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Pharmacology
An Introduction
7
th
edition
Henry Hitner , Ph.D.
Professor Emeritus
Department of Neuroscience, Physiology, and
Pharmacology
Philadelphia College of Osteopathic Medicine
Philadelphia, Pennsylvania
Adjunct Professor, Pharmacology
Physician Assistant Program
Drexel University
Philadelphia, Pennsylvania
Barbara Nagle , Ph.D.
President
Clinical Research Development and Education
III Associates
Bryn Mawr, Pennsylvania
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PHARMACOLOGY: AN INTRODUCTION, SEVENTH EDITION
Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2016 by McGraw-Hill Education. All rights reserved.
Printed in the United States of America. Previous editions © 2012, 2005, and 1999. No part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but
not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.
Some ancillaries, including electronic and print components, may not be available to customers outside the United States.
This book is printed on acid-free paper.
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ISBN 978-0-07-351381-2
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Library of Congress Cataloging-in-Publication Data
H i t n e r , H e n r y .
Pharmacology: an introduction.—7th edition / Henry Hitner, Ph.D., professor emeritus, Department of Neuroscience, Physiology, Pharmacology,
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, adjunct professor, Pharmacology Physician Assistant Program, Drexel
University, Philadelphia, Pennsylvania, Barbara Nagle, Ph.D. president, Clinical Research Development and Education III Associates, Bryn Mawr,
Pennsylvania.
pages cm
Includes index.
ISBN 978-0-07-351381-2 (alk. paper)
1. Pharmacology. I. Nagle, Barbara T. II. Title.
RM300.H57 2016
615.1—dc23 2014044612
The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the
authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites.
www.mhhe.com
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Brief Contents
About the Authors xviii
Preface xix
What Every Student Needs to Know xxiv
1 . P harmacology: A n I ntroduction 4
2 . P harmacokinetics and F actors of I ndividual V ariation 17
3 . G eriatric P harmacology 34
4 . M ath R eview and D osage C alculations 43
5 . I ntroduction to the A utonomic N ervous S ystem 58
6 . D rugs A ffecting the S ympathetic N ervous S ystem 68
7 . D rugs A ffecting the P a rasympathetic N ervous S ystem 85
8 . D rugs A ffecting the A utonomic G anglia 99
9 . S keletal M uscle R elaxants 106
10. L ocal A nesthetics 123
11. I ntroduction to the C entral N ervous S ystem 138
12 . S edative - H ypnotic D rugs and A lcohol 146
13 . A ntipsychotic and A ntianxiety D rugs 161
14 . A ntidepressants, P sychomotor S timulants, and L ithium 175
15 . P sychotomimetic D rugs of A buse 188
16 . A ntiepileptic D rugs 200
17 . A ntiparkinson D rugs 212
18. G eneral A nesthetics 225
19. O pioid A nalgesics 248
20 . N onopioid A nalgesics , N onsteroidal Anti-inflammatories ,
and A ntigout D rugs 272
21. Review of C ardiac P hysiology and P athology 304
iii
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22 . T reatment of H eart failure 312
23 . A ntiarrhythmic D rugs 326
24. A ntianginal D rugs 341
25 . D iuretics 352
26 . A ntihypertensive D rugs 373
27 . A nticoagulants and C oagulants 388
28. N utrition and T herapy 409
29. H ypolipidemic D rugs 431
30. A ntianemics 451
31. A ntihistaminic D rugs and M ast C ell Stabilizers 468
32. R espiratory P h armacology, T reatment of A sthma, and COPD 4 85
33 . T herapy of G astrointestinal D isorders: P eptic U lcers, GERD,
and V omiting 502
34. A gents T h at A ffect I ntestinal M otility 529
35. I ntroduction to the E ndocrine S ystem 546
36. A drenal S teroids 557
37. G onadal H ormones , O ral C ontraceptives, and E rectile
D ysfunction D rugs 575
38. D rugs A ffecting the T hyroid and P a rathyroid G lands
and B one D egeneration 601
39. P ancreatic H ormones and A ntidiabetic D rugs 620
40. P osterior P ituitary H ormones : A ntidiuretic H ormone
and O xytocin 653
41. A ntibacterial A gents 666
42 . A ntifungal and A ntiviral D rugs 687
43 . P arasitic I nfections: A ntiprotozoal and A nthelmintic D rugs 721
44 . A ntiseptics and D isinfectants 737
45. A ntineoplastic A gents 754
46. I mmunopharmacology 771
Glossary 783
Appendix A Latin Abbreviations Used in Medicine 798
Appendix B Abbreviations and Symbols Commonly Used in
Medical Notations 799
Photo Credits 803
Index 805
iv Brief Contents
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Table of Contents
PART 1
G e neral C o ncepts 3
CHAPTER 1
Pharmacology: An Introduction 4
Drug Sources and Major Areas of Pharmacology 5
Terminology Related to Drug Effects 6
Basic Concepts in Pharmacology 7
Dose-Response and Time-Plasma Drug Concentration Curves 8
Drug Safety 9
Drug Nomenclature 10
Drug References and Drug Legislation 10
Chapter Review 13
CHAPTER 2
Pharmacokinetics and Factors of Individual Variation 17
Drug Forms and Routes of Administration 18
Pharmacokinetic Processes 20
Clinical Factors that Determine the Intensity of Drug Response 23
Factors of Individual Variation 25
Pharmacokinetic Considerations for Pediatrics 26
Drug Interactions 28
Terminology Associated with Chronic Drug Use and Abuse 28
Chapter Review 30
CHAPTER 3
Geriatric Pharmacology 34
Drug Use in the Elderly 35
Drug Absorption and Distribution 35
Drug Metabolism and Excretion 36
Effects of Age on Drug Response 37
Drug Compliance in the Elderly 38
Chapter Review 40
CHAPTER 4
Math Review and Dosage Calculations 43
Fractions, Decimals, and Percents 44
Dosage Calculations 46
v
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Systems of Measurement 46
Calculating Dosages 48
Pediatric Dosage Calculations 49
Monitoring IV Infusion Rates 50
Chapter Review 5 2
PART 2
P h armacology of the P e ripheral N ervous
S y stem 57
CHAPTER 5
Introduction to the Autonomic Nervous System 58
Nervous System Organization 59
Overview of the ANS 60
Parasympathetic and Sympathetic Divisions 60
ANS Nerve Fibers and Neurotransmitters 63
Cholinergic and Adrenergic Receptors 65
Chapter Review 66
CHAPTER 6
Drugs Affecting the Sympathetic Nervous System 68
Adrenergic Nerve Endings 69
Adrenergic Receptors 70
Adrenergic Drug Classes 71
Alpha-Adrenergic Drugs 72
Beta-Adrenergic Drugs 73
Alpha-Adrenergic Blocking Drugs 75
Beta-Adrenergic Blocking Drugs 76
Adrenergic Neuronal Blocking Drugs 78
Chapter Review 82
CHAPTER 7
Drugs Affecting the Parasympathetic Nervous System 85
Cholinergic Nerve Activity 86
Cholinergic Receptors 86
Cholinergic Drugs 88
Clinical Indications for Anticholinesterase Drugs 91
Anticholinergic Drugs 93
Preferred Treatment for Selected Conditions 94
Chapter Review 96
vi Table of Contents
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CHAPTER 8
Drugs Affecting the Autonomic Ganglia 99
Ganglionic Stimulants 100
Drugs Used in Smoking Cessation 100
Ganglionic Blockers 102
Drug Interactions with Ganglionic Blocking Drugs 103
Chapter Review 104
CHAPTER 9
Skeletal Muscle Relaxants 106
Skeletal Muscle Relaxation 108
Peripherally Acting Skeletal Muscle Relaxants 108
Major Adverse Effects Associated with Peripheral NMB 112
Direct-Acting Skeletal Muscle Relaxants 114
Centrally Acting Skeletal Muscle Relaxants (Spasmolytics) 115
Preferred Treatment for Selected Conditions 117
Chapter Review 120
CHAPTER 10
Local Anesthetics 123
How Local Anesthetics Work 124
Types of Local Anesthetics 125
Types of Local Anesthesia 126
Adverse Effects Associated with Local Anesthetics Use 130
Clinical Applications 130
Special Considerations 131
Chapter Review 133
PART 3
P h armacology of the C e ntral N ervous
S y stem 137
CHAPTER 11
Introduction to the Central Nervous System 138
Structural and Functional Features of the Brain 139
Diencephalon and Brainstem 140
Cerebellum 141
Spinal Cord 141
Functional Components 141
Chapter Review 143
Table of Contents vii
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CHAPTER 12
Sedative-Hypnotic Drugs and Alcohol 146
Sleep Cycle 148
Mechanism of Action of Sedative-Hypnotic Drugs 149
Barbiturate Sedatives and Hypnotics 149
Benzodiazepines 152
Miscellaneous Hypnotic Drugs 154
Alcohol 155
Chapter Review 158
CHAPTER 13
Antipsychotic and Antianxiety Drugs 161
Antipsychotic Drugs 162
Phenothiazines 163
Butyrophenones 164
Thioxanthenes 165
Atypical Antipsychotic Drugs 166
Antianxiety Drugs 167
Chapter Review 172
CHAPTER 14
Antidepressants, Psychomotor Stimulants, and Lithium 175
Types of Depression 176
Selective Serotonin Reuptake Inhibitors SSRIs 177
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) 178
Tricyclic Antidepressants 179
Monoamine Oxidase Inhibitors (MAOIs) 180
Antidepressants with Additional Mechanisms of Action 182
Psychomotor Stimulants 182
Lithium 183
Preferred Therapy for Depression, Mania, and Bipolar Disorder 184
Chapter Review 185
CHAPTER 15
Psychotomimetic Drugs of Abuse 188
LSD-Type Hallucinogens 189
Psychomotor Stimulants 191
Phencyclidine 194
Marijuana 194
Chapter Review 197
viii Table of Contents
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CHAPTER 16
Antiepileptic Drugs 200
Types of Epilepsy 201
Drugs Effective for Both Generalized Tonic-Clonic and Partial Seizures 202
Drugs Effective Primarily For Partial Seizures 206
Drugs Used in the Treatment of Absence Seizures 206
Treatment of Status Epilepticus 207
Preferred Therapy for Epileptic Seizures 207
Chapter Review 209
CHAPTER 17
Antiparkinson Drugs 212
Neurotransmitters Affecting the Basal Ganglia 213
Drugs that Form Dopamine 215
Drugs that Inhibit Metabolism of Levodopa and DA 216
Dopamine Receptor Agonists 219
Miscellaneous Drugs 219
Preferred Therapy for Parkinson’s Disease 220
Chapter Review 222
CHAPTER 18
General Anesthetics 225
Types of Anesthesia 227
Characteristics of General Anesthesia 228
Mechanism of Action of General Anesthetics 229
Classes of General Anesthetics 231
Nonanesthetic Effects of General Anesthetics 236
Adjunct Medications Used in General Anesthesia 239
Special Considerations with General Anesthetic Use 242
Preferred Use of Anesthetics 244
Chapter Review 245
CHAPTER 19
Opioid Analgesics 248
Pathways for Pain Recognition 250
Clinical Indications 251
Opioid Analgesics 251
Sites and Mechanism of Opioid Action 253
Nonanalgesic Opioid Effects 256
Drug Administration and Disposition 258
Table of Contents ix
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