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Biomedical subjects

L L Gustafsson

Publications and source records attributed to L L Gustafsson.

At least 91 records · Page 5Linked to original sources

The degree of analgesia correlates to spinal morphine concentration after intrathecal administration in rats.

Antinociceptive effects of intrathecal injections of morphine and pethidine were evaluated in rats using the hot-plate and tail-flick tests. Both drugs elicited antinociceptive effects either it was evaluated with maximal response latency (sec.) or with area under the curve (AUC) (sec. X min.). The effects of pethidine were shortlived. The concentration of morphine in the spinal cord correlated to its antinociceptive effects when tested on hot plate. A minimal morphine concentration of 3 pmol/mg in the spinal cord was required to induce experimental analgesia in the rat.

Analgesia↗

Metabolic interaction between morphine and various benzodiazepines.

The interaction between benzodiazepines and the glucuronidation of morphine was studied in vitro and in vivo. All benzodiazepines tested (diazepam, N-desmethyldiazepam, oxazepam, lorazepam, clonazepam, nitrazepam and flunitrazepam) inhibited the glucuronidation of morphine in vitro in rat liver microsomes. Clonazepam was the most and nitrazepam the least powerful inhibitor, reducing the rate of morphine conjugation by 86% and 42% of the control, respectively, at a substrate and inhibitor concentration of 1.5 mM. Rats given a single oral dose of oxazepam (20 mg per kg body weight) one hour prior to an intraperitoneal dose of morphine (10 mg per kg body weight) had a lower morphine glucuronide/morphine concentration ratio in the 24 hour urine portion than control rats without pretreatment with oxazepam. These data indicate that oxazepam inhibits the glucuronidation of morphine in rats in vivo as well as in vitro.

Animals↗

Distribution of morphine and meperidine after intrathecal administration in rat and mouse.

Morphine and meperidine distribution in the neuroaxis were studied in rats after intrathecal injection through catheters ending at the lumbar level. 14C-Morphine and 3H-meperidine were injected with pharmacologic doses of each drug. Radioactivity was measured in spinal cord segments at different times. At 14 min the segment with maximum morphine concentration (T11-12) contained 8.6 +/- 2.4 (mean +/- SD) pmol/mg, a value 215 times higher than would be observed if distribution in the body were homogeneous. The ratio between concentration in the most rostral segment (C3-4) and in the segment with maximal concentration was 0.21 +/- 0.10. At 14 min the segment with maximum meperidine concentration (T9-10) contained 161.4 +/- 33.9 pmol/mg wet tissue, a value 75 times higher than would be seen with even distribution in the body. The ratio (C3-4 vs. T9-10) was 0.10 +/- 0.04 at this time. The distribution of 14C-morphine in the whole central nervous system (CNS) was studied in mice by whole body autoradiography after intrathecal injections of 5 microliters at the L5-6 level. High levels of radioactivity were detected in the whole spinal cord and in brain regions close to the basal cisterns until 2 h after injection. At 4 h only the caudal part of the spinal cord had detectable levels of radioactivity. The per cent of the injected dose of morphine that was recovered from the spinal cord was 26.5 +/- 4.5 at 14 min, 19.9 +/- 8.8 at 44 min, and 4.5 +/- 1.7 at 179 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Chloroquine and desethylchloroquine in plasma, serum, and whole blood: problems in assay and handling of samples.

A spectrophotofluorometric method for determination of chloroquine in body fluids was compared with a recently developed high performance liquid chromatographic (HPLC) method. The spectrophotofluorometric method was found to codetermine the main metabolite desethylchloroquine and thus to give higher "chloroquine" concentrations than the HPLC method. The concentrations determined with spectrophotofluorometry roughly corresponded to the calculated sum of chloroquine and desethylchloroquine as determined with the HPLC method. The concentrations of chloroquine and desethylchloroquine were higher in serum, and considerably higher in whole blood, than in plasma. The duration and force of centrifugation greatly influenced the concentrations of chloroquine and desethylchloroquine found in plasma. The concentrations decreased as centrifugal force increased reaching relatively stable levels at 500 g. Increasing the centrifugation time partly compensated for lower g forces. These methodological problems can be avoided by using whole blood for determinations of chloroquine. Since the biological activities of desethylchloroquine and chloroquine are not the same, drug monitoring should be performed with a method distinguishing between the parent drug and the metabolite.

Blood Specimen Collection↗

Kinetics of morphine in cerebrospinal fluid after epidural administration.

Forty patients undergoing arthroscopy were given an epidural dose of 0.05 mg morphine-HCl in 0.1 ml saline/kg body weight to study the disposition of morphine in the cerebrospinal fluid (CSF). In each patient one to three CSF samples were collected (86 samples in total). A mean peak concentration of 13 890 nmol/l was achieved 75 min after morphine administration. The compiled data show an elimination half-life of 162 min (r = 0.98). Individual half-lives in seven patients with three samples ranged from 61-172 min. Large interindividual variations were found in CSF-concentrations of morphine, 9- and 8-fold at 3 and 8 h, respectively, after the dose. However, 16 h after administration no patient had a concentration less than 81 nmol/l. At 8 h after the dose, CSF concentrations of morphine were significantly higher (P less than 0.05) in a group of patients (n = 5) kept uptilted (80 degrees), as compared to those in the supine position (n = 5). Such a difference was not observed 3 h after the dose. The sampling procedure and age also seemed to influence CSF concentrations of morphine. There was no correlation between the dose given in mg and the CSF concentrations achieved. Strict standardization is thus mandatory when studying the disposition of opiates in CSF after epidural or intrathecal administration. Since our calculated half-lives of morphine in CSF were similar to those reported in plasma, the long-lasting effect is probably related to the high initial morphine concentrations in CSF.

Adult↗

On the question of dose-dependent chloroquine elimination of a single oral dose.

Subjects (n = 45) were randomly given single oral doses of 2 (n = 11), 3 (n = 9), 5 (n = 8), 10 (n = 10), or 15 mg/kg (n = 7) chloroquine base. Chloroquine was analyzed by HPLC in serum samples taken at 3 to 168 hr after dosing. AUCs, calculated for the time period of 0 to 168 hr were proportional to the doses. Mean AUC value increased 6.7 times when the dose was increased 7.5 times (from 2 to 15 mg/kg). These data do not support the existence of significant capacity-limited chloroquine elimination within the dose range studied.

Adolescent↗

Characterization of chloroquine plasma protein binding in man.

Chloroquine protein binding was determined by equilibrium dialysis of purified plasma proteins and plasma samples from 20 healthy subjects and 14 patients with rheumatoid arthritis. The mean binding was 61 +/- 9% in plasma from healthy subjects (range 46-74%) and 64 +/- 7% in plasma from rheumatoid arthritis patients (range 55-79%). Albumin and alpha 1-acid glycoprotein at physiological concentrations bound chloroquine to an approximately equal extent. Protein binding is unlikely to be an important determinant of chloroquine pharmacokinetics or response.

Adolescent↗

Disposition of chloroquine in man after single intravenous and oral doses.

1 Chloroquine was given in 300 mg single doses as an i.v. infusion, an oral solution and as tablets at intervals of at least 56 days to 11 healthy volunteers. Concentrations of chloroquine and its metabolite desethylchloroquine were measured in plasma, erythrocytes and urine using h.p.l.c. 2 Chloroquine was detectable in all plasma samples up to 23 days and occasionally up to 52 days after dosage. Urinary concentrations were monitored up to 119 days. The disposition pattern was multiexponential reflecting extensive tissue binding of the drug. 3 After i.v. dosing the volume of distribution ranged from 116 to 285 l/kg and the apparent terminal half-life from 146 to 333 h. Total plasma clearance +/- s.d. was 712 +/- 166 ml/min and renal clearance 412 +/- 139 ml/min. The mean estimated urinary recovery of chloroquine was 47%, 42% and 46% after i.v., oral solution and tablets indicating nearly complete bioavailability. The corresponding figures for the metabolite were 7%, 10% and 12%. 4 The disposition of chloroquine in erythrocytes was parallel to that in plasma. The concentrations in erythrocytes were consistently 2 to 5 times higher than in plasma. 5 Subjective side effects like difficulties with swallowing and accommodation, diplopia and fatigue occurred during intravenous infusion and were closely related to plasma concentrations. No effect was seen on the electrocardiogram, mean arterial blood pressure and pulse rate. No adverse reactions were observed after the oral doses. High frequency audiometry did not reveal any significant hearing impairment for the group as a whole.

Administration, Oral↗

Extradural and parenteral morphine: kinetics and effects in postoperative pain. A controlled clinical study.

In a controlled clinical study of 20 patients undergoing arthrotomy a single dose of morphine 0.05 mg kg-1 administered extradurally resulted in more pronounced and prolonged pain relief than morphine 0.1 mg kg-1 i.m. in the period immediately after operation. This difference was significant between 2 and 11 h after morphine administration. The maximum analgesic effect for nine patients in the extradural group was obtained about 2 h after injection. Two of 10 in the extradural group experienced urinary retention. Other side-effects were mild for both groups. Plasma concentrations of morphine were measured in five patients in each group. Four hours after administration, morphine was not detectable in plasma in any of the extradural group and in two of the i.m. group. Our study gives further support for the theory that extradural morphine acts on the spinal cord.

Adult↗

Extradural pethidine with and without adrenaline during labour: wide variation in effect.

The pain-relieving effect of a single extradural dose of pethidine 25 mg with and without adrenaline was studied in 20 healthy women during labour. The study was open regarding the effects of pethidine but double-blind regarding the addition of adrenaline. In 14 of 19 women good or excellent analgesia was achieved for a period of 50-160 min. Pethidine with adrenaline 25 micrograms was not more effective than pethidine alone. Eight of the 14 women showed signs of regional analgesia to pin-prick and temperature discrimination. The patients had small (45-188 ng ml-1) concentrations of pethidine in plasma. In eight patients the plasma concentrations of pethidine were maintained for at least 1.5 h. Extradural pethidine thus induces analgesia of short and variable duration. Repeated doses may be needed, resulting in accumulation of the drug in plasma with the risk of respiratory depression in mother or child.

Anesthesia, Epidural↗

Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden.

The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates. Special interest was focused on the frequency and type of ventilatory depression. The questionnaire was answered by 84 of 93 departments (90%). Up to May 1981 extradural morphine had been given to approximately 6000-9150 patients, extradural pethidine to 220-450 and intrathecal morphine to 90-150 patients. Ventilatory depression requiring treatment with naloxone was reported in 23 patients treated with extradural morphine (0.25-0.40%) and in six given intrathecal morphine (4-7%). In 22 patients the administration of extradural morphine was considered as a major contributory factor for the occurrence of ventilatory depression. Only two of these 22 patients experienced ventilatory depression later than 6 h after the last dose of opiates (S.C., i.m., i.v. or extradural). Patients aged 70 yr or more, those receiving thoracic extradural puncture and those with reduced ventilatory capacity seemed to be overrepresented.

Adult↗

Regional epidural analgesia: kinetics of pethidine.

Low intrathecal doses of opiates produce dose-dependent long-wasting elevation of the pain threshold in rats. The effect is postulated to be mediated by a direct action on the substantia gelatinosa of the spinal cord. Eight uncontrolled and two controlled studies in man showed a long duration of analgesia for most patients in the postoperative period. The duration of effect differs widely within and between studies. Using a double-blind design, we compared the relative efficacy of epidural and parenteral pethidine to control postoperative pain after total hip replacement. Preliminary pharmacokinetic data from six patients show that epidural doses of 20 or 60 mg pethidine give a similar pattern of absorption and elimination in plasma as 2 mg pethidine/kg body weight intramuscularly. The terminal elimination half-lives of pethidine in plasma are 5-7 h for all routes of administration. The possibility cannot be excluded that the analgesic effect of epidural pethidine is partly systemically mediated.

Anesthesia, Conduction↗

Utilization of analgesics from 1970 to 1978. Prescription patterns in the county of Jämtland and in Sweden as a whole.

A comparative analysis of the usage of analgesics in the county of Jämtland and in Sweden 1970-78 has been carried out. An attempt was also made to map out the indications for prescribing such drugs. Both in Jämtland and in Sweden as a whole, analgesics sold over the counter accounted for more than half of the total usage. The same was true for fixed drug combinations. Analgesics were prescribed each year to 17% of the population of Jämtland. Fixed drug combinations containing sedatives maintained a large fraction of the amount of analgesics prescribed--31% of defined daily doses (DDDs) in 1978. Arylalkanoic acids (ibuprofen and naproxen), introduced in 1975, soon took a substantial part of the market--13% of DDDs in 1978. Though arylalkanoic acids were registered for treatment of degenerative joint diseases, four of five patients in Jämtland received them only once or twice during a two-year period. In the national study, every third prescription of these drugs was for degenerative joint diseases. The pattern of usage revealed in this study calls for improved pharmacotherapeutic training of physicians to make drug treatment more rational.

Analgesics↗