Helpful information about medicines

The 100 best proven medications are still not outdated and help better than others. Some medications also have serious side effects that patients should be aware of. All this will help you stay healthy. But doctors warn: do not self-medicate.

COLD

1. Arbidol - increases the antiviral activity of all body systems.

2. Ibupron is a strong pain reliever, it acts quickly, in the form of effervescent tablets it is gentle on the stomach, and in suppositories it is convenient for children.

3. Coldrex is an excellent vasoconstrictor drug. It works quickly because it is dissolved in hot water.

4. Nazol - relieves a runny nose and prevents the nasal mucosa from drying out, lasts 12 hours.

5. Nurofen - ambulance, works quickly. There are suppositories for babies, but they greatly worsen the quality of the blood.

6. Paracetamol (Panadol, Efferalgan) - an excellent antipyretic, indispensable for asthmatics.

7. Polyoxidonium - stimulates immune system, prescribed to children, suitable for emergency care and for prevention during an ARVI epidemic.

8. Ribomunil - restores immunity, recommended for children as the most effective remedy.

9. Sanorin is the fastest remedy for a runny nose with antiallergic components.

10. Flukol-B - cheap and effective drug, but contains 8% alcohol and is contraindicated for drivers.

LIVER

1. Antral is a domestic original drug, it has no analogues in the world, it protects liver cells from any microbial aggression.

2. Galstena - drops, an indispensable medicine for young children.

3. Lioliv - improves the condition of the liver in case of jaundice (low bilirubin).

4. Lipoferon - the drug is taken orally, it is 5 times cheaper than injectable interferons!

5. Potassium orotate - improves liver function, protein synthesis, and overall metabolism.

6. Silymarin - hexal. Herbal preparation. It contains much more active ingredient than its analogues: karsil, silybor, hepaben.

7. Cholenzym - choleretic inexpensive drug, helps digest food, improves enzyme production.

8. Holyver - choleretic drug of plant origin.

9. Hepel is a homeopathic German remedy without side effects.

10. Essentiale - for 20 years there has been no more effective drug for treating the liver.

STOMACH

1. Altan is a domestically produced herbal preparation, indispensable for peptic ulcers.

2. Acidin-pepsin. The drug increases acidity in the stomach.

3. Gastritol - drops of plant origin, good for babies.

4. Motilium - normalizes gastric motility, improves the movement of food through the stomach.

5. Sea buckthorn oil - reduces inflammatory processes in the stomach.

6. Pariet - from latest generation drugs that effectively reduce acidity in the stomach.

7. Pilobact is the newest remedy for Helicobacter.

8. Renorm - a domestic phytoconcentrate with a strong anti-inflammatory effect, normalizes digestion.

9. Riabal - relieves stomach cramps well, it is prescribed to children. Available in syrup and drops.

10. Phosphalugel is a gel that relieves heartburn attacks well and is less toxic than its analogues.

EYES

1. Zovirax is an eye ointment, indispensable for viral conjunctivitis.

2. Quinax is the best preventative for cataracts.

3. Korneregel is a gel that effectively restores the tear film on the cornea of ​​the eye.

4. Xalacom - it combines two drugs xalatan and timalol. They enhance each other's action.

5. Xalatan (travatan) - effective for glaucoma, you can drop it once a day.

6. Systane is an artificial tear, the advantage is that you can drop it once a day.

7. Uniclofen is a good non-steroidal anti-inflammatory drug in drops.

8. Floxal - drops, antibiotic, acts on a wide range of microorganisms.

9. Floxal ointment - indispensable for bacterial conjunctivitis.

10. Cycloxan is a strong antibiotic in drops, a panacea for acute conjunctivitis.

EARS

1. Amoxicillin is an antibiotic that actively fights the main pathogens that cause ENT diseases.

2. Clavicillin-Amoxicillin + clavulanic acid. In addition to microorganisms sensitive to amoxicillin, the drug also has an active effect on certain types of bacteria.

3. Otofa - ear drops, antibiotic is used for inflammatory diseases middle ear.

4. Otipax is a combination drug for local use with a pronounced analgesic and anti-inflammatory effect. The combination of phenazone and lidocaine reduces the time of onset of the anesthetic effect.

5. Nimesulide - has both analgesic, anti-inflammatory and antipyretic effects.

6. Noxprey - when administered through the nasal cavity, it causes a narrowing of the mucous membrane, reduces its swelling, as well as swelling around the mouths of the Eustachian tubes, improves drainage in case of eustachitis and otitis media.

7. Ciprofloxacin - effective local remedy for otitis, has an anti-inflammatory, antipruritic and vasoconstrictor effect, reduces swelling.

8. Cefaclor, cefixime, cefpodoxime, cefprozil, cefuroxime are second and third generation cephalosporins. They are prescribed to those who are not affected by ampicillin.

9. Edas-125 tonsillin - homeopathic drops, prescribed to children from 2 years of age for otitis, adenoids, chronic tonsillitis with water or on a piece of sugar.

10. Erythromycin - prescribed to those who are allergic to penicillin drugs.

NERVES

1. Venlaxor is an antidepressant with virtually no side effects and quickly relieves severe depression.

2. Busperon is a strong anti-anxiety drug that does not create the effect of inhibition. Can be used by drivers and students before the exam.

3. Gidazepam is a mild sleeping pill that does not affect the driver’s reaction. But you can get used to it - you can’t drink it for more than a month!

4. Zyprexa - has no serious side effects, provides immediate relief.

5. Imovan (sonap, somnol, sonavan) - the most modern sleeping pills.

6. Paxil - an antidepressant that effectively eliminates panic, fear, obsessive states (phobias), helps against anorexia, and also prolongs the course of sexual intercourse.

7. Pramestar - improves memory in general and simplifies the memorization of information.

8. Rispolept - long lasting, convenient - dissolves in the mouth like candy.

9. Sulpiride (eglanil) - simultaneously treats nerves and stomach. Another plus: I drank today - today is the result.

10. Finlepsin - treats seizures and neuritis, and also stabilizes mood.

KIDNEYS

1. Aksef is an antibiotic, convenient because it can be taken as tablets or injected. It is sold individually, complete with solvent.

2. Blemaren is the most effective dissolver of kidney stones.

3. Canephron is a herbal preparation without side effects.

4. Movalis - suppositories, a non-hormonal anti-inflammatory drug that does not irritate the rectal mucosa.

5. Nephrofit is a combined herbal medicine with anti-inflammatory and diuretic effects. Without side effects, prescribed to children over 5 years old and pregnant women.

6. Ofloxin is not aggressive to the stomach and rarely causes allergies.

7. Urosept - suppositories that act only on the urinary system.

8. Urolesan is a herbal preparation that removes sand well from the kidneys and is often prescribed to children. Available in syrup form.

9. Flemoklav solutab - a wide spectrum of antimicrobial action, recommended for weakened patients.

10. Ceftriaxone - antibiotic wide range actions with a minimum of side effects, approved for use even by pregnant women.

PROSTATE

1. Azitrox is an antibiotic, convenient - one tablet per week.

2. Gatifloxacin is the newest, fast-acting antibiotic.

3. Zoxon - gives a minimum of side effects, convenient - one tablet at night.

4. Penisten - reduces the volume of the prostate, reduces the risk of developing prostate cancer.

5. Prostamol UNO is a herbal preparation without side effects.

6. Prostatilen (Vitaprost) - extract from the prostate gland of cattle, biostimulant.

7. Proteflazide is a herbal immunostimulant, effective for prostatitis.

8. Focusin - does not lower blood pressure.

9. Funid is an antifungal drug of the latest generation.

10. Unidox Solutab is a broad-spectrum antibiotic that penetrates well into the prostate tissue.

JOINTS

1. Aspirin is indispensable for gout.

2. Alflutop - improves blood metabolism and activates metabolic processes in muscles.

3. Dona - strengthens cartilage tissue.

4. Dicloberl is a non-hormonal anti-inflammatory drug. They are used in suppositories, but injections can also be given.

5. Diclofen - has fewer side effects than others.

6. Diclofenac is effective, but affects the condition of the blood.

7. Ketanov is an effective injection drug.

8. Olfen - convenient because it is in suppositories; it does not harm the gastric mucosa.

9. Osteogenon is an effective chondoprotector that relieves joint laxity.

10. Retabolil - improves peripheral circulation.

THROAT

1. Anaferon is a good homeopathic remedy for treatment viral infections upper respiratory tract.

2. Kolustan is an aerosol that relieves swelling and inflammation well.

3. Lugol's dissolved in glycerin is the best external remedy for laryngitis.

4. Proposol-N - has pronounced antimicrobial and anti-inflammatory properties and does not have an irritating effect on the body.

5. Sinupret - has an antibacterial and anti-edematous effect, can be prescribed to children - available in the form of drops.

6. Tonsilgon is an anti-inflammatory and analgesic that helps reduce swelling of the mucous membrane of the respiratory tract.

7. Tonsilotren - increases the activity of the mucous membrane.

8. Flemoxin solutab is an effective instant antibiotic for purulent sore throat, used both internally and for rinsing.

9. Faringosept is an antiseptic that tastes good (dissolves in the mouth). Does not affect intestinal microflora.

10. Falimint - a product with a cooling effect for the treatment of diseases of the oral cavity and pharynx. Indispensable on the eve of operations, during dental prosthetics and for lecturers.

Attention! The effect of these medications depends on concomitant medications and other nuances of treatment.

Doctors warn: under no circumstances should you be treated without consulting a doctor!

BE HEALTHY!

Pharmacodynamics. Once again about homeostasis and the feedback mechanism. Pharmacological effect as a result of the interaction of a drug with cellular receptors. Basic principles of drug action. Most of the drugs we use either stimulate or inhibit biochemical processes occurring in cells, tissues, organs and systems, as well as in the body as a whole. Receptors and their types. Mechanisms of interaction of drugs with cellular receptors.

In the arsenal of a modern doctor there are more than thirty thousand drugs in various dosage forms. At the same time, several thousand diseases have already been described. The doctor must not only diagnose the disease, but also choose the medications that are used in its treatment, taking into account the numerous individual characteristics of the patient. It seems to us that only a computer can cope with such a complex task. However, doctors are capable of making the right choices, which means this is not an impossible task. Of course, only a qualified specialist can choose the right drug, but you can try to understand the basic principles that he applies when making his choice.

As mentioned briefly in the previous chapter, the effect of drugs on the body in pharmacology describes pharmacodynamics . The drug, accumulating in tissues in a certain concentration, causes changes in the biological functions of the body. Such changes are called effects, and they determine the scope of application of each specific drug.

Many drugs have the same mechanism of action and, therefore, can be grouped into groups and subgroups. The number of different pharmacological groups (subgroups) is limited to dozens. These groups are studied by a future doctor at the university. Of course, a deep understanding of the basics of pharmacology requires a lot of special knowledge and experience in the clinic. However, it is also useful for a non-specialist to try to understand at least the general principles of the action of drugs. When seeking medical help, this will increase the effectiveness of communication with the doctor. After all, on the one hand, the patient will understand the basics of the treatment process using drugs and the need for the participation of a specialist doctor in it. On the other hand, he will be able to more consciously conduct a dialogue with the doctor and, therefore, actively participate in the process of his healing. Let's try to figure out what happens inside us when we take medicine?

Let us remember how in fairy tales, at the touch of a magic wand, a living princess suddenly froze. Then all physiological processes in her body would have to stop. By examining a frozen body with the help of modern medical devices, we would be able to obtain confirmation of our knowledge acquired while reading the previous chapter; we would be convinced that the frozen body consists of organs and organ systems, which, in turn, are made of tissues, and tissues - from cells. So far, everything seems to be clear.

Now, with the help of the same magic wand, we will again revive the frozen organism of the princess. Touch... and all the cells, the tissues consisting of them and, after this, organs and systems come to life. The princess comes to life again. Each of the cells of the body begins to absorb from its environment (blood, lymph, other cells) nutrients and biologically active substances necessary to maintain life. The energy generated as a result of metabolism is spent by the cell to maintain its internal and ensure external activities. At the same time, the cell begins to release processed metabolic products into the surrounding space. Similar processes occur in tissues, organs and systems and in the body as a whole. Remember what a newly born baby does? He pees and immediately begins to search with his mouth for the nipple of the mother's breast in order to provide nutrition to his cells.

But what do physiological processes occurring at all levels have in common? Doesn't it surprise you that the cell always knows how much to secrete one enzyme to form the required amount of protein, and another to produce the required portion of carbohydrates. In the pancreas, the cells of the endocrine system “remember” what portion of insulin needs to be released into the blood so that it maintains a strictly defined glucose concentration. Where is this magician conductor in us who manages to control an infinite number of devices and maintain order at all levels? The ability of cells, tissues, organs and systems, as well as the body as a whole, not only to “remember” its normal condition, but also to maintain it over time, scientists called homeostasis . Homeostasis is also manifested in the fact that “smart” devices, embedded by nature in cells, tissues, organs and systems, as well as in the body as a whole, manage to ensure their normal functioning even under the influence of various external factors. True, the range of permissible values ​​at which they can perform their functions is limited both in magnitude and duration of action. This, however, does not detract from their natural uniqueness, and scientists continue to explore these devices, making new discoveries for themselves. Thanks to homeostasis, you and I can exist in different climatic zones, climb peaks and swim under water, endure various infections and recover from many diseases. What ultimately ensures homeostasis? Due to the feedback mechanism. It is inherent by nature in all cells, tissues, organs and systems, as well as in the body as a whole. Scientists have found that the orchestrator that ensures the coherence of the entire ensemble of biochemical processes that ensure the life of the cell and their stability is the set of chromosomes located in the cell nucleus. One of the tens of thousands of genes that make up the chromosomes is responsible for each biochemical process. The gene is inherited with the correct values ​​of the parameters of the physiological process occurring in the cell, and it constantly monitors their values. As soon as a gene begins to “feel” a change in the parameters it controls, it is activated and produces a control signal that inhibits or stimulates this process. As a result, the correct values ​​of the monitored parameters are restored.

An analogy to this process can be found by watching an instrumental ensemble play under the direction of a conductor. Listening to an orchestra, we enjoy the melody. At the same time, the conductor, with his trained ear, hears the playing of each of the instruments of the ensemble. And while this playing corresponds to the melody stored in the conductor’s memory, he does not react in any way to the playing musician. But when it detects false notes that distort the sound of the entire ensemble, it gives the musician a signal forcing him to play correctly, that is, to restore the correct values ​​of the melody parameters.

The feedback mechanism is inherent by nature in all physiological processes without exception, in which it is necessary to ensure the maintenance of parameter values ​​at genetically specified levels. There is a constant comparison of the value of the current signal with its genetically specified value. And, if these two parameters do not match, a control signal is generated and a process occurs that equalizes the values ​​of these two parameters. The feedback mechanisms created by nature through natural selection are quite perfect. However, if they are subjected to excessive stress, or act in conditions not typical for the given organism, malfunctions begin. They try, but cannot ensure the execution of the "conductor's" commands. As a result, cells, tissues, organs or systems begin to function abnormally and become ill. And if no action is taken, they will eventually die. The organism as a whole dies.

To ensure the coherent functioning of organs and systems, the human body is penetrated by various networks of signal information transmission. These include a network of nerve fibers that ensures the functioning of the central and peripheral nervous systems, as well as a network of vessels of the circulatory system, which is involved in regulation through the internal fluids of the body ( humoral regulation ). In particular, it allows the transmission of signals from the hormonal system. Control signals are transmitted through these networks using special intermediary substances. They are treated accordingly mediators And hormones .

Recognize current parameter values ​​in feedback mechanisms receptors - proteins embedded in cell surfaces cell membranes (). It is through them that the zones of the central nervous system monitor the areas of organs and systems under their control. For example, the nervous system regulates muscle contraction, causes constriction of the pupils or bronchi, and slows down the heart rate. Control influences are transmitted using one of the main mediators - acetylcholine . It reacts with receptors located on the cells of many organs and tissues. Another mediator - norepinephrine (working in tandem with acetylcholine) provide the ability to dilate the pupils, increase the number and strength of heart contractions.

Now let's look at a specific example of the effect of drugs on skeletal muscle. It is known that for skeletal muscle contraction on command central department In the nervous system, the neurotransmitter acetylcholine is released from the endings of the corresponding nerve cells, called motor neurons. It acts on skeletal muscle receptors, promoting the opening ion channels and causing the flow of sodium ions into the cell and the exit of potassium ions from the cell. In this case, depolarization occurs, which rolls in waves along the muscle fiber, causing it to contract.

Let us now assume that this system has ceased to function normally as a result of either insufficient production of the required transmitter, or a decrease in the number of receptors, or a decrease in their sensitivity. In all these cases, the signal to the muscle is weak and the strength of its contractions decreases. And, conversely, if too much mediator is released, the muscle begins to contract convulsively.

How can a pathological process be restored in a situation where the usual signals regulating cell activity are either insufficient or excessive? Of course, first the patient should undergo a thorough examination in the clinic and find out the most likely of the above causes of the pathology. The doctor will prescribe treatment, as a result of which the body will cope with the task itself. He has enough opportunities for this. But they are not unlimited. What should medications do in this case? It is easy to assume that when the signal is weak, they should enhance it (stimulate), and when it is strong, they should suppress it (inhibit).

Most of the drugs we use either stimulate or inhibit physiological processes occurring in cells, tissues, organs and systems, as well as in the body as a whole.

Now you and I must try to understand and remember that in the networks of nerve fibers and humoral regulation, different signals are transmitted through the same channels. Moreover, each mediator or hormone has its own receptor. Most often, receptors are those areas of cell membranes through which the nervous and endocrine systems regulate functions and metabolism. During evolution, cellular receptors have adapted to respond only to a certain type of mediator, hormone or biologically active substance of tissue origin ( prostaglandins , kinins and others). This specificity is ensured by the peculiarities of their structure (size, shape, charge of the macromolecule fragment) and location. So, cholinergic receptors can recognize and then bind only to acetylcholine, adrenergic receptors - with norepinephrine and adrenaline , histamine receptors - with histamine and so on. The ability of receptors to selectively react to the substances surrounding them makes it possible to select drugs that do not act on the entire body, but only on the areas responsible for the disease. As a result, certain changes occur in all such cells aimed at restoring the normal (as it was before the disease) functioning of the tissue, organ or entire organ system. For example, blood pressure decreases, pain subsides, swelling decreases, and so on. Modification of a drug's chemical structure can either increase or decrease its affinity for a particular receptor type and thereby alter therapeutic and toxic effects.

We have learned why, under the influence of drugs, no new biochemical reactions or physiological processes occur in the body. They only stimulate, imitate, inhibit or block the action of internal intermediaries that transmit signals through biological substrates between various organs and systems. The concept of biological substrate includes cell membrane receptors, enzymes , transport proteins that transport substances across cell membranes, cell ion channels and genes. All of them, in turn, are elements of the feedback mechanism. Each of the elements is involved in regulating cell functions and, therefore, can serve as a “target” for drugs. The activity of drugs is based on their physicochemical or chemical interaction with the listed substrates. The possibility of interaction of a drug with a biological substrate depends, first of all, on the chemical structure of each of them. The sequence of arrangement of atoms, the spatial configuration of the molecule, the magnitude and location of charges, and the mobility of molecular fragments relative to each other affect the strength of the bond and, thereby, the strength and duration of the pharmacological action.

In any reaction, a chemical bond is formed between a drug and a biological substrate. As you probably remember from your high school chemistry course, the bond between two different substances can be reversible or irreversible, temporary or permanent. It is formed due to electrostatic or van der Waals forces, hydrogen or hydrophobic interactions. Strong covalent bonds between a drug and a biological substrate are rare. For example, some antitumor agents Due to covalent interaction, neighboring helices are “crosslinked” DNA , which in this case is the substrate, and irreversibly damage it, causing the death of the tumor cell.

Of the two participants in the “drug + biological substrate” reaction, the first is usually well known; we know its structure and properties. About the second, we often know little or even nothing. Over the past 10-20 years, many structures and functions of various biological substrates responsible for certain processes in the body have been well studied. However, complete clarity is still very far away.

The drug molecule in most cases has a very small size compared to biological substrates, so it can only react with a small fragment of its macromolecule, which is the receptor for this drug.

It is important to note that interference by drugs in the physiological processes of the body, which ensure homeostasis through subtle feedback mechanisms, cannot remain without consequences. Therefore, the dose of the drug should be sufficient for recovery, but less than that which will destroy the feedback mechanism. It is the receptors that realize quantitative connections between dose medicine and its pharmacological action. The more sensitive the receptor is to a particular drug, the smaller the amount of drug needed to form a sufficient number of drug-receptor complexes, and total receptors of this type limits the maximum effect that a drug can have.

Recall that most receptors are proteins , representing a certain set amino acids . They provide the diversity and specificity of biological substrates necessary for the normal functioning of cells. Receptor proteins also include enzymes , which are catalysts for metabolic reactions. Many intracellular enzymes are drug targets. Medicines can inhibit or, less commonly, increase the activity of these enzymes, and also act as “false” substrates for them. For example, enzyme suppressors (inhibitors) are non-narcotic analgesics And nonsteroidal anti-inflammatory drugs , some anticancer drugs ( methotrexate), and a false substrate - methyldopa. Inhibitors angiotensin converting enzyme (captopril And enalapril), are widely used as blood pressure lowering agents ( hypotensive ) funds. By changing the activity of enzymes, drugs change intracellular processes and, thereby, ensure the development of a variety of therapeutic effects.

As we have already mentioned, transport proteins and ion channels of the cell, which are united by the general concept, can also serve as biological substrates for drugs. transport systems cells. Transport proteins are located on the cell membrane and transport ions and molecules against a concentration gradient, that is, from an area of ​​lower concentration to an area of ​​increased concentration. They play an important role in intracellular metabolism , delivering the substances it needs into the cell, they also participate in the development of the effect of drugs, transferring the drug molecule inside the cell. Often, as a result of the interaction of mediators or drugs with the receptor, with inside signal substances are formed or activated on the cell membrane. By influencing the activity of intracellular enzymes, they change the biochemical processes in the cell and, thus, its functionality. Such signaling substances are called secondary transmitters.

Ion channels are pores in the cell membrane that allow selective transport of ions into and out of the cell. Ions perform important work by changing the electrical potential and participating in various processes of transfer of substances and energy. Sodium, potassium, calcium, chlorine, and hydrogen ions play a special role in cell life. Some drugs can directly affect ion channels, while others, by interacting with cellular receptors, activate or depress (inhibit) the mechanisms that control the functioning of ion channels, and thus change their functioning. Ion channel blockers are, for example, local anesthetics. The mechanism of their action is that, penetrating into the cell, they close the sodium ion channels on the inside of the cell membrane and do not allow sodium ions to enter the cell. As a result, excitation is not transmitted along the nerve fiber, and the feeling of pain does not arise. At the same time, our consciousness does not turn off. Sodium channel blockers include many antiarrhythmic And anticonvulsants . A new class of antiulcer drugs, the first representative of which was omeprazole, also refers to blockers of ion (proton) channels. In this case, the release of hydrogen ions from the cell into the stomach cavity is regulated, where, interacting with chlorine ions, they form hydrochloric acid. Blockers and activators of calcium channels are widely used, changing the entry of calcium ions into the cell. Calcium takes part in many physiological processes, such as: muscle contraction, secretion, neuromuscular transmission, blood clotting and so on. Calcium channel blockers are such well-known cardiovascular drugs as verapamil, diltiazem, nifedipine and others.

Thus, the transfer of information into and out of the cell is carried out using a limited number of molecular mechanisms. Each of them is associated with a specific property of biological substrates capable of perceiving and transmitting various signals. Such substrates, as we have already mentioned, include receptors located on the cell membrane and inside the cell, enzymes, transport proteins and ion channels that generate, enhance, coordinate and complete the signaling process. Information received from signaling molecules (mediators, hormones and some others) forces cells to adjust their work: carry out the sent task or adapt to new conditions of existence. By imitating or blocking the work of mediators, hormones or other endogenous biologically active substances, drugs can also cause changes in the functions of cells, and, consequently, individual organs and their systems. If these changes were planned, then the effect will be therapeutic, but if they occur simultaneously, then this is a side effect of the drugs. We will talk about the side effects of drugs a little later in.

How is chemical information transferred across the cell membrane? There are four main mechanisms for such signaling (). They are distinguished by the way they overcome the barrier in the form of a cell membrane, which, as we already mentioned in the first chapter, is a two-layer lipid membrane.

The first mechanism (indicated by the number I on) - a lipid-soluble signaling molecule passes through the cell membrane and activates an intracellular receptor (for example, an enzyme). This is how nitric oxide works, through which the effect is realized nitrates , used to treat coronary heart disease. Intracellular receptors exist for a number of fat-soluble hormones ( glucocorticoids , mineralocorticoids , sex hormones , thyroid hormones ) and vitamin D. They stimulate transcription genes in the cell nucleus and thus the synthesis of new proteins. The mechanism of action of hormones, which consists in stimulating the synthesis of new proteins in the cell nucleus, explains the important features of their therapeutic effect. The effect of these drugs develops in the interval from half an hour to several hours - this is the time required for protein synthesis. Therefore, one should not expect a rapid change in the state of the body, for example, relief of symptoms during an attack of bronchial asthma. The effect of such drugs lasts from several hours to several days, when they are no longer in the body. This is due to the fact that the resulting proteins remain active in the cell for a long time, and therefore the effects of gene-active hormones disappear gradually.

The second mechanism of signal transmission through the cell membrane (indicated by number II on) is binding to cellular receptors that have extracellular and intracellular fragments (that is, transmembrane receptors). Such receptors are like intermediaries in the first stage of the action of insulin and a number of other hormones. The extracellular and intracellular parts of such receptors are connected by a polypeptide bridge passing through the cell membrane. The intracellular fragment has enzymatic activity, which increases when the signaling molecule binds to the receptor. Accordingly, the rate of intracellular reactions in which this fragment participates increases.

The next mechanism for transmitting information is the effect on receptors that regulate the opening or closing of ion channels (number III on). Natural signaling molecules that interact with such receptors include, in particular, acetylcholine , gamma-aminobutyric acid (GABA) , glycine , aspartate , glutamate and others that are mediators of various physiological processes. When binding to the receptor, the transmembrane conductivity of individual ions increases, which causes a change in the electrical potential of the cell membrane. For example, acetylcholine, interacting with cholinergic receptors, increases the entry of sodium ions into the cell and causes depolarization and muscle contraction. The interaction of gamma-aminobutyric acid with its receptor leads to an increase in the entry of chlorine ions into cells, increased polarization and the development of inhibition (suppression of the central nervous system). This signaling mechanism is characterized by the rapid development of the effect (milliseconds). Many of the drugs we'll talk about in the second part of the book work by mimicking or blocking the effects of neurotransmitters that regulate the flow of ions through channels in the cell membrane.

The fourth mechanism of transmembrane transmission of a chemical signal is realized through receptors that activate an intracellular secondary transmitter (number IV on). When interacting with such receptors, the process occurs in four stages and looks like this. The signaling molecule is recognized by a receptor on the surface of the cell membrane (first stage), and as a result of their interaction, the receptor activates second messengers on the inner surface of the membrane (second stage). The activated secondary messenger modulates (changes) the activity of the ion channel or enzyme (third stage), this leads to a change in the intracellular concentration of ions, or the activity of the corresponding enzyme (fourth stage), through which the effects are directly realized (metabolic and energy processes change). This mechanism for transmitting signal information makes it possible to strengthen the transmitted signal. Thus, if the interaction of the signaling molecule, norepinephrine, with the receptor lasts several milliseconds, then the activity of the secondary transmitter, to which the receptor relays the signal, persists for tens of seconds.

Secondary messengers are substances that are formed inside the cell and are important components of numerous intracellular biochemical reactions. The intensity and results of cell activity largely depend on their concentration. The most well-known second messengers are cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), calcium ions, diacylglycerol and inositol triphosphate.

What impacts can be realized with the participation of secondary intermediaries?

cAMP is involved in the mobilization of energy reserves (the breakdown of carbohydrates in the liver or triglycerides in fat cells), in water retention by the kidneys, in the normalization of calcium metabolism, in increasing the strength and frequency of heart contractions, in the formation of steroid hormones, in relaxation smooth muscles and so on.

Diacylglycerol, inositol triphosphate and calcium ions are involved in reactions that occur in cells when certain types of adrenergic and cholinergic receptors are excited.

cGMP is involved in the relaxation of vascular smooth muscles, stimulating the formation of nitric oxide in the vascular endothelium under the influence of acetylcholine and histamine. Through the formation of nitric oxide, a number of very effective drugs for the treatment of angina pectoris (nitrates) and correctors of erectile dysfunction (for example, the well-known drug Viagra) realize their effect.

So, there are signaling molecules (mediators, hormones, endogenous biologically active substances) and there are biological substrates with which these molecules interact, causing or modifying intracellular reactions. Drugs introduced into the body can reproduce the effects of natural signaling molecules, changing the processes regulating the functions of cells, tissues, organs and organ systems. The possible effect of the drugs depends on this.

Reproduction of action ("mimetic effect") is observed in cases where the drug substance and the natural signaling molecule have a very high correspondence physical and chemical properties, providing the same intracellular changes. The result of the interaction of the drug with the receptor in this case is the activation or inhibition of a certain cell function. Many analogues of hormones and mediators act in a similar way. The goal of creating such drugs is to obtain drugs with a more pronounced, stable and long-lasting effect compared to the mediator (adrenaline, acetylcholine, serotonin and others).

Competitive action (blocking or “lytic” effect) is common and is characteristic of drugs that are only partially similar to the signaling molecule (for example, a neurotransmitter). In this case, the drug is able to bind to one of the receptor sites, but it does not cause the entire complex of reactions that accompany the action of the natural mediator. Such a medicine, as it were, creates a protective screen over the receptor, blocking its interaction with the mediator, hormone, and so on. Competition for the receptor, called antagonism (hence the drugs - antagonists ), allows you to adjust physiological reactions. Adrenergic, anticholinergic and histaminolytic agents, some anticoagulants, antitumor and antimicrobial (bacteriostatic) drugs act in a similar way.

The next type of drug-receptor interaction is called non-competitive, and in this case the drug molecule binds to the receptor macromolecule not at the site of its interaction with the mediator, but at some other site. In this case, a change in the spatial structure of the receptor occurs, causing it to open or close to the mediator. In these cases, the drug does not interact directly with the receptor, that is, it does not imitate or block the action of the mediator. A striking example of drugs acting according to this type are benzodiazepines - a large group of structurally related compounds that have anxiolytic, hypnotic and anticonvulsant properties. By binding to specific benzodiazepine receptors, which are associated with gamma-aminobutyric acid receptors, they change the spatial configuration of the latter and increase the strength of their connection with gamma-aminobutyric acid. As a result, the inhibitory effect of this mediator on the central nervous system increases.

But it is not only physicochemical or chemical interaction with biological substrates that ensures the effect of drugs. Some drugs can increase or decrease the synthesis of endogenous regulators (mediators, hormones, etc.), or affect their accumulation in cells or in synapses .

Such effects will be discussed in more detail in the second part of the book, for example, in the chapter devoted to drugs affecting the functions of the central nervous system (in particular when considering antidepressants ).

The mechanism of action of drugs at the molecular and cellular levels is very important, but it is equally important to know what physiological processes the drug affects, that is, what its effects are at the systemic level. Take, for example, medications that lower blood pressure. The same result - lowering blood pressure - can be achieved in different ways:

Another example is coughing. If the cough is caused by inflammation of the respiratory tract, peripherally acting antitussives are prescribed, and they are often combined with expectorants. Cough in patients with tuberculosis is eliminated by centrally acting narcotic analgesics ( codeine). And, for example, in pediatric practice (for whooping cough), in severe cases, cough is treated by administering antipsychotic chlorpromazine(a drug Aminazine).

The choice of medication needed for a particular patient is made by the doctor, guided by knowledge of the mechanism of action of drugs and the therapeutic and side effects they cause. We hope that now it becomes clearer to you how difficult this choice is, and what knowledge and experience you need to have to make it correctly.

Since all organs and systems are in close relationship, then any changes in the function of one organ or system cause changes in the work of other organs and systems. This relationship manifests itself both at the physiological and biochemical levels, causing the complexity, ambiguity and versatility of the action of drugs. Thus, vasodilation and a decrease in blood pressure when taking nitroglycerin are accompanied by an increase in heart rate aimed at maintaining function. cardiovascular systems s. Increased pressure under the influence of adrenaline leads to increased breathing.

In addition, the interaction of drugs with biological substrates is greatly influenced by food intake, alcohol, the patient's age, simultaneous use of several drugs and other factors, the role of which is discussed in the following chapters.

Medicines, medicine, medicinal product, medicinal product – a substance and a set of substances of natural or synthetic origin in the form of a dosage form (solution, ointment, capsules, tablets, etc.) used for the diagnosis, prevention and treatment of diseases.

Before going on sale, medicines must undergo mandatory clinical trials and obtain permission for use.

List of medicinal products

A Acyclovir	B Biseptol Berodual Bioparox	IN		Duphaston
		Z	Ibuprofen
	Loperamide Longidaza	Milgamma Mydocalm Mexidol Mukaltin		Omeprazole
Paracetamol	RioFlora Immuno	Sinupret	T	U
Furazolidone Filtrum STI Flucanazole			H	Sh
Enterofuril Essentiale Forte

History of the drug

Even in ancient times, people tried to save their lives using various natural medicinal substances. In most cases, these are plant extracts, but preparations that were obtained from yeast, raw meat and animal waste have also been used. Many medicinal substances are available in readily available form in animal or plant materials, as a result of which medicine since ancient times has used a large number of medicinal products of animal and plant origin (for example, sea onion, opium, castor oil, known since the times of ancient Egypt; adonis, lily of the valley , foxglove, etc. were widely used in folk medicine). Only with the development of chemistry did people become convinced that the healing effect of such substances lies in the selective effect of certain chemical compounds on the body. Later, such compounds began to be obtained by synthesis in the laboratory.

The development of many scientific disciplines (physiology, anatomy and especially chemistry), as well as technological advances in the second half of the 19th century, made possible the synthesis large quantity substances that did not exist in this form or combination, but had a therapeutic effect (pyramidon, antipyrine, aspirin, plasmocide, and hundreds of others). They made it possible to study the properties of medicines, as well as to create new medicines through experimentation, which replaced various scientifically unsubstantiated theories that had previously dominated in medicine and treatment (Hahnemmann, Paracelsus and others).

German chemist and bacteriologist Paul Ehrlich is the founder of modern chemotherapy. At the end of the 19th century, he managed to create a theory of the use of chemical compounds to combat infectious diseases.

The raw materials for creating medicines are:

Animal raw materials – animal organs and glands, wax, lard, sheep wool fat, cod liver, etc.;

Plants (flowers, grass, leaves, roots, bark, fruits, seeds) and their processed products (essential and fatty oils, resins, gums, juices);

Fossil organic raw materials - products of distillation of coal, oil, as well as products of its distillation;

Inorganic minerals – mineral rocks, as well as products of their processing by metallurgy and the chemical industry;

All kinds of organic compounds represented by products of the large chemical industry.

Classification of drugs

There are several classifications based on different characteristics of drugs:

By origin – mineral, synthetic, natural;

By chemical structure (for example, compounds derivatives of imidazole, furfural, pyramidin, etc.);

By pharmacological group - the most common classification in our country, which is based on the effect of the drug on the human body;

Anatomical-therapeutic-chemical classification is an international classification that takes into account the pharmacological group of the drug, its chemical nature and the nosology of the disease for which the drug is used;

Nosological classification - according to the diseases for which the drug is used.

Study of drugs

Quantitative indicators of the drug:

Therapeutic dose;

Tolerable (tolerable) dose;

Lethal dose (usually calculated per 1 kg of person or live weight).

For many, tolerated doses are legitimized as maximum doses. The concept of “therapeutic index” is the ratio of the lethal dose to the therapeutic dose. The greater this ratio is, the more freely the specialist can prescribe the medicine.

Action of the medicine

Typically, the effect of drugs is carried out by changing the physicochemical properties of the environment where the cellular elements of the body are located. Moreover, the effect may be in the nature of a chemical combination of the drug with the elements of the body and sometimes with a direct effect on the protoplasm of cells, which is subsequently accompanied by their complete destruction.

The physiological effect of the action is either inhibition or stimulation of cellular elements. In this case, the dose of the medicine plays an important role, since the same medicine in different doses can provoke different effects - depress in large doses (up to paralysis) and excite in small doses.

An important point is the phase of action of the drug: some drugs can act during penetration into the body (for example, the entry phase according to Kravkov), others - during the period of maximum concentration in the human body (saturation phase), others - during a drop in concentration (exit phase ). Moreover, no less important is the ability of some types of drugs to cumulate, which manifests itself in a sharp increase, and in some cases, distortion of their action upon subsequent administration, which is explained by the accumulation of the drug in the body, as well as the accumulation of the effect of action.

It should also be noted that the effect of the drug largely depends on the state of health, gender, age and individual characteristics of the patient taking it. Many medications, when taken in reduced doses, can have stronger effects on children than they do on adults. Women during pregnancy, menstruation, and lactation react to medications differently than usual. The medicine has an abnormally strong effect on some people, which indicates an increased sensitivity of the body to specific substances.

Methods of application

Medicine can be introduced into the body in different ways. The medication is most often taken orally. To avoid irritation of the gastrointestinal tract and decomposition of the drug, or to achieve the greatest effect, the drug is injected under the skin using a syringe (intravenously or intramuscularly). Many medications are administered by inhalation or through the rectum.

External use of drugs is considered to be their application to the skin and to the mucous membranes of the nose, eyes, mouth, ears, genitourinary tract (up to the cerebral canal of the uterus and to the point of entry into the urinary tract), to the rectal mucosa (up to the location of the internal sphincter).

Medicines in the body change, chemical compounds with its liquids and layers are destroyed, lose their toxic properties (in some cases they acquire them). In both types, they are excreted from the human body through the kidneys, intestines, sweat glands, respiratory tract, etc.

Prescription and over-the-counter medications

A prescription for a medicinal product (in the generally accepted international classification it is not customary to use the word medicinal product, drug, but to use the concept medicinal product) is a written prescription of a medicinal product in the prescribed form, issued by a veterinarian or medical professional authorized to dispense the medicinal product or its production and vacations. Therefore, prescription drugs are drugs that are dispensed from pharmacies only with a prescription from a specialist. Over-the-counter drugs are drugs that are officially permitted to be sold without a doctor's prescription. The number of drugs that are allowed to be sold without a prescription, according to the Ministry of Health. But in August 2011, this document lost its force. As a result, today there is not a single legislatively approved procedure or document that would classify the drug as over-the-counter. For this reason, pharmacy employees are guided solely by the manufacturer’s instructions, which are printed on the packaging. The approximate ratio of prescription and over-the-counter drugs in pharmacies looks approximately 70 to 30. But today in the country there is a crisis in the “doctor-pharmacist-patient” system, which is expressed in the sale of officially prescription drugs (hormonal contraceptives, antibiotics, drugs for the cardiovascular system etc.) without a correctly executed prescription or, which is also often the case, without presenting one at all.

All this actually leads to the free sale of any medicines. Irrational use and uncontrolled use of drugs not only seriously endangers patients, but also leads to the spread of drug addiction, the formation of antibiotic-resistant strains of microorganisms and many other negative consequences.

Gradually, the state is tightening control over the circulation of medicines. For example, in June 2012, the Order of the Ministry of Health and Social Development came into force in Russia approving a new procedure for the sale of medicines that contain precursors, incl. codeine-containing painkillers, many of which were in high demand among the population. Since July 2012, in order to combat drug addiction, the above drugs have been dispensed using a special prescription form (148-1/u-88).

In our country, selling a drug without a prescription is punishable by a fine of 1-2 thousand rubles. If the situation repeats itself, inspectors can issue a protocol to the pharmacy organization, and the amount of the fine will increase to 40-50 thousand rubles.

Homeopathic medicines

In many countries around the world, these drugs are regulated variously as either “dietary supplements and products,” “drugs,” or “alternative medicines.” Today there is no established opinion of organizations agreed upon with national health authorities.

In our country homeopathic medicines fall under conventional drugs. In 2010, work began to review some types of drugs, including homeopathic ones.

Legislative regulation of medicinal products in the Russian Federation

The state regulates the circulation of medicines quite strictly. The main document regulating the circulation of medicines for 2011 is Federal Law No. 61-FZ “On the circulation of medicines” dated April 12, 2010. Subjects of drug circulation, in addition to the basic law, are subject to the laws “On the Protection of Consumer Rights”, “On Narcotic Drugs and Psychotropic Substances”, “On Licensing of Certain Types of Activities”, “On Social Services for Elderly Citizens and Disabled Persons”, etc.

The Medicines Act distinguishes between the concepts of “medicinal product” and “medicinal product”. According to the law, “medicine” is a general concept that can also include substances. In turn, drugs are medicines in the form of dosage forms used for diagnosis, treatment, disease prevention, rehabilitation, to prevent, maintain or terminate pregnancy.

Medicines used in Russia can be registered with Roszdravnadzor, which issues the state register of medicines.

The release of approved medicinal products must meet the requirements of GOST, which was adopted in 2010 and complies with the international GMP standard. By 2014, all pharmaceutical companies in the Russian Federation must switch to its requirements.

The sale of medicines is carried out only by pharmacy establishments (pharmacy kiosks, pharmacies) that have issued the appropriate license. Dietary supplements may be sold separately.

The circulation of medicinal products in our country is regulated by law, as well as by-laws, incl. regularly update the number of essential and life-saving medications, the list of narcotic drugs, etc.

Tax law

On the sale of many medicines, VAT in 2008 corresponds to ten percent (18% for dietary supplements). In Ukraine, they practice a refund of excise duty for the use of alcohol during the production of medicines, but only after their sale.

State quality control

In Russia, the quality of medicines is monitored by Roszdravnadzor, which is subordinate to the Ministry of Health. There are drug quality control centers in many large cities. Their main task is to check organizations selling medicines (compliance with sales and storage standards), as well as selective (total and in some individual regions) quality control. Based on information received from regional centers, Roszdravnadzor makes a decision to reject one or another drug.

Falsified and rejected medicines are subject to withdrawal from sale, information about them is published on the Roszdravnadzor website.

Narcotic drugs and their circulation

Narcotic drugs, according to regulatory documentation, are drugs and pharmaceutical substances that contain narcotic substances and are included in the list of narcotic drugs, psychotropic drugs, as well as their recourses, subject to strict control in accordance with current legislation and international treaties Russian Federation, incl. Single Convention on Narcotic Drugs.

From the list of narcotic drugs the following are directly related to drugs:

List II – psychotropic substances and narcotic drugs, the circulation of which is limited in Russia. Control is established in their respect in accordance with the current legislation and international treaties of the Russian Federation.

List III – psychotropic substances, the circulation of which is limited in Russia, for which certain control measures may be excluded, taking into account the current legislation of the Russian Federation and international treaties.

The state has the right to maintain a monopoly on the production of Schedule II narcotic drugs. All companies associated with the trafficking of psychotropic and narcotic substances must have a license. Pharmacies that have in their assortment drugs belonging to lists II and III must have a license to sell each list.

In addition to Rozdravnadzor, control over the circulation of narcotic drugs in our country is carried out by the Federal Service of the Russian Federation for Drug Control. Due to the fact that doctors are afraid of the development of addiction to narcotic drugs in patients and psychologically do not accept it, and also because of contradictory, confusing and changing legislation, they are wary of prescribing drugs even to those who need it.

Original “generics” and medicines

An original medicine is a drug that was previously unknown and first released for sale by the patent holder or the developer. Typically, the promotion and development of a new drug to markets is a long and expensive process. From many known compounds and those newly synthesized by searching, based on their properties and through computer modeling of biological (putative) activity, substances that are distinguished by maximum target activity are identified and synthesized. Upon completion of experiments on animals, if the result is positive, groups of volunteers are clinical trials. If effectiveness is confirmed with minor side effects, the medicine is sent into production. Based on additional tests, possible features of the action and undesirable effects are clarified. Often the most negative side effects are revealed during clinical use.

Today, almost all new drugs are patented. In most countries, patent legislation provides for patent protection of both the method of obtaining the drug and patent protection of the drug itself. The validity period of a patent for an invention in Russia may be extended by the federal body for a period calculated from the date of filing an application for the invention of a medicinal product until the date of receipt of the first permission for use, minus 5 years. Moreover, the period for which the patent is extended cannot be more than 5 years. Upon expiration of the patent, other manufacturers have the right to use and produce similar drugs (generic) on the market if they manage to prove the bioequivalence of the original and generic drugs. Moreover, the technology for producing a generic drug can be anything, the main thing is that it does not fall under patent protection. But at the same time, the manufacturer does not have the right to use the brand name, but only an international non-proprietary name or some kind of synonym, patented by him.

From a chemical point of view, the active substance of the generic and the original medicine is the same, but the production technology is different, and different degrees of purification are possible. There are other factors that affect the effectiveness of the drug.

For example, over the years, various companies have not been able to achieve exactly the same effect of acetylsalicylic acid as Bayer (the drug “aspirin”) for their generics. It turned out that the secret lay not only in the quality and purity of the raw materials, but also in the crystallization method, which provided unique, smaller crystals. But the opposite result cannot be ruled out, when a generic drug is more effective than the original medicine.

Counterfeit and falsification

The first officially registered case of detection of counterfeit medicine in Russia was recorded in 1998.

The concept of “falsified medicines” was introduced into the legislation of the Russian Federation in 2004. It is worth distinguishing between counterfeit medicines and falsification of medicines.

Counterfeit medicines are medicines that are manufactured without the permission of the patent holder.

Counterfeiting is a deliberate change in the recipe for the production of a medicinal product. Content reduction required substance or replacing expensive components with cheap ones. For example, replacing expensive cefazolit with cheaper penicillin (in this case, the drug will be less effective). In addition, other violations during production are possible: violations of the sequence and time of the technological process, poor-quality packaging materials, underestimation of the degree of purification, etc.

First of all, the effectiveness of a medicine is determined by the active substance. International law dictates that the composition and formula of the active substance cannot be a company secret. But for a certain period of time, other companies cannot produce this drug without the permission of the patent holder. Moreover, even after the expiration of the term, other companies cannot use original name drug that has been registered by the brand.

Our medical portal “site” contains information about medical devices, medicines, disinfectants, personal hygiene products and items, products and items used to care for sick people, newborn children and other medical products.

Fragment of the Ebers papyrus, which contains 877 drug recipes

Already in ancient times, people tried to save their lives using various natural medicinal substances. Most often these were plant extracts, but preparations were also used that were obtained from raw meat, yeast and animal waste. Some medicinal substances are available in easily accessible form in plant or animal raw materials, and therefore medicine has successfully used since ancient times a large number of drugs of plant and animal origin (for example, castor bean, opium, sea onion, known in ancient Egypt;, known ancient Hindus; foxglove, lily of the valley, adonis and many others, widely used traditional medicine). Only with the development of chemistry did people become convinced that the therapeutic effect of such substances lies in the selective effect of certain chemical compounds on the body. Later, such compounds began to be obtained in laboratories by synthesis.

Advances in technology and the development of a number of scientific disciplines (anatomy, physiology and especially chemistry) in the second half of the 19th century made it possible, firstly, to synthesize a significant amount of substances that did not exist in a given combination or form, but have a therapeutic effect (antipyrine, pyramidon, plasmocide, aspirin and hundreds of others), and, secondly, they made it possible to put the study of the action of drugs, as well as the search for new drugs, on the basis of a scientific experiment, which replaced the various scientifically unsubstantiated theories that had previously dominated in treatment and drug science (Paracelsus, Hahnemann, etc. ).

1. plants (leaves, herbs, flowers, seeds, berries, bark, roots) and their processed products (fatty and essential oils, juices, gums, resins);
2. animal raw materials - animal glands and organs, lard, wax, cod liver, sheep wool fat and more;
3. fossil organic raw materials - oil and its distillation products, coal distillation products;
4. inorganic minerals - mineral rocks and products of their processing by the chemical industry and metallurgy (metals);
5. all kinds of organic compounds are products of the large chemical industry.

Studying

Quantitative indicators for a drug are established: a lethal dose (usually calculated per 1 kg of live weight of an animal or person), a tolerable (tolerable) dose and a therapeutic dose. Tolerable doses (or slightly lower doses for caution) for many drugs are legalized in the form of maximum doses or so-called. higher techniques (see: Pharmacopoeia). The ratio of the lethal dose to the therapeutic dose is called the “therapeutic index” of the drug, since the higher this ratio, the more freely the drug can be prescribed.

Action

The action of drugs is carried out mainly by changing the physicochemical properties of the environment in which the cellular elements of the body are located; in this case, the effect may have the nature of a chemical combination of the drug with the elements of the body and, in some cases, with a direct effect on the protoplasm of cells, be accompanied by their complete destruction. The physiological effect of the drug is either stimulation or inhibition of the vital activity of cellular elements; In this case, the dose of the medicinal substance plays a huge role, since the same medicine in different doses can cause different effects - excite in small doses and depress (up to paralysis) in large doses.

An essential point is the phase of action of drugs: some drugs can manifest their effect at the moment of penetration into the body (entry phase according to Kravkov), others - the majority - during the period of maximum concentration in the body (saturation phase), others - at the moment of falling concentration (exit phase ); In this case, the ability of some drugs to cumulate is extremely important, manifested in a sharp increase and sometimes distortion of their action upon repeated administration, which is explained by the accumulation of the drug in the body and the accumulation of its effect.

The effect of the medicine depends on the age, type, health status and individual characteristics of the body of the person taking it. A number of drugs in a correspondingly reduced dose have a much stronger effect on children than on adults (often poisonous); women during menstruation, pregnancy, lactation react to medications differently than usual; For some people, the medicine has an abnormally strong effect, which is explained by the body’s increased sensitivity to certain substances (see: Idiosyncrasy).

Methods of application

The routes of drug administration into the body are very diverse. The most commonly used medication is taken orally. To avoid rapid decomposition of the drug or irritation of the gastrointestinal canal or to achieve the greatest speed of action, the drug is administered using a syringe under the skin - intramuscularly or intravenously. Some medications are given through the rectum or by inhalation.

External use of drugs is considered to be their application to the skin and mucous membranes of the eyes, nose, ears, oral cavity, genitourinary tract (to the point of entry into the bladder and to the cervical canal of the uterus), to the mucous membrane of the rectum (to the location of the internal sphincter) .

In the body, drugs are destroyed, changed and, entering into chemical compounds with its salts and liquids, lose their toxic properties (and sometimes, on the contrary, acquire them) and in one form or another are eliminated from the body through the intestines, kidneys, respiratory tract, sweat glands, etc.

Prescription and over-the-counter drugs

The state is gradually tightening control over the circulation of medicines. In particular, in June 2012, an order of the Ministry of Health and Social Development of the Russian Federation came into force establishing a new procedure for the dispensing of drugs containing precursors, including codeine-containing combination painkillers, most of which were popular among a large part of the population. In order to combat drug addiction, since July 2012, the above-mentioned drugs have been dispensed using prescription form 148-1/u-88.

In Russia, selling a drug without a prescription is punishable by a fine of 1-2 thousand rubles. If the situation repeats, the inspectors have the right to draw up a protocol for a legal entity, that is, a pharmacy organization, and in this case the amount of the fine increases many times - up to 40-50 thousand rubles.

Homeopathic medicines

In a number of countries, these products are regulated differently - either as “medicines”, or as “foods and supplements”, or as “alternative medicine”. Currently, there is no established opinion of international organizations on this matter, agreed upon with national health authorities.

In the Russian Federation, homeopathic medicines are subject to the same legislative regulation as conventional medicines. In 2010, work began to review the status of certain types of drugs, in particular homeopathic drugs.

Legislative regulation in the Russian Federation

The state regulates the circulation of medicines quite strictly. The main document regulating the circulation of medicines for 2011 is the Federal Law of April 12, 2010 No. 61-FZ “On the Circulation of Medicines” (adopted by the State Duma of the Federal Assembly of the Russian Federation on March 24, 2010). In addition to the basic law, subjects of drug circulation are subject to laws No. 3-FZ of 01/08/1998 “On narcotic drugs and psychotropic substances”, No. 2300-1 “On the protection of consumer rights”, No. 122-FZ of 08/02/1995 “On social services for elderly citizens and disabled people”, No. 128-FZ dated 08.08.2001 “On licensing of certain types of activities” and others.

The Law on Medicines distinguishes between the concepts of “medicinal product” and “medicinal product”. According to the law, “medicine” is a more general concept; drugs also include substances. Medicines are medicines in the form of dosage forms used for the prevention, diagnosis, treatment of disease, rehabilitation, for the preservation, prevention or termination of pregnancy. All medicines used on the territory of Russia must be registered with the appropriate authorized federal executive body - Roszdravnadzor, which maintains the state register of medicines.

The production of approved medicines must comply with the requirements of GOST, adopted in 2010. This GOST complies with the international GMP standard. All pharmaceutical enterprises in Russia are required to switch to the requirements of this GOST by 2014.

The sale of medicines (as opposed to dietary supplements) is carried out only by pharmacies (pharmacies, pharmacy kiosks) that have the appropriate license.

The circulation of medicines is regulated by law and regulations, including regularly updating the list of vital and essential medicines, etc.

Tax law

In Ukraine, there is a practice of refunding excise duty for the use of alcohol in the production of medicines, but only after their sale.

State quality control bodies

The quality of medicines in Russia is controlled by the Federal Service for Surveillance in Healthcare (Roszdravnadzor), subordinate to the Ministry of Health.

In most large cities of Russia there are quality control centers for medicines. Their main task is to check organizations selling medicines (compliance with numerous standards for the storage and sale of medicines), as well as selective (and in some regions, total) control of medicines. Based on data from regional centers, Roszdravnadzor makes decisions on rejecting a particular medicine.

In practice, everything looks a little different.

Firstly, the vast majority of quality control centers are not able to conduct complex chemical analysis. Microbiological studies are either not carried out at all or are carried out in a reduced volume. As a result, studies are often limited to assessing the appearance of the medicine (is there any unacceptable sediment, are the tablets cracked, is the packaging properly designed, is the label crooked, etc.).

Secondly, according to the current legislation in Russia, it is unacceptable to require additional analysis from the seller if the medicinal product already has a valid certificate of conformity.

Rejected and falsified medicines are subject to withdrawal from the pharmacy network; information about them is posted on the websites of Remedium and Roszdravnadzor.

Trafficking in narcotic drugs

According to regulatory documentation, narcotic drugs are medicinal products and pharmaceutical substances containing narcotic drugs and included in the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, in accordance with the legislation of the Russian Federation, international treaties of the Russian Federation, in including the Single Convention on Narcotic Drugs of 1961.

From the list of narcotic drugs the following are related to medicinal preparations:

• List II - narcotic drugs and psychotropic substances, the circulation of which in the Russian Federation is limited and in respect of which control measures are established in accordance with the legislation of the Russian Federation and international treaties of the Russian Federation
• List III - psychotropic substances, the circulation of which in the Russian Federation is limited and in respect of which certain control measures may be excluded in accordance with the legislation of the Russian Federation and international treaties of the Russian Federation

The state reserves a monopoly on the production of schedule II drugs. All enterprises associated with the trafficking of narcotic and psychotropic substances are subject to mandatory licensing. Pharmacies that stock drugs from lists II and III are required to have licenses to sell each list.

The control state body of enterprises related to the circulation of narcotic drugs, in addition to Roszdravnadzor, is the Federal Service of the Russian Federation for the Control of Drug Trafficking. Since many doctors fear the development of drug addiction in patients and psychologically do not accept it, due to confusing, as well as contradictory and frequently changing legislation, doctors are wary of prescribing narcotic drugs even to those people who need it.

Original medicines and “generics”

An original medicine is a drug that was previously unknown and was first released onto the market by the developer or patent holder. As a rule, the development and marketing of a new drug is a very expensive and lengthy process. From a variety of known compounds, as well as newly synthesized ones, substances with maximum target activity are identified and synthesized using the brute force method, based on databases of their properties and computer modeling of their expected biological activity. After animal experiments, in case of a positive result, limited clinical trials are carried out on groups of volunteers. If effectiveness is confirmed and side effects insignificant - the medicine goes into production, and based on the results of additional tests, possible features of the action are clarified and undesirable effects are identified. Often the most harmful side effects are revealed during clinical use.

Currently, almost all new drugs are patented. The patent legislation of most countries provides patent protection not only for the method of obtaining a new drug, but also for patent protection of the drug itself. In the Russian Federation, the validity period of a patent for an invention related to a medicinal product, the use of which requires obtaining permission in accordance with the procedure established by law, is extended by the federal executive body for intellectual property at the request of the patent holder for a period calculated from the date of filing the application for the invention until the date of receipt of the first such permits for use, minus five years. In this case, the period for which the validity of a patent for an invention is extended cannot exceed five years. After the patent expires, other manufacturers can reproduce and put on the market a similar drug (the so-called generic) if they prove the bioequivalence of the reproduced and original drugs. At the same time, the technology for producing a generic drug can be any, but not subject to the existing patent protection in the country. The generic manufacturer cannot use the brand name for this medicine, but only the international nonproprietary name (INN) or some new one patented by it (synonym).

From a chemical point of view, the active substance of the original medicine and the generic are the same, but the production technology is different, and different degrees of purification are possible. There are other factors that influence the effectiveness of the drug. For example, for a long time, different companies could not achieve the same effectiveness of acetylsalicylic acid for generics as Bayer, the manufacturer of the original drug “aspirin”. It turned out that the matter is not only in the purity of the raw materials, but also in the special method of crystallization, which results in special, smaller crystals. The opposite result is also possible, when the generic drug turns out to be more successful than the original medicine.

Falsification and counterfeiting

The pharmaceutical business is considered the third most profitable after the arms and drug trade. This attracts unscrupulous entrepreneurs to him. In Russia, until 1991, the problem of drug counterfeiting was practically absent.

Criticism

Large pharmaceutical companies pursue a policy of aggressive advertising of their products. Moreover, 85% of widely advertised new medical supplies have serious problems: they are not clinically tested, have incorrect dosages, they lack evidence of clinical effectiveness and data on side effects. Companies are investing in persuading doctors to prescribe their new drugs to patients (and this is where misinformation can occur) and in reassuring consumers that the products are effective and less likely to cause harm. At the same time, they often provide licensing authorities with incomplete clinical trial results that only partially meet the standards.

see also

Notes

1. Medicines // Small medical encyclopedia. - M.: Medical encyclopedia, 1991-1996.
2. "Medicines" //

Medicine, also called medicine, pharmaceutical drug or medicine, can be loosely defined as any chemical substance intended to be used for medical diagnosis to treat or prevent disease. The word pharmaceutical comes from the Greek word "Pharmakeia". The modern transliteration of the word is “pharmacy”.

... and ways to treat it. Contents of the article: Medicines against asthma Treatment of asthma with inhalers Steroids and other anti-inflammatory drugs drugs Bronchodilators in the treatment of asthma Nebulizers: home and portable Prednisone and asthma Asthma mitigation and self-care...

Classification

Drugs can be classified in various ways, such as by chemical properties, mode or route of administration, the biological system affected, or by their therapeutic effect. A well-developed and widely used classification system is the Anatomical Therapeutic Chemical (ATC) classification. The World Health Organization maintains a list of essential medicines.

Example of drug classification:

1. Antipyretics: reduction of temperature (fever/temperature)
2. Analgesics: pain relief (painkillers)
3. Antimalarial drugs: treatment of malaria
4. Antibiotics: suppression of microbial growth
5. Antiseptics: Prevent the spread of germs near burns, cuts and wounds.

Types of medications (types of pharmacotherapy)

For the gastrointestinal tract (digestive system)

• Upper gastrointestinal tract: antacids, reflux suppressants, carminatives, antidopaminergics, proton pump inhibitors, H2-histamine receptor blockers, cytoprotectors, prostaglandin analogues.
• Lower digestive tract: laxatives, antispasmodics, antidiarrheals, bile acid sequestrants, opioids.

For the cardiovascular system

• General: beta-blockers, calcium antagonists, diuretics, cardiac glycosides, antiarrhythmic drugs, nitrates, antianginal drugs, vasoconstriction and vasodilation drugs, peripheral activators.
• Affecting blood pressure (antihypertensive drugs): ACE inhibitors, angiotensin receptor blockers, alpha blockers, calcium antagonists.
• Blood coagulation: anticoagulants, heparin, antithrombotics, fibrinolytics, blood clotting factor drugs, hemostatic drugs.
• Atherosclerosis/cholesterol inhibitors: lipid-lowering agents, statins.

For the central nervous system

Drugs affecting the central nervous system include: hypnotics, anesthetics, antipsychotics, antidepressants (including tricyclic antidepressants, MAO inhibitors, lithium salts and selective serotonin reuptake inhibitors (SSRIs)), antiemetics, anticonvulsants/antiepileptics , anxiolytics, barbiturates, anti-movement disorder drugs (e.g. Parkinson's disease), stimulants (including amphetamines), benzodiazepines, cyclopyrolone, dopamine antagonists, antihistamines, cholinergics, anticholinergics, emetics, cannabinoids, 5-HT (serotonin) antagonists.

For pain and consciousness (analgesics)

The main classes of painkillers are NSAIDs, opioids and various orphan drugs such as paracetamol.

For musculoskeletal disorders

The main categories of drugs for musculoskeletal disorders are: NSAIDs (including COX-2 selective inhibitors), muscle relaxants, neuromuscular drugs and acetylcholinesterase inhibitors.

For eyes

• General: neuronal blockers, astringent, eye lubricants.
• Diagnostic: topical anesthetics, sympathomimetics, parasympatholytics, mydriatic and cycloplegic drugs.
• Antibacterial: antibiotics, local antibiotics, sulfa drugs, fluoroquinolones.
• Antifungals: imidazoles, polyenes
• Anti-inflammatory: NSAIDs, corticosteroids
• Antiallergic: mast cell inhibitors
• Against glaucoma: adrenergic agonists, beta blockers, carbonic anhydrase and tonicity inhibitors, cholinergic receptors, miotic and parasympathomimetic drugs, prostaglandin inhibitors, nitroglycerin.

For the ear, nose and nasopharynx

Sympathomimetics, antihistamines, anticholinergics, NSAIDs, steroids, antiseptics, local anesthetics, antifungals, cerumenolytes.

For the respiratory system

Bronchodilators, NSAIDs, antiallergic drugs, antitussives, mucolytics, anticongestants, corticosteroids, beta-2 antagonists, anticholinergics, steroids.

For endocrine problems

Androgens, antiandrogens, gonadotropin, corticosteroids, human growth hormone, insulin, antidiabetic agents (sulfonylureas, biguanides/metformins, thiazolidinediones, insulin), thyroid hormones, antithyroid drugs, calcitonin, diphosphonate, vasopressin analogues.

For the genitourinary system

Antifungals, alkalization agents, quinolones, antibiotics, cholinergics, anticholinergics, acetylcholinesterase inhibitors, antispasmodics, 5-alpha reductases, selective alpha-1 blockers, sildenafil, drugs to restore fertility.

For contraception

Hormonal contraception, ormeloxifene, spermicides.

NSAIDs, anticholinergics, hemostatic drugs, antifibrinolytics, hormone replacement therapy (HRT), bone regulators, beta-receptor agonists, follicle-stimulating hormone, luteinizing hormone, GnRH.

Harmolenic acid, gonadotropin release inhibitor, progestogens, dopamine agonists, estrogens, prostaglandins, gonadorelin, clomiphene, tamoxifen, diethylstilbestrol.

For skin

Emollients, anti-itch, antifungal, disinfectants, lice preparations, tar preparations, vitamin A derivatives, vitamin D analogues, keratolytics, abrasives, systemic antibiotics, local antibiotics, hormones, exfoliants, fibrinolytics, proteolytics, sunscreens, antiperspirants, corticosteroids.

Against infections and infestations

Antibiotics, antifungal drugs, antigranulomatous drugs, antituberculosis, antimalarial, antiviral, antiprotozoal, antimoebic drugs, anthelmintics.

For the immune system

Vaccines, immunoglobulins, immunosuppressants, interferons, monoclonal antibodies.

For allergic diseases

Antiallergic drugs, antihistamines, NSAIDs.

For food

Tonics, electrolytes and mineral preparations (including iron and magnesium preparations), parental nutritional supplements, vitamins, drugs for the treatment of obesity, anabolics, hematopoietic drugs, medicinal food products.

For tumor disorders

Cytotoxic drugs, therapeutic antibodies, sex hormones, aromatase inhibitors, somatostatin inhibitors, recombinant interleukins, G-CSF, erythropoietin.

For diagnostics

Contrast agents

For euthanasia

Euthanaticum is used for euthanasia and voluntary physician-assisted suicide. In many countries, euthanasia is illegal and therefore drugs for such use will not be licensed in many countries.

Use of drugs

Application is the entry of the medicine into the patient's body. The drug can be formulated in various dosage forms such as pills, tablets or capsules. There are also different options for taking medications, including intravenous (into the bloodstream through a vein) or taken orally (by mouth). They can be consumed once as a bolus; at regular intervals or continuously. The frequency of use is often abbreviated from Latin, for example “ every 8 hours" will be read as Q8H from Quaque VIII Hora.

Legal issues

Depending on the law, drugs can be divided into over-the-counter drugs (available without any restrictions) and prescription drugs (which can only be prescribed by a medical practitioner). The exact division between these two types of drugs depends on the current legislation.

In some legislation, there is a third category, drugs sold “over the counter”. You do not need a prescription to purchase them, but they must be kept in the pharmacy out of sight of customers and can only be sold by a pharmacist. Doctors may also prescribe prescription drugs off-label for purposes for which the drugs were not originally approved by regulatory authorities. The classification of pharmacotherapeutic areas helps to carry out the process of interaction between pharmacists and doctors.

The International Narcotics Control Board in the United States imposes a worldwide ban on certain drugs. They publish a long list of substances and plants whose trade and consumption (where possible) is prohibited. Over-the-counter drugs are sold without restrictions because they are considered safe enough that most people will not harm themselves by accidentally taking it as directed. In many countries, such as the UK, there is a third category of medicines that can only be sold in registered pharmacies or under the supervision of a pharmacist.

For patented drugs, countries may have certain mandatory licensing programs that, in some situations, force the drug owner to contract with other agents to manufacture the drug. Such programs may deal with unexpected shortages of a drug in the event of a serious disease epidemic, or may be part of an effort to ensure that drugs for a disease, such as AIDS, are available in countries that cannot afford to purchase them at owner's cost. .

Prescription

Prescription drugs are considered such because they can cause side effects and should not be used unnecessarily. Medical guidelines and clinical trials required for drug approval are used to better inform physician prescribing of these drugs, but errors may occur. Reasons such as interactions or side effects that prevent medications from being prescribed are called contraindications.

Errors also include overprescribing or abuse of various medications, erroneous prescribing, contraindications and lack of detailed information on dosage and instructions for use. In 2000, the definition of misprescription was studied at a conference using the Delphi method, the conference was prompted by the ambiguity of what it means to be misprescribed and the need for a uniform definition to be used in scientific papers.

Drug development

Development is the process of creating a drug. Medicines may be extracts from natural products (pharmacognosy) or may be synthesized through chemical processes. The active ingredient of the drug is combined with its “ vehicle", such as a capsule, cream, or liquid that will be applied in a specific manner of application. Child-friendly packaging will likely be used in the final product sold to consumers.

Medicines - blockbusters

A blockbuster drug is a drug that generates more than $1 billion in revenue for its owner annually.

It is estimated that about one-third of the pharmaceutical market, when drug costs are taken into account, is made up of blockbusters. About 125 titles are blockbusters. The leader was Lipitor, a cholesterol-lowering drug launched by Pfizer with sales of $12.5 billion.

In 2009, there were a total of seven new blockbuster drugs, with total sales of $9.8 billion.

Beyond this purely arbitrary financial consideration, “in the pharmaceutical industry, a blockbuster drug is one that achieves acceptance by physicians as a therapeutic standard, most often for widespread chronic (rather than acute) conditions. Patients often take the drug for a long time.”

Enovid birth control pills were the first modern medicine to be taken by those who were not sick for a long time. The emphasis on highly cost-effective drugs for long-term treatment, which has led to a decline in the importance of single-use drugs for acute conditions, has led to periodic shortages of antibiotics or vaccines, such as the shortage of influenza vaccine in the United States.

Leading blockbuster drugs

A drug	Tradename	Application	Company	Sales (billions of dollars/year)*
Atorvastatin		Hypercholesterolemia
Clopidogrel		Atherosclerosis	Bristol-Myers Squibb Sanofi
Fluticasone/salmeterol
Esomeprazole		Gastroesophageal reflux disease
Rosuvastatin		Hypercholesterolemia
Quetiapine
Etanercept		Rheumatoid arthritis	Amgen Pfizer
Infliximab		Crohn's disease, rheumatoid arthritis	Johnson & Johnson
Olanzapine		Schizophrenia

Environmental impact

Since the 1990s, water pollution from pharmaceuticals has become an environmental problem of concern. Most drugs enter the environment through human consumption and excretion, and are often poorly filtered in wastewater treatment plants that are not designed for such treatment. Once in water, they may have various, minor effects on organisms, although research is limited.

Pharmaceutical substances can also enter the environment due to improper storage, fertilizer runoff, renovated irrigation systems, and leaking sewers. In 2009, an Associated Press investigative report concluded that U.S. manufacturers legally dumped 271 million pounds of pharmaceuticals into the environment, 92% of which were the antiseptic phenol and hydrogen peroxide. The report was unable to distinguish which drugs were released into the environment by manufacturers and which by the pharmaceutical industry. It also found that approximately 250 million pounds of medications and contaminated packaging were discarded by hospitals and long-term care facilities.

Pharmacological protection environment is a branch of pharmacology and a form of pharmacovigilance that deals with the study of the release of chemicals or drugs into the environment after treatment in humans and animals. She deals especially with those pharmacological substances that have an impact on the environment after being eliminated from living organisms following pharmacotherapy.

Environmental pharmacology deals with the study of exposure to chemicals or medicinal substances into the environment by any means and in any concentrations, subsequently disturbing the balance of ecosystems. Environmental pharmacology is a broad term that includes studies of the effects of household chemicals, regardless of dose and route of entry into the environment.

Ecopharmacovigilance is the science and activity concerned with detecting, assessing, understanding and preventing the adverse effects of drugs on the environment. This is close to the WHO definition of pharmacovigilance - the science aimed at eliminating any side effects of drugs in humans after use.

The term "persistent pharmaceutical environmental pollutants" was proposed in the 2010 Pharmaceuticals and the Environment nominations as an issue raised by the Strategic Office for International Chemicals Management of the International Society of Environmental Doctors.

Story

Ancient pharmacology

The use of plants and plant substances to treat all types of diseases is believed to date back to prehistoric medicine.

The Kahuna Gynecological Papyrus, the oldest known medical text, dates back to approximately 1800 BC. and represents the first recorded use of drugs of various kinds. It and other medical papyri describe ancient Egyptian medical practices, such as the use of honey to treat infections.

The medicine of ancient Babylon demonstrates the use of prescriptions in the first half of the 2nd millennium BC. Medicinal creams and pills were used as treatment.

In the Indian subcontinent, the Atharva Veda, a sacred text of Hinduism that mainly dates back to the 2nd millennium BC. (although the hymns recorded in it are considered to be more ancient), is the first Indian text dealing with medicine. It describes herbal medicines to combat diseases. The earliest foundations of Ayurveda were built on a synthesis of ancient selected herbal practices, together with a large addition of theoretical concepts, new nosologies and new forms of therapy, dating from about 400 BC. Students of Ayurveda were required to know ten disciplines that were essential in the preparation and administration of drugs: distillation, operational skills, cooking, horticulture, metallurgy, sugar production, pharmaceutical arts, analysis and separation of minerals, mixing of metals and preparation of alkalis.

The Hippocratic Oath for doctors, dating back to the 5th century BC, speaks of the existence of “deadly drugs,” and ancient Greek doctors imported drugs from Egypt and other countries.

The first pharmacies were established in Baghdad in the 8th century AD. The injection syringe was invented by Ammar ibn Ali al-Mausili in the 9th century in Iraq. Al-Kindi, in his book De Grabidus, written in the 9th century AD, developed a mathematical scale to quantify the potency of drugs.

The Canon of Medicine, written by Ibn Sina (Avicenna), considered the father of modern medicine, reports 800 proven medicines at the time of its writing in 1025 AD. Ibn Sina's contributions included the separation of medicine from pharmacology, which was important for the development of pharmacological sciences. At least 2,000 medicinal and chemical substances were known to Islamic medicine.

Medieval pharmacology

Medieval medicine saw advantages in the field of surgery, but other than opium and quinine there were few truly effective drugs. Traditional treatments and potentially toxic metal compounds were popular treatment options. Teodorico Borgognoni (1205-1296) was one of the most important surgeons of the medieval period, he introduced and disseminated important surgical innovations, including basic antiseptic standards and the use of anesthetic agents. García de Otra described some of the herbal treatments used at that time.

Modern pharmacology

For much of the 19th century, medicines were not very effective, as Sir Oliver Holmes reflected in 1842 when he commented: “if all the medicines in the world were thrown into the sea, it would be better for all mankind and worse for all the fish.”

During World War I, Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with douching and a germicide that helped prevent gangrene.

During the interwar period the first antibacterial drugs, such as sulfa antibiotics. World War II saw the introduction of widespread and effective antimicrobial treatment due to the development and mass production of penicillin antibiotics. This was made possible by the pressures of war and the collaboration of British scientists with the American pharmaceutical industry.

Drugs commonly used in the late 1920s included aspirin, codeine, and morphine as painkillers; digoxin, nitroglycerin and quinine for heart disease and insulin for diabetes. Other drugs included antitoxins, several biological vaccines, and several synthetic drugs.

In the 1930s, antibiotics appeared: first sulfonamides, then penicillin and other antibiotics. Medicines increasingly found themselves at the center of medical practice.

In the 1950s, other drugs emerged such as corticosteroids for inflammation, rauwolfia alkaloids as a sedative and antihypertensive, antihistamines for allergic rhinitis, xanthines for asthma, and typical antipsychotics for psychosis.

By 2008, thousands of approved drugs had been developed. Increasingly, biotechnology is being used to discover biopharmaceuticals. Recently, interdisciplinary approaches have received a huge amount of new data for the development of new antibiotics and antibacterial agents, and for the use of biological agents in antibacterial therapy.

In the 1950s, new psychotropic drugs, especially the antipsychotic chlorpromazine, were developed in laboratories and gradually became widely used. Although they were considered progressive in many ways, there were also some objections due to serious side effects such as tardive dyskinesia. Patients often objected to psychiatrists and refused or stopped taking these medications when psychiatric supervision was not provided.

Governments have been active in regulating drug development and sales. In the United States, the “Elixir Sulfanilamide disaster” led to the creation of the Food and Drug Administration, and in 1938 the Federal Food, Drug, and Cosmetic Act required manufacturers to provide documentation for new drugs. In 1951, the Humphrey-Durham Amendment required certain drugs to be sold by prescription. A subsequent change in 1962 required that new drugs be tested for effectiveness and safety in clinical trials.

Until the 1970s, drug prices were not a major concern for doctors and patients. But when they began to prescribe more drugs for chronic diseases, costs became burdensome, and by the 1970s, every state in the United States required or recommended substitution of generic drugs for more expensive brands of drugs. This also led to the passage of the US Law in 2006. medical care, Part D”, which proposes that its coverage should apply to drugs.

In 2008, the United States became a leader in medical research, including pharmaceutical development. The US has some of the highest drug prices in the world and, accordingly, drug innovation is quite high. In 2000, firms based in the United States developed 29 of the 75 best-selling drugs; firms in the second largest market, Japan, developed 8, and firms in the UK - 10. France, with its strict pricing policy, developed three. Throughout the 1990s, the results were similar.