Textbook Of Pharmacology Research Articles

A textbook of clinical pharmacology

Textbooks of clinical pharmacology for medical students face two challenges. They need to provide concise information on the treatment of common diseases to enable the newly qualified doctor to acquire an adequate knowledge base to prescribe. Most textbooks succeed in this with varying ‘cost effectiveness’. The second more difficult task, more relevant to producing long-term professional competency in drug treatment, is to encourage students to think critically about drug use and the principles of clinical pharmacology and to encourage the acquisition of the skills required to practise ‘rational’ or ‘optimal’ therapeutics. Few student textbooks succeed in capturing this intellectual spirit of clinical pharmacology that separates it from the approach of other disciplines to drug treatment. The fourth edition of this textbook takes a traditional approach with the first section covering general principles, and the remaining 13 sections accounting for over 75% of the book, dealing with the treatment of common diseases (therapeutics). The book is attractively laid out, easy to read and has sufficient figures, tables, case histories and key points to hold the reader's attention, although the similarly priced ‘Integrated Pharmacology’ by Page et al. is better on visual presentation and layout. The principles of pharmacokinetics, pharmacodynamics and drug use in special groups (pregnancy, children and the elderly) are well covered at an appropriate level. This section would benefit from chapters on practical aspects of drug administration, particularly intravenous drug administration, writing prescriptions and the procedures and mindset necessary to avoid the ‘drug disasters’ that still too commonly occur in routine clinical practice. The importance of adherence to drug treatment, and its influencing factors, is not covered adequately, with only brief discussion in the chapters on the elderly and children. This approach will perpetuate the incorrect belief that poor adherence is a problem mostly in these patients. Inevitably textbooks are soon out of date and omit recent advances in therapeutics, and these sections should come with a ‘best before’ date. CD or web based updates are probably needed if textbooks are to avoid being completely replaced by electronic media. I was disappointed to see no mention of the use of thrombolysis and aspirin in acute ischaemic stroke, or beta-interferon as a treatment for multiple sclerosis. Although multiple risk factor assessment in cardiovascular risk is discussed, examples of how to use coronary risk prediction charts are not given. However, in general the therapeutics sections provide a lucid comprehensive account for students. This text is less successful in capturing the spirit of clinical pharmacology and outlining the principles and thinking which cultivate a ‘critical approach’ to the optimal use of drugs in clinical care. The North American text ‘Melmon and Morelli’s Clinical Pharmacology' is best in this respect, but it is little read in this country and too large to suit most students. This book is a reasonable recommendation to students as a core text for therapeutics teaching. Departments with integrated teaching of Pharmacology and Clinical Pharmacology and Therapeutics should probably consider other texts, which include more basic pharmacology.

Peripheral Nerve Blocks. A Colour Atlas

J. E. Chelly (Ed.) Lippincott Williams & Wilkins, 1999. 240 pp. This beautiful book reflects the growing interest in peripheral, as opposed to central, nerve blockade, and therefore makes no mention of spinal or epidural injections. The book is divided into four sections: General Concepts; Single Injection; Peripheral Blocks: Continuous Peripheral Blocks; and Paediatric Peripheral Blocks. Section One deals briefly with preparation, well with the use of a nerve stimulator and very briefly with local anaesthetic solutions. It does not set out to be a pharmacology textbook, but makes sensible suggestions as to the choice of local anaesthetic, additives and the avoidance of toxicity. The bulk of the book is made up of a beautifully illustrated practice guide to nerve blockade with over 200 of the 240 pages being dedicated to sections 2, 3 and 4. Each section is logically laid out, dealing with upper limb, lower limb and other blocks, in that order. Where there are several methods, these are given in the author's choice of order. Despite being a multi-author publication, the style is uniform throughout, and most descriptions are clear and understandable even by the inexperienced. As you read you feel that the authors are describing what they practice. Having said that, some blocks, the anterior approach to the sciatic nerve for instance, are much more easily described than performed, and I am unsure of the value of the author's variation on Beck's original approach. The sections on catheter techniques and paediatric blocks are a joy and a delight even for those who, like me, no longer practice paediatric anaesthetics. To have catheter techniques together in one section is valuable, and children definitely are different. References are limited in number with between two and eight being cited at the end of each description, but are sufficient to give depth to each section if required. Predominantly drawn on American publications, there is also a reasonable number from British and other European sources, especially French. Many of the English language references will be familiar to those interested in peripheral blocks but those in French may be less well known. The index is more than adequate, despite my best efforts to catch it out. There are, of course, oddities and niggles. It is surprising to find that Raj's supine approach to the sciatic nerve, which has the ischeal tuberosity, and the greater trochanter as landmarks, merits only three lines under ‘Anterior Approaches’. Metatarsal block is referred to as a successful alternative to ankle block, but not described. One manufacturer of insulated needles is named 60 times in the text, which eventually I found very annoying; I realised I was scanning each page for the offending name before I could read it. Other companies are also acknowledged but in what appeared to be a rather haphazard fashion, and certainly very much less often. Infinitives are split with gay abandon throughout, which still grates an old fashioned pedant like me. However, these are small points which do not, in the end, detract significantly from the value of the book, nor my enjoyment in reading it. Aimed at trainees and those more senior who wish to refresh or extend their knowledge of block techniques, it provides clear instruction in the art of peripheral nerve blockade which will support and underpin practical training. Every theatre where peripheral nerve blockade is practised should have a copy on the shelf and there will be many anaesthetists of all levels who will enjoy the book, because it is a lovely book, and learn from the descriptions, even of the blocks they do routinely.

The Ancestors of Inhalational Anesthesia: The Soporific Sponges (XIth–XVIIth Centuries)

The Ancestors of Inhalational Anesthesia: The Soporific Sponges (XIth–XVIIth Centuries)

How drug therapy can affect, threaten and compromise nutritional status

Background and aims This article reviews the published literature on the mechanisms by which drugs alter nutrient intake and the interactions between drugs and nutrients. We aimed to examine evidence of nutrient deficiencies caused by drug therapy, to indicate groups of ‘at‐risk’ patients and suggestions made for practical methods of detection and intervention.Methods Information was retrieved from a MEDLINE search of English language literature from 1963 to January 1999. Search terms included nutrient, deficiencies and interactions. Additional references were obtained from cross‐referencing related review articles and from pharmacology textbooks relating to interactions and side‐effects of drugs. All drugs are referred to by their generic names.Results Drugs can reduce nutrient intake in several ways and can be broadly classified as: (i) drugs that reduce oral intake; (ii) drugs that alter nutrient absorption and (iii) drugs that affect nutrient metabolism. In this review the mechanisms by which drugs can alter nutritional status are discussed, with specific examples of drug therapy and associated symptoms of deficiencies.Conclusions Patients at high risk of experiencing the effects of drug‐induced nutrient deficiencies are the elderly and chronically ill. Recommendations made for methods of intervention include counselling and annotations on drug prescriptions.

Textbook of Ocular Pharmacology

Textbook of Ocular Pharmacology

Textbook of Ocular Pharmacology

Textbook of Ocular Pharmacology

Drugs Prototypes and Their Exploitation

This book is a development of Dr Sneader's earlier and invaluable Drug Discovery: the Evolution of Modern Medicines, first published in 1985. The author, who is Senior Lecturer in Pharmaceutical Sciences at Strathclyde University, has identified 240 chemical prototypes and has adopted the novel approach of tracing the development of the final pharmaceutical products through a number of generations. The prototypes, on the basis of their origins, are divided into six main groups: mineral and organic; plants; animal or human body; micro-organisms; synthetic chemicals; and serendipitous discoveries. Typographic devices are employed to indicate degrees of relationship. Prototypes are enclosed in double-line boxes, next-of-kin in single-line boxes, followed by underlining and descending emphasis of type-face, extending in some instances to eight levels of descent. Chapters are introduced by family trees, on which, for example, some 55 derivatives of atropine, 50 of adrenaline or 30 of ephedrine are delineated. Much pharmaceutical fog is dispersed and some unexpected relationships become evident — phenylbutazone to quinine, naloxone to thebaine and fentanyl and its congeners, via haloperidol and pethidine, to atropine, for example. The book is replete with structural formulae, which are invaluable for demonstrating chemical relationships, to which similarities and differences of pharmacokinetic and pharmacodynamic properties can be attached. The book opens with a brief but useful chapter on drug therapy and its origins throughout the ages, starting with the Egyptian medical papyri and proceeding via Greek and Arab medicine and the Renaissance, to the nineteenth century. Comprehensive accounts of the various prototypes and derivatives follow, with brief histories of the compounds, their mode of discovery and development, including the primary references, their uses and, where known, the people involved. Although it covers the whole range of pharmaceutics, the book will be of especial interest to anaesthetists partly because of its comprehensive anaesthetic content and partly because in the nature of things the anaesthetist requires a far wider knowledge of drugs than does any other practitioner. As regards anaesthetics, a number of the inhalational agents, from nitrous oxide to enflurane and several others, including lignocaine and its derivatives, feature as serendipitous discoveries; and the cover is comprehensive. Drugs now obsolete, but which spearheaded the anaesthetic revolution of the late 1940s, are here; penta- and hexamethonium, introduced as antidotes to the muscle relaxant decamethonium and soon found serendipitously and alarmingly to have profound hypotensive effects; and mephenesin, another relaxant, derived from a constituent of an expectorant cough mixture, which itself, by substitution of a chlorine ion for a methane radicle, became an antifungal drug. This comprehensiveness is of great value to the historian and it provides a pleasant stroll down memory lane for those who lived through this period. But as regards anaesthesia there are one or two inaccuracies, or debatable statements. Horace Wells's unfortunate patient, for example, would hardly have ‘struggled in agony under the surgeon's knife’, since he was having a tooth out and Dr Frank Bennetts has shown that the number of barbiturate-attributed deaths at Pearl Harbour was greatly exaggerated. The comprehensive nature of this book makes it of interest and value to clinicians, researchers and pharmacists. It should be in the library of every medical school and postgraduate centre. It is not just another pharmacology textbook; it is like no other. Dr Sneader has produced the Burke's Peerage of pharmaceuticals.

Release of soluble nucleotidases: a novel mechanism for neurotransmitter inactivation?

When nonpeptide neurotransmitters are released from nerves, their actions are limited temporally by removal from the extracellular space via one of two active processes. For amines and amino acids, specific, high-affinity transporters mediate their uptake back into the nerves or into surrounding support cells[ 1 Amara S.G. Kuhar M.J. Annu. Rev. Neurosci. 1993; 16: 73-93 Crossref PubMed Scopus (991) Google Scholar ]. In contrast, acetylcholine and adenosine 5′-triphosphate (ATP) are broken down by extracellular enzymes. Acetylcholine is inactivated by acetylcholinesterase in the synaptic cleft and then choline is taken up into the nerve[ 2 Bowman W.C. Rand M.J. Textbook of Pharmacology. 2nd edn. Blackwell, 1980: 10.1-10.8 Google Scholar ]. Extracellular membrane-bound nucleotidases (ecto-nucleotidases) which sequentially dephosphorylate ATP to adenosine 5′-diphosphate (ADP), adenosine 5′-monophosphate (AMP) and adenosine are present in most tissues[ 3 Ziganshin A.U. Hoyle C.H.V. Burnstock G. Drug Dev. Res. 1994; 32: 134-146 Crossref Scopus (104) Google Scholar , 4 Plesner L. Int. J. Cytol. 1995; 158: 141-214 Crossref PubMed Scopus (447) Google Scholar , 5 Zimmerman H. Prog. Neurobiol. 1996; 49: 589-618 Crossref PubMed Scopus (391) Google Scholar , 6 Kennedy C. Leff P. Trends Pharmacol. 1995; Sci. 16: 168-174 Abstract Full Text PDF Scopus (164) Google Scholar ] and it is generally assumed that these enzymes terminate the neurotransmitter actions of ATP in the brain[ 7 Edwards F.A. Gibb A.J. Colquhoun D. Nature. 1992; 359: 144-146 Crossref PubMed Scopus (723) Google Scholar ] and periphery[ 8 Burnstock G. Ann. New York Acad. Sci. 1990; 603: 1-17 Crossref PubMed Scopus (360) Google Scholar , 9 Westfall T.D. Kennedy C. Sneddon P. Br. J. Pharmacol. 1996; 117: 867-872 Crossref PubMed Scopus (75) Google Scholar ]. However, it was recently found that when the sympathetic nerves innervating the guinea-pig vas deferens are stimulated, they release not only neuronal ATP, but also soluble nucleotidases which break down ATP to adenosine[ 10 Todorov L.D. et al. Nature. 1997; 387: 76-79 Crossref PubMed Scopus (213) Google Scholar ] (Fig. 1). This release of specific nucleotidases may represent a novel mechanism for terminating the actions of a neurotransmitter.

A memorable book: From magic to science

I graduated in Prague, Czechoslovakia, in 1939 one month before the Czech capital was occupied by the Nazis. I was lucky to escape to Palestine, where I joined the Czechoslovak Army, later to be transferred to the Royal Army Medical Corps. In order to acquaint myself with the British pharmacopoeia—somewhat different from the central European one—I looked up in the hospital's small library a textbook of clinical pharmacology. It was …

Adverse CNS-effects of beta-adrenoceptor blockers.

In 1962 propranolol, the first beta adrenoceptor antagonist (beta blocker), was brought on to the market. There is now a host of different beta blockers available, and these compounds are among the most commonly prescribed groups of drugs. The efficacy of beta blockers has been proven predominantly for the treatment of cardiovascular diseases. Beta blockers are also used for certain types of CNS disorders, such as anxiety disorders, essential tremor and migraine. While low toxicity means that they have a favorable risk-benefit ratio, given the high intensity of use, it is essential to have a comprehensive knowledge of adverse events. Adverse events of beta blockers that can be related to the CNS are quite often neglected, even in textbooks of clinical pharmacology or review articles, and thus often misdiagnosed. The following article, therefore, after summarizing the use of beta blockers for CNS indications, critically reviews the literature on centrally mediated adverse events. General pharmacological features of beta blockers and their molecular basis of action will briefly be addressed to the extent that they are or may become relevant for central nervous pharmacotherapy and side-effects.

Review : Infertility after chemotherapy: A review of the risks and strategies for prevention

Purpose. Infertility as a late complication of cancer chemotherapy, focusing on specific drug-related ef fects, effects observed in the treatment of certain malignancies, and strategies for prevention is re viewed. Data Sources. A MEDLINE search of articles from 1966 to present was conducted using the terms infertility, antineoplastics, amenorrhea, azospermia, oogenesis, and spermatogenesis. Additional refer ences were identified using review articles and phar macology textbooks. Study Selection. All human studies reported in English language were included. Animal studies were included when human data were insufficient or un available. Data Synthesis. Data on the infertility effects of individual antineoplastic agents are difficult to inter pret for several reasons, including small sample sizes, lack of prechemotherapy fertility assessment, inade quate long-term follow-up, and use of regimens in cluding multiple agents. In general, the incidence and severity of antifertility effects are dependent on the total dosage delivered, duration of therapy, and age at exposure. The alkylating agents have the most signif icant effects on fertility. Fertility outcomes have been reported for several different malignancies, especially in patients cured of Hodgkin's disease and testicular cancer. Information on specific antineoplastic agents and cancers are reviewed. Several methods have been employed to decrease gonadotoxic effects, but none have been effective. Conclusions. Infertility is a common late com plication of cancer chemotherapy that is receiving increasing attention as the number of cancer survi vors increases. Health care professionals should be aware of infertility risks associated with antineoplastic agents and certain malignancies, and patients should be informed of these risks as treatment decisions are made.

François Magendie and the new science of drugs

The first pure drugs from plant sources were obtained early in the 19th century. Magendie saw them as the basis for the development of a scientific pharmacopoeia based exclusively on pure compounds and, by 1821, had produced the first textbook of pharmacology based on strict scientific principles.

Oxford textbook of clinical pharmacology and drug therapy. Edited by D. G. Grahame‐Smith and J. K. Aronson. Published by Oxford University Press. pp. 756 + xviii. IBSN: 0–19–2616757

Oxford textbook of clinical pharmacology and drug therapy. Edited by D. G. Grahame‐Smith and J. K. Aronson. Published by Oxford University Press. pp. 756 + xviii. IBSN: 0–19–2616757

Book Review: Textbook of Pharmacology

Book Review: Textbook of Pharmacology

FARMAGUIDA: a databank for the analysis of the Italian drug market and drug utilization in general practice.

FARMAGUIDA, a databank of drugs marketed in Italy (2,596 pharmaceutical substances corresponding to 10,448 products), permits analysis of the nature and value of the drugs prescribed. It contains coded pharmaceutical and administrative information, an original classification, as well as indicators of the therapeutic status of each drug. The FARMAGUIDA classification was built hierarchically according to a three-level pattern: the first level (42 categories) corresponds to major pharmacological groups; the second level (157 groups) gathers drugs having similar clinical indications and/or pharmacological actions; and the third level (246 subgroups) classifies drugs according to chemical structure and/or the mechanism of action. Drugs not falling into well-established pharmacotherapeutic criteria (e.g. neurotropics or liver protectants) are classified into separate subgroups. Two larger groupings were also formulated: THER (11 headings), a utilization-oriented arrangement in which each heading also contained the corresponding placebo-like drugs, and PHARM (14 headings), a rational pharmacological arrangement, in which all placebo-like drugs were relegated into a separate set. The following quality indicators were created: DOC, which defines five degrees of documentation of clinical efficacy according to major textbooks of pharmacology and therapeutics; CLASS, which groups DOC values for a more simple evaluation of prescription data; PREP, which distinguishes monocomponent preparations from fixed-dose combinations, and also provides coded information about the rationale for the combination; HOSP, which hallmarks drugs that should be reserved for in-patients, e.g. anti-pseudomonal antibiotics. The composition of the list of reimbursable drugs, the Italian National Formulary (NF; 5782 products in 1990) was analyzed according to the FARMAGUIDA classification and indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Book reviews

Australian Dental JournalVolume 35, Issue 5 p. 479-482 Book reviews First published: October 1990 https://doi.org/10.1111/j.1834-7819.1990.tb05440.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Book reviewed in this article: MODERN CONCEPTS IN OPERATIVE DENTISTRY, edited by Preben Hörsted-Bindslev and Ivar A. Mjör PAIN RELIEF IN THE OROFACIAL REGIONS, by Jens Kilsen Petersen and Peter Milgrom TMJ AND CRANIOFACIAL PAIN: DIAGNOSIS AND MANAGEMENT, by James R. Fricton, Richard J. Kroening, and Kate M. Hathaway MICROSURGICAL TISSUE TRANSPLANTATION, edited by D. Riediger and M. Ehrenfeld ENHANCEMENT, by Manuel H. Marks and Herman Corn INFLAMMATION. A REVIEW OF THE PROCESS, by Henry O. Trowbridge and Robert C. Emling QUALITY ASSURANCE FOR DIAGNOSTIC IMAGING EQUIPMENT. Recommendations of the National Council on Radiation Protection and Measurements TEXTBOOK OF DENTAL PHARMACOLOGY AND THERAPEUTICS, by John G. Walton, John W. Thompson, and Robin A. Seymour Volume35, Issue5October 1990Pages 479-482 RelatedInformation

Textbook of dental pharmacology and therapeutics

A reciprocating abrasion testing machine was used to measure the mutual abrasion of light-cured composites and clasps in vitro. Composite specimens were produced by packing the material into hemispherical wells in a polytetrafluoroethylene block, light-curing for 20 seconds and conditioning in distilled water for one week. The composites tested included ultrafine, hybrid and conventional types. Nine clasp types were studied including cast and wrought, round and half-round, cobalt-chromium, stainless steel and gold. The tests were carried out at 37 °C. The vertical overlap (undercut) of composite and clasp was set at 0.25mm. Ten specimens were subjected to 14,500 traverses in each test Abrasion of composite was measured as weight loss and reduction in thickness of the specimens, while abrasion of clasps was measured as weight loss. Abrasion of the composites was greatest for the conventional type and least for the ultrafines, but in all cases the changes were small and unlikely to impair the clinical performance of clasps during several years' usage. The abrasion of the clasps by conventional composite was considerable and would be expected to cause a significant reduction in retention clinically.

‘Drugs for children’ - an excellent new guide

This book “aims to outline the principles and problems of drug use in children and to help physicians increase their appreciation and knowledge of specific problem areas”. It is a short (180 page) handbook on safe and effective therapy for all who prescribe for children outside hospitals; it is not a textbook of paediatic pharmacology or therapeutics. The book has been produced by the WHO Regional Office for Europe. The editor and the main contributors are paediatricians from Britain, but many experts from 14 other countries helped to prepare the text, so that it is not insular.

Bailliere's Pharmacology and Drug Information for NursesPublished by Bailliere's Pharmacology and Drug Information for Nurses2ndFWelington Published by Bailliere Tindall758pp£9.950-7070-1169-X

A team of pharmacists and nurse educators adapted this new edition from an Australian text for use in the United Kingdom. Although the aim was to move away from the format of conventional pharmacology text books for nurses, I was not immediately struck by its being particularly new or different.

BOOK REVIEWS

Book reviewed in this article:Stuart MacLeod and Ingeborg C. Radde: Textbook of pediatric clinical pharmacology. PSG Publishing Co, Littleton, Massachusetts.P. A. Voute, A. Barret, H. J. G. Bloom, J. Lemerle, M. K. Nerdhardt (eds.): Cancer in children. Clinical Management. 2nd edition. Springer‐Verlag, 1986.