How drugs act and interact, how they enter the body, what happens to them inside the body, how they are eliminated from it; the effects of genetics, age, and disease on drug action — these topics are important for, although they will generally not be in the front of the conscious mind of the prescriber, an understanding of them will enhance rational decision taking. Knowledge of the requirements for success and the explanations for failure and for adverse events will enable the doctor to maximise the benefits and minimise the risks of drug therapy. Pharmacodynamics.
The nonmedical use of drugs presents social problems with important pharmacological aspects. Social aspects Rewards for the individual Decriminalisation and legalisation Dependence Drugs and sport Tobacco Dependence Nicotine pharmacology Effects of chronic smoking Starting and stopping use Passive smoking Ethyl alcohol Pharmacology Car driving and alcohol Chronic consumption Withdrawal Pregnancy Pharmacological deterrence Psychodysleptics • Experiences with psychodysleptics • Individual substances, especially cannabis Stimulants • cocaine, • amfetamines.
In any science there are two basic requirements — classification and nomenclature (names): • Classification: drugs cannot be classified and named according to a single rational system because the requirements of chemists, pharmacologists, and doctors differ. • Nomenclature: nor is it practicable always to present each drug under a single name because the formulations in which they are presented as prescribable medicines may vary widely and commercial considerations are too often paramount.
If a drug is administered by constant-rate i.v. infusion it is important to know when steady state has been reached, for maintaining the same dosing schedule will then ensure a constant amount of drug in the body and the patient will experience neither acute toxicity nor decline of effect. The t1/2 provides the answer: with the passage of each t1/2 period of time, the plasma concentration rises by half the difference between the current concentration and the ultimate steady-state (100%) concentration. ...
Hypertension and coronary heart disease (CHD) are of great importance. Hypertension affects above 20% of the total population of the USA with its major impact on those over age 50. CHD is the cause of death in 30% of males and 22% of females in England and Wales. Management requires attention to detail, both clinical and pharmacological. The way drugs act in these diseases is outlined and the drugs are described according to class.
In past decades the number of exercising individuals and the area of sports medicine have grown considerably.
Sports medicine has developed both in terms of its clinical importance with appropriate diagnosis and adequate rehabilitation
following injury as well as its potential role in the promotion of health and prevention of life-style diseases
in individuals of all ages.
Deliberate and accidental self-poisoning Principles of treatment Poison-specific measures General measures Specific poisonings: cyanide, methanol, ethylene glycol, hydrocarbons, volatile solvents, heavy metals, herbicides and pesticides, biological substances (overdose of medicinal drugs is dealt with under individual agents) Incapacitating agents: drugs used for torture
drugs, and psychotropic drugs is increasing. Repeated episodes are not rare.1 Prescribed drugs are used in over 75% of episodes but teenagers tend to favour nonprescribed analgesics available by direct sale, e.g.
The kidneys comprise only 0.5% of body weight, yet they receive 25% of the cardiac output. Drugs that affect renal function have important roles in cardiac failure and hypertension. Disease of the kidney must be taken into account when prescribing drugs that are eliminated by it. Diuretic drugs: their sites and modes of action, classification, adverse effects and uses in cardiac, hepatic, renal and other conditions. Carbonic anhydrase inhibitors. Cation-exchange resins and their uses. Alteration of urine pH Drugs and the kidney. Adverse effects.
Problems of constipation, diarrhoea and irritable bowel syndrome are common. Infective diarrhoeal diseases are a significant cause of morbidity and mortality worldwide, especially in infants and children.The management of these conditions is reviewed. • Constipation: mode of action and use of drugs • Diarrhoea (drug treatment importance of fluid and electrolyte replacement) • Inflammatory bowel disease • Irritable bowel syndrome
STOOL BULKING AGENTS Dietary fibre comprises the cell walls and supporting structures of vegetables and fruits.
The liver is the most important organ in which drugs are structurally altered. Some of the resulting metabolites may be biologically inactive, some active and some toxic (see Chapter 7).The liver is exposed to drugs in higher concentrations than are most organs because most are administered orally and are absorbed from the gastrointestinal tract.Thus the whole dose must pass through the liver to reach the systemic circulation.
All involved agencies need to participate on this planning team from the outset to ensure a
successful and safe event. At its initial meeting, the planning team should develop its
mission and objectives, and determine the necessary components of the public safety plan.
For example, what elements are within the realm of the promoter and what are within the
realm of the public safety agencies? The planning team should also develop its structure
using ICS as a model (that is, Sections, Branches, Divisions, and Groups, as needed).
Chapter 3 will discuss ICS in greater detail....
Infection is a major category of human disease and skilled management of antimicrobial drugs is of the first importance.The term chemotherapy is used for the drug treatment of parasitic infections in which the parasites (viruses, bacteria, protozoa, fungi, worms) are destroyed or removed without injuring the hostThe use of the term to cover all drug or synthetic drug therapy needlessly removes a distinction which is convenient to the clinician and has the sanction of long usage.
Interest income is the most important source of revenue for most of the
banks. The aim of this paper is to assess the impact of dierent interest rate
scenarios on the banks' interest income. As we do not know the interest rate
sensitivity of real banks, we construct for each bank a portfolio with a similar
composition of its assets and liabilities, called 'tracking bank'. We evaluate the
eect of 260 historical interest rate shocks on the tracking banks of German
savings banks and cooperative banks.
Major Influences on Clinical Decision-Making More than a decade of research on variations in clinician practice patterns has shed much light on forces that shape clinical decisions. The use of heuristic "shortcuts," as detailed above, provides a partial explanation, but several other key factors play an important role in shaping diagnostic hypotheses and management decisions.
Recall of family history is often inaccurate. This is especially so when the history is remote and families become more dispersed geographically. It can be helpful to ask patients to fill out family history forms before or after their visits, as this provides them with an opportunity to contact relatives. Attempts should be made to confirm the illnesses reported in the family history before making important and, in certain circumstances, irreversible management decisions.
Latex intolerance has become an increasingly important concept and diagnosis. In this
textbook, we have aimed to cover all aspects of latex allergy including contact urticaria,
irritation, and allergic contact dermatitis. An evidence-based and practical approach has
been taken to describe the epidemiology, basic science, clinical presentation,
management, and prognosis of the varied manifestations of natural rubber latex
This text on human gross anatomy emphasizes the clinical importance of structure and function, through clinical correlations, surface anatomy and modern imaging techniques. It provides a review of the material in the larger text "Clinically Oriented Anatomy," by the same author.
Principles of Dose Selection The desired goal of therapy with any drug is to maximize the likelihood of a beneficial effect while minimizing the risk of adverse effects. Previous experience with the drug, in controlled clinical trials or in postmarketing use, defines the relationships between dose (or plasma concentration) and these dual effects and provides a starting point for initiation of drug therapy.
Figure 5-1 illustrates the relationships among dose, plasma concentrations, efficacy, and adverse effects and carries with it several important implications:
Principles of Genetic Variation and Human Traits (See also Chaps. 62 and 64) Variants in the human genome resulting in variation in level of expression or function of molecules important for pharmacokinetics and pharmacodynamics are increasingly recognized. These may be mutations (very rare variants, often associated with disease) or polymorphisms, variants that are much more common in a population. Variants may occur at a single nucleotide [known as single nucleotide polymorphism (SNP)] or involve insertion or deletion of one or more nucleotides.
The rate of technological progress is encouraging increasingly sophisticated lines of
enquiry in cognitive neuroscience and shows no sign of slowing down in the
foreseeable future. Nevertheless, it is unlikely that even the strongest advocates of the
cognitive neuroscience approach would maintain that advances in cognitive theory
have kept in step with methods-based developments. There are several candidate
reasons for the failure of neuroimaging studies to convincingly resolve many of the
most important theoretical debates in the literature.