Udaykumar Udaykumar

CBS Publishers & Distributors Pvt LtdDedicated to Education

Pharmacologyfor Pharmacy Students

Pharmaco

logy

for Pharmacy Stud

entsPadmaja UdaykumarPadmaja Udaykumar

Second Edition

SecondEdition

As per latest syllabus prescribed by Pharmacy Council of India

9 788194 708261

ISBN : 978-81-94708-26-1

CBS Publishers & Distributors Pvt Ltd

De

dic

ate

d to

Ed

uca

tion

Pharmacologyfor Pharmacy Students

Second Edition

4819/XI, Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, IndiaE-mail: delhi@cbspd.com, cbspubs@airtelmail.in; Website: www.cbspd.comNew Delhi | Bengaluru | Chennai | Kochi | Kolkata | Mumbai

| | | | |Hyderabad Jharkhand Nagpur Patna Pune Uttarakhand

is the thoroughly revised, completely updated and moderately enlarged edition of an exemplary textbook in pharmacology meant for bachelor in pharmacy students, following the latest syllabus prescribed by Pharmacy Council of India (PCI). Besides BPharm, it will also serve as a textbook for the students of Pharm D and D Pharm courses.

Highlights of the textbook• Written in simple and easy to understand language.• Contents presented as per the latest syllabus prescribed by

Pharmacy Council of India (PCI) in the semester system.• Single textbook completely covers pharmacology syllabus for 4th, 5th

and 6th semesters of B Pharm course.• Flowcharts explain every mechanism of action.• Multiple boxes and tables given throughout the book.• Student-friendly format for easy comprehension.• ‘Compare and Contrast’ series introduced in the book helps in

understanding the subject better and retaining the facts longer with clarity and ease to recall.

• Some mnemonics added to remember important facts and statements.

Padmaja Udaykumar MD

is Professor and Head, Department of Pharmacology, Father Muller Medical College, Mangalore, Karnataka. She has a keen interest in medical education with an experience in teaching of more than 32 years and has been on the boards of studies of many universities. She has published several titles and this is the 22nd book in the series of textbooks meant for medical, pharmacy, dental, nursing and physiotherapy students. Her other publications brought out by CBSPD are Medical Pharmacology and Pharmacology Companion. She also has several research papers to her credit. She has rich experience in clinical pharmacology, conducted and coordinated several clinical trials, and has been advising clinicians on the appropriate and rational use of drugs.

Pharmacologyfor Pharmacy Students

As per latest syllabus prescribed by Pharmacy Council of India

Second Edition

Pharmacologyfor Pharmacy Students

As per latest syllabus prescribed by Pharmacy Council of India

Second Edition

Padmaja Udaykumar MD

Professor and HeadDepartment of Pharmacology

Fr Muller Medical CollegeMangaloreKarnataka

CBS Publishers & Distributors Pvt LtdNew Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai

Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand

Disclaimer

Science and technology are constantly changing fields.New research and experience broaden the scope ofinformation and knowledge. The author has tried her bestin giving information available to her while preparing thematerial for this book. Although, all efforts have been madeto ensure optimum accuracy of the material, yet it is quitepossible some errors might have been left uncorrected.The publisher, the printer and the author will not be heldresponsible for any inadvertent errors, omissions orinaccuracies.

ISBN: 978-81-94708-26-1

Copyright © Author and Publisher

Second Edition: 2022First Edition: 2019

All rights reserved. No part of this book may be reproduced or transmitted in any form or by anymeans, electronic or mechanical, including photocopying, recording, or any information storageand retrieval system without permission, in writing, from the author and the publisher.

Published by Satish Kumar Jain and produced by Varun Jain for

CBS Publishers & Distributors Pvt Ltd4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, IndiaPh: 011-23289259, 011-23266861, 011-23266867 Fax: 011-23243014 Website: www.cbspd.com

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Printed at Magic International Pvt. Ltd., Greater Noida, UP, India

to

my dearstudents

The second edition of Pharmacology for Pharmacy Students has seen the light of the daymuch earlier than expected. It happens to be a small source of personal solace at the heights

of COVID crisis across the world.All chapters are thoroughly revised, keeping in mind B Pharm, D Pharm, and Pharm D

students. Topics on ‘biologics and biosimilars’ and treatment of heavy metal poisoning, havebeen added. The syllabus of Pharmacy Council of India is covered in entirety and the chaptersare arranged semester-wise. More flowcharts, figures and mnemonics are added.

Hope this book makes learning pharmacology easy and pleasurable.It was a pleasant surprise to receive positive feedback both from the students and staff

from across the country and abroad through mail.Please continue to send your valuable feedback to padmajaudaykumar@gmail.com

Padmaja Udaykumar

Preface to the Second Edition

Pharmacists play a major role in drug development. In fact, they are involved in the entireprocess of drug use right from research, development, manufacture, storing and reaching

it to the patient. Hence extensive knowledge of pharmacology is needed for effective andappropriate functioning in their career.

However, since there are multiple subjects to be covered in a relatively short span duringtheir course, it is necessary to simplify the subject. Books in pharmacology meant only forpharmacy students are hard to find. Hence, to reduce the burden of the students, this bookhas been published exclusively for the pharmacy students.

The Pharmacy Council of India has revised the syllabus for pharmacy and also made itsemester-wise. The latest syllabus of PCI is covered and the chapters are arranged as persemester sequence. Flowcharts, tables and figures have been used all through the book forbetter understanding. Compare and contrast tables help in better retention of the topics.

Pharm D a recently introduced course in pharmacy, also brings with it various challengesof training the students to attain the objectives of the syllabus. Extensive knowledge ofpharmacology is mandatory and the subject is spread out through the course. Pharmacologyfor Pharmacy Students, covers the topics prescribed for Pharm D students too. Many collegeshave already prescribed Medical Pharmacology for Pharm D students and may now alsofind this book useful.

Hope this book makes reading pharmacology a pleasurable experience.

Please mail your valuable feedback to padmajaudaykumar@gmail.com

Padmaja Udaykumar

Preface to the First Edition

I am grateful to the professors of pharmacy who have guided me in this endeavour. I thank Dr C Mallikarjun Rao, Principal, MCOPS, Manipal; Dr Narayana Swamy, Principal, RR

College of Pharmacy, Bangalore; Dr Satish S, Professor of Pharmacology, Srinivas College ofPharmacy, Mangalore; and Dr N Gopalan Kutty, Ex-Professor of Pharmacology, MCOPS,Manipal.

I also thank Dr Pannerselvam, Professor of Pharmaceutical Chemistry and Principal,Saraswati College of Pharmacy, UP, for editing the topic ‘Structure Activity Relationship’ andDr Chandralekha N, Assistant Professor, Department of Pharmacology, FMMC, Mangalore,for providing core material for the topic ‘Biologics and Biosimilars.’

I thank the management of Fr Muller Medical College: Rev Fr Richard Coelho, Director;Rev Fr Rudolf Ravi DSa and Rev Fr Ajith Menezes, Administrators; Rev Fr Nelson Pais,Assistant Administrator; Dr Jayaprakash Alva; Dean and Dr B Sanjeev Rai, Chief of Research,for their support.

I thank my husband Dr Udaykumar K, Medical Superintendent, Fr Muller Medical CollegeHospital, for his constant encouragement.

I thank Mr SK Jain, CMD, and Mr YN Arjuna, Senior Vice President—Publishing, Editorial and Publicity,CBS Publishers & Distributors, for persuading me to write and for publishing this book. I amgrateful to the staff of CBS, Ms Ritu Chawla and her team for the meticulous work in bringingout this book.

Padmaja Udaykumar

Acknowledgements

Section 1: General Pharmacology

Preface to the Second Edition viiPreface to the First Edition ix

Abbreviations xviii

1. Introduction and Routes ofDrug Administration 3Historical Aspects 3Definitions 4Pharmacopoeia 5Sources of Drugs 5Routes of Drug Administration 6Systemic Routes 6Local/Topical Application 13Special Drug Delivery Systems 14

2. Pharmacokinetics 17Transport of Drugs AcrossBiological Membranes 18

Absorption 19Bioavailability 22Equivalence 22Distribution 23Volume of Distribution (V) 25Biotransformation (Metabolism) 26Excretion 31Clinical Pharmacokinetics 33Drug Dosage 35Methods of Prolonging Drug Action 36

3. Pharmacodynamics 38Mechanisms of Drug Action 38Receptor 40

Contents

Dose Response Relationship 46Drug Synergism and Antagonism 48Factors that Modify the Effects of Drugs 50

4. Adverse Drug Reactions andDrug Interactions 57Adverse Drug Reactions 57Drug Allergy 58Treatment of Drug Overdosage 63Counterfeit Drugs 63Pharmacovigilance 63Drug Interactions 64

5. Drug Development, Assay, SAR, Enantio-mers, Nomenclature, Essential Medicines,Drug Regulations and Related Topics 66Drug Development 66Drug Assay 69Structure Activity Relationship 70Enantiomers 71Biologics and Biosimilars 72Drug Nomenclature 73Pharmacoeconomics 74Essential Medicines 74Rational Drug use 75P-drugs 75Chronopharmacology 76Drug Regulations 77

Section 2: Pharmacology of Drugs Acting on Peripheral Nervous System

6. Introduction to AutonomicPharmacology 81Autonomic Innervation 81

7. Cholinergic System andCholinomimetic Drugs 84Cholinergic Drugs 86

Cholinomimetic Alkaloids 88

Indirectly Acting Cholinergic Drugs 89

8. Anticholinergic Drugs 94Belladonna Alkaloids 94

Atropine Substitutes 97

xiiPharmacology for Pharmacy Students

9. Adrenergic System andSympathomimetic Drugs 101Adrenergic Transmission 101Adrenergic Drugs 103Adrenaline 104Noncatecholamines 109Vasopressors 111Nasal Decongestants 1122 Agonists 113Bronchodilators and Uterine Relaxants(Selective 2 Stimulants) 1133 Agonist 113Anorectic Agents (Anorexiants) 113Catecholamine Reuptake Inhibitors 113

10. Adrenergic Antagonists 114-Adrenergic Blocking Agents 114Selective 1 Blockers 1152 Blocker 117-Adrenergic Blocking Agents 117- and -Adrenergic Blockers 122

11. Skeletal Muscle Relaxants 1231. Peripherally Acting Skeletal

Muscle Relaxants 1242. Directly Acting Muscle Relaxants 1283. Centrally Acting Muscle Relaxants 129Drugs used in the Treatment ofLocal Muscle Spasm 132

12. Drugs used in Myasthenia Gravisand Glaucoma 133Drugs used in Treatment of Glaucoma 134

13. Local Anaesthetics 137Introduction 137Chemistry 137Mechanism of Action 138Actions 139Adverse Effects 139Individual Compounds 140Uses of Local Anaesthetics 141

Section 3: Pharmacology of Drugs Acting on Central Nervous System

14. Neurohumoral Transmission in CNS 147Excitatory Neurotransmitters 147Inhibitory Neurotransmitters 148

15. General Anaesthetics andPreanaesthetic Medication 149Introduction 149Stages of General Anaesthesia 149Mechanism of Action ofGeneral Anaesthetics 149

Inhalational Anaesthetics 150Individual Anaesthetics 151Newer Anaesthetic 154Intravenous Anaesthetics 154Preanaesthetic Medication 158

16. Sedative Hypnotics 161Benzodiazepines (BZDs) 162Newer Agents 167Barbiturates 169Miscellaneous 171

17. Antiepileptic Drugs 172Types of Epilepsy 172Antiepileptics 173

Phenytoin 174

Phenobarbitone 177

Carbamazepine 178

Ethosuximide 178

Valproic Acid 179

Benzodiazepines 179

Miscellaneous Drugs 180

Newer Antiepileptics 180

Clinical Pharmacology 182

18. Alcohols and Disulfiram 184Ethyl Alcohol (Ethanol) 184

Methyl Alcohol (Methanol,Wood Alcohol) 187

19. Drugs used in Psychiatric Disorders: Anti-psychotics and Antianxiety Agents 189Antipsychotics (Neuroleptics) 190

Chlorpromazine (CPZ) 191

Individual Antipsychotics 194

Newer Drugs 197

Other Antipsychotics 197

Antianxiety Drugs (Anxiolytics) 197

Contentsxiii

20. Antidepressants and Mood Stabilizers199

Selective SerotoninReuptake Inhibitors (SSRIs) 200

Tricyclic Antidepressants 201Serotonin NorepinephrineReuptake Inhibitors (SNRIs) 203

Atypical Antidepressants 203MAO Inhibitors 204Mood Stabilizers 206

21. Drugs used in Parkinsonism andAlzheimer’s Disease 209Dopamine Precursor 210Dopamine Receptor Agonists 211Drugs that Inhibit DA Metabolism 213Drugs that Release Dopamine 213Anticholinergics 214Drug-induced Extrapyramidal Reactions 214Drugs used in Alzheimer’s Disease 214

22. Opioid Analgesics and Antagonists 216Types of Pain 216

Analgesic 216

Opioid Analgesics 216

Morphine 217

Pethidine and its Derivatives 224

Mixed Agonists and Antagonists 228

Opioid Antagonists 229

23. CNS Stimulants and Drugs of Abuse 231Respiratory Stimulants 231

Psychomotor Stimulants 231

Convulsants 232

Nootropics 232

Drugs of Abuse 233

1. CNS Stimulants 233

2. CNS Depressants 233

3. Hallucinogens 234

Section 4: Pharmacology of Drugs Acting on Urinary System

24. Diuretics and Antidiuretics 239Physiology of Urine Formation 239Diuretics 240High Efficacy, High Ceilingor Loop Diuretics 241

Thiazides and Thiazide-like Diuretics 244

Potassium Sparing Diuretics 246

Carbonic Anhydrase Inhibitors 248

Osmotic Diuretics 249

Newer Agents 250

Antidiuretics 251

Section 5: Pharmacology of Drugs Acting on Cardiovascular System

25. Renin–Angiotensin System and otherVasoactive Peptides 257Angiotensin 257Renin Inhibitors 258Angiotensin-Converting Enzyme Inhibitors 258Angiotensin Receptor Blockers (ARBs) 261Other Vasoactive Substances 262

26. Calcium Channel Blockers 265Calcium Channels 265

27. Treatment of Cardiac Failure and Pharma-cology of Cardiac Glycosides 271Introduction to HemodynamicElectrophysiology of the Heart 271

Drugs used in Congestive CardiacFailure 273

Pharmacology of Cardiac Glycosides 277

28. Antiarrhythmic Drugs 282Sodium Channel Blockers 284Quinidine 284Other Antiarrhythmics 289

29. Drugs used in Ischaemic Heart Diseaseand Treatment of Peripheral VascularDiseases 291Angina Pectoris 291Antianginal Drugs 291Nitrates 292Calcium Channel Blockers 295-blockers 295Potassium Channel Openers 295Pharmacotherapy of Angina 297Drugs used in Myocardial Infarction 298

xivPharmacology for Pharmacy Students

30. Antihypertensive Drugs 302Diuretics 303Drug Acting on Renin–AngiotensinSystem 304

Sympatholytics 305Calcium Channel Blockers 308Vasodilators 309Treatment of Hypertension 312

31. Hypolipidaemics 314Hypolipidaemics 315Drugs used in the Treatment of Obesity 321

32. Plasma Expanders, Intravenous Fluidsand Pharmacotherapy of Shock 323Plasma Expanders 323Intravenous Fluids 324Pharmacotherapy of Shock 326

33. Haematinics 328Introduction 328Iron 328Vitamin B12 and Folic Acid 331Haematopoietic Growth Factors 333

34. Anticoagulants and Coagulants 336Heparin 337Direct Thrombin Inhibitors (DTI) 340Oral Anticoagulants 340Coagulants 344Sclerosing Agents 345

35. Fibrinolytics, Antifibrinolytics andAntiplatelet Drugs 346

Thrombolytics (Fibrinolytics) 346Antifibrinolytics 347Antiplatelet Drugs 349

Section 6: Autacoids and Related Drugs

36. Histamine and Antihistamines 355Histamine 355Histamine Antagonists (Antihistamines) 357

37. 5-Hydroxytryptamine, Ergot Alkaloidsand Treatment of Migraine 362Serotonin 362Ergot Alkaloids 364Drugs used in the Treatmentof Migraine 364

38. Prostaglandins 367Prostaglandins and Thromboxanes 367Leukotrienes 370

39. Nonsteroidal Anti-inflammatory Drugs(NSAIDs) 371Salicylates 372

Para-aminophenol Derivatives 377Propionic Acid Derivatives 378Acetic Acid Derivatives 379Fenamates (Anthranilic AcidDerivatives) 380

Pyrazolone Derivatives 380Oxicams (Enolic Acid Derivatives) 380Preferential COX-2 Inhibitors 381Selective COX-2 Inhibitors 382

40. Pharmacotherapy of Rheumatoid Arthritisand Gout 385Nonsteroidal Anti-inflammatory Drugs 385Disease Modifying Anti-rheumatic Drugs 385Adjuvants 388Pharmacotherapy of Gout 389

Section 7: Pharmacology of Drugs Acting on Endocrine System

41. Hypothalamus, Anterior PituitaryHormones and their Inhibitors 395Hypothalamic Hormones 396Anterior Pituitary Hormones 398

42. Thyroid Hormones and Antithyroid Drugs 402Thyroid hormones 402Hyperthyroidism and Antithyroid Drugs 405

43. Corticosteroids 410Glucocorticoids 410

Pharmacokinetics 413

Adverse Effects of Glucocorticoids 415

Mineralocorticoids 419

Inhibitors of Adrenal Steroids Synthesis 420

Contentsxv

44. Agents Affecting Bone Mineral Turnover421

Calcium 421Phosphorus 422Parathyroid Hormone(Parathormone—PTH) 422

Vitamin D 423Calcitonin 425Drugs used in the Disorders of Bone 426Agents used in the Prevention andTreatment of Osteoporosis 427

45. Insulin and Oral Antidiabetic Drugs 428Diabetes Mellitus 428Insulin 428Oral Antidiabetic Drugs 435Insulin Secretagogues 435Biguanides 438Thiazolidinediones (TZDs) 439-glucosidase Inhibitors 440Amylin Analogs 440SGLT-2 Inhibitors 441Treatment of Diabetes Mellitus 441Glucagon 442

46. Androgens and Anabolic Steroids 443Physiological Considerations 443Anabolic Steroids 444Antiandrogens 445Male Contraceptives 446Drugs used in Male Sexual Impotence 446

47. Estrogens, Progestins andHormonal Contraceptives 448Physiological Consideration 448Estrogens 448Selective Estrogen Receptor Modulators(SERMs) and Anti-estrogens 450

Clomiphene Citrate 452Estrogen Synthesis Inhibitors 452Progestins 453Antiprogestins and ProgesteroneReceptor Modulators 455

Drugs used in the Treatment ofMenopausal Symptoms 456

Hormonal Contraceptives 457

48. Oxytocin and Drugs Acting on the Uterus464

Uterine Stimulants 464Uterine Relaxants (Tocolytics) 466

Section 8: Pharmacology of Drugs Acting on Respiratory System

49. Drugs used in the Treatment of BronchialAsthma, Drugs used in Cough andAllergic Rhinitis 471Bronchial Asthma 471Sympathomimetic Drugs 472Methylxanthines 475Anticholinergics 476

Anti-inflammatory Drugs 477Mast Cell Stabilizers 479Leukotriene Receptor Antagonists 480Anti-IgE Antibody 480Treatment of Asthma 481Drugs used in Treatment of Cough 482Drugs used in Allergic Rhinitis 484

Section 9: Pharmacology of Drugs Acting on Gastrointestinal Tract

50. Drugs used in Peptic Ulcer 489Antacids 490H2 Receptor Blockers 492Proton Pump Inhibitors 494Muscarinic Antagonists 497Ulcer Protectives 497Other Drugs 498Treatment of H. pylori Infection 498

51. Emetics, Antiemetics andProkinetic Agents 500Physiology of Vomiting 500

Emetics 500

Antiemetics 501

Prokinetic Agents 504

xviPharmacology for Pharmacy Students

52. Drugs for Constipation and Diarrhoea 507Drugs for constipation 507Drugs used in the Treatment of Diarrhoea 511

Irritable Bowel Syndrome 514Inflammatory Bowel Diseases 515

Section 10: Chemotherapy

53. General Consideration ofChemotherapy 519Resistance to Antimicrobial Agents 521Combination of Antimicrobials 525Chemoprophylaxis 526Superinfection 527

54. Sulfonamides, Cotrimoxazole,Quinolones and Fluoroquinolones 531Sulfonamides 531Cotrimoxazole 533Quinolones 535Fluoroquinolones 535

55. Beta-Lactam Antibiotics 540Penicillins 540Natural Penicillins 541Semisynthetic Penicillins 544Beta-lactamase Inhibitors 546Cephalosporins 548Carbapenems 552Carbacephems 553Monobactams 553

56. Broad-Spectrum Antibiotics 554Tetracyclines 554Chloramphenicol 559Tigecycline 561

57. Aminoglycosides 562

58. Macrolides and other AntibacterialAgents 567Erythromycin 567Ketolides 570Miscellaneous Antibiotics 571Lincosamides 571Glycopeptide Antibiotics 571Polypeptide Antibiotics 573Other Antimicrobial Agents 573

59. Chemotherapy of Tuberculosis andLeprosy 577

Drugs used in Tuberculosis 577First-line Drugs 577

Second-line Drugs 582Treatment of Tuberculosis 583Drugs used in the Treatment of Leprosy 585

60. Antifungal Drugs 589Drugs Acting on Cell Membrane 590Allylamines 595Drugs Acting on Cell Wall 595Drugs Acting on Nucleus 596Other Topical Antifungal Agents 597

61. Antiviral Drugs 598Anti-herpes Virus Agents 599Drugs used in cytomegalovirus (CMV)Infections 601

Anti-influenza Virus Agents 602Anti-hepatitis Agents 603Antirhinoviral Drug 605Other Antiviral Drugs 605Anti-retroviral Agents 605Nucleoside and Nucleotide ReverseTranscriptase Inhibitors (NRTIs) 605

Non-nucleoside Reverse TranscriptaseInhibitors (NNRTIs) 607

Protease Inhibitors (PI) 609Entry Inhibitors 610Integrase Strand TransferInhibitors (INSTIs) 611

62. Antimalarial Drugs 613Life Cycle of the Malaria Parasite 613Chloroquine 615Quinine 618Mefloquine 619Halofantrine and Lumefantrine 620Primaquine 620Folate Antagonists 621Chloroguanide (Proguanil) 622Atovaquone 623Artemisinin and Derivatives 623Antibiotics in Malaria 624Malaria in Pregnancy 625

Contentsxvii

63. Antiamoebic Drugs 626Treatment of Pneumocystosis 630Treatment of Leishmaniasis 630Treatment of Trypanosomiasis 631

64. Anthelmintics and Drugs used in Scabiesand Pediculosis 632Benzimidazoles 632Praziquantel 635Diethylcarbamazine (DEC) 635Ivermectin 636Resistance to Anthelmintic Drugs 637Drugs used in Scabies and Pediculosis 637Pediculosis 638

65. Chemotherapy of Urinary Tract Infectionand Sexually Transmitted Disease 639Chemotherapy of UrinaryTract Infection 639

Drugs used in the Treatment ofSexually Transmitted Diseases 640

66. Cancer Chemotherapy 641Common Adverse Effects toAnticancer Drugs 642

Alkylating Agents 643Antimetabolites 646Natural and Semisynthetic Products 650Miscellaneous 653Hormones in Cancer Chemotherapy 655Biological Response Modifiers 657

67. Antiseptics and Disinfectants 660Acids 660Alcohols 661Aldehydes 661Surfactants 661Phenol Derivatives 662Halogens 663Oxidizing Agents 663Dyes 664Metallic Salts 664

Section 11: Immunopharmacology

68. Immunosuppressants, Immunostimulantsand Immunization 667Immunosuppressants 667

Immunostimulants 670Immunization 671

69. Principles of Toxicology, Treatment ofPoisoning and Chelating Agents 679Treatment of Poisoning 679General Management 681Treatment of Snake Bite 684Food Poisoning 685Cardiopulmonary Resuscitation (CPR) 686Heavy Metal Poisoning 686Lead 687Mercury 687Arsenic 688Chelating Agents 688

Section 12: Toxicology and Miscellaneous Topics

70. Enzymes in Therapy, Antioxidants, Vitaminsand Minerals 690Enzymes in Therapy 690Antioxidants 691Vitamins 692Minerals 695Sodium 696Potassium 696Magnesium 697Zinc 697Manganese 697

71. Important Drug Interactions 698

Index 703

Ang I/II/III Angiotensin I/II/IIIAC Adenylyl cyclase

ACE Angiotensin II converting enzymeACh Acetylcholine

AChE AcetylcholinesteraseACT Artemisinin-based combination

therapyACTH Adrenocorticotropic hormone

AD Alzheimer’s diseaseADH Antidiuretic hormoneADP Adenosine diphosphateAdr Adrenaline

ADR Adverse drug reactionAF Atrial fibrillation

AFl Atrial flutterAHG Antihaemophilic globulinAIDS Acquired immunodeficiency syndromeAMP Adenosine monophosphate

AMPA -aminohydroxy methylisoxazolepropionic acid

ANC Acid neutralizing capacityANP Atrial natriuretic peptideANS Autonomic nervous systemARS Anti-rabies serum

5-ASA 5-amino salicylic acidATG Antithymocyte globulinATP Adenosine triphosphateATS Antitetanus serumAZT Zidovudine

BAL British anti-LewisiteBD Twice daily

BPH Benign prostatic hypertrophyBMD Bone mineral densityBMR Basal metabolic rateBNP Brain natriuretic peptide

BP Blood pressureBSA Body surface areaBZD Benzodiazepine

CCB Calcium channel blockerCD Collecting duct

CHF Congestive heart failureChE Cholinesterase

Chy. rem Chylomicron remnantsCHD Coronary heart diseaseCCF Congestive cardiac failure

CL ClearanceCMV Cytomegalovirus

CNS Central nervous systemC.O. Cardiac output

COMT Catechol-O-methyl transferaseCOX Cyclo-oxygenaseCPZ ChlorpromazineCSF Cerebrospinal fluidCTZ Chemoreceptor trigger zone

CV CardiovascularCVS Cardiovascular system

DA DopamineDAD Delayed afterdepolarizationDAG Diacyl glycerolDAM Diacetyl monoximeDEC Diethyl carbamazine citrateDHE Dihydroergotamine

DHFA Dihydro folic acidDHFR Dihydrofolate reductase

DM Diabetes mellitusDI Diabetes insipidus

DMPA Depot medroxyprogesterone acetateDNA Deoxyribonucleic acid

DOCA Desoxy corticosterone acetatedopa Dihydroxyphenyl alanine

DOPAA 3,4-Dihydroxyphenyl acetic acidDOSS Dioctyl sulfosuccinateDOTS Directly observed treatment short course

DPT Diphtheria–Pertussis–Tetanus tripleantigen

DRC Dose-response curveDT Distal tubule

DUB Dysfunctional uterine bleeding

EACA Epsilon aminocaproic acidEAD Early after depolarizationECG ElectrocardiogramECT Electroconvulsive therapy

ED Erectile dysfunctionEEG ElectroencephalogramENS Enteric nervous systemEPO ErythropoietinEPS Extrapyramidal symptoms

EPSP Excitatory postsynaptic potentialER Estrogen receptor

ESR Erythrocyte sedimentation rate

FFA Free fatty acidFSH Follicle stimulating hormone

5-FU 5-Fluorouracil

Abbreviations

GABA Gamma aminobutyric acidGC Guanylyl cyclase

GCP Good clinical practiceG-CSF Granulocyte colony stimulating factor

GDP Guanosine diphosphateGERD Gastroesophageal reflux disease

GFR Glomerular filtration rateGH Growth hormone

GHRH Growth hormone releasing hormoneGHRIH Growth hormone release inhibitory

hormoneGIT Gastrointestinal tract

GITS Gastrointestinal therapeutic systemGLUT Glucose transporter

GMCSF Granulocyte macrophage colonystimulating factor

GnRH Gonadotropin releasing hormoneG6PD Glucose-6-phosphate dehydrogenaseGTCS Generalised tonic-clonic seizuresGTN Glyceryl trinitrateGTP Guanosine triphosphate

H Isoniazid

HAART Highly active antiretroviral therapyHb Haemoglobin

HBV Hepatitis B virusHCG Human chorionic gonadotropinHDL High density lipoprotein

5-HIAA 5-hydroxyindoleacetic acidHIV Human immunodeficiency virus

HMG-CoA Hydroxymethyl glutaryl coenzyme AHMW High molecular weight

HPA axis Hypothalamopituitary adrenal axishr Hour

HR Heart rateHRT Hormone replacement therapy5-HT 5-hydroxytryptamineHVA Homovanilic acid

IBD Inflammatory bowel diseaseIBS Irritable bowel syndromeID Intradermal (injection)Ig Immunoglobulin

IGF Insulin-like growth factorIL Interleukin

IM/im IntramuscularINH Isonicotinic acid hydrazideINR International normalized ratioIOP Intraocular pressure

IP Inositol triphosphateIPSP Inhibitory postsynaptic potentialISA Intrinsic sympathomimetic activity

IU International unitIV/iv Intravenous

JAK Janus-kinaseJNC Joint National Committee

KTZ Ketoconazole

LA Local anaestheticLDL Low density lipoproteinLES Lower esophageal sphincterLH Luteinizing hormoneLL Lepromatous leprosy

LMW Low molecular weightLOX LipoxygenaseLSD Lysergic acid diethylamide

LT LeukotrieneLVF Left ventricular failure

MAC Mycobacterium avium complexMAO Monoamine oxidaseMDR Multidrug resistant

MI Myocardial infarctionMIC Minimal inhibitory concentration

MLCK Myosin light chain kinaseMMF Mycophenolate mofetil6-MP 6-Mercaptopurine

MPTP 4-methyl-4-phenyltetrahydropyridineMtx MethotrexateMW Molecular weight

NA NoradrenalineNADP Nicotinamide adenine dinucleotide

phosphateNAG N-acetyl glucosamineNAM N-acetyl muramic acid

NANC Nonadrenergic noncholinergicNET Norepinephrine transporter

NMDA N-methyl-D-aspartateNNRTI Non-nucleoside reverse transcriptase

inhibitorNSAID Nonsteroidal anti-inflammatory drug

NSTEMI Non-ST-segment elevation myocardialinfarction

NTG NitroglycerineNTS Nucleus tractus solitarius

NVBDCP National vector-borne disease controlprogramme

OCD Obsessive-compulsive disorderOD Once daily

OPV Oral poliomyelitis vaccineORS Oral rehydration salt (solution)ORT Oral rehydration therapy

Abbreviationsxix

xxPharmacology for Pharmacy Students

PABA Para-aminobenzoic acidPAE Post-antibiotic effectPAF Platelet activating factorPAS Para-aminosalicyclic acid

PBPs Penicillin binding proteinsPBL Paucibacillary leprosyPD Parkinson’s disease

PDE PhosphodiesterasePG Prostaglandin

PGI2 ProstacyclinPI Protease inhibitor

PLA Phospholipase APLC Phospholipase CPnG Penicillin G

POMC Pro-opiomelanocortinPP Partial pressure

PPA Phenyl propanolaminePPAR Paroxisome proliferator-activated

receptorPPH Post-partum haemorrhagePPI Proton pump inhibitor

PPNG Penicillinase producing N. gonorrhoeaePSVT Paroxysmal supra-ventricular tachy-

cardiaPT Proximal tubule

PTCA Percutaneous transluminal coronaryangioplasty

PTH Parathyroid hormonePTP Post-tetanic potentiation

QID Four times a day

R Rifampin (rifampicin)RAS Renin-angiotensin systemRBC Red blood cellsREM Rapid eye movement (sleep)RNA Ribonucleic acid

RNTCP Revised National Tuberculosis ControlProgramme

RP Refractory periodRyR Ryanodine receptor

SA Sinoatrial (node)SAARD Slow acting antirheumatic drug

SBE Subacute bacterial endocarditissc/SC Subcutaneous

SCh SuccinylcholineSERDs Selective estrogen receptor down regu-

latorsSERM Selective estrogen receptor modulatorSERT Serotonin transporter

SL Sublingual

SMON Subacute myelo-optic neuropathySNRI Serotonin and noradrenaline reuptake

inhibitorSOS as requiredSPF Sun protection factor

SR Sustained releaseSRS-A Slow reacting substance of anaphylaxisSTAT Signal transducer and activator

transcriptionSTEMI ST-segment elevation myocardial

infarctionSusp Suspension

Syr Syrup

t½ Half lifetab Tablet

TBG Thyroxine binding globulinTCAs Tricyclic antidepressantsTDM Therapeutic drug monitoringTDS Three times a day

TG Triglyceride6-TG 6-ThioguanineTHC Tetrahydrocannabinol

THFA Tetrahydrofolic acidTIAs Transient ischaemic attacks

TNF- Tumor necrosis factor t-PA Tissue plasminogen activatorTRH Thyroid releasing hormoneTSH Thyroid stimulating hormoneTTS Transdermal therapeutic system

U UnitUDP Uridine diphosphateUTI Urinary tract infection

VF Ventricular fibrillationVIP Vasoactive intestinal peptideVit Vitamin

VLDL Very low density lipoproteinVMA Vanilyl mandelic acidVMC Vasomotor centre

VRSA Vancomycin resistant Staphylococcusaureus

VT Ventricular tachycardiavWF von Willebrand factor

WBC White blood cellsWHO World Health OrganizationWPW Wolff-Parkinson-White syndrome

XDR-TB Extensively drug resistant-TB

Z Pyrazinamide