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Pharmacology for Physiotherapy Students
Padmaja Udaykumar
CHAPTER 1:
General Pharmacology
INTRODUCTION AND SOURCES OF DRUGS
Definitions
Sources of Drugs
Natural Sources
Synthetic Drugs
ROUTES OF DRUG ADMINISTRATION
Enteral Route (Oral Ingestion)
Enteric Coated Tablets
Parenteral Route
Advantages
Disadvantages
1. Injections
Intradermal
Subcutaneous (SC) Injection
Intramuscular (IM)
Intravenous (IV)
Intraperitoneal
Intrathecal
Intra-articular
Intra-arterial
Intramedullary
2. Inhalation
Advantages
Disadvantages
3. Transdermal
Advantages
4. Transmucosal
Sublingual
Nasal
Rectal
Topical
SPECIAL DRUG DELIVERY SYSTEMS
PHARMACOKINETICS
Mechanisms of Transport of Drug Across Biological Membranes
Passive Transfer
Carrier-mediated Transport
Endocytosis
ABSORPTION
Bioavailability
Factors Affecting Bioavailability
Bioequivalence
DISTRIBUTION
BIOTRANSFORMATION (METABOLISM)
Site
Result of Biotransformation
Enzymes in Biotransformation
Enzyme Induction
Enzyme Inhibition
Excretion
Renal Excretion
Fecal and Biliary Excretion
Pulmonary Excretion
Other Routes of Excretion
Plasma Half-life and Steady State Concentration
Drug Dosage
Therapeutic Drug Monitoring
Methods of Prolonging Drug Action (Table 1.4)
PHARMACODYNAMICS
Mechanisms of Drug Action
1. Through Receptors
2. Through Enzymes and Pumps
3. Through Ion Channels
4. Physical Action
5. Chemical Interaction
6. Altering Metabolic Processes
Receptor
Functions of Receptors
Receptor Families
Receptor Regulation
Dose Response Relationship
Drug Potency and Maximal Efficacy
Drug Synergism and Antagonism
Antagonism
FACTORS THAT MODIFY THE EFFECTS OF DRUGS
ADVERSE DRUG REACTIONS
DRUG ALLERGY
Types of Allergic Reactions and their Mechanisms
Other Forms of Adverse Drug Reactions
Other Adverse Drug Reactions
DRUG INTERACTIONS
CHAPTER 2:
Autonomic Nervous System
INTRODUCTION TO AUTONOMIC PHARMACOLOGY
CHOLINERGIC SYSTEM
CHOLINERGIC DRUGS
Pharmacological Actions of Acetylcholine
Muscarinic Actions
Nicotinic Actions
Cholinomimetic Alkaloids
Uses
Anticholinesterases
Irreversible Anticholinesterases
ANTICHOLINERGIC DRUGS
Classification
Actions
Uses of Belladonna Alkaloids
Atropine Substitutes
ADRENERGIC SYSTEM
ADRENERGIC DRUGS (SYMPATHOMIMETICS)
Classification
Actions
Cardiovascular System
Smooth Muscles
Eye
Metabolic Effects
Skeletal Muscles
Uses of Adrenaline
Non-Catecholamines
Uses
Uses
Vasopressors
Nasal Decongestants
Selective β2 Stimulants
Anorectic Agents (Anorexiants)
ADRENERGIC ANTAGONISTS
Alpha Adrenergic Blocking Agents
Actions
Classification (Flowchart 2.4)
Beta Adrenergic Blocking Agents
Classification
Pharmacological Actions
Pharmacokinetics
Adverse Reactions
Drugs used in Glaucoma
CHAPTER 3:
Drugs Acting on Musculoskeletal System
SKELETAL MUSCLE RELAXANTS
Classification
Peripherally Acting Skeletal Muscle Relaxants
Neuromuscular Blockers (NMB)
Synthetic Competitive Blockers
Depolarizing Blockers
Uses of Peripherally Acting Skeletal Muscle Relaxants
Centrally Acting Muscle Relaxants
Uses of Centrally Acting Muscle Relaxants
Directly Acting Muscle Relaxants
Uses
DRUGS USED IN THE TREATMENT OF LOCAL MUSCLE SPASM
DRUGS USED IN OTHER MUSCULOSKELETAL DISEASES
DRUGS USED IN THE TREATMENT OF IMMUNOLOGICAL AND INFLAMMATORY NEUROMUSCULAR DISEASES
1. Idiopathic Inflammatory Myopathies
2. Demyelinating Disease
Treatment
3. Osteoarthritis
Other Drug Supplements
Non-pharmacological Measures
4. Myasthenia Gravis
Treatment
5. Systemic Lupus Erythematosus
Treatment
6. Systemic Sclerosis (Scleroderma)
Treatment
AGENTS AFFECTING BONE MINERAL TURNOVER
Calcium
Phosphate
Parathyroid Hormone (Parathormone, PTH)
Vitamin D
Source
Mechanism of Action
Actions
Pharmacokinetics
Preparations
Adverse Reactions
Calcitonin
Actions
Bisphosphonates (Etidronate, Pamidronate, Alendronate, Zoledronate)
Uses
AGENTS USED IN THE PREVENTION AND TREATMENT OF OSTEOPOROSIS
DRUGS AND EXERCISE
Effect of Exercise on the Cardiorespiratory Function
Drugs that Influence Exercise
Drugs that Decrease Exercise Tolerance
CHAPTER 4:
Anti-inflammatory Drugs and Immunopharmacology
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
Mechanism of Action
Classification
I. Nonselective COX Inhibitors
II. Preferential COX-2 inhibitors
III. Selective COX-2 Inhibitors
Salicylates
Pharmacological Actions
Pharmacokinetics
Adverse Effects
Precautions and Contraindications
Preparations
Uses
Drug Interactions
Para-aminophenol Derivatives
Paracetamol (Acetaminophen)
Uses
Propionic Acid Derivatives
Uses
Pyrazolon Derivatives
Adverse Effects
Uses
Acetic Acid Derivatives
Uses (Table 4.3)
Fenamates
Oxicams
Preferential COX-2 Inhibitors
Uses
Uses
Selective COX-2 Inhibitors
Dose
CORTICOSTEROIDS
Structure and Synthesis
Actions
A. Glucocorticoid Actions
B. Mineralocorticoid action
Mechanism of Action
Pharmacokinetics
Topical Preparations
Mineralocorticoids
DRUGS USED IN TREATMENT OF RHEUMATOID ARTHRITIS
Nonsteroidal Anti-inflammatory Drugs
Disease Modifying Anti-rheumatic Drugs
Immunosuppressants
Biological Agents
Other Anti-rheumatic Drugs
Adjuvants
Glucocorticoids
TREATMENT OF GOUT
Drugs Used in Gout
Uses
Uricosuric Drugs
IMMUNOSUPPRESSANTS AND IMMUNOSTIMULANTS
Uses
Antibodies as Immunosuppressants
Immunostimulants
Interferons
CHAPTER 5:
Drugs Acting on the Kidney
DIURETICS AND ANTIDIURETIC DRUGS
PHYSIOLOGY OF URINE FORMATION
DIURETICS
Classification
High Efficacy or Loop Diuretics
Adverse Effects of Loop Diuretics
Thiazides and Thiazide-like Diuretics
Actions and Mechanism of Action
Pharmacokinetics
Adverse Effects
Uses
Potassium Sparing Diuretics
Uses of Potassium Sparing Diuretics
Carbonic Anhydrase Inhibitors
Other Actions
Osmotic Diuretics
Uses
Newer Drugs
Drug Interactions with Diuretics
ANTIDIURETICS
CHAPTER 6:
Cardiovascular Pharmacology
CARDIAC GLYCOSIDES AND TREATMENT OF CARDIAC FAILURE
Drugs Used in Congestive Cardiac Failure
1. Diuretics
2. Vasodilators
Positive Inotropic Agents
Cardiac Glycosides
Pharmacological Actions
ANTIARRHYTHMIC DRUGS
Classification
Sodium Channel Blockers
Miscellaneous
DRUGS USED IN THE TREATMENT OF ANGINA PECTORIS
Antianginal Drugs
Nitrates
Calcium Channel Blockers
CCBs include
β-blockers
Potassium Channel Openers
Miscellaneous
Pharmacotherapy of Angina
Combination of Drugs in Angina
ANTIHYPERTENSIVE DRUGS
Classification
Diuretics (See Chapter 5)
Drugs Acting on Renin Angiotensin System
Uses
Uses
Sympatholytics
Drugs Acting Centrally
Ganglion Blockers
Adrenergic Neuron Blockers
Adrenergic Receptor Blockers
Vasodilators
Uses
Calcium Channel Blockers
Drug Interactions of Antihypertensives
Treatment of Hypertension
PHARMACOTHERAPY OF SHOCK
Treatment
PLASMA EXPANDERS
VASOACTIVE DRUGS
Vasoconstrictors
Vasodilators
CEREBRAL ISCHEMIA
Treatment of Ischemic Stroke
DRUGS USED IN TREATMENT OF PERIPHERAL VASCULAR DISEASES
HYPOLIPIDEMIC DRUGS
Hypolipidemics
HMG CoA Reductase Inhibitors (Statins)
Antioxidant
Miscellaneous
Ezetimibe
DRUGS USED IN THE DISORDERS OF COAGULATION
Anticoagulants
Classification
Heparin
Adverse Reactions
Contraindications to Heparin Therapy
Synthetic Heparin Derivative
Oral Anticoagulants
Mechanism of Action
Pharmacokinetics
Adverse Effects
Drug Interactions
Oral Direct Thrombin Inhibitor
Contraindications to Anticoagulant Therapy
THROMBOLYTICS (FIBRINOLYTICS)
Antifibrinolytics
Uses
Antiplatelet Drugs
1. Aspirin (See Chapter 4)
2. Dipyridamole
3. ADP Antagonists
4. Glycoprotein IIb/IIIa Receptor Antagonists
5. Others
Coagulants
Coagulants used Systemically
Vitamin K
Other Coagulants
HEMATINICS
Iron
Factors that Influence Iron Absorption
Preparations of Iron
Treatment
Uses of Iron
Vitamin B12 and Folic Acid
Vitamin B12
Folic Acid
Hematopoietic Growth Factors
CHAPTER 7:
Central Nervous System
SEDATIVE HYPNOTICS
Classification
Benzodiazepines
Pharmacological Actions
Mechanism of Action
Pharmacokinetics
Adverse Effects
Uses of BZDs
NEWER HYPNOTICS
1. Melatonin and Congeners
Uses
2. ‘Z’ Hypnotics
BARBITURATES
Classification
Mechanism of Action
Pharmacological Actions
CNS
Pharmacokinetics
Adverse Reactions
ANTIEPILEPTICS
Classification
Phenytoin (Diphenylhydantoin)
Pharmacological Actions
Mechanism of Action
Pharmacokinetics
Adverse Effects
Uses
Drug Interactions
Phenobarbitone
Carbamazepine
Uses
Ethosuximide
Valproic Acid
BENZODIAZEPINES
Newer Antiepileptics
Treatment of Epilepsies (Table 7.1)
DRUGS USED IN PARKINSONISM
Classification
Levodopa
Drug Interactions
Dopamine Receptor Agonists
Drugs that Inhibit DA Metabolism
Anticholinergics
OPIOID ANALGESICS AND ANTAGONISTS
Opioid Analgesics
Classification
Mechanism of Action
Pharmacological Actions
Pharmacokinetics
Adverse Effects
Management of Addiction
Uses of Morphine
Other Opioids
Pethidine (Meperidine)
Derivatives of Pethidine
Mixed Agonists and Antagonists
Opioid Antagonists
DRUGS USED IN PSYCHIATRIC DISORDERS: ANTIPSYCHOTICS, ANTIDEPRESSANTS AND ANTIANXIETY AGENTS
Antipsychotics (Neuroleptics)
Classification
Chlorpromazine (CPZ)
Pharmacological Actions
Other CNS Actions
Atypical Antipsychotics
ANTIDEPRESSANTS
Classification
Tricyclic Antidepressants
Pharmacological Actions
Pharmacokinetics
Adverse Effects
Drug Interactions
Advantages
Uses of Antidepressants
Mood Stabilizers
The Mechanism of Action
Pharmacokinetics
Adverse Effects
Precautions
Drug Interactions
Antianxiety Drugs (Anxiolytics)
Classification
CNS STIMULANTS
GENERAL ANESTHETICS
Classification
Inhalational Anesthetics
Advantages
Disadvantages
Advantages
Disadvantages
Intravenous Anesthetics
Inducing Agents
Dissociative Anesthesia
Advantages
Disadvantages
Opioid Analgesic
Neuroleptanalgesia
Benzodiazepines
Preanesthetic Medication
LOCAL ANESTHETICS
Mechanism of Action
Systemic Actions
Pharmacokinetics
Adverse Effects
Uses of Local Anesthetics
ALCOHOLS
Ethyl Alcohol (Ethanol)
Actions
Uses
Disulfiram
Methyl Alcohol/Methanol
Treatment
CHAPTER 8:
Autacoids and Respiratory System
HISTAMINE AND ANTIHISTAMINES
Histamine
Mechanism of Action
Actions
Histamine Substitutes
Antihistamines
Classification of H1 Blockers
Actions
5-HYDROXYTRYPTAMINE, ERGOT ALKALOIDS, ANGIOTENSIN AND KININS
5-Hydroxytryptamine
Actions
Serotonin Agonists
Other Agonists
Serotonin Antagonists
Ergot Alkaloids
Drugs Used in the Treatment of Migraine
Angiotensin
Actions
Kinins
EICOSANOIDS
Prostaglandins and Thromboxanes
Actions
Leukotrienes
Actions
Platelet Activating Factor (PAF)
DRUGS USED IN THE TREATMENT OF BRONCHIAL ASTHMA
Classification
Sympathomimetic Drugs
Others
Methylxanthines (See page 161)
Use in Bronchial Asthma
Anti-inflammatory Drugs
Use of Glucocorticoids in Asthma
Mast Cell Stabilizers
Leukotriene Receptor Antagonists
Anti IgE Antibody
Treatment of Asthma
Treatment
DRUGS USED IN THE TREATMENT OF COUGH
Antitussives
Central Cough Suppressants
Pharyngeal Demulcents
Expectorants
Bronchodilators
Mucolytics
DRUGS USED IN ALLERGIC RHINITIS
Treatment
Acute episode
Prophylaxis
CHAPTER 9:
Gastrointestinal Tract
DRUGS USED IN PEPTIC ULCER
Classification
Antacids
Systemic Antacids
Non-systemic Antacids
Combination of Antacids
Proton Pump Inhibitors
Ulcer Protectives
Other Drugs
Treatment of H. pylori Infection
PROKINETIC AGENTS
EMETICS AND ANTIEMETICS
Classification
Dopamine D2 Antagonists
5-HT3 Antagonists
Antimuscarinics
Neuroleptics (See page 155)
Other Antiemetics
Newer Drugs
DRUGS USED IN THE TREATMENT OF CONSTIPATION
Purgatives
Classification
Bulk Laxatives
Fecal Softeners
Osmotic Purgatives
Stimulant Purgatives
Opioid Antagonists
Enema
Use of Laxatives in Constipation
Drug Induced Constipation
Laxative Abuse
DRUGS USED IN THE TREATMENT OF DIARRHEA
WHO–ORS New Formula
Adsorbents
Antimotility Drugs (Table 9.5)
Other Drugs
Antispasmodics
CHAPTER 10:
Hormones
HYPOTHALAMUS AND ANTERIOR PITUITARY HORMONES
Anterior Pituitary Hormones
Uses
THYROID HORMONES AND ANTITHYROID DRUGS
INSULIN AND ORAL ANTIDIABETICS
Insulin
Actions of Insulin
Side Effects
Preparations of Insulin
Drug Interactions
Use of Insulin in Diabetes Mellitus
Oral Antidiabetic Drugs
Classification
Insulin Secretagogues
Sulfonylureas
Adverse Effects
Drug Interactions
Meglitinides
Biguanides
Thiazolidinediones
Disadvantages
α–Glucosidase Inhibitors
Newer Drugs
Treatment of Diabetes Mellitus
Status of Oral Antidiabetics
Glucagon
Uses
ANDROGENS AND ANABOLIC STEROIDS
Anabolic Steroids
Antiandrogens
Male Contraceptives
Drugs Used in Sexual Impotence
Sildenafil
ESTROGENS, PROGESTINS AND HORMONAL CONTRACEPTIVES
Physiologic Consideration
Estrogens
Uses
Selective Estrogen Receptor Modulators (SERMs) and Antiestrogens
Progestins
Actions
Uses
Antiprogestins
Uses
Hormonal Contraceptives
CHAPTER 11:
Geriatric Pharmacology
GERIATRIC PHARMACOLOGY
PHARMACOKINETIC CHANGES
Drug Absorption
Distribution
Metabolism
Excretion
PHARMACODYNAMIC CHANGES
ADVERSE REACTIONS IN THE ELDERLY
CRITERIA FOR SAFE PRESCRIBING IN THE ELDERLY
DEMENTIA
DRUGS USED IN ALZHEIMER'S DISEASE
CHAPTER 12:
Chemotherapy
GENERAL CONSIDERATIONS
Classification
Resistance to Antimicrobial Agents
Prevention of Resistance to Antimicrobials
Combination of Antimicrobials
Disadvantages of Antimicrobial Combination
Chemoprophylaxis
Superinfection
Misuse of Antibiotics
SULFONAMIDES
Classification
Adverse Effects
COTRIMOXAZOLE
QUINOLONES
Fluoroquinolones
Uses (Table 12.2)
BETA–LACTAM ANTIBIOTICS
Penicillins
Classification of Penicillins
Natural Penicillins
Penicillin G (Benzyl Penicillin)
Semisynthetic Penicillins
Extended Spectrum Penicillins
Antipseudomonal Penicillins
Cephalosporins
Mechanism of Action
Classification
First Generation Cephalosporins
Second Generation Cephalosporins
Third Generation Cephalosporins
Fourth Generation Cephalosporins
Fifth Generation Cephalosporins
Carbapenems
BROAD-SPECTRUM ANTIBIOTICS
Tetracyclines
Mechanism of Action
Antibacterial Spectrum
Pharmacokinetics
Adverse Effects
Contraindications
Chloramphenicol
Adverse Reactions
Drug Interactions
Uses
Tigecycline
AMINOGLYCOSIDES
Common Properties of Aminoglycosides
Adverse Effects
MACROLIDES AND OTHER ANTIBACTERIAL AGENTS
Erythromycin
Adverse Effects
Uses
Miscellaneous Antibiotics
Lincosamides
Polypeptide Antibiotics
Polymyxin and Colistin
Other Antimicrobial Drugs
Newer Agents
CHEMOTHERAPY OF URINARY TRACT INFECTIONS
CHEMOTHERAPY OF TUBERCULOSIS
CHEMOTHERAPY OF LEPROSY
Treatment of Leprosy
ANTIFUNGAL DRUGS
Classifications
Antifungal Antibiotics
Uses
Antimetabolites
Azoles
Other Topical Antifungal Agents
ANTIVIRAL DRUGS
Classification
Antiherpes Virus Agents
Uses (Table 12.8)
Anti-influenza Virus Agents
Uses
Oseltamivir and Zanamivir
Anti-hepatitis Agents
Other Antiviral Agents
Uses
Antiretroviral Agents
CHEMOTHERAPY OF MALARIA
Sulfadoxine-Pyrimethamine
ANTIAMEBIC DRUGS
Classification
Uses
DRUGS USED IN LEISHMANIASIS
ANTHELMINTICS
CANCER CHEMOTHERAPY
Classification
Common Adverse Effects to Anticancer Drugs
Alkylating Agents
Antimetabolites
Antibiotics
Vinca Alkaloids
Hormones in Cancer Chemotherapy
Miscellaneous
General Principles in the Treatment of Cancers (Table 12.12)
VACCINES AND ANTISERA
INDEX
TOC
Index
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