Brody's Human Pharmacology MECHANISM-BASED THERAPEUTICS SIXTH EDITION Lynn Wecker, PhD Distinguished University Professor Department of Psychiatry and Behavioral Neurosciences Department of Molecular Pharmacology and Physiology University of South Florida Morsani College of Medicine Tampa, Florida With David A. Taylor, PhD 2 Professor and Chair Department of Pharmacology and Toxicology Brody School of Medicine at East Carolina University Greenville, North Carolina Robert J. Theobald, Jr., PhD Professor Department of Pharmacology A.T. Still University of Health Sciences Kirksville, Missouri 3 Table of Contents Cover image Title Page Copyright Contributors Preface Dedication and Acknowledgments Section 1 Mechanisms of Drug Action and Therapeutic Principles Introduction 1 Introduction Websites 2 Pharmacodynamics 4 Biological Sites and Specificity of Drug Action General Properties of Cellular Receptors Agonists and Antagonists Receptor Families, Subtypes, and Signaling Cascades Quantitative Relationships Receptor Regulation Websites Self-Assessment Questions 3 Pharmacokinetics Absorption and Distribution Metabolism and Elimination of Drugs Clinical Considerations Calculation of Pharmacokinetic Parameters Multiple or Prolonged Dosing Special Populations and Disease Considerations Summary Further Reading Self-Assessment Questions 4 Pharmacogenetics Genes Affecting Pharmacokinetics: Drug Metabolism and Drug Transporters Genes Affecting Pharmacodynamics Cancer Pharmacogenetics 5 Summary Further Reading Websites Self-Assessment Questions 5 Drug Discovery, Development, and Regulation Drug Discovery and Development Prescription Writing and Regulation Summary Further Reading Websites Self-Assessment Questions Section 2 Chemical Mediators and Drugs Affecting Autonomic and Neuromuscular Synapses Introduction 6 Introduction to the Autonomic Nervous System Divisions of the Autonomic Nervous System Functional Responses Mediated by the Autonomic Nervous System Neurotransmission in the Autonomic Nervous System Neurotransmitters in the Autonomic Nervous System Neurotransmitter Receptors in the Autonomic Nervous System Drugs Affecting the Autonomic Nervous System 6 New Developments Further Reading Websites Self-Assessment Questions Cholinergic Drugs 7 Muscarinic Agonists, Cholinesterase Inhibitors, and Their Clinical Uses TheRapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 8 Muscarinic Antagonists and Their Clinical Uses Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics 7 Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 9 Nicotinic Agonists and Their Clinical Uses Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions Clinical Relevance for Healthcare Professionals New Developments Further Reading Websites Self-Assessment Questions 10 Neuromuscular Blocking Drugs and Nicotinic Antagonists Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions 8 New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self Assessment Questions Adrenergic Drugs 11 Adrenergic Agonists and Their Clinical Uses Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 12 Adrenergic Antagonists and Their Clinical Uses Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics 9 Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions Section 3 Drug Treatment for Disorders Affecting the Central Nervous System Introduction 13 The Central Nervous System Introduction Neurotransmission in the Central Nervous System Organization of the Central Nervous System Drug Action in the Central Nervous System Further Reading Websites Self-Assessment Questions 14 Drug Therapy for Alzheimer Disease and Other Cognitive Disorders/Dementias Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response 10 Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 15 Pharmacotherapy of Basal Ganglia Disorders Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 16 Drug Therapy for Psychoses and Bipolar Disorder Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics 11 Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 17 Drug Therapy for Depression and Anxiety Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 18 Drug Therapy for the Management of Attention Deficit- Hyperactivity Disorder Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics 12 Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 19 Drug Therapy for Insomnia and the Hypersomnias Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 20 Drug Therapy for Managing Obesity and Eating Disorders Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions 13 New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 21 Treatment of Seizure Disorders Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 22 Drug Therapy for Spasticity Disorders Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments 14 Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 23 Ethanol, Other Alcohols, and Drugs for Alcohol Use Disorder Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals Further Reading Websites Self-Assessment Questions 24 Illicit Psychoactive Compounds and Substance Use Disorder Therapeutic Overview Mechanisms of Action Relationship of Mechanisms of Action to Clinical Response Pharmacokinetics Pharmacovigilance: Adverse Effects and Drug Interactions New Developments Clinical Relevance for Healthcare Professionals 15