Medical Pharmacology and Therapeutics

742 Pages·2013·15.65 MB·English

by  Derek G. Waller

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Fourth Edition
ME DIC AL
P HAR MAC O LO G Y
THE R AP E UTIC S
&
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Fo urth Editio n
ME DIC AL
P HAR M AC O LO G Y
THE R AP E UTIC S
&
DEREK G. WALLER
BSc (HONS), DM, MBBS (HONS), FRCP
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Consultant Physician and Honorary SeniorR Clinical Lecturer in Medicine and
Clinical Pharmacology
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University Hospital Southampton NHS Foundation Trust

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Southampton, UK

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ANTHONY Pr. SAMPS& ON s
i MA, PhD, FHEA, FBPharmacolS
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a a
Reader in Clinical Pharmacology
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University of Southampton Faculty of Medicine
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Southampton, UK e
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ANDREW G. RENWICK
i OBE, BSc, PhD, DSc
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Emeritus Professor
University of Southampton Faculty of Medicine
Southampton, UK
KEITH HILLIER
BSc, PhD, DSc
Former Senior Lecturer in Pharmacology
University of Southampton Faculty of Medicine
Southampton, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2014
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© 2014 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
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This book and the individual contributions contained in it are protected under copyright by the
publisher (other than as may be noted herein).
First edition 2001
Second edition 2005
Third edition 2010
Fourth edition 2014
ISBN 9780702051807
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British Library Cataloguing in Publication Data
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A catalogue record for this book is available from the British Library
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Library of Congress Cataloging in Publication Data
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A catalog record for this book is available from the Library of Congress r
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Notices r s
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Knowledge and best practice in this ehld are constantly changing. As nnew research and experience
broaden our understanding, changaes in research methods, professiaonal practices, or medical treat-
t i
ment may become necessary.
s
Practitioners and researchers must always rely on their owrn experience and knowledge in evaluat-
e
ing and using any information, methods, compounds, or experiments described herein. In using such
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information or methods they should be mindful of their own safety and the safety of others, including
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parties for whom they have a professional responsibility.
i
With respect to any drug or pharmaceutvical products identi ed, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products liabil-
ity, negligence or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.
The
publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China
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Co nte nts
Pre ace ...........................................................................vii
SECTION 5 THE NERVOUS
Drug dosage and nomenclature .....................................ix
SYSTEM
SECTION 1 GENERAL
17. General anaesthetics ........................................ 241
18. Local anaesthetics ............................................ 251
PRINCIPLES
19. Opioid analgesics and the management
o pain ............................................................... 257
1. Principles o pharmacology and mechanisms
20. Anxiolytics, sedatives and hypnotics ............... 273
o drug action ........................................................ 3
21. The major psychotic disorders:
2. Pharmacokinetics ................................................ 31
schizophrenia and mania .................................. 281
3. Drug discovery, sa ety and e fcacy ................... 59
22. Depression, attention defcit hyperactivity
4. Neurotransmission and the peripheral
disorder and narcolepsy ................................... 293
autonomic nervous system ................................. 67
23. Epilepsy ............................................................. 309
24. Extrapyramidal movement disorders and
spasticity ........................................................... 323
SECTION 2 THE 25. Other neurological disorders: multiple
sclerosis, motor neuron disease and
CARDIOVASCULAR SYSTEM
Guillain–Barré syndrome ................................... 335
26. Migraine and other headaches ......................... 339
5. Ischaemic heart disease ..................................... 87
6. Systemic and pulmonary hypertension ............ 105
7. Heart ailure ....................................................... 125 SECTION 6 THE
8. Cardiac arrhythmias .......................................... 137
MUSCULOSKELETAL SYSTEM
9. Cerebrovascular disease and dementia ........... 155
10. Peripheral vascular disease .............................. 163
11. Haemostasis ..................................................... 169 27. The neuromuscular junction and
neuromuscular blockade .................................. 349
28. Myasthenia gravis ............................................. 355
29. Non-steroidal anti-in ammatory drugs ............. 359
SECTION 3 THE RESPIRATORY
30. Rheumatoid arthritis, other in ammatory
SYSTEM
arthritides and osteoarthritis ............................. 371
31. Hyperuricaemia and gout ................................. 383
12. Asthma and chronic obstructive pulmonary
disease .............................................................. 187
SECTION 7 THE
13. Respiratory disorders: cough, respiratory
stimulants, cystic fbrosis and neonatal GASTROINTESTINAL SYSTEM
respiratory distress syndrome .......................... 205
32. Nausea and vomiting ........................................ 391
33. Dyspepsia and peptic ulcer disease ................ 399
SECTION 4 THE RENAL SYSTEM
34. In ammatory bowel disease ............................. 411
35. Constipation, diarrhoea and irritable
14. Diuretics ............................................................ 213 bowel syndrome................................................ 417
15. Disorders o micturition .................................... 225 36. Liver disease ..................................................... 425
16. Erectile dys unction........................................... 233 37. Obesity .............................................................. 433
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vi C o n te n ts
SECTION 8 THE IMMUNE SECTION 10 THE SKIN AND
SYSTEM EYES
38. The immune response and 49. Skin disorders ................................................... 559
immunosuppressant drugs ............................... 439 50. The eye ............................................................. 569
39. Antihistamines and allergic disease ................. 449
SECTION 11 CHEMOTHERAPY
SECTION 9 THE ENDOCRINE
SYSTEM AND METABOLISM
51. Chemotherapy o in ections.............................. 581
52. Chemotherapy o malignancy ........................... 631
40. Diabetes mellitus ............................................... 457
41. The thyroid and control o metabolic rate ........ 473
42. Calcium metabolism and metabolic SECTION 12 GENERAL FEATURES:
bone disease ..................................................... 479
TOXICITY AND PRESCRIBING
43. Pituitary and hypothalamic hormones .............. 489
44. Corticosteroids (glucocorticoids and
mineralocorticoids) ............................................ 501 53. Drug toxicity and overdose .............................. 661
45. Female reproduction ......................................... 511 54. Substance abuse and dependence .................. 677
46. Androgens, anti-androgens and anabolic 55. Prescribing, adherence and in ormation
steroids ............................................................. 529 about medicines ............................................... 691
47. Anaemia and haematopoietic 56. Drug therapy in special situations .................... 695
colony-stimulating actors ................................ 535
48. Lipid disorders .................................................. 545 Index .......................................................................... 707
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Pre fa c e
The ourth edition o Medical Pharmacology and Therapeu- e ects associated with individual drugs and drug
tics has been extensively revised and updated while pre- classes.
serving the popular approach o the third edition. The text A structured approach to the principles o disease man-
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is structured to refect the ways that drugs are used in clini- agement, outlining core principles o drug choice and
cal practice. It provides in ormation suitable or all health- planning a therapeutic regimen or many common
care pro essionals who require a sound knowledge o the diseases.
basic science and clinical applications o drugs. An updated drug compendium giving details o most
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As be ore, a disease-based approach has been taken drugs in the classes discussed in the chapter that are
wherever possible with the aim o explaining clinical phar- available in the UK. For easy re erence these tables set
macology and therapeutics and the principles o drug use out key similarities and di erences among drugs in each
or the management o common diseases. Medical Phar- class and complement the in ormation provided in the
macology and Therapeutics provides sound basic pharma- chapter.
cology background material su cient to underpin the Fully revised sel -assessment questions and case-based
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clinical context. New sections on headache and drug treat- exercises to enable the reader to test their understand-
ment in palliative care have been added and many o the ing o the principles covered in each chapter.
diagrams are new or have been modi ed to urther clari y
Chapters covering generic concepts o pharmacology and
complex areas o pharmacology.
therapeutics have been extensively updated and include:
Each chapter in this ourth edition has the ollowing
how drugs work at a cellular level, drug development, drug
eatures.
metabolism and pharmacokinetics, drug toxicity and drug
An updated and succinct explanation o the major path- prescribing and genetic variations in drug handling and
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ogenic mechanisms o the disease and consequent drug responses.
clinical symptoms and signs, helping the reader to put It is our intention that the ourth edition o this book will
into context the actions o drugs and the consequences encourage readers to develop a deeper understanding o
o their therapeutic use. the principles o drug usage that will help them to become
An updated comprehensive review o major drug classes sa e and e ective prescribers and to carry out basic and
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relevant to the disease in question. Example drugs are clinical research and to teach. As medical science advances
used to illustrate pharmacological principles and to these principles should underpin the li e-long learning
introduce the reader to drugs currently in widespread essential or the maintenance o these skills.
clinical use.
Basic pharmacology and mechanisms o drug action, DGW
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key pharmacokinetic properties and important unwanted APS
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