Introduction

Clinical pharmacology is the science of drug use in humans. Clinicians of all specialties prescribe drugs on a daily basis, and this is both one of the most useful but also one of the most dangerous activities of our professional lives. Understanding the principles of clinical pharmacology is the basis of safe and effective therapeutic practice, which is why this subject forms an increasingly important part of the medical curriculum. This textbook is addressed primarily to medical students and junior doctors of all specialties, but also to other professionals who increasingly prescribe medicines (including pharmacists, nurses and some other allied professionals). Clinical pharmacology is a fast moving subject and the present edition has been completely revised and updated. It differs from the fourth edition in that it concentrates exclusively on aspects that students should know and understand, rather than including a lot of reference material. This has enabled us to keep its length down. Another feature has been to include many new illustrations to aid in grasping mechanisms and principles. The first section deals with general principles including pharmacodynamics, pharmacokinetics and the various factors that modify drug disposition and drug interaction. We have kept algebraic formulations to a minimum. Drug metabolism is approached from a practical viewpoint, with discussion of the exciting new concept of personalized medicine. Adverse drug reactions and the use of drugs at the extremes of age and in pregnancy are covered, and the introduction of new drugs is discussed from the viewpoint of students who will see manynew treatments introduced during their professional careers. Many patients use herbal or other alternative medicines and there is a new chapter on this important topic. There is a chapter on gene and cell-based therapies, which are just beginning to enter clinical practice. The remaining sections of the book deal comprehensively with major systems (nervous, musculoskeletal, cardiovascular, respiratory, alimentary, renal, endocrine, blood, skin and eye) and with multi-system issues including treatment of infections, malignancies, immune disease, addiction and poisoning

Contents

PART I GENERAL PRINCIPLES

1 Introduction to therapeutics

2 Mechanisms of drug action (pharmacodynamics) 

3 Pharmacokinetics 

4 Drug absorption and routes of administration

5 Drug metabolism

6 Renal excretion of drugs

7 Effects of disease on drug disposition 

8 Therapeutic drug monitoring 

9 Drugs in pregnancy 

10 Drugs in infants and children 

11 Drugs in the elderly 

12 Adverse drug reactions 

13 Drug interactions 

14 Pharmacogenetics 

15 Introduction of new drugs and clinical trials 

16 Cell-based and recombinant DNA therapies 

17 Alternative medicines: herbals and

nutraceuticals 

PART II THE NERVOUS SYSTEM 

18 Hypnotics and anxiolytics 

19 Schizophrenia and behavioural emergencies 

20 Mood disorders 

21 Movement disorders and degenerative 

disease 

22 Anti-epileptics 

23 Migraine 

24 Anaesthetics and muscle relaxants 

25 Analgesics and the control of pain 

PART III THE MUSCULOSKELETAL SYSTEM 

26 Anti-inflammatory drugs and the treatment

of arthritis 

PART IV THE CARDIOVASCULAR SYSTEM 

27 Prevention of atheroma: lowering plasma

cholesterol and other approaches 

28 Hypertension 

29 Ischaemic heart disease 

30 Anticoagulants and antiplatelet drugs 

31 Heart failure 

32 Cardiac dysrhythmias

PART V THE RESPIRATORY SYSTEM

33 Therapy of asthma, chronic obstructive pulmonary

disease (COPD) and other respiratory disorders

PART VI THE ALIMENTARY SYSTEM

34 Alimentary system and liver

35 Vitamins and trace elements

PART VII FLUIDS AND ELECTROLYTES

36 Nephrological and related aspects

PART VIII THE ENDOCRINE SYSTEM

37 Diabetes mellitus

38 Thyroid

39 Calcium metabolism

40 Adrenal hormones

41 Reproductive endocrinology

42 The pituitary hormones and related drugs

PART IX SELECTIVE TOXICITY

43 Antibacterial drugs

44 Mycobacterial infections

45 Fungal and non-HIV viral infections

46 HIV and AIDS

47 Malaria and other parasitic infections

48 Cancer chemotherapy

PART X HAEMATOLOGY

49 Anaemia and other haematological disorders

PART XI IMMUNOPHARMACOLOGY

50 Clinical immunopharmacology

PART XII THE SKIN

51 Drugs and the skin

PART XIII THE EYE

52 Drugs and the eye

PART XIV CLINICAL TOXICOLOGY

53 Drugs and alcohol abuse

54 Drug overdose and poisoning

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