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Redirect|MedicationRedirect|Medicines||Medicine (disambiguation)A pharmaceutical drug , also referred to as medicine , medication or medicament , can be loosely defined as any chemical substance intended for use in the medical diagnosis , cure , Therapy|treatment , or Preventive medicine|prevention of disease . http://www.fda.gov/opacom/laws/fdcact/fdcact1.htm US Federal Food, Drug, and Cosmetic Act, SEC. 210., (g)(1)(B). Accessed 17 August 2008. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do? uri=CELEX:32004L0027:EN:HTML Directive 2004/27/EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use. Article 1. Published March 31, 2004. Accessed 17 August 2008.
Classification
Medications can be classified in various ways,www.epgonline.org database of prescription pharmaceutical products including drug classifications http://www.epgonline.org/class.cfm such as by chemical property|chemical properties , mode or route of administration , biological system affected, or therapeutic effect s. An elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System (ATC system). The World Health Organization keeps a list of essential medicines .
A sampling of classes of medicine includes: # Antipyretic s: reducing fever (pyrexia/pyresis) # Analgesic s: reducing pain (painkillers) # Antimalarial drug s: treating malaria # Antibiotic s: inhibiting Microorganism|germ growth # Antiseptic s: prevention of germ growth near burn s, Cut (wound)|cut s and wound s
Atherosclerosis / cholesterol inhibitors: hypolipidaemic agent s, statin s.
For the central nervous system
See also|Psychiatric medication|Psychoactive drug Drugs affecting the central nervous system include: hypnotic s, anaesthetics , antipsychotic s, antidepressant s (including tricyclic antidepressant s, monoamine oxidase inhibitor s, Lithium pharmacology|lithium salts , and selective serotonin reuptake inhibitor s (SSRIs)), antiemetic s, Anticonvulsant|anticonvulsants/antiepileptics , anxiolytic s, barbiturate s, movement disorder (e.g., Parkinson's disease ) drugs, stimulant s (including amphetamine s), benzodiazepine s, cyclopyrrolones , dopamine antagonist s, Histamine antagonist|antihistamines , cholinergic s, anticholinergic s, emetic s, cannabinoid s, and serotonin antagonist|5-HT (serotonin) antagonists .
For pain and consciousness (analgesic drugs)
See also|Analgesic The main classes of painkillers are NSAIDs , opioid s and various Orphan drug|orphans such as paracetamol .
For musculo-skeletal disorders
The main categories of drugs for musculoskeletal disorders are: NSAID s (including COX-2 selective inhibitor s), muscle relaxant s, neuromuscular disease|neuromuscular drugs, and Acetylcholinesterase inhibitor|anticholinesterases .
Pharmaceutical drug#For nutrition|tonic s, electrolyte s and mineral preparations (including iron preparation s and Magnesium (pharmaceutical preparation)|magnesium preparations ), parenteral nutritional supplement s, vitamin s, anti-obesity drug s, anabolic drug s, haematopoietic drug s, food product drug s
See also|Barbiturate#Other non-therapeutical uses|barbituatesAn euthanaticum is used for euthanasia and Assisted suicide|physician-assisted suicide .
Euthanasia is not permitted by law in many countries, and consequently medicines will not be licensed for this use in those countries.
Administration
Administration is the delivery of a pharmaceutical drug to a patient.
It can be performed in various dosage forms such as pill (pharmacy)|pill s, Tablet (pharmacy)|tablet s, or capsule (pharmacy)|capsules .
There are also many variations in the routes of administration , including Intravenous therapy|intravenous (into the blood through a vein) and oral administration (through the mouth).
They can be administered all at once as a bolus (medicine)|bolus , at frequent intervals or continuously. Frequencies are often abbreviated from Latin, such as every 8 hours reading Q8H from Quaque VIII Hora .
Legal considerations
Depending upon the jurisdiction , medications may be divided into over-the-counter drug s (OTC) which may be available without special restrictions, and prescription only medicine (POM), which must be prescribed by a licensed medical practitioner. The precise distinction between OTC and prescription depends on the legal jurisdiction . A third category, behind-the-counter medications (BTMs), is implemented in some jurisdictions. BTMs do not require a prescription, but must be kept in the dispensary , not visible to the public, and only be sold by a pharmacist or pharmacy technician . Doctors may also prescribe prescription drugs for off-label use - purposes which the drugs were not originally approved for by the regulatory agency. The Classification of Pharmaco-Therapeutic Referrals helps guide the referral process between pharmacists and doctors.
The International Narcotics Control Board of the United Nations imposes a world law of prohibition of certain medications. They publish a lengthy list of chemicals and plants whose trade and consumption (where applicable) is forbidden. OTC medications are sold without restriction as they are considered safe enough that most people will not hurt themselves accidentally by taking it as instructed. Many countries, such as the United Kingdom have a third category of pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist .
For patented medication s, countries may have certain Compulsory license|mandatory licensing programs which compel, in certain situations, a medication's owner to contract with other agents to manufacture the drug. Such programs may deal with the contingency of a lack of medication in the event of a serious epidemic of disease, or may be part of efforts to ensure that disease treating drugs, such as AIDS drugs, are available to countries which cannot afford the drug owner's price.
Drugs which are prescription only are regulated as such because they can impose adverse effect s and should not be used unless necessary. Medical guideline s and clinical trial s required for approval are used to help inform doctors' prescription of these drugs, but errors can happen. Reasons to not prescribe drugs such as interactions or side effects are called contraindication s.
Errors include overprescription and polypharmacy , misprescription, contraindication and lack of detail in dosage and administrations instructions. In 2000 the definition of a prescription error was studied using a Delphi method conference; the conference was motivated by ambiguity in the what a prescription error and a need to use a uniform definition in studies.cite journal |author=Dean B, Barber N, Schachter M |title=What is a prescribing error? |journal=Qual Health Care |volume=9 |issue=4 |pages=232–7 |year=2000 |month=December |pmid=11101708 |pmc=1743540 |doi= 10.1136/qhc.9.4.232|url=
Development
Main|Drug development Drug development is the process by which a drug is created. Drugs can be extracted from natural products ( pharmacognosy ) or synthesized through chemical processes. The drug's active ingredient will be combined with a "vehicle" such as a Capsule (pharmacy)|capsule , cream , or liquid which will be administered through a particular route of administration . Child-resistant packaging will likely be used in the ultimate package sold to the consumer.
Blockbuster drug
A blockbuster drug is a drug generating more than $1& nbsp;billion of revenue for its owner each year." "Blockbuster medicine" is defined as being one which achieves annual revenues of over US$ 1& nbsp;billion at global level. " in European Commission, http://ec.europa.eu/competition/sectors/pharmaceuticals/inquiry/preliminary_report.pdf Pharmaceutical Sector Inquiry, Preliminary Report (DG Competition Staff Working Paper), 28 November 2008, page 17 (pdf, 1.95 MB).when|date=April 2012
A report from URCH Publishing estimated that about one third of the pharma market by value is accounted for by blockbusters. About 125 products are blockbusters. The top seller was Lipitor , a cholesterol -lowering medication marketed by Pfizer with Annual pharmaceutical drug sales|sales of $12.5& nbsp;billion .
In 2009 there were a total of seven new blockbuster drugs, with combined sales of $9.8& nbsp;billion.
Beyond this purely arbitrary financial consideration,
::"In the pharmaceutical industry, a blockbuster drug is one that achieves acceptance by prescribing physicians as a therapeutic standard for, most commonly, a highly prevalent chronic (rather than acute) condition. Patients often take the medicines for long periods." http://www.ftpress.com/articles/article.aspx? p=1163084 Finkelstein, Temin "Reasonable Rx: Solving the Drug Price Crisis" 11 January 2008
The birth control pill Enovid was the first modern drug taken by those not ill for a highly prevalent chronic condition. The focus on highly profitable drugs for chronic conditions and resulting de-emphasis of one-time acute treatment drugs has led to occasional shortages of antibiotics or vaccines, such as the influenza vaccine shortage in the United States.
Leading blockbuster drugs
Drug
Trade name
Indication
Company
Atorvastatin
Lipitor
hypercholesterolemia
Pfizer
12.5
Clopidogrel
Plavix
atherosclerosis
Bristol-Myers Squibb Sanofi
9.1
Fluticasone/ salmeterol
Seretide
asthma
GlaxoSmithKline
8.7
Esomeprazole
Nexium
acid reflux disease
AstraZeneca
8.3
Rosuvastatin
Crestor
hypercholesterolemia
AstraZeneca
7.4
Quetiapine
Seroquel
bipolar disorder schizophrenia
AstraZeneca
7.2
Adalimumab
Humira
rheumatoid arthritis
Abbott
6.6
Etanercept
Enbrel
rheumatoid arthritis
Amgen Pfizer
6.5
Infliximab
Remicade
Crohn's disease rheumatoid arthritis
Johnson & Johnson
6.4
Olanzapine
Zyprexa
schizophrenia
Eli Lilly
6.2
*Sales are for the 12 months preceding June 30, 2011.
Environmental impact
Main|Pharmaceuticals and personal care products in the environmentSince the 1990s water contamination by pharmaceuticals has been an list of environmental issues|environmental issue of concern.cite journal |author=Doerr-MacEwen NA, Haight ME |title=Expert stakeholders' views on the management of human pharmaceuticals in the environment |journal=Environ Manage |volume=38 |issue=5 |pages=853–66 |year=2006 |month=November |pmid=16955232 |doi=10.1007/s00267-005-0306-z |url= Most pharmaceuticals are deposited in the environment through human consumption and excretion, and are often filtered ineffectively by Sewage treatment|wastewater treatment plant s which are not designed to manage them. Once in the water they can have diverse, subtle effects on organisms, although research is limited. Pharmaceuticals may also be deposited in the environment through improper disposal, runoff from sludge fertilizer and reclaimed wastewater irrigation, and leaky sewage. In 2009 an investigative report by Associated Press concluded that U.S. manufacturers had legally released 271 million pounds of drugs into the environment, 92% of which was the antiseptics phenol and hydrogen peroxide . It could not distinguish between drugs released by manufacturers as opposed to the pharmaceutical industry . It also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging were discarded by hospitals and long-term care facilities.Donn J. (2009). http://www.usnews.com/articles/science/2009/04/19/tons-of-released-drugs-taint-us-water.html? PageNr=1 Tons of Released Drugs Taint U.S. Water. AP.
Pharmacoenvironmentology is a branch of pharmacology and a form of pharmacovigilance which deals entry of chemicals or drugs into the Natural environment|environment after elimination from humans and animals post-therapy. It deals specifically with those pharmacological agents that have impact on the environment via elimination through living organisms subsequent to pharmacotherapy, while Ecopharmacology is concerned with the entry of chemicals or drugs into the environment through any route and at any concentration disturbing the balance of ecology (ecosystem), as a consequence. Ecopharmacology is a broad term that includes studies of “ PPCPs ” irrespective of doses and route of entry into environment.cite book | last= Rahman | first=SZ| authorlink = | coauthors = Khan RA, Gupta V, Misbah Uddin| year = 2008 | month = | title = An Introduction to Environmental Pharmacology | chapter = Chapter 2: Pharmacoenvironmentology – Ahead of Pharmacovigilance | editor = Rahman SZ, Shahid M & Gupta A | others = | edition = Sic|? |1|th | pages = 35–52| publisher = Ibn Sina Academy | location = Aligarh, India | isbn = 978-81-906070-4-9 | url = cite journal| url = http://www.ehjournal.net/content/6/1/20| doi= 10.1186/1476-069X-6-20| last=Rahman| first=SZ| last2= Khan | first2=RA| last3=Gupta| first3=V| last4= Uddin | first4=Misbah| title= Pharmacoenvironmentology–A Component of Pharmacovigilance | journal= Environmental Health | year= 2007 | month=July| volume= 6 | issue=20| pages= 20| pmid= 17650313 | pmc=1947975Ilene Sue Ruhoy, Christian G. Daughton. Beyond the medicine cabinet: An analysis of where and why medications accumulate. Environment International 2008, Vol. 34 (8): 1157-1169
Ecopharmacovigilance is the science and activities associated with the detection, evaluation, understanding and prevention of adverse effects of pharmaceuticals in the environment. This is close to the WHO definition of pharmacovigilance, the science aiming to capture any adverse effects of pharmaceuticals in humans after use. http://www.astrazeneca.com/Responsibility/The-environment/environmental-product-stewardship/Ecopharmacovigilance Ecopharmacovigilance (AstraZeneca)
The term Environmental Persistent Pharmaceutical Pollutant s (EPPP) was suggested in the 2010 nomination of pharmaceuticals and environment as an emerging issue to Strategic Approach to International Chemicals Management (SAICM) by the International Society of Doctors for the Environment (ISDE).
History
Ancient pharmacology
Using plants and plant substances to treat all kinds of diseases and medical conditions is believed to date back to prehistoric medicine .
The Kahun Gynaecological Papyrus , the oldest known medical text of any kind, dates to about 1800 BC and represents the first documented use of any kind of medication.Griffith, F. Ll. The Petrie Papyri: Hieratic Papyri from Kahun and Gurob http://www.reshafim.org.il/ad/egypt/timelines/topics/kahunpapyrus.htm The Kahun Gynaecological Papyrus It and other medical papyri describe Ancient Egyptian medicine|Ancient Egyptian medical practices , such as using honey to treat infections.
Ancient Babylonia#Medicine|Babylonian medicine demonstrate the use of Prescription drug|prescriptions in the first half of the 2nd millennium BC . Cream (pharmaceutical)|Medicinal cream s and Pill (pharmacy)|pill s were employed as treatments.H. F. J. Horstmanshoff, Marten Stol, Cornelis Tilburg (2004), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine , p. 99, Brill Publishers , ISBN 90-04-13666-5.
On the Indian subcontinent, the Atharvaveda , a sacred text of Hinduism whose core dates from the 2nd millennium BC, although the hymns recorded in it are believed to be older, is the first Indic text dealing with medicine . It describes plant-based medications to counter diseases.See Atharvaveda XIX.34.9 The earliest foundations of ayurveda were built on a synthesis of selected ancient herbal practices, together with a massive addition of theoretical conceptualizations, new nosology|nosologies and new therapies dating from about 400 BC onwards.Kenneth G. Zysk, Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery, Oxford University Press, rev. ed. (1998) ISBN 0-19-505956-5. The student of Ayurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis .
The Hippocratic Oath for physicians, attributed to 5th century BC Greece, refers to the existence of "deadly drugs", and Medicine in ancient Greece|ancient Greek physicians imported medications from Egypt and elsewhere.Heinrich Von Staden, Herophilus: The Art of Medicine in Early Alexandria (Cambridge: Cambridge University Press, 1989), pp. 1-26.
The first pharmacy|drugstore s were created in Baghdad in the 8th century AD. The Injection (medicine)|injection syringe was invented by Ammar ibn Ali al-Mawsili in 9th century Iraq . Al-Kindi 's 9th century AD book, De Gradibus , developed a mathematical scale to quantify the strength of drug s.Felix Klein-Frank (2001), Al-Kindi , in Oliver Leaman and Hossein Nasr , History of Islamic Philosophy , p. 172. Routledge , London.
The Canon of Medicine by Ibn Sina (Avicenna), who is considered the father of modern medicine,Cas Lek Cesk (1980). "The father of medicine, Avicenna, in our science and culture: Abu Ali ibn Sina (980-1037)", Becka J. 119 (1), p. 17-23. reported 800 tested drugs at the time of its completion in 1025 AD.Citation needed|date=May 2010 Ibn Sina's contributions include the separation of medicine from pharmacology , which was important to the development of the pharmaceutical sciences .Bashar Saad, Hassan Azaizeh, Omar Said (October 2005). "Tradition and Perspectives of Arab Herbal Medicine: A Review", Evidence-based Complementary and Alternative Medicine 2 (4), p. 475-479 476. Oxford University Press . Islamic medicine knew of at least 2,000 medicinal and chemical substance s.Information taken from the abstract of Cite journal | issn = 0350-199X | volume = 51 | issue = 1–2 | pages = 47–50 | last = Hadzovic | first = S | title = Pharmacy and the great contribution of Arab-Islamic science to its development (Article in Croatian) | journal = Medicinski arhiv | year = 1997 | pmid = 9324574
Medieval pharmacology
Medieval medicine saw advances in surgery, but few truly effective drugs existed, beyond opium and quinine . Folklore cures and potentially poisonous metal-based compounds were popular treatments. Theodoric Borgognoni , (1205–1296), one of the most significant surgeons of the medieval period, responsible for introducing and promoting important surgical advances including basic antiseptic practice and the use of anaesthetic s. Garcia de Orta described some herbal treatments that were used.
Modern pharmacology
For most of the 19th century, drugs were not highly effective, leading Oliver Wendell Holmes, Sr. to famously comment in 1842 that "if all medicines in the world were thrown into the sea, it would be all the better for mankind and all the worse for the fishes".rp|21 During the First World War , Alexis Carrel and Henry Drysdale Dakin|Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene.
In the inter-war period, the first anti-bacterial agents such as the sulpha antibiotics were developed. The Second World War saw the introduction of widespread and effective antimicrobial therapy with the development and mass production of penicillin antibiotics, made possible by the pressures of the war and the collaboration of British scientists with the American pharmaceutical industry.
Medicines commonly used by the late 1920s included aspirin , codeine , and morphine for pain; Digoxin|digitalis , nitroglycerin , and quinine for heart disorders, and insulin for diabetes. Other drugs included antitoxin s, a few biological vaccines, and a few synthetic drugs. In the 1930s antibiotics emerged: first sulfa drug s, then penicillin and other antibiotics. Drugs increasingly became "the center of medical practice".cite book | year = 2008 | title = Reasonable Rx: Solving the drug price crisis | publisher = FT Press | author = Finkelstein S, Temin P rp|22 In the 1950s other drugs emerged including corticosteroids for inflammation , rauwolfia alkloids as tranqulizers and antihypertensives, antihistamine s for nasal allergies, xanthine s for asthma, and typical antipsychotic s for psychosis.rp|23-24 As of 2008, thousands of approved drugs have been drug development|developed . Increasingly, biotechnology is used to discover biopharmaceutical s. Recently, multi-disciplinary approaches have yielded a wealth of new data on the development of novel antibiotics and antibacterials and on the use of biological agents for antibacterial therapy.cite book | author= Miller, AA; Miller, PF (editor) | year=2011 | title=Emerging Trends in Antibacterial Discovery: Answering the Call to Arms | publisher= Caister Academic Press | isbn= 978-1-904455-89-9
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine , were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia . Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.
Governments have been heavily involved in the regulation of drug development and drug sales. In the U.S., the Elixir Sulfanilamide disaster led to the establishment of the Food and Drug Administration , and the 1938 Federal Food, Drug, and Cosmetic Act required manufacturers to file new drugs with the FDA. The 1951 Humphrey-Durham Amendment required certain drugs to be sold by prescription. In 1962 a subsequent amendment required new drugs to be tested for efficacy and safety in clinical trial s.rp|24-26 Until the 1970s, drug prices were not a major concern for doctors and patients. As more drugs became prescribed for chronic illnesses, however, costs became burdensome, and by the 1970s nearly every U.S. state required or encouraged the substitution of generic drugs for higher-priced brand names. This also led to the 2006 U.S. law, Medicare Part D , which offers Medicare coverage for drugs.rp|28-29 As of 2008, the United States is the leader in medical research , including pharmaceutical development. U.S. drug prices are among the highest in the world, and drug innovation is correspondingly high. In 2000 U.S. based firms developed 29 of the 75 top-selling drugs; firms from the second-largest market, Japan, developed eight, and the United Kingdom contributed 10. France, which imposes price controls, developed three. Throughout the 1990s outcomes were similar.rp|30-31
See also
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Compliance (medicine)|Compliance
Environmental Persistent Pharmaceutical Pollutant s (EPPPs)
