Medical Pharmacology at a Glance

Citation

Neal, M. J. (2020). Medical Pharmacology at a Glance (9th ed.). Wiley-Blackwell.

Chapter Summary

The ninth edition runs to 128 pages and contains 47 chapters, each a two-page spread: a large summary diagram on one page and concise text on the facing page. The front matter includes a list of core drugs, a further-reading list and a note on the companion website (online cases, flashcards and the core drug list, according to Wiley); the book ends with case studies and questions, with answers. The sample chapter published by Wiley shows how a spread works: the figure maps where drugs act, and the text explains it in short paragraphs that point repeatedly to the later chapter where each drug group is treated. The chapters below are grouped as the contents run; the titles are the book's.

Chapters 1–4: Introduction: principles of drug action; Drug–receptor interactions; Drug absorption, distribution and excretion; Drug metabolism

The general principles occupy eight pages. Chapter 1 defines pharmacodynamics and pharmacokinetics, then surveys the targets through which drugs act: receptors (ligand-gated channels, G-protein-coupled, nuclear and kinase-linked receptors), ion channels, enzymes and transport systems, with second messengers and G-proteins explained in outline. Chapters 2–4 cover drug–receptor interactions and the movement of drugs through the body, ending with metabolism.

Chapters 5–10: Local anaesthetics; Drugs acting at the neuromuscular junction; Autonomic nervous system; Autonomic drugs acting at cholinergic synapses; Drugs acting on the sympathetic system; Ocular pharmacology

The peripheral nervous system block begins with local anaesthetics (the sample chapter refers to this chapter for the basic structure of voltage-gated channels) and the neuromuscular junction, then reviews the autonomic nervous system before its cholinergic and sympathetic drugs. Ocular pharmacology closes the group, a topic that Stringer's contents, for comparison, do not list.

Chapters 11–14: Asthma, hay fever and anaphylaxis; Drugs acting on the gastrointestinal tract I: peptic ulcer; Drugs acting on the gastrointestinal tract II: motility and secretions; Drugs acting on the kidney: diuretics

From here the book is largely organised by condition and organ: the respiratory and allergic conditions, two chapters on the gut, and the diuretics.

Chapters 15–21: Drugs used in hypertension; Drugs used in angina; Antiarrhythmic drugs; Drugs used in heart failure; Drugs used to affect blood coagulation; Lipid-lowering drugs; Agents used in anaemias

The cardiovascular and blood chapters take one condition or problem per spread: hypertension, angina, arrhythmias, heart failure, coagulation, lipids and anaemia.

Chapters 22–31: Central transmitter substances; General anaesthetics; Anxiolytics and hypnotics; Antiepileptic drugs; Drugs used in Parkinson's disease; Antipsychotic drugs (neuroleptics); Drugs used in affective disorders: antidepressants; Opioid analgesics; Drugs used in nausea and vertigo (antiemetics); Drug misuse and dependence

The central nervous system block opens with a chapter on central transmitters, the CNS counterpart to the autonomic review, then moves through anaesthesia, anxiety and sleep, epilepsy, Parkinson's disease, psychosis, depression, pain and nausea, and ends with drug misuse and dependence.

Chapters 32–36: Non-steroidal anti-inflammatory drugs (NSAIDs); Corticosteroids; Sex hormones and drugs; Thyroid and antithyroid drugs; Antidiabetic agents

Anti-inflammatory drugs and the endocrine chapters: corticosteroids, sex hormones, thyroid drugs and the drugs used in diabetes.

Chapters 37–43: Antibacterial drugs that inhibit nucleic acid synthesis; Antibacterial drugs that inhibit cell wall synthesis; Antibacterial drugs that inhibit protein synthesis; Antifungal drugs; Antiviral drugs; Drugs acting on parasites I: helminths (worms); Drugs acting on parasites II: protozoa

The antimicrobial chapters return to a mechanism-based layout. The three antibacterial spreads are defined by target, and their full titles name the groups each covers: sulphonamides, trimethoprim, quinolones and nitroimidazoles; penicillins, cephalosporins and vancomycin; aminoglycosides, tetracyclines, macrolides and chloramphenicol. Antifungal, antiviral and antiparasitic drugs follow.

Chapters 44–47: Drugs used in cancer; Immunosuppressants and antirheumatoid drugs; Poisoning; Adverse drug reactions

The book closes with cancer chemotherapy, immunosuppression and antirheumatoid drugs, poisoning, and a final chapter on adverse drug reactions, followed by the case studies and questions.

Key Concepts

Chapters 1–4: General principles

• Pharmacodynamics and pharmacokinetics: what the drug does to the body, and what the body does to the drug over time (absorption, distribution, metabolism and excretion).
• Agonists and antagonists: drugs that activate receptors, and drugs that bind without activating and so reduce the action of the natural agonist.
• Four receptor families: ligand-gated ion channels, G-protein-coupled receptors, nuclear receptors and kinase-linked receptors.
• Second messengers: intracellular signals such as calcium, cAMP, InsP3 and diacylglycerol that link receptor activation to the cellular response.

Chapters 5–31: Nervous system, organ systems and the CNS

• Autonomic transmission: cholinergic and sympathetic synapses as the targets of a large group of peripheral drugs.
• Central transmitter substances: the brain's transmitters, introduced before the CNS drug chapters.
• Drug misuse and dependence: treated as a pharmacological topic in its own right.

Chapters 32–47: Endocrine, antimicrobial and cancer drugs; safety

• Antibacterial targets: nucleic acid synthesis, cell wall synthesis and protein synthesis.
• Immunosuppression: drugs that damp the immune response, grouped with antirheumatoid drugs.
• Adverse drug reactions: unwanted effects, ranging from trivial to fatal, given a chapter of their own.

Critical Analysis

Strengths

• A diagram for every topic. The two-page format puts a single explanatory figure at the centre of each chapter, and the text is written to be read against it. For students who learn visually, or who need a fast overview, this is the book's defining feature.
• Organised around conditions. Wiley describes the chapters as organised around common diseases and conditions, and the contents confirm it for the organ-system and CNS chapters (asthma, peptic ulcer, hypertension, angina, Parkinson's disease, affective disorders). This mirrors how clinical teaching is usually structured.
• Dense cross-referencing. The sample chapter refers to more than a dozen later chapters, so the opening principles are tied immediately to the drugs that illustrate them; the same habit makes the book easy to use for revision.
• Self-testing built in. Case studies with questions and answers at the end of the book, a core drug list in the front matter and online cases and flashcards give students ways to check their recall.
• Long-established and updated. This is the ninth edition, which Wiley says was revised for current guidelines and drug information, with new and revised illustrations.

Limitations

• Very short. At 128 pages for the whole of pharmacology, each topic has two pages. The book offers an overview and a revision aid, not the explanation of mechanisms, evidence and clinical reasoning that a full textbook gives.
• Compressed general principles. Pharmacokinetics and pharmacodynamics take four spreads in all; students who need to work through quantitative pharmacokinetics will need another source.
• Mixed organisation. The organ-system and CNS chapters are arranged by condition, but the antimicrobial chapters by mechanism, and some classes appear across many spreads: the index entries for β-blockers and for propranolol and atenolol point to the spreads on the sympathetic system, the eye, hypertension, angina, arrhythmias, heart failure and anxiolytics. Students who want to learn a drug class as a whole need to assemble it from several spreads.
• UK orientation. The author is an emeritus professor at King's College London, the spelling is British (anaesthetics, anaemias) and the text refers to prescribing guidelines; North American students may need to adjust terms and check local guidance.

Where It Fits in the Course

This is one of two short entry points to the pharmacology course, and the more visual one. Stringer's Basic Concepts in Pharmacology is the other: 48 short prose chapters organised by drug class, each opening with how the class is organised and using a "Trivia Sorter" to fix mechanism, side effects, unique features and interactions. The two complement each other: Stringer is better for learning a drug class as a system, Neal for seeing where drugs act and which drugs are used for a given condition.

Brenner and Stevens' Pharmacology is a mid-length textbook that covers each drug class through mechanism, pharmacokinetics, clinical uses, adverse effects and interactions; it is the natural main text to read alongside Neal. Katzung's Basic & Clinical Pharmacology and Rang and Dale's Pharmacology are the comprehensive references, Katzung linking prototype drugs to clinical use with case studies and questions, Rang and Dale building from biological targets. Neal's spreads work well as a map before a chapter in any of these, and as a revision summary afterwards.

How to Use This Book

Wiley presents the book as a companion for medical and healthcare students and as a revision tool for pharmacology examinations and the USMLE. It assumes basic physiology and biochemistry; the chapters on the autonomic nervous system and on central transmitters supply the neuroscience background the drug chapters need.

A practical plan:

• Read Chapters 1–4 first, slowly, figure and text together. They set out the vocabulary (receptor types, agonists and antagonists, second messengers, absorption and metabolism) used on every later spread.
• Then use the spreads alongside the course. Before a lecture on a system, read the matching spread; afterwards, redraw its figure from memory and add what the lecture covered.
• Learn the core drug list. Use the front-matter list as a checklist and make a simple table for each drug: mechanism, main use, main adverse effects.
• Use the cases at the end once a block of chapters is finished, and the companion website's flashcards and cases for spaced revision.
• Go deeper when needed. For quantitative pharmacokinetics or for a drug class studied as a whole, turn to a longer textbook; Neal is a map and a revision summary, not a full course on its own.