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Appendix Some Important Pharmacological Agents

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Appendix Some Important Pharmacological Agents Appendix Some important pharmacological agents Students may feel overwhelmed by the number of drugs pharmacists play a crucial role) grapple with choosing described in pharmacology textbooks. We would empha- which individual drugs to stock in the pharmacy. There sise that it is more important to understand general phar- is a play-off between stocking several individual drugs macological principles, and to appreciate the pharmacology of one category, for each of which there is good evidence of the main classes of drug, than to attempt to memorise of efficacy for distinct indications, and stocking a more details of individual agents. Specific drugs are best learned restricted choice based on indirect evidence that efficacy about when they are encountered in the setting of particu- is likely to be a common feature of different members of lar topics (e.g. noradrenergic transmission), during practi- a class of drugs. Local variations will be encountered (e.g. cal classes or (for therapeutic drugs) near a patient’s as to which angiotensin-converting enzyme inhibitor or bedside. We provide a list (www.studentconsult.com) of non-steroidal anti-inflammatory drugs are stocked in the examples of some of the most important pharmacological hospital pharmacy). If the student or clinician (e.g. doctor, agents. It is not intended as a starting point to learning dentist, veterinarian or nurse) comes to these (e.g. when pharmacology, and we would caution against attempting changing to a job in a new hospital) with a sound appre- to memorise lists of names and properties. The important ciation of the general principles of pharmacology and of agents we list here were selected subjectively; they include the specifics of the various classes of agent involved, he or (but are not limited to) the 100 drugs most likely to be she will be able to look up and understand the details of prescribed by newly qualified doctors in the UK Baker( agents favoured locally and use them sensibly. Drugs are et al., 2011) and are divided into agents of primary and grouped broadly as in the chapters of the text, and some secondary importance. For students of some subjects, and appear more than once in the lists. in different geographical areas, one or another class of drug will have more or less importance (e.g. anthelmintics are very important for veterinarians and for all clinicians in REFERENCES regions where helminthiasis is common), so these catego- Baker, E.H., Pryce Roberts, A., Wilde, K., et al., 2011. Development of a ries are meant only as a broad guide. The list includes not core drug list towards improving prescribing education and reducing only drugs used therapeutically, but also endogenous errors in the UK. Br. J. Clin. Pharmacol. 71, 190–198. mediators/transmitters (med/trnsm) and certain impor- GMC (General Medical Council), 2009. Tomorrow’s Doctors: Outcomes tant drugs used mainly as experimental tools (exp.tool) – and standards for undergraduate medical education. Online: especially important for students studying basic or applied <www.gmc-uk.org/education/undergraduate/tomorrows_ doctors_2009.asp> (accessed July 2014). pharmacology as a science subject – and drugs used for recreational (recreat) rather than therapeutic purposes. Some endogenous mediators (e.g. adrenaline [epine- KEY phrine]) are also important therapeutic drugs. The General Medical Council’s ‘Tomorrow’s Doctors’ (Note: designation does not exclude a separate therapeu- (2009) specifies that students should be able to demon- tic role – for example, nicotine and cocaine are used thera- strate knowledge of drug actions; therapeutics and phar- peutically as well as recreationally, adrenaline is used macokinetics; drug side effects and interactions, including therapeutically as well as being a mediator; conversely, for multiple treatments, long-term conditions and non- some primarily therapeutic drugs such as morphine or prescribed medication; and also including effects of drugs other opioid analgesics are used recreationally by some on the population, such as the spreadUnitedVRG of antibiotic resist- individuals.) ance. A working knowledge of drugs in the ‘primary importance’ category should be built up gradually as they med/trnsm = mediator/transmitter are encountered during training. For drugs in the second exp.tool = experimental tool category, it is usually sufficient to be aware of the mecha- recreat = drug used especially for recreational purposes nism of action, supplemented by understanding how antag = antagonist they differ from those in the primary category when This appendix was originally adapted from that in Dale, relevant. M.M., Dickenson, A.H., Haylett, D.G. 1996. Companion The choice of drugs in clinical use is somewhat to Pharmacology, second ed. Churchill Livingstone, arbitrary. Hospital formulary committees (on which Edinburgh, with permission. 723 vip.persianss.ir APPENDIX Primary Secondary Primary Secondary Cholinergic transmission (see Ch. 13) Purines (Ch. 16) Agonists Drugs/mediators acting on purinoceptors or purine uptake acetylcholine (med/trnsm) carbachol adenosine (med/trnsm) dipyridamole suxamethonium pilocarpine ( therapeutic: Ch. 21) nicotine (recreat) + theophylline, aminophylline prasugrel (Chs 24 and 28) Antagonists atropine tropicamide caffeine (recreat) tubocurarine (exp.tool) pancuronium hexamethonium (exp.tool) atracurium ATP (med/trnsm) vecuronium α-bungarotoxin (exp.tool) ADP (med/trnsm) oxybutinin tolterodine botulinum toxin clopidogrel (presynaptic action) Anticholinesterases and related drugs neostigmine pyridostigmine edrophonium pralidoxime (cholinesterase donepezil reactivator) Local hormones (Chs 17 and 18) Cytokines (all: med/trnsm) (Ch. 18) interleukins chemokines tumour necrosis factor Noradrenergic transmission (Ch. 14) Tumour necrosis factor antagonists: etanercept, infliximab Agonists interferons (med/trnsm) adrenaline (epinephrine) clonidine colony-stimulating factors (med/trnsm) (Ch. 26) (med/trnsm) noradrenaline (norepinephrine) phenylephrine (med/trnsm) Histamine and H1 and H2 antagonists (Ch. 17) isoprenaline (isoproterenol) dopamine (med/trnsm) histamine (med/trnsm) fexofenadine (exp.tool) cetirizine cyclizine salbutamol dobutamine promethazine ranitidine Antagonists cimetidine propranolol prazosin atenolol doxazosin Lipid-derived mediators (Ch. 18) metoprolol tamsulosin prostaglandins E and F Platelet-activating factor bisoprolol (med/trnsm) (med/trnsm) prostaglandin I (med/trnsm) latanoprost Drugs affecting noradrenergic neurons 2 thromboxane A (med/trnsm) lipoxins (med/trnsm) cocaine (recreat) (Ch. 48) guanethidine (exp.tool) 2 leukotrienes (med/trnsm) tyramine (exp.tool) reserpine (exp.tool) methyldopa (Ch. 22) amitryptyline (Ch. 46) Inflammatory peptides (Ch. 18) amphetamine (recreat) (Ch. 48) α-methyltyrosine (exp.tool) bradykinin icatibant (bradykinin phenelzine (Ch. 46) antagonist) substance P UnitedVRGcalcitonin-gene-related peptide (CGRP) neurokinin A 5-Hydroxytryptamine (serotonin) (Ch. 15) Drugs acting on 5-HT receptors (see Ch. 46 for 5-HT reuptake inhibitors) 5-HT (serotonin) (med/trnsm) ergotamine/ dihydroergotamine LSD (recreat) metoclopramide ondansetron granisetron methysergide pizotifen triptans (e.g. sumatriptan) ketotifen 5-HT, 5-hydroxytryptamine; LSD, lysergic acid diethylamide. 723.e1 vip.persianss.ir APPENDIX Primary Secondary Primary Secondary Cannabinoids and related drugs (Ch. 19) Vascular system (Ch. 22) 9 Antihypertensive drugs (A, B, C and D) Δ -tetrahydrocannabinol nabilone (recreat) A: Angiotensin-converting enzyme inhibitors And anandamide (med/trnsm) Angiotensin ii (At1 receptor) AntAgonists captopril lisinopril ramipril trandolapril losartan irbesartan candesartan Nitric oxide (Ch. 20) b: β-Adrenoceptor AntAgonists metoprolol nitric oxide (med/trnsm) c: cAlcium AntAgonists amlodipine L-NG-monomethyl arginine (L-NMMA) (exp.tool) nifedipine d: thiAzides And relAted diuretics bendroflumethiazide hydrochlorothiazide Heart (Ch. 21) indapamide chlortalidone Antidysrhythmic drugs (Vaughan Williams classification) α1-adrenoceptor antagonists Class I lidocaine flecainide doxazosin Class II metoprolol sotalol Other vasodilators Class III amiodarone hydralazine minoxidil Class IV verapamil nitroprusside Unclassified adenosine aliskiren (renin inhibitor) digoxin Centrally acting drugs methyldopa Antianginal drugs moxonidine Nitrates Drugs used in heart failure and shock glyceryl trinitrate diuretics (see Also Ch. 29) isosorbide mononitrate furosemide nicorandil (combined with K+-channel activation) amiloride β Blockers spironolactone metoprolol eplerenone Angiotensin-converting enzyme inhibitors And At1 Calcium antagonists AntAgonists diltiazem Cardiac glycoside digoxin Drugs acting on adrenoceptors carvedilol dobutamine bisoprolol dopamine metoprolol Vasodilators hydralazine K+-channel activators UnitedVRGisosorbide mononitrate Pulmonary hypertension epoprostenol iloprost sildenafil bosentan Atherosclerosis and dyslipidaemia (Ch. 23) simvastatin ezetimibe atorvastatin pravastatin fibrates (gemfibrozil, fenofibrate) nicotinic acid derivatives resins (colestyramine, colesevelam) 723.e2 fish oil vip.persianss.ir APPENDIX Primary Secondary Primary Secondary Haemostasis and thrombosis (Ch. 24) Skin (Ch. 27) Oral anticoagulants and related drugs Topical glucocorticoids Biologicals (specialist warfarin rivaroxiban hydrocortisone use) vitamin K (antag) clobetasone butyrate adalimumab dabigatran etexilate beclomethasone dipropionate infliximab clobetasol propionate Heparin-related drugs and related drugs
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