Chemicals in medicines

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 diseasecausing organisms (pathogens): These are:
bacteria
viruses
fungi
protozoons
An antibiotic (Greek anti, "against"; bios, "life"), is a chemical substance produced by
one organism that is destructive to another. This process traditionally has been called
antibiosis and is the opposite of symbiosis. More specifically, an antibiotic is a type of
chemotherapeutic agent that has a toxic effect on certain types of disease-producing
microorganisms without acting dangerously on the patient. The definition most used for
antibiotics is: any substance produced by a microorganism which harms or kills another
microorganism. However, antibiotics DO NOT harm viruses. Doctors often prescribe
antibiotics when you may have a viral infection because of the possibility that you may
also acquire a bacterial infection because you are so ill with a virus - being ill places a

person at risk for certain bacterial infections that are normally handled without any
problem.
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 Penicillins
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
The chemical structure of this group of antibiotics is:

Glycopeptides

Glycopeptide antibiotics are a class of antibiotic drugs. They consist of a glycosylated

cyclic or polycyclic nonribosomal peptide. Important glycopeptide antibiotics include
vancomycin, teicoplanin, ramoplanin, and decaplanin.
This class of drugs inhibits the synthesis of cell walls in susceptible microbes by
inhibiting peptidoglycan synthesis. Bacterial cell wall contains peptidoglycan strands

Peptidoglycan is composed of UDP-N-acetyl-muramic acid, UDP-N-acetylglucosamine & a pentapeptide

Cycloserine, resembles to alanine & inhibits addition of alanine into peptide
chain
Vancomycin inhibits transglycosidase enzyme & prevents peptidoglycan chain
elongation

Due to their toxicity, their use is restricted to those patients who are critically ill or who
have a demonstrated hypersensitivity to the -lactams.
The chemical structure of a glycopeptide antibiotic is

Penicillin
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
Amoxicillin, Ampicillin, Carbenicillin, Cloxacillin, Dicloxacillin, Flucloxacillin..
They are the inhibitors of cross linking of peptidoglycan strands:

Inhibit transpeptidase enzyme, involved in cross linking of peptidoglycan

strands
Also called as transpeptidation reaction & strengthens cell wall.
Defects in the synthesis of cell wall cause wholes in cell wall & changes in
permeability
Leading to bacterial swelling & lysis
Hence cell wall synthesis inhibitors are bactericidal

Common structural features of Beta-Lactams;

Tetracycline
Tetracyclines are another category of antibiotics. In addition to being used to treat
infections, they are often used to manage acne. A few of the tetracyclines frequently used
are:

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
The common chemical structure is as follows

Sulfonamides
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:

Inhibit DNA synthesis

a) Inhibitors of folate synthesis- Sulfonamides & sulfones inhibit dihydropteroate synthase (DHPS) enzyme
Trimethoprim inhibits dihydro-folate reductase (DHFR) enzyme (bacterial
DHFR more than human)
b) Inhibitors of thymidylate synthesis- Flucytosine: is a cytosine analogue &
inhibits thymidylate synthase (TS)

Converted in fungi & GI flora to 5-fluorouracil (5-FU)

5-FU converted to 5-FdUMP

5-FdUMP incorporated to DNA

Some examples of sulfonamide antibiotics are:

Mafenide, Sulfacetamide, Sulfamethizole, Sulfanilimide, Trimethoprim etc.

How Antibiotics act.

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.
Thus pencillins (beta-lactams) work by interfering with the synthesis of the bacterial cell
walls a structure that is not found in eukaryotes. The walls of bacteria are made of a
complex polymeric material called peptidoglycan. It contains both amino acids and
amino sugars. The amino sugars are of two kinds
N-acetylglucosamine (NAG) and its close relative
N-acetylmuramic acid (NAM).
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
be direct to the next chain or
include additional peptide cross bridges (e.g., 5 glycine residues) which
extend to chains in the same plane (shown here) as well as to chains above and
below.

This elaborate, covalently cross-linked structure provides the great strength of the cell
wall. It also leads to the remarkable conclusion that the bacterial cell wall meets the
definition of a single molecule!
The beta-lactam antibiotics bind to and inhibit enzymes needed for the synthesis of the
peptidoglycan wall. While they have little effect on resting bacteria, they are lethal to
dividing bacteria as defective walls cannot protect the organism form bursting in
hypotonic surroundings.
The aminoglycosides bind to the 30S subunit of the bacterial ribosome, because the
bacterial ribosome differs in several ways from the eukaryotic ribosome and thus
interferes with the formation of the initiation complex , causing misreading of the
mRNA.
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.

ANTISEPTICS
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.
Some chemical compounds/groups of chemical substances that are often used as
antiseptics are:

Alcohols
Most commonly used is ethanol (60-90%), 1-propanol (60-70%) and 2propanol/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%).

Quaternary ammonium compounds

They include the chemicals benzalkonium chloride (BAC), cetyl
trimethylammonium bromide (CTMB), cetylpyridinium chloride ,
cetylpyridinium chloride (CPC) and benzethonium chloride (BZT). Benzalkonium
chloride is used in some pre-operative skin disinfectants (conc. 0.05 - 0.5%) and
antiseptic towels. The antimicrobial activity of Quats is inactivated by anionic
surfactants, such as soaps. Related disinfectants include chlorhexidine and
octenidine.

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 .

Phenol (carbolic acid) compounds

Phenol is germicidal in strong solution, inhibitory in weaker ones. Used as a
"scrub" for pre-operative hand cleansing. Used in the form of a powder as an
antiseptic baby powder, where it is dusted onto the belly button as it heals. Also
used in mouthwashes and throat lozenges, where it has a methadone-like
painkilling effect as well as an antiseptic one. Example: TCP. Other phenolic
antiseptics include historically important, but today rarely used (sometimes in
dental surgery) thymol, today obsolete hexachlorophene, still used triclosan and
sodium 3,5-dibromo-4-hydroxybenzenesulfonate (Dibromol).

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.

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.
It is used as an antacid to relieve the symptoms of indigestion and heartburn. It is also
used to prevent osteoporosis, as a calcium supplement, and to treat high phosphate levels
in patients with kidney disease.
Antacids are usually taken after meals and at bedtime, or as directed by your doctor or
health care professional. Take your medicine at regular intervals. Do not take your
medicine more often than directed.
Need to take care before taking this:
constipation
dehydration
high blood calcium levels
kidney disease
stomach bleeding, obstruction, or ulcer
an unusual or allergic reaction to calcium carbonate, other medicines, foods, dyes, or
preservatives
pregnant or trying to get pregnant
breast-feeding
Interaction with medicines
Do not take this medicine with any of the following medications:
ammonium chloride

methenamine
This medicine may also interact with the following medications:
antibiotics like ciprofloxacin, tetracycline
captopril
delavirdine
gabapentin
iron supplements
medicines for fungal infections like ketoconazole and itraconazole
medicines for seizures like ethotoin and phenytoin
mycophenolate
quinidine
rosuvastatin
sucralfate
thyroid medicine.

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

TRANQUILLISERS
Tranquillizers also known as sedatives are man-made drugs, they are usually prescribed
by doctors as short-term treatments for depression, anxiety, stress and insomnia
(difficulty in sleeping).
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:

Valium the generic name is diazepam.

Ativan the generic name is lorazepam.

Mogadon the generic name is nitrazepam. On the street they may be called
moggies.
Normison the generic name is temazepam. On the street they may be called jellies
or eggs.
Rohypnol the generic name is flunitrazepam. On the street they may be called
roofies, rope or the forget-pill.

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.
Immediate effects of tranquillizers
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.
Long-term effects of taking tranquillizers
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.

ANTI FERTILITY DRUGS/ ORAL CONTRACEPTIVE

PILLS
The combined oral contraceptive pill (COCP), often referred to as the birth-control
pill or simply "the pill", is a birth control method that includes a combination of an
estrogen and progestogen. When taken by mouth every day, these pills inhibit female
fertility.

Mechanism of action
Combined oral contraceptive pills were developed to prevent ovulation by suppressing
the release of gonadotropins. Combined hormonal contraceptives, including COCPs,
inhibit follicular development and prevent ovulation as their primary mechanism of
action.
Progestagen negative feedback decreases the pulse frequency of gonadotropin-releasing
hormone (GnRH) release by the hypothalamus, which decreases the release of folliclestimulating hormone (FSH) and greatly decreases the release of luteinizing hormone
(LH) by the anterior pituitary. Decreased levels of FSH inhibit follicular development,
preventing an increase in estradiol levels. Progestagen negative feedback and the lack of
estrogen positive feedback on LH release prevent a mid-cycle LH surge. Inhibition of
follicular development and the absence of a LH surge prevent ovulation.
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.
A secondary mechanism of action of all progestagen-containing contraceptives is
inhibition of sperm penetration through the cervix into the upper genital tract (uterus and
fallopian tubes) by decreasing the amount of and increasing the viscosity of the cervical
mucus.

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"