1.
Pharmacology
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More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals, the two main areas of pharmacology are pharmacodynamics and pharmacokinetics. The former studies the effects of the drug on biological systems, Pharmacology is not synonymous with pharmacy and the two terms are frequently confused. In either field, the primary contrast between the two are their distinctions between direct-patient care, for practice, and the science-oriented research field, driven by pharmacology. Clinical pharmacology owes much of its foundation to the work of William Withering, Pharmacology as a scientific discipline did not further advance until the mid-19th century amid the great biomedical resurgence of that period. The first pharmacology department was set up by Rudolf Buchheim in 1847, in recognition of the need to understand how therapeutic drugs, early pharmacologists focused on natural substances, mainly plant extracts. Pharmacology developed in the 19th century as a science that applied the principles of scientific experimentation to therapeutic contexts. The discipline of pharmacology can be divided into many sub disciplines each with a specific focus, neuropharmacology is the study of the effects of medication on central and peripheral nervous system functioning. This is similar to the closely related ethnopharmacology, psychopharmacology is an interdisciplinary field which studies behavioral effects of psychoactive drugs. Another goal of behavioral pharmacology is to develop animal behavioral models to screen chemical compounds with therapeutic potentials, study of drugs which affect behavior. Ethopharmacology is a term which has been in use since the 1960s and derives from the Greek word ethos meaning character and pharmacology the study of drug actions, cardiovascular pharmacology is the study of the effects of drugs on the entire cardiovascular system, including the heart and blood vessels. Pharmacogenetics is clinical testing of genetic variation that gives rise to differing response to drugs, pharmacogenomics is the application of genomic technologies to drug discovery and further characterization of older drugs. Pharmacoepidemiology is the study of the effects of drugs in large numbers of people, systems pharmacology is the application of systems biology principles to the field of pharmacology. Toxicology is the study of the effects, molecular targets. Theoretical pharmacologists aim at rationalizing the relation between the activity of a drug, as observed experimentally, and its structural features as derived from computer experiments. They aim to find structure—activity relations, more ambitiously, it aims to predict entirely new classes of drugs, tailor-made for specific purposes. Posology is the study of how medicines are dosed and this depends upon various factors including age, climate, weight, sex, elimination rate of drug, genetic polymorphism and time of administration. It is derived from the Greek words posos meaning how much, environmental pharmacology is a new discipline
2.
Toxicology
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Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms. It also studies the effects of chemical, biological and physical agents in biological systems that establishes the extent of damage in living organisms. The relationship between dose and its effects on the organism is of high significance in toxicology. Factors that influence chemical toxicity include the dosage, the route of exposure, dioscorides, a Greek physician in the court of the Roman emperor Nero, made the first attempt to classify plants according to their toxic and therapeutic effect. Ibn Wahshiyya wrote the Book on Poisons in the 9th or 10th century and this was followed up in 1360 by Khagendra Mani Darpana. Mathieu Orfila is considered the father of toxicology, having given the subject its first formal treatment in 1813 in his Traité des poisons. In 1850, Jean Stas became the first person to isolate plant poisons from human tissue. Theophrastus Phillipus Auroleus Bombastus von Hohenheim is also considered the father of toxicology and this is often condensed to, The dose makes the poison or in Latin Sola dosis facit venenum. The goal of toxicity assessment is to identify effects of a substance. Adverse effects depend on two factors, i) routes of exposure and ii) dose. To explore dose, substances are tested in both acute and chronic models, generally, different sets of experiments are conducted to determine whether a substance causes cancer and to examine other forms of toxicity. Factors that influence chemical toxicity, Dosage Both large single exposures, the classic experimental tool of toxicology is testing on non-human animals. As of 2014, such animal testing provides information that is not available by other means about how substances function in a living organism, while testing in animal models remains as a method of estimating human effects, there are both ethical and technical concerns with animal testing. This work requires expert knowledge in molecular modeling and statistics together with expert judgment in chemistry, pivotal events in science include the discovery of penicillin, the elucidation of the DNA double helix, and the development of computers. Toxicity testing is approaching such a scientific pivot point. It is poised to take advantage of the revolutions in biology and biotechnology, as of 2010 that vision was still unrealized. As of 2014 that vision was still unrealized, in some cases shifts away from animal studies has been mandated by law or regulation, the European Union prohibited use of animal testing for cosmetics in 2013. Most chemicals display a dose response curve – at a low dose. A few chemicals have no well-defined safe level of exposure and these are treated with special care
3.
Medication
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A pharmaceutical drug is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy is an important part of the field and relies on the science of pharmacology for continual advancement. Drugs are classified in various ways, one of the key divisions is by level of control, which distinguishes prescription drugs from over-the-counter drugs. Other ways to classify medicines are by mode of action, route of administration, biological system affected, an elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System. The World Health Organization keeps a list of essential medicines, Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies, academic scientists, and governments. Governments generally regulate what drugs can be marketed, how drugs are marketed, controversies have arisen over drug pricing and disposal of used drugs. In the US, a drug is, A substance recognized by an official pharmacopoeia or formulary, a substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease. A substance intended to affect the structure or any function of the body, a substance intended for use as a component of a medicine but not a device or a component, part or accessory of a device. Pharmaceutical or a drug is classified on the basis of their origin, Drug from natural origin, Herbal or plant or mineral origin, some drug substances are of marine origin. Drug from chemical as well as origin, Derived from partial herbal and partial chemical synthesis Chemical. Drug derived from animal origin, For example, hormones, Drug derived from microbial origin, Antibiotics Drug derived by biotechnology genetic-engineering, hybridoma technique for example Drug derived from radioactive substances. An elaborate and widely used system is the Anatomical Therapeutic Chemical Classification System. The World Health Organization keeps a list of essential medicines, the main classes of painkillers are NSAIDs, opioids and Local anesthetics. For consciousness Some anesthetics include Benzodiazepines and Barbiturates, the main categories of drugs for musculoskeletal disorders are, NSAIDs, muscle relaxants, neuromuscular drugs, and anticholinesterases. Euthanasia is not permitted by law in countries, and consequently medicines will not be licensed for this use in those countries. Administration is the process by which a patient takes a medicine, there are three major categories of drug administration, enteral, parenteral, and other. It can be performed in various forms such as pills, tablets. There are many variations in the routes of administration, including intravenous and they can be administered all at once as a bolus, at frequent intervals or continuously
4.
Intravenous therapy
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Intravenous therapy is the infusion of liquid substances directly into a vein. Intravenous infusions are commonly referred to as drips, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Intravenous therapy may be used for administration, to correct electrolyte imbalances, to deliver medications. IVs can be categorized by type of vein the tube inserted, called the catheter. A peripheral IV is used on peripheral veins and this is the most common type of IV therapy used. Central IV lines have their catheters that are advanced through a vein and empty into a central vein, usually the superior vena cava. Other advantages are that because it empties near the heart, medications can also be distributed to the rest of the body. As there is room for multiple parallel compartments within the catheter, caregivers can also measure central venous pressure and other physiological variables through the line. They are also longer, which as reflected in Poiseuilles law, requires higher pressure to achieve the same flow, central IV lines carry risks of bleeding, infection, gangrene, thromboembolism and gas embolism. Surrounding structures such as the pleura and carotid artery are also at risk of damage with the potential for pneumothorax or even cannulation of the artery. There are several types of central IVs, depending on the route that the catheter takes from the outside of the body to the vein, typical uses for a PICC include, long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition. This is usually done by measuring the distance to a landmark, such as the suprasternal notch. An X-ray must be used to verify that the tip is in the place when fluoroscopy was not used during the insertion. A PICC may have a tube and connector, two or three compartments, each with its own external connector. Power-injectable PICCs are now available as well, from the outside, a single-lumen PICC resembles a peripheral IV, except that the tubing is slightly wider. The insertion site requires better protection than that of a peripheral IV, however, a PICC poses less of a systemic infection risk than other central IVs, because the insertion site is usually cooler and dryer than the sites typically used for other central lines. This helps to slow the growth of bacteria which could reach the bloodstream by traveling under the skin along the outside of the catheter, although special training is required, a PICC does not require the skill level of a physician or surgeon. It is also externally unobtrusive, and with proper hygiene and care can be left in place for months to years if needed for patients who require extended treatment, also, as a PICC travels through the axilla, it can become kinked, causing poor function
5.
Topical medication
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A topical medication is a medication that is applied to a particular place on or in the body, as opposed to systemically. Most often this means application to surfaces such as the skin or mucous membranes to treat ailments via a large range of classes including creams, foams, gels, lotions. Many topical medications are epicutaneous, meaning that they are applied directly to the skin, as a route of administration, the topical route is contrasted with the enteral route, the intravenous route, and others. A topical effect, in the sense, may refer to a local, rather than systemic. However, many topically administered drugs have effects, because they reach the circulation after being absorbed by the tissues. Topical medications differ from other types of drugs because mishandling them can lead to certain complications in a patient or administrator of the drug. Some hydrophobic chemicals, such as hormones, can be absorbed into the body after being applied to the skin in the form of a cream, gel. Transdermal patches have become a means of administering some drugs for birth control, hormone replacement therapy. One example of an antibiotic that may be applied topically is chloramphenicol, a medications potency often is changed with its base. For example, some topical steroids will be classified one or two strengths higher when moving from cream to ointment, as a rule of thumb, an ointment base is more occlusive and will drive the medication into the skin more rapidly than a solution or cream base. The manufacturer of each product has total control over the content of the base of a medication. Although containing the active ingredients, one manufacturers cream might be more acidic than the next. For example, a formulation of miconazole antifungal cream might irritate the skin less than an athlete foot formulation of miconazole cream. These variations can, on occasion, result in different clinical outcomes, no comparative potency labeling exists to ensure equal efficacy between brands of topical steroids. Studies have confirmed that the potency of some topical steroid products may differ according to manufacturer or brand, however, in a simple base like an ointment, much less variation between manufacturers is common. In dermatology, the base of a medication is often as important as the medication itself. It is extremely important to receive a medication in the correct base, a pharmacist should not substitute an ointment for a cream, or vice versa, as the potency of the medication can change. As a result, what the manufacturers marketing department chooses to list on the label of a medication might be completely different from what the form would normally be called
6.
Pharmacokinetics
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Pharmacokinetics, sometimes abbreviated as PK, is a branch of pharmacology dedicated to determining the fate of substances administered to a living organism. The substances of interest include any chemical xenobiotic such as, pharmaceutical drugs, pesticides, food additives, cosmetic ingredients, etc. It attempts to analyze chemical metabolism and to discover the fate of a chemical from the moment that it is administered up to the point at which it is eliminated from the body. Pharmacokinetics is the study of how an organism affects a drug, both together influence dosing, benefit, and adverse effects, as seen in PK/PD models. Pharmacokinetic properties of chemicals are affected by the route of administration and these may affect the absorption rate. Models have been developed to simplify conceptualization of the processes that take place in the interaction between an organism and a chemical substance. The various compartments that the model is divided into are commonly referred to as the ADME scheme, absorption - the process of a substance entering the blood circulation. Distribution - the dispersion or dissemination of substances throughout the fluids, metabolism – the recognition by the organism that a foreign substance is present and the irreversible transformation of parent compounds into daughter metabolites. Excretion - the removal of the substances from the body, in rare cases, some drugs irreversibly accumulate in body tissue. The two phases of metabolism and excretion can also be grouped together under the title elimination, the study of these distinct phases involves the use and manipulation of basic concepts in order to understand the process dynamics. All these concepts can be represented through mathematical formulas that have a graphical representation. The model outputs for a drug can be used in industry or in the application of pharmacokinetic concepts. Clinical pharmacokinetics provides many performance guidelines for effective and efficient use of drugs for human-health professionals, in practice, it is generally considered that steady state is reached when a time of 4 to 5 times the half-life for a drug after regular dosing is started. Noncompartmental methods estimate the exposure to a drug by estimating the area under the curve of a concentration-time graph, compartmental methods estimate the concentration-time graph using kinetic models. Noncompartmental methods are more versatile in that they do not assume any specific compartmental model. The final outcome of the transformations that a drug undergoes in an organism, a number of functional models have been developed in order to simplify the study of pharmacokinetics. These models are based on a consideration of an organism as a number of related compartments, the simplest idea is to think of an organism as only one homogenous compartment. However, these models do not always reflect the real situation within an organism
7.
Pharmacodynamics
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Pharmacodynamics is the study of the biochemical and physiologic effects of drugs. The effects can include those manifested within animals, microorganisms, or combinations of organisms, Pharmacodynamics is the study of how a drug affects an organism, whereas pharmacokinetics is the study of how the organism affects the drug. Both together influence dosing, benefit, and adverse effects, Pharmacodynamics is sometimes abbreviated as PD and pharmacokinetics as PK, especially in combined reference. Pharmacodynamics places particular emphasis on relationships, that is, the relationships between drug concentration and effect. One dominant example is drug-receptor interactions as modeled by L + R ⇌ L ⋅ R where L, R, and LR represent ligand, receptor and this equation represents a simplified model of reaction dynamics that can be studied mathematically through tools such as free energy maps. Antacids and chelating agents combine chemically in the body, the widest class of drugs act as ligands which bind to receptors which determine cellular effects. Upon drug binding, receptors can elicit their normal action, blocked action, in principle, a pharmacologist would aim for a target plasma concentration of the drug for a desired level of response. In reality, there are factors affecting this goal. Pharmacokinetic factors determine peak concentrations, and concentrations cannot be maintained with absolute consistency because of metabolic breakdown, genetic factors may exist which would alter metabolism or drug action itself, and a patients immediate status may also affect indicated dosage. The duration of action of a drug is the length of time that particular drug is effective, the binding of ligands to receptors is governed by the law of mass action which relates the large-scale status to the rate of numerous molecular processes. The rates of formation and un-formation can be used to determine the concentration of bound receptors. The equilibrium dissociation constant is defined by, L + R ↔ L ⋅ R K d = where L=ligand, R=receptor, the fraction of bound receptors is known as occupancy. The relationship between occupancy and pharmacological response is usually non-linear and this explains the so-called receptor reserve phenomenon i. e. the concentration producing 50% occupancy is typically higher than the concentration producing 50% of maximum response. The simplest interpretation of receptor reserve is that it is a model that states there are excess receptors on the surface than what is necessary for full effect. Thus, the existence of receptor reserve depends on the agonist, tissue, as receptor reserve is very sensitive to agonist’s intrinsic efficacy, it is usually defined only for full agonists. Often the response is determined as a function of log to consider many orders of magnitude of concentration, however, there is no biological or physical theory which relates effects to the log of concentration. It is just convenient for graphing purposes and it is useful to note that 50% of the receptors are bound when =Kd. The graph shown represents the conc-response for two hypothetical receptor agonists, plotted in a semi-log fashion, the curve toward the left represents a higher potency since lower concentrations are needed for a given response
8.
Gastrointestinal tract
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Gastrointestinal is an adjective meaning of or pertaining to the stomach and intestines. A tract is a collection of related anatomic structures or a series of connected body organs, the mouth, oesophagus, stomach, and intestines are part of the human alimentary canal. All bilaterians have a gastrointestinal tract, also called a gut or an alimentary canal and this is a tube that transfers food to the organs of digestion. In large bilaterians, the gastrointestinal tract generally also has an exit, some small bilaterians have no anus and dispose of solid wastes by other means. The gastrointestinal tract contains thousands of different bacteria in their gut flora, the human gastrointestinal tract consists of the esophagus, stomach, and intestines, and is divided into the upper and lower gastrointestinal tracts. In contrast, the digestive system comprises the gastrointestinal tract plus the accessory organs of digestion. The tract may also be divided into foregut, midgut, and hindgut, the whole human GI tract is about nine metres long at autopsy. The GI tract releases hormones from enzymes to help regulate the digestive process, the structure and function can be described both as gross anatomy and as microscopic anatomy or histology. The tract itself is divided into upper and lower tracts, the upper gastrointestinal tract consists of the buccal cavity, pharynx, esophagus, stomach, and duodenum. The exact demarcation between the upper and lower tracts is the muscle of the duodenum. Upon dissection, the duodenum may appear to be an organ, but it is divided into four segments based upon function, location. The four segments of the duodenum are as follows, bulb, descending, horizontal, the suspensory muscle attaches the superior border of the ascending duodenum to the diaphragm. The suspensory muscle is an important anatomical landmark which shows the division between the duodenum and the jejunum, the first and second parts of the small intestine. This is a muscle which is derived from the embryonic mesoderm. The lower gastrointestinal tract includes most of the intestine and all of the large intestine. In humans, the intestine is further subdivided into the duodenum, jejunum and ileum while the large intestine is subdivided into the cecum, colon, rectum. The small intestine begins at the duodenum, which receives food from the stomach and it is a tubular structure, usually between 6 and 7 m long. The area of the human, adult small intestinal mucosa is about 30 m2 and its main function is to absorb the products of digestion into the bloodstream
9.
Mouth
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It is also the cavity lying at the upper end of the alimentary canal, bounded on the outside by the lips and inside by the pharynx and containing in higher vertebrates the tongue and teeth. This cavity is known as the buccal cavity, from the Latin bucca. Some animal phyla, including vertebrates, have a digestive system, with a mouth at one end. Which end forms first in ontogeny is a used to classify animals into protostome and deuterostome. In the first multicellular animals there was probably no mouth or gut, the particles became enclosed in vacuoles into which enzymes were secreted and digestion took place intracellularly. The digestive products were absorbed into the cytoplasm and diffused into other cells, the vast majority of other multicellular organisms have a mouth and a gut, the lining of which is continuous with the epithelial cells on the surface of the body. A few animals which live parasitically originally had guts but have secondarily lost these structures, the original gut of multicellular organisms probably consisted of a simple sac with a single opening, the mouth. Indigestible waste is ejected through the mouth, in animals at least as complex as an earthworm, the embryo forms a dent on one side, the blastopore, which deepens to become the archenteron, the first phase in the formation of the gut. In deuterostomes, the blastopore becomes the anus while the gut tunnels through to make another opening. In the protostomes, it used to be thought that the formed the mouth while the anus formed later as an opening made by the other end of the gut. More recent research, however, shows that in protostomes the edges of the slit-like blastopore close up in the middle, apart from sponges and placozoans, almost all animals have an internal gut cavity which is lined with gastrodermal cells. In less advanced invertebrates such as the sea anemone, the mouth also acts as an anus, circular muscles around the mouth are able to relax or contract in order to open or close it. A fringe of tentacles thrusts food into the cavity and it can gape widely enough to large prey items. Food passes first into a pharynx and digestion occurs extracellularly in the gastrovascular cavity, annelids have simple tube-like gets and the possession of an anus allows them to separate the digestion of their foodstuffs from the absorption of the nutrients. Many molluscs have a radula which is used to scrape microscopic particles off surfaces, in invertebrates with hard exoskeletons, various mouthparts may be involved in feeding behaviour. Insects have a range of mouthparts suited to their mode of feeding and these include mandibles, maxillae and labium and can be modified into suitable appendages for chewing, cutting, piercing, sponging and sucking. Decapods have six pairs of appendages, one pair of mandibles. Sea urchins have a set of five sharp calcareous plates which are used as jaws and are known as Aristotles lantern, in vertebrates, the first part of the digestive system is the buccal cavity, commonly known as the mouth
10.
Rectal administration
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A drug that is administered rectally will in general have a faster onset, higher bioavailability, shorter peak, and shorter duration than the oral route. Another advantage of administering a drug rectally, is that it tends to produce less nausea compared to the oral route, in addition, the rectal route bypasses around two thirds of the first-pass metabolism as the rectums venous drainage is two thirds systemic and one third hepatic portal system. This means the drug will reach the system with significantly less alteration. Finally, rectal administration can allow patients to remain in the setting when the oral route is compromised. Many oral forms of medications can be crushed and suspended in water to be given via a rectal catheter and this often includes patients near the end of life. Rectal administration of medication may be performed any of the following, A suppository. An enema, the act of introducing a liquid-drug solution into the rectum, a specialized catheter designed for rectal administration of medications and liquids, that can be placed safely and remain comfortably in the rectum for repeated use
11.
Enema
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Enema, also known as clyster, is a fluid injected into the lower bowel by way of the rectum. The most frequent use of an enema is to relieve constipation or for bowel cleansing before an examination or procedure. Enemas are used as part of some alternative health therapies and are used to administer drugs for recreational or religious reasons. Bowel management is achieved through a daily enema which empties the colon to prevent unwanted and uncontrolled bowel movements that day. As part of their bowel management regime, some also use laxatives. Enemas have been used around the time of childbirth however there is no evidence for this practice, in-home use of enemas for constipation and alternative health purposes is somewhat harder to measure. Bowel stimulating enemas usually consist of water, which works primarily as a mechanical stimulant, mineral oil functions as a lubricant and stool softener, but often has the side effect of sporadic seepage from the patients anus which can soil undergarments for up to 24 hours. Glycerol is a specific bowel mucosa irritant and when introduced in very dilute solution serves to induce peristalsis, other types of enema solutions are also used, including equal parts of milk and molasses heated together to slightly above normal body temperature. At the opposite end of the spectrum, a saline solution is least irritating to the rectum and colon. This neither draws electrolytes from the body – as can happen with plain water – nor draws water into the colon, thus, a salt water solution can be used when a longer period of retention is desired, such as to soften an impaction. Emptying the lower bowel prior to a surgical procedure such as colonoscopy, because of speed and supposed convenience, enemas used for bowel emptying are commonly the more costly, sodium phosphate variety – often called a disposable enema. In a lower gastrointestinal series an enema that may contain barium sulfate powder or a water-soluble contrast agent is used in the imaging of the bowel. Called a barium enema, such enemas are sometimes the only way to view the colon in a relatively safe manner. The administration of substances into the bloodstream and this may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetics given to reduce nausea. Additionally, several agents, which work better without digestion. The topical administration of medications into the rectum, such as corticosteroids, rectal corticosteroid enemas are sometimes used to treat mild or moderate ulcerative colitis. There have been a few cases in remote or rural settings, benefits include not needing to use sterile fluids. Improper administration of an enema can cause electrolyte imbalance or ruptures to the bowel or rectal tissues resulting in internal bleeding, however, these occurrences are rare in healthy, sober adults
12.
Tablet (pharmacy)
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A tablet is a pharmaceutical dosage form. Tablets may be defined as the solid unit dosage form of medicament or medicaments with or without suitable excipients and it comprises a mixture of active substances and excipients, usually in powder form, pressed or compacted from a powder into a solid dose. The compressed tablet is the most popular form in use today. About two-thirds of all prescriptions are dispensed as solid dosage forms, a tablet can be formulated to deliver an accurate dosage to a specific site, it is usually taken orally, but can be administered sublingually, buccally, rectally or intravaginally. The tablet is just one of the forms that an oral drug can take such as syrups, elixirs, suspensions. Medicinal tablets were made in the shape of a disk of whatever color their components determined. Tablets are often stamped with symbols, letters, and numbers, sizes of tablets to be swallowed range from a few millimeters to about a centimeter. Pills are thought to date back to around 1500 BC, earlier medical recipes, such as those from 4000 BC, were for liquid preparations rather than solids. The first references to pills were found on papyruses in ancient Egypt, medicinal ingredients, such as plant powders or spices, were mixed in and formed by hand to make little balls, or pills. In ancient Greece, such medicines were known as katapotia, and the Roman scholar Pliny, Pills have always been difficult to swallow and efforts long have been made to make them go down easier. In medieval times, people coated pills with slippery plant substances, another approach, used as recently as the 19th century, was to gild them in gold and silver, although this often meant that they would pass through the digestive tract with no effect. In the 1800s sugar-coating and gelatin-coating was invented, as were gelatin capsules, in 1843, the British painter and inventor William Brockedon was granted a patent for a machine capable of Shaping Pills, Lozenges and Black Lead by Pressure in Dies. The device was capable of compressing powder into a tablet without use of an adhesive, today, pills include tablets, capsules, and variants thereof like caplets—essentially anything with medication that can be digested, minus the liquid forms, colloquially falls into the pill category. A caplet is a smooth, coated, oval-shaped medicinal tablet in the shape of a capsule. Many caplets have a running down the middle so they may be split in half easier. An orally disintegrating tablet or orodispersible tablet, is a dosage form available for a limited range of over-the-counter. In the tablet-pressing process, it is important that all ingredients be fairly dry, powdered or granular, somewhat uniform in particle size, content uniformity ensures that the same API dose is delivered with each tablet. Some APIs may be tableted as pure substances, but this is rarely the case, normally, a pharmacologically inactive ingredient termed a binder is added to help hold the tablet together and give it strength
13.
Capsule (pharmacy)
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These are made in two halves, a lower-diameter body that is filled and then sealed using a higher-diameter cap. Soft-shelled capsules, primarily used for oils and for active ingredients that are dissolved or suspended in oil, both of these classes of capsules are made from aqueous solutions of gelling agents, such as animal protein or plant polysaccharides or their derivatives. Since their inception, capsules have been viewed by consumers as the most efficient method of taking medication, after the 1982 Tylenol tampering murders, capsules experienced a minor fall in popularity as tablets were seen as more resistant to tampering. In 1834, Mothes and Dublanc were granted a patent for a method to produce a single-piece gelatin capsule that was sealed with a drop of gelatin solution and they used individual iron moulds for their process, filling the capsules individually with a medicine dropper. Later on, methods were developed that used sets of plates with pockets to form the capsules, although some companies still use this method, the equipment is not produced commercially any more. All modern soft-gel encapsulation uses variations of a developed by R. P. Scherer in 1933. His innovation was to use a die to produce the capsules. This method reduced wastage, and was the first process to yield capsules with highly repeatable dosage, the current owner of Schrerer’s technology is Catalent Pharma Solutions, the worlds largest manufacturer of prescription pharmaceutical softgels. Softgels can be a delivery system for oral drugs, especially poorly soluble drugs. This is because the fill can contain ingredients that help increase solubility or permeability of the drug across the membranes in the body. Liquid ingredients are difficult to include in any other solid dosage form such as a tablet, in 1949, the Lederle Laboratories division of the American Cyanamid Company developed the Accogel process, allowing powders to be accurately filled into soft gelatin capsules. James Murdock of London patented the two-piece telescoping gelatin capsule in 1847, the capsules are made in two parts by dipping metal pins in the gelling agent solution. The capsules are supplied as closed units to the pharmaceutical manufacturer, before use, the two halves are separated, the capsule is filled with powder or more normally pellets made by the process of Extrusion & Spheronization and the other half of the capsule is pressed on. With the compressed slug method, weight varies less between capsules, however, the machinery required to manufacture them is more complex. The powder or spheroids inside the capsule contains the active ingredient and any excipients, such as binders, disintegrants, fillers, glidant, gelatin capsules, informally called gel caps or gelcaps, are composed of gelatin manufactured from the collagen of animal skin or bone. Vegetable capsules are composed of hypromellose, a polymer formulated from cellulose, the process of encapsulation of hard gelatin capsules can be done on manual, semi-automatic and automatic machines. Softgels are filled at the time as they are produced and sealed on the rotary die of a fully automatic machine. Capsule endoscopy OROS Pharmacy Automation - The Tablet Counter Pharmaceutical formulation Pill splitting L. Lachman, the Theory and Practice of Industrial Pharmacy
14.
Bioavailability
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By definition, when a medication is administered intravenously, its bioavailability is 100%. However, when a medication is administered via other routes, its bioavailability generally decreases or may vary from patient to patient, Bioavailability is one of the essential tools in pharmacokinetics, as bioavailability must be considered when calculating dosages for non-intravenous routes of administration. Bioavailability is defined differently for drugs as opposed to dietary supplements primarily due to the method of administration and Food. Bioaccessibility is a related to bioavailability in the context of biodegradation. A molecule is said to be bioaccessible when is available to cross a cellular membrane from the environment. In pharmacology, bioavailability is a measurement of the rate and extent to which a drug reaches at the site of action and it is denoted by the letter f. Therefore, bioavailability for dietary supplements can be defined as the proportion of the administered substance capable of being absorbed, in both pharmacology and nutrition sciences, bioavailability is measured by calculating the area under curve of the drug concentration time profile. Bioavailability is commonly a factor in the production of crops. Toxic materials in soil, such as lead from paint may be rendered unavailable to animals ingesting contaminated soil by supplying phosphorus fertilizers in excess and it is the fraction of the drug absorbed through non-intravenous administration compared with the corresponding intravenous administration of the same drug. The comparison must be normalized, consequently, the amount absorbed is corrected by dividing the corresponding dose administered. The absolute bioavailability is the area under curve non-intravenous divided by AUC intravenous. For example, the formula for calculating F for a drug administered by the route is given below. If we compare the two different dosage forms having same active ingredients and compare the two drug bioavailability is called comparative bioavailability, although knowing the true extent of systemic absorption is clearly useful, in practice it is not determined as frequently as one may think. The reason for this is that its assessment requires a reference, that is. These limitations may be overcome, however, by administering a low dose of an isotopically labelled drug concomitantly with a therapeutic non-labelled oral dose. This technique eliminates pharmacokinetic issues on non-equivalent clearance as well as enabling the intravenous dose to be administered with a minimum of toxicology, the technique was first applied using stable-isotopes such as 13C and mass-spectrometry to distinguish the isotopes by mass difference. More recently, 14C labelled drugs are administered intravenously and accelerator mass spectrometry used to measure the isotopically labelled drug along with mass spectrometry for the unlabelled drug, in all such cases, to conduct an absolute bioavailability study requires that the drug be given intravenously. Intravenous administration of a drug can provide valuable information on the fundamental pharmacokinetic parameters of volume of distribution
15.
Angiogenesis
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Angiogenesis is the physiological process through which new blood vessels form from pre-existing vessels. The first vessels in the embryo form through vasculogenesis, after which angiogenesis is responsible for most, if not all, blood vessel growth during development. Angiogenesis is a normal and vital process in growth and development, as well as in wound healing and in the formation of granulation tissue. However, it is also a step in the transition of tumors from a benign state to a malignant one. Sprouting angiogenesis was the first identified form of angiogenesis and it occurs in several well-characterized stages. First, biological signals known as growth factors activate receptors on endothelial cells present in pre-existing blood vessels. Second, the endothelial cells begin to release enzymes called proteases that degrade the basement membrane to allow endothelial cells to escape from the original vessel walls. The endothelial cells then proliferate into the matrix and form solid sprouts connecting neighboring vessels. As sprouts extend toward the source of the stimulus, endothelial cells migrate in tandem. These sprouts then form loops to become a full-fledged vessel lumen as cells migrate to the site of angiogenesis, sprouting occurs at a rate of several millimeters per day, and enables new vessels to grow across gaps in the vasculature. It is markedly different from splitting angiogenesis because it forms new vessels as opposed to splitting existing vessels. By intussusception, also known as splitting angiogenesis, a new vessel is created by splitting of an existing blood vessel in two. Intussusception was first observed in neonatal rats, in this type of vessel formation, the capillary wall extends into the lumen to split a single vessel in two. There are four phases of intussusceptive angiogenesis, first, the two opposing capillary walls establish a zone of contact. Second, the endothelial cell junctions are reorganized and the vessel bilayer is perforated to allow growth factors, third, a core is formed between the 2 new vessels at the zone of contact that is filled with pericytes and myofibroblasts. These cells begin laying collagen fibers into the core to provide a matrix for growth of the vessel lumen. Finally, the core is fleshed out with no alterations to the basic structure, intussusception is important because it is a reorganization of existing cells. It allows a vast increase in the number of capillaries without an increase in the number of endothelial cells
16.
Suppository
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A suppository is a solid dosage form that is inserted into the rectum, vagina or urethra, where it dissolves or melts and exerts local or systemic effects. Suppositories are used to deliver both systemically and locally acting medications, several different ingredients can be used to form the base of a suppository, cocoa butter or a similar substitute, polyethylene glycol, hydrogels and glycerinated gelatin. The type of material used depends on the type of suppository, the type of drug, in 1991, Abd-El-Maeboud and his colleagues conducted a study on suppository insertion in The Lancet, explaining that the torpedo shape helps the device to travel internally, increasing its efficacy. The findings of this study have been challenged as there is insufficient evidence on which to base clinical practice. Alprostadil pellets are urethral suppositories used for the treatment of erectile dysfunction. They are marketed under the name Muse in the United States and its use has diminished since the development of oral impotence medications. Artesunate suppositories Enema Pessary Doyle, D, per Rectum, A History of Enemata, Journal of the Royal College of Physicians of Edinburgh, Vol.35, No.4, pp. 367–370. How Medical Practice Reflects National Culture, The Sciences, Vol.30, No.4, pp. 38–42
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Hospice
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In Western society, the concept of hospice has been evolving in Europe since the 11th century. Outside the United States, the term tends to be primarily associated with the particular buildings or institutions that specialize in such care. Outside the United States such institutions may provide care mostly in an end-of-life setting. Hospice care also involves assistance for families to help them cope with what is happening and provide care. Although the movement has met some resistance, hospice has rapidly expanded through the United Kingdom. Etymologically, the word derives from the Latin hospes, a word which served double duty in referring both to guests and hosts. Historians believe the first hospices originated in the 11th century, around 1065, the rise of the Crusading movement in the 1090s saw the incurably ill permitted into places dedicated to treatment by Crusaders. In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill, Hospices flourished in the Middle Ages, but languished as religious orders became dispersed. They were revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul, France continued to see development in the hospice field, the hospice of LAssociation des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843. Six other hospices followed before 1900, meanwhile, hospices also developed in other areas. Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, four more hospices were established in London by 1905. Australia, too, saw active development, with notable hospices including the Home for Incurables in Adelaide, the Home of Peace. In 1899, New York City saw the opening of St. Roses Hospice by the Servants for Relief of Incurable Cancer, who soon expanded with six locations in other cities. The more influential early developers of Hospice included the Irish Religious Sisters of Charity and it became very busy, with as many as 20,000 people—primarily suffering tuberculosis and cancer—coming to the hospice to die between 1845 and 1945. The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in Melbourne, in 1905, they opened St Josephs Hospice in London. There in the 1950s Cicely Saunders developed many of the principles of modern hospice care. Dame Cicely Saunders was a British registered nurse whose chronic health problems had forced her to pursue a career in social work. After the refugees death, Saunders began volunteering at St Lukes Home for the Dying Poor, Saunders entered medical school while continuing her volunteer work at St. Josephs
18.
Anatomical terms of location
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Standard anatomical terms of location deal unambiguously with the anatomy of animals, including humans. All vertebrates have the basic body plan – they are strictly bilaterally symmetrical in early embryonic stages. That is, they have left and right halves if divided down the centre. For these reasons, the directional terms can be considered to be those used in vertebrates. By extension, the terms are used for many other organisms as well. While these terms are standardized within specific fields of biology, there are unavoidable, sometimes dramatic, for example, differences in terminology remain a problem that, to some extent, still separates the terminology of human anatomy from that used in the study of various other zoological categories. The vertebrates and Craniata share a heritage and common structure. To avoid ambiguities this terminology is based on the anatomy of each animal in a standard way, for humans, one type of vertebrate, anatomical terms may differ from other forms of vertebrates. Thus what is on top of a human is the head, whereas the top of a dog may be its back, for example, many species are not even bilaterally symmetrical. In these species, terminology depends on their type of symmetry, all descriptions are with respect to the organism in its standard anatomical position, even when the organism in question has appendages in another position. This helps avoid confusion in terminology when referring to the organism in different postures. In humans, this refers to the body in a position with arms at the side. While the universal vertebrate terminology used in medicine would work in human medicine. Many anatomical terms can be combined, either to indicate a position in two axes simultaneously or to indicate the direction of a movement relative to the body, for example, anterolateral indicates a position that is both anterior and lateral to the body axis. There is no limit to the contexts in which terms may be modified to qualify each other in such combinations. Generally the modifier term is truncated and an o or an i is added in prefixing it to the qualified term, where desirable three or more terms may be agglutinated or concatenated, as in anteriodorsolateral. Such terms sometimes used to be hyphenated, but the tendency is to omit the hyphen. There is however little basis for any rule to interfere with choice of convenience in such usage
19.
Injection (medicine)
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An injection follows a parenteral route of administration, that is, administration via a route other than through the digestive tract. Since the process involves a small puncture wound to the body. Rodents used for research are often administered intracerebral, intracerebroventricular, or intraportal injections as well, long-acting forms of subcutaneous/intramuscular injections are available for various drugs, and are called depot injections. Injections are among the most common health care procedures, with at least 16 billion administered in developing, 95% of injections are administered in curative care, 3% are for immunization, and the rest for other purposes, such as blood transfusions. In some instances the term injection is used synonymously with inoculation even by different workers in the same hospital and this should not cause confusion, the focus is on what is being injected/inoculated, not the terminology of the procedure. In an intramuscular injection, the medication is delivered directly into a muscle, many vaccines are administered intramuscularly, as are codeine, metoclopramide, and many other medications. Many drugs injected intramuscularly are absorbed into the muscle fairly quickly, injections to the buttocks are known to reach the bloodstream quickly due to the large amount of muscular tissue and corresponding blood supply. Such injection allows the compound to be released in a consistent way over a long period. Depot injections are usually either solid or oil-based, depot injections may be available as certain forms of a drug, such as decanoate salts or esters. Examples of depot injections include Depo Provera and haloperidol decanoate, prostate cancer patients receiving hormone therapy usually get depot injections as a treatment or therapy. Zoladex is an example of a medication delivered by depot for prostate cancer treatment or therapy, naltrexone may be administered in a monthly depot injection to control opiod abuse, in this case, the depot injection improves compliance by replacing daily pill administration. The advantages of using a long-acting depot injection include increased medication compliance due to reduction in the frequency of dosing, a significant disadvantage is that the drug is not immediately reversible, since it is slowly released. In psychiatric nursing, a short acting depot, zuclopenthixol acetate, the pharmaceutical injection type of infiltration involves loading a volume of tissue with the drug, filling the interstitial space. Local anesthetics are often infiltrated into the dermis and hypodermis, various animals, and some plants, have been injecting for various reasons long before humans began doing so in a process commonly called stinging. Some examples include, Snakes, wasps, scorpions, venom, to kill prey, some bees, venom, to defend themselves and their nests. Stinging nettles, venom, to try to avoid being eaten, stingrays, venom, defense mechanism when provoked. The pain of an injection may be lessened by prior application of ice or topical anesthetic, recent studies suggest that forced coughing during an injection stimulates a transient rise in blood pressure which inhibits the perception of pain. Sometimes, as with an amniocentesis, an anesthetic is given
20.
Hypodermic needle
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A hypodermic needle, also called a sharp, is a very thin, hollow tube with a sharp tip which contains a small opening at the pointed end. It is commonly used with a syringe, a device with a plunger. They are used to take samples from the body, for example taking blood from a vein in venipuncture. Large bore hypodermic intervention is useful in catastrophic blood loss or treating shock. A hypodermic needle is used for delivery of liquids, or when the injected substance cannot be ingested, either because it would not be absorbed. There are many routes for an injection, with the arm being a common location. The hypodermic needle also serves an important role in research environments where sterile conditions are required, the hypodermic needle significantly reduces contamination during inoculation of a sterile substrate. The ancient Greeks and Romans knew injection as a method of delivery from observations of snakebites. There are also references to anointing and inunction in the Old Testament as well as the works of Homer, christopher Wren performed the earliest confirmed experiments with crude hypodermic needles, performing intravenous injection into dogs in 1656. These experiments consisted of using animal bladders and goose quills to administer drugs such as opium intravenously to dogs, Wren and others’ main interest was to learn if medicines traditionally administered orally would be effective intravenously. Elsholtz of Berlin were the first to experiment with injections in humans and these early experiments were generally ineffective and in some cases fatal. Injection fell out of favor for two centuries, the 19th century saw the development of medicines that were effective in small doses, such as opiates and strychnine. This spurred a renewed interest in direct, controlled application of medicine, some controversy surrounds the question of priority in hypodermic medication. Dr. Francis Rynd is generally credited with the first successful injection in 1844, Dr. Alexander Wood’s main contribution was the all-glass syringe in 1851, which allowed the user to estimate dosage based on the levels of liquid observed through the glass. Wood used hypodermic needles and syringes primarily for the application of localized, subcutaneous injection, simultaneous to Wood’s work in Edinburgh, Dr. Charles Pravaz of Lyon also experimented with sub-dermal injections in sheep using a syringe of his own design. Pravaz designed a syringe measuring 3 cm long and 5 mm in diameter, Dr. Charles Hunter, a London surgeon, is credited with the coining of the term hypodermic to describe subcutaneous injection in 1858. The name originates from two Greek words, hypo, under, and derma, skin, Hunter and Wood were involved in lengthy legal disputes over not only the origin of the modern hypodermic needle, but also because of their disagreement to the medicine’s effect once administered. Dr. Wood can be credited with the popularization and acceptance of injection as a medical technique, as well as the widespread use
21.
Syringe
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A syringe is a simple reciprocating pump consisting of a plunger that fits tightly within a cylindrical tube. The plunger can be pulled and pushed along the inside of the tube, allowing the syringe to take in. The open end of the syringe may be fitted with a hypodermic needle, syringes are frequently used in clinical medicine to administer injections, infuse intravenous drugs into the bloodstream, apply compounds such as glue or lubricant, and draw/measure liquids. The word syringe is derived from the Greek σύριγξ via back-formation of a new singular from its Greek-type plural syringes, sectors in the syringe and needle market include disposable and safety syringes, injection pens, needleless injectors, insulin pumps, and specialty needles. Hypodermic syringes are used with hypodermic needles to inject liquid or gases into body tissues, the barrel of a syringe is made of plastic or glass, usually has graduated marks indicating the volume of fluid in the syringe, and is nearly always transparent. Glass syringes may be sterilized in an autoclave, reuse of needles and syringes has caused spread of diseases, especially HIV and hepatitis, among intravenous drug users. Syringes are, however, commonly reused by diabetics, and this is if the syringe is only used by one person. In medical settings, single-use needles and syringes effectively reduce the risk of cross-contamination, syringes come with a number of designs for the area in which the blade locks to the syringe body. Perhaps the most well known of these is the Luer lock, bodies featuring a small, plain connection are known as slip tips and are useful for when the syringe is being connected to something not featuring a screw lock mechanism. Similar to this is the tip, which is essentially a slip tip but longer and tapered. These can also be used for rinsing out wounds or large abscesses in veterinary use, there is also an eccentric tip, where the nozzle at the end of the syringe is not in the centre of the syringe but at the side. This causes the blade attached to the syringe to lie almost in line with the walls of the syringe itself, syringes for insulin users are designed for standard U-100 insulin. The dilution of insulin is such that 1 mL of insulin fluid has 100 standard units of insulin, since insulin vials are typically 10 mL, each vial has 1000 units. Low dead space to reduce complications caused by improper drawing order of different insulin strengths, there are needle syringes designed to reload from a built-in tank after each injection, so they can make several or many injections on a filling. These are not used much in human medicine because of the risk of cross-infection via the needle, an exception is the personal insulin autoinjector used by diabetic patients. Venom extraction syringes are different from standard syringes, because they usually do not puncture the wound. The most common types have a nozzle which is placed over the affected area. Attempts to treat snakebites in this way are specifically advised against, as they are ineffective, syringes of this type are sometimes used for extracting human botfly larvae from the skin
22.
Catheter
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In medicine, a catheter is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure, catheters can be inserted into a body cavity, duct, or vessel. Functionally, they allow drainage, administration of fluids or gases, access by surgical instruments, the process of inserting a catheter is catheterization. In most uses, catheter is a thin, flexible tube though catheters are available in varying levels of stiffness depending on the application, a catheter left inside the body, either temporarily or permanently, may be referred to as an indwelling catheter. A permanently inserted catheter may be referred to as a permcath, the ancient Syrians created catheters from reeds. Catheter originally referred to any instrument that was inserted, such as a plug and it comes from the Greek verb καθίεμαι kathíemai, meaning let down, because the catheter was let down into the body. Drainage of urine from the kidney by percutaneous nephrostomy drainage of fluid collections, often the Seldinger technique is used. A Swan-Ganz catheter is a type of catheter placed into the pulmonary artery for measuring pressures in the heart. An embryo transfer catheter is designed to insert fertilized embryos from in vitro fertilization into the uterus and they may vary in length from approximately 150 mm to 190 mm. An umbilical line is a used in Neonatal Intensive Care Units providing quick access to the central circulation of premature infants. A Tuohy-Borst adapter is a device used for attaching catheters to various other devices. A Quinton catheter is a double or triple lumen, external catheter used for hemodialysis, an intrauterine catheter, such as a device known as a tom cat, may be used to insert specially washed sperm directly into the uterus in artificial insemination. A physician is required to administer this procedure, the earliest American invention of the flexible catheter was during the 18th century. Extending his inventiveness to his familys problems, Benjamin Franklin invented the flexible catheter in 1752 when his brother John suffered from bladder stones. Franklins catheter was made of metal with segments hinged together with a wire enclosed to provide rigidity during insertion, according to a footnote in his letter in Volume 4 of the Papers of Benjamin Franklin, Benjamin Franklin credits Francesco Roncelli-Pardino from 1720 as the inventor of a flexible catheter. In fact, Benjamin Franklin claims the flexible catheter may have been designed even earlier, an early modern application of the catheter was employed by Claude Bernard for the purpose of cardiac catheterization in 1844. The procedure involved entering a horse’s ventricles via the jugular vein and this appears to be an earlier and modern application of the catheter because this catheter approach technique is still performed by neurosurgeons, cardiologists, and cardiothoracic surgeons. David S. Sheridan was the inventor of the modern disposable catheter in the 1940s, in his lifetime he started and sold four catheter companies and was dubbed the Catheter King by Forbes magazine in 1988
23.
Epidural space
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In the spine, the epidural space is an anatomic space that is the outermost part of the spinal canal. It is the space within the canal lying outside the dura mater, in humans the epidural space contains lymphatics, spinal nerve roots, loose connective tissue, fatty tissue, small arteries, and a network of internal vertebral venous plexuses. The upper limit of the space is the foramen magnum. The lower limit is at the tip of the sacrum, at the sacrococcygeal membrane, in the head, the epidural space is known as a potential space. In rare circumstances, an artery may cause bleeding which is sufficient to create epidural space. The space between the dura and the arachnoid, the space, is also a potential space. In other mammals, the relationship between the canal and its contents is similar to that in humans, although many species possess a tail into which the epidural space is prolonged
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Nasal administration
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Nasal administration is a route of administration in which drugs are insufflated through the nose. It can be a form of either administration or systemic administration. Nasal sprays are locally acting drugs such as decongestants for cold and allergy treatment, examples of systemically active drugs available as nasal sprays are migraine drugs, nicotine replacement, and hormone treatments. The nasal cavity is covered by a thin mucosa which is well vascularised, therefore, a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without first-pass hepatic and intestinal metabolism. The effect is reached within 5 min for smaller drug molecules. Drugs which are poorly absorbed orally can also be given by this route, nasal administration is primarily suitable for potent drugs since only a limited volume can be sprayed into the nasal cavity. Drugs for continuous and frequent administration may be suitable because of the risk of harmful long-term effects on the nasal epithelium. Nasal administration has also associated with a high variability in the amount of drug absorbed. However, the variability in the amount absorbed after nasal administration should be comparable to that after oral administration, nasal sprays for local effect are quite common. Steroids, antiasthma medications such as salbutamol, ipratropium, montelukast, the recent developments in intranasal drug delivery systems are prodigious. Peptide drugs are available as nasal sprays, in this case to avoid drug degradation after oral administration. The peptide analogue desmopressin is, for example, available for both nasal and oral administration, for the treatment of diabetes insipidus, the bioavailability of the commercial tablet is 0. 1% while that of the nasal spray is 3-5% according to the SPC. Syntocinon nasal spray containing oxytocin is used to increase duration and strength of contractions during labour, gnRH analogues like nafarelin and busurelin are used for the treatment of anovulatory infertility, hypogonadotropic hypogonadism, delayed puberty and cryptorchidism. Other potential drug candidates for nasal administration include anaesthetics, antihistamines, antiemetics, intranasal midazolam is found to be highly effective in acute episodes of seizures in children. Recently, the part of the nasal cavity, as high as the cribriform plate, has been proposed for drug delivery to the brain. The nasal drug administration of naloxone was found to be as effective as the intravenous route, the prevention of abnormal nasal blood vessel growth and even the delivery of medications and drug antidotes such as hydroxocobalamin are being developed via intranasal medications. More recently interest is developing on delivery of a number of peptides, intranasal insulin is being investigated for treatment of neurodegenerative disorders such as Alzheimers disease. The live attenuated influenza vaccine sold under the brand names FluMist or Fluenz is delivered intranasally, flumist is a Quadrivalent Vaccine which contains four vaccine virus strains, an A/H1N1 strain, an A/H3N2 strain and two B strains
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