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[Current drug problems].

From the multifaceted and complex catalog of problems in drug abuse those are selected that are relevant for medical practise. After a short introduction the situation of drug abuse in the canton of Zürich is described, based on estimates about users, descriptions of consumed amounts, market prices of heroine and cocaine and a summary of some epidemiologic data and the sequelae of drug-dependence. In a second part substitution by methadone is described in detail. In a third part cocaine with its effects and adverse effects is presented in more detail.

Cocaine↗

Variable drug metabolism genes in Arab population.

Cataloging interethnic differences in the distribution of genotypes of drug metabolic genes provides valuable information for profiling the pharmacogenetics of a population. We used PCR analysis to catalog the frequencies of alleles and genotypes for CYP1A1, NAT2, GSTs, MTHFR, MTR (MS) and NQO*1 in Arabs. The frequencies of alleles and/or genotypes for CYP1A1*2A, GSTT1 null, GSTT1 and GSTM1 double null, and GSTP1 A1578G in Arabs were significantly higher than those reported in Caucasians. However, the distribution of NAT2 acetylator phenotypes in both populations was similar. In contrast, the frequencies of MTHFR 677T allele and the combined (677+1298) genotypes for low activity were lower than those reported in Caucasians. Other alleles in Arabs, including CYP1A1 T3801C and GSTP1 A1578G were present in frequencies similar to Africans. The overall profile of variations in metabolism genes in Arabs is thus unique.

Arabs↗

[Drug utilization and recommended conditions for use in children].

BACKGROUND: Studies carried out in other countries show that drugs are used in children outside the approved conditions, in a context in which investigation, information and authorization of medications in the pediatric population are scarce. OBJECTIVES: To evaluate the conditions of drug use recommended in children and variability in sources of drug information. METHODS: We performed a descriptive, retrospective study. Data on medication consumption in 1997 were obtained from a pediatric university hospital. Information on conditions of drug use in children was analyzed using a Spanish catalog of medications. This information was compared with that of a North American catalog for international reference. RESULTS: Most of the drugs used were of unrestricted (43; 47 %) or restricted (26; 28 %) pediatric use, but drugs that are not recommended (8; 9 %) or those with unspecified conditions of use in children were also used (15; 16 %). Approximately 12 % of the drugs were not identified in the North American catalog; of the remaining drugs, 60 % were of unrestricted pediatric use, 35 % of restricted use and 5 % were not recommended. CONCLUSIONS: A substantial proportion of drugs administered to hospitalized children are not recommended or their possible use in this population is not specified. It is worth encouraging research, having sources of information that help to make decisions, especially in conditions that have not been approved, and adapting regulatory attitudes, as far as possible, to the evidence and therapeutic needs.

Adolescent↗

Investigational drug tracking: Phases I-III and NDA submissions--Part I.

The author catalogs over 800 investigational drugs/biologicals currently in Phase I, II or III clinical trials or drugs/biologicals submitted to the FDA as new drug applications. The list assists in predicting when new drugs will be marketed. The entries include generic/chemical name, investigational drug number, synonyms, trade names, manufacturers, clinical trial status, predicted approval year, indications or drug class, whether the drug has been developed through biotechnology, and references. Entries were gleaned from medical journals, stock market analysis publications, and the Pharmaceutical Manufacturers Association's Medicines in Development Series. The list is alphabetized by the generic/chemical name or investigational drug number and cross-indexed by the trade name and synonyms. The list reflects those drugs which were not FDA approved as of April 15, 1994. Part I includes the trade name and synonym cross-indexes and the beginning of the main alphabetical listing by generic/chemical name or investigational drug number.

Catalogs, Drug as Topic↗

A very large diversity space of synthetically accessible compounds for use with drug design programs.

We have constructed a very large virtual diversity space containing more than 10(13) chemical compounds. The diversity space is built from about 400 combinatorial libraries, which have been expanded by choosing sizeable collections of suitable R-groups that can be attached to each link point of their scaffolds. These R-group collections have been created by selecting reagents that have drug-like properties from catalogs of available chemicals. As members of known combinatorial libraries, the compounds in the diversity space are in general synthetically accessible and useful as potential drug leads. Hence, the diversity space can be used as a vast source of compounds by a de novo drug design program. For example, we have used such a program to generate inhibitors of HIV integrase enzyme that exhibited activity in the micromolar range.

Algorithms↗

Catalog of 668 SNPs detected among 31 genes encoding potential drug targets on the cell surface.

We have been publishing a series of detailed maps of single-nucleotide polymorphisms (SNPs) detected within the genomic loci of 145 genes encoding drug-metabolizing enzymes and transporters. As an addition to the maps reported earlier, we provide here high-density SNP maps of 31 genes encoding various receptors and adhesion molecules of medical importance. By examining a total of approximately 382 kb of genomic DNA encompassing these 31 genes, we identified 668 SNPs among 48 healthy Japanese individuals: 86 in 5' flanking regions, 27 in 5' untranslated regions, 45 in coding regions, 399 in introns, 47 in 3' untranslated regions, and 64 in 3' flanking regions. We also discovered 113 variations of other types. Of the 668 SNPs, 371 (55.5%) appeared to be novel, on the basis of comparisons with the dbSNP database of the National Center for Biotechnology Information (US) or with previous publications. The maps constructed in this study will serve as an additional resource for studies of complex genetic diseases and drug-response phenotypes to be mapped by linkage-disequilibrium analyses.

Cell Adhesion Molecules↗

Human immunodeficiency virus reverse transcriptase and protease sequence database.

The HIV RT and Protease Sequence Database is an online relational database that catalogs evolutionary and drug-related human immunodeficiency virus (HIV) reverse transcriptase (RT) and protease sequence variation (http://hivdb.stanford.edu). The database contains a compilation of nearly all published HIV RT and protease sequences including International Collaboration database submissions (e.g., GenBank) and sequences published in journal articles. Sequences are linked to data about the source of the sequence sample and the antiretroviral drug treatment history of the individual from whom the isolate was obtained. The database is curated and sequences are annotated with data from >230 literature references. Users can retrieve additional data and view alignments of sequence sets meeting specific criteria (e.g., treatment history, subtype, presence of a particular mutation). A gene-specific sequence analysis program, new user-defined queries and nearly 2000 additional sequences were added in 1999.

Databases, Factual↗

Human Immunodeficiency Virus Reverse Transcriptase and Protease Sequence Database: an expanded data model integrating natural language text and sequence analysis programs.

The HIV Reverse Transcriptase and Protease Sequence Database is an on-line relational database that catalogs evolutionary and drug-related sequence variation in the human immunodeficiency virus (HIV) reverse transcriptase (RT) and protease enzymes, the molecular targets of anti-HIV therapy (http://hivdb.stanford.edu). The database contains a compilation of nearly all published HIV RT and protease sequences, including submissions from International Collaboration databases and sequences published in journal articles. Sequences are linked to data about the source of the sequence sample and the antiretroviral drug treatment history of the individual from whom the isolate was obtained. During the past year 3500 sequences have been added and the data model has been expanded to include drug susceptibility data on sequenced isolates. Database content has also been integrated with didactic text and the output of two sequence analysis programs.

Amino Acid Sequence↗

Procainamide depleted tablets not a cause of death.

Sixteen apparently intact procainamide tablets, in varied stages of drug depletion, were found distributed throughout the gastrointestinal tract of a man who died of arteriosclerotic heart disease with pulmonary complications. The tablets were found to contain procainamide by a thin layer chromatography system with cataloged compound identification characteristics. The drug was confirmed by ultraviolet spectrophotometry and gas chromatography/mass spectrometry. The concentration of the drug in the liver was in a therapeutic range and the drug was not attributed as contributing to the cause of death.

Aged↗

Survey of new antihypertensive drugs: 1982.

Over 500 compounds reported to have antihypertensive activity have been cataloged from the world literature (1979-1982). The agents were classified according to mechanism: 1) drugs interacting at alpha-adrenoceptor sites; 2) beta-adrenoceptor antagonists; 3) drugs interacting with the autonomic nervous system by mechanisms other than 1 and 2; 4) inhibitors of the renin-angiotensin system; 5) diuretics; 6) vasodilator antihypertensives; and 7) drugs with miscellaneous mechanisms and/or sites of action. Within each class the drugs were subclassified and compounds that best fit the prototypes identified. The scheme is subjective, largely because of conflicting information cited in the literature. It is clear that many new drugs are at various stages of development. Whether or not these drugs will survive the scrutiny of rigorous and lengthy preclinical and clinical development, and in fact prove to be better antihypertensive agents than the currently marketed agents, remains to be established.

Antihypertensive Agents↗

[Potential and real drug interactions in critical care patients].

OBJECTIVES: To detect potential drug interactions occurring during treatment of critically ill patients and to evaluate the real clinical and analytical repercussions of such interactions. PATIENTS AND METHODS: Seventy consecutive patients in a six-bed medical-surgical intensive care unit (ICU) were studied prospectively over a period of five months. The pharmacological department of the hospital provided the drugs through a computerized unit dosing system, using a program that gave warnings of possible drug interactions as each patient's treatment was entered. Interactions were cataloged according to clinical importance following the criteria of Hansten. The repercussions were evaluated by clinical and analytical monitoring. RESULTS: On hundred two potential interactions were detected in 44.3% of patients (1.5 interactions per patient). In 6 patients (19.3%) analytical alterations were observed but only 2 (6.4%) of them presented clinical manifestations. Most of the interactions were cataloged as being of moderate clinical importance. Digoxin was the most frequently implicated drug. The number of drugs administered per patient was 14.7 and patients receiving the most drugs were the most likely to experience and interaction. We found a significant correlation (p < 0.05) between the number of interactions and age, APACHE III score, length of ICU stay and number of drugs administered. CONCLUSIONS: The frequently of drug interactions in critically ill patients can be high, given the large number of drugs they receive. Although the real clinical repercussions of interactions are few, physicians should watch for them and the act appropriately.

Critical Care↗

Computerized information sources in toxicology and their use in a poisons centre.

The increasing volume of calls received by a poisons centre, such as the National Poisons Unit, Guy's Hospital, London is placing the present information services under escalating pressure. Recent developments in the technologies used to store and manipulate data have resulted in a number of public and private computerized systems being made available. In order to maximize the benefit of the new technologies to a Poisons Centre Information Service it would be desirable to create an integrated system to link the currently unrelated systems. Such an integrated system would be capable of retrieving bibliographic information from bibliographic files similar to MEDLINE and EMBASE and data from source information files such as RTECS and ECDIN, with the user only having to make one enquiry. This paper examines the current position with regard to computerized information sources in toxicology and discusses how an integrated system might improve the efficiency of a poisons centre's information retrieval service and outlines some of the obstacles to the development of such a system.

Catalogs as Topic↗

Collection and preparation of molecular databases for virtual screening.

Drug discovery and development research is undergoing a paradigm shift from a linear and sequential nature of the various steps involved in the drug discovery process of the past to the more parallel approach of the present, due to a lack of sufficient correlation between activities estimated by in vitro and in vivo assays. This is attributed to the non-drug-likeness of the lead molecules, which has often been detected at advanced drug development stages. Thus a striking aspect of this paradigm shift has been early/parallel in silico prioritization of drug-like molecular databases (also database pre-processing), in addition to prioritizing compounds with high affinity and selectivity for a protein target. In view of this, a drug-like database useful for virtual screening has been created by prioritizing molecules from 36 catalog suppliers, using our recently derived binary QSAR based drug-likeness model as a filter. The performance of this model was assessed by a comparative evaluation with respect to commonly used filters implemented by the ZINC database. Since the model was derived considering all the limitations that have plagued the existing rules and models, it performs better than the existing filters and thus the molecules prioritized by this filter represent a better subset of drug-like compounds. The application of this model on exhaustive subsets of 4,972,123 molecules, many of which have passed the ZINC database filters for drug-likeness, led to a further prioritization of 2,920,551 drug-like molecules. This database may have a great potential for in silico virtual screening for discovering molecules, which may survive the later stages of the drug development research.

Computational Biology↗

Investigational drug tracking: phases I-III and NDA submissions--Part II.

The author catalogs over 800 investigational drugs/biologicals currently in Phase I, II or III clinical trials or drugs/biologicals submitted to the FDA as new drug applications. Part I of this article appeared in the September issue of Hospital Pharmacy. The list assists in predicting when new drugs will be marketed. The entries include generic/chemical name, investigational drug number, synonyms, trade names, manufacturers, clinical trial status, predicted approval year, indications or drug class, whether the drug has been developed through biotechnology, and references. Entries were gleaned from medical journals, stock market analysis publications, and the Pharmaceutical Manufacturers Association's Medicines in Development Series. The list is alphabetized by the generic/chemical name or investigational drug number and cross-indexed by the trade name and synonyms. The list reflects those drugs which were not FDA approved as of April 15, 1994. Part I concludes with the remaining alphabetical listing by generic/chemical name or investigational drug number.

Clinical Trials, Phase I as Topic↗

The Pyridoxal-5'-Phosphate-Dependent Enzymes of Mycobacterium tuberculosis.

Enzymes that depend on the cofactor pyridoxal 5'-phosphate (PLP) catalyze a remarkable variety of biochemical reactions in all organisms. In particular, the genome of Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), encodes 45 bona fide PLP-dependent enzymes plus a few related proteins that presumably do not have enzymic function. The large majority of the 45 enzymes have been characterized in terms of catalytic activity and structure. Several of them have been shown to be central to the bacterium's survival and pathogenicity, while some of these enzymes are targets of an extant drug (d-cycloserine). Herein, the annotated catalog of the PLP-dependent enzymes in M. tuberculosis is presented and analyzed with three main goals in mind. The first will be to assess the specific aspects of mycobacterial metabolism that rely most on PLP-dependent enzymes. A second goal will be to signal those enzymes whose function is still uncertain and whose functional characterization may help to further understand the biology of M. tuberculosis. Finally, we will examine the potential and limitations of targeting the PLP-dependent enzymes for the development of new antimycobacterial drugs.

Mycobacterium tuberculosis↗