A Short Textbook of Medical Pharmacology https://kat.cr/user/Blink99/ A Short Textbook of Medical Pharmacology Md Abdus Salam MBBS (Dhaka), MPhil (Medical Pharmacology) Professor of Pharmacology Principal, Noakhali Medical College Co-ordinator, Noakhali Medical College Establishment Project, Bangladesh Foreword AFM Saiful Islam The Health Sciences Publishers New Delhi | London | Philadelphia | Panama https://kat.cr/user/Blink99/ Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +44 (0)20 3008 6180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +1 507-301-0496 Fax: +1 507-301-0499 Email: cservice@jphmedical.com Jaypee Medical Inc The Bourse 111 South Independence Mall East Suite 835, Philadelphia, PA 19106, USA Phone: +1 267-519-9789 Email: jpmed.us@gmail.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: Kathmandu@jaypeebrothers.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2014, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com A Short Textbook of Medical Pharmacology First Edition: 2014 ISBN 978-93-5152-007-8 Printed at Dedicated to my sons Adan Ibna Salam and Karar Ibna Salam https://kat.cr/user/Blink99/ Foreword It gives me the heartiest pleasure to put down a few words about this short textbook on medical pharmacology This book is an honest attempt to provide a clear concept to the MBBS and postgraduate medical students in their preparation for the courses as well as during their research afterwards The author has tried his best to keep the language simple and lucid, which even a lay reader will understand The presentation of drugs is given in a format basis, which can be memorized easily for viva voce and residual knowledge This book will help the students to prepare for the examinations and strengthen their basic knowledge while making themselves ready for further competitive studies in future life I wish every success to the students using this book and would like to congratulate the author and Jaypee Brothers Medical Publishers (P) LTD for bringing out this short textbook, which is enormously useful AFM Saiful Islam Professor of Pharmacology Additional Director General (Admin) Directorate General of Health Services Dhaka, Bangladesh https://kat.cr/user/Blink99/ Preface It is a difficult job to make a precise preface for any book, but each and every publication demands it In fact, medical pharmacology is a basic subject, the science of drug, happens to be an apparently small but actually a vast and intricate subject As the present curriculum is difficult for the students to be oriented without a proper guidelines well, there is no such books available to guide students through this maze Norms demand basic question in basic subject should be answered basically It was with this vision that this endeavor was undertaken to compiling a thorough, yet simple text that would endow a student with ability of answering in the what, why, when, where, who, and how (wherever possible), to face the difficulties of memorizing the curriculum All the information in this book have been provided by consulting throughly a textbook of pharmacology line by line lest any important fact be eliminated So, if anybody tries to make his or her study-time mostly effective, this book will motivate the person a lot Best wishes to all “With every breaking of the morn Fresh opportunities are newly borne” Md Abdus Salam https://kat.cr/user/Blink99/ A Short Textbook of Medical Pharmacology It is used in spastic rigidity It is also used in malignant hyperthermia 368 PRESCRIPTION WRITING • Definition • Preconditions • Samples Definition A prescription is the clinician’s (doctor’s) written order for the pharmacist, nurses and the patient A prescription should be rational and the clinician should, before prescribing, satisfy the following preconditions: Preconditions Make a diagnosis: If a definitive diagnosis cannot be made, make a tentative diagnosis However, in some cases, no diagnosis or even tentative diagnosis can be made and a prescription for symptomatic relief has to be made However, no drug should be prescribed merely to satisfy the patient Make a choice of the drug: Some drugs are contraindicated in pregnancy lactation, some others in particular patients So, for the same disease, different persons may require different drugs Therapeutic goal should be selected: In a diabetic patient requiring insulin, it may be ideal to give insulin three or four times a day and to keep blood sugar level almost normal but if the patient develops repeated hypoglycemic shock and anginal pain during the hypoglycemic episodes, it might be better to revise the therapeutic goal and to give two insulin injections a day However, ordinarily, the therapeutic goal should aim to give possible maximal benefit, to the patient Doses must be appropriate: This is an extremely important issue Overdose may be dangerous but under dose also is bad In the same disease same drug may have to be given in a different dosing regimen in different patient (e.g in a chronic renal failure case, many drugs have to be given in lower doses) Prior investigation for possible side effects should be made: For example, before prescribing Metformin or Ramipril, serum creatinine values should be checked—If serum creatinine values is too high, these drugs should not be prescribed https://kat.cr/user/Blink99/ Miscellaneous Sample Name, professional qualification, address, telephone no and registration number of the doctor Name, age, sex and address of the patient Rx Name (proprietary and official) of the drug, strength of the drug and quantity to be taken Direction regarding using Caution if any Whether the patient has to report further Date Quantity to be served by the pharmacist 10 Signature of the doctor Pharmacotherapy of some infections • Salmonella infections: Common diseases due to salmonella infections are— Enteric fever Gastroenteritis Septicemia Some asymptomatic carriers • Enteric fever: Theoretically following drugs can be used Ciprofloxacin – 500 mg 12 hourly Cotrimoxazole – 480 mg 12 hourly Amoxicillin – 750 mg times a day Chloramphenicol – 500 mg times a day Treatment to be continued for 14 days • Food poisoning: Food poisoning may be due to micro-organisms or other than micro-organism Common bacteria producing food poisoning include Salmonella (other than S typhi) Campylobacter and so on Treatment of food poisoning includes— Fluid and electrolyte correction Bowel sedation by Loperamide/Codeine – But only in nonmild cases and not before full one day after the onset of diarrhea In nonmild cases particularly in salmonella infections, Ciprofloxacin • Shigellosis Treatment includes— Fluid or semifluid roughage-free diet ORS therapy—However, in severe cases IV fluid may be necessary Excepting very mild cases no Loperamide/Codeine type of drugs Antibiotics are generally not needed If given, Ciprofloxacin 500 mg 12 hourly 369 A Short Textbook of Medical Pharmacology • Cholera: Fluid and electrolyte replacement is the mainstay of treatment Fluid should be given by IV route A day course of tetracycline (250 mg hourly) is to be given • Common cold: In uncomplicated cases, no antibiotic is necessary Treatment is only symptomatic— Paracetamol 0.5 to gm hourly Nasal decongestant if nasal congestion is marked, Xylometazoline nasal drop for only a few days • Acute sinusitis: Acute sinusitis is often a result of virus infection of upper respiratory tract on which bacterial (streptococcus/H influenzae/B catarrhalis) infection has superimposed • Measures Nasal decongestants (Xylometazoline) to ensure drainage of the sinus Antibiotics – To tackle the bacteria Amoxicillin – Clavulanic acid type of drug may have to be used • Chronic sinusitis Collect discharge from the inflamed sinus and test for bacterial identity and sensitivity → only then select the antibiotic Remove underlying pathology (polyp/septal deviation) if any Do not use antihistamine • Otitis media: This is usually a result of virus infection on which bacterial infection has super imposed Bacteria are same as those of acute sinusitis Treatment includes antibiotics (same as in acute sinusitis) • Pneumonia: Two varieties of pneumonia— Community acquired pneumonia (CAP) Hospital acquired pneumonia (HAP) IMMUNOSUPPRESSANTS • Use • Drugs Use The major use of immunosuppressants are— In prevention of rejection in organ transplants Autoimmune disorders However, they are used by superspecialists 370 Drugs These include— Glucocorticosteroids Cyclosporine Cyclophosphamide https://kat.cr/user/Blink99/ Miscellaneous Azathioprine and Mycophenolate mofetil Antilymphocytic serum Rho(D) immunoglobulin Glucocorticosteroids: They cause— a A reduction of blood lymphocyte counts b Reduction of endogenous proinflammatory materials c Reduction of circulating IgGs As immunosuppressants they are used in— a Autoimmune disorders b After organ transplants c Rarely in rheumatoid arthritis d In bronchial asthma (acts as anti-inflammatory agent) Cyclosporine: It is a derivative of fungus, is an antibiotic Its suppresses B and T lymphocyte Clinically, it is used in combination with glucocorticosteroids to prevent graft rejection after organ transplant MANAGEMENT OF • Erectile dysfunction • Osteoporosis • Obesity Erectile Dysfunction • • • • • Definition Causes Incidence Treatment Mechanism of penile erection and role of PDE-5 Definition Inability to maintain penile erection for the successful performance of sexual activity Causes Both organic and psychogenic Incidence ED is estimated to affect upto thirty million man in the United States Treatment Phosphodiesterase (PDE) inhibitors are now considered to be first-line therapy for man with ED 371 372 A Short Textbook of Medical Pharmacology Drugs Sildenafil Vardenafil Tadalafil PDE-5 Inhibitors PDE at least eleven isozymes of PED have been characterized Mechanism of penile erection and role of PDE-5 inhibitors • PDE-5 causes the breakdown of cGMP so penile erection is not maintained On the otherhand PDE-5 inhibitors are indicated for the treatment of ED due to organic or psychogenic causes Osteoporosis https://kat.cr/user/Blink99/ Miscellaneous • Definition • Morbidity • Management Definition Skeletal fragility due to progressive loss of bone mass Morbidity It is characterized by frequent bone fractures, which are a major cause of disability among the elderly Management a Nondrug measure b Drug measure a Nondrug measure i Diet adequate in calcium and vitamin D ii Weight bearing exercise iii Cessation of smoking iv Avoidance of glucocorticosteroids b Drug measure i Bisphosphonates: The bisphosphonates decrease osteoclastic bone resorption, via several mechanisms, including—1 inhibition of the osteoclastic proton pump necessary for dissolution of hydroxyapatite, decrease in osteoclastic formation/activation, and increased osteoclastic apoptosis (programmed cell death) ii Teriparatide: It increases spinal bone density and decreases the risk of vertebral fracture It is the first approved treatment for osteoporosis that stimulates bone formation iii Selective estrogen receptor modulators (SERMs): They prevents osteoporosis and reduces the risk of hip fracture iv Calcitonin: It reduces bone resorption and imporves bone architecture, relieves pain, and increases function Unfortunately, tolerance occurs with continuous use Obesity Two classes of drug are used in treating obesity: the anorexiants (appetite suppressants) Phentermine or Sibutramine and a lipase inhibitor, Orlistat 373 https://kat.cr/user/Blink99/ Index Page numbers followed by f refer to figures A indications 283 pharmacodynamics 281 Acetylcholine 141 pharmacokinetics 281 Acid-pepsin-mixture 74 structure 280 Active transport toxicity 282 ADRs of oral contraceptives 119 Ampicillin and amoxicillin—a compar amenorrhea and ovulation 120 ison 270 anemia 119 Anabolic steroids 112 carcinogenicity 120 adverse reactions 113 glucose tolerance 120 contraindications 113 headache 120 precautions and warnings 113 hepatic function 119 uses 113 hypertension 120 Anatomical layout of nervous system mood changes 120 thromboembolic disorder 119 127 thrombophlebitis 119 Anesthesia weight gain 120 protocol of 191 Agents stages of 191 alkylating 324 Anesthetics anticancer disadvantages of inhalation 195 classification 321 local 361 antihemostasis 353 classification 362 antimycobacterial 279, 283 differences with general anes antisecretory thetics 362 H2 receptors blockers 79 different forms of 363 proton pump inhibitors 80 Angina 162 antiviral 317 and diabetes 227 individual effects and dangers of 226 nitrous oxide (N2O) 192 Anginal pain 226 thiopental sodium 193 Antacids oral hypoglycemic combinations 78 biguanides 104 dosing 78 meglitinides 104 mechanism of action 77 sulfonylureas 104 properties 77 Agonist Antagonists 177 Allergy 111 Alteration of cell membrane perme- Antibiotics 82, 267 b-lactam 279 ability 263 Anticholinesterase 144 Amebiasis poisoning 146 cause 81 Anticoagulants 55 classification of drugs 81 in vivo 56 presentation of the disease 81 Antiemetics Amebicides classification 66 luminal 82 indication 66 tissue 81 Antihyperlipidemic measures 240 Aminoglycosides 279 A Short Textbook of Medical Pharmacology β Antihypertensive action: ACE inhibi- Cardiovascular tors 222 embracement in CCF 111 Antimicrobial antagonism and synerhyperlipoproteinemia 236 gism 265f management of congestive heart Antimuscarinic–atropine 149 failure 249 clinical uses -blockers (carvedilol) in 256 antispasmodic 151 causes 250 asthmatic bronchitis 152 pathogenesis 251 cycloplegic 152 varieties 250 mydriatic 152 system 216, 336 pharmacological actions 149 ACE inhibitors 256 Antiplatelets 54 antianginal drugs 226 Antischizophrenics 197 antiarrhythmic drugs 229 Anxiety 163 antihypertensives 216 Atherosclerosis 96 diuretics in 256 Autacoids and NSAIDs 332 drugs 252 B edema 242 Cell wall synthesis inhibition 263 Barbiturates 185 Cephalosporins 267, 274 Baroreceptor mechanism 217 adverse actions 278 Barrier antimicrobial activity 276 biological classification 276 blood brain clinical uses 277 BDZ skeleton 182f Chemosensitivity of different tumors Bioavailability Biochemical background of helminths 321 calcium 86 Chemotherapeutic ivermectin 85 failure microtubules 85 causes of 266 nematodes 85 management 266 piperazine 85 potentiation and antagonism 265 Blockers Chemotherapy α 160 goal of treatment 320 α-receptor of fungal diseases 314 advantages 223 of neoplastic diseases 319 b 161, 221, 229 some terms related to adverse actions 222 antibiotics 258 calcium channel (CCBs) 220 antimicrobial spectrum 259 ganglion and neuromuscular 363 antimicrobials 258 Bone remodelling 123 antiseptics 258 BP 162, 216 bactericidal 259 and peripheral resistance 162 bacteriostatic 259 types 216 chemotherapeutics 258 Broad spectrum antimicrobials 292 disinfectants 258 Buffalo hump 111 fungicides 259 C germicides 258 MBC 259 Calcium homeostasis 123 MIC 259 Campylobacter jejuni 69 sporocides 259 Cardiac Chloramphenicol 297 arrhythmia 162 adverse action 299 electrophysiology 230 376 https://kat.cr/user/Blink99/ Index clinical uses 298 indications 298 Chlorpromazine 198 Cholera 69 Cholesterol metabolism 238 synthesis 239 Clarithromycin 296 Classification of adrenoceptor blockers 159 antifungal agents 315 antimicrobials 260 steroid hormones 106 Clostridium difficile 69 Commonly used anthelmintic 86 Competitive antagonism 261 sulfonamides 262 trimethoprim 262 Concept of essential drugs 355 advantages 356 Constipation atonic 72 causes 71 choice and use of purgatives 72 drugs used 71 mechanism of drug action 72 Contraception 117 progestin preparations 118 recent popular methods of 117 Corticosteroids 105 biosynthesis 106 Cotrimoxazole 302 D Diabetes mellitus definition 94 mechanism 94 treatment goal 98 Diabetic ketoacidosis 96 microangiopathy nephropathy 97 neuropathy 97 retinopathy 97 Diarrhea abundant watery diarrhea 69 causes 67 drug therapy 68 management 67 slightly loose 69 traveler’s diarrhea 69 Differences between bacillary and amebic dysentery 68 Crohn’s disease and ulcerative colitis 68 neuro and psychopharmacology 126 sympathetic and parasympathetic system 128 type-I (IDDM) and type-II (NIDDM) 95 Diffusion facilitated Dipyridamole 55 Disease Addison’s 110 Alzheimer 127, 204 drugs used 204 Diuretics 224, 245 adverse actions 247 clinical uses 249 Domperidone 67 Doxycycline 305 Drugs acting on eye 357 mydriatics 357 antiadrenergic 158 antianginal 227 antiarrhythmic 232 classification 233 principles of selection 232 site of action 233 anticoagulauts 53 antihypertensive clinical selection 225 hypertension 218 antileprosy 290 clofazimine 291 dapsone 290 rifampicin 291 antimalarials 305, 306 blood schizontocides 307 classification of 308 gametocides 307 schizontocides 307 sporontocides 307 tissue schizontocides 307 antinicotinic ganglionic blocker 152 neuromuscular blockers 152 antipsychotics adverse actions 199 pharmacological effects 199 377 antithrombotics 54 antithyroid 121 antitubercular classification 284 antiviral classification 317 influencing uterine contraction and tocolytics 113 interactions with warfarin 58 nonspecific antidiarrheal 70 opposing homeostasis 53 rational use 357 routes of administration synthetic aspirin pethidine procaine sulfonamide thrombolytics 54 used against helminths 85 used in epilepsy 212 used to treat malaria and kala-azar 305 Ferritin 64 Filtration First-pass effect Food/drug poisoning 73 G Gastric mucus 74 Glaucoma 163, 359 drugs 359 pathogenesis of 284 principles of treatment 359 Glucocorticoids 110 adverse actions 111 clinical uses 110 Gonadotropins 91 Growth hormone 89 retardation 111 Gum hyperplasia 214 A Short Textbook of Medical Pharmacology H β Half-life importance Hapten 272 E Helicobacter pylori 76 Ecbolics Hematinics (antianemics drugs) 60 ergometrine 116 Hematopoietic growth factor 61 oxytocin 115 Henoctis discovery 109 ADRs 116 Heparin clinical uses 115 pharmacological actions 57 contraindications 116 High incidence of coronary atheroscleEdema 243 rosis 236 EDL (essential drug list) 356 Hormonal contraceptives 117 Effect of stimulation of adrenergic Hormone receptors 155 characteristics 91 Endocrine clarification and source 91 pancreas 94 classification 92 pharmacology 88, 334 of the anterior pituitary 89 Enterohepatic circulation of thyroid glands 121 Erythromycin 296 preliminaries 91 Erythropoietin 60 Hyperglycemia 111 Essential tremor 163 Hypertension 111, 120 Euphoria 111 European 10-point code against cancer Hyperthyroidism treatment 122 323 use of -blockers 122 F Hypertrophic subaortic stenosis 163 Feedback mechanism of hormonal Hypnotics 181 Hypothesis action causes 211 negative 93 dopamine 197 positive 93 378 https://kat.cr/user/Blink99/ Index I ADRs 101 chemistry 99 Idea on myasthenia gravis 145 mechanism of action 99 Immunosuppressants 370 resistance 102 cyclosporine 371 route and time of administration 99 glucocorticosteroids 371 source 98 Individual blocker—propranolol 162 systemic effects 101 Individual drugs allergic reactions 102 artemether with lumefantrine 311 edema 102 chloroquine 309 hypoglycemia 101 group of 206 lipodystrophy 102 INH 287 weight gain 102 levamisole 87 Interactions mebendazole 86 pharmacodynamics metronidazole 83 pharmacokinetics clinical uses 84 contraindications and cautions 84 Interferon adverse actions 319 mechanism of action 83 properties 318 pharmacokinetics 83 types 318 phenytoin 213 uses 319 primaquine 310 Ion channels pyrazinamide 287 Iron quinine 310 absorption 64 rifampicin 288 determination of deficiency 64 streptomycin 286 oral and parenteral forms 62 Infusion fluids total requirements 62 Darrow’s solution 71 IUD progestin 119 dextrose infusions 70 fructose (fruit sugar) infusion 70 K Hartmann solution 71 Ketamine 194 mannitol 71 Ringer’s solution 71 L sodium bicarbonate injection 71 Labor and its stages 114 Inhibition of Leishmanecidals 306, 312 bacterial cell wall synthesis 262 Life cycle of nucleic acid synthesis entamoeba histolytica 82f adsorption 264 malarial parasite 307 biosynthesis 265 Limitations of initial penicillins 268 penetration 265 Lipoprotein metabolism 237 release 265 Loop diuretics—frusemide 246 uncoating 265 protein synthesis 264 M Inhibitors Macrolides b-lactamase 274 antimicrobial spectrum 295 carbapenems 279 Management of monobactam 279 erectile dysfunction 371 nonreceptor adrenergic 225 malaria 311 selective serotonin reuptake (SSRI) advantages 209 obesity 373 Initiation of labor pain 114 osteoporosis 372 Insulin 98 Mayer-Overton principle 190 379 A Short Textbook of Medical Pharmacology Mechanism of action 240 bile acid sequestering agents— cholestyramine, colistipol 242 fibric acid derivatives, that is gemfibrozil 241 HMG CoA reductase inhibitors 240 of methyldopa 219 of protein and steroid hormone 92 Meckel’s diverticulum 73 MED (multiple endocrine diseases) 80 Microbial resistance mechanism 266 Migraine 163 Moon face 111 Morphine 173 adverse effects 176 cautions 176 clinical uses 175 contraindications 176 mechanism of analgesic effect of 174 pharmacological effects 174 Muscle relaxants classification 364 drug interaction 366 Muscle wasting 111 Mycobacterium tuberculosis 283 Myocardial infarction 163 P Panic disorder 181 Parietal cell 75 mechanism of gastric HCl secretion 75 Parkinsonism 201 treatment strategy 202 carbidopa 203 levodopa 202 Pathway 174, 178 arachidonic acid metabolism pain P-drugs 356 Penicillins classifications 269 drugs used for the Rx of 77 indications of 271 pharmacodynamics 270 pharmacokinetics 269 peptic ulcer 73 sites 73 Pharmacodynamics 173 Pharmacogenetics Pharmacognosy Pharmacokinetics 173 Pharmacological action muscarinic 142 N nicotinic 143 Nephrons—structure and function 242 Pharmacological effect of aspirin analgesic effect 179 Nephrotoxicity 282 Pharmacology Neuropharmacology 126 ANS 339 drugs clinical 2, 346 adrenergic or sympathomimetic CNS 342 or sympathetic 154 experimental antiadrenergic 158 gastrointestinal 352 anticholinergic 147 general cholinergic 140 GIT 65 chymographic tracings 165 of nervous system 125 Neurotoxicity 282 renal 341 Nitrates 228 Pharmacopia O Pharmacotherapy of some infections acute sinusitis 370 Opiates 172 cholera 370 Opium 172 chronic sinusitis 370 Osteomalacia 215 common cold 370 Osteoporosis 111, 123 enteric fever 369 factors effecting 123 food poisoning 369 Ototoxicity 282 380 https://kat.cr/user/Blink99/ Index measures 370 otitis media 370 pneumonia 370 salmonella infections 369 shigellosis 369 Pharmacy Pheochromocytoma 163 Physostigmine and neostigmine— comparison 145 Pictures of untreated endogenous depression 205 Pill combined 119 contraceptive 120 contraindications 120 indications of 120 Pralidoxime 144 Precancerous conditions 323 Prescription writing 368 Prevention of crystalluria 301 Prolactin (PRL) and PIH 90 Psychopharmacology 126, 170 analgesics 170 antidepressants 204 antiepileptics 210 antipsychotics 196 aspirin (NSAIDs) 177 general anesthetics 187 management of neurodegenerative diseases 201 opioids 172 sedative-hypnotics 181 Psychosis 111 Q Quinolones 292 ADRs 294 advantages 292 antibacterial spectrum 293 cautions 294 clinical uses 294 contraindications 294 pharmacokinetics 293 histaminic 76 muscarinic 76 prostaglandin 76 somatostatin 76 Reentry phenomenon 230 Release of hormone by hypothalamus and pituitary 88f S SAR (structure activity relationship) and super steroids 107 Schizophrenia 127, 197 Sedatives 181 Somatostatin 90 Special dangers of P falciparum malaria 308 Spiramycin 297 Steps of protein synthesis 260 Steroids and tuberculosis 112 Sulfacetamide 302 Sulfonamides 299 adverse effects 301 and cotrimoxazole 300 classification 299 Superinfection, suprainfection or opportunistic infection 273 common sufferer 274 organisms responsible 273 pathogenesis 273 treatment 274 Superiority of cephalosporins to penicillin 277 Synapse and ganglia pre and postganglionic fibers 129 Syndrome Cushing 90, 111 Zollinger–Ellison 80 System renin angiotensin aldosterone 217 respiratory 351 T Tetracyclines 303 classification of 304 Reasons of combination of N2O, drug interaction 304 halothane and oxygen 192 Therapeutics Receptor Three divisions of GAs 189 gastrin 76 Thrombolytics 59 R 381 A Short Textbook of Medical Pharmacology U Ulcer anastomotic 73 diverticular 73 duodenal 73 esophageal 73 gastric 73 peptic 73 aggravation of 111 V Vasodilators 224, 255 Vitamin and cancer 61 Vitamin K antagonist 58 Vomiting management 65 mechanism 66 Thyrotoxicosis 163 Tight junction 74 Tocolytics (uterine relaxants) ritodrine 116 Toxicities of succinylcholine 154 Toxicology Treatment of anaphylactic shock 157 cardiogenic shock 157 severe bronchial asthma 158 Tuberculosis meningeal 285 nonrespiratory 285 of the skin 285 principles of chemotherapy in 285 Types of seizures 212 382 https://kat.cr/user/Blink99/ .. .A Short Textbook of Medical Pharmacology https://kat.cr/user/Blink99/ A Short Textbook of Medical Pharmacology Md Abdus Salam MBBS (Dhaka), MPhil (Medical Pharmacology) Professor of Pharmacology. .. Saha, Associate Professor, Pharmacology – Dr Aftab Uddin Ahmed, Associate Professor, Pharmacology – Dr Jalal Bangalee, Assistant Professor, Medicine – Professor Saiful Bari of Cardiology He was... motivation: – Professor Md Nurul Islam of Pharmacology – Professor Md Zahurul Haque of Pharmacology – Professor Rafiqul Akhter of Pharmacology – Professor Feroza Parveen of Pharmacology – Dr Shyamol