GLUOCXEOGENIC ENZYMES* Neogenic Processes. The

Total Page:16

File Type:pdf, Size:1020Kb

GLUOCXEOGENIC ENZYMES* Neogenic Processes. The 96 BIOCHEMISTRY: WEBER ET AL. PROC. N. A. S. tion yielded products which competitively inhibited the aminoacylation of native sRNA. The inhibition was specific for a given amino acid acceptor. Periodate oxidation of preparations enriched in tyrosyl-sRNA and poor in valyl-sRNA yielded an inhibitor effective in the tyrosine system and ineffective in the valine system. Similar specificity was observed with a periodate-treated fraction which had been enriched in valine acceptor activity. * USPHS postdoctoral International Fellow; Fellow del Instituto Nacional de la Investigacion Cientifica de Mexico. 1 Chapeville, F., F. Lipmann, G. von Ehrenstein, B. Weisblum, W. J. Ray, Jr., and S. Benzer, these PROCEEDINGS, 48, 1086 (1962). 2 Bergmann, F. H., P. Berg, and M. Dieckmann, J. Biol. Chem., 236, 1735 (1961). 3 Apgar, J., R. W. Holley, and S. H. Merrill, J. Biol. Chem., 237, 796 (1962). 4 Berg, P., F. H. Bergmann, E. J. Ofengand, and M. Dieckmann, J. Biol. Chem., 236, 1726 (1961). 6 Zubay, G., and M. Takanami, Biochem. Biophys. Res. Commun., 15, 207 (1964). 6Nihei, T., and G. L. Cantoni, J. Biol. Chem., 238, 3991 (1963). 7 Holley, R. W., J. Apgar, B. P. Doctor, J. Farrow, M. A. Marini, and S. H. Merrill, J. Biol. Chem., 236, 200 (1961). 8 Preiss, J., P. Berg, E. J. Ofengand, F. H. Bergmann, and M. Dieckmann, these PROCEEDINGS, 45, 319 (1959). 9 Whitfeld, P. R., and R. Markham, Nature, 171, 1151 (1953). 10 Lineweaver, H., and D. Burk, J. Am. Chem. Soc., 56, 658 (1934). 11 A comparison of the products of a 4% digestion with snake venom by the two procedures showed that the capacity to accept valine was reduced to about 1% by the technique of Zubay and Takanami (ref. 5), whereas digestion at pH 8.9 resulted in retention of 33% of valine acceptor activity. 12 The quantity of periodate-oxidized sRNA required to achieve a 50% inhibition in the tyro- sine test system using fraction Tyr (Fig. 5) was about l/2o of that necessary for a 50% inhibition in the valine test system using fraction Val, (Fig. 4). This disparity can largely be accounted for by the facts that: (a) compared to crude sRNA, tyrosine acceptor sRNA was 6-fold enriched in fraction Tyr, while valine acceptor sRNA was enriched only 1.4-fold in fraction Val, (Table 2); and (b) the level of untreated sRNA used in the valine experiment contained three times more valine acceptor sRNA than the amount of tyrosine acceptor sRNA used in the tyrosine experi- ment and therefore would require a larger quantity of periodate-oxidized sRNA to achieve an equivalent inhibition. 13 Hecht, L. I., M. L. Stephenson, and P. C. Zamenenik, these PROCEEDINGS, 45, 505 (1959). INSULIN: SUPPRESSOR OF BIOSYNTHESIS OF HEPATIC GLUOCXEOGENIC ENZYMES* BY GEORGE WEBER, R. L. SINGHAL, AND S. K. SRIVASTAVA DEPARTMENT OF PHARMACOLOGY, INDIANA UNIVERSITY SCHOOL OF MEDICINE, INDIANAPOLIS, INDIANA Communicated by Charles Huggins, October 30, 1964 The homeostatic control of blood sugar depends in part on regulation of gluco- neogenic processes. The "final common path of gluconeogenesis,"l the series of steps converting pyruvate into glucose, involves a number of reversible and 4 one- way reactions. From the point of view of metabolic control our attention is Downloaded by guest on September 28, 2021 VOL. 53, 1965 BIOCHEMISTRY: WEBER ET AL. 97 focused on the one-way reactions catalyzed by the key enzymes of gluconeogenesis, glucose 6-phosphatase, fructose 1,6-diphosphatase, phosphoenolpyruvate carboxy- kinase, and pyruvate carboxylase. The limiting role of these enzymes is em- phasized by the following properties relevant to regulation. The enzymes are in- volved in circumventing thermodynamic barriers,2 they are all one-way reactions, their activities are the lowest in the gluconeogenic sequence,' and they are organ- specific since they occur only in liver and kidney where gluconeogenesis can take place. The genetic code of the key gluconeogenic enzymes probably is in the same region or on the same genetic chain, since these are the only enzymes of carbo- hydrate metabolism which are progressively deleted with increasing growth rate in hepatomas and are completely absent in rapidly growing liver tumors.3 4 In searching for regulatory influences that could selectively and differentially control the enzymatic processes of gluconeogenesis, we investigated the action of glucocorticoid hormone and insulin. Evidence will be presented indicating that the genic expression of the key gluconeogenic enzymes is regulated by the action of glucocorticoid as an inducer and insulin as a suppressor of the biosynthesis of these hepatic enzymes. Methods.-Male Wistar rats of 90-110 gm were kept in separate cages, with Purina laboratory chow and water ad libitum unless otherwise specified. The tech- niques for preparation of tissue homogenate, supernatant fluid, counting of cell nuclei, assaying glucose 6-phosphatase and fructose 1,6-diphosphatase were described previously.5' 6 The determination of RNA amount and specific activity was cited elsewhere.7 Orotic acid-6-C14 (New England Nuclear Corp.) had a specific activity of 6.5 mc/mM, and 3 jAC/100 gm rat was injected intraperitoneally 2 hr before animals were killed. Triamcinolone (Lederle) was purchased as a commercial preparation. Actinomycin D was a gift from Merck, Sharp & Dohme. Enzyme activities were expressed per cell as micromoles of substrate X 107 metabolized per hr at 370C. The RNA specific activity was calculated as cpm per mg RNA. The data were given for convenient comparison as percentages of values found in normal untreated rats. Alloxan diabetes was induced, in animals starved for 30 hr, by intraperitoneal injection of 12 mg per 100 gm rat alloxan monohydrate (Eastman). Blood sugar was determined according to Nelson's adaptation of the Somogyi method for glucose.8 Results and Discussion. -Evidence for the action of glucocorticoid hormone as inducer of biosynthesis of key gluconeogenic enzymes: For the definition of an inducer, the one recommended in the "Report of the Commission on Enzymes" is used.9 "A relative increase in the rate of synthesis of a specific apoenzyme resulting from ex- posure to a chemical substance will be called enzyme induction. The substance in- ducing such a synthesis is an enzyme inducer." The following evidence has ac- cumulated to show that this concept applies to the action of glucocorticoid hor- nmones on hepatic gluconeogenic enzymes. Glucocorticoid hormones increased the activities of rat liver glucose 6-phospha- tase,5' 10. "fructose 1,6-diphosphatase," 12phosphoenolpyruvate carboxykinase,3 14 and pyruvate carboxylase. 1" A more marked response for the specific phosphatases was obtained with triamcinolonel which was also more effective in promoting glu- coneogenesis."6 Graded effects occurred with increasing hormone dosage." 13, 17 The enzyme increases were detectable in a few hours. 1, 17. 18 The increases are Downloaded by guest on September 28, 2021 98 BIOCHEMISTRY: WEBER ET AL. PROC. N. A. S. thought to represent de novo enzyme synthesis because the rise can be blocked or prevented by inhibitors of protein synthesis such as actinomycin," 7, 18-20 puro- mycin," 13 or ethionine." 12, 13, 21 The blockers of protein synthesis were capable of interrupting the glucocorticoid-induced synthesis and then enzyme activities de- creased to normal in 24 hr." 18, 22 In acute starvation these enzymes were preferentially maintained near normal range.'3' 23-25 However, when hypophysectomized rats were fasted, the enzyme activities rapidly declined.6' 25 The preferential maintenance of specific phos- phatases in starvation also can be interrupted by actinomycin or ethionine and then activities rapidly decrease.22 Adrenalectomy returned the highly increased enzyme activities to normal in diabetic rats." 11 13 In rats carrying ACTH-secreting pituitary tumors the glucose 6-phosphatase and fructose 1,6-diphosphatase activities increased and upon adrenalectomy they re- turned to normal range.26 Thus, endogenous hormones exert biosynthetic effects similar to those observed with exogenous synthetic glucocorticoid derivatives. The role of RNA metabolism in glucocorticoid-induced metabolic responses was shown by the stimulation in the rates of incorporation of radioactive precursors into RNA.27-29 Since it was observed that actinomycin, a selective inhibitor of DNA- directed RNA synthesis,30 inhibited the cortisone-induced elevation of certain en- zymes, it was suggested that the stimulation of precursor incorporation into RNA is an integral part of the hormone action.3' Similar concepts were formed by in- vestigators who brought evidence that the early effects of corticosteroid hormones involve stimulation of RNA polymerase activity and messenger RNA synthesis in rat liver nucleus.32-36 The role of RNA metabolism in glucocorticoid action is further emphasized by the graded dose response of an increase in hepatic RNA amount and by the rise in specific activity with orotate or uracil as precursors in response to increasing doses of triamcinolone.20 22 A correlation of the glucocorticoid-induced rise in liver enzyme biosynthesis, RNA metabolism, and amino acid levels was shown and the increases found with triamcinolone were more marked than those obtained with cortisone.7' 20 This accords with the higher gluconeogenic potency of the fluori- nated steroid.'6 The involvement of DNA-directed RNA synthesis in gluconeo- genic events is indicated by the complete blocking of the triamcinolone or cortisone- induced rise in the biosynthesis of hepatic gluconeogenic enzymes'7' 18-20 and in the increase of RNA metabolism by actinomycin.7 20 The enumerated evidence favors the concept that the glucocorticoid hormones act as inducers of biosynthesis of the key gluconeogenic enzymes. Thus, gluco- corticoids act positively on the transcription of structural genes into specific cata- lytic proteins, namely, key enzymes in the gluconeogenic sequence. Evidence for the action of insulin as suppressor of biosynthesis of key gluconeogenic enzymes: In contrast to the function of an inducer, a suppressor acts negatively o11 the transcription of structural genes into enzyme proteins.
Recommended publications
  • “Seizure Disorders” January 2017 This Is the Beginning of CE PRN’S 39Th Year
    Pharmacy Continuing Education from WF Professional Associates ABOUT WFPA LESSONS TOPICS ORDER CONTACT PHARMACY EXAM REVIEWS “Seizure Disorders” January 2017 This is the beginning of CE PRN’s 39th year. WOW! Thanks for your continued participation. The primary goal of seizure disorder treatment is to achieve a seizure-free patient. We update this topic often because it’s so important. This lesson provides 1.25 (0.125 CEUs) contact hours of credit, and is intended for pharmacists & technicians in all practice settings. The program ID # for this lesson is 0798-000-18-228-H01-P for pharmacists & 0798-000-18-228-H01-T for technicians. Participants completing this lesson by December 31, 2019 may receive full credit. Release date for this lesson is January 1, 2017. To obtain continuing education credit for this lesson, you must answer the questions on the quiz (70% correct required), and return the quiz. Should you score less than 70%, you will be asked to repeat the quiz. Computerized records are maintained for each participant. If you have any comments, suggestions or questions, contact us at the above address, or call 1-843-488-5550. Please write your name, NABP eProfile (CPE Monitor®) ID Number & birthdate (MM/DD) in the indicated space on the quiz page. The objectives of this lesson are such that upon completion participants will be able to: Pharmacists: Technicians: 1. Describe the epidemiology of seizure disorders. 1. List the types of seizures. 2. List the types of seizures. 2. List factors that affect the selection of 3. Discuss the goals associated with treating seizure anticonvulsants.
    [Show full text]
  • Daniel Hussar, Phd, New Drug Update
    New Drug Update 2014* *Presentation by Daniel A. Hussar, Ph.D. Remington Professor of Pharmacy Philadelphia College of Pharmacy University of the Sciences in Philadelphia Objectives: After attending this program, the participant will be able to: 1. Identify the indications and routes of administration of the new therapeutic agents. 2. Identify the important pharmacokinetic properties and the unique characteristics of the new drugs. 3. Identify the most important adverse events and precautions of the new drugs. 4. Compare the new drugs to the older therapeutic agents to which they are most similar in activity. 5. Identify information regarding the new drugs that should be communicated to patients. New Drug Comparison Rating (NDCR) system 5 = important advance 4 = significant advantage(s) (e.g., with respect to use/effectiveness, safety, administration) 3 = no or minor advantage(s)/disadvantage(s) 2 = significant disadvantage(s) (e.g., with respect to use/effectiveness, safety, administration) 1 = important disadvantage(s) Additional information The Pharmacist Activist monthly newsletter: www.pharmacistactivist.com Dapagliflozin propanediol (Farxiga – Bristol-Myers Squibb; AstraZeneca) Antidiabetic Agent 2014 New Drug Comparison Rating (NDCR) = Indication: Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus Comparable drug: Canagliflozin (Invokana) Advantages: --May be less likely to cause hypersensitivity reactions and hyperkalemia --May be less likely to interact with other medications --May
    [Show full text]
  • Caffeine Posited to Enhance Psoriasis Tx Response
    30 Skin Disorders FAMILY P RACTICE N EWS • July 1, 2006 Caffeine Posited to Enhance Psoriasis Tx Response BY ERIK GOLDMAN versity of Michigan, Ann Arbor. The im- flammatory, and they work by inhibiting drinkers were more likely to discontinue Contributing Writer pact of coffee and other caffeine-containing an enzyme called 5-amidoimidazole-4-car- MTX therapy due to perceived lack of ef- beverages on inflammatory conditions such boxamide ribonucleotide (AICAR) trans- ficacy. A second rheumatoid arthritis study P HILADELPHIA — Patients with psori- as psoriasis has been the subject of con- formylase, resulting in AICAR accumula- involving 39 patients also showed inhibi- asis who drink coffee frequently respond troversy for some time. Many people con- tion. This leads to increased adenosine tion of the drug’s effects, but other pub- better to treatment with methotrexate sider caffeine to be proinflammatory and which has anti-inflammatory properties,” lished studies show no such effects. and sulfasalazine, Dr. Yolanda Helfrich re- have suggested that patients with inflam- explained Dr. Helfrich. “Caffeine acts as an But it appears that, at least biochemi- ported at the annual meeting of the Soci- matory diseases cut their consumption. adenosine receptor antagonist, so you’d cally, coffee has bivalent effects. While it is ety for Investigative Dermatology. On face value, one would expect coffee expect it to inhibit MTX and SSZ.” true that caffeine is an adenosine receptor That should be good news for patients to thwart the efficacy of drugs such as Indeed, a study published several years antagonist, it also increases cyclic adeno- who like to drink coffee, said Dr.
    [Show full text]
  • A Textbook of Clinical Pharmacology and Therapeutics This Page Intentionally Left Blank a Textbook of Clinical Pharmacology and Therapeutics
    A Textbook of Clinical Pharmacology and Therapeutics This page intentionally left blank A Textbook of Clinical Pharmacology and Therapeutics FIFTH EDITION JAMES M RITTER MA DPHIL FRCP FMedSci FBPHARMACOLS Professor of Clinical Pharmacology at King’s College London School of Medicine, Guy’s, King’s and St Thomas’ Hospitals, London, UK LIONEL D LEWIS MA MB BCH MD FRCP Professor of Medicine, Pharmacology and Toxicology at Dartmouth Medical School and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA TIMOTHY GK MANT BSC FFPM FRCP Senior Medical Advisor, Quintiles, Guy's Drug Research Unit, and Visiting Professor at King’s College London School of Medicine, Guy’s, King’s and St Thomas’ Hospitals, London, UK ALBERT FERRO PHD FRCP FBPHARMACOLS Reader in Clinical Pharmacology and Honorary Consultant Physician at King’s College London School of Medicine, Guy’s, King’s and St Thomas’ Hospitals, London, UK PART OF HACHETTE LIVRE UK First published in Great Britain in 1981 Second edition 1986 Third edition 1995 Fourth edition 1999 This fifth edition published in Great Britain in 2008 by Hodder Arnold, an imprint of Hodden Education, part of Hachette Livre UK, 338 Euston Road, London NW1 3BH http://www.hoddereducation.com ©2008 James M Ritter, Lionel D Lewis, Timothy GK Mant and Albert Ferro All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency.
    [Show full text]
  • Identification of Human Sulfotransferases Involved in Lorcaserin N-Sulfamate Formation
    1521-009X/44/4/570–575$25.00 http://dx.doi.org/10.1124/dmd.115.067397 DRUG METABOLISM AND DISPOSITION Drug Metab Dispos 44:570–575, April 2016 Copyright ª 2016 by The American Society for Pharmacology and Experimental Therapeutics Identification of Human Sulfotransferases Involved in Lorcaserin N-Sulfamate Formation Abu J. M. Sadeque, Safet Palamar,1 Khawja A. Usmani, Chuan Chen, Matthew A. Cerny,2 and Weichao G. Chen3 Department of Drug Metabolism and Pharmacokinetics, Arena Pharmaceuticals, Inc., San Diego, California Received September 30, 2015; accepted January 7, 2016 ABSTRACT Lorcaserin [(R)-8-chloro-1-methyl-2,3,4,5-tetrahydro-1H-3-benza- and among the SULT isoforms SULT1A1 was the most efficient. The zepine] hydrochloride hemihydrate, a selective serotonin 5-hydroxy- order of intrinsic clearance for lorcaserin N-sulfamate is SULT1A1 > Downloaded from tryptamine (5-HT) 5-HT2C receptor agonist, is approved by the U.S. SULT2A1 > SULT1A2 > SULT1E1. Inhibitory effects of lorcaserin Food and Drug Administration for chronic weight management. N-sulfamate on major human cytochrome P450 (P450) enzymes Lorcaserin is primarily cleared by metabolism, which involves were not observed or minimal. Lorcaserin N-sulfamate binds to multiple enzyme systems with various metabolic pathways in human plasma protein with high affinity (i.e., >99%). Thus, despite humans. The major circulating metabolite is lorcaserin N-sulfamate. being the major circulating metabolite, the level of free lorcaserin Both human liver and renal cytosols catalyze the formation of N-sulfamate would be minimal at a lorcaserin therapeutic dose and lorcaserin N-sulfamate, where the liver cytosol showed a higher unlikely be sufficient to cause drug-drug interactions.
    [Show full text]
  • Potentially Hazardous Drug Interactions with Psychotropics Ben Chadwick, Derek G
    Chadwick et al Advances in Psychiatric Treatment (2005), vol. 11, 440–449 Potentially hazardous drug interactions with psychotropics Ben Chadwick, Derek G. Waller and J. Guy Edwards Abstract Of the many interactions with psychotropic drugs, a minority are potentially hazardous. Most interactions are pharmacodynamic, resulting from augmented or antagonistic actions at a receptor or from different mechanisms in the same tissue. Most important pharmacokinetic interactions are due to effects on metabolism or renal excretion. The major enzymes involved in metabolism belong to the cytochrome P450 (CYP) system. Genetic variation in the CYP system produces people who are ‘poor’, ‘extensive’ or ‘ultra-rapid’ drug metabolisers. Hazardous interactions more often result from enzyme inhibition, but the probability of interaction depends on the initial level of enzyme activity and the availability of alternative metabolic routes for elimination of the drug. There is currently interest in interactions involving uridine diphosphate glucuronosyltransferases and the P-glycoprotein cell transport system, but their importance for psychotropics has yet to be defined. The most serious interactions with psychotropics result in profound sedation, central nervous system toxicity, large changes in blood pressure, ventricular arrhythmias, an increased risk of dangerous side-effects or a decreased therapeutic effect of one of the interacting drugs. A drug interaction, defined as the modification of habits, problems related to polypharmacy are likely the action of one drug by another, can be beneficial to grow. or harmful, or it can have no significant effect. An There are numerous known and potential inter- appreciation of clinically important interactions is actions with psychotropic drugs, and many of them becoming increasingly necessary with the rising use do not have clinically significant consequences.
    [Show full text]
  • Everyday-Practice-1.Pdf
    80 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 6, NO.2 Everyday Practice 2. Pharmacokinetic interactions or interactions due to alter- ations in the absorption, distribution, metabolism or Adverse drug interactions excretion of one drug by another. 3. Pharmacodynamic interactions or interactions due to S. K. BHATIACHARYA alterations in the pharmacological action of one drug by another, at or near the target site of action, and may involve the basic mechanism by which these drugs act. PHARMACEUTICAL INTERACTIONS INTRODUCTION Drugs may be inactivated or precipitated from solution if The pharmacokinetics as well as the effects of a drug can mixed in syringes or added to blood or infusion fluids prior to be altered by the previous or concurrent administration of administration. Generally the manufacturer's literature anoth~~. While .such an .interacti~n may be therapeutically provides specific warnings and guidelines which should be beneficial occasionally, In many Instances it may result in checked. Important drug interactions are listed in Table I. adverse effects. The increasing tendency for polypharmacy It is advisable to avoid mixing drugs in infusion solutions is not always guided by principles of rational drug therapy. unless it is known that the mixture is safe (e.g. potassium The long term use of potent drugs and self-medication has chloride and insulin). Two infusion sites can be used if two resulted in an increase in the incidence of adverse drug drugs have to be administered simultaneously. interactions. Every time a physician prescribes an additional drug, he or she is adding to the risk of these interactions. It PHARMACOKINETIC INTERACTIONS has been estimated that patients in hospital who are receiving These interactions may take place during absorption, more than six drugs at a time, have a 6 to 7 times greater incidence of adverse effects (including those due to drug metabolism, distribution and excretion of drugs-factors interactions) than those who are receiving less than six which .~re impo~tant for the bioavailability of a drug at its drugs.
    [Show full text]
  • Pharmacokinetic and Pharmacodynamic Interactions Between Antiepileptics and Antidepressants Domenico Italiano University of Messina, Italy
    University of Kentucky UKnowledge Psychiatry Faculty Publications Psychiatry 11-2014 Pharmacokinetic and Pharmacodynamic Interactions between Antiepileptics and Antidepressants Domenico Italiano University of Messina, Italy Edoardo Spina University of Messina, Italy 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 Italiano, Domenico; Spina, Edoardo; and de Leon, Jose, "Pharmacokinetic and Pharmacodynamic Interactions between Antiepileptics and Antidepressants" (2014). Psychiatry Faculty Publications. 40. https://uknowledge.uky.edu/psychiatry_facpub/40 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]. Pharmacokinetic and Pharmacodynamic Interactions between Antiepileptics and Antidepressants Notes/Citation Information Published in Expert Opinion on Drug Metabolism & Toxicology, v. 10, Issue 11, p. 1457-1489. © 2014 Taylor & Francis Group This is an Accepted Manuscript of an article published by Taylor & Francis Group in Expert Opinion on Drug Metabolism & Toxicology in Nov. 2014, available online: http://www.tandfonline.com/10.1517/ 17425255.2014.956081 Digital Object Identifier (DOI) http://dx.doi.org/10.1517/17425255.2014.956081 This article is available at UKnowledge: https://uknowledge.uky.edu/psychiatry_facpub/40 1 This is an Accepted Manuscript of an article published by Taylor & Francis Group in Expert Opinion on Drug Metabolism & Toxicology in Nov.
    [Show full text]
  • Status Epilepticus
    Status Epilepticus By Aaron M. Cook, Pharm.D., BCPS, BCCCP Reviewed by Gretchen M. Brophy, Pharm.D., FCCP, BCPS; Matthew J. Korobey, Pharm.D. BCCCP; and You Min Sohn, Pharm.D., M.S., BCPS, BCCCP LEARNING OBJECTIVES 1. Evaluate factors that may affect treatment success in patients with status epilepticus. 2. Distinguish gaps in the literature related to optimal status epilepticus treatment. 3. Evaluate therapeutic strategies for super-refractory status epilepticus. 4. Assess the impact of timing of status epilepticus treatment initiation, and develop strategies to optimize effective treatment. DEFINITIONS OF STATUS EPILEPTICUS ABBREVIATIONS IN THIS CHAPTER Status epilepticus is defined as continuous seizure activity for EEG Electroencephalogram greater than 5 minutes or consecutive seizures without regaining GABA g-Aminobutyric acid consciousness over 5 minutes. Status epilepticus is common in ICH Intracerebral hemorrhage the epilepsy population and is often associated with acute, severe NMDA N-methyl-D-aspartate neurological injury or illness such as traumatic brain injury (TBI), TBI Traumatic brain injury intracerebral hemorrhage (ICH), meningitis, or pharmacologic toxic- Table of other common abbreviations. ity/withdrawal. Overall, the incidence of status epilepticus is about 12 per 100,000 individuals, a value that has increased 50% since the early 2000s (Dham 2014). Status epilepticus is often divided into “convulsive” status epilepticus (in which the patient has obvi- ous clinical manifestations of seizures, mental status impairment, or postictal focal neurological deficits) and “nonconvulsive” status epi- lepticus (in which the patient has no obvious clinical manifestations of seizure, but seizure activity is revealed on electroencephalogram [EEG]). Refractory status epilepticus is defined as status epilepticus that persists despite treatment with at least two antiepileptic drugs.
    [Show full text]
  • Clinically Relevant Drug Interactions with Antiepileptic Drugs
    British Journal of Clinical Pharmacology DOI:10.1111/j.1365-2125.2005.02529.x Clinically relevant drug interactions with antiepileptic drugs Emilio Perucca Institute of Neurology IRCCS C. Mondino Foundation, Pavia, and Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy Correspondence Some patients with difficult-to-treat epilepsy benefit from combination therapy with Emilio Perucca MD, PhD, Clinical two or more antiepileptic drugs (AEDs). Additionally, virtually all epilepsy patients will Pharmacology Unit, Department of receive, at some time in their lives, other medications for the management of Internal Medicine and Therapeutics, associated conditions. In these situations, clinically important drug interactions may University of Pavia, Piazza Botta 10, occur. Carbamazepine, phenytoin, phenobarbital and primidone induce many cyto- 27100 Pavia, Italy. chrome P450 (CYP) and glucuronyl transferase (GT) enzymes, and can reduce Tel: + 390 3 8298 6360 drastically the serum concentration of associated drugs which are substrates of the Fax: + 390 3 8222 741 same enzymes. Examples of agents whose serum levels are decreased markedly by E-mail: [email protected] enzyme-inducing AEDs, include lamotrigine, tiagabine, several steroidal drugs, cyclosporin A, oral anticoagulants and many cardiovascular, antineoplastic and psy- chotropic drugs. Valproic acid is not enzyme inducer, but it may cause clinically relevant drug interactions by inhibiting the metabolism of selected substrates, most Keywords notably phenobarbital and lamotrigine. Compared with older generation agents, most antiepileptic drugs, drug interactions, of the recently developed AEDs are less likely to induce or inhibit the activity of CYP enzyme induction, enzyme inhibition, or GT enzymes. However, they may be a target for metabolically mediated drug epilepsy, review interactions, and oxcarbazepine, lamotrigine, felbamate and, at high dosages, topira- mate may stimulate the metabolism of oral contraceptive steroids.
    [Show full text]
  • Applied Pharmacology and Toxicology Examination
    PROFESSIONAL EXAMINATION OF COUNCIL IN TERMS OF THE PHARMACY ACT, 1974 (ACT 53 OF 1974) APPLIED PHARMACOLOGY AND TOXICOLOGY EXAMINATION 2020 PRACTICE PAPER TIME ALLOWED: Three (3) hours MAXIMUM MARKS: 90 PASS MARK: 45 APPLIED PHARMACOLOGY AND TOXICOLOGY EXAMINER: Dr ME Mothibe MODERATOR: Dr KC Obikeze NO. OF PAGES: 18 CANDIDATES PLEASE NOTE: (a) Ensure that you have the correct question paper for your examination. (b) Ensure that all your details as requested on the cover page are filled in correctly. (c) There is 15 minutes reading time for this paper. (d) Do not commence writing until you are told to do so. (e) The marks allocated to each question must be borne in mind when answering (f) All multiple choice questions are worth one mark. (g) There is no negative marking for incorrect answers. (h) There is only one correct answer per multiple choice question, therefore select only one option per question. (i) All questions must be answered. P a g e 1 | 18 Surname: ------------------------------------------------------------------------------------------------------ First names: -------------------------------------------------------------------------------------------------- P Number: ---------------------------------------------------------------------------------------------------- ID/Passport number: -------------------------------------------------------------------------------------- Date: ------------------------------------------------------------------------------------------------------------ Marks awarded Question Examiner Moderator
    [Show full text]
  • Cytochrome P450 (B. Brennan)
    Part I Anaesthesia Refresher Course – 2017 20 University of Cape Town Cytochrome P450 Dr Brigid Brennan UCT Department of Anaesthesia & Perioperative Medicine The cytochrome P450 (CYP450) enzymes are a major determinant of the pharmacokinetic behavior of numerous drugs. CYP450 enzymes are so named because they are bound to membranes within the cell, specifically the endoplasmic reticulum (cyto) and contain a heme pigment (chrome and P) that absorbs light at a wavelength of 450nm when exposed to carbon monoxide. Each cytochrome P450 isoenzyme consists of a single protein chain and one haem group as the binding site for the drug. The CYP450 enzymes are found predominantly in the liver but also exist in the small intestine (reducing drug bioavailability), brain, lung, adrenal gland, kidney, bone marrow, skin, ovary, testes, and placenta. Classification There are about 50 different CYP’s found in humans. There are many different isoforms of cytochrome P450. An isoform is a CYP enzyme variant that derives from one particular gene. These isoenzymes are classified according to similarities of their amino acid sequencing into families (number), subfamilies (letter) and individual genes/specific enzymes (number). Families: Members of a family must have at least 40% sequence homology. Families are numbered e.g. CYP 1, CYP 2. There are at least 74 CYP families but only about 17 have been described in man. Subfamilies: Members of a subfamily must have at least 55% sequence homology. About 30 subfamilies are well described in humans. Subfamilies are identified by a letter e.g. CYP2D Individual genes: There are about 50 important genes in man.
    [Show full text]