Week 8 Medication Paper Final Draft

Answer

 Ponatinib

Abstract

Ponatinib is one of the third line substance drugs used to diagnose an individual with chronic leukemia and specifically, patients with a mutation that is highly resistant to the initial and second line drug imatinib, bosutinib and nilotinib. The substance is described as the pan Bcr-Abl and Src-kinase inhibitor. The present study describes indications, uses, dosages, side effects, and signs of ponatinib. Ponatinib is known as a significant diagnosis medication for chronic myeloid leukemia and acute lymphoblastic leukemia. This paper also describes how it reduces the symptoms of such diseases and restoring life to normal. The study will evaluate several activities of the drug to cancer that kinases play an important role such as ovary and luger cancer, thyroid, and breast cancer as neuroblastoma and the famous myeloprolific disorders. Ponatinib is tested through clinical trials where evaluation has been done in FLT3-ITD cancer acute myelogenous leukemia, neck and head cancerous cells and certain types of cancer such as tumors of gastrointestinal stromal among specific malignancies. This analysis will establish the current preclinical and clinical studies on the drug in cancer patients and many other diseases to provide the reliable status of the drug.

Ponatinib

Ponatinib, AP24534 is a compound that was discovered by the ARIAD Pharmaceuticals Inc. in the United States of America, these pyridazines have been first identified as the nan molar inhibitors of the component with active cytoplasmic tyrosine kinase. Ponatinib is a third class inhibitor that is functional on the ancient Abl and has an IC₅₀ point value of 0.37nM plus mutant T3151 containing IC₅₀ of nM 2.0. (Molica et al., 2019). Ponatinib is very active against Bcr-Abl mutants, and the drug is prescribed at doses of 30mg to 45mg daily for oral systems, and the drug can be used continuously so long as the patient shows no progression of toxicity that is unacceptable. Additionally, Ponatinib is a third-generation TKI that counteracts the emergence of resistant clones in preclinical studies and has shown a substantial medical advantage in patients with refractory CML (Nazha et al., 2013). Moreover, ponatinib is still under the tests and trials to establish its response in FLT3 for inner tandem duplication of acute myelogenous leukemia neck and head cancer, particularly cancer of lungs and tumors of stromal gastrointestinal with other related malignancies (Hussaarts et al., 2019). In this study, the preclinical and clinical report evaluates the activity of ponatinib in cancer and other diseases to provide a complete overview of the mysterious substance.

Manufacturing Companies

Ponatinib is approved by the Food and Drug Association (FDA) as medicine which is manufactured by Incyte Biosciences Distribution B.V company and the ARIAD pharmaceuticals in the United States of America. The drug is used to offset chronic cancer like myeloid-leukemia and acute-lymphoblastic leukemia disorders which are visible by the increased multiplication of granulocytic-cell lines without the decrease of their capacity to vary. For Chronic-Myeloid leukemia and Acute Lymphoblastic Leukemia, the recommended dose is 45 mg PO daily. However, the dosage can be modified by reducing it to 30mg per day when there are substantial issues such as renal and hepatic impairment. The drug is administered through oral methods as prescribed by the physician.

Special Considerations

Absorption of Ponatinib

The drug is absorbed gently when taken orally. However, its absolute bioavailability is not known. It attains its maximum concentration in plasma within six hours after Iclusig oral administrations. In blood, it is 97.5% bound to plasma proteins and a half-life of 24 to 26 hours. Food consumption does not impact the absorption of the drug, and its aqueous solubility depends on pH, with lower pH leading to high solubility (Nazha et al., 2013).

Distribution of Ponatinib to the Body

The drug is absorbed by achieving its maximum convention then it is distributed to the whole body. Studies indicate that it is more than 99% protein-bound in vitro  According to the geometric mean, its steady volume of distribution is 1223 L (102 per cent) preceding Iclusig 45mg oral administration once per day for twenty-eight day in patients having cancer.  The drug is a weak substrate for ABCG2, P-gp, and vitro and it is not one of the substrates for organic onions which transport polypeptides.

Elimination of Ponatinib

After absorption, the drug is ultimately distributed to the whole body and since it’s a weak substance for ABCG2, p-pg. is not for organic unions which transports polypeptides.  The drug is eliminated through excretion from the body.

Ponatinib for Pediatric Patients

Pediatric patients undergoing treatment using ponatinib drugs are vulnerable to mutations that prove consistence resistance to the drug in the first and the second phase of the drug administration. When these patients are exposed to  ponatinib for long durations, their response to the medicine becomes homogeneous with no variations in the first noted symptoms. Adults in the pediatric or adolescent population experience advance effects of undescribed symptoms. diagnosing patients with leukemia and patients with pediatric issues have severe complications that the dosage should be controlled by the medical professional with a lot of concern.

Ponatinib for Patients with Renal Dysfunction

Ponatinib designed for Patients with renal dysfunction should not be administered with ponatinib because the elimination of the drug is basically through the renal way and this may cause other internal complications to the patient. These particular cases should receive doses of not more than 25mg to 30mg per day for a period prescribed by medical professionals.

Ponatinib for Pregnant and Lactating Mothers

Ponatinib contains toxic substances that are very harmful to infants and fetus in mothers therefor the compound should be avoided for pregnant mothers since the effects of the drug can easily be transferred to the unborn fetus through the mother’s blood systems where the substance is absorbed to the blood systems. During lactation, the medication should not be prescribed to such patients since the effects of the drug can harm the breastfeeding child.

Ponatinib for Patients with Liver Dysfunction

Patients with liver dysfunction need controlled dosage for the drug; these are due to the incidents that the compound works with the blood cells that transport essential nutrients to the body and unless there is enough blood purification in the body. The functioning of the drug cannot be valid, and these can cause harm to the patients coupled with a faster spread of cancerous cells in the body.

Metabolism Half-Life of Ponatinib

A higher proportion of the drug that is administered goes through the various stages of metabolism, for example, more than 64 per cent of a ponatinib dose goes through both the phase I and stage II of metabolism. It is vital to note that CYP3A4 and to a smaller extent and CYP3A5, CYP2D6, and CYP2C8 get involved in stage I metabolic rate of ponatinib in vitro. The drug is as well broken down or metabolized by amidases and esterases. The major preliminary pathway of metabolism for ponatinib is N-demethylation. The molecule has plasma terminal elimination half-life of 61 to 105 hours. Both in vivo pharmacological and in vitro biochemical testing have revealed N-desmethyl ponatinib to be significantly less active than ponatinib. The compound is highly effective for patients of ages above 45years. Patients below this age should consider alternative therapies for diseases like cancer leukemia.

Brand Name and Indications

Ponatinib which was previously referred to as AP24534 was discovered by ARIAD pharmaceutical to be used in the diagnosis for chronic myeloid leukemia and it is intended for trysine or kinase inhibitor. In the United States of America, ponatinib was approved by the Food and Drug Association (FDA) on December 14, 2012, for individuals suffering from resistance or with symptoms Ph.^{+ ,} ALL, and CML these were based on the outcomes that were obtained from PACE phase II of the trials that were reported in USA ASH meeting. Since the approval was under the observations of the food and drug association program, the applicants were required to carry out and ensure that additional research was done to establish the full functionality of the drug. Further research granted the full approval of the drug by the FDA in the year 2016 for people with chronic phase, the phase of chronic myeloid (cancer) leukemia, accelerated phase and the Philadelphia chromosomes that are have positive acute-leukemia and for those who seem not to have any other tyrosine kinase inhibitor indications (García-Aranda & Redondo, 2019). The drug is not the first in the class of inhibitors since other inhibitors are used for the diagnosis of CML and Philadelphia chromosome-positive.

Common Side Effects

The United States food and drug association has identified scenarios of ponatinib related side effects as increased in the clotting of blood observed in patients subjected to the drug. Its effects have been significant in treatment and prevention of chronic myeloid cancer or Philadelphia chromosome with positive acute lymphoblastic leukemia; Ponatinib has got specific side effects which patients should be ready for and report if such impacts become extreme and persist for an extended period. Significant side effects include dry mouth, drowsiness, loss of appetite, increased sweating, trouble sleeping, nausea, and increased perspiration (Gover-Proaktor et al., 2015). A study Badowski, Burton, Shaeer, and Dicristofano (2019) reveals that some of those side effects can be dangerous hence if they persist for long, the patient should immediately report to the doctor. While its effects have been significant in treatment and prevention of recurrent cancer or myeloid leukemia and the Philadelphia chromosome with positive acute lymphoblastic leukemia, Ponatinib has got specific side effects which patients should be ready for and report if such impacts become extreme and persist for an extended period. Significant side effects include dry mouth, drowsiness, loss of appetite, increased sweating, trouble sleeping, nausea, and increased perspiration (Gover-Proaktor et al., 2015). Continuous use of the drug may result in patients experiencing lots of hypertension and abdominal pains that come with problems of constipation and severe headaches.

Known Contradictions

Ponatinib is contraindicated in patients with several conditions. Particularly, arterial occlusions that have occurred in approximately 40 per cent of ponatinib-treated patients. According to Li et al. (2019), some patients experience more than one type of such events.  Some of the activities include stroke, stenosis, myocardial infarction, and severe peripheral vascular disease. Additionally, venous thromboembolism has been witnessed in several people under this medication (Nazha et al., 2016). According to Gover-Proaktor et al. (2015), venous occlusive events occur in iclusig-treated patients which results in venous thromboembolism. In the prevention of thromboembolism, it is essential to consider discontinuation of the drug or its reduction in patients who have developed severe venous thromboembolism.

Furthermore, cases of heart failure, which includes fatalities occurred in about 9 per cent of individuals under this medication. Additionally, contraindication which has been observed among the patients using Ponatinib is bleeding which may involve GI bleeding and intracranial bleeding. According to a study conducted by Örenay et al. (2016), severe bleeding has been observed with ponatinib therapy, which includes intracranial bleeding and GI bleeding were instances were fatal. The majority of bleeding severe events occurred in patients who had grade 4 thrombocytopenia. Interrupt therapy and evaluate in patients who develop severe or severe bleeding”. For the patients experiencing blood clotting, the medical practitioner may consider other related drugs to reduce the adverse effects that may cause additional complications to the patient.

In conclusion, Ponatinib is a multi-targeted TK inhibitor individually act as a pan-Bcr-Abl inhibitor, and its activities have been approved by the united states food and drug association for treatment and diagnosis of Ph.+ leukemia and cancers resistance to prior therapies. The substance contains high toxicity in comparison with all other TK inhibitors although it is indeed very active and is very highly recommended for patients who don’t have any other therapeutic option in the diagnosis of cancer-related diseases. Other than the Ph.+ leukemia, ponatinib shows activity in various vitro and vivo settings of varying tumors. The targeted TKs are hyperactivated or overexpressed by the operation of ponatinib drugs. In some pathologies, refractory glioblastoma results to disappointments. The full effect of the clinical tests ended or for those just started have given an overview of the usefulness of the compound on cancer with benefits of toxicity. The opinion of the study is that it is complicated to forecast the real convenience of ponatinib in various diseases. The current developments on molecules can be attained by the consistent use of TK inhibitors in association with cytotoxic anticancer drugs, the combinations of these drugs can allow a reduction in the dosage of ponatinib and its related side effects. Clinical innovations and trials are essential sources of information where tailored therapy targets are made for patients and their response to various TK inhibitors.(Naguib & Reid, 2015).  However, the tadpoles and a number of aquatic amphibians use gills like fish to breath.