Pharmacology An Introduction Henry Hitner, Ph.D. Department Neuroscience, Physiology, Philadelphia College of Osteopathie Medicine Philadelphia, Pennsylvania Adjunct Professor, Pharmacology Physician Assistant Program Drexel University Philadelphia, Pennsylvania Barbara Nagle, Ph.D. President Clinical Research Development and Education III Associates \ Pennsylvania ) Learn _
PART General Concepts 3 CHAPTER Pharmacology: An Introduction 4 Drug Sources 6 Terminology Related to Drug Effects 6 Basic Concepts in Pharmacology 7 Dose-Response Curve 8 Drug Safety 9 Drug Nomenclature 10 Drug References 13 CHAPTER 2 Pharmacokinetics and Factors of Individual Variation Drug Routes of Administration 19 Drug Absorption 20 Drug 21 Drug Metabolism 22 Drug Excretion 22 23 Drug Levels 24 Bioavailability 24 Factors of Individual Variation 25 Considerations for Pediatrics 26 Drug Interactions 28 Terminology Associated with Chronic Drug Use and Abuse 28 30 CHAPTER 3 Pharmacology 36 Drug Use in the Elderly 37 Drug Absorption 37 Drug Metabolism and Excretion 38 Effects of Age on Drug Response 38 Drug Compliance in the Elderly 40 42
CHAPTER 4 Math Review and Dosage Calculations 45 Fractions, and Percents 46 Dosage Calculations 48 Systems of 48 Calculating Dosages 50 Pediatric Dosage Calculations 51 Monitoring IV Infusion Rates 52 54 PART 2 Pharmacology of the Peripheral System 59 CHAPTER 5 Introduction to the Nervous System 60 Nervous System Organization 61 Overview of the ANS 62 Parasympathetic and Divisions 62 Cholinergic and Adrenergic Receptors 67 68 CHAPTER 6 Drugs Affecting the Sympathetic Nervous System 72 Adrenergic Nerve Endings 73 Adrenergic Receptors 74 Drugs 75 Beta-Adrenergic Drugs 77 Alpha-Adrenergic Blocking Drugs 79 Beta-Adrenergic Blocking Drugs 80 Adrenergic Neuronal Blocking Drugs 82 86 CHAPTER 7 Drugs Affecting the Parasympathetic Nervous System Cholinergic Nerve Activity 92 Cholinergic Receptors 92 Cholinergic Drugs 94 Clinical Indications for AntiCholinesterase Drugs 97 Anticholinergic Drugs 99 Preferred for Selected Conditions 102 vi Table of
CHAPTER 8 Drugs Affecting the Ganglionic Stimulants 108 Ganglionic Blockers Adverse Effects of Ganglionic Blockers 112 CHAPTER 9 Skeletal Muscie Relaxants 115 Relaxants 117 Clinical Indications 117 Peripherally Acting Skeletal Muscle Relaxants 117 Adverse and Toxic Effects Direct-Acting Skeletal Muscle Relaxants 122 Centrally Acting Skeletal Muscle Relaxants (Spasmolytics) CHAPTER 10 Anesthetics 131 Mechanism of Action Pharmacology 133 Administration 134 Adverse Effects Clinical Applications and Preferred 141 3 Pharmacology of the Central Nervous System 147 CHAPTER 11 Introduction to the Central Nervous System Structural and Functional Features of the Brain Diencephalon and Brainstem 150 151 Spinal Cord 151 Functional Components 151 153
CHAPTER 12 Sedative-Hypnotic Drugs and Alcohol Cycle Mechanism of Action of Sedative-Hypnotic Drugs 160 Sedatives and Hypnotics 160 Benzodiazepines 163 Miscellaneous Hypnotic Drugs Alcohol 166 CHAPTER 13 Antipsychotic and Antianxiety Drugs 173 Antipsychotic Drugs 174 Antianxiety Drugs CHAPTER Antidepressants, Stimulants, and Lithium Types of Depression Drugs Used to Treat Depression 190 Monoamine Oxidase Inhibitors Psychomotor Stimulants Lithium 196 Preferred Therapy for Depression, Mania, and Bipolar Disorder 197 CHAPTER 15 Drugs of Abuse 203 LSD-Type Hallucinogens 204 Psychomotor Stimulants 205 Miscellaneous Psychotomimetic Drugs 209 212 CHAPTER 16 Antiepileptic Drugs Types of Epilepsy Drugs Effective for Both Generalized and Partial Seizures 21) Drugs Effective for Partial Seizures 222 Drugs Used in the Treatment of Absence Seizures 222 Treatment of Status Epilepticus 223 Preferred Therapy for Epileptic Seizures 223 225
CHAPTER 17 Antiparkinson Drugs 229 Neurotransmitters Affecting the Basal Ganglia 230 Levodopa 230 Enzyme Inhibitors That Increase the Actions of Levodopa 234 Dopamine Receptor Agonists 235 Miscellaneous Drugs 236 Preferred Therapy for Parkinson's Disease 237 238 CHAPTER 18 General Anesthetics 243 General Anesthesia 245 General Anesthetics 247 Mechanism of Action 253 Physiological Effects of Anesthetics 254 Adjuncts to General Anesthesia 257 Special Considerations and Cautions 261 Preferred Use of Anesthetics 263 264 CHAPTER 19 Opioid Analgesics 268 Pain 270 Opioid Analgesics Drug Administration 277 Adverse Effects, Tolerance, and Physical Dependence 279 Opioid Antagonists and Respiratory Depression Opioid Antitussives 282 Drug Interactions 283 287 CHAPTER 20 Analgesics, Nonsteroidal and Antigout Drugs 292 Inflammation and Drug Action 293 Nonopioid Analgesics: Salicylates (Aspirin) 296 Acetaminophen 303 Other Nonsteroidal Antiinflammatory Drugs (NSAIDS) 305 Drugs in Treating Gout 309 Drug Interactions Preferred Therapy 313 315
Preferred Treatment with Anticoagulants and 429 430 432 CHAPTER 28 Nutrition and Therapy 436 Nutrients 437 Vitamins 442 Vitamins 443 Vitamins 447 Body Water 449 Minerals 449 454 CHAPTER 29 Hypolipidemic Drugs 459 Atherosclerosis and Arterial Disease 461 Hypolipidemic/Antilipemic Drugs 465 Other Hypolipidemic Drugs 469 Preferred Therapy Contraindications and Pregnancy 472 Drug Interactions 472 475 CHAPTER 30 Antianemics 480 Causes of Deficiency Anemia 482 Anemia 487 Acid Deficiency 488 Erythropoietin Stimulating Agents 490 493 6 Drugs That Affect the Respiratory System 499 CHAPTER 31 Antihistaminic Drugs and Mast Cell Release Inhibitors 500 Action of Histamine 502 Mast Cell Release Inhibitors 504 Antagonists 507 xii Table of Contents
CHAPTER 32 Respiratory Pharmacology, Treatment of Asthma, and COPD 520 Respiratory Diseases 521 Role of the Nervous System 524 Bronchodilator Drugs 525 Antiinflammatory Drugs 528 Antiallergic Agents 530 Mucolytics and Expectorants 530 Preferred Therapy for Asthma and COPD 532 PART 7 Pharmacology of the Gl Tract 537 CHAPTER 33 Therapy of Gastrointestinal Disorders: Peptic GERD, and Vomiting 538 Digestion and Production 539 Management of Ulcers 542 Management of Gastroesophageal Reflux Disease (GERD) 543 Antisecretory Drugs: Receptor-Mediated Drug Action 543 Acid Neutralization: Antacids 553 Barrier Enhancers: Sucralfate 555 Management of Emesis 556 563 CHAPTER 34 Agents That Affect Intestinal Motility 567 Bowel Function 569 Antidiarrheals 569 Laxatives and Cathartics 573 579 Pharmacology of the Endocrine System 585 CHAPTER 35 Introduction to the Endocrine System 586 Endocrine System 587 Axis 589 Anterior Pituitary Growth Hormone 595
CHAPTER 36 Adrenal Steroids 599 Regulating Adrenocorticoid Secretions 600 Glucocorticoids 602 Mineralocorticoids 609 Special Considerations Drug Interactions CHAPTER 37 Gonadal Hormones, Oral Contraceptives, and Dysfunction Drugs 617 Female Sex Hormones Hormonal Therapy (HRT) 622 Fertility Drugs 630 Male Sex Hormones (Androgens) 632 Erectiie Dysfunction 636 640 CHAPTER 38 Drugs Affecting the Thyroid and Parathyroid Glands and Bone Degeneration 644 Thyroid Function, Pharmacology, and Disorders 646 Parathyroid Hormones 652 Degenerative Bone Disease: Osteoporosis 654 660 CHAPTER 39 Pancreatic Hormones and Antidiabetic Drugs 665 Pancreatic Endocrine Function 667 Diabetes Mellitus 670 Treatment of Diabetes 672 Parenteral Antidiabetic Drugs: Insulin 673 Oral Antidiabetic Drugs: Secretagogues, 682 Other Oral Drugs 686 692 CHAPTER 40 Posterior Pituitary Hormones: Antidiuretic Hormone and Oxytocin 697 Posterior Pituitary Hormones 698 Antidiuretic Hormone 699 Drugs Affecting Uterine Muscle 702 Tocolytics 703 705 xiv Table of Contents
Pharmacology of Infectious Diseases 711 CHAPTER 41 Antibacterial Agents 712 Morphology of Bacteria 713 Chemotherapy 714 Penicillins 716 Cephalosporins 719 Aminoglycosides 721 Tetracyclines 722 Sulfonamides 723 Antibiotics 724 Fluoroquinolone Antimicrobials 725 Miscellaneous Antimicrobial Drugs 726 Drugs Used to Treat Tuberculosis 727 Preferred Therapy for Selected Infections 728 730 CHAPTER 42 Antifungol and Antiviral Drugs 735 Fungal Infections and Antifungol Drugs 737 Viral Diseases 748 Antiviral Drugs 754 Drug Interactions 763 765 CHAPTER 43 Parasitic Infections: Antiprotozoal and Anthelmintic Drugs 769 Protozoal Infections 770 Malaria 771 Dysentery 774 Other Protozoal Infections 776 Anthelmintic Drugs 778 CHAPTER 44 Antiseptics and Disinfectants 786 Antisepsis and Disinfection 787 Antiseptics and Disinfectants 793 797
PART Antineoplastics and Drugs Affecting the Immune System 801 CHAPTER 45 Agents 802 Types of Cancer 803 Alkylating Drugs 805 Antimetabolites 808 Drugs Derived from Natural Products Hormone Antagonists New Approaches to Cancer Chemotherapy 814 CHAPTER 46 Immune System 822 Drugs 825 Drugs 828 830 835 Appendix A Latin Abbreviations Used in Medicine 850 Appendix B Abbreviations and Symbols Commonly Used in index 857 Table of Contents