Pharmacology in Rehabilitation

by Ciccone, Charles D.

• ISBN13: 9780803607798
• ISBN10: 0803607792
• Format: Hardcover
• Copyright: 2002-01-01
• Publisher: F a Davis Co

Summary

Ithaca College, NY. Text, for physical and occupational therapy students and practitioners, on basic pharmacology and how drug therapy can affect patients receiving therapy. Previous edition: c1995.

Table of Contents

SECTION I General Principles of Pharmacology	1	(58)
Basic Principles of Pharmacology	3	(12)
Drug Nomenclature	5	(1)
What Constitutes a Drug: Development and Approval of Therapeutic Agents	5	(1)
Therapeutic Agents	5	(4)
Drug Approval Process	6	(1)
Prescription versus Over-the-Counter Medications	7	(1)
Controlled Substances	8	(1)
Basic Concepts in Drug Therapy	9	(2)
Dose-Response Curves and Maximal Efficacy	9	(1)
Potency	10	(1)
Elements of Drug Safety	11	(4)
Quantal Dose-Response Curves and the Median Effective Dose	11	(1)
Median Toxic Dose	12	(1)
Therapeutic Index	12	(3)
Pharmacokinetics I: Drug Administration, Absorption, and Distribution	15	(18)
Routes of Administration	15	(5)
Enteral	15	(2)
Parenteral	17	(3)
Drug Absorption and Distribution: Bioavailability	20	(5)
Membrane Structure and Function	20	(1)
Movement across Membrane Barriers	21	(4)
Distribution of Drugs within the Body	25	(1)
Factors Affecting Distribution	25	(1)
Volume of Distribution	25	(1)
Drug Storage	26	(2)
Storage Sites	26	(1)
Adverse Consequences of Drug Storage	26	(2)
Newer Techniques for Drug Delivery	28	(5)
Controlled-Release Preparations	28	(1)
Implanted Drug Delivery Systems	28	(1)
Targeting Drug Delivery to Specific Cells and Tissues	29	(4)
Pharmacokinetics II: Drug Elimination	33	(13)
Biotransformation	33	(3)
Cellular Mechanisms of Drug Biotransformation	34	(1)
Organs Responsible for Drug Biotransformation	35	(1)
Enzyme Induction	36	(1)
Drug Excretion	36	(1)
Drug Elimination Rates	37	(2)
Clearance	38	(1)
Half-Life	39	(1)
Dosing Schedules and Plasma Concentration	39	(1)
Variations in Drug Response and Metabolism	40	(6)
Drug Receptors	46	(13)
Receptors Located on the Cell's Surface	46	(4)
Surface Receptors Linked Directly to Ion Channels	46	(1)
Surface Receptors Linked Directly to Enzymes	47	(1)
Surface Receptors Linked to Regulatory (G) Proteins: Role of the Second Messenger	48	(2)
Intracellular Receptors	50	(1)
Drug-Receptor Interactions	50	(1)
Functional Aspects of Drug-Receptor Interactions	51	(4)
Drug Selectivity	51	(1)
Dose-Response	52	(1)
Classification of Drugs: Agonist versus Antagonist	53	(1)
Competitive versus Noncompetitive Antagonists	54	(1)
Partial Agonists	54	(1)
Receptor Regulation	55	(2)
Receptor Desensitization and Down-Regulation	55	(1)
Receptor Supersensitivity and Up-Regulation	56	(1)
Nonreceptor Drug Mechanisms	57	(2)
SECTION II Pharmacology of the Central Nervous System	59	(108)
Central Nervous System Pharmacology: General Principles	61	(10)
CNS Organization	61	(3)
Cerebrum	61	(1)
Basal Ganglia	62	(1)
Diencephalon	63	(1)
Mesencephalon and Brainstem	63	(1)
Cerebellum	63	(1)
Limbic System	64	(1)
Spinal Cord	64	(1)
The Blood-Brain Barrier	64	(1)
CNS Neurotransmitters	65	(2)
Acetylcholine	65	(1)
Monoamines	66	(1)
Amino Acids	66	(1)
Peptides	66	(1)
Other Transmitters	67	(1)
CNS Drugs: General Mechanisms	67	(4)
Sedative-Hypnotic and Antianxiety Agents	71	(12)
Sedative-Hypnotic Agents	71	(2)
Pharmacokinetics	73	(1)
Mechanism of Action	73	(3)
Benzodiazepines	73	(2)
Barbiturates	75	(1)
Other Mechanisms	75	(1)
Problems and Adverse Effects	76	(1)
Tolerance and Physical Dependence	76	(1)
Residual Effects	76	(1)
Other Side Effects	76	(1)
Antianxiety Drugs	76	(3)
Benzodiazepines	77	(1)
Buspirone	78	(1)
Other Antianxiety Drugs	78	(1)
Problems and Adverse Effects	79	(1)
Special Considerations of Sedative-Hypnotic and Antianxiety Agents in Rehabilitation	79	(1)
Case Study	80	(3)
Sedative-Hypnotic Drugs	80	(3)
Drugs Used to Treat Affective Disorders: Depression and Manic-Depression	83	(16)
Depression	83	(9)
Clinical Picture	83	(1)
Pathophysiology of Depression	84	(2)
Antidepressant Drugs	86	(6)
Use of Antidepressants in Chronic Pain	92	(1)
Treatment of Manic-Depression: Antimanic Drugs	92	(3)
Bipolar Syndrome	92	(1)
Lithium	93	(1)
Other Drugs Used in Manic-Depression	94	(1)
Special Concerns in Rehabilitation Patients	95	(1)
Case Study	96	(3)
Antidepressant Drugs	96	(3)
Antipsychotic Drugs	99	(11)
Schizophrenia	99	(1)
Neurotransmitter Changes in Schizophrenia	100	(1)
Antipsychotic Mechanism of Action	100	(1)
Antipsychotic Medications	101	(2)
Traditional Antipsychotics	102	(1)
Atypical Antipsychotics	102	(1)
Pharmacokinetics	103	(1)
Other Uses of Antipsychotics	104	(1)
Problems and Adverse Effects	104	(3)
Extrapyramidal Symptoms	104	(3)
Nonmotor Effects	107	(1)
Sedation	107	(1)
Anticholinergic Effects	107	(1)
Other Side Effects	107	(1)
Special Concerns in Rehabilitation Patients	107	(1)
Case Study	108	(2)
Antipsychotic Drugs	108	(2)
Antiepileptic Drugs	110	(13)
Classification of Epileptic Seizures	111	(1)
Rationale for Drug Treatment	112	(1)
Drugs Used to Treat Epilepsy	112	(5)
Barbiturates	112	(1)
Benzodiazepines	113	(1)
Hydantoins	114	(1)
Succinimides	114	(1)
Carbamazepine	114	(1)
Valproic Acid	115	(1)
Newer ``Second-Generation'' Agents	115	(2)
Selection of a Specific Antiepileptic Agent	117	(1)
Single-Drug Therapy versus Drug Combinations in Epilepsy	117	(1)
Pharmacokinetics	118	(1)
Special Precautions during Pregnancy	118	(1)
Treatment of Status Epilepticus	119	(1)
Withdrawal of Antiseizure Medications	119	(1)
Special Concerns in Rehabilitation Patients	119	(1)
Case Study	120	(3)
Antiepileptic Drugs	120	(3)
Pharmacologic Management of Parkinson Disease	123	(19)
Pathophysiology of Parkinson Disease	124	(1)
Etiology of Parkinson Disease: Potential Role of Toxic Substances	125	(1)
Therapeutic Agents in Parkinsonism	126	(9)
Levodopa	126	(6)
Other Drugs Used to Treat Parkinson Disease	132	(3)
Clinical Course of Parkinson Disease: When to Use Specific Drugs	135	(1)
Neurosurgical Interventions in Parkinson Disease	135	(1)
Special Considerations for Rehabilitation	136	(1)
Case Study	137	(5)
Antiparkinson Drugs	137	(5)
General Anesthetics	142	(12)
General Anesthesia: Requirements	142	(1)
Stages of General Anesthesia	143	(1)
General Anesthetic Agents: Classification and Use According to Route of Administration	143	(1)
General Anesthetics: Specific Agents	144	(2)
Inhalation Anesthetics	144	(2)
Intravenous Anesthetics	146	(1)
Pharmacokinetics	146	(1)
Mechanism of Action	147	(2)
Adjuvants in General Anesthesia	149	(2)
Preoperative Medications	149	(1)
Neuromuscular Blockers	149	(2)
Special Concerns in Rehabilitation	151	(1)
Case Study	152	(2)
General Anesthetics	152	(2)
Local Anesthetics	154	(13)
Types of Local Anesthetics	155	(1)
Pharmacokinetics	156	(1)
Clinical Use of Local Anesthetics	157	(3)
Mechanisms of Action	160	(1)
Differential Nerve Block	161	(1)
Systemic Effects of Local Anesthetics	162	(1)
Significance in Rehabilitation	162	(1)
Case Study	163	(4)
Local Anesthetics	163	(4)
SECTION III Drugs Affecting Skeletal Muscle	167	(20)
Skeletal Muscle Relaxants	169	(18)
Increased Muscle Tone: Spasticity versus Muscle Spasms	169	(2)
Specific Agents Used to Produce Skeletal Muscle Relaxation	171	(1)
Agents Used to Treat Muscle Spasms	171	(2)
Diazepam	171	(1)
Polysynaptic Inhibitors	171	(2)
Agents Used to Treat Spasticity	173	(5)
Baclofen	173	(2)
Intrathecal Baclofen	175	(1)
Dantrolene Sodium	176	(1)
Diazepam	177	(1)
Gabapentin	177	(1)
Tizanidine	177	(1)
Use of Botulinum Toxin as a Muscle Relaxant	178	(2)
Pharmacokinetics	180	(1)
Special Concerns in Rehabilitation Patients	181	(1)
Case Study	182	(5)
Muscle Relaxants	182	(5)
SECTION IV Drugs Used to Treat Pain and Inflammation	187	(74)
Opioid Analgesics	189	(17)
Source of Opioid Analgesics	189	(1)
Endogenous Opioid Peptides and Opioid Receptors	190	(2)
Endogenous Opioids	190	(1)
Opioid Receptors	191	(1)
Classification of Specific Agents	192	(2)
Pharmacokinetics	194	(1)
Mechanism of Action	195	(2)
Effect of Opioids on the Central Nervous System	195	(1)
Peripheral Effects of Opioids	196	(1)
Clinical Applications	197	(2)
Treatment of Pain	197	(1)
Use of Opioids in Patient-Controlled Analgesia	198	(1)
Other Opioid Uses	199	(1)
Problems and Adverse Effects	199	(1)
Concepts of Addiction, Tolerance, and Physical Dependence	199	(3)
Tolerance	200	(1)
Physical Dependence	200	(1)
Tolerance and Dependence during Therapeutic Opioid Use	201	(1)
Use of Methadone to Treat Opioid Addiction	201	(1)
Special Concerns in Rehabilitation Patients	202	(1)
Case Study	202	(4)
Opioid Analgesics	202	(4)
Nonsteroidal Anti-Inflammatory Drugs	206	(20)
Aspirin and Other NSAIDs: General Aspects	206	(1)
Prostaglandins, Thromboxanes, and Leukotrienes	207	(4)
Eicosanoid Biosynthesis	207	(2)
Role of Eicosanoids in Health and Disease	209	(2)
Mechanism of NSAID Action: Inhibition of Prostaglandin and Thromboxane Synthesis	211	(1)
Aspirin: Prototypical NSAID	212	(1)
Clinical Applications of Aspirin-Like Drugs	212	(1)
Treatment of Pain and Inflammation	212	(1)
Treatment of Fever	213	(1)
Treatment of Vascular Disorders	213	(1)
Prevention of Cancer	213	(1)
Problems and Adverse Effects of Aspirin-Like Drugs	213	(2)
Gastrointestinal Problems	213	(1)
Other Side Effects	214	(1)
Comparison of Aspirin with Other NSAIDs	215	(3)
COX-2 Selective Drugs	218	(1)
Acetaminophen	219	(1)
Pharmacokinetics of NSAIDs and Acetaminophen	219	(1)
Special Concerns in Rehabilitation Patients	220	(1)
Case Study	220	(6)
Nonsteroidal Anti-Inflammatory Drugs	220	(6)
Pharmacologic Management of Rheumatoid Arthritis and Osteorathritis	226	(21)
Rheumatoid Arthritis	226	(12)
Immune Basis for Rheumatoid Arthritis	227	(1)
Overview of Drug Therapy in Rheumatoid Arthritis	228	(1)
Nonsteroidal Anti-Inflammatory Drugs	229	(1)
Glucocorticoids	230	(1)
Disease-Modifying Antirheumatic Drugs	231	(6)
DMARD Combinations Used in Rheumatoid Arthritis	237	(1)
Dietary Implications for Rheumatoid Arthritis	238	(1)
Osteoarthritis	238	(3)
Acetaminophen and NSAIDs	239	(1)
Viscosupplementation	240	(1)
Glucosamine and Chondroitin Sulfate	240	(1)
Special Concerns for Antiarthritic Drug Therapy in Rehabilitation Patients	241	(1)
Case Study	242	(5)
Rheumatoid Arthritis	242	(5)
Patient-Controlled Analgesia	247	(14)
Pharmacokinetic Basis for PCA	247	(1)
PCA Dosing Strategies and Parameters	248	(2)
Types of Analgesics Used for PCA	250	(1)
Administration Routes during PCA	250	(4)
Intravenous PCA	250	(1)
Epidural and Intrathecal PCA	251	(1)
PCA Pumps	252	(2)
Comparison of PCA to Traditional Methods of Analgesic Administration	254	(2)
Problems and Side Effects of PCA	256	(1)
Pharmacologic Side Effects	256	(1)
Problems with PCA Delivery	256	(1)
Special Concerns for PCA in Rehabilitation Patients	257	(1)
Case Study	257	(4)
Patient-Controlled Analgesia	257	(4)
SECTION V Autonomic and Cardiovascular Pharmacology	261	(134)
Introduction to Autonomic Pharmacology	263	(11)
Anatomy of the Autonomic Nervous System: Sympathetic and Parasympathetic Divisions	263	(2)
Preganglionic and Postganglionic Neurons	264	(1)
Sympathetic Organization	264	(1)
Parasympathetic Organization	264	(1)
Functional Aspects of the Sympathetic and Parasympathetic Divisions	265	(1)
Function of the Adrenal Medulla	266	(1)
Autonomic Integration and Control	267	(1)
Autonomic Neurotransmitters	268	(1)
Acetylcholine and Norepinephrine	268	(1)
Other Autonomic Neurotransmitters	269	(1)
Autonomic Receptors	269	(3)
Cholinergic Receptors	269	(1)
Adrenergic Receptors	270	(2)
Pharmacologic Significiance of Autonomic Receptors	272	(2)
Cholinergic Drugs	274	(12)
Cholinergic Receptors	274	(1)
Cholinergic Stimulants	275	(5)
Direct-Acting Cholinergic Stimulants	275	(1)
Indirect-Acting Cholinergic Stimulants	276	(2)
Clinical Applications of Cholinergic Stimulants	278	(1)
Adverse Effects of Cholinergic Stimulants	279	(1)
Anticholinergic Drugs	280	(6)
Source and Mechanism of Action of Antimuscarinic Anticholinergic Drugs	280	(1)
Clinical Applications of Antimuscarinic Drugs	281	(3)
Side Effects of Anticholinergic Drugs	284	(2)
Adrenergic Drugs	286	(17)
Adrenergic Receptor Subclassifications	287	(1)
Adrenergic Agonists	288	(6)
Alpha Agonists	288	(2)
Beta Agonists	290	(2)
Drugs with Mixed Alpha and Beta Agonist Activity	292	(2)
Adrenergic Antagonists	294	(9)
Alpha Antagonists	294	(2)
Beta Antagonists	296	(3)
Other Drugs That Inhibit Adrenergic Neurons	299	(4)
Antihypertensive Drugs	303	(24)
Normal Control of Blood Pressure	304	(1)
Pathogenesis of Hypertension	305	(1)
Essential versus Secondary Hypertension	305	(1)
Possible Mechanisms in Essential Hypertension	305	(1)
Drug Therapy	306	(1)
Diuretics	306	(3)
Mechanism of Action and Rationale for Use	306	(2)
Classification of Diuretics	308	(1)
Adverse Effects of Diuretics	309	(1)
Sympatholytic Drugs	309	(5)
Beta Blockers	310	(1)
Alpha Blockers	311	(1)
Presynaptic Adrenergic Inhibitors	312	(1)
Centrally Acting Agents	313	(1)
Ganglionic Blockers	314	(1)
Vasodilators	314	(2)
Mechanism of Action and Rationale for Use	314	(1)
Specific Agents	314	(1)
Adverse Effects	315	(1)
Inhibition of the Renin-Angiotensin System	316	(2)
Mechanism of Action and Rationale for Use	316	(1)
Specific Agents	317	(1)
Adverse Effects	317	(1)
Calcium Channel Blockers	318	(1)
Specific Agents	318	(1)
Adverse Effects	319	(1)
Stepped-Care Approach to Hypertension	319	(1)
Nonpharmacologic Treatment of Hypertension	320	(1)
Special Concerns in Rehabilitation Patients	320	(1)
Case Study	321	(6)
Hypertension	321	(6)
Treatment of Angina Pectoris	327	(16)
Drugs Used to Treat Angina Pectoris	328	(1)
Organic Nitrates	328	(3)
Mechanism of Action and Rationale for Use	328	(1)
Specific Agents	329	(2)
Adverse Side Effects of Nitrates	331	(1)
Beta-Adrenergic Blockers	331	(1)
Mechanism of Action and Rationale for Use	331	(1)
Specific Agents	331	(1)
Adverse Side Effects	332	(1)
Calcium Channel Blockers	332	(3)
Mechanism of Action and Rationale for Use	332	(1)
Specific Agents	333	(1)
Adverse Side Effects	334	(1)
Use of Anticoagulants in Angina Pectoris	335	(1)
Treatment of Specific Types of Angina Pectoris	335	(3)
Stable Angina	336	(1)
Variant Angina (Prinzmetal's Ischemia)	337	(1)
Unstable Angina	337	(1)
Nonpharmacologic Management of Angina Pectoris	338	(1)
Special Concerns in Rehabilitation Patients	338	(1)
Case Study	339	(4)
Antianginal Drugs	339	(4)
Treatment of Cardiac Arrhythmias	343	(13)
Cardiac Electrophysiology	343	(3)
Cardiac Action Potentials	343	(2)
Normal Cardiac Rhythm	345	(1)
Normal Conduction of the Cardiac Action Potential	346	(1)
Mechanisms of Cardiac Arrhythmias	346	(1)
Types of Arrhythmias	346	(1)
Classification of Antiarrhythmic Drugs	347	(1)
Class I: Sodium Channel Blockers	347	(2)
Mechanism of Action and Rationale for Use	347	(1)
Specific Agents	348	(1)
Adverse Side Effects	349	(1)
Class II: Beta Blockers	349	(1)
Mechanism of Action and Rationale for Use	349	(1)
Specific Agents	350	(1)
Adverse Side Effects	350	(1)
Class III: Drugs That Prolong Repolarization	350	(1)
Mechanism of Action and Rationale for Use	350	(1)
Specific Agents	350	(1)
Adverse Side Effects	351	(1)
Class IV: Calcium Channel Blockers	351	(1)
Mechanism of Action and Rationale for Use	351	(1)
Specific Agents	351	(1)
Adverse Side Effects	351	(1)
Nonpharmacologic Treatment of Arrhythmias	352	(1)
Special Concerns in Rehabilitation Patients	352	(1)
Case Study	352	(4)
Antiarrhythmic Drugs	352	(4)
Treatment of Congestive Heart Failure	356	(17)
Pathophysiology of Congestive Heart Failure	357	(2)
Vicious Cycle of Heart Failure	357	(1)
Congestion in Left and Right Heart Failure	358	(1)
Pharmacotherapy	359	(1)
Drugs That Increase Myocardial Contraction Force (Positive Inotropic Agents)	360	(4)
Digitalis	360	(3)
Other Positive Inotropic Agents	363	(1)
Agents That Decrease Cardiac Workload	364	(4)
Angiotensin-Converting Enzyme Inhibitors	364	(1)
Beta Blockers	365	(1)
Diuretics	366	(1)
Vasodilators	367	(1)
Summary of Drug Therapy	368	(1)
Special Concerns in Rehabilitation Patients	368	(1)
Case Study	368	(5)
Congestive Heart Failure	368	(5)
Treatment of Coagulation Disorders and Hyperlipidemia	373	(22)
Normal Mechanism of Blood Coagulation	374	(1)
Clot Formation	374	(1)
Clot Breakdown	374	(1)
Drugs Used to Treat Overactive Clotting	375	(9)
Anticoagulants	376	(3)
Antithrombotic Drugs	379	(3)
Thrombolytic Drugs	382	(2)
Treatment of Clotting Deficiencies	384	(2)
Hemophilia	384	(1)
Deficiencies of Vitamin K---Dependent Clotting Factors	385	(1)
Antifibrinolytics	385	(1)
Agents Used to Treat Hyperlipidemia	386	(2)
HMG-CoA Reductase Inhibitors (Statins)	386	(1)
Fibric Acids	387	(1)
Other Lipid-Lowering Agents	388	(1)
Adverse Effects of Antihyperlipidemia Agents	388	(1)
Special Concerns in Rehabilitation Patients	388	(2)
Case Study	390	(5)
Clotting Disorders	390	(5)
SECTION VI Respiratory and Gastrointestinal Pharmacology	395	(38)
Respiratory Drugs	397	(21)
Drugs Used to Treat Respiratory Tract Irritation and Control Respiratory Secretions	397	(4)
Antitussives	398	(1)
Decongestants	398	(1)
Antihistamines	399	(1)
Mucolytics and Expectorants	400	(1)
Drugs Used to Maintain Airway Patency in Obstructive Pulmonary Disease	401	(8)
Beta-Adrenergic Agonists	401	(3)
Xanthine Derivatives	404	(2)
Anticholinergic Drugs	406	(1)
Glucocorticoids	407	(1)
Cromones	408	(1)
Leukotriene Inhibitors	409	(1)
Treatment of Bronchial Asthma	409	(2)
Pathophysiology of Bronchial Asthma	409	(1)
Long-Term Management of Asthma	410	(1)
Treatment of Reversible Bronchospasm in COPD	411	(1)
Treatment of Respiratory Problems in Cystic Fibrosis	412	(1)
Special Concerns in Rehabilitation Patients	413	(1)
Case Study	413	(5)
Respiratory Drugs	413	(5)
Gastrointestinal Drugs	418	(15)
Drugs Used to Control Gastric Acidity and Secretion	418	(5)
Antacids	419	(1)
H2 Receptor Blockers	420	(1)
Proton Pump Inhibitors	421	(1)
Treatment of H. Pylori Infection in Gastric Ulcer Disease	422	(1)
Other Agents Used to Control and Treat Gastric Ulcers	422	(1)
Antidiarrheal Agents	423	(2)
Opioid Derivatives	423	(1)
Adsorbents	424	(1)
Bismuth Salicylate	425	(1)
Laxatives and Cathartics	425	(2)
Rationale for Use	425	(1)
Specific Agents and Mechanism of Action	426	(1)
Adverse Effects	427	(1)
Miscellaneous Gastrointestinal Drugs	427	(1)
Digestants	427	(1)
Emetics	428	(1)
Antiemetics	428	(1)
Cholelitholytic Agents	428	(1)
Special Concerns in Rehabilitation Patients	428	(1)
Case Study	429	(4)
Gastrointestinal Drugs	429	(4)
SECTION VII Endocrine Pharmacology	433	(102)
Introduction to Endocrine Pharmacology	435	(13)
Primary Endocrine Glands and Their Hormones	436	(4)
Hypothalamus and Pituitary Gland	436	(2)
Thyroid Gland	438	(1)
Parathyroid Gland	438	(1)
Pancreas	438	(1)
Adrenal Gland	439	(1)
Gonads	440	(1)
Endocrine Physiology and Pharmacology	440	(5)
Hormone Chemistry	440	(1)
Synthesis and Release of Hormones	440	(1)
Feedback Control Mechanisms in Endocrine Function	441	(1)
Hormone Transport	442	(1)
Hormone Effects on the Target Cell	443	(2)
Clinical Use of Endocrine Drugs	445	(3)
Adrenocorticosteroids	448	(21)
Steroid Synthesis	448	(2)
Glucocorticoids	450	(5)
Role of Glucocorticoids in Normal Function	450	(1)
Mechanism of Action of Glucocorticoids	451	(2)
Physiologic Effects of Glucocorticoids	453	(2)
Therapeutic Glucocorticoid Agents	455	(2)
Clinical Uses of Glucocorticoids	457	(2)
Glucocorticoid Use in Endocrine Conditions	457	(1)
Use in Nonendocrine Conditions	458	(1)
Adverse Effects of Glucocorticoids	459	(1)
Adrenocortical Suppression	459	(1)
Drug-Induced Cushing Syndrome	459	(1)
Breakdown of Supporting Tissues	459	(1)
Other Adverse Effects	460	(1)
Drugs That Inhibit Adrenocortical Hormone Biosynthesis	460	(1)
Mineralocorticoids	461	(3)
Regulation of Mineralocorticoid Secretion	461	(1)
Mechanism of Action and Physiologic Effects of Mineralocorticoids	462	(1)
Therapeutic Use of Mineralocorticoid Drugs	463	(1)
Adverse Effects of Mineralocorticoid Agonists	463	(1)
Mineralocorticoid Antagonists	463	(1)
Special Concerns of Adrenal Steroid Use in Rehabilitation Patients	464	(1)
Case Study	465	(4)
Adrenocorticosteroids	465	(4)
Male and Female Hormones	469	(26)
Androgens	469	(3)
Source and Regulation of Androgen Synthesis	469	(2)
Physiologic Effects of Androgens	471	(1)
Pharmacologic Use of Androgens	472	(3)
Clinical Use of Androgens	472	(1)
Specific Agents	473	(1)
Adverse Effects of Clinical Androgen Use	474	(1)
Antiandrogens	475	(1)
Androgen Abuse	475	(3)
Nature of Androgen Abuse	475	(2)
Effects of Androgens on Athletic Performance	477	(1)
Adverse Effects of Androgen Abuse	477	(1)
Estrogen and Progesterone	478	(4)
Effects of Estrogen and Progesterone on Sexual Maturation	479	(1)
Regulation and Effects of Hormonal Synthesis during the Menstrual Cycle	479	(2)
Female Hormones in Pregnancy and Parturition	481	(1)
Pharmacologic Use of Estrogen and Progesterone	482	(4)
Conditions Treated with Estrogen and Progesterone	482	(1)
Specific Agents	483	(1)
Adverse Effects of Estrogen and Progesterone	483	(1)
Selective Estrogen Receptor Modulators	484	(1)
Antiestrogens	485	(1)
Antiprogestins	486	(1)
Oral Contraceptives	486	(3)
Types of Contraceptive Preparations	487	(1)
Mechanism of Contraceptive Action	488	(1)
Adverse Effects of Oral Contraceptives	488	(1)
Special Concerns of Sex Hormone Pharmacology in Rehabilitation Patients	489	(1)
Case Study	490	(5)
Male and Female Hormones	490	(5)
Thyroid and Parathyroid Drugs: Agents Affecting Bone Mineralization	495	(18)
Function of the Thyroid Gland	495	(3)
Synthesis of Thyroid Hormones	496	(1)
Regulation of Thyroid Hormone Release	497	(1)
Physiologic Effects of Thyroid Hormones	498	(1)
Mechanism of Action of Thyroid Hormones	498	(1)
Treatment of Thyroid Disorders	498	(4)
Hyperthyroidism	499	(2)
Hypothyroidism	501	(1)
Function of the Parathyroid Glands	502	(1)
Parathyroid Hormone	502	(1)
Regulation of Bone Mineral Homeostasis	503	(1)
Pharmacologic Control of Bone Mineral Homeostasis	504	(5)
Calcium Supplements	505	(1)
Vitamin D	506	(1)
Bisphosphonates	507	(1)
Calcitonin	507	(1)
Estrogen Therapy	508	(1)
Special Concerns in Rehabilitation Patients	509	(1)
Case Study	509	(4)
Agents Affecting Bone Mineral Metabolism	509	(4)
Pancreatic Hormones and the Treatment of Diabetes Mellitus	513	(22)
Structure and Function of the Endocrine Pancreas	513	(1)
Insulin	514	(2)
Cellular Mechanism of Insulin Action	514	(2)
Glucagon	516	(1)
Control of Insulin and Glucagon Release	516	(1)
Diabetes Mellitus	517	(3)
Type 1 Diabetes	518	(1)
Type 2 Diabetes	518	(1)
Effects and Complications of Diabetes Mellitus	519	(1)
Use of Insulin in Diabetes Mellitus	520	(4)
Therapeutic Effects and Rationale for Use	520	(1)
Insulin Preparations	521	(1)
Administration of Insulin	522	(1)
Intensive Insulin Therapy	523	(1)
Adverse Effects of Insulin Therapy	523	(1)
Oral Antidiabetic Drugs	524	(2)
Sulfonylureas	524	(2)
Other Orally Active Drugs	526	(1)
Other Drugs Used in the Management of Diabetes Mellitus	526	(1)
Glucagon	526	(1)
Immunosuppressants	526	(1)
Aldose Reductase Inhibitors	527	(1)
Nonpharmacologic Intervention in Diabetes Mellitus	527	(1)
Dietary Management and Weight Reduction	527	(1)
Exercise	528	(1)
Tissue Transplants and Gene Therapy	528	(1)
Significance of Diabetes Mellitus in Rehabilitation	528	(1)
Case Study	529	(6)
Diabetes Mellitus	529	(6)
SECTION VIII Chemotherapy of Infectious and Neoplastic Diseases	535	(115)
Treatment of Infections I: Antibacterial Drugs	537	(30)
Bacteria: Basic Concepts	538	(1)
Bacterial Structure and Function	538	(1)
Pathogenic Effects of Bacteria	538	(1)
Bacterial Nomenclature and Classification	538	(1)
Treatment of Bacterial Infections: Basic Principles	539	(1)
Spectrum of Antibacterial Activity	539	(1)
Bactericidal versus Bacteriostatic Activity	540	(1)
Basic Mechanisms of Antibacterial Drugs	540	(2)
Inhibition of Bacterial Cell Wall Synthesis and Function	540	(2)
Inhibition of Bacterial Protein Synthesis	542	(1)
Inhibition of Bacterial DNA/RNA Synthesis and Function	542	(1)
Specific Antibacterial Agents	542	(2)
Antibacterial Drugs That Inhibit Bacterial Cell Wall Synthesis and Function	544	(9)
Penicillins	544	(2)
Cephalosporins	546	(3)
Other Agents That Inhibit Bacterial Cell Wall Synthesis	549	(4)
Use of Beta-Lactamase Inhibitors	553	(1)
Drugs That Inhibit Bacterial Protein Synthesis	553	(4)
Aminoglycosides	555	(1)
Erythromycin and Other Macrolides	555	(1)
Tetracyclines	556	(1)
Other Agents That Inhibit Bacterial Protein Synthesis	556	(1)
Drugs That Inhibit Bacterial DNA/RNA Synthesis and Function	557	(4)
Aminosalicylic Acid	557	(1)
Clofazimine	558	(1)
Dapsone	558	(1)
Ethambutol	558	(1)
Fluoroquinolones	559	(1)
Metronidazole	559	(1)
Rifampin	560	(1)
Sulfonamides	560	(1)
Trimethoprim	560	(1)
Other Antibacterial Drugs	561	(1)
Capreomycin	561	(1)
Isoniazid	561	(1)
Methenamine	561	(1)
Pyrazinamide	562	(1)
Nitrofurantoin	562	(1)
Clinical Use of Antibacterial Drugs: Relationship to Specific Bacterial Infections	562	(1)
Resistance to Antibacterial Drugs	562	(1)
Special Concerns in Rehabilitation Patients	563	(1)
Case Study	564	(3)
Antibacterial Drugs	564	(3)
Treatment of Infections II: Antiviral Drugs	567	(23)
Viral Structure and Function	567	(3)
Classification of Viruses	567	(1)
Characteristics of Viruses	568	(1)
Viral Replication	569	(1)
Specific Antiviral Drugs	570	(7)
Acyclovir and Valacyclovir	570	(2)
Amantadine and Rimantadine	572	(1)
Cidofovir	573	(1)
Famciclovir and Penciclovir	573	(1)
Foscarnet	573	(1)
Ganciclovir	574	(1)
Protease Inhibitors	574	(1)
Reverse Transcriptase Inhibitors	575	(1)
Ribavirin	576	(1)
Vidarabine	577	(1)
Interferons	577	(3)
Synthesis and Cellular Effects of Interferons	578	(1)
Pharmacologic Applications of Interferons	578	(1)
Adverse Effects of Interferons	579	(1)
Control of Viral Infection with Vaccines	580	(1)
HIV and the Treatment of AIDS	580	(4)
Inhibition of HIV Proliferation in Infected Individuals	581	(1)
Anti-HIV Drug Combinations: Use of Highly Active Antiretroviral Therapy	582	(1)
HIV Vaccines	583	(1)
Management of Opportunistic Infections	584	(1)
Relevance of Antiviral Chemotherapy in Rehabilitation Patients	584	(1)
Case Study	585	(5)
Antiviral Drugs	585	(5)
Treatment of Infections III: Antifungal and Antiparasitic Drugs	590	(20)
Antifungal Agents	590	(7)
Systemic Antifungal Agents	591	(4)
Topical Antifungal Agents	595	(2)
Antiprotozoal Agents	597	(7)
Antimalarial Agents	597	(4)
Drugs Used to Treat Protozoal Infections in the Intestines and Other Tissues	601	(2)
Other Antiprotozoal Drugs	603	(1)
Anthelmintics	604	(3)
Albendazole	604	(1)
Diethylcarbamazine	605	(1)
Ivermectin	605	(1)
Mebendazole	605	(1)
Niclosamide	606	(1)
Oxamniquine	606	(1)
Piperazine Citrate	606	(1)
Praziquantel	606	(1)
Pyrantel Pamoate	607	(1)
Thiabendazole	607	(1)
Significance of Antifungal and Antiparasitic Drugs in Rehabilitation	607	(1)
Case Study	608	(2)
Antifungal Drugs	608	(2)
Cancer Chemotherapy	610	(23)
General Principles	611	(2)
Cytotoxic Strategy	611	(1)
Cell-Cycle-Specific versus Cell-Cycle-Nonspecific Drugs	611	(1)
Concepts of Growth Fraction and Total Cell Kill	612	(1)
Prevalence and Management of Adverse Effects	612	(1)
Specific Drugs	613	(12)
Alkylating Agents	613	(1)
Antimetabolites	613	(4)
Antibiotics	617	(3)
Plant Alkaloids	620	(1)
Hormones	620	(3)
Biologic Response Modifiers	623	(1)
Heavy Metal Compounds	623	(1)
Aspirin and Other NSAIDs	623	(2)
Miscellaneous Agents	625	(1)
Combination Chemotherapy	625	(1)
Use of Anticancer Drugs with other Treatments	625	(2)
Success of Anticancer Drugs	627	(1)
Resistance to Cancer Chemotherapy Drugs	628	(1)
Future Perspectives	628	(1)
Implications of Cancer Chemotherapy in Rehabilitation Patients	629	(1)
Case Study	630	(3)
Cancer Chemotherapy	630	(3)
Immunomodulating Agents	633	(17)
Overview of the Immune Response	634	(2)
Pharmacologic Suppression of the Immune Response	636	(1)
Specific Immunosuppressive Agents	636	(7)
Azathioprine	636	(2)
Cyclophosphamide	638	(1)
Cyclosporine	638	(1)
Glucocorticoids	639	(1)
Methotrexate	640	(1)
Mycophenolate Mofetil	640	(1)
Sulfasalazine	641	(1)
Sirolimus	641	(1)
Tacrolimus	642	(1)
Other Methods of Immunosuppression	642	(1)
Immunostimulants	643	(2)
Bacille Calmette-Guerin	644	(1)
Immune Globulin	644	(1)
Levamisole	645	(1)
Other Immunomodulators	645	(1)
Significance of Immunomodulating Agents in Rehabilitation	645	(1)
Case Study	646	(4)
Immunomodulating Agents	646	(4)
Appendix A: Drugs Administered by Iontophoresis and Phonophoresis	650	(2)
Appendix B: Potential Interactions between Physical Agents and Therapeutic Drugs	652	(3)
Appendix C: Use of the Physicians' Desk Reference	655	(2)
Appendix D: Drugs of Abuse	657	(3)
Appendix E: Common Drug Suffixes	660	(2)
Glossary	662	(9)
Index	671