An illustrative diagram explaining drug resistance.


An overview of antineoplastic resistance mechanisms, and examples of the major genes involved. Blue boxes indicate cancer cell proliferation mechanisms; green boxes indicate therapeutic interventions; red boxes indicate resistance mechanisms.


Chemical structure of a generic acylsulfonamide


Amurca  pit at one oil mill, in the province of  Jaén .


A cow pat.


Finasteride and dutasteride, two azasteroid pharmaceutical drugs. The nitrogen atoms in each ring system are highlighted in red.


Bromo-Seltzer newspaper ad (1908)


Emerson Drug Company's  Bromo-Seltzer Tower  headquarters in Baltimore


A horse-drawn Bromo-Seltzer wagon


Chemical structure of brydioside A


A demulcent  cough drop


Synthesis: [ 2 ] [ 3 ] [ 4 ] [ 5 ]  10%: [ 6 ]  Patents: [ 7 ] [ 8 ] [ 9 ]


Therapeutic (green) and side effect dose response curves (red) illustrating a typical starting and progressively increasing titrated doses (arrows).


Ear drops are commonly used to treat  swimmer's ear .


Yttrium-90  labeled edotreotide


Synthesis (Cmp#13): [ 2 ]  Revised: [ 3 ] [ 4 ]


Finley Ellingwood (1909)


A  uranium glass  flacon


Figure 1. Schematic of radiosynthesis using two-step two-pot pathway.


Figure 2. Schematic of radiosynthesis using two-step single-pot pathway.


Top view of a modern gallipot


The Gallipot Inn


The general structure of imidazothiazoles.


ChemDrug  Synthesis: [ 2 ] [ 3 ]  Patent: [ 4 ]


Stereo, skeletal formula of meglumine


Carboplatin , an example of a metallopharmaceutical


Metaphit as a  methanesulfonate  salt


Monastrol inhibits Eg5


Diagram depicting a representative pan-assay interference compound. The drug-like molecule specifically interacts with target B, but the PAINS-like compound non-specifically interacts with multiple targets


Relationship between percentage activity and concentration of full agonists and partial agonists


Peak-to-trough ratio in pharmacokinetics is the ratio of peak (C max ) and trough (C min ) levels of a drug over its dosing interval (τ) at steady state.


Synthesis of pelanserin


This molecular model of Perflubron is color-coded by electron density to illustrate the positive polarisation of the large bromine atom by the inductively electron-withdrawing perfluorooctyl chain.


Map of the members of PIC/S


Chemical structure of lamotrigine


Anthramycin contains pyrrolobenzodiazepine core


Forward  and reverse pharmacology approaches in drug discovery


Chemical strucuture of GS-9148, the active antiviral agent


Heinz Otto Schild (1908-1984)


MDAI , an SNRA.


MBDB , an SNRA.


Norfenfluramine , an SNRA.


Typical softgels


Advil  liqui-gels


Poster for Stomatol


Illuminated Stomatol sign, 2009


Dipping tobacco  being taken under the lip


Sulfinalol synthesis: [ 2 ]  R. E. Philion, (1978 to  Sterling ), C.A. 90, 137468 (1979).


Efficacy spectrum of receptor ligands.


One of the two enantiomers of exametazime


Seal of VAWD-approved facilities


Vishnevsky liniment on paper


Vishnevsky liniment in a package


Skeletal formula of VUF-8430


The  Recipes for Fifty-two Ailments  contains the first known mention of  qinghao   青蒿 , or  wormwood , [ 1 ]  in history. Though it appears here in a recipe against female  hemorrhoids , [ 2 ]  in later Chinese medical texts wormwood was recommended for treating intermittent  fevers . In the 1970s,  artemisinin  was isolated from  Artemisia annua  (a kind of wormwood) and shown to have  antimalarial  properties. [ 3 ]


Background: [ 3 ]


Adverse drug reaction leading to  hepatitis  (drug-induced hepatitis) with  granulomata . Other causes were excluded with extensive investigations.  Liver   biopsy .  H&E stain .


A simplified diagram showing common disease-causing bacteria and the antibiotics which act against them.


A clinical trial participant receives an injection.


Edward Jenner  vaccinating  James Phipps , a boy of eight, on 14 May 1796. Jenner failed to use a  control group .


Austin Bradford Hill  was a pivotal figure in the modern development of clinical trials.


Example of informed consent document from the  PARAMOUNT trial


Timeline of various approval tracks and research phases in the US


Newspaper advertisements  seeking patients and healthy  volunteers  to participate in clinical trials


Eli Lilly pharmaceutical company recruiting participants at the Indiana State Fair


Grapefruit  juice can act as an enzyme inhibitor,  affecting the metabolism of drugs .


Effects of the competitive inhibition of an agonist by increases in the concentration of an antagonist. A drug's potency can be affected (the response curve shifted to the right) by the presence of an antagonistic interaction.


Diagram of cytochrome P450  isoenzyme 2C9  with the  haem  group in the centre of the enzyme.


Medicinal cannabis farmed by the  University of Mississippi  for the government


Hormesis is a biological phenomenon where a low dose of a potentially harmful stressor, such as a toxin or environmental factor, stimulates a beneficial adaptive response in an organism. In other words, small doses of stressors that would be damaging in larger amounts can actually enhance resilience, stimulate growth, or improve health at lower levels.  [ 1 ]


Anatomy of the human ear


Structures of ribosomes in  prokaryotes  and  eukaryotes ; Aminoglycosides binds to the  30S subunit  at the bottom part of prokaryotic ribosomes


Events during  protein synthesis


Cell wall  components of  gram-positive  and  gram-negative  bacteria


Chemical structures of carboplatin and cisplatin


A simplified mechanism of action of  COX  inhibitors


Chemical structure of  quinine


The vestibular system in the inner ear


Illustration of a  cochlear implant


GABA A  receptor with its five subunits and where various ligands bind.


Image of latex sap from a poppy plant. Opium is extracted from latex sap.


Penicillin chemical structure


The drug-receptor recognition involves a "key", which is a ligand such as a drug, and a "lock", which is a receptor.


Summary of pharmacokinetics and pharmacodynamics


A pill organiser covering 4 daily doses over one week (labelled in French)


Swedish pill organiser, "Dosett".


Phenelzine  is a  MAOI  which contributed to SS in the  Libby Zion  case


Possible side effects of  nicotine [ 2 ] [ 3 ]


A cat eating grass – an example of zoopharmacognosy


A group of various species of parrot, including  blue-and-yellow ,  scarlet  and  chestnut-fronted macaws ,  mealy amazons ,  blue-headed parrots  and an  orange-cheeked parrot   consuming clay  in the  Tambopata National Reserve ,  Peru


A variety of  simian  species have been observed to medicate themselves when ill using materials such as plants.


A conceptual representation of how pre- and post-ingestive events control the manifestation of self-medicative behavior in mammalian herbivores [ 24 ] [ clarification needed ]


Wood ants incorporate resin into their nest to inhibit the growth of microorganisms.


Adult  monarch butterflies  lay their eggs on toxic plants to reduce parasite growth and disease in their offspring.


Bacillus odysseyi


Crystal structure of nattokinase from  Bacillus subtilis natto . PDB  4dww [ 1 ]


Cinnamon


Sandalwood


Myrrh


Frankincense


Halichondria  produces the  eribulin  ( Halaven ) precursor  halichondrin B


Doxorubicin  intercalating DNA .


Biosynthesis of  sirolimus


myo -Inositol


Inositolhexaphosphate, or phytic acid


Blackberries  are a source of polyphenols.


A  macrophage  stretching its arms to engulf two particles. Reactive oxygen species promote oxidized  LDL .


Grapes  contain certain polyphenol compounds, although none has been shown to be an antioxidant in vivo.


Cocoa  is the prime ingredient of  chocolate , a source of polyphenols.


Nolvadex (tamoxifen) 20 mg tablets.


Crystallographic structure  of afimoxifene ( carbon  = white,  oxygen  = red,  nitrogen  = blue) complexed with  ligand binding domain  of  estrogen receptor alpha  (ERα) (cyan ribbon). [ 66 ]


Blood plasma  is a type of biopharmaceutical directly extracted from living systems.


Stainless steel bioreactor for production plants


Design of engineered live bacterial therapeutics [ 1 ]


Workflow for developing engineered strains. [ 1 ]


Schematic of therapeutic bacteria strategies against hypoxic tumors


Mechanisms by which bacteria target tumors


Genetically engineered probiotics as living medicines to treat intestinal inflammation


Bacteria involved in causing and treating cancers


Stainless Steel Bioreactors


BTEC Facility


Bioreactors in BTEC's Simulated GMP Lab


Genetically engineered probiotics as living medicines to treat intestinal inflammation.  a  Genetically engineered E. coli Nissle 1917 (EcN) with csg (curli) operon deletion (PBP8 strain) containing plasmids encoding a synthetic curli operon capable of producing chimeric CsgA proteins (yellow chevrons with appended bright green domains), which are secreted and self-assembled extracellularly into therapeutic curli hybrid fibers.  b  CsgA (yellow), the main proteinaceous component of the E. coli biofilm matrix, was genetically fused to a therapeutic domain—in this case, TFF3 (PDB ID: 19ET, bright green), which is a cytokine secreted by mucus-producing cells. The flexible linker (black) includes a 6xHis tag for detection purposes.  c  Engineered bacteria are produced in bulk before delivery to the GI tract. A site of colonic inflammation is highlighted in red.  d  Interaction of E. coli and the colonic mucosa. Inflammatory lesions in IBD result in loss of colonic crypt structure, damage to epithelial tissue, and compromised barrier integrity (left panel, (−) E. coli). The resulting invasion of luminal contents and recruitment of immune cells to the site exacerbates the local inflammation. The application of E. coli (right panel, (+) E. coli) reinforces barrier function, promotes epithelial restitution, and dampens inflammatory signaling to ameliorate IBD activity. [ 1 ]


a  Several aspects require consideration during the design of an engineered bacterial therapeutic. The selection of a chassis organism can be guided by the desired site of activity and pharmacokinetic properties of the chassis, as well as manufacturing feasibility. The design of genetic circuits may also be influenced by the circuit's effectors, pragmatic concerns regarding inducer compounds, and the genetic stability of regulatory circuits. Critically, the design of an engineered bacterial drug may also be constrained by considerations for the needs of patients.  b  Optimal strain design often requires a balance between strain suitability for function in the target microenvironment and concerns for feasibility of manufacturing and clinical development. [ 4 ]


Schematic representation of a workflow for developing clinical candidate-quality engineered strains. The development workflow should incorporate technologies for optimizing strain potency, as well as predictive in vitro and in vivo assays, as well quantitative pharmacology models, to maximize translational potential for patient populations. [ 5 ]


After systemic administration, bacteria localize to the tumor microenvironment. The interactions between bacteria, cancer cells, and the surrounding microenvironment cause various alterations in  tumor-infiltrating immune cells , cytokines, and chemokines, which further facilitate tumor regression. ① Bacterial toxins from S. Typhimurium, Listeria, and Clostridium can kill tumor cells directly by inducing apoptosis or autophagy. Toxins delivered via Salmonella can upregulate Connexin 43 (Cx43), leading to bacteria-induced gap junctions between the tumor and dendritic cells (DCs), which allow cross-presentation of tumor antigens to the DCs. ② Upon exposure to tumor antigens and interaction with bacterial components, DCs secrete robust amounts of the proinflammatory cytokine IL-1β, which subsequently activates CD8+ T cells. ③ The antitumor response of the activated CD8+ T cells is further enhanced by bacterial flagellin (a protein subunit of the bacterial flagellum) via TLR5 activation. The perforin and granzyme proteins secreted by activated CD8+ T cells efficiently kill tumor cells in primary and metastatic tumors. ④ Flagellin and TLR5 signaling also decreases the abundance of CD4+ CD25+ regulatory T (Treg) cells, which subsequently improves the antitumor response of the activated CD8+ T cells. ⑤ S. Typhimurium flagellin stimulates NK cells to produce interferon-γ (IFN-γ), an important cytokine for both innate and adaptive immunity. ⑥ Listeria-infected MDSCs shift into an immune-stimulating phenotype characterized by increased IL-12 production, which further enhances the CD8+ T and NK cell responses. ⑦ Both S. Typhimurium and Clostridium infection can stimulate significant neutrophil accumulation. Elevated secretion of TNF-α and TNF-related apoptosis-inducing ligand (TRAIL) by neutrophils enhances the immune response and kills tumor cells by inducing apoptosis. ⑧ The macrophage inflammasome is activated through contact with bacterial components (LPS and flagellin) and Salmonella-damaged cancer cells, leading to elevated secretion of IL-1β and TNF-α into the tumor microenvironment. NK cell: natural killer cell. Treg cell: regulatory T cell. MDSCs: myeloid-derived suppressor cells. P2X7 receptor: purinoceptor 7-extracellular ATP receptor. LPS: lipopolysaccharide [ 18 ]


Construction of recombinant DNA, in which a foreign DNA fragment is inserted into a plasmid vector. In this example, the gene indicated by the white color is inactivated upon insertion of the foreign DNA fragment.


Diseases and conditions where stem cell treatment is promising or emerging


Mesenchymal stem cells being injected into the knee of patient


Mechanisms by which bacteria target tumors.


Diagram of the major divisions of the nervous system


Sildenafil 100 milligram tablets


Conversion of testosterone to estradiol by aromatase


Table from the 2010  DrugScience  study ranking various drugs (legal and illegal) based on statements by drug-harm experts. This study rated alcohol the most harmful drug overall, and the only drug more  harmful to others  than to the users themselves. [ 1 ]


A  0-0-1-3  media campaign poster specifically highlighting that  responsible alcohol use  may prevent risky sexual behavior that often results in unplanned pregnancy


Most sexual assaults occur when the victim has consumed alcohol, rather than " spiked " drinks. [ 38 ]


Court decision declaring stealthing as rape or sexual assault      Law prohibiting stealthing


Aphrodisiac


Ambergris


Yohimbine chemical structure


A molecule of alcohol


Ginseng


MDMA Molecule, the compound found in Ecstasy


An advertisement for pills from 1926 implies an aphrodisiac effect: "full of red-blooded vim and push".


Oral birth control


Methamphetamine is the drug most associated with  party and play .


A selection of poppers


Party and play has been associated with the  sauna and bathhouse scene . Pictured is the Club Z bathhouse in Seattle.


Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in  delphic analysis  regarding 20 popular recreational drugs. Alkyl nitrites were ranked 20th in social and physical harm, and 18th in dependence. [ 15 ]


"Who does not love Wine Wife & Song will be a fool for his lifelong!"


Specific locations and functions of the α receptors.  Image from Basic and Clinical Pharmacology by Bertram Katzung, et al. [ 1 ]


Schematic of G protein coupled receptor signaling, representing Gi GPCR signaling, Gs GPCR signaling, and Gq GPCR signaling.


An image of a patient with pheochromocytoma. In patients with this disease, a catecholamine-secreting tumor is formed, and causes excess CNS stimulation, such as excess sweating and tachycardia. Nonselective alpha blockers, such as phenoxybenzamine or phentolamine, can be used to mitigate this disease.


Benign prostate hyperplasia, a disease in which urinary retention becomes an issue. Alpha-1 blockers can be used, but it can result in side effects such as increased urination and retrograde ejaculation.


Patients with Raynaud's syndrome experience cut off blood flow from the fingers causing a large decrease in oxygen, which leads to the discoloration of the fingers. Using alpha blockers aids in restoring blood flow and treating the syndrome by stimulating the dilation of blood vessels.


Alpha-1 Receptor signaling cascade and antagonist signaling cascade.


Alpha-2 receptor signaling cascade and antagonist signaling cascade.


Conversion of morphine ( I ) to apomorphine ( II ) in the presence of acid following the example of the morphine skeleton dehydration rearrangement, outlined by Bentley [ 33 ]


Flow chart depicting the role of apomorphine in Alzheimer's disease.


Synthesis: [ 6 ] [ 7 ] [ 8 ]  Old Patent: [ 9 ]  New Patent: [ 10 ]


Imiloxan Synthesis: [ 4 ]


Synthesis: [ 6 ]  Patent: [ 7 ]


Oral administration of a liquid.


A medical professional injects medication into a gastric tube.


Administering medication rectally


Needle insertion angles for 4 types of parenteral administration of medication: intramuscular, subcutaneous, intravenous, and intradermal injection.


A transdermal patch which delivers medication is applied to the skin. The patch is labelled with the time and date of administration as well as the administrator's initials.


A medical professional applies nose drops.


Topical ocular administration


Involved subjects' positions.


A peripheral IV placed on the hand.


A medical professional performs an intradermal (ID) injection.


A dummy wears a nebulizer mask, used to administer inhaled medications.


trachea  (conducting zone) main  bronchus  (conducting zone) lobar bronchus  (conducting zone) segmental bronchus  (conducting zone) subsegmental bronchus  (conducting zone) conducting  bronchiole  (conducting zone) terminal bronchiole  (conducting zone) respiratory bronchiole  (transitional respiratory zone) alveolar duct  (transitional respiratory zone) alveolar sac  (transitional respiratory zone) alveolus  (transitional respiratory zone) [ 39 ] [ 40 ] [ 41 ] [ 42 ] [ 43 ] [ 44 ] [ 45 ] [ 46 ]


A figure illustrating the cross-sectional area of the buccal mucosa.


A schematic diagram illustrating the penetration pathway for buccal drug delivery.


Vial of Depo-Testosterone, a depot injection of  testosterone


Pharmacokinetic profile of  medroxyprogesterone acetate , a depot injection


Illustration of dermal circulation and layers


Rectal bulb syringe to administer smaller enemas.


Soapsuds enemas, one in an enema bucket with a nozzle typical for a cleansing enema, and another in an enema bag with a nozzle typical for a contrast enema


A prepared, disposable enema.


A barium enema in a disposable bag manufactured for that purpose


Pressure enema from an animal bladder (African wooden sculpture, 19th century)


The Enema  by  Abraham Bosse , ca. 1632–33


Portable enema self-administration apparatus by  Giovanni Alessandro Brambilla  (18th century; Medical History Museum, University of Zurich)


A normal clyster syringe  (front)  and the nozzle for a syringe designed for self-administration  (rear) . The latter avoided the need for a second party to attend an embarrassing procedure.


19th century satirical cartoon of a monkey rejecting an old style clyster for a new design, filled with marshmallow and opium


This nozzle (shown here in harness) can be inflated to a diameter wider than a rectum to force holding in an enema that could not otherwise be retained. Used either for pleasure or as part of  BDSM  activities.


A filled 5 litre enema bag connected to a bored  dildo , ready to inject into a recipient on the ground beneath.


A medical professional demonstrates how to offer oral medication to a dummy.


A medical professional injects medication into a gastric tube.


Administering medication rectally


A man with a nasogastric tube allowing food and medicine to be delivered through the nose and straight to the stomach


Ultrasound imaging deposits energy over a large area while therapeutic ultrasound focuses the energy on one target site.


Stable cavitation of intravascular microbubbles with FUS applies mechanical forces on BBB to increase permeability for drug delivery.


Mechanisms for loading microbubbles with drug including attaching the drug to the microbubble surface (left), encapsulating the drug inside the microbubble (middle), or embedding the drug in the microbubble membrane (right).


Illustration of  digestive system


General structure of the gut wall


Nurse preparing an infusion


Intranasal flu vaccine


Image showing the brain's ventricular system


Image showing intracerebroventricular injection using Ommaya Reservoir


Using safety needles that prevent more than one use and accidental injections ensures sterility and prevents  needlestick injuries .


An intramuscular injection is performed perpendicular to the skin, close to a 90 degree angle.


Comparison of angle of intramuscular injection with other injection types


Axial CT with left humeral head EZ-IO (power driver device) infusion of contrast.


BIG IO devices (spring-loaded)


Intraosseous infusion, pediatric


Administering a vaginal cream using an applicator.


Administering a vaginal tablet without an applicator.


Sagittal view of anatomy of patient during tracheal intubation


Invasome


Anatomy of the skin, including the stratum corneum (SC) layer


Intercellular and transcellular penetration routes through the stratum corneum


Cream, patch, and microneedles as transdermal drug delivery methods


Places where fractures can occur when testing fracture theory. Fracture theory looks for force required to separate at the interface, but fractures can occur due to cohesive failure within either of the layers.


Mode of action of mucoadhesion. Dry mucus will not adhere to a mucoadhesive, but in the presence of moisture the mucus becomes plastic and can form intermolecular bonds.


Interpenetration of a bioadhesive with mucus. In the contact stage, the two materials are brought into contact. In the consolidation stage the interpenetration of the polymers occurs.


Disk-shaped tablets


Common Patch System


A medical professional applies nose drops.


Nasal septum perforation  caused from cocaine abuse.


Lines of cocaine prepared for snorting.  Contaminated currency  such as banknotes might serve as a  fomite  of diseases like  hepatitis C [ 3 ]


Ketamine  prepared in a spiral for " snorting ". a common technique for self-administration of some recreational drugs.


Figure 1.0 - Basic anatomical features of the human eye


Figure 2.0 - Contact lens


Figure 3.0 - Molecular imprinting technique


Figure 4.0 - Example of a nanoparticle


Figure 5.0 - Example of zero-order release kinetics (y = % of drug released from contact lens; x = time (days))


Figure 6.0 - Cornea epithelium


Figure 7.0 - Glaucoma complications


Figure 8.0 - Dry eye syndrome complications


A health professional demonstrates how to offer oral medication to a dummy.


Oral administration of a liquid


Illustration of the respiratory system


Metered-dose inhaler


Dry powder inhalers, from left to right: Turbuhaler, Accuhaler, Ellipta


Soft-mist inhaler, Respimat


Administering medication rectally


Insertion of an enema nozzle as it breaches the anal sphincter.


Glycerin  ( laxative ) suppositories for insertion into the rectum.


A rectal "bulb"  syringe  for introducing a small amount of fluid into the rectum.


Enema equipment for introducing a large amount of fluid into the colon via the rectum.


Complete respiratory system


Adult and pediatric airway anatomy


Details of upper respiratory tract


Parts of the lower respiratory tract


Trachea Mainstem bronchus Lobar bronchus Segmental bronchus Bronchiole Alveolar duct Alveolus


Respiratory epithelium


3D still showing increased mucus


3D still showing constricted airways


An  insulin pump  with a subcutaneous infusion site


Comparison of angle of subcutaneous injection of a needle with other injection types.


Subcutaneous injection sites


Glycerin  suppositories ( laxative )


Four 500 mg  paracetamol  suppositories


A 54mg tablet of Concerta, which uses OROS technology.


Empty half-shell of a split  bupropion  XL 150mg manufactured by Anchen Pharmaceuticals that was soaked in water overnight and then shaken.


Claudius Galenus


Skin layers


Liposome


Micro-needles


A medical professional administering nose drops


Instillation of eye drops


A transdermal patch which delivers medication is applied to the skin. The patch is labelled with the time and date of administration as well as the administrator's initials.


Tube of factor 15 sun block lotion.


Metal case for Cruz Roja ointment from Mexico (beginning of the 20th century) from the permanent collection of the  Museo del Objeto del Objeto .


Graphical abstract of Topical Drug Classification System [ 21 ]


A 21mg dose  Nicoderm  CQ patch applied to the left arm


Contraceptive patch


Clonidine tablets and transdermal patch


A transdermal patch which delivers medication is applied to the skin in a medical setting. The patch is labelled with the time and date of administration as well as the administrator's initials.


Microneedle patch size comparison [ 1 ]


Sample transdermal patches. On left is a 'reservoir' type, on the right a 'Single-layer Drug-in-Adhesive' version. Both contain exactly the same active ingredient with identical release rates.


MNPs may puncture stratum corneum to deliver directly to the dermis layer. [ 28 ]


Disposing needlestick might cause injuries and transmission of pathogen. [ 30 ]


A set of conventional vaccine apparatus needed to be transported. [ 32 ]


V-Set : Multiple line IV injection site whereby several lines can be used at the same time for administering drugs to the patient.


Uncoated  aspirin   tablets , consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a  pharmaceutical drug  often used to treat  pain ,  fever , and  inflammation .


Nexium  (Esomeprazole) is a  proton-pump inhibitor . It is used to reduce the production of stomach acid.


An  Amazonian shaman


San Pedro , a psychoactive cactus


Cannabis  is a commonly used  recreational drug . [ 36 ]


An example of a medication is a  prescription drug .


February 1918 drawing by  Marguerite Martyn  of a visiting nurse in St. Louis, Missouri, with medicine and babies


Schematic block diagram of an adaptive design for a clinical trial [ 1 ]


An example of a Simon design, a two-stage design for a binary outcome trial.


Two possible occurrences for a two-stage trial: stopping at stage one (top) and stopping at stage two (bottom)


An example of a three-stage group sequential design, shown in terms of the test statistic.


Pictorial illustration of posterior probability approach [ 38 ]


Pictorial illustration of predictive probability approach [ 38 ]


A crystal of the astringent  alum


The astringents and acids in fresh  blackthorn  berries (sloes) give the fruit its sourness.


Sweet wormwood ( Artemisia annua )


The shell of a cone snail (Conus magus).


Turkey tail mushrooms found in Georgia, USA.


Apes  and  monkeys  are an example of animals using plants as medicine rather than food.


Sinecatechins, the first botanical drug approved by the US FDA, is an extract from the leaves of  Camellia sinensis .


Croton lechleri  bark with a few drops of  dragon's blood


An image of metoprolol (Betaloc)


An image of amlodipine tablets package (Norvasc)


An image of sublingual nitroglycerin tablets (Nitrostat)


An image of low-dose aspirin tablets (Gericare)


An image of clopidogrel tablet package (Plavix)


An image of rosuvastatin tablets (Crestor)


An image of salbutamol inhaler.


An image showing mechanism of action of antibiotics


An image of different types of inhalers.


Scientifically accurate atomic model of the external structure of SARS-CoV-2. Each "ball" is an atom.


Evidence network of COVID-19 clinical trials of 15 therapeutic candidates. [ 31 ]  Circles represent interventions or intervention groups (categories). Lines between two circles indicate comparisons in clinical trials. [ 31 ]


Convalescent plasma collected at a blood donor center during the COVID-19 pandemic.


A vial of Sotrovimab


Xocova in a Japanese blister pack


Official seal of Operation Warp Speed


A man smoking cannabis in  Kolkata, India .


Reduce medication burden and harm


A ligand is a signal which binds to the receptor to form a ligand-receptor complex. The complex further produces a physiological effect.


Under normal conditions, an allosteric activator (blue binder) is present to activate the reaction. An allosteric antagonist (red binder) binds to an allosteric site, which leads to conformational change in the receptor's active site, making the active site incompatible with the substrate.


Figure 2. Histamine


Figure 1. H1 Antihistamine


Figure 3. Dimercaprol structure


2,3-dimercaptosuccinic acid structure


Infliximab binding and inactivating TNF-alpha.


Chemical structure of flibanserin molecule.


Chemical structure of bremelanotide.


Chemical structure of leuproelin, a commonly used GnRH agonist.


Chemical structure of cyproterone acetate.


Various exercise mimetics and their effects on pathways also affected by exercise [ 1 ]


Ketamine solution poured onto glass and left to dry


Louis Goodman, who coined the phrase "me-too"


Anesthetic (orange) is shown competing with the palmitates (blue) of a palmitoylated protein (green). The displacement of the protein from the ordered lipids in the membrane (grey) renders the protein anesthetic sensitivity. The palmitate site is selective and structured similar to a protein despite being composed of lipids.


OTC  Bayer  medication with  child-resistant packaging  (cap) and  tamper-resistant  carton and innerseal


Photo of the packaging of four medicines dispensed in the United Kingdom showing their  Product Licence Numbers  and symbols denoting if they are Prescription Only Medicine (POM) or Pharmacy Medicine (P), or lacking either, denoting General Sales List (GSL). From top to bottom:  mebendazole  (P),  amlodipine  (POM),  diazepam  (POM),  paracetamol  (GSL).


Plan B One-Step


Viagra , a famous example of proprietary drug on the market


Panadol , one of the branded version of  paracetamol


generic  form of  paracetamol


Patent of the proprietary drug can only be granted after careful approval on its patent registration application. [ 45 ]


State-of-the-art  proprietary drugs for  gene therapy  occupy top rankings in the expensive drug list due to their complex mechanism but superior efficacy in  rare disease .


Scientifically accurate atomic model of the external structure of SARS-CoV-2. Each "ball" is an atom.


Patients and their diseases are  profiled in order to identify the most effective treatment for their specific case.


Mechanism of  imatinib


Final consensus terms for allele functional status and phenotype


Consecutive phases and associated challenges in Pharmacogenomics. [ 48 ]


A drug manufacturer inspection by the US  Food and Drug Administration


Diethylbarbituric acid was the first marketed barbiturate. It was sold by Bayer under the trade name Veronal.


In 1937 over 100 people died after ingesting a solution of the antibacterial  sulfanilamide  formulated in the toxic solvent diethylene glycol.


Measles cases reported in the United States before and after introduction of the vaccine


Percent surviving by age in 1900, 1950, and 1997 [ 38 ]


Malformation of a baby born to a mother who had taken thalidomide while pregnant


Arven Kırklareli Facility


Arven R&D Center


Black triangle


BFS-packaged eye drops for single use


Eye drops  sold in blow fill seal packaging


Capsules


Soft gel capsules.


Advil liqui-gels


Two-piece, hard starch capsules


Reconstruction from  μCT -data of a hard starch capsule containing  Diclofenac . Resolution 18.6 μm/pixel.


Cold chain being maintained using ice box while transporting polio vaccine


Slurry ice  used to ship sensitive food products


Truck with cooling system


Epedigree on a package with  Levothyroxine


In some countries, such as  Brazil  (photo) and  France , more than 20% of all drug sales in units are generic.


Generic drugs research


Simple 'scalloped curve' generic price decline


Examples showing the variability of generic price decline


Seasonality and price bounces


Simple example of a generic drug price bounce


Generic, brand and reimbursement (drug tariff) price decay


A forest of synthetic  pyramidal   dendrites  generated  in silico  using  Cajal 's laws of neuronal branching


WCG  screensaver ,　Influenza Antiviral Drug Search


Root of barbasco  Dioscorea mexicana


Moisture sorption isotherm


Classification of Sorption Isotherms by Brunauer Type I through V.


Figure 3. Type V Isotherm Curve Set


A 54 mg tablet of Concerta, which uses OROS technology. 22% of the drug is contained in the red overcoat, while the remaining 78% is split between two drug layers of differing concentration. The tablet uses an additional push layer that expands as water enters the tablet via the osmotic membrane. The drug is expelled via the laser-drilled hole visible on the left side of the tablet.


An illustration of the different components of the Elementary Osmotic Pump.


An illustration of the different components of the Push-Pull Osmotic Pump.


An animation illustrating the exterior/interior compositions of a tablet of Concerta, a PSOP OROS design.


An illustration of the different inner components of a tablet of Concerta, a PSOP OROS design.


Sinecatechins is an extract from the leaves of  Camellia sinensis .


Two enantiomers of a generic  amino acid  that is  chiral


An achiral 3D object without central symmetry or a plane of symmetry


A table of all  prime knots  with seven  crossings  or fewer (not including mirror images).


Animation of right-handed (clockwise)  circularly polarized   light , as defined from the point of view of a receiver in agreement with  optics   conventions .


( S )-Alanine (left) and ( R )-alanine (right) in zwitterionic form at neutral pH


Schema of the development of the axial twist in vertebrates.


Phase portrait  of Frank's model: starting from almost everywhere in  L - D  plane (except  L  =  D  line), the system approaches to one of the homochiral states (L=0 or D=0).


A  traffic sign  in  Victoria ,  Australia  warning foreigners against potentially dangerous traffic conflicts.


Stereo, skeletal formula of bromochlorofluoroiodomethane (R)


Spacefill model of bromochlorofluoroiodomethane (R)


Ball and stick model of bromochlorofluoroiodomethane (R)


Louis Pasteur - pioneering stereochemist


The Cahn-Ingold-Prelog rule


Easson-Stedman model


Ketamine enantiomers


Dopa enantiomers


Ethambutol enantiomers


Thalidomide enantiomers


Metabolic inversion - Ibuprofen enantiomers


Three-point attachment model


The flags of  Heawood map  under its automorphism group form two orbits, colored here in black and yellow.


Two  enantiomers  of a generic  amino acid  that are chiral


Here, swapping of the two groups  a  and  b  leads to a molecule that is a stereoisomer of the original. Hence, the central carbon atom is a stereocenter.


1,1′-Bi-2-naphthol  is an example of a molecule with a stereogenic axis.


Delta-ruthenium-tris(bipyridine) cation


The footprint here demonstrates chirality. Individual left and right footprints are chiral  enantiomorphs  in a plane because they are mirror images while containing no mirror symmetry individually.


Left and  right-hand rules  in three dimensions


The colored  necklace  in the middle is  chiral  in two dimensions; the two others are  achiral . This means that as physical necklaces on a table the left and right ones can be rotated into their mirror image while remaining on the table. The one in the middle, however, would have to be picked up and turned in three dimensions.


A  scalene triangle  does not have mirror symmetries, and hence is a  chiral polytope  in 2 dimensions.


Pair of chiral  dice  (enantiomorphs)


Pasteur and Molecular Asymmetry


The  S  enantiomer causes birth defects, while the  R  enantiomer is effective against morning sickness.


Enantiomer of ethambutol used to treat tuberculosis


Enantiomer of ethambutol that causes blindness


Stenciled hands at the  Cueva de las Manos  in Argentina. Left hands make up over 90% of the artwork, demonstrating the prevalence of right-handedness. [ 1 ]


A student writes with their left hand.


Michael Vick , a left-handed  American football   quarterback , winds up to throw the ball to his teammate.


Diagram of the first observation of the hyper–Rayleigh scattering optical activity effect, from silver helical nanoparticles, upon illumination with circularly polarized light at frequency ω.


Inherently chiral calixarene with XXYZ substitution pattern.


a) 2D representation of corannulene, b) 3D representation of corannulene bowl flip with C5 symmetry.


Inherently chiral paracyclophane, rendered chiral by the bromide substituent hindering rotation of the phenylene.


Chiral spiro ring system.


Countries by direction of road traffic,  c.  2020      ⇅ Left-hand traffic      ⇵ Right-hand traffic      No data


Countries with left- and right-hand traffic, currently and formerly. Changes since 1858 when  Finland  changed to the right are taken into account.    Drives on the right    Formerly drove on the left, now drives on the right    Drives on the left    Formerly drove on the right, now drives on the left    Formerly a mix of left and right in various parts of the country, now drives on the right    Formerly a mix of left and right in various parts of the country, now drives on the left    No data    Driving one way alternately at certain times


Parts of Canada were LHT until the 1920s, shown here in  Saint John, New Brunswick , 1898.


Crossover bridge near the  Takutu River Bridge  between Guyana (LHT) and Brazil (RHT)


The  Lotus Bridge  exchanges between LHT in  Macau  and RHT in  mainland China .


Left-hand traffic in  Vienna , Austria,  c.  1930


Border sign showing change of traffic direction between Sweden and Norway in 1934


A sign on the  Great Ocean Road , heavily visited by international tourists, reminding motorists to keep left in Australia


Multilingual sign at  Waiotapu  to remind tourists to drive on the left in  New Zealand .


Traffic Switchover sign at the  Thai–Lao Friendship Bridge


Legality of wrong-hand-drive vehicles by country     Usage illegal      Usage legal, but registration illegal or unknown      Registration illegal for normal vehicles, with exceptions for special (e.g. diplomatic) vehicles      Registration and usage legal      No data


Bird's-eye view of low beam light pattern for RH traffic, with long seeing range on the right and short cutoff on the left so oncoming drivers are not dazzled


Handedness of rail traffic worldwide


Helmsman's station on a Philippine Marine Corps patrol boat


Mefloquine (Lariam) 250mg tablets


Mount Hood  reflected in the waters of  Mirror Lake


A symmetrical urn and its mirror image


An example of how mirror flips text front to back rather than left to right. This cardboard word is reflected properly without being  flipped .


The word "FIRE" and its mirror image are displayed on the front of this  fire engine


A planar chiral derivative of  ferrocene , used for  kinetic resolution  of some  racemic   secondary alcohols [ 1 ]


Tartaric acid in pen sketch


Computer-rendered image of right-handed molecule


Racemic acid crystals drawn as if seen through an  optical microscope


Left:  The normally sinistral (left-handed) shell of  Neptunea angulata , a species of  sea snail  (now extinct) found mainly in the Northern Hemisphere. Right:  The normally dextral (right-handed) shell of  Neptunea despecta , a similar species found mainly in the Southern Hemisphere.


European flounder , like other  flatfish , experience an eye migration during their lifetime, making them asymmetric.


Schematic illustration of the two strike-slip fault types. The view is of the Earth's surface from above.


Tartaric acid crystals drawn as if seen through an  optical microscope


Tartar emetic


Commercially produced tartaric acid


Unpurified potassium bitartrate can take on the color of the grape juice from which it was separated.


A tendril of  Bryonia dioica  exhibiting tendril perversion


Cucurbita pepo  exhibiting tendril perversion


A telephone handset cord exhibiting tendril perversion


GIF video showing two different types of tendril perversion


Pack of thalidomide capsules


The two  enantiomers  of thalidomide: Left: ( S )-(−)-thalidomide Right: ( R )-(+)-thalidomide


Muller et al.'s two-step thalidomide synthesis


Baby born to a mother who had taken thalidomide while pregnant


Niko von Glasow, German filmmaker


Logo


Uppsala Monitoring Centre's logo as seen on the facade of its office building in Uppsala, Sweden.


Handheld anaesthetic device for  trichloroethylene , made in the UK, 1947. This device was designed for self-administration by the patient.


Anesthetic machine, showing  sevoflurane  (yellow) and  isoflurane  (purple) vaporizers on the right


Simple schematic of an anaesthetic machine


The adjustable pressure-limiting valve on a General Electric Datex-Ohmeda Aisys anaesthetic machine, with pressure gradations shown in centimetres of water


Many of today's current analytical nebulizers, as of 2017


A teflon PFA concentric nebulizer.


A Meinhard glass concentric nebulizer.


Aquasomes’ structure highlighting its tri-layer formulation consisting of a ceramic core, carbohydrate coat, and the drug itself. [ 1 ]


Preparation of aquasomes, which are synthesized layer-by-layer via self-assembly. [ 3 ]


Outline of applications of aquasomes, comprising the delivery of several types of substrates  [ 1 ]


A military autoinjector in use


Components of a  Humira  autoinjector pen


A variety of autoinjectors in use with the  US Armed Forces


Smallpox vaccine  being administered by the bifurcated needle.


A  hospital corpsman  dips a bifurcated vaccination needle into an open vial of smallpox vaccine.


Nanocellulose cross-linked with calcium chloride printed on a nanocellulose hydrogel film.


A bong with a circular carburetion port in the front of the bowl


Diagram of a bong in operation


A bong made from a plastic sports drink bottle


A variety of bongs for sale, among other merchandise in Manhattan. For legal reasons, the products are labeled as "Tobacco Use Only".


A silicone nipple shield that could be loaded with a pharmaceutical compound


Depiction of Necrotizing Enterocolitis Histopathology


Schematic illustrating cell microencapsulation


Microphotographs of the  alginate - chitosan  (AC) microcapsules


Illustration of the APA microcapsule integrity and morphological changes during simulated GI transit. (a) Pre-stomach transit. (b) Post-stomach transit (60 minutes). (c) Post-stomach (60 minutes) and intestinal (10-hour) transit. Microcapsule size: (a) 608 ± 36 μm (b) 544 ± 40 μm (c) 725 ± 55 μm. From Martoni et al. (2007).


Female anatomy - cervix and vagina


Menstrual Cycle, demonstrating hormone levels at different phases, which affect viscosity of cervical mucus


PH Scale showing 3.8-4.5 in the acidic range.


Diagram of copper IUD in uterus


Illustrated diagram of large cervical cancer tumor


Compressed NuvaRing, a hormonal vaginal ring used for contraception


Coiled coil dimer


Figure 1. Trimeric coiled coil motif is composed of three heptad-repeat monomers. The hydrophobic core results from hydrophobic interactions of residues a, d. Interhelical interactions resulting from residues e, g aid in stability and specificity of the motif.


Diagram showing clinical usage of CED to treat glioblastoma


Diagram showing different catheter designs to prevent reflux during treatment. Arrows symbolize the flow of drug during convection-enhanced delivery


Cream


Chemical structure of dextran


Drug-loaded dextran nanoparticles


Drug-loaded dextran micelle


Drug-loaded dextran cross-linked hydrogel


Vaginal douche apparatus with five quart tank from 1905 nursing text


The "fountain syringe" is used for douching, by replacing the attached  enema  nozzle with the vaginal nozzle (shown bottom left). The vaginal nozzle is longer and thicker and has lateral holes


Drip chambers at the bottom of each of two IV bags


Tablets in a  blister pack  in folding  carton


Bulk drugs in fiber drums


Preparing consumer packaging of prescription drugs at pharmacy


Birth control pills in blister packs


A foil innerseal on a  bottle


Shipment of vaccine: PU insulated box, gel packs, temp monitor, etc.


Example pharmaceutical packaging line


Stent placement in an artery using a percutaneous coronary intervention (PCI) minimally invasive technique


Diagram of stent placement. In  A , the catheter is inserted across the lesion. In  B , the balloon is inflated, expanding the stent and compressing the plaque. In  C , the catheter and deflated balloon have been removed. Before-and-after cross-sections of the artery show the results of the stent placement.


Graphic representation of a drug-eluting stent expanded into artery. The lower section is referred to as a catheter. The DES and catheter are usually one integrated medical system. The white particles represent the drug eluting into the arterial walls - inhibiting the growth of tissue into the stented area.


Andrelon dry shampoo from 1940s.


The use of red clay as a form of dry shampoo in the hair of a  Himba  woman.


Three types of dry powder inhalers: Turbuhaler, Accuhaler and Ellipta devices.


Antibiotic ear drop


Person administering ear drops


Person with otitis externa


Advertisement for Elixir d'Anvers


Label from a bottle of Elixir Raspail, claiming its effectiveness against  epidemic diseases


Poster for Elixir Mondet, 1899


Two immiscible liquids, not yet emulsified An emulsion of Phase II dispersed in Phase I The unstable emulsion progressively separates The  surfactant  (outline around particles) positions itself on the interfaces between Phase II and Phase I, stabilizing the emulsion


An example of the ingredients used to make  mayonnaise ;  olive oil ,  table salt , an egg (for  yolk ) and a  lemon  (for lemon juice). The oil and water in the egg yolk do not mix, while the  lecithin  in the yolk serves as an emulsifier, allowing the two to be blended together.


Central line insertion of catheter. This is the most common method of infusion of CAR-T cells to systemic circulation after ex-vivo manufacturing.


Cartoon example of a hydrogel-based lymphocyte complex. Multiple polymers including  fibrinogen  and  thrombin  can join to form a scaffold that can contain  lymphocytes  to deliver to solid tumors.


The formulation, loading, and delivery of engineered T-cells using a PLGA-based polymeric microneedle matrix onto a solid tumor.


Diagram from the National Cancer Institute (NCI) depicting the classical method of constructing a CAR-T cell for therapy.


Vastus lateralis site for intramuscular injection


ALK Pharma Jext300, adrenaline autoinjector, without its safety cover


The inner mechanism of an epinephrine autoinjector. 1. Four latch mechanisms that hold the plunger secure. 2. Loaded spring that drives the plunger and the needle (toward the right). 3. Plunger. 4.  Adrenaline  solution. 5. Outer body. When retracted upward (left) exposes the needle and triggers the latch mechanism. Later springs back to cover the needle after use. 6. Needle exits through a protective barrier when this is pressed against the skin.


Poster on ethosomes


Eye drops being applied


These eye drops are packaged for single use, without preservatives


Man applying eye drops


Illustration from circa 1890 advertisement for a "Compound Vapor Bath" recommended for rheumatics


An upturned vial of  hair gel


Silica gel


IUPAC definition for a gel


Hydrogel of a superabsorbent polymer


IUPAC definition for a polymer gel


https://doi.org/10.1351/goldbook.X06700 .


Polymers  prior (no gel) and after  crosslinking  (gel)


Syringe  on left, hypodermic needle with attached  colour coded   Luer-Lock  connector on right


Hypodermic needle features


Syringe made entirely of glass, similar to the Wood design, except it is etched with volume marks.


A hypodermic needle tip under microscope


Six hypodermic needles on Luer connectors. These needles are normally used with other medical devices, such as a syringe; from top to bottom:  26G ×  1 ⁄ 2 ″ (0.45 × 12 mm) (brown) 25G ×  5 ⁄ 8 ″ (0.5 × 16 mm) (orange) 22G ×  1 + 1 ⁄ 4 ″ (0.7 × 30 mm) (black) 21G ×  1 + 1 ⁄ 2 ″ (0.8 × 40 mm) (green) 20G ×  1 + 1 ⁄ 2 ″ (0.9 × 40 mm) (yellow) 19G ×  1 + 1 ⁄ 2 ″ (1.1 × 40 mm) (cream)  See also  Birmingham gauge .


Figure 1. Schematic of a basic Immunoliposome; the antibodies (red Y-shapes) are conjugated to the phospholipids (yellow-green) that encapsulate the drug (pink dots).


Figure 2: Process from which a carboxylate is converted into an unstable, amine reactive product using EDC to help stabilize it. This is then turned directly into amide bond, carboxyl group, or uses reagent, sulfo-NHS, to produce more amide bonds. [ 6 ]


Figure 4: Intravascular cells (left side) vs. extravascular cells (right side) (AI)


A type of infusion pump, manufactured by Fresenius.


A  Baxter International  Colleague CX infusion pump


Patient in an  intensive care unit  in a German hospital in 2015, with two staples of four to five stationary infusion pumps each, on top right behind him (resp. behind the visitor).


Different types of  dry powder inhalers


Nebulizer  with face mask


Penetro brand inhaler from mid 20th century Mexico, part of the permanent collection of the  Museo del Objeto del Objeto


Inhaler designed by John Mudge in 1778


Mouthpiece for an inhaler designed by Dr Beigel (1867)


Two disposable injector pens. On the top pen there is a disclaimer that it contains no insulin and is not to be used for treatment of diabetes.


An insulin pen with labels as follows: A) tip; B) medication chamber; C) plunger; D) dose window; E) dose selection dial; F) plunger button


Comparison of 4mm and 12.7mm pen needle sizes


A standard insulin syringe with needle is smaller than an injector pen.


Pathway of inhaled particles from nose to brain.


The olfactory region contains the olfactory nerve and bulb. Olfactory nerve is a network of fibers which connect to the olfactory bulb. When particles reach the bulb, they have access to different regions of the brain.


Depiction of all the different barriers in the brain. Focusing on (i), the blood brain barrier (BBB) is a highly selective membrane. It only allows passage of specific particles based on physiochemical properties.


Depiction of a lipid-based nanoparticle, liposome. The phospholipid bilayer exhibits amphipathic properties which allows encapsulation of hydrophilic and hydrophobic molecules.


Depiction of a type of polymer-based nanoparticle. Nanospheres contain a uniformly dispersed drug encapsulated in a polymeric core and matrix.


Depiction of a polymer-based nanoparticle. Nanocapsules consist of drugs encapsulated in a polymeric membrane.


Depiction of exosome formation. Following invagination of the plasma membrane, multivesicular bodies (MVBs) form and fuse with membrane to release exosomes.


Depiction of a dendrimer. A dendron represents a single unit of a dendrimer.


Illustration of intrauterine device


A copper T-shaped IUD with removal strings


An IUD as seen on pelvic X ray


Hormonal IUD  ( Mirena )


Transvaginal ultrasonography  showing a perforated copper IUD as a  hyperechoic  (rendered as bright) line at right, 30 mm (1.2 in) away from the  uterus  at left. The IUD is surrounded by a hypoechoic (dark)  foreign-body granuloma .


Removal strings of an intrauterine device exiting the cervical os of a  nulliparous  woman. Image was taken immediately after insertion and injection of lidocaine.


Intravesical drug delivery through a urinary catheter


The layers of the urothelium.


A mucoadhesive formulation adhered to bladder wall through interactions with urothelium's mucin layer.


Placement of electrodes for EMDA on the urinary bladder.


A jet injector being used in mass vaccinations,  1976 swine flu outbreak , United States


A Med-E-Jet vaccination gun from 1980


Hypospray Jet Injector used in typhus vaccination at a US military base, 1959


A jet injector being used in 1973, in  Campada , Guinea-Bissau


Skin anatomy


Passive and active methods for improvement of transdermal delivery


Different types of lasers used in LADD (a. fully ablative, b. ablative fractional, c. nonablative fractional, d. nonablative)


The treatment process using LADD and PDT


Sloan's Liniment,  right , was once a popular over-the-counter drug.


An old bottle of AA Hyde Mentholatum Ointment


A 1914 advertisement for " Antiphlogistine "


Homemade lip balms


Scheme of a liposome formed by  phospholipids  in an  aqueous  solution.


Liposomes are composite structures made of phospholipids and may contain small amounts of other molecules. Though liposomes can vary in size from low micrometer range to tens of micrometers, unilamellar liposomes, as pictured here, are typically in the lower size range with various targeting ligands attached to their surface allowing for their surface-attachment and accumulation in pathological areas for treatment of disease. [ 1 ]


Seven main categories for liposomes: multilamellar large (MLV), oligolamellar (OLV), small unilamellar (SUV), medium-sized unilamellar (MUV), large unilamellar (LUV), giant unilamellar (GUV) and multivesicular vesicles (MVV)) [ 7 ] .


A micrograph of phosphatidylcholine liposomes, which were stained with  fluorochrome   acridine orange . Method of  fluorescence  microscopy (1250-fold magnification).


Various types of phosphatidylcholine liposomes in suspension. Method of  phase-contrast microscopy  (1000-fold magnification).   The following types of liposomes are visible: small monolamellar vesicles, large monolamellar vesicles, multilamellar vesicles, oligolamellar vesicles.


Pictorial representation of targeted theranostics liposomal delivery


Schematic of a monolamellar liposome.


Lotion and  shampoo  at the  Banff Centre


Calamine lotion  is used to treat itching.


Composition of a magnetic nanoparticle


Synthesis of magnetic nanoparticles


Core-shell structure


Various applications of magnetic nanoparticles


The Mark I NAAK (left) and its training kit (right)


Metered-dose Inhaler


MDI canister and actuator components from H&T Presspart


Nicorette  Inhalator is a vapour inhalator.


CFC-free Asthalin HFA inhaler


Lactococcus lactis , a species used in microbial drug delivery


Side comparison of microneedle (350μm in depth) to standard hollow-bore needle [ 1 ]


(A) Comparison between hypodermic needle and microneedle. (B) Magnification of microneedle.


Common transdermal drug administration route.


A Dermaroller composed of shorter microneedles. It is designed for cosmetic purposes.


Range of mouthwashes by  Listerine


Swedish ad for toiletries, 1905/1906


An example of a commercial mouthwash brand which is alcohol-free


A Murphy drip apparatus [ 1 ]


John Murphy, inventor of the Murphy drip


Platinum nanoparticles


Basic liposome structure


Spraying into a nostril while closing the opposite nostril to assure the dose


Human Nasal Anatomy


FluMist Quadrivalent


Fluenz Tetra


Bordetella Bronchiseptica


Nasal spray


Another form of nebulization


A modern jet nebulizer


A vial of 0.5%  albuterol  sulfate inhalation solution for nebulizing


Sales-Girons pressurized nebulizer from 1858


Dr Siegle's steam nebulizer,  Thackray Museum of Medicine [ 27 ]


Scalp of a patient with an Ommaya reservoir.


Dr. Ommaya handling his reservoir.


Clonazepam  ODT blister pack and tablet


Etizest-1 MD (Etizest-brand 1mg-doskk  etizolam  mouth-dissolving (MD)  blister pack  and opened tablet


Modern Fritz Stephan GmbH multi-molecular sieve oxygen concentrator.


Animation of pressure swing adsorption (1) and (2), showing alternating adsorption and desorption.      I    compressed air input        A    adsorption      O    oxygen output    D    desorption      E    exhaust


Membrane cartridge.


A home oxygen concentrator in an  emphysema  patient's house. The model shown is the DeVILBISS LT 4000.


Philips Respironics Home Oxygen Concentrator.


Pressure swing adsorption medical oxygen generator "R-OXY" by RIFAIR Technical Systems.


A woman wearing an oxygen mask


Respiratory care devices image


A  T-37  pilot wearing a mask designed for both diluter- and pressure-demand breathing


Inner view of a military aviators mask showing face seal, facepiece and inhalation valves


Emergency oxygen masks deployed


US Navy Divers test built-in breathing masks inside a recompression chamber


Climber wearing an oxygen mask on the summit of Everest, 2019


Gold-plated stem pessary ( intrauterine device ) from 1920


An assortment of pessaries


Different types of pessaries


Pessary covered in  phosphate  after being left in the vagina for an extended time


A photosensitizer being used in  photodynamic therapy


Basic schematic for all photosensitizers (PS) wherein the photosensitizer absorbs light (hν) and transfers energy to create a physicochemical change


Diagram of a Type I photosensitized reaction [ 2 ]


Diagram of a Type II photosensitized reaction [ 2 ]


Modified Jablonski diagram showing the mechanism of PDT [ 19 ]


Pictured are  Chlorophyll A  (A) and Tris(2-phenylpyridine)iridium (B), two examples of organometallic photosensitizers.


Pictured from top to bottom, (A) benzophenone, (B) methylene blue, and (C) rose Bengal are all organic photosensitizers. All metals involved are purely  counterions  to keep the material in the solid state as a salt.


Dye sensitized solar cells are photosensitizers which transfer energy to semiconductors to generate energy from solar light [ 3 ]


A pill-splitter holding a tablet ready to split


Skeletal structure of polystyrene


Blue expanded polystyrene solid foam


SEM images of polystyrene microspheres


Fig. 1.0 Cancer Cell


Fig. 2.0 Benign and Malignant Tumor Cells


Fig. 3.0 Reduction and Oxidation


Fig. 4.0 Drug Release of RSNP with Disulfide Bonds in the Cytosol


Fig. 5.0 Relevant Nanoparticle Subtypes


Fig. 6.0 Ulcerative Colitis VS. Crohn's Disease


In this model of safety syringe, the needle retracts into the barrel of the syringe after use.


This syringe has a sliding needle guard


One model of safety syringe with deployable needle guard


Shampoo lather in hair


Bottles of shampoo and  lotions  manufactured in the early 20th century by the C.L. Hamilton Co. of  Washington, D.C., United States


Swedish advertisement for toiletries, 1905/1906


Typical liquid shampoo


Pet  shampoo with  VCO  and  mother of cocoa


A shampoo bar


Advertisement offering shampoo in two forms:  a bottle of liquid and a tube of gel


Silicone gel sheet (beige)


Hypertrophic scar


Keloids


A woman smoking a tobacco cigarette, the most common form of smoking


A man smoking cannabis in  Kolkata, India


A woman smoking crack cocaine


Aztec women are handed flowers and smoking tubes before eating at a banquet,  Florentine Codex , 1500.


A Persian girl smoking  by  Muhammad Qasim , 17th century


Bonsack's cigarette rolling machine, as shown on U.S. patent 238,640


An illustration of an  opium den  on the cover of  Le Petit Journal , 5 July 1903


A lengthy study conducted in order to establish the strong association necessary for legislative action (US cigarette consumption per person blue, male lung cancer rate green)


An elaborately decorated  pipe


A diagram of the human body showing some of the diseases caused by smoking


A graph that shows the efficiency of smoking as a way to absorb nicotine compared to other forms of intake


Sigmund Freud , whose doctor assisted with his suicide because of  oral cancer  caused by smoking [ 92 ]


Prevalence of daily smoking in 2012 [ 105 ]


Share adults who smoke any tobacco product on a daily or non-daily basis in 2016 [ 106 ]


An Apothecary Smoking in an Interior  by  Adriaen van Ostade , oil on panel, 1646


Skull with a Burning Cigarette  by  Vincent van Gogh , oil on canvas, 1885


Film star and iconic smoker  Humphrey Bogart


The cover of  My Lady Nicotine: A Study in Smoke  (1896) by  J.M. Barrie , otherwise best known for his play  Peter Pan


Making a  saline water  solution by dissolving  table salt  ( NaCl ) in  water . The salt is the solute and the water the solvent.


Water  is a good solvent for some polar materials because water molecules are polar and capable of forming hydrogen bonds.


An Aloka SSD 3500  ultrasound machine


The layers of the  epidermis  – the  stratum corneum  layer can be seen at the top


Example of intratumoral redox-responsive drug delivery


This Venn Diagram compares the limitations faced by endogenous chemically responsive drug delivery systems.


Three main types of mechanical stimuli; compression force, tensile force, and shear force. [ 3 ]


A drug release mechanism that is triggered by the stretching of the contact lens due to natural eye movements. [ 6 ]


Example of a drug release system triggered by the stretching of an elastomer as a consequence of a finger bending. [ 7 ]


A suspension of  flour  mixed in a glass of water, showing the  Tyndall effect


Disposable  syringe with needle, with parts labelled: plunger, barrel, needle adaptor, needle hub, needle bevel, needle shaft


According to the  World Health Organization , about 90% of the medical syringes are used to administer  drugs , 5% for  vaccinations  and 5% for other uses such as  blood transfusions . [ 1 ]


The threads of the  Luer lock  tip of this 12mL disposable syringe keep it securely connected to a tube or other apparatus.


Syringe made entirely of glass, with no parts made from plastic nor any other material


An antique glass and metal syringe


Insulin syringes are marked in insulin "units".


A dose-sparing syringe and needle being used to draw up a COVID-19 vaccine


Laboratory grease, commonly used to lubricate  ground glass joints  and  stopcocks , is sometimes loaded in syringes for easy application.


Some chemical compounds, such as  thermal paste  and various glues, e.g.  epoxy , are sold in prepackaged syringes.


De Medicina  by the Roman author  Aulus Cornelius Celsus , later the first medical textbook to be printed


Common disk-shaped tablets


Combined oral contraceptive pills  were nicknamed "the pill" in the 1960s [ citation needed ]


Variations on a common tablet design, which can be distinguished by both colour and shape


Olanzapine  tablets


Bottles


Tablets that failed due to capping and lamination compared to a normal tablet


The tablet pressing operation (click image to enlarge)


An old Cadmach rotary tablet press


Zuplenz  8 mg (approved by FDA, July 7, 2010). Photo courtesy of Aquestive Therapeutics (formerly MonoSol Rx).


Thiomers crosslink via inter- and intrachain disulfide bonding, form disulfide bonds with thiol substructures of endogenous proteins such as mucins and keratins and bind metals (Me)


Modern cough drops


A pocket tin containing small  salmiak  liquorice pastilles in the traditional diamond shape lozenge. In Europe, salmiak liquorice pastilles are considered a "traditionally-applied medicine to assist  expectoration  in the  airways "


Valda Mint Eucalyptus Gumdrops


Early 20th century "Frog In Your Throat" box, containing lozenges made of  cubeb ,  tolu balsam ,  liquorice ,  white horehound  and  wild cherry  extracts.


A tincture prepared from  white willow  bark and  ethanol , containing  salicin  (from which  salicylic acid -based products like  aspirin  are derived)


Bottle for holding  ipecac  tincture


Toothpaste from a tube being applied to the bristles of a  toothbrush


Toothpaste is sold in many brands.


A brand of red, blue and white striped toothpaste


The red area represents the material used for stripes, and the rest is the main toothpaste material. The two materials are not in separate compartments; they are sufficiently viscous that they will not mix. Applying pressure to the tube causes the main material to issue out through the pipe. Simultaneously, some of the pressure is forwarded to the stripe-material, which is thereby pressed onto the main material through holes in the pipe.


Promotional poster for the Kolynos toothpaste from the 1940s


Modern toothpaste gel, in a tube


A container with cream


A diagram showing different skin layers


A tube of hydrocortisone cream


Illustration of a colloid gel (3d model)


Hydrogel used for wound dressing


Layers of the skin


Guar gum is made from the seeds of cyamopsis tetragonolobus


Sorbitol chemical structure


Example of cosmetic gels


Topical gel


Illustration of salting out process


Transdermal implant


A microdermal prior to implantation


Healed microdermal implants


Figure 1.0  – Synthesis process of nanocomposite hydrogels


Figure 2.0  - Various examples of stimuli inducing drug release from loaded-smart hydrogels


Figure 3.0  - Example of ultrasound machine and different types of associated transducers


Figure 4.0  - Activation of ultrasound disrupts hydrogel matrix and allows for drug release. Turning off ultrasound allows for hydrogel to restore its matrix


NuvaRing


A vaporization heat wand and vaporization chamber bowl used to deliver vapor through a water pipe


Various types of electronic cigarettes


Schematic drawing of the steps followed during vesosome synthesis.


Zyprexa-Zydis  tablets from  Eli Lilly and Company ,  Japan


Citrullus lanatus ,  Plate 453 from 'Icones Plantarum'


A graph depicting a typical time course of drug plasma concentration over 96 hours, with oral administrations every 24 hours. The main pharmacokinetic metrics are annotated. Steady state is reached after about 5 × 12 = 60 hours.


Graph representing the monocompartmental action model


Graphs for absorption and elimination for a non-linear pharmacokinetic model


Plasma drug concentration vs time after an IV dose


Different forms of tablets, which will have different pharmacokinetic behaviours after their administration.


Processes in pharmacokinetics


A bioequivalency profile comparison of 150 mg extended-release  bupropion  as produced by  Impax Laboratories  for  Teva  and  Biovail  for  GlaxoSmithKline


Passing drugs may display this blue checkmark sign with the text  仿制药一致性评价  (Generic Drug Consistency Evaluation). [ 6 ]


Time course of drug plasma concentrations over 96 hours following oral administrations every 24 hours (τ). Absorption half-life 1 h, elimination half-life 12 h.


Part of a network of  capillaries  supplying brain cells


The astrocytes type 1 surrounding capillaries in the brain


Sketch showing constitution of blood vessels inside the brain


Two bottles of  Rev , a  cola  with 7%  ABV


Anhydrous caffeine, the product of the  decaffeination  process. For many caffeinated alcoholic drinks, this is a primary source of caffeine.


Sample of absolute ethanol


In certain parts of Scotland,  Buckfast Tonic Wine  is associated with drinkers who are prone to committing  anti-social behaviour  when drunk.


Chemotactic drug-targeting


The "Fe(V) intermediate" at the bottom left is a simplification: it is an Fe(IV) with a  radical heme ligand .


Oxygen rebound mechanism  utilized by cytochrome P450 for conversion of hydrocarbons to alcohols via the action of "compound I", an iron(IV) oxide bound to a heme radical cation.


Proportion of antifungal drugs metabolized by different families of P450s. [ 6 ]


Steroidogenesis , showing many of the enzyme activities that are performed by cytochrome P450 enzymes. [ 21 ]  HSD: Hydroxysteroid dehydrogenase.


Different types of Dissolution Units: A Water-bath unit equipped with USP Dissolution Apparatus 2 - Paddle (Top-left), A amber vessel water bath unit that has been equipped with USP Dissolution Apparatus 1 without baskets being placed on yet (Top-right), and a dissolution unit that uses a heating jacket (bottom)


Tablet in  blister pack


single unit  packets  with full identification (text and bar codes)


vials  of eye drops for single use


An  ampoule  containing atropine injection 1mL/0.5mg


Phases I and II of the metabolism of a lipophilic xenobiotic.


Diagram illustrating renal flow along the nephron


Illustration showing the hepatic portal vein system


Citrus fruits clustered by genetic similarity. Most commercial  varieties of citrus  are hybrids of the three species at the corners of the  ternary diagram , and genetically distinct hybrids often bear the same  common name . [ 33 ]   Furanocoumarin  production has been inherited by some hybrid  cultivars ; others have not inherited the furanocoumarin-producing genes.


Schematic representation of an IdMOC plate


A plot of LogP vs pIC 50  for 2 series of compounds (series 1: green dots, series 2: blue dots). Diagonal lines represents areas of equal LiPE. Analysis of this LiPE plot shows that series 1 includes many compounds with a high LiPE, and thus may represent a better lead series for further optimization.


Figure 1: Schematic illustration of a linear OFM probe. Exchange of compounds between the open exchange area of the OFM probe and the surrounding interstitial fluid.


Figure 2: Schematic illustration of a concentric OFM probe.


Figure 3: OFM system for clinical use, up to 48 hours, consisting of catheter, tubing, perfusate bag, pump and sample collection, All products are CE-certified.


Figure 4: Linear aOFM/dOFM probe


Figure 5: Concentric cOFM probe consisting of sampling insert, guide, healing dummy, and lock (from left to right)


Polyethylene glycol


A comparison of  uricase  and  PEG-uricase ; PEG-uricase includes 40 polymers of 10kDa PEG. PEGylation improves its solubility at physiological pH, increases serum half-life and reduces immunogenicity without compromising activity. Upper images show the whole tetramer, lower images show one of the lysines that is PEGylated. (uricase from  PDB :  1uox  and PEG-uricase  model  from reference; [ 8 ]  only 36 PEG polymers included)


Graphic representation of a physiologically based whole body model. Here, it is dissected into seven tissue/organ compartments: brain, lungs and heart, pancreas, liver, gut, kidney and adipose/muscle tissue. Blood flows, Q, and concentration, [X], of a substance of interest are depicted.


Simulated drug plasma concentration over time curves following IV infusion and multiple oral doses. The drug has an  elimination half-life  of 4 hours, and an apparent  volume of distribution  of 10 liters.


Pharmacokinetic model of drugs entering a tumor. (A) Schematic illustration of a tumor vessel illustrating loss of smooth muscle cells, local degradation of the extracellular matrix, and increased permeability of the endothelium. (B) Illustration of the pharmacokinetic model taking into account the EPR effect. The rate constants kp and kd describe exchange with the peripheral volume. The rate constants kepr and kb describe extravasation from circulation into the tumor, and intravasation back into the circulation, respectively. The rate constant kel represents clearance by the kidneys, MPS, and any other non-tumor elimination processes, such that when kb = 0, k10 = kepr + kel where kel is the elimination rate constant. (C) Standard two compartment model with central and peripheral compartments. c1 and c2 represent the drug concentration in blood (central compartment) and normal tissue (peripheral compartment), respectively. The first order rate constant k10 describes all elimination pathways, including clearance by the kidneys, uptake by the MPS, and tumor accumulation. The first order rate constants k12 and k21 describe exchange between the two compartments. Note that kp = k12, kd = k21. (D) Two compartment model defined in terms of the drug amount, where Nbl is the amount of drug in blood (mg), and Np is the amount in peripheral tissue (mg). (E) Three compartment model with the addition of a tumor “compartment” where Nt is the amount of drug in the tumor. Exchange with the tumor is described by the rate constants kepr and kb, respectively. The rate constant kel describes elimination pathways including clearance by the kidneys and uptake by the MPS, but does not include tumor accumulation. [ 13 ]


Polypharmacy is often defined as taking 5 or more medicines.


Control volume  with incoming flow rate  f in , outgoing flow rate  f out  and amount stored  m


This drinking trough has

 τ

 a

 >

 τ

 t

 {\displaystyle \tau _{a}>\tau _{t}}


An RTD curve for a reasonably well-mixed reactor


Liposomes are composite structures made of phospholipids and may contain small amounts of other molecules. Though liposomes can vary in size from low micrometer range to tens of micrometers, unilamellar liposomes, as pictured here, are typically in the lower size range, with various targeting ligands attached to their surface, allowing for their surface-attachment and accumulation in pathological areas for treatment of disease. [ 18 ]


TDM interpretation: an anticancer drug is given to a patient at a dosage of 400 mg every day at 8:00 am. A TDM sample is obtained at 6:00 am, showing a drug concentration of 0.46 mg/L.  1) Regarding “normality”, the result is around the 25th percentile, suggesting a rather high drug clearance in this patient.  2) Regarding “appropriateness”, the result suggests that the patient's most likely concentration curve (green dashed line) passes below the acceptance range of 0.75 to 1.5 mg/L at trough, raising concerns about treatment efficacy.  3) Regarding dosage adjustment to recommend, this TDM result suggests that a doubled dose of 800 mg daily might be suitable to drive the concentration curve close to target (blue dotted line).  Note that this interpretation assumes that the patient's adherence to prescription is good, and that the sample measurement is accurate.


Enzyme CYP3A4, in CYP3A subfamily, contributes to hepatotoxicity during metabolism.


Topics of pharmacodynamics


Some molecular mechanisms of pharmacological agents


Dose response curves of a full agonist, partial agonist, neutral antagonist, and inverse agonist


Simplified depiction of the mechanism of an agonist binding to a GPCR.


Simplified depiction of co-agonists activating a receptor.


Efficacy spectrum of receptor ligands.


Agonist vs. antagonist


Types of Chemosensors.  (1.)  Indicator-spacer-receptor (ISR)  (2.)  Indicator-Displacement Assay (IDA)


A dose response curve showing the normalised tissue response to stimulation by an  agonist . Low doses are insufficient to generate a response, while high doses generate a maximal response. The steepest point of the curve corresponds with an  EC 50  of 0.7  molar


Semi-log plots  of the hypothetical response to agonist, log concentration on the x-axis, in combination with different antagonist concentrations. The parameters of the curves, and how the antagonist changes them, gives useful information about the agonist's pharmacological profile. This curve is similar but distinct from that, which is generated with the ligand-bound receptor concentration on the y-axis.


Venn Diagram for Drug Intolerance


The tissue response (y-axis) to an agonist, in log concentration (x-axis), in the presence of different antagonist concentrations. The EC 50  of the agonist is represented by the x co-ordinate that corresponds with the half-maximum of the leftmost curve. This is denoted by [A]


Indacrinone Enantiomers


Graphical representation of the IC50 determination of the inhibition of an enzyme's activity by a small molecule ("drug"). Four different concentrations of the small molecule (ranging from 30 to 300 μM) were tested.


Figure 2: Example of changes in Intrinsic activity based on mutations and the presence of inverse agonists. (assuming the inverse agonist has the same binding affinity for both the normal and mutated receptor)


Beta blockers exert their pharmacological effect, decreased heart rate, by binding to and  competitively antagonising  a type of receptor called  beta adrenoceptors . [ 1 ]


Filamentation  (top right) can indicate that an antibacterial agent is targeting PBP3, FtsZ or DNA. [ 4 ]


Illustration of a possible mechanism of non-competitive or mixed inhibition.


Diagram of a typical organ bath preparation. An excised piece of smooth muscle tissue is held in an oxygenated solution in a chamber. The tissue is attached to a lever, which transmits its contraction to a myograph, thus recording the physiological response. Drugs under investigation can be administered directly to the chamber.


Schematic view of the anodization cell


Concentration-response curves illustrating the concept of potency. For a response of 0.25a.u., Drug B is more potent, as it generates this response at a lower concentration. For a response of 0.75a.u., Drug A is more potent. a.u. refers to "arbitrary units".


Antagonists will block the binding of an  agonist  at a  receptor  molecule, inhibiting the signal produced by a receptor–agonist coupling.


Agonists require higher dose/concentration to achieve the same effect when in the presence of a reversible competitive antagonist. [ 15 ]


Agonists get its maximum effect reduced when in the presence of an Irreversible Competitive Antagonist or a Reversible Non-Competitive Antagonist. [ 15 ]


Figure demonstrates the noncompetitive antagonistic behaviour of Phenoxybenzamine on alpha-adrenergiv norepinephrine receptors. [ 28 ]


Chart demonstrating the difference between agonists, silent antagonists, and inverse agonists [ 15 ]


Escitalopram , a selective serotonin reuptake inhibitor (SSRI) used as an antidepressant.


Tiagabine , a selective GABA reuptake inhibitor used as an anticonvulsant in the treatment of epilepsy and seizures.


Reserpine , a vesicular reuptake inhibitor that was used in the past to deplete serotonin, norepinephrine, and dopamine stores as an antipsychotic and antihypertensive. It was notorious for causing anxiety and depression, and as a result, was replaced by newer, more modern drugs instead.


Hyperforin , the primary active constituent responsible for the therapeutic benefits of extracts of the herb  Hypericum perforatum  (St. John's Wort), which is used as an antidepressant.


A box model explaining the processes of toxicokinetics and toxicodynamics.


Labeling of different parts of a neuron


Dopamine and serotonin pathway


Orthosteric agonist (A) binds to orthosteric site (B) of a receptor (E). Allosteric modulator (C) binds to allosteric site (D). Modulator increases/lowers the affinity (1) and/or efficacy (2) of an agonist. Modulator may also act as an agonist and yield an agonistic effect (3). Modulated orthosteric agonist affects the receptor (4). Receptor response (F) follows.


CX614, a PAM for an AMPA receptor binding to an allosteric site and stabilizing the closed conformation


Chemical Structure of anabaseine


Structures of Anabaseine at Physiological pH


Synthesis of Anabaseine


Abstract simplified diagram showing overlap between neurotransmission and metabolic activity. Neurotransmitters bind to receptors which cause changes to ion channels (black, yellow), metabotropic receptors also affect DNA transcription (red), transcription is responsible for all cell proteins including enzymes which manufacture neurotransmitters (blue).


Diagram of neural circuit which regulates melatonin production via actual circuit pathways. Green light in the eye inhibits pineal production of melatonin (Inhibitory connections shown in red). Also shown:reaction sequence for melatonin synthesis.


Various  psychoactive  drugs


The common  muscimol -bearing mushroom  Amanita muscaria  (fly agaric)


RD and gambling disorder


C. Robert Cloninger


MRI


The brain on substance dependence.


Type 2 Alcoholism


When reward dependence goes wrong


S-Adenosylmethionine , a source of methyl groups in many biogenic arsenic compounds


Arsenic poisoning is a global problem arising from naturally occurring arsenic in ground water.


Cacodylic acid , formed in the liver after ingestion of arsenic.


An 1889 newspaper advertisement for " arsenic  complexion wafers". [ 102 ]  Arsenic was known to be poisonous during the  Victorian era . [ 103 ]


X-ray image of a  54-year-old man working in the aerospace manufacturing industry with berylliosis


Beryllium ore


Diatoms are capable of synthesizing silica glass  in vivo .


Diatomaceous earth  as viewed under bright field  illumination  on a  light microscope . Diatomaceous earth is made up of  diatom   cell walls , an example of  biogenic  silica . Silica is synthesised in the diatom cell by the  polymerisation  of  silicic acid . This image of diatomaceous earth particles in water is at a scale of 6.236 pixels/ μm , the entire image covers a region of approximately 1.13 by 0.69 mm.


PET scan using fluorine-18


Topical fluoride treatment in Panama


Prozac, one of several notable fluorine-containing drugs


PET scan for diagnosis of Alzheimer's disease


Computer-generated model of nanocrystal of perflubron (red) and gentamicin (white, an antibiotic)


Sign warning of poisonous sodium fluoroacetate baits


South Africa's  gifblaar  is one of the few organisms that naturally produce fluorine compounds


The U.S. hazard signs for commercially transported fluorine [ 56 ]


Typical HF burns: the outward signs may not be evident for 24 hours, after which calcium treatments are less effective. [ 59 ]


Moroccan cow with fluorosis, from industrial contamination


The PFOS molecule


Element percentages in the human body.


Calcium roots loss (blossom end rot) on a tomato


Blossom end rot on a grape tomato


Dissection of grape tomato with blossom end rot


Calcium is used in many nerves in the  voltage-gated calcium channel  which is slightly slower than the  voltage-gated potassium channel . It is most notably used in the  cardiac action potential . [ 1 ]


Global dietary calcium intake among adults (mg/day) [ 7 ]      <400    400–500    500–600    600–700    700–800    800–900    900–1000    >1000


Calcium regulation  in the human body [ 38 ]


Reference ranges for blood tests , showing calcium levels in purple at right


Calcium GCaMP reporter in tomato pollen tube


The  Lewis structure  of a  carbon  atom, showing its four  valence electrons


Schematic of  photosynthesis  in plants. The  carbohydrates  produced are stored in or used by the plant. Photosynthesis is  foundation  of  food  on Earth


Graphic representation of  carbon ,  hydrogen ,  nitrogen ,  oxygen ,  phosphorus , and  sulfur


In humans most cobalt is found in  Vitamin B12 . A cobalt atom is visible in the center in this diagram.


Fluorite crystals


Fluoride is sold in tablets for cavity prevention.


Magnified cells of bacterium GFAJ-1 grown in medium containing arsenate


Wolfe-Simon at Mono Lake, 2010


Tufa  formations along the shore of  Mono Lake


Scanning electron micrograph  of GFAJ-1 cells grown in defined minimal medium supplemented with 1.5 mM phosphate


Structure of poly-β-hydroxybutyrate


Diagram showing a generalized view of cellular iron homeostasis in humans. Iron import can occur via endocytosis of  transferrin receptor 1  or via ferrous iron importers  DMT1  and  ZIP14 , which require the activity of iron reductases such as  STEAP2 ,  SDR-2  and  Dcytb . Intracellular iron can be stored in  ferritin  and used for protein biosynthesis, or to generate  reactive oxygen species  (ROS) and regulate transcription via  iron-responsive element-binding proteins  (IRP1/2). Export occurs through  ferroportin , often aided by  hephaestin  (Hp) and/or  ceruloplasmin  (Cp), and repressed by  hepcidin .


Structure of  Heme b ; "Fe" is the chemical symbol of iron, "II" indicates its oxidation state.


Electron micrograph of  E. coli . Most bacteria that cause human disease require iron to live and to multiply.


Illustration of blood cell production in the  bone marrow . In  iron deficiency , the bone marrow produces fewer blood cells, and as the deficiency gets worse, the cells become smaller.


Humans use  20 mg  of  iron  each day for the production of new  red blood cells , much of which is recycled from old red blood cells.


Hephaestin is an enzyme that helps release iron from enterocytes. The regulation of hephaestin expression is one of the mechanisms that control iron absorption by the body.


This schematic outlines iron metabolism in the brain illustrating that iron crosses the  blood–brain barrier  either by: [ 34 ] The  transcytosis  pathway (illustrated in the upper right segment of the image), where the complex “Fe 3+ -transferrin-transferrin receptor 1 (TfR1)” undergoes endocytosis and exocytosis from the luminal pole to the cerebral  extracellular matrix  (ECM) and  interstitial fluid . The facilitated transporter pathway, where  endothelial cells  internalize the complex “Fe 3+ -transferrin-transferrin receptor 1 (TfR1)” in endosome, reduce ferric Fe 3+  ion to ferrous Fe 2+  ion by STEAP3 enzyme and then Fe 2+  ion crosses the endosomal membrane thanks to DMT1. Fe 2+  is  then exported to the extracellular matrix (ECM) and interstitial fluid, via ferroportin coupled with ceruloplasmin.


Iron is an important topic in  prenatal care  because women can sometimes become iron-deficient from the increased iron demands of pregnancy.


Iodine cycle  diagram showing how iodine is cycled through the ecosystem, including living organisms. The figures all have units of teragrams (Tg).


Sequence of 123-iodide human scintiscans after an intravenous injection, (from left) after 30 minutes, 20 hours, and 48 hours. A high and rapid concentration of radio-iodide is evident in extrathyroidal organs like cerebrospinal fluid (left), gastric and oral mucosa, salivary glands, arterial walls, ovary and thymus. In the thyroid gland, I-concentration is more progressive, as in a reservoir (from 1% after 30 minutes, and after 6, 20 h, to 5.8% after 48 hours, of the total injected dose). [ 6 ]


A  pheochromocytoma  tumor is seen as a dark sphere in the center of the body (it is in the left adrenal gland). The image is by  MIBG   scintigraphy , showing the tumor by radiation from radioiodine in the MIBG. Two images are seen of the same patient from front and back. The image of the thyroid in the neck is due to unwanted uptake of radioiodine from a radioactive iodine-containing medication by the thyroid gland in the neck. Accumulation at the sides of the head is from salivary gland uptake of iodide. Radioactivity is also seen from uptake by the liver, and excretion and accumulation in the bladder.


Iron  in  hemoglobin  is the source of the red coloration of  vertebrate   blood .


Hemoglobin diagram


An  Iron–sulfur cluster .


Structure of  Heme b ; in the protein additional  ligand (s) would be attached to Fe.


A heme unit of human  carboxyhemoglobin , showing the  carbonyl ligand  at the apical position,  trans  to the histidine residue [ 22 ]


A bottle of lithium medicine containing 300 mg capsules of  lithium carbonate .


Magnesium – adenosine triphosphate  ionic mixture, what is often just called adenosine triphosphate colloquially in biology


Space-filling model of the  chlorophyll a  molecule, with the magnesium ion (bright-green) visible at the center of the  chlorin  group


Some good sources of magnesium


Space-filling model of the chlorophyll a molecule, with the magnesium ion (bright-green) visible at the center of the  chlorin  group


Figure 1: Magnesium in the whole plant


Figure 2: Magnesium in the plant cell


The originally published TM topology of the CorA protein


The TM topology of the MgtB protein


The predicted TM topology of the MgtE protein


The TM topology of the MRS2 and LPE10 proteins


The TM topology of the XNTA protein


The predicted TM topology of MgtE from  H. sapiens


The predicted TM topology of the TRPM6 and TRPM7 proteins


The predicted TM topology of the AtMHX protein


Reactive center of arginase with boronic acid  inhibitor   arginase  – the manganese atoms are shown in yellow.


A  FeMoco  cluster with a  molybdenum  atom in the center


Structure of the  FeMoco  active site of  nitrogenase .


The molybdenum cofactor (pictured) is composed of a molybdenum-free organic complex called  molybdopterin , which has bound an oxidized molybdenum(VI) atom through adjacent sulfur (or occasionally selenium) atoms. Except for the ancient nitrogenases, all known Mo-using enzymes use this cofactor.


Stereo, skeletal formula of octathiocane


Spacefill model of octathiocane


Ball and stick model of octathiocane


Sample of pulverised octasulfur


Silver spoons self-sanitize due to the oligodynamic effect


Diagram of phosphodiester bonds ( PO 3− 4 ) between three  nucleotides . The 5' end has a 5' carbon attached to a phosphate, and the other end, the 3' end, has a 3' carbon attached to a hydroxyl group.


Three  soil scientists  examining a  farm land  sample


The  sodium–potassium pump  a critical enzyme for regulating  sodium  and  potassium  levels in cells


Selenocysteine  is the main organic molecule involving  selenium  in  humans .


Relationship between survival of juvenile salmon and concentration of selenium in their tissues after 90 days (Chinook salmon: Hamilton et al. 1990) or 45 days (Atlantic salmon: Poston et al. 1976) exposure to dietary selenium. The 10% lethality level (LC10=1.84 μg/g) was derived by applying the biphasic model of Brain and Cousens (1989) to only the Chinook salmon data. The Chinook salmon data comprise two series of dietary treatments, combined here because the effects on survival are indistinguishable.


Selenium at nutritional levels is required for cell  homeostasis , playing a role as an  anti-oxidant  through  selenoproteins , thus, act  chemo-preventive  against cancer. In contrast, supra-nutritional levels act as  pro-oxidant  toxic in  tumour  cells. [ 39 ]


Selenium can either play a  pro-oxidant  role inducing  ROS , activating the  Akt–NF–кB pathway  or play an  antioxidant  role through  selenoprotein  synthesis such as  TXNRD  relocating to the nucleus and activating  NF-кB , resulting in further activation of  leukocytes  and pro-inflammatory  cytokine  genes. [ 39 ]


The  sodium–potassium pump , a critical enzyme for regulating sodium and  potassium  levels in cells


Here is a hand-drawn depiction of a membrane bound sodium-potassium pump and  sodium and potassium ion channels can be seen along with the directed movement of the ions indicated by arrows.


The sodium-glucose symporter is initially opened to the extracellular matrix. Once 2 sodium and the glucose bind, the conformation closes to the extracellular matrix and opens to the cytosol where the sodium and glucose are released. The confirmation of the symporter than returns to the initial confirmation.


Pictured on the left is the working CFTR where the ions are able to move through the cells and the mucus is thinned out. On the right is a not functioning CFTR that prevents the movements of ions and causes thicker mucus in the airway lumen.


Sulfate reduction and assimilation in plants  (APS, adenosine 5'-phosphosulfate; Fdred, Fdox, reduced and oxidized ferredoxin; RSH, RSSR, reduced and oxidized glutathione; SQDG, sulfoquinovosyl diacylglycerol)


Zinc fingers  help read DNA sequences.


Ribbon diagram  of human  carbonic anhydrase  II, with zinc atom visible in the center


Foods and spices  containing zinc


Dioscorides receives a mandrake root.  Vienna Dioscurides  manuscript, early 6th century.


Blackberry .  Vienna Dioscurides , early 6th century


Mandrake  (written  'ΜΑΝΔΡΑΓΟΡΑ'  in Greek capitals).  Naples Dioscurides , 7th century.


Cumin and dill from an Arabic  book of simples  ( c.  1334 ) after Dioscorides


De materia medica  in Arabic,  Spain , 12th–13th century


Byzantine   De materia medica , 15th century


Formularium Slovenicum


Page from the 6th-century  Vienna Dioscurides , an illuminated version of the 1st-century  De Materia Medica


Dioscorides ,  De materia medica ,  Byzantium , 15th century.


Dioscorides  De materia medica  in  Arabic ,  Spain , 12th-13th century


One of the four covers (Arnoullet)  of the " Lyons  printers' tribute edition to Michel de Villeneuve " [ 24 ]  edition of the Materia Medica. By  Michel de Villeneuve  &  Pietro Andrea Mattioli , printed by Balthazar Arnoullet in 1554, in Lyons.


The Green Pharmacy Cross (sometimes overlaid with  Bowl of Hygieia ), is widely used in  Europe  and  India [ citation needed ]  on pharmacy signs.


A  medication  is a drug used to diagnose, cure, treat, or prevent disease.


The Apothecary or The Chemist by  Gabriël Metsu  ( c.  1651 –67)


Pharmacy,  Tacuinum sanitatis  casanatensis (14th century)


A pharmacy worker distributing drugs to an old woman at a local clinic.


Physician and Pharmacist, illustration from  Medicinarius  (1505) by  Hieronymus Brunschwig


Dioscorides,  De Materia Medica , Byzantium, 15th century


Löwen-Apotheke in  Trier , operating continuously from at least 1241


Sign of the  Town Hall Pharmacy  in  Tallinn , operating continuously from at least 1422,  showing the  Bowl of Hygieia


A pharmacy in  Klaukkala ,  Finland


Airman 1st Class Breanna DeMasters and Staff Sgt. Giovanni Fiorito, 332nd Expeditionary Medical Group pharmacy technicians, fill prescription medication for patients, Oct. 7, Joint Base Balad Iraq.


Pharmacists now go on rounds with doctors and have more patient interaction.


Clinical pharmacists go on rounds with doctors in order to provide direct patient care and comprehensive medication management.


Blue and white  albarello  adorned with the traditional colors of Chinese Porcelain and decorated with designs derived from Kufic script, a style of Arabic script. Manufactured in Tuscany, Italy in the second half of the 15th century.


16th century Spanish Albarello with a symbol in the middle of the vase, marking it as a pharmacy jar for some powder.


Two  albarelli  fashioned with a prominent Italian motif called "a foglie" or leafy design. Most likely manufactured in the Naples district. Located at the  Metropolitan Museum of Art  in the European Sculpture and Decorative Arts collection.


Albarello jar found in Iran in the 12th century. Has Arabic religious text around the jar, as well as animals running in action.


Examples of auxiliary labels placed on prescriptions.


Auxiliary label stating the medication must be swallowed whole, without crushing or chewing.


Auxiliary labels stating "take with food or milk" and "do not take with aspirin"


Curry powder  contains the bioenhancers curcumin and piperine.


Black Pepper contains high concentrations of piperine.


The bioenhancer quercetin is inter alia included in the peel of apples and grapes.


The gingerols from ginger act as bioenhancers.


Allicin from garlic enhances the effect of a fungicide.


A simple drawing of the Bowl of Hygieia


Clinical pharmacists go on rounds with doctors in order to provide direct patient care and  comprehensive medication management .


A  hospital pharmacist  is checking a liquid solution.


Pharmacist compounding a medication using a  mortar and pestle  (c. 1923)


A  marijuana  dispensary


Collecting medicine in Mali, after attending a clinic


A cannabis dispensary in  Halifax, Nova Scotia  closes a few days before  legalization of cannabis in Canada  in October 2018.


The George Town Dispensary,  Penang


High-level dataflow diagram outlining the roles and processes involved in electronic prescribing


Made by Burroughs Wellcome & Co, this chest was used by  Robert Falcon Scott  on the first part of  Terra Nova Expedition . Such cases, made of lightweight metal, airtight and waterproof, were used by various explorers from the 1880s onwards, including  Henry Morton Stanley ,  Roald Amundsen  and  Fridtjof Nansen .


Pharmaceutical drug which emits radiation, used as a diagnostic or therapeutic agent


Dietary supplements , such as the vitamin B supplement shown above, are typically sold in pill form.


Considered a father of Western medicine,  Hippocrates  advocated the healing effects of food.


Patient Care Process


Dioscorides ’  Materia Medica ,  c.  1334  copy in Arabic, describes medicinal features of various  plants .


The  carotenoids  in  primrose  produce bright red, yellow and orange shades.


Digoxin  is a purified  cardiac glycoside  that is extracted from the  foxglove  plant,  Digitalis lanata . Digoxin is widely used in the treatment of various heart conditions.


An early pharmacy management system from 1977


Illustration of a doctor and pharmacist from  Medicinarius  (1505) by  Hieronymus Brunschwig .


Research and development investments vs log-adjusted treatment costs at launch based on list prices and net prices [ 26 ]


Medication costs per capita by country (2019, OECD) [ 53 ]


Photo of the packaging of four medicines registered in the UK, showing their  Product Licence Numbers  and symbols denoting if they are Prescription Only Medicine (POM) or Pharmacy Medicine (P)


One of a chain of pharmacies in Mexico City, Mexico, named "Doctor Discount," March 2010.


Hanging Show Globe at the Biological Sciences/Pharmacy Library of  Ohio State University


Two pharmacists in  Ferndale, Michigan  hanging show globes, 1954.


A vial of  dopamine , labeled as "DOPamine HCl"


Pharmacy personnel deliver  medical prescriptions  electronically; remote delivery of  prescription drugs  is a feature of  telepharmacy .


Illustration of  Chamaelirium luteum


Dried herbs and plant portions for Chinese herbology at a  Xi'an  market


Chinese pharmacopoeia


A traditional Chinese herbal decoction (湯劑/汤剂)


The Five Phases, which correspond to the Five Flavors


Dried  seahorses  like these are extensively used in  traditional medicine  in China and elsewhere.


An illustrative summary of commonly-used Envoy Herbs (Guiding Herbs) in Traditional Chinese Medicine


Berries of Clerodendrum infortunatum at Beliatore, India


Clerodendrum infortunatum


Inflorescence  with blooming flowers


Inflorescence  of  Clerodendrum infortunatum


Ripe fruits of  Clerodendrum infortunatum


1916  Eli Lilly  crude drug case for pharmacy students to study: contains 216 different specimens


Creighton University College of Pharmacy crude drugs circa 1910


Ethnobotanist  Richard Evans Schultes  at work in the  Amazon  in the 1940s


Plants have been widely used by  Native American  healers, such as this  Ojibwa  man.


Hydro-distillation process of  agarwood  essential oil.


Cinnamomum malabatrum , young leaves,  Kerala , India


Halichondria  produces the  eribulin  ( Halaven ) precursor  halichondrin B


Cannabis  as illustrated in Köhler's  Book of Medicinal Plants , 1897


American medical hashish


Illustrating various forms of medicinal cannabis