kidney care centre

What are drugs ?

A drug is a chemical substance that can potentially cause a change in an organism’s physiology or psychology when taken .

Drugs are typically distinguished from the food and the substances that we take as a nutritional supplement. Drugs play a very vital role in the field of medicine. There are many ways through which drugs can be consumed in the body ,these can be taken via injection, inhalation, smoking , ingestion , absorption . 

Pharmacologically , a drug is said to be a chemical substance of known structure which when administered to a living being produces a biological effect in the body. Drugs are typically used to treat, cure , prevent or diagnose a disease or to promote well being of a person .

Drugs are classified on the basis of different criterias:- 

On the basis of Pharmacological effect 

  • This tells us about how a drug affects the cells of an organism. 

On the basis of action of drugs 

  • Different drugs are known to act differently, that is each drug generates a response in its own way. 

On the basis of chemical structure 

  • This is one of the most common classification of drugs . The drugs that have the same drug action and pharmacological effect usually have a basic skeletal structure.

On the basis of molecular targets.

  • This basis of classification of drugs has been very helpful in clinical trials. This shows the type of drug action on different target molecules or drug targets.

What are the different types of drugs ?

Drugs are grouped together in different ways such as the way they affect our body, how they are used or where they can be used . 

The different types of drugs includes:- 

Depressants – Depressants are the drugs that slow down the messages between the brain and the body. These drugs by the name suggested actually do not make you depressed but slower the message effect. .

Small doses of depressants can help in relaxing, calming down and less inhibited. But the larger doses of these drugs can cause sleeplessness, vomiting, nausea, unconsciousness , and sometimes even death . Examples include alcohol, cannabis , ketamine , opioid, benzodiazepines , gamma – hydroxybutyrate etc. 

Hallucinogens – Hallucinogens are the drugs that change your sense of reality. After the consumption of these drugs , perception of the living organisms changes, that is what you see ,hear or smell may not be real. 

Small doses give you the feeling of confusion, bloating ,and dizziness whereas larger doses can cause hallucinations , memory loss , anxiety , panic and aggression. The examples include lysergic acid diethylamide , Psilocybin , Phencyclidine.    

Stimulants 

Stimulants speed up the messages between the brain and the body. Stimulants cause your heart to beat faster, high blood pressure, high body temperature, agitation and sleeplessness. 

After consuming this you may feel more awake , alert , confident or feel energetic. The larger doses of stimulants may cause anxiety, panicking , stomach cramps and paranoia . The examples include caffeine, cocaine , ecstasy , nicotine. 

Analgesics

Analgesics are also known as pain killers that relieve the symptoms of pain . Analgesics are usually overused by people having chronic pain. 

Over the counter drugs include aspirin, paracetamol, ibuprofen whereas other drugs prescribed from a doctor include codeine , fentanyl, morphine , oxycodone , pethidine .

Inhalants 

Inhalants are the drugs or substances that are taken through the nose that you breathe in ( sniffing) .

They get absorbed in the bloodstream very quickly and give an immediate effect in the body. There are basically 4 types of inhalants such as volatile , solvents ,aerosol sprays , gases , nitrites. 

Opioids 

Opioids are the painkillers that are obtained from the poppy plant or are produced synthetically using fentanyl. Opioids are also called opiates or narcotics and they usually give you a sense of euphoria. The examples include codeine, heroin, methadone , oxycodone. 

Party drugs 

Party drugs are the group of stimulants and Hallucinogens that are misused by the young people in an attempt to produce euphoria while going for partying. The most common of it is ecstasy. The risks to the health are high in such cases.  

Performance enhancing drugs 

Performance enhancing drugs are the substances taken by the people to change their physical adaptability and also boost their sporting ability. These are generally used by weight lifters and athletes . These are basically 3 types of performance enhancing drugs , these are anabolic steroids, peptides and hormones ( natural and artificial) . 

Psychoactive drugs 

Psychoactive drugs affect the way a person thinks , feels and behaves by acting mainly on the central nervous system or by changing brain functions and changing your consciousness . The examples include caffeine , cannabis. 

Synthetic drugs 

Synthetic drugs are the range of drugs that creates similar effects to that of banned drugs . They are also called “ legal highs “ , however, in most of the cases , they are actually not legal. Examples include synthetic cannabis and NBOMe . 

What are the uses of drugs ? 

Drugs provide short term as well as long term benefits to the living beings when administered. Drugs can potentially change the way how our body and mind works. They include various kinds such as prescription medicines , over the counter medicines , tobacco, alcohol and other illegal drugs . Drugs are very useful in every term but are also misused by the people.

Drugs are prescribed as medicines 

Drugs are also used as medicines in the medical terms where they are used to treat disease infections in the living organisms by producing certain metabolic processes. Infact , all kinds of diseases are treated by the application of drugs. Drugs are used as antibiotics as well. For example, in case of fever , medicines or antibiotics like paracetamol are preferred by the medical specialist.

Drugs help in the making of vaccines 

Its true that vaccines are not actually drugs but has a huge impact in the making of it. It can be noticed from recent times the importance of taking vaccines to save our lives from one of the deadliest viruses, coronavirus. Certain vaccines and antibiotics are manufactured using drugs .

me of the drugs provide us with short term pleasure for which it is highly used and often misused by tDrugs give short term pleasure

Sohe youngsters as well such as anabolic steroids, club drugs , cocaine , heroin , inhalants , marijuana , methamphetamine , opioids . Prescription drugs are misused that means that drugs are taken in larger doses than supposed to be. However, drug use is sometimes very dangerous and can eventually cause death. It can harm your body and brain even permanently. Drug use can also result in its addiction which is quite difficult to relieve further. 

Drugs are used to treat infection

Drugs are also used by medical professionals to prevent any kind of infection from spreading in the body. For example, suppose a person is suffering from polycystic ovaries, in this case the drugs can help to avoid the cyst from increasing in number and treat disease easily. In fact, any kind of infection is stopped by the use of drugs through different mediums.

Drugs help to diagnose the disease

Diagnosing a disease is the most important thing before starting any treatment and drugs help to do this. Any kind of disease diagnosed through different tests performed by the use of drugs.

Drugs promote wellbeing

Drugs are also used to promote the well being of an individual. Its income passes to relief of pain and suffering, promotes health and prevents diseases.

What are the top most used drugs?

Penicillin

Penicillin always remains the top used drug of all the times. It was the first discovered antibiotic which played a major role in saving lives of people during world wars.

Insulin

 Insulin was made as a product of the first hormone therapy effective in the treatment of type diabetes. It acts as the miracle therapy in diabetes which is also called sugar sickness.

Smallpox vaccine

Few preventive medicines or drugs have a huge impact on the smallpox vaccine as well as polio vaccines. It is literally thankfulness towards these vaccines that help to get away from such dreadful diseases.

Ether

Ether is one of the most important and widely used drug in the making of modern surgery. Ether made it possible to depress a person’s brain functioning so that major operations can be carried out.

Morphine

Morphine is the known active ingredient in opium which is used to treat pain. It has been said that a world without morphine would have more suffering. Morphine forms the basis of modern pain management.

Aspirin

Aspirin was firstly known to treat simple pain but by the time aspirin is now being used to treat a wide array of diseases such as muscle pain, arthritis, peripheral pain and it is an excellent analgesics also.

Salvarsan

Salvarsan was the first chemotherapy and it once remained the only effective treatment for one of the deadliest disease syphilis.. salvarsan is also known as Erich 606 because it was actually the 606th compound tested by the great German scientist Paul Erich

Birth control pills

Birth control pills or oral contraceptives literally change the world. Administering the birth control pills to a woman to control their reproductive processes had a far reaching medical and social impact.

Dose of drugs in general population

Drug dose

 A dose is a known or a measured quantity of a medicine or a nutrient which is delivered as a unit regretting the amount delivered larger than the dose.

  • The administration of drugs completely varies from person to person and the type and level of disease the patient is suffering.
  • The drug dose in the general public depends on several factors as well such as age ,body weight ,gender, administration root time ,administration environmental factors ,disease conditions and many more.
  • The drug molecule before administering to a patient or using in the medical field must be checked for its effectiveness and safety.
  • The regulating body United States Food and Drug administration along with other regulating bodies keeps astringent control and observations on the new drug development process and ensures its effectiveness.
  • . The doses of drugs are calculated by the 3 primary methods that include desired overhand method dimensional analysis and ratio and proportion.

drug dosage drug dosage refers to the determination as well as regulation of the amount of times a specific quantity of medicines has to be given.

The drug dosing is very important because it modulates whether the patient will experience optimal effectiveness, toxicity , death or no effect at all.

Stages of drug doses

Phase 0 =  Particularly it is an oral bioavailability and half life of the drug 

 Phase 1=  The dose ranges on the healthy volunteers for safety.

Phase 2 = It tests drugs on participants to assess efficacy and its side effects on the living organisms.

Phase 3 = tests drug on participants to know its efficacy, effectiveness and safety.

Phase 4= It is also known as a post marketing surveillance trial , it monitors long term safety and effectiveness of the drug. This phase involves pharmacovigilance .  

Drug dose adjustment in kidney disease

Drug dosing in kidney diseases( www.kidneycarecentre.in) are reviewed meticulously on the basis of three principal issues s of concern:- 

  • Perpetuation of kidney injury by the administration of nephrotoxic drugs.
  • Accumulation of nephrotoxic drugs that causes extra renal toxicity in renal impairments.
  • Clearance of vital drugs from the patients when they are receiving RRT.

Loading doses usually need not to be adjusted in chronic kidney disease. Dosing is maintained by its adjustments , dose reduction , lengthening of dose intervals or both. However, dose reduction involves dose reduction while maintaining normal dosing interval and it needs more constant drug concentrations and is also associated with the higher risks of toxicity. 

  • Dose interval is actually lengthened to allow time for the elimination of drug before redosing of it. 

It is associated with the lower risks of toxicities but it is also associated with a higher risk of sub therapeutic drug concentrations.

  • Antihypertensive drugs are given in patients with chronic kidney disorders , where thiazide are the first line agents for treating hypertension but usually are not recommended if the serum creatinine levels are higher than 2.5 mg per decilitre. 
  • If the creatinine clearance is lower than 30 ml per min , then loop diuretics remains the favourite choice for nephrologists( www.kidneycarecentre.in) to treat uncomplicated hypertension. Potassium sparing diuretics need to be avoided by patients with severe kidney disease because it raises serum potassium levels that typically accompanies renal dysfunctions. 

Some of the recommended antihypertensive agents used mainly in chronic kidney disease includes :- 

  • Benazepril – 10 mg daily intake at suggested time. 
  • Captopril. – 25 mg every 8 hours to be taken
  • Enalapril. -. 5 to 10 mg after every 12 hours to be taken 
  • Fosinopril. -. 10 mg daily intake at suggested time.
  • Lisinopril. -. 5 to 10 mg daily intake at suggested time.
  • Quinapril. – 10 to 20 mg daily intake at suggested time.
  • Ramipril. – 5 to 10 mg daily intake at suggested time.

Diuretics

  • Amiloride. – 5 mg daily intake at recommended time.
  • Bumetanide -. No adjustments required 
  • Furosemide – no adjustments required
  • Metolazone – No adjustments required
  • Spironolactone – 50 to 100 mg daily intake to be done.
  • Thiadesl. – 25 to 50 mg daily intake at suggested time.
  • Torsemide. – No adjustments required
  • Triamterene – 50 to 100 mg daily intake at suggested time.

Hypoglycemic agents 

Hypoglycemic agents are taken in chronic kidney disease and drug dosing is required in this case. But they are not recommended when the serum creatinine is higher than 1.5 mg per dl ( 130 mu per litre) in men and 1.4 mg per decilitre in women. The usual drug dosage of hypoglycemic agents are :- 

  • Acarbose – Maximum 50 to 100 mg 3 times a day .
  • Chlorpropamide – 100 to 500 mg to be taken daily
  • Glipizide – 5 mg daily intake.
  • Glyburide – 2.5 to 5 mg should be taken daily.
  • Metformin – 500 mg should be taken twice daily.

Antimicrobials.

Many antimicrobials are eliminated through renal and need dosing adjustments with chronic kidney diseases especially .However, commonly used agents do not require dose adjustments. 

Some of the usual dosages of antimicrobials are :- 

  • Fluconazole – 200 to 400 mg after every 24 hours.
  • Itraconazole – 100 to 200 mag after every 12 hours.
  • Acyclovir – 200 to 800 mg after every 4 to 12 hours.
  • Imipenem – 0.25 to 1 g after every 6 hours.
  • Cefadroxil – 0.5 to 1 g after every 12 hours.

Other medicines

  • People with advanced renal disease stage need to take analgesics to relieve pain in some of the cases. Some of the examples include Dermol, Darvon , Ultram.
  • Drug dosing adjustments required for statins and other commonly prescribed medicines by nephrologists( www.kidneycarecentre.in) includes :- 
  • Atorvastatin – 10 mg daily intake.
  • Lovastatin – 20 to 40 mg to be taken daily.
  • Simvastatin – 10 to 20 mg to be taken daily at the right timings
  • Pravastatin – 10 to 20 mg to be taken daily at scheduled timings.
  • Ranitidine – 150 to 300 mg to be taken during bedtime.

Along with these drugs , herbal treatment or Ayurveda treatment is also very popular among the patients( www.kidneycarecentre.in ) . Herbal treatment is also effective but takes a long duration to show its effectiveness. The choice of treatment completely depends upon the patients and its stage of renal disease. 

Major side effects of using drugs

Side effects usually happen when the treatment causes a problem because it does more than the target tissue. But a side effect can be positive as well , for example , laser treatment for cataracts.

The National Cancer Institute (NCI) defines side effects as an adverse effect that causes unexpected medical problems that usually happens during treatment with a drug. 

What causes an adverse effect? 

The different reasons linked to why a drug produces an adverse effect includes :- 

  • Dosage needs adjustments according to the person.
  • Individual reaction to the ingredients in the drug.
  • Sometimes a drug kills the healthy cells instead of unwanted cells. 
  • Certain interactions between drugs.

The side effects of drugs include :- 

Mild side effects

  • Constipation
  • Dermatitis or certain skin rashes .
  • Diarrhoea.
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headache
  • Insomnia
  • Nausea
  • Muscle stiffness
  • Loss of appetite
  • Alopecia or hair fall.
  • Cognitive problems
  • Low red blood cell count.

         Major side effects includes :- 

  • Suicidal thoughts.
  • Abnormal heartbeat and some pain in that school.
  • Internal bleeding.
  • Even cancer 
  • Infertility.

Side effects on the kidney by using drugs .

Taking drugs more than recommended dose produces major side effects and causes kidney damage. 

Some of the side effects on kidney includes :- 

  •  Reduced blood flow to the kidneys.
  • High blood pressure.
  • Diabetes
  • Lupus
  • Overweight
  • Change in urination frequency.
  • Decrease in mental sharpness.
  • Muscle cramps.
  • Foamy urine.
  • Puffy eyes , extremities are swollen as well.
  • Heart strokes , heart failure and other cardiovascular diseases. 
  • Drugs like cocaine , heroin , amphetamine can cause kidney damage.
  • Shortness of breath.

Major drug interactions

 Drug interactions tell us about the change in the way a drug acts in the body when taken along with other drugs , herbals , food or with other medical conditions.

However, the drug interactions depends on several other conditions like age or underlying disease conditions like certain liver and kidney diseases.(www.kidneycarecentre.in) 

The most common type of drug interactions is of pharmacokinetics type which is defined as an alternation in absorption, distribution, metabolism or excretion of one drug by the other. 

Drug interactions have been known to cause about 2.8% of all the hospitalizations annually.

Drug interactions can be categorised into 3 categories:- 

  • Drug – Drug interactions.
  • Drugs with food.
  • Drug with disease conditions.

The ten most common drug interactions include :- .

  • Fluoxetine and Phenelzine
  • Digoxin and Quinidine
  • Sildenafil and Isosorbide mononitrate 
  • Potassium chloride and Spironolactone
  • Clonidine and Propranolol
  • Warfarin and Diflunisal
  • Theophylline and Ciprofloxacin
  • Pimozide and ketoconazole.
  • Methotrexate and probenecid 
  • Bromocriptine and pseudoephedrine.

Which medicines should be generally avoided taken at the same time together? 

  • Non steroidal anti inflammatory drugs .
  • Antacids
  • Decongestants
  • Antihistamines ( First generation) 
  • Histamine 2 (H2 ) receptor antagonists.

Brands of drugs available in India

The Med India has currently informed that there are 110, 226 brands available in India.

The top brands of drugs available in India are :- 

  • Sun Pharmaceuticals Industries.
  • Dr. Reddy’s laboratories
  • Cipla
  • Aurobindo Pharma
  • Torrent Pharmaceuticals
  • Lupin Limited
  • Zydus Cadila Healthcare .

For more information visit to www.kidneycarecentre.in .