,a LANGE medical book
h h h
Katzung & Trevor’s h h
Pharmacology h
Examination
&BoardReview h h
Eleventh Edition
h
Anthony J. Trevor, PhD h h h
Professor Emeritus of Pharmacology and Toxicology
h h h h h h
Department of Cellular & Molecular Pharmacology U
h h h h h h
niversity of California, San Francisco
h h h h
Bertram G. Katzung, MD, PhD h h h h
Professor Emeritus of Pharmacology
h h h
Department of Cellular & Molecular Pharmacology
h h h h h h
University of California, San Francisco
h h h h
Marieke Kruidering-Hall, PhD h h
Associate Professor & Academy Chair of Pharmacology EducationDepartm
h h h h h h h h
ent of Cellular & Molecular Pharmacology
h h h h h
University of California, San Francisco
h h h h
NewhYorkh Chicagoh SanhFranciscoh Athensh Londonh Madridh MexicohCityhMila
nh NewhDelhih Singaporeh Sydneyh Toronto
,Copyrighth ©h 2015,h 2013,h 2010,h 2008,h 2005,h 2002h byh McGraw-
Hillh Education.hAllh rightsh reserved.h Excepth ash permittedh underh theh Unitedh Statesh CopyrighthActh ofh 1976,hnohparthofhthishpublicationhmayhbehreproducedhorhdistribute
dhinhanyhformhorhbyhanyhmeans,horhstoredhinhahdatabasehorhretrievalhsystem,hwithouththehpriorhwrittenhpermissionhofhtheh publisher,hwithhthehexceptionhthaththehprogram
h listingshmayhbehentered,hstored,handhexecutedhinhah computerhsystem,hbuththeyhmayh nothbeh reproducedhforhpublication.
ISBN:h 978-0-07-182639-6
MHID:h 0-07-182639-4
Theh materialh inh thish eBookh alsoh appearsh inh theh printh versionh ofh thish title:h ISBN:h 978-0-07-
182635-8,hMHID:h0-07-182635-1.
eBookh conversionhbyh codeMantrahVersio
nh1.0
Allh trademarksh areh trademarksh ofh theirh respectiveh owners.h Ratherh thanh puth ah trademarkh symbolh afterh everyh occurrenceh ofh ah trademarkedh name,h weh useh namesh i
nh anheditorialhfashionhonly,handhtohthehbenefithofhthehtrademarkhowner,hwithhnohintentionhofhinfringementhofhthehtrademark.hWherehsuchhdesignationshappearhinhthishbo
ok,htheyhhavehbeenhprintedhwithhinitialhcaps.
McGraw-
HillhEducationheBooksharehavailablehathspecialhquantityhdiscountshtohusehashpremiumshandhsaleshpromotionshorhforhusehinhcorporatehtraininghprograms.hTohcontacthahrep
resentative,hpleasehvisiththehContacthUshpagehathwww.mhprofessional.com.
Previoush editionsh copyrighth©h 1998,h1995,h 1993,h 1990h byhAppletonh &h Lange.
Notice
Medicinehishanhever-
changinghscience.hAshnewhresearchhandhclinicalhexperiencehbroadenhourhknowledge,hchangeshinhtreatmenthandhdrughtherapyharehrequired.hThehauthorshandhthehpublishe
rhofhthishworkhhavehcheckedhwithhsourceshbelievedhtohbehreliablehinhtheirheffortshtohprovidehinformationhthathishcompletehandhgenerallyhinhaccordhwithhthehstandardsh ac
ceptedh ath theh timeh ofh publication.h However,h inh viewh ofh theh possibilityh ofh humanh errorh orh changesh inh medicalh sciences,h neitherh theh authorsh norh theh publisherhnorhan
yhotherhpartyhwhohhashbeenhinvolvedhinhthehpreparationhorhpublicationhofhthishworkhwarrantshthaththehinformationhcontainedhhereinhishinheveryhrespecthaccuratehorhcom
plete,handhtheyhdisclaimhallhresponsibilityhforhanyherrorshorhomissionshorhforhthehresultshobtainedhfromhusehofhthehinformationhcontainedhinhthishwork.hReadersharehenco
uragedhtohconfirmhthehinformationhcontainedhhereinhwithhotherhsources.hForhexamplehandhinhparticular,hreadersharehadvisedhtohcheckhthehproducthinformationhsheethincl
udedhinhthehpackagehofheachhdrughtheyhplanhtohadministerhtohbehcertainhthaththehinformationhcontainedhinhthishworkhishaccuratehandhthathchangeshhavehnothbeenhmadehi
nhthehrecommendedhdosehorhinhthehcontraindicationshforhadministration.hThishrecommendationhishofhparticularhimportancehinhconnectionhwithhnewhorhinfrequentlyhused
hdrugs.
TERMSh OFh USE
ThishishahcopyrightedhworkhandhMcGraw-
HillhEducationhandhitshlicensorshreservehallhrightshinhandhtohthehwork.hUsehofhthishworkhishsubjecthtohthesehterms.hExcepthashpermittedhunderhthehCopyrighthActhofh197
6handhthehrighthtohstorehandhretrievehonehcopyhofhthehwork,hyouhmayhnothdecompile,hdisassemble,hreversehengineer,hreproduce,hmodify,h createh derivativeh worksh based
h upon,h transmit,h distribute,h disseminate,h sell,h publishh orh sublicenseh theh workh orh anyh parth ofh ith withouth McGraw-
Hillh Education’shpriorhconsent.hYouhmayhusehthehworkhforhyourhownhnoncommercialhandhpersonalhuse;hanyhotherhusehofhthehworkhishstrictlyhprohibited.hYourhrighthtoh
usehthehworkhmayhbehterminatedhifhyouhfailhtohcomplyhwithhthesehterms.
THEhWORKhIShPROVIDEDh“AShIS.”hMcGRAW-
HILLhEDUCATIONhANDhITShLICENSORShMAKEhNOhGUARANTEEShORhWARRANTIEShAShTOhTHEhACCURACY,h ADEQUACYh ORh COMPLETENESSh
OFh ORh RESULTSh TOh BEh OBTAINEDh FROMh USINGh THEh WORK,h INCLUDINGh ANYh INFORMATIONhTHAThCANhBEhACCESSEDhTHROUGHhTHEhW
ORKhVIAhHYPERLINKhORhOTHERWISE,hANDhEXPRESSLYhDISCLAIMhANYhWARRANTY,hEXPRESShORhIMPLIED,hINCLUDINGhBUThNOThLIMITEDhTO
hIMPLIEDhWARRANTIEShOFhMERCHANTABILITYhORhFITNESShFORhAhPARTICULARhPURPOSE.hMcGraw-Hill
Educationhandhitshlicensorshdohnothwarranthorhguaranteehthaththehfunctionshcontainedhinhthehworkhwillhmeethyourhrequirementshorhthathitshoperationhwillhbehuninterrupte
dhorherrorhfree.hNeitherhMcGraw-
HillhEducationhnorhitshlicensorshshallhbehliablehtohyouhorhanyonehelsehforhanyhinaccuracy,herrorhorhomission,hregardlesshofhcause,hinhthehworkhorhforhanyhdamageshresult
inghtherefrom.hMcGraw-HillhEducationhhashnohresponsibilityhforhthehcontenthofhanyhinformationhaccessedhthroughhthehwork.hUnderhnohcircumstanceshshallhMcGraw-
HillhEducationhand/orhitshlicensorshbehliablehforhanyhindirect,hincidental,hspecial,hpunitive,hconsequentialhorhsimilarhdamageshthathresulthfromhthehusehofhorhinabilityhtoh
usehthehwork,hevenhifhanyhofhthemhhashbeenhadvisedhofhthehpossibilityhofhsuchhdamages.hThishlimitationhofhliabilityhshallhapplyhtohanyhclaimhorhcausehwhatsoeverhwhet
herhsuchhclaimhorhcausehariseshinhcontract,htorthorhotherwise.
, Contents
Prefaceh v
ph A IV
I
RH T
H
ph A RH T
H
DRUGS WITH IMPORTANT ACTIONS
h h h h
BASIC PRINCIPLES
h 1 ON SMOOTH MUSCLE 143
h h
1. Introduction 1 16. Histamine,h Serotonin,h &h theh Ergoth
Alkaloids 143
2. Pharmacodynamics 16
17. Vasoactiveh Peptides 152
3. Pharmacokinetics 26
18. Prostaglandinsh &h Otherh Eicosanoids 158
4. Drugh Metabolism 35
19. Nitrich Oxide,h Donors,h &h Inhibitors 165
5. Pharmacogenomics 41
20. DrugshUsedhinhAsthmah&hChronichO
ph A RH T
H II bstructiveh Pulmonaryh Disease 169
AUTONOMIC DRUGS 47
V
h
ph A RH T
H
6. IntroductionhtohAutonomichPharmacology 47 DRUGS THAT ACT IN THE CENTRAL
h h h h h h
NERVOUS SYSTEM 179 h
7. Cholinoceptor-Activating
&h Cholinesterase-Inhibitingh Drugs 60
21. IntroductionhtohCNShPharmacology 179
8. Cholinoceptorh Blockersh &h Cholinesteraseh
Regenerators 69 22. Sedative-Hypnotich Drugs 186
23. Alcohols 194
9. Sympathomimetics 76
24. Antiseizureh Drugs 201
10. Adrenoceptorh Blockers 85
25. Generalh Anesthetics 208
ph A RH T
H III
26. Localh Anesthetics 216
CARDIOVASCULAR DRUGS 93 h
27. SkeletalhMusclehRelaxants 221
11. Drugsh Usedh inh Hypertension 93
28. Drugsh Usedh inh Parkinsonismh &h Otherh
12. Drugsh Usedh inh theh Treatmenth ofh Anginah Movementh Disorders 229
Pectoris 103
29. Antipsychotich Agentsh &h Lithium 236
13. DrugshUsedhinhHearthFailure 112
30. Antidepressants 244
14. Antiarrhythmich Drugs 121
31. Opioidh Analgesicsh &h Antagonists 252
15. Diureticsh &h Otherh Drugsh Thath Acth onh theh
Kidney 132 32. Drugshofh Abuse 260
iii
h h h
Katzung & Trevor’s h h
Pharmacology h
Examination
&BoardReview h h
Eleventh Edition
h
Anthony J. Trevor, PhD h h h
Professor Emeritus of Pharmacology and Toxicology
h h h h h h
Department of Cellular & Molecular Pharmacology U
h h h h h h
niversity of California, San Francisco
h h h h
Bertram G. Katzung, MD, PhD h h h h
Professor Emeritus of Pharmacology
h h h
Department of Cellular & Molecular Pharmacology
h h h h h h
University of California, San Francisco
h h h h
Marieke Kruidering-Hall, PhD h h
Associate Professor & Academy Chair of Pharmacology EducationDepartm
h h h h h h h h
ent of Cellular & Molecular Pharmacology
h h h h h
University of California, San Francisco
h h h h
NewhYorkh Chicagoh SanhFranciscoh Athensh Londonh Madridh MexicohCityhMila
nh NewhDelhih Singaporeh Sydneyh Toronto
,Copyrighth ©h 2015,h 2013,h 2010,h 2008,h 2005,h 2002h byh McGraw-
Hillh Education.hAllh rightsh reserved.h Excepth ash permittedh underh theh Unitedh Statesh CopyrighthActh ofh 1976,hnohparthofhthishpublicationhmayhbehreproducedhorhdistribute
dhinhanyhformhorhbyhanyhmeans,horhstoredhinhahdatabasehorhretrievalhsystem,hwithouththehpriorhwrittenhpermissionhofhtheh publisher,hwithhthehexceptionhthaththehprogram
h listingshmayhbehentered,hstored,handhexecutedhinhah computerhsystem,hbuththeyhmayh nothbeh reproducedhforhpublication.
ISBN:h 978-0-07-182639-6
MHID:h 0-07-182639-4
Theh materialh inh thish eBookh alsoh appearsh inh theh printh versionh ofh thish title:h ISBN:h 978-0-07-
182635-8,hMHID:h0-07-182635-1.
eBookh conversionhbyh codeMantrahVersio
nh1.0
Allh trademarksh areh trademarksh ofh theirh respectiveh owners.h Ratherh thanh puth ah trademarkh symbolh afterh everyh occurrenceh ofh ah trademarkedh name,h weh useh namesh i
nh anheditorialhfashionhonly,handhtohthehbenefithofhthehtrademarkhowner,hwithhnohintentionhofhinfringementhofhthehtrademark.hWherehsuchhdesignationshappearhinhthishbo
ok,htheyhhavehbeenhprintedhwithhinitialhcaps.
McGraw-
HillhEducationheBooksharehavailablehathspecialhquantityhdiscountshtohusehashpremiumshandhsaleshpromotionshorhforhusehinhcorporatehtraininghprograms.hTohcontacthahrep
resentative,hpleasehvisiththehContacthUshpagehathwww.mhprofessional.com.
Previoush editionsh copyrighth©h 1998,h1995,h 1993,h 1990h byhAppletonh &h Lange.
Notice
Medicinehishanhever-
changinghscience.hAshnewhresearchhandhclinicalhexperiencehbroadenhourhknowledge,hchangeshinhtreatmenthandhdrughtherapyharehrequired.hThehauthorshandhthehpublishe
rhofhthishworkhhavehcheckedhwithhsourceshbelievedhtohbehreliablehinhtheirheffortshtohprovidehinformationhthathishcompletehandhgenerallyhinhaccordhwithhthehstandardsh ac
ceptedh ath theh timeh ofh publication.h However,h inh viewh ofh theh possibilityh ofh humanh errorh orh changesh inh medicalh sciences,h neitherh theh authorsh norh theh publisherhnorhan
yhotherhpartyhwhohhashbeenhinvolvedhinhthehpreparationhorhpublicationhofhthishworkhwarrantshthaththehinformationhcontainedhhereinhishinheveryhrespecthaccuratehorhcom
plete,handhtheyhdisclaimhallhresponsibilityhforhanyherrorshorhomissionshorhforhthehresultshobtainedhfromhusehofhthehinformationhcontainedhinhthishwork.hReadersharehenco
uragedhtohconfirmhthehinformationhcontainedhhereinhwithhotherhsources.hForhexamplehandhinhparticular,hreadersharehadvisedhtohcheckhthehproducthinformationhsheethincl
udedhinhthehpackagehofheachhdrughtheyhplanhtohadministerhtohbehcertainhthaththehinformationhcontainedhinhthishworkhishaccuratehandhthathchangeshhavehnothbeenhmadehi
nhthehrecommendedhdosehorhinhthehcontraindicationshforhadministration.hThishrecommendationhishofhparticularhimportancehinhconnectionhwithhnewhorhinfrequentlyhused
hdrugs.
TERMSh OFh USE
ThishishahcopyrightedhworkhandhMcGraw-
HillhEducationhandhitshlicensorshreservehallhrightshinhandhtohthehwork.hUsehofhthishworkhishsubjecthtohthesehterms.hExcepthashpermittedhunderhthehCopyrighthActhofh197
6handhthehrighthtohstorehandhretrievehonehcopyhofhthehwork,hyouhmayhnothdecompile,hdisassemble,hreversehengineer,hreproduce,hmodify,h createh derivativeh worksh based
h upon,h transmit,h distribute,h disseminate,h sell,h publishh orh sublicenseh theh workh orh anyh parth ofh ith withouth McGraw-
Hillh Education’shpriorhconsent.hYouhmayhusehthehworkhforhyourhownhnoncommercialhandhpersonalhuse;hanyhotherhusehofhthehworkhishstrictlyhprohibited.hYourhrighthtoh
usehthehworkhmayhbehterminatedhifhyouhfailhtohcomplyhwithhthesehterms.
THEhWORKhIShPROVIDEDh“AShIS.”hMcGRAW-
HILLhEDUCATIONhANDhITShLICENSORShMAKEhNOhGUARANTEEShORhWARRANTIEShAShTOhTHEhACCURACY,h ADEQUACYh ORh COMPLETENESSh
OFh ORh RESULTSh TOh BEh OBTAINEDh FROMh USINGh THEh WORK,h INCLUDINGh ANYh INFORMATIONhTHAThCANhBEhACCESSEDhTHROUGHhTHEhW
ORKhVIAhHYPERLINKhORhOTHERWISE,hANDhEXPRESSLYhDISCLAIMhANYhWARRANTY,hEXPRESShORhIMPLIED,hINCLUDINGhBUThNOThLIMITEDhTO
hIMPLIEDhWARRANTIEShOFhMERCHANTABILITYhORhFITNESShFORhAhPARTICULARhPURPOSE.hMcGraw-Hill
Educationhandhitshlicensorshdohnothwarranthorhguaranteehthaththehfunctionshcontainedhinhthehworkhwillhmeethyourhrequirementshorhthathitshoperationhwillhbehuninterrupte
dhorherrorhfree.hNeitherhMcGraw-
HillhEducationhnorhitshlicensorshshallhbehliablehtohyouhorhanyonehelsehforhanyhinaccuracy,herrorhorhomission,hregardlesshofhcause,hinhthehworkhorhforhanyhdamageshresult
inghtherefrom.hMcGraw-HillhEducationhhashnohresponsibilityhforhthehcontenthofhanyhinformationhaccessedhthroughhthehwork.hUnderhnohcircumstanceshshallhMcGraw-
HillhEducationhand/orhitshlicensorshbehliablehforhanyhindirect,hincidental,hspecial,hpunitive,hconsequentialhorhsimilarhdamageshthathresulthfromhthehusehofhorhinabilityhtoh
usehthehwork,hevenhifhanyhofhthemhhashbeenhadvisedhofhthehpossibilityhofhsuchhdamages.hThishlimitationhofhliabilityhshallhapplyhtohanyhclaimhorhcausehwhatsoeverhwhet
herhsuchhclaimhorhcausehariseshinhcontract,htorthorhotherwise.
, Contents
Prefaceh v
ph A IV
I
RH T
H
ph A RH T
H
DRUGS WITH IMPORTANT ACTIONS
h h h h
BASIC PRINCIPLES
h 1 ON SMOOTH MUSCLE 143
h h
1. Introduction 1 16. Histamine,h Serotonin,h &h theh Ergoth
Alkaloids 143
2. Pharmacodynamics 16
17. Vasoactiveh Peptides 152
3. Pharmacokinetics 26
18. Prostaglandinsh &h Otherh Eicosanoids 158
4. Drugh Metabolism 35
19. Nitrich Oxide,h Donors,h &h Inhibitors 165
5. Pharmacogenomics 41
20. DrugshUsedhinhAsthmah&hChronichO
ph A RH T
H II bstructiveh Pulmonaryh Disease 169
AUTONOMIC DRUGS 47
V
h
ph A RH T
H
6. IntroductionhtohAutonomichPharmacology 47 DRUGS THAT ACT IN THE CENTRAL
h h h h h h
NERVOUS SYSTEM 179 h
7. Cholinoceptor-Activating
&h Cholinesterase-Inhibitingh Drugs 60
21. IntroductionhtohCNShPharmacology 179
8. Cholinoceptorh Blockersh &h Cholinesteraseh
Regenerators 69 22. Sedative-Hypnotich Drugs 186
23. Alcohols 194
9. Sympathomimetics 76
24. Antiseizureh Drugs 201
10. Adrenoceptorh Blockers 85
25. Generalh Anesthetics 208
ph A RH T
H III
26. Localh Anesthetics 216
CARDIOVASCULAR DRUGS 93 h
27. SkeletalhMusclehRelaxants 221
11. Drugsh Usedh inh Hypertension 93
28. Drugsh Usedh inh Parkinsonismh &h Otherh
12. Drugsh Usedh inh theh Treatmenth ofh Anginah Movementh Disorders 229
Pectoris 103
29. Antipsychotich Agentsh &h Lithium 236
13. DrugshUsedhinhHearthFailure 112
30. Antidepressants 244
14. Antiarrhythmich Drugs 121
31. Opioidh Analgesicsh &h Antagonists 252
15. Diureticsh &h Otherh Drugsh Thath Acth onh theh
Kidney 132 32. Drugshofh Abuse 260
iii
