Essentials of Medical Pharmacology KD Tripathi
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1Essentials of Medical Pharmacology
3Essentials of Medical Pharmacology
Sixth Edition
KD TRIPATHI MD Ex-Director-Professor and Head of Pharmacology Maulana Azad Medical College and associated LN and GB Pant Hospitals New Delhi
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, +91-11-43574357
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021,
+91-11-23245672, Rel: +91-11-32558559 Fax: +91-11-23276490, +91-11-23245683
Branches
© 2008, KD Tripathi
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, phot o copying, recording, or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 1985
Second Edition: 1988
Third Edition: 1994
Fourth Edition: 1999
Updated Reprint: 2001
Fifth Edition: 2003
Sixth Edition: 2008
9788184480856
Typeset at JPBMP typesetting unit
5Preface
The unprecedented pace of developments over the recent years in the field of drugs (medicines) has further emphasized the relevance of Pharmacology to health professionals. Molecular targets of drug action are being defined at greater resolution, refining new drugs design. Practice of medicine is transforming from ‘experience (impression) based’ to ‘evidence based’, since more and more credible evidence from well designed clinical studies is now available on the impact of different treatments on mortality, morbidity and other therapeutic outcomes. The present edition is oriented to reflect the contemporary advancements.
Adopting the ‘prototype drug’ approach and a structured, systematic and user-friendly format, the actions, mechanisms, kinetics and toxicological aspects of drugs are described along with the pharmacological basis of their use and role/status in the therapy of various diseases/conditions. By a unique synthesis of pharmacology with clinical medicine, the book is designed to be useful both to the uninitiated medical student, as well as to prescribing physicians.
All chapters have been updated to include recently introduced drugs and published information. Latest therapeutic guidelines from leading professional bodies, WHO and National Health Programmes have been incorporated, especially in areas like hypertension, hyperlipidaemias, stroke prevention, surgical prophylaxis, tuberculosis, leprosy, malaria, and HIV-AIDS. Recent developments have been highlighted, notably in hormone replacement therapy, aromatase inhibitors, bisphosphonates, selective COX-2 inhibitors, atypical antipsychotics, therapy of diabetes mellitus, heart failure, acute coronary syndromes, Alzheimer's disease, parkinsonism, glaucoma, kala azar, etc. A chapter is devoted to the principles of ‘rational use of medicines’, elements of ‘evidence based medicine’ and the process of ‘new drug development’ to reflect current importance of these topics. Another new chapter compiles the clinically important drug interactions. Some other topics added are drug transporters, pharmacogenomics, pharmacovigilance, expiry date of pharmaceuticals, single enantiomer drugs, biological response modifiers, prescribing in pregnancy, etc.
New drugs marketed in India till mid 2007 are included, while obsolete ones are deleted. Infrequently used drugs and those not available in India are described briefly in extract type. Important points are summarized in boxes. Leading trade names with dosage forms are given. Emphasis is placed on the profile of diseases and drug use in India and other tropical countries, so as to be particularly useful to students and doctors in these regions; a need not well addressed by many texts.
Thanks are due to my colleagues and students for their valuable feedback and suggestions. As previously, the major impetus for this edition has come from Shri J.P. Vij, the ever agile Chairman of Jaypee Brothers. Commendable type setting, proof reading and improvement in illustrations has been done respectively by Ms Sunita Katla, Ms Geeta Srivastava and Mr Manoj. The editorial management and moral support of my wife has been a boon.
KD Tripathi
New Delhi
5th Nov. 2007
6Extract from Preface to the First Edition
Pharmacology is both a basic and an applied science. It forms the backbone of rational therapeutics. Whereas the medical student and the prescribing physician are primarily concerned with the applied aspects, correct and skilful application of drugs is impossible without a proper understanding of their basic pharmacology. Medical pharmacology, therefore, must include both fundamental background and clinical pharmacological information. Objective and quantitative data on the use of drugs in man, i.e., relationship between plasma concentration and intensity of therapeutic/toxic actions, plasma half lives, relative efficacy of different medications and incidence of adverse effects etc., are being obtained with the aim of optimising drug therapy. The concepts regarding mechanism of action of drugs are changing. In addition, new drugs are being introduced in different countries at an explosive pace. A plethora of information thus appears to be important. However, trying to impart all this to a medical student would be counter-productive.
One of the important aims of this book is to delineate the essential information about drugs. The opening sentence in each chapter defines the class of drugs considered. A ‘prototype’ approach has been followed by describing the representative drug of a class followed by features by which individual members differ from it. Leading trade names have been included. Clinically relevant drug interactions have been mentioned. Clear-cut guidelines on selection of drugs and their clinical status have been outlined on the basis of current information. Original, simple and self-explanatory illustrations, tables and flow charts have been used with impunity. Selected chemical structures are depicted. Recent developments have been incorporated. However, discretion has been used in including only few of the multitude of new drugs not yet available in India. This is based on their likelihood of being marketed soon. The information and views have been arranged in an orderly sequence of distinct statements.
I hope this manageable volume book would serve to dispel awe towards pharmacology from the minds of medical students and provide a concise and uptodate information source for prescribers who wish to remain informed of the current concepts and developments concerning drugs.
My sincere thanks are due to my colleagues for their valuable comments and suggestions.
KD Tripathi
New Delhi
1st Jan., 1985