Pharmacology Pharmacology Michael D Randall Associate Professor and Reader in Cardiovascular Pharmacology, School of Biomedical Sciences, University of Nottingham Medical School, UK Stephen PH Alexander Associate Professor in Molecular Pharmacology, School of Biomedical Sciences, University of Nottingham Medical School, UK and David A Kendall Professor of Pharmacology, School of Biomedical Sciences, University of Nottingham Medical School, UK Pharmaceutical Press London ● Chicago Published by the Pharmaceutical Press An imprint of RPS Publishing 1 Lambeth High Street, London SE1 7JN, UK 100 South Atkinson Road, Suite 200, Grayslake, IL 60030-7820, USA © Pharmaceutical Press 2009 is a trade mark of RPS Publishing RPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great Britain First published 2009 Typeset by J&L Composition, Scarborough, North Yorkshire Printed in Great Britain by by TJ International, Padstow, Cornwall ISBN 978 0 85369 824 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. The rights of Michael Randall, Stephen Alexander and David Kendall to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988. A catalogue record for this book is available from the British Library. Contents Introduction to the FASTtrack series ix 5. Quantitative pharmacology . . . . . . . . . . 47 About the authors x Drugs which alter receptor activity 47 Preface xi Agonist activation of receptors: potency and efficacy 47 1. Pharmacodynamics . . . . . . . . . . . . . . . . 1 Antagonist occupancy of receptors: affinity Enzymes 2 estimation 53 Structural proteins 4 Radioligand binding 60 Hormones 4 Enzyme–substrate and transporter– substrate interactions 67 2. Receptors . . . . . . . . . . . . . . . . . . . . . . . 5 Drug selectivity and target identification 68 Superfamilies of receptors 5 7-Transmembrane domain receptors 5 6. Autonomic pharmacology . . . . . . . . . . . 71 Transmitter-gated ion channels 9 Organisation of the autonomic nervous system 71 Catalytic receptors 13 Pharmacology of the autonomic nervous Nuclear receptors 17 system 73 3. G-proteins and their downstream 7. Local mediators . . . . . . . . . . . . . . . . . . 79 signalling cascades . . . . . . . . . . . . . . . 21 Histamine 79 Heterotrimeric G-proteins 21 Gasotransmitters 79 Regulation of adenylyl cyclase activity and cAMP levels by Gs and Gi 23 Eicosanoids 80 nGes-rpvoroutse isny stigenmalling in the sympathetic 25 8. Pmheatramboalcisomkin.e .t i.c .s .a .n .d . d. r.u .g . . . . . . . . . . 87 lGoGefbtv Geacln:is da dtehney rlyelg cuylactlaiosne -oinf dretpineanld ceGntM ePf fects 268 ACFiblresato-rroaprntdicoeenr (kaCinLde) t ibciso aovfa eilaimbilnitay t(ioFn) 8878 Regulation of phospholipase C activity and Rate constant (k) 88 calcium levels by Gq 29 Half-life 89 G12/13–protein-coupled receptor signalling 32 Loading doses 89 Small G-proteins 33 Drug metabolism 90 Posttranslational modifications of G-proteins 34 9. Gastric pharmacology. . . . . . . . . . . . . . 93 Modulation of G-protein function: GAPs, Control of acid secretion 93 GEFs and GDIs 35 Treatment 93 4. Ion channels and transporters . . . . . . . 37 10. Lower gastrointestinal pharmacology . . 97 Ion channels regulated from inside the Diarrhoea 97 plasma membrane 37 Constipation 99 Voltage-sensitive channels 39 Irritable-bowel syndrome 99 Second messenger-operated ion channels 40 Inflammatory bowel disease 100 Intracellular channels 41 Plasma membrane transporters 41 11. Antiemetics. . . . . . . . . . . . . . . . . . . . 101 ATP-binding cassette transporters 44 Histamine H1-receptor antagonists 101 Intracellular transporters 44 Antimuscarinic agents 101 v vi Contents Histamine analogues 101 Decongestants 136 Dopamine receptor antagonists 102 Leukotriene receptor antagonists 136 5-hydroxytryptamine (5HT) receptor Anaphylaxis 136 antagonists 102 Adrenaline 136 Other agents 102 19. Anxiolytics and hypnotics . . . . . . . . . 139 12. Antiarrhythmics. . . . . . . . . . . . . . . . . 103 Benzodiazepines 139 Arrhythmias 103 b-blockers 140 The cardiac action potential 104 Antidepressants as anxiolytics 140 Autonomic control of the heart 104 20. Antidepressants . . . . . . . . . . . . . . . . 143 Antiarrhythmic drugs 104 Serotonin-selective reuptake inhibitors 13. Cardiovascular drugs. . . . . . . . . . . . . 107 (SSRIs) 143 Angiotensin-converting enzyme inhibitors Tricyclic antidepressants 144 (ACEIs) 107 Monoamine oxidase inhibitors 144 Angiotensin (AT ) receptor antagonists 108 1 Selective noradrenaline reuptake inhibitors Beta-blockers 109 (NARIs) 145 Diuretics 110 Serotonin/noradrenaline reuptake inhibitors (SNRIs) 145 Calcium channel inhibitors 110 Other drugs 145 Nitrates 111 General features of antidepressant drug Potassium channel activators 112 therapy 146 Alpha-blockers 112 Centrally acting antihypertensive 112 21. Antiepileptic drugs . . . . . . . . . . . . . . 149 Cardiac glycosides 113 Antiepileptic drugs 149 HMG CoA reductase inhibitors (statins) 114 22. Antipsychotic drugs. . . . . . . . . . . . . . 155 Fibrates 114 Antipsychotic drugs 155 14. Renal and urinary pharmacology . . . . 117 23. Parkinson’s disease . . . . . . . . . . . . . 159 Diuretics 117 Antiparkinsonian drugs 160 Bladder pharmacology 120 24. Analgesics . . . . . . . . . . . . . . . . . . . . 165 15. Antithrombotic agents: anticoagulants and antiplatelet drugs . . . . . . . . . . . . 123 Opioids 165 Oral anticoagulants 123 Other drugs 167 Injectable anticoagulants 124 Local anaesthetics 168 Antiplatelet drugs 124 Antimigraine drugs 168 Drugs for neuropathic pain treatment 169 16. Antiobesity drugs . . . . . . . . . . . . . . . 127 Drugs for trigeminal neuralgia 169 17. Asthma and chronic obstructive 25. Drugs of abuse . . . . . . . . . . . . . . . . . 171 pulmonary disease . . . . . . . . . . . . . . . 129 Common mechanisms 171 Autonomic control of airways 129 Heroin 172 Asthma 129 Cocaine 172 Bronchodilators 130 Alcohol (ethanol) 173 Anti-inflammatory agents 131 Amphetamines 173 Drugs causing bronchoconstriction 132 Ecstasy (MDMA, 18. Allergy. . . . . . . . . . . . . . . . . . . . . . . . 135 3,4-methylenedioxymethamfetamine) 173 Antihistamines 135 Cannabis 174 Topical corticosteroids 135 Benzodiazepines 174 Contents vii LSD 174 31. Non-bacterial infections: antiviral, antifungal and antiparasitic drugs . . . 199 Treatment 175 Antiviral drugs 199 26. General anaesthetics . . . . . . . . . . . . 179 Antifungal agents 200 Mechanisms of general anaesthetics 179 Antimalarial agents 201 Intravenous agents 180 Anthelmintics 202 Gaseous agents 180 Insecticides 202 27. Neuromuscular blocking drugs . . . . . 183 32. Anticancer drugs . . . . . . . . . . . . . . . . 205 Non-depolarising neuromuscular blockers 183 Cancer initiation and prevention 205 Depolarising neuromuscular blockers 184 Anticancer drugs 207 Drugs interfering with DNA and its 28. Thyroid disorders. . . . . . . . . . . . . . . . 187 replication 207 Thioamides 187 Targeted therapies 208 b-blockers 187 Drug resistance 209 Levothyroxine 187 Side-effects of anticancer drugs and rescue therapy 209 29. Diabetes mellitus . . . . . . . . . . . . . . . 189 Palliative care and additional symptom Type 1 diabetes 189 control 210 Type 2 diabetes 189 33. Steroids . . . . . . . . . . . . . . . . . . . . . . 211 Diet 190 Steroid nomenclature 211 Biguanides 190 Adrenal steroids 211 Sulphonylureas 190 Gonadal steroids 213 Meglitinide analogues 190 General principles of steroid hormone Thiazolidinediones (‘glitazones’) 191 receptor activation 216 Glucosidase inhibitors 191 Modulation of incretins 191 34. Biopharmaceuticals. . . . . . . . . . . . . . 219 Monoclonal antibodies 219 30. Antibacterial agents . . . . . . . . . . . . . 193 Recombinant hormones, cytokines and Penicillins 193 clotting factors 221 Cephalosporins 193 35. Variation in clinical efficacy. . . . . . . . 223 Glycopeptides 194 Tachyphylaxis 223 Tetracyclines 194 Receptor desensitisation 223 Macrolides 194 Tolerance to heroin 225 Clindamycin 194 Receptor densensitisation and Chloramphenicol 194 downregulation may be clinically useful 225 Aminoglycosides 195 Receptor upregulation 226 Quinolones 195 The pharmacodynamic basis of Sulphonamides and trimethoprim 195 interindividual variation 226 Metronidazole 195 Answers to self-assessment 229 Antituberculous drugs 195 Index 239 Introduction to the series FASTtrack is a new series of revision guides created for undergraduate pharmacy students. The books are intended to be used in conjunction with textbooks and reference books as an aid to revision to help guide students through their exams. They provide essential information required in each particular subject area. The books will also be useful for pre-registration trainees preparing for the Royal Pharmaceutical Society of Great Britain’s (RPSGB’s) registration examination, and to practising pharmacists as a quick reference text. The content of each title focuses on what pharmacy students really need to know in order to pass exams. Features include*: ■ concise bulleted information ■ key points ■ tips for the student ■ multiple choice questions (MCQs) and worked examples ■ case studies ■ simple diagrams. The titles in the FASTtrack series reflect the full spectrum of modules for the undergraduate pharmacy degree. Titles include: Complementary and Alternative Medicine Managing Symptoms in the Pharmacy Pharmaceutical Compounding and Dispensing Pharmaceutics: Dosage Form and Design Pharmaceutics: Drug Delivery and Targeting Pharmacology Physical Pharmacy (based on Florence & Attwood’s Physicochemical Principles of Pharmacy) Therapeutics There is also an accompanying website which includes extra MCQs, further title information and sample content: www.fasttrackpharmacy.com. If you have any feedback regarding this series, please contact us at