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(Ebook PDF) Julien'S Primer of Drug Action: A Comprehensive Guide To The Actions, Uses, and Side Effects of Psychoactive Drugs 14Th Edition
(Ebook PDF) Julien'S Primer of Drug Action: A Comprehensive Guide To The Actions, Uses, and Side Effects of Psychoactive Drugs 14Th Edition
(Ebook PDF) Julien'S Primer of Drug Action: A Comprehensive Guide To The Actions, Uses, and Side Effects of Psychoactive Drugs 14Th Edition
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CONTENTS
Preface
PART 1
Introduction to Psychopharmacology
Biological Basis of Drug Action
1 Pharmacokinetics: How Drugs Are Handled by the Body
Drug Absorption
Drug Distribution
Termination of Drug Action
Time Course of Drug Distribution and Elimination: The Concept of
Drug Half-Life
Drug Half-Life, Accumulation, and Steady State
Therapeutic Drug Monitoring
Drug Tolerance and Dependence
2 The Neuron, Synaptic Transmission, and Neurotransmitters
Overall Organization of the Brain
Overview of Synaptic Transmission
Specific Neurotransmitters
Monoaminergic Neurotransmitters
3 Pharmacodynamics: How Drugs Act
Receptors for Drug Action
Dose–Response Relationships
Variability in Drug Responsiveness—The Therapeutic Index
PART 2
Pharmacology of Drugs of Abuse
Therapeutic Potential for Drugs of Abuse
4 Epidemiology and Neurobiology of Addiction
Extent of the Drug Problem
Nosology and Psychopathology of Substance Abuse
Neurobiology of Addiction
Pharmacotherapy of Substance Use Disorders
New Directions
5 Ethyl Alcohol and the Inhalants of Abuse
ETHYL ALCOHOL
Pharmacokinetics of Alcohol
Pharmacodynamics
Pharmacological Effects
Psychological Effects
Tolerance, Dependence, and Withdrawal
Toxicity
Teratogenic Effects
Alcoholism and Its Pharmacological Treatment
INHALANTS OF ABUSE
Why Inhalants Are Abused and Who Abuses Them
Consequences of Acute Use of Inhalants
Long-Term Consequences of Chronic Inhalant Abuse
Chapter 5 Appendix: What is a Drink? How Much Alcohol is in
Your Drink?
6 Caffeine and Nicotine
CAFFEINE
Pharmacokinetics
Pharmacological Effects
Mechanism of Action
Reproductive Effects
Tolerance and Dependence
NICOTINE
Epidemiology and Public Policy
Pharmacokinetics
Mechanism of Action
Pharmacological Effects
Tolerance and Dependence
Toxicity
Effects of Passive Smoke
Effects During Pregnancy
Pharmacological Approaches to Nicotine Dependence
8 Psychedelic Drugs
Scopolamine: The Prototype Anticholinergic (ACh) Psychedelic
Monoaminergic Psychedelics
Catecholaminergic Psychedelics
Serotonergic Psychedelics
Glutaminergic NMDA Receptor Antagonists
Salvinorin A
9 Cannabis: A New Look at an Ancient Plant
Epidemiology
History
What Is Cannabis?
Mechanism of Action: Cannabinoid Receptors
Endocannabinoids
Pharmacokinetics
Pharmacological Effects of Cannabis
Synthetic Cannabinoid Agonists of Abuse
Cannabis Tolerance, Withdrawal, Addiction, and Dependence
Treatment Issues
10 Opioid Analgesics
Opioid Misuse and Abuse
Opioid Terminology
History
Pain Signaling
Opioid Receptors
Major Pharmacological Effects of Opiates
Genetic Opioid Metabolic Defects
Tolerance and Dependence
Full Opioid Agonists
Partial Agonists
Mixed Agonist-Antagonist Opioids
Pure Opioid Antagonists
Novel Opioid-Based Compounds Under Development
Future Pharmacotherapy of Opioid Dependence
Illicit Opioids of Abuse
PART 3
Psychotherapeutic Drugs
11 Antipsychotic Drugs
Schizophrenia
Historical Background and Classification of Antipsychotic Drugs
First-Generation Antipsychotics
Second-Generation Antipsychotics
Prominent Side Effects of Second-Generation Antipsychotics
CATIE and CUtLASS Studies
In the Pipeline
Recommendations for the Treatment of Schizophrenia
Additional Applications for Second-Generation Antipsychotics
12 Antidepressant Drugs
Depression
First-Generation Antidepressants
Heterocyclic Antidepressants
Selective Serotonin Reuptake Inhibitors
Serotonin + Norepinephrine Reuptake Inhibitors
Serotonin-2 Antagonists/Reuptake Inhibitors (SARIs)
Noradrenergic/Specific Serotonergic Antidepressant (NaSSA)
Atypical Antidepressant Drugs or SSRI + Drugs
STAR*D Study
Additional, Alternative, and Future Approaches to Treatment
Ketamine and Other Glutaminergic Antagonists
Experimental Agents
In the Pipeline
13 Anxiolytics, Sedative Hypnotics, Anesthetics, and
Anticonvulsants
Clinical Indications
Historical Background
Sites and Mechanisms of Action
Sedative-Induced Brain Dysfunction
Barbiturates
Nonbarbiturate Sedative-Hypnotic Drugs
Benzodiazepines
Flumazenil: A Benzodiazepine Receptor Antagonist
New Approaches for the Treatment of Anxiety
Drugs Intended for the Treatment of Insomnia
General Anesthetics
Antiepileptic Drugs
14 Drugs Used to Treat Bipolar Disorder
Bipolar Disorder
Diagnostic and Treatment Issues
STEP-BD Study
Mood Stabilizers: Lithium
Mood Stabilizers: Antiepileptic Drugs
Atypical Antipsychotics for Bipolar Disorder
In the Pipeline
Psychotherapeutic and Psychosocial Treatments
PART 4
Special Populations and Integration
15 Child and Adolescent Psychopharmacology
Pregnancy and Psychotropic Drugs
Drugs of Abuse in Children and Adolescents
Antidepressants in Childhood and Adolescence
Antipsychotics in Children and Adolescents
Anxiolytics in Children and Adolescents
Medications for the Treatment of Bipolar Disorder
Medications for Treating Autism Spectrum Disorders
Medications for Treating Behavioral or Aggressive Disorders
Analgesics in Childhood and Adolescence
Attention Deficit/Hyperactivity Disorder
16 Geriatric Psychopharmacology
Inappropriate Drug Use in the Elderly
Control of Agitated and Aggressive Behaviors in the Elderly
Undertreatment of the Elderly: Focus on Depression
Parkinson’s Disease
Alzheimer’s Disease
17 Challenging Times for Mental Health
Epidemiology of Mental Illness
First, there has been continued expansion of the clinical indications for
the major therapeutic drug classes. These ongoing changes reflect efforts on
the part of the pharmaceutical companies to expand the use of their products
to a broader array of behavioral health conditions.
We are indebted to our colleagues, who review each edition and offer
valuable criticism and suggestions for improvement. Their input is very
much appreciated and we have attempted to incorporate their
recommendations as much as possible. While making every effort to
accommodate many of their proposals, we acknowledge and regret that we
may have fallen short in some instances.
Dedication
Robert M. Julien, MD, Ph.D., was solely responsible for originally authoring
and regularly updating this well-known book for over 30 years, beginning
with the first edition in 1975. Dr. Julien’s unique achievement was to author a
text that has served for decades to make the immense amount of information
accessible and timely to all those interested in understanding this important
area of study. It is a testament to his expertise and dedication that the Primer
of Drug Action has through the years attained and maintained its reputation
as a resource that is always relevant, accurate, and remarkably up to date.
Beginning with the eleventh edition, published in 2008, we have been
honored to have been selected by Bob to join him in contributing to this
stellar work. Only by being involved as authors over the last three editions
and now the current one have we fully appreciated what a tremendous
accomplishment it is for one person to have done what Bob has
accomplished. And on top of his immense scholarship, integrity, and
generosity, Bob is a wonderful person who is a delight to work with and who
we are grateful to call our friend and colleague. So, it is a great honor to
dedicate this fourteenth edition of Julien’s Primer of Drug Action to Dr.
Robert Julien on the occasion of his seventy-fifth birthday. Happy Birthday,
Bob!
Introduction to
Psychopharmacology
This book specifically concerns drugs that affect the brain and behavior. It
is an introduction to psychopharmacology, presenting not only drugs useful
in treating psychological disorders, but also drugs prone to compulsive use
and abuse. The book begins with three chapters devoted to the fundamentals
of drug action.
Pharmacokinetics:
How Drugs Are Handled by the
Body
When we have a headache, we take it for granted that after taking some
aspirin our headache will probably disappear within 15 to 30 minutes. We
also take it for granted that, unless we take more aspirin later, the headache
may recur within 3 or 4 hours. This familiar scenario illustrates four basic
processes in the branch of pharmacology called pharmacokinetics. Using
the aspirin example, the four processes are as follows:
1. Absorption of the aspirin into the body from the swallowed tablet
2. Distribution of the aspirin throughout the body, including into a fetus if
a female is pregnant at the time the drug is taken
3. Metabolism (detoxification or breakdown) of the drug as the aspirin that
has exerted its analgesic effect is broken down into metabolites (by-
products or waste products) that no longer exert any effect
4. Elimination of the metabolic waste products, usually in the urine
On other occasions the ants endeavour to drag them into the interior
of the nest, as if desirous of retaining their company: the Paussus
then makes no resistance to its hosts; if, however, it be touched,
even very slightly, by an observer, it immediately bombards: the ants,
as may be imagined, do not approve of this, and run away. Nothing
has ever been observed that would lead to the belief that the ants
derive any benefit from the presence of the Paussi, except that these
guests bear on some part of the body—frequently the great
impressions on the pronotum—patches of the peculiar kind of
pubescence that exists in many other kinds of ants'-nest beetles,
and is known in some of them to secrete a substance the ants are
fond of, and that the ants have been seen to lick the beetles. On the
other hand, the Paussi have been observed to eat the eggs and
larvae of the ants. The larva of Paussus is not known,[95] and
Raffray doubts whether it lives in the ants' nests. There are about
200 species of Paussidae known, Africa, Asia and Australia being
their chief countries; one species, P. favieri, is not uncommon in the
Iberian peninsula and South France, and a single species was
formerly found in Brazil. The position the family should occupy has
been much discussed; the only forms to which they make any real
approximation are Carabidae, of the group Ozaenides, a group of
ground beetles that also crepitate. Burmeister and others have
therefore placed the Paussidae in the series Adephaga, but we
follow Raffray's view (he being the most recent authority on the
family),[96] who concludes that this is an anomalous group not
intimately connected with any other family of Coleoptera, though
having more affinity to Carabidae than to anything else. The recently
discovered genus Protopaussus has eleven joints to the antennae,
and is said to come nearer to Carabidae than the previously known
forms did, and we may anticipate that a more extensive knowledge
will show that the family may find a natural place in the Adephaga.
The description of the abdomen given by Raffray is erroneous; in a
specimen of the genus Arthropterus the writer has dissected, he
finds that there are five ventral segments visible along the middle, six
at the sides, as in the families of Adephaga generally. There is said
to be a great difference in the nervous systems of Carabidae and
Paussidae, but so little is known on this point that we cannot judge
whether it is really of importance.
The larvae (Fig. 99, A) are purely aquatic, and are highly modified for
this life, being elongate creatures, with sharp, mandibles and nine
abdominal segments, each segment bearing on each side a trachea
branchia; these gills assist to some extent in locomotion. The
stigmata are quite obsolete, but the terminal segment bears four
processes, one pair of which may be looked on as cerci, the other as
a pair of gills corresponding with the pair on each of the preceding
segments. The mandibles are not suctorial, but, according to
Meinert, possess an orifice for the discharge of the secretion of a
mandibular gland. Gyrinidae are chiefly carnivorous in both the larval
and imaginal instars. Fully 300 species are known; they are
generally distributed, though wanting in most of the islands of the
world except those of large size. The finest forms are the Brazilian
Enhydrus and the Porrorhynchus of tropical Asia.[97] In Britain we
have nine species, eight of Gyrinus, one of Orectochilus; the latter
form is rarely seen, as it hides during the day, and performs its rapid
gyrations at night.
The Gyrinidae are one of the most distinct of all the families of
Coleoptera: by some they are associated in the Adephagous series;
but they have little or no affinity with the other members thereof.
Without them the Adephaga form a natural series of evidently allied
families, and we consider it a mistake to force the Gyrinidae therein
because an objection is felt by many taxonomists to the maintenance
of isolated families. Surely if there are in nature some families allied
and others isolated, it is better for us to recognise the fact, though it
makes our classifications look less neat and precise, and increases
the difficulty of constructing "tables."
The larvae of the aquatic division of the family have been to a certain
extent studied by Schiödte and others; those of the Sphaeridiides—
the terrestrial group of the family—are but little known. All the larvae
seem to be predaceous and carnivorous, even when the imago is of
vegetable-feeding habits; and Duméril states that in Hydrous
caraboides the alimentary canal undergoes a great change at the
period of metamorphosis, becoming very elongate in the adult,
though in the larva it was short. The legs are never so well
developed as they are in the Adephaga, the tarsi being merely claw-
like or altogether wanting; the mandibles are never suctorial. The
respiratory arrangements show much diversity. In most of the
Hydrophilides the process is carried on by a pair of terminal spiracles
on the eighth abdominal segment, as in Dytiscidae, and these are
either exposed or placed in a respiratory chamber. In Berosus the
terminal stigmata are obsolete, and the sides of the body bear long
branchial filaments. Cussac says that in Spercheus (Fig. 101) there
are seven pairs of abdominal spiracles, and that the larva breathes
by presenting these to the air;[98] but Schiödte states that in this form
there are neither thoracic nor abdominal spiracles, except a pair
placed in a respiratory chamber on the eighth segment of the
abdomen, after the manner described by Miall as existing in
Hydrobius. No doubt Cussac was wrong in supposing the peculiar
lateral abdominal processes to be stigmatiferous. In Berosus there
are patches of aëriferous, minute pubescence on the body. The
pupae of Hydrophilides repose on the dorsal surface, which is
protected by spinous processes on the pronotum, and on the sides
of the abdomen.
The larvae of several of the larger forms of Silphidae are well known,
but very little has been ascertained as to the smaller forms. Those of
the burying-beetles have spiny plates on the back of the body, and
do not resemble the other known forms of the family. The rule is that
the three thoracic segments are well developed, and that ten
abdominal segments are also distinct; the ninth abdominal segment
bears a pair of cerci, which are sometimes elongate. Often the dorsal
plates are harder and better developed than is usual in Coleopterous
larvae. This is especially the case with some that are endowed with
great powers of locomotion, such as S. obscura (Fig. 104). The food
of the larvae is as a rule decomposing animal or vegetable matter,
but some are predaceous, and attack living objects. The larger
Silpha larvae live, like the Necrophorus, on decomposing animal
matter, but run about to seek it; hence many specimens of some of
these large larvae may sometimes be found amongst the bones of a
very small dead bird. We have found the larva and imago of S.
thoracica in birds' nests containing dead nestlings. S. atrata and S.
laevigata make war on snails. S. lapponica enters the houses in
Lapland and ravages the stores of animal provisions. S. opaca
departs in a very decided manner from the habits of its congeners,
as it attacks beetroot and other similar crops in the growing state; it
is sometimes the cause of serious loss to the growers of beet. The
larvae of the group Anisotomides are believed to be chiefly
subterranean in habits; that of A. cinnamomea feeds on the truffle,
and the beetle is known as the truffle-beetle.