Medication

Medication
Packages of medication
Other names	Medicine, drug, pharmaceutical, pharmaceutical preparation, pharmaceutical product, medicinal product, medicament, remedy
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A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a

Medication is a medicine or a chemical compound used to treat or cure illness. According to Encyclopædia Britannica, medication is "a substance used in treating a disease or relieving pain".^[3]

As defined by the

• "Any substance or combination of substances presented as having properties for treating or preventing disease in human beings; or"
• "Any substance or combination of substances which may be used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a
  immunological or metabolic action or to making a medical diagnosis."^[5]
  ^: 36

• A substance (other than food) intended to affect the structure or any function of the body.
• A substance intended for use as a component of a medicine but not a device or a component, part, or accessory of a device.
• A substance intended for use in the
  prevention of disease
  .
• A substance recognized by an official
  pharmacopeia or formulary
  .
• Biological products are included within this definition and are generally covered by the same laws and regulations, but differences exist regarding their manufacturing processes (chemical process versus biological process).[6]

Usage

Drug use among elderly Americans has been studied; in a group of 2377 people with an average age of 71 surveyed between 2005 and 2006, 84% took at least one prescription drug, 44% took at least one

One of the key classifications is between traditional

1. Antipyretics: reducing fever (pyrexia/pyresis)
2. Analgesics: reducing pain (painkillers)
3. Antimalarial drugs: treating malaria
4. Antibiotics: inhibiting germ growth
5. cuts,and wounds
6. Mood stabilizers: lithium and valproate
7. Premarin
8. Oral contraceptives
   : Enovid, "biphasic" pill, and "triphasic" pill
9. Stimulants: methylphenidate, amphetamine
10. Tranquilizers: meprobamate, chlorpromazine, reserpine, chlordiazepoxide, diazepam, and alprazolam
11. Statins: lovastatin, pravastatin, and simvastatin

Pharmaceuticals may also be described as "specialty", independent of other classifications, which is an ill-defined class of drugs that might be difficult to administer, require special handling during administration, require patient monitoring during and immediately after administration, have particular regulatory requirements restricting their use, and are generally expensive relative to other drugs.^[9]

Types of medicines

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For the digestive system

• Lower digestive tract:
  antidiarrhoeals, bile acid sequestrants, opioids
  .
• Upper
  cytoprotectants, prostaglandin analogues
  .

• Affecting
  beta-blockers, α blockers, calcium channel blockers
  , thiazide diuretics, loop diuretics, aldosterone inhibitors.
• Coagulation: anticoagulants, heparin, antiplatelet drugs, fibrinolytics, anti-hemophilic factors, haemostatic drugs.
• General: β-receptor blockers ("beta blockers"), calcium channel blockers, diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictors, vasodilators.
• hypolipidaemic agents
  .

For the central nervous system

Drugs affecting the

For pain

The main classes of painkillers are

Some anesthetics include benzodiazepines and barbiturates.

For musculoskeletal disorders

The main categories of drugs for

• Anti-allergy: mast cell inhibitors.
• Anti-fungal: imidazoles, polyenes
  .
• Anti-
  parasympathomimetics, prostaglandin agonists/prostaglandin inhibitors, nitroglycerin
  .
• corticosteroids
  .
• fluoroquinolones
  .
• Antiviral drugs
  .
• Diagnostic:
  cycloplegics
  .
• General: adrenergic neurone blocker, astringent.

For the ear, nose, and oropharynx

For the respiratory system

For endocrine problems

• Hormonal contraception.
• Ormeloxifene.
• Spermicide.

For obstetrics and gynecology

A euthanaticum is used for euthanasia and physician-assisted suicide. Euthanasia is not permitted by law in many countries, and consequently, medicines will not be licensed for this use in those countries.

Administration

A single drug may contain single or multiple active ingredients.

The administration is the process by which a patient takes medicine. There are three major categories of drug administration:

They can be administered in one dose, as a bolus. Administration frequencies^[12] are often abbreviated from Latin, such as every 8 hours reading Q8H from Quaque VIII Hora. The drug frequencies are often expressed as the number of times a drug is used per day (e.g., four times a day). It^[specify] may include event-related information (e.g., 1 hour before meals, in the morning, at bedtime), or complimentary to an interval, although equivalent expressions may have different implications (e.g., every 8 hours versus 3 times a day).^{[citation needed]}

Drug discovery

In the fields of medicine, biotechnology, and pharmacology, drug discovery is the process by which new drugs are discovered.^{[citation needed]}

Historically, drugs were discovered by identifying the active ingredient from traditional remedies or by

Drug Development Process

Discovery: The Drug Development process starts with Discovery, a process of identifying a new medicine.

Development: Chemicals extracted from natural products are used to make pills, capsules, or syrups for oral use. Injections for direct infusion into the blood drops for eyes or ears.

Preclinical research: Drugs go under laboratory or animal testing, to ensure that they can be used on Humans.

Clinical testing: The drug is used on people to confirm that it is safe to use.

FDA post-Market Review: The drug is reviewed and monitored by FDA for the safety once it is available to the public.

Regulation

The regulation of drugs varies by jurisdiction. In some countries, such as the United States, they are regulated at the national level by a single agency. In other jurisdictions, they are regulated at the state level, or at both state and national levels by various bodies, as is the case in Australia. The role of therapeutic goods regulation is designed mainly to protect the health and safety of the population. Regulation is aimed at ensuring the safety, quality, and efficacy of the therapeutic goods which are covered under the scope of the regulation. In most jurisdictions, therapeutic goods must be registered before they are allowed to be marketed. There is usually some degree of restriction on the availability of certain therapeutic goods depending on their risk to consumers.^{[citation needed]}

Depending upon the jurisdiction, drugs may be divided into over-the-counter drugs (OTC) which may be available without special restrictions, and prescription drugs, which must be prescribed by a licensed medical practitioner in accordance with medical guidelines due to the risk of adverse effects and contraindications. The precise distinction between OTC and prescription depends on the legal jurisdiction. A third category, "behind-the-counter" drugs, is implemented in some jurisdictions. These do not require a prescription, but must be kept in the dispensary, not visible to the public, and be sold only by a pharmacist or pharmacy technician. Doctors may also prescribe prescription drugs for off-label use – purposes which the drugs were not originally approved for by the regulatory agency. The Classification of Pharmaco-Therapeutic Referrals helps guide the referral process between pharmacists and doctors.

The International Narcotics Control Board of the United Nations imposes a world law of prohibition of certain drugs. They publish a lengthy list of chemicals and plants whose trade and consumption (where applicable) are forbidden. OTC drugs are sold without restriction as they are considered safe enough that most people will not hurt themselves accidentally by taking it as instructed.^[17] Many countries, such as the United Kingdom have a third category of "pharmacy medicines", which can be sold only in registered pharmacies by or under the supervision of a pharmacist.

Medical errors include over-prescription and polypharmacy, mis-prescription, contraindication and lack of detail in dosage and administration instructions. In 2000 the definition of a prescription error was studied using a Delphi method conference; the conference was motivated by ambiguity in what a prescription error is and a need to use a uniform definition in studies.^[18]

Drug pricing

In the UK, the Pharmaceutical Price Regulation Scheme is intended to ensure that the National Health Service is able to purchase drugs at reasonable prices. The prices are negotiated between the Department of Health, acting with the authority of Northern Ireland and the UK Government, and the representatives of the Pharmaceutical industry brands, the Association of the British Pharmaceutical Industry (ABPI). For 2017 this payment percentage set by the PPRS will be 4,75%.^[19]

Canada

In Canada, the Patented Medicine Prices Review Board examines drug pricing and determines if a price is excessive or not. In these circumstances, drug manufacturers must submit a proposed price to the appropriate regulatory agency. Furthermore, "the International Therapeutic Class Comparison Test is responsible for comparing the National Average Transaction Price of the patented drug product under review"^[20] different countries that the prices are being compared to are the following: France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States^[20]

Brazil

In Brazil, the prices are regulated through legislation under the name of Medicamento Genérico (generic drugs) since 1999.^[21]

India

In India, drug prices are regulated by the National Pharmaceutical Pricing Authority.

United States

In the United States, drug costs are partially unregulated, but instead are the result of negotiations between drug companies and insurance companies.^[22]

High prices have been attributed to monopolies given to manufacturers by the government.^[23] New drug development costs continue to rise as well. Despite the enormous advances in science and technology, the number of new blockbuster drugs approved by the government per billion dollars spent has halved every 9 years since 1950.^[24]

Blockbuster drug

A blockbuster drug is a drug that generates more than $1 billion in revenue for a pharmaceutical company in a single year.^[25] Cimetidine was the first drug ever to reach more than $1 billion a year in sales, thus making it the first blockbuster drug.^[26]

In the pharmaceutical industry, a blockbuster drug is one that achieves acceptance by prescribing physicians as a therapeutic standard for, most commonly, a highly prevalent chronic (rather than acute) condition. Patients often take the medicines for long periods.^[27]

History

Prescription drug history

Antibiotics first arrived on the medical scene in 1932 thanks to Gerhard Domagk;^[28] and were coined the "wonder drugs". The introduction of the sulfa drugs led to the mortality rate from pneumonia in the U.S. to drop from 0.2% each year to 0.05% by 1939.^[29] Antibiotics inhibit the growth or the metabolic activities of bacteria and other microorganisms by a chemical substance of microbial origin. Penicillin, introduced a few years later, provided a broader spectrum of activity compared to sulfa drugs and reduced side effects. Streptomycin, found in 1942, proved to be the first drug effective against the cause of tuberculosis and also came to be the best known of a long series of important antibiotics. A second generation of antibiotics was introduced in the 1940s: aureomycin and chloramphenicol. Aureomycin was the best known of the second generation.^{[citation needed]}

Lithium was discovered in the 19th century for nervous disorders and its possible mood-stabilizing or prophylactic effect; it was cheap and easily produced. As lithium fell out of favor in France, valpromide came into play. This antibiotic was the origin of the drug that eventually created the mood stabilizer category. Valpromide had distinct psychotrophic effects that were of benefit in both the treatment of acute manic states and in the maintenance treatment of manic depression illness. Psychotropics can either be sedative or stimulant; sedatives aim at damping down the extremes of behavior. Stimulants aim at restoring normality by increasing tone. Soon arose the notion of a tranquilizer which was quite different from any sedative or stimulant. The term tranquilizer took over the notions of sedatives and became the dominant term in the West through the 1980s. In Japan, during this time, the term tranquilizer produced the notion of a psyche-stabilizer and the term mood stabilizer vanished.^[30]

Premarin (conjugated estrogens, introduced in 1942) and Prempro (a combination estrogen-progestin pill, introduced in 1995) dominated the hormone replacement therapy (HRT) during the 1990s. HRT is not a life-saving drug, nor does it cure any disease. HRT has been prescribed to improve one's quality of life. Doctors prescribe estrogen for their older female patients both to treat short-term menopausal symptoms and to prevent long-term diseases. In the 1960s and early 1970s, more and more physicians began to prescribe estrogen for their female patients. between 1991 and 1999, Premarin was listed as the most popular prescription and best-selling drug in America.^[30]

The first oral contraceptive, Enovid, was approved by FDA in 1960. Oral contraceptives inhibit ovulation and so prevent conception. Enovid was known to be much more effective than alternatives including the condom and the diaphragm. As early as 1960, oral contraceptives were available in several different strengths by every manufacturer. In the 1980s and 1990s, an increasing number of options arose including, most recently, a new delivery system for the oral contraceptive via a transdermal patch. In 1982, a new version of the Pill was introduced, known as the "biphasic" pill. By 1985, a new triphasic pill was approved. Physicians began to think of the Pill as an excellent means of birth control for young women.^[30]

Stimulants such as Ritalin (methylphenidate) came to be pervasive tools for behavior management and modification in young children. Ritalin was first marketed in 1955 for narcolepsy; its potential users were middle-aged and the elderly. It was not until some time in the 1980s along with hyperactivity in children that Ritalin came onto the market. Medical use of methylphenidate is predominantly for symptoms of attention deficit/hyperactivity disorder (ADHD). Consumption of methylphenidate in the U.S. out-paced all other countries between 1991 and 1999. Significant growth in consumption was also evident in Canada, New Zealand, Australia, and Norway. Currently, 85% of the world's methylphenidate is consumed in America.^[30]

The first minor tranquilizer was Meprobamate. Only fourteen months after it was made available, meprobamate had become the country's largest-selling prescription drug. By 1957, meprobamate had become the fastest-growing drug in history. The popularity of meprobamate paved the way for Librium and Valium, two minor tranquilizers that belonged to a new chemical class of drugs called the benzodiazepines. These were drugs that worked chiefly as anti-anxiety agents and muscle relaxants. The first benzodiazepine was Librium. Three months after it was approved, Librium had become the most prescribed tranquilizer in the nation. Three years later, Valium hit the shelves and was ten times more effective as a muscle relaxant and anti-convulsant. Valium was the most versatile of the minor tranquilizers. Later came the widespread adoption of major tranquilizers such as chlorpromazine and the drug reserpine. In 1970, sales began to decline for Valium and Librium, but sales of new and improved tranquilizers, such as Xanax, introduced in 1981 for the newly created diagnosis of panic disorder, soared.^[30]

Mevacor (lovastatin) is the first and most influential statin in the American market. The 1991 launch of Pravachol (pravastatin), the second available in the United States, and the release of Zocor (simvastatin) made Mevacor no longer the only statin on the market. In 1998, Viagra was released as a treatment for erectile dysfunction.^[30]

Ancient pharmacology

Using plants and plant substances to treat all kinds of diseases and medical conditions is believed to date back to prehistoric medicine.^{[citation needed]}

The

For most of the 19th century, drugs were not highly effective, leading Oliver Wendell Holmes Sr. to famously comment in 1842 that "if all medicines in the world were thrown into the sea, it would be all the better for mankind and all the worse for the fishes".^[27]: 21

During the

In the 1950s, new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control.

Governments have been heavily involved in the regulation of drug development and drug sales. In the U.S., the

As of 2008, the United States is the leader in medical research, including pharmaceutical development. U.S. drug prices are among the highest in the world, and drug innovation is correspondingly high. In 2000, U.S.-based firms developed 29 of the 75 top-selling drugs; firms from the second-largest market, Japan, developed eight, and the United Kingdom contributed 10. France, which imposes price controls, developed three. Throughout the 1990s, outcomes were similar.^{[27]: 30–31}

Controversies

Controversies concerning pharmaceutical drugs include patient access to drugs under development and not yet approved, pricing, and environmental issues.

Access to unapproved drugs

Governments worldwide have created provisions for granting access to drugs prior to approval for patients who have exhausted all alternative treatment options and do not match clinical trial entry criteria. Often grouped under the labels of compassionate use, expanded access, or named patient supply, these programs are governed by rules which vary by country defining access criteria, data collection, promotion, and control of drug distribution.^[40]

Within the United States, pre-approval demand is generally met through

Patients who have not been able to get access to drugs in development have organized and advocated for greater access. In the United States, ACT UP formed in the 1980s, and eventually formed its Treatment Action Group in part to pressure the US government to put more resources into discovering treatments for AIDS and then to speed release of drugs that were under development.^[41]

The

In 2013, BioMarin Pharmaceutical was at the center of a high-profile debate regarding expanded access of cancer patients to experimental drugs.^[43][44]

Access to medicines and drug pricing

Essential medicines, as defined by the World Health Organization (WHO), are "those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford."^[45] Recent studies have found that most of the medicines on the WHO essential medicines list, outside of the field of HIV drugs, are not patented in the developing world, and that lack of widespread access to these medicines arise from issues fundamental to economic development – lack of infrastructure and poverty.^[46] Médecins Sans Frontières also runs a Campaign for Access to Essential Medicines campaign, which includes advocacy for greater resources to be devoted to currently untreatable diseases that primarily occur in the developing world. The Access to Medicine Index tracks how well pharmaceutical companies make their products available in the developing world.^{[citation needed]}

Some have raised ethical objections specifically with respect to pharmaceutical patents and the high prices for drugs that they enable their proprietors to charge, which poor people around the world, cannot afford.^[47][48] Critics also question the rationale that exclusive patent rights and the resulting high prices are required for pharmaceutical companies to recoup the large investments needed for research and development.^[47] One study concluded that marketing expenditures for new drugs often doubled the amount that was allocated for research and development.^[49] Other critics claim that patent settlements would be costly for consumers, the health care system, and state and federal governments because it would result in delaying access to lower cost generic medicines.^[50]

Pharmaceutical medications are commonly described as "ubiquitous" in nearly every type of environmental medium (i.e. lakes, rivers, streams, estuaries, seawater, and soil) worldwide.^{[52][53][54][55]} Their chemical components are typically present at relatively low concentrations in the ng/L to μg/L ranges.^[56][54] The primary avenue for medications reaching the environment are through the effluent of wastewater treatment plants, both from industrial plants during production, and from municipal plants after consumption.^[57] Agricultural pollution is another significant source derived from the prevalence of antibiotic use in livestock.^[56]

Scientists generally divide environmental impacts of a chemical into three primary categories: persistence, bioaccumulation, and toxicity.^[53] Since medications are inherently bio-active, most are naturally degradable in the environment, however they are classified as "pseudopersistent" because they are constantly being replenished from their sources.^[52] These Environmentally Persistent Pharmaceutical Pollutants (EPPPs) rarely reach toxic concentrations in the environment, however they have been known to bioaccumulate in some species.^[58] Their effects have been observed to compound gradually across food webs, rather than becoming acute, leading to their classification by the US Geological Survey as "Ecological Disrupting Compounds."^[52]

See also

References

External links

Wikimedia Commons has media related to Pharmaceutical drugs.

• Drug Reference Site Directory – OpenMD
• Drugs & Medications Directory – Curlie
• European Medicines Agency
• NHS Medicines A–Z
• U.S. Food & Drug Administration: Drugs
• WHO Model List of Essential Medicines