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Seminars in Dialysis Sep 2022HDF prescription should be able to satisfy the delivery of an optimal dialytic convective dose. Several factors are implicated in this endeavor. High blood flow rate is...
HDF prescription should be able to satisfy the delivery of an optimal dialytic convective dose. Several factors are implicated in this endeavor. High blood flow rate is crucial to warranty processing an adequate blood volume and to ensure the highest shear rate per fiber needed to cleanse and prevent membrane fouling. A highly permeable dialyzer is needed with a surface area aligned to blood flow and performance needs. Anticoagulation requires specific adaptation in case of low molecular weight heparin use. By default, HDF prescription modality should ideally start by postdilution mode with a stepwise increment of convective dose by probing patient tolerance and efficacy. Alternative substitution modality should be considered if dialytic convective dose could not be achieved in the usual time frame. Convective dose prescription relies either on a manual mode (pressure control or volume control) or on automated mode (ultrafiltration control) depending on the technical options of the HDF machines. Dialysate flow rate is regulated by the HDF machine but should preferably keep constant dialysis fluid flowing the dialyzer with a Qb:Qd ratio of 1.4. Treatment time should not be reduced with HDF prescription. Treatment time should fit with patient tolerance (hemodynamic, osmotic, and solute shifts) and overall solute removal efficiency. Electrolytic prescription does not require specific adjustments as compared with conventional dialysis, but the patient needs to be monitored regularly and dialysate electrolyte adjusted to lab tests. A stepwise approach for implementing ol-HDF is preferable depending on the initial condition of the patient. Three particular cases may be considered: late-stage chronic kidney disease patient transitioning to renal replacement therapy, stable dialysis patient switching to HDF, and unstable or fragile patient or specific treatment schedule. Optimal dosing of HDF and personalized care to ensure treatment adequacy is the main goal for renal replacement therapy to improve patient outcomes. That should be ensured with HDF treatment.
Topics: Anticoagulants; Dialysis Solutions; Hemodiafiltration; Heparin, Low-Molecular-Weight; Humans; Kidney Failure, Chronic; Prescriptions; Renal Dialysis
PubMed: 35297521
DOI: 10.1111/sdi.13070 -
Optometry and Vision Science : Official... Oct 2022The dewetting process of contact lenses (CLs) is a result of material and solution properties as well as environmental factors. This article describes an investigational...
SIGNIFICANCE
The dewetting process of contact lenses (CLs) is a result of material and solution properties as well as environmental factors. This article describes an investigational approach to observe and describe dewetting characteristics of different CL material and solution combinations.
PURPOSE
This study aimed to determine the in vitro dewetting characteristics of various daily disposable CLs that were assessed using a noninvasive keratograph dewetting procedure (noninvasive keratograph dry-up time). In vitro dewetting data of the same CL materials soaked in saline solution and artificial tear solution (ATS) were measured to determine additional dewetting characteristics.
METHODS
Noninvasive keratograph dry-up time was measured for six different soft CL materials and three different test conditions, in their specific blister solution, after exposure to saline and an ATS. Twenty CLs of each solution/material combination were assessed after an 8-hour soaking, during a 180-second dewetting observation, and the results were expressed by area under the curve values.
RESULTS
Fastest dewetting occurred for all materials when measured out of saline, indicated by the highest averaged area under the curve value of 9243.3 ± 38.3 over all lens materials. Slower dewetting was detected for all materials when measured out of their specific blister solution (7755.9 ± 37.1) and out of ATS (7988.8 ± 40.0). Intragroup results were statistically significantly different for all solutions showing the smallest differences within the ATS group ( P < .001, Kruskal-Wallis test).
CONCLUSIONS
A pure saline thin film is not an ideal representation of a complex tear film layer of a healthy human because it lacks any evaporative protection by a lipid layer. The use of an ATS, which more likely mimics the natural tear film, allowed in this experimental in vitro project to decrease the gap to the in vivo field. In vitro dewetting information in connection with the blister solution allows only a theoretical conclusion about the initial lens wear after lens insertion.
Topics: Blister; Contact Lenses, Hydrophilic; Humans; Lipids; Lubricant Eye Drops; Saline Solution; Tears
PubMed: 36095059
DOI: 10.1097/OPX.0000000000001939 -
Molecular Aspects of Medicine Oct 2023Glaucoma is one of the leading causes of irreversible blindness. Progression is halted with a reduction in intraocular pressure (IOP), which is most often achieved with... (Review)
Review
Glaucoma is one of the leading causes of irreversible blindness. Progression is halted with a reduction in intraocular pressure (IOP), which is most often achieved with eye drops. A major challenge in the topical treatment of glaucoma patients is the many side effects and the resulting reduced adherence. Side effects may of course be due to the molecular properties of the active pharmaceutical ingredients (APIs). There are currently six different APIs available: prostaglandin analogues, β-adrenergic inhibitors, α-adrenergic agonists, carbonic anhydrase inhibitors, rho-kinase inhibitors and muscarinic 3 agonists. But the additives used in eye drops are also known to cause damage to the ocular surface and to some extent also to the deeper tissues. Said additives are considered inactive molecular components and are added to secure for instance viscosity and pH value, and to prevent contamination. There has been an increasing focus on the harmful effects of preservatives, with the most commonly used preservative benzalkonium chloride (BAK) being particularly controversial. BAK has long been recognized as a toxin that increases the risk of ocular discomfort. This can affect the adherence and ultimately result in lack of disease control. Other issues include the addition of certain buffers, such as phosphates, and varying pH values. This review will address the different molecular components of the IOP-lowering eye drops and what to be aware of when prescribing topical glaucoma treatment.
Topics: Humans; Glaucoma; Intraocular Pressure; Eye; Preservatives, Pharmaceutical; Ophthalmic Solutions
PubMed: 37459821
DOI: 10.1016/j.mam.2023.101195 -
European Journal of Pharmaceutics and... Jun 2023Both stability and compatibility of parenteral nutrition solutions (PNS) with drug products are major concerns for clinicians and clinical pharmacists, especially when... (Review)
Review
Both stability and compatibility of parenteral nutrition solutions (PNS) with drug products are major concerns for clinicians and clinical pharmacists, especially when concurrent administration of PNS with intravenous medications (IVM) is unavoidable. Since the same physicochemical principles apply to both adult's and paediatrics' PNS, concerns about stability and compatibility may still apply to both. However, these concerns are relatively more common in paediatrics and neonatal clinical settings, where limited vascular access can be problematic and the coadministration of PNS and drugs is more common. In neonatal and paediatric populations, there have been few experimental studies and comprehensive evaluations looking at medication compatibility with frequently used PNS. This work is part of a larger research project concerned for compatibility of PNS with commonly used intravenous medication in paediatric and neonates. This paper captures and reviews published data on factors influencing stability and compatibility of parenteral nutrition solutions. This information will help clinicians and clinical pharmacists to understand the principals of the stability and compatibility of PNS, furthermore, it will inform better design of future compatibility studies, as it highlights the complexity of PNS and the multiple factors influencing the stability of PNS, and hence its compatibility with IVM. When preparing, prescribing, and administering the PNS, especially when co-administration with IVM is unavoidable, it is important to take into account the physicochemical properties of the PNS components and IVM as well as administration conditions and environmental factors. These factors should also be considered in the design of the compatibility studies of the PNS with the IVM.
Topics: Infant, Newborn; Humans; Child; Parenteral Nutrition Solutions; Pharmaceutical Preparations; Drug Stability
PubMed: 37061100
DOI: 10.1016/j.ejpb.2023.04.002 -
Drugs Apr 2024Perfluorohexyloctane ophthalmic solution (Miebo) is a single-entity, water-, steroid- and preservative-free, first-in-class semifluorinated alkane that is approved in... (Review)
Review
Perfluorohexyloctane ophthalmic solution (Miebo) is a single-entity, water-, steroid- and preservative-free, first-in-class semifluorinated alkane that is approved in the USA for the treatment of the signs and symptoms of dry eye disease (DED). DED is often linked with meibomian gland dysfunction (MGD), which causes an excessive evaporation of tears. Perfluorohexyloctane ophthalmic solution stabilizes the lipid layer of the tear film and inhibits tear evaporation by forming a monolayer at the air-liquid interface. In the phase III GOBI and MOJAVE trials in adults with DED associated with MGD, one drop of perfluorohexyloctane ophthalmic solution instilled in each eye four times daily over 8 weeks resulted in statistically significant and clinically meaningful improvements in the signs and symptoms of DED compared with hypotonic saline (0.6%). The agent was generally well tolerated, with most ocular adverse events being mild or moderate in severity. The efficacy and tolerability of perfluorohexyloctane ophthalmic solution was sustained for up to 52 weeks in an extension study (KALAHARI). As the first and currently the only prescription treatment approved in the USA directly addressing the pathophysiology of excessive tear evaporation, perfluorohexyloctane ophthalmic solution is a valuable emerging option for the management of DED.
Topics: Humans; Ophthalmic Solutions; Fluorocarbons; Dry Eye Syndromes
PubMed: 38554243
DOI: 10.1007/s40265-024-02016-5 -
Annals of Allergy, Asthma & Immunology... Jun 2020Sublingual immunotherapy (SLIT) is administered via tablets (SLIT-T) or liquid drops (SLIT-D). In North America, currently 4 SLIT-T formulations are approved by the US... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sublingual immunotherapy (SLIT) is administered via tablets (SLIT-T) or liquid drops (SLIT-D). In North America, currently 4 SLIT-T formulations are approved by the US Food and Drug Administration for allergy immunotherapy, and SLIT-D is an off-label use of subcutaneous immunotherapy (SCIT) extracts.
OBJECTIVE
To compare and contrast aspects of SLIT-T and SLIT-D, including physical characteristics, mechanism of action, dosing, efficacy, safety, adherence, and cost.
DATA SOURCES
PubMed literature review (no limits), product prescribing information, and manufacturer websites.
STUDY SELECTIONS
Publications related to physical characteristics, mechanism of action, dosing, efficacy, safety, and adherence.
RESULTS
Published evidence indicates that tablet and drop formulations differ in regard to physical characteristics, dosing, and strength of evidence for efficacy. Whether there are any differences in absorption and mechanism of action between the 2 formulations is currently unknown. Optimal dosing, efficacy, and safety have been established for SLIT-T. In contrast, in North America there is little support for efficacy of SLIT-D from randomized double-blind, placebo-controlled trials, and dose ranges have not been appropriately evaluated. SLIT-T treats a single allergen, whereas in the United States SLIT-D often contains multiple allergens to treat polysensitization. The safety profiles of SLIT-T and SLIT-D appear similar, and both formulations are considered safer than SCIT.
CONCLUSION
Professional guidelines should make a clear distinction between SLIT-T and SLIT-D in their recommendations to minimize confusion with the umbrella term SLIT.
Topics: Allergens; Health Care Costs; Humans; Medication Adherence; Pharmaceutical Solutions; Sublingual Immunotherapy; Tablets
PubMed: 31923544
DOI: 10.1016/j.anai.2019.12.025 -
Experimental Eye Research May 2022The eye is an isolated and complex organ, with multiple robust anatomical and physiological barriers on the ocular surface which protect it from noxious insults such as... (Review)
Review
The eye is an isolated and complex organ, with multiple robust anatomical and physiological barriers on the ocular surface which protect it from noxious insults such as the blink reflex, tear film and corneoscleral tissue layers. However, these also make it difficult for drugs to reach their therapeutic target within the eye, resulting in very low bioavailability in most commercially available ophthalmic drugs. This review will detail the mechanisms present on the ocular surface which impede drug delivery and give an overview of traditional eye drop formulations, as well as methods of improving their bioavailability through viscosity and permeation enhancement. We also review the evidence for more novel technologies, such as nanoparticles, in-situ gels, blood products, and alternatives to eye drops such as drug loaded contact lenses and ocular inserts.
Topics: Biological Availability; Drug Delivery Systems; Eye; Nanoparticles; Ophthalmic Solutions
PubMed: 35248559
DOI: 10.1016/j.exer.2022.109006 -
Current Drug Delivery 2023The current article mainly highlights mucoadhesive drug delivery with merits like the prolonged holding time at the action site and also provides a controlled rate of... (Review)
Review
The current article mainly highlights mucoadhesive drug delivery with merits like the prolonged holding time at the action site and also provides a controlled rate of drug release for improved therapeutic outcomes. Moreover, mucosal delivery can eliminate problems of the conventional oral route, such as first pass metabolism as well as acid degradation. However, the eye has unique anatomy and physiology that can cause hindrance and challenges in comparison to the other organs of the body. Additionally, conventional delivery vehicles like solutions, suspensions, and ointments have many demerits such as rapid precorneal clearance, subject variability, drainage, and uncontrolled release from the dosage form. Therefore, novel pharmaceutical ophthalmic formulations like gels, nanosuspensions, nano-particles, liposomes, microemulsions, iontophoretic dosage forms, and ocuserts were tried and tested in the past few years for ophthalmic delivery. These novel delivery products provide enhanced solubility and bioavailability in a controlled manner to overcome conventional demerits. Here in this review, we have summarized the improvement of drug studies that are currently underway for eye drug carriers, along with stages and important aspects of novel drug delivery to the eye.
Topics: Drug Delivery Systems; Eye; Drug Carriers; Liposomes; Biological Availability; Ophthalmic Solutions; Administration, Ophthalmic
PubMed: 36221885
DOI: 10.2174/1567201819666221010122413 -
European Journal of Pharmaceutical... Apr 2021Hydroxypropyl methylcellulose (HPMC) is a cellulose ether widely used in drug formulations due to its biocompatibility, uncharged nature, solubility in water and... (Review)
Review
Hydroxypropyl methylcellulose (HPMC) is a cellulose ether widely used in drug formulations due to its biocompatibility, uncharged nature, solubility in water and thermoplastic behavior. Particularly for ocular and ophthalmic formulations, HPMC is applied as viscosity enhancer agent in eye drops, gelling agent in injections, and polymeric matrix in films, filaments and inserts. The different therapeutic approaches are necessary due to the complex anatomic structure of the eye. The natural ocular barriers and the low drug permeation into the circulatory system make the drug administration challenging. This review presents the eye anatomy and the usual local routes of drugs administration, which are facilitated by the physicochemical properties of HPMC. The relationship between chemical structure and physicochemical properties of HPMC is displayed. The different types of formulations (local application) including HPMC for ocular drug delivery are discussed with basis on recent literature reports and patents.
Topics: Drug Delivery Systems; Eye; Hypromellose Derivatives; Methylcellulose; Ophthalmic Solutions; Solubility; Viscosity
PubMed: 33516807
DOI: 10.1016/j.ejps.2021.105736 -
Clinical Journal of the American... Aug 2022
Topics: Charcoal; Dialysis Solutions; Humans; Renal Dialysis; Uremia
PubMed: 35835517
DOI: 10.2215/CJN.06860622