Doctors Orders: Two cups of coffee in the morning

Today we were discussing drugs used to treat respiratory disorders, such as asthma and chronic obstructive pulmonary disease (COPD). One class of older drugs methylxanthines, which includes the Theophylline, Aminoophylline and Caffeine, isn't used frequently and are not drugs of choice--nonetheless, we need to review them. These drugs work by inhibiting phosphodiesterase enzymes and blockade of adenosine receptors. Basically this means that they cause bronchodilation (but not as well as beta-2 agonists, such as abulterol), they increase the ventilatory response, increase mucociliary clearance (which is important in asthmatics because the pathology of asthma results in an increase in mucus), and improved diaphragmatic performance, which is unique to this class of drugs. Bottom line, these drugs makes it easier to breathe. I'm sure your wondering why I'm telling you all of this as you probably don't care about mechanisms of action and classes of drugs--if you did care you would be a pharmacists or a physician--I have a story about coffee.

Our lecturer today started teaching medical students in 1956 and is an MD and a PhD. I think he might be the smartest person I've ever met. He is an excellent professor and I think he could teach just about any topic in medicine school at any moment without much preparation. He is amazing in that he is so intelligent, never embarasses students, is extremely helpful and very modest (but he writes extremely difficult exam questions). After discussing the respiratory effects of Methylxanthines, we discussed effects in other systems such as the gastrointestinal tract, genital urinary tract, cardiac system and central nervous system. Obviously caffeine acts on the CNS, which is the point of this blog post. He made a point that moderate doses of caffeine has the following effects on the central nervous system:

• Cortical arousal with increased alertness and deferral of fatigue


• Decreased reaction time, more rapid and clear flow of though, and increased learning capability for simple tasks

Then he bluntly said in a thick Italian accent, "If you need to stay awake to study for your exams, please just have two cups of coffee. It will work better because you will be more alert and is safer than abusing other drugs." Through out the world, people abuse substances, such as Adderall which is an amphetamine, to keep them awake for school or work. I, personally, don't know of anyone who is abusing drugs to stay awake and study, but I do know that it is habitually done in medical schools and I'm sure some of my peers are doing so. It surprised me that he stopped to talk about drug abuse and reasons it is so horrible. Not only is he an amazing professor, I think he truly cares about his students (and he looks like a cute Italian grandpa). Now back to caffeine, there are obviously side effects if you take too high a dose of caffeine including insomnia, headache tremors, and headache (which he also warned us about). Nonetheless, the moral of the story is if you need help staying alert, Doctor's orders: two cups of coffee.