HARRISON’S Manual of Medicine

CONTENTS

Contributors xiii
Preface xv
SECTION 1
CARE OF THE HOSPITALIZED PATIENT
1 Initial Evaluation and
Admission Orders for the
General Medicine Patient 1
2 Assessment of Nutritional
Status 2
3 Electrolytes/Acid-Base
Balance 5
4 Enteral and Parenteral
Nutrition 14
5 Transfusion and Pheresis
Therapy 17
6 Principles of Critical Care
Medicine 19
7 Respiratory Failure 22
8 Pain and Its Management 23
9 Procedures Commonly
Performed by Internists 28
10 Diagnostic Imaging in
Internal Medicine 32
11 Gastrointestinal Diseases 34
SECTION 2
MEDICAL EMERGENCIES
12 Acute Respiratory Distress
Syndrome (ARDS) 39
13 Cardiovascular Collapse
and Sudden Death 41
14 Shock 44
15 Sepsis and Septic Shock 49
16 Acute Pulmonary Edema 53
17 Confusion, Stupor,
and Coma 54
18 Stroke 58
19 Subarachnoid Hemorrhage 66
20 Increased Intracranial
Pressure and Head Trauma 67
21 Hypoxic-Ischemic
Encephalopathy 69
22 Status Epilepticus 72
23 Poisoning and Drug
Overdose 74
24 Diabetic Ketoacidosis and
Hyperosmolar Coma 89
25 Hypoglycemia 91
26 Infectious Disease
Emergencies 94
27 Oncologic Emergencies 101
28 Anaphylaxis 105
29 Bites, Venoms, Stings, and
Marine Poisonings 106
30 Hypothermia and Frostbite 115
31 Bioterrorism 118
SECTION 3
COMMON PATIENT PRESENTATIONS
32 Chest Pain 133
33 Abdominal Pain 136
34 Headache 139
35 Back and Neck Pain 147
36 Fever, Hyperthermia,
Chills, and Rash 156
37 Pain or Swelling of Joints 161
38 Syncope and Faintness 164
39 Dizziness and Vertigo 168
40 Acute Visual Loss and
Double Vision 171
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41 Paralysis and Movement
Disorders 175
42 Aphasias and Related
Disorders 179
43 SleepDisorders 181
44 Dyspnea 185
45 Cough and Hemoptysis 187
46 Cyanosis 192
47 Edema 194
48 Nausea, Vomiting, and
Indigestion 197
49 Weight Loss 201
50 Dysphagia 203
51 Acute Abdomen 206
52 Diarrhea, Constipation, and
Malabsorption 208
53 Gastrointestinal Bleeding 214
54 Jaundice and Evaluation of
Liver Function 218
55 Ascites 224
56 Azotemia and Urinary
Abnormalities 227
57 Anemia and Polycythemia 232
58 Lymphadenopathy and
Splenomegaly 235
SECTION 4
DISORDERS OF THE EYE, EAR, NOSE, AND THROAT
59 Common Disorders of
Vision and Hearing 241
60 Infections of the Upper
Respiratory Tract 248
SECTION 5
DERMATOLOGY
61 General Examination of
the Skin 255
62 Common Skin Conditions 259
SECTION 6
HEMATOLOGY AND ONCOLOGY
63 Examination of Blood
Smears and Bone Marrow 265
64 Red Blood Cell Disorders 267
65 Leukocytosis and
Leukopenia 272
66 Bleeding and Thrombotic
Disorders 275
67 Prevention and Early
Detection of Cancer 280
68 Cancer Chemotherapy 284
69 Myeloid Leukemias,
Myelodysplasia, and
Myeloproliferative
Syndrome 290
70 Lymphoid Malignancies 296
71 Skin Cancer 307
72 Head and Neck Cancer 309
73 Lung Cancer 310
74 Breast Cancer 316
75 Tumors of the
Gastrointestinal Tract 320
76 Genitourinary Tract Cancer 331
77 Gynecologic Cancer 334
78 Prostate Hyperplasia and
Carcinoma 338
79 Cancer of Unknown
Primary Site 341
80 Paraneoplastic Endocrine
Syndromes 344
81 Neurologic Paraneoplastic
Syndromes 346
vi CONTENTS
SECTION 7
INFECTIOUS DISEASES
82 Diagnosis of Infectious
Diseases 351
83 Antibacterial Therapy 360
84 Immunization andAd vice
to Travelers 365
85 Infective Endocarditis 372
86 Intraabdominal Infections 380
87 Infectious Diarrheas 383
88 Sexually Transmitted
Diseases andReprod uctive
Tract Infections 393
89 Infections of the Skin, Soft
Tissues, Joints, andBones 408
90 Infections in the
ImmunocompromisedHost 417
91 HIV Infection andAIDS 424
92 Hospital-AcquiredInfections 442
93 Pneumococcal Infections 445
94 Staphylococcal Infections 448
95 Streptococcal/Enterococcal
Infections, Diphtheria, and
Other Corynebacterial
Infections 455
96 Meningococcal andListerial
Infections 462
97 Infections Causedby
Haemophilus, Bordetella,
Moraxella, andHACEK
Group Organisms 466
98 Diseases Causedby Gram-
Negative Enteric Bacteria,
Pseudomonas, and
Legionella 471
99 Infections Causedby Other
Gram-Negative Bacilli 479
100 Anaerobic Infections 485
101 Nocardiosis and
Actinomycosis 492
102 Tuberculosis andOther
Mycobacterial Infections 495
103 Lyme Disease andOther
Nonsyphilitic Spirochetal
Infections 506
104 Rickettsial Diseases 510
105 Mycoplasma Infections 516
106 Chlamydial Infections 517
107 Herpesvirus Infections 520
108 Cytomegalovirus and
Epstein-Barr Virus
Infections 529
109 Influenza andOther Viral
Respiratory Diseases 533
110 Rubeola, Rubella, Mumps,
andParvovirus Infections 539
111 Enteroviral Infections 544
112 Insect- andAnimal-Borne
Viral Infections 547
113 Fungal Infections 555
114 Pneumocystis Infection 565
115 Protozoal Infections 569
116 Helminthic Infections 580
SECTION 8
CARDIOVASCULAR DISEASES
117 Physical Examination of the
Heart 593
118 Electrocardiography and
Echocardiography 596
119 Valvular Heart Disease 603
120 Cardiomyopathies and
Myocarditis 609
121 Pericardial Disease 612
122 Hypertension 616
123 ST-Segment Elevation
Myocardial Infarction
(STEMI) 621
124 Chronic Stable Angina,
Unstable Angina, andNon-
ST-Elevation Myocardial
Infarction 631
CONTENTS vii
125 Arrhythmias 638
126 Congestive Heart Failure
and Cor Pulmonale 648
127 Diseases of the Aorta 653
128 Peripheral Vascular Disease 655
129 Pulmonary Hypertension 658
SECTION 9
RESPIRATORY DISEASES
130 Respiratory Function and
Pulmonary Diagnostic
Procedures 663
131 Asthma and Hypersensitivity
Pneumonitis 668
132 Environmental Lung
Diseases 673
133 Chronic Bronchitis,
Emphysema, and Acute
or Chronic Respiratory
Failure 675
134 Pneumonia and Lung
Abscess 679
135 Pulmonary
Thromboembolism 685
136 Interstitial Lung Disease
(ILD) 687
137 Diseases of the Pleura,
Mediastinum, and
Diaphragm 691
138 Disorders of Ventilation,
Including SleepAp nea 695
SECTION 10
RENAL DISEASES
139 Approach to the Patient with
Renal Disease 699
140 Acute Renal Failure 702
141 Chronic Kidney Disease
(CKD) and Uremia 707
142 Dialysis 709
143 Renal Transplantation 711
144 Glomerular Diseases 713
145 Renal Tubular Disease 720
146 Urinary Tract Infections 724
147 Renovascular Disease 728
148 Nephrolithiasis 731
149 Urinary Tract Obstruction 734
SECTION 11
GASTROINTESTINAL DISEASES
150 Peptic Ulcer and Related
Disorders 737
151 Inflammatory Bowel
Diseases 742
152 Colonic and Anorectal
Diseases 746
153 Cholelithiasis, Cholecystitis,
and Cholangitis 749
154 Pancreatitis 753
155 Acute Hepatitis 757
156 Chronic Hepatitis 762
157 Cirrhosis and Alcoholic
Liver Disease 766
158 Portal Hypertension 769
viii CONTENTS
SECTION 12
ALLERGY, CLINICAL IMMUNOLOGY, AND RHEUMATOLOGY
159 Diseases of Immediate
Type Hypersensitivity 773
160 Primary Immunodeficiency
Diseases 776
161 SLE, RA, and Other
Connective Tissue
Diseases 779
162 Vasculitis 785
163 Ankylosing Spondylitis 788
164 Psoriatic Arthritis 791
165 Reactive Arthritis and
Reiter’s Syndrome 792
166 Osteoarthritis 794
167 Gout, Pseudogout, and
Related Diseases 796
168 Other Arthritides 799
169 Sarcoidosis 802
170 Amyloidosis 804
SECTION 13
ENDOCRINOLOGY AND METABOLISM
171 Disorders of the Anterior
Pituitary and Hypothalamus 807
172 Disorders of the Posterior
Pituitary 813
173 Disorders of the Thyroid 815
174 Disorders of the Adrenal
Gland 823
175 Obesity 828
176 Diabetes Mellitus 830
177 Disorders of the Male
Reproductive System 835
178 Disorders of the Female
Reproductive System 839
179 Hypercalcemic and
Hypocalcemic Disorders 847
180 Osteoporosis and
Osteomalacia 852
181 Disorders of Lipid
Metabolism 855
182 Hemochromatosis,
Porphyrias, and Wilson’s
Disease 861
SECTION 14
NEUROLOGY
183 The Neurologic
Examination 867
184 Neuroimaging 873
185 Seizures and Epilepsy 875
186 Tumors of the Nervous
System 883
187 Acute Meningitis and
Encephalitis 886
188 Chronic Meningitis 896
189 Multiple Sclerosis (MS) 899
190 Alzheimer’s Disease and
Other Dementias 904
191 Parkinson’s Disease 910
192 Ataxic Disorders 914
193 ALS and Other Motor
Neuron Diseases 917
194 Trigeminal Neuralgia,
Bell’s Palsy, and Other
Cranial Nerve Disorders 920
195 Autonomic Nervous
System Disorders 925
196 Spinal Cord Diseases 932
197 Peripheral Neuropathies,
Including Guillain-Barre´
Syndrome 936
198 Myasthenia Gravis (MG) 942
199 Muscle Diseases 944
200 Chronic Fatigue Syndrome 952
CONTENTS ix
SECTION 15
PSYCHIATRIC DISORDERS AND PSYCHOACTIVE SUBSTANCE USE
201 Psychiatric Disorders 955
202 Psychiatric Medications 962
203 Eating Disorders 969
204 Alcoholism 972
205 Narcotic Abuse 975
SECTION 16
ADVERSE DRUG REACTIONS
206 Adverse Drug Reactions 979
SECTION 17
WOMEN’S HEALTH
207 Women’s Health 989
SECTION 18
SCREENING AND DISEASE PREVENTION
208 Health Maintenance and
Disease Prevention 991
SECTION 19
LABORATORY VALUES
209 Appendix: Laboratory
Values of Clinical
Importance 995
Index 1011

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Color Atlas of Pharmacology 3rd edition, revised and expanded

Contents

General Pharmacology 1
History of Pharmacology. . . . . . . . 2
The Idea . . . . . . . . . . . . . . . . 2
The Impetus . . . . . . . . . . . . . . 2
Early Beginnings. . . . . . . . . . . . 3
Foundation. . . . . . . . . . . . . . . 3
Consolidation—General Recognition . 3
Status Quo . . . . . . . . . . . . . . . 3
Drug Sources . . . . . . . . . . . . . . 4
Drug and Active Principle. . . . . . . . 4
The Aims of Isolating Active
Principles . . . . . . . . . . . . . . . . . 4
European Plants as Sources of
Effective Medicines . . . . . . . . . . . 6
Drug Development . . . . . . . . . . . 8
Congeneric Drugs and Name
Diversity . . . . . . . . . . . . . . . . . 10
Drug Administration . . . . . . . . . . 12
OralDosage Forms. . . . . . . . . . . . 12
Drug Administration by Inhalation . . . 14
Dermatological Agents . . . . . . . . . 16
Skin Protection (A). . . . . . . . . . . . 16
Dermatological Agents as Vehicles (B). 16
From Application to Distribution in
the Body . . . . . . . . . . . . . . . . . 18
Cellular Sites of Action . . . . . . . . . 20
Potential Targets of Drug Action . . . . 20
Distribution in the Body . . . . . . . . 22
External Barriers of the Body . . . . . . 22
Blood–Tissue Barriers . . . . . . . . . . 24
Membrane Permeation . . . . . . . . . 26
Possible Modes of Drug Distribution . . 28
Binding to Plasma Proteins . . . . . . . 30
Drug Elimination . . . . . . . . . . . . 32
The Liver as an Excretory Organ . . . . 32
Biotransformation ofDrugs. . . . . . . 34
Drug Metabolism by Cytochrome
P450. . . . . . . . . . . . . . . . . . . . 38
The Kidney as an Excretory Organ . . . 40
Presystemic Elimination . . . . . . . . . 42
Pharmacokinetics . . . . . . . . . . . . 44
Drug Concentration in the Body as
a Function of Time—First Order
(Exponential) Rate Processes . . . . . . 44
Time Course of Drug Concentration
in Plasma . . . . . . . . . . . . . . . . . 46
Time Course of Drug Plasma Levels
during Repeated Dosing (A) . . . . . . . 48
Time Course of Drug Plasma Levels
during Irregular Intake (B). . . . . . . . 48
Accumulation: Dose, Dose Interval,
and Plasma Level Fluctuation (A) . . . . 50
Change in Elimination Characteristics
duringDrug Therapy (B). . . . . . . . . 50
Quantification of Drug Action . . . . . 52
Dose–Response Relationship . . . . . . 52
Concentration–Effect Relationship (A) . 54
Concentration–Effect Curves (B) . . . . 54
Drug–Receptor Interaction. . . . . . . 56
Concentration–Binding Curves . . . . . 56
Types of Binding Forces . . . . . . . . . 58
Covalent Bonding . . . . . . . . . . . 58
Noncovalent Bonding . . . . . . . . . 58
Agonists—Antagonists . . . . . . . . . . 60
Models of the Molecular Mechanism
of Agonist/Antagonist Action (A) . . . . 60
Other Forms of Antagonism. . . . . . . 60
Enantioselectivity of Drug Action . . . . 62
Receptor Types . . . . . . . . . . . . . . 64
Mode of Operation of G-Proteincoupled
Receptors . . . . . . . . . . . . 66
Time Course of Plasma Concentration
and Effect . . . . . . . . . . . . . . . . . 68
Adverse Drug Effects . . . . . . . . . . 70
Undesirable Drug Effects, Side
Effects . . . . . . . . . . . . . . . . . . . 70
VI Contents
Causes of Adverse Effects. . . . . . . . 70
Drug Allergy . . . . . . . . . . . . . . . 72
Cutaneous Reactions . . . . . . . . . . 74
Drug Toxicity in Pregnancy and
Lactation . . . . . . . . . . . . . . . . . 76
Genetic Variation of Drug Effects . . . 78
Pharmacogenetics . . . . . . . . . . . . 78
Drug-independent Effects . . . . . . . 80
Placebo (A) . . . . . . . . . . . . . . . . 80
Systems Pharmacology 83
Drugs Acting on the Sympathetic
Nervous System. . . . . . . . . . . . . 84
Sympathetic Nervous System. . . . . . 84
Structure of the Sympathetic
Nervous System . . . . . . . . . . . . . 86
Adrenergic Synapse . . . . . . . . . . . 86
Adrenoceptor Subtypes and
Catecholamine Actions . . . . . . . . . 88
SmoothMuscle Effects . . . . . . . . . 88
Cardiostimulation . . . . . . . . . . . . 88
Metabolic Effects. . . . . . . . . . . . . 88
Structure–Activity Relationships
of Sympathomimetics. . . . . . . . . . 90
Indirect Sympathomimetics. . . . . . . 92
α-Sympathomimetics,
α-Sympatholytics . . . . . . . . . . . . 94
β-Sympatholytics (β-Blockers) . . . . . 96
Types of β-Blockers . . . . . . . . . . . 98
Antiadrenergics . . . . . . . . . . . . . 100
Drugs Acting on the Parasympathetic
Nervous System. . . . . . . . . . . . . 102
Parasympathetic Nervous System . . . 102
Cholinergic Synapse . . . . . . . . . . . 104
Parasympathomimetics . . . . . . . . . 106
Parasympatholytics . . . . . . . . . . . 108
Nicotine. . . . . . . . . . . . . . . . . . 112
Actions ofNicotine . . . . . . . . . . . 112
Localization of Nicotinic ACh
Receptors. . . . . . . . . . . . . . . . . 112
Effects of Nicotine on Body Function . 112
Aids for Smoking Cessation. . . . . . . 112
Consequences of Tobacco Smoking . . 114
Biogenic Amines. . . . . . . . . . . . . 116
Dopamine. . . . . . . . . . . . . . . . . 116
Histamine Effects and Their
Pharmacological Properties. . . . . . . 118
Serotonin . . . . . . . . . . . . . . . . . 120
Vasodilators . . . . . . . . . . . . . . . 122
Vasodilators—Overview . . . . . . . . . 122
OrganicNitrates . . . . . . . . . . . . . 124
Calcium Antagonists . . . . . . . . . . . 126
I. Dihydropyridine Derivatives . . . . . . 126
II. Verapamil and Other Catamphiphilic
Ca2+ Antagonists . . . . . . . . . . . . . 126
Inhibitors of the Renin–Angiotensin–
Aldosterone System. . . . . . . . . . . 128
ACE Inhibitors. . . . . . . . . . . . . . . 128
Drugs Acting on Smooth Muscle . . . 130
Drugs Used to Influence Smooth
MuscleOrgans . . . . . . . . . . . . . . 130
Cardiac Drugs . . . . . . . . . . . . . . 132
Cardiac Glycosides . . . . . . . . . . . . 134
AntiarrhythmicDrugs . . . . . . . . . . 136
I. Drugs for Selective Control of
Sinoatrial and AVNodes. . . . . . . . 136
II. Nonspecific Drug Actions on
Impulse Generation and Propagation 136
Electrophysiological Actions of
Antiarrhythmics of the Na+-Channel
Blocking Type. . . . . . . . . . . . . . . 138
Antianemics . . . . . . . . . . . . . . . 140
Drugs for the Treatment of Anemias . . 140
Erythropoiesis (A) . . . . . . . . . . . 140
Vitamin B12 (B) . . . . . . . . . . . . 140
Folic Acid (B) . . . . . . . . . . . . . . 140
Iron Compounds . . . . . . . . . . . . . 142
Antithrombotics . . . . . . . . . . . . . 144
Prophylaxis and Therapy of Thromboses 144
Vitamin K Antagonists and Vitamin K . 146
Possibilities for Interference (B) . . . . . 146
Heparin (A) . . . . . . . . . . . . . . . . 148
Contents VII
Hirudin and Derivatives (B) . . . . . . . 148
Fibrinolytics. . . . . . . . . . . . . . . . 150
Intra-arterial Thrombus
Formation (A) . . . . . . . . . . . . . . 152
Formation, Activation, and
Aggregation of Platelets (B). . . . . . . 152
Inhibitors of Platelet
Aggregation (A) . . . . . . . . . . . . . 154
Presystemic Effect of ASA. . . . . . . . 154
Plasma Volume Expanders. . . . . . . 156
Drugs Used in Hyperlipoproteinemias 158
Lipid-lowering Agents. . . . . . . . . . 158
Diuretics . . . . . . . . . . . . . . . . . 162
Diuretics—AnOverview . . . . . . . . . 162
NaCl Reabsorption in the Kidney (A) . . 164
Aquaporins (AQP) . . . . . . . . . . . . 164
Osmotic Diuretics (B) . . . . . . . . . . 164
Diuretics of the Sulfonamide Type . . . 166
Potassium- sparing Diuretics and
Vasopressin. . . . . . . . . . . . . . . . 168
Potassium- sparing Diuretics (A) . . . . 168
Vasopressin and Derivatives (B) . . . . 168
Drugs for the Treatment of Peptic
Ulcers . . . . . . . . . . . . . . . . . . . 170
Drugs for Gastric and Duodenal
Ulcers . . . . . . . . . . . . . . . . . . . 170
I. Lowering of Acid Concentration . . 170
II. Protective Drugs . . . . . . . . . . 172
III. Eradication of Helicobacter
pylori (C) . . . . . . . . . . . . . . . . 172
Laxatives . . . . . . . . . . . . . . . . . 174
1. Bulk Laxatives. . . . . . . . . . . . 174
2. Irritant Laxatives . . . . . . . . . . 176
2a. Small-Bowel Irritant Purgative . . 178
2b. Large-Bowel Irritant Purgatives . 178
3. Lubricant laxatives . . . . . . . . . 178
Antidiarrheals . . . . . . . . . . . . . . 180
Antidiarrheal Agents. . . . . . . . . . . 180
Drugs Acting on the Motor System . 182
Drugs Affecting Motor Function . . . . 182
Muscle Relaxants. . . . . . . . . . . . . 184
Nondepolarizing Muscle Relaxants . . . 184
Depolarizing Muscle Relaxants . . . . . 186
AntiparkinsonianDrugs . . . . . . . . . 188
Antiepileptics . . . . . . . . . . . . . . . 190
Drugs for the Suppression of Pain . . 194
Pain Mechanisms and Pathways . . . . 194
Antipyretic Analgesics . . . . . . . . . 196
Eicosanoids . . . . . . . . . . . . . . . . 196
Antipyretic Analgesics vs. NSAIDs. . . . 198
Nonsteroidal Anti- inflammatory
Drugs (NSAIDs) . . . . . . . . . . . . . . 198
Nonsteroidal Anti- inflammatory
Drugs . . . . . . . . . . . . . . . . . . . 200
Cyclooxygenase (COX) Inhibitors . . . . 200
Local Anesthetics . . . . . . . . . . . . 202
Opioids . . . . . . . . . . . . . . . . . . 208
Opioid Analgesics—Morphine Type . . . 208
General Anesthetics . . . . . . . . . . . 214
General Anesthesia and General
Anesthetic Drugs . . . . . . . . . . . . . 214
Inhalational Anesthetics . . . . . . . . . 216
Injectable Anesthetics . . . . . . . . . . 218
Psychopharmacologicals . . . . . . . . 220
Sedatives,Hypnotics . . . . . . . . . . . 220
Benzodiazepines . . . . . . . . . . . . . 222
Benzodiazepine Antagonist . . . . . . 222
Pharmacokinetics of Benzodiazepines . 224
Therapy of Depressive Illness . . . . . . 226
Mania . . . . . . . . . . . . . . . . . . . 230
Therapy of Schizophrenia . . . . . . . . 232
Neuroleptics . . . . . . . . . . . . . . 232
Psychotomimetics (Psychedelics,
Hallucinogens) . . . . . . . . . . . . . . 236
Hormones. . . . . . . . . . . . . . . . . 238
Hypothalamic and Hypophyseal
Hormones. . . . . . . . . . . . . . . . . 238
ThyroidHormone Therapy. . . . . . . . 240
Hyperthyroidism and Antithyroid
Drugs . . . . . . . . . . . . . . . . . . . 242
Glucocorticoid Therapy . . . . . . . . . 244
I. Replacement Therapy . . . . . . . . . 244
VIII Contents
II. Pharmacodynamic Therapy with
Glucocorticoids (A) . . . . . . . . . . . 244
Androgens, Anabolic Steroids,
Antiandrogens . . . . . . . . . . . . . . 248
Inhibitory Principles . . . . . . . . . . 248
Follicular Growth and Ovulation,
Estrogen and Progestin Production . . 250
Oral Contraceptives . . . . . . . . . . . 252
Antiestrogen and Antiprogestin
Active Principles . . . . . . . . . . . . . 254
Aromatase Inhibitors . . . . . . . . . . 256
Insulin Formulations . . . . . . . . . . . 258
Variations in Dosage Form . . . . . . 258
Variation in Amino Acid Sequence. . 258
Treatment of Insulin-dependent
Diabetes Mellitus. . . . . . . . . . . . . 260
Undesirable Effects . . . . . . . . . . 260
Treatment of Maturity-Onset
(Type II) Diabetes Mellitus. . . . . . . . 262
Oral Antidiabetics . . . . . . . . . . . . 264
Drugs for Maintaining Calcium
Homeostasis . . . . . . . . . . . . . . . 266
Antibacterial Drugs . . . . . . . . . . . 268
Drugs for Treating Bacterial
Infections . . . . . . . . . . . . . . . . . 268
Inhibitors of Cell Wall Synthesis . . . . 270
Inhibitors of Tetrahydrofolate
Synthesis . . . . . . . . . . . . . . . . . 274
Inhibitors ofDNA Function . . . . . . . 276
Inhibitors of Protein Synthesis . . . . . 278
Drugs for Treating Mycobacterial
Infections . . . . . . . . . . . . . . . . . 282
Antitubercular drugs (1) . . . . . . . 282
Antileprotic drugs (2) . . . . . . . . . 282
Antifungal Drugs . . . . . . . . . . . . 284
Drugs Used in the Treatment of
Fungal Infections . . . . . . . . . . . . . 284
Antiviral Drugs. . . . . . . . . . . . . . 286
Chemotherapy of Viral Infections. . . . 286
Drugs for the Treatment of AIDS . . . . 290
I. Inhibitors of Reverse
Transcriptase—Nucleoside Agents . . 290
Nonnucleoside Inhibitors . . . . . . . 290
II.HIV protease Inhibitors . . . . . . . 290
III. Fusion Inhibitors . . . . . . . . . . 290
Antiparasitic Drugs . . . . . . . . . . . 292
Drugs for Treating Endoparasitic
and Ectoparasitic Infestations . . . . . . 292
Antimalarials . . . . . . . . . . . . . . . 294
Other TropicalDiseases . . . . . . . . . 296
Anticancer Drugs . . . . . . . . . . . . 298
Chemotherapy of Malignant
Tumors . . . . . . . . . . . . . . . . . . 298
Targeting of Antineoplastic Drug
Action (A) . . . . . . . . . . . . . . . . . 302
Mechanisms of Resistance to
Cytostatics (B) . . . . . . . . . . . . . . 302
Immune Modulators . . . . . . . . . . 304
Inhibition of Immune Responses . . . . 304
Antidotes . . . . . . . . . . . . . . . . . 308
Antidotes and Treatment of
Poisonings. . . . . . . . . . . . . . . . . 308
Therapy of Selected Diseases 313
Hypertension. . . . . . . . . . . . . . . 314
Angina Pectoris . . . . . . . . . . . . . 316
Antianginal Drugs . . . . . . . . . . . . 318
Acute Coronary Syndrome—
Myocardial Infarction . . . . . . . . . . 320
Congestive Heart Failure . . . . . . . . 322
Hypotension . . . . . . . . . . . . . . . 324
Gout. . . . . . . . . . . . . . . . . . . . 326
Obesity—Sequelae and
Therapeutic Approaches. . . . . . . . . 328
Osteoporosis . . . . . . . . . . . . . . . 330
Rheumatoid Arthritis. . . . . . . . . . . 332
Migraine. . . . . . . . . . . . . . . . . . 334
Common Cold . . . . . . . . . . . . . . 336
Atopy and Antiallergic Therapy . . . . . 338
Bronchial Asthma. . . . . . . . . . . . . 340
Emesis . . . . . . . . . . . . . . . . . . . 342
Alcohol Abuse. . . . . . . . . . . . . . . 344
Local Treatment of Glaucoma. . . . . . 346
Contents IX
Further Reading 349
Drug Indexes 351
Trade Name – Drug Name . . . . . . . 352 Drug Name – Trade Name. . . . . . . . 369
Subject Index 381


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Martindale The Complete Drug Reference Thirty-sixth edition Edited by Sean C Sweetman BPharm, FRPharmS

Contents

Preface v
Abbreviations viii
Contracted Names for Ions and Groups xi
Atomic Weights of the Elements xiii
Volume 1
• Monographs on drugs and ancillary substances
Analgesics Anti-inflammatory Drugs and Antipyretics 1
Anthelmintics 134
Antibacterials 158
Antidementia Drugs 362
Antidepressants 372
Antidiabetics 431
Antiepileptics 465
Antifungals 517
Antigout Drugs 552
Antihistamines 561
Antimalarials 594
Antimigraine Drugs 616
Antimyasthenics 629
Antineoplastics 635
Antiparkinsonian Drugs 791
Antiprotozoals 822
Antivirals 850
Anxiolytic Sedatives Hypnotics and Antipsychotics 952
Blood Products Plasma Expanders and Haemostatics 1042
Bone Modulating Drugs 1083
Bronchodilators and Anti-asthma Drugs 1108
Cardiovascular Drugs 1152
Chelators Antidotes and Antagonists 1435
Colouring Agents 1469
Contrast Media 1474
Corticosteroids 1490
Cough Suppressants Expectorants Mucolytics and Nasal Decongestants 1547
Dermatological Drugs and Sunscreens 1576
Disinfectants and Preservatives 1622
Electrolytes 1667
Gases 1688
Gastrointestinal Drugs 1692
General Anaesthetics 1779
Growth Hormone and its Modulators 1798
Immunosuppressants 1810
Local Anaesthetics 1850
Miotics Mydriatics and Antiglaucoma Drugs 1873
Muscle Relaxants 1887
Neuromuscular Blockers 1900
Nonionic Surfactants 1914
Nutritional Agents and Vitamins 1922
Obstetric Drugs 2002
Organic Solvents 2019
Paraffins and Similar Bases 2028
Pesticides and Repellents 2034
Radiopharmaceuticals 2052
Sex Hormones and their Modulators 2058
Soaps and Other Anionic Surfactants 2138
Stabilising and Suspending Agents 2140
Stimulants and Anorectics 2148
Thyroid and Antithyroid Drugs 2165
Urological Drugs 2178
Vaccines Immunoglobulins and Antisera 2201
Supplementary Drugs and Other Substances 2244



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Non-prescription Medicines Alan Nathan BPharm, BA, FRPharmS Freelance pharmacy writer and consultant London, UK

Contents

Preface ix
About the author xi
1 Acne 1
2 Athlete's foot 9
3 Benign prostatic hyperplasia 15
4 Cardiovascular medicines 19
5 Chlamydia (Chlamydia trachomatis infection) 25
6 Colds 29
7 Cold sores 37
8 Constipation 43
9 Corns and calluses 55
10 Cough 59
11 Cradle cap 71
12 Cystitis 73
13 Dandruff and seborrhoeic dermatitis 77
14 Diarrhoea 85
15 Dry skin 95
16 Ear problems 101
17 Emergency hormonal contraception 107
18 Eye conditions 113
19 Fungal nail infection (onychomycosis) 123
20 Haemorrhoids 125
21 Hay fever 133
22 Head lice 145
23 Indigestion 151
24 Insect bites and stings 169
25 Irritable bowel syndrome 175
26 Irritant and allergic dermatitis and mild eczema 181
27 Migraine 187
28 Motion sickness 193
29 Mouth ulcers 199
30 Nappy rash 205
31 Obesity management 209
32 Oral thrush 213
33 Pain 215
34 Pattern baldness 235
35 Premenstrual syndrome 239
36 Scabies 243
37 Smoking cessation products 249
38 Sore throat 261
39 Temporary sleep disturbance 265
40 Threadworm and roundworm 271
41 Vaginal candidiasis 277
42 Vaginitis and vaginal dryness 283
43 Verrucas 285
44 Warts 291
Index 293
viii | Contents
Preface
The first reclassification of a medicine from Prescription-only (POM) to
Pharmacy sale (P) status was in 1983. Since then there has been a steady
stream of POM-to-P transfers, and more than 80 medicines are now available
over the counter (OTC) that previously could be obtained only by a visit to a
doctor. The government has reaffirmed its commitment to making medicines
more accessible to the public and has pledged to continue and increase the rate
of POM-to-P reclassifications and, where appropriate, to further deregulate
medicines to General Sale List (GSL) status to make them even more widely
available.
Pharmacists have traditionally had a major role in the management of
minor illness, which POM-to-P has increased. This role will increase further
as more medicines for preventing and treating more serious conditions are
made available without prescription.
The usefulness of non-prescription medicines and the important role they
play in self-care have tended to be underestimated, and the information
available about them, including in the main reference sources for medical
professionals, is sparse. This book is the only publication in the UK that deals
with non-prescription medicines comprehensively and in depth. Its aim is to
help pharmacists and other healthcare professionals to make well-informed
recommendations and to give their patients sound advice on non-prescription
medicines.
In this book, OTC medicines currently available in the UK are reviewed in
alphabetically arranged chapters on the conditions for which they are licensed
to treat. This book will also be of value to pharmacists and other health
professionals in the Republic of Ireland, because most of the proprietary
branded medicines available in the UK are also available under the same name
in Ireland. Also, patients from the UK, including from Northern Ireland, often
ask for UK products, and these products are familiar as transnational advertising
raises awareness. The classification of non-prescription medicines in
Ireland is generally similar to that it in the UK, but due to licensing restrictions
some medicines that are available without prescription in the UK are not in
Ireland.
Information is provided on the following aspects of products:
* compounds or constituents
* mode of action
* indications
* evidence of efficacy
* side-effects
* cautions and contraindications
* interactions
* dosage
* presentations and formulations
* products available and manufacturers (either all products in a category or,
for categories where there are a large number of products, a representative
selection)
* each section concludes with a summary of key points and suggestions for
the most appropriate products to recommend.
Evidence of the efficacy of medicines is cited where it exists. However, few
clinical trials on medicines for OTC use have been published, and most of the
available evidence comes from the use of medicines as POMs before their
reclassification to P status. In some instances, medicines are licensed for nonprescription
use for different indications and at different doses from their use
as prescription drugs, and caution may therefore be necessary in extrapolating
clinical trial evidence to OTC use. There is very little clinical trial evidence for
medicines that were already licensed for OTC use before POM-to-P reclassifications
began. Such trials as could be found and appear to meet current
methodological standards are cited.
This edition has been completely revised and brought up to date. New
products have been included and assessed, and discontinued products have
been deleted. New chapters on chlamydia obesity, and benign prostatic hyperplasia
have been added.
A feature introduced with the last edition – the publication of 6-monthly
updates on the Pharmaceutical Press website (www.pharmpress.com/onlineresources)
– is continued with this edition.
Alan Nathan
Marc2010

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Handbook of Clinical Drug Data

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..xv
PART I DRUG MONOGRAPHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Principal Editor: Philip O. Anderson, PharmD
Analgesic and Anti-inflammatory Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Antimigraine Drugs, Toy S. Biederman, PharmD . . . . . . . . . . . . . . . . . . . . . . 3
Antirheumatic Drugs, Stephen M. Setter, PharmD, DVM,
Danial E. Baker, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Nonsteroidal Anti-inflammatory Drugs, Stephen M. Setter,
PharmD, DVM, Danial E. Baker, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 16
Opioids, Mark T. Holdsworth, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Antimicrobial Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Aminoglycosides, Renée-Claude Mercier, PharmD . . . . . . . . . . . . . . . . . . . . . . 55
Antifungal Drugs, Polly E. Kintzel, PharmD, Philip O. Anderson,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Antimycobacterial Drugs, Craig R. Ballard, PharmD . . . . . . . . . . . . . . . . . . . . 82
Antiparasitic Drugs, Philip O. Anderson, PharmD . . . . . . . . . . . . . . . . . . . . . . . 93
Antiviral Drugs, Craig R. Ballard, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
β-Lactams, Renée-Claude Mercier, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Macrolides, Craig R. Ballard, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Quinolones, Renée-Claude Mercier, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Sulfonamides, Craig R. Ballard, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Tetracyclines, Philip O. Anderson, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Miscellaneous Antimicrobials, Renée-Claude Mercier,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Antineoplastics, Chemoprotectants, and Immunosuppressants . . . . . . . . . . . . . . . 204
Antineoplastics, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Alkylating Agents, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Antimetabolites, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Cytokines, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
DNA Intercalating Drugs, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . 237
v
Hormonal Drugs and Antagonists, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . 245
Mitotic Inhibitors, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Monoclonal Antibodies, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . 260
Miscellaneous Antineoplastics, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . 263
Chemoprotectants, Robert T. Dorr, PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Immunosuppressants, Polly E. Kintzel, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 270
Cardiovascular Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Antiarrhythmic Drugs, Jerry L. Bauman, PharmD . . . . . . . . . . . . . . . . . . . . . . 297
Antihypertensive Drugs, James J. Nawarskas, PharmD . . . . . . . . . . . . . . . . . . 324
β-Adrenergic Blocking Drugs, Jerry L. Bauman, PharmD . . . . . . . . . . . . . . . . 354
Calcium-Channel Blocking Drugs, Jerry L. Bauman,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Hypolipidemic Drugs, James Wooten, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 368
Inotropic Drugs, Robert J. DiDomenico, PharmD . . . . . . . . . . . . . . . . . . . . . . 386
Nitrates, Robert J. DiDomenico, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Central Nervous System Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Anticonvulsants, Brian K. Alldredge, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . 415
Antidepressants, Glen L. Stimmel, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 444
Antipsychotic Drugs, Glen L. Stimmel, PharmD . . . . . . . . . . . . . . . . . . . . . . . 460
Anxiolytics, Sedatives, and Hypnotics, Glen L. Stimmel,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
Lithium, Glen L. Stimmel, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480
Neurodegenerative Disease Drugs, Toy S. Biederman, PharmD . . . . . . . . . . . 481
Ophthalmic Drugs for Glaucoma, Raymond W. Hammond,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Gastrointestinal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Acid-Peptic Therapy, Julianna Chan, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 528
Antiemetics, Mark T. Holdsworth, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 553
Gastrointestinal Motility, Robert E. Pachorek, PharmD,
Julianna Chan, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Miscellaneous Gastrointestinal Drugs, Julianna Chan,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574
Hematologic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595
Coagulants and Anticoagulants, Robert J. DiDomenico, PharmD . . . . . . . . . . 595
Hematopoietics, Robert J. DiDomenico, PharmD . . . . . . . . . . . . . . . . . . . . . . 617
vi CONTENTS
Hormonal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 631
Adrenal Hormones, Robert E. Pachorek, PharmD . . . . . . . . . . . . . . . . . . . . . . 631
Antidiabetic Drugs, Stephen M. Setter, PharmD, DVM,
John R. White, Jr., PA-C, PharmD, R. Keith Campbell,
BSPharm, MBA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 642
Contraceptives, Betty J. Dong, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Female Sex Hormones, Betty J. Dong, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 679
Thyroid and Antithyroid Drugs, Betty J. Dong, PharmD . . . . . . . . . . . . . . . . . 697
Renal and Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 716
Diuretics, Paul G. Cuddy, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 716
Electrolytes, Paul G. Cuddy, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 734
Bisphosphonates, Paul G. Cuddy, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 752
Gout Therapy, Robert E. Pachorek, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . 757
Respiratory Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769
Antiasthmatics, Patricia L. Marshik, PharlD . . . . . . . . . . . . . . . . . . . . . . . . . 769
Antihistamines, Patricia L. Marshik, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . 790
Corticosteroids, Patricia L. Marshik, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . 804
Cough and Cold, Robert E. Pachorek, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 809
PART II CLINICAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815
Principal Editor: William G. Troutman, PharmD
Chapter 1 Drug-Induced Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
Blood Dyscrasias, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . 817
Hepatotoxicity, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 830
Nephrotoxicity, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 841
Oculotoxicity, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . 850
Ototoxicity, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 859
Pancreatitis, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . 863
Sexual Dysfunction, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . 867
Skin Disorders, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . 873
Chapter 2 Drug Use in Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877
Drugs and Pregnancy, Anna Taddio, BSPharm, MSc, PhD . . . . . . . . . . . . . . . 877
Drugs and Breastfeeding, Philip O. Anderson, PharmD . . . . . . . . . . . . . . . . . . 914
Pediatric Drug Therapy, William E. Murray, PharmD . . . . . . . . . . . . . . . . . . . 943
Geriatric Drug Therapy, Dianne E. Tobias, PharmD . . . . . . . . . . . . . . . . . . . . 948
Renal Disease, Gary R. Matzke, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 954
Chapter 3 Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 979
CONTENTS vii
Chapter 4 Medical Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000
Anaphylaxis, William G. Troutman, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . 1000
Cardiac Arrest, Robert J. DiDomenico, PharmD, Allison E. Einhorn,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1002
Poisoning, Blaine E. Benson, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1011
Status Epilepticus, Brian K. Alldredge, PharmD . . . . . . . . . . . . . . . . . . . . . . 1015
Chapter 5 Drug Interactions and Interferences . . . . . . . . . . . . . . . . . . . . . . . . . 1019
Cytochrome P450 Enzyme Interactions, Philip D. Hansten,
PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1019
Drug-Induced Discoloration of Feces and Urine . . . . . . . . . . . . . . . . . . . . . . . 1024
Chapter 6 Nutrition Support, Fred Shatsky, BSPharm . . . . . . . . . . . . . . . . . . . 1027
PART III APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1051
Principal Editor: William G. Troutman, PharmD
Appendix 1 Conversion Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1053
Appendix 2 Anthropometrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1057
Appendix 3 Laboratory Indices, William G. Troutman, PharmD . . . . . . . . . . . 1061
Appendix 4 Drug-Laboratory Test Interferences,
David G. Dunlop, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1070
Appendix 5 Pharmacokinetic Equations,
James R. Lane, Jr., PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1081
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1085

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Pharmacotherapy Handbook Seventh Edition

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x
To the Reader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
SECTION 1: BONE AND JOINT DISORDERS
Edited by Terry L. Schwinghammer
1. Gout and Hyperuricemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
2. Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
3. Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
4. Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
SECTION 2: CARDIOVASCULAR DISORDERS
Edited by Terry L. Schwinghammer
5. Acute Coronary Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
6. Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
7. Cardiopulmonary Arrest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
8. Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82
9. Hyperlipidemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98
10. Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
11. Ischemic Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
12. Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
13. Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .156
14. Venous Thromboembolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
SECTION 3: DERMATOLOGIC DISORDERS
Edited by Terry L. Schwinghammer
15. Acne Vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
16. Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
17. Skin Disorders and Cutaneous Drug Reactions . . . . . . . . . . . . . . . . . .196
SECTION 4: ENDOCRINOLOGIC DISORDERS
Edited by Terry L. Schwinghammer
18. Adrenal Gland Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
19. Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210
20. Thyroid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
SECTION 5: GASTROINTESTINAL DISORDERS
Edited by Joseph T. DiPiro and Terry L. Schwinghammer
21. Cirrhosis and Portal Hypertension. . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
22. Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
23. Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
24. Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
25. Hepatitis, Viral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
26. Inflammatory Bowel Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
27. Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
28. Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
29. Peptic Ulcer Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
SECTION 6: GYNECOLOGIC AND OBSTETRIC DISORDERS
Edited by Barbara G. Wells
30. Contraception. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
31. Hormone Therapy in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
32. Pregnancy and Lactation: Therapeutic Considerations . . . . . . . . . . . 353
SECTION 7: HEMATOLOGIC DISORDERS
Edited by Cecily V. DiPiro
33. Anemias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
34. Sickle Cell Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
SECTION 8: INFECTIOUS DISEASES
Edited by Joseph T. DiPiro
35. Antimicrobial Regimen Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
36. Central Nervous System Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
37. Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
38. Fungal Infections, Invasive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
39. Gastrointestinal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
40. Human Immunodeficiency Virus/Acquired Immune
Deficiency Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
41. Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
42. Intraabdominal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
43. Respiratory Tract Infections, Lower. . . . . . . . . . . . . . . . . . . . . . . . . . . 465
44. Respiratory Tract Infections, Upper. . . . . . . . . . . . . . . . . . . . . . . . . . . 478
45. Sepsis and Septic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
46. Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49347. Skin and Soft-Tissue Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .509
48. Surgical Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .522
49. Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .532
50. Urinary Tract Infections and Prostatitis . . . . . . . . . . . . . . . . . . . . . . . .544
51. Vaccines, Toxoids, and Other Immunobiologics. . . . . . . . . . . . . . . . .556
SECTION 9: NEUROLOGIC DISORDERS
Edited by Barbara G. Wells
52. Epilepsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .577
53. Headache: Migraine and Tension-Type . . . . . . . . . . . . . . . . . . . . . . . .599
54. Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .614
55. Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .629
56. Status Epilepticus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .637
SECTION 10: NUTRITIONAL DISORDERS
Edited by Cecily V. DiPiro
57. Assessment and Nutrition Requirements . . . . . . . . . . . . . . . . . . . . . . .647
58. Enteral Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .655
59. Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .663
60. Parenteral Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .669
SECTION 11: ONCOLOGIC DISORDERS
Edited by Cecily V. DiPiro
61. Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .679
62. Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .689
63. Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .699
64. Lymphomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .704
65. Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .713
SECTION 12: OPHTHALMIC DISORDERS
Edited by Cecily V. DiPiro
66. Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .719
SECTION 13: PSYCHIATRIC DISORDERS
Edited by Barbara G. Wells
67. Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .727
68. Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .735
69. Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75670. Major Depressive Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 778
71. Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
72. Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
73. Substance-Related Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 823
SECTION 14: RENAL DISORDERS
Edited by Cecily V. DiPiro
74. Acid–Base Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 839
75. Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849
76. Chronic Kidney Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 858
77. Drug Dosing in Renal Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . 875
78. Electrolyte Homeostasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 881
SECTION 15: RESPIRATORY DISORDERS
Edited by Terry L. Schwinghammer
79. Allergic Rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 897
80. Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 906
81. Chronic Obstructive Pulmonary Disease. . . . . . . . . . . . . . . . . . . . . . . 921
SECTION 16: UROLOGIC DISORDERS
Edited by Cecily V. DiPiro
82. Benign Prostatic Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 931
83. Erectile Dysfunction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 936
84. Urinary Incontinence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 944
APPENDICES
Edited by Barbara G. Wells
Appendix 1. Allergic and Pseudoallergic Drug Reactions. . . . . . . . . . . 951
Appendix 2. Geriatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 955
Appendix 3. Drug-Induced Hematologic Disorders . . . . . . . . . . . . . . . 958
Appendix 4. Drug-Induced Liver Disease . . . . . . . . . . . . . . . . . . . . . . . 962
Appendix 5. Drug-Induced Pulmonary Disorders . . . . . . . . . . . . . . . . 965
Appendix 6. Drug-Induced Kidney Disease. . . . . . . . . . . . . . . . . . . . . . 971
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 975

Preface

This seventh edition of the pocket companion to Pharmacotherapy: A Pathophysiologic

Approach, seventh edition, is designed to provide practitioners and

students with critical information that can be easily used to guide drug therapy

decision making in the clinical setting. To ensure brevity and portability, the

bulleted format provides the user with essential textual information, key tables

and figures, and treatment algorithms.

Corresponding to the major sections in the main text, disorders are alphabetized

within the following sections: Bone and Joint Disorders, Cardiovascular

Disorders, Dermatologic Disorders, Endocrinologic Disorders, Gastrointestinal

Disorders, Gynecologic and Obstetric Disorders, Hematologic Disorders,

Infectious Diseases, Neurologic Disorders, Nutritional Disorders, Oncologic

Disorders, Ophthalmic Disorders, Psychiatric Disorders, Renal Disorders,

Respiratory Disorders, and Urologic Disorders. Drug-induced conditions associated

with allergic and pseudoallergic reactions, hematologic disorders, liver

disease, pulmonary disorders, and kidney disease appear in five tabular appendices.

In the seventh edition, information on the management of pharmacotherapy

in the elderly has been added as an appendix. Also in the seventh

edition, chapters have been added on adrenal gland disorders and influenza.

Carrying over a popular feature from Pharmacotherapy, each chapter is

organized in a consistent format:

• Disease state definition • Desired outcome

• Concise review of relevant pathophysiology • Treatment

• Clinical presentation • Monitoring

• Diagnosis

The treatment section may include nonpharmacologic therapy, drug selection

guidelines, dosing recommendations, adverse effects, pharmacokinetic

considerations, and important drug–drug interactions. When more in-depth

information is required, the reader is encouraged to refer to the primary text,

Pharmacotherapy: A Pathophysiologic Approach, seventh edition.

It is our sincere hope that students and practitioners find this book helpful

as they continuously strive to deliver highest quality patient-centered care.

We invite your comments on how we may improve subsequent editions of

this work.

Barbara G. Wells

Joseph T. DiPiro

Terry L. Schwinghammer

Cecily V. DiPiro

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