CLINICAL PHARMACOLOGY 2003 (PART 4)

Clinical pharmacology comprises all aspects of the scientific study of drugs in man. Its objective is to optimise drug therapy and it is justified in so far as it is of practical use.Over recent years pharmacology has undergone great expansion resulting from technology that allows the understanding of molecular action and the capacity to exploit this. The potential consequences for therapeutics are enormous. All cellular mechanisms (normal and pathological), in their immense complexity are, in principle, identifiable. What seems almost an infinity of substances, transmitters, local hormones, cell growth factors, can be made, modified and tested to provide agonists,...
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CLINICAL PHARMACOLOGY 2003 (PART 4) 2 Clinical pharmacology SYNOPSIS circumstances of infinite variety is vital to success without harm: to maximise benefit and minimise Clinical pharmacology comprises all aspects of risk. All these issues are the concern of clinical the scientific study of drugs in man. Its pharmacologists and are the subject of this book. objective is to optimise drug therapy and it is The drug and information explosion of the past justified in so far as it is of practical use. six decades combined with medical need has called into being the discipline, clinical pharmacology. The discipline is now recognised as both a healthOver recent years pharmacology has undergone great care and an academic specialty; indeed, no med-expansion resulting from technology that allows the ical school can now be considered complete with-understanding of molecular action and the capacity out a department or subdepartment of Clinicalto exploit this. The potential consequences for thera- Pharmacology.peutics are enormous. All cellular mechanisms The clinical pharmacologists role is to provide(normal and pathological), in their immense com- facts and opinions that are useful for optimising theplexity are, in principle, identifiable. What seems treatment of patients. Therapeutic success with drugsalmost an infinity of substances, transmitters, local is becoming more and more dependent on the userhormones, cell growth factors, can be made, modified having at least an outline understanding of bothand tested to provide agonists, partial agonists, pharmacodynamics and pharmacokinetics. And thisinverse agonists and antagonists. And interference outline is quite simple and easy to acquire. Howeverwith genetic disease processes is now possible. humane and caring doctors may be, they cannotIncreasingly large numbers of substances will deserve dispense with scientific skill.to be investigated in therapeutics and used foraltering physiology to the perceived advantage (realor imagined) of humans. But, with all these developments and their poten- • the general aspects of rational, safe and effective drugtial for good, comes capacity for harm, whether therapyinherent in the substances or as a result of human • drug therapy of individual diseasesmisapplication. • introduction of new medicines. Successful use of the power conferred (by bio-technology in particular) requires understanding ofthe enormous complexity of the consequences of Pharmacology is commonly practised in concertinterference. Willingness to learn the principles of with other clinical specialties. More detailed aspectspharmacology and how to apply them in individual comprise: 37 2 CLINICAL PHARMACOLOGY1. Pharmacology a special kind of investigator is required, one • Pharmacodynamics: how drugs, alone and in whose training has equipped him not only with the combination, affect the body (young, old, principles and technics of laboratory well, sick) pharmacology but also with knowledge of clinical • Pharmacokinetics: absorption, distribution, medicine ... metabolism, excretion or, how the body, well Clinical scientists of all kinds do not differ or sick, affects drugs fundamentally from other biologists; they are set2. Therapeutic evaluation apart only to the extent that there are special • Whether a drug is of value difficulties and limitations, ethical and practical, in • How it may best be used seeking knowledge from man.2 • Formal therapeutic trials Pharmacology is the same science whether animal • Surveillance studies for both efficacy and or man is investigated. The need for it grows rapidly safety (adverse effects): as not only scientists, but now the whole community, pharmacoepide ...