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I det avslutande kapitlet, kapitel 9 (The vision - sustainable pharmaceutical management in a sustainable society av Ake Wennmalm, Bengt-Erik Bengtsson och Bo Gunnarsson) diskuteras processen for lakemedelsutveckling, dess forutsattningar samt hur vagen till en hallbar lakemedelsanvandning kan se ut. Det argumenteras for att hallbarhet pa detta omrade, pa samma satt som inom andra omraden, maste inkludera ekonomiska, miljomassiga och sociala aspekter, samt omfatta hela processen fran utveckling och produk- tion, till anvandning och hantering av oanvanda lakemedel.

Olika drivkrafter for, och emot, en hallbar utveckling diskuteras, sasom marknadskrafter, efterfragan fran konsumenter och forskrivare, politiska beslut, och nya beslutsmekanismer inklusive globalt verkande, politiskt obundna organisationer. Slutligen lyfts ett antal positiva exempel fram, sasom forskningsaktiviteter som bidrar till okad kunskap for battre risk- bedomningar, nyligen genomforda Europeiska lagkrav pa miljoriskbedomn- ing for nya lakemedel, och krav pa system for insamlande av oanvanda eller kasserade lakemedel. Europeiska Kommissionen namner ocksa lakemedel i miljon som ett "emerging environmental problem" (COM [2008]666, par 1.3.3).

Bland viktiga svenska initiativ namns till exempel screening av lakemedel i buy xanax with money order svenska vatten initierat av Naturvardsverket, samt forslag fran Lakemedelsverket att inkludera miljohansyn i reglerna for "Good Manufacturing Practice" (GMP), och att tillata att miljohansyn vags in i risk-nyt- tavarderingen av nya humana lakemedel. Referenser 1.Huggett DB, Cook JC, Ericson JF, Williams RT. A theoretical model for utilizing mammalian pharmacology and safety data to prioritize potential impacts of human pharmaceuticals to fish. 2.Fick J, Lindberg RH, Parkkonen J, Arvidsson buy xanax with money order B, Tysklind M, Larsson DGJ. Therapeutic levels of levonorgestrel detected in blood plasma offish: results from screening rainbow trout exposed to treated sewage effluents. 3.Zeilinger J, Steger-Hartmann T, Maser E, Goller S, Vonk R, Lange R. Effects of Synthetic Gestagens on Fish Reproduction. Environmental Toxicology and Chemistry 28 :2663-2670.

Bioconcentration of Pharmaceuticals buy xanax with money order Jerker Fick1, Roman order phentermine no prescription required Grabic1, D.G.Joakim Larsson2 Richard H Lindberg1 and Mats Tysklind1 :Umea University, 2University of Gothenburg Residues of human pharmaceuticals have been widely detected in various parts buy xanax with money order of the environment and trace concentrations are often found in sewage effluent and surface waters, typically ranging from low ng L-1 to low pg L-1 levels (Lindberg et al., 2005; Nikolaou et al., 2007; Loos et al., 2009).

These concentrations, however, are orders of magnitude com buy xanax buy xanax below buy xanax with money order the therapeutic concentrations reached in human blood plasma. Thus, the potential for a physiological impact of pharmaceuticals on water-living organisms (such as fish) have been questioned. On the other hand, the levels measured in surface waters do not simply mirror the levels encountered by the receptors or enzymes present inside the fish living in these waters. Indeed, levels of pharmaceutical in for example fish blood plasma is sometimes much higher than the levels in the surrounding water. This can be explained by the concepts of bioconcentration and bioaccumulation. Bioconcentration is a process where the level of a chemical in an aquatic organism increases by uptake from the water, eventually reaching a stable concentration higher than that of the surrounding water. Bioconcentration is often presented as a bioconcentration factor (BCF), which is the concentration of the studied chemical in the entire body or in a tissue per concentration of the chemical in water (reported as L/kg).

This physical property characterizes the accumulation of pollutants through chemical partitioning from the aqueous phase into an organic phase, such as the gill of a fish. Bioconcentration values are typically derived from controlled laboratory conditions, where the chemical is absorbed from the water via the gills and/ or the skin.



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