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Drug metabolism is a clinically important process occurring throughout the body, but principally in the liver, which determines the efficacy and toxicity of many of the most widely used drugs. Knowledge of drug metabolism is important in optimizing the use of drugs, maximizing benefits and minimizing harms.
Treatment decisions should be based on data from randomized controlled trials. However, trials are susceptible to bias, and there may be important limitations to the data. Critical appraisal of such studies will need to consider both the methodological rigour of the study and the applicability of the results to real-life clinical practice. Instead of simply glancing at the abstract, readers should...
Despite the fact that prescribing is one of the commonest medication interventions, the process involved is highly complex and therefore not surprisingly it is prone to significant error and misjudgement with potentially serious consequences for patients. This article takes a very simple clinical scenario in order to illustrate the principles which every prescriber should know.
Adverse drug reactions (ADRs) affect around 5–10% of medical in-patients, and one-half of ADRs occur prior to admission. In the USA, more than 100,000 patients die from ADRs each year, and as they are often missed, they should be considered in the differential diagnosis of a wide range of conditions. ADRs can be classified according to dose-relatedness, time-course, and susceptibility (DoTS). ADRs...
Pharmacokinetics is a tool for describing the movement of drugs through the body over time, and deals with the processes of absorption from the site of administration, distribution throughout the body, metabolism or conjugation of the drug, and elimination from the body. Pharmacokinetics can be thought of as what the patient does to the drug (whereas pharmacodynamics is what the drug does to the patient)...
Models of drug development are moving away from those traditionally represented by large multinational pharmaceutical companies. The reasons for this trend and the likely shape of the pharmaceutical industry of the future are discussed here. The principal targets of the approaches that have delivered the majority of the medicines available today are encompassed by the concept of a ‘receptor’. While...
Clinical pharmacology encompasses an understanding of how drugs work and their appropriate use in humans. This chapter gives an overview of the general principles, and subsequent contributions will explore these areas in more detail. Some recent references are included to guide reading around the topics discussed.
Prescribers should have some understanding of receptor mechanisms because many drugs commonly used in modern practice act on receptors, safe drug usage requires an understanding of receptor pharmacology and future advances in pharmacology and therapeutics are likely to develop from the discovery of further receptors and molecular modelling of drugs to interact with them. This article covers basic...
Stroke remains the second most common cause of death worldwide and the most common cause of neurological disability in the developed world. Progress has been made in the primary prevention of stroke through more aggressive treatment of risk factors, particularly hypertension, resulting in a fall in stroke incidence. However, there is still scope for improvement in secondary prevention, particularly...
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