products of metabolites. • Each kidney contains approximately one million nephrons and is capable of forming urine independently. • Urine formation starts from glomerular filtration (g.f.) in a prodigal way. • Normally, about 180 L of fluid is filtered everyday: all soluble constituents of blood minus the plasma proteins (along with substances bound to them) and lipids, are filtered at the glomerulus. -
Using Medications, Cosmetics, Or Eating Certain Foods Can Increase Sensitivity to Ultraviolet Radiation
USING MEDICATIONS, COSMETICS, OR EATING CERTAIN FOODS CAN INCREASE SENSITIVITY TO ULTRAVIOLET RADIATION. INDIVIDUALS SHOULD CONSULT A PHYSICIAN BEFORE USING A SUNLAMP, IF THEY ARE TAKING MEDICATIONS. THE ITEMS LISTED ARE POTENTIAL PHOTOSENSITIZING AGENTS THAT MAY INCREASE SENSITIVITY TO ULTRAVIOLET LIGHT THAT MAY RESULT IN A PHOTOTOXIC OR PHOTOALLERGIC RESPONSES. PHOTOSENSITIZING MEDICATIONS Acetazolamide Amiloride+Hydrochlorothizide Amiodarone Amitriptyline Amoxapine Astemizole Atenolol+Chlorthalidone Auranofin Azatadine (Optimine) Azatidine+Pseudoephedrine Bendroflumethiazide Benzthiazide Bromodiphenhydramine Bromopheniramine Captopril Captopril+Hydrochlorothiazide Carbaamazepine Chlordiazepoxide+Amitriptyline Chlorothiazide Chlorpheniramine Chlorpheniramin+DPseudoephedrine Chlorpromazine Chlorpheniramine+Phenylopropanolamine Chlorpropamide Chlorprothixene Chlorthalidone Chlorthalidone+Reserpine Ciprofloxacin Clemastine Clofazime ClonidineChlorthalisone+Coal Tar Coal Tar Contraceptive (oral) Cyclobenzaprine Cyproheptadine Dacarcazine Danazol Demeclocycline Desipramine Dexchlorpheniramine Diclofenac Diflunisal Ditiazem Diphenhydramine Diphenylpyraline Doxepin Doxycycline Doxycycline Hyclate Enalapril Enalapril+Hydrochlorothiazide Erythromycin Ethylsuccinate+Sulfisoxazole Estrogens Estrogens Ethionamide Etretinate Floxuridine Flucytosine Fluorouracil Fluphenazine Flubiprofen Flutamide Gentamicin Glipizide Glyburide Gold Salts (compounds) Gold Sodium Thiomalate Griseofulvin Griseofulvin Ultramicrosize Griseofulvin+Hydrochlorothiazide Haloperidol -
Evidence Review G: Step 4 Treatment
National Institute for Health and Care Excellence Final Hypertension in adults: diagnosis and management [G] Evidence review for step 4 treatment NICE guideline NG136 Intervention evidence review underpinning recommendations 1.4.44 to 1.4.50 in the guideline August 2019 Final This evidence review was developed by the National Guideline Centre Hypertension in adults: Final Contents Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian. Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive.