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Obat

Dari Wikipedia Indonesia, ensiklopedia bebas berbahasa Indonesia.

Langsung ke: navigasi, cari

Obat adalah benda yang dapat digunakan untuk merawat penyakit, membebaskan gejala, atau memodifikasi proses kimia dalam tubuh.

[sunting] Pendistribusian legal

Di Amerika Serikat, seorang medis profesional dapat memperoleh obat dari perusahaan farmasi atau farmasi (yang membeli obat dari perusahaan farmasi). Farmasi dapat juga menyediakan obat secara langsung kepada pasien bila obat tersebut dapat dengan aman digunakan sendiri, atau diberi kuasa dengan preskripsi yang ditulis oleh dokter.

Kebanyakan obat mahal harganya untuk dibeli pasien ketika pertama kali dipasarkan, namun asuransi kesehatan dapat dipakai untuk meringankan biaya. Ketika paten untuk suatu obat berakhir, obat generik dibuat dan diedarkan oleh perusahaan saingan yang menyebabkan harga murah. Obat yang tidak membutuhkan preskripsi dari orang medis profesional dikenal dengan nama obat OTC (bahasa Inggris: Over the Counter, yang berarti di kasir) dapat dijual di toko biasa.

Di Indonesia, obat mahal lebih banyak karena besarnya biaya pemasaran yang ditanggung oleh perusahaan farmasi, terutama untuk obat ethical. Walaupun secara hukum promosi obat jenis ini tidak perbolehkan, tetapi secara praktik, banyak biaya yang diserap oleh tenaga medis sendiri.

Obat dapat diperoleh melalui apotik, puskesmas, toko obat dan tenaga medis sendiri.

[sunting] Klasifikasi

Obat dapat diklasifikasikan dalam banyak cara, atas dasar mekanisme aksi, efek dan status (legal atau tidak legal).

Analgesik obat pembunuh rasa sakit Non-NSAID antipiretik Acetaminophen (juga dikenal dengan parasetamol, atas atas nama dagang Tilenol), yang dapat menyebabkan masalah lever bila digunakan secara kronik NSAIDS Aspirin atau ASA (acetylsalicylic acid), yang juga antipiretik Ibuprofen (juga dikenal dengan nama dagang: Advil, Motrin, Nuprin and Brufen)

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Opioids, narkotik pembunuh rasa sakit yang kuat dan membuat ketagihan

yang juga digunakan sebagai obat rekreasi karena efek euphoriknya. Opiates

Sintetik dan setengah-sintetik opioids

obat rekreasi biasanya digunakan untuk mengubah emosi atau fungsi tubuh untuk rekreasi

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GHB

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Obat gaya hidup digunakan untuk meningkatkan kualitas hidup Viagra

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Drug

From Wikipedia, the free encyclopedia

For other meanings, see Drug (disambiguation). For mind altering drugs, see psychoactive drugs.

Drug From Wikipedia, the free encyclopedia Jump to: <a href=navigation , search For other meanings, see Drug (disambiguation) . For mind altering drugs, see psychoactive drugs . Caffeine is the most widely used psychoactive substance in the world. A drug is any biological substance, synthetic or non-synthetic, that when taken into the organism's body, will in some way alter the biological functions of that organism. This broad definition can be taken to include such substances as food . However more strict applications of the word prevail in everyday life. In these cases the word "drug" is usually used to refer specifically to medicine , vitamins , entheogenic sacrements , consciousness expanding and recreational drugs . Many natural substances such as beers , wines , and some mushrooms , blur the line between food and drugs and when ingested affect the functioning of both mind and body . The word "drug" is etymologically derived from the Dutch/Low German word "droog", which means "dry", since in the past, most drugs were dried plant parts. Drugs are usually distinguished from endogenous biochemicals by being introduced from outside the organism. For example, insulin is a hormone that is synthesized in the body; it is called a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is called a drug. " id="pdf-obj-3-19" src="pdf-obj-3-19.jpg">

Caffeine is the most widely used psychoactive substance in the world.

A drug is any biological substance, synthetic or non-synthetic, that when taken into the organism's body, will in some way alter the biological functions of that organism. This broad definition can be taken to include such substances as food. However more strict applications of the word prevail in everyday life. In these cases the word "drug" is usually used to refer specifically to medicine, vitamins, entheogenic sacrements, consciousness expanding and recreational drugs. Many natural substances such as beers, wines, and some mushrooms, blur the line between food and drugs and when ingested affect the functioning of both mind and body. The word "drug" is etymologically derived from the Dutch/Low German word "droog", which means "dry", since in the past, most drugs were dried plant parts.

Drugs are usually distinguished from endogenous biochemicals by being introduced from outside the organism. For example, insulin is a hormone that is synthesized in the body; it is called a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is called a drug.

Contents

 

<a href=[ edit ] Medication " id="pdf-obj-4-16" src="pdf-obj-4-16.jpg">

[edit] Medication

 

Main article: Medication

A medication is a drug taken to cure and reduce any symptoms of an illness or medical condition, or may be used as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms. Dispensing of medication is often regulated by the government into three categories — over the counter (OTC) medications, which are available in pharmacies and supermarket's without special restrictions, behind the counter (BTC), which are dispensed by a pharmacist without needing a doctor's prescription, and Prescription only medicines (POM), which must be prescribed by a licensed medical professional, usually a physician.

Most Over the counter medications are generally considered to be safe enough that most people will not hurt themselves if they are taken as instructed. In UK, BTC medicine is called pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist. However, the precise distinction between OTC and prescription depends on the legal jurisdiction.

Medications are typically produced by pharmaceutical companies and are often patented to protect their exclusive rights to produce them, but they can also be derived from naturally occurring substance in plants called herbal medicine. Those that are not patented (or with expired patents) are called generic drugs since they can be produced by other companies without restrictions or licenses from the patent holder.

Drugs, both medications and recreational can be administered in a number of ways,

 

Orally, as a liquid or solid (pill), that is absorbed through the stomach.

Inhaled, as a vapor.

Injected as a liquid either intramuscular or intravenous.

Rectally as a pill, that is absorbed by the colon.

Bolus, a substance into the stomach to dissolve slowly.

Many drugs can be administered in a variety of ways.

[edit] Recreational drugs

 

Main article: Recreational drug use Further information: Prohibition (drugs)

Recreational drug use is the use of psychoactive drugs for recreational purposes rather than for work, medical or spiritual purposes. Much controversy has arisen over recreational drug use, and governments across the world have regulated the consumption and/or distribution of drugs in the name of fighting drug abuse, but many countries' laws are criticized for being passed under ulterior motives or for being hypocritical. This seems to be changing, slowly, as Canada follows the Netherlands' lead and largely decriminalizes marijuana.

[edit] Legal definition of drugs

Some countries also defined what a drug is by law. In the United States, the Federal Food, Drug, and Cosmetic Act defines a drug as being an article "intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals" or an article "(other than food) intended to affect the structure or any function of the body of man or other animals." FDCA § 201(g)(1).

[edit] List of drugs

See list of drugs for an alphabetical list of drugs by name. Many drugs have more than one name and, therefore, the same drug may be listed more than once. Brand names and generic names are differentiated by the use of capital initials for the former. Some drugs may have slang names and may need to be accessed using those names.

[edit] See also

 

[edit] External links

 

Get rid of drugs. Drug Addiction Treatment Useful resource website with detailed

information on drugs and how to treat drug addiction. "Say NO to drugs" May 4

2007

Drug Culture by Richard DeGrandpre, Duke University Press, 2006.

Cannabis: An apology By Jonathan Owen, The Independent, 7 March 2006. 'don't drug + drive' German web-site providing information on the influence of recreational drugs in driving.

v d e

Muscles, Bones, and Joints Allergy Infections and Infestations Endocrine system

Major Drug Groups

Antihistamines
Antihistamines

Analgesic

From Wikipedia, the free encyclopedia

Jump to: navigation, search “Painkiller” redirects here. For other uses, see Painkiller (disambiguation).

Contents

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<a href=[ edit ] The major classes " id="pdf-obj-7-69" src="pdf-obj-7-69.jpg">

[edit] The major classes

[edit] Paracetamol and NSAIDs

The exact mechanism of action of paracetamol is uncertain, but it appears to be acting centrally. Aspirin and the NSAIDs inhibit cyclooxygenase, leading to a decrease in prostaglandin production; this reduces pain and also inflammation (in contrast to paracetamol and the opioids). [citation needed]

Paracetamol has few side effects, but dosing is limited by possible hepatotoxicity (potential for liver damage). NSAIDs may predispose to peptic ulcers, renal failure, allergic reactions, and hearing loss. [citation needed] They may also increase the risk of hemorrhage by affecting platelet function. The use of certain NSAIDs in children under 16 suffering from viral illness may contribute to Reye's syndrome.

[edit] COX-2 inhibitors

 

Main article: COX-2 inhibitor

These drugs have been derived from NSAIDs. The cyclooxygenase enzyme inhibited by NSAIDs was discovered to have at least 2 different versions: COX1 and COX2. Research suggested that most of the adverse effects of NSAIDs were mediated by blocking the COX1 (constitutive) enzyme, with the analgesic effects being mediated by the COX2 (inducible) enzyme. The COX2 inhibitors were thus developed to inhibit only the COX2 enzyme (traditional NSAIDs block both versions in general). These drugs (such as rofecoxib and celecoxib) are equally effective analgesics when compared with NSAIDs, but cause less gastrointestinal hemorrhage in particular. However post-launch data indicated increased risk of cardiac and cerebrovascular events with these drugs, and rofecoxib was subsequently withdrawn from the market. The role for this class of drug is currently hotly debated.

[edit] Opiates and morphinomimetics

Morphine, the archetypal opioid, and various other substances (e.g. codeine, oxycodone, hydrocodone, diamorphine, pethidine) all exert a similar influence on the cerebral opioid receptor system. Tramadol and buprenorphine are thought to be partial agonists of the opioid receptors. Dosing of all opioids may be limited by opioid toxicity (confusion, myoclonic jerks and pinpoint pupils), but there is no dose ceiling in patients who tolerate this.

Opioids, while very effective analgesics, may have some unpleasant side-effects. Up to 1 in 3 patients starting morphine may experience nausea and vomiting (generally relieved by a short course of antiemetics). Pruritus (itching) may require switching to a different opioid. Constipation occurs in almost all patients on opioids, and laxatives (lactulose, macrogol-containing or co-danthramer) are typically co-prescribed.

When used appropriately, opioids and similar narcotic analgesics are safe and effective, carrying relatively little risk of addiction. Occasionally, gradual tapering of the dose is required to avoid withdrawal symptoms.

[edit] Specific agents

In patients with chronic or neuropathic pain, various other substances may have analgesic properties. Tricyclic antidepressants, especially amitriptyline, have been shown to improve pain in what appears to be a central manner. The exact mechanism of carbamazepine, gabapentin and pregabalin is similarly unclear, but these anticonvulsants are used to treat neuropathic pain with modest success.

[edit] Specific forms and uses

[edit] Combinations

Analgesics are frequently used in combination, such as the paracetamol and codeine preparations found in many non-prescription pain relievers. They can also be found in combination with vasoconstrictor drugs such as pseudoephedrine for sinus-related preparations, or with antihistamine drugs for allergy sufferers.

The use of paracetamol, as well as aspirin, ibuprofen, naproxen, and other NSAIDS concurrently with weak to mid-range opiates (up to about the hydrocodone level) has been shown to have beneficial synergistic effects by combating pain at multiple sites of action—NSAIDs reduce inflammation which, in some cases, is the cause of the pain itself while opiates dull the perception of pain—thus, in cases of mild to moderate pain caused in part by inflammation, it is generally recommended that the two are prescribed

together.[1]

[edit] Topical or systemic

Topical analgesia is generally recommended to avoid systemic side-effects. Painful joints, for example, may be treated with an ibuprofen- or diclofenac-containing gel; capsaicin also is used topically. Lidocaine and steroids may be injected into painful joints for longer-term pain relief. Lidocaine is also used for painful mouth sores and to numb areas for dental work and minor medical procedures.

[edit] Psychotropic agents

Tetrahydrocannabinol and some other cannabinoids, either from the Cannabis sativa plant or synthetic, have analgesic properties, although the use of cannabis derivatives is illegal in many countries. Other psychotropic analgesic agents include ketamine (an NMDA receptor antagonist), clonidine and other α 2 -adrenoreceptor agonists, and mexiletine and other local anaesthetic analogues.

[edit] Atypical and/or Adjuvant Analgesics

Orphenadrine, cyclobenzaprine, scopolamine, atropine, gabapentin, first-generation antidepressants and other drugs possessing anticholinergic and/or antispasmodic properties are used in many cases along with analgesics to potentiate centrally acting analgesics such as opioids when used against pain especially of neuropathic origin and to and modulate the effects of many other types of analgesics by action in the parasympathetic nervous system. Dextromethorphan has been noted to slow the development of tolerance to opioids and exert additional analgesia by acting upon the NMDA receptors—some analgesics such as methadone and ketobemidone and perhaps piritramide have intrinsic NMDA action.

The use of adjuvant analgesics is an important and growing part of the pain-control field and new discoveries are made practically every year. Many of the drugs also combat the side effects of opioid analgesics, an added bonus. For example, antihistamines including orphenadrine combat the release of histamine caused by many opioids, methylphenidate, caffeine, ephedrine, dextroamphetamine, and cocaine work against heavy sedation and may elevate mood in distressed patients as do the antidepressants. The one indisputably true benefit of THC to chronic pain patients on opioids may be its superior anti-nauseant action, though it would make more sense to go the route of the Marinol capsule, or oral, rectal, or vapour administration of hash oil rather than smoking cannabis for the same reasons most doctors advise against smoking tobacco.

[edit] Addiction

In the United States in recent years, there has been a wave of new addictions to prescription narcotics such as oxycodone (OxyContin) and hydrocodone (Vicodin, Lortab etc.) when available in pure formulations as opposed to combined with other medications (as in Percocet which contains both oxycodone and acetaminophen/paracetamol). Hydrocodone is only available in pure form in some European countries as the original hydrocodone pharmaceutical, Dicodid tablets. Far from reducing addiction liability, the paracetamol content of many codeine, dihydrocodeine, hydrocodone, and oxycodone

pharmaceuticals in the United States only saddles users with the high risk of severe liver damage, and extraction of the opioids with cold water or solvents reduces this problem for the sophisticated abuser, self-medicator, and legitimate prescription holder alike [2]. Most hydrocodone, codeine, and dihydrocodeine cough syrups available in the United States also contain active ingredients such as acetaminophen which are dangerous in overdose.

[edit] See also

 

[edit] References

 

Cancer pain relief and palliative care. Report of a WHO expert committee [World

Health Organization Technical Report Series, 804] . Geneva, Switzerland: World Health Organization; 1990. pp. 1–75. ISBN 92-4-120804-X. Bandolier pain site (Oxford pain group)

Anesthesia

From Wikipedia, the free encyclopedia

Anesthesia or anaesthesia (see spelling differences) (from Greek: γάνεσθαι, anesthai, "without feeling") has traditionally meant the condition of having the perception of pain and other sensations blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846.

For other uses, see Anesthesia (disambiguation).

Today, the term general anesthesia in its most general form can include:

 

Analgesia - blocking the conscious perception of pain

Amnesia - preventing memory formation

Relaxation - preventing unwanted movement or muscle tone

Obtundation of reflexes, preventing exaggerated autonomic reflexes

Contents

<a href=[ edit ] Types " id="pdf-obj-11-121" src="pdf-obj-11-121.jpg">

[edit] Types

 

There are several forms of anesthesia:

 

General: anesthesia resulting in amnesia, with a loss of protective airway reflexes.

While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol. Amnesia is the main characteristic, while analgesia and muscle relaxation may be present, to varying degrees. Regional: Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body. Administered with local anesthesia to peripheral nerve bundles, such as the brachial plexus in the neck. Examples include the interscalene block for shoulder surgery, axillary block for wrist surgery, and femoral nerve block for leg surgery. While traditionally administered as a single injection, newer techniques involve placement of indwelling catheters for continuous or intermittent administration of local anesthetics.

 

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Spinal: aka "Sub Arachnoid Block" Refers to a regional block resulting from a small volume of local anesthetics being injected into the spinal canal. The spinal canal is covered by the dura mater, through which the spinal needle enters. The spinal canal contains cerebrospinal fluid and the spinal cord. The sub arachnoid block is usually injected between the 4th

 

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and 5th lumbar vertebrae, because the spinal cord usually stops at the 1st lumbar vertebra, while the canal continues to the sacral vertebrae. It results in a loss of pain sensation and muscle strength, usually up to the level of the chest (nipple line or 4th thoracic dermatome). Epidural: Regional block resulting from an injection of a large volume of local anesthetic into the epidural space. The epidural space is a potential space that lies underneath the ligamenta flava, and outside the dura mater (outside layer of the spinal canal). This is basically an injection around the spinal canal.

 

Local anesthesia is similar to regional anesthesia, but exerts its effect on a smaller area of the body.

Not all surgical procedures require anesthetic. Sometimes no anesthetic is required, and conscious sedation is used, which does not result in loss of consciousness or significant analgesia, but frequently produces a degree of amnesia, and relaxes the patient.

According to a 1999 report from the Institute of Medicine, anesthesia care today is nearly 50 times safer than it was 20 years ago.

[edit] History

 

Anesthesia was used by the Incas. Shamans chewed coca leaves and drilled holes in the heads of their patients (to let the bad spirits escape) while spitting into the wounds they'd inflicted. The mixture of resin and saliva numbed the site allowing hours of drilling. [citation

Also, Dioscorides, for example, reports potions being prepared from opium and mandragora as surgical anesthetics.

In the East, in the 10th century work Shahnameh, the author describes a caesarean section performed on Rudaba when giving birth, in which a special wine agent was prepared by a Zoroastrian priest, and used to produce unconsciousness for the operation. Although largely mythical in content, the passage does at least illustrate knowledge of anesthesia in ancient Persia.

[edit] Non-pharmacological methods

Hypnotism and acupuncture have a long history of use as anesthetic techniques. In China, Taoist medical practitioners developed anesthesia by means of acupuncture. Chilling tissue (e.g. with ice) can temporarily cause nerve fibers (axons) to stop conducting sensation, while hyperventilation can cause brief alteration in conscious perception of stimuli including pain (see Lamaze).

In modern anesthetic practice, these techniques are seldom employed.

[edit] Herbal derivatives

 

The first herbal anesthesia was administered in prehistory. Opium and Cannabis were two of the most important herbs used. They were ingested or smoked. Alcohol was also used, its vasodilatory properties being unknown. In early America preparations, datura, with the active ingredient scopolamine, was used, as was coca. In Medieval Europe various preparations of mandrake were tried as was henbane (hyoscyamine).

In 1804, the Japanese surgeon Hanaoka Seishū performed general anaesthesia for the operation of a breast cancer (mastectomy), by combining Chinese herbal medicine know- how and Western surgery techniques learned through "Rangaku", or "Dutch studies". His patient was a 60-year-old woman called Kan Aiya. [1] He used a compound he called Tsusensan, based on the plants Datura metel, Aconitum and others.

[edit] Early gases and vapours

The first <a href=herbal anesthesia was administered in prehistory . Opium and Cannabis were two of the most important herbs used. They were ingested or smoked. Alcohol was also used, its vasodilatory properties being unknown. In early America preparations, datura , with the active ingredient scopolamine , was used, as was coca . In Medieval Europe various preparations of mandrake were tried as was henbane ( hyoscyamine ) . In 1804 , the Japanese surgeon Hanaoka Seishū performed general anaesthesia for the operation of a breast cancer ( mastectomy ) , by combining Chinese herbal medicine know- how and Western surgery techniques learned through " Rangaku ", or "Dutch studies". His patient was a 60-year-old woman called Kan Aiya. He used a compound he called Tsusensan, based on the plants Datura metel , Aconitum and others. [ edit ] Early gases and vapours Contemporary re-enactment of Morton's October 16 , 1846 , ether operation; daguerrotype by Southworth & Hawes . In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s . The anaesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley ) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes , and reported in a paper in 1800 . But initially the medical uses of this so-called "laughing gas" were limited - its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Horace Wells Connecticut , a travelling dentist, had demonstrated it the previous year 1845 , at Massachusetts General Hospital . Wells made a mistake, in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colourful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulphuric acid. " id="pdf-obj-13-63" src="pdf-obj-13-63.jpg">
The first <a href=herbal anesthesia was administered in prehistory . Opium and Cannabis were two of the most important herbs used. They were ingested or smoked. Alcohol was also used, its vasodilatory properties being unknown. In early America preparations, datura , with the active ingredient scopolamine , was used, as was coca . In Medieval Europe various preparations of mandrake were tried as was henbane ( hyoscyamine ) . In 1804 , the Japanese surgeon Hanaoka Seishū performed general anaesthesia for the operation of a breast cancer ( mastectomy ) , by combining Chinese herbal medicine know- how and Western surgery techniques learned through " Rangaku ", or "Dutch studies". His patient was a 60-year-old woman called Kan Aiya. He used a compound he called Tsusensan, based on the plants Datura metel , Aconitum and others. [ edit ] Early gases and vapours Contemporary re-enactment of Morton's October 16 , 1846 , ether operation; daguerrotype by Southworth & Hawes . In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s . The anaesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley ) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes , and reported in a paper in 1800 . But initially the medical uses of this so-called "laughing gas" were limited - its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Horace Wells Connecticut , a travelling dentist, had demonstrated it the previous year 1845 , at Massachusetts General Hospital . Wells made a mistake, in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colourful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulphuric acid. " id="pdf-obj-13-65" src="pdf-obj-13-65.jpg">

Contemporary re-enactment of Morton's October 16, 1846, ether operation; daguerrotype by Southworth & Hawes.

In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s. The anaesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes, and reported in a paper in 1800. But initially the medical uses of this so-called "laughing gas" were limited - its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Horace Wells Connecticut, a travelling dentist, had demonstrated it the previous year 1845, at Massachusetts General Hospital. Wells made a mistake, in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colourful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulphuric acid.

Another dentist, William E. Clarke, performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540). In March 1842 in Danielsville, Georgia, Dr. Crawford Long was the first to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later.

On October 16, 1846, another dentist, William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumour from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia.

Another dentist, <a href=William E. Clarke , performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540 ) . In March 1842 in Danielsville, Georgia , Dr. Crawford Long was the first to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later. On October 16 , 1846 , another dentist, William Thomas Green Morton , invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumour from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia . Anesthesia pioneer Crawford W. Long Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons, including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether . An American born physician, Boott who had travelled to London, encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anaesthetist. On the same day, Saturday 19 December 1846 in Dumfries Royal Infirmary, Scotland, A Dr Scott used ether for a surgical procedure. The first use of anaesthesia in the southern hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability . In England it was quickly replaced with chloroform . Discovered in 1831 , the use of chloroform in anaesthesia is usually linked to James Young Simpson , who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847 . Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold . " id="pdf-obj-14-33" src="pdf-obj-14-33.jpg">
Another dentist, <a href=William E. Clarke , performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540 ) . In March 1842 in Danielsville, Georgia , Dr. Crawford Long was the first to use anaesthesia during an operation, giving it to a boy (John Venables) before excising a cyst from his neck; however, he did not publicize this information until later. On October 16 , 1846 , another dentist, William Thomas Green Morton , invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumour from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia . Anesthesia pioneer Crawford W. Long Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons, including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether . An American born physician, Boott who had travelled to London, encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anaesthetist. On the same day, Saturday 19 December 1846 in Dumfries Royal Infirmary, Scotland, A Dr Scott used ether for a surgical procedure. The first use of anaesthesia in the southern hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability . In England it was quickly replaced with chloroform . Discovered in 1831 , the use of chloroform in anaesthesia is usually linked to James Young Simpson , who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847 . Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold . " id="pdf-obj-14-35" src="pdf-obj-14-35.jpg">

Anesthesia pioneer Crawford W. Long

Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons, including Liston, Dieffenbach, Pirogoff, and Syme undertook numerous operations with ether. An American born physician, Boott who had travelled to London, encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anaesthetist. On the same day, Saturday 19 December 1846 in Dumfries Royal Infirmary, Scotland, A Dr Scott used ether for a surgical procedure. The first use of anaesthesia in the southern hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability. In England it was quickly replaced with chloroform.

Discovered in 1831, the use of chloroform in anaesthesia is usually linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold.

Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses and occasionally members of the public were often pressed into giving anaesthetics at this time). This led to many deaths from the use of chloroform which (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anaesthesia (Hannah Greener) was recorded on 28 January 1848.

John Snow of London published articles from May 1848 onwards 'On Narcotism by the Inhalation of vapours' in the London Medical Gazette. Snow also involved himself in the production of equipment needed for inhalational anaesthesia.

The surgical amphitheatre at Massachusetts General Hospital, or "ether dome" still exists today, although it is used for lectures and not surgery. The public can visit the amphitheater on weekdays when it is not in use.

[edit] Early local anesthetics

 

The first effective local anesthetic was cocaine. Isolated in 1859, it was first used by Karl Koller, at the suggestion of Sigmund Freud, in ophthalmic surgery in 1884. Before that doctors had used a salt and ice mix for the numbing effects of cold, which could only have limited application. Similar numbing was also induced by a spray of ether or ethyl chloride. A number of cocaine derivatives and safer replacements were soon produced, including procaine (1905), Eucaine (1900), Stovaine (1904), and lidocaine (1943).

Opioids were first used by Racoviceanu-Piteşti, who reported his work in 1901.

[edit] Anesthesia providers

 

Physicians specialising in peri-operative care, development of an anesthetic plan, and the administration of anesthetics are known in the UK as anaesthetists, and, in the U.S., as

anesthesiologists. All anaesthetics in the UK, Australia, New Zealand and Japan are

administered by physicians. Nurse anesthetists also administer anesthesia in 109 nations. [2] In the US, 35% of anesthetics are provided by physicians in solo practice, about 55% are provided by ACTs with anesthesiologists medically directing CRNAs, and about 10%

are provided by CRNAs in solo practice. [3] [4] [5] -

[6]

[7]

-

[edit] Physician Anesthesiologists / Anesthetists

In the U.S., the training of a physician anesthesiologist typically consists of 4 years of college, 4 years of medical school, 1 year of internship, and 3 years of residency. According to the American Society of Anesthesiologists, Anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered annually. [8]

In the UK this training lasts a minimum of seven years after the awarding of a medical degree and two years of basic residency, and takes place under the supervision of the Royal College of Anaesthetists. In Australia and New Zealand, it lasts five years after the

awarding of a medical degree and two years of basic residency, under the supervision of the Australian and New Zealand College of Anaesthetists. Other countries have similar systems, including Ireland (the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland), Canada and South Africa.

In the UK, completion of the examinations set by the Royal College of Anaesthetists leads to award of the Diploma of Fellowship of the Royal College of Anaesthetists (FRCA). In the US, completion of the written and oral Board examinations by a physician anesthesiologist allows one to be called "Board Certified" or a "Diplomate" of the American Board of Anesthesiology.

Other specialties within medicine are closely affiliated to anaesthetics. These include intensive care medicine and pain medicine. Specialists in these disciplines have usually done some training in anaesthetics. The role of the anaesthetist is changing. It is no longer limited to the operation itself. Many anaesthetists consider themselves to be peri- operative physicians, and will involve themselves in optimizing the patient's health before surgery (colloquially called "work-up"), performing the anaesthetic, following up the patient in the post anesthesia care unit and post-operative wards, and ensuring optimal analgesia throughout.

[edit] Nurse Anesthetists

In the United States, nurse practitioners specializing in the provision of anesthesia are known as Nurse anesthetists (CRNAs). As of 2007 CRNAs represent 50% of the anesthesia workforce in the United states with over 33,000 licensed providers. According to the American Association of Nurse Anesthetists, CRNAs provide 27 million hands-on anesthetics each year, roughly two thirds of the US total and are the sole providers of anesthesia in more than 70 percent of rural area hospitals. Thirty-four percent of nurse anesthetists practice in communities of less than 50,000. CRNAs start school with a bachelors Science degree and at least 1 year of critical care nursing experience, and gain a masters degree in nurse anesthesia before passing the mandatory Certification Exam. The average CRNA student has 5-7 years of nursing experience before entering a 27-30 month masters level anesthesia program. [9]

CRNAs may work with podiatrists, dentists, anesthesiologists, surgeons, obstetricians and other professionals requiring their services. CRNAs administer anesthesia in all types of surgical cases, and are able to apply all the accepted anesthetic techniques -- general, regional, local, or sedation. Nurse Anesthetists are licensed to practice anesthesia independently, as well as in Anesthesia Care Teams, which are led by a physician anesthesiologist. [10] CRNAs may also practice in parallel with their physician colleagues in certain institutions, both types of provider caring for their own patients independently and consulting whenever collaboration is appropriate to patient outcome.

[edit] Anesthesia assistants

The term anesthesia assistant identifies individuals in various countries who assist in the provision of anesthesia under the direction of a physician.

In the United Kingdom, personnel known as ODPs (operating department practitioners) or Anaesthetic nurses provide support to the physician anesthetist.

In the USA, Anesthesiologist Assistants are another group who participate in anesthetic care. They earn a masters degree and practice under physician supervision in sixteen states through licensing, certification or physician delegation [11] . In New Zealand, anaesthetic technicians complete a course of study recognized by the New Zealand Association of Anaesthetic Technicians and Nurses.

[edit] Anesthetic agents

[edit] Local anesthetics

 

Local anesthetics are agents which prevent transmission of nerve impulses without causing unconsciousness. They act by binding to fast sodium channels from within (in an open state). Local anesthetics can be either ester or amide based.

Ester local anesthetics (eg. procaine, amethocaine, cocaine) are generally unstable in solution and fast acting, and allergic reactions are common.

Amide local anesthetics (eg. lidocaine, prilocaine, bupivicaine, levobupivacaine, ropivacaine and dibucaine) are generally heat stable, with a long shelf life (around 2 years). They have a slower onset and longer half life than ester anaesthetics, and are usually racemic mixtures, with the exception of levobupivacaine (which is S(-) -bupivacaine) and ropivacaine (S(-)-ropivacaine). These agents are generally used within regional and epidural or spinal techniques, due to their longer duration of action which provides adequate analgesia for surgery, labor and symptomatic relief.

Only preservative free local anesthetic agents may be injected intrathecally.

[edit] Adverse effects of local anaesthesia

Local anesthetic drugs are toxic to the heart (where they cause arrhythmia) and brain (where they may cause unconsciousness and seizures). Arrhythmias may be resistant to defibrillation and other standard treatments, and may lead to loss of heart function and death.

The first evidence of local anesthetic toxicity involves the nervous system, including agitation, confusion, dizziness, blurred vision, tinnitus, a metallic taste in the mouth, and nausea that can quickly progress to seizures and cardiovascular collapse.

Direct infiltration of local anesthetic into skeletal muscle will cause temporary paralysis of the muscle.

Toxicity can occur with any local anesthetic as an individual reaction by that patient. Possible toxicity can be tested with pre-operative procedures to avoid toxic reactions during surgery.

[edit] Current inhaled general anesthetic agents

 

Xenon (rarely used)

Volatile agents are specially formulated organic liquids that evaporate readily into vapors, and are given by inhalation for induction and/or maintenance of general anesthesia. The ideal anesthetic vapor or gas should be non-flammable, non-explosive, lipid soluble, should possess low blood gas solubility, have no end organ (heart, liver, kidney) toxicity or side effects, should not be metabolized and should be non-irritant when inhaled by patients.

No anesthetic vapor currently in use meets all these requirements. The vapors in current use are halothane, isoflurane, desflurane and sevoflurane. Nitrous oxide is a common adjuvant gas, making it one of the most long-lived drugs still in current use.

In theory, any anesthetic vapor can be used for induction of general anesthesia. However, most of the halogenated vapors are irritating to the airway, perhaps leading to coughing, laryngospasm and overall difficult inductions. Commonly used agents for inhalational induction include sevoflurane and halothane. All of the modern vapors can be used alone or in combination with other medications to maintain anesthesia (nitrous oxide is not potent enough to be used as a sole agent).

Currently research into the use of xenon as an anesthetic is underway, but the gas is very expensive to produce and requires special equipment for delivery, as well as special monitoring and scavenging of waste gas.

Volatile agents are frequently compared in terms of potency, which is inversely proportional to the minimum alveolar concentration. Potency is directly related to lipid solubility. This is known as the Meyer-Overton hypothesis. However, certain pharmacokinetic properties of volatile agents have become another point of comparison. Most important of those properties is known as the blood:gas partition coefficient. This concept refers to the relative solubilty of a given agent in blood. Those agents with a lower blood solubility (i.e. a lower blood:gas partition coefficient, e.g. desflurane) give the anesthesia provider greater rapidity in titrating the depth of anesthesia, and permit a more rapid emergence from the anesthetic state upon discontinuing their administration. In fact, newer volatile agents (e.g. sevoflurane, desflurane) have been popular not due to their potency [minimum alveolar concentration], but due to their versatility for a faster emergence from anesthesia, thanks to their lower blood:gas partition coefficient.

[edit] Current IV general or sedative agents

 

[edit] Muscle relaxants

 

Succinylcholine (also known as suxamethonium in the UK, New Zealand, Australia and other countries)

Curare, the active ingredient of which is tubocurarine

[edit] Adverse effects of muscle relaxants

Succinylcholine may cause hyperkalemia if given to burn patients, or paralysed (quadraplegic, paraplegic) patients. The mechanism is reported to be through upregulation of acetylcholine receptors in those patient populations. Succinylcholine may also trigger malignant hyperthermia in susceptible patients.

Another potentially disturbing adverse effect is anesthesia awareness. In this situation, patients paralyzed with muscle relaxants may awaken during their anesthesia. If this fact is missed by the anaesthesia provider, the patient may be aware of his surroundings, but be incapable of moving or communicating that fact. Neurological monitors are becoming increasingly available which may help decrease the incidence of awareness. Most of these monitors use proprietary algorithms to determine whether any individual 'should' be unable to form memory. Despite the widespread marketing of these devices many case reports exist in which awareness under anesthesia has occurred despite apparently adequate anesthesia as measured by the neurologic monitor. [citation needed]

[edit] Opioid analgesics

 

Diamorphine, (diacetyl morphine, also known as heroin)

Codeine, (methyl morphine)

Meperidine, also called pethidine in the UK, New Zealand, Australia and other countries

Naloxone, chemically similar to some analgesics; not a painkiller and reverses the effects of morphine-like agents.

[edit] Anesthetic equipment

 

Main article: Anaesthetic equipment

In modern anesthesia, a wide variety of medical equipment is desirable depending on the necessity for portable field use, surgical operations or intensive care support. Anesthesia practitioners must possess a comprehensive and intricate knowledge of the production and use of various medical gases, anaesthetic agents and vapours, medical breathing circuits and the variety of anaesthetic machines (including vaporizers, ventilators and pressure gauges) and their corresponding safety features, hazards and limitations of each piece of equipment, for the safe, clinical competence and practical application for day to day practice.

[edit] Anesthetic monitoring

Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. This will generally include monitoring of heart rate (via ECG), oxygen saturation (via pulse oximetry), blood pressure, inspired and expired gases (for oxygen, nitrous oxide, carbon dioxide, and volatile agents), and may also include monitoring of temperature, arterial blood pressure and waveforms, central venous pressure, cerebral activity (via EEG), neuromuscular activity (via peripheral nerve stimulation monitoring), cardiac output, and urine output. In addition, the operating room's environment must be monitored for temperature and humidity and for buildup of exhaled inhalational anesthetics which might impair the function of operating room personnel.

Antibiotic

From Wikipedia, the free encyclopedia

<a href=[ edit ] Anesthetic monitoring Patients being treated under general anesthetics must be monitored continuously to ensure the patient's safety. This will generally include monitoring of heart rate (via ECG ) , oxygen saturation (via pulse oximetry ) , blood pressure , inspired and expired gases (for oxygen , nitrous oxide , carbon dioxide , and volatile agents), and may also include monitoring of temperature , arterial blood pressure and waveforms, central venous pressure , cerebral activity (via EEG ) , neuromuscular activity (via peripheral nerve stimulation monitoring ) , cardiac output , and urine output. In addition, the operating room's environment must be monitored for temperature and humidity and for buildup of exhaled inhalational anesthetics which might impair the function of operating room personnel. Antibiotic From Wikipedia, the free encyclopedia Jump to: navigation , search This article may require cleanup to meet Wikipedia's quality standards . Please discuss this issue on the talk page or replace this tag with a more specific message . This article has been tagged since March 2007 . Staphylococcus aureus - Antibiotics test plate. An antibiotic is a chemical compound that inhibits or abolishes the growth of microorganisms, such as bacteria , fungi , or protozoans . The original meaning of antibiotic includes any agent with biological activity against living organisms; however, the term is commonly used to refer to substances with anti-bacterial, anti-fungal, or anti- parasitical activity. The first antibiotic compounds used in modern medicine were produced and isolated from living organisms, for example, the penicillin class produced " id="pdf-obj-21-57" src="pdf-obj-21-57.jpg">

This article may require cleanup to meet Wikipedia's quality standards.

Please discuss this issue on the talk page or replace this tag with a more specific message. This article has been tagged since March 2007.

<a href=Staphylococcus aureus - Antibiotics test plate. An antibiotic is a chemical compound that inhibits or abolishes the growth of microorganisms, such as bacteria , fungi , or protozoans . The original meaning of antibiotic includes any agent with biological activity against living organisms; however, the term is commonly used to refer to substances with anti-bacterial, anti-fungal, or anti- parasitical activity. The first antibiotic compounds used in modern medicine were produced and isolated from living organisms, for example, the penicillin class produced " id="pdf-obj-21-76" src="pdf-obj-21-76.jpg">

Staphylococcus aureus - Antibiotics test plate.

An antibiotic is a chemical compound that inhibits or abolishes the growth of microorganisms, such as bacteria, fungi, or protozoans. The original meaning of antibiotic includes any agent with biological activity against living organisms; however, the term is commonly used to refer to substances with anti-bacterial, anti-fungal, or anti- parasitical activity. The first antibiotic compounds used in modern medicine were produced and isolated from living organisms, for example, the penicillin class produced

by fungi in the genus Penicillium, or streptomycin from bacteria of the genus Streptomyces. With the advent of organic chemistry many antibiotics are now also obtained by chemical synthesis, such as the sulfa drugs. Many antibiotics are relatively small molecules with a molecular weight less than 2000 Da.

by fungi in the genus <a href=Penicillium , or streptomycin from bacteria of the genus Streptomyces . With the advent of organic chemistry many antibiotics are now also obtained by chemical synthesis , such as the sulfa drugs . Many antibiotics are relatively small molecules with a molecular weight less than 2000 Da . Points of attack on bacteria by antibiotics Unlike previous treatments for infections, which often consisted of administering chemical compounds, such as strychnine and arsenic with high toxicity also against mammals , antibiotics from microbes had no or few side effects and high effective target activity. Most anti-bacterial antibiotics do not have activity against viruses, fungi, or other microbes. Anti-bacterial antibiotics can be categorized based on their target specificity: "narrow-spectrum" antibiotics target particular types of bacteria, such as Gram-negative or Gram-positive bacteria, while broad-spectrum antibiotics affect a wide range of bacteria. The effectiveness of individual antibiotics varies with the location of the infection, the ability of the antibiotic to reach the site of infection, and the ability of the microbe to inactivate or excrete the antibiotic. Some anti-bacterial antibiotics destroy bacteria (bactericidal), whereas others prevent bacteria from multiplying (bacteriostatic). Oral antibiotics are simply ingested, while intravenous antibiotics are used in more serious cases, such as deep-seated systemic infections . Antibiotics may also sometimes be administered topically , as with eye drops or ointments . " id="pdf-obj-22-25" src="pdf-obj-22-25.jpg">

Points of attack on bacteria by antibiotics

Unlike previous treatments for infections, which often consisted of administering chemical compounds, such as strychnine and arsenic with high toxicity also against mammals, antibiotics from microbes had no or few side effects and high effective target activity. Most anti-bacterial antibiotics do not have activity against viruses, fungi, or other microbes. Anti-bacterial antibiotics can be categorized based on their target specificity: "narrow-spectrum" antibiotics target particular types of bacteria, such as Gram-negative or Gram-positive bacteria, while broad-spectrum antibiotics affect a wide range of bacteria.

The effectiveness of individual antibiotics varies with the location of the infection, the ability of the antibiotic to reach the site of infection, and the ability of the microbe to inactivate or excrete the antibiotic. Some anti-bacterial antibiotics destroy bacteria (bactericidal), whereas others prevent bacteria from multiplying (bacteriostatic).

Oral antibiotics are simply ingested, while intravenous antibiotics are used in more serious cases, such as deep-seated systemic infections. Antibiotics may also sometimes be administered topically, as with eye drops or ointments.

Contents

 

o

<a href=[ edit ] History " id="pdf-obj-23-58" src="pdf-obj-23-58.jpg">

[edit] History

 
 
o <a href=10.1 Resources [ edit ] History See also: Timeline of antibiotics Penicillin Although potent antibiotic compounds for treatment of human diseases caused by bacteria (such as tuberculosis , bubonic plague , or leprosy ) were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago. Many other ancient cultures, including the ancient Egyptians and ancient Greeks already used molds and plants to treat infections , owing to the production of antibiotic substances by these organisms. At this time, however, the compounds having antibiotic activity and present in molds or plants were unknown. The antibiotic properties of Penicillium sp. were first described in France by Ernest Duchesne in 1897 . However, his work went by without much notice from the scientific community until Alexander Fleming ' s discovery of Penicillin (see below). Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic Salvarsan by Paul Ehrlich in 1909 , for the first time allowing an efficient treatment of the then-widespread problem of Syphilis . The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine. Antibiotics were further developed in Britain following the re-discovery of Penicillin in 1928 by Alexander Fleming . More than ten years later, Ernst Chain and Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. "Antibiotic" was originally used to refer only " id="pdf-obj-23-72" src="pdf-obj-23-72.jpg">
 
o <a href=10.1 Resources [ edit ] History See also: Timeline of antibiotics Penicillin Although potent antibiotic compounds for treatment of human diseases caused by bacteria (such as tuberculosis , bubonic plague , or leprosy ) were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago. Many other ancient cultures, including the ancient Egyptians and ancient Greeks already used molds and plants to treat infections , owing to the production of antibiotic substances by these organisms. At this time, however, the compounds having antibiotic activity and present in molds or plants were unknown. The antibiotic properties of Penicillium sp. were first described in France by Ernest Duchesne in 1897 . However, his work went by without much notice from the scientific community until Alexander Fleming ' s discovery of Penicillin (see below). Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic Salvarsan by Paul Ehrlich in 1909 , for the first time allowing an efficient treatment of the then-widespread problem of Syphilis . The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine. Antibiotics were further developed in Britain following the re-discovery of Penicillin in 1928 by Alexander Fleming . More than ten years later, Ernst Chain and Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. "Antibiotic" was originally used to refer only " id="pdf-obj-23-76" src="pdf-obj-23-76.jpg">

Penicillin

 

Although potent antibiotic compounds for treatment of human diseases caused by bacteria (such as tuberculosis, bubonic plague, or leprosy) were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago. [1] Many other ancient cultures, including the ancient Egyptians and ancient Greeks already used molds and plants to treat infections, owing to the production of antibiotic substances by these organisms. At this time, however, the compounds having antibiotic activity and present in molds or plants were unknown.

The antibiotic properties of Penicillium sp. were first described in France by Ernest Duchesne in 1897. However, his work went by without much notice from the scientific community until Alexander Fleming's discovery of Penicillin (see below).

Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic Salvarsan by Paul Ehrlich in 1909, for the first time allowing an efficient treatment of the then-widespread problem of Syphilis. The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine.

Antibiotics were further developed in Britain following the re-discovery of Penicillin in 1928 by Alexander Fleming. More than ten years later, Ernst Chain and Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. "Antibiotic" was originally used to refer only

to substances extracted from a fungus or other microorganism, but has come to include also the many synthetic and semi-synthetic drugs that have antibacterial effects.

[edit] Classes of antibiotics

At the highest level, antibiotics can be classified as either bactericidal or bacteriostatic. Bactericidals kill bacteria directly where bacteriostatics prevent them from dividing. However, these classifications are based on laboratory behavior; in practice, both of these are capable of ending a bacterial infection.

Fusidic acid

 

Antibiotics [2]

 
Antibiotic <a href=s " id="pdf-obj-24-31" src="pdf-obj-24-31.jpg">

Generic Name

Brand Names

Common Uses

Side Effects

   

Infections caused

 

bacteria, such as

 

   

particularly

 
 
   
   
   
 
   

Gastrointestinal

upset and diarrhea

 

Nausea (if alcohol

 

taken concurrently)

Allergic reactions

   

Gastrointestinal

upset and diarrhea

 

Nausea (if alcohol

 
 

taken

concurrently)

Allergic reactions

   
 

Gastrointestinal

upset and diarrhea

 

Nausea (if alcohol

taken

 

concurrently)

 

Allergic reactions

 
   
 

Gastrointestinal upset and diarrhea Nausea (if alcohol taken concurrently)

Allergic reactions

   
   
   

Zitrocin

Nausea, vomiting,

and diarrhea

(especially at

 

higher doses)

 
 

 
   
   
 
 

Gastrointestinal

 

Wide range of

 

upset and diarrhea

 

infections;

Allergy with

penicillin used for

serious

 
 
 

Brain and kidney

 

damage (rare)

 
   

Eye, ear or

 
 

bladder infections;

usually applied

Kidney and nerve

 

directly to the eye or inhaled into the lungs; rarely given

damage (when given by injection)

by injection

   

Ciproxin,

Urinary tract

Nausea (rare), tendinosis

infections,

(rare)

   
 
   
 

Prontosil (archaic)

 

Nausea, vomiting,

and diarrhea

 

(including skin

Sulfanilimide (archaic)

 

infections (except

rashes)

sulfacetamide and

Crystals in urine

 

mafenide);

 

mafenide is used

Decrease in white

topically for burns

Sensitivity to

sunlight

 
   

Gastrointestinal

 

upset

Sensitivity to

 

infections, Lyme

 

sunlight

Staining of teeth

     

Potential toxicity

to mother and

infections

fetus during

   

pregnancy

 

Others

 

infections

 

(obsolete)

 

Macrodantin,

<a href=Spectinomycin " id="pdf-obj-28-56" src="pdf-obj-28-56.jpg">

Visual Disturbance

 

Generic Name

Brand Names

Common Uses

Side Effects

[edit] Production

 

Since the first pioneering efforts of Florey and Chain in 1939, the importance of antibiotics to medicine has led to much research into discovering and producing them. The process of production usually involves screening of wide ranges of microorganisms, testing and modification. Production is carried out using fermentation; a process that is important in anaerobic conditions when there is no oxidative phosphorylation to maintain the production of adenosine triphosphate (ATP) by glycolysis.

[edit] Side effects

Possible side effects are varied, and depend on the antibiotics used. They can range from fever and nausea to major allergic reactions including photodermatitis. [citation needed] One of the more common side effects is diarrhea, sometimes caused by the anaerobic bacterium Clostridium difficile, which results from the antibiotic disrupting the normal balance of intestinal flora, [3] (which may be alleviated by taking probiotics [citation needed] ). A disruption of the population of healthy bacteria in the vagina, or vaginal flora, caused by the use of antibiotics is also common. [citation needed] Other side effects can result from interaction with other drugs, such as elevated risk of tendon damage from administration of a quinolone antibiotic with a systemic corticosteroid.

It is a common assertion that some antibiotics can interfere with the efficiency of birth control pills. Although there remain few known cases of complication, the majority of antibiotics do not interfere with contraception, despite widespread misinformation to the contrary. [4]

[edit] Antibiotic misuse

Common forms of antibiotic misuse include failure to take the entire prescribed course of the antibiotic, or failure to rest usually because the patient feels better, but before the infecting organism is completely eradicated. In addition to treatment failure, these practices can result in antibiotic resistance in which the bacteria survive the abbreviated treatment. Taking antibiotics in inappropriate situations is another common form of antibiotic misuse. Common examples of this would be the use of antibacterials for viral infections such as the common cold.

Currently, it is estimated that greater than 50% of the antibiotics used in the U.S. are given to feed animals (e.g. chickens, pigs and cattle) in the absence of disease. [5] Antibiotic use in food animal production has been associated with the emergence of antibiotic resistant strains of bacteria including Salmonella, Campylobacter, Escherichia coli and Enterococcus among others. There is substantial evidence from the US and the EU that these resistant bacteria cause antibiotic resistant infections in humans. The American Society for Microbiology (ASM), the American Public Health Association (APHA) and the American Medical Association (AMA) have called for substantial restrictions on antibiotic use in food animal production including an end to all non- therapeutic uses. The food animal and pharmaceutical industries have fought hard to prevent new regulations that would limit the use of antibiotics in food animal production. For example, in 2000 the US Food and Drug Administration (FDA) announced their intention to rescind approval for fluoroquinolone use in poultry production because of substantial evidence linking it to the emergence of fluoroquinolone resistant Campylobacter infections in humans. The final decision to ban fluoroquinolones from use in poultry production was not made until 5 years later because of challenges from the food animal and pharmaceutical industries. Today, there are two federal bills (S.742 and H.R. 2562) aimed at phasing out non-therapeutic antibiotics in US food animal production. These bills are endorsed by many public health and medical organizations including the American Nurses Association (ANA), the American Academy of Pediatrics (AAP), and the American Public Health Association (APHA).

Excessive use of prophylactic