Mansoura Clinical Pharmacology

123 Pages·2016·10.77 MB·English

by  Mansoura University

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

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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.

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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

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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

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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

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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

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