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Some problems in dry powder inhaler formulation include low dose efficiency and changes in dispersibility during storage. For lung deposition particles should have aerodynamic size of 1 - 5µm. Poor dispersion of drug particles from carriers' surface is thought to be the main reason for low dose efficacy. A tertiary component of small particles has been generally added to formulation to improve fine particle dose. Small particles are usually manufactured by micronization. This may induce crystal defects and amorphous sites on the surface of crystals. Amorphous sites are metastable and they may crystallize during storing. Changes in particles crystallinity may have an action on efficiency and stability of dry powder inhalers. Conditioning is designated as stabilisation of particles surface by mixture of solvent vapour and inert gas. Vapour may also dissolve surface roughness. This is called deliquescence. Ostwald ripening is phenomenon whereby small particles dissolves and recrystallizes onto larger crystals. This can be extended for surface asperities. Amorphous materials have also better solubility than crystalline materials so amorphous sites may also dissolve and recrystallize onto crystalline surface. Amorphous sites may crystallize spontaneously by absorbing plasticizing agents from vapour phase or by influence of temperature. The purpose of this work was to study process variables in conditioning and their effect on modification of surface roughness and stabilization of micronized α-lactose monohydrate and test drug substance. The purpose was also to study how surface modification and stabilization effects on powders flowability and stability of dry powder inhaler. The dry powder inhaler contained two different vicinity of lactose and two different drug substances. Conditioning was based on evaporation of liquid from open surface. Studied process variables were temperature of powder, temperature of bath of liquid phase and flow rate of nitrogen gas. The aim of this study was to form a process design for conditioning of new substances, to improve powders flowability and to remove changes in fine particle dose during storage. Surface roughness was studied by laser diffraction analysis and specific surface area measurements and also by electron microscopy. Specific surface area was measured by nitrogen adsorption method. Stabilization of amorphous sites ware studied by dynamic vapour sorption. Flowability was measured by angle of repose and with FlowPro device. Fine particle dose was measured with next generator impactor device. The study showed that increasing the amount of solvent in vapour increases surface smoothness and stabilization. Also increase of temperature of sample increased stabilization. Influence of temperature on surface smoothness was not as clear. Changes in temperature may have altered adsorption and kinetic of crystallization of dissolved molecules. Flowability of lactose was significantly improved. Condition did not improve dry powder inhalers fine particle dose, but there was significant difference between different process conditions. This was concluded to be caused of surface modification. It was also shown that different process conditions affected on formulations stability.

Raman spectroscopy is based on vibrations that occur between the atoms of a compound. The overall structural energy is derived from the electronical energy as well as vibrational, rotational and translational energy. In Raman spectroscopy the vibrational and rotational energies are essential. Usually the excitation energy used in Raman spectroscopy can be either in the region of visible light or NIR. The sample absorbs the energy and energy is also scattered back to all possible directions. Elastic scattering is called the Rayleigh scattering. In that case the back-scattered photons have an equal energy as the original excitation energy. However, some of the scattering happens inelastically and it forms the basis of Raman-phenomena. If the detected photons have smaller energy than the original, it is called the Stokes scattering. If the energy is bigger, it is anti-Stokes scattering. Raman is typically very rare and weak phenomenon. The spectral features in Raman spectra consist of the intensities and energies of the back scattered photons. Raman spectroscopy provides very accurate and detailed structural information on the molecule. It is basically a label-free technique with minimal need for sample preparation and the measurements can also be carried out e.g. through container walls. Further, Raman is quite insensitive to hydrous samples and it is suitable to solutions and biological assessments. However, there are some drawbacks that are formed by the luminescence phenomena i.e. fluorescence. Strong fluorescent backgrounds can mask the relevant Raman features in spectra because Raman and fluorescence are competetive processes. For instance many drug molecules have such structures that they cause strong fluorescence. It is also one of the reasons that pharmaceutical applications and measurements have been partly limited due to this problem. There are applications to improve and enhance a Raman signal. For example resonance phenomena and SERS are favored. To solve the fluorescence-related problems there are also means; one can change the laser wavelenght, photobleach the sample or apply different kinds of data manipulation techniques to the spectral data achieved. There are drawbacks with these methods. They can be slow, complex, damage the samples and still insufficient fluorescence suppression is a problem. In this study a novel time-gated CMOS-SPAD detection technique is applied to non-fluorescent and fluorescent drug measurements. The new detection system has a programmable on-chip delay time and it is synchronized with a picosecond pulsed laser. The scattered photons can be measured in the time scale when they are simultaneously measured in traditional energy and intensity wise. Raman scattering occurs in the timescale of sub-picoseconds while the fluorescence phenomena happen typically in the order of nanoseconds. This time difference can be exploited effectively to suppress the fluorescence. In the literature review of this study the basis of vibrational spectroscopy is introduced - especially Raman spectroscopy. The techniques related, as well as the novel time-resolved technique are covered. Further, different kinds of applications in the field of Raman spectroscopy are reviewed, mainly pharmaceutics-related and biologically relevant applications. In the experimental work the focus was to compare a continuous-wave 785 nm laser setup coupled with the CCD-detector to the pulsed picosecond 523 nm laser coupled with the CMOS-SPAD-detector. The measurements were performed on different kinds of drugs, both non-fluorescent and fluorescent. The aim was to obtain information on the effectiveness of CMOS-SPAD-technique on fluorescence suppression for solid drugs and solutions. Secondary goals were to collect knowledge on the similarities and differences between the Raman setups used for solution measurements, to optimize and discuss the key elements of setups for solids and solutions and to show preliminarily the applicability of the CMOS-SPAD-system on fluorescent drug's solutions as well as find out the requirements related to quantitative assessments using Raman spectroscopy. In drug research there is also constant need for reliable in vitro cell assays. The assessments made in this study may prove useful to the future applications e.g. measurements with living cells. An effective fluorescence suppression was achieved to strong fluorescent backgrounds using the novel time-resolved CMOS-SPAD-detection system coupled with the pulsed picosecond 532 nm laser. The setup is potentially a convenient tool to overcome many fluorescence-related limitations of Raman spectroscopy for laboratory and process analytical technology (PAT) use in the pharmaceutical setting. The results achieved encourage to consider that with careful calibration and method validation there is potential for quantitative analysis, biopharmaceutical and biological applications e.g. in vitro cell studies where most Raman techniques suffer from strong fluorescence backgrounds. Other potential fields for future applications can be also considered.

Cortisol is a vital hormone for normal bodily functions. Both physical and mental stress, as well as many diseases like the Cushing syndrome are known to increase the human cortisol levels. These levels can be measured in many biological matrixes, such as saliva. Traditionally, these measurements have been done by using immunoassays or liquid chromatographic-mass spectrometric methods (LC-MS). However, in the last few years, ambient ionization techniques, which are quick and easy to use, have also proven suitable for quantitative analysis of compounds in biological matrixes. Thus, these techniques could offer an alternative to traditional methods in the analysis of cortisol from human saliva. The aim of this study was to investigate the suitability of desorption atmospheric pressure photoionization (DAPPI) for quantitative analysis of steroids in saliva. The investigated steroids were dehydroepiandrosterone (DHEA), cortisol and testosterone. Because of the low quantities of testosterone and DHEA in saliva, the study was mainly focused on cortisol analysis. In this study, the ionization mechanism for the steroids was observed to be proton transfer with every tested spray solvent (acetone, chlorobentzene and toluene). Even though the choice of spray solvent did not change the ionization mechanism, it affected the efficiency of ionization. In cortisol measurements acetone was observed to be the best solvent. The temperature of the microchip, as well as the UV-lamp used (dc- or rf-lamp), only affected the ionization slightly. In this study, measuring cortisol in non-pretreated saliva was not successful. However, solid phase extraction (SPE) method for the pretreatment of saliva was optimized with high recovery for cortisol (106 %). The detection limit for cortisol (50 nM) in water samples and the linear area of cortisol in both water and pretreated saliva samples (500 nM - 10 µM) were also determined. Poor repeatability of DAPPI-system was the main challenge in these measurements. The DAPPI-MS-method developed in this study is suitable for analyzing cortisol in pretreated saliva samples. However, without further development it is not sensitive enough to be used in quantitative analysis of cortisol in salivary levels.

COVID-19 pandemic has caused a global crisis and its effects have also been reflected to pharmaceutical supply in Finland. At the beginning of the crisis the effects were especially evident in the consumption of self-medication analgesics, prescription drugs and drugs related to respiratory diseases. In a global crisis, collaboration between the public, private and third sector is becoming increasingly important, and it is important to consider how to develop the capacity for collaboration between organizations in different sectors during a pandemic. The purpose of this study was to find out how the cross-sector collaboration between the public, private and third sector of the pharmaceutical supply in Finland was organized in the crisis caused by the COVID-19 pandemic, what was the role of the cross-sector collaboration and how the preparedness and crisis management of the drug supply could be improved. The study was conducted as a semi-structured interview survey and the interviewees were selected to cover the various sectors of Finnish pharmaceutical care as well as possible. The analysis was performed by the Gioia method and thematic design. Based on the study the organization of cross-sector collaboration was both operator- and authority-oriented and the legislation and environment in the drug supply created the framework for the crisis management. Both the authorities and the advocacy organizations can be described as having acted as hubs for organization. There was no clear crisis organization in drug supply, but different actors were involved in the crisis management at different stages of the crisis. The role of collaboration was emphasized in the sharing of information and resources and in joint solution of problems. The collaboration enabled foresight and preparedness, a focus on core tasks and crisis management, and mutual benefit. Lessons learned from the COVID-19 pandemic include the need to increase and intensify collaboration, increase crisis plans and crisis training, update the system of security of supply and mandatory reserve supplies, increase self-sufficiency, and increase overall governance. Cross-sectoral collaboration was seen as useful in crisis management of the crisis in the drug supply chain. The collaboration promotes the formation of a common picture of the situation and the flow of information from the field to decision-makers. Comparing the results of this study with the literature it can be said that the results partially support the previous literature. However, crisis management of the pharmaceutical supply chain from the organization of cross-sectoral collaboration point of view has not been studied in the past.

Tissue plasminogen activator (tPA) is a serine protease that cleaves the inactive plasminogen to a broad-spectrum protease plasmin. Plasmin is involved in the degradation of blood clots by breaking down the fibrin network. In addition to it's role in the fibrinolytic system, tPA participates in the functions of the central nervous system. tPA is expressed in several brain areas and has been shown to be involved in neuronal plasticity. tPA's effects on brain plasticity are mediated in part via degradation of extracellular matrix proteins, but mainly via processing of brain-derived neurotrophic factor (BDNF). Plasmin cleaves pro-BDNF into BDNF that serves as primary endogenous ligand for TrkB neurotrophin receptor. TrkB signalling is strongly associated with the regulation of neuronal plasticity such as neurogenesis, synaptogenesis and long-term potentiation (LTP). On the contrary, pro-BDNF binds and activates p75 neurotrophin receptor that regulates many distinct, even opposite, effects on neuronal plasticity such as long-term depression and synapse refraction. Enhancement of brain plasticity is considered to be important for the therapeutic effects of antidepressant drugs and this is at least partially mediated via BDNF. Antidepressants activate TrkB receptors and increase BDNF protein levels in the rodent brain but the mechanism behind this remains obscure. Given that tPA is an important factor in the processing of BDNF, it is a possible mediator for antidepressants' neurotrophic effects. The effects of antidepressants on tPA activity have been previously studied only in the blood circulatory system. The aim of the experimental part of this Master's thesis was to examine the effects of antidepressant fluoxetine on tPA activity and protein levels in mouse hippocampus. Also the effects of fluoxetine on BDNF-TrkB signalling were studied. Fluoxetine was administered to mice acutely (30 mg/kg, i.p., 1 h) and chronically (0,08 mg/ml in drinking water, 3 weeks). tPA activity was studied using SDS-PAGE - and in situzymographies. TrkB activation, tPA and BDNF protein levels were measured using western blot. BDNF protein levels were also examined with ELISA method. No changes in tPA activity were found after acute fluoxetine treatment. In line with this result is the observation that also the BDNF levels remained unchanged. However, TrkB receptor activity was increased in fluoxetine treated mice. It seems possible that BDNF is not involved in the TrkB activation caused by acute fluoxetine treatment. Chronic fluoxetine treatment caused a significant increase in the BDNF protein levels compared to water-drinking control mice. This was not, however, associated with significant changes in TrkB activity. No changes in tPA activity were observed, which suggests that tPA is not involved in the increase of BDNF levels after chronic fluoxetine treatment. Interestingly, tPA antibody detected three distinct proteins in western blot of whose levels acute fluoxetine treatment regulated. However, more studies are needed to identify these proteins and to reveal the significance of such an effect of fluoxetine. According to this study, neither acute nor chronic fluoxetine treatment affects tPA activity in mouse hippocampus. However, environmental enrichment has been shown to enhance tPA activity and produce similar neurotrophic effects as chronic fluoxetine treatment. Therefore the result of this study concerning effect of chronic antidepressant treatment on tPA activity should be verified.

The incidence of wet age-related macular degeneration (AMD) is increasing with ageing. AMD leads to blindness if it is not treated properly. Common treatment is to administrate intravitreal growth factor inhibitors. An ageing population increases the number of patients which overloads the public health services and expands costs. Traditionally, injections have been administered by physicians but because of the limited recourses nurses have been trained to administer injections. In addition, injections can be administered as physician's clinical extra work to alleviate the queue and as an outsourcing service from the private sector. As the resources of the public health service are limited, it is important to evaluate used methods reliably. The target of this research was to investigate the administration costs of intravitreal injections which are administered by physicians, nurses, a physician or a nurse working extra to alleviate the queue or by a private sector. The used method was cost analysis because the effectiveness of the care is the same regardless of the administer of the injection. The source of costs was Ecomed database of HUS, the data of cost accounting and catalogue of billing from the outsourcing service. The costs were examined in perspective of the producer of the service. Based on the cost analysis, the administration costs per injection are following: administered by physicians 51,39 €, nurse-administered 51,19 €, administered by a physician to alleviate the queue 100,46 €, nurse-administered to alleviate the queue 72,87 €, administered by a physician in outsourcing service 276,19 and nurse-administered in outsourcing service 269,85 €. The annual total costs of the producer of the service were 4 563 726 €. By increasing the number of injections administered by a nurse of HUS the need for an outsourcing service can be decreased which may decrease the annual total costs by two million euro. It is important to find cost-effective solutions because the number of patients are increasing. Based on this research it is more profitable to increase the number of injections administered by a nurse of HUS than to train more nurses to administrate injections to alleviate the queue or to work in outsourcing services. The result of this research can be adapted in planning of the public health services.

Quartz crystal microbalance (QCM) and surface plasmon resonance (SPR) spectroscopy are methods measuring mass changes on solid surface. During measurement fluid flows over sensor. The aim of this study was to find out if it's possible to culture a biofilm using QCM and SPR methods and compare biofilms with those cultured in test tubes under static fluid conditions. Enrofloxacin antibiotic was tested against biofilm cultured in SPR. Biofilms were imaged electron microscopically. Bacteria used were Staphylococcus pseudintermedius and Corynebacterium auriscanis and a combination of those. Biofilm was successfully cultured by both methods repeatably. S.pseudintermedius formed a biofilm, but C.auriscanis didn't. Together S.pseudintemedius and C.auriscanis formed thicker biofilm than S.pseudintermedius alone. There were difference between biofilms depending on culturing conditions. Biofilm covered the surface quicker and bacterial density was higher under flowing conditions than static fluid. The growth of biofilm was ceased during enrofloxacin feeding, but not destroyed. Growth continued after stopping enrofloxacin feeding. QCM and SPR methods are suitable for culturing biofilms. They measure mass changes on solid surface but tell nothing about the architecture of biofilm. QCM and SPR could be good methods for studying compounds destroying biofilm matrix or trying to find coating materials to prevent bacterial adhesion.

This qualitative study was carried out as a semi-structured interview study, which was supplemented with quantitative information from centralized cytotoxic preparation units in Finland hospital pharmacies and with information about interviewees. Quantitative information was collected using questionnaires. The proportion of centralized cytotoxic preparation units that responded to the background information questionnaire was 95% (19/20) of all centralized cytotoxic preparation units in mainland Finland. In the autumn of 2022, hospital pharmacy employees (n=23) participating in the reconstitution of cancer drugs were interviewed. On average, the interviewees had 14 years of work experience in the reconstitution of anticancer medicines. They represented 75% (15/20) of the centralized cytotoxic preparation units in mainland Finland, covering centralized cytotoxic preparation units of different sizes and locations in different parts of Finland. In 2021, 88% of the anticancer medicines in all centralized cytotoxic preparation units in Finland were reconstituted at the workplaces of interviewed. According to the interviews, the reconstitution of anticancer medicinal products involves the possibility of an error in several stages of the process. An error can occur when prescribing the medicine, transferring prescription information, when selecting the raw materials, reconstituting of the cancer medicine and during transport. The interviewees identified 24 risks associated with these stages, that could lead to patient safety incidents. Safeguards have been built to avert errors or promote the detection of the errors. Based on the research data, the safeguards were classified into six categories: the development of the technology, guiding work through guidelines, strengthening competence, standardizing practices, controlled working environment and learning from deviations. In Finland, it has not previously been studied or classified with which functions and principles the centralized cytotoxic preparation units have built safeguards to prevent patient safety incidents. This study shows that reconstitution of cancer medicines is a risky process. To improve the quality of reconstituted cancer medicines and patient safety, both the system- and person-focused safeguards have been built into the risk points of the processes of the centralized cytotoxic preparation units, but their utilization varied between centralized cytotoxic preparation units. Based on comprehensive data, the research result can be generalized to centralized cytotoxic preparation units in Finland hospital pharmacies.

Obesity is a growing health challenge in Finland. Despite the fact, that obesity is recognized as a chronic disease, it remains underdiagnosed and undertreated. In the past few years, two new anti-obesity drugs have entered the market to support the lifestyle changes Anti-obesity medication would be a natural option to support lifestyle changes, but physicians have not widely adopted the medication in their treatment patterns. The aim of this study was to understand, what are the abilities of primary care physician (PCP) to treat obesity, considering their knowledge, resources and, local care pathways. In addition, the study sought to determine the most important factors, that are involved in the initiation of anti-obesity medication. The study was conducted as a semi-structured thematic interview. A total of nine PCPs from all over Finland were interviewed for the study. Of these, three worked on the private sector and six on the public sector. The interviews were conducted during October-November 2020. The framework of the interviews was built based on the previous studies and information within a pharmaceutical company specializing in the treatment of obesity. The content was analysed with inductive content analysis. PCPs interested in the treatment of obesity raised the topic of weight quite easily in various situations and some of them mentioned that they even find it easy to bring up the subject. However, the subject is mainly brought up when the patient already has some weight-related comorbidities. Preventively, weight is less often talked about, especially because of a lack of human and time resources. Currently the most comprehensive care pathways and interdisciplinary teams are in occupational healthcare. In occupational healthcare, resources are perceived as adequate and the interdisciplinary teams works well. In most healthcare centers, a separate care pathway for the treatment of obesity had not been built. In general, knowledge of the obesity treatment was considered adequate, but education on the biological basis of obesity is needed. Most of the PCPs knew about the new anti-obesity drugs and had positive attitude towards them, but they did not prescribe the drugs themselves. The most significant barrier to prescribe the anti-obesity drugs, was the price of the products and the lack of reimbursement. In addition, experience with anti-obesity drugs is limited and the need for education is high. Currently, occupational health physicians have better abilities to treat obesity in terms of care pathways, interdisciplinary teams and, resources than PCPs in public healthcare. The conditions are also better for the implementation of pharmacotherapy as resources and care pathways enables proper lifestyle guidance alongside pharmacotherapy. Prior to reimbursement, pharmacotherapy may not be a realistic option in the public sector, and the conditions for proper lifestyle guidance alongside pharmacotherapy are not sufficient in all locations.

Digital technologies have brought new prospects also in pharmaceutical industry and marketing. Communication between different interest groups has become faster and more convenient. There has also been development of new marketing methods utilizing digital technology. E-detailing, mobile applications and social media sites are examples of novel ways to market medicines and disseminate medical information. The aim of this study was to find out how doctors see electronic detailing (e-detailing). The study was carried out by electronic questionnaire, which was answered by 45 Finnish doctors. Doctors who participated in this study had attended e-detailing organized by Pfizer before. Roger's innovation diffusion model was used in drawing up the questions and as theoretical framework of this study. The results of this study showed that doctors regard e-detailing mainly positively and they intend to participate e-detailing also in the future. About one fourth of the doctors, who answered, think that e-detailing is more useful than traditional detailing. In general, doctors do not prefer e-detailing to traditional or group detailing. They also attend e-detailing more seldom than other forms of detailing. In addition, doctors see that e-detailing is more additional value than substitute for traditional detailing. According to this study e-detailing can be a useful tool for pharmaceutical companies mainly because it is a convenient and effective way to contact doctors. The biggest challenges of e-detailing are lack of personality and difficulties in changing timing of arranged detailing sessions. All in all, novel marketing methods may enable that pharmaceutical companies can take doctors' different needs into account. On the other hand, controlling the totality demands that pharmaceutical companies have a functional CRM-strategy and uniform communication.