Current Drug Therapy (v.7, #3)

Pharmacological Management of Psychosis in Parkinson Disease: A Review by Danish Bhatti, Diego Torres-Russotto (151-163).
Psychosis in Parkinson Disease (PDP) is a common clinical problem and presents a pharmacologicaltherapeutic conundrum. Many patients with PDP require anti-parkinsonian drugs for motor control, but the use of thesemedications has been associated with worsening of the psychotic symptoms. Differences from other psychotic disordersinclude 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 realizationthat the dopaminergic system is not the sole player. This has led to pharmacological research beyond antipsychotics. Inthis article we review the general management of PDP, the available evidence for the pharmacological management ofPDP, and the medications profile and safety. Useful tables, practical recommendations and treatment algorithm areproposed.

Inappropriate Antidopaminergic Drug Use in Parkinson’s Disease Inpatients by Saioa Domingo-Echaburu, Unax Lertxundi, Elena Gonzalo-Olazabal, Javier Peral-Aguirregoitia, Inaki Pena-Bandres (164-169).
Introduction: Many patients with Parkinson&#8217;s disease (PD) require hospitalization for medical or surgicalproblems other than motor features of PD, and are often admitted to non-neurological wards.</P><P>Objectives: To assess the prevalence of inappropriate antidopaminergic drug use (prescription and administration) amongPD inpatients. Other objectives were to study an association between chronic antidopaminergic prescription and theprevalence of inappropriate drug use in PD inpatients and to assess omission of chronic anti-PD treatment duringadmission.</P><P>Methods: Patients with PD admitted to a small acute care hospital with no Neurology ward from January 2009 to August2011 were identified through hospital discharge data. Medical notes, nursing notes, and drug charts were reviewedretrospectively.</P><P>Results: 73 admissions from 47 patients were included in the study. Prevalence of inappropriate antidopaminergicprescription was 43,8 &#37;. 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 chronicantipsychotics; mostly on quetiapine. Chronic domperidone was prescribed in 9/73 admissions. Chronic antipsychotic usewas positively associated with inappropriate antipsychotic administration: OR&#61; 8,1 CI 95&#37; (2,0-32,85). Chronic anti-PDprescription was omitted in 12/73 admissions.</P><P>Conclusion: Although not always administered, inappropriate antidopaminergic drugs were very frequently prescribed inPD 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&#8217; education would be helpfulto improve the care of PD inpatients.

Recent Advances in Nasal Drug Delivery Using Natural Polymers by Nirmala Prajapati, Pranati Srivastava, Shilpi Bhargava (170-178).
With the present scenario of development of newer drug delivery systems, correspondingly various routes arealso being explored for systemic or local drug delivery to the patients. In the same context, nasal drug delivery is servingas a very effective route for the delivery of therapeutically active compounds. In such drug delivery system, drugs havinglower 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 depthwith, nasal physiology and factors affecting drugs permeability which special reference to biological and pharmaceuticalconsiderations. Structural features and various nasal delivery systems have also been discussed. Furthermore, applicationsof various natural polymers for the delivery of small organic molecules, antibiotics, proteins, vaccines and DNA throughthe nasal route have been extensively reviewed.

Metallo &#946; lactamase (MTLs) are a subtype of enzymes causing resistance to carbapenems which are reported inmany countries all over the world. This is of great concern as carbapenems are the most potent agents in treatingmultidrug resistance Enterobacteriaceae. The aim of this study was detection of metallo &#946; lactamase producingEnterobacteriaceae from patients and associated risk factors with resistance in Sanandaj hospitals, Iran. This study was acase control project. A case patient was defined as a patient who had an isolate of resistance Enterobacteriaceae producingMTLs and the control patient was the one who carried sensitive Enterobacteriaceae strains against carbapenems. Thepresence of MTLs was determined by double disk diffusion assay with a disk of imipenem and the other one beingimipenem and EDTA. The potential risk factors for resistance trait were checked with patients&#8217; history and currentsituations. Data were analyzed statistically by SPSS software. The main risk factors for acquisition of MTLs were foundto be history of antibiotic use in the last two weeks [OR 4.959 CI95&#37; (2.370-10.374)], immunosuppression [OR 7.328,CI95&#37; (3.517-15.266)] , ICU hospitalization [OR2,618 CI95&#37; (1.450-4.451)] and Imipenem sensitivity [OR 0.000CI95&#37; (0.000-0.001)]. This date address the factors that influence the resistance transmission such as ICU hospitalizationand should be consider in infections controlling programs especially in hospitals.

Transdermal delivery offers opportunities for inventive, challenging and valuable research with patientbenefits. However, the prominent challenge in designing transdermal drug delivery systems is to overcome the naturaltransport barrier of the skin, the stratum corneum. Several physical and chemical enhancement techniques have beeninvestigated in the last decade to breach the skin barrier and assist the transport of macromolecules across skin. Recenttechnological 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 throughsuccessful transdermal delivery of hydrophilic macromolecules, vaccines, proteins, peptides, oligonucleotides, fluorescentdyes 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 therapeuticapplications and prophylactic interventions for various diseases.

Emerging Therapeutic Strategies for Rheumatoid Arthritis by Kavita Gajbhiye, Devendra Soni, Vandana Soni (198-206).
Rheumatoid arthritis is a chronic auto-immune disease that is characterized by both localized and systemicinflammation of internal organs and joints. Elevated plasma concentrations of pro-inflammatory cytokines, such asinterleukin-6 (IL-6), interleukin-1b (IL-1b), tumor necrosis factor- ? (TNF-?), and acute phase proteins, are responsiblefor both localized and systemic inflammation. Rheumatoid arthritis is a disease which is affecting 1-1.5% of thepopulation worldwide and females are more affected than male, with a ratio of 2:1. Rheumatoid arthritis symmetricallyaffect both side of joints i.e., interphalangeal joints such as the proximal interphalangeal, metacarpophalangeal, andmetatarsophalangeal joints of the hands and feet as well as the wrist and ankle. There are number of drugs moleculesavailable for treatment of rheumatoid arthritis which have limited efficiency with serious side effects. After thedevelopment of targeted drug delivery system, the panic of adverse effects and toxicity has been reduced for other nontargetbody organs. Furthermore, the efficiency of drugs towards target site has also increased. With this review our grouptried to discuss various novel strategies available for the treatment of autoimmune disease i.e., rheumatoid arthritis.

Assessment and Treatment of Older People with Depression in a Secondary Mental Health Trust by Stephen Curran, Rebecca Spencer, Sonja Kruger, Andrew Byrne, Vijayalakshmi Saravanan, Bo Wynn (207-211).
The treatment of depression in older people needs an integrated approach with pharmacological and psychosocialapproaches working together. Within secondary mental health services there are patients with severe depressionwho are often at a significant risk. There is evidence to suggest the older antidepressants are over prescribed to the elderlyin primary care and there are gaps in the assessment information recorded. This study aimed to identify if the same issueswere present in secondary care.</P><P>This study was a retrospective case note survey of 181 patients aged 65 and over referred to a secondary mental healthservice with depression. Eligible patient&#8217;s case notes were surveyed in pairs and data was recorded on data collectionforms using electronic records and paper case notes to ensure the data was comprehensive.</P><P>Older people treated for their current episode of depression are seven times more likely to receive the newer classes ofantidepressants (SSRI, SNRI and NASSA) than in their previous depressive episodes (odds ratio 7.27 95&#37; CI: 3.78 -13.98; p&#60;0.001). NICE recommends SSRIs as they are less likely to be discontinued due to side effects. However, for allantidepressants prescribed there was no information recorded about side effects for 75&#37;, or treatment response for 37&#37;.Other significant missing information included severity and duration of depression, exercise, alcohol, smoking, nonpharmacologicalinterventions and BMI. Comprehensive assessment and clear recording are needed. Further researchcould repeat this survey in other services to see how far the results can be generalised.

Liposomal Hydrogels: A Novel Drug Delivery System for Wound Dressing by Shailesh Thirumaleshwar, Parthasarthi Kulkarni, Devegowda Gowda (212-218).
Liposomal hydrogel as a wound dressing provides a barrier that effectively prevents the contamination of thewound and further progression of infection to deeper tissues. The drug encapsulated within the liposomes increases thedrug concentration locally and decreases systemic drug concentration and hydrogels combine the features of moist woundhealing with good fluid absorbance. And act as a barrier against bacteria, oxygen permeability, it is easy to handle, henceit is useful as a moist wound dressing material. Besides hydrogels by nature of transparency promote monitoring of woundhealing.