제1장 약의 특징과 몸의 관계                                                              1

1-1 약의 종류와 특징 1(내복약)····································································································2

1-2 약의 종류와 특징 2(외용약)····································································································4

1-3 약의 종류와 특징 3(주사제와 정리)······················································································6

1-4 몸과 약물동태························································································································8

1-5 의존과 약물중독···················································································································10

1-6 소아와 고령자······················································································································12

1-7 임산부와 수유부···················································································································14

1-8 약의 관리····························································································································16

1-9 약과 정보····························································································································18

1-10 약과 의료(환자)안전···········································································································20

제2장 신경의 질환과 치료                                                                23

2-1 신경의 구조 · 분류와 기능··································································································24

2-2 자극이 전달되는 구조와 작용·······························································································26

2-3 말초신경의 기능과 질환의 치료····························································································28

2-4 중추신경에 관련된 질환의 이해 포인트···············································································30

2-5 중추신경의 전달물질이 많은 질환·························································································32

2-6 중추신경의 전달물질이 작은 질환·························································································34

2-7 국소마취의 구조 

      - 말초신경으로의 작용을 억제하는 구조············································································36

2-8 전신마취의 구조 

      - 중추신경으로의 작용을 억제하는 구조·············································································38

2-9 수면제는 중추마취제···········································································································40

2-10 신경의 만성질환인 간질(뇌전증)·························································································42

제3장 심장 · 혈액 · 신장에 관련된 질환과 치료                                            45

3-1 혈액이 흐르는 구조 

      - 심장 · 혈관 · 신장의 기능······························································································46

3-2 고혈압의 원인과 치료 [대사증후군 관련 질환]···································································48

3-3 심장의 질환과 치료 1 

      - 허혈성심질환(ischemic heart disease)············································································50

3-4 심장의 질환과 치료 2 

      - 심부전(heart failure)····································································································52

3-5 심장의 질환과 치료 3 

      - 부정맥(arrhythmia)·······································································································54

3-6 신장의 기능·······················································································································56

3-7 이뇨제의 구조와 부작용······································································································58

3-8 혈액 이상에 관련된 약물 1 

      - 지질이상증[대사증후군 관련 질환]·················································································60

3-9 혈액 이상에 관련된 약물 2 

      - 빈혈, 항응고제·············································································································62

제4장 미량이지만 체내에서 중요한 역할을 하는 물질과 관련된 질환                      65

4-1 호르몬의 기능····················································································································66

4-2 혈당에 관련된 호르몬 1 

      - 당뇨병의 기본[대사증후군 관련 질환]··············································································68

4-3 혈당에 관련된 호르몬 2 

      - 당뇨병과 인슐린[대사증후군 관련 질환]··········································································70

4-4 뇌하수체 호르몬이 자극하는 기관과 관련된 질환 1 

      - 부신피질 · 수질 호르몬·································································································72

4-5 뇌하수체 호르몬이 자극하는 기관과 관련된 질환 2 

      - 갑상선 호르몬과 부갑상선 호르몬···················································································74

4-6 뇌하수체 호르몬이 자극하는 기관과 관련된 질환 3

      - 성호르몬과 경구피임약··································································································76

4-7 소화효소와 보조효소

      - 소화액과 비타민의 기능과 치유······················································································78

제5장 기관(지)이나 폐에 관련된 질환과 치료                                               81

5-1 기관(지)과 폐의 기능··········································································································82

5-2 호흡에 관련된 질환 

      - 기관지천식과 기침약, 가래약·························································································84

5-3 호흡에 관련된 기타 질환

     - 흡인성 폐렴, 만성 폐쇄성 폐질환, 수면무호흡증후군, 기흉············································86

제6장 소화관에 관련된 질환과 치료                                                            89

6-1 소화관(입~항문)의 기능과 궤양··························································································90

6-2 소화관에 관련된 기타 질환과 치료······················································································92

6-3 상 · 하부 내시경검사········································································································94

6-4 경관영양과 약물···············································································································96

제7장 간 · 담관계 · 췌장에 관련된 질환과 치료                                                 99

7-1 간의 기능·······················································································································100

7-2 간의 질환과 치료 - 간염, 간경변과 간암, 알코올성 간장애···················································102

7-3 담관계와 췌장의 질환과 치료····························································································104

제8장 체외로부터의 방어 구조                                                                 107

8-1 면역의 구성과 기능···········································································································108

8-2 면역 기능을 높이는 약물과 예방접종···················································································110

8-3 알레르기의 분류와 항체·····································································································112

8-4 알레르기의 질환과 치료·····································································································114

8-5 염증과 항염증제···············································································································116

8-6 자가면역 질환 - 교원병(류마티스성 질환, SLE), 염증성 장질환·············································118

제9장 암(악성 신생물)과 치료                                                                  121

9-1 암(악성 신생물)················································································································122

9-2 항암제 총론·····················································································································124

9-3 항암제 각론과 부작용 1····································································································126

9-4 항암제 각론과 부작용 2····································································································128

9-5 항암제의 부작용에 대한 대응····························································································130

9-6 암성 통증의 특징과 평가··································································································132

9-7 암성 통증의 종류와 치료··································································································134

9-8 WHO 방식 3단계 진통제 사다리와 약물의 사용법·······························································136

9-9 의료용 마약의 부작용 대책·······························································································138

제10장 감염증과 치료                                                                        141

10-1 감염증의 사고방식과 세균의 종류····················································································142

10-2 세균 감염증 치료의 기본································································································144

10-3 항균제 치료의 구조와 기능·····························································································146

10-4 결핵(tuberculosis)·········································································································148

10-5 바이러스의 특징과 종류 1·······························································································150

10-6 바이러스의 특징과 종류 2·······························································································152

10-7 진균(fungi)의 특징과 종류·······························································································154

10-8 감염경로와 표준예방책····································································································156

10-9 병원체와 소독약·············································································································158

레벨 UP 감염증 치료 항균제, 한 걸음 더··················································································160

제11장 기타 각 기관에 관련된 질환과 치료                                                     165

11-1 대표적인 눈 질환 - 녹내장, 백내장, 안구건조증·································································166

11-2 피부 질환과 욕창의 치료··································································································168

11-3 골절과 치료····················································································································170

11-4 수액의 특징····················································································································172

각 장의 마무리 문제(해답 · 해설)·······························································································175

약어 목록································································································································180

찾아보기··································································································································183

<책 소개>

본서는 ‘약물이 몸의 어디에서 작용하거나, 작용시키고자 하는지 상상하기 어렵다’라는 문제를 해결하기 위해 ‘몸의 구조, 질환의 발생원인, 약물을 사용하는 목적이나 구조를 순서에 맞춰 이해하는 것이 중요하다’라는 개념을 정리하였습니다. 더불어 학생이나 의료진분들께 ‘생리학과 약리학의 관계를 이해하기 쉽게 설명했다’는 평을 받아 저자로서 매우 기뻤습니다.

본서에는 의약품의 업데이트, 국가시험의 동향에 맞춘 변경사항에 더해 저자가 의료안전관리자라는 입장에서 임상 현장에서 느낀 주의점도 포함했습니다. 또한, ‘구체적인 약제명이 있으면 좋겠다’는 요청도 반영했습니다. 단, 처음 보시는 분들은 일부 중요한 약물을 제외하고, ‘명칭을 외우기보다 먼저 약물을 사용하는 이유와 질환을 개선하는 흐름의 이해’를 중시해 주셨으면 좋겠습니다.

역설적이기는 하지만 ‘국가시험에 자주 나오는 내용은 임상 현장에서도 중요한 실용 부분이며, 의료안전에 관련된 부분이 주로 출제된다’는 사고방식을 중시하고 있기 때문에 의료종사자를 목표로 하는 학생은 물론, 의료 현장에서 업무를 보고 있는 혹은 공백기가 있었던 의료진분들께도 도움이 될 것으로 기대합니다. 단, 본서는 약물치료의 ‘전체 이미지와 흐름의 이해’에 중점을 두고 있으며, 임상 현장에 관해서는 전문가와 같이 관련 서적으로 심화 학습하시길 바랍니다.

<서문>

본서는 2018년 발간 후, 여러분 덕분에 많은 대학교에서 교재와 참고서로 사용되었습니다. 또한, 학생이나 의료진분들께 ‘생리학과 약리학의 관계를 이해하기 쉽다’는 평을 받아 저자로서 매우 기뻤습니다. 본서에서는 ‘약물이 몸의 어디에서 작용하거나, 작용시키고자 하는지 상상하기 어렵다’라는 문제를 해결하기 위해 ‘몸의 구조, 질환의 발생 원인, 약물을 사용하는 목적이나 구조를 순서에 맞춰 이해하는 것이 중요하다’라는 개념으로 정리한 것이며, 이에 찬성을 해주신 것으로 생각해 안도합니다.

그러나 의료, 특히 약의 정보는 시시각각으로 업데이트되고 있습니다. 신약 외에 의료비의 억제를 목적으로 한 제네릭 약품 도입 등, 계속 확인해야 할 것이 증가하고 있습니다. 또한, 의약품이라는 ‘물건’뿐 아니라 이를 다루는 ‘사람(환자나 의료진)의 사고방식’도 항상 변화하고 있어 하나를 개선해도 새로운 문제가 발생합니다. 의약품에 관련된 의료사고가 보도되기는 하나 이는 빙산의 일각이라 해도 과언이 아닙니다. 안전한 의료서비스 제공이 주목받는 가운데 이는 임상 현장에서 당연히 의식해야 하고, 학생에게도 매우 중요합니다.

이번 개정에서는 의약품의 업데이트, 국가시험의 동향에 맞춘 변경사항에 더해 저자가 의료안전관리자라는 입장에서 임상 현장에서 느낀 주의점도 포함했습니다. 또한, ‘구체적인 약제명이 있으면 좋겠다’는 요청도 반영했습니다. 단, 처음 보시는 분들은 일부 중요한 약물을 제외하고, ‘명칭을 외우기보다 먼저 약물을 사용하는 이유와 질환을 개선하는 흐름의 이해’를 중시해 주셨으면 좋겠습니다. 단, 추가한 약물은 신중하게 골랐지만, 계속해서 의견이나 느낀 점을 알려주시면 매우 감사하겠습니다.

본서는 역설적이기는 하지만 ‘국가시험에 자주 나오는 내용은 임상 현장에서도 중요한 실용 부분이며, 의료안전에 관련된 부분이 주로 출제된다’는 사고방식을 중시하고 있기 때문에 의료종사자를 목표로 하는 학생은 물론, 의료 현장에서 업무를 보고 있는 혹은 공백기가 있었던 의료진분들께 도움이 될 것으로 기대합니다. 단, 본서는 약물치료의 ‘전체 이미지와 흐름의 이해’에 중점을 두고 있습니다. 임상 현장에 관해서는 전문가와 같이 관련 서적으로 심화 학습하시길 바랍니다.

마지막으로 본서를 활용해 주시고 귀중한 의견을 주신 교수님, 학생, 의료진분들께 감사드립니다. 또한, 개정판 작업에 남산당 편집부와 제작 스텝분들께 많은 도움을 받았습니다. 이 자리를 빌려 감사 인사드립니다.

2020년 7월

MACHITANI Yasunori 

<본서특징>

1. 처음 약리학을 배우는 학생들을 비롯해 신입, 공백기가 있는 의료진, 타 직종을 대상으로 한 약물강의 등에 본서를 활용할 수 있도록 중점을 두었다.

2. 몸의 구조, 다음으로 질환의 발생 원인, 마지막으로 약을 사용하는 목적이나 구조를 순서에 맞춰 이해할 수 있도록 정리하였다. 

3. 대략적인 약물의 역할을 이해하는 것을 목표로 하여 몸의 연결과 약물치료의 흐름을 어떻게 임상에 활용하는지에 주목하였다. 

4. 임상에서의 활용을 고려해 간호사를 시작으로 물리치료사, 작업치료사, 임상병리사, 방사선기사, 임상공학기사 등, 많은 직종에 통용될 수 있도록 정리하였다. 

5. 요구되는 약물치료의 지식으로써, 국가시험에 출제되는 문제는 특히 중요하다고 생각하여 각종 국가시험에서 자주 출제되는 내용을 의식해 집필하였다.