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Drugs 101 second half.pdf

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University of Ottawa
Biopharmaceutical sciences
William Ogilvie

drugs 101 new Heart medications  heart has been recognized since ancient times  -lots of different properties that it does not do -affection -soul -its just a pump -only organ in the body that actually moves  -gladiator wounds provide first glimpse of function  -William Harvey -first described major properties of how the circulatory system works properly  -credit for discovery of how circulatory works  -not actually the fist person though it was an arabic scholar ibn al-Nafis  -this is because of european based society -Heart pumps about 2 and a half billion times in life time -5, 6 litres each minute -100,000 km of blood vessels  -coronary vessels feed the heart  Much cancer death is avoidable  -tabacco -diet -obesity  -alcohol -lack of exercise saturated fats cause avoidable heart disease  smoking kills by poisoning the heart -hemoglobin carries o2 in the blood  -co sticks to hemoglobin better than 02 -lack of o2 damages the heart and blood vessels  obesity kills by overworking the heart  -diet high in fruits and vegetables in beneficial -variety in the diet is important  -men are 10x more likely to have a heart attack then women  -heart attacks in young women often mis diagnosed  -heart attack risk equalizes after menopause  -estrogen replacment has no effect  -stress dramatically increases your risk  -exercise protects your heart  -family history of heart disease  Many microbes linked to heart disease -herpes virus -crytomegalovirus Heathy Gums for a Heathy Heart  -homcysteine levels linked to heart problems  -homocysteine is recycled using b vitamins  -b vitamin supplements do not give a benefit  Problems that can arise with your heart -improper functioning of the valves -impared neural activity  improper function corrected by surgery  -new valves from pigs  Heart stimulated by sympathetic nerves -impossible to make drugs that will function safely with parasympathetic drugs  If your heart is beating to quickly you can take noradrenaline antagonist -stops normal messenger from sticking  -b-blockers keep heart rate under control  (bata blocker propranale one of the first drugs -slow hearts corrected with a pacemaker  -dangerous to fix with drugs  -high blood pressure is the silent killer -two blood pressure are measured -normal value is 120/80 -first number is the systolic pressure  -pressure when heart squeezes -About 40-50 mm higher than diastolic  -second number is the diastolic pressure  -pressure when heart rests  pay attention to diastolic pressure -below 90 you are good above you have hyper tension -after 115 they prescribe medication -each time this increases by 5 mm heart attack risk is increased by 25 % Hypertension affects 20% of adults 2 types essential- what you need to survive/ not understood well how this is regulated thought to be connected to high sodium levels  -this is a irreversible problem even if you cut out the salt  -salt is required for life doe  -salt was used asa currency  -roman soldiers payed in salt -processed and fast foods contain lots of salt  -processing removes flavour -salt puts it back  recommended daily intake -1- 1 and a half grams per day -most canadians eat double that per day  hypertension affects 20% of adults  Essential  -high sodium -irreversable -sytemic vasodilation opens blood vessels  pit viper venom lowers blood pressure  -bothrops jararaca -venom is a potent vasodilator  -snake venom is not "drug like"  -expensive hard to make high amounts -side effects its a venom  -can't make a pill has to be injected  what makes a chemical drug like -cheap -eassy to make -something you can take as a pill venom blocks the formation of angiotensin 11 (vasoconstrictor) -blocks enzyme makes blood vessels big  -went back to chemical structure of the venom and made it drug like  captopril was the first ACE inhibitor -had annoying side effects -cough -copper taste  Enalapril had improved side effect profile -100 x more potent than captopril -small doses required -no copper taste  Ang 11 antagonist for hypertention -latest version -you can get a build up in the hormone Congestive heart failure  -used to call it dropsee -you look inflated in lower parts of the body -the blood vessels in the body tend to leek fluid -liquid pools in the body -enlargment in legs and lower body  Many cAUSES -CORONARY HEART DISEASE -HIGH BLOOD PRESSURE -heart valve problems -abnormal rhythm  William withering discovers heart drug -foxglove plant (witch bells) stimulates heart reverses drop see -digitalis boosts heart function  -cant make it synthetically  -you can only get it from the plant  -withering would make a tea the extract the drug -the problem is its hard to control the dose / could be fatal because of overdose  we no longer make an extract its a purified extract  -get it in a pill Digitalis has narrow therapeutic window -gap between the effective dose and the dangerous dose  -fatal dose is 3 pills -digoxin at hospital for sick children in toronto used to kill a bunch of babies  -charles cullen kills over 40 people with digoxin  -Coenzyme Q10 for congestive heart failure  -no benefit  angina caused by impaired blood flow to heart -pain in heart -counteracted by nitroglycerin under tongue to treat angina  -nitroglycerine nasal spray  dynamite workers discover heart benefits  -inhalled nitroglycerine got headaches but their heart problems would go away -nitroglycerine available by patch -exploding patients  before viagra there was nitro arginine for angina -nitroglycerine and arginine make NO in the body  -no benefit from arginine  -heath canada warns against arginine for angina  Arterial blockages involve cholesterol  -cholesterol is found in all animal cells  -high blood cholesterol associated with heart attack  -half of heart attack patients have normal cholesterol levels  Where does our cholesterol come from  -diet makes a vey small contribution to the levels of cholesterol in our body -majority of our cholesterol is made in liver  -saturated fats  -eggs suffered cuz of dis  egg yoke 300 mg of cholesterol  -omega 3 are great for market -omega 3 fatty acids reduce irregular heart beat  -feed chickens with fish meal  -omega 3 from flax seed does not work the same way    The ethics of smart drugs  The salt we eat has iodine which is important with early brain development -there are studies that show that countries with little iodine are not as smart as people that do -adds 10-15 iq points if eaten during early development  some drugs improve cognitive function -alzheimers -dementia -aphasia -schizophrenia  small improvement for sleep deprived  drugs for narcolepsy keep you awake  -pulling an all nighter not always beneficial  amphetamines improve concentration -people on automotive lines used to take these makes you focus  -dexedrine  -adderall  Ephedra is widely used  Ritalin improves behaviour in ADHD  feeling good does not = better performance  **effects are small and variable  -follow inverted u shaped curves  -after too much you become impaired rather than improved  -the effect you get depends where you lie on the curve  Cognitive functions have different drug sensitivities  ability 1 may increase where ability 2 decreases  -easier to mess stuff up than to make it better  -benefits are highly questionable  -Is there a downside  -all drugs have side effects  -may help or impair  -prescription drugs only legal for patients  -conterfit drugs are $75 billion market  drugs are dangerous because they are illegal  -fines -jail time -new mandatory minimum sentences  criminal record  -limits employment opportunities  Nutraceuticals  Modern migration towards herbal remedies  -has happened in the last 30 years people are rejecting modern medicine and going to herbal remedies  Organic products are becoming popular -no additives -no synthetic pesticides -no synthetic fertilizer  -no genetically modified organisms  No regulations over use of "natural" -herbal remedies used by 40 % of population -herbal remedies are a $20 billion business  -herbals are not produced this way  -many herbals are mass produced  -grown industrially  -herbal industry has very few rules  -modern drugs are standardized  -purified substances -consistant dose  -herbal remedies are not standardized  -not inspected  -products can be misleading  Which omega 3 is in your fish oil  -eicosapentaenoic acid -docosahexaenoic acid No benefit to omega 3  testing is limited or coexistent -safety is based on past history -adverse event reporting not required -efficacy is based on "previous reports  -doctrine of signatures -doctrine of humours -anecdotal evidenc  -quality of science is highly variable  Echinacea is the most popular herbal remedies  -used to treat colds  -has been sold for 200 years first found in snake oil  -advertised as a native recipe  -has no effect on colds  -increased risk of rash  cold fx -poor studies  -choose their patients  -manipulation of data  ginseng root looks like the human body  -claims are non specific  -ginkolidies increase circulation in the brain  -circulation does not improve brain function  -interfears with blooot clotting -saw palmetto for benign prostate hyper -labels are carefully written  Garlic used by egyptions to improve strength  -adolphus hohensee and garlic breath  -people like visual effects  Allicin thought to affect cholesterol  -garlic uses allicin for protection (garlic flavour) allicin is unstable  -gets into your bloodstream enzymes will go after it and give you garlic breath  -smell com
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