Pharmacist Cognitive Service and Pharmaceutical Care: Today and Tomorrow Outlook

 

Mauro LUISETTO1*, Francesca CARINI1, Giovanni BOLOGNA1, Behzad Nili-Ahmadabadi2

1Hospital Pharmacists Manager, Dipartimento Farmaceutico, Azienda USL Piacenza, ITALY 

2Nano Drug Delivery, Chapel Hill, NC, USA 

Abstract

The aim of this work was to ask more use of clinical pharmacists in medical team .The application of pharmaceutical care principle in practice settings can improve clinical outcomes, reducing therapy errors and containment cost. An opportunity to use pharmacist’s expertise in assisting physician’s drug and medical devices specialists. Isn’t time for the medical community to get aid of the clinical pharmacists to work side by side and assist the physicians, in order to give a better care, protect and safeguard patients. The rationale of this focus article was to invite pharmacists to take a much more active role and to help physicians using their expertise in order to complete the therapeutic work in a more rational way. Pharmacists need to get out of their private stores, sharing their expertise and knowledge, by making active presence in the very infrastructure of clinical centers, such as hospitals and ambulatory.Physicians alone cannot cover every aspect of the  pharmacological treatment,  for example in the field of  drug therapy  monitoring, interactions, adverse drug reaction (ADR), toxicology, novel delivery systems, immunoglobuline-based therapeutics and other innovative drugs   and medical devices systems, which have their pharmaceutical specific worlds.

For over 80 years the only role`s pharmacists played were compounding and consulting for over the counter drugs. By the year 2025, the innovative polymer and nano drug delivery systems, genomes, immunoglobuline-based therapeutics and stem cells and other innovation will add or substitute to the ordinary local, enteral, or parenteral dosage forms. That era is now rapidly changing, and the all nations  pharmacists need to come out of their convenient type of stores to the aid of the physicians in their actual duties, taking role in that missing  rescuing the patients which in many occasions, their health and even lives can be  at risk (Drug  allergy  undetected ).

Observing some actual university courses of clinical pharmacy in different countries and some old and new studies involving clinical pharmacists taking part of wards’ medical teams, we have noticed that the pharmaceutical care service given by a pharmacist has an undeniable positive impact on, and improves  the clinical outcome in the pharmacological therapies (Pharmaceutical treatments, on therapeutic levels).

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Phytochemical Screening and Antibacterial Activity of Ethanol Extract of Leaves and Twigs of Azadirachta indica A. Juss

 

Ravi K*, Bharavi K, Ravi Kumar P, Vamsi Krishna B 

Department of veterinary pharmacology and toxicology NTR College of Veterinary Science, Gannavaram, Andhrapradesh, India – 521102

Abstract

Azadiracheta indica A. Juss commonly known as Neem belongs to family Meliaceae. Each part of A. indica has been used extensively for various ailments. In the present study A. indica leaves and twigs were shade dried and made into powder. This powdered material was subjected for extraction using ethanol (10gm powder in 100ml ethanol). Ethanol extracts (EE) of leaves and twigs were qualitatively screened for the presence of phytochemicals viz. alkaloids, flavonoids, saponins, tannins, polyphenols and steroids. The in vitro antibacterial potential of ethanol extract of leaves and twigs against methicillin sensitive Staphylococcus aureus MSSA (ATCC 25923) and E. Coli (ATCC 25922) was evaluated by determining minimal inhibitory concentration (MIC).   Ethanol extract of A. indica leaves showed favorable MIC values than the ethanol extract of twigs against MSSA whereas against E. coli both the MIC values are comparable. In conclusion, both ethanol extracts of A. indica leaves and twigs were found to have potent antibacterial activity against MSSA and E. Coli.

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 A Review of Polymorphism and the Amorphous State in the Formulation Strategy of Medicines and Marketed Drugs

 

Mahmoud Omar*, Patrick Makary* and Michal Wlodarski 

University College London, School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX

Abstract

The different sold physical form of a medicine can affect its formulation and biological activity greatly. For such reasons, modern pharmaceuticals need to pass through extensive solid-state   evaluation. Within the recent year, pharmaceutical research became more and more aware with different solid-state as amorphous form, polymorphic salts and co crystals.  This review is the short outline for the different solid states giving specific examples for different marketed pharmaceutical products that had to pass through solid-state perforation.

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aPTT: 1st Recognition for Human Whole Blood on QCM-D Platform

 

Munawar Hussain*

Biosensor Research Group, Institute of Clinical and Experimental Transfusion Medicine and Centre of Clinical Transfusion Medicine (ZKT), Tuebingen University and German Red Cross Blood Transfusion Service BW/H, 72072, Germany

Abstract

Activated partial thromboplastin time (aPTT) assay for whole blood on quartz crystal microbalance with dissipation (QCM-D) platform has been recognized for the first time. QCM-D platform is studied in parallel with ‘gold standard’ mechanical coagulometer in the perspective of anticoagulant bio-sensing. In this report, the lowest sample volume application of 1.66 µL of human whole blood for aPTT has been demonstrated. Mechanical coagulomter uses 60 times higher whole blood (and each reagent) volume application of 100 µL for aPTT laboratory experiments. This study is important in the terms of its robustness due to direct whole blood method and its cost-effectiveness due to lowest sample (and reagents) volume application. This could be fundamental support for spot test application by employing QCM-D in laboratory and sergry. Anticoagulant doses in 20 blood samples have been measured on QCM-D platform in comparison to ‘gold standard’. Each technique yielded relative standard deviation values between 7 and 15 depending on different doses of anticoagulant. Furthermore, QCM-D technique is advantageous over `gold standard’ for additional monitoring of the whole kinetics of coagulation. It displays total coagulation recognition from frequency and dissipation shifts, which is impossible on `gold standard’.

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Design and In-Vitro Evaluation of Colon Targeted Prednisolone Solid Dispersion Tablets

 

Sura Zuhair Mahmood Alkazzaz*, Wedad Kamal Ali

Department of Pharmaceutics, College of Pharmacy, University of Al-Mustansiriya, Baghdad-Iraq

Abstract

In the present investigation an attempt was made to prepare colon targeted enteric coated tablet containing different prednisolone solid dispersion formulations, to prevent ulcerative colitis, improve the patient compliance and reduce the side effects of drug in the gastro intestinal tract (GIT). Solid dispersion is one of the most widely used approaches to enhance the solubility as well as dissolution rate of poorly water soluble drugs. Solid dispersions (SDs) of Prednisolone with D-mannitol, PEG 4000 and Kollicoat IR were prepared and evaluated to deliver Prednisolone to the colon in a pre-solubilized form. The selected formula using drug compatible excipients was compressed into fast disintegrating tablets and then coated with Eudragit S100 (pH-responsive polymer),  several variables related to both solid dispersion preparation (carrier type and drug to the carrier ratio) and tablet coating (coat level) were studied to show their effects on drug solubility and dissolution. Different analytical techniques like differential scanning caloremitry (DSC), powder x-ray diffraction (PXRD) and scanning electron microscopy (SEM) were studied to prove the change of drug particle from crystal to amorphous form in SDs. The 1:3 Prednisolone/Kollicoat IR SDs showed the greatest improvement in the dissolution rate. The coating level was critical for determining the duration of the lag phase. Best result was given by the 16% coat (Eudragit S100/ Dibutyl phthalate/ talc). This coating level showed an acceptable lag time for the proposed colonic targeting (5 h) as the selected tablet resisted pre-colonic pH values, followed by an immediate release stage in pH 7.4. The suggested covered (coated) tablets may provide a colonic delivery system for prednisolone with enhanced solubility and bioavailability.

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`Argatroban` Monitoring in Human Plasma: aPTT and PiCT Studies on QCM-D vs `Gold Standard`

 

Munawar Hussain*

Biosensor Research Group, Institute of Clinical and Experimental Transfusion Medicine and Centre of Clinical Transfusion Medicine (ZKT), Tuebingen University and German Red Cross Blood Transfusion Service BW/H, 72072, Germany

Abstract

Low-molecular weight heparins (LMWHs) are used as effective and safe alternative anticoagulants to unfractionated heparin (UFH) in surgery. Argatroban is an important example of such kind of anticoagulant and is the most-used   anticoagulant in surgery after UFH. This is first report of comparative study of argatroban on quartz crystal microbalance with dissipation (QCM-D) platform via activated partial thromboplastin time (aPTT) and prothrombinase induced clotting test (PiCT). The QCM-D platform has been comparatively studied with ‘gold standard’ (i.e. mechanical coagulometer). Human plasma samples of healthy donors (n=20) spiked with different doses of argatroban were subjected to these measurements. QCM-D yields information of aPTT or PiCT and total coagulation points from frequency and dissipation signals. Overall PiCT data yielded lower variability as compare to that of aPTT. QCM-D platform provides the additional advantage of cost-effectiveness in the perspectives of the lowest sample (and reagent) volume consumption of 1.66 µL.

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A Straightforward Detection of HIT Type II via QCM-D

 

Munawar Hussain*, Frank K. Gehring, Stefan Sinn, Hinnak Northoff

Biosensor Research Group, Institute of Clinical and Experimental Transfusion Medicine and Centre of Clinical Transfusion Medicine (ZKT), Tuebingen University and German Red Cross Blood Transfusion Service BW/H, 72072, Germany 

Abstract

Abstract

Heparin Induced Thrombocytopenia (HIT) is an undesired antibody based immune reaction against complexes of platelet factor 4 and heparin. HIT occurs in patients receiving heparin as anticoagulant over several days and is connected to the risk of life threatening thrombosis through intravasal platelet aggregation. HIT antibodies are routinely detected by Enzyme Linked Immunosorbent Assay (ELISA). However, not all antibodies lead to platelet aggregation and therefore, to clinical problems. The clinical relevance of a HIT ELISA positive serum can be confirmed by functional tests for platelet activation, like the heparin induced platelet activation (HIPA) test. However, these tests are tedious and cumbersome. Therefore, we present a straightforward approach by applying quartz crystal microbalance technology for functional assays for diagnosis of HIT type II. We utilized the qCell T (quartz crystal microbalance with dissipation (QCM-D)) platform of 3T analytik, Tuttlingen, Germany to demonstrate platelet aggregation measurements induced by clinically relevant HIT positive type II sera of patients. During the measurements changes in frequency and dissipation were recorded. This revealed statistically significant differences between high and low dose measurements in both, PRP and washed platelets. Platelet adhesion to the sensor surfaces was visualized by scanning electron microscopy (SEM). QCM-D data was in good accordance to SEM images. The results presented here promising that in the future specially adapted QCM-D sensors could be a serious straight forward alternative to currently used functional HIT assays.

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Design and Evaluation of Floating Microspheres of Pantoprazole Sodium

 

Behin Sundara Raj1*, Jigar Pancholi2, Punitha Isaac Samraj3

1School of Pharmacy, Curtin University, Bentley, Perth, Western Australia – 6102
2Department of Pharmaceutics, Shree Devi college of Pharmacy, Airport Road, Kenjar, Mangalore, Karnataka, India – 574 142
3Department of Pharmacognosy, Shree Devi college of Pharmacy, Airport Road, Kenjar, Mangalore, Karnataka, India – 574 142

Abstract

In the present study, an attempt was made to prepare floating microspheres of Pantoprazole sodium by a non-aqueous solvent evaporation method. The half-life of Pantoprazole sodium is 1-1.5 hours and rapidly eliminated from the body. It is in a perfect world suited to be conveyed through floating multiunit measurements structure. Biocompatible polymers, Eudragit S100 and HPMC K 100M were utilized alongside the medication as a part of diverse extents. The prepared six formulations (F1-F6) were characterized for their drug polymer compatibility (IR study), micromeritic properties, particle size, percentage yield, scanning electron microscopy, buoyancy studies, drug encapsulation efficiency and in vitro drug release studies. The formulated microspheres were free flowing. The optical microscopic studies revealed that the particles were of the size range of 193.29-517.16 μm. SEM studies indicated that the microspheres were porous and almost spherical in shape. The prepared floating microspheres were found to produce the percentage yield of 84.43-91.93%, drug encapsulation efficiency was 65.83-90.03% and buoyancy percentage was 61.7-78.46%. In-vitro drug release studies showed cumulative percentage drug release between 69.27-79.06%. The information acquired in this study recommends that a micro particulate floating dose type of Pantoprazole sodium can be effectively intended to give delayed arrival of medication and thus enhanced bioavailability.

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Prothrombin Time (PT) for Human Plasma on QCM-D Platform: A Better Alternative to `Gold Standard`

 

Munawar Hussain

Biosensor Research Group, Institute of Clinical and Experimental Transfusion Medicine and Centre of Clinical Transfusion Medicine (ZKT), Tuebingen University and German Red Cross Blood Transfusion Service BW/H-72072, Germany

Abstract

Measurements of hemostasis parameters such as Prothrombin time (PT) are substantial in various clinical cases of extensive surgery, dialysis or innate hemostasis disorders. This is the first study of recognition of PT assay for human plasma on quartz crystal microbalance with dissipation (QCM-D) platform. QCM-D technique has been compared in parallel with ‘gold standard’ mechanical coagulometer in the terms of anticoagulant monitoring in 20 plasma samples. In this report the shortest sample volume consumption of 2.66 µl of human plasma for PT has been demonstrated on QCM-D platform. This also demonstrates the shortest reagent (thromborel) volume consumption employed ever for PT. `Gold standard` employs 38 folds higher plasma as well as reagent volume consumption. Additionally, QCM-D technique proved superior to `gold standard’ for monitoring of the whole process of plasma coagulation kinetics. It yielded total coagulation information from frequency and dissipation shifts, which are impossible on `gold standard’. Furthermore, QCM-D platform offers the calculation of fibrinogen concentration along with PT and total coagulation monitoring in single set of measurements. Fibrinogen concentration can be calculated from calibration curves having R2 values of 0.99. This is promising support for Point of Care (POC) settings in the perspective that it covers the extreme range of fibrinogen from 1.0 to 6 g/L. PT based QCM-D platform for plasma application proved better alternative to that of `gold standard` and it paves the path towards routine laboratory method.

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