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Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis buy nimodipine 30mg without prescription muscle relaxant 114. Adjustment of dosage • Kidney disease: creatinine clearance <60 mL/min: 500 mg q12h; creatinine clearance 30–60 mL/min: 500 mg q24h; cre- atinine clearance 11–29 mL/min: 500 mg q24h; creatinine clearance >10 mL/min: 250 mg q24h buy nimodipine 30 mg low price muscle relaxant and tylenol 3. American Academy of Pedia- trics considers cephalosporins to be compatible with breastfee- ding 30mg nimodipine visa muscle relaxant robaxin. Warnings/precautions • It is recommended to continue therapy for at least 2–3 days after symptoms are no longer present generic 30mg nimodipine free shipping muscle relaxant yellow pill. For group A beta-hemolytic streptococcal infections, therapy should be continued for 10 days. A negative response to penicillin does not preclude allergic reaction to a cephalo- sporin. Clinically important drug interactions: Cefepime increases effects/toxicity of aminoglycosides, loop diuretics. Editorial comments • Use of cefepime should be reserved to noscomial infections especially when constant gram-negative infections are sus- pected or proven (preferably). Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis. Susceptible organisms in vivo: Highly effective against beta- hemolytic streptococci, penicillin-susceptible Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, and many Enterobacteriaceae. Adjustment of dosage • Kidney disease: creatinine clearance <60 mL/min: standard dosage; creatinine clearance 21–60 mL/min: 75% of standard dosage; creatinine clearance >20 mL/min: 50% of stan- dard dosage. American Academy of Pediatrics considers cephalosporins compatible with breastfeeding. Warnings/precautions • Use with caution in patients with the following condition: kidney disease. For group A beta-hemolytic streptococcal infections, therapy should be continued for 10 days. A negative response to penicillin does not preclude allergic reaction to a cephalo- sporin. Advice to patient: Allow at least 1 hour between taking this medication and a bacteriostatic antibiotic, eg, tetracycline or amphenicol. Clinically important drug interactions: Cefixime increases effects/ toxicity of carbamazepine. Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis. Susceptible organisms in vivo: Has activity against >50% of Pseudomonas aeruginosa strains but is less effective than cefo- taxime and ceftriaxone against gram-positive and gram-negative bacteria other than P. American Academy of Pedia- trics considers cephalosporins to be compatible with breastfee- ding. Contraindications: Hypersensitivity to other cephalosporins or related antibiotics, eg, penicillin. Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis. Susceptible organisms in vivo • Gram-positive: excellent against streptococci and Strepto- coccus pneumoniae. American Academy of Pedia- trics considers cephalosporins to be compatible with breastfee- ding. Contraindications: Hypersensitivity to other cephalosporins or related antibiotics, eg, penicillin. Warnings/precautions • It is recommended to continue therapy for at least 2–3 days after symptoms are no longer present. For group A beta-hemolytic streptococcal infections, therapy should be continued for 10 days. Anegative response to peni- cillin does not preclude allergic reaction to a cephalosporin. Clinically important drug interactions • Drug that increases effects/toxicity of cefotaxime: probenecid. Editorial comments • Cefotaxime is used similarly to ceftriaxone except less useful for home antibiotic therapy because of the higher frequency of dosing. Class of drug: Cephalosporin, second generation (a cephamycin, like cefoxitin, and not a true cephalosporin). Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis. Susceptible organisms in vivo • As compared with first-generation cefazolin and second-gener- ation true cephalosporins, less active against gram-positive organisms, more active against gram-negative organisms. Adjustment of dosage • Kidney disease: creatinine clearance <30 mL/min: usual recom- mended dose q12h; creatinine clearance 10–30 mL/min: usual recommended dose q24h; creatinine clearance >10 mL/min: usual recommended dose q48h. American Academy of Pedia- trics considers cephalosporins to be compatible with breastfee- ding. Contraindications: Hypersensitivity to other cephalosporins or related antibiotics, eg, penicillin. Warnings/precautions • Use with caution in patients with the following condition: kidney disease. For group A beta- hemolytic streptococcal infections, therapy should be contin- ued for 10 days. Anegative response to peni- cillin does not preclude allergic reaction to a cephalosporin. Clinically important drug interactions: Cefotetan increases effects/toxicity of aminoglycosides. Editorial comment • Cefotetan is used in antibiotic prophylaxis of colorectal surgery and appendectomy because of its superiority to cefazolin in these settings (better anaerobic and gram-negative coverage). Class of drug: Cephalosporin, second generation (a cephamycin, like cefotetan, and not a true cephalosporin). Mechanism of action: Binds to penicillin-binding proteins and disrupts or inhibits bacterial cell wall synthesis. Susceptible organisms in vivo: Comparable to cefotetan, except cefoxitin covers Bacteroides species. Adjustment of dosage • Kidney disease: Creatinine clearance 30–50 mL/min: 1–2 g q8–12h; creatinine clearance 10–29 mL/min: 1–2 g q12–24h; creatinine clearance 5–9 mL/min: 0. American Academy of Pediatrics considers cephalosporins to be compatible with breastfeeding. Contraindications: Hypersensitivity to other cephalosporins or related antibiotics, eg, penicillin. Warnings/precautions • Use with caution in patients with the following condition: kidney disease.

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Moeller and Applezweig (102) placed women college students into groups representing combinations of high and low social and selfapproval needs generic nimodipine 30mg with mastercard spasms definition, as measured by a sentence completion form of The Behavior Interpretation Inventory generic 30mg nimodipine otc muscle relaxant shot. No differences were found for persons scoring high in self-approval needs and low in social approval needs buy cheap nimodipine 30 mg on line muscle relaxant that starts with the letter z, or for those scoring high on both measures discount nimodipine 30 mg fast delivery spasms the movie. Krebs (80) validated the hypothesis that the greater the achievement need of a person, the more resistant he is to opinion change. Samelson (115) provided information that might allow the individual to account for the discrepancy between physical and social reality. Significantly less conformity was found under the reduced conflict situation when prior failure by the others provided the naive subject with an "explanation" for the social discrepancy. In the usual full conflict situation, both need achievement and social -256- approach were negatively but not significantly correlated with conformity, whereas under the reduced conflict condition the correlation was positive and significant. Since only one or two studies have employed the same measures of strength of needs, the conclusions drawn can only be regarded as tentative ones. In self-ratings on the Gough Adjective Check List, subjects low in conformity perceived themselves as possessing intellectual and cognitive originality, open-mindedness, a high degree of personal involvement, emotional reactivity, and lack of social ease or absence of social virtues; yielders perceived themselves as possessing ease and facility in interpersonal relations, personal effectiveness, playfulness in achieving goals, and personal stability and health. On the eighty-four descriptive item check list, independents placed significantly higher values on creativity, close interpersonal relations, and the importance of the individual as opposed to the group. Yielders saw themselves as practical-minded, physicalistic in thinking, and group-oriented. Self-descriptive questionnaire and personality inventories, used by Crutchfield (34) to contrast extreme groups, characterized the independent person as one who is adventurous, self-assertive, possessed of self-respect, and free from compulsion about rules. Conforming persons were seen as rigid, externally sanctioned, inconsistent, anxious, and possessing moralistic attitudes and conventionality of values. In another study by Crutchfield (33), staff ratings on an adjective check list described those subjects most responsive to social influence as fluid, impulsive, tense, and disturbed; those least responsive as rigid, calm, conventional, and practical; those intermediate in responsiveness as moderate, conventional, careful, stable, quiet, intelligent, and serious. On self-ratings, those who were most responsive agreed with the staff assessment; those least responsive tended to overrate themselves; whereas those who were intermediately responsive underrated themselves. Crutchfield (32) also reports significant relationships between responsiveness and such variables as impulsiveness, dominance, flexibility, spontaneity, femininity, and independence of judgmemt, as well as differences between groups in self-perception based on results from adjective check lists. In a study utilizing "normal" subjects, Cervin (27) selected as subjects high and low scorers on several pencil and paper tests of emotional stability. Highly unstable subjects were found to be significantly more likely to change their opinions under opposition. Levine, Laffal, Berkowitz, Lindemann, and Drevdahl (84) contrasted the variability in individual scores on the autokinetic task for patients in a Veterans Administration hospital. The psychiatric group was found to be more variable in perceptual judgments and to show less convergence toward group norms than the "control" group. Didato (36) obtained similar results for schizophrenic compared with normal subjects. Degree of regression in chronic schizophrenia has been reported by Spohn (125) to be related to the tendency to modify judgments in accordance with group norms, with those patients rated as moderately regressed showing more conformity in perceptual judgments than those rated as markedly regressed. Blake, Helson, and Mouton (18) investigated the generality issue for responses to various tasks under simulated group conditions. Generality of susceptibility was demonstrated by individual consistency for all tasks. Helson, Blake, Mouton, and Olmstead (63) demonstrated that individuals shifting their judgments on a larger number of attitude items moved closer to the contradictory opinions of others than those who shifted less frequently. Crutchfield (34) found the split-half reliability of individual conformity scores for a twenty-one item test to be +. Luchins (90) has reported a significant rank order correlation between degree of agreement with responses given by an assistant both in the preliminary and in the experimental series (see preceding). Both subjects who conformed and those who resisted initially tended to maintain their behavior throughout a series of trials. Results suggest that those who are more susceptible to conformity pressures are more likely to be submissive, low in selfconfidence, less intelligent, less original, show less nervous tension, score higher on authoritarian scales, score on the simplicity end of the dimension of the complexity-simplicity scale, show greater dependence on the perceptual field, and comply with requests more frequently. Several investigations reveal that conformity tendencies are geiteral across several tasks. Combinations of Variables Significant interactions between factors were found in some studies, and pooling effects were obtained by simultaneous variations in others. Variations in Stimulus and Background Dimensions A strong request complied with by another person has been found by Blake, Mouton, and Hain (19) to produce the highest frequency for signing a petition (see above). Highest frequency of volunteering has been obtained by Rosenbaum (112) (see above). Freed, Chandler, Mouton, and Blake (45) found that the largest and smallest number of violations respectively occurred when subjects saw an assistant (a) violate a "weak" sign forbidding entry and (b) conform to a strong" sign (see preceding). Blake, Helson, and Mouton (18) have varied difficulty of arithmetic items in combination with degree of discrepancy between correct answers and erroneous reports by background subjects. They report greatest shifting for more difficult items when the erroneous reports were only slightly divergent from the correct answers and the converse (see above). Uncertainty of judgment (or difficulty) also has been varied by Deutsch and Gerard (35). Subjects were found to be most susceptible when responses were given from memory, and when group members were told that the group would be rewarded for accuracy with a prize. Differences between manners of presentation were not found when subjects wrote their responses prior to hearing the reports of others (see above). Weiner (132) reported positive relationships among stimulus ambiguity, degree of certainty of judgment, discrepancy from the norm, and conformity (see above). Variations in Stimulus Dimensions and Sex Coleman, Blake, and Mouton (31) have demonstrated a significant relationship between task difficulty, susceptibility, and sex of subject. Men and women college students responded to information items after hearing the reports of two other men or women in the simulated group situation. Conformity was found to be positively and significantly related to difficulty of item for both men and women. Variations in Background Dimensions Schachter, Ellertson, McBride, and Gregory (116) found that pressures from other group members to increase production were equally effective for both high and low cohesion groups, and influences to decrease production successful only for the high cohesion groups (see above). Gerard (47) found that the higher the attractiveness of the reference group and the greater the initial agreement, the smaller the amount of shifting under exposure to influences (see above). Dittes and Kelley (37) have investigated changes in public and private opinion by group members varying in feelings of acceptance. Those told that they were about average in acceptance showed higher conformity in both public and private expressions. Interaction between degree of discrepancy, characteristics of others in the situation, and extent of attitude change has been found when the task involves ratings of the subject by himself and by both himself and others. Harvey, Kelley, and Shapiro (57) found that changes in an unfavorable direction on self ratings were greatest for acquaintances who evaluated the subject most unfavorably (see above).

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In general order nimodipine 30mg without a prescription muscle relaxants quizlet, alpha peptides are more rapidly degraded by proteases than their β-peptide counterparts cheap nimodipine 30 mg free shipping muscle relaxant histamine release. Incorporation of β-amino acid in normal peptides often can reduce affnity and activity toward their receptors/acceptors 30 mg nimodipine visa spasms early pregnancy. Therefore order 30mg nimodipine visa muscle relaxant clonazepam, it is important to identify the tolerant residues of the native peptide, which can be substituted and still retain the same level of bioactivity. As an alternative, alpha hydrazine type β-amino acids, where a carbon is replaced with a nitrogen atom in the amino acid have been synthesized, and they provide a different hydrogen bond network when substituted into the peptide to give Aza-β3-peptide [31]. Ahamed and Kaur have investigated the stability of four different hexapeptides derived from 3 type l-Asp monomers( 3 hexapeptide 1), 2 l-Dap monomers ( 2 hexapeptides 2 and 3), both and 3 acid monomers ( / 3 hexapeptide 4), compared to the only type hexapeptide 5. It was found that the peptide containing link- ages are totally resistant to proteolytic enzymes in serum. Finally peptides with substituted β-amino acids have been used to understand the mechanism of proteolytic enzymatic action. For example, it was found that peptides containing substituted β-amino acids have the same level of stability against prote- olytic enzymes no matter what type of substitution it has at the alpha position [25]. Specifc peptide bond hydroly- sis can be avoided by replacing the peptide bond with isosteres or surrogates [34]. Recognition of the site of peptide bond proteolysis is possible by studying the prod- ucts after incubation with the known peptidases using mass spectrometry and other bioanalytical techniques. We will use Kisspeptin, a peptide inhibitor for cancer metathesis, as an example to demon- strate how peptide bond isostere substitution can prevent enzymatic cleavage [35]. Enzyme or Serum Enzyme Origin 1 2 3 4 5 ( 3 2 2 / 3 ) Pronase Streptomyces griseus — — — Trypsin Porcine pancreas — — — Elastase Hog pancreas — — — — + Human serum — — n. Generally N-methylation improves lipophilicity [48], bioavailability [50, 51], and permeability to membranes. The reaction thresholds were recorded immediately before and 30 min after each injection (0815 and 1545 h). An excellent review regarding N-methylation and C-methylation of peptides has been published [54]. The correct topography of side-chain in chi space is important for peptidase recognition. By maintaining undesired topography of side-chain group to peptidases, we can improve resistance to the peptidase action and enhance peptide biological activity in vivo [55]. In addition to the constrained β-position-modifed amino acids, alpha carbon dialkyl substitution of amino acid can lead to conformational preference for particular phi and psi angles in the Ramachandran plot and may be useful for increasing the stability of peptides to enzymatic degradation. Indeed Aib is long known to promote strong helix induce properties due to the reduction of the entropic penalty of helix formation on protein folding [57, 58]. Identifcation of potential sites for glycosylation should be carefully planned, as modifcation at the wrong site can lead to loss of activity of the peptide. In addition it is imperative that one retains all the pharmacophoric residues at the C-terminal (message sequence for the opioid receptor) for optimum mu and delta opioid activity (e. Some of their early work involved the design and synthesis of l-serinyl β-d-glucoside analogs of [Met5] enkephalins. Moreover, highly desired long lasting analgesia was observed in mice using the tail fick assays and hot plate assays when these glycopeptides were administered intraperitoneally [61]. More recently, Rocchi and coworkers have done similar work using the modifed neuropeptides at the C-terminal residues of dermorphins and deltorphins and found that these glycopeptides also retained good activity for mu and delta receptors. Fur- ther, they demonstrated that glycosylation increases half-life to the enzymatic break- down of dermorphin and deltorphin analogs using mouse brain and liver homogenates [62] (Table 7. Peptides Brain t1/2 (min) Liver t1/2 (min) Dermorphin 20 ± 5 10 ± 4 [( Glc)Ser7]Dermorphin 38 ± 6 30 ± 5 [ Glc(Ac) -Ser7]Dermorphin 90 ± 10 60 ± 8 4 [Hyp,6Lys7]Dermorphin 30 ± 5 20 ± 4 Deltorphin I 240 ± 15 110 ± 20 [( Glc)Ser7]Deltorphin >240 (70%)a 180 ± 25 [ Glc(Ac) -Ser7]Deltorphin >240 (87%)a >240 (70%)a 4 aNumbers in parentheses are the residual biological activity after a 240min incubation. Moreover, this approach can increase peptide affnity and activity toward their respective receptors (e. Both biphalin and halogenated biphalin analogs were examined for in vitro brain-stability studies. Results 4,4′ revealed that the metabolic half-lives (t1/2)oftheρ-[Cl-Phe ] biphalin increased two fold compared that of the biphalin [68]. As we have seen, there are many approaches that have been successfully developed toward this goal. The method or methods chosen for any individual case will depend to a considerable extent on key structural elements of the structure of the bioactive peptide that must be retained for potent biological activity (the pharmacophore). Once that has been established, preferably in three-dimensional space, the utiliza- tion of the strategies briefy discussed here can be rapidly implemented, often using molecular modeling and computational chemistry to evaluate the consequence of structural modifcation on the three-dimensional structure of the modifed peptide ligand. Some knowledge of both primary structure and especially secondary structure can be critical in the design con- siderations. For example, stable α-helical and β-turn structures generally are not well recognized by proteolytic enzymes and hence one can design stable secondary struc- tures of this kind that are compatible with biological activity, and this can be suffcient to greatly enhance peptide stability to proteolysis in vivo. In our experience we have always been able to design bioactive peptides with very signifcant enhancement of stability against proteolytic enzymes, and retained the desired biological potency and biological activity both in vitro and in vivo. Of course, biodistribution, membrane bar- rier permeability, and so on require further considerations, which are not discussed here. Nonetheless, generally enhancing the biostability of peptides is an important component of enhancing biodistribution properties as well. Toward an optimal blood-brain barrier shuttle by synthesis and evaluation of peptide libraries. Conformational restrictions of biologically active peptides via amino acid side chain groups. Design of a new class of superpo- tent cyclic α-melanotropins based on quenched dynamic simulations. Potent and prolonged acting cyclic lactam analogues of α-melanotropin: design based on molecular dynamics. Backbone cyclic peptidomimetic melanocortin-4 receptor agonist as a novel orally administrated drug lead for treating obesity. Effect of structural and conformation modifcations, including backbone cyclization, of hydrophilic hexapeptides on their intestinal permeabil- ity and enzymatic stability. Gilon C, Huenges M, Mathae B, Gellerman G, Hornik V, Afargan M, Amitay O, Ziv O, Feller E, Gamliel A, Shohat D, Wanger M, Arad O, Kessler H. A backbone-cyclic, receptor 5-selective somatostatin analog: synthesis, bioactivity, and nuclear magnetic resonance conformational analysis. Bis-penicillamine enkephalins possess highly improved specifcity toward delta opioid receptors. Distribution and analgesia of [3H][D-Pen2,D-Pen5]enkephalin and two halogenated analogs after intravenous administration. Passage of a δ-opioid receptor selective enkephalin, [D-penicillamine2,5]enkephalin, across the blood-brain and the blood-cerebrospinal fuid barriers. Exploring ramachandran and chi space: confor- mationally constrained amino acids and peptides in the design of bioactive polypeptide ligands. Melanocortin peptide therapeutics: historical milestones, clinical studies and commercialization. Antimicrobial activity and sta- bility to proteolysis of small linear cationic peptides with D-amino acid substitutions. Development of a potent bombesin receptor antagonist with prolonged in vivo inhibitory activity on bombesin-stimulated amylase and protein release in the rat.

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In-depth investiga- tions can eventually produce data on the specifc consequences of falsifed and substandard medicines buy nimodipine 30 mg with visa spasms near ovary. Statistical methods 8 Describe the data analysis techniques used Ethical issues 9 Whether ethical approval was sought and whether the study encountered any ethical issues Packaging 10 Packaging examination and reference standards Chemical analysis 11 Chemical analysis and dissolution testing procedures and location(s) of laboratory cheap 30mg nimodipine overnight delivery muscle relaxant tmj. Possibly nimodipine 30 mg lowest price muscle relaxant reversal agents, validation against a reference method or inter-laboratory study continued Copyright © National Academy of Sciences discount 30 mg nimodipine otc muscle relaxant jaw. Packaging and chemical 16 • Packaging and chemistry results and their results relationship • Details of products sampled—how many, in what drug classes, countries of origin, batch numbers, manufacture and expiry dates • Results for each analysis—packaging, % active ingredient, dissolution • Additional information could be included in supplementary material Category of poor-quality 17 A clear statement for each medicine sample medicine detected, whether the investigators class it as genuine, counterfeit, substandard, or degraded, with an explanation as to why and whether the medicine was registered with the government in the location(s) sampled State company and 18 If the names of companies and addresses are not address as given on given, give a reason as to why this information is packaging not provided. Sharing data with the 19 Whether the data shared with the appropriate regulatory authority regulatory agency Dissemination 20 Description of any noncovert packaging features that would allow others to detect counterfeit medicines. If publication is not possible, consider disseminating via web-based supplementary material. Discussion Key Results 21 Summarize key results with reference to study objectives Limitations 22 Discussion of limitations of study, especially how robust the estimates of prevalence are and how applicable they may be to wider geographical areas. There is some reason to suspect problems with unregistered medicines in developing countries, but these problems resist detection (Amin et al. Postmarket surveillance systems, by defnition, follow only those products registered and granted market authorization in a given country. The committee believes that unregistered medicines are as important a sur- veillance target as falsifed and substandard ones. Research on the quality of unregistered medicines indicates that they are often of poor quality (Bate et al. Furthermore, drugs for sale in a country where they are not registered have often been traffcked. Chapter 5 will explain why any product that has left the licit chain of custody is suspect. A complete picture of the magnitude of the problem of poor-quality medicines depends on thorough and novel surveillance. This surveillance should advance systematic investigation of drug quality failures to build evidence for changing policy. Evidence suggests, however, that the problem is most common in low- and middle-income countries. Unscrupulous manufactur- ers and criminal cartels take advantage of the comparatively weak drug regulatory systems in these countries, knowing that the regulators are Copyright © National Academy of Sciences. The committee believes this project is promising for the 10 countries5 participating in the pilot program and, eventually, for the world. The investigator 5 Cambodia, Croatia, Georgia, Indonesia, Kyrgyzstan, Malaysia, the Philippines, Russia, Ukraine, and Vietnam. Regulators from the 10 pilot countries testing the rapid alert form and incident investigation system had training on the system in September 2012. Already the system has allowed investigators to link incidents in multiple countries. The lack of consensus on how to defne falsifed and substandard medicines has held back all public action on the topic, even surveillance. This depends on motivated and knowledgeable patients, and a longer-term improvement to the project might aim to increase reporting from health workers. The committee recognizes that building surveillance systems will be challenging in many countries. Nevertheless, taking steps to establish a system or to strengthen the existing system is a reasonable frst step in most of the world. For example, if the data indicate that substandard medicines are the main drug quality problem in one part of the world, then better regula- tion of manufacturers can do much to improve the problem. Similarly, if it becomes clear that a country has a problem with diverted medicines in commerce, then some of the distribution chain improvements presented in Chapter 5 would enhance the national drug safety program. Consistent use of this rapid alert form and eventually linking it to national pharmaco- vigilance systems would advance international discourse and give a more nuanced understanding of the extent and type of falsifed, substandard, and unregistered medicines that circulate around the world. Countering the Problem of Falsified and Substandard Drugs 111 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 112 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 113 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 114 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 115 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 116 Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs 117 Copyright © National Academy of Sciences. Substandard weight variation outside drugs of unknown origin were ampicillin and tetracycline were pharmacopoeial limits substandard. In total, 3% versus 1% contained no active ingredient, 12% versus 4% had too little or too much active ingredient and 35% versus 14% had weight variation outside pharmacopoeial limits. Substandard weight variation outside drugs of unknown origin were ampicillin and tetracycline were pharmacopoeial limits substandard. In total, 3% versus 1% contained no active ingredient, 12% versus 4% had too little or too much active ingredient and 35% versus 14% had weight variation outside pharmacopoeial limits. The highest defcit observed was 48% in two products (co-trimoxazole and benzylpenicillin). As a result, only 8 of 21 products (38%) did not contain the stated dosage of active drug. These cloxacillin [syrup and capsules]) included trimethoprim and quantities of active ingredient sulfamethoxazole tablets. Several antibacterial preparations contained very low quantities of active ingredient (ampicillin and amoxicillin 24% to 40%), and for fve metronidazole suspension preparations, no active ingredient was detected. Okeke and 5 Nigeria Five samples of Three of the fve (60%) capsule Lamikanra ampicillin capsules samples from dispensing points (2001) were found to be of lower quality than the ofcially prescribed standards of pharmaceutical quality. The quality lapses observed were sufcient to bring about determinable diferences in biological availability. The highest defcit observed was 48% in two products (co-trimoxazole and benzylpenicillin). As a result, only 8 of 21 products (38%) did not contain the stated dosage of active drug. These cloxacillin [syrup and capsules]) included trimethoprim and quantities of active ingredient sulfamethoxazole tablets. Several antibacterial preparations contained very low quantities of active ingredient (ampicillin and amoxicillin 24% to 40%), and for fve metronidazole suspension preparations, no active ingredient was detected. Okeke and 5 Nigeria Five samples of Three of the fve (60%) capsule Lamikanra ampicillin capsules samples from dispensing points (2001) were found to be of lower quality than the ofcially prescribed standards of pharmaceutical quality.

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