● Introduction 41 ● Role of dru

25 20 10 Life-threatening toxicity

● Introduction 45 ● Harmful eff

vagina in girls in their late teens

an anti-analgesic effect when combi

Case history A 20-year-old female m

METABOLISM At birth, the hepatic mi

lifelong effects as a result of tox

DISTRIBUTION Ageing is associated w

DIGOXIN Digoxin toxicity is common

FURTHER READING Dhesi JK, Allain TJ

Factors involved in the aetiology o

analgesic. Following its release, t

antibiotics, such as penicillin or

predisposes to non-immune haemolysi

● Introduction 71 ● Useful inte

Response Therapeutic range Toxic ra

Table 13.1: Interactions outside th

Table 13.5: Competitive interaction

● Introduction: ‘personalized m

Table 14.2: Variations in drug resp

lipoprotein (LDL) is impaired. LDL

Key points • Genetic differences

• Discovery • • Screening Pre

Too many statistical comparisons pe

ETHICS COMMITTEES Protocols for all

Table 16.1: Recombinant proteins/en

duration and benefit. Adenoviral ve

● Introduction 97 ● Garlic 97

A case report has suggested a possi

including hypericin and pseudohyper

PART II THE NERVOUS SYSTEM

● Introduction 105 ● Sleep diff

and daytime sleeping should be disc

Key points • Insomnia and anxiety

Box 19.1: Dopamine theory of schizo

The Boston Collaborative Survey ind

Oral medication, especially in liqu

e.g. interpersonal difficulties or

Partial response to first-line trea

Key points Drug treatment of depres

Case history A 45-year-old man with

Levodopa PRINCIPLES OF TREATMENT IN

• pulmonary, retroperitoneal and

CHOREA The γ-aminobutyric acid con

Cholinergic crisis Treatment of mya

● Introduction 133 ● Mechanisms

absolute arbiter. The availability

Table 22.2: Metabolic interactions

FURTHER ANTI-EPILEPTICS Other drugs

Case history A 24-year-old woman wh

Assessment of migraine severity and

● General anaesthetics 145 ● In

is the theoretical concern of a ‘

• Respiratory system - apnoea fol

Competitive antagonists (vecuronium

have also proved useful in combinat

● Introduction 155 ● Pathophysi

ASPIRIN (ACETYLSALICYLATE) Use Anti

Key points Drugs for mild pain •

increases, correlating with the hig

• If possible, use oral medicatio

PART III THE MUSCULOSKELETAL SYSTEM

● Introduction: inflammation 167

Chapter 33). All NSAIDs cause wheez

• Stomatitis suggests the possibi

Pharmacokinetics Allopurinol is wel

PART IV THE CARDIOVASCULAR SYSTEM

● Introduction 177 ● Pathophysi

esponsible for the strong predilect

Ezetimibe Fat Muscle Dietary fat In

educed). The risk of muscle damage

● Introduction 185 ● Pathophysi

Each of these classes of drug reduc

AT 1 receptor) produce good 24-hour

Table 28.2: Examples of calcium-cha

Key points Drugs used in essential

Case history A 72-year-old woman se

Assess risk factors Investigations:

Persistent ST segment elevation Thr

Mechanism of action GTN works by re

Because of the risks of haemorrhage

Intrinsic pathway XIIa XIa the acti

that the pharmacodynamic response i

used with apparent benefit in acute

● Introduction 211 ● Pathophysi

The drugs that are most effective i

therapeutic plasma concentration ca

● Common dysrhythmias 217 ● Gen

BASIC LIFE SUPPORT CARDIOPULMONARY

arrest. The electrocardiogram is li

should be given to insertion of an

Drug interactions Amiodarone potent

effect when treating sinus bradycar

Case history A 24-year-old medical

PART V THE RESPIRATORY SYSTEM

CHAPTER 33 THERAPY OF ASTHMA, CHRON

STEP 5: CONTINUOUS OR FREQUENT USE

Adenylyl cyclase Table 33.1: Compar

Drug interactions Although synergis

use in asthma has declined consider

α 1-antitrypsin deficiency, neutro

PART VI THE ALIMENTARY SYSTEM

● Peptic ulceration 247 ● Oesop

PEPTIC ULCERATION 249 • With rega

Ranitidine has a similar profile of

Vestibular stimulation ? via cerebe

cortical centres affecting vomiting

• in hepatocellular failure to re

Ciprofloxacin is occasionally used

withdrawal), small doses of benzodi

Table 34.7: Dose-independent hepato

● Introduction 265 ● General ph

dinucleotide (NAD) and nicotinamide

Table 35.1: Common trace element de

PART VII FLUIDS AND ELECTROLYTES

● Introduction 273 ● Volume ove

Key points Diuretics Diuretics are

is sometimes caused by drugs, notab

or with potassium-sparing diuretics

Greger R, Lang F, Sebekova, Heidlan

PART VIII THE ENDOCRINE SYSTEM

● Introduction 285 ● Pathophysi

in prefilled injection devices (‘

Metformin should be withdrawn and i

FURTHER READING American Diabetes A

deficiency. Potassium iodide (3 mg

fertility. It is contraindicated du

● Introduction 297 ● Vitamin D

effective in life-threatening hyper

Further reading Block GA, Martin KJ

Table 40.1: Actions of cortisol and

injection may be useful, but if don

CHAPTER 41 REPRODUCTIVE ENDOCRINOLO

elease by the pituitary via negativ

Treatment with depot progestogen in

infusion using an infusion pump to

significant proportion of men who r

with symptoms caused by the release

FURTHER READING Birnbaumer M. Vasop

PART IX SELECTIVE TOXICITY

● Principles of antibacterial che

2. transfer of resistance between o

Pharmacokinetics Absorption of thes

Mechanism of action Macrolides bind

asic quinolone structure dramatical

Case history A 70-year-old man with

PRINCIPLES OF MANAGEMENT OF MYCOBAC

Pharmacokinetics Absorption from th

MYCOBACTERIUM LEPRAE INFECTION Lepr

POLYENES AMPHOTERICIN B Uses Amphot

therapy is adequate though more fre

NUCLEOSIDE ANALOGUES ACICLOVIR Uses

Table 45.3: Summary of available ac

Uses Interferon-α when combined wi

● Introduction 351 ● Immunopath

Table 46.1: Examples of combination

NON-NUCLEOSIDE ANALOGUE REVERSE TRA

FUSION INHIBITORS Uses Currently, e

salvage therapy include azithromyci

● Malaria 361 ● Trypanosomal in

Pharmacokinetics Chloroquine is rap

Table 47.2: Drug therapy of non-mal

● Introduction 367 ● Pathophysi

Table 48.1: Classification of commo

Polymorph count/mm 3 (a) (b) 10 000

doses are used to prepare patients

Adverse effects Methotrexate Inhibi

Table 48.7: Summary of clinical pha

Table 48.9: Summary of the clinical

Plasma membrane Signal transduction

Table 48.10: Monoclonal antibodies

INTERFERON-ALFA 2B Interferon-alfa

PART X HAEMATOLOGY

● Haematinics - iron, vitamin B 1

one marrow to produce red cells. Th

EPO Erythroid precursors Erythrocyt

Therapeutic principles The extent o

PART XI IMMUNOPHARMACOLOGY

● Introduction 399 ● Immunity a

Key points Antigen recognition Expr

Table 50.1: Novel anti-proliferativ

Key points Treatment of anaphylacti

DRUGS THAT ENHANCE IMMUNE SYSTEM FU

PART XII THE SKIN

● Introduction 411 ● Acne 411

DERMATITIS (ECZEMA) PRINCIPLES OF T

SPECIALISTS ONLY SPECIALISTS ONLY E

TREATMENT OF OTHER SKIN INFECTIONS

effect of too high a dose of UVB in

PART XIII THE EYE

● Introduction: ocular anatomy, p

to cause pupillary dilatation, name

Table 52.3: Antibacterial agents us

Table 52.6: Common drug-induced pro

PART XIV CLINICAL TOXICOLOGY

● Introduction 433 ● Pathophysi

Table 53.2: Central nervous system

which provide anonymized data to th

Peak plasma levels after smoking ci

Key points Acute effects of alcohol

FURTHER READING Goldman D, Oroszi G

Table 54.2: Common indications for

Table 54.5: Antidotes and other spe

Commission on Human Medicines (CHM)

Note: Page numbers in italics refer

atrial fibrillation 217, 221 digoxi

Cushing’s syndrome 302 cyclic ade

5-fluorouracil 375-6 fluoxetine, mo

children 54 diazepam 108 iron prepa

non-steroidal anti-inflammatory dru

puberty (male), delay 314 puerperiu

tolerance 9, 433 benzodiazepines 10