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Midterm 1 Notes (Lecture + Readings)

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CHEM 183
Joe Schwarcz

World of Chem Drugs: Midterm 1 Notes Preliminary Perspectives: An Overview of World of Chemistry Drugs - King Charles II – Sir Charles Scarburgh was his doctor, used bloodletting to rid him of his disrupted humors (now known as convulsions) - Urine used to detect disease – Uroscopy (the study of urine) - Uroscopy flask used to be a symbol for doctors - Diagnosis by urine color – Uroscopy wheels are chats displaying different possible urine colors - Brown (liver problems), red (bleeding), bright yellow (vitamin B2 or excess riboflavin), no color (hydrated) - Gas Chromatography and Mass Spectrometry (GCMS) used today to analyze urine – 147 different compounds in urine - Until recently doctors were not able to do much (temperature, pulse) to cure people – sometimes the presence of a doctor can boost the immune system (like a placebo effect) - Myth: angel or a god would provide healing (ex. St. Sebastian believed to have curative powers - Life Expectancy: - 1900s in North America: 47 years for men; Presently: 80 years (+2–3 for women, – 2–3 for men) - Why? maternal mortality rate was 50/10,000 births until 1940, antibiotics were introduced and in 1980 rate dropped to 1/10,000 - World Avg.: 67 years (Andorra highest expectancy: 84 years, Canada (8th place) 81 years) - Africa – lowest life expectancies due to high child mortality rate and disease (Swaziland lowest expectancy 40 years old) - Life expectancy has increased steadily since 1900 – 1918 Influenza (Spanish Flu) Pandemic caused it to drop - Deaths Worldwide: (mainly due to infectious diseases) - Respiratory (5M); Diarrheal (3M); Tuberculosis (3M); Malaria (2M, 1M are children), HIV (2M) - Population Age Segments: - US: % of pop. +65 fairly constant since 1960s, by 2020 16% (1/6) of pop. will be 65+ - Japan: 28% of pop. expected to be 65+ by 2020 - World Avg.: 9% of pop. expected to be 65+ by 2020 - Current oldest living person is in Japan (115); oldest person recoded in Canada (Marie-Louise Meilleur, 117); oldest person ever (Jeanne Calment, 122) - If you are 20 year old, 91% change you have a living grandmother; A century ago a 20 year old had an 83% change of having a living mother - Population of cities will increase significantly over the next decade - Spanish Flu (1918–1919) Pandemic – largest disease epidemic: - 30–50 million deaths worldwide - Face masks, sneeze screens, isolation were preventative measures - Bacterial pneumonia cause most of the deaths (DNA was analyzed and virus was reconstructed) - Pneumonia was caused after the flu wipes out the bronchial cells in the lungs causing normally harmless bacteria from the nose/mouth to become harmful and invade and multiply in the lungs - Survivors studied – blood samples indicated they all reacted to the flu – still have protective antibodies to the virus (could be used to fight future outbreaks) - 1911 Flu Epidemic - Kemps Balsam: derived from herbs, has medicinal taste and smell but no curative properties - Plague of Athens – symptoms were fever, bad breath, blisters, ulcers, vomiting; people died of diarrhea; similar to Ebola Virus - Plagues initially associated with miasma (bad air) – doctors were fully covered, masks stuffed with flowers Eradication of Disease - WHO estimate: vaccinations have saved over 40M lives in 20 years (mainly in Africa) - Drug and non-drug methods used to eradicate disease - Smallpox, caused by a virus – eradicated via vaccination, which is a non-drug method - Polio – nearly eradicated – eradicated in Americas in 1991 - Leprosy – Hansen’s Disease – bacterial infection – recently controlled using a multi-drug therapy - In the 1980s there were 12m cases, now there are 200K - Guinea Worm Disease (Dracunculiasis) - Prevalent in Africa and India - Caused by a water flea carrying a nematode larvae (worm), worm is ingested and body remains a host for the worm, worm then emerges from body - Non-Drug Eradication: filter water using cheese cloth and educate people about filtering 1 World of Chem Drugs: Midterm 1 Notes - Carter Center and Gates Foundation committed to eradicating it worldwide - Chagas Disease (Kissing Disease) - Caused by assassin bug (kissing bug) and the parasite transmitted by it (studied by Charles Darwin) - Symptoms may occur 10–20 years following bite – neglected disease due to its rarity - Prevented using insecticides - Anti-Fungal drugs used to treat fungal infections - Case of esophagus – constriction due to fungus – balloon angioplasty or roto-router treatment used - Malaria, a parasitic disease - 50% of children in Congo affected – 120M cases/year, 2M deaths/year, 1M are children - 380 species of Anopheline mosquito, only 60 transmit disease - Slows Africa’s economic growth at a rate of 1%/year - Early Cure: quinine extracted from the cinchona plant - 1820, Pelletier and Caventou – purify Quinine from bark - Fact: tonic water contains Quinine (British drank to prevent malaria, origin of Gin and Tonic) - Alkaloids, like Quinine contain a nitrogen atom connected to 2 carbons and an aromatic ring, molecules that have this structure are often physiologically active - Later Treatment: DDT (1940s) safe for humans but impacted bird reproduction so it was ban - 500M lives saved with DDT (it has saved more lives than any other substance) - Now: insecticide treated nets (DDT) – Jeff Sachs wants nets to be given to Africa for free - Possible Prevention: genetically-modified parasite-resistant mosquitos, Chinese herbal remedy - Syphilis “The Great Pox” (1495) - People given Salversan 606 – contained an arsenic compound that was toxic What is a Drug? - Def: a chemical agent that affects living matter OR any preparation that, in a person’s mind has a beneficial effect on his well-beings (placebo) - Prescription Drugs: 350B dollar market in N. America - OTC: 1/10 of prescription drug market, 25B dollars in N. America - 3 important things about drugs: - Indications – what a drug is recommend for - Conta-indications – situations where you should not be taking the medication - Side-Effects – effects other than what you are aiming for Placebo Effect – today known as the Placebo Response b/c effect involves a response on the part of the participant - Approx. 30–35% of individuals taking a placebo during a trial will improve in health. Therefore any drug that is deemed effective must be able to exceed the 35% improvement rate b/c that much of the group will fell better after taking a placebo - Nocebo Effect – opposite of placebo effect – people who are told a substance is dangerous will react negatively to it regardless of its real nature (Ex. Aspartame) A Historical Perspective - Pharmakon means drug (Greek origin) - Sumerians (2200 BC) – first to think about medications - 16 beer recipes - Plants major sources of drug discovery – opium came from the poppy (active ingredient: morphine) – willow leaves to alleviate joint pain - Egyptians – willow leaves for inflammation, fat from animals to treat baldness, ox liver to treat night blindness - Hippocrates (460–370 BC) – excluded superstition from methods, most of his remedies were useless except his cure for night-blindness with Ox Liver (liver has vitamin A) and his cure for crying babies of poppy juice and fly excitement (poppy juice would have sedated babies) - Doctrine of Humors – body consisted of blood (air), phlegm (water), black bile (earth) and yellow bile (fire) and each element corresponded with an earth element - Bark of Willow Tree – alleviate childbirth pain - Galen (~131 AD) – worked with gladiators in Rome, wounds were “windows into the body” - Dioscorides (40–90 AD) – De Materia Medica, first medical book (info. about plants and their medical effects) - ex. strawberry, beet, opium, bullrush, wormwood used in Absinthe, arum dioscordies used as an expectorant (causes one to vomit), saffron when drank with passum (sweet wine) is a diuretic (causes water to be eliminated from body as urine) 2 World of Chem Drugs: Midterm 1 Notes - Avicenna and Maimonides (Jewish doctor in Spain) (1135–1204) – doctors known for their writing about the practice of medicine - Maimonides prescribed the broth of fowl to treat various things, where the chicken soup myth comes from - Arabic World – logical methods of medicine lost to Europe until 700, Moors brought this logical culture back to Spain - Paracelcus (1493–1541) - Medical activist, preacher of science, believed proof came from experiment and reasoning not authority - “Only the dose makes the poison” – father of modern toxicology - Invented ether as an anesthetic (treated alcohol with acids) - Introduced chemicals as treatments for disease - Opposed polypharmacy – when you take different drugs for different problems - Wrote in code, why most of his writing was not transferred to modern times - Against Doctrine of Humors - Mandrake Root – thought to have powers because it resembled the human body - Blood Transfusions – failure prone due to un-sanitized equipment, lack of understanding of blood-typing - Doctrine of Signatures (1700s-1800s) – Jakob Bohme - Ideas influencedHegel and Schopenhauer - God marked everything he had created with a sign (or signature) that indicated their purpose for creation – if there is a form of association b/w a disease and a plant/animal then that should be successful in treating that disease - Ex. carrots good for eyes, walnuts good for brain, bezoar stone treated plague (kidney stone from goats), nails added to wine (iron source) - William Withering (1700s) – foxglove plant assisted in Dropsy (congestive heart failure) - Today, Lanoxin (Digoxin – active ingredient) is used to treat CHF and is derived from foxglove - Published info. on foxglove in An Account of the Foxglove and some of its Medical Uses (1785, one of the first medical articles), also A Botanical Arrangement of all the Vegetables Growing in Great Britain - Medical journals only began circulating in 1800s and they were not peer reviewed - Samuel Hahnemann (1800s) – homeopathy - “Like cures like” - Very diluted substances to treat (benefits mainly placebo effect) - Joseph Lister (1800s) - Phenol (antiseptic), spraying it reduced post-surgery infections - Washing hands and wearing rubber gloves prevented infection and sepsis - Listerine – in 1900s used for dandruff control and deodorant – contains Thymol and alcohol (27%) - Thymol (antiseptic) is closely related to phenol - Propofol, milk of amnesia – anesthetic - Small changes in chemical structures can make a large difference in the physiological properties of the substances - Thomas Roddick introduced antisepsis - Sepsis – systematic inflammatory response syndrome (SIRS) – caused by a body’s response to an infection that leads to inflammation and blood clotting (may lead to organ failure) - 1910 – operating rooms changed, resembled operating rooms of the present, infections reduced - William Olser (McGill), key role in development of tools used for diagnosis - Started medical education in N. America at 2 universities: McGill and John Hopkins - “Comfort always, cure rarely” - “Listen to the patient carefully and they will tell you the diagnosis” - Used a then revolutionary method of talking and listening to patients - Iodine/Alcohol – kill bacteria - Ammonium Carbonate (smelling salts) – cause one to wake up - ABT-594 found in Epipedobates tricolor (frog) is 200x more effective than morphine, non-addictive - Some frogs have neurotoxins under their skin - Ipec is an emetic (induced vomiting) - Aconite is a poison (used by Romeo) - Cantharidine (extracted from Spanish Flies) – irritant - Periwinkle yields Vincristine, used in chemo - Minoxidil – previously used for high blood pressure, now used for hair growth 3 World of Chem Drugs: Midterm 1 Notes Patent Medicines (1850s-1906) - 1906: FDA put into place in the US – prior to this there were no proper drugs (i.e. researched and tried) - 1938: Federal Food, Drug and Cosmetic Act - Proof of safety - Regulated cosmetics - Food Standards - 1951: Humphrey Durham Amendment to 1938 – 2 categories of drugs, prescription and OTC - Prior to this prescription was only for narcotics and cocaine - Prescription Drugs = $300 B in NA; OTC Drugs = $25B NA - FDA catalogs drugs by chemical type, can be more specific in classification (if it is molecular entity, new derivative, new formulation, new combination, already marketed/expired patent, new use for a drug) - Clinical Trials are considered to be the Gold Standard by the FDA to test the effectiveness of a drug - Thalidomide – drug used in Canada and Europe for nausea in the first trimester of pregnancy - Worked but was a potent teratogen – children born with short limbs, normal intelligence (Tony Meledez, Thomas Quasthoff) - Frances Kelsey – worked for FDA, discovered Thalidomide was a problem - Other uses: blood cancer, MS, Chron’s disease, breast cancer, brain cancer, Hansen’s disease - New Drugs: 10–15 years to come to market, takes $300B, new drugs can come from plants, animals, make drugs through molecular modeling or fragment based lead discovery - Kaplan-Meir Plot – compares medication to a placebo – if two lines split means medication is effective - Lipinski Rule of Five – used by pharmaceutical companies as a qualitative measure of effectiveness - Drugs are made using: - Molecular Modeling – 3D version of certain molecules, optimization of the pharmaceutical agent, active site of an enzyme is a frequent target of pharmaceutical agents - Fragment Based Lead Discovery Technique (FBLDT) – simple atom arrangements that bind to biological targets, different arrangements have different effects - The largest pharmaceutical companies have $20B+/year - Top Companies: Pfizer, AstraSeneca, Merck, Novartis - N. America consumes 50% of the world total of drug sales ($230B) - 1996: prescriptions written in Can. dominated by Tylenol with codeine, now Lipitor (cholesterol) - Excipients - 40 different categories of materials in pills that are not the medicine, $4B global market/year - Risk factors contribute to the probability that a certain disease will affect an individual Pain - Congenital Analgesia – condition where people do not feel pain - Gender differences: varies, makes analysis difficult - Women – migraines, tension headaches, arthritis - Men – cluster headaches, back pain - Which personality type feels more pain? Introverts feel more pain, extroverts complain more - Which hair color feels more pain? Blondes - 2 Types of Pain: - Acute – results from disease, inflammation or injury – confined by time (ST) - Chronic – persists, representing the disease itself (LT) - 20% of people suffer from chronic pain, 25% of people over 65 suffer chronic pain - The more pain there is, the longer it takes to recover - Lebenswecker – stick with sharp points at one end and a lever to pull on the other, pull lever points snap back out and hurt the body part the device is placed on – this is done to redirect pain - Prior to pain relievers, Doctors performed other medical procedures to treat pain - Demons in the head believed to cause pain – trepanations were used to treat patients (drill the skull) - Doctors has to be physically fit, most doctors were male – orthopedic surgeons were always men until the 1960s - Dr. Li – opiate activity in camel pituitary gland – discovered a long peptide (chain of amino acids) called B- Lipotropin that had a segment for fat metabolism, segment associated with skin color of humans, and pain relief segment - Called pain relief segment Endorphin (The morphine within) – Enkephalins are made up of 5 amino acids stimulate the action of morphine - Measurement of pain can be studied putting rats on hot plate – test reaction time with and without painkillers - Acupuncture – based on thought that there are regions of the body that allow for suppression of neurotransmitters 4 World of Chem Drugs: Midterm 1 Notes - Wall and Melzak – Gates Theory (1960s) – small diameter nerve fibers carry pain stimuli through a gate mechanism. large diameter nerve fibers going through the same gate can inhibit transmission of smaller nerve cells carrying the pain signal - Pain signals can be interfered with by stimulating the periphery of the pain site - Pain Gate shut by stimulating nerves that carry the pain by more mild applications such as rubbing, massaging, acupuncture and ice packs. Also shut by release of endorphins - Inhibiting transmission of pain signals in some part of the spinal cord and thus cannot get to the brain - Solomon Snyder – studying neuron synapses and endorphins - Enkephalins can deactivate pain signal, can be addictive, perhaps why some people do extreme sports to get a rush of these molecules Pain Relievers - $3B spent/year in N. America, 50B tablets/year - Canada – can advertise a prescription drug but cannot say what it is for OR advertise medical condition without mentioning drug - 2 Types of Pain Relievers: - Non-Steroidal Anti-Inflammatory Drugs (NSAID) – affect heart and stomach – ASA, Ibuprofen, Naproxen Sodium - COX inhibitors – COX1 (stomach protection) and COX2 (pain and inflammation) - Drug blocks COX1 and COX2 – pain and inflammation reduced, stomach protection compromised (ASA, Ibuprofen, Naproxen Sodium) - Inhibit COX2 – prevent pain and inflammation without affecting stomach (Celebrex, Vioxx) - Other – affect liver – Acetaminophen Aspirin - Generic Term: Acetyl Salicylic Acid (ASA) - Good for Treating: pain (headache, arthritis, body ache, muscular pain), inflammation, fever, heart disease - Not Good for Treating: deep-rooted visceral pain - High Intake: Salicylism (ingesting 12–25 tablets), Tinnitus (caused by Salicylism, ringing of the ears), Death (20–30 tablets) - Children’s Size sold to prevent overdoses in children – tablets contain 80mg vs. 325mg and bottles contain 24 tablets - 58B tablets consumer worldwide/year – no longer most used pain reliever in N. America - Edward Stone (1763) – rediscovered potential of the Willow Tree through the application of the Doctrine of Signatures - Henri Leroux (1829) – extracted Salicin from the Willow bark (Willow Trees are in the Salix family) - Salicin used to treat pain and fever but was an impure substance - Rafaelle Piria (1838) – purified Salicin (extracted the active ingredient, making Salicylic Acid) - Salicylic Acid: - Properties – Analgesic (relieves pain), Antipyretic (lowers fever), Anti-inflammatory - Side Effects – bitter taste, irritates stomach - Felix Hoffman (Aug. 10, 1897) – chemist at bayer treated Salicylic Acid, resulted in a compound with the same properties that was easier on the stomach – Acetyl Salicylic Acid - Acetyl Salicylic Acid: - Hoffman treated Salicylic Acid with Acetic Acid (vinegar) causing a condensation reaction to occur (water expelled) resulting in ASA or Aspirin - Patent: molecular formula included and rheumatism - US – Bayer lost patent to ASA and the name rights allowing anyone to produce it and call their product Aspirin - Canada – Bayer lost patent to ASA allowing anyone to produce it, but not naming rights - Carl Duisberg promoted use of Aspirin – first mass-marketed drug – initially sold as a powder - Science: - Ulf Von Euler (1934) – discovered Prostaglandins (produced by prostate gland) - John Vane (1971) – mode of action of Prostaglandins: damaged cells produce Arachidonic Acid, which is a precursor to Prostaglandins, which go to the brain and transmit signals to the nerves causing you to feel pain - Aspirin blocks the conversion of Arachidonic Acid to Prostaglandins, the conversion is done by the enzyme CycloOxygenase (COX) – Aspirin is a COX inhibitor - Heart Disease: Aspirins main use today 5 World of Chem Drugs: Midterm 1 Notes - Found to reduce the risk of heart attack, acts as an anticoagulant (blood thinner) which helps to prevent clotting – prevents formation of certain Prostaglandins that aid in clotting (Thromboxane, A 2 - Benefit for secondary prevention (people who have already had one attack) or for those at risk of heart disease - Physicians Health Study (1989) - 22,000 male physicians aged 40–84 studied for 5 years – men were taking 1 Aspirin OR 1 placebo every other day – found that rates for heart attacks were lower during these years (fatal/non-fatal) - Taking Aspirin increases bleeding in your stool, so if you have colon cancer you go see your doctor and catch cancer at an earlier stage – Chronic aspirin users have fewer colon cancer deaths – benefits not apparent before 10 years, 14 tablets/week - Side Effects: - Gastric Irritation - Gastrointestinal Bleeding - Ulcers – 3,000 deaths/year - Due to Prostaglandins role in regulation of acid secretion and protection of stomach lining - Prevention: ASA buffered with Antacids (counteracts acid in stomach), coated aspirin (delayed release) - Allergic Re
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