Brenner and Stevens’ Pharmacology

611 Pages·2022·17.456 MB·English

by  Craig Stevens

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PBrHennAerR anMd SAtevCenOs’ LOGY
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PBrHennAerR anMd StAeveCnsO’ LOGY
SIXTH EDITION
Craig W. Stevens, PhD
Professor of Pharmacology
Oklahoma State University
Center for Health Sciences
Tulsa, Oklahoma
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
BRENNER AND STEVENS’ PHARMACOLOGY, SIXTH EDITION ISBN: 978-0-323-75898-7
Copyright © 2023 by Elsevier, Inc. All rights reserved.
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Previous editions copyrighted 2018, 2013, 2010, 2006, and 2000
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Printed in Canada
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Preface
Medical pharmacology is primarily concerned with the the cell membrane, like morphine acting on opioid recep-
mechanisms by which drugs treat disease processes, relieve tors. Small molecule inhibitors are effective in many neo-
symptoms, and counteract the molecular manifestations of plastic (cancer) diseases and other pathological states with
pathological states. Pharmacology is also concerned with a well-defined molecular pathway. This new class of drugs
the factors that determine the time course of drug action, with intracellular targets was added to Chapter 45.
including drug absorption, distribution, metabolism, and The book has been meticulously organized to include
excretion. Students are often overwhelmed by the vast extensive cross-referencing of many drugs that have more
amount of pharmacological information available today. than one therapeutic use or multiple classifications. This
This textbook provides the essential concepts and drug will aid the reader in following a particular drug that is
information that students need to be successful in their included in different chapters. Additionally, to aid the
courses without an overwhelming amount of detail. reader in drug recognition, drug names are followed by trade
This text is primarily intended for students who are tak- (brand) names in Small CapS Font. This helps because the
ing their first course in pharmacology, but it will also be trade name of many drugs are heavily advertised and the
useful for those who are preparing to take medical boards reader may already have some knowledge of their drug uses.
or licensing examinations. Because of the large number of As all medications are indexed under both their generic
drugs available today, this text emphasizes the general prop- and brand names, this book is also a valuable reference for
erties of drug categories and prototypical drugs. The chapters a quick review of drugs encountered in the reader’s personal
begin with a drug classification box to familiarize students or professional life. However the student reader will bear in
with drug categories, subcategories, and specific drugs to be mind that for purposes of examination and boards, the un-
presented in the chapter. Additionally, all FDA-approved branded generic drug name is exclusively used.
drugs are listed along with the emphasized drugs to enhance The book now in your hands was extensively revised
the value of this textbook as a reference volume. for the 6th edition to include all new drugs on the mar-
In the four years since the publication of the previous ket since the last edition (more than 200), and to exclude
edition of Brenner and Stevens’ Pharmacology, major trends older drugs that were withdrawn from the market. Much
in the development and marketing of new medications ancillary drug information, such as chemical structures and
and new formulations were apparent. First, there was an unremarkable pharmacokinetics, was shortened or deleted.
explosion of combination drugs released onto the market The figures that were retained were updated and new figures
in recent years. This is a good thing, as there is often phar- added, with an emphasis on illustrating drug mechanisms of
macological synergy between combined agents, but also action. A modern graphic style was developed for the figures
because patient compliance is greatly improved. It is easier to improve understanding and to entice the eye.
to take one pill than two, or three, or four. The usual prod- This new edition is sadly noted by the recent passing of Dr.
uct combines two successful and effective single agents for George M. Brenner, my mentor, my friend, and co-author on
the treatment of a disorder. These newly approved combi- previous editions of this textbook. George hired me 30 years
nation drugs are included in this 6th edition of Brenner & ago as a young Assistant Professor of Pharmacology, collabo-
Stevens’ Pharmacology. rated on research projects, and encouraged my career as an
Second, the market is flush with immunopharmacology academic scientist. Dr. Brenner had an encyclopedic knowl-
drug products. Immunopharmacology products are rampant edge of medications and his expertise is greatly missed. On
and apparent to both the physician and consumer by the another sad note, this book was written during the COVID-
numerous monoclonal antibody drugs touted in TV com- 19 pandemic which took hundreds of thousands of lives
mercials. Pharmaceutical manufacturing of monoclonal due to infection with the SARS-CoV-2 virus. Although at
antibody drugs that target enzymes, receptors, or other pro- the time of this writing there are no fully-approved FDA
teins is a rapidly growing sector of biologicals. Many thera- treatments for the pandemic virus, special sections on the
peutic classes of pharmacological agents now have one or emergency use drugs and developing vaccines are included
two drugs that work via antibodies or that target immune in Chapter 43 and Chapter 46.
system factors. Because of the exponential growth of immu- I thank my numerous offspring and their mates for their
nopharmacology drugs, a new Chapter 46 was added to close constant love and attention which inspires me to undertake
the book. such massive projects like this textbook. I especially want
Third, the development and marketing of small molecule to thank my OB/GYN wife, Dr. Timmeni L. Stevens, D.O.,
inhibitors skyrocketed in the last five years. Small molecule (‘the real doctor’) for her help on Chapter 34, Drugs Affecting
inhibitors were developed to go inside of cells and inhibit Fertility and Reproduction. I also appreciate the fine people
particular kinases or other enzymes and proteins. By con- at Elsevier, who bring it all together to produce the nicely
trast, more traditional drugs target receptor or enzymes on designed textbook now in your hands. The interactions with
vi Preface
Alexandra Mortimer, Meghan Andress, and Kevin Travers Craig W. Stevens, PhD
were especially professional and pleasant. They seem to Professor of Pharmacology
really enjoy their career and know what they are doing. OSU-Center for Health Sciences
Finally, I am a pharmacologist who spent most of my Tulsa, Oklahoma
career as a preclinical researcher using animals and cell
cultures as models for understanding the human condition.
I am not a physician or medical consultant. Therefore none
of the following text should be taken as medical advice.
Contents
Section I 21 Local and General Anesthetics 233
22 Psychotherapeutic Drugs 243
PRINCIPLES OF PHARMACOLOGY
23 Opioid Analgesics and Antagonists 261
1 Introduction to Pharmacology and Drug
24 Drugs for Neurodegenerative Diseases 273
Names 3
25 Drugs of Abuse 285 
2 Pharmacokinetics or What the Body Does to
the Drug 11
3 Pharmacodynamics or What the Drug Does to Section V
the Body 27
PHARMACOLOGY OF RESPIRATORY AND
4 Drug Development and Drug Safety 35 OTHER SYSTEMS
5 Toxicology Principles and the Treatment of
26 Autacoid Drugs That Mimic Endogenous
Poisoning 47 
Substances 301
27 Pharmacological Treatment of Respiratory
Section II Disorders 313
AUTONOMIC AND NEUROMUSCULAR 28 Pharmacological Treatment of
PHARMACOLOGY Gastrointestinal Disorders 325
29 Drugs for Headache Disorders 339
6 Parasympathetic, Neuromuscular
30 Drugs for Pain, Inflammation, and Arthritic
Pharmacology, and Cholinergic Agonists 59
Disorders 347 
7 Cholinergic Receptor Antagonists 75
8 Sympathetic Neuropharmacology and
Adrenergic Agonists 83 Section VI
9 Adrenergic Receptor Antagonists 95  ENDOCRINE PHARMACOLOGY
31 Hypothalamic and Pituitary Hormone
Section III Drugs 363
CARDIOVASCULAR, RENAL, AND 32 Drugs for the Treatment of Thyroid
Disorders 371
HEMATOLOGIC PHARMACOLOGY
33 Adrenal Steroids and Related Drugs 379
10 Antihypertensive Drugs 105
34 Fertility and Reproduction Drugs 389
11 Antianginal Drugs 119
35 Drugs for the Treatment of Diabetes 407
12 Drugs for the Treatment of Heart
36 Drugs Affecting Calcium and Bone
Failure 127
Formation 421 
13 Diuretic Drugs 137
14 Drugs for Cardiac Dysrhythmia 147
Section VII
15 Drugs for Hyperlipidemia 161
16 Antithrombotic and Thrombolytic Drugs 173 ANTIMICROBIAL AND CHEMOTHERAPEUTIC
AGENTS
17 Hematopoietic Drugs 187 
37 Principles of Antimicrobial
Section IV Chemotherapy 433
38 Antibiotics That Inhibit Bacterial Cell Wall
CENTRAL NERVOUS SYSTEM PHARMACOLOGY
Synthesis 445
18 Introduction to Central Nervous System 39 Antibiotics That Inhibit Bacterial Protein
Pharmacology 197 Synthesis 457
19 Sedative-Hypnotic and Anxiolytic Drugs 209 40 Other Antimicrobial Agents Such as
20 Antiepileptic Drugs 221 Quinolones and Antifolate Drugs 467
viii Contents
41 Antimycobacterial Drugs for Treating 45 Antineoplastic Agents 515
Tuberculosis and Other Diseases 475 46 Immunopharmacology, Biologicals, and Gene
42 Drugs for the Treatment of Fungal Therapy 531
Infections 483
43 Drugs for the Treatment of Viral Answers and Explanations 545
Infections 491 Index 565
44 Drugs for the Treatment of Parasites 505