Table Of Content

Pharmacology Gary C. Rosenfeld, Ph.D. Professor DepartmentofIntegratedBiologyandPharmacologyand GraduateSchoolofBiomedicalSciences AssistantDeanforEducationPrograms UniversityofTexasMedicalSchoolatHouston Houston,Texas David S. Loose, Ph.D. AssociateProfessor DepartmentofIntegratedBiologyandPharmacologyand GraduateSchoolofBiomedicalSciences UniversityofTexasMedicalSchoolatHouston Houston,Texas Withspecialcontributionsby Medina Kushen, M.D. WilliamBeaumontHospital RoyalOak,Michigan Todd A. Swanson, M.D., Ph.D. WilliamBeaumontHospital RoyalOak,Michigan AcquisitionsEditor:CharlesW.Mitchell ProductManager:StaceyL.Sebring MarketingManager:JenniferKuklinski ProductionEditor:PaulaWilliams Copyright(cid:2)C 2010LippincottWilliams&Wilkins 351WestCamdenStreet Baltimore,Maryland21201-2436USA 530WalnutStreet Philadelphia,PA19106 Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinanyformorby anymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrievalsystemwithoutwritten permissionfromthecopyrightowner. Thepublisherisnotresponsible(asamatterofproductliability,negligenceorotherwise)foranyinjuryresulting fromanymaterialcontainedherein.Thispublicationcontainsinformationrelatingtogeneralprinciplesof medicalcarewhichshouldnotbeconstruedasspecificinstructionsforindividualpatients.Manufacturers’ productinformationandpackageinsertsshouldbereviewedforcurrentinformation,including contraindications,dosagesandprecautions. PrintedintheUnitedStatesofAmerica LibraryofCongressCataloging-in-PublicationData Rosenfeld,GaryC. Pharmacology/GaryC.Rosenfeld,DavidS.Loose;withspecialcontributionsbyMedinaKushen, ToddA.Swanson.—5thed. p.;cm.—(Boardreviewseries) Includesindex. ISBN978-0-7817-8913-4(softcover:alk.paper) 1. Pharmacology—Examinations,questions,etc.I. Loose,DavidS.II. Title.III. Series:Boardreviewseries. [DNLM:1. Pharmacology—ExaminationQuestions. QV18.2R813p2010] RM301.13.R672010 6150.1076—dc22 2009010547 Thepublishershavemadeeveryefforttotracethecopyrightholdersforborrowedmaterial.Iftheyhave inadvertentlyoverlookedany,theywillbepleasedtomakethenecessaryarrangementsatthefirstopportunity. We’dliketohearfromyou!IfyouhavecommentsorsuggestionsregardingthisLippincottWilliams& Wilkinstitle,pleasecontactusattheappropriatecustomerservicenumberlistedbelow,orsendcorrespondence [email protected],pleaseremembertoincludeyourmailingaddress,phonenumber, andareferencetothebooktitleandauthorinyourmessage.Topurchaseadditionalcopiesofthisbookcallour customerservicedepartmentat(800)638-3030orfaxordersto(301)824-7390.Internationalcustomersshould call(301)714-2324. Preface to the Fifth Edition Thisconcisereviewofmedicalpharmacologyisdesignedformedicalstudents,dentalstu- dents, and others in the health care professions. It is intended primarily to help students prepare for licensing examinations, such as the United States Medical Licensing Exami- nationStep1(USMLE)orothersimilarexaminations.Thisbookpresentscondensedand succinctdescriptionsofrelevantandcurrentBoard-driveninformationpertainingtophar- macology without the usual associated details. It is not meant to be a substitute for the comprehensivepresentationofinformationanddifficultconceptsfoundinstandardphar- macologytexts. ORGANIZATION Thefiftheditionbeginswithachapterdevotedtothegeneralprinciplesofdrugaction,fol- lowedbychaptersconcernedwithdrugsactingonthemajorbodysystems.Otherchapters discuss autocoids, ergots, anti-inflammatory and immunosuppressive agents, drugs used totreatanemiasanddisordersofhemostasis,infectiousdiseases,cancer,andtoxicology. Eachchapterincludesapresentation ofspecificdrugswithadiscussionoftheirgen- eralproperties,mechanismofaction,pharmacologiceffects,therapeuticuses,andadverse effects. A drug list, tables, and figures summarize essential drug information included in allchapters. Clinicallyoriented,USMLE-stylereviewquestionsandanswerswithexplanationsfol- loweachchaptertohelpstudentsassesstheirunderstandingoftheinformation.Similarly, acomprehensiveexaminationconsistingofUSMLE-stylequestionsisincludedattheend ofthebook.Thisexaminationservesasaself-assessmenttooltohelpstudentsdetermine theirfundofknowledgeanddiagnoseanyweaknessesinpharmacology. KeyFeatures n Updatedwithcurrentdruginformation n End-of-chapterreviewtestsfeatureupdatedUSMLE-stylequestions n 2-colortablesandfiguressummarizeessentialinformationforquickrecall n Updateddruglistsforeachchapter n AdditionalUSMLE-stylecomprehensiveexaminationquestionsandexplanations GaryC.Rosenfeld,Ph.D. DavidS.Loose,Ph.D. v Acknowledgments Theauthorsacknowledgeandthankourcolleaguesfortheirsupportandcontributionsto thisbookandourmedicalstudentsforbeingourharshestcritics. vi Contents Preface v Acknowledgments vi 1. GENERAL PRINCIPLES OF DRUG ACTION 1 I. Dose–ResponseRelationships 1 II. DrugAbsorption 6 III. DrugDistribution 9 IV. DrugEliminationandTerminationofAction 10 V. Biotransformation(Metabolism)ofDrugs 11 VI. ExcretionofDrugs 14 VII. Pharmacokinetics 15 ReviewTest 19 2. DRUGS ACTING ON THE AUTONOMIC NERVOUS SYSTEM 26 I. ThePeripheralEfferentNervousSystem 26 II. ParasympathomimeticDrugs 31 III. Muscarinic-ReceptorAntagonists 35 IV. Ganglion-BlockingDrugs 38 V. SkeletalMuscleRelaxants 38 VI. SympathomimeticDrugs 41 VII. AdrenergicReceptorAntagonists 47 ReviewTest 52 3. DRUGS ACTING ON THE RENAL SYSTEM 60 I. Diuretics 60 II. NondiureticInhibitorsofTubularTransport 66 ReviewTest 68 vii viii Contents 4. DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM 72 I. AgentsUsedtoTreatCongestiveHeartFailure(CHF) 72 II. AntiarrhythmicDrugs 78 III. AntianginalAgents 83 IV. AntihypertensiveDrugs 85 V. DrugsthatLowerPlasmaLipids 91 ReviewTest 95 5. DRUGS ACTING ON THE CENTRAL NERVOUS SYSTEM 100 I. Sedative–HypnoticDrugs 100 II. Antipsychotic(Neuroleptic)Drugs 105 III. AntidepressantDrugs 109 IV. Lithium 114 V. OpioidAnalgesicsandAntagonists 115 VI. AntiparkinsonianDrugsandDrugsUsedtoTreatAlzheimer’sDisease 121 VII. AntiepilepticDrugs 125 VIII. GeneralAnesthetics 128 IX. LocalAnesthetics 133 X. DrugsofAbuse 136 ReviewTest 145 6. AUTOCOIDS, ERGOTS, ANTI-INFLAMMATORY AGENTS, AND IMMUNOSUPPRESSIVE AGENTS 150 I. HistamineandAntihistamines 150 II. SerotoninandSerotoninAntagonists 154 III. Ergots 155 IV. Eicosanoids 157 V. NonsteroidalAntiinflammatoryDrugs(NSAIDs) 159 VI. DrugsUsedforGout 167 VII. ImmunosuppressiveAgents 168 ReviewTest 172 7. DRUGS USED IN ANEMIA AND DISORDERS OF HEMOSTASIS 175 I. DrugsUsedintheTreatmentofAnemias 175 II. DrugsActingonMyeloidCells 179 III. DrugsUsedinHemostaticDisorders 179 ReviewTest 186