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These drugs increase the permeability of the blood–brain barrier temporarily by increasing the osmotic pressure in the blood which loosens the tight junctions between the endothelial cells. By loosening the tight junctions normal injection of drugs through an [IV] can take place and be effective to enter the brain. [ 8 ]
It has been found to increase oxygen consumption in the brain, apparently in connection to ATP metabolism, and increases the activity of adenylate kinase in rat brains. [ 26 ] [ 27 ] Piracetam, while in the brain, appears to increase the synthesis of cytochrome b5 , [ 28 ] which is a part of the electron transport mechanism in mitochondria .
Blood flow may increase up to twice the normal flow but no more. If the increased blood flow is sufficient to supply the brain's oxygen needs then no symptoms will result. [6] However, if blood flow cannot be increased or if doubled blood flow does not correct the problem, symptoms of cerebral hypoxia will begin to appear.
Cerebral blood flow (CBF) is the blood supply to the brain in a given period of time. [8] In an adult, CBF is typically 750 millilitres per minute or 15.8 ± 5.7% of the cardiac output. [9] This equates to an average perfusion of 50 to 54 millilitres of blood per 100 grams of brain tissue per minute. [10] [11] [12]
Struggling, restlessness, and seizures can increase metabolic demands and oxygen consumption, as well as increasing blood pressure. [31] [36] Analgesia and sedation are used to reduce agitation and metabolic needs of the brain, but these medications may cause low blood pressure and other side effects. [10]
The blood–brain barrier is formed by the brain capillary endothelium and excludes from the brain 100% of large-molecule neurotherapeutics and more than 98% of all small-molecule drugs. [28] Overcoming the difficulty of delivering therapeutic agents to specific regions of the brain presents a major challenge to treatment of most brain disorders.