Pharmacology and Public HealthMini-Med Spring 2021

Pharmacology

Name some common medicines found at home!

Here are a few, but there are many more!

● Advil● Tylenol● Motrin● Aleve● Excedrin● Benadryl● Mucinex● NyQuil/DayQuil

● Visine● Pepto-Bismol● TUMS● Allegra● Flonase● Claritin● Sudafed● Robitussin

How Does it Work?

Ibuprofen

Ibuprofen facts

▪ Common brand names include Motrin and Advil

▪ Is classified as an NSAID (Nonsteroidal anti-inflammatory drug)

▪ Used mostly for pain, fever, and inflammation

▪ Ibuprofen purchased over-the-counter (OTC) in low dosages, while prescription doses are available for higher dosages.

▪ Prostaglandins are molecules that cause inflammation

▪ Cyclooxygenase (COX) enzymes are a necessary part of the body’s pathway to produce prostaglandins

▪ There are 2 COX enzymes: “COX-1” and “COX-2”

▪ Ibuprofen belongs to a class of drugs called NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) that reduce inflammation by inhibiting (blocking) cyclooxygenase (COX) enzymes▪ Ibuprofen is a non-selective NSAID, meaning it blocks both

COX-1 and COX-2 (rather than blocking one or the other)

▪ Therefore, ibuprofen inhibits the production of prostaglandins, which reduces inflammation

Ibuprofen – Mechanism of Action

Phospholipids

Arachidonic Acid

Prostaglandins

NSAIDs(ibuprofen)

Inflammation

COX-1 or COX-2

Prostaglandins are a class of molecules that promote ___?

A) A healthy heartB) InflammationC) Bone healthD) Allergic ReactionsE) Digestion

Prostaglandins are a class of molecules that promote ___?

A) A healthy heartB) InflammationC) Bone healthD) Allergic ReactionsE) Digestion

How Does it Work?

Acetaminophen

Acetaminophen facts

● A common brand name is Tylenol● Is considered an analgesic (pain reducer) and an antipyretic (fever reducer)● It is used to relieve aches, pains, and reduce fever

○ It is commonly used in the treatment of pain associated with arthritis● Proper dosing depends on type of tablet

Acetaminophen DOES NOT reduce inflammation

▪ It is believed this drug works mostly on the central nervous system in the brain centers responsible for pain and fever

▪ Like the NSAIDs, studies show acetaminophen inhibits the COX enzymes. So what makes the 2 drugs different?

▪ Where they act. Acetaminophen works mostly in the central nervous system, so it can’t reach inflammation in the body as NSAIDs can

▪ The effect of acetaminophen on the heat centers of the brain are believed to cause the body to sweat and lose body heat which reduces fever

Where does acetaminophen (Tylenol) produce its effect?

A) The Central Nervous SystemB) The Cardiovascular SystemC) The armsD) The Muscular SystemE) The legs

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Where does acetaminophen (Tylenol) produce its effect?

A) The Central Nervous SystemB) The Cardiovascular SystemC) The armsD) The Muscular SystemE) The legs

How Does it Work?

Penicillin

Penicillin is an Antibiotic

● Humans can suffer from bacterial infections (like strep throat)● Antibiotics are a class of drugs that selectively kill/harm bacterial cells, but not human cells

○ To do this, antibiotics must “target” a structure that is in bacterial cells, but not in human cells● Bacterial cells oftentimes have a structure called a cell wall, while human cells never have a cell wall● Penicillin works by inhibiting cell wall synthesis, which selectively hinders bacterial cell survival, but not

human cell survival (since human cells don’t contain a cell wall)● Other types of antibiotics target different bacterial cell structures, but the concept is the same:

○ Antibiotics must target something in bacteria cells but not human cells

How Does it Work?

Antihistamines

Allergies, Histamines, and Antihistamines

▪ The immune system works to prevent infection of the body by dangerous foreign substances (like bacteria)

▪ An allergy is an immune system response to a foreign substance that doesn’t really pose a threat to your body (like dog dander or pollen)

▪ When certain immune system cells recognize a foreign substance, they release histamines

▪ Histamines bind to histamine receptors in the body, which ultimately produces inflammation and itching

▪ Antihistamines work by preventing/blocking histamines from binding to the histamine receptors in the body, thereby reducing the inflammation and itching, and combating allergies

Public Health

Public Health

• The science of protecting and improving the health of people and their communities by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases.

• In short, public health focuses on interventions to help prevent disease, rather than treating diseases once they have already developed

Smoking – A public health crisis with a

public health solution

Smoking – What we

know now

• Smoking is the leading cause of preventable death worldwide

• Smoking can cause:• Cancer• Heart disease• Stroke• Lung diseases• Diabetes• Chronic obstructive pulmonary disease

• On average, smokers die 10 years earlier than non-smokers

• Cigarette smoking accounts for 480,000 deaths in the United States per year

But in the early 1900s, the dangers of smoking were not known…

● Advertisements glamorizing smoking and falsely claiming cigarettes had health benefits caused tobacco use in the USA to increase

● Lung cancer went from a very rare disease in 1900 to the leading cancer diagnosed in American men in the 1950s

- Note how the increase in lung cancer lags the increase in cigarette consumption in the graph● In the 1950s, several studies were published that

showed a causal link between smoking and lung cancer

1964 Surgeon General’s Report

▪ Mounting evidence that cigarettes caused lung cancer led to a public health intervention – a report from the US Surgeon General in 1964

▪ “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.”

● This report and the policy measures that followed it (including an advertisement ban and a tax increase on cigarettes) caused cigarette smoking to decrease in the USA

● Lung cancer rates eventually decreased

Number of Cigarettes per Capita

What is the focus of public health?

A) Disease TreatmentB) SurgeryC) Lowering drug pricesD) Educating more doctorsE) Disease Prevention

What is the focus of public health?

A) Disease TreatmentB) SurgeryC) Lowering drug pricesD) Educating more doctorsE) Disease Prevention

Vaping – A New Public Health

Crisis

Vaping facts▪ E-cigarettes are generally believed to be safer than

cigarettes because they do not contain tobacco

▪ HOWEVER, THEY ARE STILL DANGEROUS…

▪ 99% of e-cigarettes sold in the USA contain nicotine, a chemical that is highly addictive

▪ Nicotine can harm brain development in people under 20 years old

▪ E-cigarettes may contain chemicals that damage the lungs when inhaled.

▪ Researchers believe vitamin E acetate is a particularly dangerous chemical for the lungs in e-cigarette aerosols.

▪ Vitamin E is in a lot of food and is safe to eat, but when inhaled into the lungs it can cause damage

▪ As of February 2020, 2,807 people have been hospitalized and 68 people have died from a vaping related lung problem

▪ Big picture: research on health effects of vaping still ongoing, but it does seem to increase risk of lung damage

X-ray Findings

Normal lung x-ray. Note the lungs are dark with very little white infiltrate

X-ray from a patient with vaping related lung injury. Note the white lines spreading throughout both lobes,

indicating damage to the small airways of the lungs

The Predatory Practices of Vaping

companies▪ E-cigarettes are supposed to be an alternative

to cigarettes for those who already use cigarettes

▪ However, much of the advertising for e-cigarettes was intended to reach young non-smokers

▪ E-cigarette companies heavily advertised on social media platforms with young users

▪ E-cigarette ads (like the one to the left) frequently feature sleek designs, bright colors, and young models

● In addition, flavored e-cigarettes are particularly appealing to teenagers

○ 82% of youth who used e-cigarettes in 2020 used flavored varieties

Vaping - Public Health Interventions

● On January 2, 2020 the US Food and Drug Administration (FDA) prohibited the sale of prefilled pod or cartridge based e-cigarettes in any flavor other than menthol flavor or tobacco flavor ○ The goal was to get rid of flavors, which appeal to young users

● Some states have enacted broader laws to ban all flavored e-cigarette sales

● Additionally, there have been numerous advertising campaigns targeted to young Americans educating them on the dangers of vaping.

● Note that vaping ads are still legal, but there are ongoing discussions about outlawing them

● Results?

○ In 2020 1.6 million fewer young Americans used e-cigarette products than in 2019

What addictive chemical can be found in both cigarettes and e-cigarettes?

A) TobaccoB) Carbon DioxideC) VibraniumD) KryptoniteE) Nicotine

What addictive chemical can be found in both cigarettes and e-cigarettes?

A) TobaccoB) Carbon DioxideC) VibraniumD) KryptoniteE) Nicotine

QUESTIONS?

Sources

https://www.cdcfoundation.org/what-public-health

https://salud-america.org/the-upstream-downstream-parable-for-health-equity/

https://www.businessinsider.com/vintage-tobacco-adverts-that-would-be-illegal-today-2016-6

www.cancer.org

https://www.researchgate.net/publication/11080330_Tobacco_use_and_cancer_An_epidemiologic_perspective_for_geneticists

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#diseases

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

https://truthinitiative.org/sites/default/files/media/files/2020/12/Truth_E-cigarette%20Fact%20Sheet_Dec_2020.pdf

https://www.forbes.com/sites/kathleenchaykowski/2018/11/16/the-disturbing-focus-of-juuls-early-marketing-campaigns/?sh=2905d9b114f9

https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-06-01-003_508.pdf

https://www.fda.gov/news-events/press-announcements/national-survey-shows-encouraging-decline-overall-youth-e-cigarette-use-concerning-uptick-use

https://www.lawsonresearch.ca/news/case-report-describes-suspected-new-type-vaping-related-lung-injury