The Hands-on Guide to Clinical Pharmacology

Sukhdev Chatu

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9781405191951
• eBook ISBN: 9781444398984
• Edition: 3
• Topic: Medicine
• Subtopic: Pharmacology

Are you about to sit your pharmacology exams? Do you lack confidence in prescribing? Would it help to have a quick reference, pocket-sized reassurance on common drugs and the conditions that they are used in?

The Hands-on Guide to Clinical Pharmacology is the perfect companion for students, doctors, nurses, pharmacists and other health care professionals who need help on the ward or are preparing for exams. It includes sections containing both treatment regimens of common conditions and detailed information on the relevant drugs that help you obtain a better understanding of therapeutic management.

The benefits include:

• A-Z of over 100 key drugs in a one-drug-per-page format
• A systems-based approach
• Fully indexed text
• Clear explanations of drug mechanisms - a regular feature of pharmacology exams
• Management guidelines for common conditions within each system
• Brand new two-colour design to help with information retrieval
• A new chapter on chemotherapy agents

Take the stress out of clinical pharmacology with The Hands-on Guide!

CARDIOVASCULAR SYSTEM

Management guidelines (pp. 2–8)

Anaphylactic shock

Dysrhythmias

Bradycardia

Atrial fibrillation (AF)

Paroxysmal

Persistent

Permanent

Atrial flutter

Paroxysmal supraventricular tachycardia (PSVT)-(narrow complex tachycardia)

Ventricular fibrillation (VF)

Ventricular tachycardia

Heart failure

Acute

Chronic

Hyperlipidaemia

Hypertension

Ischaemic heart disease

Stable angina

Acute coronary syndromes

Unstable angina

Non-ST elevation myocardial infarction (MI)

ST elevation MI

Post MI

Thromboembolism

Deep vein thrombosis (DVT)

Pulmonary embolism

Drug types (pp. 9–11)

Beta blockers

Calcium-channel blockers

Diuretics

Drugs (pp. 12–40)

Angiotensin-converting enzyme (ACE) inhibitors

Adenosine, alpha1 blockers, amiodarone, amlodipine, angiotensin-receptor blockers (ARBs), aspirin, atenolol, atropine

Bendroflumethiazide, bezafibrate

Clopidogrel

Digoxin, diltiazem, dobutamine, dopamine

Epinephrine, ezetimibe

Furosemide

Heparin

Methyldopa

Nicorandil, nitrates (glyceryl trinitrate [GTN], isosorbide dinitrate

[ISDN], isosorbide mononitrate [ISMN])

Sildenafil, simvastatin, spironolactone

Tenecteplase

Verapamil

Warfarin

Management Guidelines

ANAPHYLACTIC SHOCK

• Give 0.5 mg (0.5 ml of 1:1000) epinephrine intramuscular (IM) (given intravenous [IV] if there is no central pulse or if severely unwell) if any compromise in airway (stridor, tongue swelling), breathing (low oxygen saturations, wheeze) or circulation (hypotensive, pale, clammy).
• Most ideal site to inject IM epinephrine is the middle third of thigh on the anterolateral aspect.
• Give high-flow oxygen through face mask.
• Gain IV access.
• Give 10 mg of IV chlorpheniramine.
• Give 100–200 mg IV hydrocortisone.
• Consider salbutamol nebulizer and IV aminophylline if bronchospasm present.
• Administer IV fluids if required to maintain blood pressure (BP).
• Repeat IM epinephrine every 5 minutes if no improvement, as guided by BP, pulse and respiratory function.
• If still no improvement, consider intubation and mechanical ventilation.
• Follow-up:
  • Suggest a medic alert bracelet naming culprit allergen.
  • Identify allergen with skin prick testing and consider referral to an allergy clinic at a later stage.
  • Self-injected epinephrine may be necessary for the future.

DYSRHYTHMIAS

Bradycardia

• Look for and treat underlying cause (e.g. drugs, hypothyroidism, post MI).
• If pulse rate <40 bpm and patient symptomatic, give IV atropine up to a maximum dose of 3 mg.
• If no response, consider external, percussion or temporary venous pacing until underlying cause corrected or permanent pacemaker inserted.

Atrial fibrillation (AF)

• Look for and treat any underlying cause.
• Antiarrhythmic agents are used to restore sinus rhythm or control ventricular rate.
• Consider anticoagulation with warfarin (aspirin if warfarin contraindicated or inappropriate) to prevent thromboembolic events. The CHAD score can help in making a decision however all those with valvular heart disease should be anticoagulated
• Paroxysmal AF:
  • Self-terminating, usually lasts less than 48 hours.
  • If recurrent, consider warfarin and antiarrhythmic drugs (e.g. sotalol, amiodarone).
• Persistent AF:
  • Lasts more than 48 hours and can be converted to sinus rhythm either chemically (amiodarone, beta blocker or flecainide) or with synchronized direct current (DC) shock.
  • In cases of synchronized DC shock, administer warfarin for 1 month, then give DC shock under general anaesthetic to revert to sinus rhythm (only if no structural heart lesions are present) and continue warfarin for 1 month thereafter. If haemodynamically unstable, DC cardiovert with IV heparin or LMWH.
• Permanent AF:
  • To control the ventricular rate use digoxin, a rate-limiting calcium-channel blocker, beta blocker or amiodarone as monotherapy or in combination.
  • Warfarin for anticoagulation (give aspirin if warfarin is contraindicated or inappropriate) if risk of emboli is high
  • Consider pacemaker or radiofrequency ablation if all else fails.

Atrial flutter

• Look for and treat any underlying cause.
• Treat as for acute AF.
• In chronic atrial flutter, maintain on warfarin to prevent thromboembolic events and antiarrhythmic medication (e.g. sotalol, amiodarone) and consider radiofrequency ablation.

Paroxysmal supraventricular tachycardia (PSVT)

• Most terminate spontaneously, if not perform vagal manoeuvres (e.g. carotid sinus massage if no bruits, Valsalva manoeuvre), which transiently increase atrioventricular (AV) block.
• If this fails, give IV adenosine in incremental doses.
• If this fails, or adenosine is contraindicated, give IV verapamil.
• If the patient is haemodynamically compromised, give synchroniz...

Table of contents

• Cover
• Title Page
• Copyright
• Preface to The Third Edition
• Acknowledgements
• Abbreviations
• Chapter 1: Cardiovascular System
• Chapter 2: Respiratory System
• Chapter 3: Gastrointestinal System
• Chapter 4: Neurological System
• Chapter 5: Psychiatry
• Chapter 6: Musculoskeletal System
• Chapter 7: Diabetes and Endocrine System
• Chapter 8: Dermatology
• Chapter 9: Pain Management
• Chapter 10: Infection
• Chapter 11: Immunization
• Chapter 12: Obstetrics and Gynaecology
• Chapter 13: Anaesthesia
• Chapter 14: Poisoning and Overdose
• Chapter 15: Cancer Therapy
• Index