Medical Pharmacology and Therapeutics

OFC
IFC
Half Title
Dedication
Title
Copyright
Contents
Preface
Drug Dosage and Nomenclature
1 - Principles of Pharmacology and Mechanisms of Drug Action
STUDYING PHARMACOLOGY
FINDING DRUG INFORMATION
RECEPTORS AND RECEPTOR-MEDIATED MECHANISMS
ACTIONS OF DRUGS AT BINDING SITES (RECEPTORS)
MAJOR TYPES OF RECEPTORS
Transmembrane Ion Channels
Seven-Transmembrane Receptors
The G-protein system
Second messenger systems
Cyclic nucleotide system
The phosphatidylinositol system
Protease-activated receptors
Enzyme-Linked Transmembrane Receptors
Intracellular (Nuclear) Receptors
OTHER SITES OF DRUG ACTION
PROPERTIES OF RECEPTORS
Receptor Binding
Receptor Selectivity
Drug Stereochemistry and Activity
Receptor Numbers
PROPERTIES OF DRUG ACTION
DOSE–RESPONSE RELATIONSHIPS
SELECTIVITY
POTENCY
EFFICACY
TYPES OF DRUG ACTION
AGONISTS
Affinity and Intrinsic Activity
Spare Receptors
ANTAGONISTS
PARTIAL AGONISTS
INVERSE AGONISTS
ALLOSTERIC MODULATORS
ENZYME INHIBITORS AND ACTIVATORS
NONSPECIFIC ACTIONS
PHYSIOLOGICAL ANTAGONISTS
TOLERANCE TO DRUG EFFECTS
GENETIC VARIATION IN DRUG RESPONSES
SUMMARY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
FURTHER READING
2 - Pharmacokinetics
THE BIOLOGICAL BASIS OF CLINICAL PHARMACOKINETICS
GENERAL CONSIDERATIONS
Passage Across Membranes
Passive diffusion
Passage through membrane pores or ion channels
Carrier-mediated processes
Pinocytosis
Drug Ionisation and Membrane Diffusion
ABSORPTION
ABSORPTION FROM THE GUT
Drug Structure
Drug Formulation
Gastric Emptying
First-Pass Metabolism
Intestinal lumen
Intestinal wall
Liver
Lung
ABSORPTION FROM OTHER ROUTES
Percutaneous (Transcutaneous) Administration
Intradermal and Subcutaneous Injection
Intramuscular Injection
Intranasal Administration
Inhalation
Minor Routes
DISTRIBUTION
REVERSIBLE PROTEIN BINDING
IRREVERSIBLE PROTEIN BINDING
DISTRIBUTION TO SPECIFIC TISSUES
Brain
Fetus
ELIMINATION
METABOLISM
Phase 1
Phase 2
Factors Affecting Drug Metabolism: Inducers and Inhibitors
EXCRETION
Excretion via the Urine
Glomerular filtration
Reabsorption
Tubular secretion
Excretion Via the Faeces
THE MATHEMATICAL BASIS OF CLINICAL PHARMACOKINETICS
GENERAL CONSIDERATIONS
Zero-Order Reactions
First-Order Reactions
ABSORPTION
Rate of Absorption
Extent of Absorption
DISTRIBUTION
Rate of Distribution
Extent of Distribution
ELIMINATION
Rate of Elimination
The activity of the organ of elimination
Reversible passage of drug from the blood into tissues
Extent of Elimination
CHRONIC ADMINISTRATION
Time to Reach Steady State
Plasma Concentration at Steady State
Oral Administration
Loading Dose
PHARMACOKINETICS OF BIOLOGICAL DRUGS
GENETIC VARIATION AND PHARMACOKINETICS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
DESCRIPTIVE QUESTION
CASE-BASED QUESTIONS
Case 1
Case 2
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
DESCRIPTIVE ANSWERS
CASE-BASED ANSWERS
Case 1 Answer
Case 2 Answer
FURTHER READING
3 - Drug Discovery, Safety and Efficacy
DRUG DISCOVERY
DRUG APPROVAL
SAFETY
QUALITY
EFFICACY
ESTABLISHING SAFETY AND EFFICACY
PRECLINICAL STUDIES
TOXICITY TESTING
CLINICAL TRIALS: PHASES I–III
Phase I Studies
Phase II Studies
Phase III Studies
Postmarketing Surveillance: Phase IV (Pharmacovigilance)
SELF-ASSESSMENT
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
OBA ANSWERS
FURTHER READING
4 - Neurotransmission and the Peripheral Autonomic Nervous System
THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS
PRINCIPLES OF NEUROTRANSMISSION
PRESYNAPTIC RECEPTORS AND MODULATION OF TRANSMITTER RELEASE
THE PERIPHERAL AUTONOMIC NERVOUS SYSTEM
THE SYMPATHETIC NERVOUS SYSTEM AND NORADRENERGIC TRANSMISSION
SYNTHESIS AND STORAGE OF CATECHOLAMINES: NORADRENALINE, ADRENALINE AND DOPAMINE
NORADRENALINE RELEASE
UPTAKE AND METABOLISM OF RELEASED NORADRENALINE
Monoamine Oxidase
Catechol-O-Methyltransferase
SYMPATHETIC NERVOUS SYSTEM RECEPTORS
THE PARASYMPATHETIC NERVOUS SYSTEM AND CHOLINERGIC TRANSMISSION
SYNTHESIS OF ACETYLCHOLINE
STORAGE OF ACETYLCHOLINE
RELEASE OF ACETYLCHOLINE
METABOLISM AND INACTIVATION OF RELEASED ACETYLCHOLINE
CHOLINERGIC RECEPTORS
Nicotinic N1 (or NG) Receptors
Nicotinic N2 (or NM) Receptors
Muscarinic Receptors
OTHER TRANSMITTERS IN THE PERIPHERAL NERVOUS SYSTEM
AMINES
Dopamine
Synthesis and storage of dopamine
Release of dopamine
Removal of activity of released dopamine
Dopamine receptors
Serotonin (5-Hydroxytryptamine)
Synthesis of serotonin
Storage of serotonin
Release of serotonin
Metabolism and removal of serotonin activity
Serotonin receptors
Histamine
Synthesis of histamine
Storage of histamine
Release of histamine
Removal of histamine activity
Histamine receptors
AMINO ACIDS
γ-Aminobutyric Acid
Synthesis and storage of γ-aminobutyric acid
Release of γ-aminobutyric acid
Removal of γ-aminobutyric acid activity
γ-Aminobutyric acid receptors
Glutamate
Synthesis and storage of glutamate
Release of glutamate
Removal of glutamate activity
Glutamate receptors
Glycine
Synthesis and storage of glycine
Release of glycine
Removal of glycine activity
Glycine receptors
Imidazoline receptor ligands
PEPTIDES
PURINES
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
5 - Ischaemic Heart Disease
MYOCARDIAL PERFUSION
CLINICAL MANIFESTATIONS OF MYOCARDIAL ISCHAEMIA
STABLE ANGINA PECTORIS
ACUTE CORONARY SYNDROMES (UNSTABLE ANGINA, MYOCARDIAL INFARCTION AND SUDDEN CARDIAC DEATH)
Unstable Angina
Myocardial Infarction and Sudden Cardiac Death
DRUGS FOR TREATING ANGINA
ORGANIC NITRATES
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
BETA-ADRENOCEPTOR ANTAGONISTS (β-BLOCKERS)
Mechanism of Action and Effects in Angina
Pharmacokinetics
Unwanted Effects
CALCIUM CHANNEL BLOCKERS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
POTASSIUM CHANNEL OPENERS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
SPECIFIC SINUS NODE INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
LATE SODIUM CURRENT INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF STABLE ANGINA
MANAGEMENT OF ACUTE CORONARY SYNDROMES
EARLY MANAGEMENT OF NON-ST ELEVATION ACUTE CORONARY SYNDROMES (NSTE-ACS)
EARLY MANAGEMENT OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
SECONDARY PROPHYLAXIS AFTER MYOCARDIAL INFARCTION
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
STABLE ANGINA
ACUTE CORONARY SYNDROMES
6 - Systemic and Pulmonary Hypertension
SYSTEMIC HYPERTENSION
CIRCULATORY REFLEXES AND THE CONTROL OF SYSTEMIC BLOOD PRESSURE
AETIOLOGY AND PATHOGENESIS OF SYSTEMIC HYPERTENSION
CONSEQUENCES OF HYPERTENSION
ANTIHYPERTENSIVE DRUGS
DRUGS AFFECTING THE RENIN–ANGIOTENSIN SYSTEM
Angiotensin-converting enzyme (ACE) inhibitors
Mechanisms of action and uses
Pharmacokinetics
Unwanted effects
Angiotensin II Receptor Antagonists
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Direct Renin Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Vasodilators
Diuretics
Mechanism of action in hypertension
Thiazide and thiazide-type diuretics
Loop diuretics
Potassium-sparing diuretics
Calcium Channel Blockers
Potassium Channel Openers
Mechanism of action
Pharmacokinetics
Unwanted effects
Hydralazine
Mechanism of action
Pharmacokinetics
Unwanted effects
Nitrovasodilators
Mechanism of action
Pharmacokinetics
Unwanted effects
Drugs Acting on the Sympathetic Nervous System
Beta-adrenoceptor antagonists
Mechanism of action in hypertension
Alpha-adrenoceptor antagonists (α-blockers)
Mechanisms of action and uses
Pharmacokinetics
Unwanted effects
Centrally acting antihypertensive drugs
Selective imidazoline receptor agonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Centrally acting α2-adrenoceptor agonists
Mechanisms of action
Pharmacokinetics
Unwanted effects
TREATMENT OF SYSTEMIC HYPERTENSION
Drug Regimens in Hypertension
Resistant and refractory hypertension
Additional treatment to reduce risk of vascular complications
Hypertension in Special Groups
Accelerated or malignant hypertension and hypertensive emergency
Renal artery stenosis
Diabetic nephropathy
Phaeochromocytoma
Primary hyperaldosteronism
Pregnancy
PULMONARY ARTERIAL HYPERTENSION
DRUGS FOR TREATING IDIOPATHIC PULMONARY HYPERTENSION
Endothelin Receptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Prostaglandins
Selective Prostacyclin Receptor Agonist
Mechanism of action
Pharmacokinetics
Unwanted effects
Phosphodiesterase-5 Inhibitors
Guanylate Cyclase Stimulator
Mechanism of action
Pharmacokinetics
MANAGEMENT OF PULMONARY ARTERIAL HYPERTENSION
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
EXTENDED-MATCHING-ITEM QUESTION
CASE-BASED QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWER
FURTHER READING
Systemic Hypertension
Pulmonary Arterial Hypertension
7 - Heart Failure and Shock
MAINTENANCE OF CARDIAC OUTPUT
PATHOPHYSIOLOGY OF HEART FAILURE
ACUTE LEFT VENTRICULAR FAILURE
CHRONIC HEART FAILURE
ROLE OF CALCIUM IN CARDIAC CONTRACTION
SHOCK
PATHOPHYSIOLOGY OF SHOCK
Cardiogenic Shock
Distributive (Vasodilatory) Shock
INOTROPIC AND SYMPATHOMIMETIC DRUGS FOR THE TREATMENT OF HEART FAILURE AND SHOCK
CARDIAC GLYCOSIDES
Mechanism of Action and Effects
Effect on myocardial contractility
Effects on cardiac action potential and intracardiac conduction
Pharmacokinetics
Unwanted Effects
Exacerbating Factors for Cardiac Glycoside Toxicity
Treatment of Cardiac Glycoside Toxicity
SYMPATHOMIMETICS
Mechanisms of Action and Effects
Pharmacokinetics
Unwanted Effects
PHOSPHODIESTERASE INHIBITORS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITORS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF HEART FAILURE
ACUTE LEFT VENTRICULAR FAILURE
CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION
Nonpharmacological Treatment
Diuretics
Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists
Beta-Adrenoceptor Antagonists
Sacubitril Valsartan
Ivabradine
Digoxin
Other Vasodilators
Cardiac Resynchronisation Therapy and Implantable Cardioverter Defibrillators
HEART FAILURE WITH PRESERVED EJECTION FRACTION
MANAGEMENT OF SHOCK
Cardiogenic Shock
Distributive (Vasodilatory) Shock
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
8 - Cardiac Arrhythmias
BASIC CARDIAC ELECTROPHYSIOLOGY
PACEMAKER ACTIVITY OF CELLS IN THE SPECIALISED CONDUCTING SYSTEM
CONTROL OF DEPOLARISATION IN PACEMAKER AND NONPACEMAKER CELLS
CONTROL OF CELL REPOLARISATION IN PACEMAKER AND NONPACEMAKER CELLS
MECHANISMS OF TACHYARRHYTHMOGENESIS
MECHANISMS OF ACTION AND CLASSIFICATION OF ANTIARRHYTHMIC DRUGS
VAUGHAN-WILLIAMS CLASSIFICATION
Class I
Class II
Class III
Class IV
Unclassified Drugs
PROARRHYTHMIC ACTIVITY OF ANTIARRHYTHMIC DRUGS
CLASS IA DRUGS
Pharmacokinetics
Unwanted effects
CLASS IB DRUGS
Pharmacokinetics
Unwanted effects
CLASS IC DRUGS
Flecainide
Pharmacokinetics
Unwanted effects
Propafenone
Pharmacokinetics
Unwanted effects
CLASS II DRUGS
Beta-Adrenoceptor Antagonists
Pharmacokinetics
CLASS III DRUGS
Amiodarone
Pharmacokinetics
Unwanted effects
Sotalol
Pharmacokinetics
Unwanted effects
CLASS IV DRUGS
Calcium Channel Blockers
OTHER DRUGS FOR CARDIAC RHYTHM DISTURBANCES
Cardiac Glycosides
Adenosine
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Atropine Sulfate and Glycopyrronium Bromide
Magnesium Sulfate
DRUG TREATMENT OF ARRHYTHMIAS
SUPRAVENTRICULAR TACHYARRHYTHMIAS
Atrial Premature Beats
Focal Atrial Tachycardia
Atrial Flutter
Atrial Fibrillation
Avoiding stroke
Better symptom control
Junctional (Nodal) Tachycardias
Immediate Management of Narrow-Complex Tachycardia of Uncertain Origin
VENTRICULAR TACHYARRHYTHMIAS
Ventricular Ectopic Beats
Ventricular Tachycardia
Ventricular Fibrillation
BRADYCARDIAS
Sinus Bradycardia
Atrioventricular (AV) Block (‘Heart Block’)
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
9 - Cerebrovascular Disease and Dementia
STROKE
AETIOLOGY
Ischaemic Strokes and Transient Ischaemic Attacks
Haemorrhagic Strokes
PREVENTION AND TREATMENT OF STROKE
Primary Prevention of Ischaemic Stroke
Acute Reperfusion Therapy for Ischaemic Stroke
Secondary Prevention of Recurrent Ischaemic Stroke
Primary Prevention of Haemorrhagic Stroke
Acute Treatment of Haemorrhagic Stroke
Secondary Prevention of Recurrent Haemorrhagic Stroke
SUBARACHNOID HAEMORRHAGE
DRUGS FOR SUBARACHNOID HAEMORRHAGE
Nimodipine
Pharmacokinetics
Unwanted effects
MANAGEMENT OF SUBARACHNOID HAEMORRHAGE
DEMENTIA
ALZHEIMER’S DISEASE
Drugs for Alzheimer’s Disease
Anticholinesterases
Mechanisms of action and effects
Pharmacokinetics
Unwanted effects
N-methyl-d-aspartate receptor antagonists
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Treatment of Alzheimer’s Disease
VASCULAR DEMENTIA
Treatment of Vascular Dementia
DEMENTIA WITH LEWY BODIES
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
Stroke
Subarachnoid Haemorrhage
Dementia
10 - Peripheral Artery Disease
ATHEROMATOUS PERIPHERAL ARTERY DISEASE
SYMPTOMS OF PERIPHERAL ARTERY DISEASE
DRUGS FOR PERIPHERAL ARTERY DISEASE
Naftidrofuryl Oxalate
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Cilostazol
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF INTERMITTENT CLAUDICATION
Nonpharmacological Treatment
Pharmacological Treatment
Surgical Treatment
ACUTE AND CRITICAL LIMB ISCHAEMIA
MANAGEMENT OF ACUTE AND CRITICAL LIMB ISCHAEMIA
RAYNAUD’S PHENOMENON
MANAGEMENT OF RAYNAUD’S PHENOMENON
Nonpharmacological Treatment
Pharmacological Treatment
Arterial vasodilators
Drugs acting primarily on blood components
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
11 - Haemostasis
PLATELETS AND PLATELET AGGREGATION
BLOOD COAGULATION AND THE COAGULATION CASCADE
ARTERIAL AND VENOUS THROMBOSIS
ANTIPLATELET DRUGS
CYCLOOXYGENASE INHIBITORS
Mechanism of Action on Platelets
PHOSPHODIESTERASE INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted Effects
ADENOSINE DIPHOSPHATE (ADP) RECEPTOR ANTAGONISTS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
GLYCOPROTEIN IIB-IIIA RECEPTOR ANTAGONISTS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
Epoprostenol
Mechanism of Action
Pharmacokinetics
Unwanted Effects
CLINICAL USES OF ANTIPLATELET DRUGS
ANTICOAGULANT DRUGS
INJECTABLE ANTICOAGULANTS
Heparins
Mechanism of action and effects
Pharmacokinetics
Unfractionated heparin
Low-molecular-weight heparins
Control of heparin therapy
Unwanted effects
Fondaparinux
Mechanism of action
Pharmacokinetics
Unwanted effects
ORAL ANTICOAGULANTS
Vitamin K Antagonists
Mechanism of action
Pharmacokinetics
Monitoring of oral vitamin K antagonist therapy
Unwanted effects
Direct-Acting (Non–Vitamin K-Dependent) Oral Anticoagulants
Direct factor Xa inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Direct thrombin inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
CLINICAL USES OF ANTICOAGULANTS
VENOUS THROMBOEMBOLISM
Prevention of Deep Vein Thrombosis
Mechanical methods
Low-dose subcutaneous heparin
Oral anticoagulants
Treatment of Established Venous Thromboembolism
Therapeutic anticoagulation
Surgical venous thrombectomy
Thrombolysis
ANTICOAGULATION FOR ARTERIAL THROMBOEMBOLISM
THE FIBRINOLYTIC SYSTEM
FIBRINOLYTIC (THROMBOLYTIC) AGENTS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
Clinical Uses of Fibrinolytic Agents
ANTIFIBRINOLYTIC AND HAEMOSTATIC AGENTS
Antifibrinolytic Agents
Mechanisms of action
Pharmacokinetics
Unwanted effects
Desmopressin
CLINICAL USES OF ANTIFIBRINOLYTIC AND HAEMOSTATIC AGENTS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
Antiplatelet Agents
Anticoagulants
Fibrinolytic Drugs
Haemostatic Drugs
12 - Asthma and Chronic Obstructive Pulmonary Disease
ASTHMA
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DRUGS FOR ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DRUG DELIVERY TO THE LUNG
Pressurised Metered-Dose Inhaler
Pressurised Metered-Dose Inhaler with a Spacer
Dry-Powder Inhaler
Nebulisers
SYMPTOM-RELIEVING DRUGS FOR AIRFLOW OBSTRUCTION (BRONCHODILATORS; ‘RELIEVERS’)
β2-Adrenoceptor Agonists
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Antimuscarinics
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Methylxanthines
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Magnesium Sulfate
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
ANTIINFLAMMATORY DRUGS FOR AIRWAYS OBSTRUCTION (‘PREVENTERS’)
Corticosteroids
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Leukotriene Receptor Antagonist
Mechanisms of action and effects
Pharmacokinetics
Unwanted effects
Phosphodiesterase Type 4 Inhibitor
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Antibodies Targeting Type 2 Inflammatory Cytokines and IgE
Mechanism of action
Pharmacokinetics
Unwanted effects
Macrolide Antibiotics
Cromones
Pharmacokinetics
Unwanted effects
MANAGEMENT OF ASTHMA
ACUTE ASTHMA
PROPHYLAXIS OF CHRONIC ASTHMA
ASPIRIN-INTOLERANT ASTHMA
MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
EXTENDED-MATCHING-ITEM QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
General
Asthma
Chronic Obstructive Pulmonary Disease
13 - Respiratory Disorders: Cough, Respiratory Stimulants, Cystic Fibrosis, Idiopathic Pulmonary Fibrosis and Neonatal Re ...
COUGH
DRUGS FOR TREATMENT OF COUGH
Antitussives (Cough Suppressants)
Centrally acting drugs (opioids)
Peripherally acting drugs
Locally acting drugs
Expectorants
Mucolytics
MANAGEMENT OF COUGH
RESPIRATORY STIMULANTS (ANALEPTIC DRUGS)
CYSTIC FIBROSIS
CFTR MODULATORS
Mechanism of Action and Uses
Pharmacokinetics
Unwanted effects
Treatment of Lung Disease
Treatment of Malabsorption
IDIOPATHIC PULMONARY FIBROSIS
NEONATAL RESPIRATORY DISTRESS SYNDROME
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
FURTHER READING
Cough
Cystic Fibrosis
Idiopathic Pulmonary Fibrosis
Neonatal Respiratory Distress Syndrome
14 - Diuretics
FUNCTIONS OF THE KIDNEY
THE KIDNEY AND MAINTENANCE OF SALT AND WATER BALANCE
The Proximal Convoluted Tubule
The Loop of Henle
The Distal Convoluted Tubule
The Connecting Tubule and the Collecting Ducts
Autoregulation of Glomerular Perfusion by Tubulo-Glomerular Feedback And Hormonal Control
DIURETIC DRUGS
LOOP DIURETICS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
THIAZIDE AND RELATED DIURETICS
Mechanisms of Action and Effects
Pharmacokinetics
Unwanted Effects
POTASSIUM-SPARING DIURETICS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
CARBONIC ANHYDRASE INHIBITORS
Mechanism of Action and Uses
Pharmacokinetics
Unwanted Effects
OSMOTIC DIURETIC
Mechanism of Action and Uses
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF DIURETIC-INDUCED HYPOKALAEMIA
MAJOR USES OF DIURETICS
Diuretics for Treatment of Oedema in Heart Failure, Nephrotic Syndrome and Hepatic Cirrhosis
Management of oedema resistant to diuretics
Diuretics for Treatment of Hypertension
Diuretic Use in Hypercalciuria with Renal Stone Formation
Carbonic Anhydrase Inhibitors for Glaucoma
Acetazolamide for Altitude Sickness
Mannitol for Acute Brain Injury
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
EXTENDED-MATCHING-ITEM QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
FURTHER READING
15 - Disorders of Micturition
PATHOPHYSIOLOGY OF MICTURITION
DISORDERS OF MICTURITION
OVERACTIVE BLADDER AND URGE URINARY INCONTINENCE
DRUGS FOR TREATMENT OF OVERACTIVE BLADDER
Muscarinic Receptor Antagonists
β3-Adrenoceptor Agonist
MANAGEMENT OF OVERACTIVE BLADDER
HYPOTONIC BLADDER
URETHRAL SPHINCTER INCOMPETENCE
LOWER URINARY TRACT SYMPTOMS IN MEN AND BENIGN PROSTATE ENLARGEMENT
DRUGS FOR BENIGN PROSTATE ENLARGEMENT
Alpha1-Adrenoceptor Antagonists
5α-Reductase Inhibitors
Pharmacokinetics
Unwanted effects
Plant Extracts
TREATMENT OF LOWER URINARY TRACT SYMPTOMS WITH BENIGN PROSTATE ENLARGEMENT
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
EXTENDED-MATCHING-ITEM QUESTIONS
CASE-BASED QUESTION
ANSWERS
TRUE/FALSE ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
16 - Erectile Dysfunction
PHYSIOLOGY OF ERECTION
ERECTILE DYSFUNCTION
DRUGS FOR ERECTILE DYSFUNCTION
ORAL PHOSPHODIESTERASE INHIBITORS
Mechanism of Action and Uses
Pharmacokinetics
Unwanted Effects
ALPROSTADIL
MANAGEMENT OF ERECTILE DYSFUNCTION
PREMATURE EJACULATION
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
17 - General Anaesthetics
~
MECHANISMS OF ACTION OF GENERAL ANAESTHETICS
DRUGS USED IN ANAESTHESIA
INTRAVENOUS ANAESTHETICS
Pharmacokinetics
Unwanted Effects
INTRAVENOUS OPIOIDS
Pharmacokinetics
Unwanted Effects
INHALATIONAL ANAESTHETICS
Pharmacokinetics
Unwanted Effects
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
18 - Local Anaesthetics
PHARMACOLOGY
MECHANISM OF ACTION
Structural Requirements of Local Anaesthetics
Time to onset of action
Receptor binding
Duration of Action
Binding to Other Receptors
PHARMACOKINETICS
UNWANTED EFFECTS
Local Effects
Systemic Effects
TECHNIQUES OF ADMINISTRATION
SURFACE ADMINISTRATION
INFILTRATION ANAESTHESIA
PERIPHERAL NERVE BLOCK ANAESTHESIA
EPIDURAL ANAESTHESIA
SPINAL ANAESTHESIA
INTRAVENOUS REGIONAL ANAESTHESIA
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
EXTENDED-MATCHING-ITEM QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
EXTENDED-MATCHING-ITEM ANSWERS
FURTHER READING
19 - Opioid Analgesics and the Management of Pain
PAIN AND PAIN PERCEPTION
ANALGESIC DRUGS
NONSTEROIDAL ANTIINFLAMMATORY DRUGS
OPIOIDS
NONOPIOID, NON-NSAID ANALGESICS
OPIOID ANALGESICS
Mechanism of Action
Effects and Clinical Uses
Effects on the central nervous system
Analgesia
Euphoria and dysphoria
Respiratory depression
Suppression of the cough centre
Vomiting
Miosis
Endocrine effects
Peripheral effects
Gastrointestinal tract
Cardiovascular system
Other systems
Tolerance and dependence
Pharmacokinetics
Unwanted Effects
NONOPIOID, NON-NSAID AGENTS USED FOR ANALGESIA
PAIN MANAGEMENT
ACUTE PAIN
CHRONIC PAIN
NEUROPATHIC PAIN
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
20 - Anxiety, Obsessive-Compulsive Disorder and Insomnia
ANXIETY DISORDERS
BIOLOGICAL BASIS OF ANXIETY DISORDERS
ANXIOLYTIC DRUGS
Benzodiazepines
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Azapirones
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MANAGEMENT OF ANXIETY DISORDERS
OBSESSIVE-COMPULSIVE DISORDER
MANAGEMENT OF OBSESSIVE-COMPULSIVE DISORDER
INSOMNIA
SLEEP PATTERNS
HYPNOTIC DRUGS
Benzodiazepines
Non-Benzodiazepine Hypnotics that Modulate the GABAA Receptor
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MANAGEMENT OF INSOMNIA
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE BEST ANSWER (OBA) QUESTION
EXTENDED-MATCHING-ITEM QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
21 - Schizophrenia and Bipolar Disorder
SCHIZOPHRENIA
BIOLOGICAL BASIS OF SCHIZOPHRENIA
Dopamine–Glutamate Interactions and Their Possible Involvement in Schizophrenia
ANTIPSYCHOTIC DRUGS
CLASSIFICATION
CONVENTIONAL (FIRST-GENERATION) ANTIPSYCHOTIC DRUGS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
ATYPICAL (SECOND-GENERATION) ANTIPSYCHOTIC DRUGS
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF SCHIZOPHRENIA
MANIA AND BIPOLAR DISORDER
BIOLOGICAL BASIS OF BIPOLAR DISORDER
MOOD-STABILISING DRUGS FOR BIPOLAR DISORDER
LITHIUM
Mechanism of Action
Pharmacokinetics
Unwanted Effects
ANTICONVULSANTS
Mechanism of Action in Bipolar Disorder
MANAGEMENT OF BIPOLAR DISORDER
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
EXTENDED-MATCHING-ITEM QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
Schizophrenia
Bipolar Disorder
22 - Depression, Attention Deficit Hyperactivity Disorder and Narcolepsy
DEPRESSION
BIOLOGICAL BASIS OF DEPRESSION
Corticotropin-Releasing Hormone in Depression
Serotonergic and Noradrenergic Pathways in Depression
Regulation of Brain-Derived Neurotrophic Factor (BDNF) in Depression
ANTIDEPRESSANT DRUG ACTION
ANTIDEPRESSANT DRUGS
Tricyclic Antidepressant Drugs
Mechanism of action
Pharmacokinetics
Unwanted effects
Drug interactions
Selective Serotonin Reuptake Inhibitors (SSRI) and Related Antidepressants
Mechanism of action
Pharmacokinetics
Unwanted effects
Drug interactions
Serotonin and Noradrenaline Reuptake Inhibitors (SNRI)
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Noradrenaline Reuptake Inhibitors (NRI)
Mechanism of action
Pharmacokinetics
Unwanted effects
Presynaptic α2-Adrenoceptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Serotonin Receptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Irreversible Monoamine Oxidase A and B Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Drug interactions
Reversible Inhibitors of Monoamine Oxidase A
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Drug interactions
Melatonin Receptor Agonist and Serotonin Receptor Antagonist
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MANAGEMENT OF DEPRESSION
ATTENTION DEFICIT HYPERACTIVITY DISORDER AND NARCOLEPSY
ATTENTION DEFICIT HYPERACTIVITY DISORDER
NARCOLEPSY
DRUGS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER AND NARCOLEPSY
Atomoxetine
Mechanism of action
Pharmacokinetics
Unwanted effects
Methylphenidate
Mechanism of action
Pharmacokinetics
Unwanted effects
Dexamfetamine
Mechanism of action
Pharmacokinetics
Unwanted effects
Modafinil
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER
MANAGEMENT OF NARCOLEPSY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
EXTENDED-MATCHING-ITEM QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
Depression
Narcolepsy and ADHD
23 - Seizures and Epilepsy
PATHOLOGICAL BASIS OF SEIZURES AND EPILEPSY
NEUROTRANSMITTERS AND SEIZURES
ANTISEIZURE DRUGS
SODIUM CHANNEL BLOCKERS
Carbamazepine, Oxcarbazepine, Eslicarbazepine Acetate
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Phenytoin and Fosphenytoin
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Lacosamide
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Lamotrigine
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Zonisamide
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Rufinamide
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
GAMMA-AMINOBUTYRIC ACID RECEPTOR AGONISTS
Benzodiazepines
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Phenobarbital and Primidone
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
GAMMA-AMINOBUTYRIC ACID REUPTAKE INHIBITOR
Tiagabine
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
GAMMA-AMINOBUTYRIC ACID TRANSAMINASE INHIBITOR
Vigabatrin
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
DRUGS WITH MULTIPLE ACTIONS
Sodium Valproate
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Topiramate
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
NEURONAL CALCIUM CHANNEL BLOCKERS
Ethosuximide
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Gabapentin and Pregabalin
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
SYNAPTIC VESICLE PROTEIN 2A INHIBITORS
Levetiracetam and Brivaracetam
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
AMPA GLUTAMATE RECEPTOR ANTAGONIST
Perampanel
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
CANNABINOIDS
INTERACTIONS AMONG ANTISEIZURE DRUGS
MANAGEMENT OF EPILEPSY
TREATMENT OF INDIVIDUAL SEIZURES
PROPHYLAXIS FOR SEIZURES
Refractory Epilepsy
Therapeutic Drug Monitoring
Duration of Treatment
Childhood Febrile Seizures
ANTISEIZURE DRUGS IN PREGNANCY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
24 - Extrapyramidal Movement Disorders and Spasticity
THE BASAL GANGLIA AND CONTROL OF MOTOR FUNCTION
PARKINSON’S DISEASE AND RELATED SYNDROMES
DRUGS FOR PARKINSON’S DISEASE
DOPAMINERGIC DRUGS
Levodopa
Mechanism of action
Pharmacokinetics
Unwanted effects
Dopamine Receptor Agonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Selective Monoamine Oxidase Type B Inhibitors
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Catechol-O-Methyltransferase Inhibitors
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
ANTIMUSCARINIC DRUGS
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
AMANTADINE
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MANAGEMENT OF PARKINSON’S DISEASE AND RELATED SYNDROMES
OTHER INVOLUNTARY MOVEMENT DISORDERS (DYSKINESIAS)
MONOAMINE DEPLETOR FOR MOVEMENT DISORDERS
Tetrabenazine
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF DYSKINESIAS AND DYSTONIAS
SPASTICITY
DRUGS FOR SPASTICITY
Diazepam
Baclofen
Mechanism of action
Pharmacokinetics
Unwanted effects
Cannabinoids
Mechanisms of action, effects and uses
Pharmacokinetics
Unwanted effects
Tizanidine
Mechanisms of action
Pharmacokinetics
Unwanted effects
Dantrolene
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
MANAGEMENT OF SPASTICITY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
Parkinson’s Disease
Other Movement Disorders and Spasticity
25 - Other Neurological Disorders: Multiple Sclerosis, Motor Neuron Disease and Guillain–Barré Syndrome
MULTIPLE SCLEROSIS
DISEASE-MODIFYING THERAPIES
MANAGEMENT OF MULTIPLE SCLEROSIS
MOTOR NEURON DISEASE
DRUG TREATMENT
GUILLAIN–BARRÉ SYNDROME
EARLY MANAGEMENT
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
26 - Migraine and Other Headaches
~
MIGRAINE
PATHOGENESIS OF MIGRAINE
DRUGS FOR MIGRAINE
SPECIFIC DRUGS FOR THE ACUTE MIGRAINE ATTACK
Triptans
Mechanisms of action and effects
Pharmacokinetics
Unwanted effects
Ergotamine
Mechanism of action
Pharmacokinetics
Unwanted effects
PROPHYLACTIC DRUGS
Beta-Adrenoceptor Antagonists
Antiseizure Drugs
Amitriptyline
Calcitonin Gene-Related Peptide (CGRP) Antagonists
Mechanisms of action and effects
Pharmacokinetics
Unwanted effects
ACE Inhibitors and Angiotensin II Receptor Antagonists
MANAGEMENT OF MIGRAINE AND OTHER HEADACHES
ACUTE MIGRAINE ATTACKS
PROPHYLAXIS OF MIGRAINE
MEDICATION-OVERUSE HEADACHE
MANAGEMENT OF OTHER HEADACHES
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE BEST ANSWER (OBA) QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
FURTHER READING
27 - The Neuromuscular Junction and Neuromuscular Blockade
NEUROMUSCULAR TRANSMISSION
DRUGS ACTING AT THE NEUROMUSCULAR JUNCTION
ACETYLCHOLINESTERASE (AChE) INHIBITORS (ANTICHOLINESTERASES)
INHIBITORS OF ACETYLCHOLINE RELEASE
NEUROMUSCULAR JUNCTION BLOCKERS
Competitive N2 Receptor Antagonists (Nondepolarising Blockers)
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Depolarising Neuromuscular-Blocking Drugs
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
INDICATIONS FOR NEUROMUSCULAR-BLOCKING DRUGS
ENDOTRACHEAL INTUBATION
DURING SURGICAL PROCEDURES
CRITICAL ILLNESS
ANTAGONISING NEUROMUSCULAR BLOCK
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
28 - Myasthenia Gravis
ACETYLCHOLINESTERASE (AChE) INHIBITORS
MECHANISM OF ACTION AND EFFECTS
PHARMACOKINETICS AND CLINICAL USES
UNWANTED EFFECTS
MANAGEMENT OF MYASTHENIA GRAVIS
LAMBERT–EATON MYASTHENIC SYNDROME
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
29 - Nonsteroidal Antiinflammatory Drugs
THE ROLE OF CYCLOOXYGENASE ENZYMES IN THE ACTIONS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS
NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDs)
MECHANISMS OF ACTION
CLASSIFICATION OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS
ACTIONS AND EFFECTS OF NONSELECTIVE NONSTEROIDAL ANTIINFLAMMATORY DRUGS
Analgesic Effect
Antiinflammatory Effect
Antipyretic Effect
Reduction of Platelet Aggregation
PHARMACOKINETICS
UNWANTED EFFECTS
Gastrointestinal Effects
Renal Effects
Cardiovascular Effects
Hypersensitivity
Effects in Pregnancy
Other Unwanted Effects
CYCLOOXYGENASE-2-SELECTIVE INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
PARACETAMOL
Mechanism of Action
Pharmacokinetics
Unwanted Effects
INDICATIONS FOR USING NONSTEROIDAL ANTIINFLAMMATORY DRUGS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
EXTENDED-MATCHING-ITEM/CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
EXTENDED-MATCHING-ITEM/CASE-BASED ANSWERS
FURTHER READING
30 - Rheumatoid Arthritis, Other Inflammatory Arthritides and Osteoarthritis
RHEUMATOID ARTHRITIS
OTHER TYPES OF INFLAMMATORY ARTHRITIS: THE SPONDYLOARTHROPATHIES
DRUGS FOR TREATMENT OF INFLAMMATORY ARTHRITIS
CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Methotrexate
Sulfasalazine
Antimalarials
Mechanism of action
Monitoring and prevention of unwanted effects
Leflunomide
Mechanism of action
Pharmacokinetics
Unwanted effects
Monitoring and prevention of unwanted effects
TARGETED SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Janus Kinase Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Phosphodiesterase Type 4 Inhibitors
Mechanism of action and use
Pharmacokinetics
Unwanted effects
BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Tumour Necrosis Factor Alpha (TNFα) Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Interleukin-1 Receptor Antagonist
Mechanism of action
Pharmacokinetics
Unwanted effects
Interleukin-6 Receptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Interleukin-12 and Interleukin-23 Receptor Antagonist
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Interleukin-17A Inhibitor
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
T-Cell Activation Inhibitors
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Anti-CD20 B-Cell Depleter
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
MANAGEMENT OF RHEUMATOID ARTHRITIS
MANAGEMENT OF SPONDYLOARTHROPATHIES
OSTEOARTHRITIS
MANAGEMENT OF OSTEOARTHRITIS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
Rheumatoid Arthritis and Other Inflammatory Arthritides
Osteoarthritis
31 - Hyperuricaemia, Gout and Pseudogout
THE PATHOPHYSIOLOGY OF GOUT
PSEUDOGOUT
DRUGS FOR THE TREATMENT OF GOUT AND PREVENTION OF HYPERURICAEMIA
DRUGS FOR THE TREATMENT OF ACUTE GOUT
Colchicine
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
DRUGS FOR TREATMENT OF HYPERURICAEMIA
Xanthine Oxidase Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Rasburicase
Mechanism of action
Pharmacokinetics
Unwanted effects
Uricosuric Agents
Mechanism of action
Pharmacokinetics
Unwanted effects
TREATMENT OF GOUT
ACUTE GOUT
PREVENTION OF GOUT ATTACKS
TREATMENT OF PSEUDOGOUT
SELF-ASSESSMENT
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
32 - Nausea and Vomiting
NAUSEA AND VOMITING
ANTIEMETIC AGENTS
Antihistamines
Mechanism of action and clinical use
Pharmacokinetics
Unwanted effects
Antimuscarinic Agent
Mechanism of action and clinical use
Pharmacokinetics
Unwanted effects
Dopamine Receptor Antagonists
Mechanism of action and clinical use
Pharmacokinetics
Unwanted effects
5-HT3 Receptor Antagonists
Mechanism of action and clinical use
Pharmacokinetics
Unwanted effects
Neurokinin 1 Receptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
Cannabinoids
Mechanism of action and clinical use
Pharmacokinetics
Unwanted effects
Corticosteroids
Benzodiazepines
MANAGEMENT OF NAUSEA AND VOMITING
Drug-Induced Vomiting
Postoperative Nausea and Vomiting
Motion Sickness
Vomiting in Pregnancy
VERTIGO
DRUGS FOR TREATMENT OF VERTIGO
MANAGEMENT OF VERTIGO
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
33 - Dyspepsia, Peptic Ulcer Disease and Gastrooesophageal Reflux Disease
THE SPECTRUM OF DISEASE
NON-ULCER (FUNCTIONAL) DYSPEPSIA
PEPTIC ULCER DISEASE AND GASTRITIS
Mechanisms of Protection of Gastric and Duodenal Mucosa
Aetiology of Peptic Ulceration and Gastritis
Helicobacter pylori and peptic ulceration
Helicobacter pylori and gastric ulceration
Helicobacter pylori and duodenal ulceration
Drugs and Peptic Ulceration
Other Causes of Peptic Ulcer
GASTROOESOPHAGEAL REFLUX DISEASE (GORD)
OESOPHAGEAL SPASM
CONTROL OF GASTRIC ACID SECRETION
DRUGS FOR TREATING DYSPEPSIA, PEPTIC ULCER AND GASTROOESOPHAGEAL REFLUX DISEASE
ANTISECRETORY DRUGS
Proton Pump Inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Histamine H2 Receptor Antagonists
Mechanism of action
Pharmacokinetics
Unwanted effects
ANTACIDS
Mechanism of action
Unwanted effects
Antacids with Alginic Acid
CYTOPROTECTIVE DRUGS
Sucralfate
Mechanism of action
Pharmacokinetics
Unwanted effects
Prostaglandin Analogues
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF DYSPEPSIA, PEPTIC ULCER AND GASTROOESOPHAGEAL REFLUX DISEASE
NON-ULCER DYSPEPSIA
CONFIRMED PEPTIC ULCERATION
ERADICATION OF HELICOBACTER PYLORI INFECTION
BLEEDING FROM PEPTIC ULCERS
PEPTIC ULCERATION ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS
GASTROOESOPHAGEAL REFLUX DISEASE
OESOPHAGEAL SPASM
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
34 - Inflammatory Bowel Disease
Inflammatory Bowel Disease
DRUGS FOR INFLAMMATORY BOWEL DISEASE
AMINOSALICYLATES
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
CORTICOSTEROIDS
CYTOKINE MODULATORS (TUMOUR NECROSIS FACTOR ALPHA INHIBITORS)
Mechanism of Action and Uses
ANTILYMPHOCYTE ANTIBODY
Mechanism of Action and Uses
IMMUNOSUPPRESSANTS
ANTIBACTERIALS
MANAGEMENT OF INFLAMMATORY BOWEL DISEASE
ULCERATIVE COLITIS
CROHN’S DISEASE
MICROSCOPIC COLITIS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
35 - Constipation, Diarrhoea and Irritable Bowel Syndrome
CONSTIPATION
LAXATIVES
Bulk-Forming Laxatives
Osmotic Laxatives
Irritant and Stimulant Laxatives
Faecal Softeners
MANAGEMENT OF CONSTIPATION
DIARRHOEA
DRUGS FOR TREATING DIARRHOEA
Opioids
Adsorbent and Bulk-Forming Agents
MANAGEMENT OF DIARRHOEA
Clostridioides difficile-Associated Diarrhoea
IRRITABLE BOWEL SYNDROME
DRUGS FOR TREATING IRRITABLE BOWEL SYNDROME
Antimuscarinic Drugs
Mechanism of action
Pharmacokinetics
Unwanted effects
Other Antispasmodic Agents
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF IRRITABLE BOWEL SYNDROME
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
36 - Liver Disease
ACUTE LIVER FAILURE
MANAGEMENT OF ACUTE AND SUBACUTE LIVER FAILURE
CHRONIC LIVER DISEASE AND LIVER CIRRHOSIS
AUTOIMMUNE HEPATITIS
MANAGEMENT OF AUTOIMMUNE HEPATITIS
PRIMARY BILIARY CHOLANGITIS
MANAGEMENT OF PRIMARY BILIARY CHOLANGITIS
CHRONIC VIRAL HEPATITIS
DRUGS FOR TREATMENT OF CHRONIC VIRAL HEPATITIS
Nucleoside and Nucleotide Analogues
Mechanism of action and uses
Resistance
Pharmacokinetics
Unwanted effects
Direct-Acting Antivirals: HCV Protease Inhibitors
Mechanism of action
Resistance
Unwanted effects
Direct-Acting Antivirals: Nonstructural Protein NS5A and NS5B Inhibitors
Mechanism of action
Resistance
Unwanted effects
Interferon Alfa
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MANAGEMENT OF CHRONIC VIRAL HEPATITIS
Chronic Hepatitis B Infection
Chronic Hepatitis C Infection
COMPLICATIONS OF DECOMPENSATED CIRRHOSIS
CHRONIC HEPATIC ENCEPHALOPATHY
Management of Chronic Hepatic Encephalopathy
VARICEAL HAEMORRHAGE
Management of Bleeding Gastrooesophageal Varices
Prevention of Variceal Bleeding and Rebleeding
ASCITES IN CHRONIC LIVER DISEASE
Management of Ascites
SELF-ASSESSMENT
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
37 - Obesity
PATHOGENESIS OF OBESITY
DRUGS FOR TREATMENT OF OBESITY
DRUGS ACTING ON THE GASTROINTESTINAL TRACT
Mechanism of Action
Pharmacokinetics
Unwanted Effects
CENTRALLY ACTING APPETITE SUPPRESSANTS
MANAGEMENT OF OBESITY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
FURTHER READING
38 - The Immune Response and Immunosuppressant Drugs
BIOLOGICAL BASIS OF THE IMMUNE RESPONSE
INNATE IMMUNITY
ADAPTIVE IMMUNITY
Cell-Mediated Immunity
Humoral Immunity
UNWANTED IMMUNE REACTIONS
Hypersensitivity Reactions
Type 1 (allergy, immediate)
Type 2 (cytotoxic, antibody-dependent)
Type 3 (immune complex disease)
Type 4 (cell-mediated, delayed-type hypersensitivity)
Autoimmunity
Blood Transfusion and Transplant Rejection
IMMUNOSUPPRESSANT DRUGS
CORTICOSTEROIDS
CALCINEURIN INHIBITORS
Ciclosporin
Mechanism of action
Pharmacokinetics
Unwanted effects
Tacrolimus
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
MECHANISTIC TARGET OF RAPAMYCIN (mTOR) INHIBITORS
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
ANTIPROLIFERATIVE AGENTS
Azathioprine
Mechanism of action
Pharmacokinetics
Unwanted effects
Cyclophosphamide
Mycophenolate Mofetil and Mycophenolic Acid
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
FOLIC ACID ANTAGONIST
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
INTERLEUKIN-2 RECEPTOR ANTIBODIES
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
SELECTIVE CO-STIMULATION BLOCKER
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
COMPLEMENT BLOCKERS
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
ANTITHYMOCYTE GLOBULIN
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
IgG DEGRADING ENZYME
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
IMMUNOSUPPRESSION IN INFLAMMATORY AND AUTOIMMUNE DISEASE
IMMUNOSUPPRESSION IN ORGAN TRANSPLANTATION
LONG-TERM EFFECTS OF IMMUNOSUPPRESSION
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
39 - Antihistamines and Allergic Disease
ATOPY, ALLERGIC DISORDERS AND ANAPHYLAXIS
HISTAMINE AS AN AUTACOID IN HOST DEFENCE
HISTAMINE H1 RECEPTOR ANTAGONISTS (ANTIHISTAMINES)
MECHANISMS OF ACTION AND EFFECTS
PHARMACOKINETICS
UNWANTED EFFECTS
MANAGEMENT OF ALLERGIC DISORDERS
ANAPHYLAXIS
SEASONAL AND PERENNIAL RHINITIS
URTICARIA AND ANGIOEDEMA
ALLERGIC CONJUNCTIVITIS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
40 - Diabetes Mellitus
CONTROL OF BLOOD GLUCOSE
REGULATION OF INSULIN SECRETION AND EFFECTS OF INSULIN
REGULATION OF GLUCAGON SECRETION AND EFFECTS OF GLUCAGON
DIABETES MELLITUS
TYPE 1 DIABETES MELLITUS
TYPE 2 DIABETES MELLITUS
INSULIN AND INSULIN ANALOGUES FOR TREATMENT OF DIABETES MELLITUS
NATURAL INSULIN FORMULATIONS
Pharmacokinetics
Unwanted Effects
INSULIN ANALOGUES
Mechanism of Action and Effects
Rapid-acting insulin analogues
Long-acting insulin analogues
Pharmacokinetics
Unwanted Effects
THERAPEUTIC REGIMENS FOR INSULIN AND INSULIN ANALOGUES
OTHER PARENTERAL GLUCOSE-LOWERING DRUGS
GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
ORAL GLUCOSE-LOWERING DRUGS
SULFONYLUREAS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
MEGLITINIDES
Mechanism of Action
Pharmacokinetics
Unwanted Effects
BIGUANIDE
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
THIAZOLIDINEDIONE
Mechanisms of Action and Effects
Pharmacokinetics
Unwanted Effects
DIPEPTIDYL PEPTIDASE-4 INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
GLUCOSIDASE INHIBITOR
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
DRUGS TO INCREASE PLASMA GLUCOSE LEVELS
GLUCAGON
Mechanism of Action and Use
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF TYPE 1 DIABETES MELLITUS
MANAGEMENT OF TYPE 1 DIABETES MELLITUS IN SPECIAL SITUATIONS
MANAGEMENT OF TYPE 2 DIABETES MELLITUS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
41 - The Thyroid and Control of Metabolic Rate
THYROID FUNCTION
THYROID HORMONES
THYROTOXICOSIS
DRUGS FOR TREATMENT OF THYROTOXICOSIS
Thionamides
Mechanism of action
Pharmacokinetics
Unwanted effects
MANAGEMENT OF THYROTOXICOSIS
Graves’ Disease
Toxic Nodular Goitre and Toxic Adenoma
Amiodarone-Induced Thyrotoxicosis
Thyroiditis
HYPOTHYROIDISM
MANAGEMENT OF HYPOTHYROIDISM
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
42 - Calcium Metabolism and Metabolic Bone Disease
PHYSIOLOGY OF BONE TURNOVER
PLASMA CALCIUM HOMEOSTASIS
PARATHYROID HORMONE AND CALCIUM HOMEOSTASIS
VITAMIN D AND CALCIUM HOMEOSTASIS
CALCITONIN AND CALCIUM HOMEOSTASIS
HYPERCALCAEMIA
ANTIRESORPTIVE DRUGS FOR TREATING HYPERCALCAEMIA
Bisphosphonates
Mechanisms of action and effects
Pharmacokinetics
Unwanted effects
Salmon Calcitonin (Salcatonin)
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
Cinacalcet
Mechanism of action and effects
Pharmacokinetics
Unwanted effects
TREATMENT OF HYPERCALCAEMIA
HYPOCALCAEMIA
DRUGS FOR HYPOCALCAEMIA
Vitamin D compounds
Mechanism of action
Pharmacokinetics
Unwanted effects
TREATMENT OF HYPOCALCAEMIA
METABOLIC BONE DISEASE
OSTEOMALACIA AND VITAMIN D DEFICIENCY
RENAL BONE DISEASE
OSTEOPOROSIS
Drugs for Treating Osteoporosis
Bisphosphonates
Denosumab
Mechanism of action
Pharmacokinetics
Unwanted effects
Raloxifene
Mechanism of action
Pharmacokinetics
Unwanted effects
Prevention of Osteoporosis
Management of established osteoporosis and fragility fractures
PAGET’S DISEASE OF BONE
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
43 - Pituitary and Hypothalamic Hormones

ANTERIOR PITUITARY AND RELATED HYPOTHALAMIC HORMONES
GROWTH HORMONE
Growth Hormone for Therapeutic Use
Pharmacokinetics
Unwanted effects
Acromegaly
Drugs for Acromegaly
Somatostatin analogues
Mechanisms of action and uses
Pharmacokinetics
Unwanted effects
Growth hormone receptor antagonist
Mechanism of action
Pharmacokinetics
Unwanted effects
Dopamine receptor agonists
Treatment of Acromegaly
ADRENOCORTICOTROPIC HORMONE
Adrenocorticotropic Hormone for Therapeutic Use
Pharmacokinetics
Unwanted effects
Uses of tetracosactide
PROLACTIN
Hyperprolactinaemia
GONADOTROPIN-RELEASING HORMONE
GnRH-Related Products for Therapeutic Use
Synthetic GnRH (gonadorelin)
Gonadorelin analogues
Mechanism of action
Clinical uses of gonadorelin analogues
Pharmacokinetics
Unwanted effects
GnRH receptor antagonists
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
GONADOTROPINS
Gonadotropins for Therapeutic Use
Unwanted effects
Clinical Uses of Gonadotropins
INFERTILITY
Drugs for Inducing Ovulation
Clomifene
Mechanism of action and use
Pharmacokinetics
Unwanted effects
Drug Treatment of Female Infertility
Preparation for Assisted Reproduction (In Vitro Fertilisation)
Polycystic Ovary Syndrome
Management of polycystic ovary syndrome
POSTERIOR PITUITARY HORMONES
VASOPRESSIN (ANTIDIURETIC HORMONE)
Vasopressin Analogues
Pharmacokinetics
Unwanted effects
Clinical Uses of Vasopressin and its Analogues
Diabetes Insipidus
Management of diabetes insipidus
Syndrome of Inappropriate Antidiuresis
Vasopressin V2 receptor antagonist
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Treatment of syndrome of inappropriate antidiuresis
OXYTOCIN
HYPOPITUITARISM
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
44 - Corticosteroids (Glucocorticoids and Mineralocorticoids)
CORTICOSTEROID HORMONES
CONTROL OF CORTICOSTEROID HORMONE SYNTHESIS AND RELEASE
MODE OF ACTION OF CORTICOSTEROID HORMONES
GLUCOCORTICOIDS
ACTIONS OF GLUCOCORTICOIDS
Immunosuppressant and Antiinflammatory Actions
Antiinflammatory Effects
Metabolic Effects
Effects on Bone Metabolism
Central Nervous System Effects
Mineralocorticoid Effects
PHARMACOKINETICS OF GLUCOCORTICOIDS
Physiological Replacement Therapy for Corticosteroid Deficiency
CLINICAL USES OF THERAPEUTIC DOSES OF SYSTEMICALLY ADMINISTERED GLUCOCORTICOIDS
CLINICAL USES OF THERAPEUTIC DOSES OF TOPICALLY ADMINISTERED GLUCOCORTICOIDS
UNWANTED EFFECTS OF GLUCOCORTICOIDS
Cessation of Glucocorticoid Therapy
CUSHING’S SYNDROME
MINERALOCORTICOIDS
FLUDROCORTISONE
Pharmacokinetics
Unwanted Effects
Clinical Uses of Fludrocortisone
PRIMARY HYPERALDOSTERONISM (CONN’S SYNDROME)
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTION
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
CASE-BASED ANSWERS
FURTHER READING
45 - Female Reproduction
PHYSIOLOGY OF THE MENSTRUAL CYCLE
PHYSIOLOGY OF PREGNANCY
CELLULAR ACTION OF OESTROGENS AND PROGESTOGENS
STEROIDAL CONTRACEPTIVES
MECHANISMS OF HORMONAL CONTRACEPTION
THE COMBINED HORMONAL CONTRACEPTIVE
Monophasic Combined Contraceptive Preparations
Biphasic and Triphasic Combined Contraceptive Preparations
Tricycling, Continuous and Tailored Regimens for Combined Hormonal Contraceptives
PROGESTOGEN-ONLY CONTRACEPTIVES
Oral Progestogen-Only Contraceptives
Parenteral Progestogen-Only Contraceptives
Intrauterine Progestogen-Only Device
EFFICACY OF HORMONAL CONTRACEPTION
EMERGENCY CONTRACEPTION
PHARMACOKINETICS OF CONTRACEPTIVE SEX STEROIDS
Drug Interactions
UNWANTED EFFECTS OF CONTRACEPTIVE SEX STEROIDS
NON-CONTRACEPTIVE USES OF HORMONAL CONTRACEPTIVES
Menorrhagia
Primary Dysmenorrhoea
Premenstrual Syndrome
Endometriosis
THE MENOPAUSE
HORMONE-REPLACEMENT THERAPY AND RELATED DRUGS
Oral Oestrogens and Progestogens
Subcutaneous Oestrogen Implants
Transdermal Oestrogen and Oestrogen with Progestogen
Vaginal Oestrogen
Tibolone
Pharmacokinetics
Unwanted effects
MANAGEMENT OF MENOPAUSAL SYMPTOMS
PREGNANCY AND LABOUR
THE ONSET AND INDUCTION OF LABOUR
Prostaglandins
Oxytocin
Oestradiol/Oestriol
Progesterone
STAGES OF LABOUR
MYOMETRIAL RELAXANTS (TOCOLYTICS) AND PRETERM LABOUR
Calcium Channel Blockers
Atosiban
Mechanism of action
Pharmacokinetics
Unwanted effects
Beta2-Adrenoceptor Agonists
Management of Preterm Labour
DRUGS FOR INDUCING AND AUGMENTING LABOUR
Dinoprostone
Unwanted effects
Oxytocin
Pharmacological Induction and Augmentation of Labour
PAIN RELIEF IN LABOUR
POSTPARTUM HAEMORRHAGE
Ergometrine Maleate
Pharmacokinetics
Unwanted effects
Prevention and Management of Postpartum Haemorrhage
MEDICAL ABORTION
Mifepristone
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Prostaglandin Derivatives
Induction of Medical Abortion
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
46 - Androgens, Antiandrogens and Anabolic Steroids
ANDROGENS AND ANABOLIC STEROIDS
MALE HYPOGONADISM
FEMALE ANDROGEN DEFICIENCY
THERAPEUTIC MALE SEX HORMONES
Actions of Testosterone
Pharmacokinetics
Unwanted Effects
Clinical Uses of Testosterone
DANAZOL
Mechanism of Action
Pharmacokinetics
Unwanted Effects
Clinical Uses of Danazol
ANABOLIC STEROIDS
ANTIANDROGENS
BICALUTAMIDE AND FLUTAMIDE
Mechanism of Action
Pharmacokinetics
Unwanted Effects
CYPROTERONE ACETATE
Mechanism of Action
Pharmacokinetics
Unwanted Effects
CLINICAL USES OF ANTIANDROGENS
5α-REDUCTASE INHIBITORS
Mechanism of Action and Effects
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
47 - Anaemia and Haematopoietic Colony-Stimulating Factors
ANAEMIA
IRON
Iron Deficiency
Therapeutic Iron Preparations
Oral iron
Unwanted effects
Parenteral iron
Unwanted effects
Therapeutic Use of Iron
FOLIC ACID
Folate Deficiency
Therapeutic Use of Folic Acid
VITAMIN B12
Vitamin B12 Deficiency
Therapeutic Use of Vitamin B12
ERYTHROPOIETIN
Pharmacokinetics
Unwanted Effects
Therapeutic Uses of Epoetin
DRUG TREATMENT IN OTHER ANAEMIAS
Aplastic Anaemia
Sideroblastic Anaemia
Autoimmune Haemolytic Anaemia
β-Thalassaemia Major
Sickle Cell Anaemia
DRUGS AS A CAUSE OF ANAEMIA
NEUTROPENIA
DRUGS FOR NEUTROPENIA
Granulocyte Colony-Stimulating Factors
Pharmacokinetics
Unwanted effects
Therapeutic Use of Colony-Stimulating Factors
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
48 - Lipid Disorders
LIPIDS AND LIPOPROTEINS
CHOLESTEROL AND TRIGLYCERIDES
LIPOPROTEINS
PROCESSING OF LIPIDS ABSORBED FROM THE GUT
PLASMA TRANSPORT AND LIVER PROCESSING OF LIPIDS
FORMATION OF ATHEROMA
DRUGS FOR HYPERLIPIDAEMIAS
3-HYDROXY-3-METHYLGLUTARYL-COENZYME A REDUCTASE INHIBITORS (STATINS)
Mechanism of Action and Effects
Pharmacokinetics
Unwanted Effects
SPECIFIC CHOLESTEROL ABSORPTION INHIBITOR
Mechanism of Action
Pharmacokinetics
Unwanted Effects
BILE ACID SEQUESTRANTS
Mechanism of Action
Unwanted Effects
FIBRATES
Mechanism of Action
Pharmacokinetics
Unwanted Effects
ADENOSINE TRIPHOSPHATE CITRATE LYASE (ACL) INHIBITOR
Mechanism of Action
Pharmacokinetics
Unwanted Effects
NICOTINIC ACID AND DERIVATIVES
Mechanism of Action
Pharmacokinetics
Unwanted Effects
OMEGA-3 FATTY ACIDS
Unwanted Effects
PROPROTEIN CONVERTASE SUBTILISIN/KEXIN (PCSK) TYPE 9 INHIBITORS
Mechanism of Action
Pharmacokinetics
Unwanted Effects
SMALL INTERFERING RIBONUCLEIC ACID (siRNA)
Mechanism of Action
Pharmacokinetics
Unwanted Effects
MANAGEMENT OF HYPERLIPIDAEMIAS
Lipid Lowering for Primary Prevention of Cardiovascular Disease
Secondary Prevention of Cardiovascular Disease
Mechanisms of Prevention of Coronary Events by Lipid-Lowering Drugs
Management of Hypertriglyceridaemia
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
49 - Skin Disorders
VEHICLES FOR TOPICAL SKIN APPLICATIONS
ATOPIC AND CONTACT DERMATITIS
ATOPIC ECZEMA (ATOPIC DERMATITIS)
CONTACT DERMATITIS
OTHER TYPES OF DERMATITIS
TREATMENT OF ATOPIC ECZEMA
TREATMENT OF CONTACT DERMATITIS
PSORIASIS
DRUGS FOR TREATMENT OF PSORIASIS
Topical Therapy
Emollients
Keratolytics
Vitamin D analogues
Topical retinoid
Topical calcineurin inhibitors
Dithranol
Coal tar preparations
Phototherapy
Topical corticosteroid preparations
Systemic Treatments
Methotrexate
Retinoids
Ciclosporin
Biologic agents
Dimethyl fumarate
CHOICE OF TREATMENT FOR PSORIASIS
ACNE VULGARIS
DRUGS FOR TREATMENT OF ACNE
Topical Treatments
Systemic Treatments
CHOICE OF TREATMENT FOR ACNE
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
50 - The Eye
Regulation of visual acuity, pupil size and aqueous humour
Accommodation
Pupil Size
Drainage of Aqueous Humour
TOPICAL APPLICATION OF DRUGS TO THE EYE
MYDRIATIC AND CYCLOPLEGIC DRUGS
ANTIMUSCARINIC DRUGS
SYMPATHOMIMETICS
GLAUCOMA
DRUGS FOR GLAUCOMA
Prostaglandin Analogues
β-Adrenoceptor Antagonists
Sympathomimetics
Carbonic Anhydrase Inhibitors
Rho Kinase (ROCK) Inhibitor
Miotic Drugs (Muscarinic Agonists)
TREATMENT OF GLAUCOMA
OTHER DRUGS ADMINISTERED TOPICALLY TO THE EYE
ANTIBACTERIAL AGENTS
ANTIVIRAL AGENTS
CORTICOSTEROIDS
ANTIALLERGIC AGENTS
LOCAL ANAESTHETICS
NONSTEROIDAL ANTIINFLAMMATORY DRUGS
DRY EYE SYNDROME
AGE-RELATED MACULAR DEGENERATION
TREATMENT OF AGE-RELATED MACULAR DEGENERATION
DIABETIC RETINOPATHY
TREATMENT OF DIABETIC RETINOPATHY
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
EXTENDED-MATCHING-ITEM QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
EXTENDED-MATCHING-ITEM ANSWERS
CASE-BASED ANSWERS
FURTHER READING
51 - Drugs for Infections
~
BACTERIAL INFECTIONS
CLASSIFICATION OF ANTIBACTERIAL DRUGS
ANTIMICROBIAL RESISTANCE
ANTIBACTERIAL DRUG RESISTANCE
Spontaneous Mutation
Conjugation
Transduction
Transformation
ANTIBACTERIAL DRUGS
Drugs Affecting the Cell Wall: β-Lactam Antibacterials
Mechanism of action of β-lactam antibacterials
Penicillins
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Cephalosporins
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Monobactams
Carbapenems
Other Drugs Affecting the Cell Wall
Glycopeptides
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Daptomycin
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Polymyxins
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Drugs Affecting Bacterial Nucleic Acids
Quinolones (fluoroquinolones)
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Metronidazole and tinidazole
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Nitrofurantoin
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Macrocyclic antibiotic
Mechanism of action and use
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Drugs Affecting Bacterial Protein Synthesis
Macrolides
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Aminoglycosides
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Tetracyclines
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Tigecycline
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Chloramphenicol
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Lincosamides
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Fusidic acid
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Oxazolidinones
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Drugs Affecting Bacterial Metabolism
Sulfonamides
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Trimethoprim
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Drugs Used for Tuberculosis
Rifamycins
Mechanism of action and spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Isoniazid
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Pyrazinamide
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Ethambutol
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Other drugs used in the treatment of tuberculosis
Drugs Used for Leprosy
Dapsone
Mechanism of action and use
Resistance
Pharmacokinetics
Unwanted effects
Clofazimine
Mechanism of action and use
Pharmacokinetics
Unwanted effects
PRINCIPLES OF ANTIBACTERIAL THERAPY
Empirical Treatment
Spectrum of Antibacterial Activity
Combination Therapy
Bactericidal Versus Bacteriostatic Drugs
Site of Infection
Mode of Administration
Duration of Therapy
Chemoprophylaxis
TREATMENT OF SELECTED BACTERIAL INFECTIONS
Upper Respiratory Tract Infections
Sinusitis and Otitis Media
Lower Respiratory Tract Infections
Acute bronchitis
Pneumonia
Suppurative lung disease
Urinary Tract Infections
Gastrointestinal Infection
Biliary Tract Infection
Osteomyelitis
Septic Arthritis
Cellulitis
Sepsis
Infective Endocarditis
Meningitis
Tuberculosis
FUNGAL INFECTIONS
ANTIFUNGAL DRUGS
Drugs That Impair Fungal Cell Membrane Barrier Function
Polyenes
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Drugs That Inhibit Fungal Cell Membrane or Cell Wall Synthesis
Imidazoles
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Triazoles
Mechanism of action and spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Terbinafine
Mechanism of action and use
Resistance
Pharmacokinetics
Unwanted effects
Echinocandins
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Drugs That Inhibit Macromolecule Synthesis
Flucytosine
Mechanism of action and use
Resistance
Pharmacokinetics
Unwanted effects
Drugs That Interact with Microtubules
Griseofulvin
Mechanism of action and use
Resistance
Pharmacokinetics
Unwanted effects
TREATMENT OF SPECIFIC FUNGAL INFECTIONS
Aspergillus
Candida
Cryptococcus
Skin and Nail Infections
Prophylaxis of Fungal Infection in Immunocompromised Individuals
VIRAL INFECTIONS
ANTIVIRAL DRUGS
Drugs Active Against HIV
Nucleoside/nucleotide reverse transcriptase inhibitors
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Non-nucleoside reverse transcriptase inhibitors
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
HIV protease inhibitors
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
HIV fusion-entry inhibitor
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Chemokine (C-C motif) receptor 5 co-receptor antagonist
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
HIV integrase inhibitors
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Drugs for Herpesvirus and Cytomegalovirus Infections
Nucleoside inhibitors of viral DNA polymerase
Mechanism of action
Spectrum of activity
Resistance
Pharmacokinetics
Unwanted effects
Non-nucleoside inhibitors of viral DNA polymerase
Mechanism of action
Resistance
Pharmacokinetics
Unwanted effects
Drugs for Treating Hepatitis Viruses
Drugs for Treating Influenza Virus
M2 ion channel inhibitors
Neuraminidase inhibitors
Mechanism of action
Pharmacokinetics
Unwanted effects
Cap-dependent endonuclease inhibitor
Mechanism of action
Pharmacokinetics
Unwanted effects
Drugs for Treating Respiratory Syncytial Virus
Palivizumab
Mechanism of action and use
Pharmacokinetics
Unwanted effects
Drug for Treating Coronaviruses
Nucleotide analogue
Mechanism of action
Pharmacokinetics
Unwanted effects
Other Drugs for Viral Infections
Immunomodulators
Interferon alpha
Baricitinib
IL-6 pathway inhibitors
Corticosteroids
TREATMENT OF SPECIFIC VIRAL INFECTIONS
HIV Infection
Varicella Zoster Virus Infections
Herpes Simplex Virus Infections
Cytomegalovirus Infection
Influenza
Coronavirus Disease 2019 (COVID-19)
Viral Hepatitis
Respiratory Syncytial Virus
PROTOZOAL INFECTIONS
MALARIA
Antimalarial Drugs
Chloroquine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Mefloquine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Primaquine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Quinine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Pyrimethamine with sulfadoxine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Proguanil
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Artemether with lumefantrine
Mechanism of action and resistance
Pharmacokinetics
Unwanted effects
Treatment of Malaria
Prophylaxis Against Malaria
OTHER PROTOZOAL INFECTIONS
Atovaquone
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Pentamidine
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Sodium Stibogluconate
Mechanism of action and use
Pharmacokinetics
Unwanted effects
HELMINTHIC INFECTIONS
ANTIHELMINTHIC DRUGS
Ivermectin
Mechanism of action and use
Pharmacokinetics
Unwanted effects
Diethylcarbamazine
Mechanism of action and use
Pharmacokinetics
Unwanted effects
Benzimidazoles
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Niclosamide
Mechanism of action and use
Pharmacokinetics
Unwanted effects
Praziquantel
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
Case 1 answers
Case 2 answers
Case 3 answers
Case 4 answers
FURTHER READING
Antibacterial Drugs
Antifungal Drugs
Antiviral Drugs
Antiprotozoal Drugs
Antihelminthic Drugs
52 - Drugs for Cancer
~
THE BIOLOGY OF CANCER
CYTOTOXIC ANTICANCER DRUGS
MECHANISMS OF ACTION
RESISTANCE
DRUG COMBINATIONS
UNWANTED EFFECTS
Gastrointestinal Tract
Bone Marrow
Hair Follicle Cells
Reproductive Organs
Growing Tissues in Children
Extravasation of Intravenous Drug
Tumour Lysis Syndrome
Peripheral Neuropathy
SPECIFIC CYTOTOXIC ANTICANCER DRUGS
DRUGS AFFECTING NUCLEIC ACID FUNCTION
Alkylating Drugs
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Cytotoxic Antibiotics
Mechanisms of action and uses
Pharmacokinetics
Unwanted effects
Platinum Compounds
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Antimetabolites
Folic acid antagonists
Mechanism of action and uses. 
Pharmacokinetics. 
Unwanted effects
Base analogue antimetabolites
Mechanism of action and uses. 
Pharmacokinetics. 
Unwanted effects
DRUGS THAT INHIBIT MITOSIS
Vinca Alkaloids
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Taxanes
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Camptothecin Analogues (Topoisomerase I Inhibitors)
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
Podophyllotoxins (Topoisomerase II Inhibitors)
Mechanism of action and uses
Pharmacokinetics
Unwanted effects
TARGETED ANTICANCER DRUGS
DRUGS AFFECTING TYROSINE KINASES AND OTHER PROTEIN KINASES
Growth Factor Inhibitors
Mechanism of action and uses
Protein Kinase Inhibitors
Pharmacokinetics
Unwanted effects
POLY ADP RIBOSE POLYMERASE (PARP) INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted effects
PROTEASOME INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted effects
B-CELL LYMPHOMA-2 (Bcl-2) INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted effects
HEDGEHOG PATHWAY INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted effects
MISCELLANEOUS ANTICANCER DRUGS
HORMONAL ANTICANCER DRUGS
Glucocorticoids
Oestrogens
Progestogens
Oestrogen Receptor Antagonists
Aromatase Inhibitors
Androgen Receptor Antagonists
Gonadorelin Analogues
IMMUNE CHECKPOINT INHIBITORS
Mechanism of action
Pharmacokinetics
Unwanted effects
OTHER IMMUNOTHERAPY FOR SPECIFIC TUMOURS
CLINICAL USES OF ANTICANCER DRUGS
ANTICANCER DRUG THERAPY FOR SPECIFIC MALIGNANCIES
OESOPHAGEAL CANCER
GASTRIC CANCER
PANCREATIC CANCER
COLORECTAL CANCER
LUNG CANCER
MELANOMA
RENAL CANCER
BLADDER CANCER
PROSTATE CANCER
TESTICULAR CANCER
OVARIAN CANCER
CERVICAL CANCER
ENDOMETRIAL CANCER
BREAST CANCER
Oestrogen Receptor-Positive Tumours
Oestrogen Receptor-Negative Tumours
ACUTE MYELOID LEUKAEMIAS
ACUTE LYMPHOBLASTIC LEUKAEMIA
CHRONIC MYELOID LEUKAEMIA
CHRONIC LYMPHOCYTIC LEUKAEMIA
MALIGNANT LYMPHOMAS
MULTIPLE MYELOMA
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE-BEST-ANSWER (OBA) QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
CASE-BASED ANSWERS
FURTHER READING
53 - Drug Toxicity and Overdose
~
DRUG TOXICITY AND ADVERSE EFFECTS
TYPES OF UNWANTED EFFECT
PHARMACOLOGICAL TOXICITY
BIOCHEMICAL TOXICITY
Paracetamol
Cyclophosphamide
Isoniazid
Spironolactone
Aromatic Amines and Nitrites
Methaemoglobinaemia
Haemolysis
IMMUNOLOGICAL TOXICITY
THE YELLOW CARD SCHEME
SELF-POISONING AND DRUG OVERDOSE
MANAGEMENT PRINCIPLES
MANAGING ADVERSE EFFECTS
Immediate Measures
Supportive Measures
Cardiac or respiratory arrest
Hypotension
Arrhythmias
Seizures
Renal failure
Hepatic failure
Impaired temperature regulation
REDUCING TOXICITY
Prevention of Absorption of Poisons
Activated charcoal
Elimination of Poisons
Multiple-dose activated charcoal (MDAC)
Renal elimination
Haemodialysis and haemoperfusion
Specific Antidotes
Competitive receptor antagonists
Chelating agents
Compounds that affect drug metabolism
Antibodies
SOME COMMON SPECIFIC POISONINGS
Paracetamol
Salicylates
Antidepressants
Opioid Analgesics
Beta-Adrenoceptor Antagonists
Ecstasy
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
CASE-BASED QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
CASE-BASED ANSWERS
FURTHER READING
54 - Substance Abuse and Dependence
THE BIOLOGICAL BASIS OF DEPENDENCE
THE MESOCORTICOLIMBIC REWARD PATHWAY
DRUGS OF ABUSE
PSYCHOMOTOR STIMULANTS
Cocaine
Mechanism of action and effects
Pharmacokinetics
Management of cocaine dependence
Amfetamine and Derivatives
Mechanism of action and effects
Pharmacokinetics
Management of amfetamine dependence
Cathinone Stimulants
Mechanism of action
Pharmacokinetics
Nicotine and Tobacco
Mechanism of action
Effects of nicotine and tobacco
Respiratory effects
Cardiovascular effects
Psychological effects
Other effects
Pharmacokinetics of nicotine
Dependence on and withdrawal from nicotine
Nicotine replacement therapy
Bupropion
Varenicline
PSYCHOTOMIMETIC AGENTS
Hallucinogens
Mechanism of action and effects
Pharmacokinetics
Cannabis
Mechanism of action and effects
Uses of cannabinoids
Pharmacokinetics
Dissociative Anaesthetics
Mechanism of action and effects
Pharmacokinetics
CENTRAL NERVOUS SYSTEM DEPRESSANTS
Alcohol (Ethyl Alcohol, Ethanol)
Mechanism of action and effects
Other effects of alcohol
Cardiovascular effects
Liver
Other gastrointestinal consequences
Sexual function
Neuropsychiatric effects
Carcinogenesis and teratogenesis
Pharmacokinetics
Alcohol abuse and dependence
Gamma-Hydroxybutyric Acid
Mechanism of action and effects
Pharmacokinetics
Inhaled Solvents
NEW PSYCHOACTIVE SUBSTANCES
CONTROLLED DRUGS
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE BEST ANSWER (OBA) QUESTIONS
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWERS
FURTHER READING
55 - Prescribing, Adherence and Information About Medicines
~
DUTIES OF THE PRESCRIBER
GENERIC PRESCRIBING
DOSAGE
DOSE
FREQUENCY AND TIMES OF ADMINISTRATION
THE ROUTE OF ADMINISTRATION
THE QUANTITY TO BE SUPPLIED OR THE DURATION OF THERAPY
OTHER ITEMS ON A PRESCRIPTION
ADHERENCE, CONCORDANCE AND COMPLIANCE
INFORMING PEOPLE ABOUT THEIR MEDICINES
RATIONAL PRESCRIBING
THE PRESCRIBING SAFETY ASSESSMENT (PSA)
FURTHER READING
General prescribing
Preparation for the UK Prescribing Safety Assessment (PSA)
56 - Drug Therapy in Special Situations
PRESCRIBING IN PREGNANCY
PHARMACOKINETICS IN PREGNANCY
DRUGS AND BREASTFEEDING
PHARMACOKINETICS IN LACTATION
PRESCRIBING FOR CHILDREN
PHARMACOKINETICS IN NEONATES AND CHILDREN
Absorption
Distribution
Metabolism
Renal Elimination
PRESCRIBING FOR OLDER PEOPLE
PHARMACOKINETICS IN OLDER PEOPLE
Absorption and Distribution in Older People
Metabolism in Older People
Renal Elimination in Older People
PRESCRIBING IN RENAL FAILURE
PHARMACOKINETICS IN RENAL FAILURE
PRESCRIBING IN LIVER DISEASE
PHARMACOKINETICS IN LIVER DISEASE
PRESCRIBING IN PALLIATIVE CARE
PAIN
NAUSEA AND VOMITING
ANOREXIA/CACHEXIA/FATIGUE SYNDROME
CONSTIPATION
BREATHLESSNESS
HICCUPS
CONTINUOUS SUBCUTANEOUS INFUSIONS
DRUG INTERACTIONS
PHARMACODYNAMIC INTERACTIONS
PHARMACOKINETIC INTERACTIONS
Absorption
Distribution
Metabolism
Excretion
SELF-ASSESSMENT
TRUE/FALSE QUESTIONS
ONE BEST ANSWER (OBA) QUESTION
ANSWERS
TRUE/FALSE ANSWERS
OBA ANSWER
FURTHER READING
Index
IBC