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دانلود کتاب Clinical Pharmacy and Therapeutics
دانلود کتاب داروسازی بالینی و درمانی
مشخصات کتاب
Clinical Pharmacy and Therapeutics
ویرایش: [6 ed.]
نویسندگان: Cate Whittlesea (editor). Karen Hodson (editor)
سری:
ISBN (شابک) : 0702070122, 9780702070129
ناشر: Elsevier
سال نشر: 2018
تعداد صفحات: 1112
زبان: English
فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود)
حجم فایل: 18 Mb
قیمت کتاب (تومان) : 75,000
در صورت تبدیل فایل کتاب Clinical Pharmacy and Therapeutics به فرمت های PDF، EPUB، AZW3، MOBI و یا DJVU می توانید به پشتیبان اطلاع دهید تا فایل مورد نظر را تبدیل نمایند.
توجه داشته باشید کتاب داروسازی بالینی و درمانی نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب داروسازی بالینی و درمانی
اکنون در ششمین ویرایش خود، این کتاب درسی پرفروش و چند رشته ای همچنان از مهارت های داروسازان، پزشکان و پرستاران برای ارائه رژیم های دارویی بهینه استفاده می کند. نویسندگان درک فرآیندهای بیماری را با قدردانی از فرآیندهای پاتوفیزیولوژیک، داروسازی بالینی و پایگاه شواهد یکپارچه می کنند. هر فصل توسط یک داروساز و یک پزشک بالینی نوشته شده است، و هر فصل با نکات کلیدی شروع می شود و با مواردی برای آزمایش درک به پایان می رسد. نسخه ششم اکنون برای اولین بار در StudentConsult است و به متن کامل دسترسی آنلاین می دهد.
توضیحاتی درمورد کتاب به خارجی
Now in its sixth edition, this best-selling, multi-disciplinary textbook continues to draw on the skills of pharmacists, clinicians and nurses to present optimal drug regimens. The authors integrate an understanding of the disease processes with an appreciation of the pathophysiological processes, clinical pharmacy and the evidence base. Each chapter is co-written by a pharmacist and a clinician, and each chapter begins with key points and ends with cases to test understanding. The sixth edition is now on StudentConsult for the first time, giving online access to the full text.
فهرست مطالب
IFC CLINICAL PHARMACY AND THERAPEUTICS CLINICAL PHARMACY ANDTHERAPEUTICS Copyright Preface Acknowledgements List of Contributors Contents 1 - GENERAL 1 - Clinical Pharmacy Practice Development of clinical practice in pharmacy Pharmaceutical care Medication-related problems Medicines optimisation Pharmaceutical consultation Medicines-taking behaviour Consultation process Clinical pharmacy functions and knowledge Step 1. Establishing the need for drug therapy Step 1.1. Relevant patient details Step 1.2. Medication history Step 1.3. Deprescribing Step 2. Selecting the medicine Step 2.1. Identify drug–patient interactions Step 2.2. Identify drug–disease interactions Step 2.3. Drug–drug interactions Step 3. Administering the medicine Step 3.1. Calculating the appropriate dose Step 3.2. Selecting an appropriate regimen Step 4. Providing the medicine Step 5. Monitoring therapy Step 6. Patient advice and education Step 7. Evaluating effectiveness References 2 - Prescribing Rational and effective prescribing What is meant by rational and effective prescribing? Pharmacists as prescribers and the legal framework Evolution of non-medical prescribing Supplementary prescribing Non-medical independent prescribing Accountability Ethical framework Autonomy Non-maleficence Beneficence Justice and veracity Professional frameworks for prescribing Off-label and unlicensed prescribing Prescribing across the interface between primary and secondary care Clinical governance Competence and competency frameworks The prescribing process Consultation Building relationships Providing structure Initiating the session Gathering information Physical examination Explanation and planning Closing the session Communicating risks and benefits of treatment Adherence Medication review Factors that influence prescribers Patients and prescribing decisions The informed patient Healthcare policy Colleagues Pharmaceutical industry Cognitive factors Strategies to influence prescribing Managerial approaches to influence prescribing Local and national guidelines Incentives Provision of comparative (benchmarking) information Support and education Conclusion References 3 - Practical Pharmacokinetics General applications Time to maximal response Need for a loading dose Dosage alterations Choosing a formulation Application to therapeutic drug monitoring Basic concepts Volume of distribution Elimination Absorption Dosing regimens Peak and trough levels Interpretation of drug concentration data Sampling times Dosage adjustment Capacity limited clearance Increasing clearance Therapeutic range Clinical applications Estimation of creatinine clearance Digoxin Action and uses Plasma concentration–response relationship Distribution Elimination Absorption Practical implications Theophylline Plasma concentration–response relationship Distribution Elimination Product formulation Practical implications Gentamicin Clinical use Therapeutic range Distribution Elimination Practical implications Vancomycin Concentration–response relationship Absorption and distribution Elimination Practical applications Lithium Dose-dependent effects Dose-independent effects Distribution Elimination Practical implications Phenytoin Plasma concentration–response relationship Distribution Elimination Practical implications Carbamazepine Distribution Elimination Absorption Practical implications Valproate Plasma concentration–response relationship Distribution Elimination Practical implications Newer epilepsy treatments Plasma concentration–response relationship Practical implications Ciclosporin Plasma concentration–response relationship Distribution Elimination Practical implications Tacrolimus Plasma concentration–response relationship Absorption Distribution Elimination Practical implications Sirolimus Concentration–response relationship Absorption and distribution Elimination Practical applications References Further reading 4 - Drug Interactions Epidemiology Susceptible patients Mechanisms of drug interactions Pharmacokinetic interactions Absorption Drug distribution Drug metabolism Elimination interactions Pharmacodynamic interactions Antagonistic interactions Additive or synergistic interactions Serotonin syndrome Drug or neurotransmitter uptake interactions Drug–food interactions Drug–herb interactions Conclusion References Further reading 5 - Adverse Drug Reactions Assessing the safety of drugs Definitions Classification of adverse drug reactions Rawlins–Thompson classification The DoTS system Factors that affect susceptibility to adverse drug reactions Age Comorbidities and concomitant medicines use Sex Ethnicity Pharmacogenetics Erythrocyte glucose-6-phophatase dehydrogenase deficiency Porphyrias Immunological reactions Formulation issues that contribute to adverse drug reactions Epidemiology of adverse drug reactions Pharmacovigilance and epidemiological methods in adverse drug reaction detection Spontaneous reporting Signal detection Causality assessment Yellow Card Scheme Direct patient reporting Published case reports Cohort studies Case–control studies Roles of health professionals Identifying and assessing adverse drug reactions in clinical practice Preventing adverse drug reactions Monitoring therapy Explaining risks to patients References Further reading Useful websites 6 - Laboratory Data Haematology data Red blood cells Red blood cell count Reticulocytes Haemoglobin Mean cell volume Packed cell volume Mean cell haemoglobin Mean cell haemoglobin concentration Platelets White blood cell count Neutrophils Basophils Eosinophils Lymphocytes Monocytes Coagulation Monitoring coagulation Prothrombin time International Normalised Ratio Activated partial thromboplastin time Fibrinogen Urea and electrolytes Fluid homeostasis Fluid balance Water depletion Water excess Sodium Sodium distribution Sodium regulation Hyponatraemia Hypernatraemia Potassium Potassium distribution Potassium regulation Hypokalaemia Hyperkalaemia Urea Creatinine Magnesium Hypomagnesaemia Hypermagnesaemia Liver profile and associated tests Bilirubin Enzymes Transaminases Alkaline phosphatase γ-Glutamyl transpeptidase Albumin Amylase Ammonia Calcium and phosphate Calcium Calcium distribution Calcium regulation Hypercalcaemia Hypocalcaemia Phosphate Phosphate distribution Phosphate regulation Hyperphosphataemia Hypophosphataemia Inflammatory markers Erythrocyte sedimentation rate C-reactive protein Procalcitonin Special tests Glucose Glycated haemoglobin Cardiac markers Troponins Lactate dehydrogenase Beta-d-glucan D-dimers Xanthochromia Creatine kinase Immunoglobulins Uric acid Iron, transferrin and iron binding Iron Ferritin Transferrin Vitamin B12 and folate Tumour markers Arterial blood gases pH Carbon dioxide Oxygenation Bicarbonate Interpreting arterial blood gases Acknowledgement References Further reading Useful websites 7 - Parenteral Nutrition Introduction Malnutrition Nutrition screening Incidence of undernutrition Indications for parenteral nutrition Nutrition support teams Components of a parenteral nutrition regimen Water volume Amino acids Energy Dual energy Glucose Lipid emulsions Micronutrients Trace elements Vitamins Electrolytes Administration of parenteral nutrition Routes of administration Peripheral route Central route Peripherally inserted central catheters Infusion control Pumps Temperature Compounded formulations Formulations Licensed, ready-to-use products Cyclic infusions Pharmaceutical issues Physical stability Precipitation Lipid destabilisation Chemical stability Vitamin stability Amino acid stability Maillard reaction Microbial contamination Shelf-life and temperature control Drug stability Filtration Light protection Nutritional assessment and monitoring Initial assessment Monitoring Complications Line sepsis Line occlusion Refeeding syndrome Specific disease states Liver Renal failure Pancreatitis Sepsis and injury Respiratory Heart failure Diabetes mellitus Cancer and palliative care Pre- and postsurgery Short bowel syndrome Long-term parenteral nutrition Paediatric parenteral nutrition Nutritional requirements Formulation and stability issues Heparin Route of administration Further reading Useful websites 8 - Pharmacoeconomics Terms used in health economics Choice of comparator Types of health economic evaluations Cost–benefit analysis Cost-effectiveness analysis Cost–utility analysis Costs and consequences Discounting Decision analysis Economic evaluation of medicines Risk management of unwanted drug effects Medication non-adherence Incentives and disincentives Conclusion References Further reading Useful websites 2 - LIFE STAGES 9 - Neonates Drug disposition Absorption Distribution Metabolism Elimination Major clinical disorders Respiratory distress syndrome Patent ductus arteriosus Bronchopulmonary dysplasia Bacterial infection Viral infections Necrotizing enterocolitis Apnoea Hypoxic–ischaemic encephalopathy Haemorrhagic disease of the newborn Principles and goals of therapy Rapid growth Therapeutic drug monitoring Avoiding harm Time scale of clinical changes Patient and parent care Reference Further reading 10 - Paediatrics Demography Congenital anomalies Cancer Asthma, eczema and allergy Infections Mental health disorders Drugs, smoking and alcohol Nutrition and exercise The normal child Drug disposition Pharmacokinetic factors Absorption Distribution Drug metabolism Renal excretion Other factors Drug therapy in children Dosage Choice of preparation Buccal route Oral route Nasogastric, gastrostomy and jejunostomy administration Rectal route Parenteral route Pulmonary route Dose regimen selection Medicines optimisation Medicines in schools Policies and guidance Responsibility for common medicines Special schools Monitoring parameters Assessment of renal function Adverse drug reactions Medication errors Licensing medicines for children Medicines licensing process Unlicensed and ‘off-label’ medicines Legislation on medicines for children Further reading Useful websites 11 - Geriatrics Pharmacokinetics Absorption First-pass metabolism Distribution Renal clearance Hepatic clearance Pharmacodynamics Reduced homeostatic reserve Orthostatic circulatory responses Postural control Thermoregulation Cognitive function Visceral muscle function Age-related changes in specific receptors and target sites α-Adrenoceptors β-Adrenoceptors Cholinergic system Benzodiazepines Warfarin Digoxin Common clinical disorders Dementia Parkinsonism Stroke Treatment of acute stroke Secondary prevention Primary prevention Osteoporosis Prevention Treatment Arthritis Hypertension Treatment of hypertension Myocardial infarction Cardiac failure Leg ulcers Urinary incontinence Stress incontinence Overflow incontinence Detrusor instability Constipation Gastro-intestinal ulceration and bleeding Principles and goals of drug therapy in older people Avoid unnecessary drug therapy Effect of treatment on quality of life Treat the cause rather than the symptom Drug history Concomitant medical illness Choosing the drug Dose titration Choosing the right dosage form Packaging and labelling Good record keeping Regular supervision and review of treatment Adverse drug reactions Adherence Conclusion References 3 - THERAPEUTICS 12 - Dyspepsia, Peptic Ulcer Disease and Gastro-Oesophageal Reflux Disease Epidemiology Pathophysiology Peptic ulcer disease Helicobacter pylori Non-steroidal anti-inflammatory drugs Selective cyclo-oxygenase-2 inhibitors Gastro-oesophageal reflux disease Drug-related causes of gastro-oesophageal reflux disease Functional dyspepsia Patient assessment and clinical manifestations Peptic ulcer disease Gastro-oesophageal reflux disease Investigations Endoscopy Radiology Helicobacter pylori detection Treatment Undiagnosed dyspepsia Peptic ulcer disease Acute bleeding peptic ulcer Uncomplicated peptic ulcer disease Treatment of non-steroidal anti-inflammatory drug-associated ulcers Prophylaxis of non-steroidal anti-inflammatory drug ulceration Helicobacter pylori and prevention of non-steroidal anti-inflammatory drug–related ulcers Prophylaxis of gastro-intestinal bleeding during anti-platelet therapy Helicobacter pylori–negative, non-steroidal anti-inflammatory drug–negative ulcers Gastro-oesophageal reflux disease Functional dyspepsia Pyloric stenosis Zollinger–Ellison syndrome Stress ulcers Drugs for dyspepsia Proton pump inhibitors Adverse drug reactions Drug interactions H2-receptor antagonists Adverse drug reactions Drug interactions Bismuth chelate Adverse drug reactions Sucralfate Adverse drug reactions Drug interactions Antacids Adverse drug reactions Drug interactions Acknowledgment References 13 - Inflammatory Bowel Disease Introduction Epidemiology Aetiology Environmental Diet Smoking Infection Enteric microflora Drugs Appendicectomy Stress Genetic Ethnic and familial Pathophysiology Disease location Crohn’s disease Ulcerative colitis Colitis not yet classified Other types of colitis Clinical manifestation Crohn’s disease Small bowel, ileocaecal and terminal ileal disease Crohn’s colitis Perianal disease Gastroduodenal and oral disease Stricturing Crohn’s disease Ulcerative colitis Acute severe disease Moderately active disease Proctitis Toxic dilatation Extra-intestinal complications Joints and bones Skin Eye Hepatobiliary Thromboembolic Anaemia Other complications of inflammatory bowel disease Investigations Endoscopy Radiology Laboratory findings Stool tests Clinical assessment tools Treatment of inflammatory bowel disease Nutritional therapy Drug treatment Rectal route Corticosteroids Aminosalicylates Immunosuppressants Biologic agents Antibiotics Other treatments Surgical treatment Patient care Optimising pharmacological treatments in inflammatory bowel disease Pregnancy Smoking Osteoporosis Anaemia Opportunistic infections and vaccination Colonoscopic surveillance Acknowledgments References 14 - Constipation and Diarrhoea Constipation Incidence Aetiology Differential diagnosis General management Non-drug advice Drug treatment Diarrhoea Incidence Aetiology Signs and symptoms Investigations Treatment General measures Dehydration treatment Drug treatment Acknowledgement References 15 - Adverse Effects of Drugs on the Liver Risk factors Patient factors Age Sex Genetics Enzyme induction and metabolism Drug factors Daily dose Polypharmacy Disease factors Pre-existing liver disease Concurrent diseases and pregnancy Aetiology/pathophysiology/clinical manifestation Cholestasis Aetiology Pathophysiology Clinical manifestation Steatosis Aetiology Pathophysiology Clinical manifestation Hepatitis Aetiology Acute hepatitis Pathophysiology Clinical manifestation Chronic active hepatitis Pathophysiology Clinical manifestation Fibrosis Aetiology Pathophysiology Clinical manifestations Tumours Aetiology Pathophysiology Clinical manifestation Necrosis Aetiology Pathophysiology Clinical manifestation Vascular disorders Investigations Biochemical tests Serological markers Radiological investigations Liver biopsy Treatment Diagnosis Withdrawal Rechallenge Management Antidotes Corticosteroids Supportive treatment Pruritus Coagulation disorders Long-term treatment Patient counselling Minimising the risk of drug-induced liver injury Acknowledgment References Further reading 16 - Liver Disease Acute liver disease Chronic liver disease Causes of liver disease Viral infections Hepatitis A Hepatitis B Hepatitis D Hepatitis C Hepatitis E Alcohol Non-alcoholic fatty liver disease Immune disorders Autoimmune hepatitis Primary biliary cholangitis Primary sclerosing cholangitis Vascular abnormalities Metabolic and genetic disorders Haemochromatosis Wilson’s disease α1-Antitrypsin deficiency Glycogen storage disease Gilbert’s syndrome Drugs Clinical manifestations of liver disease Symptoms of liver disease Signs of liver disease Cutaneous signs Abdominal signs Jaundice Portal hypertension Ascites Sexual characteristics Investigation of liver disease Biochemical liver function tests Laboratory investigation of aetiology Imaging techniques Liver biopsy and Fibroscan Patient care Pruritus Anion exchange resins Antihistamines Ursodeoxycholic acid Rifampicin Opioid antagonists Topical preparations Clotting abnormalities Ascites Diuretics Paracentesis Transjugular intrahepatic portosystemic shunting Automated low-flow pump system (Alfapump) Spontaneous bacterial peritonitis Hepatic encephalopathy Oesophageal varices Endoscopic management Pharmacological therapy Self-expanding metallic stents Transjugular intrahepatic portosystemic stent shunt Prevention of re-bleeding Acute liver failure Liver transplantation Disease-specific therapies Hepatitis B Hepatitis C Alcoholic liver disease Non-alcoholic fatty liver disease Autoimmune hepatitis Primary biliary cholangitis Primary sclerosing cholangitis Wilson’s disease References Further reading Useful websites 17 - Acute Kidney Injury Definition and incidence Classification and causes Pre-renal acute kidney injury Hypovolaemia Hypotension Intra-renal acute kidney injury Acute tubular necrosis Immune and inflammatory renal disease Differentiating pre-renal from renal acute kidney injury Post-renal acute kidney injury Clinical manifestations Acute kidney injury with volume depletion Acute kidney injury with volume overload Diagnosis and clinical evaluation Monitoring fluid balance in acute kidney disease Intravascular monitoring Monitoring key parameters in acute kidney disease Course and prognosis Pre-renal acute kidney injury Post-renal acute kidney injury Management Early preventive and supportive strategies Identification of patients at risk Withdrawal and avoidance of nephrotoxic agents Optimisation of renal perfusion Establishing and maintaining an adequate diuresis Drug therapy and renal auto-regulation Non-dialysis treatment of established acute kidney injury Uraemia and intravascular volume overload Hyperkalaemia Acidosis Hypocalcaemia Hyperphosphataemia Infection Other problems Uraemic gastro-intestinal erosions Nutrition Renal replacement therapy Forms of renal replacement therapy Haemodialysis Haemofiltration Haemodiafiltration Acute peritoneal dialysis Drug dosage in renal replacement therapy Factors affecting drug use Absorption Metabolism Distribution Excretion Nephrotoxicity References Further reading Useful websites 18 - Chronic Kidney Disease and End-Stage Renal Disease Measurement of renal function Serum creatinine Chronic kidney disease epidemiology estimate of glomerular filtration rate equation Other estimates of kidney function Creatinine clearance Cockroft–Gault equation Estimates of glomerular filtration rate in paediatric patients Urea Significance of chronic kidney disease Causes of chronic kidney disease Ischaemic/hypertensive renal disease Metabolic diseases Chronic glomerulonephritis Lower urinary tract disease Reflux disease Renal stone disease Chronic pyelonephritis Extrinsic renal tract obstruction Hereditary/congenital diseases Unknown cause Clinical manifestations Polyuria and nocturia Proteinuria and albuminuria Haematuria Hypertension and fluid overload Clinical findings Uraemia Clinical findings Anaemia Clinical findings Bone disease (renal osteodystrophy) Clinical findings Neurological changes Clinical features Muscle function Clinical findings Electrolyte disturbances Sodium Potassium Hydrogen ions Diagnosis, investigations and monitoring Ultrasonography Computed tomography, magnetic resonance imaging and intravenous urography Nuclear medicine investigations Renal biopsy Rate of progression of chronic kidney disease Prognosis Treatment Reversal or arrest of primary disease Hypertension Calcium channel blockers Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers Diuretics β-Blockers Selective α1-blockers Vasodilators Centrally acting drugs Management of symptoms Gastro-intestinal Pruritus Dietary modifications Fluid retention Anaemia Acidosis Neurological problems Osteodystrophy Hyperphosphataemia Vitamin D deficiency and hyperparathyroidism Renal transplantation Immunosuppressants Calcineurin inhibitors (ciclosporin and tacrolimus) Ciclosporin Tacrolimus Steroids Azathioprine Mycophenolate mofetil Sirolimus Monoclonal antibodies Polyclonal antibodies Other precautions Implementation of regular dialysis treatment References 19 - Hypertension Epidemiology Regulation of blood pressure Clinical presentation Malignant (accelerated) hypertension Management of hypertension Diagnosis of hypertension Ambulatory or home blood pressure measurements Hypertension classification Assessment of the hypertensive patient Secondary causes Contributing factors Evidence of end-organ damage Determination of cardiovascular risk Treatment Non-pharmacological approaches Drug treatment Treatment thresholds Target blood pressures Antihypertensive drug classes Renin–angiotensin system antagonists Calcium channel blockers Diuretics α-Adrenoreceptor blockers Centrally acting agents β-Adrenoreceptor antagonists Other agents Drug selection Clinical trial evidence Recommendations for drug sequencing Timing of dosing Special patient groups Race Elderly Diabetes Renal disease Stroke Pregnancy Oral contraceptives Hormone replacement therapy Ancillary drug treatment Aspirin Lipid-lowering therapy References Further reading Useful websites 20 - Coronary Heart Disease Prevalence Risk factors Aetiology Modification of risk factors Clinical syndromes Stable angina Treatment to reduce risk Angiotensin-converting enzyme inhibitors Statins Symptom relief and prevention β-Blockers Calcium channel blockers Nitrates Nicorandil Ivabradine Ranolazine Acute coronary syndrome Definition and cause Treatment of ST-elevation myocardial infarction Immediate care to alleviate pain, prevent deterioration and improve cardiac function Restoring coronary flow and myocardial tissue perfusion Management of complications Prevention of further infarction or death (secondary prophylaxis) Treatment of non-ST-elevation acute coronary syndromes Antiplatelet and anticoagulant drugs Anti-ischaemic drugs Statins Patient care References 21 - Chronic Heart Failure Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment of heart failure Diuretics Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers β-Blockers Mineralocorticoid receptor antagonists Sacubitril Ivabradine Digoxin Nitrates/hydralazine Inotropic/Vasopressor agents Other agents Guidelines Patient care Patient education and self-monitoring Monitoring effectiveness of drug treatment Monitoring safety of drug treatment Potential problems with diuretic therapy Potential problems with angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker and mineralocorticoid receptor ... Potential problems with β-blocker therapy Potential problems with sacubitril/valsartan therapy Potential problems with digoxin therapy Potential problems with other cardiovascular drugs Potential problems with non-cardiovascular agents References Further reading Useful websites 22 - Arrhythmias Normal cardiac electrophysiology Cardiac action potential Resting membrane potential Pacemaker activity Depolarisation Repolarisation Refractoriness Normal cardiac conduction Arrhythmia mechanisms Abnormal impulse formation Abnormal automaticity Triggered activity Abnormal impulse propagation Re-entry Clinical problems Diagnosis Management Tachycardia Supraventricular tachycardias Inappropriate sinus tachycardia Atrial flutter Focal atrial tachycardia Junctional re-entry tachycardia Atrial fibrillation Ventricular tachyarrhythmias Ventricular tachycardia Ventricular fibrillation Emergency management of ventricular arrhythmias Ongoing management of ventricular arrhythmias Bradycardia Drug therapy Vaughan–Williams classification Class I antiarrhythmic drugs Class III antiarrhythmic drugs Adenosine Ivabradine Digoxin Patient care References Further reading Useful websites 23 - Thrombosis Venous thromboembolism Epidemiology Aetiology Protein C deficiency Protein S deficiency Factor V Leiden Antithrombin III deficiency Lupus anticoagulant Prothrombin G20210A mutation Fibrinogen gamma 10034T Oestrogens Malignancy Surgery Clinical manifestations Investigations Deep vein thrombosis Pulmonary embolism Treatment Prophylaxis Heparins Heparinoids Hirudins Fondaparinux Oral anticoagulants Fibrinolytic drugs Patient care Arterial thromboembolism Aetiology Treatment and prevention Aspirin Clopidogrel Prasugrel Ticagrelor Dipyridamole Glycoprotein IIb/IIIa inhibitors Patient care References Further reading Useful website 24 - Dyslipidaemia Lipid transport and lipoprotein metabolism High-density lipoprotein Reverse cholesterol transport pathway Triglycerides Aetiology Primary dyslipidaemia Familial hypercholesterolaemia Familial combined hyperlipidaemia Familial type III hyperlipoproteinaemia Familial lipoprotein lipase deficiency Familial apolipoprotein C-II deficiency Lipoprotein(a) Secondary dyslipidaemia Diabetes mellitus Hypothyroidism Chronic renal failure Nephrotic syndrome Obesity Alcohol Drugs Cardiovascular risk assessment Primary prevention QRisk2 Other risk assessment tools Secondary prevention Treatment Lipid profile Lifestyle Body weight and waist measurement Diet Exercise Drugs Primary prevention Secondary prevention Lipid-lowering therapy Statins Adverse effects Pleiotropic properties Over-the-counter sale Patient counselling Cholesterol absorption inhibitors Fibrates Adverse effects Bile acid binding agents Adverse effects Patient counselling Nicotinic acid and derivatives Fish oils Soluble fibre Proprotein convertase subtilisin/kexin type 9 inhibitors Drugs in development Cholesterol ester transfer protein inhibitors Other options Low-density lipoprotein apheresis Lomitapide References Further reading Useful websites 25 - Asthma Introduction Epidemiology Aetiology Pathophysiology Clinical signs and symptoms Investigations Lung function testing Further investigations Reversibility testing Measurement of airway hyper-responsiveness Measures of airway inflammation Other tests Treatment Chronic treatment Inhaled corticosteroids Short-acting β-agonists Long-acting β-agonists Leukotriene antagonists Long-acting antimuscarinics Theophylline preparations Biological therapies Oral corticosteroids Steroid-sparing agents Cromones Acute treatment Risk stratification and assessment Treatment Patient care Structure of an asthma review Assessment of asthma control Patient education Inhaler technique Different inhaler devices Pressurised metered dose inhaler Breath-actuated metered dose inhaler Dry powder inhalers Soft-mist metered dose inhaler Adherence Management plans References Further reading Useful websites 26 - Chronic Obstructive Pulmonary Disease Definitions Epidemiology Aetiology Pathology and pathophysiology Clinical manifestations Symptoms, signs and natural history Investigations Classification Treatment Managing stable chronic obstructive pulmonary disease Surgical treatments Smoking cessation Bronchodilators Roflumilast Theophylline and aminophylline Mucolytics Prophylactic antibiotics Pharmacological management of exacerbations of chronic obstructive pulmonary disease Bronchodilators Antibiotics Corticosteroids Aminophylline Thromboprophylaxis Physiotherapy Management of acute respiratory failure in chronic obstructive pulmonary disease Patient care Pulmonary rehabilitation Vaccination Stopping smoking Nicotine replacement therapy Bupropion Varenicline Electronic cigarettes Effect of smoking on concomitant medications Oxygen therapy Antidepressants Palliative care Management of breathlessness Benzodiazepines References Further reading Useful websites 27 - Insomnia Definitions and epidemiology Pathophysiology Sleep systems Aetiology and clinical manifestations Investigations and differential diagnosis Treatment Non-pharmacological therapies Hypnotic medicines Benzodiazepines Zopiclone Eszopiclone Zolpidem Zaleplon Suvorexant Other hypnotic medicines Antihistamines Diphenhydramine and promethazine Melatonin Potential adverse effects of hypnotic use Tolerance and dependence Rebound insomnia Oversedation and hangover effects Drug interactions Rational pharmacological treatment of insomnia Patient care Type of insomnia The elderly The young Disease states Choice of pharmacological treatment Rate of elimination Duration and timing of administration Medicines and driving References Further reading Useful websites 28 - Anxiety Disorders Pathophysiology Aetiology and clinical manifestations Investigations and differential diagnosis Treatment Psychological interventions Pharmacotherapy Benzodiazepines Antidepressant drugs Other medications occasionally used in anxiety References Further reading Useful websites 29 - Affective Disorders Classification Depression Mania and hypomania Bipolar and unipolar disorders Epidemiology Aetiology Genetic causes Environmental factors Biochemical factors Endocrine factors Physical illness and side effects of medication Clinical manifestations Depression Bipolar disorder Mania/Hypomania Severity Investigations Rating scales Beck depression inventory Hamilton depression rating scale Treatment Treatment of depression Drug treatment Other treatments Treatment of mania Benzodiazepines Valproate semisodium Antipsychotics Longer-term management Patient care References Further reading Useful website 30 - Schizophrenia Classification Symptoms and diagnosis Acute psychotic illness Causes of schizophrenia Developmental model Environmental factors Genetic model Transmitter abnormality model Vulnerability model Other factors Pharmacological treatment Antipsychotics Mode of action of antipsychotics ‘Typical’ or ‘first generation’ and ‘atypical’ or ‘second generation’ antipsychotics Selecting an antipsychotic and dose Side effects Clozapine and refractory illness Using antipsychotics Maximum and equivalent doses Onset of effect Long-acting formulations of antipsychotics Interactions and antipsychotics Therapeutic drug monitoring References Further reading 31 - Epilepsy Epidemiology Incidence and prevalence Prognosis Mortality Aetiology Pathophysiology Clinical manifestations Generalised seizures Tonic-clonic seizures Typical absence seizures Atypical absence seizures Absence seizures with special features Myoclonic seizures Tonic seizures Clonic seizures Atonic seizures Focal seizures Epileptic spasms Diagnosis Treatment Treatment during seizures Status epilepticus Febrile convulsions Long-term treatment General principles of treatment Initiation of therapy in newly diagnosed epilepsy Maintenance dosage Altering drug regimens Withdrawal of drugs When to make dose changes Newer antiepileptic drugs Follow-up and monitoring of treatment Chronic epilepsy Stopping treatment Monitoring antiepileptic therapy Drug development and action Antiepileptic drug profiles Acetazolamide Brivaracetam Carbamazepine Clobazam Clonazepam Diazepam Eslicarbazepine acetate Ethosuximide Felbamate Gabapentin Lacosamide Lamotrigine Levetiracetam Oxcarbazepine Perampanel Phenobarbital Phenytoin Piracetam Pregabalin Primidone Rufinamide Sodium valproate Stiripentol Tiagabine Topiramate Vigabatrin Zonisamide Recent and future evidence for antiepileptic drugs References Further reading 32 - Parkinson’s Disease Background Aetiology Environment Genetics Pathophysiology Clinical features Motor features Non-motor features Differential diagnosis Drug-induced Parkinsonism Investigations Treatment General approach Drug treatment Dopamine agonists Apomorphine Catechol-O-methyl transferase inhibitors Monoamine oxidase type B inhibitors Amantadine Antimuscarinic drugs Surgical treatment Patient care Psychosis and dementia Autonomic problems References Further reading 33 - Dementia Definition Epidemiology Incidence and prevalence Prognosis Clinical manifestations Alzheimer’s disease Causes of Alzheimer’s disease Pathophysiology of Alzheimer’s disease Vascular dementia Dementia with Lewy bodies Neuropathology The rarer dementias Parkinson’s disease dementia Frontotemporal dementia Corticobasal degeneration Progressive supranuclear palsy Creutzfeldt–Jakob disease HIV-associated neurocognitive disorder Huntington’s disease Multiple sclerosis Niemann–Pick disease type C Normal pressure hydrocephalus Posterior cortical atrophy Alcohol-related brain damage Consequences of the dementia process Behavioural changes in dementia Diagnosis of the dementias General signs and symptoms of dementia Classification of dementias The screening process Assessing cognitive function Diagnostic features of Alzheimer’s disease Ascertaining severity of Alzheimer’s disease Diagnostic features of vascular dementia Diagnostic features of dementia with Lewy bodies Diagnostic features of the rarer dementias Diagnostic features of Parkinson’s disease dementia Diagnostic features of frontotemporal dementia Diagnostic features of corticobasal degeneration Diagnostic features of progressive supranuclear palsy Diagnostic features of Creutzfeldt–Jakob disease Diagnostic features of HIV-associated neurocognitive disorder Diagnostic features of Huntington’s disease Diagnostic features of multiple sclerosis cognitive difficulties Diagnostic features of Niemann–Pick disease type C Diagnostic features of normal pressure hydrocephalus Diagnostic features of posterior cortical atrophy Diagnostic features of alcohol-related brain damage Treatment of dementia Alzheimer’s disease Acetylcholinesterase inhibitors N-Methyl-d-aspartate receptor antagonist – memantine Emerging treatments for Alzheimer’s disease Treatment of rarer dementias Treatment strategy for behavioural and psychological symptoms of dementia Patient care Safer medicines use Preventing dementia Reducing cardiovascular risk Herbal supplements, aromatherapy and social and behavioural interventions Ginkgo biloba Vitamin E Folic acid, vitamin B12 and iron Supporting people with concerns about possible dementia Communicating with people with dementia and their carers Adapting communication skills Information provision for carers References Further Reading Useful websites 34 - Pain Neuroanatomy of pain transmission Neurotransmitters and pain Management Analgesic ladder Analgesic drugs Paracetamol Non-steroidal anti-inflammatory drugs Mechanism of action Side effects and tolerability COX-2 selective drugs Clinical considerations Guidance on NSAID use Other non-opioid analgesics Opioid analgesics Opioids for mild to moderate pain Opioids for severe pain Agonist–antagonist and partial agonists Buprenorphine Pentazocine Tramadol Tapentadol Side effects of opioids Respiratory depression Sedation Nausea and vomiting Constipation Smooth muscle spasm Other side effects Tolerance, dependence and addition Opioids and driving Special techniques for opioid administration Patient-controlled analgesia Epidural analgesia Epidural opioids Local anaesthetics Epidural local anaesthetics Adjuvant medicines Antidepressants Clinical use of antidepressants in long-term pain Antiepileptic drugs Ketamine Anxiolytics Antihistamines Skeletal muscle relaxants Botulinum toxin Clonidine Cannabinoids Stimulation-produced analgesia Transcutaneous electrical nerve stimulation and acupuncture Treatment of selected pain syndromes Postoperative pain Cancer pain Opioid use in cancer pain Use of adjuvant drugs and treatments for cancer pain Specific cancer pain syndromes Neuropathic pain Specific neuropathic pain syndromes Back and neck pain Osteoarthritis and rheumatoid arthritis Myofascial pain Postamputation and phantom limb pain Headache Migraine Cluster headache Dysmenorrhoea Burn pain References Further reading Useful websites 35 - Nausea and Vomiting Epidemiology Pathophysiology Patient management Antiemetic drugs Antihistamines Antimuscarinics Antidopaminergics Phenothiazines and butyrophenones Metoclopramide Domperidone Olanzapine Selective 5HT3-receptor antagonists Neurokinin-1 receptor antagonists Cannabinoids Corticosteroids Complementary and alternative medicines Drug treatment in selected circumstances Postoperative nausea and vomiting Chemotherapy-induced nausea and vomiting Pregnancy-associated nausea and vomiting Migraine Labyrinthitis Motion sickness Drug-associated nausea and vomiting Palliative care–associated nausea and vomiting Conclusion References Further reading 36 - Respiratory Infections Colds and flu Influenza Sore throat (pharyngitis) Causative organisms Clinical features Diagnosis Treatment Acute epiglottitis Causative organisms Clinical features Diagnosis Treatment Otitis media Causative organisms Clinical features Diagnosis Treatment Acute sinusitis Causative organisms Clinical features Diagnosis Treatment Lower respiratory tract infections Acute bronchitis Causative organisms Clinical features Diagnosis Treatment Pertussis Diagnosis Treatment Bronchiolitis Causative organisms Diagnosis Treatment Exacerbations of chronic obstructive pulmonary disease Diagnosis Treatment Community acquired pneumonia Causative organisms Diagnosis Empirical treatment Targeted therapy Prevention Hospital-acquired pneumonia Clinical features Diagnosis Treatment Prevention Aspiration pneumonia Treatment Novel coronaviruses Severe acute respiratory syndrome Middle East respiratory syndrome coronavirus Cystic fibrosis Infective organisms Treatment 37 - Urinary Tract Infections Epidemiology Infants Children Adults Elderly Aetiology and risk factors Pathogenesis Organism Host Abnormalities of the urinary tract Clinical manifestations Infants Children Adults Elderly Investigations Dipsticks Microscopy Culture Treatment Non-specific treatments Antimicrobial chemotherapy Antibiotic resistance Uncomplicated lower urinary tract infections Adults Duration of treatment Children Acute pyelonephritis Relapsing urinary tract infection Catheter-associated infections Antimicrobial catheters Bacteriuria of pregnancy Prevention and prophylaxis Cranberry juice Antibiotic prophylaxis Children References Further reading 38 - Gastro-Intestinal Infections Pathophysiology Host factors Gastric acidity Intestinal motility Resident microflora Immune system Organism factors Toxins Mucosal damage Systemic invasion Clinical manifestations Investigations Treatment Antibiotic therapy Conditions for which antibiotic therapy is not available or not usually required Conditions for which antimicrobial therapy may be considered Conditions for which antimicrobial therapy is usually indicated Patient care References Further reading Useful websites 39 - Infective Meningitis Aetiology and epidemiology Bacterial meningitis Viral meningitis Fungal meningitis Pathophysiology Clinical manifestations Diagnosis Drug treatment Antimicrobial therapy Pharmacokinetic considerations Recommended regimens Patient care Prevention of person-to-person transmission References Further reading 40 - Surgical Site Infection and Antimicrobial Prophylaxis Epidemiology Surveillance Risk factors Prosthetic implants Duration of surgery Patient-related factors Other factors Smoking Diabetes mellitus Age Pathogenesis Prevention of surgical site infection Antimicrobial prophylaxis Choice of antimicrobial Timing and duration Repeat doses β-Lactam allergy Topical or local antimicrobial prophylaxis References Further references Useful websites 41 - Tuberculosis Introduction Epidemiology Aetiology Clinical features Latent infection Active tuberculosis Microbiological testing Radiology Public health action Bacille Calmette-Guérin Vaccination Treatment Drug-sensitive tuberculosis Active tuberculosis without central nervous system involvement Active tuberculosis with central nervous system involvement Drug-resistant tuberculosis Mono-resistant tuberculosis Multidrug-resistant tuberculosis Extensively drug-resistant tuberculosis HIV/tuberculosis co-infection Latent tuberculosis infection Adverse effects Paradoxical reactions Adverse drug reactions Monitoring of treatment Drug interactions Adherence Supervised versus unsupervised treatment Patient education Special circumstances Renal disease Liver disease Pregnancy and breastfeeding Elderly Children References Useful websites 42 - HIV Infection Pathogenesis Clinical manifestations Investigations and monitoring Current and previous infections CD4 count Viral load Resistance testing Tropism testing Drug treatment Antiretroviral therapy When to start therapy Choosing and monitoring therapy Treatment interruptions Post-exposure prophylaxis Pre-exposure prophylaxis Women with HIV Ethnicity Nucleoside and nucleotide analogue reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Protease inhibitors Integrase inhibitors Entry inhibitors Toxicity of antiretroviral therapies Cardiovascular risk associations of antiretroviral agents Specific HIV drug choice HIV drug–drug interactions Absorption Metabolism Excretion Hepatitis B co-infection Hepatitis C co-infection Opportunistic infections Fungal infections Pneumocystis jirovecii pneumonia Oropharyngeal/oesophageal candidiasis Cryptococcus neoformans Protozoal infections Toxoplasmosis Cryptosporidiosis Bacterial infections M. avium intracellulare/M. avium complex Viral infections Herpes simplex and varicella zoster Cytomegalovirus Impact of antiretroviral therapy and clinical infections Cancers Kaposi’s sarcoma High-grade B-cell non-Hodgkin’s lymphoma Invasive cervical cancer Neurological manifestations Progressive multifocal leucoencephalopathy Acknowledgements References Further reading Useful websites 43 - Fungal Infections Introduction Laboratory diagnosis Fungal infection Antifungal agents Superficial infection Candida infections Epidemiology Clinical presentation Treatment Dermatophytosis Epidemiology Clinical presentation Diagnosis Treatment Pityriasis versicolor Clinical presentation Diagnosis Treatment Ear infection Clinical presentation Diagnosis Treatment Infections with saprophytic fungi Deep-seated fungal infections Fungal infections in the compromised host Common mycoses Epidemiology and predisposing factors Clinical presentation Diagnosis Choice of treatment References Further reading Useful websites 44 - Thyroid and Parathyroid Disorders Hypothyroidism Epidemiology Aetiology Clinical manifestations Myxoedema coma Investigations Testing thyroid function: Pitfalls for the unwary Treatment Patient care Prevention Hyperthyroidism/thyrotoxicosis Epidemiology Aetiology Graves’ disease Nodular disease Thyroiditis Clinical manifestations Investigations Treatment Immediate treatment of thyrotoxicosis Graves’ disease Nodular thyroid disease Antithyroid drugs The regimen Patient counselling Thyroid ablative therapy Treatment of complications Ophthalmopathy Treatment of localised myxoedema Thyroid Crisis Drugs and the thyroid Drugs and thyrotoxicosis Drugs and hypothyroidism Calcium and parathyroid hormone Physiology Hypoparathyroidism/hypocalcaemia Aetiology Clinical manifestations Investigations Treatment Hyperparathyroidism Epidemiology Aetiology Clinical manifestations Investigations Treatment Treatment of hypercalcaemia References Further reading Useful websites 45 - Diabetes Mellitus Introduction Epidemiology Aetiology Pathophysiology Pathophysiology of insulin resistance Clinical manifestations Type 1 diabetes Type 2 diabetes Diagnosis Diabetic emergencies Hypoglycaemia Causes of hypoglycaemia Nocturnal hypoglycaemia Treatment of hypoglycaemia Diabetic ketoacidosis Diagnosis of diabetic ketoacidosis Treatment of diabetic ketoacidosis Hyperosmolar hyperglycaemic state Diagnosis of hyperosmolar hyperglycaemic state Treatment of hyperosmolar hyperglycaemic state Long-term diabetes complications Macrovascular disease Cardiovascular disease Hypertension Peripheral vascular disease Microvascular disease Retinopathy Nephropathy Peripheral neuropathy Macro- and microvascular disease combined Diabetic foot problems Treatment of diabetes Structured education programmes Diet Carbohydrates and sweeteners Alcohol Fats Protein Fibre Salt Obesity management in type 2 diabetes Insulin therapy in type 1 diabetes Insulin species of origin Insulin preparations Insulin delivery Insulin regimens Storage of insulin Adverse effects of insulin Management of type 2 diabetes Biguanides Sulfonylureas Meglitinides Thiazolidinediones Sodium-glucose co-tansporter-2 inhibitors Dipeptidyl peptidase-4 inhibitors Incretin mimetics Insulin therapy in type 2 diabetes Α-glucosidase inhibitors Treating hypertension Patient care Annual review Glycaemic management Monitoring glycaemic control Clinic monitoring Home monitoring Acknowledgments References Further reading Useful websites 46 - Menstrual Cycle Disorders Premenstrual syndrome Epidemiology Aetiology Hormones Vitamins and minerals Essential fatty acids Psychological factors Symptoms Management Non-pharmacological strategies Pharmacological management Dysmenorrhoea Epidemiology Primary dysmenorrhoea Aetiology and symptoms Secondary dysmenorrhoea Aetiology and symptoms Treatment Heavy menstrual bleeding Epidemiology Aetiology and investigation Treatment Endometriosis Aetiology Epidemiology Symptoms Treatment References Further reading Useful websites 47 - Menopause Menopause Physiological changes Ovarian Urogenital system Bone Musculoskeletal system Cardiovascular system Miscellaneous changes Psychological and neurological changes Management Hormone replacement therapy Oestrogen therapy Progestogen therapy Oestrogen and progestogen regimens Tibolone Raloxifene Clinical monitoring Stopping HRT Treatment with hormone replacement therapy Vasomotor symptoms Urogenital tract Bone Musculoskeletal system Cardiovascular system Coronary heart disease Venous thromboembolism Cancer Colorectal cancer Ovarian cancer Endometrial cancer Breast cancer Psychological symptoms Central nervous system Alternatives to hormone replacement therapy References Further reading 48 - Drugs in Pregnancy and Lactation Drugs as teratogens Drugs as teratogens Critical periods in human fetal development Pre-embryonic stage: weeks 0–2 post-conception Embryonic stage: weeks 3–8 post-conception Fetal stage: weeks 9–38 post-conception Principles of teratogenesis Timing of exposure Drug dose Species Genotype and environmental interaction Pharmacological effect Maternal pharmacokinetic changes Absorption Distribution Albumin is the main plasma protein responsible for binding acidic drugs such as phenytoin and salicylates, whereas α1-acid glyco... Metabolism Excretion Fetal–placental transfer Maternal pharmacodynamic changes Drug dosing in pregnancy Drug selection in pregnancy Pre-conception advice Post-conception advice Teratology information services and pregnancy registries Transfer of drugs into breast milk Milk/plasma concentration ratio Calculating the infant ‘dose’ ingested via milk Variability Assessing the risk to the infant Pharmacokinetic and pharmacodynamic factors Pharmacogenetic factors Reducing risk to the breastfed infant Special situations Neonates and premature infants Glucose-6-phosphate dehydrogenase deficiency Allergy Recreational drug use Drug effects on lactation Acknowledgements References 49 - Prostate Disease Epidemiology Pathophysiology Symptoms Examination and investigations History Physical examination Investigations Urodynamic studies Imaging Prostatic ultrasound scan Flexible cystoscopy Treatment Watchful waiting Therapeutic management α-Adrenoceptor blocking drugs 5α-Reductase inhibitors Antimuscarinic receptor antagonists Phosphodiesterase 5 inhibitors β3-Adrenoceptor agonists Vasopressin analogue Combination therapy Phytotherapy Surgical treatments Prostate artery embolisation UroLift Patient care Age Family history Diet Other factors Pathophysiology Screening Symptoms Examination and investigation Physical examination Imaging Prostate-specific antigen Prostate biopsy Cancer staging Treatment Localised prostate cancer Established treatments with curative intent Minimally invasive procedures Non-curative intent: ‘Watchful waiting’ Locally advanced prostate cancer Metastatic prostate cancer Surgical castration Other palliative treatments Castrate-resistant prostate cancer Oestrogen Corticosteroids Chemotherapy Sipuleucel-T Radium-223 Chemoprevention Diet Drugs Patient care Pathophysiology Symptoms Examination and investigations Treatment Patient care Acknowledgements References Further reading Useful websites 50 - Anaemia Epidemiology Aetiology Haemopoiesis and erythropoiesis Haemopoiesis Erythropoiesis Clinical manifestations Investigations Iron-deficiency anaemia Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Anaemia of chronic disease Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Sideroblastic anaemias Epidemiology Aetiology Pathophysiology Drugs and toxins Clinical manifestations Investigations Treatment Patient care Megaloblastic anaemias Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Folic acid deficiency anaemia Vitamin B12 deficiency anaemia Haemolytic anaemias General clinical manifestations General treatment Autoimmune haemolytic anaemia Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Sickle cell anaemia Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Thalassaemias Epidemiology Aetiology Pathophysiology Clinical manifestations Investigations Treatment Patient care Glucose-6-phosphate dehydrogenase deficiency Epidemiology Aetiology Pathophysiology Clinical manifestation Investigations Treatment Patient care Acknowledgement References Further reading Useful websites 51 - Leukaemia Epidemiology Aetiology Radiation Exposure to chemicals and cytotoxic drugs Viruses Genetic factors Haematological disorders Pathophysiology Acute leukaemias Classification of acute myeloblastic leukaemia Classification of acute lymphoblastic leukaemia Chronic leukaemias Chronic lymphocytic leukaemia Chronic myelocytic leukaemia Clinical manifestations Acute leukaemia Chronic leukaemia Chronic myelocytic leukaemia Chronic lymphocytic leukaemia Investigations Treatment Acute leukaemia Acute lymphoblastic leukaemia Acute myeloblastic leukaemia (non-acute promyelocytic leukaemia) Acute promyelocytic leukaemia Chronic leukaemia Chronic myelocytic leukaemia Chronic lymphocytic leukaemia Stem cell transplantation The basic principle Allografts and autografts Peripheral blood stem cells versus marrow stem cells Complications of allogeneic bone marrow transplantation Reduced intensity allografting The place of stem cell transplantation Patient care Supportive care Infection in the immunocompromised patient Preventive measures Treatment of infection References Further reading Useful websites 52 - Lymphomas Hodgkin’s lymphoma Aetiology Pathology Signs and symptoms Laboratory findings Investigations and staging Management Nodular lymphocyte-predominant Hodgkin’s lymphoma Classical Hodgkin’s Lymphoma New agents Non-Hodgkin’s lymphoma Aetiology Signs and symptoms Laboratory findings Histopathology and classification Diagnosis Molecular subtypes Staging Treatment Indolent non-Hodgkin’s lymphoma Aggressive non-Hodgkin’s lymphoma Very aggressive lymphoma Lymphoblastic lymphomas/leukaemia Patient care Counselling and support Patient-specific treatment modifications Supportive care Nausea and vomiting Tumour lysis syndrome Mucositis Bone marrow suppression Neutropenic sepsis Growth factor support References Further reading Useful websites 53 - Solid Tumours Epidemiology Aetiology Environmental factors Screening and prevention Screening Prevention Chemoprevention Cancer at the cellular level Oncogenes Tumour-suppressor genes The cancer cell Tumour growth Tumour spread Patient management Clinical assessment Presentation Diagnosis Tumour markers Staging investigations Staging classification Performance status Prognostic factors Treatment Treatment goals Treatment guidelines Treatment methods Cytotoxic chemotherapy Chemotherapy regimen Chemotherapy scheduling Chemotherapy dose Adjuvant chemotherapy Neo-adjuvant chemotherapy Synchronous chemoradiation Adverse effects of cytotoxic drugs Chemotherapy-specific adjunctive treatments Targeted therapies Epidermal growth factor receptor Vascular endothelial growth factor receptor Human epidermal growth factor receptor type 2 Capecitabine Management of patients receiving cytotoxic chemotherapy Prescription verification Cumulative dosing Dose modification or delay Drug interactions Patient information and counselling Symptom control Nausea and vomiting Pain control Bone marrow suppression Extravasation In-patient or outpatient treatment Domiciliary treatment Monitoring anticancer therapy Toxicity Response to treatment References Further reading Useful websites 54 - Rheumatoid Arthritis and Osteoarthritis Epidemiology Aetiology and pathophysiology Clinical manifestations Diagnosis Investigations Inflammatory markers Serology Auto-antibodies Other blood parameters Disease activity Treatment Drug treatment Disease-modifying anti-rheumatic drugs (conventional/synthetic) Glucocorticoids Non-steroidal anti-inflammatory drugs Biologic disease-modifying anti-rheumatic drugs Targeted synthetic disease-modifying anti-rheumatic drugs Rheumatoid arthritis treatment pathway Rheumatoid arthritis and pregnancy Patient care Epidemiology Pathophysiology Aetiology Diagnosis Management Non-pharmacological treatment Weight loss Exercise Physical aids Joint surgery Pharmacological management Recommended treatments for osteoarthritis Other therapies available for osteoarthritis management Future management Patient Care References Further reading Useful websites 55 - Gout and Hyperuricaemia Pathophysiology Risk factors Hyperuricaemia Genetics Age, sex and socioeconomics Renal disease Comorbidities Diet Alcohol Medication Presentation and diagnosis Course of disease Treatment Management of an acute attack Colchicine Non-steroidal anti-inflammatory drugs Corticosteroids Interleukin-1 inhibitors Management of chronic gout Allopurinol Febuxostat Selective urate reabsorption inhibitors (uricosuric agents) Benzbromarone Sulfinpyrazone Probenecid Lesinurad Uricolytics (uricases) Rasburicase Pegloticase Preventing gout flare when initiating urate-lowering therapy Colchicine NSAIDs Corticosteroids Patient care Acknowledgements References Further reading Useful websites 56 - Glaucoma Epidemiology Primary open-angle glaucoma Normal tension glaucoma Ocular hypertension Primary angle-closure glaucoma Secondary glaucoma Congenital glaucoma Aetiology Pathophysiology Clinical manifestations Primary open-angle glaucoma Chronic primary angle-closure glaucoma Acute primary angle closure Secondary glaucomas Investigations Perimetry (visual field testing) Pachymetry Nerve fibre analysis Treatment Primary open-angle glaucoma Medical treatment Surgical treatment Acute primary angle-closure glaucoma Normal tension glaucoma Secondary glaucoma Drug treatment Ocular prostanoids: prostaglandin analogues and prostamides Latanoprost Travoprost Tafluprost Bimatoprost β-Blockers Timolol Levobunolol Carteolol Betaxolol Carbonic anhydrase inhibitors Acetazolamide Topical carbonic anhydrase inhibitors Sympathomimetic agents Apraclonidine Brimonidine Topical miotics New drugs in development Combination products Fixed combination of timolol and dorzolamide Fixed combination of timolol and latanoprost Fixed combination of timolol and travoprost Fixed combination of timolol and bimatoprost Fixed combination of timolol and brimonidine Fixed combination of timolol and brinzolamide Fixed combination of timolol and tafluprost Fixed combination of brinzolamide and brimonidine Hyperosmotic agents Glycerol Mannitol Patient care Primary open-angle glaucoma Primary angle-closure glaucoma Patient adherence References Further Reading Useful websites 57 - Drug-induced Skin Disorders Diagnosis Drug-induced skin disorders Drug reactions causing changes in skin function Abnormal photosensitivity Pigmentary changes Nail changes Hair changes Changes to the skin’s immune system and skin malignancy Mild drug-induced skin disorders Drug-induced exanthems Urticaria and angioedema Pruritus Fixed drug eruptions Acneiform eruptions Psoriasiform eruptions Lichenoid eruptions Xerosis, eczematous eruptions and contact dermatitis Erythema nodosum Hand–foot reactions Severe drug-induced skin disorders Erythema multiforme Stevens–Johnson syndrome and toxic epidermal necrolysis Drug reaction with eosinophilia and systemic symptoms Acute generalised exanthematous pustulosis Erythroderma and exfoliative dermatitis Lupus erythematosus Vasculitis Skin necrosis Patient care References Further reading Useful websites 58 - Eczema and Psoriasis Pathology and clinical features Clinical types Atopic eczema Exacerbating factors Contact dermatitis Allergic contact dermatitis Irritant contact dermatitis Discoid eczema Dyshidrotic eczema Stasis eczema Asteatotic eczema Seborrhoeic dermatitis Treatment Emollients Bandaging Topical corticosteroids Antibiotics and corticosteroid combinations Calcineurin inhibitors Antihistamines Coal tar preparations Systemic therapies Corticosteroids Ciclosporin Azathioprine Methotrexate Mycophenolate mofetil Phototherapy Patient care Pathology and clinical features Precipitating factors Infections Drugs Koebner phenomenon Alcohol and smoking Emotional stress Clinical types Psoriasis vulgaris Guttate psoriasis Generalised pustular psoriasis Palmoplantar psoriasis Flexural psoriasis Erythrodermic psoriasis Psoriatic arthropathy Psoriatic nail disease Treatment Topical therapy Corticosteroids Vitamin D analogues Coal tar Dithranol Salicylic acid Topical treatment of psoriasis at special sites Scalp Flexures/Genitals Nails Phototherapy UVB Photochemotherapy with UVA after psoralen exposure Systemic therapy Methotrexate Ciclosporin Acitretin Hydroxyurea/hydroxycarbamide Fumaric acid esters Biologic therapy TNF-α antagonists IL-12/IL-23 antagonists IL-17 antagonists Patient care References Further reading Useful websites 59 - Wounds Structure of the skin Wound healing Factors affecting wound healing Age Diabetes Infection Nutrition Smoking Drugs Wound assessment Diabetic foot ulcers Epidemiology Aetiology Clinical signs Diagnosis Treatment Infection Other considerations Prevention of recurrence Leg ulcers Epidemiology Aetiology Venous ulcers Clinical signs Diagnosis Treatment Prevention of recurrence Arterial ulcers Clinical signs Diagnosis Treatment Prevention of recurrence Mixed ulcers Pressure ulcers Epidemiology Common sites of pressure ulcers Aetiology Clinical signs Category/stage I: non-blanchable erythema Category/stage II: partial skin loss Category/stage III: full-thickness skin loss Category/stage IV: full-thickness tissue loss Unstageable: depth unknown Suspected deep tissue injury: depth unknown Diagnosis Treatment Prevention of pressure ulcers Principles of wound management References 4 - APPENDICES 1 - Medical Abbreviations 2 - Glossary INDEX B C D E F G H I J K L M N O P Q R S T U V W X Y Z IBC IBC
