A simple bioanalytical method for the quantification of antiepileptic drugs in dried blood spots

An increasing number of publications on the dried blood spot (DBS) sampling approach for the quantification of drugs and metabolites have been spurred on by the inherent advantages of this sampling technique. In the present research, a selective and sensitive high-performance liquid chromatography method for the concurrent determination of multiple antiepileptic drugs (AEDs) [levetiracetam (LVT), lamotrigine (LTG), phenobarbital (PHB)], carbamazepine (CBZ) and its active metabolite carbamazepine-10,11 epoxide (CBZE)] in a single DBS has been developed and validated. Whole blood was spotted onto Guthrie cards and dried. Using a standard punch (6 mm diameter), a circular disc was punched from the card and extracted with methanol: acetonitrile (3:1, v/v) containing hexobarbital (Internal Standard) and sonicated prior to evaporation. The extract was then dissolved in water and vortex mixed before undergoing solid phase extraction using HLB cartridges. Chromatographic separation of the AEDs was achieved using Waters XBridge™ C18 column with a gradient system. The developed method was linear over the concentration ranges studied with r ≥ 0.995 for all compounds. The lower limits of quantification (LLOQs) were 2, 1, 2, 0.5 and 1 μg/mL for LVT, LTG, PHB, CBZE and CBZ, respectively. Accuracy (%RE) and precision (%CV) values for within and between day were <20% at the LLOQs and <15% at all other concentrations tested. This method was successfully applied to the analysis of the AEDs in DBS samples taken from children with epilepsy for the assessment of their adherence to prescribed treatments.

Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability. Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population. Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health. Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

Assessment of the occurrence and potential effects of pharmaceuticals and personal care products in South Florida waters and sediments

A LLE-GC-MS method was developed to detect PPCPs in surface water samples from Big Cypress National Park, Everglades National Park and Biscayne National Park in South Florida. The most frequently found PPCPs were caffeine, DEET and triclosan with detected maximum concentration of 169 ng/L, 27.9 ng/L and 10.9 ng/L, respectively. The detection frequencies of hormones were less than PPCPs. Detected maximal concentrations of estrone, 17β-estradiol, coprostan-3-ol, coprostane and coprostan-3-one were 5.98 ng/L, 3.34 ng/L, 16.5 ng/L, 13.5 ng/L and 6.79 ng/L, respectively. An ASE-SPE-GC-MS method was developed and applied to the analysis of the sediment and soil area where reclaimed water was used for irrigation. Most analytes were below detection limits, even though some of analytes were detected in the reclaimed water at relatively high concentrations corroborating the fact that PPCPs do not significantly partition to mineral phases. An online SPE-HPLC-APPI-MS/MS method and an online SPE-HPLC-HESI-MS/MS method were developed to analyze reclaimed water and drinking water samples. In the reclaimed water study, reclaimed water samples were collected from the sprinkler for a year-long period at Florida International University Biscayne Bay Campus, where reclaimed water was reused for irrigation. Analysis results showed that several analytes were continuously detected in all reclaimed water samples. Coprostanol, bisphenol A and DEET's maximum concentration exceeded 10 μg/L (ppb). The four most frequently detected compounds were diphenhydramine (100%), DEET (98%), atenolol (98%) and carbamazepine (96%). In the study of drinking water, 54 tap water samples were collected from the Miami-Dade area. The maximum concentrations of salicylic acid, ibuprofen and DEET were 521 ng/L, 301 ng/L and 290 ng/L, respectively. The three most frequently detected compounds were DEET (93%), carbamazepine (43%) and salicylic acid (37%), respectively. Because the source of drinking water in Miami-Dade County is the relatively pristine Biscayne aquifer, these findings suggest the presence of wastewater intrusions into the delivery system or the onset of direct influence of surface waters into the shallow aquifer.

Assessment of the occurrence and potential risks of pharmaceuticals and their metabolites in fish and water using liquid chromatography mass spectrometry

A comprehensive method for the analysis of 11 target pharmaceuticals representing multiple therapeutic classes was developed for biological tissues (fish) and water. Water samples were extracted using solid phase extraction (SPE), while fish tissue homogenates were extracted using accelerated solvent extraction (ASE) followed by mixed-mode cation exchange SPE cleanup and analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS). Among the 11 target pharmaceuticals analyzed, trimethoprim, caffeine, sulfamethoxazole, diphenhydramine, diltiazem, carbamazepine, erythromycin and fluoxetine were consistently detected in reclaimed water. On the other hand, caffeine, diphenhydramine and carbamazepine were consistently detected in fish and surface water samples. In order to understand the uptake and depuration of pharmaceuticals as well as bioconcentration factors (BCFs) under the worst-case conditions, mosquito fish were exposed to reclaimed water under static-renewal for 7 days, followed by a 14-day depuration phase in clean water. Characterization of the exposure media revealed the presence of 26 pharmaceuticals while 5 pharmaceuticals including caffeine, diphenhydramine, diltiazem, carbamazepine, and ibuprofen were present in the organisms as early as 5 h from the start of the exposure. Liquid chromatography ultra-high resolution Orbitrap mass spectrometry was explored as a tool to identify and quantify phase II pharmaceutical metabolites in reclaimed water. The resulting data confirmed the presence of acetyl-sulfamethoxazole and sulfamethoxazole glucuronide in reclaimed water. To my knowledge, this is the first known report of sulfamethoxazole glucuronide surviving intact through wastewater treatment plants and occurring in environmental water samples. Finally, five bioaccumulative pharmaceuticals including caffeine, carbamazepine, diltiazem, diphenhydramine and ibuprofen detected in reclaimed water were investigated regarding the acute and chronic risks to aquatic organisms. The results indicated a low potential risk of carbamazepine even under the worst case exposure scenario. Given the dilution factors that affect environmental releases, the risk of exposure to carbamazepine will be even more reduced.

Concentration of human pollution tracers with ionic liquids

The main objective of the present thesis consists on the development of an analytical preconcentration technology for the concomitant extraction and concentration of human pollution tracers from wastewater streams. Due to the outstanding tunable properties of ionic liquids (ILs), aqueous biphasic systems (ABS) composed of ILs can provide higher and more selective extraction efficiencies for a wide range of compounds, being thus a promising alternative to the volatile and hazardous organic solvents (VOCs) typically used. For that purpose, IL-based ABS were employed and adequately characterized as an one-step extraction and concentration technique. The applicability of IL-based ABS was verified by their potential to completely extract and concentrate two representative pharmaceutical pollution tracers, namely caffeine (CAF) and carbamazepine (CBZ), from wastewaters. The low concentration of these persistent pollutants (usually found in μg·dm-3 and ng·dm-3 levels, respectively) by conventional analytical equipment does not permit a proper detection and quantification without a previous concentration step. Preconcentration methods commonly applied are costly, timeconsuming, with irregular recoveries and make use of VOCs. In this work, the ABS composed of the IL tetrabutylammonium chloride ([N4444]Cl) and the salt potassium citrate (K3[C6H5O7]) was investigated while demonstrating to be able to completely extract and concentrate CAF and CBZ, in a single-step, overcoming thus the detection limit of the applied analytical equipment. Finally, the hydrotropic effect responsible for the ability of IL-based ABS to extract and concentrate a wide variety of compounds was also investigated. It was shown that the IL rules the hydrotropic mechanism in the solubility of CAF in aqueous solutions, with an increase in solubility up to 4-fold. Moreover, the proper selection of the IL enables the design of the system that leads to a more enhanced solubility of a given solute in the IL-rich phase, while allowing a better extraction and concentration. IL-based ABS are a promising and more versatile technique, and are straightforwardly envisaged as selective extraction and concentration routes of target micropollutants from wastewater matrices.

Assessment of the Occurrence and Potential Risks of Pharmaceuticals and their Metabolites in Fish and Water Using Liquid Chromatography Mass Spectrometry

A comprehensive method for the analysis of 11 target pharmaceuticals representing multiple therapeutic classes was developed for biological tissues (fish) and water. Water samples were extracted using solid phase extraction (SPE), while fish tissue homogenates were extracted using accelerated solvent extraction (ASE) followed by mixed-mode cation exchange SPE cleanup and analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS). Among the 11 target pharmaceuticals analyzed, trimethoprim, caffeine, sulfamethoxazole, diphenhydramine, diltiazem, carbamazepine, erythromycin and fluoxetine were consistently detected in reclaimed water. On the other hand, caffeine, diphenhydramine and carbamazepine were consistently detected in fish and surface water samples. In order to understand the uptake and depuration of pharmaceuticals as well as bioconcentration factors (BCFs) under the worst-case conditions, mosquito fish were exposed to reclaimed water under static-renewal for 7 days, followed by a 14-day depuration phase in clean water. Characterization of the exposure media revealed the presence of 26 pharmaceuticals while 5 pharmaceuticals including caffeine, diphenhydramine, diltiazem, carbamazepine, and ibuprofen were present in the organisms as early as 5 h from the start of the exposure. Liquid chromatography ultra-high resolution Orbitrap mass spectrometry was explored as a tool to identify and quantify phase II pharmaceutical metabolites in reclaimed water. The resulting data confirmed the presence of acetyl-sulfamethoxazole and sulfamethoxazole glucuronide in reclaimed water. To my knowledge, this is the first known report of sulfamethoxazole glucuronide surviving intact through wastewater treatment plants and occurring in environmental water samples. Finally, five bioaccumulative pharmaceuticals including caffeine, carbamazepine, diltiazem, diphenhydramine and ibuprofen detected in reclaimed water were investigated regarding the acute and chronic risks to aquatic organisms. The results indicated a low potential risk of carbamazepine even under the worst case exposure scenario. Given the dilution factors that affect environmental releases, the risk of exposure to carbamazepine will be even more reduced.

Desenvolvimento de métodos electroquímicos de quantificação de fármacos em amostras de água contaminadas

Este trabalho teve como objectivo, o desenvolvimento de um método electroquímico, para quantificação do fármaco carbamazepina (CBZ) em águas contaminadas. Neste trabalho foram utilizados quatro métodos voltamétricos: a voltametria cíclica, a voltametria de varrimento linear, a voltametria de onda quadrada e a voltametria de impulso diferencial. Os eléctrodos de trabalho utilizados foram, o eléctrodo de mercúrio de gota suspensa, o eléctrodo de carbono vítreo clássico e um eléctrodo de carbono vítreo modificado com um filme de nanotubos de carbono de paredes múltiplas (MWCNTs). O eléctrodo de mercúrio de gota suspensa permitiu o estudo da redução da CBZ numa região de potencial mais catódico, e os eléctrodos de carbono vítreo, com e sem modificação, permitiram o estudo da oxidação da CBZ numa região de potencial mais anódico. Nas condições experimentais estudadas, o eléctrodo de mercúrio de gota suspensa revelou ser um sensor voltamétrico pouco eficaz na determinação quantitativa da carbamazepina, em amostras com uma matriz complexa. Entre os eléctrodos de carbono vítreo, o eléctrodo de carbono vítreo modificado com os MWCNTs revelou ser o sensor voltamétrico mais eficaz e sensível, na detecção e determinação da carbamazepina. Modificado com um filme de nanotubos de carbono de paredes múltiplas, que previamente foram dispersos em dihexadecilhidrogenofosfato (DHP) e água, este novo eléctrodo permitiu obter uma resposta electroquímica da CBZ, consideravelmente superior ao eléctrodo não modificado. Utilizando a voltametria de varrimento linear e as condições experimentais consideradas óptimas, o eléctrodo nanoestruturado permitiu obter uma relação linear entre o sinal medido e a concentração da CBZ no intervalo 0.13- 1.60 M (30.7- 378 g -1), com os limites de detecção e quantificação mais baixos, até à data reportados com métodos electroquímicos (0.04 e 0.14M, respectivamente). O eléctrodo modificado foi aplicado na quantificação da CBZ, em formulações farmacêuticas, em águas naturais tratadas e em amostras de águas residuais, ambas dopadas, obtendo-se taxas de recuperação consideravelmente elevadas (100.6%, 98.0%,95.8%, respectivamente). Os resultados obtidos, na análise da CBZ em amostras ambientais, com o eléctrodo modificado, foram comparados com resultados obtidos por HPLC-UV e LC­ ESI-MS/MS, validando o método electroquímico desenvolvido neste trabalho. ABSTRACT: The aim of this work was to develop a new electrochemical method for the quantification of carbamazepine (CBZ) in contaminated waters. ln this study, four voltammetric methods were used: cyclic voltammetry, linear sweep voltammetry, square wave voltammetry and differential pulse voltammetry. the working electrodes used were the hanging mercury drop electrode (HMDE), the classical glassy carbon electrode (GCE), and a glassy carbon electrode modified with a film of multi-walled carbon nanotubes (MWCNls). Using HMDE, the reduction of CBZ was studied in the cathodic potential region. the CGE sensors, with or without modification, allowed the study of CBZ oxidation in the anodic potential region. ln the tested conditions, the results obtained for the quantification of CBZ using the HMDE sensor were not very satisfactory, especially when more complex samples were analysed. When the MWCNls-dihexadecyl hydrogen phosphate (DHP) film­ coated GCE was used for the voltammetric determination of CBZ, the results obtained showed that this modified electrode exhibits excellent enhancement effects on the electrochemical oxidation of CBZ. the oxidation peak current of CBZ at this film­ modified electrode increased significantly, when compared with that at a bare glassy carbon electrode. The enhanced electrooxidation and voltammetry of CBZ at the surface of MWCNTs-DHP film coated GCE in phosphate buffer solution (pH 6.71) was attributed to the unique properties of MWCNTs such as large specific surface area and strong adsorptive properties providing more reaction sites. The proposed method was applied to the quantification of CBZ in pharmaceutical formulations, drinking water and wastewater samples with good recoveries and low limits of detection and quantification (0.04 and 0.14 M, respectively), and was positively compared with chromatographic techniques usually used in the quantification of pharmaceutical compounds in environmental samples. HPLC-UV and LC-ESI-MS/MS were also used in the quantification of CBZ in pharmaceutical formulations and wastewater samples to prove the importance and accuracy of his voltammetric method.