The Effect of Caffeine on Cardiac Vulnerability to Tachyarrhythmia in the Rat
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Cardiovascular Monitoring with Acetylcholinesterase Inhibitors: a Clinical Protocol† Jeremy P
Advances in Psychiatric Treatment (2007), vol. 13, 178–184 doi: 10.1192/apt.bp.106.002725 Cardiovascular monitoring with acetylcholinesterase inhibitors: a clinical protocol† Jeremy P. Rowland, John Rigby, Adam C. Harper & Rosalind Rowland Abstract There has been significant anxiety among prescribers regarding the potential for cardiac adverse effects associated with acetylcholinesterase (AChE) inhibitors in Alzheimer’s disease. There is no consensus on how to manage this cardiovascular risk, and memory clinics vary widely in their practice. Review of published evidence reveals that the incidence of cardiovascular side-effects is low, and that serious adverse events are rare. Intensive cardiovascular screening such as pre-treatment electrocardiograms or 24 h cardiac monitoring is not justified. Furthermore, there are no high-risk groups to target. This article suggests pragmatic guidelines for managing cardiovascular risk in patients receiving AChE inhibitors. The guidelines are intended to be easy to incorporate into routine clinical practice in a memory clinic. A few years ago it was estimated that almost 18 thus followed some uncertainty as to how treatment million people worldwide had dementia (Alzheimer’s should be properly managed. Society, 2004), with Alzheimer’s disease accounting Since the manufacturers’ cautions remain (see the for over half of cases (Fratiglioni, 2000). The second- relevant entries in http://emc.medicines.org.uk) and generation acetylcholinesterase (AChE) inhibitors guidance has been unforthcoming, services now vary donepezil, rivastigmine and galantamine were widely in their practice: some, for example, require introduced into clinical practice from 1997 for the electrocardiograms (ECGs) before use and during symptomatic treatment of Alzheimer’s disease, and treatment, whereas others do not. -
(12) United States Patent (10) Patent No.: US 6,844,355 B2 Somberg Et Al
USOO684.4355B2 (12) United States Patent (10) Patent No.: US 6,844,355 B2 Somberg et al. (45) Date of Patent: Jan. 18, 2005 (54) OPTICALLY ACTIVE ISOMERS OF QUININE Catterall, (1992) Physiol. Rev. 72(supp):S15-S48. AND QUINDINE AND THEIR RESPECTIVE Chan et al., (1991) J. Chromatogr. 571:291-297. BIOLOGICALACTION Chen et al., (1998) Nature 392:293–296. (75) Inventors: John C. Somberg, Lake Forest, IL Coplen et al., (1991) Circulation 84:527. (US); Vasant Ranade, Libertyville, IL Drabowicz et al., (1984) “Chemical Abstracts” Phosphorus (US) Sulfur 16:2676–270 (XP002165239). Engler et al., (1985) Helv. Chim. Acta. 68:789–800. (73) Assignee: Academic Pharmaceuticals, Inc., Lake Ficker et al., (1998) Circ. Res. 82:386–395. Bluff, IL (US) Gellens et al., (1992) Proc. Natl. Acad. Sci. 89:554–558. (*) Notice: Subject to any disclaimer, the term of this Gutzwiller et al., (1973) “Chemical Abstracts” Helv. Chim. patent is extended or adjusted under 35 Acta. 79:1494–1503 (XP002165238). U.S.C. 154(b) by 0 days. Hartmann et al. (1994) Circ. Res. 75:114-122. Karle I.L. et al., (1981) Proc. Natl. Acad. Sci. 78:5938–5941. (21) Appl. No.: 10/168,919 Karle, J.M. (1997) Antimicrob. Agents Chemother. (22) PCT Filed: Dec. 22, 2000 41:791-794. Kiehn et al. (1996) Circulation 94:2572–2579. (86) PCT No.: PCT/US00/352.13 Krafte et al., (1994) Europ. J. Pharma. 266:245-254. S371 (c)(1), Li et al. (1996) Circ. Res. 78:689-696. (2), (4) Date: Oct. 30, 2002 Sanguinetti et al., (1990) J. -
Malathion Human Health and Ecological Risk Assessment Final Report
SERA TR-052-02-02c Malathion Human Health and Ecological Risk Assessment Final Report Submitted to: Paul Mistretta, COR USDA/Forest Service, Southern Region 1720 Peachtree RD, NW Atlanta, Georgia 30309 USDA Forest Service Contract: AG-3187-C-06-0010 USDA Forest Order Number: AG-43ZP-D-06-0012 SERA Internal Task No. 52-02 Submitted by: Patrick R. Durkin Syracuse Environmental Research Associates, Inc. 5100 Highbridge St., 42C Fayetteville, New York 13066-0950 Fax: (315) 637-0445 E-Mail: [email protected] Home Page: www.sera-inc.com May 12, 2008 Table of Contents Table of Contents............................................................................................................................ ii List of Figures................................................................................................................................. v List of Tables ................................................................................................................................. vi List of Appendices ......................................................................................................................... vi List of Attachments........................................................................................................................ vi ACRONYMS, ABBREVIATIONS, AND SYMBOLS ............................................................... vii COMMON UNIT CONVERSIONS AND ABBREVIATIONS.................................................... x CONVERSION OF SCIENTIFIC NOTATION .......................................................................... -
On Tardive Dyskinesia'
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.37.8.941 on 1 August 1974. Downloaded from Journial of Neurology, Neurosurgery, alid Psychiatry, 1974, 27, 941-947 Effect of cholinergic and anticholinergic agents on tardive dyskinesia' H. L. KLAWANS2 AND R. RUBOVITS Fr-om the Divisioni of Neurology, Michael Reese Medical Center, Chicago, Illinois anid the Departmentt ofPsychiatry, University of Maryland, Baltimore, Maryland, U.S.A. SYNOPSIS Tardive dyskinesia, like several other choreiform disorders, is felt to be primarily related to dopaminergic activity within the striatum. Physostigmine has been demonstrated to improve the abnormal movements in patients with tardive dyskinesia while scopolamine tends to aggravate abnormal movements and in some cases elicits abnormal movement not previously observed. This evidence supports the hypothesis that anticholinergic therapy in patients prone to develop tardive dyskinesia may increase the incidence of this disorder the threshold for the by lowering appearance guest. Protected by copyright. of these movements. Tardive dyskinesia is a well-recognized side- been fully elucidated. However, there is evidence effect of long-term neuroleptic therapy (Crane, which suggests that dopamine acting at striatal 1968). The most prominent manifestation dopaminergic receptor sites may be closely is lingual-facial-buccal dyskinesia. Limb and related to the initiation of these choreiform trunkal chorea may accompany the facial move- movements in several clinical settings. Drugs ments (Paulson, 1968). The syndrome is most which alter the availability of dopamine at often seen in patients ranging in age from 50 to dopaminergic receptor sites alter choreiform 70 years who are most often diagnosed as symptomatology. Huntington's chorea is re- suffering chronic deteriorating schizophrenia. -
Dietary Supplements Compendium Volume 1
2015 Dietary Supplements Compendium DSC Volume 1 General Notices and Requirements USP–NF General Chapters USP–NF Dietary Supplement Monographs USP–NF Excipient Monographs FCC General Provisions FCC Monographs FCC Identity Standards FCC Appendices Reagents, Indicators, and Solutions Reference Tables DSC217M_DSCVol1_Title_2015-01_V3.indd 1 2/2/15 12:18 PM 2 Notice and Warning Concerning U.S. Patent or Trademark Rights The inclusion in the USP Dietary Supplements Compendium of a monograph on any dietary supplement in respect to which patent or trademark rights may exist shall not be deemed, and is not intended as, a grant of, or authority to exercise, any right or privilege protected by such patent or trademark. All such rights and privileges are vested in the patent or trademark owner, and no other person may exercise the same without express permission, authority, or license secured from such patent or trademark owner. Concerning Use of the USP Dietary Supplements Compendium Attention is called to the fact that USP Dietary Supplements Compendium text is fully copyrighted. Authors and others wishing to use portions of the text should request permission to do so from the Legal Department of the United States Pharmacopeial Convention. Copyright © 2015 The United States Pharmacopeial Convention ISBN: 978-1-936424-41-2 12601 Twinbrook Parkway, Rockville, MD 20852 All rights reserved. DSC Contents iii Contents USP Dietary Supplements Compendium Volume 1 Volume 2 Members . v. Preface . v Mission and Preface . 1 Dietary Supplements Admission Evaluations . 1. General Notices and Requirements . 9 USP Dietary Supplement Verification Program . .205 USP–NF General Chapters . 25 Dietary Supplements Regulatory USP–NF Dietary Supplement Monographs . -
021879Orig1s000
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 021879Orig1s000 OTHER REVIEW(S) 505(b)(2) ASSESSMENT Application Information NDA # 021879 NDA Supplement #: S- N/A Efficacy Supplement Type SE- N/A Proprietary Name: Nuedexta Established/Proper Name: (dextromethorphan/quinidine) Dosage Form: Capsules Strengths: dextromethorphan 20mg with quinidine 10 mg Applicant: Avanir Pharmaceuticals, Inc. Date of Receipt: April 30, 2010 PDUFA Goal Date: October 30, 2010 Action Goal Date (if different): Proposed Indication(s): indicated for the treatment of pseudobulbar affect (PBA) secondary to either amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) GENERAL INFORMATION 1) Is this application for a recombinant or biologically-derived product and/or protein or peptide product OR is the applicant relying on a recombinant or biologically-derived product and/or protein or peptide product to support approval of the proposed product? YES NO If “YES “contact the (b)(2) review staff in the Immediate Office, Office of New Drugs. ReferenceVersion ID: 2857112 March 2009 page 1 INFORMATION PROVIDED VIA RELIANCE (LISTED DRUG OR LITERATURE) 2) List the information essential to the approval of the proposed drug that is provided by reliance on our previous finding of safety and efficacy for a listed drug or by reliance on published literature. (If not clearly identified by the applicant, this information can usually be derived from annotated labeling.) Source of information* (e.g., Information provided (e.g., published literature, name of pharmacokinetic data, or specific referenced product) sections of labeling) quinidine sulfate nonclinical safety literature nonclinical safety *each source of information should be listed on separate rows 3) Reliance on information regarding another product (whether a previously approved product or from published literature) must be scientifically appropriate. -
Pharmaceuticals As Environmental Contaminants
PharmaceuticalsPharmaceuticals asas EnvironmentalEnvironmental Contaminants:Contaminants: anan OverviewOverview ofof thethe ScienceScience Christian G. Daughton, Ph.D. Chief, Environmental Chemistry Branch Environmental Sciences Division National Exposure Research Laboratory Office of Research and Development Environmental Protection Agency Las Vegas, Nevada 89119 [email protected] Office of Research and Development National Exposure Research Laboratory, Environmental Sciences Division, Las Vegas, Nevada Why and how do drugs contaminate the environment? What might it all mean? How do we prevent it? Office of Research and Development National Exposure Research Laboratory, Environmental Sciences Division, Las Vegas, Nevada This talk presents only a cursory overview of some of the many science issues surrounding the topic of pharmaceuticals as environmental contaminants Office of Research and Development National Exposure Research Laboratory, Environmental Sciences Division, Las Vegas, Nevada A Clarification We sometimes loosely (but incorrectly) refer to drugs, medicines, medications, or pharmaceuticals as being the substances that contaminant the environment. The actual environmental contaminants, however, are the active pharmaceutical ingredients – APIs. These terms are all often used interchangeably Office of Research and Development National Exposure Research Laboratory, Environmental Sciences Division, Las Vegas, Nevada Office of Research and Development Available: http://www.epa.gov/nerlesd1/chemistry/pharma/image/drawing.pdfNational -
ENLON-PLUS (Edrophonium Chloride, USP and Atropine Sulfate, USP) Injection
NDA 19-677/S-005 NDA 19-678/S-005 Page 3 ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection Rx only DESCRIPTION ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection, for intravenous use, is a sterile, nonpyrogenic, nondepolarizing neuromuscular relaxant antagonist. ENLON-PLUS is a combination drug containing a rapid acting acetylcholinesterase inhibitor, edrophonium chloride, and an anticholinergic, atropine sulfate. Chemically, edrophonium chloride is ethyl (m-hydroxyphenyl) dimethylammonium chloride; its structural formula is: Molecular Formula: C10H16ClNO Molecular Weight: 201.70 Chemically, atropine sulfate is: endo-(±)-alpha-(hydroxymethyl)-8-methyl-8-azabicyclo [3.2.1]oct-3-yl benzeneacetate sulfate (2:1) monohydrate. Its structural formula is: Molecular Formula: (C17H23NO3)2·H2SO4·H2O NDA 19-677/S-005 NDA 19-678/S-005 Page 4 Molecular Weight: 694.84 ENLON-PLUS contains in each mL of sterile solution: 5 mL Ampuls: 10 mg edrophonium chloride and 0.14 mg atropine sulfate compounded with 2.0 mg sodium sulfite as a preservative and buffered with sodium citrate and citric acid. The pH range is 4.0- 5.0. 15 mL Multidose Vials: 10 mg edrophonium chloride and 0.14 mg atropine sulfate compounded with 2.0 mg sodium sulfite and 4.5 mg phenol as a preservative and buffered with sodium citrate and citric acid. The pH range is 4.0-5.0. CLINICAL PHARMACOLOGY Pharmacodynamics ENLON-PLUS (edrophonium chloride, USP and atropine sulfate, USP) Injection is a combination of an anticholinesterase agent, which antagonizes the action of nondepolarizing neuromuscular blocking drugs, and a parasympatholytic (anticholinergic) drug, which prevents the muscarinic effects caused by inhibition of acetylcholine breakdown by the anticholinesterase. -
Integrated Approach for Identifying the Molecular, Cellular, and Host Responses to Chemical Insults
Integrated Approach for Identifying the Molecular, Cellular, and Host Responses to Chemical Insults Audrey E. Fischer, Emily P. English, Julia B. Patrone, Kathlyn Santos, Jody B. G. Proescher, Rachel S. Quizon, Kelly A. Van Houten, Robert S. Pilato, Eric J. Van Gieson, and Lucy M. Carruth e performed a pilot study to characterize the molecular, cellular, and whole-organism response to nonlethal chemical agent exposure in the central nervous system. Multiple methodologies were applied to measure in vitro enzyme inhibition, neuronal cell pathway signaling, and in vivo zebrafish neural development in response to challenge with two different classes of chemical compounds. While all compounds tested exhibited expected enzyme inhibitory activity against acetylcholinesterase (AChE), a well-characterized target of chemical agents, distinct differences between chemical exposures were detected in cellular toxicity and pathway target responses and were tested in a zebrafish model. Some of these differences have not been detected using conventional chemical toxicity screening methods. Taken together, the data demonstrate the potential value of an integrated, multimethodological approach for improved target and pathway identification for subsequent diagnostic and therapeutic biomarker development. INTRODUCTION To build capability and leverage new and growing cell models to complete living organisms. Regardless of biology and chemistry expertise at APL, a collabora- the model selected, challenges exist in sample collection, tive, cross-departmental effort was established through a dose determination, and biases inherent in each assay/ series of related independent research and development technology. Therefore, multiple experimental methodol- (IR&D) projects. The focus of this effort was on mitiga- ogies brought to bear on a particular biological question tion of chemical and biological threat agents. -
Carey Nat Pope
CAREY NAT POPE College of Veterinary Medicine Oklahoma State University 264 McElroy Hall Stillwater, OK 74078 [email protected] (405)744-6257 (fax)744-4345 EDUCATION 1981-1985 University of Texas Graduate School of Biomedical Sciences, Houston, TX. Degree: Ph.D. (Pharmacology/Toxicology). 1977-1979 Stephen F. Austin State University, Nacogdoches, TX. Degree: M.S. (Biology). 1974-1976 Stephen F. Austin State University, Nacogdoches, TX. Degree: B.S. (Biology). 1971-1973 University of Houston, Houston, TX. EXPERIENCE 12/2015-present Adjunct Professor, Department of Biochemistry and Molecular Biology, Oklahoma State University, Stillwater, OK 10/2014-present Adjunct Professor, Department of Integrative Biology, Oklahoma State University, Stillwater, OK 3/2013-present Director, Graduate Certificate Program in Interdisciplinary Toxicology, Oklahoma State University, Stillwater, OK. 6/2012-present Director, Interdisciplinary Toxicology Program, Oklahoma State University, Stillwater, OK. 7/1/2006-1/31/2012 Head, Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK. 8/1/2005-6/30/06 Interim Head, Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK. 1/2000-present Professor and Sitlington Endowed Chair in Toxicology, Department of Physiological Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK. 8/95-12/99 Director, Division of Toxicology, College of Pharmacy and Health Sciences, University of Louisiana at Monroe, Monroe, LA. Division included five full-time tenured or tenure-track members and one instructor and was responsible for implementing B.S., M.S. and Ph.D. degree programs in Toxicology. 12/93-12/99 Director, B.S. Toxicology Program, College of Pharmacy and Health Sciences, University of Louisiana at Monroe, Monroe, LA. -
Pyridostigmine Bromide Tablets, USP 8249401/0420 Rx Only
PYRIDOSTIGMINE BROMIDE- pyridostigmine bromide tablet American Health Packaging ---------- Pyridostigmine Bromide Tablets, USP 8249401/0420 Rx only DESCRIPTION Pyridostigmine bromide is an orally active cholinesterase inhibitor. Chemically, pyridostigmine bromide is 3-hydroxy-1-methylpyridinium bromide dimethylcarbamate. Its structural formula is: Pyridostigmine bromide tablets USP is available as a 60 mg tablet for oral administration. The tablet contains the following inactive ingredients: colloidal silicon dioxide, lactose anhydrous, magnesium stearate and stearic acid. CLINICAL PHARMACOLOGY Pyridostigmine bromide inhibits the destruction of acetylcholine by cholinesterase and thereby permits freer transmission of nerve impulses across the neuromuscular junction. Pyridostigmine is an analog of neostigmine (Prostigmin ®), but differs from it in certain clinically significant respects; for example, pyridostigmine is characterized by a longer duration of action and fewer gastrointestinal side effects. INDICATIONS AND USAGE Pyridostigmine bromide tablets are useful in the treatment of myasthenia gravis. CONTRAINDICATIONS Pyridostigmine bromide is contraindicated in mechanical intestinal or urinary obstruction, and particular caution should be used in its administration to patients with bronchial asthma. Care should be observed in the use of atropine for counteracting side effects, as discussed below. WARNINGS Although failure of patients to show clinical improvement may reflect underdosage, it can also be indicative of overdosage. As is true of all cholinergic drugs, overdosage of pyridostigmine bromide may result in cholinergic crisis, a state characterized by increasing muscle weakness which, through involvement of the muscles of respiration, may lead to death. Myasthenic crisis due to an increase in the severity of the disease is also accompanied by extreme muscle weakness, and thus may be difficult to distinguish from cholinergic crisis on a symptomatic basis. -
Mytelase (Ambenonium Chloride) Tablets Label
NDA 010155/S-022 NDA 010155/ S-023 FDA Approved Labeling Text dated 11/10/2011 Page 1 MYTELASE® AMBENONIUM CHLORIDE DESCRIPTION MYTELASE, brand of ambenonium chloride, is [Oxalylbis (iminoethylene)] bis[(o chlorobenzyl) diethylammonium] dichloride, a white crystalline powder, soluble in water to 20 percent (w/v). Inactive Ingredients: Acacia, Dibasic Calcium Phosphate, Gelatin, Lactose, Magnesium Stearate, Starch, Sucrose. CLINICAL PHARMACOLOGY The compound is a cholinesterase inhibitor with all the pharmacologic actions of acetylcholine, both the muscarinic and nicotinic types. Cholinesterase inactivates acetylcholine. Like neostigmine, MYTELASE suppresses cholinesterase but has the advantage of longer duration of action and fewer side effects on the gastrointestinal tract. The longer duration of action also results in more even strength, better endurance, and greater residual effect during the night and on awakening than is produced by shorter-acting anticholinesterase compounds. INDICATION AND USAGE This drug is indicated for the treatment of myasthenia gravis. CONTRAINDICATIONS Routine administration of atropine with MYTELASE is contraindicated since belladonna derivatives may suppress the parasympathomimetic (muscarinic) symptoms of excessive gastrointestinal stimulation, leaving only the more serious symptoms of fasciculation and paralysis of voluntary muscles as signs of overdosage. MYTELASE should not be administered to patients receiving mecamylamine, or any other ganglionic blocking agents. MYTELASE should also not be administered to patients with a known hypersensitivity to ambenonium chloride or any other ingredients of MYTELASE. WARNINGS Because this drug has a more prolonged action than other antimyasthenic drugs, simultaneous administration with other cholinergics is contraindicated except under strict medical supervision. The overlap in duration of action of several drugs complicates dosage schedules.