List of anaesthetic drugs

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A wide variety of drugs are used in modern anaesthetic practice. Many are rarely
used outside of anaesthesia, although others are used commonly by all disciplines.
Some of the prominent ones include:

local anaesthetics
general anaesthetics
inhalational anaesthetics
volatile anaesthetics
desflurane
sevoflurane
isoflurane
halothane
enflurane
methoxyflurane
nitrous oxide
xenon
intravenous anaesthetics
propofol
etomidate
barbiturates
methohexital
thiopentone/thiopental
benzodiazepines
midazolam
diazepam
ketamine
analgesics
opioids
morphine
fentanyl
alfentanil
sufentanil
remifentanil
methadone
meperidine / pethidine
NSAIDs
muscle relaxants
depolarising muscle relaxants
succinylcholine, also known as suxamethonium
nondepolarising (curare-like) muscle relaxants
atracurium
cisatracurium
vecuronium
rocuronium
mivacurium
tubocurarine
pancuronium bromide
vasoconstrictors, also known as vasopressors
phenylephrine
ephedrine
metaraminol
antiemetics: phenothiazines, e.g.: prochlorperazine, promethazine, cyclizine;
butyrophenones, e.g.: droperidol; antihistamines, e.g.: dimenhydrinate (old);
newer agents: ondansetron and tropisetron, and granisetron; steroids, e.g.:
dexamethasone; and lastly, metoclopramide (variable efficacy).

See also

wikithesia.com The anaesthesia wiki for anaesthetists

Antiemetic
From Wikipedia, the free encyclopedia
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An antiemetic is a drug that is effective against vomiting and nausea. Anti-
emetics are typically used to treat motion sickness and the side effects of opioid
analgesics, general anaesthetics and chemotherapy directed against cancer.

Contents [hide]
1 Types of Antiemetics
2 References
3 See also

[edit] Types of Antiemetics

Antiemetics include:

5-HT3 receptor antagonists - these block serotonin receptors in the central

nervous system and gastrointestinal tract. As such, they can be used to treat
post-operative and cytotoxic drug nausea & vomiting.
Dolasetron (Anzemet)
Granisetron (Kytril, Sancuso)
Ondansetron (Zofran)
Tropisetron (Navoban)
Palonosetron (Aloxi)
Mirtazapine (Remeron)
Dopamine antagonists act in the brain and are used to treat nausea and vomiting
associated with neoplastic disease, radiation sickness, opioids, cytotoxic drugs
and general anaesthetics.
Domperidone
Droperidol, haloperidol, chlorpromazine, promethazine, prochlorperazine. Some of
these drugs are limited in their usefullness by their extra-pyramidal and sedative
side-effects.
Metoclopramide (Reglan) also acts on the GI tract as a pro-kinetic, and is thus
useful in gastrointestinal disease; however, it is poor in cytotoxic or post-op
vomiting.
Alizapride
Antihistamines (H1 histamine receptor antagonists), effective in many conditions,
including motion sickness and severe morning sickness in pregnancy.
Cyclizine
Diphenhydramine (Benadryl)
Dimenhydrinate (Gravol, Dramamine)
Meclizine (Bonine, Antivert)
Promethazine (Pentazine, Phenergan, Promacot)
Hydroxyzine
Cannabinoids are used in patients with cachexia, cytotoxic nausea, and vomiting,
or who are unresponsive to other agents.
Cannabis (Marijuana). Most patients prefer smoked or vaporized cannabis over
pharmaceutical versions because they do not contain all 66 cannabinoids that are
in cannabis, many of which have medicinal applications. Medical marijuana is also
much less expensive than related pharmaceuticals. CBD is a main cannabinoid not in
Marinol or Cesamet.
Dronabinol (Marinol). Ninety percent of sales are for cancer and AIDS patients.
The other 10% of its sales thought to be for pain, Multiple Sclerosis and also for
Alzheimer's disease.
Nabilone (Cesamet). Put back on the market in late 2006. In the US, it is a
Schedule II substance unlike Marinol which is Schedule III and cannabis which is
Schedule I.
Sativex is an oral spray containing THC and CBD. It is currently legal in Canada
and a few countries in Europe but not in the U.S.
Benzodiazepines
Midazolam given at the onset of anesthesia has been shown in recent trials to be
as effective as ondansetron, a 5-HT3 antagonist in the prevention of post-
operative nausea and vomiting. Further studies need to be undertaken.
Lorazepam said to be very good as an adjunct treatment for nausea along with first
line medications such as Compazine or Zofran.
Anticholinergics
Hyoscine (also known as scopolamine)
Steroids
Dexamethasone given in low dose at the onset of a general anaesthetic for surgery
is an effective anti-emetic. The specific mechanism of action is not fully
understood.
NK1 receptor antagonist
Aprepitant Commercially available NK1 Receptor antagonist
Casopitant Investigational NK1 receptor antagonist
Other
Trimethobenzamide; thought to work on the CTZ
Ginger
Emetrol also claimed to be an effective antiemetic.
Propofol given intravenously. It has been used in an acute care setting in
hospital as a rescue therapy for emesis.
Peppermint claimed to help nausea or stomach pain when added into a tea or
peppermint candies.
Muscimol purported as such [1]
Ajwain purported to be antiemetic. It is a popular spice in India, Ethiopia and
Eritrea.
Non-pharmaceutical therapies with some evidence of efficacy include acupuncture
and hypnosis. All drugs have potential side effects. It is important to try to
reduce the baseline risk of nausea and vomiting, particularly with respect to
surgery.

[edit] References
^ Chemical Data Sheet
Pharmaceutical drug
From Wikipedia, the free encyclopedia
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"Medication" redirects here. For other uses, see Medication (disambiguation).
This article has multiple issues. Please help improve the article or discuss
these issues on the talk page.
It needs additional references or sources for verification. Tagged since February
2007.

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It may require general cleanup to meet Wikipedia's quality standards. Tagged since
November 2007.
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.

Contents [hide]
1 Classification
2 Types of medications (type of pharmacotherapy)
2.1 For the gastrointestinal tract or digestive system
2.2 For the cardiovascular system
2.3 For the central nervous system
2.4 For pain & consciousness (analgesic drugs)
2.5 For musculo-skeletal disorders
2.6 For the eye
2.7 For the ear, nose and oropharynx
2.8 For the respiratory system
2.9 For endocrine problems
2.10 For the reproductive system or urinary system
2.11 For contraception
2.12 For obstetrics and gynecology
2.13 For the skin
2.14 For infections and infestations
2.15 For immunology
2.16 For allergic disorders
2.17 For nutrition
2.18 For neoplastic disorders
2.19 For diagnostics
2.20 For euthanasia
3 Legal considerations
4 Other/related topics
5 Blockbuster drug
5.1 Leading blockbuster drugs
6 See also
7 References
8 External links

[edit] Classification
Medication can be usually classified in various ways, e.g. by its chemical
properties, mode of administration, biological system affected, or therapeutic
effects (beneficial effects). An elaborate and widely used classification system
is the Anatomical Therapeutic Chemical Classification System (ATC system).

A sampling of classes of medicine:

Antipyretics : reducing fever (pyrexia)

Analgesics : painkillers
Anti-malaria 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, opioids

[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

See also: Psychiatric medication
hypnotic, anaesthetics, antipsychotic, antidepressant (including tricyclic
antidepressants, monoamine oxidase inhibitor, lithium salt, selective serotonin
reuptake inhibitor), anti-emetic, anticonvulsant and antiepileptic, anxiolytic,
barbiturate, movement disorder drug, stimulant (including amphetamines),
benzodiazepine, cyclopyrrolone, dopamine antagonist, antihistamine, cholinergic,
anticholinergic, emetic, cannabinoids, 5-HT antagonist

[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 the ear, nose and oropharynx

sympathomimetic, antihistamine, anticholinergic, NSAIDs, steroid, antiseptic,
local anesthetic, antifungal, cerumenolyti

[edit] For the respiratory system

bronchodilator, NSAIDs, anti-allergic, antitussive, mucolytic, decongestant
corticosteroid, beta-receptor antagonist, anticholinergic, steroid
[edit] For endocrine problems
androgen, antiandrogen, gonadotropin, corticosteroid, human growth hormone,
insulin, antidiabetic (sulfonylurea, biguanide/metformin, thiazolidinedione,
insulin), thyroid hormones, antithyroid drugs, calcitonin, diphosponate,
vasopressin analogues

[edit] For the reproductive system or urinary system

antifungal, alkalising agent, quinolones, antibiotic, cholinergic,
anticholinergic, anticholinesterase, antispasmodic, 5-alpha reductase inhibitor,
selective alpha-1 blocker, sildenafil, fertility medication

[edit] For contraception

Hormonal contraception
Ormeloxifene
Spermicide

[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, 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.[3] 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[4] [5] (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] See also

List of drugs
Bioburden
Child-resistant packaging
Compliance
Herbalism
Medical prescription
Medicinal chemistry
Medicine
Nocebo
Patient safety
Pharmaceutical company
Pharmacology
Placebo
Prescription drug
Use of biotechnology in pharmaceutical manufacturing
Vaccine

[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.
^ ""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 [1]
^ Blockbuster Drugs 2006: Executive Overview, from Report Buyer[2]

[edit] External links

WHO Model List of Essential Medicines
[hide]v � d � eMajor drug groups

Gastrointestinal tract/metabolism (A) stomach acid (Antacids, H2 antagonists,

Proton pump inhibitors) � Antiemetics � Laxatives �
Antidiarrhoeals/Antipropulsives � Anti-obesity drugs � Anti-diabetics � Vitamins �
Dietary minerals

Blood and blood forming organs (B) Antithrombotics (Antiplatelets, Anticoagulants,

Thrombolytics/fibrinolytics) � Antihemorrhagics (Platelets, Coagulants,
Antifibrinolytics)

Cardiovascular system (C) cardiac therapy/antianginals (Cardiac glycosides,

Antiarrhythmics, Cardiac stimulants)
Antihypertensives � Diuretics � Vasodilators � Beta blockers � Calcium channel
blockers � renin-angiotensin system (ACE inhibitors, Angiotensin II receptor
antagonists, Renin inhibitors)

Antihyperlipidemics (Statins, Fibrates, Bile acid sequestrants)

Skin (D) Emollients � Cicatrizants � Antipruritics � Antipsoriatics � Medicated

dressings

Reproductive system (G) Hormonal contraception � Fertility agents � SERMs � Sex

hormones

Endocrine system (H) Hypothalamic-pituitary hormones � Corticosteroids

(Glucocorticoids, Mineralocorticoids) � Sex hormones � Thyroid
hormones/Antithyroid agents

Infections and infestations (J, P) Antibiotics � Antifungals � Antimycobacterials

(Tuberculosis treatment, Leprostatic agents) � Antivirals � Vaccines �
Antiparasitics (Antiprotozoals, Anthelmintics) � Ectoparasiticide

Malignant disease (L01-L02) Anticancer agents (Antimetabolites, Alkylating,

Spindle poisons, Antineoplastic, Topoisomerase inhibitors)

Immune disease (L03-L04) Immunomodulators (Immunostimulants, Immunosuppressants)

Muscles, bones, and joints (M) Anabolic steroids � Anti-inflammatories (NSAIDs) �

Antirheumatics � Corticosteroids � Muscle relaxants � Bisphosphonates

Brain and nervous system (N) Anesthetics (General, Local) � Analgesics �

Antimigraines � Anticonvulsants � Mood stabilizers � Antiparkinson drugs
Psycholeptics (Anxiolytics, Antipsychotics, Hypnotics/Sedatives) �
Psychoanaleptics (Antidepressants, Stimulants/Psychostimulants)

Respiratory system (R) Decongestants � Bronchodilators � Cough medicines � H1

antagonists

Sensory organs (S) Ophthalmologicals � Otologicals � Ophthalmological preparations

� Otological preparations

Other ATC (V) Antidotes � Contrast media � Radiopharmaceuticals � Dressings