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Drug Treatment of Cardiac Arrhythmias
367
BOOK REVIEWS
Mayo Clin Proc, May 1984, Vol 59
ied rodents. (They prefer pellets over gels, liquids, and powders.) The final section covers precursor control of serotonergic and catecholaminergic function, the regulation of levels of tyrosine and tryptophan, the effects of diet, and the physiologic and pharmacologic implications of these facts. This volume and the others in this series constitute a comprehensive practical reference source that contains review articles and bibliographies on topics related to nutrition and the brain. It will be useful to physicians, neuroscientists, public health and nutrition specialists, and pharmacologists. Shelley A. Cross, M.D. Department of Neurology
Pharmacology: Drug Actions and Reactions, 3rd ed, by Ruth R. Levine, 526 pp, with illus, $19.95, Boston, Little, Brown & Company, 1983 An understanding of the basic principles of pharmacology is essential to the learning of drug actions and interactions. This book illustrates such principles in a simplistic fashion that can be understood by all health professionals. I am proud to attest to this fact on the basis of my experience with the first edition of this book as a student of pharmacology. The format of presentation in this book motivated me and sparked my enthusiasm for further expansion of my interest in pharmacology. Moreover, that experience has certainly influenced my recommending this book to pharmacology students who are in various disciplines such as pharmacy, pharmacology, and medicine. The author stated her objectives in the first edition: "I have tried to prepare a text that alone will provide the nonprofessional with a basic understanding of pharmacology but that may also serve as an introduction for those who will be professionally concerned with the interactions of drugs and living organisms. I hope, too, that this book will serve the further purpose of implementing the presentation of pharmacology in nonprofessional schools so that students in biology, chemistry, psychology, physical education, and premedical programs as well as those in other fields will have the opportunity to acquire some training in one of the youngest of the experimental medical sciences—pharmacology." These objectives are still well demonstrated throughout the third edition of the book. The constructive modifications that evolved over the years, in response to suggestions from students and teachers, add further d i -
mension to this well-organized and concisely written
book. An opening chapter on the history of pharmacology is refreshing to read, and the subsequent chapters describe definitions, basic principles and mechanisms of action, absorption, distribution, excretion, and biotransformation of drugs. Additionally, general principles of the quantitative aspects of drug action are demonstrated with several appropriate illustrations. Other valuable sections describe factors that modify drug effects, toxicity, and pharmacologic highlights of drug abuse and drug dependence. The comprehensive review of the development and evaluation of new drugs is highly useful and is presented in such a manner that all health professionals can understand and appreciate the magnitude of work involved in bringing a drug into clinical use. The concepts and principles of pharmacology are well illustrated with examples of common therapeutic agents. Similar principles are also demonstrated with other chemicals that affect the physiology and biochemistry of living organisms. The approach of introducing concepts in a simple manner and developing them into more complex states assists the understanding of readers from diverse backgrounds. The section entitled "Guides for Study and Review" is extremely valuable for students. The glossary and appendices are other aids to enhance fast learning. I heartily recommend this book to those who have a genuine interest in learning the general principles of pharmacology. Prince K. Zachariah, M.D. Division of Hypertension and Internal Medicine
Drug Treatment of Cardiac Arrhythmias, edited by Lawrence A. Gould, 436 pp, with illus, $49.50, Mount Kisco, New York, Futura Publishing Company, 1983 For several years, physicians in the United States have been limited to four basic drugs—quinidine, procainamide, ß-blockers, and disopyramide—for treating cardiac arrhythmias. In recent years, a number of new antiarrhythmic agents have become available for clinical use outside of the United States. Now an increasing number of patients within the United States are receiving these new drugs as participants in clinical investigations or under compassionate use when their arrhythmias are not controlled by standard therapy. Many patients who are taking these drugs are under the surveillance of cardiologists or internists in their home area who may not
Mayo Clin Proc, May 1984, Vol 59
be very familiar with the drugs. Therefore, this book, which includes detailed discussions of the standard drugs and also many of the drugs currently being investigated, provides a valuable guide to practicing internists and cardiologists who are frequently asked to treat patients with cardiac arrhythmias. The book contains 19 chapters written by 27 clinical investigators who are very experienced and knowledgeable concerning antiarrhythmic agents. Thirteen of the chapters are based on individual antiarrhythmic agents. A chapter on digitalis as an antiarrhythmic drug and a chapter on the role of vasodilators in treating arrhythmias are also included. Atropine and sympathomimetic amines are discussed as antiarrhythmic agents in individual chapters. Each chapter reviews the history of the drug, its pharmacologic and electrophysiologic characteristics, contraindications, toxicity, and interactions with other agents. The suggested dosage and route of administration are also provided for each agent. The major emphasis of this volume is on the pharmacologic and electrophysiologic aspects of these drugs. Although brief consideration is given to the indications for treatment with these drugs and their role in the management of arrhythmias, this discussion is rather limited. The indications for treating asymptomatic premature ventricular beats or ventricular tachycardia remain somewhat controversial. This book deals more with the agents that are available for treating these arrhythmias and much less with whether the arrhythmia should be treated. A large portion of the book details drugs that are not yet clinically available. This is useful, well-presented information but may be of minimal interest to the practicing clinician who is not treating patients with investigational drugs. The available drugs are included, but the presentations are less detailed. In this regard, the chapter on verapamil as an antiarrhythmic agent is rather sketchy. Of the drugs that are currently available for treating arrhythmias, the chapter on digitalis as an antiarrhythmic drug and the chapter on treatment of cardiac arrhythmias with propranolol and other ß-blockers are outstanding. Of the chapters on investigational drugs, the one on amiodarone is best presented. With our ever-increasing emphasis on electrocardiographic monitoring of patients in medical intensive care units and the more frequent use of ambulatory 24-hour monitoring techniques, cardiac arrhythmias are now being identified more frequently. It is becoming increasingly clear that some arrhythmias identified might be ignored, whereas others may be signaling potentially life-threatening events. We do not yet know all of the prognostic factors for these arrhythmias or the impact of drug therapy on the associated prognosis. This book will
BOOK REVIEWS
368
not provide a definitive answer on which arrhythmias to treat, but once the decision has been made to treat, it can provide the clinician with a valuable collection of the basic facts on most antiarrhythmic drugs currently available by prescription and for investigational use. Because the field of investigational antiarrhythmic drugs is rapidly expanding, some promising drugs, such as propafenone, are not included in this book. This is a well-written, concise compendium of valuable information on antiarrhythmic drugs which provides a well-ordered and easy-to-use reference source on the clinical experience, pharmacologic actions, and side effects of antiarrhythmic drugs. It will be a useful addition to the library of practicing cardiologists and internists who care for patients with cardiac arrhythmias. Michael B. Mock, M.D. Division of Cardiovascular Diseases and Internal Medicine
Developmental-Behavioral Pediatrics, by Melvin D. Levine, William B. Carey, Allen C. Crocker, and Ruth T. Gross, 1,253 pp, with illus, $79, Philadelphia, W. B. Saunders Company, 1983 Developmental-Behavioral Pediatrics represents an ambitious undertaking to provide a comprehensive textbook for a relatively new field. Indeed, the authors have made major contributions to that new field and intend to create an even newer field by use of the hyphen in their title. Developmental pediatrics and behavioral pediatrics have been developing as separate fields, and it does make admirable sense for them to become more cohesive. All of the editors are well-known pediatricians; they have solicited chapters from pediatricians, child psychiatrists, psychologists, neurologists, nurses, educators, social workers, speech and language pathologists, recreational therapists, and others. Surprisingly, despite the multiplicity of authors and disciplines, the book maintains a sense of unity. In part, this cohesiveness comes from the editorial arrangement of the book into eight sections: background, patterns of variation over time, milieus and circumstances, biologic influences, outcomes during childhood, assessing and describing variation, enhancing development and adaptation, and professionals and children. I have high praise for the book. The list of topics is comprehensive, as the book has 64 chapters and 1,253 pages. Most of the chapters are written by acknowledged experts. The discussions of the effects of physical matura-
BOOK REVIEWS
Mayo Clin Proc, May 1984, Vol 59
ied rodents. (They prefer pellets over gels, liquids, and powders.) The final section covers precursor control of serotonergic and catecholaminergic function, the regulation of levels of tyrosine and tryptophan, the effects of diet, and the physiologic and pharmacologic implications of these facts. This volume and the others in this series constitute a comprehensive practical reference source that contains review articles and bibliographies on topics related to nutrition and the brain. It will be useful to physicians, neuroscientists, public health and nutrition specialists, and pharmacologists. Shelley A. Cross, M.D. Department of Neurology
Pharmacology: Drug Actions and Reactions, 3rd ed, by Ruth R. Levine, 526 pp, with illus, $19.95, Boston, Little, Brown & Company, 1983 An understanding of the basic principles of pharmacology is essential to the learning of drug actions and interactions. This book illustrates such principles in a simplistic fashion that can be understood by all health professionals. I am proud to attest to this fact on the basis of my experience with the first edition of this book as a student of pharmacology. The format of presentation in this book motivated me and sparked my enthusiasm for further expansion of my interest in pharmacology. Moreover, that experience has certainly influenced my recommending this book to pharmacology students who are in various disciplines such as pharmacy, pharmacology, and medicine. The author stated her objectives in the first edition: "I have tried to prepare a text that alone will provide the nonprofessional with a basic understanding of pharmacology but that may also serve as an introduction for those who will be professionally concerned with the interactions of drugs and living organisms. I hope, too, that this book will serve the further purpose of implementing the presentation of pharmacology in nonprofessional schools so that students in biology, chemistry, psychology, physical education, and premedical programs as well as those in other fields will have the opportunity to acquire some training in one of the youngest of the experimental medical sciences—pharmacology." These objectives are still well demonstrated throughout the third edition of the book. The constructive modifications that evolved over the years, in response to suggestions from students and teachers, add further d i -
mension to this well-organized and concisely written
book. An opening chapter on the history of pharmacology is refreshing to read, and the subsequent chapters describe definitions, basic principles and mechanisms of action, absorption, distribution, excretion, and biotransformation of drugs. Additionally, general principles of the quantitative aspects of drug action are demonstrated with several appropriate illustrations. Other valuable sections describe factors that modify drug effects, toxicity, and pharmacologic highlights of drug abuse and drug dependence. The comprehensive review of the development and evaluation of new drugs is highly useful and is presented in such a manner that all health professionals can understand and appreciate the magnitude of work involved in bringing a drug into clinical use. The concepts and principles of pharmacology are well illustrated with examples of common therapeutic agents. Similar principles are also demonstrated with other chemicals that affect the physiology and biochemistry of living organisms. The approach of introducing concepts in a simple manner and developing them into more complex states assists the understanding of readers from diverse backgrounds. The section entitled "Guides for Study and Review" is extremely valuable for students. The glossary and appendices are other aids to enhance fast learning. I heartily recommend this book to those who have a genuine interest in learning the general principles of pharmacology. Prince K. Zachariah, M.D. Division of Hypertension and Internal Medicine
Drug Treatment of Cardiac Arrhythmias, edited by Lawrence A. Gould, 436 pp, with illus, $49.50, Mount Kisco, New York, Futura Publishing Company, 1983 For several years, physicians in the United States have been limited to four basic drugs—quinidine, procainamide, ß-blockers, and disopyramide—for treating cardiac arrhythmias. In recent years, a number of new antiarrhythmic agents have become available for clinical use outside of the United States. Now an increasing number of patients within the United States are receiving these new drugs as participants in clinical investigations or under compassionate use when their arrhythmias are not controlled by standard therapy. Many patients who are taking these drugs are under the surveillance of cardiologists or internists in their home area who may not
Mayo Clin Proc, May 1984, Vol 59
be very familiar with the drugs. Therefore, this book, which includes detailed discussions of the standard drugs and also many of the drugs currently being investigated, provides a valuable guide to practicing internists and cardiologists who are frequently asked to treat patients with cardiac arrhythmias. The book contains 19 chapters written by 27 clinical investigators who are very experienced and knowledgeable concerning antiarrhythmic agents. Thirteen of the chapters are based on individual antiarrhythmic agents. A chapter on digitalis as an antiarrhythmic drug and a chapter on the role of vasodilators in treating arrhythmias are also included. Atropine and sympathomimetic amines are discussed as antiarrhythmic agents in individual chapters. Each chapter reviews the history of the drug, its pharmacologic and electrophysiologic characteristics, contraindications, toxicity, and interactions with other agents. The suggested dosage and route of administration are also provided for each agent. The major emphasis of this volume is on the pharmacologic and electrophysiologic aspects of these drugs. Although brief consideration is given to the indications for treatment with these drugs and their role in the management of arrhythmias, this discussion is rather limited. The indications for treating asymptomatic premature ventricular beats or ventricular tachycardia remain somewhat controversial. This book deals more with the agents that are available for treating these arrhythmias and much less with whether the arrhythmia should be treated. A large portion of the book details drugs that are not yet clinically available. This is useful, well-presented information but may be of minimal interest to the practicing clinician who is not treating patients with investigational drugs. The available drugs are included, but the presentations are less detailed. In this regard, the chapter on verapamil as an antiarrhythmic agent is rather sketchy. Of the drugs that are currently available for treating arrhythmias, the chapter on digitalis as an antiarrhythmic drug and the chapter on treatment of cardiac arrhythmias with propranolol and other ß-blockers are outstanding. Of the chapters on investigational drugs, the one on amiodarone is best presented. With our ever-increasing emphasis on electrocardiographic monitoring of patients in medical intensive care units and the more frequent use of ambulatory 24-hour monitoring techniques, cardiac arrhythmias are now being identified more frequently. It is becoming increasingly clear that some arrhythmias identified might be ignored, whereas others may be signaling potentially life-threatening events. We do not yet know all of the prognostic factors for these arrhythmias or the impact of drug therapy on the associated prognosis. This book will
BOOK REVIEWS
368
not provide a definitive answer on which arrhythmias to treat, but once the decision has been made to treat, it can provide the clinician with a valuable collection of the basic facts on most antiarrhythmic drugs currently available by prescription and for investigational use. Because the field of investigational antiarrhythmic drugs is rapidly expanding, some promising drugs, such as propafenone, are not included in this book. This is a well-written, concise compendium of valuable information on antiarrhythmic drugs which provides a well-ordered and easy-to-use reference source on the clinical experience, pharmacologic actions, and side effects of antiarrhythmic drugs. It will be a useful addition to the library of practicing cardiologists and internists who care for patients with cardiac arrhythmias. Michael B. Mock, M.D. Division of Cardiovascular Diseases and Internal Medicine
Developmental-Behavioral Pediatrics, by Melvin D. Levine, William B. Carey, Allen C. Crocker, and Ruth T. Gross, 1,253 pp, with illus, $79, Philadelphia, W. B. Saunders Company, 1983 Developmental-Behavioral Pediatrics represents an ambitious undertaking to provide a comprehensive textbook for a relatively new field. Indeed, the authors have made major contributions to that new field and intend to create an even newer field by use of the hyphen in their title. Developmental pediatrics and behavioral pediatrics have been developing as separate fields, and it does make admirable sense for them to become more cohesive. All of the editors are well-known pediatricians; they have solicited chapters from pediatricians, child psychiatrists, psychologists, neurologists, nurses, educators, social workers, speech and language pathologists, recreational therapists, and others. Surprisingly, despite the multiplicity of authors and disciplines, the book maintains a sense of unity. In part, this cohesiveness comes from the editorial arrangement of the book into eight sections: background, patterns of variation over time, milieus and circumstances, biologic influences, outcomes during childhood, assessing and describing variation, enhancing development and adaptation, and professionals and children. I have high praise for the book. The list of topics is comprehensive, as the book has 64 chapters and 1,253 pages. Most of the chapters are written by acknowledged experts. The discussions of the effects of physical matura-