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1
Chapter 4Chapter 4
Circulatory System Agents
2
Section 1
β-Adrenergic Block Agents ( 肾上腺能 β- 受体阻滞剂 )
3
Propranolol Hydrochloride( 盐酸普萘洛尔 )
1-Isopropylamino-3-(1-naphthyloxy)-2-propanol hydrochloride
O NH
H OH. HCl
1
23
4
Structure Activity Relation (SAR)
O NH
H OH
Substituted by S,CH2 or NCH3,activity lower
S-configuration isomer¡s̄ activity is better
By tert-butyl and isopropyl ,activity highest.Or number of C more than 3.
Benzene,naphthalene,heterocycle and condensed ring.on the ring can be methyl,chloride,methoxyl and nitro-.2,4-or2,3,6-substitute simultaneously,best activity.
5
Section 2
Calcium Channel Blockers
6
Ion channel concept :
classification :
a kind of transmembrane biomacromolecule
take the action of ion pump like activating enzyme
and adjust many kinds of physiologic function
produce and transmit electrical signal
sodium channel potassium channel
calcium channel chlorine channel
7
Nifedipine ( 硝苯地平 )
IUPAC name: 3,5-dimethyl 2,6-dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate
Other name: 1,4-Dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinedicarboxylic acid dimethyl ester
HN
O
O
O
O
NO2
1 2
34
5
6
Adalat / Procardia( 心痛定 )
INN:International Non-proprietary Names
8
Other 1,4-dihydropyridine agentsHN
O
O
O
O
NO2
HN
O
O
O
O O
NO2
N
HN
O
O
NO2
O
O
HN
O
O
O
O
NO2
HN
O
O
O
O
NO2
HN
O
O
O
O
Cl
ONH2
Nifedipine Nimodipine Nicardipine
Nisoldipine Nitrendipine Amlodipine
9
SAR of Nifedipine
HN
OO
OONO2
position 4 requires an aromatic substitution ortho- and/or meta-position requir
an electron-withdrawing group
position 3 and 5 must be carboxylic ester
nitro group is essential
position 2 and 6 substituted with an alkyl group
10
Section 3
Sodium and Potassium Channels Blockers
11
Mexiletine Hydrochloride( 盐酸美西律 )
1-(2,6-Dimethylphenoxy)-2-propanamine hydrochloride
ONH2 .HCl
1
2
3
1-methyl-2-(2,6-xylyloxy)ethylamine hydrochloride
12
Amiodarone Hydrochloride( 盐酸胺碘酮 )
(2-Butyl-3-benzofuranyl)[4-(2-(diethyl- amino) ethoxy)-3,5-diiodophenyl] methanone hydrochloride
O
O
O
I
I
N
. HCl
3
2
1
1
41
2
13
Angiotensin( 血管紧张素 )Converting Enzyme Inhibitors (ACEI)
& Angiotensin Receptor Ⅱ
Antagonists( 拮抗剂 )
Section 4
14
Captopril ( 卡托普利 )
1-[ ( 2S) -3-Mercapto( 巯基 )-2-methyl-1- oxopropyl ) ]-L-proline( 脯氨酸 )
HS N
H
O
OHO
123
15
Its analogue
N
HN
H OO
OH
OO
HS NH
O
OHO
Enalapril
A non-thiol-containing ACE inhibitor
Act as prodrug
Converted to activation by hydrolysis of its ethyl ester to form the diacid enalaprilat.
OH
No thiol group, devoid of the side effects of rash and loss of taste sense with Captopril.
Captopril
16
Angiotensin( 血管紧张素 )ⅡReceptor Antagonists( 拮抗剂 )
17
Losartan ( 氯沙坦 )
2-Butyl-4-chloro-1-[[2’-(1H-tetrazol-5-yl)[1,1’-biphenyl]-4-yl]methyl]-1H-imidazole-5-methanol
N
NHN
N
N
N
OH
Cl
1
2
34
5
1′2′
1
4
18
Section 5
NO Donor Drugs
19
The Nobel Assembly at the Karolinska Institute in Stockholm, Sweden, has awarded the Nobel Prize in Physiology or Medicine for 1998 to Robert F Furchgott, Louis J Ignarro and Ferid Murad for their discoveries concerning "the nitric oxide as a signalling molecule in the cardiovascular system".
The Nobel Prize in Physiology or Medicine 1998
20
Mechanism of action
NitrovasodilatorsEndothelial Cells
NO
GC* Guanylate cyclase(GC)
GTP cGMP
MLCKMLCK* MLCK-PO4
NO formed in smooth muscle from nitrovasodilators ( 硝基血管扩张剂 )or from endothelial cell (EDRF) activates guanylate cyclase ( 鸟苷酸环化酶 ,GC*).
GC* activates cGMP-dependent protein kinases( 激酶 )that phosphorylate myosin light-chain kinase (MLCK, 肌凝蛋白 ), cause its inactivation and subsequent muscle relaxation.
21
Section 6
Cardiac Agents( 强心剂 )
22
Digoxin ( 地高辛 )
OH
Steroid structure
23
Section 7
Lipid Regulators
24
Lovastatin ( 洛伐他汀 )
2-methylbutanoic acid 1,2,3,7,8,8a-hexahydro-3,7-dimethyl-8-[2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)ethyl]-1-naphthalenyl ester
O
H
H
HO
OH
O
O
1
35
7
88a
25
Analogues of -statin
O O
H
H
HH
H
O
H OOH
H
Lovastatin
O O
H
HH
H
O
H OOH
H
Mevastatin Pravastatin
O O
H
HH
H
O
H OOH
H
Simvastatin
NOH OH
O
OH
F
Fluvastatin
O O
H
HO
H
HH
HO
H
HO
OH
OH
H
CH3
26
Section 8
Antithrombotic Drugs( 抗血栓药 )
27
ClassificationOH
O
O
O
N
S Cl
H
OO
O
OH O
O
Antiplatelet drug
Anticoagulant
Thrombolytic Urokinase
Clopidogrel
Warfarin SodiumAccording tomechanism
Aspirin
Dicoumarol( 双香豆素 )
Streptokinase
O O
OH OH
O O
28
Aspirin
More than 100 years for antipyretic analgesic( 解热止痛剂 ).
In 1954, discovered that it can extend bleeding time. In 1971, found its mechanism by inhibiting the synth
esis of PG.
Arachidonic acid( 花生四烯酸 )
Endoperoxide (EP)
Thromboxane A2
epoxidase
Aspirin Clopidogrel
inhibit inhibit
29
Warfarin Sodium
4-Hydroxy-3-(3-oxo-1-phenylbutyl)-2H-1-benzopyran-2-one sodium salt.
3-(α-acetonylbenzyl)-4-hydroxycoumarin( 羟基香豆
素 )sodium salt
O
ONa O
O
43
21
30
Warfarin interacts with many commonly-used drugs, and the metabolism of warfarin varies greatly between patients.
Antibiotics, alcohol, herbs and some food have been reported to interact with warfarin.
Vitamin K.
31
Chapter 5
Digestive System Agents
32
Classification
AntiacidsAntiacids
Inhibit the different linkInhibit the different link of acid secretionof acid secretion
Mucous membraneMucous membrane(( 黏膜 )
protective drugsprotective drugs
Anticholinergic agents( 抗胆碱能药 )
H2-receptor antagonists
Antigastrin agents( 抗胃泌素 )
Proton pump inhibitors
Cimetidine( 西咪替丁 )
Omeprazole( 奥美拉唑 )
Pirenzepine( 哌仑西平 )
Proglumide( 丙谷胺 )
Prostaglandin E (前列腺素 E ) /Sucralfate (硫糖铝) /Alginic Acid (藻朊酸)
Mechanism of action
NaHCO3/MgO
33
Ranitidine Hydrochloride( 盐酸雷尼替丁 )
N-[2-[[[5-[(dimethylamino)methyl-2-furanyl] methyl]thio]ethyl]-N’- methyl-2-nitro-1,1-ethenediamine monohydrochloride
An aminoalkyl furan derivative with pKa values of 2.7 and 8.2.
. HClS
HN
NO2
HNO
N
(side chain and dimethylamino)
34
Proton pump (PP) inhibitors A group of drugs whose main action is a pronounced an
d long-lasting reduction of gastric acid production. Significantly more effective than H2 antagonists and red
uce gastric acid secretion by up to 99%. The most potent inhibitors of acid secretion, and the mo
st widely-selling drugs in the world. They are generally considered safe and effective.
Majority of these drugs are benzimidazole derivatives; however, new research indicates that imidazopyridine derivatives may be more effective.
35
Omeprazole ( 奥美拉唑 )
(R,S)-5-methoxy-2-(4-methoxy-3,5-dimethyl-2-pyridylmethylsulfinyl)benzimidazole
A white to off-white crystalline powder with very slight solubility in water
N
ONH
NOS
O
1
2
34
5
36
Section 3
Prokinetics( 促动力药 )
37
Concept and classification Prokinetics
Classification D2 receptor antagonists Metoclopramide( 甲氧氯普胺 )
Periphery D2 receptor antagonists Domperidone( 多潘立酮 )
Acetylcholine agonists Cisapride( 西沙必利 )
Promote GI content to push forward, used in the treatment of GI dyskinesis( 动力障碍 ) such as reflux esophagitis( 返流食道炎 ), dyspepsia( 消化不良 ), intestinal obstruction( 肠梗阻 ), etc.
38
Common Prokinetics
NH
NO
H2N
Cl
O
HN
NO
Cl
NN
HN
O
NO
O
FCl
H2N
O
NH
O
Metoclopramide Domperidone
Cisapride
39
Cisapride ( 西沙必利 )
N
Cl
H2N
O
NH
O
O
FO
1
2
3
4
5
1
234
3 and 4-C are both chiral C
3 and 4-substituents on the same side of pyridine ring
4-amino-5-chloro-N-((3S,4S)-1-[3-(4-fluoro phenoxy)propyl]-3-methoxypiperidin-4-yl)-2-methoxybenzamide
40
NH
O
Cl
H2N O
N O
FO
NH
O
Cl
H2N O
N O
FO
NH
O
Cl
H2N O
N O
FO
NH
O
Cl
H2N O
N O
FO
34
2-cis isomers in
clinic
4-isomersof
Cisapride
41
Domperidone ( 多潘立酮 )
N
HN
N
N
HN
OCl
O
5-chloro-1-(1-[3-(2-oxo-2,3-dihydro-1H-benzo[d]imidazol-1-yl)propyl] piperidin-4-yl)-1H-benzo[d]imidazol-2(3H)-one
吗丁啉
42
Section 4
Adjuvant for Hepatic and Biliary Diseases
( 肝胆疾病辅助治疗药物 )
43
Common drugs
HO OH
O
NH2
O
Glutamic Acid( 谷氨酸 )
O
OO
HO
OH
OH
Glucurolactone( 葡醛内酯 )
OH
HO
OH
OHO
HOOH
O
HOOH
Lactulose( 乳果糖 )
O O
O
OO
OO
O
OO
Bifendate( 联苯双酯 )
OHO
OH OOH
O
O
OHO
OH
2
2`
3
3`
Silibinin( 水飞蓟宾 )
44
Chapter 6
Antipyretic Analgesics &
Nonsteroidal Anti-inflammatory Agents
45
HO O
O ONomenclature:Acetylsalicylic acid; 2-Acetoxy benzoic acid; (Aspro, Empirin)
White crystal or white crystalline powerHydrolyzed to form salicylic acid
Aspirin—AcetylAcetylsalicylic acid It is more potent, less irritating.
46
Paracetamol ( 对乙酰氨基酚 )
N -(4-Hydroxyphenyl) acetamide; Acetaminophen; N-Acetal-p-aminopheno
l; 4-Hydroxyacetanilide; APAP
NH
O
HO
It is Aniline and p-Aminophenol derivative. It isn’t anti-inflammatory, different with Aspirin. Not to exceed the recommended dosages.
47
Metabolic Pathway of Paracetamol
N
O
OH
HO
NH
OHO
Paracetamol
Ferrihemoglobin and hepatotoxicity
NH
O
NH
OO
NH2
O
NH
OS
HOO
OONH
OOGlu
Acetanilide Phenacetin
Ferrihemoglobin
children
adults
48
N
O
OH
HO
Ferrihemoglobin and hepatotoxicity
O
N
O
HO
N
O
HO
N
O
O
N
OSG
orgatein
S
O
HO
NH
O
GSH
Toxicity metabolite
N-Acetylethylenimine quinone
acetylcysteine
kidneyHepatonecrosis, renal failure
49
Salicylic acid
OH
OH
OHO O
O O
NH
O
HO
ParacetamolAspirinSalicylic acid
Antipyretic Analgesics
50
Diclofenac Sodium( 双氯芬酸钠 )
Sodium 2-[(2,6-dichloroanilino)phenyl]acetate
ONa
NH
ClCl
O
Indicated for short- and long-term treatment of RA, OA, and ankylosing spondylitis(强直性脊柱炎) .Available as delayed-release tablets.
51
Ibuprofen (布洛芬)
α-Methyl-4-(2-methyl propyl)phenylacetic acid 2-(4-isobutylphenyl)propionic acid
O
OHS-(+) isomer
52
Naproxen (萘普生)
(+)6-Methoxy-α-methyl-2-naphthaleneacetic acid
OO
OHH1
2
3
456
White to off-white crystal. Sparingly soluble in acidic solutions, freely soluble in alkaline solutions, and higly soluble in organic or lipid-like solutions.
S(+)isomer
53
NN
OH
O
O
NH
OH
O ONa
NH
ClCl
O
Oxyphenbutazone
Mefenamic AcidDiclofenac Sodium
NO
OHO
O
Cl
Indomethacin
O
OH
Ibuprofen
OO
OHH
Naproxen
SN
NH N
OOH
O O
Piroxicam
N
F F
F
S
OO
H2N
Celecoxib
54
Chapter 10
Diuretics and Synthetic Hypoglycemic Drugs
55
Type 1 Diabetes (insulin-dependent)
Formerly known as insulin-dependent diabetes mellitus (IDDM, 胰岛素依赖性糖尿病 ).
The β–cells of the pancreatic islets of Langerhans are destroyed, probably by an autoimmune process, such that insulin production is grossly deficient.
There exists only a weak genetic link in the etiologyof this form of diabetes.
Type 1 diabetes is invariably treated with insulin.
56
Type 2 Diabetes (noninsulin-dependent)
Formerly known as noninsulin-dependent diabetes mellitus (NIDDM).
Frequently associated with obesity in its mainly adult victims. Serum insulin levels are normal or elevated, so in essence this is a disease of insulin resistance.
There is a strong genetic link in the etiology of the condition, and insulin therapy is not always required.
57
Classification of Hypoglycemic Drug
Sulfonylureas( 磺酰脲类 ) Biguanides( 双胍类 ) α-Glucosidase inhibitors(α- 葡萄糖苷酶抑制
剂 ) Thiazolindiones( 噻唑烷二酮类 )
58
Glibenclamide( 格列本脲 )
1-[[p-[2-(5-chloro-o-anisamido)ethyl]-phenyl]sulfonyl] -3-cyclohexylurea.
Second-generation oral hypoglycemic agent. The drug has a half-life elimination of 10h, but its hyp
oglycemic effect remains for up to 24h.
59
Glimepiride( 格列美脲 )
1-[[p-[2-(3-ethyl-4-methyl-2-oxo-3-pyrroline-1-carboxamido)ethyl] phenyl]sulfonyl]-3-(trans-4-methylcyclohexyl)urea.
The third-generation oral hypoglycemic agent. It is metabolized primarily through oxidation of the alkyl side chain of the pyr
rolidine, with a minor metabolic route involving acetylation of the amine.
60
Biguanide (( 双胍类双胍类 ) ) :
N , N-Dimethylimidodicarbonimidic diamide hydrochloride
Metformin Hydrochloride (盐酸二甲双胍)
61
α-Glucosidase Inhibitors
1-(2-Hydroxyethyl)-2-(hydroxymethyl)piperidine-3,4,5-triol
O
HO
HO
OH
OH
OH
pyranose
Miglitol ( 米格列醇 )
62
Thiazolindiones( 噻唑烷二酮类 )
N
O
S
NH
O
O
COOH
COOH
H
H
Chemical Name:(5-[[4-[2-methyl-2-pyridinylamino)ethoxy]phenyl]methyl] -2,4-thiazolidinedione maleate
Rosiglitazone Maleate( 马来酸罗格列酮 )
63
Diuretics ( 利尿剂 )
64
Furosemide
Name:
5-(Aminosulfonyl)-4-chloro-2-[(2-furanylmethyl )amino] benzoic acid
S
OO
H2N
Cl
O
OH
NH
O
Most effective,Strongest diuretic!
65
A negative feature of all above-discussed diuretics is that they increase the renal excretion rate of K+ and thus can induce hypokalemia( 低钾血 ).
The K+-sparing diuretics including Spironolactone and Triameterene.
Other: Potassium-sparing diuretics
Keep K+
66
Prostaglandins Peptide Hormones Steroid Hormones Natural hormones and their analogues
Chapter 11 Hormones
67
1. Prostaglandins ( 前列腺素 , PG)
68
Basic chemical Structure
This acid contains 20 carbon atoms.
7 carbons and carboxyl group in the upside chain
8 carbons in the downside chain
5-m-alicyclic
69
2. Peptide Hormones ( 肽类激素 )
70
Insulin ( 胰岛素 )
Insulin’s MW. 5807.69 Insulin molecule consists of chain A and B, with 21 and 30 amino acid residue, respectively. The chains are connected by two disulfide linkages, and an additional disulfide linkage within chain A.
71
3. Steroid Hormones( 甾体激素 )
Estradiol ( 雌二醇 )
Testosterone propionate ( 丙酸睾酮 )
Progesterone ( 黄体酮 )
Dexamethasone acetate ( 醋酸地塞米松 )
72
Backbone of Structure
甾SteroidSteroid
73
3.1 Steroid Estrogen( 雌激素 )
Natural estrogens : Estradiol ( 雌二醇 ), Estrone ( 雌酮 ) and Estriol ( 雌三醇 ).
Estradiol > Estrone > Estriol Ratio of activity is 1 : 0.3 : 0.1
Estrogens Classify: Steroid estrogen and Non-steroid estrogen .
74
Estradiol ( 雌二醇 )
75
3.2 Non-Steroidal Estrogen and Selective Estrogen Receptor Modulator
Non-Steroidal estrogen are mainly biphenylethylene compounds.
SERMs compounds mainly
triphenylethylene compounds.
76
Diethylstilbestrol ( 己烯雌酚 )
Chemical name : ( E)-4, 4’-(1, 2-Diethyl-1, 2-ethenediyl)bisphenol Non-Steroidal Estrogen
77
Tamoxifen Citrate( 枸橼酸他莫昔芬 )
Chemical name: (Z)-2-[4-(1, 2-diphenyl-1-butenyl)-phenoxy]-
N, N-dimethyl ethanamine citrate. Dimethylamino-ethoxyphenyl group exists i
n many drugs’ structure.
78
Selectivity of Anti-estrogens’ Target Organ
Antioestrogens
Target organs Indication
Clomifen sex organ Sterility( 不孕 )
Tamoxifen lacteal gland Breast cancer ( 乳癌 )
Roloxifen skeleton Osteoporosis ( 骨质疏松 )
79
Structure features
Differences of structure
Progesterone 17β-acetyl
Testosterone 17β-hydroxyl
Testosterone ( 睾酮 )Progesterone ( 黄体酮 )
80
Levonorgestrel( 左炔诺孕酮 )
Chemical name: D-(-) 17-Ethynyl-17- hydroxy-18-methyl-estro-4-en-3-one
O
OH
H
H H
18
17
3.5 Steroid Contraceptive agents3.5 Steroid Contraceptive agents(( 避孕药避孕药 ))
81
Hormone, its excitomotor and antagonist
( 激素、激动剂和拮抗剂 ) 激素 合成激动剂 激素拮抗剂
孕激素 (拮抗剂)
O
O
黄体酮
Progesterone
O
OH
炔诺酮
Norethisterone
O
OHN
米非司酮
Mifepristone
雌激素 (拮抗剂)
OH
HO
雌二醇 Estradiol
HO
OH
己烯雌酚 Diethylstilbestrol
HO
ON
4-羟基他莫昔芬
Hydroxytamoxifen
pregnancy (hormone antagonist)
estrogen (hormone antagonist)
Hormones synthesized excitomotor
Hormone antagonist
82
1 . Mineralcorticoids (盐皮质激素): Oxygen atoms do not exist at C-11 and C-17 at the same time.
Aldosterone( 醛甾酮 ) , Deoxycorticosterone( 去氧皮质酮 )
2 . Glucocorticoids (糖皮质激素): Oxygen atoms do exist at C-11 and C-17 at the same time. Hydrocortisone( 氢化可的松 ), Cortisone( 可的松 )
3.7 Adrenocorticoids3.7 Adrenocorticoids(( 肾上腺皮质激素肾上腺皮质激素 ))
83
Dexamethasone Acetate( 醋酸地塞米松 )
Chemical name: 9--Fluoro-11, 17, 21-
trihydroxypregna-16-methylpregna-1, 4-diene-3,20- dione-21-acetate.
O
O
OHO
O
F
HO
84
Chapter 12 Vitamin
85
Classification and Effect of Vitamin
Lipid soluble vitamin Daily dose (mg)
Main effect
Vitamin A (retinol) 1.5 Used for xerophthalmia( 干眼症 ), vitamin A deficiency disease
Vitamin D2 (ergocalciferol) vitamin D deficiency disease, osteoporosis (骨质疏松症)Vitamin D3 (colecalciferol) 0.025
Vitamin E
(tocopherol)
Vitamin E deficiency, intermittent limp (间歇性跛行)
Vitamin K1 (phyonadione) 1 Antihemorrhagic( 止血 )vitamin, can resist newborn hemorrhage (出血 ), low plasminogen disease( 低凝血酶原症 ), vitamin K deficiency
Vitamin K2
Vitamin K3
(Menadione Sodium Bisulfite)
86
Water-soluble vitamin
Daily dose (mg)
Main effect
Vitamin B1
(thiamine hydrochloride)
1.5 Vitamin B deficiency, peripheral neuritis(周围神经炎)
Vitamin B2 (riboflavine) 2 Lactochrome(核黄素 )deficiency disease
Vitamin B6
(pyridoxine hydrochloride) 3
Vitamin B dependence syndrome, deficiency, congenital dysbolism(先天代谢障碍 )
Vitamin B12 (cyanocobalamine) 0.005
Malignant anaemia(恶性贫血 ), megaloblastic anemia(巨幼红细胞性贫血 ), anaemia(贫血 )and spirit system disease caused by anti-folic drugs( 抗叶酸药 )
Vitamin H (biotin) 0.25 Vitamin H deficiency
Vitamin C
(ascorbic acid) 60Vitamin C deficiency, acidation urine, idiopathic methemoglobinemia (特发性高铁血红蛋白血症 )
87
Vitamin A Acetate
Chemical name: (All-trans)-3,7-Dimethyl-9-(2,6,6-trimethyl-
1-cyclohexene-1-yl)-2,4,6,8-nonatetraen-1-ol acetate.
All-trans retinol acetate.
O
O
24681'
2'
6'
88
Vitamin E Acetate
Chemical name : (±)3, 4-Dihydro-2, 5, 7, 8-tetramethyl -2-(4, 8, 12-trimethyl-tridecyl)-2H-
benzopyran-6-ol acetate. -Tocopherol Acetate
89
Vitamin C
Chemical name : 2-oxo-L-threo-hexono-1,4- lactone-2,3-enediol. (R)-3,4-dihydroxy-5-[(S)- 1,2-dihydroxyethyl] fu
ran-2(5H)-one. Ascorbic Acid.
OO
HO
H OH
OH
OH
90
4 Optical Isomers of Vitamin C
L-(+)antiscorbic acid has highest activity, which is 20 times of D-(-)-isoascorbic acid.
D-(-)- antiscorbic acid and L-(+)- isoascorbic acid are ineffective.
O O
HO
H OH
OH
OH
O O
H OH
OH
HO OH O O
HO
HO H
OH
OH
O O
HO H
OH
HO OH
L-(+)-¿¹»µÑªËá D-(-)-¿¹»µÑªËá D-(-)-Ò쿹»µÑªËá L-(+)-Ò쿹»µÑªËáL-(+)antiscorbic acidL-(+)antiscorbic acid D-(-)-antiscorbic acidD-(-)-antiscorbic acid D-(-)-isoantiscorbic acidD-(-)-isoantiscorbic acid L-(+)-isoantiscorbic acidL-(+)-isoantiscorbic acid