Chapter

Fundamentals of Drug Therapy in Neurology

Michael V. Johnston and Robert A. Gross

in Principles of Drug Therapy in Neurology

Second edition

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780195146837
Published online April 2013 | e-ISBN: 9780199322961 | DOI: http://dx.doi.org/10.1093/med/9780195146837.003.0012

Series: Contemporary Neurology Series

Fundamentals of Drug Therapy in Neurology

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The number of drugs available for treatment of neurological disorders continues to expand steadily and the aim of this book is to provide a perspective for neurologists, psychiatrists, and other clinicians on how they can be used effectively. This perspective includes information about the pathophysiology of disease as well as drug interactions with the nervous system and the rest of the body. This introductory chapter deals with the fundamental concepts that are common to more specific treatment issues covered in detail in the rest of the book (Table 1–1). First we discuss some major molecular targets of drug action in the nervous system, an area that has expanded greatly as a result of the use of molecular genetic and electrophysiological techniques. The interaction of drugs with these targets is generally known as pharmacodynamics (PD) or the study of mechanisms of action and the relationship between drug concentration and effect. Then we discuss the absorption, distribution, metabolism and elimination of drugs, which determine their pharmacokinetics (PK). Taken together, a drug’s PD and PK characteristics define its therapeutic window or the range of dose and/ or blood level at which it has optimal effect with minimal side effects. For many drugs these characteristics are under genetic control and this is the major focus of the field of pharmacogenetics. Genetic variation in the distribution and metabolism of drugs as well as in targets of drug action such as ion channels and neurotransmitter receptors are being recognized at an increasing rate. Pharmacogenetic factors can influence the dose of a drug required for treatment of individual patients, as well as its efficacy if a mutation is present in its molecular target of action. Another important factor that strongly influences drug therapy in neurology is the toxicity of these drugs. Because they target the nervous system, these drugs are prone to produce potentially disabling effects on cognition and other brain functions and this often influences the choice of drugs for individual patients. Finally we discuss the influence of age on effects of nervous system drugs, especially on fetuses, pregnant women, and elderly individuals.

Chapter.  15744 words.  Illustrated.

Subjects: Neurology

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