`
`i
`
`Diane S. Aschenbrenner, MS, APRN, BC
`Course Coordinator
`-
`
`Johns Hopkins University
`School of Nursing
`Baltimore, Maryland
`
`Samantha J. Venable, MS, RN, FNP
`Professor
`\
`Saddleback College
`‘
`Mission Viejo, California
`
`
`
`Wolters Kluiiv
`Health
`
`- ‘_fl
`
`ott Williams & Wilkins
`
`Medac Exhibit 2005
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`Koios v. Medac
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`IPR2016-01370
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`Medac Exhibit 2005
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`Senior Acquisitions Editor: Hilarie Surrena
`Development Editor: Betsy Gentzler
`Editorial Assistant: Liz Harris
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`
`3rd Edition
`
`Copyright © 2009 Wolters Kluwer Health I Lippincott Williams BC Wilkins.
`Copyright © 2006, 2002 by Lippincott Williams 66 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 scanned—in
`or other electronic copies, or utilized by any information storage and retrieval system without written permission from the
`copyright owner, except for brief quotations embodied in critical articles, and reviews. Materials appearing in this book pre—
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`copyright. To request permission, please contact Lippincott Williams SCI'Wilkins at 530 Walnut Street, Philadelphia PA
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`9
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`6
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`5
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`4
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`3
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`2
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`1
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`Printed in China
`
`Library of Congress Cataloging-in-I’ublication Data
`
`Aschenbrenner, Diane 5.
`Drug therapy in nursing 1 Diane S. Aschenbrenner, Samantha J. Venable. — 3rd ed.
`p. ; cm.
`Includes bibliographical references and index.
`ISBN-13: 978—0-7817-6587—9 (alk. paper)
`ISBN—10: 0781765810 [alk. paper)
`1. Variable, Samantha J. I]. Title.
`1. Chemotherapy. 2. Pharmacology. 3. Nursing.
`[DNLM: 1. Drug Therapy—Nurses‘ Instruction. 2. Pharmaceutical Preparation%Nurses’ Instruction. 3. Pharmacology—
`Nurses’ Instruction. WB 330 A313d 2009]
`RM125.N83 2.009
`615.5‘8—dc22
`
`r
`
`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 of the 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 selecrion 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.
`
`LWWCOM
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`

`

`
`
`Preface
`
`“How will I ever learn all ofthis?” and “Where do I begin?” are questions 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 that is 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 hames. It gives students a “method”
`of learning and organizing large amounts of information. Drug Therapy in Nursing, 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 Therapy in Nursing, Third 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 ofnursing pharmacology. Learn-
`ing the pharmacology facts about different drug prototypes is on ly half of the knowledge
`nursing students need. Because they’re learning to be nurses, they must understand how
`to apply this knowledge to patient care. 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 nursing 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
`Therapy in Nursing, Third 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. [f 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 use of the nursing process framework. Pharmacologic
`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 Drug Therapy 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.
`
`xiii
`
`Page 00003
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`

`

`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 Therapy 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 basic
`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 pharma—
`cology: pharmacotherapeutics, pharmacokinetics, and pharmacodynamics; and adverse
`effects and drug interactions.
`I,
`Unit 3, Core Patient Variables, includes seven chapters that highlight informatioi'i 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 life—span issues (chil-
`dren, pregnant or breast-feeding women, and older adults}; lifestyle, diet, and habits issues
`(substance abuse, dietary 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 débtidement therapy, enteral and nutritional supplements, parenteral nutrition, immu-
`nizations and immunization schedules for the United States and Canada, drugs causing
`photosensitivity, drugs 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 are key to understanding each chapter’s contents.
`- Chapter Summaries highlight the most important information presented in the chapter.
`- 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
`
`0 More patbophysiology information relevant to drug therapy is included to assist with
`understanding and critical thinking.
`I All chapters have been updated and include new drugs approved by the FDA.
`
`Page 00004
`
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`
`

`

`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 C011]-
`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. IEach 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.
`Community—Based 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!
`
`3
`
`Resources for Instructors
`The following tools are available upon textbook adoption to instructors on -: Pointg.
`http://thePointhw.com/aschenbrenner3e:
`
`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
`COI‘ll'SC.
`
`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«Lectu re 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 TruefF-alse questions are integrated into the presentations to promote class
`participation and allow instructors to rise 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
`ouline discussion boards.
`
`Prelace
`
`JIV
`
`Page 00005
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`

`

`xvi Preface
`
`' Assignments [and suggested answers) include group, written, clinical, and web
`assignments.
`¢ Case Studies for every drug 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 CD7
`ROM bound into this book and on rI-.‘.Puinr;‘:
`
`- NCLEX-Style Review Questions for every chapter feature traditional and alternative-
`format NCLEX-style questions.
`- CONCEPTSinactiu-IANIMATI'Z:}N illustrating pharmacologic and pharmacokinetic
`mechanisms bring the text to life.
`- MTCHfiE'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:
`
`Iv 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.
`D
`\
`I Additional CONCEPTS‘m ucfimANIMATliziN and \NATCHifz'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 6c 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 complainant 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 management). The Study Guide provides students fur-
`ther study and learning opportunities through various techniques, such as multiplenchoice
`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
`
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`

`

`
`
`CHAPTER 7
`
`Life Span: Pregnant or Breast-Feeding Women 79
`- Diane S. Aschenbrenner
`
`C H A P T E R
`
`8
`
`Life Span: Older Adults 91
`' Diane S. Aschenbtenner
`
`C H A P T E R
`
`9
`
`Lifestyle: Substance Abuse 104
`* Samantha J. Venable
`
`CHAPTER ‘fD
`
`Lifestyle, Diet, and Habits: Nutrition
`and Complementary Medications 123
`' Samantha J. Venable
`
`CHAPTER 11
`
`Environment: Influences on Drug Therapy 132
`' Samantha J. Venable
`
`CHAPTER 12
`
`Culture and Inherited Traits:
`
`Considerations in Drug Therapy 138
`' Diana 5. 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 dismissed it? this chapter include epineph—
`rine, phenylepbi'ilte, cl'orffdiiie, dopaiitine, fenoldopmn,
`pmzosin, and proprmtolol.
`
`C H A P T E R
`
`1 4
`
`Drugs Affecting Cholinergic Function 132
`' Samantha J. Venable
`
`The prototypes discussed in this chapter include pilo—
`cm'pioe, nicotine, neostfgmine, and atropine.
`
`Page 00007
`
`Contents
`
`1
`Foundations for Drug Therapy
`in Nursing 1
`
`C H A P T E R
`
`1
`
`Nursing Management of Drug Therapy 1
`' Diane S. Aschenbrenner
`
`CHAPTER 2
`
`Pharmaceuticals: Development,
`Safeguards, and Delivery 13
`' Samantha]. Venable
`
`C H A P T E R
`
`3
`
`Drug Administration 28
`' Diane S. Aschcnbrcnncr
`
`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
`
`C H A P T E R
`
`6
`
`Life Span: Children 65
`' Diane S. Aschenbrennet
`
`Page 00007
`
`

`

`xxvi Contents
`
`UNlT
`Analgesic and Anti-inflammatory
`Drugs 373
`
`CHAPTER 23
`
`Drugs Treating Severe Pain 373
`0 Diane S. Aschenbrenner
`
`5 C
`
`entral Nervous System Drugs 203
`
`CHAPTER 15
`
`Drugs Producing Anesthesia and
`Neuromuscular Blocking 203
`- Samantha]. Venable
`
`The prototypes discussed in this chapter include isofluraae,
`propofoi, iidocaiae, tuhocurariue, and succiayichoiiue.
`
`The prototypes discussed in this chapter include
`iriorphiite, codeine, and perrtazocifle.
`
`CHAPTER 24
`
`Drugs Treating Mild to Moderate Pain, Fever,
`Inflammation, and Migraine Headache 399
`0 Samantha Van-able
`
`The prototypes discussed in this chapter irtciude aspirin,
`ibuprofen, acetaminophen, and sumatriptarr.
`
`C H A P T E R
`
`2 5
`
`Drugs Treating Rheumatoid Arthritis and Gout 427
`- Santa ntha J. Vena Isle
`The prototypes disci-rssed in this chapter iuciude
`methotrexate, etairercept, coichicirte, and aiiopuriitoi.
`
`1 C
`
`ardiovascular and Renal
`
`System Drugs 451
`
`C HA P T E R,
`
`2 6
`
`Drugs Affecting Lipid Levels 451
`' Diane S. Aschenbrenncr
`
`The prototype discussed in this chapter is iouasiatia.
`
`C H A P T E R
`
`2 7
`
`Drugs Affecting Urinary Output 466
`' Diane S. Aschenbrenncr
`
`The prototypes discussed it: this chapter iiicilide
`hydrochiorothiazide, firrosemide, triamtereue, mamzitoi,
`acetazoiamide, hethauechoi, and toiterodine.
`
`C H A F’ T E R
`
`2 8
`
`C H A P T E R
`
`‘l 6
`
`Drugs Affecting Muscle Spasm and Spasticity 227
`- Samantha J. Venable
`The prototypes discussed in this chapter iizciude
`cycioheumprine, haciofea. and dantroieae.
`
`CHAPTER 17
`
`Drugs Treating Parkinson Disease and
`Other Movement Disorders 242
`
`0 Samantha]. Venable
`
`The prototypes discussed in this chapter include carbidopa—
`ieuodopa, riiuzoie, and giatiramer.
`
`C H A P T E R
`
`1 8
`
`Drugs Relieving Anxiety and Promoting Sleep 262
`I Diane S. Aschenbrenner
`
`The prototype discussed hi this chapter is iorazepam.
`
`C H A P T E R
`
`1 9
`
`Drugs Treating Mood Disorders 279
`' Diane 5. Ascheribt'enner
`
`The prototypes discussed in this chapter inciude sertraiirze,
`uortriptyiirre. pherieiziue, and lithium.
`
`CHAPTER 20
`
`Drugs Treating Psychotic Disorders
`and Dementia 308
`' Diane S. Aachenbrenner
`
`The prototypes discussed it! this chapter include haioperidoi,
`oiauzapine, and riuastigmirre.
`
`C H A P T E R
`
`2 1
`
`Drugs Treating Seizure Disorders 328
`- Diane S. Aschenbrenner
`
`The prototypes discussed it: this chapter include phenytoirz,
`iorazepam, and ethosuximide.
`
`Drugs Affecting Blood Pressure 493
`0 Diane S. Aschenbl‘enner
`
`CHAPTER 22
`
`Drugs Stimulating the Central Nervous System 351
`' Samantha j. Von-able
`The prototypes discussed in this chapter include dextror
`amphetamine, sihutramiue, and caffeiue.
`
`The prototypes discussed in this chapter include captoprii,
`iosartau. epierenoae. iahetaioi, ciom‘diue, hydraiaziue,
`dopamine, and uitroprusside.
`
`Page 00008
`
`Page 00008
`
`

`

`C H A P T E Fl
`
`2 9
`
`C H A P T E Fl
`
`3 6
`
`Drugs Treating Heart Failure 535
`' Diane S. Aschenbcenncr
`
`Drugs That Are Cell Cycle—Specific 690
`' Mikaela Olsen and Marie Swisher
`
`Contents
`
`nxvii
`
`The prototypes discussed in this chapter include digoxin
`and iiesiritide.
`
`C H A P T E Fl
`
`3 0
`
`Drugs Treating Angina 553
`0 Diane S. Aschenbrenner
`
`The prototypes discussed it: this chapter iitciude nitro-
`glycerin, propraiioioi, uerapamii, aspirin, ciopidogrei,
`and heparin.
`
`C H A P T E H
`
`3 1
`
`Drugs Affecting Cardiac Rhythm 565
`I Diane S. Aschenbrcnncr
`
`The prototypes discussed in this chapter iriciude quinidiize,
`proprauoloi, amiodarone, uerapamii, and sodium
`polystyrene suifouate.
`
`C H A P T E Fl
`
`3 2
`
`Drugs Affecting Coagulation 594
`' Diane 5. Aschenbrenncr
`
`The prototypes discussed in this chapter include heparin;
`warfarin; ciopidogrei; perttoxifyiiiiie; aitepiase, recorrthi—
`izant; antihemophiiic factor,- aud amiirocaproic acid.
`
`UNIT
`Hematopoietic and Immune
`System Drugs 627
`
`CHAPTEFl 33
`
`Drugs Affecting Hematopoiesis 627
`I Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter iizciude epoetin
`alfa, fiigrastim, and opreiuehiu (interieuhin—I 1).
`
`C H A P T E Fl
`
`3 4
`
`Drugs Affecting the immune Response 644
`' Brenda K. Shelton
`
`The prototypes discussed in this chapter inciude interferon
`difa—Za, rituximah, and cyciosporiite.
`
`C H A P T E Fl
`
`3 5
`
`Drugs Affecting Corticosteroid Levels 669
`' Samantha]. Variable
`
`Prototypes discussed in this chapter incitide predm'sorte,
`fli-tdrocortisoue, and airtiriogiutethimide.
`
`The prototypes discussed in this chapter incitide
`S—fluorouracii (STU), uiucristihe, etoposide, paciitaxei,
`topotecmt, and hydroxym'ea.
`
`CHAPTER 37
`
`Drugs That Are lCell Cycle-Nonspecific 720
`' Mikaela Olsen and Marie Swisher
`
`The prototypes discussed in this chapter include
`cyclophosphamide, carmustirie, doxoruhiciri,
`and tamoxifen.
`
`ll
`Antimicrobial Drugs 745
`
`C H A P T E Pl
`
`3 8
`
`Principles of Antimicrobial Therapy 745
`' Samantha]. Venable
`
`C H A P T E Fl
`
`3 9
`
`Antibiotics Affecting the Bacterial Cell Wall 754
`' Samantha]. Venable
`The prototypes discussed in this chapter iifcittde peniciiiiiz G,
`cefazoiin, and uaitcomyciu.
`
`CHAPTER 40
`
`Antibiotics Affecting Protein Synthesis 776
`' Samantha J. Venable
`
`The prototypes discussed it: this chapter include gerrtami-
`chi, ciirrdamycirt, erythromycht, iiiiezoiid, quinupristiu/
`daifopristin, tetracyciine, and chiorampheuicoi.
`
`CHAPTER 41
`
`Drugs That Are Miscellaneous Antibiotics 805
`° Samantha]. Venable
`The prototypes discussed in this chapter include
`ciprofloxaciii arid daptomycin.
`
`CHAPTER 42
`
`Drugs Treating Urinary Tract Infections 316
`0 Samantha j. Venable
`
`The prototype discussed in this chapter is stiifamethoxctzoie-
`trimethoprim.
`
`Page 00009
`
`Page 00009
`
`

`

`uwiii Contents
`
`C H A F‘ T E Fl
`
`4 3
`
`Drugs Treating Mycobacterial Infections 828
`' Samantha J. Vcnable
`
`II
`Gastrointestinal System Drugs 991
`
`The prototypes discussed in this chapter irtciude isortiazid
`and rifmnpiir.
`
`C H A P T E R
`
`5 0
`
`C H A P T E Fl
`
`4 4
`
`Drugs Treating Fungal Infections 842
`' Samantha J. Venablc
`
`The prototypes discussed in this chapter include
`nmphotericirr B and fltrconazoie.
`
`Drugs Affecting the Upper Gastrointestinal Tract 991
`0 Samantha Venabie
`
`The prototypes discussed in this chapter irtciude ortrepre—
`zoie, mnitidirre, eimnimtm hydroxide with rrmgrtesimn
`hydroxide, ritetocfopmmide, pmtcreiipase, oriistttt, and
`orrdansetron.
`
`C H A P T E R
`
`4 5
`
`C H A P T E Fl
`
`5 1
`
`Drugs Treating Viral Infections 862
`' Samantha J. Venable
`
`The prototype discussed in this chapter is acyclovir.
`
`C H A P T E Fl
`
`4 5
`
`Drugs Affecting the Lower Gastrointestinal Tract 1028
`° Samantha Venahle
`
`The prototypes discussed in this chapter irzchrde
`stmethicone, diphertoscyinte H Ci with atropine sulfate,
`ratogrtesium hydroxide, titosetron, tmd mesnfmrtme.
`
`Drugs Treating HIV Infection and AIDS 879
`0 Samantha J. Venable
`The prototypes discussed in this chapter inchrde zidotmdhte,
`efauh’enz, saqtrirmoii; and ertfiwirtide.
`
`C H A P T E Fl
`
`4 7
`
`Drugs Treating Parasitic Infections 912
`' Samantha J. Vcnablc
`
`The prototypes discussed it: this chapter iitcftrde
`chioroquirze, metronidezor'e, penttmtidine isethiormte,
`meherzdezoie, and permethrirt.
`
`Ifl
`Respiratory System Drugs 941
`
`C H A P T E R
`
`4 8
`
`Drugs Affecting the Upper Respiratory System 941
`' Samantha J. Vcnablc
`
`The prototypes discussed in this chapter include
`dextromethorphmt, psetrdoephedrihe, fexofeuttdirte,
`mid gtrcrifenesin.
`
`C H A P T E Fl
`
`4 9
`
`Drugs Affecting the Lower Respiratory System 961
`' Samantha]. Venable
`The prototypes discussed in this chapter incttrde ncetyie
`cysteine, eihtrteroi, ipmtropitrrrr bromide, theophyiiirre,
`fltrrrisoiide, crorrtoiyrr soditrrit, and zefirftrhest.
`
`Ii
`Endocrine System Drugs 1051
`
`o H A P T E ‘R
`
`5 2
`
`Drugs Affecting Blood Glucose Levels 1051
`' Diane S. Aschcn brenner
`
`The prototypes discussed in this chapter incl-tide regular
`insulin, gfyhm'ide, metformht, :md gitrcagort.
`
`CHAPTER 53
`
`Drugs Affecting Pituitary, Thyroid, Parathyroid,
`and Hypothalamic Function 1083
`' Samantha Vena ble
`
`Prototypes discussed in this chapter incinde somtttropirt;
`desrrtopressin; ieuothytoxihe; methhrtttzoie; caicitonirt,
`saimorz; and caicitriof.
`
`C H A P T E Fi
`
`5 4
`
`Drugs Affecting Men’s Health and Sexuality 1120
`' Diane S. Aschenbrenner and Shari J. Lynn
`
`The prototypes discussed in this chapter include
`testosterone, sifdermfif, firmsteride, and rrtittoxidil.
`
`C H A P T E Ft
`
`5 5
`
`Drugs Affecting Women’s Health and Sexuality 1138
`° Diane S. Aschenbrenner
`
`The prototypes discussed in this chapter irrciude
`corringtrted estrogen, progesterone, and ritendrormte.
`
`Page 00010
`
`Page 00010
`
`

`

`Contents Mix
`
`0 H A P T E F1
`5 6
`Drugs “fading Uterine motility 1 152
`- Diane S. Aschenbrenncr
`The prototypes discussed in this chapter inciude oxytocin
`and tert'mtaiine.
`
`Appendices
`
`Appendix D Parenteral Nutrition 1193
`Appendix E Immunizations and Recommended
`Schedu|es 1196
`
`Appendix F Drugs That May Cause
`Photosensitivity 1206
`Appendix G Drugs Affected by Grapefruit Juice 1211
`
`Appendix A Diagnostic Imaging Agents 1181
`Appendix B Enzyme or Débridement Therapy 1186
`Appendix c Enteral and Nutritional
`Supplements 1189
`
`Appendix H Cytochrome P450 Drug
`|
`'
`1213
`"tera‘t'ons
`t.
`t
`.
`Answers 0 Ques Ions for Study and Rewew 1219
`Iridex 1239
`
`Page 00011
`
`Page 00011
`
`

`

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

`

`C H A PT E R 3 Drug Administration
`
`23
`
`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 of drug administration, explains the different forms of
`drug preparations, and shows how the route and drug form
`interact with the core drug knowledge and the core patient
`variables.
`
`
`
`DRUG ADMINISTRATION ROUTES:
`GENERAL CONSIDERATIONS
`
`y
`
`The three basic routes of drug administration are enteral,
`parenteral, and topical. (Some authorities place topical in
`the parenteral category.)
`
`- 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 cnteral
`route is orally. The enteral route also includes drugs
`that are administered through a nasogastric- (NG) or
`a gastrostomy (GI tube.
`' The parenteral route avoids or circumvents the GI tract
`and is associated with all forms of injections: intra—
`muscular {[M)5 subcutaneous (SC or SQ), and intra—
`venous (lV). Less commonly used parenteral routes
`than IM, SC, and IV are intraderrnal {into the dermis),
`inttathecal (into the cerebrospinallfluid), intrararticular
`{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 membranes,
`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
`Ioeal effect. An example is corticosteroid cream applied to
`relieve the itch from a rash. Howaver, 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 adminisrration site. An
`example is the narcotic used for pain reilef, fentanyl, which
`is imbedded in a transdermal patch and applied to the skin.
`Drugs administered by a route other than the enteral
`route have the advantage of avoiding the first—pass metab0~
`lism in the iiver. Drugs administered enterally are absorbed
`from the stomach and small intestine. However, they first
`pass throuin the liver, the primary organ for drug metabo—
`lism, before being distributed throughout the body. Drugs
`
`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 phannacokinetics.)
`
`
`
`ENTERAL ROUTE AND FORMS
`
`VVATCH£§§LEARN
`The enteral route involves using the GI tract for the admin—
`istration and absorption of drugs. Entetal drugs, particu—
`larly oral drugs, are manufactured and prepared in a variety
`of forms, including solid tablets and capsules and liquid
`elixirs 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-medicate with oral drug forms.
`
`Oral Drug Forms
`' Tablets
`A tablet is a soli