Health is the functional and/or metabolic efficiency of an organism, at any moment in time, at both the cellular and global levels. All individual organisms, from the simplest to the most complex, vary between optimum health and zero health (dead).

In the medical field, health is commonly defined as an organism's ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance," known as homeostasis.

Another widely accepted definition of health is that of the World Health Organization "WHO". It states that "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life." The WHO definition is not without criticism, as some argue that health cannot be defined as a state at all, but must be seen as a process of continuous adjustment to the changing demands of living and of the changing meanings we give to life. The WHO definition is therefore considered by many as an idealistic goal rather than a realistic proposition.

The LaLonde report suggested that there are four general determinants of health which he called "human biology", "environment", "lifestyle", and "healthcare organization"[2] Thus, health is maintained through the science and practice of medicine, but can also be improved by individual effort. Physical fitness, weight loss, healthy eating, stress management training and stopping smoking and other substance abuse are examples of steps to improve one's health. Workplace programs are recognized by an increasingly large number of companies for their value in improving health and well-being of their employees, and increasing morale, loyalty and productivity at work. A company may provide a gym with exercise equipment, start smoking cessation programs, provide nutrition, weight or stress management training. Other programs may include health risk assessments, health screenings and body mass index monitoring.

An increasing measure of the health of populations is height, which is strongly regulated by nutrition and health care, among other standard of living and quality of life matters. The study of human growth, its regulators and its implications is known as auxology.

Wellness is a term sometimes used to describe the psychological state of being healthy, but is most often used in the field of alternative medicine to describe one's state of being.

Exercise

U.S. Marine emerges from the water upon completing the swimming portion of a triathlon.

Physical exercise is the performance of some activity in order to develop or maintain physical fitness and overall health. It is often directed toward also honing athletic ability or skill. Frequent and regular physical exercise is an important component in the prevention of some of the diseases of affluence such as cancer, heart disease, cardiovascular disease, Type 2 diabetes and obesity.

Exercises are generally grouped into three types depending on the overall effect they have on the human body:

• Flexibility exercises such as stretching improve the range of motion of muscles and joints.
  Aerobic exercises such as walking and running focus on increasing cardiovascular endurance.
  Anaerobic exercises such as weight training or sprinting increase short-term muscle strength.

Physical exercise is considered important for maintaining physical fitness including healthy weight; building and maintaining healthy bones, muscles, and joints; promoting physiological well-being; reducing surgical risks; and strengthening the immune system.

Proper nutrition is at least as important to health as exercise. When exercising it becomes even more important to have good diet to ensure the body has the correct ratio of macronutrients whilst providing ample micronutrients, this is to aid the body with the recovery process following strenuous exercise. When the body falls short of proper nutrition, it gets into starvation mode developed through evolution and depends onto fat content for survival. Research suggest that the production of thyroid hormones can be negatively affected by repeated bouts of dieting and calorie restriction.

Proper rest and recovery is also as important to health as exercise, otherwise the body exists in a permanently injured state and will not improve or adapt adequately to the exercise.

The above two factors can be compromised by psychological compulsions (eating disorders such as exercise bulimia, anorexia, and other bulimias), misinformation, a lack of organization, or a lack of motivation. These all lead to a decreased state of health.

Delayed Onset Muscle Soreness can occur after any kind of exercise, particularly if the body is in an unconditioned state relative to that exercise.

Hygiene

Hygiene is the maintenance of healthy practices. In modern terminology, this is usually regarded as a particular reference to cleanliness. The term Hygiene originates as a reference to Hygieia, who was a daughter of Asclepius and the goddess of health, cleanliness and sanitation. The related term personal grooming/grooming means to enhance one's physical appearance or appeal for others, by removing obvious imperfections in one's appearance or improving one's hygiene.

Outward signs of good hygiene include the absence of visible dirt (including dust and stains on clothing) or of bad odor/smells. Since the development of the germ theory of disease, hygiene has come to mean any practice leading to the absence of harmful levels of bacteria.

Good hygiene is an aid to health, beauty, comfort, and social interactions. It directly aids in disease prevention and/or disease isolation. (That is, good hygiene will help keep one healthy and thus avoid illness. If one is ill, good hygiene can reduce one's contagiousness to others.)

Washing (with water) is the most common example of hygienic behavior. Washing is often done with soap or detergent which helps to remove oils and to break up dirt particles so they may be washed away.

Hygienic practices—such as frequent hand washing or the use of boiled (and thus sterilized) water in surgery/medical operations—have a profound impact on reducing the spread of disease. This is because they kill or remove disease-causing microbes (germs) in the immediate surroundings. For instance, washing one's hands after using the toilet and before handling food reduces the chance of spreading E. coli bacteria and Hepatitis A, both of which are spread from fecal contamination of food.

Adequate hygiene requires an adequate and convenient supply of clean water. In much of the developing world maintaining an acceptable level of cleanliness is difficult or impossible for much of the population due to lack of adequate water supply and sanitation. This results in the rapid spread and extent of diseases such as trachoma which are rare in the developed world.

Nutrition

The updated USDA food pyramid, published in 2005, is a general nutrition guide for recommended food

Nutrition is a science which studies the relationship between diet and states of health and disease. Dieticians are Health professionals who are specialized in this area of expertise. They are also the only highly trained health professionals able to provide safe, evidence-based and accurate dietary advice and interventions.

Between the extremes of optimal health and death from starvation or malnutrition, there is an array of disease states that can be caused or alleviated by changes in diet. Deficiencies, excesses and imbalances in diet can produce negative impacts on health, which may lead to diseases such as scurvy, obesity or osteoporosis, as well as psychological and behavioral problems. Moreover, excessive ingestion of elements that have no apparent role in health, (e.g. lead, mercury, PCBs, dioxins), may incur toxic and potentially lethal effects, depending on the dose. The science of nutrition attempts to understand how and why specific dietary aspects influence health.

Mental health

Mental health is a concept refers to a human individual's emotional and psychological well-being. Merriam-Webster defines mental health as "A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life."

According to the World Health Organization (WHO), there is no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined. In general, most experts agree that "mental health" and "mental illness" are not opposites. In other words, the absence of a recognized mental disorder is not necessarily an indicator of mental health.

One way to think about mental health is by looking at how effectively and successfully a person functions. Feeling capable and competent; being able to handle normal levels of stress, maintain satisfying relationships, and lead an independent life; and being able to "bounce back," or recover from difficult situations, are all signs of mental health.

References

• WHO. Constitution of the World Health Organization , Geneva, 1946. Accessed October 30, 2006.
• Lalonde, Marc. "A New Perspective on the Health of Canadians." Ottawa: Minister of Supply and Services; 1974.
• Common fitness mistakes people make Stay Fit retrived on 11-13-2006
• WHO (1979) Health for All, Sr. Nos. 1, 2

Links

• World Health Organization
• National Center for Health Statistics (USA)
• National Institute of Health (USA)
• Centers for Disease Control and Prevention (USA)
• Wellness Monitor Information

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

A drug is any biological substance, synthetic or non-synthetic, that is taken for non-dietary needs. It is usually synthesized outside of an organism, but introduced into an organism to produce its action. That is, when taken into the organisms body, it will produce some effects or alter some bodily functions (such as relieving symptoms, curing diseases or used as preventive medicine or any other purposes).

Note that natural endogenous biochemicals (such as hormones) can bind to the same receptor in the cell, producing the same effect as a drug. Thus, drug is merely an artificial definition that distinguishes whether that molecule is synthesized within an organism or outside an organism. For instance, insulin is a hormone that is synthesized in the body; it is considered as a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is considered as a drug.

It is a substance which is not food, and which, when ingested, affects the functioning of the mind, or the body, or both. However, under the philosophy of Chinese medicine, food is also considered a drug as it affects particular parts of body and cures some diseases. Thus, food does satisfy the above definition of drug so long as ingestion of it would alter some bodily functions.

Coffee is the most widely used psychotropic beverage in the world. In 1999 the average consumption of coffee was 3.5 cups per day per U.S. citizen.

Drugs used as medicines

A medication is a drug taken to cure or reduce symptoms of an illness or medical condition, or may use as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms. Dispensing of medication is often regulated by the government into three categories -- over the counter (OTC) medications, which are available in pharmacies and and supermarket's without special restrictions, behind the counter (BTC), which are dispensed by a pharmacist without needing a doctor's prescription, and Prescription only medicines (POM), which must be prescribed by a licensed medical professional, usually a physician.

Most OTC medications are generally considered to be safe enough that most people will not hurt themselves if they are taken as instructed. In UK, BTC medicine is called pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist. However, the precise distinction between OTC and prescription depends on the legal jurisdiction.

Medications are typically produced by pharmaceutical companies and are often patented to protect their exclusive rights to produce them, but they can also be derived from naturally occurring substance in plants called herbal medicine. Those that are not patented (or with expired patents) are called generic drugs since they can be produced by other companies without restrictions or licenses from the patent holder.

The cigarette is the common pharmaceutical form of tobacco – one of the world’s best selling drugs.

Recreational drugs

Recreational drug use is the use of psychoactive drugs for recreational purposes rather than for work, medical or spiritual purposes. Much controversy has arisen over recreational drug use, and governments across the world have regulated the consumption and/or distribution of drugs in the name of fighting drug abuse, but many countries' laws are criticised for being passed under ulterior motives or for being hypocritical.

Wine is a common alcoholic beverage.

List of drugs

See list of drugs for an alphabetical list of drugs by name. Many drugs have more than one name and, therefore, the same drug may be listed more than once. Brand names and generic names are differentiated by the use of capital initials for the former.

Cannabis is another commonly used recreational drug

Links

• Health Care - Drugs: prescription and medication
• History of Drugs From High Times Encyclopedia Of Recreational Drugs - 1977

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

An abortifacient is a substance that induces abortion.

History

The ancient Greek colony of Cyrene at one time had an economy based almost entirely on the production and export of Silphium, a powerful abortifacient in the parsley family. Silphium figured so prominently in the wealth of Cyrene that the plant appeared on the obverse and reverse of coins minted there. Silphium, which was native only to that part of Libya, was overharvested by the Greeks and was effectively driven to extinction.

As the Catholic Church gained control of European society, women who dispensed abortifacient herbs found themselves classified as witches and were often persecuted.

Present time

Herbal abortifacients

Many herbs sold "over the counter" today, including Wild carrot, Black cohosh, Pennyroyal, Nutmeg, and Mugwort, are themselves abortifacients. Typically the labeling will contraindicate use by pregnant women, but will not contain an explanation for this contraindication. There are naturally occurring abortifacients like green Papaya and Common Rue though there does not seem to be any available data on their efficacy.

King's American Dispensatory of 1898 recommended a mixture of brewer's yeast and pennyroyal tea as "a safe and certain abortive"

Pharmaceutical abortifacients

The methods of operation of prescription drugs used as abortifacients are better understood than those of traditional herbal remedies, but they have been controversial since the 1980s. The most prominent of these is Mifepristone (also known as "RU-486" and marketed under the brand name "Mifeprex"), which is used in conjunction with Misoprostol (an anti-ulcer drug marketed under the name "Cytotec"). Mifepristone has been approved for inducing abortions in many Western countries since the late 1990s, while this use of Misoprostol is off-label.

Misoprostol alone is sometimes used for self-induced abortion in Latin American countries where legal abortion is not available, and by some immigrants from these countries in the United States who cannot afford a legal abortion.

Pre-implantation labeling controversy

There is controversy as to whether a woman is pregnant at the time of fertilization, or at the implantation of the blastocyst in the uterine lining. Some agents have a proposed back-up effect of preventing implantation and thus destroying the blastocyst, although their primary effect is to prevent fertilization. American federal and British laws mark the beginning of pregnancy at implantation; thus, these agents are labeled as contraceptives, rather than abortifacients. They are generally not effective if taken after implantation. Labeling of these agents as abortifacient is most ardently supported by those opposed to abortion,  usually due to their belief that human life begins at fertilization. The following agents may prevent implantation of a blastocyst, although, in most cases, they merely prevent fertilization:

• Hormonal contraceptives
  
  • Combined estrogen & progesterone:
    
    • Combined oral contraceptive pill ("The Pill")*
      Contraceptive patch
      Contraceptive vaginal ring
      Lunelle (monthly injection)
  • Progesterone used alone:
    
    • Progesterone only pill (POP)*
      Depo Provera (injection every three months)
      Implants (such as Norplant or Implanon)
      IntraUterine System ("IUS")
• Intrauterine device ("IUD")*
• Some herbal contraceptives may work primarily by preventing implantation

(*) These methods may also be used as Emergency contraception. POPs are also packaged for use as emergency contraception under the brand name "Plan B".

References

1. Kramer, Heinrich, & Sprenger, Jacob. (1487). Malleus Maleficarum. (Montague Summers, Trans.). Retrieved June 3, 2006.
2. Vivian M. Dickerson (June 2005). Emergency Contraception: Out of Sight, Out of Mind? (PDF). Advanced Studies in Medicine, Vol. 5, No. 6 pp. 283-284. Johns Hopkins University, School of Medicine. Retrieved on 2006-08-03.
3. Finn, J.T. (2005-04-23). "Birth Control" Pills cause early Abortions. Pro-Life America — Facts on Abortion. prolife.com. Retrieved on 2006-08-25.
4. Abortion Facts. Center for Bio-Ethical Reform. Retrieved on 2006-08-03.

Links

• SisterZeus on Pregnancy Termination
• Signs of pregnancy

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). This derives from Greek an-, "without", and -algia, "pain". Analgesic drugs act in various ways on the peripheral and central nervous system; they include paracetamol (acetaminophen), the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, synthetic drugs with narcotic properties such as tramadol, and various others. Some other classes of drugs not normally considered analgesics are used to treat neuropathic pain syndromes; these include tricyclic antidepressants and anticonvulsants.

Addiction

In the United States in recent years, however, there has been a wave of new addictions to prescription narcotics such as oxycodone (OxyContin) and hydrocodone (Vicodin, Lortab etc.) when available in pure formulations as opposed to combined with other medications (as in Percocet which contains both oxycodone and acetaminophen/paracetamol).

References

• Cancer pain relief and palliative care. Report of a WHO expert committee [World Health Organization Technical Report Series, 804] . Geneva, Switzerland: World Health Organization; 1990. pp. 1-75. ISBN 92-4-120804-X.
• Bandolier pain site (Oxford pain group)

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Contemporary re-enactment of Morton's October 16, 1846, ether operation; daguerrotype by Southworth & Hawes.

A wide variety of drugs are used in modern anaesthetic practice. Many are rarely used outside of anaesthesia, although others are used commonly by all disciplines. Some of the prominent ones include:

• local anaesthetics
• general anaesthetics
  
  • inhalational anaesthetics
    
    • volatile anaesthetics
      
      • desflurane
        sevoflurane
        isoflurane
        halothane
        enflurane
        methoxyflurane
    • nitrous oxide
    • xenon
  • intravenous anaesthetics
    
    • propofol
      etomidate
    • barbiturates
      
      • methohexital
        thiopentone/thiopental
    • benzodiazepines
      
      • midazolam
      • diazepam
    • ketamine
• analgesics
  
  • opioids
    
    • morphine
    • fentanyl
    • alfentanil
      sufentanil
      remifentanil
    • methadone
    • meperidine / pethidine
  • NSAIDs
• muscle relaxants
  
  • depolarising muscle relaxants
    • succinylcholine, also known as suxamethonium
  • nondepolarising (curare-like) muscle relaxants
    
    • atracurium
      cisatracurium
      vecuronium
      rocuronium
      mivacurium
      tubocurarine (see mislabelled article "turbocurnanine" under "search." Can this article be placed correctly under tubocurarine also?)
      pancuronium bromide
• vasoconstrictors, also known as vasopressors
  
  • phenylephrine
  • ephedrine
  • metaraminol
• antiemetics: phenothiazines, e.g.: prochlorperazine, promethazine, cyclizine;

butyrophenones, e.g.: droperidol; antihistamines, e.g.: dimenhydrinate (old); newer agents: ondansetron and tropisetron, and granisetron; steroids, e.g.: dexamethasone; and lastly, metoclopramide (variable efficacy).

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Video: Acupuncture Anaesthesia

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1, Diabetes mellitus type 2, Gestational diabetes
Pre-diabetes: Impaired fasting glycaemia, Impaired glucose tolerance
Disease Management
Diabetes management: Diabetic diet, Anti-diabetic drugs, Conventional insulinotherapy, Intensive insulinotherapy
Blood tests
Fructosamine, Glucose tolerance test, Glycosylated hemoglobin

An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. They usually work by lowering the glucose levels in the blood. There are different types of anti-diabetic drugs, and their use depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Insulin, exenatide, and pramlintide are the only non-oral antidiabetic drugs. Insulin is the mainstay of treatment in Type I diabetes, in which insulin production is impaired. In Type II diabetes, Insulin is used when oral medication has become ineffective. Exenatide and pramlintide are new injectable medications approved in 2005 in the US by the FDA to treat Diabetes mellitus type 2.

Sulfonylureas

Sulfonylureas were the first widely used oral hypoglycemic medications. They are insulin secretagogues, triggering insulin release by direct action on the K_ATP channel of the pancreatic beta cells. Eight types of these pills have been marketed in North America, but not all remain available. The "second-generation" drugs are now more commonly used. They are more effective than first-generation drugs and have fewer side effects.

Sulfonylureas bind strongly to plasma proteins. Sulfonylureas are only useful in Type II diabetes, as they work by stimulating endogenous release of insulin. They work best with patients over 40 years old, who have had diabetes mellitus for under ten years. They can not be used with type I diabetes, or diabetes of pregnancy. They can be safely used with metformin or -glitazones. The primary side effect is hypoglycemia.

• First-generation agents
  
  • tolbutamide (Orinase)
    acetohexamide (Dymelor)
    tolazamide (Tolinase)
    chlorpropamide (Diabinese)
• Second-generation agents
  
  • glipizide (Glucotrol)
    glyburide (Diabeta, Micronase, Glynase)
    glimepiride (Amaryl)
    gliclazide (Diamicron)

Meglitinides

Meglitinides are related to sulfonylureas and of often called "short-acting secretagogues." The amplification of insulin release is shorter and more intense, and they are taken with meals to boost the insulin response to each meal.

• repaglinide (Prandin) - The max dosage is 16mg/day. Take this drug 0 to 30 minutes prior before eating a meal. If a meal is skipped, then the medication should also be skipped.
• nateglinide (Starlix) - The max dosage is 360 mg/day, usually 120 mg three times a day (TID). It also follows the same recommendations as repaglinide.

Adverse reactions include weight gain and hypoglycemia.

Biguanides

Biguanides reduce hepatic glucose output and increase uptake of glucose by the periphery, including skeletal muscle. Although it must be used with caution in patients with impaired liver or kidney function, metformin has become the most commonly used agent for type 2 diabetes in children and teenagers.

• metformin (Glucophage)
• Phenformin (DBI): used in 1960-1980s, withdrawn due to lactic acidosis risk.

Metformin should be temporarily discontinued before any radiographic procedure involving intravenous iodinated contrast as patients are at an increased risk of lactic acidosis.

Thiazolidinediones

Thiazolidinediones, also known as "glitazones," bind to PPARγ, a type of nuclear regulatory protein involved in transcription of numerous genes regulating glucose and fat metabolism. They act as "insulin sensitizers" without increasing insulin secretion.

• rosiglitazone (Avandia)
  pioglitazone (Actos)
  troglitazone (Rezulin): used in 1990s, withdrawn due to hepatitis and liver damage risk.

Alpha glucosidase inhibitors

Alpha glucosidase inhibitors are "diabetes pills" but not technically hypoglycemic agents because they do not have a direct effect on insulin secretion or sensitivity. These agents slow the digestion of starch in the small intestine, so that glucose from the starch of a meal enters the bloodstream more slowly, and can be matched more effectively by an impaired insulin response or sensitivity. These agents are effective by themselves only in the earliest stages of impaired glucose tolerance, but can be helpful in combination with other agents in type 2 diabetes.

• miglitol (Glyset)
  acarbose (Precose/Glucobay)

These medications are rarely used in the United States because of the severity of their side effects (flatulence and bloating). They are more commonly prescribed in Europe.

Incretin mimetic

Exenatide (also Exendin-4, marketed as Byetta) is the first of a new class of medications approved for the treatment of type 2 diabetes. It is to be used in conjunction with oral medications such as metformin and/or a sulfonylurea to improve glucose control. The medication is injected twice per day using a specially designed pen. The typical human response is both an improvement of the release of internal insulin by the pancreas and suppression of pancreas glucagon release, behaviors more typical of individuals without blood sugar control problems. In the presence of exenatide, these responses are greater when the blood sugar is elevated.

DPP-4 inhibitors

• Dipeptidyl peptidase-4 (DPP-4) inhibitors (vildagliptin, sitagliptin) increase blood concentration of GLP-1 (glucagon-like peptide-1).

Amylin analogue

• Pramlintide.

Experimental agents

Many other potential drugs are currently in investigation by pharmaceutical companies. Some of these are simply newer members of one of the above classes, but some work by novel mechanisms. For example, at least one compound that enhances the sensitivity of glucokinase to rising glucose is in the stage of animal research. Others are undergoing phase I/II studies.

• PPARα/γ ligands (muraglitazar and tesaglitazar) - development stopped due to adverse risk profile
• SGLT (sodium-dependent glucose transporter 1) inhibitors increase urinary glucose.
• FBPase (fructose 1,6-bisphosphatase) inhibitors decrease gluconeogenesis in liver.

Insulin by mouth

The basic appeal of oral hypoglycemic agents is that most people would prefer a pill to an injection. Unlike all the oral drugs described in this article, insulin is a protein. Protein hormones, like meat proteins, are digested in the stomach and gut. One alternative delivery method is by inhalation. In 2006 the U.S. Food and Drug Administration approved the use of Exubera, the first inhalable insulin.

However, the potential market for an oral form of insulin is enormous and many laboratories have attempted to devise ways of moving enough intact insulin from the gut to the portal vein to have a measurable effect on blood sugar. One can find several research reports over the years describing promising approaches or limited success in animals, and limited human testing, but as of 2004, no products appear to be successful enough to bring to market.[1]

Herbal extracts

The first registred use of anti-diabetic drugs was as herbal extracts used by indians in the Amazon Basin for the treatment of type 2 diabetes, and today promoted as vegetable insulin although not formally an insulin analog.[1] The major recent development was done in Brazil around Myrcia sphaerocarpa and other Myrcia species.

"Many countries, especially in the developing world, have a long history of the use of herbal remedies in diabetes (...) STZ diabetic rats were also used to test Myrcia Uniflora extracts (...) ".

The usual treatment is with concentrated (root) Myrcia extracts, commercialized in a 4 US dollar per kilogram packed rocks (~100 times cheaper than equivalent artificial drugs), named "Pedra hume de kaá". Phytochemical analysis of the Myrcia extracts reported kinds of flavanone glucosides (myrciacitrins) and acetophenone glucosides (myrciaphenones), and inhibitory activities on aldose reductase and alpha-glucosidase.

A recent review article presents the profiles of plants with hypoglycaemic properties, reported in the literature from 1990 to 2000 and states that "Medical plants play an important role in the management of diabetes mellitus especially in developing countries where resources are meager."

References

• Lebovitz HE. Therapy for Diabetes Mellitus and Related Disorders. 4th edition. Alexandria:American Diabetes Association, 2004.
• Holland, Norman & Adams, Michael Patrick. Core Concepts in Pharmacology. Pearson Education, Inc. New Jersey. 2003.
• Soumyanath, Amala(ed.) (2005-11-01). Traditional Medicines for Modern Times, 1st Edition (in english), Taylor & Francis. ISBN 0415334640.
• McNeill, John H. (1999-02-01). Experimental Models of Diabetes, 1st Edition (in english), CRC Press, 208. ISBN 0849316677.
• Matsuda, H, Nishida N, Yoshikawa M. (Mar 2002). "Antidiabetic principles of natural medicines. V. Aldose reductase inhibitors from Myrcia multiflora DC. (2): Structures of myrciacitrins III, IV, and V.". Chem Pharm Bull (Tokyo) 50(3): 429-31.
• Bnouham M et al (2006). "Medicinal plants with potential antidiabetic activity - A review of ten years of herbal medicine research (1990-2000)". Int J Diabetes & Metabolism 14: 1-25.

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Video: FDA Approves First Inhaled Insulin

Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up one half of analgesics, remedying pain by reducing inflammation as opposed to opioids which affect the brain.

Steroidal anti-inflammatory drugs

Many steroids, specifically glucocorticoids, reduce inflammation by binding to cortisol receptors. These drugs are often referred to as corticosteroids, though that is a larger category.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), alleviate pain by counteracting the cyclooxygenase (COX) enzyme. On its own COX enzyme synthesizes prostaglandins, creating inflammation. In whole the NSAIDs prevent the prostaglandins from ever being synthesized, reducing or eliminating the pain.

In addition to medical drugs, many herbs have anti-inflammatory qualities, including hyssop, Arnica montana which contains helenalin, a sesquiterpene lactone, and willow bark, which contains salicylic acid, a substance related to the active ingredient in aspirin.

On the other hand, there are analgesics like paracetamol, called acetaminophen in the U.S. and sold under the brand name of Tylenol, which are commonly associated with anti-inflammatory drugs but which have no anti-inflammatory effects.

Some are concerned about the long term usage of NSAIDs as they cause gastric erosions which can become stomach ulcers and in extreme cases result in death. The risk of death as a result of use of NSAIDs is 1 in 10,000 for young adults aged 16-45. The risk increases ten fold for those over 75.

Ice treatment

Applying ice to a tissue injury has an anti-inflammatory effect and is often suggested as an injury treatment and pain management technique for athletes.

Anti-inflammatory Foods

Due to concerns over the gastric problems caused by NSAIDs researchers are turning to more natural solutions to dealing with the problem of inflammation. One ingredient with a great future potential is capsaicin, a naturally occurring ingredient in chili peppers. Studies have shown some success in the control of pain and inflammation when capsaicin is applied topically.

Others advocate the consumption of anti-inflammatory foods as a means of controlling inflammation. Anti-inflammatory foods include most colorful fruits and vegetables, oily fish and certain nuts, seeds, herbs and spices. Those following an anti-inflammatory diet will avoid refined oils and sugars, and show a preference for anti-inflammatory foods in their meal choices. Several types of "Smoker’s Paradoxes" [29], i.e. cases where smoking appears to have specific beneficial effects, have been observed; often the actual mechanism remains undetermined. For instance, recent studies suggest that smokers require less frequent repeated revascularization after percutaneous coronary intervention (PCI) [29], [30]. Smoking appears to interfere with development of Kaposi's sarcoma [31], breast cancer among women carrying the very high risk BRCA gene [32], preeclampsia [33], and atopic disorders such as allergic asthma [34]. A plausible mechanism of action in these cases may be the nicotine in tobacco smoke acting as an anti-inflammatory agent [35] and interfering with the disease process.

Links

• Health advice regarding NSAIDs
• NSAIDs and adverse effects
• List of anti-inflammatory food
• Topical capsaicin for pain relief

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Video: How to Treat Osteoarthritis Symptoms : How to Use Anti-Inflammatory Cream for Osteoarthritis

An electrostatic potential map of the nitrate ion. Areas colored red are lower in energy than areas coloured yellow. The oxygen atoms carry the majority of the negative charge.

An antianginal is any drug used in the treatment of angina pectoris, a symptom of ischaemic heart disease.

Drugs used are nitrates such as nitroglycerin (glyceryl trinitrate) or pentaerythritol tetranitrate; beta blockers, either cardioselectives such as acebutolol or metoprolol, or non-cardioselectives such as oxprenolol or sotalol; or calcium channel blockers, either Class I agents (e.g., verapamil), Class II agents (e.g., amlodipine, nifedipine), or the Class III agent diltiazem.

Nitrates cause vasodilation of the venous capacitance vessels by simulating the endothelium-derived relaxing factor (EDRF). Used to relieve both exertional and vasospastic angina by allowing venous pooling, reducing the pressure in the ventricles and so reducing wall tension and oxygen requirements in the heart. Short-acting nitrates are used to abort angina attacks that have occurred, while longer-acting nitrates are used in the prophylactic management of the condition.

Beta blockers are used in the prophylaxis of exertional angina by reducing the work the heart is allowed to perform below the level that would provoke an angina attack. They cannot be used in vasospastic angina and can precipitate heart failure.

Calcium ion (Ca++) antagonists (Calcium channel blockers) are used in the treatment of both exertional and vasospastic angina. In vitro, they dilate the coronary and peripheral arteries and have negative inotropic and chronotropic effects - decreasing afterload, improving myocardial efficiency, reducing heart rate and improving coronary blood flow. In vivo, the vasodilation and hypotension trigger the baroreceptor reflex. Therefore the net effect is the interplay of direct and reflex actions. Class I antiarrhythmic agents have the most potent negative inotropic effect and may cause heart failure; Class II agents do not depress conduction or contractility; the Class III agent has negligible inotropic effect and causes almost no reflex tachycardia.

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The cardiac action potential

Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation.

While the use of antiarrhythmic agents to suppress atrial arrhythmias (atrial fibrillation and atrial flutter) is still in practice, it is unclear whether suppression of atrial arrhythmias will prolong life.

In the past, it was believed that suppression of the potentially dangerous ventricular arrhythmias, ventricular tachycardia and ventricular fibrillation would prolong life, but it was found in large clinical trials that suppression of these arrhythmias would paradoxically increase mortality, which may happen due to the increased workload these drugs place on the heart.

In individuals with atrial fibrillation, antiarrhythmics are still used to suppress arrhythmias. This is often done to relieve the symptoms that may be associated with the loss of the atrial component to ventricular filling (atrial kick) that is due to atrial fibrillation or flutter.

In individuals with ventricular arrhythmias, antiarrhythmic agents are often still in use to suppress arrhythmias. In this case, the patient may have frequent arrhythmic events or be at high risk for ventricular arrhythmias. Antiarrhythmic agents may be considered the first-line therapy in the prevention of sudden death in certain forms of structural heart disease, and failure of these agents to suppress arrhythmias may lead to implantation of an implantable cardioverter-defibrillator (ICD).

The use of antiarrhythmic agents in this population may be in conjunction with an ICD. In this case, the ICD is used to prevent sudden death due to ventricular fibrillation, while the antiarrhythmic agent(s) are used to suppress ventricular tachyarrhythmias so that the ICD doesn't shock the patient frequently.

Many attempts have been made to classify antiarrhythmic agents. The problem arises from the fact that many of the antiarrhythmic agents have multiple modes of action, making any classification imprecise.

References

1. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5;347(23):1825-33. (Medline abstract)
    
2. Nichol G, McAlister F, Pham B, Laupacis A, Shea B, Green M, Tang A, Wells G. Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart. 2002 Jun;87(6):535-43. (Medline abstract)
    
3. The Cardiac Arrhythmia Suppression Trial (CAST): The CAST investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomised trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989, 321:406–412.
    
4. The Cardiac Arrhythmia Suppression Trial II (CAST II): The CAST II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med. 1992 Jul 23;327(4):227-33. (Medline abstract)
    
5. Lenz TL, Hilleman DE, Department of Cardiology, Creighton University, Omaha, Nebraska. Dofetilide, a New Class III Antiarrhythmic Agent. Pharmacotherapy 20(7):776-786, 2000. (Medline abstract)

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Bronchial Asthma
Classifications and external resources
ICD-10: J45.
ICD-9: 493
OMIM: 600807
DiseasesDB: 1006
MedlinePlus: 000141
eMedicine: med/177  emerg/43
MeSH: C08.127.108

Asthma is a disease of the respiratory system in which the airways constrict, become inflamed, and are lined with excessive amounts of mucus, often in response to one or more "triggers," such as exposure to an environmental stimulant (or allergen), cold air, exercise, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold.

This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which respond to bronchodilators. Between episodes, most patients feel fine.

The disorder is a chronic or recurring inflammatory condition in which the airways develop increased responsiveness to various stimuli, characterized by bronchial hyper-responsiveness, inflammation, increased mucus production, and intermittent airway obstruction. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and enviromental changes.

Public attention in the developed world has recently focused on asthma because of its rapidly increasing prevalence, affecting up to one in four urban children.[2] Susceptibility to asthma can be explained in part by genetic factors, but no clear pattern of inheritance has been found. Asthma is a complex disease that is influenced by multiple genetic, developmental, and environmental factors, which interact to produce the overall condition.

Links

• National Heart, Lung, and Blood Institute — Asthma – U.S. NHLBI Information for Patients and the Public page.
• National Heart, Lung, and Blood Institute — Asthma – U.S. NHLBI Information for Health Professionals page.
• MedLinePlus: Asthma – a U.S. National Library of Medicine page.
• American Academy of Allergy, Asthma, and Immunology – a U.S. organization of medical professionals with a special interest in treating and researching conditions such as allergic rhinitis, asthma, atopic dermatitis/eczema, and anaphylaxis.
• Asthma UK – a patient-oriented site with information on asthma and ways that UK residents can help improve asthma-related policy.
• Asthma Foundation of Queensland Information and education for Australian asthma sufferers.
• Children's Hospital & Regional Medical Center — Allergies, Asthma & Immune System – A Seattle, Washington hospital website with patient-oriented videos on asthma and the immune system.
• Case Studies in Environmental Medicine (CSEM): Environmental Triggers of Asthma – Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services.
• Asthma as Neurogenic Inflammatory Disease Neurogenic aspects of asthma. Pathophysiological links with other inflammatory disorders.

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Video: Understanding Asthma

An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system.

Anticholinergics are typically reversible competitive inhibitors of one of the two types of acetylcholine receptors, and are classified according to the receptors that are affected: antimuscarinic agents operate on the muscarinic acetylcholine receptors, and antinicotinic agents operate on the nicotinic acetylcholine receptors. The majority of anticholinergics are antimuscarinics.

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Video: Anticholinergics (mechanism of action causing bronchodilatation)

An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some chemical compounds are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis equipment..

As medications

Anticoagulants are given to people to stop thrombosis (blood clotting inappropriately in the blood vessels). This is useful in primary and secondary prevention of deep vein thrombosis, pulmonary embolism, myocardial infarctions and strokes in those who are predisposed.

Vitamin K antagonists

The oral anticoagulants are a class of pharmaceuticals that act by antagonizing the effects of vitamin K. It is important to note that they take at least 48 to 72 hours for the anticoagulant effect to develop fully. In cases when an immediate effect is required, heparin must be given concomitantly. Generally, these anticoagulants are used to treat patients with deep-vein thrombosis (DVT), pulmonary embolism, atrial fibrillation, and mechanical prosthetic heart valves.

These oral anticoagulants are used widely as poisons for mammalian pests, especially rodents.

The most important oral anticoagulants are:

• Warfarin (Coumadin). This is the main agent used in the U.S. and UK
• Acenocoumarol and phenprocoumon This is used more commonly outside the U.S. and the UK
• Phenindione

Heparin and derivative substances

Heparin is a biological substance, usually made from pig intestines. It works by activating antithrombin III, which blocks thrombin from clotting blood. Heparin can be used in vivo (by injection), and also in vitro to prevent blood or plasma clotting in medical devices. Vacutainer brand test tubes containing heparin are usually colored green.

Low molecular weight heparin is a more highly processed product that is useful as it does not require monitoring of the APTT coagulation parameter (it has more predictable plasma levels) and has less side effects.

Fondaparinux is a synthetic sugar composed of the five sugars (pentasaccharide) in heparin that bind to antithrombin. It is a smaller molecule than low molecular weight heparin.

Direct thrombin inhibitors

Another type of anticoagulant is the direct thrombin inhibitors. Current members of this class include argatroban, lepirudin, and bivalirudin. An oral direct thrombin inhibitor, ximelagatran (Exanta®) may replace warfarin for some indications. It is awaiting Food and Drug Administration (FDA) approval.

Anticoagulants outside the body

Laboratory instruments, test tubes, blood transfusion bags, and medical and surgical equipment will get clogged up and become nonoperational if blood is allowed to clot. Chemicals can be added to stop blood clotting. Apart from heparin, most of these chemicals work by binding calcium ions, preventing the coagulation proteins from using them.

• EDTA is denoted by mauve or purple caps on Vacutainer brand test tubes. This chemical strongly and irreversibly binds calcium. It is in a powdered form.
  Citrate is usually in blue Vacutainer tube. It is in liquid form in the tube and is used for coagulation tests, as well as in blood transfusion bags. It gets rid of the calcium, but not as strongly as EDTA. Correct proportion of this anticoagulant to blood is crucial because of the dilution. It can be in the form of sodium citrate or ACD.
  Oxalate has a similar mechanism to citrate. It is the anticoagulant used in fluoride (grey top) tubes.

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Carbamazepine

The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. The goal of an anticonvulsant is to suppress the rapid and excessive firing of neurons that start a seizure. Failing this, a good anticonvulsant would prevent the spread of the seizure within the brain and offer protection against possible excitotoxic effects that may result in brain damage. An excellent anticonvulsant would have few serious side effects. However, no such drug exists.

Many anticonvulsants block Sodium (Na+) channels, Calcium (Ca2+) channels, AMPA receptors or NMDA receptors. Some anticonvulsants inhibit the metabolism of GABA or increase its release.

In the following list, the dates in parentheses are the earliest approved use of the drug.

Aldehydes

• Paraldehyde (1882). One of the earliest anticonvulsants. Still used to treat status epilepticus, particularly where there are no resuscitation facilities.

Aromatic allylic alcohols

• Stiripentol (2001 - limited availability). Indicated for the treatment of severe myoclonic epilepsy in infancy (SMEI).

Barbiturates

Barbiturates are drugs that act as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. The following are classified as anticonvulsants:

Benzodiazepines

The benzodiazepines are a class of drugs with hypnotic, anxiolytic, anticonvulsive, amnestic and muscle relaxant properties.

Bromides

• Potassium bromide (1857). The earliest effective treatment for epilepsy. There would not be a better drug for epilepsy until phenobarbital in 1912. It is still used as an anticonvulsant for dogs and cats.

Carbamates

• Felbamate (1993). This effective anticonvulsant has had its usage severely restricted due to rare but life-threatening side effects.

Carboxamides

The following are carboxamides:

• Carbamazepine (1965). A popular anticonvulsant that is available in generic formulations.
  Oxcarbazepine (1990). A derivative of carbamazepine that has similar efficacy but is better tolerated.

Fatty acids

The following are fatty-acids:

• The valproates — valproic acid, sodium valproate, and divalproex sodium (1978).
  Vigabatrin (1989).
  Progabide
  Tiagabine (1997).

Vigabatrin and progabide are also analogs of GABA.

Fructose derivatives

• Topiramate (1995).

Gaba analogs

• Gabapentin (1993).
  Pregabalin (2004).

Hydantoins

The following are hydantoins:

• Ethotoin (1957).
  Phenytoin (1938).
  Mephenytoin
  Fosphenytoin (1996).

Oxazolidinediones

The following are oxazolidinediones:

• Paramethadione
  Trimethadione (1946).
  Ethadione

Propionates

• Beclamide

Pyrimidinediones

• Primidone (1952).

Pyrrolidines

• Brivaracetam
  Levetiracetam (1999).
  Seletracetam

Succinimides

The following are succinimides:

• Ethosuximide (1955).
  Phensuximide
  Mesuximide

Sulfonamides

• Acetazolamide (1953).
  Sulthiame
  Methazolamide
  Zonisamide (1990).

Triazines

• Lamotrigine (1991).

Ureas

• Pheneturide
  Phenacemide

Valproylamides (amide derivatives of valproate)

• Valpromide
  Valnoctamide

References

• Drug Reference for FDA Approved Epilepsy Drugs
• UK Anti-Epileptic Drugs List

Links

• eMedicine: Antiepileptic Drugs: an overview
• NINDS: Anticonvulsant Screening Program
• Use of Anticonvulsants in Pharmacotherapy of Bronchial Asthma
• MDNG: Anticonvulsants and Bone Health

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An antidote is a substance which can counteract a form of poisoning.

Sometimes, the antidote for a particular toxin is manufactured by injecting the toxin into an animal in small doses and the resulting antibodies are extracted from the animals' blood. The venom produced by some snakes, spiders, and other venomous animals is often treatable by the use of these antivenoms, although a number do lack one, and a bite or sting from such an animal often results in death.

However, some toxins have no known antidote. For example, the poison ricin, which is produced from the waste byproduct of castor oil manufacture, has no antidote, and as a result is often fatal if it enters the human body in sufficient quantities.

Ingested poisons are frequently treated by the oral administration of activated charcoal, which adsorbs the poison, and then it is flushed from the digestive tract, removing a large part of the toxin.

Poisons which are injected into the body (such as those from bites or stings from venomous animals) are usually treated by the use of a constriction band which limits the flow of lymph and/or blood to the area, thus slowing circulation of the poison around the body.

Poison and Toxic Signs

• Acetaminophen (paracetamol) poisoning is given N-acetylcysteine as the antidote.
  Anticholinergic poisoning is given Physostigmine sulfate as the antidote.
  Benzodiazepine poisoning is given flumazenil as the antidote.
  Carbon monoxide poisoning is given oxygen as the antidote.
  Anticholinesterase poisoning is given atropine sulfate and Pralidoxime chloride 2-PAM as the antidote.
  Cyanide poisoning is given amyl nitrite, sodium nitrite, and thiosulfate as the antidote.
  Digoxin poisoning is given anti digoxin fab fragments as the antidote.
  Ethylene glycol poisoning is given ethanol or fomepizole as the antidote.
  Extrapyramidal signs poisoning is given diphenhydramine hydrochloride and benztropine mesylate as the antidote.
  Heavy metal poisoning is given chelators, calcium disodium edetate (EDTA), dimercaprol (BAL), penicillamine, and 2,3-dimercaptosuccinic acid (DMSA, succimer) as the antidote.
  Iron poisoning is given deferoxamine mesylate as the antidote.
  Isoniazid poisoning is given pyridoxine as the antidote.
  Methanol poisoning is given ethanol or fomepizole as the antidote.
  Methemoglobinemia poisoning is given methylene blue as the antidote.
  Opioid poisoning is given naloxone hydrochloride as the antidote.
  Warfarin poisoning is given vitamin K phytonadione and fresh frozen plasma as the antidote.

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H2 antagonist

An antihistamine is a drug which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the histamine receptor. Only agents where the main therapeutic effect is mediated by negative modulation of histamine receptors are termed antihistamines - other agents may have antihistaminergic action but are not true antihistamines.

In common use, the term antihistamine refers only to H₁-receptor antagonists, also known as H₁-antihistamines. It has been discovered that these H₁-antihistamines are actually inverse agonists at the histamine H₁-receptor, rather than antagonists per se. (Leurs, Church & Taglialatela, 2002)

Pharmacology

In allergic reactions an allergen (a type of antigen) interacts with and cross-links surface IgE antibodies on mast cells and basophils. Once the mast cell-antibody-antigen complex is formed, a complex series of events occurs that eventually leads to cell-degranulation and the release of histamine (and other chemical mediators) from the mast cell or basophil. Once released, histamine can react with local or widespread tissues through histamine receptors.

Histamine, acting on H₁-receptors, produces pruritus, vasodilatation, hypotension, flushing, headache, tachycardia, bronchoconstriction, increases vascular permeability, potentiates pain, and more. (Simons, 2004)

While H₁-antihistamines ameliorate these effects, they are only efficacious if administered prior to the allergen-challenge. In severe allergies, such as anaphylaxis or angioedema, these effects may be so severe as to be life-threatening. Epinephrine, often in the form of an autoinjector (Epi-pen), is required by people with such hypersensitivities.

References

• Forneau E, Bovet D (1933). Recherches sur l'action sympathicolytique d'un nouveau derive du dioxane. Arch Int Pharmacodyn 46, 178-91.
• Leurs R, Church MK, Taglialatela M (2002). "H₁-antihistamines: inverse agonism, anti-inflammatory actions and cardiac effects". Clin Exp Allergy 32 (4): 489-98. PMID 11972592.
• Nelson, WL (2002). In Williams DA, Lemke TL (Eds.). Foye's Principles of Medicinal Chemistry (5 ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-683-30737-1
• Rossi S (Ed.) (2004). Australian Medicines Handbook 2004. Adelaide: Australian Medicines Handbook. ISBN 0-9578521-4-2
• Simons FE (2004, Nov 18). "Advances in H₁-antihistamines". N Engl J Med 351 (21): 2203-17. PMID 15548781 Abstract.

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Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.

Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). There are many classes of antihypertensives, which—by varying means—act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

Which type of medication to use initially for hypertension has been the subject of several large studies and resulting national guidelines.The fundamental goal of treatment should be the prevention of the important "endpoints" of hypertension such as heart attack, stroke and heart failure. Several classes of medications are effective in reducing blood pressure. However, these classes differ in side effect profiles, ability to prevent endpoints, and cost. The choice of more expensive agents, where cheaper ones would be equally effective, may have negative impacts on national healthcare budgets.^[1]

In the United States, the JNC7 (The Seventh Report of the Joint National Committee on Prevention of Detection, Evaluation and Treatment of High Blood Pressure) recommends starting with a thiazide diuretic if single therapy is being initiated and another medication is not indicated.^[2] This is based on a slightly better outcome for chlortalidone in the ALLHAT study versus other anti-hypertensives and because thiazide diuretics are relatively cheap.^[3] A subsequent smaller study (ANBP2) published after the JNC7 did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older male patients.^[4]

Despite thiazides being cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.^[5]

In the United Kingdom, the June 2006 "Hypertension: management of hypertension in adults in primary care"^[6] guideline of the National Institute for Health and Clinical Excellence, downgraded the role of beta-blockers due to their risk of provoking type 2 diabetes.^[7]

References

1. ^ Nelson MR, McNeil JJ, Peeters A et al (Jun 4 2001). "PBS/RPBS cost implications of trends and guideline recommendations in the pharmacological management of hypertension in Australia, 1994-1998". Med J Aust 174 (11): 565-8. PMID 11453328.
2. ^ ^a b c Chobanian AV et al (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA 289: 2560-72. PMID 12748199.
3. ^ ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (Dec 18 2002). "Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)". JAMA 288 (23): 2981-97. PMID 12479763.
4. ^ Wing LM, Reid CM, Ryan P et al (Feb 13 2003). "A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly". NEJM 348 (7): 583-92. PMID 12584366.
5. ^ Wang TJ, Ausiello JC, Stafford RS (1999). "Trends in Antihypertensive Drug Advertising, 1985–1996". Circulation 99: 2055-2057. PMID 10209012.
6. ^ Hypertension: management of hypertension in adults in primary care (PDF). National Institute for Health and Clinical Excellence. Retrieved on 2006-09-30.
7. ^ Sheetal Ladva (28/06/2006). NICE and BHS launch updated hypertension guideline. National Institute for Health and Clinical Excellence. Retrieved on 2006-09-30.

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An antimicrobial is a substance that kills or inhibits the growth of microbes such as bacteria (antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (anti-parasitic activity).

Main classes

Antibiotics

Antibiotics are generally used to treat bacterial infections. The toxicity to humans and other animals from antibiotics are generally considered to be low. However, prolonged use of certain antibiotics can decrease the number of gut flora, which can have a negative impact on health. Some recommend that during or after prolonged antibiotic use, that one should consume probiotics and eat reasonably to replace destroyed gut flora.

The term antibiotic originally described only those formulations derived from living organisms but is now applied also to synthetic antimicrobials, such as the sulfonamides.

The discovery, development, and clinical use of antibiotics during the 20th century have substantially decreased the morbidity and mortality from bacterial infections. The antibiotic era began with the therapeutic application of sulfonamide drugs in 1936, followed by a “golden” period of discovery from approximately 1945 to 1970, when a number of structurally diverse, highly effective agents were discovered and developed. However, since 1980 the introduction of new antimicrobial agents for clinical use has declined. Paralleled to this there has been an alarming increase in bacterial resistance to existing agents.^[1] Antibiotics are among the most commonly used drugs. For example, 30% or more hospitalized patients are treated with one or more courses of antibiotic therapy. However, antibiotics are also among the drugs commonly misused by physicians, e.g. usage of antibiotic agents in viral respiratory tract infection. The inevitable consequence of widespread and injudicious use of antibiotics has been the emergence of antibiotic-resistant pathogens, resulting in the emergence of a serious threat to global public health. The resistance problem demands that a renewed effort be made to seek antibacterial agents effective against pathogenic bacteria resistant to current antibiotics. One of the possible strategies towards this objective is the rational localization of bioactive phytochemicals.

Traditional healers have long used plants to prevent or cure infectious disease. Many of these plants have been investigated scientifically for antimicrobial activity and a large number of plant products have been shown to inhibit the growth of pathogenic microorganisms. A number of these agents appear to have structures and modes of action that are distinct from those of the antibiotics in current use, suggesting that cross-resistance with agents already in use may be minimal. So, it is worthwhile to study plants and plant products for activity against resistant bacteria.

Essential oils

Many essential oils are included in pharmacopoeias as having antimicrobial activity, including:

• Oregano oil - in alternative medicine
  Tea tree oil - in cosmetics, medicine
  Mint oil - in medicine, cosmetics (tooth paste etc.)
  Sandalwood oil - in cosmetics
  Clove oil - stomatology etc.
  Nigella sativa (Black cumin) oil
  Onion oil (Allium cepe) - phytoncides, in phytotherapy
  Leleshwa oil
  Lavender oil
  Lemon oil
• Eucalyptus oil
• Peppermint oil
• Cinnamon oil
  Clove oil

Cations and elements

Many heavy metal cations such as Hg²⁺, Cu²⁺, and Pb²⁺ have antimicrobial activities, but are also very toxic to other living organisms, thus making them unsuitable for treating infectious diseases.

Ionic Silver is an excellent antimicrobial, with relatively low toxicity against non-target organisms. However, prolonged high intake of ionic silver may lead to health problems, such as argyria. In an inorganic matrix, silver ions are slowly released via an ion-exchange mechanism. The release of silver ions from the surface is slow, but just fast enough to maintain an effective concentration at and near the surface of the material. Once the silver ion leaves the surface of the matrix and reaches the surface of the microorganism, its mechanism of antimicrobial action begins. Uptake of silver ions by a microbial cell can occur by several mechanisms, including passive diffusion and active transport by systems that normally transport essential ions.

While the silver ions may bind non-specifically to cell surfaces and cause disruptions in cellular membrane function, it is widely believed that the antimicrobial properties of silver depend upon silver binding within the cell. Once inside the cell, silver ions begin to interrupt critical functions of the microorganism. Silver ions are highly reactive and readily bind to electron donor groups containing sulphur, oxygen and nitrogen, as well as negatively charged groups such as phosphates and chlorides. A prime molecular target for the silver ion resides in cellular thiol (-SH) groups, commonly found in critical proteins called enzymes. Enzymes become denatured because of conformational changes in the molecule that result from silver ion binding. Many of the enzymes that silver ions denature are necessary in the cellular generation of energy.

If the energy source of the cell is incapacitated, the cell cannot maintain osmotic pressure, necessary substrates leak out of the cell and the microbe will quickly die. In addition to the well-known reaction of silver ions and proteins, several studies suggest that silver ions react with the base pairs of DNA, interfering with DNA replication. Studies on silver nanoparticles have shown antimicrobial activity, including activity against pathogenic Escherichia coli and HIV.

Reference

1. ^ Levy SB (ed) (1994) Drug Resistance: The New Apocalypse (special issue) Trends Microbiol 2: 341–425

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Anti-obesity drugs include all pharmacological treatments intended to reduce or control weight. Because these drugs are intended to alter one of the fundamental processes of the human body, anti-obesity drugs are medically prescribed only in cases of morbid obesity, where weight loss is life-saving.

Mechanisms of action

Anti-obesity drugs operate through one or more of the following mechanisms:

• Suppression of the appetite.
• Increase of the body's metabolism.
• Interference with the body's ability to absorb specific nutrients in food. For example, orlistat blocks fat breakdown and thereby prevents fat absorption.

Anorectics (also known as anorexigenics) are primarily intended to suppress the appetite, but most of the drugs in this class also act as stimulants (dexedrine, e.g.), and patients have abused drugs "off label" to suppress appetite (e.g. digoxin).

Side effects

Some anti-obesity drugs have severe and often life-threatening side effects. These side effects are often associated with their mechanism of action. In general, stimulants carry a risk of high blood pressure, faster heart rate, palpitations, closed-angle glaucoma, drug addiction, restlessness, agitation, and insomnia.

Another drug, Orlistat, blocks absorption of dietary fats, and as a result may cause oily spotting bowel movements, oily stools, stomach pain, and flatulence.

Limitations of current knowledge

The limitation of drugs for obesity is that we still do not know fully the neural basis of appetite and how to modulate it. Appetite is clearly a very important instinct to promote survival. Arguably any drug that would abolish appetite may carry a high mortality risk and may be unsuitable for clinical use.

Because the human body uses various chemicals and hormones to protect its stores of fat (a reaction probably useful to our ancestors when food was scarce in the past,) there has not yet been found a 'silver bullet', or a way to completely circumvent this natural habit of protecting excess food stores. Because of this, anti-obesity drugs are not a practical long-term solution for people who are overweight.

Future developments

More recent developments may be promising in development of drugs that can combat obesity. The discovery of cannabinoid receptors in the brain, liver and muscle has stimulated research in a new class of drugs, namely cannabinoid (CB1) receptor antagonists. One such drug in development is Rimonabant from Sanofi-Aventis, it is designed to block the effects of endogenous cannabinoids. This type of drug is particularly interesting since it not only causes weight loss but reverses the metabolic effects of obesity such as insulin resistance and hyperlipidemia. It is also interesting to note that this class of drugs may decrease the tendency to abuse substances such as alcohol and tobacco. The weight loss reported with rimonabant is modest (approximately 20 lbs.), although it is unlikely that this drug will successfully treat morbid obesity. It promises to be very useful in treating modest obesity and reversing some of the metabolic complications of this condition.

Reference

• Snow V, Barry P, Fitterman N, Qaseem A, Weiss K; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005;142:525-31. Fulltext. PMID 15809464.

Links

• Prescription Medications for the Treatment of Obesity
• Diet pills & supplements General review of diet pills
• Diet pills & supplements Open directory resource for diet supplements

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Parkinson's disease
Classifications and external resources

Illustration of the Parkinson disease by Sir William Richard Gowers from A Manual of Diseases of the Nervous Systemin 1886
ICD-10	G20.
ICD-9	332
DiseasesDB	9651
MedlinePlus	000755
eMedicine	neuro/304  neuro/635 in young pmr/99 rehab

Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech.

Parkinson's disease belongs to a group of conditions called movement disorders. It is often characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia), and in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the results of excessive muscle contraction, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic, meaning it persists over a long period of time, and progressive.

PD is the most common cause of parkinsonism, a group of similar symptoms. PD is also called "primary parkinsonism" or "idiopathic PD" ("idiopathic" meaning of no known cause). While most forms of parkinsonism are idiopathic, there are some cases where the symptoms may result from toxicity, drugs, genetic mutation, head trauma, or other medical disorders.

History

Symptoms of Parkinson's disease have been known and treated since ancient times.^[1] However, it was not formally recognised and its symptoms were not documented until 1817 in An Essay on the Shaking Palsy[2] by the British physician James Parkinson. Parkinson's disease was then known as paralysis agitans. The underlying biochemical changes in the brain were identified in the 1950s, due largely to the work of Swedish scientist Arvid Carlsson who later went on to win a Nobel Prize. L-dopa entered clinical practice in 1967^[3], and the first study reporting improvements in patients with Parkinson's disease resulting from treatment with L-dopa was published in 1968.^[4]

Diagnosis

There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. The Unified Parkinson's Disease Rating Scale is the primary clinical tool used to assist in diagnosis and determine severity of PD. Indeed, only 75% of clinical diagnoses of PD are confirmed at autopsy^[10]. Early signs and symptoms of PD may sometimes be dismissed as the effects of normal aging. The physician may need to observe the person for some time until it is apparent that the symptoms are consistently present. Usually Doctors look for shuffling of feet and lack of swing in the arms. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. However, CT and MRI brain scans of people with PD usually appear normal.

Descriptive epidemiology

Parkinson's disease is widespread, with a prevalence estimated between 100 and 250 cases per 100,000 in North America; globally prevalence estimates range from a low of 15 per 100,000 in China to a high of 657 per 100,000 in Argentina. Because prevalence rates can be affected by socio-ecomically driven differences in survival as well as biased by survey technique problems ^[11] , incidence is a more sensitive indicator: rates have ranged from 1.5 per 100,000 in China to a high of 14.8 per 100,000 in Finland.^[12] Incidence has been estimated by several groups. A study carried out in northern California^[13] observed an age and sex corrected incidence of 13.4 per 100,000/year. The study authors noted a rapid increase in incidence with age, male rates nearly double female rates, and an elevated rate amongst Hispanics. A study in Spain^[14] (of a population of people aged 65 to 85) calculated incidence, adjusted for age and sex, of 186.8/100,000 per year, with men's rates being 2.55 times that of women. For the same age group, the northern California study observed an incidence of roughly 120/100,000/year. A Dutch study^[15], published in the same year, noted age-specific incidence rates from 0.3 per 1000 person-years in subjects aged 55 to 65 years, to 4.4 per 1000 person-years for those aged ≥85 year, and a sex ratio of 1.55 for male incidence.

Cases of PD are reported at all ages, though it is quite rare in people younger than 40 and the average age at which symptoms begin is 58-60; it is principally a disease of the elderly. It occurs in all parts of the world, but appears to be more common in people of European ancestry than in those of African ancestry. Those of East Asian ancestry have an intermediate risk. It is more common in rural than urban areas and men are affected slightly more often than women. It is highly unusual for people under 40 to develop Parkinson's Disease, and twin studies (Tanner)^[16]. have shown such disease to be almost entirely genetically caused.

Related diseases

There are other disorders that are called Parkinson-plus diseases. These include:

• Multiple system atrophy (MSA)
  
  • Shy-Drager syndrome (SDS)
  • Striatonigral degeneration (SND)
  • Olivopontocerebellar atrophy (OPCA)
• Progressive supranuclear palsy (PSP)
• Corticobasal degeneration (CBD)

Some people include dementia with Lewy bodies (DLB) as one of the 'Parkinson-plus' syndromes. Although idiopathic Parkinson's disease patients also have Lewy bodies in their brain tissue, the distribution is denser and more widespread in DLB. Even so, the relationship between Parkinson disease, Parkinson disease with dementia (PDD) and dementia with Lewy bodies (DLB) might be most accurately conceptualized as a spectrum, with a discrete area of overlap between each of the three disorders. The natural history and role of Lewy bodies is very little understood.

Patients often begin with typical Parkinson's disease symptoms which persist for some years; these Parkinson-plus diseases can only be diagnosed when other symptoms become apparent with the passage of time. These Parkinson-plus diseases usually progress more quickly than typical ideopathic Parkinson disease. The usual anti-Parkinson's medications are typically either less effective or not effective at all in controlling symptoms; patients may be exquisitely sensitive to neuroleptic medications like haloperidol. Additionally, the cholinesterase inhibiting medications have shown preliminary efficacy in treating the cognitive, psychiatric, and behavioral aspects of the disease, so correct differential diagnosis is important.

Wilson's disease (hereditary copper accumulation) may present with parkinsonistic features; young patients presenting with parkinsonism may be screened for this rare condition. Essential tremor is often mistaken for Parkinson's disease but usually lacks all features besides tremor.

Prognosis

PD is not by itself a fatal disease, but it does get worse with time. The average life expectancy of a PD patient is generally lower than for people who do not have the disease^[60]. In the late stages of the disease, PD may cause complications such as choking, pneumonia, and falls that can lead to death.

The progression of symptoms in PD may take 20 years or more. In some people, however, the disease progresses more quickly. There is no way to predict what course the disease will take for an individual person. One commonly used system for describing how the symptoms of PD progress is called the Hoehn and Yahr scale.

Another commonly used scale is the Unified Parkinson's Disease Rating Scale (UPDRS). This much more complicated scale has multiple ratings that measure mental functioning, behavior, and mood; activities of daily living; and motor function. Both the Hoehn and Yahr scale and the UPDRS are used to measure how individuals are faring and how much treatments are helping them. It should be noted that neither scale is specific to Parkinson's Disease; that patients with other illnesses can score in the Parkinson's range.

With appropriate treatment, most people with PD can live productive lives for many years after diagnosis.

Notable Parkinson's sufferers

One famous sufferer of young-onset Parkinson's is Michael J. Fox, who has written a book about his experience of the disease and established The Michael J. Fox Foundation for Parkinson's Research to develop a cure for Parkinson's disease within this decade.

Other famous sufferers include Pope John Paul II, playwright Eugene O'Neill, artist Salvador Dalí, evangelist Billy Graham, former US Attorney General Janet Reno, boxer Muhammad Ali, dictators Adolf Hitler, Franco and Mao Zedong, and numerous actors such as Terry-Thomas, Deborah Kerr, Kenneth More, Vincent Price and Michael Redgrave.

The film Awakenings (starring Robin Williams and Robert De Niro and based on genuine cases reported by Oliver Sacks) deals sensitively and largely accurately with a similar disease, postencephalitic parkinsonism.

References

Links

National-level and International Organisations

• American Parkinson Disease Association
• European Parkinson's Disease Association
• National Parkinson Foundation (US)
• Parkinson Society Canada
• Parkinson's Disease Society (UK)
• Parkinson's Disease Foundation (US)
• Parkinson's Action Network (US)
• Parkinsons Research Foundation (US)
• World Parkinson Disease Association

Charts

• Parkinson's Drug Comparison Chart (PDF)

Other sites

• Parkinson's Disease at the Open Directory Project

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Blood clot diagram

An

antiplatelet drug

is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. They are effective in the arterial circulation, where anticoagulants have little effect.

They are widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease.

Choice of antiplatelet drug

A recent review [1] states: "....low-dose aspirin increases the risk of major bleeding 2-fold compared with placebo. However, the annual incidence of major bleeding due to low-dose aspirin is modest—only 1.3 patients per thousand higher than what is observed with placebo treatment. Treatment of approximately 800 patients with low-dose aspirin annually for cardiovascular prophylaxis will result in only 1 additional major bleeding episode." Further, "...the cost to prevent one major GI bleeding episode from aspirin in 1 year by substituting clopidogrel therapy would be $1,216,180..."

Antiplatelet drugs

The most important antiplatelet drugs are:

• Cyclooxygenase inhibitors
  • Aspirin
• Adenosine diphosphate receptor inhibitors
  • Clopidogrel (Plavix)
  • Ticlopidine (Ticlid)
• Phosphodiesterase inhibitors
  • Cilostazol (Pletal)
• Glycoprotein IIB/IIIA inhibitors (intravenous use only)
  • Abciximab (ReoPro)
    Eptifibatide (Integrilin)
    Tirofiban (Aggrastat)
• Adenosine reuptake inhibitors
  • Dipyridamole (Persantine)

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Chlorpromazine

The term antipsychotic is applied to a group of drugs used to treat psychosis. Common conditions with which antipsychotics might be used include schizophrenia, mania and delusional disorder, although antipsychotics might be used to counter psychosis associated with a wide range of other diagnoses. Antipsychotics also have some effects as mood stabilizers, leading to their frequent use in treating mood disorder (particularly bipolar disorder) even when no signs of psychosis are present. Some antipsychotics (haloperidol, pimozide) are used off-label to treat Tourette syndrome.

Antipsychotics are also referred to as neuroleptic drugs, or simply neuroleptics. The word neuroleptic is derieved from Greek. 'Neuro' refers to the nerves and 'lept' means 'to take hold of'. Thus the word means 'taking hold of one's nerves' which implies their role in mood stabilization.

There are currently two main types of antipsychotics in use, the typical antipsychotics and atypical antipsychotics. A new class of antipsychotic drugs has recently been discovered, known as dopamine partial agonists. Clinical development has progressed rapidly on partial dopamine agonists, and one drug in this class (aripiprazole) has already been approved by the Food and Drug Administration. Although the underlying mechanism of this new class is different from all previous typical and atypical antipsychotics, dopamine partial agonists are often categorized as atypicals.

Typical antipsychotics are sometimes referred to as major tranquilizers, due to the fact that some of them can tranquilize and sedate. This term is increasingly disused because many newer antipsychotics do not have strong sedating properties and the terminology implies a connection with benzodiazepines, whereas none exists.

History and design

The original antipsychotic drugs were happened upon largely by chance and were tested empirically for their effectiveness.

The first antipsychotic was chlorpromazine, which was developed as a surgical anesthetic. It was first used on psychiatric patients in the belief that it would have a calming effect. However, the drug soon appeared to reduce psychosis beyond this calming effect, and now some believe that it causes a reduction of psychosis unrelated to the sedating effect of the medication. It was introduced for the treatment of psychosis during the period when lobotomy was a common treatment and was hailed as a "cure" for schizophrenia. It was then touted to provide a "chemical lobotomy," causing similar neurological effects without requiring surgery.

The newer atypical antipsychotics are supposedly rationally designed drugs in which a theoretical understanding of both the condition to be treated and the effect of certain molecules on the body is used to develop potential new drug candidates.

References

• Jones, H. M., & Pilowsky, L. S. (2002) Dopamine and antipsychotic drug action revisited. British Journal of Psychiatry, 181, 271-275.

Links

• Bipolar Meds - The Antipsychotics
• FDA Public Health Advisory - Public Health Advisory for Antipsychotic Drugs used for Treatment of Behavioral Disorders in Elderly Patients

• FROTA LH. Partial Agonists in the Schizophrenia Armamentarium. Tardive Dysphrenia: The newest challenge to the last generation atypical antipsychotics drugs? J Bras Psiquiatr 2003; Vol 52 Supl 1;14-24. Free full-text in Portuguese with Abstracts in English available here

• FROTA LH. Fifty Years of Antipsychotic Drugs in Psychiatry. "Cinqüenta Anos de Medicamentos Antipsicóticos em Psiquiatria." 1st ed; Ebook: CD-Rom/On-Line Portuguese, ISBN 85-903827-1-0, File .pdf (Adobe Acrobat) 6Mb, Informática, Rio de Janeiro, august 2003, 486pp. Free full-text on Portuguese available online here

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

A cough medicine is a drug used to treat coughing and related conditions. Dry coughs are treated with cough suppressants (antitussives) that suppress the body's urge to cough, while productive coughs (coughs that produce phlegm) are treated with expectorants that loosen mucus from the respiratory tract. These medicines are widely available in the form of cough syrup, also known as linctus.

Cough suppressants

Cough suppressants may act centrally (on the brain, and specifically the vagus nerve) or locally (on the respiratory tract) to suppress the cough reflex.

Centrally acting suppressants include dextromethorphan (DXM), noscapine, ethyl morphine and codeine.

Peripherally acting substances include local anaesthetics, which reduce the sensation of nerves in the throat, and demulcents, which coat the esophagus. Although it is commonly believed that cough medicines must coat the throat to be effective, there is no evidence that it is possible to control coughing by this means.

One might think it unwise to suppress the cough reflex (the mechanism for expelling mucus from the respiratory tract) but severe coughing may lead to lung irritation, causing a vicious cycle. The cough reflex is also very strong and cannot be completely suppressed. However, dry cough (without mucus production) or cough that is exhausting and preventing sleep should be treated with suppressants.

Recent studies have found that theobromine, a compound found in cocoa, is more effective as a cough suppressant than prescription codeine. This molecule suppresses the "itch" signal from the nerve in the back of the throat that causes the cough reflex. It is possible to get an effective dose from 50g of dark chocolate, which contains 2 to 10 times more cocoa than milk chocolate. Theobromine was also free from side effects in the blind tests.^[1]

Expectorants

An expectorant (from Latin ex- "out" + pectoris "of the chest") is a medicine or herb which increases the expulsion of tracheal or bronchial mucus through expectoration or coughing. In over-the-counter preparations, guaifenesin is often used. The effectiveness of expectorants in cough medicines has been questioned; however, water is an effective expectorant and drinking adequate water thins the mucus and enables it to be expelled more easily.[1]

Herbal remedies considered to be expectorants include the following:

Aniseed (Pimpinella anisum),
Balm of Gilead (Populus gileadensis),
Balsam of Peru (Myroxylon perierae),
Balsam of Tolu (Myroxylon toluifera),
Bloodroot (Sanguinaria canadensis),
Cannabis (Cannabis Sativa),
Cardamom (Elettaria caradamomum),
Coltsfoot (Tussilago farfara),
Comfrey (Symphytum officinale),
Elderflower (Sambucus nigra),
Elecampane (Inula helenium),
Garlic (Allium sativum),
Golden seal (Hydrastis canadensis),
Grindelia (Grindelia camporum),
Hyssop (Hyssopus officinalis),
Iceland moss (Cetraria islandica),
Irish moss (Chondrus crispus),
Liquorice (Glycyrrhiza glabra),
Lobelia (Lobelia inflata),
Lungwort (Sticta pulmonaria),
Marshmallow (Althaea officinalis),
Mouse ear (Hieracium pilosella),
Mullein (Verbascum thapsus),
Pleurisy root (Asclepias tuberosa),
Senega (Polygala senega),
Skunk Cabbage (Symplocarpus foetidus),
Squill (Urginea maritima),
Thuja (Thuja occidentalis),
Thyme (Thymus vulgaris),
Vervain (Verbena officinalis),
White horehound (Marrubium vulgare),
Wild cherry (Prunus serotona).

Cough drops

Cough drops or throat lozenges are tablets which people can suck to soothe the throat or to alleviate excessive coughing. They are usually small, sweetened (often with artificial sweeteners), and contain an oral anesthetic, such as menthol, which anesthesizes the receptors in the throat that cause the cough reflex. The occasional use of "lozenge" (first used in 1530, according to the Oxford English Dictionary) is due to the original lozenge shape of cough drops. Popular brands of cough drops include Fisherman's Friend, Halls, Ricola, and Luden's.

Controversy

In 2002, researchers at the University of Bristol (Schroeder & Fahey) published a study in the British Medical Journal indicating that some cough medicines are no more effective than placebos.[2] In 2006, the American College of Chest Physicians published a guideline that had the dual message that many over-the-counter cough medicines are not effective and that those that are effective in treating the symptom do not treat the underlying cause; the underlying disorder emphasized by the guideline was pertussis (whooping cough) in the elderly.^[3] This guideline has been referred to by many news articles in the lay press, which emphasize the economic impact of discouraging cough medicine use while not touching on the health concerns expressed.^[4]

Many cough mixtures contain both an expectorant and a suppressant -- even though an expectorant requires the action of a cough to expel mucus. Many believe this supports the idea that cough suppression is just a placebo effect. However, in practice the two active ingredients combine to provide less coughing, but more productive coughs.

Colloquial term usage

"Cough medicine", for example "Grandpa's old cough medicine", is also a commonly used euphemism for whiskey and other strong alcoholic beverages, or even actual cough medicine such as NyQuil which in some formulations has a high alcohol content.

Notes

1. ^ Vince, Gaia. "Persistent coughs melt away with chocolate", New Scientist, November 22, 2004.
2. ^ Knut Schroeder and Tom Fahey (2002). "Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults". British Medical Journal 324: 329–331. PMID 11834560.
3. ^ American College of Chest Physicians (January 9, 2006). New Cough Guidelines Urge Adult Whooping Cough Vaccine; Many OTC Medications Not Recommended for Cough Treatment. Press release.
4. ^ Tanner, Lindsey. "U.S. doctors say cough syrups don't work", The News Journal from Associated Press (link is to MSNBC on-line version), January 10, 2006, pp. A3.

Links

• Cough medicines not helpful - from MayoClinic.com

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Cannabinoids are a group of chemicals which activate the body's cannabinoid receptors. Before other types were discovered, the term referred to a unique group of secondary metabolites found in the cannabis plant, which are responsible for the plant's peculiar pharmacological effects. Currently, there are three general types of cannabinoids: herbal cannabinoids occur uniquely in the cannabis plant; endogenous cannabinoids are produced in the bodies of humans and other animals; and synthetic cannabinoids are similar compounds produced in a laboratory.

Cannabinoid receptors

Before the 1980s, it was often speculated that cannabinoids produced their physiological and behavioral effects via nonspecific interaction with cell membranes, instead of interacting with specific membrane-bound receptors. The discovery of the first cannabinoid receptors in the 1980s helped to resolve this debate. These receptors are common in animals, and have been found in mammals, birds, fish, and reptiles. There are currently two known types of cannabinoid receptors, termed CB1 and CB2.

CB1 receptors are found primarily in the brain, specifically in the basal ganglia and in the limbic system, including the hippocampus. They are also found in the cerebellum and in both male and female reproductive systems. CB1 receptors are essentially absent in the medulla oblongata, the part of the brain stem that is responsible for respiratory and cardiovascular functions. Thus, there is not a risk of respiratory or cardiovascular failure as there is with many other drugs. CB1 receptors appear to be responsible for the euphoric and anticonvulsive effects of cannabis.

CB2 receptors are almost exclusively found in the immune system, with the greatest density in the spleen. CB2 receptors appear to be responsible for the anti-inflammatory and possibly other therapeutic effects of cannabis.

Synthetic & Patented Cannabinoids

Historically, laboratory synthesis of cannabinoids were often based on the structure of herbal cannabinoids and a large number of analogs have been produced and tested, especially in a group led by Roger Adams as early as 1941 and later in a group led by Raphael Mechoulam. Newer compounds are no longer related to natural cannabinoids or are based on the structure of the endogenous cannabinoids.

Synthetic cannabinoids are particularly useful in experiments to determine the relationship between the structure and activity of cannabinoid compounds, by making systematic, incremental modifications of cannabinoid molecules.

Other notable synthetic cannabinoids include:

CP-55940 Produced in 1974, this synthetic cannabinoid receptor agonist is many times more potent than THC
HU-210 2-9 times as potent as THC
SR 141716A and SR 144528 CB1 and CB2 receptor antagonists, respectively
Nabilone Used as an anti-emetic in chemotherapy
Levonantradol Used as an anti-emetic and analgesic
Marinol Used as a presription medicine for appetite stimulation
Sativex A naturally based cannabis extract that contains both THC and CBD

Miscellaneous

• delta-9-Tetrahydrocannabinol (Δ⁹-THC, THC) and delta-8-tetrahydrocannabinol (Δ⁸-THC), mimic the action of anandamide, a neurotransmitter produced naturally in the body. The THCs produce the high associated with marijuana by binding to the CB₁ cannabinoid receptors in the brain.
• Tetrahydrocannabivarin (THCV), prevalent in certain South African and Southeast Asian strains of Cannabis. It is an antagonist of THC at CB₁ receptors and attenuates the psychoactive effects of THC.[3]
• Cannabidiol (CBD), non-psychoactive and not affecting psychoactivity of THC.[4] CBD has anti-inflammatory effects. CBD is the precursor of THC and is the main cannabinoid in low-THC Cannabis strains.
• Cannabinol (CBN), a degradation product of THC, produces a depressant effect
• Cannabichromene (CBC), non-psychoactive and not affecting psychoactivity of THC,[5] a precursor of CBD and THC
• Cannabigerol (CBG), non-psychoactive

Links

• Chemical Ecology of Cannabis (J. Intl. Hemp Assn. - 1994)
• Structure Activity Relationships of the Cannabinoids (NIDA Monograph 79 - 1987)
• Marijuana and Medicine - Assessing the Science Base (Institute of Medicine - 1999)
• What Every Doctor Should Know About Cannabinoids
• Therapeutic Potential in Spotlight at Cannabinoid Researchers' Meeting
• THC (tetrahydrocannabinol) accumulation in glands of Cannabis (Cannabaceae)
• Cannabis 2002 Report (Ministry of Public Health of Belgium)
• The Health and Psychological Effects of Cannabis Use (Australia - Monograph 44 - 2001)
• House of Lords Report - Cannabis (United Kingdom - 1998)
• Inheritance of Chemical Phenotype in Cannabis Sativa (Genetics)
• Cannabis: A Health Perspective and Research Agenda (World Health Organization - 1997)
• Canadian Senate Report on Cannabis - 2002
• Medicinal marijuana laws and policies
• Erowid Compounds found in Cannabis sativa
• The Endocannabinoid System Network (ECSN) - A CME source about the Endocannabinoid System

References

• M. A. ElSohly, D. Slade. Chemical constituents of marijuana: The complex mixture of natural cannabinoids.Life Sci. 78, 539-548 (2005)
• Hanuš L. Biogenesis of cannabinoid substances in the plant. Acta Univ. Palacki. Olomuc. (Olomouc), Fac. Med. 116, 47-53 (1987)
• Hanuš L., Krejčí Z. Isolation of two new cannabinoid acids from Cannabis sativa L. of Czechoslovak origin. Acta Univ. Olomuc., Fac. Med. 74, 161-166 (1975)
• Hanuš L., Krejčí Z., Hruban L. Isolation of cannabidiolic acid from Turkish variety of cannabis cultivated for fibre. Acta Univ. Olomuc., Fac. Med. 74, 167-172 (1975)
• Turner C. E., Mole M. L., Hanuš L., ElSohly H. N. Constituents of Cannabis sativa L. XIX. Isolation and structure elucidation of cannabiglendol. A novel cannabinoid from an Indian variant. J. Nat. Prod. - Lloydia 44 (1), 27-33 (1981)
• Devane W. A., Hanuš L., Breuer A., Pertwee R. G., Stevenson L. A., Griffin G., Gibson D., Mandelbaum A., Etinger A., Mechoulam R. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 258, 1946-1949 (1992)
• Hanuš L., Gopher A., Almog S., Mechoulam R.: Two new unsaturated fatty acid ethanolamides in brain that bind to the cannabinoid receptor. J. Med. Chem. 36, 3032-3034 (1993)
• Mechoulam R., Ben-Shabat S., Hanuš L., Ligumsky M., Kaminski N.E., Schatz A.R., Gopher A., Almog S., Martin B.R., Compton D.R., Pertwee R.G., Griffin G., Bayewitch M., Barg J., Vogel Z. Identification of an endogenous 2-monoglyceride, present in canine gut, that binds to the peripheral cannabinoid receptors. Biochem. Pharmacol. 50(1), 83-90 (1995)
• Hanuš L., Abu-Lafi S., Fride E., Breuer A., Shalev D. E., Kustanovich, I., Vogel Z., Mechoulam R.: 2-Arachidonyl Glyceryl Ether, a Novel Endogenous Agonist of the Cannabinoid CB1 Receptor. PNAS 98 (7), 3662-3665 (2001)
• Huffman, J.W. 2000. The search for selective ligands for the CB2 receptor. Current Pharmaceutical Design 6(13): 1323-1337

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Micrograph showing decidualization of the endometrium (as also seen in pregnancy) due to (exogenous) progesterone. H&E stain.

Hormonal contraception

refers to birth control methods that act on the hormonal system.

Currently, all hormonal contraceptives are designed for use by women rather than men, though research on a male hormonal contraceptive (“the male Pill”) has been underway for some time.

Hormonal contraceptives may be introduced into the woman’s body in many different ways, among them orally, vaginally, transdermally, or through injections or implants. The oral method was the first and most famous of these; within a few years of its introduction in 1960, "the Pill" became one of the most popular contraceptives in the United States and elsewhere, and it remains so today.

Hormonal contraception may act in one or more ways to prevent pregnancy. It may cause ovulation to cease, preventing the possibility of fertilization; it may thicken the woman’s cervical mucus, making penetration of the uterus by sperm more difficult; or it may alter and thin the endometrium so that a fertilized egg has difficulty implanting. (Technically, if the drug works in this third fashion, it acts as a contragestive rather than a contraceptive, since it has not prevented conception, acting instead to prevent gestation.)

Advantages

• If used properly, hormonal contraceptives are highly effective; except for abstinence, vasectomy, and tubal ligation, no other method of birth control has as great a degree of effectiveness.

• Hormonal contraceptives allow spontaneous intercourse.

Disadvantages

• Hormonal contraceptives offer no protection against sexually transmitted infections, placing non-monogamous individuals and couples at high risk for contracting such an infection.
• Like many other forms of birth control, hormonal contraceptives rely on the woman to use them correctly. Some, such as implants, require relatively little attention; others, such as injections or transdermal patches, require a schedule ranging from a week to several months. Still others—the wide varieties of oral contraception require a daily schedule. For example, many patient information leaflet for these pharmaceuticals suggest using a back up method of birth control if 2 or more doses are missed.^[1]
• Hormonal contraceptives can have side effects, including: weight gain, loss of libido, hair loss, mood swings, bleeding between periods, nausea, breast tenderness, headaches, mastalgia, depression, ovarian cysts, constant bleeding (metrorrhagia), panic attacks, muscle pain, heart palpitations, pain during sex, acne, abdominal cramps, dizziness, weakness or fatigue, leg cramps, nausea, vaginal discharge or irritation, bloating, swelling of the hands or feet, backache,insomnia, pelvic pain, rash, hot flashes,joint pain, convulsions, jaundice, urinary tract infections, and allergic reactions.
• Hormonal contraceptives can have serious health risks, such as ectopic pregnancy, decreased bone density, deep vein thrombosis, pulmonary embolus, uterine perforation, blood clot/stroke (stroke intensified risk for women who smoke) and death.
• Artificial contraception is objectionable to some religious traditions. These objections are furthered by the suggested, yet unproven post-fertilisation mode of action of preventing the implantation of a blastocyst.
• Hormonal contraceptives require a prescription in the United States and most other countries because of potential health risks.

Effects on rates of cancers

There is a mixed effect of combined hormonal contraceptives on the rates of various cancers, with the International Agency for Research on Cancer (IARC) concluding that "Combined oral contraceptives are carcinogenic to humans" and that "there is also conclusive evidence that these agents have a protective effect against cancers of the ovary and endometrium":^[2]

• The (IARC) note that "the weight of the evidence suggests a small increase in the relative risk for breast cancer among current and recent users" which following discontinuation then lessens over a period of 10 years to similar rates as women who never used them.
• Small increases are also seen in the rates of cervical cancer and hepatocellular (liver) tumours.
• Endometrial and ovarian cancer risks are approximately halved and persists for at least 10 years after cessation of use; although "sequential oral contraceptives which were removed from the consumer market in the 1970s was associated with an increased risk for endometrial cancer".
• Studies have overall not shown effects on the relative risks for colorectal, malignant melanoma or thyroid cancers.
• Numerous studies have shown carcinogenicity in experimental animals.

Types of Hormonal Contraception

Oral Contraceptives

• Combined oral contraceptive pill -- known colloquially as "The Pill", it is a combined estrogen and progesterone pill which is taken daily at the same time.
• Progesterone only pill (POP)

Non-surgical devices

• Contraceptive patch - an adhesive patch containing hormones which is applied to the skin and worn continuously. It is changed each week for three weeks and removed for one week.
• Contraceptive vaginal ring ("NuvaRing") - a flexible ring containing estrogen and progesterone, it is inserted into the vagina and worn for three continuous weeks, removed for one week, then replaced with a new ring.

Surgical devices

• Implants - a set of small, flexible rods which contain progesterone, which are implanted under the skin. Norplant, an implant of this type, is being phased out of production, though Implanon, a newer implant, was approved in July of 2006, and Jadelle was approved in 1996.^[3]
• Progesterone IntraUterine System - otherwise known as the IUS, this device is inserted into the uterus by a health care professional, where it continuously releases progesterone. It remains in the uterus for a period of years, as determined by the manufacturer.

Injections

• Lunelle - a monthly injection of progesterone, not currently available for sale.
• Depo Provera - an injection of progesterone administered every three months.

Most combined and progesterone-only pills may also be taken in high doses as emergency contraception (also known as the morning after pill). However, unlike plain copper IUDs, hormonal IUS is not approved for emergency contraception.

Cenchroman

Centchroman is sometimes mistaken for a hormonal contraceptive, probably because it is a pill that prevents pregnancy. Although it may be correctly termed a 'weekly contraceptive pill', it is not a hormonal contraceptive. Centchroman is a Selective Estrogen Receptor Modulator, or SERM. It causes ovulation to occur sooner than it normally would, while causing the lining of the uterus to build more slowly, which, together, prevent pregnancy. Centchroman is legally available only in India.

Footnotes

1. ^ Yasmin 28 Tablets, Physician Labeling (PDF). Berlex. Retrieved on 2006-08-16.
2. ^ International Agency for Research on Cancer (IARC) (1999). “5. Summary of Data Reported and Evaluation”, Oral Contraceptives, Combined, Vol. 72, p49.
3. ^ Jadelle® Implants. Population Council (May 2005). Retrieved on 2006-10-25.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

Chemotherapy is the use of chemical substances to treat disease. In its modern-day use, it refers primarily to cytotoxic drugs used to treat cancer.

In its non-oncological use, the term may also refer to antibiotics (antibacterial chemotherapy). In that sense, the first modern chemotherapeutic agent was Paul Ehrlich's arsphenamine, an arsenic compound discovered in 1909 and used to treat syphilis. This was later followed by sulfonamides discovered by Domagk and penicillin G discovered by Alexander Fleming.

Other uses of cytostatic chemotherapy agents (including the ones mentioned below) are the treatment of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis, the treatment of some chronic viral infections such as Hepatitis, and the suppression of transplant rejections (see immunosuppression and DMARDs).

History

The era of chemotherapy began in the 1940s with the first uses of nitrogen mustards and folic acid inhibitors. Cancer drug development since then has exploded into a multi-billion dollar industry. The targeted-therapy revolution has arrived, but the principles and limitations of chemotherapy discovered by the early researchers still apply.

Principles

Cancer is the uncontrolled growth of cells due to damage to DNA (mutations) and, occasionally, due to an inherited propensity to develop certain tumours. Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body - in other words, the body attacks its own cells. In contrast, transplant rejection happens because a normal healthy human immune system can distinguish foreign tissues and attempts to destroy them. Also the reverse situation, called graft-versus-host disease, may take place.

Broadly, most chemotherapeutic drugs work by impairing mitosis (cell division), effectively targeting fast-dividing cells. As these drugs cause damage to cells they are termed cytotoxic. Some drugs cause cells to undergo apoptosis (so-called "cell suicide").

Unfortunately, scientists have yet to be able to locate specific features of malignant and immune cells that would make them uniquely targetable (barring some recent examples, such as the Philadelphia chromosome as targeted by imatinib). This means that other fast dividing cells such as those responsible for hair growth and for replacement of the intestinal epithelium (lining) are also affected. However, some drugs have a better side-effect profile than others, enabling doctors to adjust treatment regimens to the advantage of patients in certain situations.

As chemotherapy affects cell division, tumours with high growth fractions (such as acute myelogenous leukemia and the lymphomas, including Hodgkin's disease) are more sensitive to chemotherapy, as a larger proportion of the targeted cells are undergoing cell division at any time.

Chemotherapeutic drugs affect "younger" tumours (i.e. less differentiated) more effectively, because at a higher grade of differentiation, the propensity to growth usually decreases. Near the center of some solid tumours, cell division has effectively ceased, making them insensitive to chemotherapy. Another problem with solid tumours is the fact that the chemotherapeutic agent often does not reach the core of the tumour. Solutions to this problem include radiation therapy (both brachytherapy and teletherapy) and surgery.

Dosage

Dosage of chemotherapy can be difficult: if the dose is too low, it will be ineffective against the tumor, while at excessive doses the toxicity (side-effects, neutropenia) will be intolerable to the patient. This has led to the formation of detailed "dosing schemes" in most hospitals, which give guidance on the correct dose and adjustment in case of toxicity. In immunotherapy, they are in principle used in smaller dosages than in the treatment of malign diseases.

In most cases, the dose is adjusted for the patient's body surface area, a composite measure of weight and height that mathematically approximates the body volume. The BSA is usually calculated with a mathematical formula or a nomogram, rather than by direct measurement.

Delivery

Most chemotherapy is delivered intravenously, although there are a number of agents that can be administered orally (e.g. melphalan, busulfan,capecitabine). Depending on the patient, the cancer, the stage of cancer, the type of chemotherapy, and the dosage, intravenous chemotherapy may be given on either an inpatient or outpatient basis. For continuous, frequent or prolonged intravenous chemotherapy administration, various systems may be surgically inserted into the vasculature to maintain access. Commonly used systems are the Hickman line, the Port-a-Cath or the PICC line. These have a lower infection risk, are much less prone to phlebitis or extravasation, and abolish the need for repeated insertion of peripheral cannulae.

Treatment schemes

There are a number of strategies in the administration of chemotherapeutic drugs used today. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms.

Combined modality chemotherapy is the use of drugs with other cancer treatments, such as radiation therapy or surgery. Most cancers are now treated in this way. Combination chemotherapy is a similar practice which involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest advantage is minimising the chances of resistance developing to any one agent.

In neoadjuvant chemotherapy (preoperative treatment) initial chemotherapy is aimed for shrinking the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective.

Adjuvant chemotherapy (postoperative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. This can help reduce chances of resistance developing if the tumour does develop. It is also useful in killing any cancerous cells which have spread to other parts of the body. This is often effective as the newly growing tumours are fast-dividing, and therefore very susceptible.

Palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, a better toxicity profile is generally expected.

Most chemotherapy regimens require that the patient is capable to undergo the treatment. Performance status is often used as a measure to determine whether a patient can receive chemotherapy, or whether dose reduction is required.

References

1. ^ Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001;323:16-21. PMID 11440936.
2. ^ Tannock IF, Ahles TA, Ganz PA, Van Dam FS. Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol 2004;22:2233-9. PMID 15169812.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

A decongestant is a broad class of medications used to relieve nasal congestion. Generally, they work by reducing swelling of the mucous membranes in the nasal passages. The effects are not limited to the nose and these medicines can increase hypertension (blood pressure). These are normally paired with antihistamines to lessen this effect, but they don't always even each other out. These agents are usually administered topically (by the intranasal route) or orally. Examples of oral decongestants include pseudoephedrine and phenylephrine.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.

In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994^[1] as a product that meets each of the following criteria:

1. It is intended to supplement the diet and bears or contains one or more of the following dietary ingredients:
   • a vitamin,
   • a mineral,
   • an herb or other botanical (excluding tobacco),
   • an amino acid,
   • a dietary substance for use by man to supplement the diet by increasing the total daily intake (e.g., enzymes or tissues from organs or glands),
   • a concentrate, such as a meal replacement or energy bar, or
   • a metabolite, constituent, or extract.
2. It is intended for ingestion in pill, capsule, tablet, or liquid form.
3. It is not represented for use as a conventional food or as the sole item of a meal or diet.
4. It is labeled as a "dietary supplement".

The FDA regulates dietary supplements as foods, and not as drugs. The FDA does not pre-approve dietary supplements on their safety and efficacy, unlike drugs. In contrast, the FDA can only go after dietary supplement manufacturers after they have put unsafe products on the market. However, certain foods (such as infant formula and medical foods) are deemed special nutritionals because they are consumed by highly vulnerable populations and are thus regulated more strictly than the majority of dietary supplements.

The claims that a dietary supplement makes are essential to its classification. If a dietary supplement claims in any way to cure, mitigate, or treat a disease, it would be considered to be an unauthorized new drug and in violation of the applicable regulations and statutes. As the FDA states it in a response to this question in a FAQ:

Is it legal to market a dietary supplement product as a treatment or cure for a specific disease or condition?
No, a product sold as a dietary supplement and promoted on its label or in labeling* as a treatment, prevention or cure for a specific disease or condition would be considered an unapproved--and thus illegal--drug. To maintain the product's status as a dietary supplement, the label and labeling must be consistent with the provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.
*Labeling refers to the label as well as accompanying material that is used by a manufacturer to promote and market a specific product.

Dietary supplements are permitted to make structure/function claims. These are broad claims that the product can support the structure or function of the body (e.g., "glucosamine helps support healthy joints"). The FDA must be notified of these claims within 30 days of their first use, and there is a requirement that these claims be substantiated. Nevertheless, many critics claim that dietary supplements overstate their importance and their impact on overall health. Evidence of many of the claimed benefits of certain dietary supplements has yet to meet standard scientific criteria of credibility, based on large scale, double blind testing with statistically significant outcomes.

Other claims that required approval from FDA include health claims and qualified health claims. Health claims are permitted to be made if they meet the requirements for the claims found in the applicable regulations. Qualified health claims can be made through a petition process, including scientific information, if FDA has not approved a prior petition.

European Union

The Food Supplements Directive^[2] requires that supplements be demonstrated to be safe, both in quantity and quality. Some vitamins are essential in small quantities but dangerous in large quantities. Some herbal remedies, notably St Johns Wort, may interact with drugs or render them less effective. Such an issue has been raised in the case of oral contraceptives. Consequently, only those supplements that have been proven to be safe may be sold without prescription. In practice, the number of reported incidents with food supplements is nevertheless low.

In Europe, it is also an established notion that food supplements should not be labeled with drug claims but can bear -to a degree that differs from one member state to the other- health claims.

Legal challenge

The dietary supplements industry in Europe strongly opposed the Directive. A large number of consumers throughout Europe, including over one million in the UK, and many doctors and scientists, have signed petitions against what are viewed by the petitioners as unjustified restrictions of consumer choice ^[3]. The European Court of Justice ruled^[4] on 12 July 2005 that the Directive is valid, although the court's own Advocate General advised that the declaration was invalid under EU law ^[3]. The court made clear, however, that it must be possible for manufacturers to add vitamins and minerals to the list of ingredients of a food supplement, that refusal must be on scientific grounds, and that there should be a right to appeal.

Russia

Russian legislation, Ministry of Health's order № 117 dated as of 15 April, 1997, under the title “Concerning the procedure for the examination and health certification of Biologically Active Dietary Supplements”, provides the usage of the following terminology:

As a rule, BADSs are foodstuffs with clinically proven effectiveness. BADSs are recommended not only for prophylactics, but can be included into a complex therapy for the prevention of pharmaceutical therapy's side effects and for the achievement of complete remission.

The development of BADSs and their applications has been very fast moving. They were originally considered as dietary supplements for people who had heightened requirements for some normal dietary components (for example, sportsmen). Later, they were employed as preventive medicines against chronic diseases.

Notes

1. ^ US Dietary Supplement Health and Education Act of 1994
2. ^ Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements
3. ^ ^a b "Controversial EU vitamins ban to go ahead" (the Times, July 12 2005)
4. ^ The Court confirms the validity of the Community Directive on food supplements (Press release)

Links

• Dietary Supplement Further information
• US FDA/CFSAN Dietary Supplements
• Monitoring the Adverse Health Effects of Dietary Supplements Further information
• What's in the Bottle? An Introduction to Dietary Supplements (NCCAM)
• BBC Health: Vitamins on the BBC website. Note especially warnings [1] to pregnant women on Vitamin A (Retinol) and unspecified multivitamins.
• NIH info on herbal supplements
• National Nutritional Foods Association
• Supplements and Health Conditions Further information

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.