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Yücel NT, Asfour AAR, Evren AE, Yazıcı C, Kandemir Ü, Özkay ÜD, Can ÖD, Yurttaş L. Design and synthesis of novel dithiazole carboxylic acid Derivatives: In vivo and in silico investigation of their Anti-Inflammatory and analgesic effects. Bioorg Chem 2024; 144:107120. [PMID: 38219479 DOI: 10.1016/j.bioorg.2024.107120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
Inflammation is a complex set of interactions that can occur in tissues as the body's defensive response to infections, trauma, allergens, or toxic compounds. Therefore, in almost all diseases, it can be observed because of primary or secondary reasons. Since it is important to control and even eliminate the symptoms of inflammation in the treatment of many diseases, anti-inflammatory and analgesic drugs are always needed in the clinic. Therefore, the discovery of new anti-inflammatory/analgesic drugs with increased effectiveness and safer side effect profiles is among the popular topics of medicinal chemistry. Therefore, in this study, in order to synthesize and diversify new molecules, we focused on the N,N-dithiazole carboxylic acid core and linked it with the chalcone functional group. The final eleven molecules were analyzed via HRMS, 1H NMR, and 13C NMR. The antinociceptive effects of the test compounds were examined by tail-clip, hot-plate, and formalin methods in mice, while their anti-inflammatory activities were investigated by carrageenan-induced inflammation tests in rats. The motor activities of the experimental animals were evaluated using an activity-meter device. Obtained findings revealed that none of the test compounds (10 mg/kg) were effective in the tail-clip and hot-plate tests. However, compounds 4b, 4c, 4f, 4 h, and 4 k in the serial shortened the paw-licking times of mice in the late phase of the formalin test indicating that these compounds had peripherally-mediated antinociceptive effects. The same compounds, moreover, showed potent anti-inflammatory effects by significantly reducing paw edema of rats in the inflammation tests. To provide an approach to pharmacological findings regarding possible mechanisms of action, the binding modes of the most active compounds were investigated by in silico approaches. The results of molecular docking studies indicated that the anti-inflammatory and analgesic activities of the compounds might be related to the inhibition of both COX-1 and COX-2 isoenzymes. Findings obtained from in silico studies showed that 4 k, which was chosen as a model for its analogs in the series, forms strong bindings to the basic residues (Arg120, Tyr355), side pocket loop area and deep hydrophobic regions of the enzyme. Moreover, results of the molecular dynamics simulation studies revealed that ligand-COX enzyme complexes are quite stable. Obtained results of in vivo and in silico studies are in harmony, and all together point out that compounds 4b, 4c, 4f, 4 h, and 4 k have significant anti-inflammatory and analgesic activities with good ADME profiles. The potential of the derivatives, whose pharmacological activities were revealed for the first time in this study, as anti-inflammatory and analgesic drug candidates, needs to be evaluated through comprehensive clinical studies.
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Affiliation(s)
- Nazlı Turan Yücel
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
| | - Abd Al Rahman Asfour
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
| | - Asaf Evrim Evren
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey; Pharmacy Services, Vocational School of Health Services, Bilecik Seyh Edebali University, Bilecik 11100, Turkey.
| | - Cevşen Yazıcı
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
| | - Ümmühan Kandemir
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey; Department of Medical Services and Techniques, Vocational School of Health Services, Bilecik Şeyh Edebali University, Bilecik 11100, Turkey
| | - Ümide Demir Özkay
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
| | - Özgür Devrim Can
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
| | - Leyla Yurttaş
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26100, Turkey
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Heidarpoor Saremi L, Ebrahimi A, Lagzian M. Identification of new potential cyclooxygenase-2 inhibitors: insight from high throughput virtual screening of 18 million compounds combined with molecular dynamic simulation and quantum mechanics. J Biomol Struct Dyn 2020; 39:1717-1734. [PMID: 32122267 DOI: 10.1080/07391102.2020.1737574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The cyclooxygenase isoenzymes (COX-1 and COX-2) have a critical role in inflammation, fever, and pain. In contrary to COX-1, COX-2 is specifically expressed in inflamed tissues. Because of the subtle difference between both enzyme active sites, targeting COX-2 represents an efficient strategy for the development of novel inhibitors against inflammation with fewer side effects. In order to identify potential inhibitors of COX-2, more than 18,000,000 small molecules were retrieved from the ZINC database and virtually screened against it with a gradual increase in the precision through combined multistep docking. The results were sorted according to the rank-by-rank, induced-fit docking, and MM-GBSA evaluation. Subsequently from the final hit list, two top hits along with an approved selective inhibitor (celecoxib) were further investigated by the molecular dynamics (MD) simulations. The results were indicated that ZINC16934653 and ZINC40484701 demonstrate the highest affinity for the COX-2 binding pocket. Both ligands were bound to the important active-site residues, which are necessary for the correct orientation of inhibitors inside the binding cavity. Their binding free energies were comparable to celecoxib. 100 ns MD simulation is revealed that ZINC40484701 is more preferred in comparison with ZINC16934653 and celecoxib. In addition, non-covalent interactions between the compounds and key residues located in 6 Å distance from the COX-2 binding site show similar patterns of bonding by the reduced density gradient and the independent gradient model. Therefore, ZINC40484701 can be a potential candidate for further in vitro and in vivo analysis after lead-optimization efforts.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Leily Heidarpoor Saremi
- Department of Chemistry, Computational Quantum Chemistry Laboratory, University of Sistan and Baluchestan, Zahedan, Iran
| | - Ali Ebrahimi
- Department of Chemistry, Computational Quantum Chemistry Laboratory, University of Sistan and Baluchestan, Zahedan, Iran
| | - Milad Lagzian
- Department of Biology, Faculty of Sciences, University of Sistan and Baluchestan, Zahedan, Iran
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An Active Learning Activity to Reinforce the Design Components of the Corticosteroids. PHARMACY (BASEL, SWITZERLAND) 2018; 6:pharmacy6010016. [PMID: 29401733 PMCID: PMC5874555 DOI: 10.3390/pharmacy6010016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/17/2022]
Abstract
Despite the popularity of active learning applications over the past few decades, few activities have been reported for the field of medicinal chemistry. The purpose of this study is to report a new active learning activity, describe participant contributions, and examine participant performance on the assessment questions mapped to the objective covered by the activity. In this particular activity, students are asked to design two novel corticosteroids as a group (6-8 students per group) based on the design characteristics of marketed corticosteroids covered in lecture coupled with their pharmaceutics knowledge from the previous semester and then defend their design to the class through an interactive presentation model. Although class performance on the objective mapped to this material on the assessment did not reach statistical significance, use of this activity has allowed fruitful discussion of misunderstood concepts and facilitated multiple changes to the lecture presentation. As pharmacy schools continue to emphasize alternative learning pedagogies, publication of previously implemented activities demonstrating their use will help others apply similar methodologies.
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Lourenço AL, Salvador RRS, Silva LA, Saito MS, Mello JFR, Cabral LM, Rodrigues CR, Vera MAF, Muri EMF, de Souza AMT, Craik CS, Dias LRS, Castro HC, Sathler PC. Synthesis and mechanistic evaluation of novel N'-benzylidene-carbohydrazide-1H-pyrazolo[3,4-b]pyridine derivatives as non-anionic antiplatelet agents. Eur J Med Chem 2017; 135:213-229. [PMID: 28453995 DOI: 10.1016/j.ejmech.2017.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/27/2017] [Accepted: 04/11/2017] [Indexed: 12/13/2022]
Abstract
Cardiovascular diseases (CVDs) account for over 17 million deaths globally each year, with atherosclerosis as the underlying cause of most CVDs. Herein we describe the synthesis and in vitro mechanistic evaluation of novel N'-benzylidene-carbohydrazide-1H-pyrazolo[3,4-b]pyridines (3-22) designed as non-anionic antiplatelet agents and presenting a 30-fold increase in potency compared to aspirin. The mechanism underlying their antiplatelet activity was elucidated by eliminating potential targets through a series of in vitro assays including light transmission aggregometry, clot retraction, and quantitative ELISA, further identifying the reduction in biosynthesis of thromboxane B2 as their main mechanism of action. The intrinsic fluorescence of the compounds permits their binding to platelet membranes to be readily monitored. In silico structure-activity relationship, molecular docking and dynamics studies support the biological profile of the series revealing the molecular basis of their activity and their potential as future molecular therapeutic agents.
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Affiliation(s)
- André L Lourenço
- Programa de Pós-Graduação em Patologia - Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil; Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| | - Raquel R S Salvador
- Programa de Pós-Graduação em Ciências Aplicadas a Produtos para Saúde (PPG-CAPS) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Leonardo A Silva
- Programa de Pós-Graduação em Ciências e Biotecnologia (PPBI) - Instituto de Biologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Max S Saito
- Programa de Pós-Graduação em Patologia - Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Juliana F R Mello
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF) - Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Lúcio M Cabral
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF) - Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Carlos R Rodrigues
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF) - Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Maria A F Vera
- Laboratório de Química Medicinal (LQMed) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Estela M F Muri
- Laboratório de Química Medicinal (LQMed) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Alessandra M T de Souza
- Programa de Pós-Graduação em Ciências Aplicadas a Produtos para Saúde (PPG-CAPS) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Charles S Craik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| | - Luiza R S Dias
- Programa de Pós-Graduação em Ciências Aplicadas a Produtos para Saúde (PPG-CAPS) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil; Laboratório de Química Medicinal (LQMed) - Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - Helena C Castro
- Programa de Pós-Graduação em Patologia - Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil; Programa de Pós-Graduação em Ciências e Biotecnologia (PPBI) - Instituto de Biologia, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - Plínio C Sathler
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF) - Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, RJ, Brazil.
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Elghamry I, El-Ayaan U, Youssef MM, Al-Shihry S, Letzel M, Mattay J. Photochemical and DNA degradation studies on tenoxicam, lornoxicam, and their photolysis products. MONATSHEFTE FUR CHEMIE 2016. [DOI: 10.1007/s00706-016-1765-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Philip A, Stephens M, Mitchell SL, Watkins EB. Design and implementation of a laboratory-based drug design and synthesis advanced pharmacy practice experience. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2015; 79:43. [PMID: 25995518 PMCID: PMC4428428 DOI: 10.5688/ajpe79343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/03/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To provide students with an opportunity to participate in medicinal chemistry research within the doctor of pharmacy (PharmD) curriculum. DESIGN We designed and implemented a 3-course sequence in drug design or drug synthesis for pharmacy students consisting of a 1-month advanced elective followed by two 1-month research advanced pharmacy practice experiences (APPEs). To maximize student involvement, this 3-course sequence was offered to third-year and fourth-year students twice per calendar year. ASSESSMENT Students were evaluated based on their commitment to the project's success, productivity, and professionalism. Students also evaluated the course sequence using a 14-item course evaluation rubric. Student feedback was overwhelmingly positive. Students found the experience to be a valuable component of their pharmacy curriculum. CONCLUSION We successfully designed and implemented a 3-course research sequence that allows PharmD students in the traditional 4-year program to participate in drug design and synthesis research. Students report the sequence enhanced their critical-thinking and problem-solving skills and helped them develop as independent learners. Based on the success achieved with this sequence, efforts are underway to develop research APPEs in other areas of the pharmaceutical sciences.
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Affiliation(s)
- Ashok Philip
- Union University School of Pharmacy, Jackson, Tennessee
| | - Mark Stephens
- Union University School of Pharmacy, Jackson, Tennessee
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Lourenço AL, Saito MS, Dorneles LEG, Viana GM, Sathler PC, Aguiar LCDS, de Pádula M, Domingos TFS, Fraga AGM, Rodrigues CR, de Sousa VP, Castro HC, Cabral LM. Synthesis and antiplatelet activity of antithrombotic thiourea compounds: biological and structure-activity relationship studies. Molecules 2015; 20:7174-200. [PMID: 25903367 PMCID: PMC6272548 DOI: 10.3390/molecules20047174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 12/31/2022] Open
Abstract
The incidence of hematological disorders has increased steadily in Western countries despite the advances in drug development. The high expression of the multi-resistance protein 4 in patients with transitory aspirin resistance, points to the importance of finding new molecules, including those that are not affected by these proteins. In this work, we describe the synthesis and biological evaluation of a series of N,N'-disubstituted thioureas derivatives using in vitro and in silico approaches. New designed compounds inhibit the arachidonic acid pathway in human platelets. The most active thioureas (compounds 3d, 3i, 3m and 3p) displayed IC50 values ranging from 29 to 84 µM with direct influence over in vitro PGE2 and TXA2 formation. In silico evaluation of these compounds suggests that direct blockage of the tyrosyl-radical at the COX-1 active site is achieved by strong hydrophobic contacts as well as electrostatic interactions. A low toxicity profile of this series was observed through hemolytic, genotoxic and mutagenic assays. The most active thioureas were able to reduce both PGE2 and TXB2 production in human platelets, suggesting a direct inhibition of COX-1. These results reinforce their promising profile as lead antiplatelet agents for further in vivo experimental investigations.
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Affiliation(s)
- André Luiz Lourenço
- Programa de Pós-graduação em Patologia, Departamento de Patologia, Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói CEP 24033-900, RJ, Brazil.
| | - Max Seidy Saito
- Programa de Pós-graduação em Patologia, Departamento de Patologia, Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói CEP 24033-900, RJ, Brazil.
| | - Luís Eduardo Gomes Dorneles
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | - Gil Mendes Viana
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | - Plínio Cunha Sathler
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | | | - Marcelo de Pádula
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | | | - Aline Guerra Manssour Fraga
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | - Carlos Rangel Rodrigues
- ModMolQSAR, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | - Valeria Pereira de Sousa
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
| | - Helena Carla Castro
- LABiEMOL, Departamento de Biologia Celular e Molecular, Universidade Federal Fluminense (UFF), Niterói CEP 24033-900, RJ, Brazil.
| | - Lucio Mendes Cabral
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-902, RJ, Brazil.
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Henriksen B, Roche V. Creation of medicinal chemistry learning communities through enhanced technology and interdisciplinary collaboration. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2012; 76:158. [PMID: 23129857 PMCID: PMC3475787 DOI: 10.5688/ajpe768158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/09/2012] [Indexed: 05/12/2023]
Abstract
Objectives. To build an integrated medicinal chemistry learning community of campus and distance pharmacy students though the use of innovative technology and interdisciplinary teaching.Design. Mechanisms were implemented to bring distance students into campus-based medicinal chemistry classrooms in real time, stimulate interaction between instructors and various student cohorts, and promote group work during class. Also, pharmacy clinician colleagues were recruited to contribute to the teaching of the 3 medicinal chemistry courses.Assessment. Student perceptions on the value of technology to build community and advance learning were gleaned from course evaluations, in class feedback, and conversations with class officers and student groups. Responses on a survey of second-year students confirmed the benefits of interdisciplinary content integration on engagement and awareness of the connection between drug chemistry and pharmacy practice. A survey of clinician colleagues who contributed to teaching the 3 medicinal chemistry courses found their views were similar to those of students.Conclusions. The purposeful use of technology united learners, fostered communication, and advanced content comprehension in 3 medicinal chemistry courses taught to campus and distance students. Teaching collaboration with pharmacy clinicians enhanced learner interest in course content and provided insight into the integrated nature of the profession of pharmacy.
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Affiliation(s)
- Brian Henriksen
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA.
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Satyanarayanajois SD. Active-learning exercises to teach drug-receptor interactions in a medicinal chemistry course. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2010; 74:147. [PMID: 21179258 PMCID: PMC2987287 DOI: 10.5688/aj7408147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/12/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To incorporate structural biology, enzyme kinetics, and visualization of protein structures in a medicinal chemistry course to teach fundamental concepts of drug design and principles of drug action. DESIGN Pedagogy for active learning was incorporated via hands-on experience with visualization software for drug-receptor interactions and concurrent laboratory sessions. Learning methods included use of clicker technology, in-class assignments, and analogies. ASSESSMENT Quizzes and tests that included multiple-choice and open-ended items based on Bloom's taxonomy were used to assess learning. Student feedback, classroom exercises, and tests were used to assess teaching methods and effectiveness in meeting learning outcomes. CONCLUSION The addition of active-learning activities increased students' understanding of fundamental medicinal chemistry concepts such as ionization state of molecules, enzyme kinetics, and the significance of protein structure in drug design.
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Harrold MW, McFalls MA. A pharmacy practice laboratory exercise to apply biochemistry concepts. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2010; 74:144. [PMID: 21179255 PMCID: PMC2987284 DOI: 10.5688/aj7408144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/12/2010] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To develop exercises that allow pharmacy students to apply foundational knowledge discussed in a first-professional year (P1) biochemistry course to specific disease states and patient scenarios. DESIGN A pharmacy practice laboratory exercise was developed to accompany a lecture sequence pertaining to purine biosynthesis and degradation. The assignment required students to fill a prescription, provide patient counseling tips, and answer questions pertaining to the disease state, the underlying biochemical problem, and the prescribed medication. ASSESSMENT Students were graded on the accuracy with which they filled the prescription, provided patient counseling, and answered the questions provided. Overall, students displayed mastery in all of these areas. Additionally, students completed a course survey on which they rated this exercise favorably, noting that it helped them to integrate basic science concepts and pharmacy practice. CONCLUSION A laboratory exercise provided an opportunity for P1 students to apply foundational pharmacy knowledge to a patient case and can serve as a template for the design of additional exercises.
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Affiliation(s)
- Marc W Harrold
- Duquesne University, School of Pharmacy, Pittsburgh, PA, USA.
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