Pharmaceutical drug

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"Medication" redirects here. For other uses, see Medication (disambiguation).

A pharmaceutical drug, also referred to as medicine or medicament, can be loosely defined as any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.^[1]^[2] Other synonyms include pharmacotherapy, pharmacotherapeutics, and drug treatment.

[edit] Classification

Medications can be classified in various ways^[3], such as by chemical properties, mode of administration, biological system affected, or therapeutic effects. An elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System (ATC system). The World Health Organization keeps a list of essential medicines.

A sampling of classes of medicine includes:

Antipyretics: reducing fever (pyrexia/pyresis)
Analgesics: painkillers
Antimalarial drugs: treating malaria
Antibiotics: inhibiting germ growth
Antiseptics: prevention of germ growth near burns, cuts and wounds

[edit] Types of medications (type of pharmacotherapy)

[edit] For the gastrointestinal tract or digestive system

Upper digestive tract: antacids, reflux suppressants, antiflatulents, antidopaminergics, proton pump inhibitors, H2-receptor antagonists, cytoprotectants, prostaglandin analogues
Lower digestive tract: laxatives, antispasmodics, antidiarrhoeals, bile acid sequestrants, opioid...gatartic drugs

[edit] For the cardiovascular system

General: beta-receptor blocker or beta blocker, calcium channel blockers, diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictor, vasodilator, peripheral activator
Affecting Blood pressure: ACE inhibitors, angiotensin receptor blockers, alpha blocker
Coagulation: anticoagulant, heparin, antiplatelet drug, fibrinolytic, anti-hemophilic factor, haemostatic drugs
Atherosclerosis/cholesterol agents: hypolipidaemic agents, statins.

[edit] For the central nervous system

[edit] For pain & consciousness (analgesic drugs)

Further information: Analgesic

The main classes of painkillers are NSAIDs, opioids and various orphans such as paracetamol, tricyclic antidepressants and anticonvulsants.

[edit] For musculo-skeletal disorders

NSAIDs (including COX-2 selective inhibitors), muscle relaxant, neuromuscular drug
anticholinesterase

[edit] For the eye

General: adrenergic neurone blocker, astringent, ocular lubricant
Diagnostic: topical anesthetics, sympathomimetics, parasympatholytics, mydriatics, cycloplegics
Anti-bacterial: antibiotics, topical antibiotics, sulfa drugs, aminoglycosides, fluoroquinolones
Anti-viral:
Anti-fungal: imidazoles, polyenes
Anti-inflammatory: NSAIDs, corticosteroids
Anti-allergy: mast cell inhibitors
Anti-glaucoma: adrenergic agonists, beta-blockers, carbonic anhydrase inhibitors/hyperosmotics, cholinergics, miotics, parasympathomimetics, prostaglandin agonists/prostaglandin inhibitors. nitroglycerin

[edit] For contraception

[edit] For obstetrics and gynecology

NSAIDs, anticholinergic, haemostatic drug, antifibrinolytic, Hormone Replacement Therapy, bone regulator, beta-receptor agonist, follicle stimulating hormone, luteinising hormone, LHRH
gamolenic acid, gonadotropin release inhibitor, progestogen, dopamine agonist, oestrogen, prostaglandin, gonadorelin, clomiphene, tamoxifen, Diethylstilbestrol

[edit] For the skin

emollient, anti-pruritic, antifungal, disinfectant, scabicide, pediculicide, tar products, vitamin A derivatives, vitamin D analogue, keratolytic, abrasive, systemic antibiotic, topical antibiotic, hormones, desloughing agent, exudate absorbent, fibrinolytic, proteolytic, sunscreen, antiperspirant, corticosteroid

[edit] For infections and infestations

antibiotic, antifungal, antileprotic, antituberculous drug, antimalarial, anthelmintic, amoebicide, antiviral, antiprotozoal

[edit] For immunology

vaccine, immunoglobulin, immunosuppressant, interferon, monoclonal antibody

[edit] For allergic disorders

anti-allergic, antihistamine, NSAIDs

[edit] For nutrition

tonic, iron preparation, electrolyte, parenteral nutritional supplement, vitamins, anti-obesity drug, anabolic drug, haematopoietic drug, food product drug

[edit] For neoplastic disorders

cytotoxic drug, therapeutic antibody, sex hormones, aromatase inhibitor, somatostatin inhibitor, recombinant interleukins, G-CSF, erythropoietin

[edit] For diagnostics

contrast media

[edit] For euthanasia

An euthanaticum is used for euthanasia and physician-assisted suicide, see also barbiturates.

Euthanasia is not permitted by law in many countries, and consequently medicines will not be licenesed for this use in those countries.

[edit] Legal considerations

Medications may be divided into over-the-counter drugs (OTC) which may be available without special restrictions, and prescription only medicine (POM), which must be prescribed by a licensed medical practitioner. The precise distinction between OTC and prescription depends on the legal jurisdiction.

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

For patented medications, countries may have certain mandatory licensing programs which compel, in certain situations, a medication's owner to contract with other agents to manufacture the drug. Such programs may deal with the contingency of a lack of medication in the event of a serious epidemic of disease, or may be part of efforts to ensure that disease treating drugs, such as AIDS drugs, are available to countries which cannot afford the drug owner's price.

[edit] Other/related topics

Polypharmacy: suggests that multiple use of prescribed and non-prescribed medications, (use of 5 or more), can have adverse effects on the recipient.

Zoopharmacognosy: Animal usage of drugs and non-foods.

[edit] Blockbuster drug

A blockbuster drug is a drug generating more than $1 billion of revenue for its owner each year.^[4] The search for blockbusters has been the foundation of the R&D strategy adopted by big pharmaceutical companies, but this looks set to change. New advances in genomics, and the promise of personalized medicine, are likely to fragment the pharmaceutical market.

A recent report from Urch Publishing estimated that about one third of the pharma market by value is accounted for by blockbusters. About 100 products are blockbusters. The top seller was Lipitor, a cholesterol-lowering medication marketed by Pfizer with sales of $12.2 billion.

[edit] Leading blockbuster drugs

Medication	Trade name	Company	Sales^[5] ^[6] (billion $), year
atorvastatin	Lipitor	Pfizer	12 (2007) <
clopidogrel	Plavix	Bristol-Myers Squibb and sanofi-aventis	5.9 (2005)
enoxaparin	Lovenox or Clexane	sanofi-aventis
celecoxib	Celebrex	Pfizer	2.3 (2007)
omeprazole	Losec/Prilosec	AstraZeneca	2.6 (2004)
esomeprazole	Nexium	AstraZeneca	3.3 (2003)
Fexofenadine	Telfast/Allegra	Aventis	1.87 (2004)
quetiapine	Seroquel	AstraZeneca	1.5 (2003)
metoprolol	Seloken/Toprol	AstraZeneca	1.3 (2003)
budesonide	Pulmicort/Rhinocort	AstraZeneca	1.3 (2003) (plus some fraction of the $0.6bn sales of Symbicort)

[edit] Environmental impact

Since the 1990s water contamination by pharmaceuticals has been an environmental issue of concern.^[7] Most pharmaceuticals are deposited in the environment through human consumption and excretion, and are often filtered ineffectively by wastewater treatment plants which are not designed to manage them. Once in the water they can have diverse, subtle effects on organisms, although research is limited. Pharmaceuticals may also be deposited in the environment through improper disposal, runoff from sludge fertilizer and reclaimed wastewater irrigation, and leaky sewage.^[7] In 2009 an investigative report by Associated Press concluded that U.S. manufacturers had legally released 271 million pounds of drugs into the environment, 92% of which was the antiseptics phenol and hydrogen peroxide. It could not distinguish between drugs released by manufacturers as opposed to the pharmaceutical industry. It also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging were discarded by hospitals and long-term care facilities.^[8]

[edit] History

For most of the nineteenth century, drugs were not highly effective, leading Oliver Wendell Holmes, Sr. to famously comment in 1842 that "if all medicines in the world were thrown into the sea, it would be all the better for mankind and all the worse for the fishes".^[9]^:21 Medicines commonly used by the late 1920s included aspirin, codeine, and morphine for pain; digitalis, nitroglycerin, and quinine for heart disorders, and insulin for diabetes. Other drugs included antitoxins, a few biological vaccines, and a few synthetic drugs. In the 1930s antibiotics emerged: first sulfa drugs, then penicillin and other antibiotics. Drugs increasingly became "the center of medical practice".^[9]^:22 In the 1950s other drugs emerged including corticosteroids for inflammation, rauwolfia alkloids as tranqulizers and antihypertensives, antihistamines for nasal allergies, xanthines for asthma, and typical antipsychotics for psychosis.^[9]^:23-24 As of 2008, thousands of approved drugs have been developed. Increasingly, biotechnology is used to discover biopharmaceuticals.^[9]

Governments have been heavily involved in the development and sale of drugs. In the U.S., the Elixir Sulfanilamide disaster led to the establishment of the Food and Drug Administration, and the 1938 Federal Food, Drug, and Cosmetic Act required manufacturers to file new drugs with the FDA. The 1951 Humphrey-Durham Amendment required certain drugs to be sold by prescription. In 1962 a subsequent amendment required new drugs to be tested for efficacy and safety in clinical trials.^[9]^:24-26

Until the 1970s, drug prices were not a major concern for doctors and patients. As more drugs became prescribed for chronic illnesses, however, costs became burdensome, and by the 1970s nearly every U.S. state required or encouraged the substitution of generic drugs for higher-priced brand names. This also led to the 2006 U.S. law, Medicare Part D, which offers Medicare coverage for drugs.^[9]^:28-29

As of 2008, the United States is the leader in medical research, including pharmaceutical development. U.S. drug prices are among the highest in the world, and drug innovation is correspondingly high. In 2000 U.S. based firms developed 29 of the 75 top-selling drugs; firms from the second-largest market, Japan, developed eight, and the United Kingdom contributed 10. France, which imposes price controls, developed three. Throughout the 1990s outcomes were similar.^[9]^:30-31

[edit] See also

[edit] References

^ US Federal Food, Drug, and Cosmetic Act, SEC. 210., (g)(1)(B). Accessed 17 August 2008.
^ Directive 2004/27/EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use. Article 1. Published March 31, 2004. Accessed 17 August 2008.
^ www.epgonline.org database of prescription pharmaceutical products including drug classifications [1]
^ ""Blockbuster medicine" is defined as being one which achieves annual revenues of over US$ 1 billion at global level." in European Commission, Pharmaceutical Sector Inquiry, Preliminary Report (DG Competition Staff Working Paper), 28 November 2008, page 17 (pdf, 1.95 MB).
^ Pharmaceutical Market Trends, 2006-2010, from Urch Publishing [2]
^ Blockbuster Drugs 2006: Executive Overview, from Report Buyer[3]
^ ^a ^b Doerr-MacEwen NA, Haight ME (November 2006). "Expert stakeholders' views on the management of human pharmaceuticals in the environment". Environ Manage 38 (5): 853–66. doi:10.1007/s00267-005-0306-z. PMID 16955232.
^ Donn J. (2009). Tons of Released Drugs Taint U.S. Water. AP.
^ ^a ^b ^c ^d ^e ^f ^g Finkelstein S, Temin P (2008). Reasonable Rx: Solving the drug price crisis. FT Press.

[edit] External links

WHO Model List of Essential Medicines

[0] US Federal Food, Drug, and Cosmetic Act, SEC. 210., (g)(1)(B). Accessed 17 August 2008.

[1] Directive 2004/27/EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use. Article 1. Published March 31, 2004. Accessed 17 August 2008.

[2] www.epgonline.org database of prescription pharmaceutical products including drug classifications [1]

[3] ""Blockbuster medicine" is defined as being one which achieves annual revenues of over US$ 1 billion at global level." in European Commission, Pharmaceutical Sector Inquiry, Preliminary Report (DG Competition Staff Working Paper), 28 November 2008, page 17 (pdf, 1.95 MB).

[4] Pharmaceutical Market Trends, 2006-2010, from Urch Publishing [2]

[5] Blockbuster Drugs 2006: Executive Overview, from Report Buyer[3]

[Doerr-MacEwen-6] Doerr-MacEwen NA, Haight ME (November 2006). "Expert stakeholders' views on the management of human pharmaceuticals in the environment". Environ Manage 38 (5): 853–66. doi:10.1007/s00267-005-0306-z. PMID 16955232.

[7] Donn J. (2009). Tons of Released Drugs Taint U.S. Water. AP.

[Reasonable-8] ^ ^a ^b ^c ^d ^e ^f ^g Finkelstein S, Temin P (2008). Reasonable Rx: Solving the drug price crisis. FT Press.

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