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Pharmaceutical Sciences Discussion Responses

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Oxycodone Sarah Kim Rowan University Background Oxycodone is a well-known semisynthetic schedule II-controlled substance in the US known for its alleviation for moderate to severe acute pain developed in 1916 (1, 2). German researchers developed this from opium-derived thebaine, which was extracted from opium poppy (1). Oxycontin, an extended-release version of oxycodone throughout the day, was approved by the FDA in 1995, which was then introduced to the US in 1996 (1). Although opioids get a bad reputation due to its addictiveness, The World Health Organization (WHO) classifies them as essential medicines (3). This includes morphine and codeine because of their use in treating severe pain, pain management, and optimizing quality of life (3). Oxycodone is more similar to morphine than it is to codeine and is superior to morphine in oral absorption and bioavailability (4). It is also more tolerated than morphine and they are similar in terms of protein binding and lipophilicity (1, 4). For over 80 years, the chemical formula has been 14-hydroxy-7,8 dihydrocodeinone that was first introduced to the US in a fixed combination with acetylsalicylic acid, acetaminophen (APAP), or nonsteroidal anti-inflammatory drugs (NSAIDS) (5). Due to how addictive opioids can be and the potential side effects that can occur from patient to patient, it is necessary to titrate the dose for a proper balance between analgesia and unwanted side effects (1). An extended-release form of oxycodone called Remoxy was developed in 2011 after chemical and physical manipulation to maintain the rate-controlling mechanism (1). One study conducted showed an oxycodone/naloxone combination in a 2:1 ratio that provided pain relief with less constipation, a common side effect of oxycodone use (1). Another combination using carbamazepine and oxycodone was seen to alleviate symptoms of trigeminal neuralgia, facial pain (1). The most common formulation combines 5mg of oxycodone with 325mg of APAP which is considered weak and used for mild to moderate pain. This combination has been used for over 20 years with proven efficacy and safety for patients suffering from chronic pain, acute pain, cancer-related pains, and many other situations that may affect a person’s quality of life (5). Despite the advantages, oxycodone is prone to pharmacokinetic drug interactions that could cause dangerous side effects (1). Oxycodone is metabolized by CYP3A4 and CYP2D6 enzymes present in the liver (2, 4). It can be offered as an alternative to morphine or hydromorphone due to its effectiveness against the skin, muscle, and esophageal pain (1). It has been found to be safer than morphine and used for cancer-related pains despite the variability of pains throughout patients. Oxycodone is also more potent than morphine in patients with chronic pains, indicating its superiority to morphine in some pain conditions (1). A study observing healthy subjects after the administration of oxycodone through oral and intramuscular (IM) routes was conducted to observe the pharmacokinetics and metabolism. It was found that only about 10% was excreted through the urine and the bioavailability of oral oxycodone was about 60% after IM administration (6). References (1) Moradi, M., Esmaeili, S., Shoar, S., & Safari, S. (2012). Use of oxycodone in pain management. Anesthesiology and pain medicine, 1(4), 262–264. (2) Lugo, R.A.; Kern, S.E. (2005). The Pharmacokinetics of Oxycodone, Journal of Pain & Palliative Care Pharmacotherapy, 18:4, 17-30, DOI: 10.1080/J354v18n04_03 (3) Galanie, S., Thodey, K., Trenchard, I. J., Filsinger Interrante, M., & Smolke, C. D. (2015). Complete biosynthesis of opioids in yeast. Science (New York, N.Y.), 349(6252), 1095–1100. (4) Davis, M.P.; Varga, J.; Dickerson, D.; et al. (2003). Normal-release and controlledrelease oxycodone: pharmacokinetics, pharmacodynamics, and controversy. Support Care Cancer, 11, 84–92. DOI: 10.1007/s00520-002-0385-9 (5) Coluzzi, F.; Mattia, C. (2005). Oxycodone. Pharmacological profile and clinical data in chronic pain management. Minerva Anestesiol, 71, 451-60. (6) Poyhia, R.; Seppala, T.; Olkkola, K.T.; Klaso, E. (1992). The pharmacokinetics and metabolism of oxycodone after intramuscular and oral administration to healthy subjects. British Journal of Clinical Pharmacology, 33, 617-621. Assignment 3 – Semester-Long Research Project: first draft GLIPIZIDE Structure: ChemicalFormula:1-cyclohexyl-3-[[p-[2-(5methylpyrazinecarboxamido) ethyl] phenyl] sulfonyl] urea. Molecular formula: C21H27N5O4S Molecular weight: 445.55g.mol-1 DRUG DISCOVERY AND USES: Glipizide is an anti-diabetic medication used along with diet and exercise, sometimes with other medications too, to treat Type-2 diabetes. This type-2 Diabetes is the condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood. It comes under class of drugs called sulfonylureas. Glipizide lowers blood sugar by stimulating the pancreas to create insulin (a natural substance required for the body’s breakdown of sugar) and by assisting the body’s utilization of insulin. This drug will only help lower blood sugar in people whose bodies produce insulin naturally. Glipizide is not used to treat type 1 diabetes (a disease in which the body does not produce insulin and hence cannot regulate the amount of sugar in the blood) or diabetic ketoacidosis (a condition in which the body does not produce insulin and thus cannot manage the amount of sugar in the blood) (a serious condition that may occur if high blood sugar is not treated). It was first introduced in 1984 and is available in various countries including Canada and the U.S. According to the 2018 Clinical Practice Guidelines by Diabetes Canada, sulfonylurea drugs are considered a second-line glucose-lowering therapy following metformin. FDA APPROVALS: It was patented in 1969 and approved for medical use in 1971. Glipizide was approved for medical use in the United States in 1984. It is available as a generic medication. In 2019, it was the 54th most prescribed medication in the United States, with more than 13 million prescriptions. The once-daily glipizide GITS 1) lowered HbA1c, FPG, and PPG over a dose range of 5-60 mg, 2) was maximally effective at 5 mg (using HbA1c) or 20 mg (using FPG) based on pharmacokinetic and pharmacodynamic relationships, 3) maintained its effectiveness in poorly controlled patients (those with entry FPG > or = 250 mg/dl), 4) was safe and well tolerated in a wide variety of patients with NIDDM, and 5) did not produce weight gain or adversely affect lipids. WARNINGS: SPECIAL WARNING ON INCREASED CARDIOVASCULAR MORTALITY. RISK OF The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program (UGDP), a long-term prospective clinical trial designed to evaluate the effectiveness of glucose- lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to one of four treatment groups (Diabetes, 19, supp. 2: 747–830, 1970). UGDP reported that patients treated for 5 to 8 years with diet plus a fixed dose of tolbutamide (1.5 grams per day) had a rate of cardiovascular mortality approximately 21⁄2 times that of patients treated with diet alone. A significant increase in total mortality was not observed, but the use of tolbutamide was discontinued based on the increase in cardiovascular mortality, thus limiting the opportunity for the study to show an increase in overall mortality. Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and advantages of GLUCOTROL and of alternative modes of therapy. Although only one drug in the sulfonylurea class (tolbutamide) was included in this study, it is prudent from a safety standpoint to consider that this warning may also apply to other oral hypoglycemic drugs in this class, in view of their close similarities in mode of action and chemical structure. PHYSICAL PROPERTIES AND FORMULATION: ChemicalFormula:1-cyclohexyl-3-[[p-[2-(5methylpyrazinecarboxamido) ethyl] phenyl] sulfonyl] urea. Molecular formula: C21H27N5O4S Molecular weight: 445.55g.mol-1 Density: 1.34 g/cm3 Melting Point: 208-209°C Solubility: 37.2 mg/l Glipizide is a whitish, odorless powder with a pKa of 5.9. It is insoluble in water and alcohols, but soluble in 0.1 N NaOH; it is freely soluble in dimethylformamide. GLUCOTROL tablets for oral use are available in 5 and 10 mg strengths. Inert ingredients present are colloidal silicon dioxide; lactose; microcrystalline cellulose; starch; stearic acid. Glipizide GITS (Gastrointestinal Therapeutic System) is formulated as a once-a-day controlled release tablet for oral use and is designed to deliver 2.5, 5, or 10 mg of glipizide. (YS-2-7063) (5 mg and 10 mg tablet) and black ink (S-1-8106) DOSAGE AND ADMINISTRATION: There is no fixed dosage regimen for the management of diabetes mellitus with GLUCOTROL or any other hypoglycemic agent. In addition to the usual monitoring of urinary glucose, the patient’s blood glucose must also be monitored periodically to determine the minimum effective dose for the patient; to detect primary failure, i.e., inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, i.e., loss of an adequate blood-glucose-lowering response after an initial period of effectiveness. Glycosylated hemoglobin levels may also be of value in monitoring the patient’s response to therapy. Short-term administration of GLUCOTROL may be sufficient during periods of transient loss of control in patients usually controlled well on diet. In general, GLUCOTROL should be given approximately 30 minutes before a meal to achieve the greatest reduction in postprandial hyperglycemia. Initial Dose The recommended starting dose is 5 mg, given before breakfast. Geriatric patients or those with liver disease may be started on 2.5 mg. Pediatric Use: Safety and effectiveness in children have not been established. Geriatric Use: A determination has not been made whether controlled clinical studies of GLUCOTROL included enough subjects aged 65 and over to define a difference in response from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. ADVERSE REACTIONS: 
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