Ivacaftor in cystic fibrosis: the first disease modifying agent

The exact magnitude of cystic fibrosis (CF) in India is not known, as it is often misrepresented and underdiagnosed. CF is caused by a mutation in the gene that encodes for the CF transmembrane conductance regulator (CFTR) protein whose dysfunction leads to multiorgan manifestations. Most CF mutations either reduce the number of CFTR channels at the cell surface or impair the channel function. Current treatments (mucolytics, antibiotics and anti-inflammatory agents) target the secondary effects of CFTR dysfunction and help to ameliorate the symptoms but do not address the basic defect of the disease. Ivacaftor is a first-in-class oral CFTR potentiator that increases the CFTR channel opening. In clinical trials, ivacaftor has shown improved pulmonary function, normalization of sweat chloride concentration, substantial weight gain as well as acceptable safety profile. The most frequent adverse effects associated with ivacaftor include headache, oropharyngeal pain, upper respiratory tract infection, nasal congestion, abdominal pain and nasopharyngitis. FDA has approved this agent for the treatment of CF in patients aged 6 years or older with at least one copy of the G551D mutation in the CFTR gene. Searches of medline, cochrane database, medscape, SCOPUS and clinicaltrials.org were made for terms like CFTR potentiator, cystic fibrosis, and ivacaftor. Relevant journal articles from last 5 years were chosen

INTERNATIONAL JOURNAL OF PHARMACY & LIFE SCIENCES Safe medication disposal: Need to sensitize undergraduate students

Abstract The presence of pharmaceuticals in potable waters is escalating with an evergrowing consumption of medications. Concerns regarding environmental significance and human health risk involved are often raised but control at source generation is not being adequately emphasized. To explore the knowledge, attitude, beliefs about drug wastage and methods adopted by students to dispose unused and leftover medications at home. This was a cross-sectional, descriptive survey. A detailed, anonymous questionnaire having both open and close-ended questions to assess drug disposal practices was administered to second, third and fourth year dental students. The data collected was analyzed and expressed as counts and percentages. 236 dental students participated in the survey. 70% reported the possession of upto five expired medications at home. The major reason for possession of unused, expired medicines was purchase of over the counter (OTC) drugs for self-medication.52%agreed that drug wastage can be managed by returning to pharmacy.97% had not heard of drug take-back initiatives.92% admitted that no advice on drug disposal had been received by them. Antipyretics (54%) and analgesics (64%) were the major drug class stockpiled unused and expired drugs in students' homes. The predominant method adopted for drug disposal was via household trash(94%) followed by storing in home medicine chests(28%).48% students agreed that returning to pharmacist is an acceptable way to dispose drugs. Knowledge about environmental implications of unsafe medication disposal was found to be inadequate among dental undergraduate students. There is need to increase their awareness about safe and prudent disposal methods. With reduced wastage of medication, the ecological footprint of medicines can be greatly reduced

SELF–MEDICATION AMONG DENTAL UNDERGRADUATE STUDENTS WITH ANTIBIOTICS: LOOKING BEYOND THE KNOWN

Introduction: Though self-medication with antibiotics (SMA) is a potential contributor to resistance among pathogenic organisms to antibiotics, very few studies have evaluated pattern and prevalence of SMA among dental students.Objective: The study was conducted to compare features of practice of SMA among second year undergraduate dental students and BDS students pursuing internship (interns) of a North Indian dental college.Methods: This was a cross-sectional, anonymous, descriptive study with a six-month illness recall. Dental undergraduate students were administered a questionnaire consisting of both open and close-ended questions regarding various aspects of self- medication with antibiotics. The students were categorized into two groups for the comparative study. Group 1 comprised BDS second year students who were unexposed to pharmacology subject and Group 2 comprised interns possessing a sound knowledge of pharmacology. Written informed consent was taken from all the participants. Comparison between the two groups was done by chi-square test.Results: A total of 150 respondents participated in the study. 51.3% (n=39) students in group1 and 74.3% (n=55) students in group 2 had self-medicated in the last six months, the antibiotics most commonly used being amoxicillin (53.8%vs.29.1)and azithromycin (34.5%vs.28.2%).The most common indications for SMA included  common-cold, cough and sore throat, fever and diarrhea. Most of the respondents procured antibiotics from pharmacies (68.4% vs.85.1%) after consulting previous prescription or parents. Conclusion: SMA was significantly higher and inappropriate in the senior dental undergraduate cohort compared to the junior cohort, calling for effective interventional strategies to promote rational use of antibiotics.Keywords: antibiotic resistance, dental students, self-medicatio

Spinosad: An effective and safe pediculicide

Although head lice are not a major health hazard, they have been a source of irritation and disgust for thousands of years. Despite the use of over-the-counter (OTC) treatments, it has high prevalence, and epidemics occur regularly. Permethrin 1% is currently recommended as a drug of choice, but many areas have shown resistance to this insecticide. A 0.9% suspension of spinosad, a naturally occurring pest control product, has recently been approved by the USFDA for treatment of pediculosis capitis. It acts by enhancing the action of nicotinic acetylcholine, resulting in paralysis of the parasite. Clinical trials show that spinosad is more effective and safe than current drugs of treatment. Additionally, it does not require nit combing. Spinosad appears as a powerful recruit in the battle against head lice

Ingenol mebutate: A novel topical drug for actinic keratosis

The global incidence of non-melanoma skin cancer is rising. Significant morbidity leading to unacceptable cosmetic outcomes and/or functional impairment is a major concern. Search for non-surgical, non-invasive and tissue-sparing treatment modalities has led to development of new therapeutic agents. Actinic keratoses (AK) are one part of a continuous spectrum of benign sun damage to squamous cell carcinoma (SCC). Although it is not possible to predict which AK might progress to SCC, the presence of AK is a biomarker of risk for patients and must be treated to avoid possible morbidity and mortality. Ingenol mebutate is a novel topical drug from the latex sap of a plant-Euphorbia peplus that acts by chemoablative and immunostimulatory properties. Clinical studies have proven it to be safe and efficacious, leading to FDA approval of this chemotherapeutic agent for field therapy of AK in 2012. Current topical agents for field therapy of AK must be applied for weeks, whereas ingenol needs to be applied for three days. Ingenol offers a new therapeutic option that is convenient, safe, effective, acceptable and well-tolerated

Mirabegron: A first-in-class beta-3 agonist for overactive bladder

Overactive bladder (OAB), an under-diagnosed and under-treated condition, is a symptom complex characterized by urinary urgency, with or without urinary incontinence. Although antimuscarinic agents are the established first-line pharmacological treatment, insufficient efficacy, resistance and adverse effects such as dry mouth, constipation and dysuria have created the need for better drugs. Mirabegron, an oral beta-3-adrenergic agonist and first in a new class of drugs, has been recently approved by the US Food and Drug Administration to treat adults with OAB with symptoms of urge urinary incontinence, urgency and urinary frequency. By relaxing the detrusor muscle during the filling phase, mirabegron increases the storage capacity of the bladder and lengthens the interval between voiding. It does not affect bladder contraction or residual urine volume. In clinical trials, mirabegron significantly reduced the mean number of daily incontinence episodes as well as the mean number of micturitions per 24 h as compared with placebo. The most common side-effects are nasopharyngitis, urinary tract infections and headache. By exploiting a novel target, mirabegron represents a new therapeutic approach to OAB treatment with a distinct mechanism of action and gives a new hope to patients with significantly impaired quality of life due to OAB who are unable to tolerate antimuscarinic agents and who show insufficient effect from antimuscarinics