Chiropractor Job

Chiropractors treat patients with health problems of the neuromusculoskeletal system, which includes nerves, bones, muscles, ligaments, and tendons. They use spinal adjustments, manipulation, and other techniques to manage patients’ health concerns, such as back and neck pain.

Important Qualities

Decision-making skills. Chiropractors must determine the best course of action when treating a patient. They must also decide when to refer patients to other health care professionals.

Detail oriented. Chiropractors must be observant and pay attention to details so that they can make proper diagnoses and avoid mistakes that could harm patients.

Dexterity. Because they use their hands to perform manual adjustments to the spine and other joints, chiropractors should be well-coordinated to perform therapy effectively.

Empathy. Chiropractors often care for people who are in pain. They must be understanding and sympathetic to their patients’ problems and needs.  

Interpersonal skills. Chiropractors must be personable to keep clients coming to them. Also, because chiropractors frequently touch patients in performing therapy, they should be able to put their patients at ease.

Chiropractors must earn a Doctor of Chiropractic (D.C.) degree and a state license. Doctor of Chiropractic programs typically take 4 years to complete and require at least 3 years of undergraduate college education for admission.

Chiropractors typically do the following:

  • Assess a patient’s medical condition by reviewing their medical history, listening to the patient’s concerns, and performing a physical examination
  • Analyze the patient’s posture, spine, and reflexes
  • Conduct tests, including evaluating a patient’s posture and taking x rays
  • Identify health problems
  • Provide neuromusculoskeletal therapy, which involves adjusting a patient’s spinal column and other joints by hand
  • Give additional treatments, such as applying heat or cold to a patient’s injured areas
  • Advise patients on health and lifestyle issues, such as exercise, nutrition, and sleep habits
  • Refer patients to other health care professionals, if needed

Chiropractors focus on patients’ overall health. Chiropractors believe that misalignments of the spinal joints interfere with a person’s neuromuscular system and can result in lower resistance to disease, as well as other conditions of poor health.

Some chiropractors use procedures such as massage therapy, rehabilitative exercise, and ultrasound in addition to spinal adjustments and manipulation. They also may apply supports, such as braces or shoe inserts, to treat patients and relieve pain.

In addition to operating a general chiropractic practice, some chiropractors concentrate in areas such as sports, neurology, orthopedics, pediatrics, or nutrition, among others. Chiropractors in private practice are responsible for marketing their businesses, hiring staff, and keeping records.

Quick Facts: Chiropractors
2012 Median Pay $66,160 per year

$31.81 per hour
Entry-Level Education Doctoral or professional degree
Work Experience in a Related Occupation None
On-the-job Training None
Number of Jobs, 2012 44,400
Job Outlook, 2012-22 15% (Faster than average)
Employment Change, 2012-22 6,500

Chiropractors held about 44,400 jobs in 2012. Most chiropractors work in a solo or group practice. About 37 percent were self-employed in 2012. A small number work in hospitals or physicians’ offices.

Chiropractors typically work in office settings that are clean and comfortable. They may be on their feet for long periods when examining and caring for patients.
Work Schedules

Although most chiropractors worked full time, about 1 out of 3 worked part time in 2012. Chiropractors may work in the evenings or on weekends, to accommodate working patients. Self-employed chiropractors set their own hours.

Employment of chiropractors is projected to grow 15 percent from 2012 to 2022, faster than the average for all occupations. People across all age groups are increasingly seeking chiropractic care, because most chiropractors treat patients without performing surgery or prescribing drugs.

Chiropractic treatment of the back, neck, limbs, and involved joints has become more accepted as a result of research and changing attitudes about additional approaches healthcare. As a result, chiropractors are increasingly working in hospitals and clinics as part of a team-based model of patient care.

The aging of the large baby-boom generation will lead to new opportunities for chiropractors. Older adults are more likely to have neuromusculoskeletal and joint problems and they are seeking treatment for these conditions more often as they lead longer, more active lives.

Dentist Job

Dentists diagnose and treat problems with teeth and tissues in the mouth, along with giving advice and administering care to help prevent future problems.

Work Environment

Dentists held about 146,800 jobs in 2012. Some dentists own their own businesses and work alone or with a small staff.
How to Become a Dentist

Dentists must be licensed in all states; requirements vary by state. To qualify for a license in most states, applicants must graduate from an accredited dental school and pass written and practical exams.

The median annual wage for dentists was $149,310 in May 2012.
Job Outlook

Employment of dentists is projected to grow 16 percent from 2012 to 2022, faster than the average for all occupations.

Quick Facts: Dentists
2012 Median Pay $149,310 per year

$71.79 per hour
Entry-Level Education Doctoral or professional degree
Work Experience in a Related Occupation None
On-the-job Training See How to Become One
Number of Jobs, 2012 146,800
Job Outlook, 2012-22 16% (Faster than average)
Employment Change, 2012-22 23,300

Dentists typically do the following:

  • Remove decay from teeth and fill cavities
  • Repair cracked or fractured teeth and remove teeth
  • Straighten teeth to correct bite issues
  • Place sealants or whitening agents on teeth
  • Administer anesthetics to keep patients from feeling pain during procedures
  • Write prescriptions for antibiotics or other medications
  • Examine x rays of teeth, gums, the jaw, and nearby areas for problems
  • Make models and measurements for dental appliances, such as dentures, to fit patients
  • Teach patients about diet, flossing, use of fluoride, and other aspects of dental care

Dentists use a variety of equipment, including x-ray machines, drills, mouth mirrors, probes, forceps, brushes, and scalpels. They also use lasers, digital scanners, and other computer technologies.

Most dentists are general practitioners and handle a variety of dental needs. Other dentists practice in one of nine specialty areas:

Dental public health specialists promote good dental health and the prevention of dental diseases in specific communities.

Endodontists perform root-canal therapy, by which they remove the nerves and blood supply from injured or infected teeth.

Oral and maxillofacial radiologists diagnose diseases in the head and neck through the use of imaging technologies.

Oral and maxillofacial surgeons operate on the mouth, jaws, teeth, gums, neck, and head, including procedures such as surgically repairing a cleft lip and palate or removing impacted teeth.

Oral pathologists diagnose conditions in the mouth, such as bumps or ulcers, and oral diseases, such as cancer.

Orthodontists straighten teeth by applying pressure to the teeth with braces or other appliances.

Pediatric dentists focus on dentistry for children and special-needs patients.

Periodontists treat the gums and bone supporting the teeth.

Prosthodontists replace missing teeth with permanent fixtures, such as crowns and bridges, or with removable fixtures such as dentures.

Dentists held about 146,800 jobs in 2012. Some dentists own their own businesses and work alone or with a small staff. Other dentists have partners in their practice, and some work for more established dentists as associate dentists.

Dentists usually work in offices. They wear masks, gloves, and safety glasses to protect themselves and their patients from infectious diseases.


Most dental students need at least a bachelor’s degree before entering dental school; requirements vary by school. All dental schools require applicants to have completed certain required science courses, such as biology and chemistry. Majoring in a science, such as biology, might increase the chances of being accepted, but no specific major is required to enter most dental programs.

College undergraduates who plan on applying to dental school must usually take the Dental Acceptance Test (DAT) during their junior year. Admission to dental school can be competitive. Dental schools use these tests along with other factors, such as grade point average and recommendations, to admit students into their programs.

Dental schools require students to take classes in subjects such as local anesthesia, anatomy, periodontology (the study of oral disease and health), and radiology. All dental schools include practice where students work with patients in a clinical setting under the supervision of a licensed dentist.

High school students who want to become dentists should take courses in chemistry, physics, biology, anatomy, and mathematics.


All nine dental specialties require dentists to complete additional training before practicing that specialty. They must usually complete a 1- or 2-year residency in a program related to their specialty. General dentists do not require any additional training after dental school.

Dentists who want to teach or do research full time usually spend an additional 2 to 5 years in advanced dental training. Many practicing dentists also teach part time, including supervising students in dental school clinics.

Licenses, Certifications, and Registrations

All states require dentists to be licensed; requirements vary by state. Most states require a dentist to have a degree from an accredited dental school and to pass a written and practical exam.

In addition, a dentist who wants to practice in one of the nine specialties must have a license in that specialty. This usually requires 2 to 4 years of additional education after dental school and, in some cases, the completion of a special state exam. A postgraduate residency term also may be required, usually lasting up to 2 years.

Important Qualities

Communication skills. Dentists must have excellent communication skills. They must be able to communicate effectively with patients, dental hygienists, dental assistants, and receptionists.

Detail oriented. Dentists must be detail oriented so patients receive appropriate treatments and medications. They must also pay attention to space, shape, and color of teeth. For example, they may need to closely match a false tooth with a patient’s other teeth.

Dexterity. Dentists must be good at working with their hands. They work with tools in a limited area.

Leadership skills. Most dentists work in their own practice. This requires them to manage and lead a staff.

Organizational skills. Strong organizational skills, including keeping accurate records of patient care, are critical in both medical and business settings.

Patience. Dentists may work for long periods of time with patients who need special attention. Children and patients with a fear of dental work may require a lot of patience.

Physical stamina. Dentists should be comfortable performing physical tasks, such as bending over patients for long periods.

Problem-solving skills. Dentists need strong problem-solving skills. They must evaluate patients’ symptoms and choose the appropriate treatments.

Occupational Therapist Job

Occupational therapists carry out treatment plans to help patients with a variety of daily tasks. Occupational therapists treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.

What Occupational Therapists Do

Occupational therapists treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.

Occupational therapists typically do the following:

  • Observe patients doing tasks, ask them questions, and review their medical history
  • Evaluate a patient’s condition and needs
  • Develop a treatment plan for patients, laying out the types of activities and specific goals to be accomplished
  • Help people with various disabilities with different tasks, such as leading an autistic child in play activities
  • Demonstrate exercises—for example, joint stretches for arthritis relief—that can help relieve pain for people with chronic conditions
  • Evaluate a patient’s home or workplace and, based on the patient’s health needs, identify potential improvements, such as labeling kitchen cabinets for an older person with poor memory
  • Educate a patient’s family and employer about how to accommodate and care for the patient
  • Recommend special equipment, such as wheelchairs and eating aids, and instruct patients on how to use that equipment
  • Assess and record patients’ activities and progress for patient evaluations, for billing, and for reporting to physicians and other healthcare providers
  • Work Environment

    About half of occupational therapists work in offices of occupational therapy or in hospitals. Others work in schools, nursing homes, physicians’ offices, and home health services. Therapists spend a lot of time on their feet while working with patients.

    Quick Facts: Occupational Therapists
    2012 Median Pay $75,400 per year

    $36.25 per hour
    Entry-Level Education Master’s degree
    Work Experience in a Related Occupation None
    On-the-job Training None
    Number of Jobs, 2012 113,200
    Job Outlook, 2012-22 29% (Much faster than average)
    Employment Change, 2012-22 32,800

    How to Become an Occupational Therapist

    Occupational therapists typically have a master’s degree in occupational therapy. All states require occupational therapists to be licensed or registered.

    The median annual wage for occupational therapists was $75,400 in May 2012.

    Job Outlook

    Employment of occupational therapists is projected to grow 29 percent from 2012 to 2022, much faster than the average for all occupations. Occupational therapy will continue to be an important part of treatment for people with various illnesses and disabilities, such as Alzheimer’s disease, cerebral palsy, autism, or the loss of a limb.

    Occupational therapists held about 113,200 jobs in 2012. The industries that employed the most occupational therapists in 2012 were as follows: 

    Hospitals; state, local, and private 28%
    Offices of physical, occupational and speech therapists, and audiologists 22
    Elementary and secondary schools; state, local, and private 12
    Nursing care facilities (skilled nursing facilities) 9
    Home health care services 9

    Therapists spend a lot of time on their feet while working with patients. They also may be required to lift and move patients or heavy equipment. Many work in multiple facilities and have to travel from one job to another.


    Most occupational therapists enter the occupation with a master’s degree in occupational therapy. In March 2013, there were 149 occupational therapy programs accredited by the Accreditation Council for Occupational Therapy Education, part of the American Occupational Therapy Association; 145 are master’s degree programs and the remaining 4 are doctoral degree programs.

    Admission to graduate programs in occupational therapy generally requires a bachelor’s degree and specific coursework, including biology and physiology. Many programs also require applicants to have volunteered or worked in an occupational therapy setting.

    Master’s programs generally take 2 to 3 years to complete; doctoral programs take about 3 years. Some schools offer a dual-degree program in which the student earns a bachelor’s degree and a master’s degree in 5 years. Part-time programs that offer courses on nights and weekends are also available.

    Both master’s and doctoral programs require at least 24 weeks of supervised fieldwork, in which prospective occupational therapists gain clinical work experience.

    Licenses, Certifications, and Registrations

    All states require occupational therapists to pass the national examination administered by the National Board for Certification in Occupational Therapists (NBCOT). To sit for the NBCOT exam, candidates must have earned a degree from an accredited educational program and completed all fieldwork requirements.

    Therapists must pass the NBCOT exam to use the title “Occupational Therapist Registered" (OTR). They must also take continuing education classes to maintain certification.

    The American Occupational Therapy Association also offers a number of certifications for therapists who want to demonstrate their advanced level of knowledge in a specialty area, such as pediatrics, mental health, or low vision.

    Important Qualities

    Communication skills. Occupational therapists must be able to listen attentively to what patients tell them and be able to explain what they want their patients to do.

    Compassion. Occupational therapists are usually drawn to the profession by a desire to help people and improve the daily lives of others.

    Flexibility. Occupational therapists must be flexible when treating patients. Because not every type of therapy will work for each patient, therapists may need to be creative when determining the treatment plans and adaptive devices that best suit each patient’s needs.

    Interpersonal skills. Because occupational therapists spend their time teaching and explaining therapies to patients, they should be able to earn the trust and respect of their patients.

    Patience. Dealing with injuries, illnesses, and disabilities is frustrating for many people. Occupational therapists should be patient in order to provide quality care to the people they serve.

    Writing skills. When communicating in writing with other members of the patient’s medical team, occupational therapists must be able to explain clearly the treatment plan for the patient and any progress made by the patient.

    Medical Assistant Job

    Medical assistants usually complete many different kinds of tasks such as measuring a patient’s blood pressure or taking a patient’s temperature. Medical assistants complete administrative and clinical tasks in the offices of physicians, podiatrists, chiropractors, and other health practitioners. Their duties vary with the location, specialty, and size of the practice.

    Medical Assistant Jobs

    What does a medical assistant do?

  • Take and record patient history and personal information
  • Measure vital signs
  • Help the physician with patient examinations
  • Give patients injections as directed by the physician
  • Schedule patient appointments
  • Prepare blood for laboratory tests
  • Quick Facts: Medical Assistants
    2012 Median Pay $29,370 per year

    $14.12 per hour
    Entry-Level Education Postsecondary non-degree award
    Work Experience in a Related Occupation None
    On-the-job Training None
    Number of Jobs, 2012 560,800
    Job Outlook, 2012-22 29% (Much faster than average)
    Employment Change, 2012-22 162,900

    Medical assistants take and record patients’ personal information. They must be able to keep that information confidential and discuss it only with other medical personnel who are involved in treating the patient.

    Electronic health records (EHRs) are changing medical assistants' jobs. More and more physicians are adopting EHRs, moving all their patient information online. Assistants need to learn the EHR software that their office uses.

    Medical assistants should not be confused with physician assistants, who examine, diagnose, and treat patients under a physician's supervision.

    In larger practices or hospitals, medical assistants may specialize in either administrative or clinical work.

    Administrative medical assistants often fill out insurance forms or code patients’ medical information. They often answer telephones and schedule patient appointments. Assistants may work closely with hospital administrators and laboratory services. Some assistants buy and store supplies and equipment for the office.

    Clinical medical assistants have different duties, depending on the state where they work. They may do basic laboratory tests, dispose of contaminated supplies, and sterilize medical instruments. They may have additional responsibilities, such as instructing patients about medication or special diets, preparing patients for x rays, removing stitches, drawing blood, or changing dressings.

    Some medical assistants specialize according to the type of medical office where they work. The following are examples of specialized medical assistants:

    Ophthalmic medical assistants and optometric assistants help ophthalmologists and optometrists, respectively, provide eye care. They show patients how to insert, remove, and care for contact lenses. Ophthalmic medical assistants also may help an ophthalmologist in surgery.

    Podiatric medical assistants work closely with podiatrists (foot doctors). They may make castings of feet, expose and develop x rays, and help podiatrists in surgery.


    High school students interested in a career as a medical assistant should take courses in biology, chemistry, and anatomy.

    Medical assistants typically graduate from postsecondary education programs, and employers may prefer to hire assistants who have completed these programs. Programs for medical assisting are available from community colleges, vocational schools, technical schools, and universities and take about 1 year to complete. These programs usually lead to a certificate or diploma. Some community and junior colleges offer 2-year programs that lead to an associate’s degree. All programs have classroom and laboratory portions that include lessons in anatomy and medical terminology.

    Some medical assistants have a high school diploma or equivalent and learn their duties on the job.

    There are no formal educational requirements for becoming a medical assistant in most states. Some states require assistants to graduate from an accredited program, pass an exam, or both to do advanced tasks, such as taking x rays and giving injections.

    Important Qualities

    Analytical skills. Medical assistants must be able to understand and follow medical charts and diagnoses. They may be required to code a patient’s medical records for billing purposes.

    Detail oriented. Medical assistants need to be precise when taking vital signs or recording patient information. Physicians and insurance companies rely on accurate records.

    Interpersonal skills. Medical assistants need to be able to discuss patient information with other medical personnel, such as physicians. They often interact with patients who may be in pain or in distress, so they need to be able to act in a calm and professional manner.

    Technical skills. Medical assistants should be able to use basic clinical instruments so they can take a patient’s vital signs, such as heart rate and blood pressure.


    Medical assistants who do not have postsecondary education learn their skills through on-the-job training. Physicians or other medical assistants may teach a new assistant medical terminology, the names of the instruments, how to do daily tasks, how to interact with patients, and other tasks that help keep an office running smoothly. Medical assistants also learn how to code both paper and electronic health records and how to record patient information. It can take several months for an assistant to complete training, depending on the facility.

    Licenses, Certifications, and Registrations

    Medical assistants are not required to be certified. However, employers prefer to hire certified assistants.

    Several organizations offer certification. Some require the assistant to pass an exam, and others require graduation from an accredited program. In most cases, an applicant must be at least 18 years old before applying for certification.

    The National Commission for Certifying Agencies, part of the Institute for Credentialing Excellence, accredits five certifications for medical assistants:

    The median annual wage for medical assistants was $29,370 in May 2012. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $21,080, and the top 10 percent earned more than $41,570.

    Most medical assistants work full time. Some work evenings or weekends to cover shifts in medical facilities that are always open.

    Job Outlook

    Job Prospects

    Medical assistants who earn certification may have better job prospects.

    Occupational Title SOC Code Employment, 2012 Projected Employment, 2022 Change, 2012-22 Employment by Industry
    Percent Numeric

    SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program

    Medical assistants

    31-9092 560,800 723,700 29 162,900 [XLS]

    Employment of medical assistants is projected to grow 29 percent from 2012 to 2022, much faster than the average for all occupations. The growth of the aging baby-boom population will continue to spur demand for preventive medical services, which are often provided by physicians. As their practices expand, physicians will hire more assistants to perform routine administrative and clinical duties, allowing the physicians to see more patients.

    An increasing number of group practices, clinics, and other healthcare facilities need support workers, particularly medical assistants, to do both administrative and clinical duties. Medical assistants work mostly in primary care, a steadily growing sector of the healthcare industry. In addition, federal health legislation will expand the number of patients who have access to health insurance, increasing patient access to medical care.

    Additional demand also is expected because of new and changing tasks for medical assistants as part of the medical team. As more and more physicians’ practices switch to electronic health records (EHRs), medical assistants’ job responsibilities will continue to change. Assistants will need to become familiar with EHR computer software, including maintaining EHR security and analyzing electronic data, to improve healthcare information.

    Job Prospects

    Medical assistants who earn certification may have better job prospects.

    Occupational Title SOC Code Employment, 2012 Projected Employment, 2022 Change, 2012-22 Employment by Industry
    Percent Numeric

    SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program

    Medical assistants

    31-9092 560,800 723,700 29 162,900 [XLS]

    Thrive – Interesting Facts

    Brand/Commercial Names

    Thrive lozenges can help you stop smoking by reducing withdrawal symptoms and nicotine cravings. Using Thrive lozenges can enable you to reduce the daily number of cigarettes smoked to ease the transition into a smoke-free lifestyle. Although smoking cessation is preferable, THRIVE lozenges can also be used in cases when you need to temporarily refrain from smoking, for example, in smoke-free areas, airplanes, etc. or in other situations when you wish to avoid smoking. Product effectiveness is directly related to your motivation to stop smoking.

    Active Ingredient(s)

    Nicotine (as nicotine bitartrade dihydrate)

    Chemically and Mechanistically Related Drugs

    Nicotex, Nicorette, Nicoderm, Nicogum, Nicotinell, Thrive and Commit Lozenge

    Pediatric Use
    Do not give this medication to anyone under 18 years old without medical advice.

    Use in the Elderly
    In elderly patients, failure to thrive describes a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments. Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity. Four syndromes are prevalent and predictive of adverse outcomes in patients with failure to thrive: impaired physical function, malnutrition, depression, and cognitive impairment.

    Interesting Fact(s)
    Thrive® Lozenges dissolve quickly in your mouth, releasing controlled amounts of nicotine into your body for relief of your cravings and withdrawal symptoms. One lozenge should be placed in the mouth and allowed to dissolve. Move the lozenge occasionally from one side of the mouth to the other. Repeat until the lozenge is completely dissolved (about 10 minutes).
    The Nicotine transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

    Nicotine as Therapy
    There’s a cheap, common, and mostly safe drug, in daily use for centuries by hundreds of millions of people that only lately has been investigated for its therapeutic potential for a long list of common ills. The list includes Alzheimer disease, Parkinson disease, depression and anxiety, schizophrenia, attention deficit hyperactivity disorder (ADHD), and even pain and obesity. Why has interest in this potential cure-all been slow to develop? One reason: in its current forms the drug offers pharmaceutical companies no possibility of substantial profit. Another, perhaps more important: the drug is reviled as the world’s most addictive.
    Nicotine is an alkaloid in the tobacco plant Nicotiana tabacum, which was smoked or chewed in the Americas for thousands of years before European invaders also succumbed to its pleasures and shipped it back to the Old World.

    Nicotine and the Brain
    People with depressive-spectrum disorders, schizophrenia, and adult ADHD tend to smoke heavily, which suggested to researchers that nicotine may soothe their symptoms. Common to all these disorders is a failure of attention, an inability to concentrate. Nicotine helps.
    Smokers also have lower rates of neurodegenerative disorders, and nicotine improves cognitive and motor functioning in people with Alzheimer disease and Parkinson disease.
    Some researchers is heading the first study ever to examine the efficacy and safety of nicotine patches for treating mild cognitive impairment, thought to be a precursor of Alzheimer disease. The researchers hope to see a positive effect on attention and learning. They also heads two studies of nicotinic stimulation in ADHD, using the patch, nicotine blockers, and some novel drugs that activate nicotine receptors.

    Nicotine and Pain
    Two much newer topics of academic research are nicotine’s potential for pain relief and for treating obesity. Nicotine itself has provided modest pain relief in animal studies.
    Meanwhile, nicotine is also being investigated as an analgesic in humans.
    The nice thing about nicotine and drugs like nicotine is that they have opposite side effects to anesthetics. Instead of being respiratory depressants, they are respiratory stimulants. Instead of being sedating, they increase alertness.

    Nicotine and Weight Gain
    Nicotine may be the most effective drug around for weight control. As ex-smokers know, to their rue, one of the worst things about quitting cigarettes is putting on pounds—as much as 10% of body weight.
    Ming Li and his colleagues at the University of Texas in San Antonio, Texas, are studying nicotine’s effects on weight. In the weight study, nicotine-treated rats not only lost weight, they lost about 20% of their body fat compared to saline-treated controls. The researchers suggest that, among its other effects, nicotine alters fat storage.

    Nicotine’s Future
    Developing new drugs that selectively target specific subtypes of nicotine receptors is an expensive proposition. And therein lies a question. Will nicotine-based therapy consist mostly of costly new drugs from the pharmaceutical industry? Or can less expensive nicotine products like the patch, chewing gum, and nasal spray—which are generally intended for smoking cessation but widely available, usually without prescription—find their way into the world’s medicine cabinets?
    Yet much of the work to date showing nicotine’s effectiveness on a huge range of disorders has involved products available at any drugstore and intended to help people quit smoking. Newhouse is using patches for mild cognitive impairment. Flood has demonstrated pain relief with nasal spray and will use patches in her next study. And Role feels that gum hasn’t been adequately explored for its therapeutic potential. Nicotine gum, she notes, is a better imitator of smoking than the patch because it delivers brief hits rather than a steady supply. But Role also points out that nicotine has its serious problems—addictive potential, cardiovascular damage, and (especially when delivered through the mucosa) cancer.

    Ritalin – Interesting Facts

    Brand/Commercial Names
    Methylphenidate, Concerta®, Metadate CD®, Metadate ER®, Methylin®, Methylin ER ®, Quillivant XR®, Ritalin®, Ritalin® LA, Ritalin® SR

    Ritalin is used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) in adults and children. Ritalin is also used to treat narcolepsy (a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep). Ritalin is in a class of medications called central nervous system (CNS) stimulants. It works by changing the amounts of certain natural substances in the brain.

    Active Ingredient(s)
    Ritalin tablets contain the active ingredient methylphenidate hydrochloride, which is a type of medicine called a stimulant.

    Chemically and Mechanistically Related Drugs
    There are two main kinds of attention deficit hyperactivity disorder ADHD medications: stimulants and non-stimulants.
    Stimulants include Concerta, Ritalin LA, Focalin XR, Metadate CD, Daytrana, Adderall, and Vyvanse. They come as a liquid, pill, capsule, and even a patch. Stimulants work very quickly, and people with ADHD may see an improvement right away.
    Non-stimulants work a little differently in the brain than stimulants. They may take longer to work, but they work better than stimulants for some people. Non-stimulants include atomoxetine (Strattera), extended release guanfacine (Intuniv), extended release clonidine (Kapvay), and certain antidepressants (such as Wellbutrin).

    Pediatric Use
    The American Academy of Pediatrics (AAP) recommends that behavioral therapy be used as the first-line treatment for preschoolers, and that methylphenidate, better known as Ritalin or Concerta, be prescribed only after behavior management therapies have been tried without success.

    Use in the Elderly
    Depressive symptoms, apathy, and fatigue are common symptoms among medically ill older adults and patients with advanced disease, and are associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect.

    Worldwide Sales
    Methylphenidate U.S. retail sales in 2013 was $1,383,814,000

    Interesting Fact(s)
    In the US, Delaware, Virginia and Michigan rank as the top three states for Ritalin use, and most of the prescriptions are for elementary and middle school age children. Doctors in these states prescribe at least 33 grams for every 1,000 residents, 56 percent more than the national average, according to figures compiled by the Federal Drug Enforcement Agency.

    Future Developments
    During the past few years considerable debate has arisen within academic journals with respect to the use of smart drugs or cognitive enhancement pharmaceuticals. Some studies seek to examine the foundations of this cognitive enhancement debate using the example of methylphenidate use among college students.
    The argument taken is that much of the enhancement debate rests upon inflated assumptions about the ability of such drugs to enhance and over-estimations of either the size of the current market for such drugs or the rise in popularity as drugs for enhancing cognitive abilities. Some studies overview empirical evidence that methylphenidate has the ability to significantly improve cognitive abilities in healthy individuals, and examine whether the presumed uptake of the drug is either as socially significant as implied or growing to the extent that it requires urgent regulatory attention. In addition, those studies review the evidence of side-effects for the use of methylphenidate which may be an influential factor in whether an individual decides to use such drugs. The primary conclusions are that neither drug efficacy, nor the benefit-to-risk balance, nor indicators of current or growing demand provide sufficient evidence that methylphenidate is a suitable example of a cognitive enhancer with mass appeal.

    Prozac – Interesting Facts

    Brand/Commercial Names
    Fluoxetine, Prozac® Weekly, Rapiflux®, Sarafem®, Selfemra®

    Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won’t go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Fluoxetine (Sarafem) is used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.


    Active Ingredient(s)

    fluoxetine hydrochloride

    Chemically and Mechanistically Related Drugs

    Beginning in the 1950s, scientists developed a number of synthetic drugs for the treatment of depression, which represented a major step forward at the time.
    The Tricyclics
    The tricyclic drugs (Tofranil, (Elavil, Limbitrol, Endep, Norpramin, Adapin, Sinequan, Pamelor, Aventyl ) were the first antidepressant medications. They dominated the market for more than twenty years, and are still used today, though less frequently. They work by desensitizing a receptor in the neuron that absorbs the neurotransmitters norepinephrine and dopamine into the cells. This results in higher levels of these two chemicals in the synapse, and consequent improvements in mood.
    A serious problem with the tricyclics is their level of side effects, particularly in patients over age sixty-five.
    The Monoamine Oxidase Inhibitors
    The monoamine oxidase inhibitors (Nardil, Parnate), or MAOIs, have a different mechanism of action than the other antidepressants. They work by reducing the quantity of the enzyme MAO within the synapse.
    While the MAOIs have fewer side effects than the tricyclic drugs, they can still cause problems in some individuals.
    The Selective Serotonin Re-Uptake Inhibitors
    Prozac (fluoxetine hydrochloride) was the first selective serotonin re-uptake inhibitor, or SSRI, put on the market. Prozac’s success has spawned other SSRIs, including Zoloft (sertraline hydrochloride) and Paxil (paroxetine hydrochloride).
    Prozac and the other SSRIs can exact a high price for their benefits. Prozac is considered better than the older drugs because “only” 17 percent of the people who try it have to stop because of negative experiences, compared with nearly a third (31 percent) of the patients taking the tricyclic drugs. Zoloft and Paxil are similar to Prozac in terms of their side effects.
    Wellbutrin (bupropion hydrochloride) seems to boost norepinephrine function, with no impact on serotonin levels. The main difficulty with this drug is its association with seizures.
    Desyrel (trazodone hydrochloride) works on the serotonin system. Rather than being used for its antidepressant effects, it is most often prescribed along with Prozac because the drowsiness Desyrel induces counteracts Prozac’s tendency to produce insomnia.
    Effexor (venlafaxine hydrochloride) is chemically similar to an antidepressant compound in chocolate known as phenylethylamine (PEA), sometimes associated with the “love effect.” It is likely that PEA raises the level of endorphins in the brain, which creates a sense of well-being. The tradition of giving chocolates on Valentine’s Day reflects our intuitive knowledge of this effect.

    As of April 2, 2010, fluoxetine is one of four antidepressant drugs that the FAA allows pilots to take. The others are sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

    Pediatric Use
    In the US, a survey of drug companies found that between 1995 and 1999, use of Prozac-like drugs for children aged seven to 12 increased by 151 per cent, and in those aged under six by 580 per cent. In 2004, children aged five and under were America’s fastest-growing segment of the non-adult population using antidepressants. ‘Selective mutism’ (fear of speaking in social situations) is one affliction common in preschoolers and has been treated with Prozac.
    A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as fluoxetine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant.

    Use in the Elderly
    Fluoxetine is generally not recommended for use in the elderly because of its long half-life and prolonged side effects.

    Worldwide Sales
    Roughly 19.49 million prescriptions for this drug were filled in 2009, 24.4 million in 2010, and the number increased to over 24.5 million prescriptions in 2011. Prozac was considered the very first SSRI (Selective Serotonin Reuptake Inhibitors) medication to hit the market and was approved in 1987. It is widely regarded as the most popular antidepressant and some would consider “Prozac" to antidepressants as “Coke" is to soda. In addition to being approved for major depression, it is also used for OCD, eating disorders, and trichotillomania.

    Interesting Fact(s)
    You’ve probably heard about all the prescription meds in our water supply. Turns out Prozac in public waters makes shrimp act nutty—and not in a good way.

    Seems that the active ingredient in antidepressants like Prozac boosts serotonin in the shrimps’ nervous system and make them wiggle away from safe, dark waters toward the light, where they’re more likely to be devoured by predators.

    And because researchers don’t think Prozac has the same mood-elevating effect in shrimp as it does in people, the crustaceans don’t even get to die happy.
    Future Developments
    Prozac, an antidepressant that revolutionized the medical landscape, can cause birth defects if taken during pregnancy and can increase suicidal thoughts and behavior in children and young adults. Patients have targeted Eli Lilly & Co., drug manufacturer, with numerous Prozac lawsuits, claiming the company didn’t properly warn them about the drug’s dangerous side effects.
    Eli Lilly paid more than $50 million by 2000 to settle dozens of lawsuits related to Prozac. The drug remains on the market, although the FDA now requires it to carry a black-box label warning stating that it may increase suicidal thoughts or behavior in young people. So far, the company has refused to admit liability in birth defect cases.

    Myonal – Interesting Facts

    Brand/Commercial Names
    Eperisone, Expose

    Myonal acts by relaxing both skeletal muscles and vascular smooth muscles, and demonstrates a variety of effects such as reduction of myotonia, improvement of circulation, and suppression of the pain reflex. The drug inhibits the vicious circle of myotonia by decreasing pain, ischaemia, and hypertonia in skeletal muscles, thus alleviating stiffness and spasticity, and facilitating muscle movement.
    Myonal also improves dizziness and tinnitus associated with cerebrovasculardisorders or cervical spondylosis.


    Active Ingredient(s)
    Eperisone HCl

    Chemically and Mechanistically Related Drugs
    Inaperisone, Silperisone, Tolperisone

    Pediatric Use
    Safety in children has not been established (insufficient clinical experience).

    Use in the Elderly
    Since the elderly often have a physiological hypofunction, it is advisable to take measures, such as reduction in dosage under careful supervision.

    Interesting Fact(s)
    Study of Myonal versus tizanidine for treatment of chronic low back pain.
    Many therapies exist for treatment of chronic low-back pain (LBP) including the use of muscle relaxant and analgesic drugs. The aim of this study was to compare efficacy and tolerability of Myonal and tizanidine in combination treatment with tramadol in chronic LBP.
    Both associations assumed for one month, have shown effective for LBP at rest and with effort. Myonal /tramadol, reducing discontinuation and allowing a better adherence to the therapy, may be considered a viable option for the treatment of chronic LBP.

    Future Developments
    Myonal suffers from a very low bioavailability when taken orally, as a result of high first pass intestinal metabolism; a transdermal patch containing Myonal is currently in development in South Korea. This has shown promise, with the antispasmodic effect lasting over 24 hours, compared to one to two hours following oral administration.
    Myonal is also under investigation as an antihypertensive agent, with promising results from trials on beagles.

    Modafinil – Interesting Facts

    Brand/Commercial Names


    Modafinil is used to treat excessive sleepiness caused by narcolepsy (a condition that causes excessive daytime sleepiness) or shift work sleep disorder (sleepiness during scheduled waking hours and difficulty falling asleep or staying asleep during scheduled sleeping hours in people who work at night or on rotating shifts). Modafinil is also used along with breathing devices or other treatments to prevent excessive sleepiness caused by obstructive sleep apnea/hypopnea syndrome (OSAHS; a sleep disorder in which the patient briefly stops breathing or breathes shallowly many times during sleep and therefore doesn’t get enough restful sleep). Modafinil is in a class of medications called wakefulness promoting agents. It works by changing the amounts of certain natural substances in the area of the brain that controls sleep and wakefulness.


    Active Ingredient(s)

    Chemically and Mechanistically Related Drugs
    Adrafinil or Modafinil to give you more energy and vitality, you might be curious as to what the main differences between these smart drugs are. These are two of the most popular cognitive enhancement drugs available today with considerable benefits recorded for speed of cognition, memory, productivity and general alertness.
    The original clinical purpose of Adrafinil was to help those who have sleep problems.
    Many users also seem to experience a higher level of energy from this supplement. This is most likely due to the fact that it works by increasing the presence of the neurotransmitter Hypocretin. This brain chemical actually controls how alert and awake a person will feel.
    Mood is also generally improved while using Adrafinil. This is caused by an increase in the levels of Dopamine and Serotonin within the brain.
    Adrafinil is also capable of stimulating Glutamate receptors in the brain. As Glutamate receptors are stimulated and their pathways activated, this supplement increases memory and may also improve the speed of recall.
    Ritalin is a controlled substance under the Misuse of Drugs act, the spokesperson says. Possession of it without a prescription is illegal and it is a Class B drug.

    Pediatric Use
    Provigil is not approved for use in children for any medical condition. It is not known if Provigil is safe or effective in children under 17 years of age.

    Use in the Elderly
    Although appropriate studies on the relationship of age to the effects of Modafinil have not been performed in the geriatric population, geriatric-specific problems are not expected to limit the usefulness of Modafinil in the elderly. However, elderly patients may have a slower removal of this medicine from the body, which may require an adjustment in the dose for patients receiving Modafinil.

    Worldwide Sales
    Q3 2013 sales: $176,996,000

    Interesting Fact(s)
    Modafinil is a stimulant in the same vein as caffeine and adenosine, but the difference in how it works the brain means it doesn’t have the same side-effects that the others do.
    The way caffeine and Adenosine work is that they block certain receptors in the brain that react to dopamine, which makes it slow down. This means, for example, that coffee does not give you energy, but rather, doesn’t let the brain realize it needs more energy. This is why people crash after caffeine. The effect goes away and all the tiredness catches up to you. Modafinil doesn’t have that problem.
    No one really knows how it works yet, but it seems that instead of blocking the brain’s Dopamine processing, it just slows production of Dopamine. On top of that, it also prevents the re-uptake of another neurotransmitter called noradrenaline, which triggers sleep.
    The end result, and one of the most mysterious, is that Modafinil doesn’t trigger sleep debt. People who stay awake for a day or two on Modafinil don’t report a need to catch up on sleep after the effect wears off. They can sleep the normal amount!

    Ketamine – Interesting Facts

    Brand/Commercial Names
    Ketalar®, Ketaject®, Ketaset®, Vetalar®;

    Ketamine is an anesthetic medication. Ketamine is used to put you to sleep for surgery and to prevent pain and discomfort during certain medical tests or procedures.
    Primarily used in veterinary applications as a tranquilizer.
    Recreationally used as a psychedelic and for its dissociative effects.
    Psychological: Decreased awareness of general environment, sedation, dream-like state, vivid dreams, feelings of invulnerability, increased distractibility, disorientation, and subjects are generally uncommunicative. Intense hallucinations, impaired thought processes, out-of-body experiences, and changes in perception about body, surroundings, time and sounds. Delirium and hallucinations can be experienced after awakening from anesthesia.
    Physiological: Anesthesia, cataplexy, immobility, tachycardia, increased blood pressure, nystagmus, hypersalivation, increased urinary output, profound insensitivity to pain, amnesia, slurred speech, and lack of coordination.


    Active Ingredient(s)
    Ketamine hydrochloride

    Chemically and Mechanistically Related Drugs
    Lanicemine (a drug originally developed to treat epilepsy that targets the same brain receptors as ketamine), Tiletamine and Phencyclidine (PCP)

    Pediatric and Elderly Use
    Occasionally used as a short-acting general anesthetic for children and elderly patients.

    Worldwide Sales
    A huge seizure of ketamine and a law change in India, the major supplier globally of the drug, are being blamed for a ‘ketamine drought’. Dozens of factories in the Indian states of Maharashtra, Andhra Pradesh, and Gujarat manufacture tonnes of ketamine annually for the legitimate international medical and veterinary markets. But many illegal outfits also operate and sell the chemicals to narcotraffickers worldwide.
    The U.S. general anesthesia market (drugs such as propofol, midazolam & diazepam, fospropofol disodium, sodium pentothal, ketamine, methohexital sodium, pentobarbital, etomidate and fentanyl) was valued at $2 billion in 2011 and is poised to grow at a CAGR of approximately 4% to reach $2.3 billion by 2015.

    Interesting Fact(s)
    Ketamine has a reputation as an illicit party drug due to its hallucinogenic effects. But in a handful of ketamine clinics around the country, people who weren’t helped by standard treatments are getting a series of infusions to ease their depression.
    In tests, almost 70 percent of people who responded negatively to ordinary antidepressants improved within hours of taking the ketamine. Because around 40 percent of depressed people don’t respond to medication, this could be a huge help. And many others only respond after many months or years of trying different treatments.
    The drug has also been used in emergency rooms for curbing suicidal thoughts, making it a potential lifesaver. But it hasn’t been thoroughly studied for long-term safety and effectiveness, and the FDA hasn’t approved it to treat depression.
    Ketamine was widely employed as a field anaesthetic by the US Army during the Vietnam War.

    Future Developments
    Ketamine has been in the market for the past 41 years. There are four major players of ketamine in the U.S. market. JHP Pharmaceuticals is the only company which offers a branded generic of ketamine – ketalar. Ketalar is expected to maintain its position in the market in the coming five years but with a decreasing share in the market, due to high cost compared to the generic counterparts.

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