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Adenosine antagonist properties but pronounced phosphodiesterase inhibitory effects, did not affect either total pancreatic or islet blood flow 10 min after administration data not shown ; . Effects of selective adenosine-receptor inhibitors on the response to glucose: Mean arterial blood pressure, blood glucose or serum insulin concentrations were not affected by DMPX A2 receptor antagonist ; or DPCPX A1 receptor antagonist ; when compared to salineor glucose-injected rats given the vehicle DMSO only Table 2 ; . Administration of DMSO followed by a saline injection did not affect total pancreatic or islet blood flow when compared to the results in control animals injected with saline + saline values for the latter animals are included in Table 1 and Figure 1, respectively ; . The glucoseinduced increment of islet blood flow was not altered by the presence of DMSO Figure 2 ; . DMPX affected neither total pancreatic Table 2 ; nor islet blood flow in saline- or glucoseinjected rats Figure 2 ; . However, after pretreatment with DPCPX there was no glucosestimulated increase in islet blood flow Figure 2 ; . Effects of adenosine: Infusion of adenosine induced an increase in both blood glucose and serum insulin concentrations, which was seen both immediately after the infusion and 1 min later Table 3 ; . Pretreatment with L-NAME, a nitric oxide synthase inhibitor, did not affect this response in blood glucose to adenosine. However, L-NAME prevented the increase in serum insulin concentrations induced by adenosine, although not affecting the rebound increase in insulin concentration seen 1 min after ending the adenosine infusion. In salineinfused rats, L-NAME pretreatment effected a slight decrease of both blood glucose and serum insulin concentrations. The mean arterial blood pressure was markedly decreased by the adenosine infusion, but a rebound hypertension was consistently seen after ending the infusion Table 3 ; . L-NAME markedly increased mean arterial blood pressure in otherwise untreated control rats, but only partially prevented the adenosine-induced decrease in blood pressure. A rebound hypertension was seen also in L-NAME treated rats and felodipine.
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Fig. 23.14. A general process for the rational design of peptide mimetics: A ; identification of crucial pharmacophoric groups, B ; determination of the spatial arrangement of these groups, and C ; use of a template to mount the key functional groups in their proper conformation. Groups highlighted with an asterisk comprise the pharmacophore of the heptapeptide. Reprinted by permission 44, for example, drug information.
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Similarly there was discussion of the problem of disposal. A pharmacist pointed out the very different life lengths of different medicines; she was particularly concerned about pump sprays and inhalers. In visiting patients at home she had seen them `lying around the house'. On hearing this, a study participant agreed that disposal was difficult and described how she used to put old tablets into a mug of boiling water before flushing them down the toilet. With the increased use of blister packs, this strategy is even more difficult. It was interesting to discover in the seminars that some professionals have not heard of brown bag schemes as a way of organising appropriate disposal. Two study participants raised the question of dispensing `error'. They mentioned problems they have experienced when the pharmacist has dispensed different medicines to those that were prescribed. One had returned her tablets to the pharmacy and had insisted on receiving the correct medicine; this was given. The other participant mentioned a similar experience but had decided not to complain. She had pointed the substitution out to the pharmacist whose explanation, she felt, was satisfactory. Similarly, there was discussion, particularly in London, of the use of hospital outpatient departments and their role in prescribing and dispensing medicines. Here again there were the same kind of problems regarding collaboration at the local level. In summary, all these contributions to the discussions reflected a shared concern to establish a better collaboration between the prescribing doctor, the dispensing pharmacist and the patient. It was clear that in the course of consulting, prescribing, dispensing, collecting and consuming, all parties have distinctive concerns that occasionally conflict. They are all concerned, however, in working together to achieve effective medication, for example, florinef for.
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