Current Drug Therapy - Volume 7, Issue 3, 2012

Psychosis in Parkinson Disease (PDP) is a common clinical problem and presents a pharmacological therapeutic conundrum. Many patients with PDP require anti-parkinsonian drugs for motor control, but the use of these medications has been associated with worsening of the psychotic symptoms. Differences from other psychotic disorders include the association with the use of anti-parkinsonian drugs, and the common presentation with visual hallucinations. Understanding of the pathophysiology of this phenomenon in PD has grown over the last few decades with the realization that the dopaminergic system is not the sole player. This has led to pharmacological research beyond antipsychotics. In this article we review the general management of PDP, the available evidence for the pharmacological management of PDP, and the medications profile and safety. Useful tables, practical recommendations and treatment algorithm are proposed.

Introduction: Many patients with Parkinson's disease (PD) require hospitalization for medical or surgical problems other than motor features of PD, and are often admitted to non-neurological wards. Objectives: To assess the prevalence of inappropriate antidopaminergic drug use (prescription and administration) among PD inpatients. Other objectives were to study an association between chronic antidopaminergic prescription and the prevalence of inappropriate drug use in PD inpatients and to assess omission of chronic anti-PD treatment during admission. Methods: Patients with PD admitted to a small acute care hospital with no Neurology ward from January 2009 to August 2011 were identified through hospital discharge data. Medical notes, nursing notes, and drug charts were reviewed retrospectively. Results: 73 admissions from 47 patients were included in the study. Prevalence of inappropriate antidopaminergic prescription was 43,8 %. Antipsychotics (mainly haloperidol) were prescribed in 24 admissions and administered in 11. Metoclopramide was prescribed in 17 admissions and administered in 9. 14/73 admissions were on chronic antipsychotics; mostly on quetiapine. Chronic domperidone was prescribed in 9/73 admissions. Chronic antipsychotic use was positively associated with inappropriate antipsychotic administration: OR= 8,1 CI 95% (2,0-32,85). Chronic anti-PD prescription was omitted in 12/73 admissions. Conclusion: Although not always administered, inappropriate antidopaminergic drugs were very frequently prescribed in PD inpatients. Patients on chronic antipsychotics had an 8 fold risk increase of inappropriate antipsychotic administration. Chronic antiemetic treatment was correct in most of the cases, and domperidone was frequent in the outpatient setting. Omission of anti-PD medication was quite frequent. Protocols and health care professionals' education would be helpful to improve the care of PD inpatients.

With the present scenario of development of newer drug delivery systems, correspondingly various routes are also being explored for systemic or local drug delivery to the patients. In the same context, nasal drug delivery is serving as a very effective route for the delivery of therapeutically active compounds. In such drug delivery system, drugs having lower absorption rate can be administered with the use of absorption enhancers through thin nasal mucosal layer. Similarly, drug residence time in the nasal cavity can also be increased by using various synthetic and natural polymers. Some mucoadhesive polymers have been reported to serve both of the above functions. The present review deals in depth with, nasal physiology and factors affecting drugs permeability which special reference to biological and pharmaceutical considerations. Structural features and various nasal delivery systems have also been discussed. Furthermore, applications of various natural polymers for the delivery of small organic molecules, antibiotics, proteins, vaccines and DNA through the nasal route have been extensively reviewed.

Metallo β lactamase (MTLs) are a subtype of enzymes causing resistance to carbapenems which are reported in many countries all over the world. This is of great concern as carbapenems are the most potent agents in treating multidrug resistance Enterobacteriaceae. The aim of this study was detection of metallo β lactamase producing Enterobacteriaceae from patients and associated risk factors with resistance in Sanandaj hospitals, Iran. This study was a case control project. A case patient was defined as a patient who had an isolate of resistance Enterobacteriaceae producing MTLs and the control patient was the one who carried sensitive Enterobacteriaceae strains against carbapenems. The presence of MTLs was determined by double disk diffusion assay with a disk of imipenem and the other one being imipenem and EDTA. The potential risk factors for resistance trait were checked with patients' history and current situations. Data were analyzed statistically by SPSS software. The main risk factors for acquisition of MTLs were found to be history of antibiotic use in the last two weeks [OR 4.959 CI95% (2.370-10.374)], immunosuppression [OR 7.328, CI95% (3.517-15.266)] , ICU hospitalization [OR2,618 CI95% (1.450-4.451)] and Imipenem sensitivity [OR 0.000 CI95% (0.000-0.001)]. This date address the factors that influence the resistance transmission such as ICU hospitalization and should be consider in infections controlling programs especially in hospitals.

Transdermal delivery offers opportunities for inventive, challenging and valuable research with patient benefits. However, the prominent challenge in designing transdermal drug delivery systems is to overcome the natural transport barrier of the skin, the stratum corneum. Several physical and chemical enhancement techniques have been investigated in the last decade to breach the skin barrier and assist the transport of macromolecules across skin. Recent technological advances in this field include novel combination strategies of penetration enhancement techniques, microneedle array designs, needle-free technologies, nanocarriers, metered dose and microstructured transdermal systems. The present review reports on recent advances in physical approaches towards enhanced transdermal penetration. Enhancement strategies comprehensively covered in this review emphasize the significant achievements gained through successful transdermal delivery of hydrophilic macromolecules, vaccines, proteins, peptides, oligonucleotides, fluorescent dyes and plasmid delivery. Some commercially available technologies for transdermal delivery have also been covered. These novel technologies hold immense potential to advance further into clinical practice and enable better therapeutic applications and prophylactic interventions for various diseases.

Rheumatoid arthritis is a chronic auto-immune disease that is characterized by both localized and systemic inflammation of internal organs and joints. Elevated plasma concentrations of pro-inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1b (IL-1b), tumor necrosis factor- α (TNF-α), and acute phase proteins, are responsible for both localized and systemic inflammation. Rheumatoid arthritis is a disease which is affecting 1-1.5% of the population worldwide and females are more affected than male, with a ratio of 2:1. Rheumatoid arthritis symmetrically affect both side of joints i.e., interphalangeal joints such as the proximal interphalangeal, metacarpophalangeal, and metatarsophalangeal joints of the hands and feet as well as the wrist and ankle. There are number of drugs molecules available for treatment of rheumatoid arthritis which have limited efficiency with serious side effects. After the development of targeted drug delivery system, the panic of adverse effects and toxicity has been reduced for other nontarget body organs. Furthermore, the efficiency of drugs towards target site has also increased. With this review our group tried to discuss various novel strategies available for the treatment of autoimmune disease i.e., rheumatoid arthritis.

The treatment of depression in older people needs an integrated approach with pharmacological and psychosocial approaches working together. Within secondary mental health services there are patients with severe depression who are often at a significant risk. There is evidence to suggest the older antidepressants are over prescribed to the elderly in primary care and there are gaps in the assessment information recorded. This study aimed to identify if the same issues were present in secondary care. This study was a retrospective case note survey of 181 patients aged 65 and over referred to a secondary mental health service with depression. Eligible patient's case notes were surveyed in pairs and data was recorded on data collection forms using electronic records and paper case notes to ensure the data was comprehensive. Older people treated for their current episode of depression are seven times more likely to receive the newer classes of antidepressants (SSRI, SNRI and NASSA) than in their previous depressive episodes (odds ratio 7.27 95% CI: 3.78 - 13.98; p<0.001). NICE recommends SSRIs as they are less likely to be discontinued due to side effects. However, for all antidepressants prescribed there was no information recorded about side effects for 75%, or treatment response for 37%. Other significant missing information included severity and duration of depression, exercise, alcohol, smoking, nonpharmacological interventions and BMI. Comprehensive assessment and clear recording are needed. Further research could repeat this survey in other services to see how far the results can be generalised.

Liposomal hydrogel as a wound dressing provides a barrier that effectively prevents the contamination of the wound and further progression of infection to deeper tissues. The drug encapsulated within the liposomes increases the drug concentration locally and decreases systemic drug concentration and hydrogels combine the features of moist wound healing with good fluid absorbance. And act as a barrier against bacteria, oxygen permeability, it is easy to handle, hence it is useful as a moist wound dressing material. Besides hydrogels by nature of transparency promote monitoring of wound healing.