Seven Important Drugs

1. The Plant of Good and Evil - Opium opium, substance derived by collecting and drying the milky juice in the unripe seed pods of the opium poppy, Papaver somniferum. Opium varies in color from yellow to dark brown and has a characteristic odor and a bitter taste. Its chief active principle is the alkaloid morphine, a narcotic. Other constituents are the alkaloids codeine, papaverine, and noscapine (narcotine); heroin is synthesized from morphine. Morphine, heroin, and codeine are addicting drugs; papaverine and noscapine are not. A tincture of opium is called laudanum; paregoric is a mixture of opium, alcohol, and camphor. Effects and Addictive Nature Opium and its various constituents exert effects upon the body ranging from analgesia, or insensitivity to pain, to narcosis, or depressed physiological activity leading to stupor. Opium users describe experiencing a feeling of calm and well-being. Opium addicts in otherwise good physical and mental health whose drug needs are met are thought to experience no debilitating physiological effects from their addiction, although there is some evidence that immune function is compromised. However, their preoccupation with the drug and its acquisition can lead to malnutrition and general poor self-care and an increased risk of disease. Medical Uses Opium was commonly used as an analgesic until the development of morphine. Morphine continues to be prescribed for relief of severe pain, but fears of its addictive potential have limited its use. Laudanum was used in the 1800s to promote sleep and alleviate pain; codeine suppresses coughing; paregoric stops diarrhea. Medicinal opiates were freely available in the United States and Europe in the 19th cent., and the number of addicted people surged as a result. History The medicinal properties of opium have been known from the earliest times, and it was used as a narcotic in Sumerian and European cultures at least as early as 4000 BC The drug was introduced into India by the Muslims and its use spread to China. Early in the 19th cent., against Chinese prohibitions, British merchants began smuggling opium into China in order to balance their purchases of tea for export to Britain, an act that set the stage for the Opium Wars. Chinese emigrants to the United States, who were employed to build the transcontinental railroad, brought the opium-smoking habit to the West Coast. During the 19th cent. opium was grown in the United States as well as imported. Besides indiscriminate medical use, opiates were available in the United States in myriad tonics and patent medicines, and smoking in opium dens was unhindered, resulting in an epidemic of opiate addiction by the late 1800s. The generous use of morphine in treating wounded soldiers during the Civil War also produced many addicts. Importation of opium by Chinese nationals was prohibited in 1887; in 1906 the Pure Food and Drug Act required accurate labeling of patent medicines. The Harrison Narcotics Act of 1914 taxed and regulated the sale of narcotics and prohibited giving maintenance doses to addicts who made no effort to recover, leading to the arrest of some physicians and the closing of maintenance-treatment clinics. Since then, numerous laws attempting to regulate importation, availability, use, and treatment have been passed, and the concern with opium addiction per se has largely been replaced by concern with heroin, cocaine, marijuana, and other illegal drugs. Large quantities of opium are still grown, some for legitimate use, on opium poppy farms in Southwest Asia (primarily Afghanistan and Pakistan), Southeast Asia (the "Golden Triangle," primarily in Myanmar), and Latin America (primarily Colombia); the vast majority of the world's opium is currently produced in Afghanistan. The opium gum may be crudely refined and smoked (e.g., "brown sugar" ) or converted to morphine and heroin. Growers usually make more for opium than for other crops, and the cultivation and refining employ hundreds of thousands of people, but the real profits go to the drug traffickers. It is estimated that the street price for heroin is 153 to 183 times that of the opium bought from the farmer. Despite laws and agreements to control its use, a worldwide illicit opium traffic persists. See also drug addiction and drug abuse. Bibliography See publications of the Drugs & Crime Data Center and Clearinghouse, the Bureau of Justice Statistics Clearinghouse, and the National Clearinghouse for Alcohol and Drug Information; M. Booth, Opium: A History (1996); P.-A. Chouvy, Opium: Uncovering the Politics of the Poppy (2010). 2. The Divine Plant of the Incas - Cocaine Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. It produces short-term euphoria, energy, and talkativeness in addition to potentially dangerous physical effects like raising heart rate and blood pressure. How Is Cocaine Used? The powdered form of cocaine is either inhaled through the nose (snorted), where it is absorbed through the nasal tissue, or dissolved in water and injected into the bloodstream. Crack is a form of cocaine that has been processed to make a rock crystal (also called “freebase cocaine”) that can be smoked. The crystal is heated to produce vapors that are absorbed into the blood-stream through the lungs. (The term “crack” refers to the crackling sound produced by the rock as it is heated.) The intensity and duration of cocaine’s pleasurable effects depend on the way it is administered. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last 5 to 10 minutes. In order to sustain their high, people who use cocaine often use the drug in a binge pattern—taking the drug repeatedly within a relatively short period of time, at increasingly higher doses. This practice can easily lead to addiction, a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences. How Does Cocaine Affect the Brain? Cocaine is a strong central nervous system stimulant that increases levels of the neurotransmitter dopamine in brain circuits regulating pleasure and movement. Normally, dopamine is released by neurons in these circuits in response to potential rewards (like the smell of good food) and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine prevents the dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this flood of dopamine that causes cocaine’s characteristic high. With repeated use, cocaine can cause long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction. With repeated use, tolerance to cocaine also often develops; many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong their high, but this can also increase the risk of adverse psychological or physiological effects. What Are the Other Health Effects of Cocaine? Cocaine affects the body in a variety of ways. It constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. Because cocaine tends to decrease appetite, chronic users can become malnourished as well. Most seriously, people who use cocaine can suffer heart attacks or strokes, which may cause sudden death. Cocaine-related deaths are often a result of the heart stopping (cardiac arrest) followed by an arrest of breathing. People who use cocaine also put themselves at risk for contracting HIV, even if they do not share needles or other drug paraphernalia. This is because cocaine intoxication impairs judgment and can lead to risky sexual behavior. Some effects of cocaine depend on the method of taking it. Regular snorting of cocaine, for example, can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine by the mouth can cause severe bowel gangrene as a result of reduced blood flow. Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV, hepatitis C, and other blood-borne diseases. Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations. Cocaine is more dangerous when combined with other drugs or alcohol (poly-drug use). For example, the combination of cocaine and heroin (known as a “speedball”), carries a particularly high risk of fatal overdose 3. The Powder of the Countess - Quinine Found in the bark of the cinchona tree, quinine is a compound with many medicinal applications, including fever-reducing, painkilling and anti-inflammatory properties. It was the first treatment for malaria and is still used today to treat some cases of the disease, which is caused by the parasite Plasmodium falciparum. Several stories tell of the discovery of quinine's medicinal qualities. One legend describes a South American Indian who, while suffering from malaria, drank from a pool of bitter-tasting water contaminated by nearby cinchona trees, after which his fever disappeared. The first documented use of quinine to treat malaria occurred in Peru in 1630. While approved by the FDA to treat malaria, quinine is not approved for its off-label use in treating nighttime leg cramps. In 2010, the FDA announced that it had received 38 reports over a three-year period of serious side effects resulting from quinine use, including blood disorders and two deaths. A more mundane use of quinine is as an ingredient in tonic water. You might wonder if drinking enough tonic water could cure malaria. It would take a lot! A 12-oz bottle of tonic water contains 40 mg of quinine, while the daily dose to treat malaria is 700 mg to 1,050 mg per day. 4. The Remedy in Every Medicine Cabinet - Aspirin What is aspirin? What is aspirin for? Last updated: 26 September 2014 4 Like44 Pain / Anesthetics Arthritis / Rheumatology Headache / Migraine add your opinion email Knowledge center Ratings for this article (click to rate) Public / Patient: 1 2 3 4 5 46 ratings Health Professionals: 1 2 3 4 5 27 ratings Aspirin, or acetylsalicylic acid (ASA) is a salicylate drug, and is generally used as an analgesic (something that relieves pain without producing anesthesia or loss of consciousness) for minor aches and pains, to reduce fever (an antipyretic), and also as an anti-inflammatory drug. Aspirin has also become increasingly popular as an anti-platelet - used to prevent blood clot formation - in long-term low doses to prevent heart attacks and strokes in high risk patients. Nowadays, aspirin is often given to patients immediately after a heart attack to prevent recurrence or cardiac tissue death. Aspirin is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are medications with analgesic, antipyretic (something that reduces a fever), and in higher doses anti-inflammatory effects. Non-steroidal means they are not steroids, which often have similar effects. As analgesics, NSAIDs are generally non-narcotic (do not cause insensibility or stupor). The most prominent NSAIDs are aspirin, ibuprofen and naproxen - mainly because most of them are OTC (over-the-counter, no prescription required) medications. Aspirin was the first discovered NSAID. Aspirin in its present form has been around for over 100 years and is still one of the most widely used medications in the world. It is estimated that approximately 40,000 metric tons of it is consumed annually. Aspirin is a trademark owned by German pharmaceutical company Bayer; the generic term is acetylsalicylic acid (ASA). A short history of aspirin Acetylsalicylic acid (aspirin) is a derivative of salicylate, which can be found in such plants as willow trees and myrtle. ca. 3000 BC - An ancient Sumer stone tablet from the Third Dynasty of Ur of medical text mentions willow-tree based remedies. However, it does not specify what the remedies were for. Sumer was a civilization and a historical region located in Mesopotamia, southern Iraq, known as the "Cradle of Civilization". ca. 1543 BC - The Ebers Papyrus, an ancient Egyptian medical text, mentions willow and myrtle being used for remedies to treat pain, fever and inflammation. Some say that although the text is ancient it may be a copy of the original. ca. 460-370 BC - Hippocrates, a Greek physician, recommended willow bark preparations for childbirth pains and controlling fever. ca. 30 AD - Aulus Cornelius Celsus, an encyclopedist, mentioned willow leaf extract for "redness, heat, swelling and pain" - what he termed as "the four signs of inflammation" in his De Medicina, believed to be the only surviving section of a much larger encyclopedia. ca. 40-90 AD - Pedanius Dioscorides, a Greek physician, pharmacologist and botanist, mentioned remedies from the willow plant in his De Materia Medica (Regarding Medical Matters), a five-volume book that was translated into Latin (he wrote the original in Greek). 23-79 AD - Gaius Plinius Secundus (known as Piny the Elder), a naturalist, author and naval commander in the early Roman Empire, mentioned willow plant remedies in an encyclopedic work called Naturalis Historia (Natural History). 200 AD - remedies derived from the willow plant were widely used throughout the Roman Empire and Arab civilizations. Before 1492 - Before the Europeans ever set foot in America, the Huron, Mohawk, Cree, Chippewa and many other north American tribes had been using the bark and twigs of the American White Willow to make remedies and teas for the treatment of pain relief, inflammation and fevers. Ancient Aztec and Mayan folklore in Mexico and Central America mention the use of 'sauce' (willow) for similar treatments. 1763 - Edward Stone, England, a Church of England rector wrote a letter to the Royal Society which described some of his experiments with willow bark extract to cure ague - a word used to describe intermittent fever, pain, chills fatigue; probably malaria. He compared the effects of willow bark to Peruvian bark, which contains quinine (and attacks the infectious cause of malaria). He noticed that the willow bark relieved symptoms of ague, while the Peruvian bark was more effective. He had discovered salicylic acid, the active ingredient in aspirin. Willow bark derived remedies subsequently became much more popular in England than the more expensive Peruvian bark. 1800s - Organic chemistry began to develop rapidly in Europe. Several scientists tried to isolate and purify the active ingredients of many medications, including willow bark. 1828 - Joseph Buchner, a German chemist, managed to obtain what were then considered as fairly pure salicin crystals. 1829 - Henri Leroux, a French chemist obtained purer forms. 1830 - Johann Pagenstecher, a Swiss pharmacist, said he had discovered a new painkiller which he had isolated from the common remedy of meadowsweet Spiraea ulmaria, which we know today contained salicylic acid, flavone-glycosides, essential oils and tannins. 1838 - Raffaele Piria, an Italian chemist, managed to devise a way of obtaining a more powerful acid form of willow extract, which he called salicylic acid. Karl Jacob Lowig, who was trying to isolate the active ingredients in Spiraea, eventually found out that it was the same salicylic acid that Piria had identified. 1840-1894 - During this period various forms of salicylate medicines, including salicin, salicylic acid, and sodium salicylate became more widely used by doctors for the treatment of pain, fever and inflammation. However, their gastric irritation side effects were considerable. 1890 - Friedrich Carl Duisberg, a German chemist and industrialist became head of the management of Bayer, a large German company. He created a pharmaceutical division within the company and placed Arthur Eichengrun, a former university chemist in charge. Heinrich Dreser was placed in charge of a pharmacology group for testing new drugs. 1894 - Felix Hoffman, a German chemist, joined Bayer's pharmaceutical group. These three men, Dreser, Eichengrun and Hoffman, were to become key players in the development of acetylsalicylic acid as Aspirin. 1897 - Hoffman's boss, Eichengrun, assigned him to find a substitute for salicylic acid; one that did not irritate the stomach so much. Hoffman eventually found the best way of making acetylsalicylic acid (ASA), from salicylic acid refluxed with acetic anhydride (reflux = to boil a liquid in a vessel attached to a condenser so that the vapors continuously condense for reboiling). The ASA was sent to the pharmacology group for testing, and initial results were good. However, the ASA did not proceed to clinical trials because Dreser was concerned about salicylic acid's effect on weakening the heart - probably because of the doses given to patients with rheumatism. Hoffman had progressed in developing diacetylmorphine, which became Dreser's focus for development - this eventually led to the invention and branding of heroin. Eichengrun, annoyed with Dreser's reluctance, wanted to pursue clinical trials with ASA, so he approached Felix Golgmann, Bayer's Berlin representative, and arranged for surreptitious clinical trials. The trials gave good results, without the hitherto complications that occurred with salicylic acid. Dreser still objected, but big boss Duisberg ordered full testing. Eventually, Dreser accepted that ASA had great potential and Bayer proceeded with production. Dreser wrote a report about the findings, but did not mention Hoffman or Eichengrun in it. For many years Dreser said Hoffman was the sole discoverer of Aspirin. Arthur Eichengrun died in December 1949. Earlier in that year he wrote an article Fifty Years of Aspirin in which he said that Hoffman did not know the purpose of his research and that Hoffmann's role was restricted to the initial lab synthesis using Eichengrun's process and nothing more. Controversy continued for many decades, and still does so to a certain extent today, as to who was primarily responsible for aspirin's development. According to Bayer today, it was Hoffman. Some historians agree while others don't. Eichengrun went on to hold 47 patents for various inventions. However, he never disputed aspirin's claim to priority until half a century later, even though he had ample opportunity to do so. 1915 - Aspirin became available as an OTC (over-the-counter, no prescription required) medication in tablet form. 1920s - Aspirin became a commonly used medication for the treatment of neuralgia, lumbago and rheumatism. 1948 - A Californian GP (general practitioner, primary care physician) reported that many of his patients who regularly took aspirin had significantly lower rates of heart attacks. 1952 - Chewable Aspirin became available. 1969 - Apollo Moon astronauts had Aspirin included in their self-medication kits. 1988 - The FDA (Food and Drug Administration), USA, proposed use of aspirin for reducing risk of recurrent myocardial infarction, heart attack, and preventing first myocardial infarction in patients with unstable angina. The same agency also approved aspirin use for the prevention of recurrent mini-strokes (recurrent transient-ischemic attacks) in men, it also made aspirin standard therapy for men after suffering a stroke. 1988 - A study by Dr. Charles Hennekens and team found that aspirin dramatically reduces risk of a first myocardial infection. Hennekens later found the same for cardiovascular disease. 1998 - A major study, The Hypertension Optimal Study, published in The Lancet showed that low dose ASA combined with medication for hypertension significantly reduced the risk of myocardial infarction and major cardiovascular events in patients with hypertension. 5. Calming a Swollen Toe - Colchicine Relieves pain and increases the response of cancer cells to x-ray treatment, cause vomitting, bloody diarrhea, delirium and schock. 6. A Cure for Dropsy - Digitalis Foxglove is a plant. Although the parts of the plant that grow above the ground can be used for medicine, foxglove is unsafe for self-medication. All parts of the plant are poisonous. Chemicals taken from foxglove are used to make a prescription drug called digoxin. Digitalis lanata is the major source of digoxin in the US. Foxglove is used for congestive heart failure (CHF) and relieving associated fluid retention (edema); irregular heartbeat, including atrial fibrillation and “flutter;” asthma; epilepsy; tuberculosis; constipation; headache; and spasm. It is also used to cause vomiting and for healing wounds and burns. How does it work? Foxglove contains chemicals from which the prescription medication digoxin (Lanoxin) is made. These chemicals can increase the strength of heart muscle contractions, change heart rate, and increase heart blood output. 7. The Accidental Miracle - Penicillin What is penicillin? How do penicillins work? Last updated: 26 September 2014 17 Like66 Infectious Diseases / Bacteria / Viruses add your opinion email Knowledge center Ratings for this article (click to rate) Public / Patient: 1 2 3 4 5 93 ratings Health Professionals: 1 2 3 4 5 83 ratings Penicillins are a certain collection of antibiotics that eliminate infection causing bacteria. Also known in short as pen or PCN, they originate from a type of fungi called Penicillium fungi. They are used in the treatment or prevention of many different bacterial infections, usually caused by Gram-positive organisms. They are well known in medicine as they are one of the first types of antibiotic used for major infections and diseases, and are still used regularly in modern medicine. Penicillins are all β-Lactam (Beta-Lactam) antibiotics, which are antibiotic molecules with a β-Lactam nucleus. There are a number of penicillin types, that react to bacteria in a variety of degrees, some of these are: ampicillin amoxicillin flucloxacillin phenoxymethylpenicillin. According to Medilexicon's medical dictionary, penicillin is: 1. Originally, an antibiotic substance obtained from cultures of the molds Penicillium notatum or P. chrysogenum; interferes with cell wall synthesis in bacteria. 2. One of a family of natural or synthetic variants of penicillic acid. They are mainly bactericidal, are especially active against gram-positive organisms, and, with the exception of hypersensitivity reactions, show a particularly low toxic action on animal tissue. . History of Penicillins Penicillins were originally discovered by Ernest Duchesne (a medical student) in the late 19th Century, and then re-discovered for its antibiotic properties by Alexander Fleming in 1928. He realized this when a sample of a certain bacteria (Staphylococcus) became contaminated by some mold (Penicillium fungi) and that all bacteria cells closest to the mold were dying. It was with further testing that Fleming realized the mold was actually creating a bacteria destroying substance, which he later named penicillin. This was the catalyst that brought about the future of antibiotic discovery. Before Fleming's discovery, there were others that came across the bacteriostatic effects of penicillium fungi (such as Duchesne, mentioned above), but at the time knowledge of bacterial and viral infections was not strong enough to support any practical use to this finding. How do penicillins work? Our immune system is usually enough to destroy harmful bacteria, as we have white blood cells that attack them before they multiply. Even if symptoms do occur, our immune system can usually fight off the infection itself. Nevertheless there are instances where it is all too much for our bodies, and they need help which is where antibiotics come in. Bacteria are constantly rebuilding their cell walls (known as peptidoglycan synthesis), which is how they protect themselves and maintain their structure. Penicillins work by damaging and penetrating these cell walls, thus killing the bacteria cells. Bacteria can build a resistance to this by making β-lactamase , which defends the bacterial walls by assaulting the β-lactam ring. This defense can be counteracted by combining the penicillins with β-lactamase inhibitors. What are Penicillins for? Penicillins were one of the first drugs used to treat diseases such as syphilis, and are still in great use in modern day medicine. Many kinds of bacteria however are now penicillin resistant. There are three main instances where penicillins would be used, these are: To help fight off a bacterial infection e.g. tonsillitis To prevent infection for someone with a weakened immune system due to existing illness/condition e.g. someone with sickle cell disease To give someone's immune system help if they are undergoing treatment which could leave them vulnerable to infection. What are the Side-effects of Penicillins? Like a lot of drugs, penicillins have adverse effects, there are some common side effects and some rare. The common side effects can occur in no more than 10% of those that take penicillins, they include: diarrhea feeling and being sick rashes and other types of less serious allergic reactions. The rarer side effects, which occur in less than 1%, can be: dizziness inflammation of the liver (hepatitis) kidney inflammation (nephritis) dermatitis convulsions/fits (especially in epileptics) erythema thrush blood disorders. What can Penicillins be taken with? When a number of medicines are used in sync, one may prevent or hinder the other(s) from working properly. For instance, some penicillins are known to weaken the effectiveness of oral contraceptives. This is called drug-drug interaction. The most common medicines or substances that cannot be taken alongside penicillins include: Allopurinol - when taken with ampicillin or amoxicillin, there is risk of developing a non allergic rash. Oral Contraceptives - can impede their effectiveness when used alongside penicillins, thus increasing the chance of getting pregnant. Methotrexate - penicillin decreases the body's ability to rid itself of this methotrexate, this can lead to serious complications. Substances and medicines that can be taken with penicillins are: Probenecid - this drug can hinder the body's capacity to remove penicillin, however this is not necessarily a problem. Using the two drugs together would increase the amount of penicillins in the bloodstream and improve their effects. Alcohol - there are no complications caused by consuming alcohol while taking penicillins. How to use Penicillins Penicillins are normally consumed orally (through the mouth). However, some types can only be injected. Examples of these are: ticarcillin plus clavulanic acid (Timentin) temocillin (Negaban) piperacillin plus tazobactam (Tazocin) benzylpenicillin (Crystapen). Before taking penicillin there are some factors to consider, such as: Being allergic to penicillin - if this is the case penicillin should definitely not be taken. This applies to all types of penicillin - if you have been allergic to one you will be allergic to them all. If you have been allergic to other β-Lactam antibiotics, you will be allergic to penicillin Having a history of allergies - people with previous allergies, such as eczema or asthma are at greater risk of going into anaphylactic shock if they take penicillins. This risk is still small but don't be afraid to check with your doctor if you have had any allergies in the past or still do. Are pregnant and breastfeeding - only phenoxymethylpenicillin is not guaranteed safe when pregnant so should only be used if completely necessary, most of the other types are fine. When breastfeeding it is important to take note that phenoxymethylpenicillin can pass into the breast milk, this can affect the baby. Some penicillins are mixed with clavulanic acid and again shouldn't be used when pregnant and breastfeeding unless it is the only option. Suffering from liver or severe kidney problems - penicillins should be taken with care. It is crucial that the whole course of penicillin is completed to prevent the infection returning. If the course is not completed, the chance of the bacteria becoming more resilient to future treatments is greatly increased. This is due to the bacteria left over from the incomplete course of treatment building up resistance to the penicillin as it has had previous exposure. This shows how important it is to finish the course (even if feeling better) and kill any remaining bacteria. If a dose is ever missed, you should try to take the dose as soon as possible and then continue back to the normal course. If you haven't realized by the time for the next dose, the forgotten dose should be skipped altogether as it is important a double dose is not taken. If more than one dose has been missed, it is worth contacting your doctor for advice on how to proceed. Written by Mike Paddock