Views
5 years ago

A Textbook of Clinical Pharmacology and Therapeutics

A Textbook of Clinical Pharmacology and Therapeutics

infusion using an

infusion using an infusion pump to induce or augment labour, usually in conjunction with rupture of membranes. Uterine activity must be monitored carefully and hyperstimulation avoided. Large doses of oxytocin can cause excessive fluid retention. Oxytocin should not be started within six hours of administration of vaginal prostaglandins. A combination formulation of ergometrine and oxytocin (syntometrine) is used for bleeding due to incomplete abortion and in the routine management of the third stage of labour. This is administered by intramuscular injection with the delivery of the anterior shoulder. A useful alternative in severe postpartum haemorrhage in patients with an atonic uterus unresponsive to ergometrine and oxytocin is carboprost. OXYTOCIN Oxytocin produces contractions of the smooth muscle of the fundus of the pregnant uterus at term, and of the mammary gland ducts. It is released from the pituitary by suckling and also by emotional stimuli. Any role in the initiation of labour is not established. There is no known disease state of over- or under-production of oxytocin. Synthetic oxytocin is effective when administered by any parenteral route, and is usually given as a constant-rate intravenous infusion to initiate or augment labour, often following artificial rupture of the membranes. A low dose is used to initiate treatment titrated upwards if necessary. The side effects of oxytocin include uterine spasm, tetanic contractions, water intoxication and hyponatraemia, and uterine hyperstimulation. ERGOMETRINE Ergometrine (an alkaloid derived from ergot, a fungus that infects rye) is a powerful oxytocic. The uterus is sensitive at all times, but especially so in late pregnancy. It is given intramuscularly, or intravenously in emergency. Oxytocin produces slow contractions with full relaxations between, whilst ergometrine produces faster contractions superimposed on a tonic persistent contraction (it is for this reason that ergometrine is unsuitable for induction of labour). If given intramuscularly, oxytocin acts within one to two minutes, although the contraction is brief, but ergometrine takes five minutes to act. Ergometrine can cause hypertension, particularly in preeclamptic patients, in whom it should be used with care, if at all. PROSTAGLANDINS Prostaglandins are naturally occurring lipid-derived mediators. Prostaglandins are involved in a wide range of physiological and pathological processes, including inflammation (see Chapter 26) and haemostasis and thrombosis (see Chapter 30). Prostaglandin E2 has a potent contractile action on the human uterus, and also softens and ripens the cervix. In addition, it has many other actions, including inhibition of acid secretion by the stomach, increased mucus secretion within the gastro-intestinal tract, contraction of gastro-intestinal smooth muscle, relaxation of vascular smooth muscle and increase in body temperature. MALE REPRODUCTIVE ENDOCRINOLOGY 313 Specialized uses of prostaglandins in the perinatal period include the use of prostaglandin E 1 (alprostadil) in neonates with congenital heart defects that are ‘ductus-dependent’. It preserves the patency of the ductus arteriosus until surgical correction is feasible. Conversely, in infants with inappropriately patent ductus arteriosus, indometacin given intravenously can cause closure of the ductus by inhibiting the endogenous biosynthesis of prostaglandins involved in the preservation of ductal patency. MALE REPRODUCTIVE ENDOCRINOLOGY INTRODUCTION The principal hormone of the testis is testosterone, which is secreted by the interstitial (Leydig) cells. Testosterone circulates in the blood, bound to a plasma globulin. The plasma concentration is variable, but should exceed 10 nmol/L in adult males. Cells in target tissues convert testosterone into the more active androgen dihydrotestosterone by a 5-αreductase enzyme. Both testosterone and dihydrotestosterone are inactivated in the liver. Androgens have a wide range of activities, the most important of which include actions on: • development of male secondary sex characteristics (including male distribution of body hair, breaking of the voice, enlargement of the penis, sebum secretion and male-pattern balding); • protein anabolic effects influencing growth, maturation of bone and muscle development; • spermatogenesis and seminal fluid formation. Testicular function is controlled by the anterior pituitary. • Follicle-stimulating hormone acts on the seminiferous tubules and promotes spermatogenesis. • Luteinizing hormone stimulates testosterone production. The release of FSH and LH by the pituitary is in turn mediated by the hypothalamus via gonadotrophin-releasing hormone. ANDROGENS AND ANABOLIC STEROIDS Uses Many cases of impotence are psychogenic in origin and treatment with androgens is inappropriate. In impotent patients with low concentrations of circulating testosterone, replacement therapy improves secondary sex characteristics and may restore erectile function and libido, but it does not restore fertility. (Treatment of patients with hypogonadism secondary to hypothalamic or pituitary dysfunction who wish to become fertile includes gonadotrophins or pulsatile gonadotrophinreleasing hormone.) Replacement therapy is most reliably achieved by intramuscular injection of testosterone esters in oil, of which various preparations are available. They should usually be given at two- to three-week intervals to control

314 REPRODUCTIVE ENDOCRINOLOGY symptoms. Alternatively, testosterone undecanoate or mesterolone can be taken by mouth; these drugs are formulated in oil, favouring lymphatic absorption from the gastro-intestinal tract. Delayed puberty due to gonadal deficiency (primary or secondary) or severe constitutional delay can be treated by testosterone esters or gonadotrophins. Care is needed because premature fusion of epiphyses may occur, resulting in short stature and such treatment is best supervised by specialist clinics. Occasional patients with disseminated breast cancer derive considerable symptomatic benefit from androgen treatment. Anabolic steroids (e.g. nandrolone, stanozolol, danazol) have proportionately greater anabolic and less virilizing effects than other androgens. They have generally been disappointing in therapeutics and have been widely abused by athletes and body builders. Their legitimate uses are few, but include the treatment of some aplastic anaemias, the vascular manifestations of Behçet’s disease and the prophylaxis of recurrent attacks of hereditary angioneurotic oedema. Mechanism of action Testosterone and dihydrotestosterone interact with intracellular receptors in responsive cells, leading to new protein synthesis. Adverse effects Virilization in women and increased libido in men are predictable effects. In women, acne, growth of facial hair and deepening of the voice are common undesirable features produced by androgens. Other masculinizing effects and menstrual irregularities can also develop. In the male, excessive masculinization can result in frequent erections or priapism and aggressive behaviour. Children may undergo premature fusion of epiphyses. Other adverse effects include jaundice, particularly of the cholestatic type, and because of this complication methyltestosterone is no longer prescribed. Azospermia occurs due to inhibition of gonadotrophin secretion. In patients treated for malignant disease with androgens, hypercalcaemia (which may be severe) is produced by an unknown mechanism. Oral testosterone preparations in oil cause various gastro-intestinal symptoms including anorexia, vomiting, flatus, diarrhoea and oily stools. Pharmacokinetics Although testosterone is readily absorbed following oral administration, considerable presystemic metabolism occurs in the liver. It can be administered sublingually, although this route is seldom used. Testosterone in oil is well absorbed from intramuscular injection sites, but is also rapidly metabolized. Esters of testosterone are much less polar and are more slowly released from oily depot injections and are used for their prolonged effect. Inactivation of testosterone takes place in the liver. The chief metabolites are androsterone and etiocholanolone, which are mainly excreted in the urine. About 6% of administered testosterone appears in the faeces having undergone enterohepatic circulation. ANTI-ANDROGENS CYPROTERONE Uses Cyproterone acetate is used in men with inoperable prostatic carcinoma, before initiating treatment with gonadotrophinreleasing hormone analogues to prevent the flare of disease activity induced by the initial increase in sex hormone release. It has also been used to reduce sexual drive in cases of sexual deviation and in children with precocious puberty. In women, it has been used to treat hyperandrogenic effects (often seen in polycystic ovary disease), including acne, hirsutism and malepattern baldness. The potentially adverse effects of cyproterone on HDL and LDL caution against long-term use, and the risk–benefit ratio should be considered carefully before embarking on treatment for relatively minor indications. Mechanism of action Cyproterone acts by competing with testosterone for its highaffinity receptors, thereby inhibiting prostatic growth, spermatogenesis and masculinization. It also has strong progestational activity and a very weak glucocorticoid effect. Adverse effects Side effects include gynaecomastia in approximately 20% of patients (occasionally with benign nodules and galactorrhoea), inhibition of spermatogenesis (which usually returns to normal six months after cessation of treatment) and tiredness and lassitude (which can be so marked as to make driving dangerous). DUTASTERIDE AND FINASTERIDE Use Dutasteride and finasteride inhibit 5α-reductase and reduce prostate size with improvement in urinary flow rate and symptoms of obstruction. They are useful alternatives to alpha blockers (e.g. doxazosin) for benign prostatic hypertrophy, particularly in men with a significantly enlarged prostate. Prostate-specific antigen should be measured as treatment must not delay the diagnosis of prostate cancer. Adverse effects include impotence, decreased libido, ejaculation disorders, breast tenderness and enlargement. Women of child-bearing potential should avoid handling crushed or broken tablets of finasteride or leaking capsules of dutasteride. A low strength of finasteride is licensed for treating malepattern baldness in men. DRUGS THAT AFFECT MALE SEXUAL PERFORMANCE The complex interplay between physiological and psychological factors that determines sexual desire and performance makes it difficult to assess the influence of drugs on sexual function. In randomized placebo-controlled blinded studies, a small but

  • Page 2 and 3:

    A Textbook of Clinical Pharmacology

  • Page 4 and 5:

    A Textbook of Clinical Pharmacology

  • Page 6 and 7:

    This fifth edition is dedicated to

  • Page 8 and 9:

    FOREWORD viii PREFACE ix ACKNOWLEDG

  • Page 10 and 11:

    PREFACE Clinical pharmacology is th

  • Page 12 and 13:

    PART I GENERAL PRINCIPLES

  • Page 14 and 15:

    ● Use of drugs 3 ● Adverse effe

  • Page 16 and 17:

    and acquired factors, notably disea

  • Page 18 and 19:

    100 Effect (%) 0 0 5 10 1 10 100 (a

  • Page 20 and 21:

    Dose ratio -1 100 50 The relationsh

  • Page 22 and 23:

    ● Introduction 11 ● Constant-ra

  • Page 24 and 25:

    In reality, processes of eliminatio

  • Page 26 and 27:

    lood (from which samples are taken

  • Page 28 and 29:

    ● Introduction 17 ● Bioavailabi

  • Page 30 and 31:

    ROUTES OF ADMINISTRATION ORAL ROUTE

  • Page 32 and 33:

    Transdermal absorption is sufficien

  • Page 34 and 35:

    FURTHER READING Fix JA. Strategies

  • Page 36 and 37:

    and thromboxanes are CYP450 enzymes

  • Page 38 and 39:

    and lorazepam. Some patients inheri

  • Page 40 and 41:

    Orally administered drug Parenteral

  • Page 42 and 43:

    ● Introduction 31 ● Glomerular

  • Page 44 and 45:

    ACTIVE TUBULAR REABSORPTION This is

  • Page 46 and 47:

    DISTRIBUTION Drug distribution is a

  • Page 48 and 49:

    Detailed recommendations on dosage

  • Page 50 and 51:

    DIGOXIN Myxoedematous patients are

  • Page 52 and 53:

    ● Introduction 41 ● Role of dru

  • Page 54 and 55:

    25 20 10 Life-threatening toxicity

  • Page 56 and 57:

    ● Introduction 45 ● Harmful eff

  • Page 58 and 59:

    vagina in girls in their late teens

  • Page 60 and 61:

    an anti-analgesic effect when combi

  • Page 62 and 63:

    Case history A 20-year-old female m

  • Page 64 and 65:

    METABOLISM At birth, the hepatic mi

  • Page 66 and 67:

    lifelong effects as a result of tox

  • Page 68 and 69:

    DISTRIBUTION Ageing is associated w

  • Page 70 and 71:

    DIGOXIN Digoxin toxicity is common

  • Page 72 and 73:

    FURTHER READING Dhesi JK, Allain TJ

  • Page 74 and 75:

    Factors involved in the aetiology o

  • Page 76 and 77:

    analgesic. Following its release, t

  • Page 78 and 79:

    antibiotics, such as penicillin or

  • Page 80 and 81:

    predisposes to non-immune haemolysi

  • Page 82 and 83:

    ● Introduction 71 ● Useful inte

  • Page 84 and 85:

    Response Therapeutic range Toxic ra

  • Page 86 and 87:

    Table 13.1: Interactions outside th

  • Page 88 and 89:

    Table 13.5: Competitive interaction

  • Page 90 and 91:

    ● Introduction: ‘personalized m

  • Page 92 and 93:

    Table 14.2: Variations in drug resp

  • Page 94 and 95:

    lipoprotein (LDL) is impaired. LDL

  • Page 96 and 97:

    Key points • Genetic differences

  • Page 98 and 99:

    • Discovery • • Screening Pre

  • Page 100 and 101:

    Too many statistical comparisons pe

  • Page 102 and 103:

    ETHICS COMMITTEES Protocols for all

  • Page 104 and 105:

    Table 16.1: Recombinant proteins/en

  • Page 106 and 107:

    duration and benefit. Adenoviral ve

  • Page 108 and 109:

    ● Introduction 97 ● Garlic 97

  • Page 110 and 111:

    A case report has suggested a possi

  • Page 112 and 113:

    including hypericin and pseudohyper

  • Page 114 and 115:

    PART II THE NERVOUS SYSTEM

  • Page 116 and 117:

    ● Introduction 105 ● Sleep diff

  • Page 118 and 119:

    and daytime sleeping should be disc

  • Page 120 and 121:

    Key points • Insomnia and anxiety

  • Page 122 and 123:

    Box 19.1: Dopamine theory of schizo

  • Page 124 and 125:

    The Boston Collaborative Survey ind

  • Page 126 and 127:

    Oral medication, especially in liqu

  • Page 128 and 129:

    e.g. interpersonal difficulties or

  • Page 130 and 131:

    Partial response to first-line trea

  • Page 132 and 133:

    Key points Drug treatment of depres

  • Page 134 and 135:

    Case history A 45-year-old man with

  • Page 136 and 137:

    Levodopa PRINCIPLES OF TREATMENT IN

  • Page 138 and 139:

    • pulmonary, retroperitoneal and

  • Page 140 and 141:

    CHOREA The γ-aminobutyric acid con

  • Page 142 and 143:

    Cholinergic crisis Treatment of mya

  • Page 144 and 145:

    ● Introduction 133 ● Mechanisms

  • Page 146 and 147:

    absolute arbiter. The availability

  • Page 148 and 149:

    Table 22.2: Metabolic interactions

  • Page 150 and 151:

    FURTHER ANTI-EPILEPTICS Other drugs

  • Page 152 and 153:

    Case history A 24-year-old woman wh

  • Page 154 and 155:

    Assessment of migraine severity and

  • Page 156 and 157:

    ● General anaesthetics 145 ● In

  • Page 158 and 159:

    is the theoretical concern of a ‘

  • Page 160 and 161:

    • Respiratory system - apnoea fol

  • Page 162 and 163:

    Competitive antagonists (vecuronium

  • Page 164 and 165:

    have also proved useful in combinat

  • Page 166 and 167:

    ● Introduction 155 ● Pathophysi

  • Page 168 and 169:

    ASPIRIN (ACETYLSALICYLATE) Use Anti

  • Page 170 and 171:

    Key points Drugs for mild pain •

  • Page 172 and 173:

    increases, correlating with the hig

  • Page 174 and 175:

    • If possible, use oral medicatio

  • Page 176 and 177:

    PART III THE MUSCULOSKELETAL SYSTEM

  • Page 178 and 179:

    ● Introduction: inflammation 167

  • Page 180 and 181:

    Chapter 33). All NSAIDs cause wheez

  • Page 182 and 183:

    • Stomatitis suggests the possibi

  • Page 184 and 185:

    Pharmacokinetics Allopurinol is wel

  • Page 186 and 187:

    PART IV THE CARDIOVASCULAR SYSTEM

  • Page 188 and 189:

    ● Introduction 177 ● Pathophysi

  • Page 190 and 191:

    esponsible for the strong predilect

  • Page 192 and 193:

    Ezetimibe Fat Muscle Dietary fat In

  • Page 194 and 195:

    educed). The risk of muscle damage

  • Page 196 and 197:

    ● Introduction 185 ● Pathophysi

  • Page 198 and 199:

    Each of these classes of drug reduc

  • Page 200 and 201:

    AT 1 receptor) produce good 24-hour

  • Page 202 and 203:

    Table 28.2: Examples of calcium-cha

  • Page 204 and 205:

    Key points Drugs used in essential

  • Page 206 and 207:

    Case history A 72-year-old woman se

  • Page 208 and 209:

    Assess risk factors Investigations:

  • Page 210 and 211:

    Persistent ST segment elevation Thr

  • Page 212 and 213:

    Mechanism of action GTN works by re

  • Page 214 and 215:

    Because of the risks of haemorrhage

  • Page 216 and 217:

    Intrinsic pathway XIIa XIa the acti

  • Page 218 and 219:

    that the pharmacodynamic response i

  • Page 220 and 221:

    used with apparent benefit in acute

  • Page 222 and 223:

    ● Introduction 211 ● Pathophysi

  • Page 224 and 225:

    The drugs that are most effective i

  • Page 226 and 227:

    therapeutic plasma concentration ca

  • Page 228 and 229:

    ● Common dysrhythmias 217 ● Gen

  • Page 230 and 231:

    BASIC LIFE SUPPORT CARDIOPULMONARY

  • Page 232 and 233:

    arrest. The electrocardiogram is li

  • Page 234 and 235:

    should be given to insertion of an

  • Page 236 and 237:

    Drug interactions Amiodarone potent

  • Page 238 and 239:

    effect when treating sinus bradycar

  • Page 240 and 241:

    Case history A 24-year-old medical

  • Page 242 and 243:

    PART V THE RESPIRATORY SYSTEM

  • Page 244 and 245:

    CHAPTER 33 THERAPY OF ASTHMA, CHRON

  • Page 246 and 247:

    STEP 5: CONTINUOUS OR FREQUENT USE

  • Page 248 and 249:

    Adenylyl cyclase Table 33.1: Compar

  • Page 250 and 251:

    Drug interactions Although synergis

  • Page 252 and 253:

    use in asthma has declined consider

  • Page 254 and 255:

    α 1-antitrypsin deficiency, neutro

  • Page 256 and 257:

    PART VI THE ALIMENTARY SYSTEM

  • Page 258 and 259:

    ● Peptic ulceration 247 ● Oesop

  • Page 260 and 261:

    PEPTIC ULCERATION 249 • With rega

  • Page 262 and 263:

    Ranitidine has a similar profile of

  • Page 264 and 265:

    Vestibular stimulation ? via cerebe

  • Page 266 and 267:

    cortical centres affecting vomiting

  • Page 268 and 269:

    • in hepatocellular failure to re

  • Page 270 and 271:

    Ciprofloxacin is occasionally used

  • Page 272 and 273:

    withdrawal), small doses of benzodi

  • Page 274 and 275: Table 34.7: Dose-independent hepato
  • Page 276 and 277: ● Introduction 265 ● General ph
  • Page 278 and 279: dinucleotide (NAD) and nicotinamide
  • Page 280 and 281: Table 35.1: Common trace element de
  • Page 282 and 283: PART VII FLUIDS AND ELECTROLYTES
  • Page 284 and 285: ● Introduction 273 ● Volume ove
  • Page 286 and 287: Key points Diuretics Diuretics are
  • Page 288 and 289: is sometimes caused by drugs, notab
  • Page 290 and 291: or with potassium-sparing diuretics
  • Page 292 and 293: Greger R, Lang F, Sebekova, Heidlan
  • Page 294 and 295: PART VIII THE ENDOCRINE SYSTEM
  • Page 296 and 297: ● Introduction 285 ● Pathophysi
  • Page 298 and 299: in prefilled injection devices (‘
  • Page 300 and 301: Metformin should be withdrawn and i
  • Page 302 and 303: FURTHER READING American Diabetes A
  • Page 304 and 305: deficiency. Potassium iodide (3 mg
  • Page 306 and 307: fertility. It is contraindicated du
  • Page 308 and 309: ● Introduction 297 ● Vitamin D
  • Page 310 and 311: effective in life-threatening hyper
  • Page 312 and 313: Further reading Block GA, Martin KJ
  • Page 314 and 315: Table 40.1: Actions of cortisol and
  • Page 316 and 317: injection may be useful, but if don
  • Page 318 and 319: CHAPTER 41 REPRODUCTIVE ENDOCRINOLO
  • Page 320 and 321: elease by the pituitary via negativ
  • Page 322 and 323: Treatment with depot progestogen in
  • Page 326 and 327: significant proportion of men who r
  • Page 328 and 329: with symptoms caused by the release
  • Page 330 and 331: FURTHER READING Birnbaumer M. Vasop
  • Page 332 and 333: PART IX SELECTIVE TOXICITY
  • Page 334 and 335: ● Principles of antibacterial che
  • Page 336 and 337: 2. transfer of resistance between o
  • Page 338 and 339: Pharmacokinetics Absorption of thes
  • Page 340 and 341: Mechanism of action Macrolides bind
  • Page 342 and 343: asic quinolone structure dramatical
  • Page 344 and 345: Case history A 70-year-old man with
  • Page 346 and 347: PRINCIPLES OF MANAGEMENT OF MYCOBAC
  • Page 348 and 349: Pharmacokinetics Absorption from th
  • Page 350 and 351: MYCOBACTERIUM LEPRAE INFECTION Lepr
  • Page 352 and 353: POLYENES AMPHOTERICIN B Uses Amphot
  • Page 354 and 355: therapy is adequate though more fre
  • Page 356 and 357: NUCLEOSIDE ANALOGUES ACICLOVIR Uses
  • Page 358 and 359: Table 45.3: Summary of available ac
  • Page 360 and 361: Uses Interferon-α when combined wi
  • Page 362 and 363: ● Introduction 351 ● Immunopath
  • Page 364 and 365: Table 46.1: Examples of combination
  • Page 366 and 367: NON-NUCLEOSIDE ANALOGUE REVERSE TRA
  • Page 368 and 369: FUSION INHIBITORS Uses Currently, e
  • Page 370 and 371: salvage therapy include azithromyci
  • Page 372 and 373: ● Malaria 361 ● Trypanosomal in
  • Page 374 and 375:

    Pharmacokinetics Chloroquine is rap

  • Page 376 and 377:

    Table 47.2: Drug therapy of non-mal

  • Page 378 and 379:

    ● Introduction 367 ● Pathophysi

  • Page 380 and 381:

    Table 48.1: Classification of commo

  • Page 382 and 383:

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

  • Page 384 and 385:

    doses are used to prepare patients

  • Page 386 and 387:

    Adverse effects Methotrexate Inhibi

  • Page 388 and 389:

    Table 48.7: Summary of clinical pha

  • Page 390 and 391:

    Table 48.9: Summary of the clinical

  • Page 392 and 393:

    Plasma membrane Signal transduction

  • Page 394 and 395:

    Table 48.10: Monoclonal antibodies

  • Page 396 and 397:

    INTERFERON-ALFA 2B Interferon-alfa

  • Page 398 and 399:

    PART X HAEMATOLOGY

  • Page 400 and 401:

    ● Haematinics - iron, vitamin B 1

  • Page 402 and 403:

    one marrow to produce red cells. Th

  • Page 404 and 405:

    EPO Erythroid precursors Erythrocyt

  • Page 406 and 407:

    Therapeutic principles The extent o

  • Page 408 and 409:

    PART XI IMMUNOPHARMACOLOGY

  • Page 410 and 411:

    ● Introduction 399 ● Immunity a

  • Page 412 and 413:

    Key points Antigen recognition Expr

  • Page 414 and 415:

    Table 50.1: Novel anti-proliferativ

  • Page 416 and 417:

    Key points Treatment of anaphylacti

  • Page 418 and 419:

    DRUGS THAT ENHANCE IMMUNE SYSTEM FU

  • Page 420 and 421:

    PART XII THE SKIN

  • Page 422 and 423:

    ● Introduction 411 ● Acne 411

  • Page 424 and 425:

    DERMATITIS (ECZEMA) PRINCIPLES OF T

  • Page 426 and 427:

    SPECIALISTS ONLY SPECIALISTS ONLY E

  • Page 428 and 429:

    TREATMENT OF OTHER SKIN INFECTIONS

  • Page 430 and 431:

    effect of too high a dose of UVB in

  • Page 432 and 433:

    PART XIII THE EYE

  • Page 434 and 435:

    ● Introduction: ocular anatomy, p

  • Page 436 and 437:

    to cause pupillary dilatation, name

  • Page 438 and 439:

    Table 52.3: Antibacterial agents us

  • Page 440 and 441:

    Table 52.6: Common drug-induced pro

  • Page 442 and 443:

    PART XIV CLINICAL TOXICOLOGY

  • Page 444 and 445:

    ● Introduction 433 ● Pathophysi

  • Page 446 and 447:

    Table 53.2: Central nervous system

  • Page 448 and 449:

    which provide anonymized data to th

  • Page 450 and 451:

    Peak plasma levels after smoking ci

  • Page 452 and 453:

    Key points Acute effects of alcohol

  • Page 454 and 455:

    FURTHER READING Goldman D, Oroszi G

  • Page 456 and 457:

    Table 54.2: Common indications for

  • Page 458 and 459:

    Table 54.5: Antidotes and other spe

  • Page 460 and 461:

    Commission on Human Medicines (CHM)

  • Page 462 and 463:

    Note: Page numbers in italics refer

  • Page 464 and 465:

    atrial fibrillation 217, 221 digoxi

  • Page 466 and 467:

    Cushing’s syndrome 302 cyclic ade

  • Page 468 and 469:

    5-fluorouracil 375-6 fluoxetine, mo

  • Page 470 and 471:

    children 54 diazepam 108 iron prepa

  • Page 472 and 473:

    non-steroidal anti-inflammatory dru

  • Page 474 and 475:

    puberty (male), delay 314 puerperiu

  • Page 476:

    tolerance 9, 433 benzodiazepines 10

A-Textbook-of-Clinical-Pharmacology-and-Therapeutics-5th-edition
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
Clinical Pharmacology and Therapeutics
World Journal of Gastrointestinal Pharmacology and Therapeutics
Experience In Using PBPK Models in Clinical Pharmacology Reviews
Role of Quantitative Clinical Pharmacology in Guiding Drug
Diagnosis and pharmacological management of Parkinson's - SIGN
Prescribing and Pharmacology of Controlled Drugs: Critical Issues ...
An Anatomico-Clinical Overview - Advances in Clinical ...
NEWS - The Journal of Clinical Endocrinology & Metabolism
2012 EDUCATIONAL BOOK - American Society of Clinical Oncology
HIV/AIDS Treatment and Care : Clinical protocols for the European ...
A textbook of pharmacology and therapeutics, or, The action of ...
CLINICAL PHARMACOLOGY AND THERAPEUTICS FOR THE ...
O - Journal of Pharmacology and Experimental Therapeutics
Pharmacology and therapeutics, clinical trial - Dermage
O - Journal of Pharmacology and Experimental Therapeutics
B - Journal of Pharmacology and Experimental Therapeutics
Clinical pharmacology and therapeutics - Royal College of Physicians