A Textbook of Clinical Pharmacology and Therapeutics
● 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