Do I look bloated to you?

Hello. This past week has been an interesting one. I have not really done any homework since I got back from Spring Break. The laziness has been nice, but it has certainly increased my stress level.

This week I would like to make a departure once more. This past Tuesday I attended a funeral for my wife's grandfather. He died of natural causes after a long fight with heart failure. This forum is not appropriate to discuss the nature of my beliefs about the soul of man, but I do not believe that he is gone forever. When I too die I will no doubt be reunited with those who have preceded me to the next stage of existence. That is all I have to say about that.

Due to this experience I have chosen to focus on a medication that is often administered for the person who is enduring the complication of heart failure. This is especially relevant as I did a survey for this medication just yesterday as I spoke with a co-worker.
This weeks 'DotW' feature will be: Lasix, or Furosemide.
Here is a molecule of Lasix, also known as Furosemide. Using my limited understanding of chemistry, even though that is going to be my minor, I can see several sites where a possible reaction could occur. This molecule looks rather reactive.

Lasix is a form of Diruetic. Basically what this means is that it causes your body to loose fluid.
According to www.rateadrug.com:

Furosemide

Furosemide (INN) or frusemide (former BAN) is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Sanofi-Aventis under the brand name Lasix. It has also been used to prevent thoroughbred race horses from bleeding through the nose during races.Along with some other diuretics, furosemide is also included on the World Anti-Doping Agency's banned drug list due to its alleged use as a masking agent for other drugs.

That is a rather succinct summation of what Lasix is. Now, however, we must look at what a loop diuretic is.
This a graphic that explains the mechanism of absorption and action through which Lasix acts.

As you look through the mechanism you can see that Furosemide is labeled in the fifth group of actions going from left to right. There are a lot of ways that your body can have a diruetic agent act upon it.
Each type of medication works in a different part of the Nephron. The Nephron is the functional structure and basic unit of the Kydney (http://en.wikipedia.org/wiki/Nephron). The above picture is a simplified version of a Nephron.

Each class of diuretics has a distinct site of action in the nephron...Furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrine) and torsemide (Demadex) work in the loop of Henle. (http://www.cmellc.com/geriatrictimes/g010327.html)

With the help of www.drugs.com we learn that a loop diruetic is essentially a 'water pill' that does not allow your body to absorb salt and instead passes that salt through your urine.

Diuretics are actually compounds that increase the urinary salt excretion, and water just happens to come along...Chemically, diuretics are organic anionic compounds.
-Christian W. Mende M.D. (http://www.cmellc.com/geriatrictimes/g010327.html)

Like most medications there are a number of cases in which it may be prescribed. I have chosen to discuss Lasix as they are used in the treatment of the heart failure patient, but the list of possible doses is, but is not limited to: congestive heart failure, kydney disorder, hypertension and liver disease (http://www.drugs.com/lasix.html). Additionally there are cases in which a medication such as Lasix is used to treat the symptoms of a different drug therapy. No specific instances come to mind, but a chain of drugs meant to relieve the symptoms of a first medication is not at all uncommon.

Now we have reached the end of our discussion on Lasix. Thank you for coming. As I ponder on the current status of medicine and pharmacology I find myself thinking that we have come a long way. The fact that my wife's grandfather was able to live as long as he did after he had his first surgery was nothing short of miraculous. That is due to prayers on his behalf and due to the advances in modern medicine that we all take for granted.
There is much more work to be done though.
I wish the best of luck to those who are working even now to improve the absorption pathways and better understand the human anatomy.

A perfect circle

Today is the last day (sniff) I promised myself I would not cry (sniff), but I just can't help it (weeping uncontrollably).

But, seriously it will be somewhat weird to not have to be working on something for www.rateadrug.com, at least as far as the internship is concerned. I have my final paper basically written, I just need to put in some more supporting information from my survey results, and I should be done. That will be weird, I have worked on this thing practically nonstop since I got the raw data. Although, it will be nice to focus only on school, this is intended to be my last semester seeking a degree and thus I don't have the option of taking things again if I don't do well. Plus, I want to take a glassblowing class and that will take up more time.

When I began this blog I started out by talking about the medical treatments for Hydrocephalus. It seems only fitting that I finish with talking about that subject. It makes the whole thing tie up in one neat knot, I think.
We have talked about Acetazolamide and Furosemide and illustrated the mechanisms by which they work. In the case of both of these medications they are essentially used to decrease the amount of CSF that is retained in the body - commonly known as loop diuretics (for further info on those two drugs check out the links to previous posts). And, according to http://emedicine.medscape.com/article/1135286-treatment both Acetazolamide and Furosemide work well for infants. Basically any medical treatment for Hydrocephalus must cover only the acute as long term use of either Acetazolamide or Furosemide can cause damge to the body. Chronic Hydrocephalus must be treated surgically.

I have, however, found a new medication I was previously unaware of: Isosorbide.
I will talk about Isosorbide, and if I can, I want to find a video of the shunt insertion surgery, I can't guarantee that I will, but I think I can at least link it.
The use of medication to treat Hydrocephalus is a controversial topic. It is believed that the best way to provide a 'normal' life for anyone who has Hydrocephalus is to perform a surgical procedure and either shunt - punt in a valve that dumps off excess pressure - or to perform a interventriculostomy - basically a hole is drilled between the ventricles of the brain to allow for absorption of CSF and to relieve pressure by spreading it out across the brain.

Isosorbide Mononitrate looks like this to a chemist:

Unfortunately, I am taking biochem this semester, so I can't talk about what this thing does in your body exactly, but I do have some good resources at my fingertips.

Isosorbide mononitrate is in a class of drugs called nitrates. Isosorbide mononitrate dilates (widens or relaxes) blood vessels (arteries and veins). When blood vessels are dilated, it is easier for the heart to pump. Also, more blood, which is rich in oxygen, can flow to the heart.
(http://www.drugs.com/isosorbide_mononitrate.html)

And, of course, www.rateadrug.com has some interesting resources for anyone who is taking Isosorbide, or wants to know more about it. According to
Dlmeyers1970:

When I first started taking the medication it gave my significant headaches, dizziness and a stomach ache, but after one week the side effects stopped. I am so glad for this medication because it has stopped my coranary artery from spasming and the chest pain is finally gone. I used to have chest pain, in varying strengths, all day long, and now I am chest pain free.
(http://www.rateadrug.com/Isosorbide-Mononitrate-side-effects.aspx)

Of course, that person is talking about taking the medication for angina and other heart-related troubles, but it can be used for short term treatment of Hydrocephalics as well.



I have managed to get some videos of the procedures I have been talking about. The first will be a short animation about insertion of a VP shunt - the VP shunt is the most common shunt that I see opst-operatively. Basically with the VP shunt the end of the catheter is placed in the periotoneal cavity so the body can re-absorb the extra CSF.
The second is from a thing I found on youtube.com where a neurosurgeon is giving a basic definition of Hydrocephalus.



Lastly, there will be a link to a video of an actual surgical procedure. I can't, and won't, post that on here due to it's code and it's gory content, but the link is well worth watching. The video should be about an hour long.
http://www.or-live.com/distributors/NLM-Flash/nep_2553/rnh.cfm?id=838

Sorry, it took me so long to figure out how to post video, but I did at the end! Best for last!

That concludes our internship, and our internship blog. Thanks for staying tuned. I have really appreciated tdoing this work. Thanks also to www.rateadrug.com for giving me a shot at working with them in this internship.
Bye, and stay classy internet.