Human Immunology and Application in Medicine

人體免疫與藥物應用

Immunology Self-defense Pathogens: Bacteria Virus Parasites

(1) 　 The Mechanism for How to Defense(2) 　 How to Strengthen Immune System

Edward Jenner and Cowpox Vaccine Edward Jenner,M.D.(British) 1789 將取自擠奶女工痘痂之牛痘病毒 (C

owpox Virus) ，給一位八歲男孩子接種，使他得到抵抗天花病毒 (Smallpox Virus) 感染之免疫力

—Active Immunisation.

1900 Germany Chemist Paul Ehrlich and Ab Phytotoxin 免疫老鼠後得到之血清 (Antitoxin) 具有中和植物毒素的作用　　　　　　　　　　　　 ---Antibody Side Chain Theory 1908 Nobel Prize

Elie Metchnikoff and Phagocytes 1885 Biologist(Russia)Elie metchnikoff 發現以玫瑰刺進 Invetebr

ates 體內其周圍會出現 Macrophagocytes 後來在哺乳動物發現也有此類 Cell

1908 shared Nobel Prize with Paul Ehrlich

Basic Components of　　　　　　　　 the Immune System

Medicine, DrugChemical MoleculeDrug + Receptor-------- Drug-Receptor Complex------ Pharmacologic Response

Adverse ReactionSide Effect

Routes of Drug Administration　 1. Oral Administration　 2. Sublingual　 3. Rectal　 4. Intravenous　 5. Intramuscular　 6. Subcutaneous　 7. Inhalation

Classification

1. Chemical Classification

2. Pharmacological Classification Licenc(s)e System

1. Viagra (Sildenafil)

2. Amphetamine (1) Caffeine (2) Morphine (3) Heroine (4) Codeine

Adverse Drug Reaction (Side Effect) Aspirin-----Acidic

Natural products Purity Standardization

1. Garlic Garlic is a bulb.It may be used As dried, powdered,and compressed into a tablet. Key Component—Alliin

Sulfur Content

Alliin--------Allicin(odor)Cholesterol-Lowering Effect

2.Chamomile Bisabolol Anti-Inflammatory Effect Anti-Allergenic Activity

3.Cranberry Citric,Malic,Benzoic and Qunic Acids Cranberry Juice has been used as a UrinaryTract Disinfectant.

Cranberry makes urine become more acidic.Inhibition of bacterial growth.

4.Ginkgo biloba Vasodilation on both arterial And venous circulation. Increase cerebral blood flow.

It might be useful for disorder of memory(Alzheimer’s Disease).

5. Ginseng The root of the species Panax ginseng, also called Asian or Korean ginseng Ginsenoside stimulates the CNS,combats fatigue.

Pharmacological Classification1. Acting on the GI Tract

(1) Peptic Ulcer No Acid,No Ulcer Antacids: NaHCO3, Mg(OH)2, Al(OH)3

1.Lederscon: Al(OH)3 +Mg(OH)22.Ulsanic: (Sucralfate) Insoluble in water Not absorbed from GI

It binds to the ulcer site to form a protective barrier that prevents exposure of the lesion to acid. Side Effect:Constipation

3. Motility and Secretion Metoclopramide: Dopamine Antagonist 刺激胃腸之運動

4. Laxatives 加速糞便通過腸道

2. Drugs used in Hypertension

3. Anxiolytics,Sedatives and Hypnotics CNS Inhibitor:Anxiolytics 輕微之中樞神經系統抑制可使激動或焦　　　　　　　　　　　　慮的人平靜下來

Benzodiazepines(BDZs) Sleep Disorder Acute Anxiety StatesAt night large dose:Hypnotics Day time small dose: Anxiolytic,SedativeSublingual,IM,IV

Dependence of BDZs: Physical Withdrawal Syndrome Drug Interactions of BDZs:With Alcohol------------ Additive or Synergistic Effect

Triazolam(Halcion) 小白板has all of the characteristic benzodiazepinepharmacological actions.It ismarked as a sedative-hypnotic drug.

(1) Anxiolytic(2) Sedative-Hypnotic(3) Anti-Convulsant(4) Muscle Relaxant

Withdrawal Syndrome of DZs 焦慮 失眠 頭痛 厭食 嘔吐 發抖 全身虛弱停藥後 5-6 days later

4. Antipsychotics DrugsAlso known as Neuroleptics( 鎮神藥 ) Or Major TranquilizersSchizophrenia( 精神分裂 )

Treatment: Hyperactivity of DopaminePositive Symptoms: Paranoia( 偏執 ),Hallucination, Delusion( 錯覺 )

Negative Symptoms:Thought Disorder,Behavioural Disturbances, Flat or Inappropriate Affect ( 單調或不合宜的情感 ), Social Withdrawal

Pharmacological action: Sedation,Disinterest( 冷漠 ), Limited Range of Emotion Dysphoria( 不快 ) Improve positive Symptom

Side Effect: Orthostatic Hypotension, Xerostomia( 口乾 ), Akathysia( 不能靜坐 ) Agitation( 情緒激昂 ) Delirium( 譫妄 ) Gynecomastia ( 男性女乳化 ) Tolerance

長期使用 臉部變形 口周圍震顫 顆粒性白血球缺乏

Classification of Antipsychotics1. Phenothiazine Chlorpromazine (Thorazine) Strong Sedation 治療具暴力傾向病人

Side Effect: 顆粒性白血球缺乏 Photosensitization More than 3weeks IM or IV

2. Lithium Manic-Depressive Illness 治療狂燥型憂鬱症

It might prevent excessive Release of Dopamine Side Effect: Polydipsia 劇渴 Polyuria 多尿 Edema Tetratogenic

Antidepressants(1)Endogenous Depression

　內生性憂鬱症　　 Profound Sadness 深悲　　 Passimism 悲觀　　 Loss of Interest　　 Sleep Disturbances

Change in AppetiteDiminished Libido 性慾降低Difficulty in Concentration 15% Suicide

(2) Reactive Depression 反應性憂鬱症　　與 Life Events 有關如　　　　　　　　　　　　　　個人失敗或生理疾病

(3) Manicdepressive Disorder 躁鬱症 Pharmacological Action:　 Antidepressants can block Reuptake of Norepinephrine

5. Anti-Inflammatory Drug 發炎是細胞受破壞與感染時正常之反應

可能引發疼痛與發燒

Nonsteroidal Antiinflammatory Drugs (NSAIDs)(1) Aspirin Acetylsalicylic Acid(ASA) Low cost & Effective Dose:4g/day 具有止痛抗發炎與解熱作用

(2) Acetaminophen Tylenol,Panado

(3) Morphine Classification of Pain A. Physiological Most common Ex.Getting a cut B. Inflammatory Infection Tissue Injury

C. Neuropathic Injury to CNS or PNS

Pain Manegement Morphine—Pain Relieving Opium Papaver somniferum Depression of CNS Treatment of Severe Pain急性劇烈及持續性內臟疼痛有效

Increased Tolerance to Pain Lower Perception of External Stimuli Feeling of Well-Being(Euphoria) Addiction

Withdrawal Symptom Physical Dependence CNS Hyperactivity: 憂慮 顫抖 頭痛 易怒 心跳加速 肌肉 Spasticity Vomiting Anorexia

Action Mechanism: 提高 Threshold of Pain Analgesia ,Euphoria Sedation, Respiratory Depression

Abuse: Decrease Anxiety Produce Euphoria Side Effect: Constipation Mental Clouding

6. Drugs used in Nausea and Vertigo(Anti-Emetics)

7. Sex Hormones and Drugs Male:Testosterone Female:Estrogen( 動情素 ) Progesterone( 黃體素 )

Play Profound roles in Reproduction & in the Menstrual Cycle

Testosterone: Androgenic(Promoting male physical Characteristics) Anabolic(Muscle Building)

Estrogen:Development of secondary sex Characteristics in women at PubertyDevelopment of Lipid & Other Tissues that contribute To Breast Shape and Function.

Fluid Retention in the Breast.Development of Vagina,Uterus.Pigmentation of the nipples.

DES: Diethylstilbestrol Same Activity of Estrogen

Phytoestrogens: Several Natural Plant Substance That have General Structural Features Similar to Those of Estrogen

Genistein:from soybeanDaidzein:from soybeanCoumestrol:from legumes

Therapeutic Action1. Treating Cardiovascular Disease2. Reducing Postmenopausal Symptoms3. Preventing Osteoporosis

Birth Control 1. Inhibition of Ovulation Estrogen + Progestrone 2. Abortifacient( 墮胎藥 ) Mifepristone(RU486) 1980 France Roussell Uclaf Synthesized 38486---RU486

(1) Antagonizing the Effect of Progesterone at Receptor(2) Decrease in Progesterone Secretion(3) Softening of the Cervix, Which aids in expulsion Of the Fertilized Ovum

High Dose of EstrogenCigarette Smoking increase The risk of(1) Thromboembolic Disease Blood Clots(2) Cancer Cell Spreading

降低 Estrogen Content1.Progestin Minipill Progesterone only Suppress Ovulation2.Depo(Provera) IM Injection Medroxyprogesterone

3.Transdermal Contraceptives FDA approved the 1st transdermal contraceptive Patch in 2001 Norelgestromin+Estradiol Once a week for 3 weeks 1%--Pregnancy 99%--OK

4. Progesterone IUD Low Progesterone Dose 38 mg of microcrystalline progesterone dispersed in silicone oil The dispersion is contained in a flexible polymer in the approximate shape of a T

The Polymer acts as a membrane to permit 65ug of progesterone to be releasedSlowly into the uterus each day for 1 year.Problem:perforation of Uterus and Cervix

5. Contraceptive Implants Norplant 6. Capsules of Levonorgestrel

Implanted in the midportion of the upperarm provided contraception for up to 5 years

性 腺Secondary Sex CharacteristicsTestes:Testosterone睪丸功能異常隱睪症性腺功能不足

Ovaries:Estrogen,Progesterone卵巢功能異常 月經異常 卵巢瘤 孩提時代引起性早熟

排卵引起微幅體溫上升 0.2 C 36.4--------------------36.6 C安全避孕方法卵子存活不超過 72hrs精子在陰道存活不超過 72hrs72+72=144hrs=6 days 危險期

8. Antidiabetic Drugs

9. Antibiotics(1) Penicillin

Penicillin G Abuse-------Resistance Allergic Reaction 6-APA—Semisynthetic

(2) Cephalosporin Cephalexin

(3) Streptomycin Neurotoxic reactions Disturbance of Equilibrium Diminished Auditory Perception

(4)Vancomycin Inhibition of Cell Wall (peptidoglycan) Toxic Side Effect:Slight Cotinued use may lead to Impaired Auditory

(5) TetracyclineCa,Mg,Fe and Al ion

(6) Chloramphenicol(7) Erythromycin

10. Poisoning

An Introduction to Drug Education1.Efforts to limit the use and abuse of various drugs Drug,Alcohol,Tobacco Drug:Alter the structure and Functions of the body.

Drug Abuse: Chronic,Excessive use of the drug,physical or personal harm is very likely to occur.

Addiction: Uncontrolled compulsion To use a drug.

Withdrawal: A variety of physical and emotional symptoms that occur when an accustomed dose level of a drug is abruptly cut off.

Prevention: Avoid or decrease health Problems.Intervention: Early identification and treatment of an alcohol or other drug problem that has already begun.

Treatment: Activities done with the objective of eliminating an individual’s drug abuse and repairing some of the damage and disability that has occurred.

Central Nerve System Inhibitors1. Alcohols Stimulation first, Then Inhibition of CNS Disulfiram(Antabuse) Block Metabolism of EtOH

2. Barbituates Secobarbital Seconal,Red,红中 紅色膠囊 Amobarbital Amital 青發 青色膠囊 Methaqualone Nominox,White 白板 白色藥片

To CNS Like Morphine Benzodiazepine

Triazolam(Halcion) 小白板has all of the characteristic benzodiazepinepharmacological actions.It ismarked as a sedative-hypnotic drug.

3.CNS depressant Anxiolytic,Sedative, Hypnotic Morphine Extracted From Opium Papaver somniferum Analgestic

Heroine Pentazocine Talwin, Sosegone(Taiwan) 30-50mg=10mg of Morphine White Crystalline Powder

3. Cocaine Since 1800,Chewing coca leaves Mountain of South America In 1860, Cocaine was Isolated

1880s was used by German military to combat fatigue. Addictive properties At low dose, Feeling of well-being, Decreased fatigue Local Anesthetic

Clinical Symptoms of Drug Abuse 1. Convulsion 2. Inhibition of Respiration 3. Hallucination 4. Ataxia 5. Hypertension 6. Hypotension

Story of CocaineCocaine , AmphetamineCNS StimulantCocaine:more strong than AmphetamineMore Euphoria and Addiction

Erythroxylum coca leaves印地安人認為上帝賜予減輕飢渴禮物含有改 變心智之神秘物質 咬嚼古柯葉

Spanish brought coca leaves to Europe,路途遙遠運送時間太長作用消失故未在歐洲 引起流行

Clinical Symptoms of Cocaine Intoxication1. Death Overdose Suicide Accidents

2. CNS Headache Convulsion

3.Psychosis Cocaine Euphoria Cocaine Dysphoria Cocaine Schizophreniform

Involuntary(Passive) Smoking 1. Main Stream 15% 5% CO 2. Side Stream 85% 10-15% CO

1. IS and Children’s Health Asthma 支氣管炎 肺炎

2. IS and Adult’s Health Eye Stimulation Headache Cough Induce Asthma

3. IS and Lung Cancer More than 1 box/day Lung Cancer罹患率增加 2.1-3.0 X Below 1 box/day,Lung Cancer 罹患率增加 1.6X

4. IS and Fetus Baby of Smoking Mother 體重較輕 200g Newborn BW 小於 2500g 之機率增加 2倍