Pharmacology in Rehabilitation, 3rd ed.

Ciccone CD. Philadelphia, PA 19103, FA Davis Co, 2002, hardcover, 701 pp, illus, ISBN: 0-8036-0779-2, $54.95.

Unlike many pharmacology textbooks, this book was written specifically for rehabilitation professionals and primarily for physical therapists. The author is a physical therapist with expertise in pharmacology, which lends a unique professional perspective to this textbook. Case examples relevant to physical therapists are inserted at the end of every chapter, providing the reader with specific insights on how the drug class discussed in the chapter can interact with a therapy regimen. The cases also provide an opportunity for readers to reflect on their experiences with patients who are receiving a particular drug therapy. The author uses a generous number of tables, charts, and diagrams to help organize and explain drug-related concepts.

This book consists of 37 chapters, which are organized into 8 sections. Most of these sections have been updated since the second edition of this book. The first section covers general principles of pharmacology and discusses the pharmacodynamics and pharmacokinetics involved in drug therapy. These chapters review drug administration, absorption, distribution, and elimination as well as drug receptor theory. This information lays the foundation for the remaining sections, which deal with the various drug classes. Each chapter has subsections that describe the various drugs or substances that fall into that class. The author also discusses the rationale for drug treatment for a particular disorder, the selection of specific agents to manage the disorder, the problems and adverse effects associated with a particular drug class, the mechanism of action, and, finally, special considerations and concerns for patients in rehabilitation.

Section 2 describes central nervous system pharmacology and begins with a brief description of the various brain structures most likely involved in drug interactions. This is followed by an explanation of the different neurotransmitters involved in drug-receptor interactions. The author includes sedative-hypnotic, antianxiety, antipsychotic, antiepileptic, antiparkinsonian, and anesthetic (local and general) drugs in this group. Whenever a drug class is discussed within the context of a disease such as Parkinson disease, the author provides a concise overview of the disease, making the relationship between drug and target tissue clear.

Section 3 covers drugs that affect skeletal muscle relaxation in the treatment of spasticity. Drugs such as baclofen, dantrolene sodium, and gabapentin are included, along with newer additions such as tizanidine and botulinum toxin. Section 4 describes drugs used to treat pain and inflammation, including the opioid analgesics, nonsteroidal antiinflammatory drugs, patient-controlled analgesia (PCA), and drugs used in the pharmacological management of both rheumatoid arthritis and osteoarthritis. Section 5 covers autonomic and cardiovascular pharmacology. The anatomy and physiology of the autonomic nervous system are explained as a lead-in to a more in-depth discussion of adrenergic, cholinergic, and antihypertensive drugs. The author also discusses drugs used in the management of angina, arrhythmias, and congestive heart failure and the treatment of coagulation disorders.

Section 6 explains respiratory and gastrointestinal pharmacology. Specific drugs include the antitussives, decongestants, antihistamines, and expectorants. Ciccone describes the pathophysiology of the conditions, including cystic fibrosis and asthma, managed by these drugs. The gastrointestinal compounds described include the [H.sub.2]-receptor blockers and proton pump inhibitors. The author makes a concerted effort to subtly update the reader on new findings that may be relevant in the treatment of a disorder. For example, he describes the bacterial nature (H pylori) underlying gastric ulcer disease and the rationale for the use of antibiotics in the management of this condition.

Section 7 covers endocrine pharmacology and begins with an explanation of the endocrine organs and hormones that each produces. After reviewing endocrine physiology and pharmacology, the author embarks on a description of several hormone groups including the adrenocorticosteroids, male and female hormones, thyroid/ parathyroid hormones, and pancreatic hormones. The chapter dealing with diabetes mellitus provides a comprehensive pharmacological overview and also includes a section on nonpharmacological intervention.

Section 8 is the final section of the book and contains several chapters that discuss chemotherapy and neoplastic diseases. This section includes a discussion of antibacterial, antiviral, antifungal, antiparasitic, chemotherapeutic, and immunomodulating agents.

The back of the book has 5 appendixes that are useful adjuncts to the main text. The appendixes include a list of drugs and compounds used in phonophoresis and iontophoresis, a chart describing interactions between physical agents and certain drugs, a demonstration of how to use the Physician's Desk Reference, a list of the drugs with high abuse potential, and a list of the common drug suffixes that will make drug recognition easier. The book also has an extensive glossary and index.

This book contains a great amount of information that has immediate relevance in any physical therapy setting where patients are taking medications. In a rapidly changing field such as pharmacology, the author has managed to condense much research information into a concise and very user-friendly format. This textbook was written primarily for rehabilitation professionals, and the case examples at the end of each chapter provide practical scenarios that readers can use as problem-solving exercises.

This book is a thorough, well-referenced text that any rehabilitation professional will appreciate. The theme--pharmacology in rehabilitation--is universal because it transcends all our specialties. I recommend this text to both beginning and expert clinicians who want a more comprehensive understanding of pharmacology in rehabilitation.

Tiziano Marovino, PT
Preferred Medicine
Allen Park, Mich

Mr Marovino is a doctoral student at Creighton University and a practice manager at a sports and outpatient orthopedic practice in Michigan. His research interests include biomechanics and exercise theory.

Note: Author Charles Ciccone, PT, PhD, who is Editor for "Evidence in Practice" and Reviews, did not participate in the review process for this book, including reviewer assignment and editing.