Fundamentals of Pharmacology
9th edition
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Preface viii
Acknowledgements x
Features xi
Educator resources xiv
Figures and tables xv
Section I An introduction to sociocultural aspects, law and ethics 1
1 Sociocultural aspects 2
2 Health professionals and the law 12
3 Ethical issues in health care 21
Section II Medicine administration and professional responsibilities 31
4 Medicine formulations, storage and routes of administration 32
5 The clinical decision-making process 51
6 Medicine administration strategies and documentation 57
7 Medication errors 70
Section III General aspects of pharmacology 77
8 Drug nomenclature 78
9 Pharmacokinetics 84 10 Pharmacodynamics 100
Pharmacogenetics 113 12 Drug interactions 121 13 Pharmacokinetic factors that modify drug action 127 14 Paediatric and geriatric pharmacology 132 Section IV Toxicology 147
Poisoning and envenomation 148
16 The management of acute clinical overdose 156 17 Contemporary substances of abuse 164 18 Medicine safety 175
Section V Autonomic pharmacology 187
19 General aspects of neuropharmacology 188
20 Adrenergic pharmacology 196
21 Cholinergic pharmacology 220
Section VI Neuropharmacology 245
22 Antipsychotic agents 246
23 Anxiolytics and hypnotics 258
24 Antidepressants and mood stabilisers 269
25 Neurodegenerative disorders 286
26 Antiseizure agents and muscle relaxants 305
27 Central nervous system stimulants 325
Section VII Pain and anaesthesia 333
28 Analgesics 334
29 Migraine and other headaches 352
30 General anaesthesia 360
31 Local anaesthesia 368
Section VIII Inflammation, immunity and cancer 377
32 Anti-inflammatory agents 378
33 Antigout medicines 396
34 Antihistamines 404
35 Immunomodulating agents 412
36 Cancer chemotherapy 432
Section IX Cardiovascular and respiratory pharmacology 455
37 Dyslipidaemia 456
38 Antihypertensive agents 467
39 Antianginal agents 487
40 Anticoagulant, antiplatelet, fibrinolytic and haemostatic agents 498
41 Diuretics and other renal medicines 515
42 Heart failure 529
43 Antidysrhythmic agents 546
44 Fluid and potassium imbalances 556
45 Antianaemic agents 571
46 Medicines used in obstructive and restrictive lung disease 577
47 Coughs, colds and respiratory allergy medicines 598
Section X The modulation of gastrointestinal function 611
48 Gastrointestinal tract medicines 612
49 Antiemetic agents 636
50 Enteral and parenteral nutrition 644
Section XI Endocrine and metabolic pharmacology 657
51 Pituitary conditions 658
52 Thyroid conditions 669
53 Diabetes mellitus and blood glucose management 676
54 Adrenal cortex conditions 695
55 Gonadal conditions 702
56 Bone disorders 720
57 Obesity 729
Section XII Antimicrobial pharmacology 741
58 Introduction to antimicrobial therapy 742
59 Antibacterial agents 748
60 Antituberculotic and antileprotic agents 770
61 Antiseptics and disinfectants 781
62 Antiparasitic agents 789
63 Antiviral agents 806
64 Antifungal agents 824
Section XIII Special topics in pharmacology 839
65 Skin conditions 840
66 Ophthalmic medicines 855
67 Herbal medicines 872
Appendices
A Common prescription terminology 891
B SI units 892
C Medicine calculations 895
D Common symbols used in medication charts 899
E Important herbal medicine interactions 900
Glossary 903
Index 921
Preface
Fundamentals of Pharmacology is primarily a text for undergraduate and postgraduate students in the health science disciplines, particularly those in nursing. Students of other health disciplines whose roles involve pharmacological therapy (such as pharmacy, podiatry, optometry, paramedic and physiotherapy), as well as those studying basic science, should find much of the material relevant to their studies. Qualified health professionals may also find this textbook useful as a part of their continuing professional education and postgraduate studies.
Our approach
Philosophically, our goal is to empower health professionals through an understanding of the fundamental scientific principles of pharmacology that inform clinical practice. To promote understanding, we believe that the effects of medicines on physiological and pathophysiological processes have to be clearly explained. We have included a small amount of chemistry and biochemistry where appropriate in order to facilitate this understanding. With a greater appreciation of the action of medicines and their target tissues, the reader should be able to deduce what therapeutic and adverse effects to expect, as well as the precautions and contraindications to consider. We have sought to balance the
pharmacology content with considerations associated with clinical practice in the most readable way.
Furthermore, where possible we have tended to describe the important characteristics of medicine groupings rather than focus on individual agents, and have used prototypes and common generics as examples. The rationale for this approach is that new medicines are regularly entering the market while older agents are removed. The average practitioner cannot possibly keep up with all of these changes. However, if a student knows which grouping a new agent belongs to, the principal characteristics of the medicine can be easily deduced.
This book is primarily designed to establish the foundations in pharmacology. We encourage students to refer to independent sources of electronic and hard-copy references found in clinical settings, such as the Australian Medicines Handbook, or Therapeutic Guidelines, for more detailed information regarding individual therapeutic agents (e.g. dosage, special precautions and toxicological information).
We hope that you will find this textbook a valuable companion in your pursuit of a fundamental understanding in that most fascinating area of clinical knowledge—pharmacology.
Changes in the ninth edition
This edition reflects the availability of medicines in Australia and New Zealand at the time of publication. Consistent with the information currently available to us, we have updated the book by including new medicines that have entered the marketplace and excluding those that have been removed since the last edition.
Pharmacology is a complex area of study for health professional students. We are always looking for ways to enhance readability for students. In this edition, content has been carefully reviewed. The book has been reduced and made more concise, down from the 79 chapters of the last edition, to 67 chapters for this edition. This change reflects the streamlining of content. Section headings, and some chapter headings, reflect a stronger focus on body systems and the treatment of common conditions. We have also removed the medicine summary tables at the end of most chapters as this information is readily available in sources such as the Australian Medicines Handbook.
We have changed our terminology with respect to the use of the words patient and drug. We have completely avoided the term patient as it reflects an unequal relationship between health service user and provider. Instead, we refer to the person or people or individuals. We have also favoured the term medicine over the term drug, as it reflects the clinical or therapeutic use of a substance rather than an illicit or recreational usage. We have tended to use the term drug in the scientific pharmacological context, when referring to pharmacodynamic or pharmacokinetic properties.
Where appropriate, the therapeutic approaches and the new medicines associated with the management of important clinical conditions—such as cardiovascular disease, diabetes mellitus, infectious disease, immune disorders and psychiatric illness have been brought up to date with current clinical guidelines.
A number of new figures and tables have been included to assist students in visualising difficult pharmacological concepts, the sites of actions of medicines, and the range of effects expected in a person when particular types of medicines are administered. New concept maps linking the pharmacology and pathophysiology are included in this edition. We now cover nociception and pain, diabetes mellitus, rheumatoid arthritis, asthma, inflammatory bowel disease and ischaemic heart disease.
End-of-chapter and end-of-section features
The book contains hundreds of end-of-chapter questions to assist in the consolidation of learning—all of these have been reviewed.
Revised integrated case studies appear at the end of sections to assist with making the links between theory and practice.
Acknowledgements
With thanks to those people who supported us in the preparation of the 9th edition of this textbook, which we commenced around the 30th anniversary year of the publication of our first edition, originally co-written with our colleague Alan Galbraith.
This edition was written during the COVID-19 pandemic. While most people were baking and bread-making, gardening, obtaining a new puppy, watching government press conferences, home-schooling, doing fitness workouts in the lounge, practising home hairdressing, and bingeing on streaming service offerings, we were writing a textbook. Our writing was subject to great disruption, but with the support of the Pearson Australia team and our families, we think it, like the pandemic bread-making, has risen to the occasion.
This textbook is designed for student health professionals, so it is fitting that we acknowledge and pay tribute to the commitment and sacrifice of all health professionals who have delivered front-line health care services to our communities during the pandemic to the very best of their abilities.
We sincerely thank the team at Pearson Australia for their work in the production of this edition. Our thanks to Mandy Sheppard, Senior Portfolio Manager, and our Development Editor, Anna Carter, for their amazing support and patient encouragement as we all tried to
navigate our way through the challenges posed by the COVID-19 pandemic. We are also grateful for the expertise of our Production Manager, Linda Chryssavgis. We thank our copy editors, Kate Stone and Bobby, for their excellent attention to detail and good humour
Reviewers
The authors would like to thank the following reviewers for their contribution to the project:
Caroline Browne, Murdoch University
Adeniyi Adeleye, Central Queensland University
Jackie Dempsey, Western Sydney University
Maja Husaric, Victoria University
Anne Marks, Western Sydney University
David Simcock, James Cook University
Peter Thomas, University of Wollongong
Adil Vakil, University of Notre Dame
Jane White, Edith Cowan University
Shane Bullock and Elizabeth Manias
January 2022
