Stereoisomeric pharmacovigilance and racemic drugs in hospital formularies

The rapid emergence of published data regarding drug enantiomers should be reflected in the use of racemic drugs in the clinical setting. The Department of Pharmacy, University of Malta, becoming aware of the problems created by the unknowledgeable use of racemic drugs has conducted two studies. The first study data focused on quantifying the number of chiral drugs in the Maltese National Formulary, being administered as racemic mixtures, in order to provide a better basis for purchase specifications when procuring drugs. The second study analyzed attitudes by physicians towards drug chirality.peer-reviewe

Drugs and the athlete : what is the price for winning at any cost?

Man has always sought to go faster, higher, quicker and has embarked on all kinds of means in order to achieve these aims. The first use of performance enhancing compounds can be traced back to the ancient Olympic Games, but the first list of banned ergogenic aids was only issued in 1967. Yet athletes are still being found positive. They should be educated that these drugs are not only on the list because they are illegal means of achieving results, but all of them have side effects which can lead to severe short-term and long-term health problems for athletes. Drug doping in Maltese sports could become a major ethical, educational, financial, and health management problem. Community pharmacists have an important role to play in advising athletes, sportsmen and women about which drugs or OTCs can or cannot be taken during sports events.peer-reviewe

Out of the shadows : services for persons with epilepsy in Malta

Epilepsy is the most common neurological disorder in clinical practice and it is a generic term used to define a variety of seizure disorders. A seizure is a disturbance in the electrical activity of the brain. There are more than 20 different epilepsies and syndromes, according to recent international reclassification of symptoms by the International League Against Epilepsy. These seizures affect awareness, produce brief loss of muscle control and may involve sensory distortions. Early diagnosis is crucial. Children and adults with undiagnosed seizures risk developing a more severe, more difficult to treat condition with consequent poor prognosis and increased medical costs.peer-reviewe

Chiral drugs : one drug or two? : Clinical pharmacology through the looking glass : reflections on the racemate vs enantiomer debate

Most of the synthetic chiral agents administered as drugs are still marketed as racemic mixtures. Such drug enantiomers can differ substantially in their pharmacological, pharmacokinetic and toxic properties. The development of enantiomerically pure drugs would lead to better therapeutic indices, and less complex interactions. Thus, the re-realisation of the importance of stereochemistry in pharmacology has an important contribution to make to the development and use of safer and more effective medicines. The impact of chirality on drug development and registration policies is discussed.peer-reviewe

COST : matchmaking for researchers

As many researchers are aware, while the EU offers a huge variety of funding possibilities, many of the funding mechanisms are tied to projects which require consortia made up of partners from different countries. Many researchers based in Malta, especially younger researchers, query on how one gets invited to participate in such consortia. In addition, the complex funding and administrative procedures involved in many of these EU projects, may put off several local scientists and researchers from applying for such funds. COST, Cooperation in Science and Technology, offers a facilitated mechanism which tackles and overcomes these hurdles.peer-reviewe

Abuse of OTC and prescribed drugs : popping pills for thrills?

Several studies have shown that there is a high prevalence of prescription and over the counter (OTC) drug misuse among certain population groups. In this paper, an overview will be given as to which classes of groups are mostly abused or misused. An analysis will be given as to the various factors, including associated etiologic and social factors, which could lead to prescribed and OTC drug abuse. Warning signs of prescribed and OTC drug abuse misuse will be described. Best practices in the treatment of prescribed and OTC drug abuse will be given, together with a discussion on the role of pharmacists, health care professionals and regulatory authorities in the prevention and education of this key issue in health care. The benefits of easier access to medicines should be balanced against the potential harm from unsupervised or inappropriate use of prescribed medication.peer-reviewe

Gender differences in epilepsy : perceived or real?

Epilepsy is the third most common chronic neurological condition across all ages, affecting around 1% of the population world wide. While epidemiological studies do not indicate any differences in the incidence of epilepsy in males and females, there may be significant differences in the impact and effect the condition may have between males and females across all ages. These differences may not only be due to possible differences in antiepileptic drug (AED) efficacy, AED drug-drug interactions due to hormonal differences, and possible teratogenetic effects in women of child bearing age, but also differences in the social impact of the condition. These issues challenge both the woman with epilepsy, and the various health care professionals involved in her care.peer-reviewe

The clinical relevance of pharmacokinetics and drug interactions with anti epileptic drugs

No single antiepileptic drug (AED) is appropriate in all clinical situations and therapeutic decisions on the selection of the appropriate AED should be made on a variety of specific factors. Pharmacokinetics has an important role to play in the clinical practice of antiepileptic drug therapy, as it is important in estimating individualised drug dosage regimens necessary to achieve drug plasma concentrations without causing unacceptable toxicity.peer-reviewe

Drug doping in sports : an overview and recommendations for the Maltese context

The use of legal and illicit medical substances is widespread in international sport and becoming more complex. Serious concern exists about the use of illicit substances, as listed in the list of the World Anti Doping Agency (WADA) of prohibited substances. This phenomenon is also present among Maltese athletes and positive doping cases have been reported in the media among local sportspersons from varying disciplines. In this paper, a review of the current international conventions with respect to drug doping in sport will be given together with an overview of the prohibited substances. The Maltese situation will also be assessed. Limited local data indicate that this is an underground phenomenon which has existed and persisted over the years. The testing programs, with some exceptions, have to date been very poor and most sporting disciplines are not tested regularly. Recommendations will be made in order to readdress the lacuna in data available, as well as the knowledge and education of this subject among local sportspersons, coaches and sports officials, and various health care professionals. In addition, a call is made for Malta to implement the WADA Code as soon as possible, and sign and ratify the UNESCO and Council of Europe conventions, while ensuring that adequate resources are made available for their enforcement.peer-reviewe

Understanding the molecular pharmacology of the serotonergic system : using fluoxetine as a model

Objectives: Serotonin is a monoamine neurotransmitter that is widely distributed in the body and plays an important role in a variety of psychological and other body functions such as mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation and social behaviour. This review will assess the use of fluoxetine, one of the most commonly used selective serotonin reuptake inhibitors, as a model for understanding the molecular pharmacology of the serotoninergic system. Key findings: Seven serotonin receptor families have been discovered to date. All serotonin receptors, except 5-HT 3, are G-protein coupled, seven transmembrane receptors that activate an intracellular second messenger cascade. The 5-HT 3 receptor is a ligand-gated ion channel. Furthermore, 5-HT 1A receptors are known as autoreceptors since their stimulation inhibits the release serotonin in nerve terminals. A transporter protein found in the plasma membrane of serotonergic neurones is responsible for the reuptake of this neurotransmitter. Selective serotonin reuptake inhibitors, such as fluoxetine, act primarily at the serotonin transporter protein and have limited, if any, reaction with other neurotransmitter systems. Selective serotonin reuptake inhibitors appear to bind with the serotonin transporter with different rates of occupancy, duration and potency. Summary: The following review focuses on the interaction of serotonin with this membrane transporter in the body and assesses the use of fluoxetine as a reference drug in the understanding of this interaction.peer-reviewe