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Biomedical subjects

R Calvo

Publications and source records attributed to R Calvo.

At least 127 records · Page 7Linked to original sources

Effect of sodium valproate on midazolam distribution.

The displacement of midazolam, a new water-soluble, short acting benzodiazepine, from its plasma binding sites by sodium valproate, has been studied in man. An increase of its free fraction (ranging from 2.71 to 5.35%) in plasma from epileptic patients receiving sodium valproate was observed. A similar situation was created in rabbits by pretreatment with sodium valproate (600 mg kg-1 day-1) and posterior hypnosis with midazolam. Due to the interaction, sodium valproate-pretreated rabbits showed an increase in midazolam brain levels (130.91 micrograms g-1 in cortex vs 84.55 micrograms g-1 in control animals). Therefore, it seems likely that displacement of midazolam by sodium valproate in epileptic patients could lead to an increase of the midazolam response.

Adult↗

Serum protein binding of penbutolol in patients with hepatic cirrhosis.

Serum protein binding of penbutolol, a non-cardioselective beta-blocker agent of basic nature, has been studied in healthy subjects and in patients with hepatic cirrhosis. The percentage of free penbutolol in serum containing 200 ng/ml was markedly increased in patients with hepatic cirrhosis, when compared with the group of healthy volunteers (8.17 +/- 1.13% in patients vs 3.41 +/- 0.19 in control). No significant differences in the levels of serum alpha-acid-glycoprotein (the major protein implicated in the serum binding of penbutolol) were detected. Differences in the overall affinity constant for the binding were apparent between both groups (nKa = 5.28 X 10(5) M-1 in patients vs 12.03 X 10(5) M-1 in healthy volunteers). These results suggest a qualitative change in alpha-acid-glycoprotein molecule, from hepatic patients, but further studies are needed to clarify this point.

Adult↗

A special outpatient clinic for following patients with implanted tachyarrhythmia devices.

Implantable anti-tachycardia devices have become an additional therapeutic option for those patients afflicted with life-threatening tachyarrhythmias. Follow-up of these complex devices are time-consuming and, if mismanaged, may be dangerous to the patient. For these reasons, a special anti-tachycardia device clinic was started at Newark Beth Israel Medical Center in July 1984. From the inception of the clinic to September 1985, 24 patients were followed. Seventy-five percent had antitachycardia devices (ATDs) implanted for treatment of ventricular tachyarrhythmias (VT/VF) with the remaining 25% for supraventricular tachycardias. All patients were seen every 3 months or more often if clinically required. Of 112 clinic examinations, 102 (91%) were scheduled appointments (group I) while the remaining 10 visits (group II) were unscheduled and preceded by symptomatic episodes. The problems detected in clinic (groups I and II) ranged from sudden failure of an AICD to apprehension. Appropriate nonoperative treatment was given during clinic evaluation for 60% of the problems detected in group II, while the remaining 40% required eventual surgical intervention. Compliance throughout the 15-month follow-up period was 100%. Major benefits of the clinic cited by patients and their families were continuity of care, the time allotted to meet the individual needs, and management of most problems on an out-patient basis.

Electrocardiography↗

Interaction between thiopentone and sodium valproate. An in vitro and in vivo study.

The effect of sodium valproate on the binding of thiopentone to serum protein was studied in vitro. In the absence of valproate the unbound fraction of thiopentone was 15.2 +/- 0.64%, but with concentrations of valproic acid in excess of the therapeutic range, it increased to 22.42 +/- 1.65%. Scatchard plots for thiopentone in the absence and presence of valproate were investigated also. The barbiturate was bound by one group of binding sites with the association constant, Ka = 2.81 X 10(3) litre mol-1 and the number of binding sites (n) = 2.3. There was a marked decrease in this association constant in the presence of valproic acid (Ka = 1.82 X 10(3) litre mol-1), but without significant change in the number of binding sites (n = 2.13). Additionally, the effect of administration of sodium valproate i.v. on thiopentone anaesthesia was examined in rabbits. The recovery time from thiopentone was markedly longer in the presence of the anticonvulsant drug (17.0 min v. 37.1 min).

Anesthesia Recovery Period↗

Differential effects of valproic acid on the serum protein binding of lorazepam and diazepam.

Valproic acid and free fatty acids have been shown to displace diazepam from its plasma binding sites both in vitro and in vivo. Since lorazepam exhibits a substantial degree of binding, but differs from other benzodiazepines in that no increase in its free fraction in serum is observed when free fatty acids are raised, the effect of valproate on the serum protein binding of diazepam and lorazepam was assessed. Sodium valproate produced a marked increase in the free fraction of diazepam, but practically no effect on the percentage of free lorazepam.

Blood Proteins↗

Underestimation of albumin content by bromocresol green, induced by drug displacers and uremia.

Phenylbutazone and clofibric acid, two drugs strongly bound to human albumin, produce low readings of albumin content in serum when the bromocresol green immediate reaction is used. This abnormality is observed at drug concentrations within the range obtained during therapeutic use, and tends to be more marked in diluted samples of serum. Abnormally low values of albumin content are also obtained when the bromocresol green method is used in uremic sera, and the disparity seems related to the degree of carbamylation of these samples. The reported interferences are great enough in some cases as to suggest that the use of the immediate reaction between bromocresol green and serum should not be considered a valid measure of albumin content when these factors cannot be totally excluded.

Adult↗

The electronic structure of Fe2+ in reaction centers from Rhodopseudomonas sphaeroides. III. EPR measurements of the reduced acceptor complex.

Electron paramagnetic resonance (EPR) spectra of the reduced quinone-iron acceptor complex in reaction centers were measured in a variety of environments and compared with spectra calculated from a theoretical model. Spectra were obtained at microwave frequencies of 1, 9, and 35 GHz and at temperatures from 1.4 to 30 K. The spectra are characterized by a broad absorption peak centered at g = 1.8 with wings extending from g approximately equal to 5 to g less than 0.8. The peak is split with the low-field component increasing in amplitude with temperature. The theoretical model is based on a spin Hamiltonian, in which the reduced quinone, Q-, interacts magnetically with Fe2+. In this model the ground manifold of the interacting Q-Fe2+ system has two lowest doublets that are separated by approximately 3 K. Both perturbation analyses and exact numerical calculations were used to show how the observed spectrum arises from these two doublets. The following spin Hamiltonian parameters optimized the agreement between simulated and observed spectra: the electronic g tensor gFe, x = 2.16, gFe, y = 2.27, gFez = 2.04, the crystal field parameters D = 7.60 K and E/D = 0.25, and the antiferromagnetic magnetic interaction tensor, Jx = -0.13 K, Jy = -0.58 K, Jz = -0.58 K. The model accounts well for the g value (1.8) of the broad peak, the observed splitting of the peak, the high and low g value wings, and the observed temperature dependence of the shape of the spectra. The structural implications of the value of the magnetic interaction, J, and the influence of the environment on the spin Hamiltonian parameters are discussed. The similarity of spectra and relaxation times observed from the primary and secondary acceptor complexes Q-AFe2+ and Fe2+Q-B leads to the conclusion that the Fe2+ is approximately equidistant from QA and QB.

Biophysical Phenomena↗

Procaine hydrolysis defect in uraemia does not appear to be due to carbamylation of plasma esterases.

Procaine esterase activity in plasma from patients with renal failure is decreased by 40%. Since cyanate is formed from urea and readily carbamylates certain blood proteins, a possible role for cyanate in the depression of plasma esterase activity in uraemic patients was considered. However, in vitro carbamylation of normal plasma in a range similar to that detected in uraemic patients did not influence procaine esterase activity. Kinetic analysis of the reaction showed that the maximal hydrolyzing capacity but not the Km in uraemic plasma was diminished (5.0 +/- 0.3 X 10(-5) moles hydrolyzed per litre of plasma per minute and a Km of 3.9 +/- 0.2 X 10(-5) mol/l in plasma from normal volunteers as compared to 3.1 +/- 0.1 X 10(-5) mol/l/min and 3.5 +/- 0.2 X 10(-5) ml/l in plasma from patients with renal failure). Therefore, not carbamylation but rather a decrease in enzyme synthesis is the likely explanation for the lower rate of procaine hydrolysis in uraemic plasma.

Adult↗

Effects of carbamylation of plasma proteins and competitive displacers on drug binding in uremia.

The effects of in vitro carbamylation of plasma with potassium cyanate on the binding of sulfisoxazole and diazepam have been investigated. Incubation of plasma with potassium cyanate produced varying degrees of carbamylation of plasma proteins which were associated with a decrease in the binding of sulfisoxazole (100 mg/l), a drug bound to site I on the human albumin. Scatchard plots showed that this decreased binding resulted from a decrease in affinity without changes in the number of binding sites. Similar changes were detected in uremia. Carbamylation of plasma proteins did not affect the binding of diazepam (3 mg/l), a drug bound to site II. The plasma protein binding of sulfisoxazole and diazepam was decreased in samples from uremic patients. Charcoal treatment did not modify the binding of sulfisoxazole to normal or carbamylated plasma while it reduced, but did not normalize, the binding defect in uremic plasma. On the other hand, charcoal treatment brought the binding of diazepam in uremic plasma to normal values. It seems that only drug binding site I is carbamylated in uremia, while competitive displacers bind to sites I and II.

Adult↗

Plasma protein binding of etomidate in different age groups and in patients with chronic respiratory insufficiency.

Plasma protein binding of etomidate, an intravenous anesthetic agent of basic nature, has been studied in healthy subjects of different age groups and in patients with chronic respiratory insufficiency. No differences were detected in the plasma protein binding of etomidate between young children and young adults, but elderly subjects exhibited decreased binding. Low levels of serum albumin may account in part for this decreased binding, but differences in the amount of etomidate bound per mol of albumin and in affinity constants for the binding were also apparent between young adults and elderly individuals. Although plasma protein binding of etomidate may also be decreased in patients with chronic respiratory insufficiency, further studies are needed to clarify this point.

Adult↗

Effects of disease and acetazolamide on procaine hydrolysis by red blood cell enzymes.

Procaine hydrolysis in vitro has been studied in whole blood, plasma, and washed erythrocytes. Esterase activity was higher in whole blood than in either diluted plasma or resuspended erythrocytes. Eserine and echothiophate specifically inhibited plasma procaine esterase activity, while acetazolamide blocked hydrolysis of procaine by washed erythrocytes. Kinetic studies in whole blood also identified 2 different enzymes. Procaine esterase activity associated with red blood cells was not impaired in patients with renal failure or hepatic cirrhosis, but procaine half-life (t 1/2) in whole blood of normal subjects was longer after 250 mg acetazolamide.

Acetazolamide↗

Plasma protein carbamylation and decreased acidic drug protein binding in uremia.

The effects of in vitro carbamylation of plasma with potassium cyanate on drug-protein binding have been investigated. Potassium cyanate added to samples of normal plasma and incubated for 30 to 150 min induced time-related plasma protein carbamylation. Carbamylation of plasma did not influence quinidine protein binding, but resulted in decreased salicylate binding. The increased free fraction of salicylate in plasma correlated with the degree of carbamylation of plasma proteins (r = 0.99; p less than 0.001). Plasma from patients with chronic renal disease showed varying degrees of plasma protein carbamylation, correlating with the values of free plasma salicylate (r = 0.80; p less than 0.05). Scatchard plots for sulfadiazine binding in plasma from patients with uremia and in normal plasma carbamylated in vitro with potassium cyanate showed changes in the 2 groups when compared with those in normal individuals. If cyanate is produced in vivo from urea in patients with uremia, plasma protein carbamylation may play a role in the decreased plasma protein binding of some acidic drugs.

Adult↗

Etomidate and plasma esterase activity in man and experimental animals.

No hydrolysis of etomidate in plasma in vitro was detected in samples from man, horse, cow, sheep, guinea pig or white rabbit. Brown rabbits showed a moderate degree of hydrolysis and it was marked in plasma from Wistar rats. In this species, a single enzyme, an alliesterase, participated in the hydrolysis in plasma. Etomidate did not interfere with the hydrolysis of procaine by plasma pseudocholinesterase in man.

Animals↗

Multi-clinic double-blind comparison of triazolam (Halcion) and placebo administered for 14 consecutive nights in outpatients with insomnia.

In this multi-clinic double-blind study, patients suffering from insomnia were treated with triazolam 0.5 mg (Halcion) or placebo for 14 days. Four investigators treated 239 patients, 122 on triazolam and 117 on placebo. Thirty-nine patients, 10 on triazolam and 29 on placebo, dropped out for ineffectiveness of the medication and 32 patients, 16 in each group, dropped out for side effects. Analysis of pooled efficacy data showed that triazolam was significantly better than placebo on all efficacy parameters measured, including how much the medication helped the patients sleep, onset of sleep, duration of sleep, duration compared to usual, number of nocturnal awakenings, and feeling of restfulness in the morning. Triazolam did not produce evidence of tolerance development after 2 weeks of treatment. The same variety of side effects occurred on each treatment and primarily included drowsiness, grogginess, headaches, impaired coordination nausea, and dizziness.

Adolescent↗