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Medicine cabinet

2017.12.12 0+

That was the name for the cabinet over the bathroom sink in my house when I was growing up. What ever you call the place you keep medications, take a peek in my well-stocked cabinet below.

Brands are the proprietary names and trademarks of the pharmaceutical companies that make and distribute them. Names in parentheses are generic or chemical names. You may see either or both on labels of your medicines. With some exceptions, the medications presented require a prescription.

medicinetop

This content is for educational information only. Ask your physician or pharmacist any questions you may have about taking your medications.

Analgesics

What I call 'em

pain pills

They are used for

headaches, muscle aches and pains

Examples

  • Aleve (naproxen)

  • Aspirin

  • Celebrex (celecoxib)

  • Codeine

  • Motrin (ibuprofen)

  • Tylenol (acetaminophen)


“Feeling no pain” in Greek. These are some of the most common medications taken. Many are available OTC (over the counter-without prescription). Most all of these drugs work on three things: pain, inflammation, and fever. Each varies in its potency for one of these three complaints. Aspirin and Tylenol are taken for colds, headaches, sinus pain, muscular aches. Aspirin has a strong anti-inflammatory action and is often taken for many problems involving inflammatory reactions: infections, bruising, broken bones and arthritis.

A newer drug, Celebrex, interrupts a different point in the inflammatory process and is called a COX-2 inhibitor. Although the latter avoids the side effects of aspirin, recent research has raised concerns about side effects associated with Celebrex which call for consultation with your physician as to which medication is best for you.

Severe pain, such as after surgery, may require stronger analgesics, narcotics, such as codeine, Darvon or Percodan.

Antacids

What I call 'em

indigestion pills

They are used for

heartburn

Examples

  • Prevacid (lansoprazole)

  • Prilosec (omeprazole)-OTC

  • Tums

  • Zantac (ranitidine)

Who hasn’t had “heartburn” after a big, fatty or spicy meal? So called “heartburn” has nothing to do with the heart, but refers to the burning pain felt behind the breast bone related to meals. The cause is gastric acid backing up into the esophagus.

There are three levels of treatment for mild to moderate to severe symptoms. Popping a Tums or Rolaids, which contains an alkaline chemical, directly neutralizes acid. If heartburn occurs frequently, several times a week, your physician may recommend Zantac or Pepcid which are OTC available histamine blockers. Histamine in the stomach is one of the signals that stimulates acid production. For severe heartburn your physician may prescribe a medication that directly blocks acid production, a proton-pump inhibitor, such as Prevacid (sounds like someone combined “prevent” and “acid”). Each is progressively more effective, but more expensive and with more side effects. However, Prilosec is now available OTC at lower cost than prescription versions.

Antiarthritic

What I call 'em

rheumatism pills

They are used for

rheumatoid arthritis

Examples

  • Aspirin

  • Aleve (naproxin)

  • Celebrex (celecoxib)

  • Humira (adalimumab)

  • Remicade (infliximab)


Rheumatoid arthritis is an autoimmune disease, that is, the immune system attacks joint tissue as if it were foreign tissue leading to joint pain, swelling, redness, warmth (the four criteria of inflammation). Ultimately, joint tissues are damaged. The cause is unknown, but something triggers the inflammatory reaction which becomes chronic and results in destruction of joint structures.

All antiarthritic medications have a common goal, to avoid, suppress or interrupt the inflammatory process. Keep in mind that inflammation is a normal and desirable process when we have an infection. Normally, the inflammatory process, involving bringing in leucocytes (white blood cells) and antibodies does it job and then resolves with the healing process. It is when inflammation develops as a result of an abnormal trigger and/or becomes chronic that normal tissues can be damaged with joint destruction and immobility as a result.

Aspirin and Aleve belong to a category of drugs called NSAIDS (nonsteroidal antiinflammatory drugs). These medications inhibit synthesis of an intermediary chemical in the inflammatory process called prostaglandins. A newer drug, Celebrex, interrupts a different point in the inflammatory process and is called a COX-2 inhibitor. Although the latter avoids the side effects of aspirin, recent research has raised concerns about side effects associated with Celebrex which call for consultation with your physician as to which medication is best for you.

Humira represents a new category of drug recently developed, called slow-acting anti-inflammatory agents, which targets another trigger for inflammation, TNF-alpha. TNF (tumor necrosis factor) is a normal trigger for inflammation, but when produced in abnormally high levels, triggers a chronic, destructive inflammation in joints. This medication has a unique action. It is an genetically engineered antibody which binds and “hides” TNF from the immune system thereby avoiding destructive activity. Since TNF is a normal part of the inflammatory process, patients who already have an ongoing infection must consult with their physician about its use or continued use.

Remicade is heavily advertised for Crohn’s Disease, a chronic inflammatory disease primarily involving the bowel. However, it is approved for rheumatoid arthritis also. It has a similar mechanism of action as Humira.

Antibiotics

What I call 'em

bug killers

They are used for

microbial infections

Examples

  • Amoxil (amoxicillin)

  • Erythromycin

  • Keflex (cephalexin)

  • Pen-Vee (Penicillin)

  • Septra (sulfamethoxazole)

  • Vibramycin (doxycycline)


There are many of these drugs so only a brief overview can be offered. Two major categories are called broad spectrum meaning many types of microorganisms are affected, and narrow spectrum meaning one or a few microorganisms are affected. First, how do antibiotics work? How can they kill “bugs” but not us? Two examples follow: Humans need folic acid but can’t make it, so we have to get it in our diet as a vitam
in. Bacteria can’t take in folic acid, so they must make it. Sulfa drugs block synthesis of folic acid. Voila! Okay for us. Bad for bacteria. Another example is bacteria have an extra layer around themselves called a cell wall. Penicillins block cell wall synthesis. Humans lack a cell wall outside our cell membranes. Okay for us. Bad for bacteria.

Sulfonamides, also called sulfa drugs (not “sulfur” as in brimstone!), were the earliest antibiotics. In those old WWII movies when you see them sprinkling a powder on wounds, that may be a sulfa drug. Over time many organisms have developed resistance to sulfa drugs, so newer antibiotics have to be used. Or, patients develop allergic reactions to sulfa drugs and they must be replaced with other antibiotics. However, they are still used for urinary tract infections and in burn units among other specific uses. Why do you suppose SULFAcetamide, SULFAmethoxazole, and SULFAsalazine are called “sulfa” drugs?

Penicillin is effective against a wide variety of microorganisms including pneumococcal pneumonia, staphylococcal infections, meningitis, syphilis and gonorrhea. How would you know that nafcillin, oxacillin, ampicillin and amoxicillin are all forms of peniCILLIN? Unfortunately, some individuals develop an allergic reaction to penicillins and many microorganisms have become resistant. In this category are newer antibiotics called cephalosporins. Resistant strains have developed against these antibiotics also. What is the nature of antibiotic resistance (more difficult to kill)? In the case of penicillins some microorganisms have developed an enzyme, penicillinase, that inactivates the antibiotic. Microorganisms may also change the chemical structure of their cell walls, the target of penicillins and cephalosporins. Those wily bacteria!

Tetracyclines interfere with bacterial protein synthesis. They effectively stop bacterial growth so our immune system can finish them off. This works because of subtle differences in the protein making machinery of microorganisms and human cells. Tetracyclines (I have doxycycline in my cabinet) are used in chlamydial infections, Lyme disease, Rocky Mountain spotted fever, mycoplasma pneumonia, cholera, syphilis, among others. Another inhibitor of protein synthesis is Erythromycin which is the drug of choice for Legionnaires Disease and one of the few antibiotics that can penetrate the prostate gland. Since it covers a similar spectrum of microorganisms as penicillins, it can be used to treat syphilis in patients who are allergic to penicillin.

Why won’t my doctor prescribe an antibiotic when I have a really bad cold? Common colds are caused by viruses. Viruses have neither cell walls nor their own metabolic machinery (they use yours). Consequently, antibiotics don’t work against viruses.

Anticoagulants

What I call 'em

blood thinners

They are used for

prevent blood clots

Examples

  • Coumadin (warfarin)

  • Heparin

  • Plavix (clopidogrel)


Well, they really don’t make your blood thinner. What they do is make your blood less likely to clot (coagulate) when it is undesirable for clotting to take place like inside your coronary arteries (remember thrombus and embolus?). Since anticoagulants interfere with the clotting mechanism, their use must be carefully monitored to make sure clotting does take place normally with a finger cut, but prevent clots forming after your hip surgery.

Anticonvulsants

What I call 'em

epilepsy drugs

They are used for

prevent seizures

Examples

  • Dilantin (phenytoin)

  • Phenobarbital

  • Neurontin (gabapentin)


Although head trauma or a brain tumor can cause seizures, many times there is no specific cause and it may be inherited. The function of anticonvulsant drugs is to suppress the source of abnormal electrical activity in the brain. Dilantin is a first choice drug in controlling many forms of seizures. Dilantin along with Valium (a tranquilizer) are first line drugs for “status epilepticus”, continuous seizure activity which must be stopped quickly. However, there are various anticonvulsants for specific forms of epilepsy, all with differing effectiveness, side effects and potential drug interactions with other medications. Many famous people have had epilepsy: Socrates, Julius Caesar, Napoleon, Handel, Charles Dickens, Alfred Nobel and Elton John among many others.