Figure 1-2 Preventive use of drugs. Dramamine is an over-the-counter drug that is taken to prevent motion sickness and vomiting. The word vomiting does not appear on the drug package, but the word antiemetic, which means pertaining to against vomiting, appears at the top right.
The American Academy of Pediatrics issues an annual immunization schedule to prevent childhood diseases. All children must receive certain immunizations before they are permitted to enroll in school. Exceptions are granted for religious reasons or when immunization are medically inadvisable.
Figure 1-4 Foxglove plant. This beautiful wild flowering plant is commonly known as foxglove, but its scientific name is Digitalis lanata. The drug digitalis (which is no longer in use) came from this plant, as does the modern drug digoxin (Lanoxin), which is used to treat congestive heart failure.
Herbs have been a part of all cultures for centuries and have been mentioned frequently in literature. Henbane, a very toxic herb, was supposed to have been the poison that Claudius used to kill his brother, Hamlet’s father. “Henbane should not be confused with wolfsbane. Students of literature know wolfsbane to be useful as a vampire repellant (Dracula, 1897); however, we should point out that double-blind studies demonstrating the effectiveness of this plant have not as yet been conducted.” (Michael C. Gerald, Pharmacology: An Introduction to Drugs, 2nd ed. Englewood Cliffs, NJ: Prentice Hall, 1981, p. 149, out of print.)
Figure 1-7 Cocaine in a common drug. This 1885 advertisement was for the drug Cocaine Toothache Drops. It was not known at that time that cocaine was a highly addictive drug. Children as well as adults became addicted to this drug. National Library of Medicine.
Because of its devastating adverse effects in unborn children, thalidomide would have been relegated to an obscure footnote in medical history, but in 1997 it was discovered to be a useful drug in treating cancer, AIDS, and leprosy. The potential adverse effects of this drug are so great that it is only considered as a viable treatment option for these life-threatening diseases.
The FDA regulates the use of thalidomide in two ways: (1) by limiting the number of physicians who can prescribe it and (2) by requiring women taking the drug not to have sexual intercourse or to use two forms of birth control (so that there is virtually no risk of them giving birth to a child with phocomelia).
Thalidomide is now an official prescription drug used to treat multiple myeloma, leprosy, graft-versus-host disease, and several types of cancers. It is also officially recognized as an orphan drug that is used to treat wasting syndrome from HIV, as well as Crohn’s disease.
Figure 1-8 Dietary supplements. Dietary supplements, such as vitamins, minerals, and herbs, are manufactured in tablets and capsules that resemble prescription and over-the-counter drugs. However, the bottle label clearly states “Dietary Supplement,” and the reverse side of the bottle provides information under the heading of “Supplement Facts.”
Figure 1-9 Controlled substance symbol. The capital C stands for controlled substance. The number written inside (always a Roman numeral) indicates the assigned schedule. It is important to remember that a C with the Roman numeral IV inside it does not mean that the drug is to be given by the intravenous (I.V.) route; it means that the drug is a Schedule IV controlled substance.
Figure 1-10 Schedule II drug. OxyContin is a prescription drug that is used to treat severe pain. It is also a popular drug of abuse. Because it is a Schedule II drug—see the symbol on the label—it has a high potential for addiction. The drug bottle is sitting on a blue pill-counting tray in the pharmacy. This tray helps the pharmacist accurately count out the exact number of tablets specified in the patient’s prescription. The logo in the center of the tray reminds the pharmacist to “Check, Counsel, Communicate.” Getty Images, Inc.
There has been a longstanding debate over whether marijuana (a Schedule I drug) should be legally available to treat patients with certain medical conditions. In 1996, voters in California passed Proposition 215 to allow seriously ill patients to use marijuana if approved by their primary care physician. Eight other states passed similar laws.
However, the federal law that prohibits the manufacturing and distribution of marijuana supersedes individual state laws. In November 2000, the U.S. Supreme Court agreed to hear a case that sought an exemption from the federal law for cases of medical necessity. The American Medical Association (AMA) advised that marijuana did provide medical benefit to patients with certain conditions, and many other groups supported the legalization of marijuana to varying degrees.
In May 2001, however, the Supreme Court issued a decision that federal drug laws that ban the manufacture and distribution of marijuana allow for no exceptions, even for medical necessity. Despite this ruling, many patients do use the marijuana plant to treat themselves.
Of note is that the main active ingredient in marijuana is available as the prescription drug dronabinol (Marinol). It is a Schedule III drug and is used to treat nausea and vomiting caused by chemotherapy and to stimulate the appetite in patients with HIV.