Intestinal Absorption Study: Challenges and Absorption Enhancement Strategies in Improving Oral Drug Delivery.

The oral route is the most common and practical means of drug administration, particularly from a patient's perspective. However, the pharmacokinetic profile of oral drugs depends on the rate of drug absorption through the intestinal wall before entering the systemic circulation. However, the enteric epithelium represents one of the major limiting steps for drug absorption, due to the presence of efflux transporters on the intestinal membrane, mucous layer, enzymatic degradation, and the existence of tight junctions along the intestinal linings. These challenges are more noticeable for hydrophilic drugs, high molecular weight drugs, and drugs that are substrates of the efflux transporters. Another challenge faced by oral drug delivery is the presence of first-pass hepatic metabolism that can result in reduced drug bioavailability. Over the years, a wide range of compounds have been investigated for their permeation-enhancing effect in order to circumvent these challenges. There is also a growing interest in developing nanocarrier-based formulation strategies to enhance the drug absorption. Therefore, this review aims to provide an overview of the challenges faced by oral drug delivery and selected strategies to enhance the oral drug absorption, including the application of absorption enhancers and nanocarrier-based formulations based on in vitro, in vivo, and in situ studies.

Development of a board game to assist pharmacists learning the potentially inappropriate medications in older people.

BACKGROUND AND PURPOSE: Pharmacists have been reported to have inadequate awareness about potentially inappropriate medications (PIMs) in older people. This warrants more efforts to enhance their familiarity and knowledge in this topic. A board game was developed based on the 2019 American Geriatrics Society (AGS) Beers Criteria to assist pharmacists learning the topic. EDUCATIONAL ACTIVITY AND SETTING: The board game is played using dice and pawns and involved players encounter questions on various aspects of PIMs in older people. Questions used in the board game were reviewed by a panel of experts. The board game exposed pharmacists to drug-drug and drug-disease/syndrome interactions. The board game was pilot tested among 16 pharmacists and played by a group of 34 pharmacists. Close- and open-ended feedback regarding the board game were sought in both sessions using a self-developed questionnaire. FINDINGS: All pharmacists in the pilot test (PT) and actual game (AG) sessions agreed that the board game is an innovative, useful, and interesting way to learn about PIMs in older people. All pharmacists in the PT session and a high majority of those in the AG session agreed that the board game increased their knowledge about PIMs in older people. The open-ended responses showed generally positive feedback. SUMMARY: The board game can be useful as an educational tool to supplement traditional teaching methods to assist pharmacists learning the PIMs in older people. Periodic review and relevant modifications of the board game content can be done to ensure its efficiency and relevance.

The use of herbal and dietary supplement among community-dwelling elderly in a suburban town of Malaysia.

BACKGROUND: The use of herbal and dietary supplement (HDS) in health and disease management has gained global attention. HDS are generally accepted by the public and are associated with positive health behaviours. However, several reports have been documented with regards to their potential adverse effects and interaction with conventional medicines. Limited data is currently available on the use of HDS among elderly population in Malaysia. This present study aims to investigate the prevalence of and pattern of HDS use among a sample of community-dwelling elderly in a suburban town in Malaysia. METHODS: A cross-sectional survey was conducted between March and May 2019 among the elderly aged ≥60 years old. The participants with the following criteria were included in the study: aged ≥60 years, residing in Puncak Alam and able to understand Malay or English language. Data were collected using a pre-validated questionnaire. All statistical analysis was conducted using IBM SPSS ver. 23. RESULTS: Overall, 336 out of 400 elderly responded to the survey, achieving a response rate of 84%. This study observed that almost 50% of the respondents were using at least one type of HDS in the past one month of the survey. Among HDS non-users, most of them preferred to use modern medicines (62.6%, 114/182). Among the HDS users, 75.3% (116/154) were using at least one type of modern medicine (prescription or over-the-counter medicine). Multivariate analysis showed that having good to excellent perceived health (adjusted OR = 2.666, 95% CI = 1.592-4.464), having felt sick at least once in the past one month (adjusted OR = 2.500, 95% CI = 1.426-4.383), and lower body mass index (adjusted OR = 0.937, 95% CI = 0.887-0.990) were associated with HDS use. It was noted that only a small percentage of HDS users (16.2%, 25/154) had informed healthcare providers on their HDS use. CONCLUSION: The use of HDS is common among the elderly sampled. Hence, healthcare providers should be more vigilant in seeking information of HDS use for disease management in their elderly patients. Campaigns that provide accurate information regarding the appropriate use of HDS among the elderly are pertinent to prevent misinformation of the products.