Oxford Textbook of Clinical Pharmacology and Drug Therapy

by Grahame-Smith, David; Aronson, Jeffrey

• ISBN13: 9780192632340
• ISBN10: 0192632345
• Edition: 3rd
• Format: Paperback
• Copyright: 2002-10-03
• Publisher: Oxford University Press

Summary

The Oxford Textbook of Clinical Pharmacology and Drug Therapy continues to provide medical students and clinicians with a unique insight into why drugs have their therapeutic effects, by presenting the basic pharmacological principles of pharmacology as they affect the patient. Anunderstanding of these clinical pharmacological principles is essential for rational, safe, effective, and economical prescribing. The text shows how knowledge of the scientific basis of drug action is applied in a clinical context to devise the most effective treatments for disease and to maximizethe therapeutic effects of the drugs being used. This new edition includes an appraisal of the value of evidence-based medicine and a greater discussion of issues in genetics. There are specialist contributors for areas of infectious disease, gastrointestinal disorders, blood disorders, general anaesthesia, cancer chemotherapy, andimmunosuppression. The revision also includes updates to both the pharmacopoeia and the drug therapy section to reflect new developments in both available drugs and ineir their use.

Author Biography

D. G. Grahame-Smith, CBE, MBBS, PhD, FRCP: Emeritus Professor of Clinical Pharmacology, University of Oxford J. K. Aronson, MBChB, DPhil, FRCP: Clinical Reader in Clinical Pharmacology, University of Oxford Honorary Consultant Physician, Oxfordshire Health Authority

Table of Contents

A note about drug nomenclature	p. viii
Consulting authors	p. ix
Clinical pharmacology: the scientific basis of drug therapy
The four processes of drug therapy
The pharmaceutical process	p. 4
The pharmacokinetic process	p. 5
The pharmacodynamic process	p. 5
The therapeutic process	p. 5
The pharmaceutical process: is the drug getting into the patient?
Patient compliance/concordance	p. 7
Systemic availability (bioavailability)	p. 8
Special drug formulations	p. 9
The pharmacokinetic process: is the drug getting to its site of action?
Drug absorption and systemic availability	p. 13
Drug distribution	p. 15
Drug metabolism	p. 17
Drug excretion	p. 19
Simple pharmacokinetic calculations	p. 20
The mathematics of pharmacokinetics	p. 29
The pharmacodynamic process: is the drug producing the required pharmacological effect?
The types of pharmacological actions of drugs	p. 35
Stereoisomerism and drug action	p. 42
Graded responses to drugs: the dose-responsive curve in drug therapy	p. 43
The therapeutic process: is the pharmacological being translated into a therapeutic effect?
Translation of the pharmacological effect of a drug into a therapeutic effect during short-term drug therapy	p. 47
Translation of the pharmacological effect of a drug into a therapeutic effect during long-term drug therapy	p. 50
The aims of drug therapy	p. 53
Practical applications of the analysis of drug therapy
The application of pharmacokinetics to the planning of drug dosage regimens	p. 57
The application of the processes of drug therapy in analysing failure to respond to treatment	p. 61
Monitoring drug therapy
Monitoring the therapeutic effects of drugs	p. 68
Monitoring the pharmacodynamic effects of drugs	p. 69
Monitoring drug pharmacokinetics (plasma concentration measurement)	p. 71
Pharmacogenetics and pharmacogenomics
Pharmacokinetic genetic variations	p. 79
Pharmacodynamic genetic variations	p. 83
Adverse reactions to drugs
History	p. 89
Incidence of adverse drug reactions	p. 90
Classification of adverse drug reactions	p. 90
Dose-related adverse drug reactions	p. 92
Non-dose-related adverse drug reactions	p. 94
Long-term and withdrawal effects causing adverse drug reactions	p. 96
Delayed effects causing adverse drug reactions	p. 98
Surveillance methods used in detecting adverse drug reactions	p. 99
Drug interactions
Incidence of significant drug interactions	p. 105
Drugs likely to be involved in interactions	p. 106
Pharmaceutical interactions	p. 106
Pharmacokinetic interactions	p. 107
Pharmacodynamic interactions	p. 113
Lists of clinically important drug interactions	p. 117
Drug therapy in young and old people
Drug therapy in young people	p. 119
Drug therapy in old people	p. 123
Drug therapy and reproduction
Hormonal contraception	p. 127
Hormone replacement therapy	p. 130
The treatment of infertility	p. 130
Drug therapy during pregnancy	p. 131
Drug therapy in the termination of pregnancy and in the management of pre-term labour and labour	p. 138
Drug therapy and breastfeeding	p. 139
Patient compliance/concordance
Factors that affect compliance	p. 141
Methods of measuring compliance	p. 142
Methods of improving compliance	p. 143
Placebos
Uses and abuses of placebos	p. 145
Factors that influence the response to placebos	p. 146
Mode of action of placebos	p. 146
Adverse effects of placebos	p. 146
Drug discovery and development: the pharmaceutical industry and the regulatory authorities
Drug discovery	p. 147
Drug development	p. 149
Post-marketing surveillance	p. 150
Advertising	p. 150
Regulatory authorities	p. 150
Local drug and therapeutics committees	p. 151
Drug costs	p. 151
Drug trials
Definition of a clinical trial	p. 154
The conduct of a clinical trial	p. 164
Ethics	p. 164
The drug history and the clinical examination and investigation of drug effects
Taking the drug history	p. 167
Clinical examination and investigation of drug effects	p. 169
The importance of good records and communication	p. 170
Practical prescribing
Principles of prescribing
The benefit:risk ratio in prescribing	p. 173
Evidence-based medicine	p. 175
How to choose a drug	p. 175
How to write a prescription
Practical prescription writing	p. 181
Proprietary names versus approved names	p. 184
Prescribing controlled drugs	p. 187
Repeat prescribing	p. 187
Abbreviations	p. 188
Sources of information on drugs
Pharmaceutical information	p. 189
Pharmacokinetics	p. 190
Pharmacological effects of drugs	p. 190
Therapeutic	p. 190
Pharmacogenetics	p. 190
Adverse effects of drugs	p. 190
Drug interactions	p. 190
Clinical trials	p. 190
Patient compliance	p. 190
Prescribing information	p. 190
Computerized databases	p. 191
Drug information services	p. 191
Bibliography	p. 191
The drug therapy of disease
Introduction to drug therapy	p. 197
The drug therapy of infectious diseases
Antibacterial drugs: the treatment of bacterial infections	p. 200
Chemotherapy of viral infections	p. 210
Chemotherapy of protozoal infections	p. 214
Chemotherapy of helminthic infections	p. 218
Chemotherapy of trematode infections	p. 218
Chemotherapy of fungal infections	p. 218
Prevention of infections using vaccines and immunoglobulins	p. 220
The drug treatment of sexually transmitted diseases	p. 222
The drug therapy of cardiovascular disorders
Hypertension	p. 226
Angina pectoris	p. 233
Acute myocardiat infarction	p. 236
Cardiac arrhythmias	p. 241
Cardiac failure	p. 248
Infective endocarditis	p. 253
Venous thromboembolic disease	p. 255
The drug therapy of respiratory diseases
The use of oxygen in respiratory disorders	p. 260
Cough	p. 260
Pneumonias	p. 261
Chronic obstructive lung disease	p. 263
Bronchial asthma	p. 263
Pulmonary tuberculosis	p. 270
Inflammatory lung disorders	p. 272
Cystic fibrosis	p. 273
Drug-induced respiratory disorders	p. 273
The drug therapy of gastrointestinal, hepatic, and biliary disorders
Antacids	p. 276
Antiemetics	p. 277
Peptic ulceration	p. 279
Laxatives	p. 282
Antidiarrhoeal drugs	p. 283
Irritable bowel syndrome	p. 284
Gastrointestinal infections	p. 284
Ulcerative colitis	p. 285
Crohn's disease	p. 287
Drugs and the liver	p. 288
Drug therapy in the treatment of chronic liver disease	p. 291
Drug treatment of gallstones	p. 292
Drugs and the kidney and the drug therapy of renal, urinary tract, and prostatic disorders
Diuretic therapy	p. 296
Potassium depletion	p. 300
Hyperkalaemia	p. 301
The place of drugs in the management of acute renal insufficiency	p. 301
The place of drugs in the management of chronic renal insufficiency	p. 302
The drug treatment of glomerulonephritis	p. 305
Drugs in the treatment of urinary tract infection	p. 306
Drug treatment of urinary calculi	p. 307
Drugs and the urinary bladder: the treatment of incontinence, detrusor instability, and enuresis	p. 307
Drug therapy of tumours of the kidney	p. 308
Drug therapy of prostatic disease	p. 308
Drug-induced renal damage	p. 309
Drugs and dialysis	p. 310
The drug therapy of endocrine and metabolic disorders
Disorders of the pituitary gland	p. 313
Disorders of the adrenal gland	p. 316
Disorders of the thyroid gland	p. 318
Disorders of calcium metabolism	p. 321
Diabetes mellitus	p. 324
Disorders of lipid metabolism	p. 333
The management of obesity	p. 337
The drug therapy of blood disorders
Anaemias	p. 339
Myeloproliferative disorders	p. 342
Lymphoproliferative disorders	p. 343
Acute leukaemias	p. 344
Monoclonal gammopathies	p. 345
Drug-induced blood dyscrasias	p. 346
Complications of blood transfusion	p. 348
Blood substitutes	p. 349
The drug therapy of disorders of bones and joints
Arthritis	p. 351
Gout and hyperuricaemia	p. 358
Musculoskeletal disorders caused by drugs	p. 360
Paget's disease of bone	p. 360
The prevention and treatment of postmenopausal osteoporosis	p. 362
The drug therapy of neurological disorders
Meningitis and encephalitis	p. 363
Parkinson's disease and Parkinsonism	p. 365
Epilepsy	p. 367
Migraine	p. 370
Myasthenia gravis	p. 372
Muscle spasticity	p. 374
Vertigo	p. 375
Trigeminal neuralgia	p. 376
Drug-induced movement disorders	p. 376
The drug therapy of psychiatric disorders
Mechanisms of action of drugs used in psychiatric disorders	p. 377
The use of psychotropic drugs	p. 380
The relief of pain
Anatomical and neuropharmacological mechanisms underlying pain sensation	p. 389
Mechanisms of action of analgesics	p. 390
Principles underlying the use of analgesics in the treatment of pain	p. 391
The practical use of analgesics	p. 893
The treatment of intractable pain in terminal malignant disease	p. 395
Postoperative pain	p. 396
General anaesthesia and local anaesthetics
Premedication	p. 398
Induction of anaesthesia	p. 398
Muscle relaxants	p. 398
Maintenance of anaesthesia	p. 400
Postoperative medication	p. 404
Local anaesthetics	p. 405
Drug dependence and abuse
Factors that predispose to drug dependence	p. 411
Opiates	p. 412
Cocaine and amphetamines (including Ecstasy)	p. 414
Cannabis	p. 415
LSD and other psychedelic drugs	p. 416
Solvents and nitrites	p. 416
Alcohol	p. 416
Benzodiazepines	p. 417
Barbiturates	p. 418
Anabolic steroids	p. 418
Tobacco (nicotine)	p. 418
Accounts of drug dependence	p. 419
The management of poisoning
The immediate management of the acutely ill patient	p. 000
The detailed management of poisoning	p. 000
Sources of information	p. 000
Agents used in the treatment of poisoning	p. 000
The principles of cancer chemotherapy
Tumour responsiveness to chemotherapy	p. 438
The actions of chemotherapeutic drugs relevant to the clinical uses	p. 439
Clinical evaluation of tumours before and after treatment	p. 442
Combination chemotherapy	p. 442
Regimens for cancer chemotherapy	p. 442
Adverse effects of drugs used in cancer chemotherapy	p. 442
The practical use of cytotoxic drugs	p. 444
Immunosuppression and the drug therapy of allergies, connective tissue disorders, and primary immunodeficiencies
Immune disease: pathogenesis and mechanisms of action of drugs	p. 447
The use of glucocorticoids as anti-inflammatory, antiallergic, and immunosuppressive agents	p. 450
The drug therapy of allergic and autoimmune disorders	p. 452
The management of primary immunodeficiences	p. 454
Immunosuppression in tissue and organ transplantation	p. 455
Pharmacopoeia
Introductory notes	p. 459
Index to drugs listed in the pharmacopoeia	p. 461
Pharmacopoeia	p. 469
General index	p. 611
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