Transkarbams as transdermal permeation enhancers: Effects of ester position and ammonium carbamate formation

GSH/enzyme-responsive 2-sulfonyl-1-methylimidazole prodrug for enhanced transdermal drug delivery and therapeutic efficacy against hyperthyroidis

Novel GSH/enzyme-responsive anti-hyperthyroidism prodrugs designed for transdermal delivery of 2-sulfonyl-1- methylimidazole (MMI) were synthesized by a Michael addition reaction of MMI with propiolic acid (PA) followed by esterification with three long chain fatty alcohols and their structures were characterized by ¹H-NMR, ¹³C-NMR and mass spectrometry. Their maximum steady state flux through rat skin in the PG/W solution was found to be more than 37-times faster than that of MMI. The result may be attributed to the improved lipophilicity of prodrug and rapid bioconversion. The prodrugs were hydrolyzed by esterase on passing through the skin and appeared mainly as intermediate MMI-PA in the receiver compartment and accompanied by a small amount of MMI and intact prodrug. The prodrugs did not release any MMI in the media without GSH or with 100 µM GSH, while the obvious MMI release could be observed within 6.4 h in the media containing 2 mM and 10 mM GSH, and their maximum cumulative release rates reached 95.07% for lauryl alcohol ester prodrug (MMI-PA-OLa). MMI-PA-OLa exhibited a significant inhibition effect on lactoperoxidase (LPO) after being incubated in millimolar GSH media, whose inhibition rate was very similar to that of free MMI with an equivalent dose. These results suggested that MMI-PA-OLa could pass efficiently through the skin and release MMI in response to the intracellular environment.

Tranexamic Acid Tamponade to Control Postoperative Surgical Hemorrhage

When preparing for oral surgery, patients taking anticoagulants usually should not discontinue their medication because of the risk of a thromboembolic event. The therapeutic effect of many anticoagulants is not readily measured, so preoperatively, the surgeon cannot know the true risk for postoperative hemorrhage. The risk of a thromboembolic event usually outweighs the concerns of controlling postoperative hemorrhage. Hemophilia patients are also at risk for postoperative bleeding. Single extractions probably do not pose a serious risk for postoperative hemorrhage. However, when a mucogingival flap is raised in these patients, there may be prolonged bleeding. Surgical sponges saturated with aqueous tranexamic acid solution and compressed onto the bleeding site with biting pressure may stop bleeding. Bleeding was stopped in the case example presented here after three 10-minute compressions over 30 minutes in a patient taking aspirin and clopidogrel for a previous thromboembolic event and a metal coronary stent. The clot formed is very fragile and is prone to bleeding, so it should not be disturbed. This technique needs to be studied for efficacy.