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Book Review: Biological and Chemical Terrorism: A Pharmacy Preparedness Guide

The objectives for the second edition of this book are to provide clinicians a compendium of updated information on drugs used for the prevention or treatment of cardiovascular disease as well as the scientific basis for various pharmacologic approaches. The book is coedited and coauthored by 3 physicians and scientists with a long record of research and publishing in the cardiovascular field. The list of 115 contributors is primarily composed of physicians but also includes 5 PharmDs. The book’s title may be misleading to some pharmacists who are expecting in-depth discussions of drug therapy for various disease states. Unlike other therapeutics books, the content is organized by drug classes rather than disease states or organ systems. This is a large textbook, with 1072 pages, including 51 individual chapters and 8 appendices. The chapters are organized into 5 major parts. Part I includes 6 introductory chapters covering basic principles of clinical pharmacology, the placebo effect, compliance, new drug development, health economic issues, and a historical perspective on cardiovascular pharmacology. Part II includes 21 chapters on various cardiovascular drug classes. In addition to covering commonly used drugs (e.g., βblockers, antiarrhythmics), there are chapters on smoking cessation drugs, fish oil, vitamins and antioxidants, and natriuretic and vasoactive peptides. Part III includes 19 chapters on new drug classes in development. Examples include potassium-channel openers, renin inhibitors, endothelin antagonists, matrix metalloproteinases, vasopeptidase inhibitors, and drugs to inhibit apoptosis. Part IV consists of 5 chapters on special topics covering drug interactions, pediatric cardiovascular pharmacology, alternative medicine, quality-of-life issues, and treatment of peripheral vascular disease. Part V includes 8 appendices on topics such as pharmacokinetics of cardiac drugs, use in pregnancy and nursing, hepatic and renal dosing, gender issues, geriatric use, and ethnic issues. For the most part, the book is well organized, especially in Parts II and III. However, the order and selection of topics for the introductory chapters (Part I) and the special topics (Part IV) appear to be somewhat random. In general, the book provides updated and accurate drug information organized in a format similar to that of the previous edition; however, the second edition includes more reference citations. To accommodate expanding drug knowledge and increased number of drugs currently available or in development, Part IV (special topics) has been shortened by omitting previously included chapters on treatment of various disease states. One exception is the chapter on the treatment of peripheral vascular disease that was retained despite the fact the disease-based focus is inconsistent with the rest of the book. For the most part, the presentation of material is consistent throughout the text. This is most likely due to the fact that the 3 editors authored or coauthored the majority of chapters and edited those written by other contributors. Drug information is provided on basic pharmacology, mechanisms of action, indications, pharmacokinetics, dosing considerations, drug interactions, and adverse effects. Each chapter is extensively referenced from the primary and secondary literature. Throughout the book, major findings of clinical trials that form the rationale for using various drug therapies are referenced. The book does not include additional discussions on the strengths or weaknesses of the various trials. Within the constraints of any published textbook, this edition provides the most recent trial information. Trial results released through December 2002 are included in this edition, which was published in early 2003. Figures and tables are used extensively and effectively throughout the book to illustrate major principles or summarize key points. A major plus for the book is the extensive information provided on new cardiovascular drugs in development. Minuses include the relative lack of comparative analyses within and between drug classes and minimal discussion on designing or monitoring drug therapy regimens. There is also considerable variation between chapters in the extent and depth of information provided for individual drugs or drug classes. For example, the antiarrhythmic chapter provides only a brief overview of each drug. Important topics such as proarrhythmia and torsades de pointe are listed only as potential adverse effects of individual drugs, with no additional discussion. Given the seriousness of these adverse effects, more discussion would seem to be warranted. Finally, although the appendices provide very useful information, they are either unreferenced or referenced only from the previous edition. Overall, the book provides a useful updated reference for cardiovascular agents. The target audiences are physicians and a broad range of other healthcare professionals. Given the extensive amount of information that is provided, the recommended cost of $159 is certainly justified. For pharmacists who do not specialize in cardiology or those in other healthcare settings, the book will provide a comprehensive resource for cardiovascular drugs. Specialists and nonspecialists alike should appreciate the section on drugs in development, which provides comprehensive information on emerging agents that is difficult to find in a single reference. I would not recommend the book as a textbook for therapeutics courses; however, it would be appropriate for elective cardiovascular drug courses. In addition, clerkship students, residents, or fellows would find the book to be a useful tertiary resource. Therefore, I would recommend that medical libraries or drug information centers purchase the book.