Pharmacology for Anaesthesia and Intensive Care

Pharmacology for Anaesthesia and Intensive Care

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PharmacologyforAnaesthesiaandIntensiveCare

THIRD EDITION

Thethirdeditionofthismarket-leadingbookhasbeenthoroughlyupdatedand

expanded,withadditionalcontributionsfromexpertsinthefield,toincludeallnew

drugsavailabletotheanaesthetistandintensivecarespecialist.Basic

pharmacologicalprinciples,vitaltounderstandinghowindividualdrugsactually

havetheireffects,aredealtwithmethodicallyandwithmanyhighlyannotated

diagramsandtables.Withhospitalinfectionsbecomingincreasinglyprevalent,the

importantsectiononantibioticshasbeenfurtherexpanded.Withthethirdedition,

thiswellestablishedtitlecontinuestoprovideitsreaderswiththemostconciseyet

comprehensivecoverageofallaspectsofpharmacology.Anidealaidtostudyand

practiceforjuniorandtraineeanaesthetists,criticalcarenursesandallphysicians

andhealthcareprofessionalsworkingintheatre,accidentandemergency

departmentsorintensivecareunits.

TomPeckisaConsultantAnaesthetistatRoyalHampshireCountyHospital,

Winchester.

SueHillisaConsultantNeuroanaesthetistatSouthamptonGeneralHospital.

MarkWilliamsisaConsultantAnaesthetistatRoyalPerthHospital,Australia.

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Pharmacology for Anaesthesia

and Intensive Care

THIRD EDITION

TomPeck,SueHillandMarkWilliams

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CAMBRIDGEUNIVERSITYPRESS

Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore,Sa˜oPaulo,Delhi

CambridgeUniversityPress

TheEdinburghBuilding,CambridgeCB28RU,UK

PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress,NewYork

www.cambridge.org

Informationonthistitle:www.cambridge.org/9780521704632

(cid:1)C TomPeckSueHillandMarkWilliams2008

Thispublicationisincopyright.Subjecttostatutoryexception

andtotheprovisionsofrelevantcollectivelicensingagreements,

noreproductionofanypartmaytakeplacewithout

thewrittenpermissionofCambridgeUniversityPress.

Firstpublished2000

PrintedintheUnitedKingdomattheUniversityPress,Cambridge

AcataloguerecordforthispublicationisavailablefromtheBritishLibrary.

LibraryofCongressCataloging-in-PublicationData

Peck,T.E.

Pharmacologyforanaesthesiaandintensivecare/TomPeck,S.Hill,MarkWilliams.–3rded.

p.;cm.

Includesbibliographicalreferencesandindex.

ISBN978-0-521-70463-2(pbk.)

1.Pharmacology. 2.Anesthetics. 3.Anesthesia. 4.Criticalcaremedicine.

I.Hill,S.A.(SueA.) II.Williams,Mark(MarkAndrew)1965- III.Title.

[DNLM: 1.Anesthetics–pharmacology. 2.CardiovascularAgents–pharmacology.

3.IntensiveCare.QV81P367p2007]

RM300.P396 2007

615(cid:2).1–dc22 2007029048

ISBN978-0-521-70463-2paperback

CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyofURLsfor

externalorthird-partyinternetwebsitesreferredtointhispublication,anddoesnotguarantee

thatanycontentonsuchwebsitesis,orwillremain,accurateorappropriate.

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CONTENTS

Preface page ix

Foreword xi

SECTION I Basicprinciples 1

1 Drugpassageacrossthecellmembrane 1

2 Absorption,distribution,metabolismandexcretion 8

3 Drugaction 24

4 Druginteraction 40

5 Isomerism 45

6 Mathematicsandpharmacokinetics 50

7 Medicinalchemistry 85

SECTION II Coredrugsinanaestheticpractice 99

8 Generalanaestheticagents 99

9 Analgesics 135

10 Localanaesthetics 163

11 Musclerelaxantsandanticholinesterases 175

SECTION III Cardiovasculardrugs 197

12 Sympathomimetics 197

13 Adrenoceptorantagonists 217

14 Anti-arrhythmics 228

15 Vasodilators 246

16 Antihypertensives 258

SECTION IV Otherimportantdrugs 270

17 Centralnervoussystem 270

18 Antiemeticsandrelateddrugs 282

19 Drugsactingonthegut 292

20 Intravenousfluids 298

21 Diuretics 305

22 Antimicrobials 311

23 Drugsaffectingcoagulation 335

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vi Contents

24 DrugsusedinDiabetes 347

25 Corticosteroidsandother

hormonepreparations 353

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CONTRIBUTOR

Dr.A.S.Grice,BSc,DCH,FRCA,ConsultantAnaesthetist,Exeter

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PREFACE

Thethirdeditionhasseenfurtherchanges.Themathematicssectionhasbeenover-

hauledandexpandedtogiveabetterbaseforthekinetics.Anadditionalchapter

hasbeenaddedonintravenousfluids,andthechaptersonintravenousandvolatile

anaestheticshavebeencombinedwithanexpandedsectiononthemolecularmech-

anismofanaesthesia.

Wehavetriedtomaintainthestyleoftheprevioustwoeditionswithanemphasis

onclaritybothintermsofpresentationandcontent.Inadditionwehavetriedvery

hardtoeliminatethosesmallerrorsthataredisproportionatelyirritating.Wehope

thatthisbookwillcontinuetobeahelpfulaidtothewiderangeofreadersitappears

tohaveattracted.

TomPeck

SueHill

MarkWilliams

ix