Cover Page


Title Page

Preface to The Third Edition

Clinical pharmacology is relevant to most aspects of medicine and a basic knowledge of it is essential for those healthcare professionals involved in the clinical management of patients. With this in mind, it has become necessary to update the previous (second) edition in order to incorporate evolvements in this field.

The first edition of Hands-on Guide to Clinical Pharmacology was written by Alexander Milson, Christopher Tofield and me while we were still medical students (at St Bartholomew's & The Royal London Hospital School of Medicine and Dentistry). At that time, we were in need of a practical yet concise set of notes to revise clinical pharmacology. Hence, what started as a collated set of revision notes was soon expanded upon, structured and turned into the first edition.

Following the success of that original version, it soon became evident that an updated second edition was required and in demand. To the credit of all those involved in the making of that text, this success has continued to date. In this third edition, each chapter has been updated and the information expanded to include more drugs and management scenarios, as well as a new chapter on chemotherapy agents.

The purpose of this book has primarily been two-fold and remains unchanged. First, it is designed to serve as a revision aid for all students involved in the study of clinical pharmacology. Second, it is presented as a user-friendly rapid reference guide and should be of value to healthcare professionals such as medical students, doctors, pharmacists and nurses.

This book is a guide to those drugs that are most likely to be encountered on hospital wards or during a course of study. It also outlines the treatment regimens of common conditions. The most relevant and important interactions, adverse effects and contraindications have been selected. However, it is not intended as an exhaustive account of clinical pharmacology and doses have purposely been omitted. Further, more detailed information is best obtained from a local formulary (e.g. British National Formulary).

The aim for this book has always been accuracy while maintaining conciseness -- a feature that is much valued by students and busy professionals! Certainly, this book will help you to manage pharmacology in a clinical setting and, above all, take the stress out of related exams!

S. Chatu


First and foremost, I would like to acknowledge the input of my co-authors from the first and second editions of this book, Alexander Milson and Christopher Tofield. Their contributions laid the foundation for this latest edition.

The three of us will always be grateful for the support we received, in getting the first edition off the ground, from Professor Nigel Benjamin and Professor Mark Caulfield while at St Bartholomew's & the Royal London Hospital School of Medicine and Dentistry.

I am sincerely grateful to all those colleagues who took time out of their busy schedules to check all the material and for kindly offering me their expert suggestions.

For the opportunity to update this book to its third edition I must extend my thanks to Wiley-Blackwell and also to all the staff involved in its production.

Finally, I send my heartfelt thanks to all the readers who have always been vital to the success of this venture.

Sukhdev Chatu


ABG Arterial blood gas
ACE Angiotensin-converting enzyme
ADH Antidiuretic hormone
ADP Adenosine diphosphate
AF Atrial fibrillation
ALT Alanine transaminase
APTT Activated partial thromboplastin time
ARB Angiotensin-receptor blocker
5-ASA 5-aminosalicylic acid
AST Aspartate transaminase
ATP Adenosine triphosphate
AV Atrioventricular
BCG Bacillus Calmette–Guérin
BMI Body mass index
BP Blood pressure
BPH Benign prostatic hyperplasia
BMI Body mass index
cAMP Cyclic adenosine monophosphate
CABG Coronary artery bypass graft
CBT Cognitive behavioural therapy
CCU Coronary care unit
cGMP Cyclic guanosine monophosphate
CLL Chronic lymphoid leukaemia
CMV Cytomegalovirus
CNS Central nervous system
COC Combined oral contraceptive
COMT Catechyl-O-methyl transferase
COPD Chronic obstructive pulmonary disease
COX Cyclo-oxygenase
CPAP Continuous positive airways pressure
CPR Cardiopulmonary resuscitation
CSF Cerebrospinal fluid
CT Computerized tomography
CTG Cardiotocography
CVA Cerebrovascular accident
CXR Chest X-ray
D2 Dopamine2
DC Direct current
DDP-4 Dipeptidyl peptidase-4
DEXA Dual energy X-ray absorptiometry
DMARD Disease-modifying antirheumatic drug
DNA Deoxyribonucleic acid
DT Diphtheria, tetanus
DTP Diphtheria, tetanus, pertussis
DVT Deep vein thrombosis
EBV Epstein–Barr virus
ECG Electrocardiogram
ECT Electroconvulsive therapy
EPO Erythropoietin
FBC Full blood count
FEV1 Forced expiratory volume in 1 second
FSH Follicle-stimulating hormone
5-FU 5-fluorouracil
GABA Gamma-aminobutyric acid
G-CSF Granulocyte-colony stimulating factor
GI Gastrointestinal
GIP Glucose-dependent insulinotropic polypeptide
GIST Gastrointestinal stromal tumour
GLP-1 Glucagon-like peptide 1
GP General practitioner
G6PD Glucose-6-phosphate dehydrogenase
GTN Glyceryl trinitrate
HAART Highly active antiretroviral therapy
HACEK Haemophilus (H. parainfluenzae, H. aphrophilus, H. paraphrophilus), Actinobacillus actinomycetemcomitans (Aggregatibacter actinomycetemcomitans) Cardiobacterium hominis, Eikenella corrodens, Kingella kingae
Hb Haemoglobin
HbA1c Haemoglobin A1c
HBsAg Hepatitis B surface antigen
HDL High-density lipoprotein
Hib Haemophilus influenzae type b
H1 Histamine1
H2 Histamine2
HIV Human immunodeficiency virus
HMG-CoA 3-hydroxy 3-methylglutaryl co-enzyme A
HOCM Hypertrophic obstructive cardiomyopathy
HPV Human papilloma virus
HRT Hormone replacement therapy
5-HT 5-hydroxytryptamine
ICD Implantable cardiac defibrillator
Ig Immunoglobulin
IHD Ischaemic heart disease
IM Intramuscular
INR International normalized ratio
ISA Intrinsic sympathomimetic activity
ISDN Isosorbide dinitrate
ISMN Isosorbide mononitrate
ITU Intensive therapy unit
IUCD Intrauterine contraceptive device
IV Intravenous
LABA Long-acting beta agonist
LDL Low-density lipoprotein
LFT Liver function test
LMWH Low-molecular-weight heparin
LV Left ventricular
LVEF Left ventricular ejection fraction
LVF Left ventricular failure
MAb Monoclonal antibody
MAO Monoamine oxidase
MAOI Monoamine oxidase inhibitor
MI Myocardial infarction
MMR Measles, mumps, rubella
MRSA Methicillin-resistant Staphylococcus aureus
NMDA N-methyl-D-aspartate
MMSE Mini Mental State Examination
NRT Nicotine replacement therapy
NRTI Nucleoside reverse transcriptase inhibitor
NRTK Non-receptor tyrosine kinase
NSAID Non-steroidal anti-inflammatory drug
Pco2 Partial pressure carbon dioxide
Po2 Partial pressure oxygen
PCA Patient-controlled analgesia
PCI Percutaneous coronary intervention
PDE5 Phosphodiesterase type 5
PE Pulmonary embolism
PEFR Peak expiratory flow rate
PGE2 Prostaglandin E2
PID Pelvic inflammatory disease
POP Progestogen-only pill
PPAR Peroxisome proliferator-activated receptor
PPI Proton-pump inhibitor
PTH Parathyroid hormone
PUVA Psoralen with ultraviolet A
PSVT Paroxysmal supraventricular tachycardia
PVD Peripheral vascular disease
RNA Ribonucleic acid
RTK Receptor tyrosine kinase
SA Sinoatrial
SC Subcutaneous
SIADH Syndrome of inappropriate antidiuretic hormone
SLE Systemic lupus erythematosus
SSRI Selective serotonin re-uptake inhibitor
STAT-C Specifically targeted antiviral therapy for hepatitis C
SVT Supraventricular tachycardia
T3 Triiodothyronine
T4 Thyroxine
TCA Tricyclic antidepressant
TENS Transcutaneous electrical nerve stimulation
TIA Transient ischaemic attack
TIBC Total iron-binding capacity
TKI Tyrosine kinase inhibitor
TNF Tumour necrosis factor
tPA Tissue plasminogen activator
TPMT Thiopurine methyltransferase
TSH Thyroid-stimulating hormone
U&Es Urea and electrolytes
UTI Urinary tract infection
UVB Ultraviolet B
V2 Vasopressin2
VF Ventricular fibrillation
VLDL Very low-density lipoprotein
V/Q Ventilation/perfusion
VRE Vancomycin-resistant enterococci
VT Ventricular tachycardia
WPW Wolff–Parkinson–White