Medical Pharmacology at a Glance MI CHA EL J . N EA L Professor of Pharmacology Division of Pharmacology and T herapeutics Kings Co llege London The Rayne Institute 51Thoma s's Hospital London F OU RT H ED ITI O N Blackwell Scie nce e I ~M7 . 1~ 2 . 1<N7.2 IMI2 h)' t11 l"~·l1 S, ic"",~ Lid a Bl a< lwd l Puhh,hmg ( ·om ny Editorial OUic" " ().,ne) \l ead.< hlnrd OX2 n iL. t' K T O'I , w IUIIK6.~ 2CII'>:!tlt> Rl"d dl Sde 'C.loc.•. l~l \bin S"""l. \ bkkn. \l .'\021411 -50III.lIS A Td : 17111.'1I111\2~1 Blll, L ~11 Sci~ 'CA,ill Ply. ~ l :ni' il) SII't'C!. C""""'. Victori<1 3(l~3. A"'lrah<1 Td : IIUl.l',H47ll.lCMI Bl, L ~II Wi,,,,·n,,:h.oll, Vc1ia~. K u rf il N ~ II <L " l1 m ~7. 1(1707 fkr!in. Getman) TrI: +4~(OI.lO.l2 NIWI l1le ri~ht nf lhe Author he." Kknl'hC'd <1, .he AU lhorofth is Woo Ila.' bttn "-,-,,,ned in vonJano.'C ilh the: ("op)ri~hl. (~i~n, and r- .l rn h ,0\,1 19l111. All ri~hb n-ed o p;u1 oIth" pul.hullOO II\lIY be n:prod~'Cd. stored m a rellit:. 'aJ 'y"cm . (1f uan"","ed. on;any f<Jmlor h)' ;an)' mean'. O'Ieo uunic:. m~.:hanio.·<11. phoI'''~'Pying.I' e,: nllng , 0lh<-r4-,-e. ""'<'J'I "-' pennil1l."d b) the t'" Copyrillhl. llr'<ill"" and Poumh At.11 ~1I11. '" ilhoul the: prior penn i""", of Ihr l"'b1i>ho."r . fiN puN;, 1'1117 kepn med Itnlll. 1'Il(t,l(1",i'·"I .I'l'ollI . I~l U,,;"'C1 Second C'dllion IW2 Reprimed IW 3 U ; 'CI .I9'.4, I'l'J5(l",i~"I. I'J'Jt> Thirdttlili , 1'1'17 R ~ pri nl . -d 1'l"17. IY'lll. 21M M••21.\1 F oun h ttlili , 2tM 12 Calalo!!"" I'ttor <l' flit lh,,' uuc are lIvailabl from lhe Briti"" Lilmuy and lhe Libral) of Congre", Set in WI I! pl Ti""', h) Or al'h i rall l.ld. H'"'ll Kong Prinled and ht ,l<l in ,,"' at Britain by MI'G B uub Lid. Botlmin Com all For fun her inf" m'ali on 'Ill HI", l wcll S<;ie nec. vi'il nur ,h,iIC: w ,hlaeL ,·II· ·ic",: ·'''n Contents Preface 7 How to use this hook 7 Further reading 7 Introductio n: principles of drug action 8 2 Drug -r ec eptor imeracnons 10 3 Drug absorption, distribution and excretion 12 4 Drug metabolism 14 5 Local anaesthetics 16 fi Drugs acting at the neuromuscular junction 18 7 Autonomic nervous system 20 8 Autonomic drugs acting at cholinergic synapses 22 lJ Drugs acting on the sympathetic sys tem 24 10 Ocular pharmacolog y 26 I I Asthma, hay fever and anaphylaxis 28 12 Drugs acting on the gastrointestinal tract. l: Peptic ulcer 30 13 Drugs acting on the gastrointest inal tract. II: Moti lity and secretions 32 14 Drugs acting on the kidney-cdiuretics 34 15 Drugs used in hypertension 36 16 Drugs usedin angina 3X 17 Antiarrhythmi c drugs 40 18 Drugs used in heart failure 42 19 Drugs used 10affect blood coagu lation 44 20 Lipid-lowering dru gs 46 2 1 Agents used in anaemias 48 22 Ccnrrulrransrniue r substances 50 23 Gene ral anaesthetics 52 24 Anx iolytics and hypnotics 54 25 Aruiepileptic drugs 5(, 26 Drugs used in Parkinson's disease 58 27 Antipsychot ic drugs (ncurolcptics) 6() 2R Drugs used in affective disorders -antid epre ssants 62 29 Opioid analgexics 64 30 Drugs used in nausea and vertigo (untiemetic sj 66 31 Drug misuse and dependence oR 32 Non-steroidal anti-intlamrnutory drugs ( NSAIDs) 70 33 Cortico steroids 72 34 Sex hormones and drugs 74 35 Thyroid and antithyroid drugs 76 36 Antidia betic agents 7X 37 Antibacterial dru gs that inhibit nucleic acid synthesis: sulphonamidcx. rrimcthoprirn. quinolones and nitroimidazoles 80 3M Antibacterial drugs that inhibit cell wall synthesis: penicillin s. cephalosporins and vancomyc in X2 39 Antibacterial drugs that inhibit protein synthesis: amin ogjycoside s. tetrac yclines, macrolidcs and chloramphenicol 84 40 Antifungal and antiviral drugs 10:6 4 1 Drugs acting on parasites. I: Helminths (worms) 88 42 Drugs acting a ll parasites, 1I:Protozoa (} () 43 Drugs used in cancer 92 44 Poisoning 94 45 Adverse drug reactions 96 Index (}H 5 [...]... that predominates in the heart (Chapter 7).lt i, rarely used Pa ncuronlum is an uminoxtcroid neuromuscular blocking drug with a relatively long duration of action It docs nor block gangl ia or cause histamine release However it has a dose-related atropine-like effect on the heart that can produce tachycardia vecurcnlum and au-acurtu m T hese arc commonly used agents Vecuronium has no cardiovascular... apt er 17 Cardiac to xicity probably dtJt:s not occur in subc o nv ulvive d oses Yaccular smoo th musc le Th e loc al effects vary L'oc aine is a vasoconstrictor (because it hloc ks norcpincphine reuptake and potentiates sympat hetic acuvhy) hile procaine is a vasodilato r, \ 10-.1 . ch arc inhibitory. I Pupillary dilat ation (more light reaches the retina). 2: Bronchiolar dilatation rfacituatcs increased ventilation). 3 Hea rt rate and. Medical Pharmacology at a Glance MI CHA EL J . N EA L Professor of Pharmacology Division of Pharmacology and T herapeutics Kings Co llege London The Rayne