Pre - Feasibility Report
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Could Mycolactone Inspire New Potent Analgesics? Perspectives and Pitfalls
toxins Review Could Mycolactone Inspire New Potent Analgesics? Perspectives and Pitfalls 1 2 3, 4, , Marie-Line Reynaert , Denis Dupoiron , Edouard Yeramian y, Laurent Marsollier * y and 1, , Priscille Brodin * y 1 France Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR8204-CIIL-Center for Infection and Immunity of Lille, F-59000 Lille, France 2 Institut de Cancérologie de l’Ouest Paul Papin, 15 rue André Boquel-49055 Angers, France 3 Unité de Microbiologie Structurale, Institut Pasteur, CNRS, Univ. Paris, F-75015 Paris, France 4 Equipe ATIP AVENIR, CRCINA, INSERM, Univ. Nantes, Univ. Angers, 4 rue Larrey, F-49933 Angers, France * Correspondence: [email protected] (L.M.); [email protected] (P.B.) These three authors contribute equally to this work. y Received: 29 June 2019; Accepted: 3 September 2019; Published: 4 September 2019 Abstract: Pain currently represents the most common symptom for which medical attention is sought by patients. The available treatments have limited effectiveness and significant side-effects. In addition, most often, the duration of analgesia is short. Today, the handling of pain remains a major challenge. One promising alternative for the discovery of novel potent analgesics is to take inspiration from Mother Nature; in this context, the detailed investigation of the intriguing analgesia implemented in Buruli ulcer, an infectious disease caused by the bacterium Mycobacterium ulcerans and characterized by painless ulcerative lesions, seems particularly promising. More precisely, in this disease, the painless skin ulcers are caused by mycolactone, a polyketide lactone exotoxin. In fact, mycolactone exerts a wide range of effects on the host, besides being responsible for analgesia, as it has been shown notably to modulate the immune response or to provoke apoptosis. -
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin Healthcare
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin healthcare 4/22/2020 Overview benzodiazepines • Examples of benzos and benzo like drugs • Indications for benzos • Pharmacology of benzos • Side effects and contraindications • Benzo withdrawal • Benzo tapers 12/06/2018 Sedative/Hypnotics • Benzodiazepines • Alcohol • Z-drugs (Benzo-like sleeping aids) • Barbiturates • GHB • Propofol • Some inhalants • Gabapentin? Pregabalin? 12/06/2018 Examples of benzodiazepines • Midazolam (Versed) • Triazolam (Halcion) • Alprazolam (Xanax) • Lorazepam (Ativan) • Temazepam (Restoril) • Oxazepam (Serax) • Clonazepam (Klonopin) • Diazepam (Valium) • Chlordiazepoxide (Librium) 4/22/2020 Sedatives: gaba stimulating drugs have incomplete “cross tolerance” 12/06/2018 Effects from sedative (Benzo) use • Euphoria/bliss • Suppresses seizures • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Sleep inducing • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 Tolerance to benzo effects? • Effects quickly diminish with repeated use (weeks) • Euphoria/bliss • Suppresses seizures • Effects incompletely diminish with repeated use • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Seep inducing • Durable effects with repeated use • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 If you understand this pharmacology you can figure out the rest... • Potency • 1 mg diazepam <<< 1 mg alprazolam • Duration of action • Half life differences • Onset of action • Euphoria, clinical utility in acute -
Acute Migraine Treatment
Acute Migraine Treatment Morris Levin, MD Professor of Neurology Director, Headache Center UCSF Department of Neurology San Francisco, CA Mo Levin Disclosures Consulting Royalties Allergan Oxford University Press Supernus Anadem Press Amgen Castle Connolly Med. Publishing Lilly Wiley Blackwell Mo Levin Disclosures Off label uses of medication DHE Antiemetics Zolmitriptan Learning Objectives At the end of the program attendees will be able to 1. List all important options in the acute treatment of migraine 2. Discuss the evidence and guidelines supporting the major migraine acute treatment options 3. Describe potential adverse effects and medication- medication interactions in acute migraine pharmacological treatment Case 27 y/o woman has suffered ever since she can remember from “sick headaches” . Pain is frontal, increases over time and is generally accompanied by nausea and vomiting. She feels depressed. The headache lasts the rest of the day but after sleeping through the night she awakens asymptomatic 1. Diagnosis 2. Severe Headache relief Diagnosis: What do we need to beware of? • Misdiagnosis of primary headache • Secondary causes of headache Red Flags in HA New (recent onset or change in pattern) Effort or Positional Later onset than usual (middle age or later) Meningismus, Febrile AIDS, Cancer or other known Systemic illness - Neurological or psych symptoms or signs Basic principles of Acute Therapy of Headaches • Diagnose properly, including comorbid conditions • Stratify therapy rather than treat in steps • Treat early -
Accurate Measurement, and Validation of Solubility Data † ‡ ‡ § † ‡ Víctor R
Article Cite This: Cryst. Growth Des. 2019, 19, 4101−4108 pubs.acs.org/crystal In the Context of Polymorphism: Accurate Measurement, and Validation of Solubility Data † ‡ ‡ § † ‡ Víctor R. Vazqueź Marrero, , Carmen Piñero Berríos, , Luz De Dios Rodríguez, , ‡ ∥ ‡ § Torsten Stelzer,*, , and Vilmalí Lopez-Mej́ ías*, , † Department of Biology, University of Puerto RicoRío Piedras Campus, San Juan, Puerto Rico 00931, United States ‡ Crystallization Design Institute, Molecular Sciences Research Center, University of Puerto Rico, San Juan, Puerto Rico 00926, United States § Department of Chemistry, University of Puerto RicoRío Piedras Campus, San Juan, Puerto Rico 00931, United States ∥ Department of Pharmaceutical Sciences, University of Puerto RicoMedical Sciences Campus, San Juan, Puerto Rico 00936, United States *S Supporting Information ABSTRACT: Solubility measurements for polymorphic com- pounds are often accompanied by solvent-mediated phase transformations. In this study, solubility measurements from undersaturated solutions are employed to investigate the solubility of the two most stable polymorphs of flufenamic acid (FFA forms I and III), tolfenamic acid (TA forms I and II), and the only known form of niflumic acid (NA). The solubility was measured from 278.15 to 333.15 K in four alcohols of a homologous series (methanol, ethanol, 1- propanol, n-butanol) using the polythermal method. It was established that the solubility of these compounds increases with increasing temperature. The solubility curves of FFA forms I and III intersect at ∼315.15 K (42 °C) in all four solvents, which represents the transition temperature of the enantiotropic pair. In the case of TA, the solubility of form II could not be reliably obtained in any of the solvents because of the fast solvent- mediated phase transformation. -
S1 Table. List of Medications Analyzed in Present Study Drug
S1 Table. List of medications analyzed in present study Drug class Drugs Propofol, ketamine, etomidate, Barbiturate (1) (thiopental) Benzodiazepines (28) (midazolam, lorazepam, clonazepam, diazepam, chlordiazepoxide, oxazepam, potassium Sedatives clorazepate, bromazepam, clobazam, alprazolam, pinazepam, (32 drugs) nordazepam, fludiazepam, ethyl loflazepate, etizolam, clotiazepam, tofisopam, flurazepam, flunitrazepam, estazolam, triazolam, lormetazepam, temazepam, brotizolam, quazepam, loprazolam, zopiclone, zolpidem) Fentanyl, alfentanil, sufentanil, remifentanil, morphine, Opioid analgesics hydromorphone, nicomorphine, oxycodone, tramadol, (10 drugs) pethidine Acetaminophen, Non-steroidal anti-inflammatory drugs (36) (celecoxib, polmacoxib, etoricoxib, nimesulide, aceclofenac, acemetacin, amfenac, cinnoxicam, dexibuprofen, diclofenac, emorfazone, Non-opioid analgesics etodolac, fenoprofen, flufenamic acid, flurbiprofen, ibuprofen, (44 drugs) ketoprofen, ketorolac, lornoxicam, loxoprofen, mefenamiate, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, pranoprofen, proglumetacin, sulindac, talniflumate, tenoxicam, tiaprofenic acid, zaltoprofen, morniflumate, pelubiprofen, indomethacin), Anticonvulsants (7) (gabapentin, pregabalin, lamotrigine, levetiracetam, carbamazepine, valproic acid, lacosamide) Vecuronium, rocuronium bromide, cisatracurium, atracurium, Neuromuscular hexafluronium, pipecuronium bromide, doxacurium chloride, blocking agents fazadinium bromide, mivacurium chloride, (12 drugs) pancuronium, gallamine, succinylcholine -
Benzodiazepines Vs Barbiturates for Alcohol Withdrawal: Analysis of 3 Different Treatment Protocols
American Journal of Emergency Medicine 37 (2019) 733–736 Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Brief Report Benzodiazepines vs barbiturates for alcohol withdrawal: Analysis of 3 different treatment protocols Amelia C. Nelson a, Joy Kehoe a, Jeffrey Sankoff b, David Mintzer c, Julie Taub c, Kevin A. Kaucher a,⁎ a Department of Pharmacy, Denver Health Medical Center, 777 Bannock ST. MC #0056, Denver, CO 80204, United States of America b Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, MC #0108, Denver, CO 80204, United States of America c Department of Medicine, Denver Health Medical Center, 601 Broadway Street, MC 4000, Denver, CO 80203, United States of America article info abstract Article history: Introduction: Alcohol withdrawal treatment varies widely. Benzodiazepines are the standard of care, with rapid Received 19 December 2018 onset and long durations of action. Recent drug shortages involving IV benzodiazepines have required incorpo- Accepted 2 January 2019 ration of alternative agents into treatment protocols. Phenobarbital has similar pharmacokinetics to select ben- zodiazepines frequently used for alcohol withdrawal. The objective of this study is to describe the effectiveness Keywords: and safety of our institutional protocols during three time periods utilizing benzodiazepines and barbiturates Phenobarbital for the acute treatment of alcohol withdrawal in the emergency department. Benzodiazepines Methods: Adult patients presenting to the ED for acute alcohol withdrawal from April 1st, 2016 to January 31st, Diazepam Lorazepam 2018 were reviewed. Patients who received at least one dose of treatment were included. Treatments were Alcohol withdrawal based on availability of medication and given protocol at time of presentation. -
Drug and Medication Classification Schedule
KENTUCKY HORSE RACING COMMISSION UNIFORM DRUG, MEDICATION, AND SUBSTANCE CLASSIFICATION SCHEDULE KHRC 8-020-1 (11/2018) Class A drugs, medications, and substances are those (1) that have the highest potential to influence performance in the equine athlete, regardless of their approval by the United States Food and Drug Administration, or (2) that lack approval by the United States Food and Drug Administration but have pharmacologic effects similar to certain Class B drugs, medications, or substances that are approved by the United States Food and Drug Administration. Acecarbromal Bolasterone Cimaterol Divalproex Fluanisone Acetophenazine Boldione Citalopram Dixyrazine Fludiazepam Adinazolam Brimondine Cllibucaine Donepezil Flunitrazepam Alcuronium Bromazepam Clobazam Dopamine Fluopromazine Alfentanil Bromfenac Clocapramine Doxacurium Fluoresone Almotriptan Bromisovalum Clomethiazole Doxapram Fluoxetine Alphaprodine Bromocriptine Clomipramine Doxazosin Flupenthixol Alpidem Bromperidol Clonazepam Doxefazepam Flupirtine Alprazolam Brotizolam Clorazepate Doxepin Flurazepam Alprenolol Bufexamac Clormecaine Droperidol Fluspirilene Althesin Bupivacaine Clostebol Duloxetine Flutoprazepam Aminorex Buprenorphine Clothiapine Eletriptan Fluvoxamine Amisulpride Buspirone Clotiazepam Enalapril Formebolone Amitriptyline Bupropion Cloxazolam Enciprazine Fosinopril Amobarbital Butabartital Clozapine Endorphins Furzabol Amoxapine Butacaine Cobratoxin Enkephalins Galantamine Amperozide Butalbital Cocaine Ephedrine Gallamine Amphetamine Butanilicaine Codeine -
The Effects of Antiepileptic Inducers in Neuropsychopharmacology, a Neglected Issue
University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 7-2015 The ffecE ts of Antiepileptic Inducers in Neuropsychopharmacology, a Neglected Issue. Part II: Pharmacological Issues and Further Understanding Jose de Leon University of Kentucky, [email protected] Right click to open a feedback form in a new tab to let us know how this document benefits oy u. Follow this and additional works at: https://uknowledge.uky.edu/psychiatry_facpub Part of the Psychiatry and Psychology Commons Repository Citation de Leon, Jose, "The Effects of Antiepileptic Inducers in Neuropsychopharmacology, a Neglected Issue. Part II: Pharmacological Issues and Further Understanding" (2015). Psychiatry Faculty Publications. 36. https://uknowledge.uky.edu/psychiatry_facpub/36 This Article is brought to you for free and open access by the Psychiatry at UKnowledge. It has been accepted for inclusion in Psychiatry Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. The Effects of Antiepileptic Inducers in Neuropsychopharmacology, a Neglected Issue. Part II: Pharmacological Issues and Further Understanding Notes/Citation Information Published in Revista de Psiquiatría y Salud Mental, v. 8, issue 3, p. 167-188. © 2015 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ Digital Object Identifier (DOI) http://dx.doi.org/10.1016/j.rpsm.2014.10.005 This article is available at UKnowledge: https://uknowledge.uky.edu/psychiatry_facpub/36 The Effects of Antiepileptic Inducers in Neuropsychopharmacology, a Neglected Issue. Part II: Pharmacological Issues and Further Understanding Jose de Leon © 2015 Elsevier B.V. -
Package Leaflet: Information for the User
ENR 2186544 ENR 2186545 PACKAGE LEAFLET: INFORMATION FOR THE USER <invented name> 100 mg capsules, hard Active substance: flupirtine maleate Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. - Keep this leaflet. You may need to read it again. - If you have any further questions, ask your doctor or pharmacist. - This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. - If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. What is in this leaflet 1. What <invented name> is and what it is used for 2. What you need to know before you take <invented name> 3. How to take <invented name> 4. Possible side effects 5. How to store <invented name> 6. Contents of the pack and other information 1. What <invented name> is and what it is used for <invented name> is a medicine used to treat acute pain of mild to moderate intensity coming from various origins. 2. What you need to know before you take <invented name> Do not take <invented name> - if you are allergic to flupirtine maleate or any of the other ingredients of this medicine (listed in section 6). - if you are at risk of hepatic encephalopathy and patients with cholestasis, <invented name> should not be administered, as onset or deterioration of encephalopathy or ataxia may occur in these patients. -
United States, Lorazepam, with Its Longer Half-Life Compared Appropriate As Initial Treatment for Generalized Tonic-Clonic Et
In the United States, lorazepam, with its longer half-life compared to diazepam, is considered most appropriate as initial treatment for generalized tonic-clonic status epilepticus. (Wheless JW et al. Eds. Treatment of pediatric epilepsy: Expert opinion 2005. J Child Neurol Dec 2005;20(Suppl 1):S46-S49). If the seizure continues despite the maximum dose of benzodiazepine, this is followed with IV fosphenytoin as the most appropriate second drug selection. TOPIRAMATE AND VALPROATE COMPARED IN TREATMENT OF JUVENILE MYOCLONIC EPILEPSY A pilot, randomized, controlled trial comparing topiramate (n=19) and valproate (n=9) in adolescents/adults with juvenile myoclonic epilepsy (JME) was conducted in the Childrens Hospitals of Denver, CO, and Cincinnati, OH. Of patients completing a 26 week trial of these agents titrated to optimal effect, 8 of 12 (67%) in the topiramate group and 4 of 7 (57%) in the valproate group were seizure-free during the 12-week maintenance period. Median daily doses were 250 mg topiramate and 750 mg valproate. Adverse events resulted in discontinuance of treatment in 2 (11%) of topiramate-treated and one (11%) valproate- treated patients. Valproate had a higher incidence of systemic toxicity than topiramate, including nausea (33%), weight gain (22%), increased appetite (22%), alopecia (33%) and rash (22%). A double-blind trial of topiramate in JME is recommended. (Levisohn PM, Holland KD. Topiramate or valproate in patients with juvenile myoclonic epilepsy: A randomized open-label comparison. Epilepsy & Behavior 2007;10:547-552). COMMENT. Topiramate may be an effective alternative treatment to valproate for juvenile myoclonic epilepsy (JME). An expert opinion panel rated valproate and lamotrigine as most appropriate treatment for JME in males, and lamotrigine followed by topiramate in females. -
Muscle Relaxants for Pain Management in Rheumatoid Arthritis (Review)
Muscle relaxants for pain management in rheumatoid arthritis (Review) Richards BL, Whittle SL, Buchbinder R This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2012, Issue 1 http://www.thecochranelibrary.com Muscle relaxants for pain management in rheumatoid arthritis (Review) Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 3 BACKGROUND .................................... 6 OBJECTIVES ..................................... 7 METHODS ...................................... 7 RESULTS....................................... 10 Figure1. ..................................... 11 Figure2. ..................................... 13 Figure3. ..................................... 15 Figure4. ..................................... 15 Figure5. ..................................... 16 Figure6. ..................................... 17 Figure7. ..................................... 17 Figure8. ..................................... 18 DISCUSSION ..................................... 20 AUTHORS’CONCLUSIONS . 21 ACKNOWLEDGEMENTS . 22 REFERENCES ..................................... 22 CHARACTERISTICSOFSTUDIES . 24 DATAANDANALYSES. 35 Analysis 1.1. Comparison 1 Muscle relaxant versus control, Outcome 1 Pain 24hrs. 37 Analysis 1.2. Comparison 1 Muscle relaxant -
022345Orig1s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 022345Orig1s000 OTHER REVIEW(S) SEALD LABELING: PI SIGN-OFF REVIEW APPLICATION NUMBER NDA 022345 APPLICANT Valeant Pharm N.A. PRODUCT NAME Potiga (ezogabine) SUBMISSION DATE 15 April 2011 PDUFA DATE 15 June 2011 SEALD SIGN-OFF DATE 10 June 2011 OND ASSOCIATE DIRECTOR Laurie Burke FOR STUDY ENDPOINTS AND LABELING This memo confirms that no critical prescribing information (PI) deficiencies were noted in the SEALD Labeling Review filed 8 June 2011 and no critical deficiencies have been found in the final agreed-upon PI reviewed today. SEALD has no objection to PI approval at this time. Reference ID: 2959126 --------------------------------------------------------------------------------------------------------- This is a representation of an electronic record that was signed electronically and this page is the manifestation of the electronic signature. --------------------------------------------------------------------------------------------------------- /s/ ---------------------------------------------------- LAURIE B BURKE 06/10/2011 Reference ID: 2959126 NDA 22345 Potiga Potiga PMR/PMC Development Template: PREA Efficacy/Safety Study for Ezogabine PMR # 1 This template should be completed by the PMR/PMC Development Coordinator and included for each PMR/PMC in the Action Package. PMR/PMC Description: Prospective, randomized, placebo-control, double-blinded efficacy/ safety trial of Potiga (ezogabine) in children >12 years old. PMR/PMC Schedule Milestones: Final protocol Submission Date: 11/2012 Study/Clinical trial Completion Date: 01/2018 Final Report Submission Date: 05/2018 Other: MM/DD/YYYY 1. During application review, explain why this issue is appropriate for a PMR/PMC instead of a pre-approval requirement. Check type below and describe. Unmet need Life-threatening condition Long-term data needed Only feasible to conduct post-approval Prior clinical experience indicates safety Small subpopulation affected Theoretical concern Other This is part of a PREA requirement.