예방약학 I II (5판)

- v -
목 차(Ⅰ)
머리말 ························································
····························································
······················ ⅲ
1. 예방약학 서론 ···················································
··············································· 1
1.1 예방약학 개요 ···················································
·················································· 1
1.1.1 예방약학의 교육 목표 ··············································
················································ 1
1.1.2 위생화학의 탄생과 예방약학으로의 발전적 변화 ··································
················ 2
1.1.3 보건의료와 예방약학 ···············································
················································ 3
1.1.4 예방약학의 내용과 범위 ·············································
············································· 4
2. 보건위생 ······················································
····················································· 9
2.1 질병과 건강 ····················································
···················································· 9
2.1.1 건강의 개념 ···················································
··························································· 9
2.1.2 건강의 성립조건 ·················································
·················································· 10
2.1.3 질병 발생의 다요인설 ··············································
·············································· 11
2.1.4 질병 발생 과정 ·················································
······················································ 13
2.1.5 질병 예방 대책 ·················································
······················································ 14
2.2 보건통계 ·····················································
······················································ 17
2.2.1 보건통계의 활용범위 ···············································
··············································· 17
2.2.2 보건통계자료의 종류 ···············································
··············································· 17
2.2.3 보건통계의 지표 ·················································
···················································· 18
2.3 역학 ·······················································
·························································· 23
2.3.1 역학의 활용 ···················································
························································· 23
2.3.2 역학자료의 종류 ·················································
···················································· 25
2.3.3 역학연구 방법 ··················································
······················································ 26
2.3.4 질병의 역학적 특성 ···············································
················································ 35
▪목 차▪
- vi -
2.4 전염성 질병의 역학과 관리 ·············································
·································· 39
2.4.1 감염과 질병의 발현 ···············································
················································ 39
2.4.2 전염성 질병의 생성 과정 ·············································
········································· 41
2.4.3 전염성 질병의 관리 ···············································
················································ 43
2.5 비전염성 질환의 역학과 관리 ············································
······························· 47
2.5.1 비전염성 질환의 역학적 특성 ···········································
···································· 47
2.5.2 비전염성 질환 관리의 일반원칙 ··········································
·································· 49
2.5.3 만성 비전염성 질환 ···············································
················································ 51
2.6 보건의료와 약사의 역할 ··············································
······································ 55
2.6.1 보건의료의 개념 ·················································
···················································· 55
2.6.2 일차보건의료와 알마타선언 ············································
······································· 56
2.6.3 보건의료 서비스의 범위 ·············································
··········································· 57
2.6.4 지역사회 보건의료와 약사 ············································
········································· 58
2.6.5 지역사회 개국 약사의 역할 ············································
······································· 59
2.6.6 국제 보건 위생 협력 ···············································
··············································· 60
3. 영양과 건강 ····················································
··············································· 63
3.1 식품과 영양 ····················································
·················································· 63
3.2 당질과 질환 ····················································
·················································· 65
3.2.1 분류 및 용도 ··················································
························································ 65
3.2.2 당질의 소화, 흡수 및 기능 ············································
········································ 69
3.2.3 당질과 다른 영양소의 상호작용 ··········································
·································· 71
3.2.4 당질대사의 이상과 질병 ·············································
··········································· 72
3.2.5 당의 과다섭취에 의한 질병 ············································
······································· 75
3.2.6 섬유질과 건강 ··················································
······················································ 76
3.3 지질과 질환 ····················································
·················································· 87
3.3.1 분류 및 용도 ··················································
························································ 87
▪목 차▪
- vii -
3.3.2 지질의 소화와 흡수 ···············································
················································ 91
3.3.3 지질의 생리기능 ·················································
···················································· 94
3.3.4 지질대사 이상과 질병 ··············································
·············································· 97
3.4 단백질과 질환 ···················································
············································· 103
3.4.1 단백질의 구조 ··················································
····················································· 104
3.4.2 필수 아미노산 ··················································
····················································· 106
3.4.3 체내질소 균형 ··················································
····················································· 108
3.4.4 단백질의 품질 ··················································
····················································· 114
3.4.5 단백질의 영양가 판정 ··············································
············································ 115
3.4.6 단백질과 연관된 질병 ··············································
············································ 118
3.5 비타민과 질환 ···················································
············································· 123
3.5.1 분류와 용도 ···················································
······················································· 123
3.5.2 비타민 각론 ···················································
······················································· 127
3.5.3 비타민과 암 ···················································
······················································· 149
3.5.4 비타민과 임신 ··················································
····················································· 155
3.5.5 비타민과 기타 질병 ···············································
··············································· 156
3.5.6 비타민의 독성 ··················································
····················································· 157
3.6 무기질과 질환 ···················································
············································· 163
3.6.1 물과 전해질의 평형 ···············································
··············································· 163
3.6.2 무기질 ·····················································
····························································
·· 171
3.6.3 무기질 각론 ···················································
······················································· 173
3.7 영양과 에너지 대사 ················································
········································ 189
3.7.1 에너지 단위 ···················································
······················································· 189
3.7.2 식품의 에너지 ··················································
····················································· 189
3.7.3 에너지 대사량의 측정 ··············································
············································ 190
3.7.4 기초대사 ····················································
···························································
· 191
3.7.5 특이동적작용 ··················································
······················································ 193
3.7.6 에너지소요량 ··················································
······················································ 193
3.7.7 영양 권장량과 섭취량 ··············································
············································ 194
▪목 차▪
- viii -
3.8 식품과 의약품의 상호작용 ·············································
································· 197
3.9 건강기능 식품 ···················································
············································· 207
3.9.1 식품의 기능 ···················································
······················································· 207
3.9.2 건강기능 식품의 필요성 ·············································
········································· 207
3.9.3 건강기능 식품 ··················································
····················································· 209
3.9.4 건강기능 식품소재 ················································
··············································· 210
3.10 기능성 화장품 ··················································
············································ 235
3.10.1 화장품과 기능성 화장품 ·············································
········································ 235
3.10.2 기능성 화장품의 종류 ··············································
·········································· 235
3.10.3 기능성 화장품 효능 평가방법 ··········································
·································· 237
3.10.4 기능성 화장품 안전성 평가방법 ·········································
······························· 238
4. 식품위생 ······················································
················································ 241
4.1 식품과 건강 ····················································
················································ 241
4.1.1 식품위생학의 정의 ················································
··············································· 241
4.1.2 식품으로부터 유래되는 건강장해 ·········································
······························· 242
4.2 식품과 미생물 ···················································
············································· 245
4.2.1 자연유래 미생물 ·················································
·················································· 245
4.2.2 식품의 위생지표균 ················································
··············································· 248
4.2.3 식품의 부패 ···················································
······················································· 250
4.3 식중독 ······················································
······················································ 263
4.3.1 세균성 식중독 ··················································
····················································· 266
4.3.2 바이러스성 식중독 ················································
··············································· 278
4.3.3 자연독 식중독 ··················································
····················································· 280
4.3.4 알레르기성 식중독 ················································
··············································· 295
4.3.5 곰팡이독 ····················································
···························································
· 296
4.3.6 식품과 전염병 ··················································
····················································· 306
4.3.7 식품과 기생충 ··················································
····················································· 315
▪목 차▪
- ix -
4.4 식품오염물질 ···················································
··············································· 325
4.4.1 화학성 식중독 ··················································
····················································· 326
4.5 식품첨가물 ····················································
·················································· 335
4.5.1 식품첨가물의 안전성 및 규제 ···········································
·································· 337
4.5.2 식품첨가물의 행정 ················································
··············································· 340
4.5.3 식품첨가물 각론 ·················································
·················································· 345
4.6 식품잔류물 ····················································
·················································· 385
4.6.1 잔류 농약 ····················································
·························································· 385
4.6.2 사료첨가물과 동물용 의약품 ···········································
···································· 387
4.7 식품중의 발암 및 항암물질 ·············································
······························· 391
4.7.1 식품과 발암성의 관계 ··············································
············································ 391
4.7.2 식품중의 발암성․변이원성물질 ··········································
································ 391
4.7.3 가공, 조리에 의해 생기는 발암성 물질 ······································
························ 393
4.7.4 식품중의 항변이원성 및 항암물질 ·········································
····························· 396
4.8 식품 일반 ·····················································
·················································· 399
4.8.1 우유 ······················································
····························································
··· 399
4.8.2 유전자 재조합 식품 ···············································
··············································· 403
4.9 식품위생행정 및 법규 ···············································
······································ 409
4.9.1 식품위생행정 ··················································
······················································ 409
4.9.2 식품위생법규 ··················································
······················································ 409
4.9.3 식품위생감시 ··················································
······················································ 410
4.9.4 식품가공분야의 품질관리제도 ···········································
·································· 412
부록(Ⅰ)
[부록 Ⅰ] 허용보존료와 그 사용기준 ··········································
································· 415
[부록 Ⅱ] 허용 산화방지제와 그 사용기준 ········································
·························· 416
[부록 Ⅲ] 착색료의 종류와 그 사용기준 ·········································
···························· 417
▪목 차▪
- x -
[부록 Ⅳ] 발색제와 그 사용기준 ············································
······································ 418
[부록 Ⅴ] 표백제와 그 사용기준 ············································
···································· 419
[부록 Ⅵ] 밀가루 개량제와 그 사용기준 ·········································
··························· 420
[부록 Ⅶ] 감미료와 그 사용기준 ············································
·································· 421
[부록 Ⅷ] 식품에 사용할 수 있는 착향료 ········································
···························· 422
[부록 Ⅸ] 인삼(건조품)의 농약잔류허용기준 ·······································
························ 423
[부록 Ⅹ] 식육의 농약 잔류 허용기준 ··········································
······························· 424
[부록 Ⅺ] 생약의 유기염소계 잔류농약 적용범위와
허용기준 (식품의약품 안전청 고시 제 1999-5호) ·····································
· 425
[부록 Ⅻ] 식품중 항생물질의 잔류 허용기준 ·······································
······················· 426
[부록 ⅩⅢ] 식품중 합성항균제의 잔류 허용기준 ·····································
················ 427
[부록 ⅩⅣ] 식품중 성장호르몬제의 잔류허용기준 ····································
··············· 428
[부록 ⅩⅤ] 식품위생행정 및 법규 부록 ·········································
···························· 429
[부록 ⅩⅥ] 식품첨가물의 사용기준 ···········································
·································· 438
INDEX ·························································
························································ ⅰ
찾아보기 ·······················································
························································· ⅺ
- xi -
목 차(Ⅱ)
머리말 ························································
····························································
······················ ⅰ
5. 화학물질과 독성 ··················································
········································· 487
5.1 환경인자와 건강 ··················································
··········································· 487
5.1.1 환경인자에 대한 생체 반응 ············································
····································· 487
5.1.2 생체방어 ····················································
·························································· 488
5.1.3 화학물질과 건강영향 ···············································
············································· 490
5.2 화학물질의 생체내 동태 ··············································
···································· 493
5.2.1 흡수 ······················································
····························································
····· 494
5.2.2 분포와 축적 ···················································
······················································· 502
5.2.3 배설 ······················································
····························································
····· 507
5.3 화학물질의 대사 ··················································
··········································· 515
5.3.1 대사의 중요성 ··················································
····················································· 516
5.3.2 화학물질의 해독과 독화 ·············································
········································· 517
5.3.3 PhaseⅠ 및 Phase Ⅱ ···············································
·········································· 519
5.3.4 약물대사효소의 분포 ···············································
············································· 522
5.3.5 대사 효소 ····················································
·························································· 522
5.3.6 화학물질의 생체내 대사양식 ···········································
···································· 528
5.3.7 장내세균의 역할 ·················································
·················································· 545
5.3.8 화학물질 대사에 영향을 미치는 인자 ·······································
·························· 547
5.4 화학물질의 독성발현기전 ··············································
·································· 557
5.4.1 간장해성 화학물질의 독성기전 ··········································
·································· 557
5.4.2 혈액장해성 화학물질의 독성기전 ·········································
······························· 564
5.4.3 화학발암기전 ··················································
······················································ 568
▪목 차▪
- xii -
5.5 중금속 ······················································
······················································ 585
5.5.1 카드뮴(Cd) ···················································
························································· 585
5.5.2 크롬(Cr) ····················································
···························································
· 590
5.5.3 납(Pb) ·····················································
····························································
·· 592
5.5.4 수은(Hg) ····················································
···························································
598
5.5.5 비소 ······················································
····························································
····· 603
5.5.6 생체내에서의 금속간 상호작용 ··········································
·································· 606
5.6 농약 ·······················································
························································ 609
5.6.1 농약의 특성과 건강장해 ·············································
········································· 609
5.6.2 유기염소계 살충제 ················································
··············································· 614
5.6.3 유기인계 살충제 ·················································
·················································· 617
5.6.4 Carbamate계 살충제 ···············································
············································· 621
5.6.5 유기염소계 제초제와 TCDD ············································
··································· 623
5.6.6 Bipyridyl 유도체 제초제 ·············································
········································· 625
5.7 유기오염물질 ···················································
··············································· 627
5.7.1 PCB ·······················································
····························································
···· 627
5.7.2 유기용제 ····················································
···························································
· 632
5.7.3 다환방향족탄화수소 ···············································
··············································· 642
5.7.4 Plastic monomer와 첨가제 ············································
······································ 643
5.8 내분비계 장애물질 ·················································
········································· 653
5.8.1 정의 ······················································
····························································
····· 653
5.8.2 특성 ······················································
····························································
····· 653
5.8.3 생태계에 미치는 영향 ··············································
············································ 654
5.8.4 인간에 미치는 영향 ···············································
··············································· 655
5.8.5 내분비계 장애기전 ················································
··············································· 656
5.8.6 내분비계 장애물질 평가 ·············································
········································· 658
5.8.7 생활환경 관리 ··················································
····················································· 660
6. 물리적 환경인자와 건강 ···············································
································ 663
▪목 차▪
- xiii -
6.1 물리조건과 생체 ··················································
··········································· 663
6.1.1 공기의 온열조건 ·················································
·················································· 664
6.1.2 체온조절과 온열조건 ···············································
············································· 665
6.1.3 체감온도 지표 ··················································
··················································· 666
6.1.4 저압, 고압환경과 생체 ··············································
··········································· 668
6.2 방사선과 생체 ···················································
············································· 671
6.2.1 방사능 오염의 현황 ···············································
··············································· 672
6.2.2 식품의 방사선 조사와 위생 ············································
····································· 673
6.2.3 방사능의 인체영향 ················································
··············································· 681
6.2.4 마이크로파 ···················································
························································· 685
6.2.5 전자기장 ····················································
···························································
· 686
6.3 소음 ·······················································
························································ 689
6.3.1 음의 물리량 ···················································
······················································· 689
6.3.2 음의 감각량 ···················································
······················································· 690
6.3.3 소음원 ·····················································
····························································
·· 691
6.4 진동 ·······················································
························································ 693
6.4.1 진동의 성질과 단위 ···············································
··············································· 693
6.4.2 진동이 인체에 미치는 영향 ············································
····································· 694
7. 환경오염과 건강 ··················································
········································· 697
7.1 생태계와 물질순환 ·················································
········································· 697
7.1.1 물질순환과 생물 ·················································
·················································· 697
7.1.2 영양염류의 환경내 순환 ·············································
········································· 699
7.1.3 환경오염물질의 생태계내 동태 ··········································
·································· 702
7.2 수질오염과 건강영향 ················································
······································· 713
7.2.1 물과 건강장해 ··················································
····················································· 713
7.2.2 상수 ······················································
····························································
····· 718
7.2.3 공공용수 ····················································
···························································
· 733
▪목 차▪
- xiv -
7.2.4 수질오염 ····················································
···························································
· 734
7.3 대기오염과 건강영향 ················································
······································· 763
7.3.1 공기와 환경인자 ·················································
·················································· 763
7.3.2 공기의 조성 ···················································
····················································· 764
7.3.3 공기의 생체영향 ·················································
·················································· 765
7.3.4 공기의 주요 오염성분과 생체영향 ·········································
····························· 769
7.3.5 실내 환경과 위생 ················································
················································· 777
7.3.6 대기오염과 방지대책 ···············································
············································· 787
7.3.7 악취 ······················································
····························································
····· 797
7.4 토양오염과 건강영향 ················································
······································· 799
7.4.1 토양오염의 원인과 경로 ·············································
········································· 799
7.4.2 토양오염의 특성 ·················································
················································ 799
7.4.3 토양오염의 현황 ·················································
················································ 801
7.4.4 우리나라 토양오염물질의 기준항목 ········································
··························· 802
7.5 폐기물오염과 건강 ·················································
········································· 803
7.5.1 폐기물 관리 ···················································
······················································· 803
7.5.2 생활 폐기물 ···················································
······················································· 804
7.5.3 사업장 폐기물 ··················································
··················································· 807
7.5.4 실험실 폐기물 ··················································
····················································· 808
7.5.5 의료폐기물 ···················································
························································· 810
7.5.6 폐기물 처리와 건강장애 ·············································
········································· 811
8. 유해화학물질의 평가와 규제 ·············································
···························· 813
8.1 화학물질의 안전성 ·················································
········································· 813
8.1.1 독과 약 ·····················································
···························································
· 813
8.1.2 용량－반응 관계 ·················································
·················································· 815
8.1.3 건강의 판정 ···················································
······················································· 822
8.1.4 판정조건과 규제기준 ···············································
············································· 824
▪목 차▪
- xv -
8.2 유해화학물질의 관리 ················································
······································· 829
8.2.1 유해화학물질의 규제와 관리 ···········································
···································· 829
8.2.2 안전성 평가 ···················································
······················································· 835
9. 산업위생관리 ····················································
············································ 847
9.1 산업위생 ·····················································
···················································· 847
9.1.1 산업위생의 목표 ·················································
·················································· 847
9.1.2 산업위생의 현황 ·················································
·················································· 849
9.1.3 산업위생사업 ··················································
······················································ 850
9.1.4 직업성 질환 ···················································
······················································· 852
9.2 의약품제조 위생관리 ················································
······································· 857
9.2.1 GMP의 정의 및 필요성 ··············································
········································· 857
9.2.2 KGMP의 주요내용 ·················································
·············································· 858
9.2.3 기타 GMP 관련기준과 제조위생 관리 ········································
························ 860
부록(Ⅱ)
[부록 1] 먹는물 수질기준 ···············································
·············································· 863
[부록 2] 먹는물 수질기준 ···············································
·············································· 865
[부록 3] 환경기준 ···················································
······················································ 867
[부록 4] 수질오염물질의 배출허용기준 ·········································
······························ 872
[부록 5] 방류수 수질기준 ···············································
·············································· 874
[부록 6] 대기오염물질의 배출허용기준 ·········································
······························ 875
[부록 7] 토양오염 우려기준 및 토양오염 대책기준 ····································
·············· 882
[부록 8] 최대허용체부하량과 직업상의 피폭에 대한 공기 및
물중의 방사성핵종의 최대허용농도 ···········································
···················· 883
[부록 9] 의약품 안전성평가 독성시험법 ·········································
···························· 887
[부록 10] 각종 용수의 규격 기준(KP) ··········································
······························ 897
[부록 11] 작업환경 관리구역에 따른 청정도 관리기준 ··································
············ 899
INDEX ·························································
························································ ⅰ
찾아보기 ·······················································
························································· ⅺ