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Dietary restrictions are required during the are reduced by collection of urine for at least 4 hours purchase prednisolone mastercard allergy forecast tacoma. Fluid intake must be restricted to below 600 mL at a constant rate of about 2% per day purchase prednisolone with paypal allergy shots red vial. It is filtered in the 6 hours preceding the test completely and not significantly reabsorbed. Creatinine clearance is mainly determined by creatinine secretion by the tubules is increased when renal tubular function filtrate flow is slow, and patients must be given at least D. Creatinine clearance is dependent upon lean 600 mL of H O at the start of the test and kept well 2 body mass hydrated throughout. Body size determines how Body fluids/Apply knowledge of fundamental biological much creatinine is produced, and clearance must be characteristics/Creatinine clearance/1 normalized to eliminate this variable. Te patient is uremic and will be hyperkalemic lower reference limit, but above 60 mL/min, indicate C. D Cystatin C is a small protease inhibitor that is data/Creatinine clearance/2 produced at a constant rate, eliminated exclusively by glomerular filtration, and is not dependent on 58. Which of the following tests is a specific measure age, sex, or nutritional status. Urea is 100% filtered by the glomeruli they are associated with significant health risks. Blood urea levels are independent of diet The Fishberg concentration test measures the C. Urea is not significantly reabsorbed by the ability to concentrate urine after deprivation of tubules water. Urea excretion is a specific measure of glomerular excrete free water after excessive water intake. The clearance test is more sensitive if done properly, since as serum creatinine goes up, the urine creatinine goes down. Which of the following dyes are used in Answers to Questions 1–3 Sternheimer–Malbin stain? Transitional cells have pale blue cytoplasm, procedures/Staining/1 but renal cells take up both dyes, resulting in an azurophilic appearance (orange-purple cytoplasm 2. When seen in large numbers, nucleus dark blue they indicate urinary tract injury (with pseudopod B. Renal epithelium: cytoplasm light blue, nucleus extensions, they point to infection). Glitter cells: cytoplasm dark blue, nucleus dark results from contamination by vaginal or skin flora purple that multiply in vitro, especially in unrefrigerated D. Red cells stain very pale pink or not at all and hyaline casts stain faintly pink. Insufficient volume is causing microscopic results unless corrective action is taken. The specimen to be underestimated should be diluted with normal saline to 12 mL, then D. Sediment should be prepared according to the established Body fluids/Apply knowledge to identify sources of procedure and the results multiplied by the dilution error/Urinalysis/3 factor (in this case, 12 ÷ 5, or 2. B Caudate cells are transitional epithelium that have a epithelial cells in the urinary system is correct? Caudate epithelial cells originate from the upper bladder and the pelvis of the kidney. Transitional cells originate from the upper and the ureters as well as the urinary bladder and urethra, ureters, bladder, or renal pelvis renal pelvis. Cells from the proximal renal tubule are usually polyhedral, or oval, depending upon the portion of round in shape the tubule from which they originate. Squamous epithelium line the vagina, urethra, proximal tubule are columnar and have a distinctive and wall of the urinary bladder brush border. Squamous epithelia line the vagina Body fluids/Apply knowledge of fundamental biological and lower third of the urethra. Which of the statements regarding examination and can be confused in unstained sediment. Renal cells can be differentiated reliably from sheets of transitional and squamous cells. Large numbers of transitional cells are often seen derived from the urinary bladder. Neoplastic cells from the bladder are not found they should be referred to a pathologist for in urinary sediment cytological examination. Which of the following statements regarding cells Answers to Questions 7–11 found in urinary sediment is true? Transitional cells are considered a an eccentric round nucleus normal component of the sediment unless present C. Clumps of bacteria are frequently mistaken for significant when seen conclusively in the sediment. Conclusive Body fluids/Apply knowledge of fundamental biological identification requires staining. Trichomonas vaginalis characteristics/Urine sediment/2 displays an indistinct nucleus and two pairs of 8. Renal tubular epithelial cells are shed into the when passing through the glomerulus, often urine in largest numbers in which condition? Oval fat bodies are often seen in: approximately 150 × 60 μm and are nonoperculated. B Oval fat bodies are degenerated renal tubular epithelia that have reabsorbed cholesterol from the Body fluids/Correlate clinical and laboratory data/ filtrate. Although they can occur in any inflammatory Urine sediment/2 disease of the tubules, they are commonly seen in the nephrotic syndrome, which is characterized by marked proteinuria and hyperlipidemia. All of the following statements regarding urinary Answers to Questions 12–17 casts are true except: A. C Proteinuria accompanies cylindruria because protein jogging or exercise is the principle component of casts. An occasional granular cast may be seen in a exercise, hyaline casts may be present in the normal sediment sediment in significant numbers but will disappear C. Hyaline casts will dissolve readily in alkaline urine solute concentration, slow movement of filtrate, and Body fluids/Apply knowledge to recognize sources of reduced filtrate formation. The appearance of a error/Urine casts/2 cast is dependent upon the location and time spent in the tubule, as well as the chemical and cellular 13. Reduced filtrate formation cells, immunoglobulins, light chains, cellular proteins, D. C Pseudocasts are formed by amorphous urates that characteristics/Urine casts/2 may deposit in uniform cylindrical shapes as the 14. Granular casts may form by Body fluids/Apply knowledge of fundamental biological degeneration of cellular casts, but some show no characteristics/Urine casts/1 evidence of cellular origin.

If liver cleanses (page 552) make matters worse for a day and then better prednisolone 5mg line allergy medicine and caffeine, you know bacteria are entrenched in the liver purchase prednisolone in india allergy treatment sublingual. Depression All persons I have seen with clinical depression had small roundworms in the brain. The usual worms are hookworms (Ancylostoma), Ascaris of cats and dogs, Trichinellas and Strongyloides. Although it is commonly believed that hookworms penetrate the skin when walking barefoot on earth, this appears to be a negligible route. Letting little children clean up after their own bowel movements is even more hazardous. If no- body suffers from depression, you can use bleach (stored in the garage) to disinfect the stool, otherwise use alcohol (50% grain alcohol). Other family members should be cleared of these four worms on the same day or as close to it as possible. In the depressed person, the microscopic parasites travel immediately to the brain. In others, they may simply reside in the intestine or lungs or liver, or other organs. Depression, even of long standing, can lift within days after the brain finally has its territory to itself. Look in the mirror and smile at yourself for your success in vanquishing your invaders. Manic Depression This variety of depression is associated with Strongyloides, as the main parasite in the brain. Strongyloides is the same worm that causes migraines and other severe types of recurrent headache. The amazing truth is that some family members do not get infected with it or at least do not get brain symptoms! It is very difficult to eradicate Strongyloides in a whole family and thereby let the depressed person get well. You must also stop even washing your face in chlorinated water (use a pure carbon filter system). Of course, there should be no bleach container in the house, even when tightly closed; nor should bleached clothing be worn. Humans, it seems, must lick fingers with the same compulsion that cows lick their noses and cats lick their rears. The single, most significant advance in human hygiene would most assuredly be stopping the hand to mouth habit. Together with the new pollutants, solvents, and heavy metals, parasites will overtake us unless we change. Although you may be free of manic depression in a day, reinfecting yourself weeks later will attack your brain like a hurricane; it has not yet healed, the routes are open. She was parasitized by intestinal flukes (in the intestine), dog whipworm, Strongyloides and human liver flukes. She set to work again, leaving no detail undone, because she could remember how good it felt to be free of depression (not drugged out of it). Three months later she still had Strongyloides (she had a cat) but she did her first liver cleanse anyway. She substituted 4 ornithine and 2 ginseng capsules daily (more if tension was not relieved) for Prozac and cured her problem. But in less than three months, when only half her clean-up chores were done, she was already saying positive things about her job. When he switched back to plain tap water (filtered in small quantities) the depression lifted in a week and he was no longer crying over anything. Only one of her two dogs had Strongyloides (saliva test) and the cat was free of them also. She was full of cesium (from drinking refrigerator water) and vanadium (from a gas leak). In two months she had accomplished the impossible: all pets and herself were free of Strongyloides, they had repaired three gas leaks and her depression was just a memory. Styrene (from styro- foam cups), methyl ethyl ketone (beverage) and carbon tetrachlo- ride were in his brain also, probably setting the stage for parasite reproduction. He had high levels of mercury and silver but highest of all–throughout his body–was chlorine (from bleach and tap water). He could already tell on his way home from the dentist that something special had happened. He resolved to clean up his whole body and recover from his illness using logical methods, like ours. Staying away from regular chlorinated water was a fine challenge to his resolve but with whole house filtering now available he may have done it. He had Ascaris and hookworm and two dozen more assorted parasites including fluke stages. All parasites were killed in half an hour by frequency generator at his first visit whereupon he immediately announced himself free of depression; better than the last eight years. Schizophrenia Much more mold toxin was seen in schizophrenic families than in other kinds of illness. They usually had four or more kinds of mold toxins at the same time, meaning that one toxin was not detoxified before the next was already eaten. Schizophrenia does not require mercury or other dental metal pollution for its expression. This pattern is logical when it is seen that young children can have schizophrenia. Schizophrenia is an ancient illness, being described in some very old literature, before dentistry existed. Other mycotoxins are also present, including sterigmatocystin, cytochalasin B, and aflatoxin. As the mycotoxin panorama changes, brain symptoms can change from compulsive hand washing to paranoia or from hearing voices to meanness in disposition. It would not be difficult or ex- pensive to experiment with a mold-free diet in our prisons. The usual source for these is the household water (household plumbing may have lead solder joints). Parasites always found in schizophrenia are hookworms (4 Ancylostoma varieties) in the brain. Zap the parasites in the whole family for three days, fol- lowed by repetitions twice a week. Do a thorough diagnostic search of all foods eaten at the last meal, the water drunk, the air breathed. Healing of the brain is very rapid; in less than one week feelings and behavior are more normal. Perhaps there are herbs that hasten healing; considering how old the illness is, there must surely be several useful herbs.

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Alerting staff to medication errors: Hospitals can save $90 purchase generic prednisolone allergy testing how many needles,000 a year averting extended stays order generic prednisolone allergy testing arm. Use of an automated dispensing device system to assist in patient care monitoring activities. Differences in doctors’ and nurses’ assessments of hospital culture and their views about computerised order entry systems. Cultures in hospitals and their influence on attitudes to, and satisfaction with, the use of clinical information systems. Contextual implementation model: a framework for assisting clinical information system implementations. Using information technology to improve health quality and safety in community health centers. Dose timing and patient compliance with two antibiotic treatment regimens for lower respiratory tract infections in primary care. Implementation of a pharmacy-based, computer- assisted, concurrent antibiotic review service in a 688 bed acute tertiary care community hospital. Assessing nurse interaction with medication administration technologies: the development of observation methodologies. Doctor of Pharmacy Clerkship Student Interaction with a Physician Order-Entry System. Impact of automation on pharmacist interventions and medication errors in a correctional health care system. The application of information and communication technologies to clinical activity: Electronic health and clinical records. E-prescribing effects: Pilot project studies E-prescribing standards in long-term care. Journal of the American Health Information Management Association 2007;78(1):36-8. The effect of point-of-care personal digital assistant use on resident documentation discrepancies. Redesigning the order entry process to provide time for clinical training and pharmaceutical care. Evaluation of turnaround time for medication order processing with use of a novel scanning system. Evaluation of three dosage-prediction methods for initial in-hospital stabilization of warfarin therapy. Evaluation of electronic drug prescriptions at a university hospital [Portuguese]. Electronic medical prescription at a university hospital: writing failures and users’ opinions. Nonprogramming relational database primer: a case study--pharmacist intervention audits. Case study: identifying potential problems at the human/technical interface in complex clinical systems. A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. Medicare program; physicians referrals to health care entities with which they have financial relationships; exceptions for certain electronic prescribing and electronic health records arrangements. Automatic voice mail for delivering computer-generated anticoagulant dose advice to patients. Strategies for pharmacy integration and pharmacy information system interfaces, Part 2: Scope of work and technical aspects of interfaces. Strategies for pharmacy integration and pharmacy information system interfaces, Part 1: History and pharmacy integration options. Incorporation of a gentamicin dosage calculator into a computerized prescriber-order-entry system. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Increasing the success of physician order entry through human factors engineering. Healthcare informatics : the business magazine for information and communication systems 2009;26(12):22, 24-2, 25. Validation of an insulin infusion nomogram for intensive glucose control in critically ill patients. An overview of the effect of computer-assisted management of anticoagulant therapy on the quality of anticoagulation. Computer-adjusted dosage of anticoagulant therapy improves the quality of anticoagulation. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. The effect and adoption of electronic health records: A systematic review and national survey of physicians in the United States University of California, Los Angeles. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Outpatient provider order entry: Implementation process and a comparison to handwritten prescriptions. Pharmacy intervention reduced excessive antibiotic monitoring in the intensive care units. A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. Effectiveness evaluation of bar code implementation in hospital -- an illustration of out-patient pharmacy information system. Outcome-oriented quality assurance program for the clinical pharmacokinetics monitoring service. Help to therapeutics by a daily computer monitoring of potential drug interactions. Controlled study in diabetic children comparing insulin-dosage adjustment by manual and computer algorithms. Optimisation of treatment by applying programmable rate-controlled drug delivery technology. Successful implementation of a comprehensive computer-based patient record system in Kaiser Permanente Northwest: strategy and experience. Implementation of online drug use criteria to facilitate nonformulary drug requests. Survey of patient and physician assessment of a compliance reminder device in the treatment of hypertension. Non-intrusive guideline-based electronic disease management programme: Principles and evaluation of a pilot.

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This strategy (essentially a prodrug strategy) involves coupling the drug to a peptide or protein “vector” which normally undergoes receptor-mediated transcytosis safe prednisolone 5 mg allergy medicine under 2, to form a so-called “chimeric peptide” (Figure 13 purchase prednisolone 20 mg allergy shots vs. sinus surgery. The chemical linker joining the therapeutic agent to the transport vector is cleaved, freeing the therapeutic agent to bind to the appropriate target receptor. Design considerations in the development of effective chimeric peptides include vector specificity for the brain, vector pharmacokinetics, coupling between vector and drug, and intrinsic receptor affinity for the released drug. The use of a native peptide or protein such as insulin, insulin-like growth factor or transferrin as transport vectors is associated with a number of disadvantages, including rapid clearance of the peptide from the bloodstream. The use of insulin per se triggers insulin receptors in peripheral tissues and causes hypoglycemia. If transferrin is used as a vector, the exogenous transferrin competes for uptake with endogenous transferrin. As the endogenous concentration of transferrin in the plasma is very high (25 μM), only limited uptake is therefore possible. Alternatively, monoclonal antibodies (Mabs) to the relevant receptors can be used as transport vectors. These include poor stoichiometry of the drug to the transport vector which thus limits the mass transport of the drug. However, this problem is circumvented with the use of pegylated immunoliposomes, which increases by several log orders the drug-carrying capacity of the vector. Alternatively, many “large molecule” drugs are active in brain in nM concentrations, and such concentrations are easily achieved with the a 1:1 stoichiometry of drug and transport vector. The method also requires that the linker will be cleaved in vivo and that the drug will retain biological activity after release, if a disulfide linker is utilized to conjugate the vector and the drug. This study showed that the brain volume of distribution (V ) of the drug (tritiated daunomycin) increasedD with time following a single intravenous injection, indicating that the liposomes were sequestered by the brain. However, antisense agents will not exert pharmacologic effects in vivo following delivery to 332 Figure 13. The drug is entrapped within a liposome vector to which is attached antibodies on poly(ethylene glycol) linkers cells via receptor-mediated endocytosis systems unless there is endosomal release of the antisense agent into the cytosol. Therefore, present-day antisense drug delivery systems need to be designed and optimized to facilitate endosomal release. Explain the differences between the brain capillary endothelium and the non-brain capillary endothelium. The absence or overproduction of a specific protein in the body can lead to a variety of clinical manifestations depending on the structural or functional role that the protein normally plays in the body. However, the clinical use of many protein drugs is limited by their inappropriate concentration in blood, poor oral bioavailability, high manufacturing cost, chemical and biological instability and/or rapid hepatic metabolism and renal excretion. In addition, few protein drugs can efficiently enter target cells unless administered at very high doses, which can lead to toxic side-effects. These limitations lead to their frequent administration with an increased treatment cost and reduced patient compliance (also see Section 1. Gene therapy is a method for the treatment or prevention of disease that uses genes to provide the patient’s somatic cells with the genetic information necessary to produce specific therapeutic proteins needed to correct or to modulate a disease. The promise of somatic gene therapy is to overcome limitations associated with the administration of therapeutic proteins, including low bioavailability, inadequate pharmacokinetic profiles and high cost of manufacture. Providing a therapeutic gene as a “pre-drug” to a patient to allow either the production of therapeutic proteins that may be difficult to administer exogenously or the inhibition of abnormal protein production may circumvent some limitations associated with the use of recombinant therapeutic proteins. Plasmid-based gene medicine contains three components: • a therapeutic gene that encodes a specific therapeutic protein in the form of a plasmid; • a plasmid-based gene expression system that controls the functioning of a gene within a target cell; • a gene delivery system that controls the delivery of the plasmid expression system to specific locations within the body. The gene delivery system distributes the plasmid to the desired target cell, after which the plasmid is internalized into the cell. Once inside the cytoplasm, the plasmid can then translocate to the nucleus, where gene expression begins, leading to the production of a therapeutic protein through the steps of transcription and translation. The gene expression system can be engineered to control whether the resulting protein will remain within the cell for an intracellular effect or will be secreted out of the cell for either a local or systemic action. The gene expression system can also be adjusted to control the level of protein production, as well as the fidelity and duration of gene expression (Figure 14. A viral vector consists of genetic material encapsulated in a particle that can be taken up by the target cell, leading to transgene expression of virally encoded genes. Retroviruses infect only dividing cells and thus are often used to introduce genes into cells ex vivo where cell division can be stimulated with growth-promoting media. Retroviral vectors can also be directly administered to patients, though the applicability of this approach is limited by the rapid inactivation of retroviruses by human 336 Figure 14. A) Gene delivery systems are designed to control the location of a gene within the body by affecting distribution, and access of a gene expression system to the target cell receptor followed by intracellular and nuclear translocation. B) Plasmid-based gene expression systems are designed to control the level and duration of in vivo production of a therapeutic gene product complement. However, retroviral vectors are not safe to use because of its random insertion into the host cell chromosome, which may lead to insertional mutagenesis and oncogenesis. Adenoviral vectors infect both dividing and non-dividing cells in many different tissues including airway epithelial cells, endothelial cells, hepatocytes and various tumors. The adenovirus genome is much larger (about 35 kb) and its organization is much more complex than retroviruses. Genes introduced into cells using adenoviral vectors are maintained in the nucleus episomally and provide transsient expression of transgenes. Compared to viral vectors, gene medicines present several potential advantages, including: • low cost; • non-infectivity; • absence of immunogenicity; • good compliance; 337 • well-defined characteristics; • possibility of repeated clinical administration. Plasmids encode bacterial origin of replication, usually derived from a high copy plasmid and a selectable marker, usually a gene that confers resistance to an antibiotic, such as kanamycin or neomycin. These “prokaryotic” plasmid segments permit the production of large quantities of a given plasmid in bacteria. The minimal transcription unit required for the expression of a therapeutic protein consists of 5′ enhancer/promoter upstream of the gene encoding for the therapeutic protein and a poly(A) signal downstream of the gene. Tissue- specific promoters are designed to interact with transcription factors or other nuclear proteins present in the desired target cells. The chicken skeletal a-actin promoter contains positive as-acting elements required for efficient transcriptional activity in myogenic cells. Therefore, an a-actin promoter could direct high expression of recombinant protein in skeletal muscle. The efficiency of polyadenylation is important for gene expression, as transcripts that fail to be cleaved and polyadenylated are rapidly degraded in the nuclear compartment. Therefore, in vivo pulsatile production of certain therapeutic proteins may be beneficial for their clinical applications. This can be achieved by including gene switches in a gene expression system to turn on or off the transcription of an administered gene. A gene switch is designed to be part of a gene expression system that contains both the gene switch and a therapeutic gene. In the positive system, the target gene will be inactive until the administration of an exogenous compound or ligand.

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Hence buy prednisolone 40 mg overnight delivery allergy forecast joplin mo, in vitro drug release rate is often consistent with the in vivo release profile discount 10mg prednisolone with mastercard allergy medicine containing alcohol. Also, for oral delivery, changes in pH or ionic strength in the gastrointestinal tract will not affect the drug release rate. In parenteral therapy, the subcutaneously implantable, osmotic mini-pumps developed by the Alza Corp. Osmotic mini-pumps, such as the Oros osmotic pump, are also available for controlled 60 release via the oral route (see Section 6. They allow physicians and patients to precisely control the infusion rate of a drug. Externally programmable pumps can facilitate: • zero-order controlled drug release; • intermittent drug release. Ideally, a pump should deliver the drug at the prescribed rate(s) for extended periods of time and thus should incorporate a wide range of delivery rates, ensure accurate, precise and stable delivery, contain reliable pump and electrical components and finally, provide a simple means to monitor pump status and performance. A pump should also be convenient for the patient and thus should ideally be reasonably small in size and inconspicuous, have a long reservoir life and be easy to program. The biocompatibility of the device surface is also an important issue for consideration. Other safety concerns include danger of over- dosage, drug leakage and pump blockage. For example, drug release may be controlled by the way in which pH or ionic strength affects the swellability of a polymeric delivery system. More sophisticated systems incorporate specific enzymes which causes changes in localized pH or increases in localized concentrations of specific substrates such as glucose. The change in pH caused by the biotransformation of the substrate by the enzyme thereby causes a change in permeability of a pH-sensitive polymeric system in response to the specific biomolecule. Such systems may be used to modulate the release of drug through a controlled feedback mechanism. Site-specific drug delivery is desirable in therapeutics, in order to improve: • drug safety, as toxic side-effects caused by drug action at non-target sites are minimized; • drug efficacy, as the drug is concentrated at the site of action rather than being dispersed throughout the body; 61 • patient compliance, as increased safety and efficacy should make therapy more acceptable and thus improve compliance. In its simplest form, drug targeting can be achieved by the local administration of the therapeutic compound; this strategy is feasible even with conventional dosage forms. For example, if the site for desired drug action is the skin, the medication may be applied in ointment, lotion, or cream form, directly on the desired site. Direct injection of an anti-inflammatory agent into a joint is another example of site-specific delivery which is achievable without having recourse to a highly specialized drug delivery and targeting system. Sophisticated drug targeting technology is also available, particularly for oral and parenteral delivery. However, technology is not yet advanced sufficiently for the design of “magic bullet” drug delivery systems, proposed by Paul Ehrlich at the turn of the 20th century (see Section 1. For oral delivery, systems are available to achieve site-specific delivery within the gastrointestinal tract; for example, targeting the drug to the small intestine, colon, or gut lymphatics. Drug delivery systems available for targeted oral delivery include those that use enteric coatings, prodrugs, osmotic pumps, colloidal carriers and hydrogels; these technologies are discussed in Chapter 6. Technologies for targeted drug delivery are most advanced for parenteral administration. Such technologies are concerned with delivering drugs to specific targets in the body and also to protect drugs from degradation and premature elimination. They include the use of: • soluble carriers, such as monoclonal antibodies, dextrans, soluble synthetic polymers; • particulate carriers, such as liposomes, micro- and nano-particles, microspheres; • target-specific recognition moieties, such as monoclonal antibodies, carbohydrates and lectins. These technologies, and the various anatomical, physiological and pathological issues that pertain to their use, are discussed in detail in Chapter 5. Recent advances in biological and chemical sciences have led to the development of various “Smart” technologies to ensure more effective drug delivery and targeting of drugs to specific sites within the body. The advantages and limitations of these systems are discussed in detail in Chapter 16. Such systems are used to achieve site-specific drug delivery following parenteral administration. Release of the attached drug molecules at the target site can be achieved by enzymatic or hydrolytic cleavage. Larger complexes, some undergoing clinical trials, include drug conjugates with soluble natural, or synthetic, polymers. Nano- and microparticles Nanoparticles are solid colloidal particles, generally less than 200 nm. Such systems include poly (alky1- cyanoacrylate) nanoparticles used for parenteral drug delivery and targeting. Microparticles are colloidal particles in the micrometer scale, typically in the size range 0. Synthetic polymers, such as poly(lactide-co-glycolide), are widely used in the preparation of microparticulate drug delivery systems and also as biodegradable implantable devices. Natural polymers, such as albumin, gelatin and starch, are also used as microparticulate drug carriers. Liposomes, vesicular structures based on one or more lipid bilayer(s) encapsulating an aqueous core, represent highly versatile carriers. Liposomes can be prepared using a variety of techniques to give a wide range of sizes (approximately 30 nm–10 µm), structures and physicochemical properties, to facilitate the encapsulation of both water-soluble and lipid-soluble drugs (see Section 5. Commercial products based on liposome technology are available and many more products are in clinical trials, for a variety of indications. Macrodevices Macrodevices are widely used in many applications, including: • parenteral drug delivery, mechanical pumps, implantable devices; • oral drug delivery: solid dosage forms such as tablets and capsules which incorporate controlled release/ targeting technologies; • buccal drug delivery: buccal adhesive patches and films; • transdermal drug delivery: transdermal patches, iontophoretic devices; • nasal drug delivery: nasal sprays and drops; • pulmonary drug delivery: metered-dose inhalers, dry-powder inhalers, nebulizers; • vaginal drug delivery: vaginal rings, creams, sponges; • ophthalmic drug delivery: ophthalmic drops and sprays. This is painful for the patient, as well as generally requiring the intervention of medical professionals. The oral route, which involves merely swallowing a tablet, liquid or capsule, thus represents a much more convenient and attractive route for drug delivery. Some other dosage forms, for example nebulizers, pessaries and suppositories, may meet with more limited patient compliance. Ease of termination The dosage form should be easily removed either at the end of an application period, or in the case where continued drug delivery is contra-indicated. A transdermal adhesive system is easily removed if necessary, as is a buccal patch. However, non-biodegradable polymeric implants and osmotic pumps must be surgically retrieved at the end of treatment. Although a biodegradable polymeric implant does not require surgical retrieval, its continuing biodegradation makes it difficult to terminate drug delivery, or to maintain the correct dose at the end of its lifetime. Biocompatibility and absence of adverse effects The drug delivery system should be non-toxic and non-immunogenic.

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