The Vanco Avenger

Well, here we are. Another week has come and gone. Midterms have just begun/ended and the semester is now in full swing.
I have also upped my efforts at trying to get surveys done. For anyone reading this and wondering how best to reach a large amount of people in a short amount of time I suggest fliers. I have put up fliers all over the campus at school and that seems to be helping. I am also going to be putting things on cars, and doing a fairly aggressive mailing campaign to doctors and other health professionals. I also am planning on speaking with the nursing staff, pharmacists and doctors with whom I work. I am hoping all of that pays off. I want to be the top intern.

And I went running for the first time in about 3 months today. I enjoyed it, but man if you don't keep your endurance up, it goes downhill fast. I used to be able to skip-rope for about 15 minutes and run 2 miles in the same morning and it didn't really faze me, but now, not so much.

OK, now to the subject I am sure we have all been waiting for, the 'Drug of the Week'.
This week's drug shall be :
Vancomycin Hydrochloride.

Vancomycin, or Vanco as it is commonly called, is the heavy hitter when it comes to preventing infection. Often, Vanco is administered post-operatively as a pre-medication against infection. Vanco does not absorb well through the digestive tract. In fact pill form Vanco is used to treat infections of the intestinal system. For Vanco to be effective at preventing infection it must be administered through IV or placed directly on the operation site.
This drug has one large molecule:
Once again the finer points of this molecule are outside the scope of this blog, but that is one complicated molecule. Recently in an Organic Chemistry course I was supposed to label and recognize certain aspects of this molecule, needless to say, it took awhile.
Vanco is also one of the only drugs on the market right now that is capable of attacking MRSA or Methicillin Resistant Staphylococcus Aureus.
Normal antibiotics attack bacterium by inhibiting growth of the cell wall. MRSA is a so called 'super-bug' because it has developed a way in which it can go around the cell wall inhibiting agent of a antibiotic drugs.
In times past western medicine has been too quick to administer any form of antibiotic agent and that, combined with patients who have not taken the full dose of their medications, has caused/allowed bacterium to develop methods for combating the way that common antibiotic agents work; or have worked in the past.

This shows an animation of how Vanco is able to inhibit cell wall growth even in MRSA infections:
http://student.ccbcmd.edu/courses/bio141/lecguide/unit2/control/vanres.html
Unfortunately I was unable to get the animation to post, so the link will have to suffice. The animation shows, basically, the way in which Vanco molecules bind to sites on the cell wall and keep the bacterium cell from forming which causes cell lysis or simply put; it splits the cell.

There are, however, complications to using this medication. According to:
http://findarticles.com/p/articles/mi_m3230/is_1_37/ai_n9770627

'Because vancomycin-resistant staphylococci are very rare, vancomycin has long been considered the gold standard for treating MRSA infections. Unfortunately, despite its in vitro activity, when vancomycin is used as single-drug therapy to treat MRSA infections, cure rates in serious infections have been very disappointing....44% failures in treating bacteremia...40% failures in treating lower respiratory-tract infections.
In treating nonserious MRSA infections, such as wounds, skin, and urinary-tract infections (UTIs), in addition to slow cure rates and failures, vancomycin is practically and economically burdensome. Because there is no oral form, a patient for whom vancomycin is prescribed must wear an infusaport [an intravenous system placed into the chest, often used for chemotherapy treatment, a.k.a. a Broviac] around the clock. Additionally, he must visit daily an infusion center or have home infusion service. To avoid toxicity, blood levels must be monitored. Vancomycin drug acquisition, administration, and laboratory costs are approximately $100 per day.'

There is current research attempting to find better alternatives to Vanco and to create new medicines to combat resistant bacteria. This is one of the major focuses of medicinal chemists today.

IBUPROFEN TO THE RESCUE!

Strep throat update day 7. So, I am now feeling much better. When I wrote the last blog I was shivering due to fever complications, but now I feel pretty good. After a brief and fairly convenient trip to the doctor we came home with Amoxicillin and some throat spray. That combined with the Ibuprofen I was taking in mass quantities got me through the next few days.

So, as previously mentioned, I have decided to discuss a medication that I used a great deal while sick. After thinking on this for awhile I have decided to focus on Ibuprofen. I used it a lot to keep my fever down and keep me functioning and I have also seen it used post-operatively for pain control.


Here is an organic model of an Ibuprofen molecule:
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). Because of it's non-steroidal effects it does not upset the hormonal balance of the body. Ibuprofen works by inhibiting an enzyme called cyclooxygenase, which in turn inhibits the transformation of fatty acids into products known as prostaglandins. This is what allows the drug to act as an analgesic and anti-inflammatory agent.
Ibuprofen is comparable to aspirin and is usually taken to relieve mild to moderate pain and has even been shown to be effective in slowing the pulmonary decline of those who suffer from Cystic Fibrosis.
(http://www.3dchem.com/molecules.asp?ID=14)

Ibuprofen is an over-the-counter medication and, unlike my previous 'Drug of the Week' feature widely known and used for both adult and pediatric patients.
Despite it's common use though, it is interesting to look at just what it is, and how it works. Even the common stuff has some pretty cool mechanism and history.
Ibuprofen definitely came to my rescue this past weekend.

Thanks Ibuprofen. Thibuprofen

Can you spare an antibiotic?

The life of a student is not an easy one. Especially if you are working and trying to fulfill Pre-Med classes with a good enough score to actually be considered.

Things get considerably worse when you are sick. It seems that I get ill about this same time every year. I can count at least 3 years in a row when I was sick in the beginning/middle of February. When I lived in Ireland both of my ears got really plugged up with wax for some reason. I have always been able to fight the infection off before, this is pretty much the only time of year when I get sick. After working in a childrens hospital for nearly 2 years I can count the sick days I have taken with one finger.

But, according to www.webmd.com I have strep throat. This one I know I can kick myself, but that will sure not be fun. I am looking forward to later today when I can get to a doctors office and they can give me some of that sweet antibiotic therapy.

It is times like this when I see the true value of medications. This illness will also give me an opportunity to fill out some surveys myself about drugs that I have taken - or will be taking.
I am also grateful for programs like the PPREP program which spread the word about medications and for things like webmd.com.
I had always steered away from those institutions because of the dangers of self-diagnosis, but they can be valuable tools to help the medical professional narrow down your condition.

It is often not just about asking the right questions, but giving the right answers too.

Perhaps my next drug feature will take a change of course and I will discuss antibiotics - they seem to have a bit more timeliness to me right now.

Um...Sir...? Are you aware you are leaking CSF at an alarming rate?

Well, here we are again. Has it really been a week? In some ways it feels much shorter, but in many other ways it feels A LOT LONGER.

This is the first installment in the 'Drug of the Week' feature. And we will begin by tackling a big one, Diamox or acetazolamide. Here is a skeletal structure of the organic molecule:And here is a space filling model:
Diamox is used mostly to treat edemas, seizure disorders, glaucoma or altitude sickness.
As I work primarily with Hydrocephalic children, this drug is of particular interest to me because of its effectiveness in pharmaceutically treating Hydrocephalus.
'...medical treatment with a medication which decreases the production of the cerebrospinal fluid may be tried to improve some of the symptoms of hydrocephalus.'
(http://www.nervous-system-diseases.com/obstructive-hydrocephalus.html)

'Hydrocephalus is an excess accumulation of cerebrospinal fluid in or around the brain that can be produced by a broad spectrum of disorders. It can develop at any age and its incidence is increasing, both in infants and adults. Although the standard treatment of hydrocephalus is cerebrospinal fluid shunting, there are certain circumstances in which medical treatment, alone or in combination with shunting, has been suggested as an alternative. Carbonic anhydrase inhibitors, loop diuretic agents, osmotic agents and fibrinolytic therapy are discussed. The most suitable drug seems to be acetazolamide [Diamox], alone or in combination...'
(http://www.ncbi.nlm.nih.gov/sites/entrez)

Diamox works as as an inhibitor of the enzyme carbonic anhydrase. Essentially, it acts as a diuretic and causes the body to lose water. This loss of water also affects the production of cerbrospinal fluid causing a decrease and therefore a decrease in intercranial pressure.

'Diamox blocks an enzyme in the kidney and makes the blood acidic which is interpreted by the brain as a signal to breathe more. Diamox therefore, enhances the physiological response to altitude by increasing the rate and depth of breathing and it ... acts as a mild diuretic...'
(http://www.lycos.com/info/diamox--drugs.html)

It appears at this time, however that, 'The safety and effectiveness of acetazolamide [Diamox] in pediatric patients has not been established.'
(http://www.rxlist.com/acetazolamide-drug.htm)

There are, however, studies which show the effectiveness of this drug for children, some dating all the way back to 1958 and some - such as the abstract quoted just above this line - as recent as 2005.

Quoting from PEDIATRICS Vol. 22 No. 5 November 1958, pp. 875: 'Observations in a Case of Hydrocephalus Treated with Diamox®

The effect of Diamox® on the formation of cerebrospinal fluid was studied in a patient with noncommunicating internal hydrocephalus over a period of 1 year. During the administration of Diamox® the frequency of ventricular aspiration was markedly reduced, with long periods when no aspirations were necessary. Percutaneous aspiration of the shunt tube was performed only after signs of increased intracranial pressure developed. Each time the drug was discontinued, signs of increased intracranial pressure soon became evident.' 'Confirmation of this observation would be desirable since satisfactory management of this pediatric problem is usually difficult or impossible.'
(http://pediatrics.aappublications.org/cgi/content/abstract/22/5/875-a)

The finer points of these articles are outside the scope of this discussion, but prove to make the point rather well. These are only two of the abstracts from medical journals I chose to include, other date exists; further enhancing the idea and proof of clinical effectiveness in the pediatric patient.

So, why did I spend the last several hours of my life discussing and compiling data on Diamox? And why does this matter to you, my reader? With all of the trial data and information that shows that this drug can have a postive effect on adults with Hydrocephalus I think that more consideration should be taken towards using it in the pediatric patient as well. I have shown several instances in which it has had a beneficial effect, and I think that more people should become aware of this disorder, and alternative treatments to surgery.

...in medias res

It is only the beginning, and yet, there is so much to talk about. After finding out that I was going to be part of the premed internship with www.rateadrug.com I had a lot of work to do. The title of this blog alone took me about an hour to come up with. And, this is about the fourth draft I have written for this first blog entry.

I have been racking my brains trying to come up with a specific area of focus. My main interest is in gathering medications that relate to neurological studies as this is my area of focus at my job with Primary Children's Hospital and I have a large amount of experienced health care workers from which I can gather information.
However, this is too small of a segment of the population.

So, I have decided that I will focus on two things. I will collect general information surveys from the population at large: friends, family, students, patients etc. And starting next week I will be doing a drug of the week feature. This will be based upon medications that I deal with at my work. The drug of the week feature will be largely my own research and the opinion of medical professionals with whom I work. This should help me to fulfill my two major goals and gather a great deal of information.

And if you are stumbling upon this blog and feel like contributing you can go to www.rateadrug.com and do a survey on any medication you are currently taking or have been on in the past including over the counter stuff. When the survey asks you where you heard about the webpage put PPREP in the first dropdown menu and TB927 in the second.

Cheers, and look forward to next week's feature drug!