Final PDF to printer Pharmacology An Introduction 7 th edition Henry Hitner , Ph.D. Professor Emeritus Department of Neuroscience, Physiology, and Pharmacology Philadelphia College of Osteopathic 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 Bryn Mawr, Pennsylvania hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd ii 44//2288//1155 77::4466 AAMM Final PDF to printer PHARMACOLOGY: AN INTRODUCTION, SEVENTH EDITION Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2016 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2012, 2005, and 1999. 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Pharmacology: an introduction.—7th edition / Henry Hitner, Ph.D., professor emeritus, Department of Neuroscience, Physiology, Pharmacology, Philadelphia College of Osteopathic 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, Bryn Mawr, Pennsylvania. pages cm Includes index. ISBN 978-0-07-351381-2 (alk. paper) 1. Pharmacology. I. Nagle, Barbara T. II. Title. RM300.H57 2016 615.1—dc23 2014044612 The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites. www.mhhe.com hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd iiii 22//1177//1155 99::0066 AAMM Final PDF to printer Brief Contents About the Authors xviii Preface xix What Every Student Needs to Know xxiv 1 . P harmacology: A n I ntroduction 4 2 . P harmacokinetics and F actors of I ndividual V ariation 17 3 . G eriatric P harmacology 34 4 . M ath R eview and D osage C alculations 43 5 . I ntroduction to the A utonomic N ervous S ystem 58 6 . D rugs A ffecting the S ympathetic N ervous S ystem 68 7 . D rugs A ffecting the P a rasympathetic N ervous S ystem 85 8 . D rugs A ffecting the A utonomic G anglia 99 9 . S keletal M uscle R elaxants 106 10. L ocal A nesthetics 123 11. I ntroduction to the C entral N ervous S ystem 138 12 . S edative - H ypnotic D rugs and A lcohol 146 13 . A ntipsychotic and A ntianxiety D rugs 161 14 . A ntidepressants, P sychomotor S timulants, and L ithium 175 15 . P sychotomimetic D rugs of A buse 188 16 . A ntiepileptic D rugs 200 17 . A ntiparkinson D rugs 212 18. G eneral A nesthetics 225 19. O pioid A nalgesics 248 20 . N onopioid A nalgesics , N onsteroidal Anti-inflammatories , and A ntigout D rugs 272 21. Review of C ardiac P hysiology and P athology 304 iii hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd iiiiii 22//1177//1155 99::0066 AAMM Final PDF to printer 22 . T reatment of H eart failure 312 23 . A ntiarrhythmic D rugs 326 24. A ntianginal D rugs 341 25 . D iuretics 352 26 . A ntihypertensive D rugs 373 27 . A nticoagulants and C oagulants 388 28. N utrition and T herapy 409 29. H ypolipidemic D rugs 431 30. A ntianemics 451 31. A ntihistaminic D rugs and M ast C ell Stabilizers 468 32. R espiratory P h armacology, T reatment of A sthma, and COPD 4 85 33 . T herapy of G astrointestinal D isorders: P eptic U lcers, GERD, and V omiting 502 34. A gents T h at A ffect I ntestinal M otility 529 35. I ntroduction to the E ndocrine S ystem 546 36. A drenal S teroids 557 37. G onadal H ormones , O ral C ontraceptives, and E rectile D ysfunction D rugs 575 38. D rugs A ffecting the T hyroid and P a rathyroid G lands and B one D egeneration 601 39. P ancreatic H ormones and A ntidiabetic D rugs 620 40. P osterior P ituitary H ormones : A ntidiuretic H ormone and O xytocin 653 41. A ntibacterial A gents 666 42 . A ntifungal and A ntiviral D rugs 687 43 . P arasitic I nfections: A ntiprotozoal and A nthelmintic D rugs 721 44 . A ntiseptics and D isinfectants 737 45. A ntineoplastic A gents 754 46. I mmunopharmacology 771 Glossary 783 Appendix A Latin Abbreviations Used in Medicine 798 Appendix B Abbreviations and Symbols Commonly Used in Medical Notations 799 Photo Credits 803 Index 805 iv Brief Contents hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd iivv 22//1177//1155 99::0066 AAMM Final PDF to printer Table of Contents PART 1 G e neral C o ncepts 3 CHAPTER 1 Pharmacology: An Introduction 4 Drug Sources and Major Areas of Pharmacology 5 Terminology Related to Drug Effects 6 Basic Concepts in Pharmacology 7 Dose-Response and Time-Plasma Drug Concentration Curves 8 Drug Safety 9 Drug Nomenclature 10 Drug References and Drug Legislation 10 Chapter Review 13 CHAPTER 2 Pharmacokinetics and Factors of Individual Variation 17 Drug Forms and Routes of Administration 18 Pharmacokinetic Processes 20 Clinical Factors that Determine the Intensity of Drug Response 23 Factors of Individual Variation 25 Pharmacokinetic Considerations for Pediatrics 26 Drug Interactions 28 Terminology Associated with Chronic Drug Use and Abuse 28 Chapter Review 30 CHAPTER 3 Geriatric Pharmacology 34 Drug Use in the Elderly 35 Drug Absorption and Distribution 35 Drug Metabolism and Excretion 36 Effects of Age on Drug Response 37 Drug Compliance in the Elderly 38 Chapter Review 40 CHAPTER 4 Math Review and Dosage Calculations 43 Fractions, Decimals, and Percents 44 Dosage Calculations 46 v hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd vv 22//1177//1155 99::0066 AAMM Final PDF to printer Systems of Measurement 46 Calculating Dosages 48 Pediatric Dosage Calculations 49 Monitoring IV Infusion Rates 50 Chapter Review 5 2 PART 2 P h armacology of the P e ripheral N ervous S y stem 57 CHAPTER 5 Introduction to the Autonomic Nervous System 58 Nervous System Organization 59 Overview of the ANS 60 Parasympathetic and Sympathetic Divisions 60 ANS Nerve Fibers and Neurotransmitters 63 Cholinergic and Adrenergic Receptors 65 Chapter Review 66 CHAPTER 6 Drugs Affecting the Sympathetic Nervous System 68 Adrenergic Nerve Endings 69 Adrenergic Receptors 70 Adrenergic Drug Classes 71 Alpha-Adrenergic Drugs 72 Beta-Adrenergic Drugs 73 Alpha-Adrenergic Blocking Drugs 75 Beta-Adrenergic Blocking Drugs 76 Adrenergic Neuronal Blocking Drugs 78 Chapter Review 82 CHAPTER 7 Drugs Affecting the Parasympathetic Nervous System 85 Cholinergic Nerve Activity 86 Cholinergic Receptors 86 Cholinergic Drugs 88 Clinical Indications for Anticholinesterase Drugs 91 Anticholinergic Drugs 93 Preferred Treatment for Selected Conditions 94 Chapter Review 96 vi Table of Contents hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd vvii 44//2288//1155 77::4466 AAMM Final PDF to printer CHAPTER 8 Drugs Affecting the Autonomic Ganglia 99 Ganglionic Stimulants 100 Drugs Used in Smoking Cessation 100 Ganglionic Blockers 102 Drug Interactions with Ganglionic Blocking Drugs 103 Chapter Review 104 CHAPTER 9 Skeletal Muscle Relaxants 106 Skeletal Muscle Relaxation 108 Peripherally Acting Skeletal Muscle Relaxants 108 Major Adverse Effects Associated with Peripheral NMB 112 Direct-Acting Skeletal Muscle Relaxants 114 Centrally Acting Skeletal Muscle Relaxants (Spasmolytics) 115 Preferred Treatment for Selected Conditions 117 Chapter Review 120 CHAPTER 10 Local Anesthetics 123 How Local Anesthetics Work 124 Types of Local Anesthetics 125 Types of Local Anesthesia 126 Adverse Effects Associated with Local Anesthetics Use 130 Clinical Applications 130 Special Considerations 131 Chapter Review 133 PART 3 P h armacology of the C e ntral N ervous S y stem 137 CHAPTER 11 Introduction to the Central Nervous System 138 Structural and Functional Features of the Brain 139 Diencephalon and Brainstem 140 Cerebellum 141 Spinal Cord 141 Functional Components 141 Chapter Review 143 Table of Contents vii hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd vviiii 22//1177//1155 99::0077 AAMM Final PDF to printer CHAPTER 12 Sedative-Hypnotic Drugs and Alcohol 146 Sleep Cycle 148 Mechanism of Action of Sedative-Hypnotic Drugs 149 Barbiturate Sedatives and Hypnotics 149 Benzodiazepines 152 Miscellaneous Hypnotic Drugs 154 Alcohol 155 Chapter Review 158 CHAPTER 13 Antipsychotic and Antianxiety Drugs 161 Antipsychotic Drugs 162 Phenothiazines 163 Butyrophenones 164 Thioxanthenes 165 Atypical Antipsychotic Drugs 166 Antianxiety Drugs 167 Chapter Review 172 CHAPTER 14 Antidepressants, Psychomotor Stimulants, and Lithium 175 Types of Depression 176 Selective Serotonin Reuptake Inhibitors SSRIs 177 Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) 178 Tricyclic Antidepressants 179 Monoamine Oxidase Inhibitors (MAOIs) 180 Antidepressants with Additional Mechanisms of Action 182 Psychomotor Stimulants 182 Lithium 183 Preferred Therapy for Depression, Mania, and Bipolar Disorder 184 Chapter Review 185 CHAPTER 15 Psychotomimetic Drugs of Abuse 188 LSD-Type Hallucinogens 189 Psychomotor Stimulants 191 Phencyclidine 194 Marijuana 194 Chapter Review 197 viii Table of Contents hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd vviiiiii 44//2288//1155 77::4466 AAMM Final PDF to printer CHAPTER 16 Antiepileptic Drugs 200 Types of Epilepsy 201 Drugs Effective for Both Generalized Tonic-Clonic and Partial Seizures 202 Drugs Effective Primarily For Partial Seizures 206 Drugs Used in the Treatment of Absence Seizures 206 Treatment of Status Epilepticus 207 Preferred Therapy for Epileptic Seizures 207 Chapter Review 209 CHAPTER 17 Antiparkinson Drugs 212 Neurotransmitters Affecting the Basal Ganglia 213 Drugs that Form Dopamine 215 Drugs that Inhibit Metabolism of Levodopa and DA 216 Dopamine Receptor Agonists 219 Miscellaneous Drugs 219 Preferred Therapy for Parkinson’s Disease 220 Chapter Review 222 CHAPTER 18 General Anesthetics 225 Types of Anesthesia 227 Characteristics of General Anesthesia 228 Mechanism of Action of General Anesthetics 229 Classes of General Anesthetics 231 Nonanesthetic Effects of General Anesthetics 236 Adjunct Medications Used in General Anesthesia 239 Special Considerations with General Anesthetic Use 242 Preferred Use of Anesthetics 244 Chapter Review 245 CHAPTER 19 Opioid Analgesics 248 Pathways for Pain Recognition 250 Clinical Indications 251 Opioid Analgesics 251 Sites and Mechanism of Opioid Action 253 Nonanalgesic Opioid Effects 256 Drug Administration and Disposition 258 Table of Contents ix hhiitt1133881144__ffmm__ii--xxxxvv..iinndddd iixx 22//1177//1155 99::0077 AAMM