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Mansoura Clinical Pharmacology PDF

123 Pages·2016·10.77 MB·English
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Copyrighhts © 2016 bby the Deparrtment of Clinnical Pharmaacology at Faaculty of Meedicine, Mnassoura Universitty, Egypt. Previouss editions copyright © 20015, 2014, 20013, 2012, 2011, 2010, 22009, 2008, 22000 by the Departmment of Cliniccal Pharmacoology at Facuulty of Mediccine, Mnasouura Universitty, Egypt. No part of this book may be reprroduced or ddistributed inn any form orr by any meaans, or storedd in a databasee or retrievall system, witthout the prioor written peermission of tthe copyrighhts owner, Departmment of Cliniccal Pharmacoology at Facuulty of Mediccine, Mansouura Universitty. This is aa copyrightedd work and iss protected bby the Egypttian Intellectuual Property Law 82 of 2002. Use of this wwork is subjecct to this laww. The Deparrttment of Clinnical Pharmaacology at MMansoura Facculty of Medicinee reserves alll rights in annd to the worrk. 2000 ةنسسل 1456 :بتككلا رادب عاديلإا ممقر 2000/9//6 خيراتب Preface C linical training for undergraduate students often focuses on diagnostic rather than therapeutic skills. Sometimes students are only expected to copy the prescribing behavior of their clinical teachers, or existing standard treatment guidelines, without explanation as to why certain treatment is chosen. Books may not be much help either. Pharmacology reference works and formularies are drug-centered, and although clinical textbooks and treatment guidelines are disease-centered and provide treatment recommendations, they rarely discuss why these therapies are chosen. Different sources may give contradictory advice. This book in primarily intended for under graduate medical students who are about to enter the clinical phase of their studies. It will provide step by step guidance to the process of rational prescribing together with many illustrative examples. It teaches also skills that are necessary throughout a clinical career. Postgraduate students and practicing doctors may also find it a source of straightforward information. I wish to acknowledge the ongoing efforts of my contributing authors, and we are deeply grateful to all those who have with such good grace given us their time and energy to supply valuable facts and opinions, they principally include:  Prof. Hussein El-Beltagi who took over the preparation of all books since the 1st edition in 1995 including the revision process, printing control, distribution and selling control.  Assist. Prof. Mohamed-Hesham Daba who took over the revision process and amendments of the last two editions.  Assist. Prof. Abdel-Motaal Fouda who prepared the last two editions in a readable up- to-date text to provide essential information necessary throughout the clinical career.  Dr. Sameh Abdel-Ghany who assisted in the revision process. Much of any merit this book may have is due to the generosity of those named above. Gamal M. Dahab (MD, PhD) Professor Emeritus in Clinical Pharmacology Mansoura Faculty of Medicine   iii Misssion aand Vission Our mission The Clinnical Pharmmacology DDepartment is seeking excellencee and leadeership in fouur major core acctivities: eduucation, ressearch, commmunity serrvice, and ffaculty and staff development. We aree connectinng basic mmedical sciences with clinical ccare througgh innovattive and disciplinned teachinng of clinicaal pharmacoology in an iintegrative mmanner Our vvision The deppartment off Clinical Phharmacologgy is aimingg to be a premier acaddemic model in the field of pharmacoloogy and theerapeutics in Egypt annd Middle EEast through promoting use of the bestt therapeutics and devveloping newwer experimmental and clinical reseearch projeects. Valuees The guuiding prinnciples and beliefs ffor the deppartment  Excellence, creativity, innovation, fairness, honesty, transparenncy, collabboration, teammwork and lifelong learning  Reccognition thaat our studeent comes ffirst  All mmembers oof our department musst see themmselves as integral to the successs of our misssion and ouur departmeent as integral to their ppersonal suuccess.  As we subscrribe to theese values,, we shall be professsionals in the professsion of education. iv Contributers Effat A. Haroun MD, PhD Somaya A. Mokbel MD, PhD Prof. of Clin Pharmacology Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Elhamy M. El-Kholy MD, PhD Amany A. Shalaby MD, PhD Prof. of Clin Pharmacology Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Gamal M. Dahab MD, PhD, MSc (Int.Med) Amal Abdel-Hamid MD, PhD Prof. of Clin Pharmacology Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Farida M. El-Banna MD, PhD Essam A. Ghyati MD, PhD Prof. of Clin Pharmacology Assist. Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Aly M. Gaballah MD, PhD, MSc (int.Med) Mohamed-Hesham Y. Daba MD, PhD Prof. of Clin Pharmacology Assist. Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Layla T. Hanna MD, PhD Abdel-Motaal M. Fouda MD, PhD Prof. of Clin Pharmacology Assist. Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Mohamed Kheriza MD, PhD, MSc (Int.Med) Vivian Boshra MD, PhD Prof. of Clin Pharmacology Assist. Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Abdel-Rahman A. Yassin MD, PhD Hala A. Al-Ashri MD, PhD Prof. of Clin Pharmacology Assist. Prof. of Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Mohmmad A. Attia MD, PhD Nageh Rizk MD, PhD Prof. of Clin Pharmacology Lecturer in pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Mohamed Abdel-Ghani MD, PhD Elsayed A. Hassan MD, PhD Prof. of Clin Pharmacology Lecturer in Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Hussien M. El-Beltagi MD, PhD Mohamed Abdel-Monem MD, PhD Prof. of Clin Pharmacology Lecturer in Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Karawan M. Abdel-Rahman MD, PhD Mahmoud A. Naga MD, PhD Prof. of Clin Pharmacology Lecturer in Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine   v Ahmad Hassan MD, PhD Mohamed Abou El-khair MD, PhD Lecturer in Clin Pharmacology Lecturer in Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Ahlam El-masry MD, PhD Sameh A. Abdel-Ghani MSc. Lecturer in Clin Pharmacology Assist. Lecturer in Clin Pharmacology Mansoura Faculty of Medicine Mansoura Faculty of Medicine Rehab Hamdy MD, PhD Lecturer in Clin Pharmacology Mansoura Faculty of Medicine   vi Table of Contents   CHAPTER 1: GENERAL PRINCIPLES Part 1: Pharmacodynamics 1 Receptors 2 Ion channels 7 Enzymes 8 Carrier molecules 8 Part 2: Factors affecting the dose-response relationship 8 Factors related to the drug 8 Factors related to the patient 10 Part 3: Clinical pharmacokinetics 13 Absorption of drugs 13 Distribution of drugs 15 Elimination of drugs 16 Metabolism of drugs 20 Part 4: Adverse drug reactions 23 Drug induced liver injury 24 ADR on pregnancy 25 Part 5: Principles of drug interactions 26 Pharmacokinetic interactions 26 Pharmacodynamic interactions 28 Review questions 30 CHAPTER 2: AUTONOMIC PHARMACOLOGY Part 1: Basic information 39 Part 2: Adrenergic agonists 46 Direct acting sympathomimetic drugs 46 Indirect acting sympathomimetic drugs 51 Mixed acting sympathomimetic drugs 52 Part 3: Adrenergic receptor antagonists 53 Alpha adrenergic blockers 53 Beta adrenergic blockers 58 Part 4: Sympathoplegic drugs 62 Centrally acting sympathoplegic drugs 62 Adrenergic neuron blockers 63 Part 5: Parasympathomimetic drugs 64 Direct acting parasympathomimetics 64 Indirect acting parasympathomimetics 67 vii Part 6: Muscarinic antagonists 71 Part 7: Ganglion blocking drugs 74 Part 8: Neuromuscular blockers 74 Review questions 78 CHAPTER 3: DIURETIC AGENTS AND VOLUME BALANCE Part 1: Basic information 85 Part 2: Diuretic classes and agents 87 Loop diuretics 88 Thiazide diuretics 89 Potassium sparing diuretics 90 Osmotic diuretics 92 Part 3: Advantages and disadvantages of diuretics in some edematous 94 conditions Congestive heart failure 94 Chronic kidney disease 94 Liver cirrhosis 95 Lower limb edema due to pregnancy 95 Part 4: Volume depletion and fluid replacement 96 Part 5: Disorders of serum sodium and potassium 97 Part 6: Manipulation of the urine pH 100 Review questions 102   viii

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