Four more magnificent medicines

 

crutchfieldsquareMy last two columns have described 10 advances in medicine that have enriched the quality and prolonged the lives of humankind. This week’s column features four more magnificent medicines that have changed the way we live.

 

  1. Water-whacker: furosemide

This medication eliminates unwanted water. Medicines that do this are called diuretics. Water reduction can reduce unwanted swelling known as edema. Edema is a water-based swelling from an accumulation of water.

Furosemide works by blocking the kidneys from reabsorbing water as they normally would. As a result, more urine is produced, which reduces the accumulated water, which reduces edema.

Furosemide is commonly used to treat edema from heart failure. The heart beats poorly, and the kidneys interpret this as a need to increase blood volume. It can also be employed to produce an overall reduction in blood volume, which also lowers blood pressure. Curiously, furosemide is also used in race horses to reduce nasal bleeds during strenuous running.

 

  1. Battling mental illness

Chlorpromazine revolutionized the treatment of mental illness. Before 1954, there were no effective medications to treat people with mental illness. Patients with schizophrenia or other psychotic disorders were institutionalized and treated with talk therapy or even electroconvulsive-electroshock treatments. None of these worked well.

It was discovered in France that patients being treated for post-surgical shock with a medicine named chlorpromazine, who also had schizophrenia or other psychotic disorders, showed remarkable improvements in their conditions. Subsequent testing of the medication in U.S. mental institutions confirmed that it did, indeed, have good results in the treatment of schizophrenia and other psychotic disorders.

The mechanism of action of is to block dopamine receptors, eliminating much of the erroneous chemical signaling in the brain, allowing many patients to lead somewhat normal lives. Chlorpromazine was approved in 1952 under the trade name of Thorazine. Over the next quarter of a century, the number of patients institutionalized with schizophrenia or other psychotic disorders was reduced nearly 70 percent.

The medicine does have significant side effects, most notably a “herky-jerky” movement disorder, but chlorpromazine was the first in a class of new medicines that changed the lives of millions with mental illness.

 

  1. Mysterious wonder: acetaminophen

Acetaminophen, trade name Tylenol, is a pain reliever (analgesic) and fever reducer (antipyretic). It, however, does not significantly relieve inflammation like aspirin can.

Acetaminophen was first discovered in the late 1800s but was not seriously considered for common use until the 1940s. Acetaminophen became available for over-the-counter consumption in 1959.

Acetaminophen is great for treating minor aches and pains and headaches and is also a common ingredient in many over-the-counter flu remedies or treatments. Acetaminophen is the treatment of choice to treat fever in children with flu-like symptoms. It can be combined with other stronger opioid analgesics to give greater pain relief when needed (for cancer and post-operative pain, for example).

Quite peculiarly, although the drug has been around since the 1800s, the mechanism of how it works is still poorly understood and up for much debate. Overdoses of acetaminophen can lead to permanent liver damage. Acetaminophen is one of the most commonly used medicines in the world and is on the World Health Organization’s list of essential medicines.

 

  1. Transplant transformer

Cyclosporine reduces fatal infections that can occur after organ transplantation. While the 1960s were a great pioneering time for surgical transplantation, one big problem remained: To keep the body from rejecting a new (and foreign) organ, the patients had to be given medicines to calm down the immune system (immunosuppressants).

Unfortunately, the immunosuppressants suppressed the entire immune system, leaving the transplant recipient vulnerable to multiple infections, many of which were fatal. Cyclosporine was the first medicine that afforded the ability to keep the transplant recipient from rejecting the new organ without suppressing the entire immune system.

A Swiss pharmaceutical company in the 1960s encouraged their employees to collect soil samples while travelling or on vacation. They had their employees do this in hopes of discovering new medicines. Cyclosporine was actually found as a product of a fungus in a soil sample from Norway. It had the desired and unique ability to suppress the part of the immune system that was involved in the rejection of transplants (T-cells) but leave the part of the immune system that fights many infections (B-cells) alone.

Cyclosporine is not without significant side effects including kidney damage and must be used with caution and often with other medications. It was approved by the FDA for use in transplant patients in 1983. Cyclosporine is also very effective in treating psoriasis and other inflammatory conditions.

 

Next time I will discuss medicines that improve self-esteem, treat deadly viral infections, and more.

 

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.