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Kinetically guided therapy with gentamicin in neonates with sepsis during the first week of life
Pokorná, Pavla ; Chládek, Jaroslav (advisor) ; Perlík, František (referee) ; Patočková, Jitka (referee)
Gentamicin (Ge) belongs to the group of aminoglycoside antibiotics frequently used in the treatment of neonates with sepsis in combination with betalactams. The first part of the disertation investigates a kinetically guided therapy with gentamicin (Ge) and the impact of covariates on pharmacokinetics/pharmacodynamics (PK/PD) while the second part describes the tolerability of treatment. This open-label, prospective study included preterm and term neonates (n=108) who experienced critically illness during the first week of life and were treated with Ge and admitted to the neonatal intensive care unit. The primary goal of the study was to perform a pharmacokinetic study after the first dose of Ge. The influence of covariates on PK was analyzed (body weight, gestational age-GA, fluid retention, persistent ductus arteriosus-PDA, postnatal age, therapeutic hypothermia-HT) as well as the success rate in the achivement of target therapeutic concentrations in the first week of pharmacotherapy. Fitting of the parameters of two-compartment model to the four plasma concentrations of Ge (CplGe) concentations after the first dose was used to estimate individual PK of Ge: distribution volume (Vd1) and clearance (CL1). Neonates were stratified into four groups according to GA and the presence of a PDA (S1-PDA=18,...
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Frequency of occurrence of selected single nucleotide polymorphisms of CYP2C8 and MDR1 in the Czech population and their influence on the effect of amiodarone
Pechandová, Kristina ; Perlík, František (advisor) ; Král, Jiří (referee) ; Anzenbacher, Pavel (referee)
Frekvence výskytu vybraných bodových polymorfismů CYP2C8 a MDR1 v české populaci a jejich vliv na působení amiodaronu Úvod: Variabilita lékové odpovědi je někdy podmíněna genetickými rozdíly v metabolismu a transportu léčiv. Interindividuální rozdíly jsou často způsobeny polymorfismy, které ovlivňují biotransformační aktivitu enzymů a expresi transportérů. V disertační práci jsme věnovali pozornost cytochromu P450 izoenzymu CYP2C8 a MDR1. Nejprve jsme popsali frekvenci výskytu vybraných variantních alel CYP2C8*2, CYP2C8*3 (2 substituce v exonu 3 a 8, CYP2C8*3G416A a CYP2C8*3A1196G), CYP2C8*4, CYP2C8 P404A u zdravé české populace a variantních alel MDR1 v exonech: 26 C3435T, 21 G2677A/T, 12 C1236T a 17 T-76A. Následně jsme sledovali vliv těchto polymorfismů na působení amiodaronu u vybraného souboru pacientů. Metody: Genotyp MDR1 a CYP2C8 jsme stanovili pomocí PCR-RFLP za využití specifických restrikčních enzymů a primerů. Frekvence genotypů MDR1jsme určili u 189 zdravých dobrovolníků a CYP2C8 u 161 zdravých osob. Do sledování jsme dále zařadili 63 pacientů užívajících amiodaron déle než dva měsíce. Jejich léčbu jsme posuzovali ze záznamů lékařské dokumentace, s využitím standardních biochemických a hematologických vyšetření a záznamů EKG. Koncentrace amiodaronu a jeho metabolitu N-...
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The influence of individual genetic predisposition to the pharmacokinetics and pharmacodynamics of chosen opioids
Matoušková, Olga ; Perlík, František (advisor) ; Votava, Martin (referee) ; Mičuda, Stanislav (referee)
MUDr. Olga Matoušková - the dissertation theses The influence of individual genetic predisposition to the pharmacokinetics and pharmacodynamics of chosen opioids ABSTRACT Introduction: The aim of this thesis is to study the influence of polymorphism of CYP2D6 and MDR1 on the pharmacokinetics and pharmacodynamics of tramadol in healthy volunteers using measurement. A secondary objective is to evaluate these polymorphisms in relation to the analgesic efficacy and side effects of piritramide for acute postoperative pain. Materials and methods: In two prospective work studying the influence of genetic predisposition on the pharmacokinetic and pharmacodynamic parameters of tramadol, we included a total of 90 healthy volunteers. Clinical studies on opioid analgesia and influence of genetic predisposition to the pharmaco-therapeutic effects and side effects in patients with acute postoperative pain, we included a total of 161 patients with acute postoperative pain. Polymorphism genotyping CYP2D6 and MDR1 gene we performed PCR - RFLP analysis, to determine concentrations of tramadol and metabolite, we used gas and liquid chromatography and pharmacodynamic effects of opioids was evaluated by pupilometric measurement and visual analogue scale. Results and conclusion: Variability of the opioid effect is influenced by...
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Frequency of selected genetic polymorphisms of cytochrome P450 in the Czech population and the influence of CYP2C9 genotype on the hypolipidemic effect of fluvastatin
Buzková, Helena ; Perlík, František (advisor) ; Bultas, Jan (referee) ; Mičuda, Stanislav (referee)
55 Abstract Frequency of selected genetic polymorphisms of cytochrome P450 in the Czech population and the influence of CYP2C9 genotype on the hypolipidemic effect of fluvastatin Introduction: One of the main factors of genetically determined variability in response of humans to administered drugs are differences in catalytic activity of metabolizing enzymes, which are caused mainly by genetic polymorphisms in cytochrom P450 family enzymes. This thesis consists of two parts and it is presented as a commentary to the original papers. The first aim was to investigate the frequency of functionally important variant alleles of three main isoenzymes of cytochrome P450 gene: CYP2D6, CYP2C9, CYP2C19, throughout the Czech population, predict the prevalence of poor metabolizer phenotypes, and then to compare the results to the data from other populations. Secondly, we analysed the correlation between the CYP2C9 genotype and cholesterol-lowering effect of fluvastatin in human hypercholesterolemic patients. Methods: Genotypes were determined by PCR-RFLP. The presence of alleles CYP2D6*1, *6, *5, *4, *3, and gene duplication was analysed in 233 healthy volunteers, CYP2C9*1, *2 and*3 in 254 subjects and CYP2C19*1, *2 and *2 in 218 subjects. Eighty seven patients on fluvastatin therapy, and 48 patients on monotherapy...
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Circadian rhythm of parathyroid hormone and bone remodeling: implication for the osteoporosis treatment with teriparatide (parathormone [1-34])
Rašková, Mária ; Zikán, Vít (advisor) ; Žofková, Ivana (referee) ; Perlík, František (referee)
Circadian rhythm of parathyroid hormone (PTH) is well documented, but its physiological role is not fully understood. In healthy individuals, biochemical markers of bone remodeling follow a similar circadian rhythm to PTH with a nocturnal rise in bone resorption and formation. The loss of PTH diurnal variation was observed not only in primary hyperparathyroidism, but also in patients with postmenopausal osteoporosis. Continuously elevated concentrations of PTH lead to excessive stimulation of bone resorption, whereas intermittent PTH administration has a strong osteoanabolic effect in patients with osteoporosis. It has not been examined whether the skeletal sensitivity to PTH action depends also on the time of its application. The aim of our study was to verify the hypothesis that the application of teriparatide (TPTD, recombinant human PTH [1-34]) at different times of the day in the context of its diurnal variability affects the physiological circadian rhythm of bone remodeling and also the bone mineral density (BMD) after the long-term TPTD treatment. Fourteen women with postmenopausal osteoporosis treated with 20 micrograms of TPTD daily, applied subcutaneously either in the morning or evening, were included in the first study. The concentration of serum C-terminal telopeptide of type I collagen...
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Metabolism, transport and anticancer effect of classical and novel taxanes
Václavíková, Radka ; Gut, Ivan (advisor) ; Perlík, František (referee) ; Anzenbacherová, Eva (referee)
L I I I I I I I I t CONCLUSIONS The dissertation thesis contributes to detail knowledge of the metabolism, transport and anticancer effects of classical taxanes (paclitaxel and docetaxel) as well as their novel synthetic analogs (SB-T-1103, SB-1'-1214 and SB-T-1216). The r]lost rmportanl reslrlts concerning studies on these anticancet drugs are srultnarized as iollorvs: o Detail metabolisrrr oť paclitaxel and docetaxel rvas estimated in human. rat. pig arrd minipig liver microsomes. The metabolism of docetaxel rvas the same i:r all four tested species. Drug rvas metabolized mainly to hydroxydocetaxel and two minor h1'droxyoxazol.idinones A and B. Despite various simiiarities between human and pig netabolism of paclitaxel, the profile oť paclitaxel metabolites in the studied species r'u.as different and main hunan metabolite óo.oHP renrains uniquelv human one' The other new metabolites of paclitaxel w.ere revealed. speciíicall1 di-oHP in ra1s and a new. hydroxypaclitaxel in rats. pigs and minipigs. q,here thrs metabolite is the main metabolic pathway oť paciitaxel. The major enzymes responsible for oxidative metaboiism of paclitaxei are CYP2CB and CYP3A4 in humans and CYP3Ai/2 in rats. Docelaxel is oxidatively metabolized by GYP3A famil"v in humans as rvell as in rats. The oxidation metabolism of classical...
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Kinetically guided therapy with gentamicin in neonates with sepsis during the first week of life
Pokorná, Pavla ; Chládek, Jaroslav (advisor) ; Perlík, František (referee) ; Patočková, Jitka (referee)
Gentamicin (Ge) belongs to the group of aminoglycoside antibiotics frequently used in the treatment of neonates with sepsis in combination with betalactams. The first part of the disertation investigates a kinetically guided therapy with gentamicin (Ge) and the impact of covariates on pharmacokinetics/pharmacodynamics (PK/PD) while the second part describes the tolerability of treatment. This open-label, prospective study included preterm and term neonates (n=108) who experienced critically illness during the first week of life and were treated with Ge and admitted to the neonatal intensive care unit. The primary goal of the study was to perform a pharmacokinetic study after the first dose of Ge. The influence of covariates on PK was analyzed (body weight, gestational age-GA, fluid retention, persistent ductus arteriosus-PDA, postnatal age, therapeutic hypothermia-HT) as well as the success rate in the achivement of target therapeutic concentrations in the first week of pharmacotherapy. Fitting of the parameters of two-compartment model to the four plasma concentrations of Ge (CplGe) concentations after the first dose was used to estimate individual PK of Ge: distribution volume (Vd1) and clearance (CL1). Neonates were stratified into four groups according to GA and the presence of a PDA (S1-PDA=18,...
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Frequency of occurrence of selected single nucleotide polymorphisms of CYP2C8 and MDR1 in the Czech population and their influence on the effect of amiodarone
Pechandová, Kristina ; Perlík, František (advisor) ; Král, Jiří (referee) ; Anzenbacher, Pavel (referee)
Frequency of occurrence of selected single nucleotide polymorphisms of CYP2C8 and MDR1 in the Czech population and their influence on the effect of amiodarone Introduction: Variability in drug response is sometimes conditioned by genetic differences in the metabolism and the transport of drugs. Interindividual differences are often caused by polymorphisms affecting biotransformation activity of enzymes and expression of transporters. In the thesis we paid attention to the cytochrome P450 CYP2C8 and MDR1. First, we described the frequency of occurrence of selected variant alleles CYP2C8 * 2, CYP2C8 * 3 (2 substitution in exon 3 and 8, CYP2C8 and CYP2C8 * 3G416A * 3A1196G), CYP2C8 * 4, CYP2C8 P404A in the healthy Czech population and MDR1 variant alleles in these exons: 26 C3435T, 21 G2677A/T, 12 C1236T a 17 T-76A. Subsequently, we studied the influence of these polymorphisms on effects of amiodarone in the selected group of patients. Methods: We determined genotypes MDR1 a CYP2C8 by PCR-RFLP by using restriction enzymes and specific primers. We determined the frequency of MDR1 genotypes in 189 healthy volunteers and CYP2C8 in 161 healthy subjects. Further we included into the study 63 patients treated with amiodarone for longer than two months. Their treatment was assessed from medical records and...
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