Physiological Pharmaceutics

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Chapter TwelveVaginal and Intrauterine Drug DeliveryANATOMY AND PHYSIOLOGYMucosaBlood and nerve supplyUterine and vaginal fluidpHEnzymatic activityMucusMenstruationMenopauseDisorders of the vaginaDRUG ABSORPTION THROUGH THE VAGINA/UTERUSDRUG DELIVERYVaginalCreams and gelsPessaries or tabletsVaginal ringsBioadhesive delivery systemsIntrauterinedevicesCONCLUSIONREFERENCES271
272 <strong>Physiological</strong> <strong>Pharmaceutics</strong>ANATOMY AND PHYSIOLOGYThe word vagina means sheath and it is a fibromuscular tube between 6 and 10 cm longin a adult female extending from the cervix (outer end) of the uterus (Figure 12.1). Thevagina lies obliquely upward and backward behind the bladder and urethra and in front ofthe rectum and anal canal. The axis of the vagina forms an angle of over 90° with that ofthe uterus, but this can vary considerably depending on the fullness of the bladder andrectum, and during pregnancy. The cervix of the uterus extends for a short distance into thevagina. It is normally pressed against its posterior wall creating recesses in the vagina at theback, on each side, and at the front of the cervix. These are known as the anterior andposterior fornices located to the front and back of the cervix. The posterior fornix is thelargest of the fornices and the lateral fornices found to the sides. The upper part of theposterior wall of the vagina is covered by peritoneum which is folded back onto the rectumto form the rectouterine pouch. The lower part of the posterior vaginal wall is separatedfrom the anal canal by tissue known as the perineal body.In female mammals the function of the vagina is to receive the male reproductive cells,or sperm, and is part of the birth canal. In humans, it also functions as an excretory canalfor the products of menstruation.The uterus or womb is a hollow, inverted pear-shaped fibro-muscular organ. Its shapeand weight varies enormously depending on menstrual cycle and previous pregnancies. Ina young female, with no previous pregnancies, the uterus is approximately 8 cm long, 5 cmwide and 2.5 cm thick and weighs approximately 30–40 g but it enlarges to four to five timesthis size in pregnancy.The narrower, lower end is called the cervix; this projects into the vagina. The cervixis made of fibrous connective tissue and is of a firmer consistency than the body of theuterus. The two uterine tubes enter the uterus at opposite sides, near its top. The part of theuterus above the entrances of the tubes is called the fundus; that below is termed the body.Between birth and puberty, the uterus gradually descends into the true pelvis from theabdomen. After puberty, the uterus is located behind the symphysis pubis and bladder andin front of the rectum. The uterus is supported and held in position by the other pelvicFigure 12.1 The female reproductive system
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For Alexander and SarinaWith all ou
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First edition 1989Second edition fi
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viPrefacepublishers, who I am sure,
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viiiAcknowledgementsFig 6.5 is repr
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Table of Contents1. Cell Membranes,
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xiiContentsGASTRIC pH .............
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xivContents9. Nasal Drug Delivery .
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Chapter OneCell Membranes, Epitheli
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Membranes and barriers 3Figure 1.1
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Membranes and barriers 5Modulation
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Membranes and barriers 7Membrane pr
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Chapter TwoParenteral Drug Delivery
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Parenteral drug delivery 21Figure 2
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Parenteral drug delivery 23catheter
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Parenteral drug delivery 29fluid is
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Parenteral drug delivery 33Receptor
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Parenteral drug delivery 3526. Tsuj
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38 Physiological PharmaceuticsANATO
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44 Physiological PharmaceuticsABSOR
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58 Physiological Pharmaceutics59. A
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60 Physiological PharmaceuticsINTRO
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72 Physiological Pharmaceutics12. W
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Chapter FiveThe StomachANATOMY AND
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The stomach 77Figure 5.2 Structure
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The stomach 79Gastric glandsThe gas
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The stomach 81Figure 5.7 Mechanism
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The stomach 83absorbed from the sto
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The stomach 85Night-time transient
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The stomach 87particle size indiges
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The stomach 89Figure 5.13 MRI cross
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The stomach 91species and man is po
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The stomach 93Figure 5.15 The effec
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The stomach 95emerged from the shel
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The stomach 97Figure 5.17 The gastr
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The stomach 99In order to improve b
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The stomach 101Figure 5.21—Gastri
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The stomach 103The anatomy and dime
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The stomach 10533:1283-1290.35. Cun
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The stomach 10782. Ingani HM, Timme
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Chapter SixDrug Absorption from the
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Small intestine 111Figure 6.1 Secti
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Small intestine 113are uncommon and
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Small intestine 115underlying tissu
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Small intestine 117Brief periodic b
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Small intestine 119is extremely rap
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Small intestine 121Figure 6.5 Segme
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Small intestine 123Measurements of
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Small intestine 125Figure 6.8 Small
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Small intestine 127Scintigraphy oft
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Small intestine 129It is known that
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Small intestine 131It was soon real
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Small intestine 133colonic absorpti
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Small intestine 135also transform d
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Small intestine 137REFERENCES1. Bry
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Small intestine 13949. Hidalgo IJ,
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Small intestine 14193. Bogentoft C,
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Page 266 and 267: Chapter ElevenOcular Drug DeliveryI
Page 268 and 269: Ocular drug delivery 251STRUCTURE O
Page 270 and 271: Ocular drug delivery 253chamber. It
Page 272 and 273: Ocular drug delivery 255The superfi
Page 274 and 275: Ocular drug delivery 257Figure 11.7
Page 276 and 277: Ocular drug delivery 259Figure 11.9
Page 278 and 279: Ocular drug delivery 261Influence o
Page 280 and 281: Ocular drug delivery 263SpraysSpray
Page 282 and 283: Ocular drug delivery 265endothelial
Page 284 and 285: Ocular drug delivery 267polymers ha
Page 286 and 287: Ocular drug delivery 269sustained-r
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Page 301 and 302: 284 GlossaryAntipyrine An analgesic
Page 303 and 304: 286 GlossaryClonazepam An anticonvu
Page 305 and 306: 288 GlossaryEsterase An enzyme whic
Page 307 and 308: 290 Glossaryfound in the synovial f
Page 309 and 310: 294 GlossaryPectoral muscle Chest m
Page 311 and 312: 296 Glossarysize exclusion (gel fil
Page 313 and 314: 298 GlossaryTributyrase An enzyme w
Page 315 and 316: 300 Indexß-glucuronidase 276B cell
Page 317 and 318: 302 IndexDiazoxide 262Dichlorodiphe
Page 319 and 320: 304 IndexGelling polymers 264Gels 1
Page 321 and 322: 306 IndexEpithelium 225Factors affe
Page 323 and 324: 308 IndexOros ® 158Osmotic deliver
Page 325 and 326: 310 IndexAbsorption 186Age 188Disea
Page 327: 312 IndexDrug absorption 277Fluid 2
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