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The words ‘medicine’ and 'drug' are often used in our country to mean the same substances: any
substance, manufactured artificially, which can help recovery from sickness, relieve symptoms or
modify a natural process in the body. A medicine is often a mixture of several chemical
compounds. Even if it has only one active component compound often other substances are used
as fillers or binders to give it bulk. Chemistry, the science related to chemical substances,
provides us the tools to make and study the substances that are the constituents of almost all
medicines. The past hundred years or so, ever since the advent of organic chemistry, many
chemical compounds have been discovered in nature that are effective for curing diseases.
Modern chemistry has also made it possible to synthesize several medicines using methods of
organic chemistry.
The most common medicines can be classified into few groups, e.g. antibiotics, antiseptics,
analgesics, tranquillizers, antipyretics, hormonal, steroids etc.
There are very many medicines that come under each of these groups. Often several chemical
compounds that make a particular group of medicines, say antibiotics have similar chemical
structure. Since the medicines in a particular group are effective for treating a particular type of
ailment or disease, their mode of action can also be very similar. But, the methods used to isolate
a medicine from its natural sources or to synthesize it are most often very different.
ANTIBIOTICS
Our body and our domestic animals, can serve as hosts to a wide variety of disease-
causing organisms (pathogens): These are:
• bacteria
• viruses
• fungi
• protozoon’s
The overwhelming majority of antibiotic substances are natural products that certain
bacteria and fungi (molds) produce and send outside of their cells. About 90% of the
antibiotics in use today, are isolated from bacteria. There are a few antibiotics, however,
which are completely synthetic... that is, are made from scratch in the laboratory. These
particular antibiotics are designed to inhibit some process previously identified to be
completely unique to bacteria, and necessary for the bacterium to remain alive.
An antibiotic can be most often classified into any one of the following categories of
chemical compound:
1. Amino glycosides
2. Glycopeptides
3. Beta Lactams also known as Penicillin’s
4. Tetracycline
5. Quinolines
6. Sulfonamides
Amino glycosides
Amino glycosides are antibiotics that are often administered into veins or muscle to treat
serious bacterial infections. Some amino glycosides are also used orally to treat intestinal
infections or topically to treat eye infections. Some very popular examples of this group
of antibiotics are
• Streptomycin
• Kanamycin
• Neomycin
• Gentamycin
They are the inhibitors of protein synthesis, ↓ 30S ribosomal subunit, but some
abnormal proteins insert in cell membrane & form pores, thus become bactericidal
This class of drugs inhibits the synthesis of cell walls in susceptible microbes by
inhibiting peptidoglycan synthesis. Bacterial cell wall contains peptidoglycan strands
Due to their toxicity, their use is restricted to those patients who are critically ill or who
have a demonstrated hypersensitivity to the β-lactams.
Penicillin is one major class of antibiotics. They are used to treat strep throat and
countless other infections. Examples of various kinds of penicillin include
Achromycin V (Tetracycline)
Minocin (Minocycline)
Vibramycin (Doxycycline)
They are the inhibitors of protein synthesis, ↓ 30S ribosomal subunit & are
bacteriostatic
The chemical structure of most tetracycline is related to the following structure. The
name is derived from the fact that it is made up of four rings (cycles).
Quinolones
The quinolones are a family of broad-spectrum antibiotics. The parent of the group is
nalidixic acid. The majority of quinolones in clinical use belong to the subset of
fluoroquinolones, which have a fluoro group attached the central ring system.
Quinolones and fluoroquinolones are bactericidal drugs, actively killing bacteria.
Quinolones inhibit the bacterial DNA gyrase or the topoisomerase II enzyme, thereby
inhibiting DNA replication and transcription.
They are the inhibitors of DNA replication & mitosis, inhibit bacterial topisomerase-II [
in gram (-) bacteria] & topoisomerase IV [in gram (+) bacteria], inhibit DNA replication
& are bactericidal
Sulfonamide drugs (known widely as "sulfa drugs") were the first antibacterial
antibiotics, and paved the way for the antibiotic revolution in medicine. The first
sulfonamide was trade named Prontosil, which is a prodrug. Experiments with Prontosil
began in 1932 in the laboratories of the Bayer Corporation, a component of the huge
German chemical trust IG Farben. The dye-based drug was synthesized by Bayer chemist
Josef Klarer and tested in animals under the direction of physician/researcher Gerhard
Domagk. Domagk quickly won the 1939 Nobel Prize in Medicine and Physiology, an
honor that Hitler forbade him to accept.
They are the inhibitors of DNA & cell division, can affect microbial DNA & cell
division in following ways:
Antibiotics attack a metabolic pathway found in the bacterium but not in the host. This is
not an insurmountable problem for bacterial pathogens because they differ in many
respects from eukaryotes.
These two form a linear polymer of NAG alternating with NAM. They are linked by a
glycosidic bond between the #1 and #4 carbons (this is the linkage attacked by lysozyme)
and are oriented in the same way they are in cellulose. Side chains containing 4 or 5
amino acids are attached to each NAM. These form covalent bonds with amino acids in
adjacent chains. The bonds may
Tetracyclines also bind to the 30S subunit of the bacterial ribosome. They prevent the
transfer of activated amino acids to the ribosome so protein synthesis is halted.
The fluoroquinolones block the action of two bacterial topoisomerases — enzymes that
relieve the coils that form in DNA when the helix is being opened in preparation for
replication or transcription or repair.
block the synthesis of folic acid. Mammals ignore PABA and its analogs and thus can
tolerate sulfa drugs.
The mode of action of Sulfonamides is a bit different. Both bacteria and their human
hosts require folic acid for nucleic acid synthesis (it is converted into prunes and
thymidine) as well as protein synthesis (precursor of the amino acids methionine and
glycine). However, bacteria synthesize their folic acid starting with para-aminobenzoic
acid (PABA), while we must ingest our folic acid already formed; that is, for us it is a
vitamin.
Production of antibiotics
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 ATP by glycolysis.
ANALGESICS
Analgesics are medicines that help to control pain and reduce fever. An analgesic
(colloquially known as a painkiller) is any member of the diverse group of drugs used to
relieve pain (achieve analgesia). This derives from Greek an-, "without", and -algia,
"pain". Examples of analgesics that are available over the counter are: aspirin,
acetaminophen, ibuprofen, ketoprofen and naproxen sodium. Some analgesics contain a
combination of ingredients in one pill, such as aspirin, acetaminophen and caffeine.
Analgesics act in various ways on the peripheral and central nervous system; they include
paracetamol (acetaminophen), the nonsteroidal anti-inflammatory drugs (NSAIDs) such
as the salicylates, narcotic drugs such as morphine, synthetic drugs with narcotic
properties such as tramadol, and various others. Some other classes of drugs not normally
considered analgesics are used to treat neuropathic pain syndromes; these include
tricyclic antidepressants and anticonvulsants.
Thus acetylsalicylic acid (commonly known as aspirin) is a salicylate with the chemical
structure:
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce
the possibility of infection, sepsis, or putrefaction. They should generally be
distinguished from antibiotics that destroy microorganisms within the body, and from
disinfectants, which destroy microorganisms found on non-living objects. Some
antiseptics are true germicides, capable of destroying microbes (bactericidal), whilst
others are bacteriostatic and only prevent or inhibit their growth. Antibacterial are
antiseptics that only act against bacteria.
• Alcohols
Most commonly used is ethanol (60-90%), 1-propanol (60-70%) and 2-
propanol/isopropanol (70-80%) or mixtures of these alcohols. They are commonly
referred to as "surgical alcohol". Used to disinfect the skin before injections are
given, often along with iodine (tincture of iodine) or some cationic surfactants
(benzalkonium chloride 0.05 - 0.5%, chlorhexidine 0.2 - 4.0% or octenidine
dihydrochloride 0.1 - 2.0%).
• Boric acid
Used in suppositories to treat yeast infections of the vagina, in eyewashes, and as
an antiviral to shorten the duration of cold sore attacks. Put into creams for burns.
Also common in trace amounts in eye contact solution. Though it is popularly
known as an antiseptic, it is in reality only a soothing fluid, and bacteria will
flourish comfortably in contact with it.
• Chlorhexidine Gluconate
A biguanidine derivative, used in concentrations of 0.5 - 4.0% alone or in lower
concentrations in combination with other compounds, such as alcohols. Used as a
skin antiseptic and to treat inflammation of the gums (gingivitis). The
microbicidal action is somewhat slow.
Hydrogen peroxide
Used as a 6% (20Vols) solution to clean and deodorise wounds and ulcers. More
common 1% or 2% solutions of hydrogen peroxide have been used in household
first aid for scrapes, etc. However, even this less potent form is no longer
recommended for typical wound care as the strong oxidization causes scar
formation and increases healing time. Gentle washing with mild soap and water or
rinsing a scrape with sterile saline is a better practice.
• Iodine
Usually used in an alcoholic solution (called tincture of iodine) or as Lugol's
iodine solution as a pre- and post-operative antiseptic. No longer recommended to
disinfect minor wounds because it induces scar tissue formation and increases
healing time. Gentle washing with mild soap and water or rinsing a scrape with
sterile saline is a better practice. Novel iodine antiseptics containing
iodopovidone/PVP-I (an iodophor, complex of povidone, a water-soluble
polymer, with triiodide anions I3-, containing about 10% of active iodine, with the
commercial name Betadine) are far better tolerated, don't affect wound healing
negatively and leave a depot of active iodine, creating the so-called "remanent,"
or persistent, effect. The great advantage of iodine antiseptics is the widest scope
of antimicrobial activity, killing all principle pathogens and given enough time
even spores, which are considered to be the most difficult form of
microorganisms to be inactivated by disinfectants and antiseptics.
• Mercurochrome
Not recognized as safe and effective by the U.S. Food and Drug Administration
(FDA) due to concerns about its mercury content. Another obsolete
organomercury antiseptics include bis-(fenylmercury) monohydrogenborate .
• Sodium chloride
Used as a general cleanser. Also used as an antiseptic mouthwash. Only a weak
antiseptic effect, due to hyperosmolality of the solution above 0.9%.
• Sodium hypochlorite
Used in the past, diluted, neutralised and combined with potassium permanganate
in the Daquin's solution. Nowadays used only as disinfectant.
DISINFECTANTS
By the middle of the nineteenth century, post-operative sepsis infection accounted for the
death of almost half of the patients undergoing major surgery.
In 1839 the chemist Justin von Liebig had asserted that sepsis was a kind of combustion
caused by exposing moist body tissue to oxygen. It was therefore considered that the best
prevention was to keep air away from wounds by means of plasters, collodion or resins.
When, in 1865, Louis Pasteur suggested that decay was caused by living organisms in the
air, which on entering matter caused it to ferment, Lister made the connection with
wound sepsis.
In the previous year Lister had heard that 'carbolic acid' was being used to treat sewage in
Carlise, and that fields treated with the affluent were freed of a parasite causing disease in
cattle.
Pasteur suggested three methods: filter, heat, or expose them to chemical solutions. The
first two were inappropriate in a human wound, so Lister experimented with the third.
As the germ theory of disease became more widely accepted, it was realized that
infection could be better avoided by preventing bacteria from getting into wounds in the
first place. This led to the rise of sterile surgery. Some consider Lister "the father of
modern antisepsis."
In 1879 Listerine mouthwash was named after him for his work in antisepsis. Also named
in his honor is the bacterial genus Listeria, typified by the food-borne pathogen Listeria
monocytogenes.
The first major development towards modifying basic antimicrobial agents to make them
more specialized, more effective, was in 1906 when Bechhold and Ehrlich synthesized
the bis-phenols. They found that by linking two phenol rings directly or by mean of an
alkaline group, the bactericidal and bacteriostatic effects of the phenols were greatly
enhanced. Further work was done on the bis-phenol (During 1931) leading eventually to
the synthesis of hexachlorophene.
Iodine has also been modified for use as an antiseptic. The Iodine molecules can be added
to other substances which have the ability to increase the antimicrobial qualities of the
elements, whilst reducing the irritancy of iodine.
.
Antiseptics: An agent that inhibits or destroys microorganisms on living tissue including
skin, oral cavities and open wounds.
Sanitizing agents: An agent which reduces microbes on inanimate surfaces, the number
of all forms of microbial life including fungi, viruses and bacteria.
Sporicidal agents: An agent that destroys bacterial and fungal spores when used in
sufficient concentration for a specified contact time. It is expected to kill all vegetative
microorganisms.
Sterilants: An agent that destroys all forms of microbial life including fungi, viruses and
all forms of bacteria and their spores. Sterilants are liquid or vapor-phase agents.
5) Fungal spores and vegetative molds Trichophyton, Crytococcus and Candida sp.and
yeasts.
Classification of Disinfectants
Target Disinfectants
Because a wide range of different materials of construction are used in clean rooms and
other controlled areas, each material needs to be evaluated separately to validate the
efficacy of a given disinfectant.
Typical surfaces to be decontaminated by disinfectants in a Pharmaceutical
manufacturing Area.
Materials Application
1) Stainless steel Work surfaces, filling equipments and tanks.
2) Glass Windows and vessels.
3) Plastic, Vinyl Curtains.
4) Plastic, Polycarbonate Insulation coating.
5) Lexan(Plexiglas’s) Shields.
6) Epoxy-Coated gypsum Walls and Ceilings.
7) Fiber glass-Reinforced Wall paneling.
plastic
8) Terrazzo tiles Floors.
APPLICATIONS OF DISINFECTANTS
Disinfectant Uses
Alcohols Ethyl or isopropyl alcohol at 70-80% concentration is a good
general purpose disinfectant; not effective against bacterial
spores.
Phenols Effective against vegetative bacteria, fungi and viruses
containing liquids, unpleasant odor.
Formaldehyde Concentration of 5-8% formalin is a good disinfectant against
vegetative bacteria, spores and viruses; known carcinogen;
irritating odor.
Quaternary Ammonium Cationic detergents are strongly surfaced active; extremely
Compounds effective against lipoviruses; ineffective against bacterial
spores; may be neutralized by anionic detergents (i.e. soaps).
Chlorine Low concentrations (50-500 ppm) are active against vegetative
bacteria and most viruses; higher concentrations (2,500 ppm)
are required for bacterial spores; corrosive to metal surfaces;
must be prepared fresh; laundry bleach (5.25% chlorine) may
be diluted and used as a disinfectant.
Recommended for general use; effective against vegetative
Iodine bacteria and viruses; less effective against bacterial spores;
Wescodyne diluted 1 to 10 is a popular disinfectant for washing
hands.
The following are six primary variables that influence the efficacy of disinfection:
1) Nature of the item to be disinfected:
The rougher the surface, the longer the contact time required for disinfection.
The number of microorganism present will lengthen the time for effective disinfection to
take place. In general, higher numbers of organisms require more time for disinfection.
3) Resistance of microorganisms:
Some microorganisms are more resistant to disinfection than others. The generally
accepted order from the most resistance to the least resistant is: bacterial spore,
mycobacteria, hydropjillic viruses, fungi, vegetative bacteria, lipid viruses. Disinfecting a
spill with a small concentration of bacterial spores will require longer disinfection time
than a large concentration of lipid viruses.
However, some disinfectants are not as effective in higher concentrations. Iodophors must
be diluted according to the directions on the label; over-diluting or under-diluting may
substantially lower the microbial potency. Alcohols used in concentration above 90% are
less effective because the water added to dilute the alcohol allows it to penetrate better and
reach its target. Optimal concentration range is between 70-90%.
The presences of organic soiling matter will compromises disinfection. Blood, blood
product, bodily fluids and feces contain significant amounts of proteins, and protein will
bind and inactivate some disinfectants or slow their action. Therefore, in the presence of
large amounts of protein, a higher concentration of disinfectant and longer contact time
will be necessary to achieve maximal disinfection.
1) Incidur:
Range of application:
High risk areas like Operation theatres, Intensive care Unit (ICU), laboratories
and drug manufacturing units.
Mode of Action:
It interferes with enzymes with –SH groups and Thiol group of proteins.
2) Levermed:
• Iso-propyl Alcohol...……………20%
• Benzalkonium chloride………...0.5%
• Emollents.
Range of Application:
• Industrial Quality Control Laboratories, Research Institutes, Academics, Drug
Manufacturing units.
Mode of Action:
• It generally shows action towards membrane permeability. It coagulates cellular
components.
3) Oxivir:
Composition:
Hydrogen peroxide
Alkyl Benzene sulphonic acid
Alcohol ethoxylate (C12-15) 3EO
Hydroxyethene-1-1-diphosphonic acid
2- butoxyethanol
Range of Application:
Oxivir is purposely used in Hospitals, laboratories, Institutes and Drug
manufacturing units.
Mode of Action:
Oxivir shows action on enzymes with –SH group.
4) Virex II 256:
Composition:
Didecyl dimethyl ammonium chloride……………………..8.7%
n-alkyl dimethyl benzyl ammonium chloride………………8.19%
Lauryl amine amine oxide
Ethylene diamine tetra acetic acid sodium salt
Sodium biocarbonate
Aldehyde free product No negative occupational hazard Eco friendly and user
friendly
Cleaner and disinfectant Single shot product Time and cost effective
Range of Application:
Virex II 256 is purposely used for instruments disinfection. It is also used for
surface disinfection. It is also used for washing and other tiled surfaces. It is
compatible with most metals and surfaces used in pharmaceuticals units,
Laboratories and Research Institute.
Mode of Action:
It causes general cell components coagulations.
ANTACIDS
Antacids perform a neutralization reaction, i.e. they buffer gastric acid, raising the pH to
reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the
gastrointestinal mucosa, they signal pain to the central nervous system. This happens
when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers
in the esophagus or the duodenum.
Other mechanisms may contribute, such as the effect of aluminum ions inhibiting smooth
muscle cell contraction and delaying gastric emptying.
Calcium Carbonate
CALCIUM CARBONATE is a calcium salt. calcium carbonate, CaCO3, white chemical
compound that is the most common nonsiliceous mineral. It occurs in two crystal forms:
calcite, which is hexagonal, and aragonite, which is rhombohedral. Calcium carbonate is
largely insoluble in water but is quite soluble in water containing dissolved carbon
dioxide, combining with it to form the bicarbonate Ca(HCO3)2. Such reactions on
limestone (which is mainly composed of calcite) account for the formation of stalactites
and stalagmites in caves. Iceland spar is a pure form of calcium carbonate and exhibits
birefringence, or double refraction.
ANTIHISTAMINES
A histamine antagonist is an agent which serves to inhibit the release of histamine.
The term antihistamine usually refers to the classical H1 receptor blockers.
Reversible & competitive H1 receptor antagonists block the binding of histamine to its
receptors.
These compounds do not influence the formation or release of histamine. [Cromolyn
which inhibits the release of histamine from mast cells and is useful in the treatment of
asthma.]
Histamine
Basic amine autacoid stored in granules of mast cells and basophils.
IgE-dependent release
IgE-independent release (C3a and C5a, or drugs (e.g., d-tubocurarine).
Acts as neurotransmitter in histaminergic nerves
Histamine Synthesis
Histamine Receptors
3 Receptors
• H1, H2, H3 (H4 suggested)
All receptors G-protein-coupled
Signaling pathway
• H1 (PLC - IP3 & DAG)
• H2 (AC – cAMP)
• H3 (decrease in Ca2+ flux).
Allergic diseases
• allergic rhinitis (hay fever)
• Allergic conjunctivitis
• urticaria (Triple response)
• anaphylactic shock
• Allergic angioedema
Drug reactions
Insect bites
Hyper secretion of acid in peptic ulcers.
Classification
1st Generation
2nd Generation
1st Generation
Key Members
• Diphenhydramine
• Chlorpheniramine
• Doxylamine
• Hydroxyzine
Characteristics
• High lipophilicity, easily enters CNS
• Highly sedative
• Anti-muscarinic, anti-α-adrenergic, anti-5HT
• Some have anti-motion sickness effect
• Some have local anaesthetic effect
• Generally short-acting
2nd Generation
Key Members
• Desloratadine (loratadine)
• Fexofenadine (terfenadine)
• Cetirizine
• Azelastine
Characteristics
• No CNS entry (Low lipophilicity, most ionized; also protein binding)
• Non-sedating
• No significant autonomic receptor blocking effect
• Generally long-acting
• Some are cardio toxic
The most commonly prescribed tranquillizers are from the class of drugs called
benzodiazepines (benzos) and are known as minor tranquillizers. There are various
benzos and they are usually known by their brand names, a few of the well known
products include:
Drugs of abuse
The easy availability of tranquillizers has made them common as drugs of abuse. Some
drug abusers take tranquillizers to bring them down after using stimulants such as ecstasy
or cocaine. Others take them to enhance the effect of alcohol.
Temazepam has become a street drug as a substitute for heroin and Rohypnol is the
tranquilizer most associated with "date rape" as it has been known to be used to spike
drinks. The victim is often unaware that they have been slipped a drug and while under
the influence they are vulnerable to sexual abuse and rape.
Tranquillisers calm the user down and reduce feelings of agitation and restlessness, they
also slow down mental activity and produce drowsiness. Tranquillisers can have a
relaxing effect on the muscles. High doses of tranquillizers can make users forgetful,
dizzy and can induce sleep.
The effects of tranquillizers can begin after 10-40 minutes and can last for 3-6 hours but
this depends greatly on the drug used and the strength prescribed.
If mixed with alcohol or other depressant drugs tranquillizers can be extremely dangerous
and can cause a fatal overdose.
A low dosage of tranquillizers prescribed for a short period of time is unlikely to pose
any greater risk to health. However, if you take tranquillizers regularly a tolerance can
develop, so you will need to take more to get the same effect and you may also find you
become dependent on them. Therefore it is recommended that tranquillizers are not used
for long periods, and should not be taken for more than a 2-4 week period. If you are
taking them for insomnia a 2-3 night break from the tranquillizers each week is
recommended.
After 2-3 weeks of continuous use tranquillizers may become ineffective as sleeping pills
and after 4 months ineffective against anxiety.
Long term use of tranquillizers can cause depression, memory loss, mental confusion,
stomach disorders and aggressive behaviour.
The withdrawal effects can be very unpleasant and include sickness, headaches,
irritability, anxiety, nausea and in some cases panic attacks.
Mechanism of action
Estrogen was originally included in oral contraceptives for better cycle control (to
stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding),
but was also found to inhibit follicular development and help prevent ovulation. Estrogen
negative feedback on the anterior pituitary greatly decreases the release of FSH, which
inhibits follicular development and helps prevent ovulation.
Drug interactions
Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or
increased chance of pregnancy. These include drugs such as rifampicin, barbiturates,
phenytoin and carbamazepine. In addition cautions are given about broad spectrum
antibiotics, such as ampicillin and doxycycline, which may cause problems "by impairing
the bacterial flora responsible for recycling ethinylestradiol from the large bowel"