§:Drug Therapy in Nursing
`
`Diane S. Aschenbrenner, MS, APRN, B
`Course Coordinator
`-
`
`Johns Hopkins University
`School of Nursing
`Baltimore, Maryland
`
`Samantha J. Venable, Ms, RN, FNP
`Professor
`
`Saddleback College
`Mission Viejo, California
`
`‘\
`
`N
`
`;;-j:_wo1ters Kluwéif
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`|-€.'::al1l1
`Philadelphia - Baltimore - N_
`Buenos Aires - Hong Kong. v
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`='jrj__cott Williams & Wilkins
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`Medac Exhibit 2024
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`Frontier Therapeutics v. Medac
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`Page 00001
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`Medac Exhibit 2024
`Frontier Therapeutics v. Medac
`IPR2016-00649
`Page 00001
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`Senior Acquisitions Editor: Hilarie Surrena
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`3rd Edition
`
`Copyright © 2009 Wolters Kluwer Health I Lippincott Williams Sc Wilkins.
`Copyright © 2006, 2002 by Lippincott Williams (Sc Wilkins. All rights reserved. This book is protected by copyright. No
`part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scannecl—in
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`Printed in China
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`Library of Congress Cataloging-in-Publication Data
`
`Aschenbrenner, Diane 5.
`Drug therapy in nursing i Diane S. Aschenbrenner, Samantha J. Venable. — 3rd ed.
`p. ;cm.
`Includes bibliographical references and index.
`ISBN-I 3: 978-0-78 17-6587-9 (alk. paper)
`ISBN-10: 0—7S17—6587—0 talk. paper)
`I. Venable, Samantha J. II. Title.
`1. Chemotherapy. 2. Pharmacology. 3. Nursing.
`[DNLM: 1. Drug Therapy—-Nurses‘ Instruction. 2. Pharmaceutical Preparations—Nurses’ Instruction. 3. Pharmacology-
`Nurses’ i.I1SI'_l'LlCtl0I'1. WB 330 A3 13d 2009]
`RM125.N83 2009
`615.5'8—dc22
`
`_.
`
`2007040471
`
`Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. How-
`ever, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from applica-
`tion ofthe information in this book and make no warranty, expressed or implied, with respect to the currency, completeness,
`or accuracy of the contents of the publication. Application of this information in a particular situation remains the profes-
`sional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute
`and universal recommendations.
`
`The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are
`in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research,
`changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader
`is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and pre-
`cautions. This is particularly important when the recommended agent is a new or infrequently employed drug.
`
`Some drugs and medical devices presented in this publication have Food and Drug Administration {FDA} clearance for lim-
`ited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each
`drug or device planned for use in his or her clinical practice.
`
`LWW.COM
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`Page 00002
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`

`
`Preface
`
`“How will I ever learn all of this?” and “Where do I begin?” are questiorls that nursing stu-
`dents frequently ask themselves and their faculty when beginning to study pharmacology.
`The subject is indeed vast for novices in the profession who lack the skills to organize drug
`information appropriately. Students feel overwhelmed by all of the isolated pieces of drug
`information they must learn. Consequently, they lose sight of “the forest for the trees.”
`
`Prototype Approach
`For years, many pharmacology faculty have favored a prototype approach to teaching
`pharmacology. This method encourages identification of “the major trees” and facilitates
`recognition of “the forest.” Use of _a prototype, a drug thatis representative of a class (or
`group} of drugs, helps students because it offers a systematic approach to grouping drug
`data, while beginning to recognize individual drug ’names. It gives students a “method”
`of learning and organizing large amounts of information. Drug The:-spy in Niusing, Third
`Edition, is designed and written by faculty who themselves teach nursing pharmacology
`using the prototype approach. At last, nursing pharmacology faculty have a text that
`matches the way they teach. Drug Ti:-erapy in Nursing, Tisrird Edition, is that text!
`
`Clinical Judgment and Clinical Application
`Drug Therapy in Nursing, Third Edition, is unique in that it presents a totally nursing-
`focused framework to support the teaching and learning of nursing pharmacology. Learn-
`ing the pharmacology facts about different drug prototypes is only half of the knowledge
`nursing students need. Because they’re learning to be nurses, they must understand how
`to apply this knowledge to patientcare. Nurses must learn to think critically, evaluate
`information, and make decisions. However, this essential aspect of knowledge application
`has never been thoroughly addressed in nursing pharmacology texts. Frequently, students
`view rrarrsirig application of drug knowledge as less important than learning the hard drug
`facts. This thinking is fostered when the pharmacology textbooks they use present the
`nursing process after or apart from drug knowledge in a brief paragraph or chart. Drug
`The:-npy in Nursing, Tiaird Edition, fully integrates core drug knowledge with core patient
`information, appropriately stressing, as no other text does, the relationship between the
`two bodies of information.
`As with all other factual, scientific, or medical information used by nurses, students
`must learn to integrate this knowledge into their practice and apply it to patient care.
`Applying drug information to patient care may overwhelm students because every patient
`is different, with different responses, positive or negative, to the same drug therapy. If the
`student sees each patient situation as an isolated case, learning is again hampered. This
`text provides a systematic framework for assessing and evaluating patient responses that
`change in accord with health, age, gender, lifestyle, and other factors. This important
`patient focus is strengthened by rise of the nursing process framework. Pharniacologic
`facts are integrated into nursing, to help the student apply knowledge to practice, safely
`administer drugs, educate patients, and begin to make the journey from novice to expert.
`
`Use of a Systematic Framework
`The authors of Dmg T.-'aernpy in Nursing, Third Edition, present a systematic framework
`for drug therapy with every prototype drug. The framework consists of two basic areas
`of information: first, core drug knowledge and core patient variables; and second, actions
`of the nurse using this knowledge.
`
`Page 00003
`
`

`
`xiv Preface
`
`Core Drug Knowledge highlights the important drug facts about a prototype drug.
`Core drug knowledge includes pharmacotherapeutics, pharmacokinetics, pharmaco-
`dynamics, contraindications and precautions, adverse effects, and drug interactions.
`Core Patient Variables identify the major topics that should be assessed in every patient
`to determine special considerations that need to be taken into account when administer-
`ing a drug to a patient. Core patient variables include health status; life span and gender;
`lifestyle, diet, and habits; environment; and culture and inherited traits. The text presents
`the relevant variables for each particular prototype.
`The nurse uses knowledge about the drug and knowledge about the patient to maximize
`the therapeutic effect of the drug, minimize the adverse effects of the drug, or provide
`patient and family education. The authors of this text call what the nurse does with knowl-
`edge about the drug and the individual patient “nursing management of drug therapy."
`
`Organization
`
`Drug Tiaempy in Nursing, Third Edition, has twelve units. The first three units address
`the principles and process of nursing management of drug therapy, and the basics of core
`drug knowledge and patient-related variables. The next nine units present the nursing
`management of drugs affecting various body systems and disease states. The text con-
`cludes with eight appendices.
`'
`Unit 1, Foundations for Drug Therapy in Nursing, consists of three chapters. Chapter 1
`explains the framework for the text and how this framework relates to the application of
`drug knowledge to clinical practice. This is a crucial chapter for students to read so that they
`will best understand the content in the rest of the text. The remaining chapters address bgsic
`pharmaceutical knowledge, drug development and its related safeguards, and drug delivery,
`and the modes of drug administration.
`Unit 2, Core Drug Knowledge, includes two chapters that present the basics of pl1arrna—
`cology: pharmacothetapeutics, pharmacokinetics, and phatmacodynamics; and adverse
`effects and drug interactions.
`__
`Unit 3, Core Patient Variables, includes seven chapters that highlight info:-matioln per-
`tinent to patient assessment relevant to drug therapy. This is not an exhaustive list of every
`aspect that can he considered by these variables. The topics include iife—span issues (chil-
`dren, pregnant or breast-feeding women, and older adults}; lifestyle, diet, and habits issues
`(substance abuse, dieta1'y considerations, and complementary medication use); environ-
`ment (influences on drug therapy}; and culture and inherited traits {considerations in drug
`therapy). The core patient variable of health status is not presented, as this includes all
`physiology, pathophysiology, disease states, and their related treatments.
`Units 4 through '12 present drugs affecting the various body systems and drugs used to
`treat diseases and their symptoms.
`The Appendices present essential information on diagnostic imaging agents, enzymes
`and débridement therapy, cnteral and nutritional supplements, parenteral nutrition, immu-
`nizations and immunization schedules for the United States and Canada, drugs causing
`photosensitivity, d1'ugs that interact with grapefruit juice, and drugs metabolized by the
`P450 system. Emphasis is given in the appendices to the nursing management of these drug
`therapies.
`
`Pedagogy
`
`- Chapter Learning Objectives identify key content within the chapter to help direct
`student learning.
`0 Key Terms identify terms that a1'e key to understanding each chapter’s contents.
`I Chapter Summaries highlight the most important information presented in the chapter.
`I Questions for Study and Review encourage the student to reflect on the important
`aspects of the chapter. Answers are provided in the back of the text.
`
`New To This Edition
`
`6 More pathophysiology information relevant to drug therapy is included to assist with
`understancling and critical thinking.
`I All chapters have been updated and include new drugs approved by the FDA.
`
`Page 00004
`
`

`
`Black Box warnings from the FDA labels have been added to the discussion of each
`prototype when applicable.
`Safety alerts have been added to the Memory Chips to emphasize prevention of coin-
`mon medication errors.
`Separate chapters are included on drugs affecting fungal and viral infections, with
`revised expanded content.
`The chapter sequence has been reorganized to promote student comprehension and
`learning.
`
`Key Features
`Concept Maps introduce the student to all drugs that will be mentioned in the chap—
`ter. Each map identifies the drug class, its prototype, and drugs in the class that are
`similar to or different than the prototype. Concept maps also refer the student to
`other chapters if related drugs are covered elsewhere.
`Physiology Figures illustrate physiologic processes relevant to the drug class and link
`drug actions to physiology.
`I
`Memory Chips assist students in studying and preparing for clinical practice, provid-
`ing a quick reference of key points for each prototype drug.
`Focus on Research boxes highlight current research in pharmacology. The implica-
`tions for nursing practice are addressed for each article.
`ComrnI.1nity—Bast:d Concerns highlight nursing issues related to drug therapy carried
`out in patients’ homes and communities.
`Critical Thinking Scenarios challenge students to develop critical thinking skills for
`applying pharmacology knowledge to patient care. Answers are provided for
`instructors on thePoint.
`'
`Drug Summary Tables relate pharmacotherapeutics and general dosage data to
`pharmacokinetic parameters.
`Drug Interaction Tables, for every prototype drug, highlight known drug—drug and
`drug—food interactions. When diagnostic and laboratory test values are affected by
`drug use, this information is pointed out as well.
`
`Teaching/Learning Package
`
`'|
`
`These excellent ancillary materials make teaching and learning even easier!
`
`Resources for Instructors
`The following tools are available upon textbook adoption to instructors on -: Point;
`http://thePoint.|ww.co mlas chenbrenrier3e:
`
`The Test Generator lets you generate new tests from a bank containing over 550
`NCLEX—style questions to help you assess your students’ understanding of the course
`material.
`Lesson Plans organize all ancillary resources by learning objective to assist in prepar-
`ing your lessons.
`A sample Syllabus provides guidance for structuring your nursing pharmacology
`C0l‘.ll'5L’..
`
`An Image Bank contains illustrations from the book in formats suitable for printing
`and incorporating into PowerPoint presentations and Internet sites.
`
`In addition, an extensive collection of materials is provided for each book chapter:
`
`Pre-Lecture Quizzes are quick, knowledge-based assessments that allow you to check
`students’ reading before you begin your instruction. Answers are also provided.
`PowerPoint Presentations provide an easy way for you to integrate the textbook with
`your students‘ classroom experience, either via slide shows or handouts. Multiple-
`choice and TruefFalse questions are integrated into the presentations to promote class
`participation and allow instructors to use i-clicker technology.
`Guided Lecture Notes walk you through the chapters, objective by objective, and
`provide you with corresponding PowerPoint slide numbers.
`Discussion Topics {and suggested answers) can be used as conversation starters or in
`online discussion boards.
`
`Page 00005
`
`

`
`xvi
`
`Preface
`
`I Assignments {and suggested answers} include group, written, clinical, and web
`assignments.
`* Case Studies for eve1'y d1'ug chapter in the book are provided to help your students
`apply their knowledge to clinical scenarios.
`
`Resources for Students
`
`Valuable learning tools for students are available both on the free Student’s Resource CD-
`ROM bound into this book and on rl-...P0int;‘:
`
`NCLEX-Style Review Questions for every chapter feature traditional and alternative-
`format NCLEX-style questions.
`CONCEPT5I'nmfimAN|MAT|{::°N illustrating pharniacologic and pharmacokirietic
`mechanisms bring the text to life.
`V\&TCH':§E'LEARN video clips demonstrate important concepts related to medication
`administration and preventing medication errors, teaching students habits for careful
`clinical practice.
`Dosage Calculation Quizzes provide review of dosage calculation concepts to further
`promote patient safety
`Monographs of the 100 most commonly prescribed drugs, a Spanish—English Audio
`Glossary, and an NCLEX Alternate Item Format Tutorial are also provided.
`
`In addition to these resources, the following are also available exclusively on thcPoint:
`
`- Drug Class Review Exercises, based on the Concept Maps in the text, are interactive
`drag-and-drop exercises that allow students to place the drugs in their appropriate
`drug classes and hear the drug names pronounced.
`- Additional CONCEPTS'u- ucfimAN|MATl-E:-N and v\rATcH-:5-LEARN video clips related to
`physiology and pathophysiology concepts offer students additional tools for review.
`I Journal Articles, corresponding to every book chapter, offer students access to current
`research available in Lippincott Williams (‘SC Wilkins journals.
`
`Study Guide
`Study Guide to Accompany Drug Therapy in Nursing, Third Edition, authored by Diane
`Aschenbrenner and Samantha Venable, has been carefully designed to complement the
`textbook. Information is reviewed according to the types of knowledge presented in each
`textbook chapter {e.g., key terms, physiology and pathophysiology, core drug knowledge,
`core patient variables, and nursing manage1‘nent}.The Sn-rd)! Guide provides students fur-
`ther study and learning opportunities through various techniques, such as multiple-choice
`questions, matching, decision trees, and case studies, that encourage critical thinking and
`the application of knowledge. Students move through the levels of learning, beginning
`with knowledge of terms and acquisition of facts, and progressing to the application of
`knowledge in each chapter. Answers for all of the exercises are provided at the end of the
`study guide to assist students with independent study.
`
`Page 00006
`
`

`
`CHAPTER 7
`
`Life Span: Pregnant or Breast-Feeding Women 79
`' Diane S. Aachen brenncr
`
`CHAPTER 8
`
`Life Span: Older Adults 91
`* Diane S. Aschenbrenner
`
`CHAPTER 9
`
`Lifestyle: Substance Abuse 104
`* Santantha J. Venable
`
`CHAPTER 10
`
`Lifestyle, Diet, and Habits: Nutrition
`and Complementary Medications 123
`0 Samantha]. Venable
`
`CHAPTER 11
`
`Environment: Influences on Drug Therapy 132
`' Samantha J. Venable
`
`CHAPTER 12
`
`Culture and Inherited Traits:
`
`Considerations in Drug Therapy 138
`' Diane S. Aschenbrenner
`
`UNIT
`
`Peripheral Nervous System Drugs 151
`
`C H A P T E R
`
`1 3
`
`Drugs Affecting Adrenergic Function 151
`' Samantha J. Venable
`
`The prototypes discussed in this chapter‘ include epinepi7—
`riize, pi:eiiyiepi:I1'iize, cionidine, dopamine, fenozlaloprzm,
`prazosin, and proprcmoloi.
`
`CHAPTER 14
`
`Drugs Affecting Cholinergic Function 182
`' Samantha]. Venable
`
`T.-"78 prototypes discussed in this chapter inc.-lude pilo-
`cmpine, nicotine, iieostigmiize, mm’ aflopiize.
`
`Contents
`
`1 F
`
`oundations for Drug Therapy
`in Nursing 1
`
`CHAPTER 1
`
`Nursing Management of Drug Therapy 1
`0 Diane S. Ascht-:nbre11ne1'
`
`CHAPTER 2
`
`Pharmaceuticals: Development,
`Safeguards, and Delivery 13
`' Samantha]. Venable
`
`CHAPTER 3
`
`Drug Administration 28
`' Diane S. Ast:l1r:nlJ1‘ennc1'
`
`2 C
`
`ore Drug Knowledge 39‘
`
`CHAPTER 4
`
`Pharmacotherapeutics, Pharmacokinetics,
`and Pharmacodynamics 39
`° Diane S. Aschenbrenner
`
`CHAPTER 5
`
`Adverse Effects and Drug Interactions 54
`° Diane S. Aschenbrenner
`
`U
`
`N
`
`I 3
`
`Core Patient Variables 65
`
`CHAPTER 6
`
`Life Span: Children 65
`* Diane S. Aschenlarennet
`
`Page 00007
`
`

`
`Intvi Contents
`
`UNIT
`Analgesic and Anti-inflammatory
`Drugs 373
`
`CHAPTER 23
`
`Drugs Treating Severe Pain 373
`' Diane S. Aschenbrenncr
`
`5 C
`
`entral Nervous System Drugs 203
`
`CHAPTER 15
`
`Drugs Producing Anesthesia and
`Neuromuscular Blocking Z03
`' Samantha Venabie
`
`The prototypes discussed in this chapter iuciude isoflurcme,
`propofoi, iidocuirie, tuhocurariue, mid succirryicizroiiue.
`
`The prototypes discussed in this chcrpter include
`morphine, codeine, cmd peutozociite.
`
`C H A P T E R
`
`2 4
`
`Drugs Treating Mild to Moderate Pain, Fever,
`Inflammation, and Migraine Headache 399
`0 Samantha Venable
`
`The prototypes discussed in this chapter irtciude uspirin,
`ibuprofen, ocetumiriopheu, and sumcitripttm.
`
`CHAPTER 25
`
`Drugs Treating Rheumatoid Arthritis and Gout 427
`' Samantha J. Venabie
`
`The prototypes discussed in this chapter iitciude
`methotrexute, etcmercept, coichiciue, crud uiiopiri-inoi.
`
`1 C
`
`ardiovascular and Renal
`
`System Drugs 451
`
`C H _ A P T E R’
`
`2 6
`
`Drugs Affecting Lipid Levels 451
`* Diane S. Asci1e11bren11e1'
`
`The prototype discussed in this chapter is iouustutiri.
`
`C H A P T E R
`
`2 7
`
`Drugs Affecting Urinary Output 466
`° Diane S. Aschenb1'enn::r
`
`The prototypes discussed in this chapter iuciude
`h-ydrochiorothiazicie, furosemide, triumtereire, irmmtitoi,
`ucetuzoiemide, hethtmechoi, and toiterodiue.
`
`C H A P T E R
`
`2 8
`
`C H A P T E R
`
`‘l 6
`
`Drugs Affecting Muscle Spasm and Spasticity 227
`- Samantha]. Venable
`
`The prototypes discussed in this chapter irtciude
`cjicioheuzuprine, htrciofeu, and dcmtroieue.
`
`CHAPTER 17
`
`Drugs Treating Parkinson Disease and
`Other Movement Disorders 242
`
`0 Samantha]. Venable
`
`The prototypes discussed in this chapter inciude curi7idopu—
`ieuodopa, riiuzoie, tmd giatimmer.
`
`C H A P T E R
`
`1 8
`
`Drugs Relieving Anxiety and Promoting Sleep 262
`- Diane S. Aschenbrenner
`
`The prototype discussed in this chapter is iorazepcim.
`
`C H A P T E R
`
`1 9
`
`Drugs Treating Mood Disorders 279
`' Diane S. Ascheltbtenner
`
`The prototypes discussed in this chapter iuciude sertraiine.
`uortriptyiiue. pheiteizirie, arid iithium.
`
`CHAPTER 20
`
`Drugs Treating Psychotic Disorders
`and Dementia 308
`' Diane 5. Aschenbtenner
`
`The prototypes discussed in this chapter iircitide huioperidoi,
`oiuuzrrpiue, and riuustigmiue.
`
`CHAPTER 21
`
`Drugs Treating Seizure Disorders 328
`' Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter iuciude pheuytoirt,
`ioruzepcrm, arid ethosuximide.
`
`Drugs Affecting Blood Pressure 493
`' Diane S. Aschcn|J1‘en1‘Ie1'
`
`C H A P T E R
`
`2 2
`
`Drugs Stimulating the Central Nervous System 351
`' Santantha Vermhie
`
`The prototypes discussed or this chapter iuciude dextro-
`amphetumiite, sihutmmiue, mid coffeiue.
`
`The prototypes discussed iu this ciuipter iuciude cuptoprii,
`iosurtoii, epiereuoue, iohetdioi, ciottidiue, hydr'dittzi'ue,
`dopmuiue, mid uitroprussicie.
`
`Page 00008
`
`

`
`C H A P T E R
`
`2 9
`
`CHAPTER 36
`
`Drugs Treating Heart Failure 535
`0 Diane 5. Ascheltbrenrtor
`
`Drugs That Are Cell Cyc|e—Specific 690
`' Mikaela Olsen and i\/Iarit: Swisher
`
`The prototypes discussed in this chapter include digoxiu
`and nesiritide.
`
`The prototypes discussed in this chapter include
`5-;‘luorourc1'cii {5—FU), vincristine, etoposide, paclitaxel,
`topotecan, and hydroxy.-area.
`
`Contents
`
`Juwii
`
`C H A P T E R
`
`3 7
`
`Drugs That Are Cell Cycle-Nonspecific 720
`' Mikaela Olsen and Marie Swisher
`
`The prototypes discussed in this chapter include
`cyclophosphamide, carmitstine, doxorul7icin,
`and tamoxifen.
`
`H A
`
`ntimicrobial Drugs 745
`
`C H A P T E R
`
`3 8
`
`Principles of Antimicrobial Therapy 745
`' Samantha]. Venable
`
`C H A P T E R
`
`3 9
`
`Antibiotics Affecting the Bacterial Cell Wall 754
`' Samantha]. Venable
`
`The prototypes discussed in this chapter include peniciliin C,
`cefazolin, and uancornycin.
`
`CHAPTER 40
`
`Antibiotics Affecting Protein Synthesis 776
`' Samantha ]. Venable
`
`The prototypes discussed in this chapter include gentami-
`cin, clindamycin, erythromycin, iinezolid, quinupristinf
`daifopristin, tetracycline, and chioramphenicol.
`
`CHAPTER 41
`
`Drugs That Are Miscellaneous Antibiotics 805
`* Samantha]. Venable
`
`The prototypes discussed in this chapter include
`ciprofloxacin and daptomycin.
`
`C H A P T E R
`
`4 2
`
`Drugs Treating Urinary Tract Infections 316
`* Samantha j. Venable
`
`The prototype discussed in this chapter is sulfatnethoxazole-
`trimethopriin.
`
`C H A P T E Ft
`
`3 0
`
`Drugs Treating Angina 553
`- Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter inciude nitro-
`glycerin, propranolol, trerapaniii, aspirin, clopidogrel,
`and heparin.
`
`C H A P T E R
`
`3 1
`
`Drugs Affecting Cardiac Rhythm 565
`0 Diane S. Ascl1enlJ1'c11r1er
`
`The prototypes discussed in this chapter include quinidine,
`propranoiol, amiodarone, uerapamil, and sodium
`polystyrene suifonate.
`
`C H A P T E R
`
`3 2
`
`Drugs Affecting Coagulation 594
`' Diane 5. Ascl1e11l3tet1neL'
`
`The prototypes discussed in this chapter include heparin;
`warfariu; ciopidogrel; peutoxifyliine; alteplase, recombi-
`nant; antihernophilic factor; and aminocaproic acid.
`
`UNIT
`Hematopoietic and Immurie
`System Drugs 627
`
`CHAPTER 33
`
`Drugs Affecting Hematopoiesis 627
`I Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter inciude epoetin
`alfa, filgrastim, and opreluehin (interleukin-I 1).
`
`CHAPTER 34
`
`Drugs Affecting the Immune Response 644
`I Brenda K. Shelton
`
`The prototypes discussed in this chapter include interferon
`alfa-2a, rituximab, and cyciosporine.
`
`CHAPTER 35
`
`Drugs Affecting Corticosteroid Levels 669
`' Samantha J. Venable
`
`Prototypes discussed in this chapter include prednisone,
`fludrocortisone, and antinogiutethimide.
`
`Page 00009
`
`

`
`mriii Contents
`
`C H A P T E Fl
`
`4 3
`
`Drugs Treating Mycobacterial Infections 828
`' Samantha J. Venable
`
`II
`Gastrointestinal System Drugs 991
`
`The prototypes discussed in this chapter include isoniazid
`and rifampin.
`
`C H A P T E R
`
`5 0
`
`C H A P T E F!
`
`4 4
`
`Drugs Treating Fungal Infections 842
`' Samantha J. Venablc
`
`The prototypes discussed in this chapter include
`arnphotericin B and fluconazoie.
`
`C H A P T E Fl
`
`4 5
`
`Drugs Treating Viral Infections 862
`' Samantha J. Venable
`
`The prototype discussed in this chapter is acyclovir
`
`C H A F’ T E Fl
`
`4 5
`
`Drugs Treating HIV Infection and AIDS 879
`' Samantha J. Venable
`
`The prototypes discussed in this chapter include zidouudine,
`efavirenz, saquinavir; and enfuairtide.
`
`CHAPTER 47
`
`Drugs Treating Parasitic Infections 912
`' Samantha J. Vcnablc
`
`The prototypes discussed in this chapter include
`chioroquine, metronidazole, pentarnidine isethionate,
`mehendazoie, and perrnethrin.
`
`Ifl
`Respiratory System Drugs 941
`
`C H A P T E Fl
`
`4 8
`
`Drugs Affecting the Upper Respiratory System 941
`' Samantlia J. Vcnable
`
`The prototypes discussed in this chapter include
`dextromethorphan, pseudoephedrine, fexofenadine,
`and guaifenesin.
`
`C H A P T E R
`
`4 9
`
`Drugs Affecting the Lower Respiratory System 961
`' Samantha J. Venable
`
`The prototypes discussed in this chapter inciude acetyi—
`cysteine, alhuterol, ipratropium bromide, theophyiiine,
`flunisoiide, crornolyn sodium, and zafirhiieast.
`
`Drugs Affecting the Upper Gastrointestinal Tract 991
`0 Samam:I1a Venable
`
`The prototypes discussed in this chapter include 0nIepra-
`zole, ranitidine, aiuminum hydroxide with magnesium
`hydroxide, inetociopramide, pancrelipase, orlistat, and
`ondansetron.
`
`C H A P T E Fl
`
`5 1
`
`Drugs Affecting the Lower Gastrointestinal Tract 1028
`' Samantha Venahle
`
`The prototypes discussed in this chapter include
`simethicone, diphenoxyiate H Ci with atropine sulfate,
`magnesium hydroxide, alosetron, and mesalarnine.
`
`I2
`Endocrine System Drugs 1051
`
`C H A P T E ‘R
`
`5 2
`
`Drugs Affecting Blood Glucose Levels 1051
`' Diane S. Aschcn brtrnner
`
`The prototypes discussed in this chapter include regular
`insulin, giyhuride, metformin, and giucagon.
`
`CHAPTER 53
`
`Drugs Affecting Pituitary, Thyroid, Parathyroid,
`and Hypothalamic Function 1083
`' Samantha Vena ble
`
`Prototypes discussed in this chapter inciude somatropin;
`desrriopressin; ievothyroxine; rnethimazoie; calcitonin,
`salmon; and calcitrioi.
`
`C H A P T E R
`
`5 4
`
`Drugs Affecting Men’s Health and Sexuality 1120
`0 Diane S. Aschenbrenner and Shari J. Lynn
`
`The prototypes discussed in this chapter include
`testosterone, sildenafil, finasteride, and rninoxidil.
`
`C H A P T E R
`
`5 5
`
`Drugs Affecting Womelfs Health and Sexuality 1138
`'' Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter include
`conjiigated estrogen, progesterone, and alendronate.
`
`Page 00010
`
`

`
`Contents
`
`xxix
`
`C H A P T E F!
`5 6
`D“'95 Afiectmg uteri“ M°fi"ty 1 162
`I Diane S. Aschenbrennel‘
`
`AppendixD Parentera! Nutrition 1193
`Appendix E Immunizations and Recommended
`schedmes 1196
`
`The prototypes discussed in this chapter irrcizrde oxyrocin
`and m_b_,m“”e_
`
`Appendices
`
`Appendix A Diagnostic Imaging Agents 1181
`Appendix B Enzyme or Débridement Therapy 1 186
`
`Appendix C Enteral and Nutritional
`Supplements 1189
`
`Appendix F Drugs That May Cause
`Photosensitivity 1206
`Appendix G Drugs Affected by Grapefruit Juice 121‘!
`
`APPe"di" H cYt°‘h'°me P450 DW9
`I
`'
`1213
`nteractlons
`Answers to Questions for Study and Review 1219
`
`inde-X 1239
`
`Page 00011
`
`

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`This material may be protected by Copyright law (Title 17 U.S. Code)
`
`Page 00012
`
`

`
`rug therapy can be administered by several different routes
`01' methods. These routes of administration require dif-
`ferent preparations or forms of a drug. Most drugs are
`available from the drug manufacturer in multiple forms. The
`selection of the route and form is based on the interaction
`
`between core drug knowledge and core patient variables. In
`managing drug therapy, nurses use this information to assess
`patient needs, plan care, administer drugs, and evaluate the
`effectiveness of therapy. This chapter describes the different
`routes ofdrug administration, explains the different forms of
`drug preparations, and shows how the route and drug fo1'm
`interact with the core drug knowledge and the core patient
`variables.
`
`DRUG ADMINISTRATION ROUTES:
`
`GENERAL CONSIDERATIONS
`
`The three basic routes of drug administration a1'e enteral,
`parenteral, and topical. {Some authorities place topical in
`the parenteral category.)
`
`I The enteral route uses the gastrointestinal {GI} tract for
`the ingestion and absorption of drugs. The most com-
`mon method of administering drugs through the enteral
`route is orally. The enteral route also includes drugs
`that are administered through a nasogastric {NC} or
`a gastrostomy {G} tube.
`0 The parenteral route avoids or circuihvents the GI t1'act
`and is associated with all forms of injections: intra-
`muscular HM), subcutaneous {SC or SQ}, and intra-
`venous (lV}. Less commonly used parenteral routes
`than IM, SC, and IV are intraderrnal {into the dermis),
`irltrathecal {into the cerebrospinallilluidj, intra—articular
`{into a joint], and intra—arterial {into an artery}.
`The topical route is technically another parenteral route
`because it also bypasses the GI tract. Drugs administered
`topically are applied to the skin or mucous niembraiies,
`including those of the eyes, ears, nose, vagina, rectum,
`and lungs.
`
`Drugs are administered for their local or systemic effects.
`For example, most drugs applied topically to the skin or
`mucous membranes exert their effect at that site, which is a
`local effect. An example is corticosteroid cream applied to
`relieve the itch from a rash. However, certain drugs given
`topically are absorbed by the skin and distributed through-
`out the body systems to produce a systemic effect. Drugs
`given for a systemic effect by any route must be capable of
`being transported into the blood and distributed through the
`body to a location distant from the administration site. An
`example is the narcotic used for pain relief, fentanyl, which
`is imbedded in a transdernial patch and applied to the skin.
`Drugs administered by a route other than the enteral
`route have the advantage of avoiding the first—pass metabo-
`lism in the liver. Drugs administered enterally are absorbed
`from the stomach and small intestine. However, they first
`pass through the liver, the primary organ for drug metabo-
`lism, before being distributed throughout the body. Drugs
`
`CHAPTER 3 Drug Administration
`
`administered parenterally and even some topical drugs are
`transported directly into the blood, thereby bypassing the
`liver. {See Chapter 4 for a complete discussion of the first-
`pass effect and the processes of phannacol<inetics.l
`
`ENTERAL ROUTE AND FORMS
`
`\NATCH¢:§:'LEARN
`The ente1'al route involves using the GI tract for the admin-
`istration and absorption of drugs. Enteral drugs, particu-
`larly oral drugs, are manufactured and prepared in a variety
`of forms, including solid tablets and capsules and liquid
`clixirs and syrups. Because the oral route of administration
`is the most common enteral route, oral dosage forms are the
`most common preparations. They are convenient, economi-
`cal, and easy to use.
`Some oral drugs, such as antacids and laxatives, are given
`for their local effect in the GI tract, but most are given to
`achieve a systemic effect. In most cases, patients can reliably
`self-medicare with oral drug forms.
`
`Oral Drug Forms
`' Tablets
`A tablet is a solid dosage form that is prepared by compress-
`ing or molding a drug into var