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Index
Cover Page
Preface
UNIT 1 Fundamental Principles of Pharmacology
CHAPTER 1 Introduction to Pharmacology: Concepts and Connections
LEARNING OUTCOMES
KEY TERMS
Brief History of Pharmacology
1.1 The practice of applying products to relieve suffering has been recorded throughout history by virtually every culture.
CONNECTION Checkpoint 1.1
Pharmacology: The Study of Medicines
1.2 Pharmacology is the study of medicines.
Characteristics of an Ideal Drug
1.3 The perfect drug is safe and effective.
Classification of Drugs
1.4 Drugs may be organized by their therapeutic classification or pharmacologic classification.
CONNECTION Checkpoint 1.2
Drug Prototypes
1.5 A prototype drug is the agent to which all other medications in a class are compared.
Naming Drugs
1.6 Drugs have chemical, generic, and trade names.
1.7 Generic drugs are less expensive than brand-name drugs, but they may differ in bioavailability.
PharmFACT
Connecting Pharmacology to Clinical Nursing Practice
1.8 Pharmacology is intimately connected to nursing practice and is a key intervention in relieving and preventing human suffering.
CHAPTER 1 Understanding the Chapter
Key Concepts Summary
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 2 Drug Regulations
LEARNING OUTCOMES
KEY TERMS
Patent Medicines
2.1 Early American history saw the rise of patent medicines and the lack of adequate drug regulations.
Brief History of Drug Legislation
2.2 In the 1900s, drug legislation was enacted to make drugs safer and more effective.
Drug Standards
2.3 The standardization of drug purity and strength is specified by the United States Pharmacopeia-National Formulary.
The U.S. Food and Drug Administration
2.4 The regulatory agency responsible for ensuring that drugs and medical devices are safe and effective is the U.S. Food and Drug Administration.
Drug Approval
2.5 The drug approval process established by the Food and Drug Administration ensures that drugs sold in the United States are safe and effective.
PharmFACT
CONNECTION Checkpoint 2.1
Changes to the Drug Approval Process
2.6 The U.S. Food and Drug Administration has sped up the process of drug review.
PharmFACT
Prescription and Over- the-Counter Drugs
2.7 Over-the-counter drugs are usually safe and effective when used according to label instructions.
PharmFACT
Drug Schedules
2.8 Drugs with a potential for abuse are categorized into schedules.
CONNECTION Checkpoint 2.2
Prescriptive Authority for Nurses
2.9 Advanced practice nurses are allowed to prescribe drugs under state regulations.
CHAPTER 2 Understanding the Chapter
Key Concepts Summary
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 3 Pharmacokinetics
LEARNING OUTCOMES
KEY TERMS
Introduction to Pharmacokinetics
3.1 Pharmacokinetics focuses on what the body does to drugs after they are administered.
3.2 Drugs use diffusion and active transport to cross plasma membranes to reach their target cells.
Primary Processes of Pharmacokinetics
3.3 Absorption is the process of moving a drug from the site of administration to the bloodstream.
Route of Administration
Enteral route:
Tablets and Capsules:
PharmFACT
Sublingual and Buccal Routes:
Nasogastric and Gastrostomy Tubes:
Topical route:
Parenteral route:
Intradermal and Subcutaneous Administration:
Intramuscular Administration:
Intravenous Administration:
CONNECTION Checkpoint 3.1
Drug Concentration and Dose
GI Tract Environment
Blood Flow to the Absorption Site
Drug Ionization
Drug Interactions
Surface Area
3.4 Distribution describes how drugs are transported throughout the body.
Blood flow to tissues:
Drug solubility:
Tissue storage:
Drug-protein binding:
Special barriers to drug distribution:
3.5 Metabolism is a process that changes the activity of a drug and makes it more likely to be excreted.
CONNECTION Checkpoint 3.2
Hepatic microsomal enzymes:
Patient variation in metabolism:
3.6 Excretion processes remove drugs from the body.
Renal excretion:
Pulmonary excretion:
Glandular secretion:
Fecal and biliary excretion:
Time–Response Relationships
3.7 The therapeutic response of most drugs depends on their concentration in the plasma.
3.8 The drug half-life estimates the duration of action for most medications.
3.9 Repeated dosing allows a plateau drug plasma level to be reached.
CHAPTER 3 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 4 Pharmacodynamics
LEARNING OUTCOMES
KEY TERMS
Interpatient Variability
4.1 Patients have widely different responses to drugs, which can be depicted on a frequency distribution curve.
Therapeutic Index
4.2 The therapeutic index describes a drug’s margin of safety.
CONNECTION Checkpoint 4.1
Dose–Response Relationship
4.3 The dose–response relationship describes how the actions of a drug change with increasing dose.
Potency and Efficacy
4.4 Potency and efficacy are fundamental concepts of pharmacodynamics that describe a drug’s activity.
Receptor Theory
4.5 Most drugs produce their actions by activating or inhibiting specific cellular receptors.
Agonists and Antagonists
4.6 Agonists, partial agonists, and antagonists compete for cellular receptors and can modify drug action.
CONNECTION Checkpoint 4.2
Pharmacogenetics
4.7 In the future, pharmacogenetics may allow customization of drug therapy.
CHAPTER 4 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 5 Adverse Drug Effects and Drug Interactions
LEARNING OUTCOMES
KEY TERMS
Adverse Drug Effects
5.1 The nurse plays a key role in preventing and managing adverse drug effects.
PharmFACT
5.2 The FDA continues to monitor for new adverse events after a drug is approved and marketed.
5.3 Allergic reactions are caused by a hyperresponse of the immune system.
5.4 Idiosyncratic reactions are unusual drug responses often caused by genetic differences among patients.
PharmFACT
5.5 Some drugs have the ability to induce cancer or cause birth defects.
5.6 Drug toxicity may be specific to particular organs.
Drug Interactions
5.7 Drug interactions may significantly affect pharmacotherapeutic outcomes.
5.8 Pharmacokinetic drug interactions include changes in the absorption, distribution, metabolism, or excretion of medications.
CHAPTER 5 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 6 Medication Errors and Risk Reduction
LEARNING OUTCOMES
KEY TERMS
Medication Errors and Their Impact on Health Care
6.1 Medication errors are preventable events that may significantly impact treatment outcomes.
Factors Contributing to Medication Errors
6.2 Medication errors may be caused by human factors, inadequate communication, or confusing labels, packaging, or drug names.
CONNECTION Checkpoint 6.1
Drug Names and Medication Errors
6.3 Certain drugs have higher rates of medication errors.
PharmFACT
Reporting Medication Errors
6.4 Medication errors must be properly documented and reported.
CONNECTION Checkpoint 6.2
Strategies for Reducing Medication Errors
6.5 Nurses use multiple strategies for reducing medication errors.
6.6 Thorough medication reconciliation is an important means of reducing medication errors.
6.7 Adequate patient education and adherence are essential strategies for safe medication usage.
PharmFACT
6.8 Health care agencies are actively involved in reducing medication errors.
6.9 Analytical tools may be used to identify risk and analyze errors.
CHAPTER 6 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 7 The Role of Complementary and Alternative Therapies in Pharmacotherapy
LEARNING OUTCOMES
KEY TERMS
Types of Complementary and Alternative Therapies
7.1 Complementary and alternative therapies are used by a large number of people to prevent and treat disease.
History of Herbal Therapies
7.2 Natural products from plants have been used as medicines for thousands of years.
PharmFACT
Standardization of Herbal Products
7.3 Herbal products are available in a variety of formulations, some containing standardized extracts and others containing whole herbs.
Dietary Supplement Regulation
7.4 Herbal products and dietary supplements are not regulated in the same manner as prescription medications.
CONNECTION Checkpoint 7.1
Herb–Drug Interactions
7.5 Natural products may have pharmacologic actions and can interact with conventional drugs.
CONNECTION Checkpoint 7.2
Specialty Supplements
7.6 Specialty supplements are nonherbal dietary products that are widely used to promote wellness.
CHAPTER 7 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 2 Pharmacology and the Nurse–Patient Relationship
CHAPTER 8 Pharmacotherapy During Pregnancy and Lactation
LEARNING OUTCOMES
KEY TERMS
Rationale for Drug Use During Pregnancy and Lactation
8.1 Women frequently use drugs during pregnancy and lactation.
Pharmacotherapy During Pregnancy
8.2 Physiological changes during pregnancy can alter normal pharmacokinetic responses.
Pharmacotherapy During Lactation
8.6 Transfer of drugs from mother to infant may occur through breast milk.
PharmFACT
8.7 Drugs present in breast milk may cause adverse effects in the breast-feeding infant.
CONNECTION Checkpoint 8.3
CHAPTER 8 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 9 Pharmacotherapy of the Pediatric Patient
LEARNING OUTCOMES
KEY TERMS
Testing and Labeling of Pediatric Drugs
9.1 Legislation has attempted to improve the testing and labeling of pediatric drugs.
PharmFACT
Pharmacokinetic Variables in Pediatric Patients
9.2 Pharmacokinetic responses in children differ from those in adults.
Pharmacologic Implications Associated with Growth and Development
9.3 The role of the nurse in administering medications changes with each developmental age group.
Medication Safety for Pediatric Patients
9.4 The nurse is a key member of the health care team in ensuring medication safety in pediatric patients.
Determining Pediatric Drug Dosages
9.5 The nurse must be accurate when calculating drug dosages of pediatric patients.
Adverse Drug Reactions in Children and Promoting Adherence
9.6 Pediatric patients are more susceptible than adults to adverse drug effects.
CONNECTION Checkpoint 9.3
PharmFACT
CHAPTER 9 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 10 Pharmacotherapy of the Geriatric Patient
LEARNING OUTCOMES
KEY TERMS
Polypharmacy
10.1 Older adults take more medications than any other segment of the population.
CONNECTION Checkpoint 10.1
Physiological Changes Related to Aging
10.2 Anatomic and physiological changes associated with aging may alter the patient’s response to medications.
Pharmacokinetic and Pharmacodynamic Changes in Older Adults
10.3 Normal aging processes can alter pharmacokinetic and pharmacodynamic responses to drugs.
Adherence and Drug Misuse Among Older Adults
10.4 Adherence with the therapeutic regimen is a major challenge for many older adults.
CONNECTION Checkpoint 10.3
Adverse Drug Reactions in Older Adults
10.5 Older adults are at high risk for experiencing adverse drug reactions and interactions.
PharmFACT
CHAPTER 10 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 11 Individual Variations in Drug Responses
LEARNING OUTCOMES
KEY TERMS
Psychosocial Influences
11.1 Many psychosocial influences impact pharmacotherapy.
CONNECTION Checkpoint 11.1
Cultural and Ethnic Variables
11.2 Cultural and ethnic variables can influence pharmacotherapy.
PharmFACT
PharmFACT
Genetic Influences
11.3 Genetic polymorphisms can affect drug action.
Enzymes
Receptors or Drug Targets
CONNECTION Checkpoint 11.2
Gender Influences
11.4 Males and females may respond differently to drugs.
CHAPTER 11 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 3 Pharmacology of the Autonomic Nervous System
CHAPTER 12 Review of Neurotransmitters and the Autonomic Nervous System
LEARNING OUTCOMES
KEY TERMS
Overview of the Nervous System
12.1 The two major subdivisions of the nervous system are the central nervous system and the peripheral nervous system.
12.2 The peripheral nervous system is divided into somatic and autonomic components.
Structure and Function of the Autonomic Nervous System
12.3 The autonomic nervous system is divided into two mostly opposing components: the sympathetic and parasympathetic branches.
Synaptic Transmission
12.4 Synaptic transmission allows information to be communicated between two nerves or from nerves to muscles or glands.
12.5 Autonomic drugs exert their effects by acting at synapses.
Cholinergic Transmission
12.6 Acetylcholine is the neurotransmitter released at cholinergic receptors, which may be nicotinic or muscarinic.
PharmFACT
Cholinergic Receptors and Neurotransmitters
CONNECTION Checkpoint 12.1
Termination of Acetylcholine Action
Adrenergic Transmission
12.7 Norepinephrine is the primary neurotransmitter released at adrenergic receptors, which may be alpha or beta.
PharmFACT
Alpha-Adrenergic Receptors
Beta-Adrenergic Receptors
Termination of Norepinephrine Action
CONNECTION Checkpoint 12.2
12.8 The adrenal medulla is a specialized type of sympathetic nervous system tissue that secretes epinephrine and norepinephrine.
Regulation of Autonomic Functions
12.9 The autonomic nervous system is influenced by higher levels of control in the cerebral cortex and hypothalamus.
Classifying Autonomic Drugs
12.10 Autonomic drugs are classified by which receptors they stimulate or block.
CHAPTER 12 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 13 Cholinergic Agonists
LEARNING OUTCOMES
KEY TERMS
Cholinergic Receptors
13.1 Drugs can activate cholinergic receptors either directly or indirectly.
Muscarinic Agonists
13.2 Muscarinic agonists produce their effects by directly stimulating cholinergic receptors.
Direct Acting (Muscarinic Agonists)
Indirect Acting (Cholinesterase Inhibitors)
CONNECTION Checkpoint 13.1
PharmFACT
PROTOTYPE DRUG Bethanechol (Urecholine)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Bethanechol (Urecholine)
Pharmacotherapy of Myasthenia Gravis
13.5 Acetylcholinesterase inhibitors are used in the pharmacotherapy of myasthenia gravis to increase the strength of muscular contraction.
PharmFACT
PROTOTYPE DRUG Pyridostigmine (Mestinon, Regonol)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Pyridostigmine (Mestinon, Regonol)
Nicotinic Agonists
13.6 Nicotine acts by activating Ach receptors at the ganglia.
Implementation
CONNECTION Checkpoint 13.3
CHAPTER 13 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 14 Cholinergic Antagonists
LEARNING OUTCOMES
KEY TERMS
Classification of Cholinergic Antagonists
14.1 Cholinergic antagonists act by blocking the effects of acetylcholine at muscarinic or nicotinic receptors.
Muscarinic Antagonists
14.2 Muscarinic antagonists have been used for a diverse number of conditions, but they are rarely drugs of choice due to their adverse effects.
CONNECTION Checkpoint 14.1
PharmFACT
PROTOTYPE DRUG Atropine (Atropen)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Atropine (Atropen)
Nicotinic Antagonists: Ganglionic Blockers
14.3 Ganglionic blockers act at the autonomic ganglia to lower blood pressure in emergency situations.
Nicotinic Antagonists: Neuromuscular Blockers
14.4 Muscle contraction occurs when the motor end plate is depolarized.
Ganglionic Blocker
Neuromuscular Blockers
14.5 Depolarizing neuromuscular blockers are given to produce muscle paralysis during short medical–surgical procedures.
CONNECTION Checkpoint 14.3
PROTOTYPE DRUG Succinylcholine (Anectine, Quelicin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
CONNECTION Checkpoint 14.4
Drugs Similar to Succinylcholine (Anectine)
14.6 Nondepolarizing neuromuscular blockers are given to produce muscle paralysis during longer surgical procedures.
CHAPTER 14 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 15 Adrenergic Agonists
LEARNING OUTCOMES
KEY TERMS
Actions of Adrenergic Agonists
15.1 Adrenergic agonists activate the sympathetic nervous system to produce fight-or-flight symptoms.
CONNECTION Checkpoint 15.1
PharmFACT
Mechanisms of Action of Adrenergic Agonists
15.2 Adrenergic agonists may act directly by binding to adrenergic receptors, or indirectly by increasing the amount of norepinephrine at synapses.
Classification of Adrenergic Agonists
15.3 Adrenergic agonists may be classified as catecholamines or noncatecholamines.
CONNECTION Checkpoint 15.2
Nonselective Adrenergic Agonists
15.4 The nonselective adrenergic agonists activate both alpha and beta receptors and are used to treat bronchospasm, cardiac arrest, and hypotension.
PROTOTYPE DRUG Epinephrine (Adrenalin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Epinephrine (Adrenalin)
Alpha-Adrenergic Agonists
15.5 Alpha-adrenergic agonists are used to relieve nasal decongestion and elevate blood pressure.
PROTOTYPE DRUG Phenylephrine (Neo-Synephrine)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Phenylephrine (Neo-Synephrine)
Beta-Adrenergic Agonists
15.6 Beta-adrenergic agonists are used to treat asthma, shock, heart failure, and other cardiac disorders.
CHAPTER 15 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 16 Adrenergic Antagonists
LEARNING OUTCOMES
KEY TERMS
Actions of Adrenergic Antagonists
16.1 Adrenergic antagonists act by blocking the effects of norepinephrine at adrenergic receptors.
CONNECTION Checkpoint 16.1
Alpha-Adrenergic Antagonists
16.2 Alpha1-adrenergic antagonists are used to treat hypertension and benign prostatic hyperplasia.
PharmFACT
PROTOTYPE DRUG Prazosin (Minipress)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Prazosin (Minipress)
Beta-Adrenergic Antagonists
16.3 Nonselective beta-adrenergic antagonists affect both beta1 and beta2 receptors and are prescribed for HTN, angina, and other cardiovascular disorders.
Selective Beta1-Adrenergic Antagonists
Alpha1 and Beta Blockers (Centrally Acting)
Mixed Alpha1- and Beta-Adrenergic Antagonists
PROTOTYPE DRUG Propranolol (Inderal, InnoPran XL)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Propranolol (Inderal, InnoPran XL)
CHAPTER 16 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 4 Pharmacology of the Central Nervous System
CHAPTER 17 Review of the Central Nervous System
LEARNING OUTCOMES
KEY TERMS
Scope of Central Nervous System Pharmacology
17.1 Medications affect the central nervous system by stimulating or suppressing the firing of specific neurons.
CONNECTION Checkpoint 17.1
Neurons and Neurotransmission
17.2 Neurons in the central nervous system communicate with each other and with body tissues, using neurotransmitters.
PharmFACT
Adrenergic synapses:
Cholinergic synapses:
Dopaminergic synapses:
CONNECTION Checkpoint 17.2
Endorphins and enkephalins:
Gamma aminobutyric acid synapses:
Glutamate synapses:
Serotonergic synapses:
PharmFACT
Structural Divisions of the Central Nervous System
17.3 The central nervous system is divided into several major structural components.
Functional Systems of the Central Nervous System
17.4 Several functional divisions of the central nervous system are important to pharmacotherapy.
CHAPTER 17 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 18 Pharmacotherapy of Anxiety and Sleep Disorders
LEARNING OUTCOMES
KEY TERMS
Anxiety Disorders
18.1 Proper diagnosis of anxiety disorders is important to identifying the most effective treatment option.
CONNECTION Checkpoint 18.1
18.2 Anxiety disorders may be divided into five major categories.
Medications
Medical Conditions
PharmFACT
PharmFACT
18.3 Specific regions of the brain have been identified that are responsible for anxiety.
Sleep Disorders
18.4 Sleep occurs in distinct stages.
PharmFACT
18.5 Sleep disorders affect a large percentage of the population.
Management of Anxiety and Sleep Disorders
18.6 There is a link between insomnia and anxiety.
PharmFACT
18.7 Management of anxiety and sleep disorders utilizes a combination of pharmacologic and nonpharmacologic therapies.
Pharmacotherapy of Anxiety and Insomnia
18.8 Benzodiazepines are preferred drugs for generalized anxiety disorder and the short-term therapy of insomnia.
Benzodiazepines for Anxiety
Benzodiazepines for Insomnia
Nonbenzodiazepine Anxiolytics
PROTOTYPE DRUG Lorazepam (Ativan)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Lorazepam (Ativan)
CHAPTER 18 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 19 Pharmacotherapy of Mood Disorders
LEARNING OUTCOMES
KEY TERMS
Categories of Mood Disorders
19.1 The two primary categories of mood disorders are depression and bipolar disorder.
Major Depressive Disorder
19.2 Major depressive disorder is characterized by a depressed mood, with accompanying symptoms, that lasts at least 2 weeks.
PharmFACT
Pathophysiology of Depression
19.3 The pathophysiology of depression has biologic, genetic, and environmental components.
CONNECTION Checkpoint 19.1
Assessment of Depression
19.4 Assessment and diagnosis of depression are a collaborative effort among health care providers.
19.5 The majority of patients who attempt suicide have major depression.
Nonpharmacologic Therapies for Depression
19.6 Depression is sometimes treated with nonpharmacologic therapies.
PharmFACT
Pharmacotherapy of Depression
19.7 The mechanism of action of antidepressants involves modulation of neurotransmitter levels in the brain.
Tricyclic Antidepressants
19.8 Tricyclic antidepressants were once the mainstay for the treatment of depression but they have many adverse effects.
Tricyclic Antidepressants (TCAs)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
Atypical Antidepressants
MAO Inhibitors (MAOIs)
CONNECTION Checkpoint 19.2
PROTOTYPE DRUG Imipramine (Tofranil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Imipramine (Tofranil)
Selective Serotonin Reuptake Inhibitors
19.9 Selective serotonin reuptake inhibitors are the drugs of choice for treating depression due to their low incidence of serious adverse effects.
PROTOTYPE DRUG Fluoxetine (Prozac, Sarafem)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Fluoxetine (Prozac, Sarafem)
Atypical Antidepressants
19.10 Atypical antidepressants are alternatives to the selective serotonin reuptake inhibitors for depression and anxiety disorders.
PROTOTYPE DRUG Venlafaxine (Effexor)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Venlafaxine (Effexor)
Monoamine Oxidase Inhibitors
19.11 Monoamine oxidase inhibitors are effective antidepressants but are seldom used due to potentially serious adverse effects.
Description
History and Claims
Standardization
Evidence
PROTOTYPE DRUG Phenelzine (Nardil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Phenelzine (Nardil)
Bipolar Disorder
19.12 Bipolar disorder is a serious psychiatric disorder characterized by extreme mood swings from depression to euphoria.
Drugs for Bipolar Disorder
19.13 Lithium is the conventional therapy for the treatment of bipolar disorder.
Antiseizure Drugs
Atypical Antipsychotic Drugs
PROTOTYPE DRUG Lithium Carbonate (Eskalith, Lithobid)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Lithium Carbonate (Eskalith, Lithobid)
19.14 Antiseizure and atypical antipsychotic drugs are used to control symptoms of bipolar disorder.
CHAPTER 19 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 20 Pharmacotherapy of Psychoses
LEARNING OUTCOMES
KEY TERMS
Characteristics of Psychoses
20.1 Psychoses are severe mental disorders characterized by the inability to recognize reality.
PharmFACT
Symptoms of Schizophrenia
20.2 Schizophrenia, the most common psychosis, has both positive and negative symptoms.
Etiology of Schizophrenia
20.3 The precise etiology of schizophrenia remains unknown.
PharmFACT
Management of Psychoses
20.4 Medical management of psychosis is challenging because patients often lack insight into their disease and believe their behavior is normal.
Antipsychotic Drugs
20.5 Selection of an antipsychotic drug depends on its spectrum of adverse effects and the experience of the health care provider.
First-Generation Antipsychotics
20.6 The phenothiazines are effective at treating schizophrenia symptoms but exhibit a high incidence of adverse effects.
Phenothiazines
Nonphenothiazines
PROTOTYPE DRUG Chlorpromazine
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Chlorpromazine
Second-Generation (Atypical) Antipsychotics
20.8 Second-generation antipsychotics have become drugs of choice for the treatment of schizophrenia.
PROTOTYPE DRUG Risperidone (Risperdal)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Risperidone (Risperdal)
CHAPTER 20 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 21 Pharmacotherapy of Degenerative Diseases of the Central Nervous System
LEARNING OUTCOMES
KEY TERMS
Degenerative Diseases of the Central Nervous System
21.1 Degenerative diseases of the central nervous system are characterized by irreversible and progressive loss of neuronal function.
PharmFACT
Parkinson’s Disease
21.2 Parkinson’s disease is a progressive neurodegenerative disorder characterized by abnormal motor movement.
21.3 Parkinson’s disease is caused by a lack of sufficient amounts of dopamine produced by the substantia nigra.
CONNECTION Checkpoint 21.1
Pharmacotherapy of Parkinson’s Disease
21.4 The drugs used for Parkinson’s disease help to alleviate symptoms but do not cure the disease.
21.5 Replacement therapy with levodopa is the most effective therapy for treating Parkinson’s disease.
PROTOTYPE DRUG Levodopa and Carbidopa (Sinemet, Parcopa)
Classification:
Therapeutic Effects and Uses:
Dopamine Replacement Agent
Dopamine Agonists
COMT Inhibitors
Monoamine Oxidase-B Inhibitors
Miscellaneous Drug
Mechanism of Action:
Pharmacokinetics (Levodopa):
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
21.6 Dopamine agonists may be used as monotherapy for early symptoms of Parkinson’s disease or as adjuncts to levodopa in patients with advanced disease.
PROTOTYPE DRUG Pramipexole (Mirapex)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Levodopa and Pramipexole (Mirapex)
Alzheimer’s Disease
21.9 Alzheimer’s disease, the most common dementia, leads to a progressive loss of cognitive function.
PharmFACT
Pharmacotherapy of Alzheimer’s Disease
21.10 Pharmacotherapy of Alzheimer’s disease produces only modest results and is ineffective at stopping the progression of the disorder.
Cholinesterase Inhibitors
CONNECTION Checkpoint 21.3
PROTOTYPE DRUG Donepezil (Aricept)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Description
History and Claims
Standardization
Evidence
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Donepezil (Aricept)
Multiple Sclerosis
21.11 Multiple sclerosis is a chronic, neurodegenerative disease that is treated with immunomodulator drugs.
Amyotrophic Lateral Sclerosis
21.12 The pharmacotherapy of amyotrophic lateral sclerosis is limited to a single drug.
Implementation
CHAPTER 21 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 22 Pharmacotherapy of Seizures
LEARNING OUTCOMES
KEY TERMS
Characteristics of Seizure Disorders
22.1 Epilepsy is characterized by recurrent seizures caused by disturbances in the electrical activity of the brain.
PharmFACT
22.2 Seizure disorders differ throughout the lifespan.
Classification of Seizure Disorders
22.3 Most seizures are classified as generalized or partial.
Generalized Seizures
Partial Seizures
Other Seizures
Generalized Seizures
Clinical Question
How is epilepsy different in the older adult population?
Evidence
Implications
Critical Thinking Questions
Partial Seizures
22.4 Some types of seizures are called special epileptic seizures or are unclassified.
22.5 The selection of antiepileptic drug therapy is dependent on seizure type and characteristics.
PharmFACT
22.6 Antiepileptic drugs act by suppressing abnormal neuronal discharges.
Antiepileptic Drugs
22.7 Barbiturates are traditional drugs for tonic–clonic seizures that have been replaced by newer and safer medications.
Barbiturates
Benzodiazepines
Hydantoins
Dicarbazepines
Succinimides
Miscellaneous Antiepileptic Drugs
Other Miscellaneous Drugs
CHAPTER 22 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 23 Pharmacotherapy of Muscle Spasms and Spasticity
LEARNING OUTCOMES
KEY TERMS
Etiology and Pathophysiology of Muscle Spasms and Spasticity
23.1 Whereas muscle spasms are often caused by overuse of skeletal muscle, muscle spasticity involves damage to motor nerves.
Nonpharmacologic Therapies for Muscle Spasms and Spasticity
23.2 Nonpharmacologic interventions for treating muscle spasms and spasticity are limited.
Clinical Question
Can children with cerebral palsy with spasticity be safely and effectively treated with intrathecal baclofen?
Evidence
Implications
Critical Thinking Questions
PharmFACT
Pharmacotherapy of Muscle Spasms
23.3 Nonsteroidal anti-inflammatory drugs and skeletal muscle relaxants are used to treat muscle spasms.
CONNECTION Checkpoint 23.1
PROTOTYPE DRUG Cyclobenzaprine (Amrix, Flexeril)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Cyclobenzaprine (Amrix, Flexeril)
Pharmacotherapy of Muscle Spasticity
23.4 Direct-acting skeletal muscle relaxants are often used to relieve muscle spasticity.
PROTOTYPE DRUG Dantrolene (Dantrium, Revonto)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Dantrolene (Dantrium)
Skeletal Muscle Relaxants as Surgical Adjuncts
23.5 Skeletal muscle relaxants are administered during surgery in combination with anesthetic agents.
Implementation
CHAPTER 23 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 24 Central Nervous System Stimulants and Drugs for Attention Deficit/Hyperactivity Disorder
LEARNING OUTCOMES
KEY TERMS
Characteristics of Central Nervous System Stimulants
24.1 Central nervous system stimulants increase alertness, enhance the ability to concentrate, and delay the symptoms of fatigue.
PharmFACT
Etiology and Pathophysiology of Attention Deficit/Hyperactivity Disorder
24.2 Attention deficit/hyperactivity disorder is characterized by inattention, hyperactivity, and impulsive behavior.
Inattention
Hyperactivity/Impulsivity
Pharmacotherapy of Attention Deficit/Hyperactivity Disorder
24.3 Psychostimulants are central nervous system stimulants indicated for the treatment of ADHD and narcolepsy.
CONNECTION Checkpoint 24.1
Amphetamines and Amphetamine-Like Drugs
Nonstimulants for ADHD
Drugs for Narcolepsy
Methylxanthine
Clinical Question
Should cardiovascular risk influence the decision to use medications for ADHD?
Evidence
Implications
Critical Thinking Questions
PROTOTYPE DRUG Amphetamine and Dextroamphetamine (Adderall, Adderall XR)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Amphetamine and Dextroamphetamine (Adderall, Adderall XR)
Pharmacotherapy of Narcolepsy
24.5 Narcolepsy is characterized by excessive daytime sleepiness and is treated with central nervous system stimulants and antidepressants.
PharmFACT
PROTOTYPE DRUG Modafinil (Provigil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Modafinil (Provigil)
Methylxanthines
24.6 Methylxanthines are central nervous system stimulants used for their ability to increase alertness or their effects on the respiratory system.
PROTOTYPE DRUG Caffeine
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Caffeine
CHAPTER 24 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 25 Pharmacotherapy of Severe Pain and Migraines
LEARNING OUTCOMES
KEY TERMS
General Principles of Pain Management
25.1 The primary goal of pain management is to reduce pain to a level that allows the patient to continue normal daily activities.
25.2 Proper assessment and classification of pain guides its treatment.
PharmFACT Low Back Pain in America
Clinical Question
Are opioids appropriate for the management of chronic noncancer pain?
Evidence
Implications
Critical Thinking Question
25.3 Health care providers and patients sometimes hold myths about pain that impede optimum pain management.
25.4 Pain transmission processes allow multiple targets for pharmacologic intervention.
Pain Management with Opioids
25.6 Opioid analgesics exert their effects by interacting with specific receptors in the central nervous system.
25.7 Opioids are the drugs of choice for moderate to severe pain that cannot be controlled with other classes of analgesics.
Opioid Agonists with High Effectiveness
Opioids with Moderate Effectiveness
Opioids with Mixed Agonist-Antagonist Effects
Pain Management with Nonopioids
25.9 Nonsteroidal anti-inflammatory drugs are the medications of choice for mild to moderate pain.
25.10 A few miscellaneous analgesics reduce pain by acting on the central nervous system.
PROTOTYPE DRUG Tramadol (Ultram, Others)
Classification:
Therapeutic Effects and Uses:
Implementation
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Tramadol (Ultram)
Pharmacotherapy with Opioid Antagonists
25.12 The primary indication for an opioid antagonist is opioid-induced respiratory depression.
CONNECTION Checkpoint 25.3
Pharmacotherapy of Migraines
25.13 Migraines are a severe type of headache related to specific triggers.
PharmFACT Migraine Statistics
25.14 Analgesics and triptans are the primary classes of drugs used to abort acute migraine pain.
CHAPTER 25 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 26 Anesthetics and Anesthesia Adjuncts
LEARNING OUTCOMES
KEY TERMS
Types of Anesthesia
26.1 Anesthesia is used to produce a controlled loss of sensation during a diagnostic or surgical procedure.
Principles of General Anesthesia
26.2 Balanced anesthesia uses multiple drugs to provide for the safe induction and maintenance of general anesthesia.
PharmFACT
Intravenous Anesthetics
26.3 Intravenous anesthetics include opioids, benzodiazepines, and several miscellaneous agents.
PharmFACT
26.4 Opioids are used as intravenous anesthetics to provide analgesia and to accomplish neurolept anesthesia.
PROTOTYPE DRUG Fentanyl (Sublimaze)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Opioids
Benzodiazepines
Miscellaneous IV Anesthetics
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdosage:
Nursing Responsibilities:
Drugs Similar to Fentanyl (Sublimaze)
Inhalation Anesthetics
26.7 Inhalation anesthetics used to produce loss of consciousness are classified as gases or volatile liquids.
Clinical Question
Can a risk for malignant hyperthermia be predicted?
Evidence
Implications
Critical Thinking Questions
PROTOTYPE DRUG Nitrous Oxide
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interaction:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Nitrous Oxide
26.8 Volatile liquid general anesthetics are used to induce and maintain deep anesthesia.
Gas
Volatile Liquids
PROTOTYPE DRUG Isoflurane (Forane)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Isoflurane (Forane)
Local Anesthetics
26.9 Local anesthetic agents block pain transmission in peripheral nerves and are grouped in two major classes.
Ester Type
Amide Type
26.10 Ester-type local anesthetics have been widely used for topical and spinal anesthesia.
Implementation
PROTOTYPE DRUG Procaine (Novocaine)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Procaine (Novocaine)
Adjuncts to Anesthesia
26.12 Adjunctive agents are used during the perioperative phase to enhance anesthesia or to treat the potential adverse effects of the anesthetics.
CHAPTER 26 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 27 Pharmacology of Substance Abuse
LEARNING OUTCOMES
KEY TERMS
Fundamental Concepts of Substance Abuse
27.1 A wide variety of different substances may be abused by patients.
PharmFACT
Legislation of Controlled Substances
27.2 Drugs with a potential for abuse are restricted by the Controlled Substances Act and are categorized into schedules.
CONNECTION Checkpoint 27.1
Addiction and Dependence
27.3 Addiction is an overwhelming compulsion to continue repeated drug use.
PharmFACT
27.4 Physical and psychological dependence lead to continued drug-seeking behavior despite negative health and social consequences.
27.5 A withdrawal syndrome is a set of characteristic symptoms that occurs when an abused substance is discontinued.
Tolerance
27.6 Tolerance occurs when the body adapts to a drug and larger doses are needed to produce a therapeutic effect.
Central Nervous System Depressants
27.7 Central nervous system depressants, which include sedatives, opioids, and alcohol, decrease the activity of the central nervous system.
PharmFACT
Sedatives and Antianxiety Drugs
Opioids
Treatment of opioid addiction:
PROTOTYPE DRUG Buprenorphine with naloxone (Suboxone, Zubsolv)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Buprenorphine with Naloxone (Suboxone, Zubsolv)
Alcohol (Ethanol)
CONNECTION Checkpoint 27.2
PROTOTYPE DRUG Disulfiram (Antabuse)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Disulfiram (Antabuse)
Marijuana and Related Substances
27.8 Marijuana is the most frequently abused illicit substance.
Hallucinogens
27.9 Hallucinogens and club drugs cause an altered state of thought and perception.
LSD and Similar Hallucinogens
Club Drugs and Miscellaneous Hallucinogens
Central Nervous System Stimulants
27.10 Stimulants such as amphetamines and cocaine increase the activity of the central nervous system.
Amphetamines and Methylphenidate
Cocaine
Caffeine
Nicotine
27.11 Nicotine is a powerful and highly addictive cardiovascular and central nervous system stimulant.
PharmFACT
PROTOTYPE DRUG Varenicline (Chantix)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Varenicline (Chantix)
Inhalants
27.12 Inhalant abuse occurs when patients breathe the fumes of vaporized substances.
Implementation
Anabolic Steroids
27.13 Anabolic steroids are abused for their ability to increase muscle strength.
27.14 The nurse has a pivotal role in recognizing and treating substance abuse.
CHAPTER 27 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 5 Pharmacology of the Cardiovascular System
CHAPTER 28 Review of the Cardiovascular System
LEARNING OUTCOMES
KEY TERMS
Structure and Function of the Cardiovascular System
28.1 The cardiovascular system consists of the blood, heart, and blood vessels.
Functions and Properties of Blood
28.2 Blood consists of formed elements and plasma.
CONNECTION Checkpoint 28.1
PharmFACT
28.3 Hemostasis is a complex process involving multiple steps and a large number of enzymes and factors.
Cardiac Structure and Function
28.4 The heart is responsible for pumping blood throughout the circulatory system.
PharmFACT
28.5 The coronary arteries bring essential nutrients to the myocardium.
28.6 The cardiac conduction system keeps the heart beating in a synchronized manner.
28.7 Cardiac output is determined by stroke volume and heart rate.
Hemodynamics and Blood Pressure
28.8 The primary factors responsible for blood pressure are cardiac output, peripheral resistance, and blood volume.
PharmFACT
28.9 Neural regulation of blood pressure includes baroreceptor and chemoreceptor reflexes.
CONNECTION Checkpoint 28.3
28.10 Hormones may have profound effects on blood pressure.
CHAPTER 28 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 29 Pharmacotherapy of Hyperlipidemia
LEARNING OUTCOMES
KEY TERMS
Types of Lipids and Lipoproteins
29.1 Lipids are classified as triglycerides, phospholipids, or sterols.
29.2 Lipoproteins are important predictors of cardiovascular disease.
Measurement and Control of Serum Lipids
29.3 Blood lipid profiles are important diagnostic tools in guiding the therapy of dyslipidemias.
29.4 Lipid levels can often be controlled through therapeutic lifestyle changes.
Drugs for Dyslipidemias
29.5 The statins are the most effective drugs for reducing blood lipid levels.
HMG-CoA Reductase Inhibitors
Bile Acid Sequestrants
Fibric Acid Drugs
Other Drugs for Dyslipidemia
PROTOTYPE DRUG Atorvastatin (Lipitor)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Atorvastatin (Lipitor)
Miscellaneous Drugs for Dyslipidemias
29.9 Newer strategies have been developed to treat dyslipidemias.
CHAPTER 29 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 30 Pharmacotherapy with Calcium Channel Blockers
LEARNING OUTCOMES
KEY TERMS
Physiological Role of Calcium Channels in Muscle Contraction
30.1 Calcium channels facilitate contraction in cardiac and smooth muscles.
CONNECTION Checkpoint 30.1
Types of Calcium Channels
30.2 The calcium channel consists of multiple subunits and is present in many tissues.
Consequences of Calcium Channel Blockade
30.3 Blocking calcium channels has significant physiological effects on the heart and vascular smooth muscle.
Classification of Calcium Channel Blockers
30.4 Calcium channel blockers are classified by their chemical structures as dihydropyridines or nondihydropyridines.
30.5 The dihydropyridines are selective for vascular smooth muscle and are used to treat hypertension and angina pectoris.
Dihydropyridines
Nondihydropyridines
PROTOTYPE DRUG Nifedipine (Adalat CC, Procardia XL)
Classification:
Therapeutic Effects and Uses:
Dihydropyridines
Nondihydropyridines
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Nifedipine (Adalat CC, Procardia XL)
CHAPTER 30 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 31 Drugs Affecting the Renin-Angiotensin-Aldosterone System
LEARNING OUTCOMES
KEY TERMS
Components of the Renin-Angiotensin-Aldosterone System
31.1 The formation of angiotensin II requires two enzymatic steps.
31.2 Renin secretion is controlled by the juxtaglomerular cells of the kidney and the sympathetic nervous system.
CONNECTION Checkpoint 31.1
CONNECTION Checkpoint 31.2
31.3 Angiotensin-converting enzyme is responsible for the formation of angiotensin II.
Physiological Actions of the Renin-Angiotensin-Aldosterone System
31.4 Angiotensin II has multiple effects on the cardiovascular system that raise blood pressure and affect cardiac function.
Drugs Affecting the Renin-Angiotensin-Aldosterone System
31.6 ACE inhibitors are key drugs in the pharmacotherapy of hypertension and heart failure.
PharmFACT
PROTOTYPE DRUG Lisinopril (Prinivil, Zestril)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Lisinopril (Prinivil, Zestril)
CHAPTER 31 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 32 Diuretic Therapy and the Pharmacotherapy of Renal Failure
LEARNING OUTCOMES
KEY TERMS
Review of Renal Physiology
32.1 The kidneys are major organs of excretion and body homeostasis.
CONNECTION Checkpoint 32.1
32.2 The composition of filtrate changes dramatically as a result of the processes of reabsorption and secretion.
CONNECTION Checkpoint 32.2
Pharmacotherapy for Patients with Renal Failure
Ions
Metabolic Waste Products
32.3 Renal failure may significantly impact the success of pharmacotherapy.
PharmFACT
Diuretic Therapy
32.4 Diuretics are used to treat hypertension, heart failure, accumulation of edema fluid, and renal failure.
Loop (High-Ceiling) Diuretics
32.5 The most effective diuretics are the loop diuretics that block sodium reabsorption in the loop of Henle.
Clinical Question
Does diuretic use contribute to the risk of falls in the older adult?
Evidence
Implications
Critical Thinking Questions
PROTOTYPE DRUG Furosemide (Lasix)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Treatment of Overdose:
Pregnancy:
Nursing Responsibilities:
Drugs Similar to Furosemide (Lasix)
Thiazide and Thiazide-Like Diuretics
32.6 The thiazides are the most commonly prescribed class of diuretics.
PROTOTYPE DRUG Hydrochlorothiazide (Microzide)
Short Acting
Intermediate Acting
Long Acting
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Treatment of Overdose:
Pregnancy:
Nursing Responsibilities:
Drugs Similar to Hydrochlorothiazide (Microzide)
Potassium-Sparing Diuretics
32.7 Potassium-sparing diuretics have low effectiveness but can help prevent hypokalemia.
Sodium Channel Inhibitors
Aldosterone Antagonists
Sodium ion channel inhibitors:
Aldosterone antagonists:
PROTOTYPE DRUG Spironolactone (Aldactone)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Treatment of Overdose:
Pregnancy:
Nursing Responsibilities:
Drugs Similar to Spironolactone (Aldactone)
Amiloride (Midamor):
Eplerenone (Inspra):
Triamterene (Dyrenium):
CONNECTION Checkpoint 32.4
Osmotic Diuretics
32.8 Osmotic diuretics cause diuresis by increasing the osmolality of the filtrate.
Carbonic Anhydrase Inhibitors
Osmotic Diuretics
PROTOTYPE DRUG Mannitol (Osmitrol)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Mannitol (Osmitrol)
Carbonic Anhydrase Inhibitors
32.9 Carbonic anhydrase inhibitors are weak diuretics that have specific indications.
PROTOTYPE DRUG Acetazolamide (Diamox)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Acetazolamide (Diamox)
Description
History and Claims
Standardization
Evidence
Implementation
CHAPTER 32 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 33 Pharmacotherapy of Fluid Imbalance, Electrolyte, and Acid–Base Disorders
LEARNING OUTCOMES
KEY TERMS
Principles of Fluid Balance
33.1 Body fluids are exchanged between intracellular and extracellular compartments.
CONNECTION Checkpoint 33.1
33.2 Osmolality or tonicity determines the movement of body fluids.
33.3 Overall fluid balance is regulated primarily by hormones acting upon the kidneys.
CONNECTION Checkpoint 33.2
Fluid Replacement Agents
33.4 Dehydration may be treated with fluid volume expanders.
33.5 Transfusions of blood products are used to treat serious conditions that cannot be managed effectively by other means.
PharmFACT
PROTOTYPE DRUG Normal Serum Albumin (Albuminar, Plasbumin, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Normal Serum Albumin (Albuminar, Plasbumin, Others)
33.6 Crystalloids are intravenous solutions that closely resemble the composition of extracellular fluid.
Physiology of Electrolytes
33.8 Electrolytes are charged substances that are essential to homeostasis.
Pharmacotherapy of Electrolyte Imbalances
33.9 Sodium balance is closely associated with water balance.
Pharmacotherapy of Acid–Base Imbalances
33.12 The pH of body fluids must be maintained between very narrow limits.
33.13 The pharmacotherapy of acidosis includes the administration of alkaline drugs.
PROTOTYPE DRUG Sodium Bicarbonate
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Sodium Bicarbonate
33.14 The pharmacotherapy of alkalosis includes the administration of acidic drugs.
PROTOTYPE DRUG Ammonium Chloride
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Herbal/Food:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Ammonium Chloride
CHAPTER 33 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 34 Pharmacotherapy of Hypertension
LEARNING OUTCOMES
KEY TERMS
Etiology and Pathogenesis of Hypertension
34.1 Failure to properly manage hypertension can lead to stroke, heart failure, or myocardial infarction.
Nonpharmacologic Management of Hypertension
34.2 Therapeutic lifestyle changes can reduce blood pressure and lessen the need for antihypertensive medications.
Description
History and Claims
Standardization
Evidence
Guidelines for the Management of Hypertension
34.3 Research-based guidelines have been developed to aid the health care provider in providing optimum treatment for patients with hypertension.
Pharmacotherapy of Hypertension
34.4 The choice of antihypertensive medication is determined by the degree of hypertension and the presence of other medical conditions.
Initial Drug of Choice
Adding Drugs to the Antihypertensive Regimen
Thiazide Diuretic with ACE Inhibitor
Thiazide Diuretic with Angiotensin II Blocker
Thiazide Diuretic with Autonomic Drug
Thiazide Diuretic with Potassium-Sparing Diuretic
Other Combinations
Enhancing Patient Adherence
Antihypertensives in African Americans
Drug Classes for Hypertension
34.5 Diuretics are often drugs of first choice for treating mild to moderate hypertension.
Management of Hypertensive Emergency
34.10 Hypertensive crisis is a medical emergency that is treated by the intravenous administration of antihypertensive medications.
PROTOTYPE DRUG Nitroprusside Sodium (Nitropress)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Nitroprusside Sodium (Nitropress)
PharmFACT
Implementation
CHAPTER 34 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 35 Pharmacotherapy of Angina Pectoris and Myocardial Infarction
LEARNING OUTCOMES
KEY TERMS
Pathophysiology of Myocardial Ischemia
35.1 Myocardial ischemia develops when there is inadequate blood supply to meet the metabolic demands of cardiac muscle.
Myocardial Oxygen Supply
Myocardial Oxygen Demand
Etiology of Coronary Artery Disease
35.2 Coronary artery disease is the major cause of myocardial ischemia.
CONNECTION Checkpoint 35.1
Pathophysiology of Angina Pectoris
35.3 Angina pectoris is characterized by severe chest pain brought on by physical exertion or emotional stress.
PharmFACT
Nonpharmacologic Therapy of Coronary Artery Disease
35.4 Therapeutic lifestyle changes can decrease the frequency of anginal episodes and reduce the risk of coronary artery disease.
Description
History and Claims
Standardization
Evidence
Pharmacologic Management of Angina Pectoris
35.5 The pharmacologic management of angina includes organic nitrates, beta-adrenergic blockers, and calcium channel blockers.
CONNECTION Checkpoint 35.2
Drug Classes for Angina Pectoris
35.6 Organic nitrates may be used to terminate or prevent angina episodes.
PROTOTYPE DRUG Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur, Others)
Pathophysiology of Myocardial Infarction
35.9 Early diagnosis and pharmacotherapy of myocardial infarction increase chances of survival.
Organic Nitrates
Beta-Adrenergic Antagonists
Calcium Channel Blockers
Miscellaneous Drug
Pharmacologic Management of Myocardial Infarction
35.10 Thrombolytic drugs can restore perfusion to ischemic regions of the myocardium if administered soon after a myocardial infarction.
35.11 Drugs are used to treat the symptoms and complications of acute myocardial infarction.
Aspirin
Clinical Question
Does relief of chest pain by the administration of nitroglycerin indicate the presence of CAD with myocardial ischemia?
Evidence
Implications
Critical Thinking Questions
Anticoagulants and Antiplatelet Drugs
Anticoagulants:
Adenosine diphosphate receptor blockers:
Glycoprotein IIb/IIIa Inhibitors
Other antiplatelet drugs:
Nitrates
Beta-Adrenergic Blockers
Angiotensin-Converting Enzyme Inhibitors
Pain Management
PharmFACT
35.12 Vasopressors are used following cardiopulmonary arrest to reestablish coronary and cerebral blood flow.
Implementation
CHAPTER 35 Understanding the Chapter
Key Concepts Summary
Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 36 Pharmacotherapy of Heart Failure
LEARNING OUTCOMES
KEY TERMS
Etiology of Heart Failure
36.1 Heart failure is closely associated with disorders such as chronic hypertension, coronary artery disease, and diabetes.
Pathophysiology of Heart Failure
36.2 The body attempts to compensate for heart failure by increasing cardiac output.
Ventricular Hypertrophy
Activation of the Sympathetic Nervous System
CONNECTION Checkpoint 36.1
Increased Plasma Volume and Preload
Natriuretic Peptides and Neurohumoral Factors
36.3 Symptoms of heart failure occur when compensatory mechanisms fail to maintain adequate cardiac output.
Pharmacologic Management of Heart Failure
36.4 The specific therapy for heart failure depends on the clinical stage of the disease.
Clinical Question
Does maintaining glucose control in diabetes decrease the incidence of heart failure?
Evidence
Implications
Critical Thinking Questions
Drugs for Heart Failure
36.5 Angiotensin-converting enzyme inhibitors are drugs of choice for heart failure.
ACE Inhibitors and Angiotensin Receptor Blockers (ARBs)
Diuretics
Beta-Adrenergic Blockers
Vasodilator
Cardiac Glycoside
36.6 Diuretics relieve symptoms of heart failure by reducing fluid overload and decreasing blood pressure.
CONNECTION Checkpoint 36.2
36.7 Beta-adrenergic antagonists can dramatically reduce hospitalizations and increase the survival of patients with heart failure.
36.8 Vasodilators reduce symptoms of heart failure by reducing preload or afterload.
CHAPTER 36 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 37 Pharmacotherapy of Dysrhythmias
LEARNING OUTCOMES
KEY TERMS
Etiology of Dysrhythmias
37.1 Some dysrhythmias produce no patient symptoms, while others may be life threatening.
Phases and Measurement of the Cardiac Action Potential
37.2 The phases of cardiac action potential include rapid depolarization, a long plateau, and repolarization.
Classification of Dysrhythmias
37.4 Dysrhythmias are classified by the impulse origin and type of rhythm abnormality produced.
General Principles of Dysrhythmia Management
37.5 Antidysrhythmic drugs are only used when there is a clear benefit to the patient.
Drugs for Dysrhythmias
37.6 Antidysrhythmic drugs are classified by their mechanism of action.
Sodium Channel Blockers: Class I
37.7 Class I antidysrhythmics act by blocking ion channels in myocardial cells.
I: Sodium Channel Blockers
Class IA: Sodium Channel Blockers
Class IB: Sodium Channel Blockers
Class IC: Sodium Channel Blockers
Class II: Beta-Adrenergic Antagonists
Class III: Potassium Channel Blockers
Class IV: Calcium Channel Blockers
Miscellaneous Antidysrhythmics
Class IA:
PROTOTYPE DRUG Procainamide
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Procainamide
Disopyramide (Norpace):
Quinidine:
Class IB:
Lidocaine (Xylocaine):
Mexiletine (Mexitil):
Phenytoin (Dilantin):
Class IC:
Flecainide (Tambocor):
Propafenone (Rythmol):
Beta-Adrenergic Antagonists: Class II
37.8 Beta-adrenergic antagonists reduce automaticity as well as slow conduction velocity in the heart.
Potassium Channel Blockers: Class III
37.9 Potassium channel blockers prolong the refractory period of the heart.
PROTOTYPE DRUG Amiodarone (Cordarone, Pacerone)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Amiodarone (Cordarone, Pacerone)
Calcium Channel Blockers: Class IV
37.10 Calcium channel blockers are used to treat atrial dysrhythmias.
CONNECTION Checkpoint 37.3
Miscellaneous Antidysrhythmics
37.11 Adenosine and digoxin are used for specific dysrhythmias.
CHAPTER 37 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 38 Pharmacotherapy of Coagulation Disorders
LEARNING OUTCOMES
KEY TERMS
Disorders of Hemostasis
38.1 Thromboembolic disorders are abnormalities of hemostasis that include deep venous thrombosis and pulmonary embolism.
PharmFACT
CONNECTION Checkpoint 38.1
38.2 Coagulation disorders are caused by decreased numbers of platelets or by deficiencies in specific clotting factors.
Overview of Coagulation Modifiers
38.3 The normal coagulation process can be modified by a number of different mechanisms.
Anticoagulants
38.4 Heparin is the traditional drug of choice for rapid anticoagulation.
Low-Molecular-Weight Heparins (LMWHs)
Direct Thrombin Inhibitors
Factor Xa Inhibitors
Antiplatelet Drugs
38.7 Antiplatelet drugs provide anticoagulation by reducing the aggregation properties of platelets.
ADP Receptor Blockers
Glycoprotein IIb/IIIa Receptor Antagonists
Drugs for Intermittent Claudication
38.8 The adenosine diphosphate receptor blockers are antiplatelet drugs prescribed for the prevention and treatment of arterial thrombosis.
Description:
History and Claims:
Standardization:
Evidence:
PROTOTYPE DRUG Clopidogrel (Plavix)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Treatment of Overdose:
Pregnancy:
Nursing Responsibilities:
Drugs Similar to Clopidogrel (Plavix)
Drugs for Intermittent Claudication
38.10 Coagulation modifiers can be used to treat symptoms of intermittent claudication.
38.11 Fibrinolysis is a process that removes thrombi.
Thrombolytics
38.12 Thrombolytics are used to dissolve existing intravascular clots in patients with myocardial infarction and stroke.
PROTOTYPE DRUG Alteplase (Activase)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Implementation
Drugs Similar to Alteplase (Activase)
Hemostatics
38.13 Hemostatics are used to promote the formation of clots.
PROTOTYPE DRUG Aminocaproic Acid (Amicar)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations
Patient and Family Education
Drugs Similar to Aminocaproic Acid (Amicar)
Drugs for Hemophilia
38.14 Hemophilia is treated by replacing the missing clotting factor(s) or by inhibiting coagulation.
PharmFACT
von Willebrand’s Disease
CHAPTER 38 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 39 Pharmacotherapy of Hematopoietic Disorders
LEARNING OUTCOMES
KEY TERMS
Physiology of Hematopoiesis
39.1 Hematopoiesis is a dynamic process that is responsive to the changing demands of the body.
PharmFACT
CONNECTION Checkpoint 39.1
Hematopoietic Growth Factors
39.2 Erythropoietin stimulates production of red blood cells and is used to treat anemia.
PROTOTYPE DRUG Epoetin Alfa (Epogen, Procrit)
Classification:
Therapeutic Effects and Uses:
Erythropoietic Growth Factors
Colony-Stimulating Factors
Platelet Enhancers
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Epoetin Alfa (Epogen, Procrit)
Classification of Anemias
39.5 Anemias may be caused by hemorrhage or a change in red blood cell production or destruction.
Iron Salts
Antianemic Drugs
39.6 Administration of iron salts can rapidly reverse symptoms of iron deficiency anemia.
PROTOTYPE DRUG Ferrous Sulfate (Feosol, Feostat, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations
Patient and Family Education
Drugs Similar to Ferrous Sulfate (Feosol, Feostat, Others)
CHAPTER 39 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 6 Pharmacology of Body Defenses
CHAPTER 40 Review of Body Defenses and the Immune System
LEARNING OUTCOMES
KEY TERMS
Organization of the Lymphatic System
40.1 The lymphatic system is the primary organ system that protects the body from invasion by foreign agents.
PharmFACT
Innate (Nonspecific) Body Defenses
40.2 Innate body defenses are the body’s first line of defense against pathogens.
Inflammation
40.3 Inflammation is a nonspecific defense mechanism that neutralizes or destroys foreign substances and microbes.
40.4 Inflammation proceeds with the release of chemical mediators.
CONNECTION Checkpoint 40.1
Specific (Adaptive) Body Defenses
40.5 The specific body defenses include the humoral and cell-mediated immune systems.
Humoral Immune Response
40.6 The humoral immune response is mediated by B lymphocytes and includes the secretion of antibodies.
Cell-Mediated Immune Response
40.7 The cell-mediated immune response is mediated by T lymphocytes and includes the secretion of cytokines.
PharmFACT
PharmFACT
CONNECTION Checkpoint 40.2
CHAPTER 40 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 41 Pharmacotherapy of Inflammation and Fever
LEARNING OUTCOMES
KEY TERMS
Pathophysiology of Inflammation and Fever
41.1 Inflammation is a nonspecific body response to antigens and tissue injury.
Pharmacotherapy of Inflammation
41.2 Treatment of inflammation includes nonpharmacologic therapies and the administration of anti-inflammatory drugs.
Description
History and Claims
Standardization
Evidence
PharmFACT
Nonsteroidal Anti-Inflammatory Drugs
Salicylates
41.3 Aspirin is an inexpensive, effective, first-generation nonsteroidal anti-inflammatory drug commonly used by adults.
PharmFACT
PROTOTYPE DRUG Aspirin (Acetylsalicylic Acid)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Aspirin (Acetylsalicylic Acid)
Ibuprofen-Like Drugs
41.4 Ibuprofen and similar nonsteroidal anti-inflammatory drugs are the most common drugs for treating mild to moderate pain and inflammation.
PROTOTYPE DRUG Ibuprofen (Advil, Motrin, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Ibuprofen (Advil, Motrin, Others)
Clinical Question
When treating children with fevers, which is more effective: ibuprofen, acetaminophen, or both?
Evidence
Implications
Critical Thinking Questions
PharmFACT
Cyclooxygenase-2 Inhibitors
41.5 Celecoxib is an effective second-generation nonsteroidal anti-inflammatory drug, but its use is limited due to an increased risk of myocardial infarction and stroke.
PROTOTYPE DRUG Celecoxib (Celebrex)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
CONNECTION Checkpoint 41.2
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Celecoxib (Celebrex)
Antipyretic and Analgesic Drugs
41.6 Acetaminophen is administered for pain relief and to reduce fever, but it has no anti-inflammatory properties.
PROTOTYPE DRUG Acetaminophen (Tylenol)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Acetaminophen (Tylenol)
Implementation
CHAPTER 41 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 42 Immunostimulants and Immunosuppressants
LEARNING OUTCOMES
KEY TERMS
42.1 Immunomodulators are substances that either enhance or suppress the ability of the body to fight infection and disease.
Immunostimulants
42.2 Interferons are biologic response modifiers that have antiviral and antineoplastic activity.
PROTOTYPE DRUG Interferon Alfa-2b (Intron A)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Interferons
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Interferon alfa-2b (Intron A)
Immunosuppressants
42.4 Immunosuppressants are used to prevent transplant rejection and for the treatment of autoimmune disorders.
CHAPTER 42 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 43 Immunizing Agents
LEARNING OUTCOMES
KEY TERMS
Discovery of Vaccines
43.1 The eradication of smallpox was a great triumph in modern medicine.
Vaccines and the Immune System
43.2 Vaccines are used to activate the immune system for the purpose of disease prevention.
CONNECTION Checkpoint 43.1
Types of Vaccines
43.3 There are four traditional methods of producing vaccines.
General Principles of Vaccine Administration
43.4 Vaccines should be administered by an established schedule with precautions taken for patients who are immunosuppressed or pregnant.
Active Immunity: Bacterial Immunizations
43.5 Active immunity can be induced to prevent bacterial infections.
Diphtheria
Pathophysiology:
Diphtheria toxoid:
Pertussis (Whooping Cough)
Pathophysiology:
Immunization:
Tetanus
Pathophysiology:
Immunization:
Pneumococcus
Pathophysiology:
Immunization:
Meningococcus
Pathophysiology:
Immunization:
Active Immunity: Viral Immunizations
43.6 Effective vaccines that prevent viral infections have been developed.
CONNECTION Checkpoint 43.3
Hepatitis B
Pathophysiology:
Immunization:
PROTOTYPE DRUG Hepatitis B Vaccine (Engerix-B, Recombivax HB)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Hepatitis B Vaccine (Engerix-B, Recombivax HB)
Hepatitis A
Pathophysiology:
Immunization:
Influenza
Pathophysiology:
Immunization:
Rabies
Pathophysiology:
Immunization: preexposure and postexposure:
Measles, Mumps, and Rubella
Measles (rubeola) pathophysiology:
Mumps pathophysiology:
Rubella or German measles pathophysiology:
Immunization:
Polio
Pathophysiology:
Immunization:
Varicella Zoster
Pathophysiology:
Immunization:
PharmFACT
Human Papillomavirus
Pathogenesis:
Immunization:
PharmFACT
Rotavirus
Pathophysiology:
Immunization:
Passive Immunity
43.7 Antibodies are administered to provide passive immunity.
PROTOTYPE DRUG Rho[D] Immune Globulin (RhoGAM)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Rho[D] Immune Globulin (RhoGAM)
CHAPTER 43 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 7 Pharmacology of the Respiratory System and Allergy
CHAPTER 44 Pharmacotherapy of Asthma and Other Pulmonary Disorders
LEARNING OUTCOMES
KEY TERMS
Physiology of the Lower Respiratory Tract
44.1 The physiology of the respiratory system involves two main processes: perfusion and ventilation.
Pathophysiology of Asthma
44.2 Asthma is a chronic disease that has both inflammatory and bronchospasm components.
PharmFACT
Administration of Pulmonary Drugs via Inhalation
44.3 Inhalation is a common route of administration for pulmonary drugs because it delivers drugs directly to their sites of action.
Principles of Asthma Pharmacotherapy
44.4 The goals of asthma pharmacotherapy are to terminate acute bronchospasms and to reduce the frequency of asthma attacks.
Quick-Relief Medications
Long-Acting Medications
PharmFACT
44.5 Beta2-adrenergic agonists are the most effective drugs for relieving acute bronchospasm.
Clinical Question
What role do elementary school teachers play in the management of asthma?
Evidence
Implications
Critical Thinking Questions
PROTOTYPE DRUG Albuterol (Proventil, Ventolin, VoSpire)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Beta Agonists/Sympathomimetics
Anticholinergics
Methylxanthines
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Albuterol (Proventil, Ventolin, VoSpire)
Chronic Obstructive Pulmonary Disease
44.12 Chronic obstructive pulmonary disease may be treated with bronchodilators, anti-inflammatory agents, and mucolytics.
Implementation
CHAPTER 44 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 45 Pharmacotherapy of Allergic Rhinitis and the Common Cold
LEARNING OUTCOMES
KEY TERMS
Physiology of the Upper Respiratory Tract
45.1 The upper respiratory tract acts as a defense in preventing systemic infection.
Pathophysiology of Allergic Rhinitis
45.2 Allergic rhinitis is caused by exposure to an environmental allergen, which leads to symptoms that resemble those of the common cold.
PharmFACT
Pharmacotherapy of Allergic Rhinitis
45.3 Drugs for allergic rhinitis include those that prevent the disorder and those that relieve symptoms.
45.4 Antihistamines are widely used to treat allergic rhinitis and other minor allergies.
First-Generation Drugs
Second-Generation Drugs
CONNECTION Checkpoint 45.1
PROTOTYPE DRUG Fexofenadine (Allegra)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Fexofenadine (Allegra)
Decongestants
45.7 Intranasal and oral sympathomimetics are the most effective drugs for relieving nasal congestion.
PharmFACT
PROTOTYPE DRUG Pseudoephedrine (Sudafed)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Pseudoephedrine (Sudafed)
Drugs for the Common Cold
45.8 The common cold is caused by a virus and is treated with some of the same drugs as those used to treat allergic rhinitis.
Description
History and Claims
Standardization
Evidence
PharmFACT
Antitussives
45.9 Antitussives are drugs used to suppress the cough reflex.
Antitussives: Opioids
Antitussives: Nonopioids
Expectorant
Mucolytics
PROTOTYPE DRUG Dextromethorphan (Delsym, Robitussin DM, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Dextromethorphan (Delsym, Robitussin DM, Others)
Expectorants and Mucolytics
45.10 Expectorants and mucolytics are used to treat thick bronchial secretions.
CHAPTER 45 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 8 Pharmacology of Infectious and Neoplastic Diseases
CHAPTER 46 Basic Principles of Anti-Infective Pharmacotherapy
LEARNING OUTCOMES
KEY TERMS
Pathogenicity and Virulence
46.1 Pathogens cause disease due to their ability to invade tissues or secrete toxins.
CONNECTION Checkpoint 46.1
Describing and Classifying Bacteria
46.2 Bacteria are described by their staining characteristics, shape, and ability to utilize oxygen.
Classification of Anti-Infectives
46.3 Anti-infective drugs are classified by their susceptible organisms, chemical structures, and mechanisms of action.
Mechanisms of Action of Anti-Infectives
46.4 Anti-infective drugs act by selectively targeting a pathogen’s metabolism or life cycle.
Gram-Positive Bacilli
Gram-Positive Cocci
Gram-Negative Bacilli
Gram-Negative Cocci
Spirilla/Spirochetes
Other Organisms
Inhibition of cell wall synthesis
Inhibition of protein synthesis
Disruption of plasma membrane
Inhibition of nucleic acid synthesis
Inhibition of metabolic pathways
Inhibition of Cell Wall Synthesis
Inhibition of Protein Synthesis
Disruption of the Plasma Cell Membrane
Inhibition of Nucleic Acid Synthesis
Inhibition of Metabolic Pathways (Antimetabolites)
Other Mechanisms of Action
PharmFACT
Acquired Resistance
46.5 Acquired resistance is a major clinical problem that is worsened by the inappropriate use of anti-infectives.
Mechanisms of Resistance
Promotion of Resistance
Prevention of Resistant Strains
CONNECTION Checkpoint 46.2
46.6 Several resistant strains are major clinical challenges due to the lack of therapeutic options.
Methicillin-resistant Staphylococcus aureus (MRSA):
Vancomycin-resistant enterococci (VRE):
PharmFACT
46.7 Careful selection of the correct antibiotic is essential for effective pharmacotherapy and to limit adverse effects.
Indications and Selection of Specific Anti-Infectives
46.8 Depending on the pathogen, anti-infective therapy may be conducted with a single drug or a combination of drugs.
CONNECTION Checkpoint 46.3
46.9 Anti-infectives may be administered to prevent infections.
Host Factors Affecting Anti-Infective Selection
46.10 Patient factors such as host defenses, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence the choice of anti-infective.
Host Defenses
Local Tissue Conditions
Allergy History
Other Host Factors
CONNECTION Checkpoint 46.4
Superinfections
46.11 Superinfections can occur when an anti-infective antibiotic kills host flora.
CHAPTER 46 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 47 Antibiotics Affecting the Bacterial Cell Wall
LEARNING OUTCOMES
KEY TERMS
Structure of Bacterial Cell Walls
47.1 Bacterial cell walls consist of layers of carbohydrate and protein chains, which are constructed by enzymes called penicillin-binding proteins.
Penicillins
47.2 The penicillins, one of the oldest and safest groups of antibacterials, are primarily active against gram-positive bacteria.
Natural Penicillins
Broad-Spectrum Penicillins (Aminopenicillins)
Extended-Spectrum (Antipseudomonal) Penicillins
Penicillinase-Resistant (Antistaphylococcal) Penicillins
PharmFACT
Natural Penicillins
PROTOTYPE DRUG Penicillin G
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Penicillin G
Broad-Spectrum Penicillins (Aminopenicillins)
PROTOTYPE DRUG Ampicillin (Principen)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Ampicillin (Principen)
Extended-Spectrum (Antipseudomonal) Penicillins
Penicillinase-Resistant (Antistaphylococcal) Penicillins
Cephalosporins
47.3 The cephalosporins are similar in structure and function to the penicillins and are widely prescribed for gram-negative infections.
First Generation
Second Generation
Third Generation
Fourth Generation
Fifth Generation
CONNECTION Checkpoint 47.2
PROTOTYPE DRUG Cefazolin (Ancef, Kefzol)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Herbal/Food:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities (includes all generations of cephalosporins):
Drugs Similar to Cefazolin (Ancef, Kefzol)
Carbapenems
47.4 The carbapenems are resistant to beta lactamase and are broad-spectrum alternatives to penicillin.
Carbapenems
Miscellaneous Cell Wall Inhibitors
PROTOTYPE DRUG Imipenem-Cilastatin (Primaxin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Imipenem-Cilastatin (Primaxin)
Miscellaneous Cell Wall Inhibitors
47.5 Several miscellaneous cell wall inhibitors have activity against resistant microbes.
PROTOTYPE DRUG Vancomycin (Vancocin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Vancomycin (Vancocin)
CHAPTER 47 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 48 Antibiotics Affecting Bacterial Protein Synthesis
LEARNING OUTCOMES
KEY TERMS
Mechanisms of Antibiotic Inhibition of Bacterial Protein Synthesis
48.1 Antibiotics inhibit microbial protein synthesis by binding to the bacterial ribosome.
Tetracyclines
48.2 Tetracyclines have broad antimicrobial activity against many gram-positive and gram-negative bacteria.
Clinical Question
What are the current recommendations for prevention or treatment of traveler’s diarrhea?
Evidence
Implications
Critical Thinking Question
PROTOTYPE DRUG Tetracycline (Sumycin, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Tetracycline (Sumycin, Others)
Macrolides
48.3 The macrolides are alternatives to penicillin for many gram-positive infections.
CONNECTION Checkpoint 48.1
PROTOTYPE DRUG Erythromycin (EryC, Erythrocin, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Herbal/Food:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Erythromycin (EryC, Erythrocin, Others)
Aminoglycosides
48.4 The aminoglycosides are effective against aerobic gram-negative organisms but have the potential to cause ototoxicity and nephrotoxicity.
CONNECTION Checkpoint 48.2
PROTOTYPE DRUG Gentamicin (Garamycin, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Gentamicin (Garamycin, Others)
Miscellaneous Inhibitors of Bacterial Protein Synthesis
48.5 Several inhibitors of protein synthesis are effective against resistant infections but may have significant adverse effects that limit their use.
CHAPTER 48 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 49 Fluoroquinolones and Miscellaneous Antibacterials
LEARNING OUTCOMES
KEY TERMS
Bacterial DNA Replication
49.1 Bacterial DNA replication requires several different enzymes to uncoil, unwind, and duplicate the DNA.
Inhibition of DNA Replication
49.2 Drugs have been discovered that inhibit different steps in bacterial DNA replication.
Fluoroquinolones
49.3 Fluoroquinolones are antibiotics whose therapeutic applications have expanded in recent years to treat many gram-positive and gram-negative infections.
First Generation
Second Generation
Third Generation
Fourth Generation
Adverse Effects
Cartilage toxicity:
GI toxicity:
Hypersensitivity reactions:
Cardiotoxicity:
Nervous system toxicity:
Phototoxicity:
Hepatotoxicity:
Resistance:
PharmFACT
PROTOTYPE DRUG Ciprofloxacin (Cipro)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Ciprofloxacin (Cipro)
Besifloxacin (Besivance):
Gatifloxacin (Zymar, Zymaxid):
Gemifloxacin (Factive):
Levofloxacin (Levaquin):
Moxifloxacin (Avelox, Moxeza, Vigamox):
Norfloxacin (Noroxin):
Ofloxacin (Ocuflox, Floxin Otic):
Miscellaneous Antibacterials
49.4 A number of miscellaneous antibacterials have specific clinical indications.
CHAPTER 49 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 50 Sulfonamides and the Pharmacotherapy of Urinary Tract Infections
LEARNING OUTCOMES
KEY TERMS
Pathophysiology of Urinary Tract Infections
50.1 Infections can occur in any portion of the urinary tract.
Pharmacotherapy of Urinary Tract Infections
50.2 Choice of pharmacotherapy for acute urinary tract infection depends on the severity of the infection and the presence of comorbid conditions.
Acute Uncomplicated Cystitis
Clinical Question
Are urinary tract symptoms a reliable indicator of UTI in the older adult?
Evidence
Implications
Critical Thinking Question
CONNECTION Checkpoint 50.1
Complicated Urinary Tract Infection
PharmFACT
50.3 Infants, children, pregnant women, older adults, and those with recurring urinary tract infections require modifications to standard pharmacotherapy.
Infants and Children
Pregnancy
CONNECTION Checkpoint 50.2
Older Adults
Recurring Urinary Tract Infections
PharmFACT
Sulfonamides
50.4 Sulfonamides are the traditional drugs of choice for urinary tract infections, but resistance limits their usefulness.
Sulfonamides
Urinary Antiseptics and Miscellaneous Drugs
Adverse Effects
PROTOTYPE DRUG Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
Urinary Antiseptics
50.5 Urinary antiseptics are anti-infective drugs used exclusively for urinary tract infections.
Description
History and Claims
Standardization
Evidence
PROTOTYPE DRUG Nitrofurantoin (Furadantin) and Nitrofurantoin Macrocrystals (Macrobid, Macrodantin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Nitrofurantoin (Furadantin) and Nitrofurantoin Macrocrystals (Macrobid, Macrodantin)
CHAPTER 50 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 51 Pharmacotherapy of Mycobacterial Infections
LEARNING OUTCOMES
KEY TERMS
Types of Mycobacterial Infections
51.1 Several species of mycobacteria are important human pathogens.
PharmFACT
Pathogenesis and Diagnosis of Tuberculosis
51.2 Tuberculosis is a respiratory infection that exhibits both active and latent stages.
CONNECTION Checkpoint 51.1
Pharmacotherapy of Tuberculosis
51.3 The pharmacotherapy of tuberculosis requires special dosing regimens and schedules.
CONNECTION Checkpoint 51.2
51.4 First-line or primary antituberculosis drugs are the most efficacious and safest drugs for treating M. tuberculosis infections.
Standard Regimen
Patients Who Are HIV Positive
First-Line Drugs
Second-Line Drugs
Pregnant Patients
Clinical Question
Evidence
Implications
Critical Thinking Question
Chemoprophylaxis Patients
PROTOTYPE DRUG Isoniazid (INH)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Isoniazid (INH)
Drugs for Leprosy
51.6 Leprosy is caused by a mycobacterium and is treated by a multidrug regimen.
PharmFACT
PROTOTYPE DRUG Dapsone (DDS)
Classification:
Therapeutic Effects and Uses:
Implementation
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Dapsone (DDS)
Drugs for Mycobacterium Avium Complex Infections
51.7 Mycobacterium avium complex infections are common in patients with impaired immune function.
CHAPTER 51 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 52 Pharmacotherapy of Fungal Infections
LEARNING OUTCOMES
KEY TERMS
Characteristics of Fungi and Fungal Infections
52.1 Serious fungal infections are uncommon in people with healthy immune defenses.
Systemic
Superficial
Cutaneous and Subcutaneous
52.2 Mycoses are classified as superficial, subcutaneous, or systemic.
52.3 Antifungal drugs act by disrupting the fungal cell membrane or wall, affecting fungal enzymes, or disrupting replication.
Clinical Question
What factors reduce the exposure of a patient with neutropenia to fungal pathogens?
Evidence
Implications
Critical Thinking Question
CONNECTION Checkpoint 52.1
Drugs for Systemic Fungal Infections
52.4 Systemic or invasive fungal disease may require intensive pharmacotherapy for extended periods.
Azoles
PROTOTYPE DRUG Amphotericin B Deoxycholate (Fungizone)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Amphotericin B Deoxycholate (Fungizone)
Drugs for Both Systemic and Superficial Fungal Infections
52.5 Azoles are the drugs of choice for many mycoses due to their efficacy and favorable safety profile.
PROTOTYPE DRUG Fluconazole (Diflucan)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Fluconazole (Diflucan)
Drugs for Superficial Fungal Infections
52.6 Drugs for superficial mycoses are safe and effective at eliminating fungi on the skin, nails, or mucous membranes.
CHAPTER 52 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 53 Pharmacotherapy of Protozoan and Helminthic Infections
LEARNING OUTCOMES
KEY TERMS
Classification and Pathogenesis of Protozoan Infections
53.1 Protozoa are diverse, single-celled organisms that can cause widespread disease.
53.2 The female Anopheles mosquito is the carrier of several species of Plasmodium, the parasite responsible for malaria.
PharmFACT
Drugs for Malaria
53.3 The three goals of malaria pharmacotherapy are chemoprophylaxis, treatment of acute attacks, and prevention of relapses.
Drugs for Nonmalarial Protozoan Infections
53.4 Amebiasis, giardiasis, and cryptosporidiosis are caused by intestinal parasites and are usually acquired through contaminated water or food.
PharmFACT
Classification and Pathogenesis of Helminthic Infections
53.6 Helminthic infections cause significant intestinal disease, particularly in areas with poor sanitation.
Drugs for Helminthic Infections
53.7 Antihelminthic drugs are usually successful in rapidly eliminating the parasites and have few serious adverse effects.
PROTOTYPE DRUG Mebendazole (Vermox)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Mebendazole (Vermox)
CHAPTER 53 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 54 Pharmacotherapy of Non-HIV Viral Infections
LEARNING OUTCOMES
KEY TERMS
Characteristics of Viruses
54.1 Viruses are infectious agents with simple structures.
54.2 The replication cycle of a virus occurs in five stages.
Pharmacotherapy of Non-HIV Viral Infections
54.3 Antiviral drugs target a specific viral structure or stage of its replication cycle.
Drugs for Herpesviruses
54.4 Pharmacotherapy can lessen the severity of acute herpes simplex infections and prolong latency.
Drugs for Influenza Viruses
54.5 Pharmacotherapy of influenza viruses includes drugs to prevent infection as well as agents to treat active infections.
PharmFACT
CONNECTION Checkpoint 54.2
Influenza Prophylaxis
Influenza Treatment: Neuraminidase Inhibitors
PROTOTYPE DRUG Amantadine (Symmetrel)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Amantadine (Symmetrel)
Drugs for Hepatitis Viruses
54.6 The most effective therapies for hepatitis infections are antivirals and drugs that boost the immune system to rid the body of the virus.
CHAPTER 54 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 55 Pharmacotherapy of HIV-AIDS
LEARNING OUTCOMES
KEY TERMS
Pathogenesis of HIV Infection
55.1 HIV causes a profound loss of immune function.
General Principles of HIV Pharmacotherapy
55.2 Treatment of HIV infection is difficult due to the latent nature of the virus and the development of resistant strains.
Classification of Antiretroviral Drugs
55.3 Six classes of antiretroviral drugs are available to treat HIV infection.
Nonnucleoside Reverse Transcriptase Inhibitors
Nucleoside and Nucleotide Reverse Transcriptase Inhibitors
Protease Inhibitors
Miscellaneous Antiretrovirals
Pharmacokinetic considerations:
Antiretroviral Drugs
55.4 Reverse transcriptase inhibitors block the synthesis of viral DNA.
PROTOTYPE DRUG Zidovudine (Retrovir, AZT)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Zidovudine (Retrovir, AZT)
Prophylaxis of HIV Infections
55.8 The development of vaccines to prevent HIV has produced disappointing results.
Implementation
CONNECTION Checkpoint 55.2
55.9 Postexposure prophylaxis of HIV infection is designed to prevent transmission to health care workers.
55.10 Preexposure prophylaxis has been shown to be partially effective in certain groups.
55.11 The risk of perinatal transmission of HIV can be markedly reduced by specialized drug protocols.
Pharmacotherapy of Opportunistic Infections Associated with HIV-AIDS
55.12 Loss of immune function due to HIV often results in opportunistic infections that require anti-infective therapy.
CHAPTER 55 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 56 Basic Principles of Antineoplastic Therapy
LEARNING OUTCOMES
KEY TERMS
Characteristics of Cancer
56.1 Cancer is characterized by rapid, uncontrolled growth of cells that eventually invade normal tissues and metastasize.
Etiology of Cancer
56.2 The etiology of cancer may be chemical, physical, or biologic.
Detection and Prevention of Cancer
56.3 The keys to successful cancer treatment are prevention and early detection.
CONNECTION Checkpoint 56.1
Goals of Chemotherapy
56.4 The three primary goals of chemotherapy are cure, control, and palliation.
PharmFACT
CONNECTION Checkpoint 56.2
Staging and Grading of Cancer
56.5 Cancers are described by their stage and grade.
T Category: Describes the Primary Tumor
N Category: Describes Whether or Not the Cancer Has Spread to Lymph Nodes
M Category: Describes Whether or Not Distant Metastases Are Present
The Cell Cycle and Growth Fraction
56.6 Many antineoplastic drugs are more effective when given at specific stages of the cell cycle and in tumors with a high growth fraction.
Description
History and Claims
Evidence
Cell Kill Hypothesis
56.7 The goal of chemotherapy is to kill as many cancer cells as possible while sparing normal cells.
Improving the Success of Chemotherapy
56.8 Use of multiple drugs and intermittent dosing are strategies that allow for greater success of chemotherapy.
Combination Chemotherapy
CONNECTION Checkpoint 56.3
Dosing Schedules
Route of Administration
Oral:
Intravenous:
Intrathecal:
Intra-arterial:
Intraperitoneal:
Intravesicular:
Toxicity of Antineoplastic Agents
56.9 Serious toxicity limits therapy with most antineoplastic agents.
Hematologic System
Gastrointestinal Tract
Cardiopulmonary System
Urinary System
Reproductive System
Nervous System
Skin and Soft Tissue
Other Effects
PharmFACT
CHAPTER 56 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 57 Pharmacotherapy of Neoplasia
LEARNING OUTCOMES
KEY TERMS
Classification of Antineoplastic Drugs
57.1 Antineoplastic drugs kill or stop the growth of cancer cells and may be classified in multiple ways.
PharmFACT
Antineoplastic Medications
Alkylating Agents
57.2 Alkylating agents change the shape of the deoxyribonucleic acid double helix and prevent cancer cells from dividing normally.
Nitrogen Mustards
Nitrosoureas
Platinum Compounds
Miscellaneous Alkylating Agents
CONNECTION Checkpoint 57.1
PROTOTYPE DRUG Cyclophosphamide (Cytoxan)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Cyclophosphamide (Cytoxan)
Antimetabolites
57.3 Antimetabolites disrupt the critical cellular pathways of cancer cells.
Antitumor Antibiotics
57.4 The antibiotic antineoplastics contain substances obtained from bacteria that have the ability to kill cancer cells.
PROTOTYPE DRUG Doxorubicin (Adriamycin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Doxorubicin (Adriamycin)
Anthracyclines:
Daunorubicin (Cerubidine):
Epirubicin (Ellence):
Idarubicin (Idamycin):
Mitoxantrone (Novantrone):
Nonanthracyclines:
Bleomycin (Blenoxane):
Dactinomycin (Actinomycin-D, Cosmegen):
Mitomycin (Mutamycin):
Hormones and Hormone Antagonists
57.5 Hormones and hormone antagonists block the substances necessary for continued growth of tumors.
Selective estrogen receptor modifiers:
Aromatase inhibitors:
Gonadotropin-releasing hormone analogs:
Hormones
Hormone Antagonists
Androgen receptor blockers:
PROTOTYPE DRUG Tamoxifen
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Tamoxifen
Selective estrogen receptor modifiers:
Fulvestrant (Faslodex):
Raloxifene (Evista):
Toremifene (Fareston):
Aromatase inhibitors:
Anastrozole (Arimidex):
Exemestane (Aromasin):
Letrozole (Femara):
Gonadotropin-releasing hormone analogs and related drugs:
Degarelix (Firmagon):
Goserelin (Zoladex):
Histrelin (Supprelin LA, Vantas):
Leuprolide (Eligard, Lupron, Viadur):
Triptorelin (Trelstar):
Androgen blockers:
Bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron):
Abiraterone (Zytiga) and enzalutamide (Xtandi):
Natural Products
57.6 Natural products that are derived from plants include the vinca alkaloids, taxanes, and topoisomerase inhibitors.
Vinca Alkaloids
Taxanes
Topoisomerase Inhibitors
Miscellaneous Natural Products
Vinca alkaloids:
Taxanes:
Topoisomerase inhibitors:
PROTOTYPE DRUG Vincristine (Oncovin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Vincristine (Oncovin)
Vinblastine (Velban):
Vinorelbine (Navelbine):
Taxanes:
Cabazitaxel (Jevtana):
Docetaxel (Taxotere):
Paclitaxel (Abraxane, Taxol):
Topoisomerase inhibitors:
Irinotecan (Camptosar):
Topotecan (Hycamtin):
Etoposide (VePesid):
Teniposide (Vumon):
PharmFACT
Biologic Response Modifiers and Targeted Therapies
57.7 Biologic response modifiers and targeted therapies enhance the body’s ability to kill tumor cells.
Implementation
CONNECTION Checkpoint 57.3
Miscellaneous Antineoplastics
57.8 Several miscellaneous antineoplastics act by unique mechanisms.
Drugs for Reducing Adverse Effects
57.9 Medications are used to relieve the adverse effects experienced by patients undergoing chemotherapy.
Preparing and Administering Antineoplastics
57.10 Nurses who are preparing and delivering antineoplastics must exercise extreme caution to protect themselves from medication exposure.
CHAPTER 57 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 9 Pharmacology of the Gastrointestinal System
CHAPTER 58 Review of the Gastrointestinal System
LEARNING OUTCOMES
KEY TERMS
Overview of the Digestive System
58.1 The function of the digestive system is to extract nutrients from food to fuel metabolic processes in the body.
Physiology of the Upper Gastrointestinal Tract
58.2 The upper gastrointestinal tract is responsible for mechanical and chemical digestion.
PharmFACT
CONNECTION Checkpoint 58.1
Physiology of the Lower Gastrointestinal Tract
58.3 The small intestine is the longest portion of the alimentary canal and is the primary organ for absorption.
PharmFACT
CONNECTION Checkpoint 58.2
58.4 The large intestine contains host flora and is a major site of water reabsorption.
Physiology of the Accessory Organs of Digestion
58.5 The liver is the most important accessory digestive organ.
PharmFACT
CONNECTION Checkpoint 58.3
Regulation of Digestive Processes
58.6 Digestion is regulated by numerous hormonal and nervous factors.
Nutrient Categories and Metabolism
58.7 The chemical breakdown of food is accomplished by digestive enzymes.
CHAPTER 58 Understanding the Chapter
Key Concepts Summary
References
Selected Bibliography
CHAPTER 59 Pharmacotherapy of Peptic Ulcer Disease
LEARNING OUTCOMES
KEY TERMS
Physiology of the Upper Gastrointestinal Tract
59.1 The stomach secretes acid, enzymes, and hormones that are essential to digestive physiology.
Etiology and Pathogenesis of Peptic Ulcer Disease
59.2 Peptic ulcer disease is associated with a number of etiologic risk factors.
PharmFACT
CONNECTION Checkpoint 59.1
Etiology and Pathogenesis of Gastroesophageal Reflux Disease
59.3 Gastroesophageal reflux disease is a chronic condition characterized by persistent heartburn.
PharmFACT
Pharmacotherapy of Peptic Ulcer Disease and Gastroesophageal Reflux Disease
59.4 Peptic ulcer disease and gastroesophageal reflux disease are best treated with a combination of pharmacotherapy and lifestyle changes.
Pharmacotherapy with Proton Pump Inhibitors
59.5 Proton pump inhibitors block gastric acid secretion and are the drugs of choice in the therapy of peptic ulcer disease and gastroesophageal reflux disease.
Description
History and Claims
Standardization
Evidence
PROTOTYPE DRUG Omeprazole (Prilosec)
Classification:
Therapeutic Effects and Uses:
Clinical Question
Evidence
Implications
Critical Thinking Question
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment for Overdose:
Nursing Responsibilities:
Drugs Similar to Omeprazole (Prilosec)
Pharmacotherapy with H2-Receptor Antagonists
59.6 The H2-receptor antagonists suppress gastric acid secretion and are widely prescribed for treating peptic ulcer disease and gastroesophageal reflux disease.
PROTOTYPE DRUG Ranitidine (Zantac)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Ranitidine (Zantac)
Pharmacotherapy with Antacids
59.7 Antacids are alkaline substances that neutralize stomach acid to treat symptoms of heartburn.
PROTOTYPE DRUG Aluminum Hydroxide (AlternaGEL, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Aluminum Hydroxide (AlternaGEL, Others)
Pharmacotherapy of Helicobacter pylori Infection
59.8 The gram-negative bacterium H. pylori is associated with approximately 70% of patients with peptic ulcer disease.
CONNECTION Checkpoint 59.3
Miscellaneous Drugs Used for Peptic Ulcer Disease and Gastroesophageal Reflux Disease
59.9 Several miscellaneous drugs, including sucralfate, bismuth subsalicylate, and misoprostol, are beneficial in treating peptic ulcer disease.
CHAPTER 59 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 60 Pharmacotherapy of Bowel Disorders and Other Gastrointestinal Conditions
LEARNING OUTCOMES
KEY TERMS
Pathophysiology of Constipation
60.1 Constipation is characterized by infrequent or difficult bowel movements.
Pharmacotherapy with Laxatives
60.2 Laxatives are drugs that increase the frequency and quality of bowel movements.
Bulk Forming
Saline and Osmotic
Stimulant
Stool Softener/Surfactant
Herbal Agents
Miscellaneous Laxatives
Pathophysiology of Diarrhea
60.3 Diarrhea is an abnormal increase in the frequency and fluidity of bowel movements.
Pharmacotherapy of Diarrhea
60.4 Opioids are the most effective drugs for controlling severe diarrhea.
Opioids
Miscellaneous Antidiarrheals
PROTOTYPE DRUG Diphenoxylate with Atropine (Lomotil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Diphenoxylate with Atropine (Lomotil)
Pharmacotherapy of Inflammatory Bowel Disease
60.5 Inflammatory bowel disease is treated with immunosuppressants and anti-inflammatory drugs.
Implementation
First-Line Drugs for Inflammatory Bowel Disease
Drugs for Irritable Bowel Syndrome
PROTOTYPE DRUG Sulfasalazine (Azulfidine)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Herbal/Food:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Sulfasalazine (Azulfidine)
Pharmacotherapy of Irritable Bowel Syndrome
60.6 Irritable bowel syndrome is treated with dietary management, symptomatic therapy, and drugs that regulate intestinal motility.
PharmFACT
Pathophysiology of Nausea and Vomiting
60.7 Nausea and vomiting occur when the vomiting center in the medulla is stimulated.
PharmFACT
Pharmacotherapy of Nausea and Vomiting
60.8 Antiemetics are prescribed to treat nausea, vomiting, and motion sickness.
Pharmacotherapy of Pancreatitis
60.9 Pancreatic enzymes are administered as replacement therapy for patients with chronic pancreatitis.
PharmFACT
CHAPTER 60 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 61 Vitamins and Minerals
LEARNING OUTCOMES
KEY TERMS
Role of Vitamins in Health and Disease
61.1 Although the importance of nutrition has been known for centuries, the specific vitamins were discovered in the 1900s.
61.2 Vitamins are essential for optimal health.
Regulation of Vitamins
61.3 Government regulations and consumer knowledge about vitamins are limited.
PharmFACT
Recommended Dietary Allowance
61.4 The recommended dietary allowance is the dietary intake level that is sufficient to meet the nutrient requirements for most people.
Fat-Soluble Vitamins
61.5 Fat-soluble vitamins include vitamins A, D, E, and K.
Vitamin A (Aquasol A)
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Vitamin D (Calcijex, Rocaltrol)
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
PharmFACT
Vitamin E (Aquasol E, Vita-Plus E, Others)
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Vitamin K (AquaMEPHYTON)
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
CONNECTION Checkpoint 61.1
Water-Soluble Vitamins
61.6 Water-soluble vitamins include the B-complex vitamins and vitamin C.
Thiamine: Vitamin B1
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Riboflavin: Vitamin B2
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Niacin: Vitamin B3
Pyridoxine: Vitamin B6
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Recommended Intake:
Pregnancy:
Nursing Responsibilities:
CONNECTION Checkpoint 61.2
Folic Acid: Vitamin B9
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Cyanocobalamin: Vitamin B12
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Vitamin C: Ascorbic Acid
Therapeutic Effects and Uses:
Mechanism of Action:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Recommended Intake:
Nursing Responsibilities:
Minerals
61.7 Macrominerals are inorganic substances needed in amounts of at least 100 mg per day for normal body functioning.
CHAPTER 61 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 62 Enteral and Parenteral Nutrition
LEARNING OUTCOMES
KEY TERMS
62.1 Nutritional supplementation is required for patients with certain medical conditions.
62.2 Supplemental nutrition may be provided by the oral or parenteral route.
Enteral Nutrition
62.3 Various methods are utilized to administer enteral feedings to the patient.
Methods of Administration
62.4 Enteral feedings can be delivered by bolus, intermittent drip or infusion, continuous infusion, or cyclic intermittent infusion.
Enteral Formulations
62.5 Several types of liquid nutrition formulas are commercially available for enteral feedings.
Elements of Enteral Nutrition
62.6 Most enteral nutrition formulas contain four basic classes of nutrients.
Carbohydrates:
Proteins:
Lipids:
Other nutrients:
Complications of Enteral Therapy
62.7 Although considered physiological in nature, total enteral nutrition can predispose the patient to various complications.
Aspiration:
Nausea and vomiting:
Diarrhea:
Gastrointestinal
Mechanical
Metabolic
Metabolic complications:
Clogged feeding tube:
Interrupted infusions:
Drug and Food Interactions
62.8 Most medications that are administered orally can also be delivered to the patient via an enteral tube.
CONNECTION Checkpoint 62.1
Parenteral Nutrition
62.9 Parenteral nutrition is used when patients are unable to tolerate enteral feedings.
PharmFACT
Components of Total Parenteral Nutrition Solutions
62.10 The basic total parenteral nutrition solution consists of carbohydrates, lipids, amino acids, electrolytes, minerals, and vitamins.
Carbohydrates:
CONNECTION Checkpoint 62.2
Lipids:
Amino acids:
Electrolytes and minerals:
Vitamins:
CONNECTION Checkpoint 62.3
Complications of Parenteral Therapy
Mechanical
Metabolic
Infection
62.11 As with enteral therapy, patients who are receiving parenteral nutrition therapy can experience various complications.
Mechanical complications:
Metabolic complications:
Infectious complications:
Drug and Food Interactions
62.12 Certain drugs are incompatible and should not be added to parenteral nutrition solutions.
CONNECTION Checkpoint 62.4
Implementation
CHAPTER 62 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 63 Weight Reduction Strategies and the Pharmacotherapy of Obesity
LEARNING OUTCOMES
KEY TERMS
Etiology of Obesity
63.1 Genetic and lifestyle factors contribute to the etiology of obesity.
PharmFACT
Pathogenesis of Obesity
63.2 Appetite is regulated by the satiety center in the hypothalamus and is influenced by various hormones.
CONNECTION Checkpoint 63.1
Measurement of Obesity
63.3 Obesity is measured by using the body mass index and waist circumference.
PharmFACT
Nonpharmacologic Therapies for Obesity
63.4 Nonpharmacologic treatment of obesity should be attempted prior to initiating pharmacotherapy.
Pharmacotherapy of Obesity
63.5 Drugs used for weight management affect appetite or the absorption of fats.
CONNECTION Checkpoint 63.2
63.6 Lipase inhibitors cause weight loss by interfering with the absorption of fats.
PROTOTYPE DRUG Orlistat (Alli, Xenical)
Classification:
Therapeutic Effects and Uses:
Description
History and Claims
Standardization
Evidence
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Orlistat (Alli, Xenical)
63.7 Anorexiants are drugs used to induce weight loss by suppressing appetite and hunger.
CONNECTION Checkpoint 63.3
Adjuncts to Obesity Therapy
63.8 Artificial sweeteners and fat substitutes are sometimes used as adjuncts to weight management programs.
CHAPTER 63 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 10 Pharmacology of the Endocrine System
CHAPTER 64 Review of the Endocrine System
LEARNING OUTCOMES
KEY TERMS
Overview of the Endocrine System
64.1 The endocrine system controls homeostasis through the secretion of hormones.
Hormone Receptors
64.2 Hormones must bind to specific receptors to cause physiological changes.
Negative Feedback Mechanisms
64.3 Most hormone action is regulated through negative feedback.
Neuronal stimuli:
Humoral stimuli:
Hormonal stimuli:
CONNECTION Checkpoint 64.1
Hormone Pharmacotherapy
64.4 Hormone pharmacotherapy is indicated for a diverse variety of conditions.
CONNECTION Checkpoint 64.2
CHAPTER 64 Understanding the ChapterKey Concepts Summary
References
Selected Bibliography
CHAPTER 65 Hypothalamic and Pituitary Drugs
LEARNING OUTCOMES
KEY TERMS
Functions of the Hypothalamus
65.1 The hypothalamus controls many diverse body processes and secretes hormones that influence pituitary function.
CONNECTION Checkpoint 65.1
Functions of the Pituitary Gland
65.2 The pituitary gland secretes hormones that control many diverse body functions.
Pharmacotherapy of Growth Hormone Disorders
65.3 Growth hormone deficiency in adults and children can be treated by administering recombinant growth hormone.
PROTOTYPE DRUG Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Saizen, Serostim, Zorbtive)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Saizen, Serostim, Zorbtive)
Pharmacotherapy of Antidiuretic Hormone Disorders
65.5 Pharmacotherapy is used to treat deficient or excess secretion of antidiuretic hormone.
Implementation
CONNECTION Checkpoint 65.2
PharmFACT
PROTOTYPE DRUG Desmopressin (DDAVP)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Desmopressin (DDAVP)
CHAPTER 65 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 66 Pharmacotherapy of Diabetes Mellitus
LEARNING OUTCOMES
KEY TERMS
Physiology of Serum Glucose Control
66.1 Serum glucose is maintained within a narrow range by the hormones insulin and glucagon.
PharmFACT
Pathophysiology of Diabetes Mellitus: Types of Diabetes
66.2 Type 1 diabetes is characterized by insufficient insulin synthesis by the pancreas, whereas type 2 diabetes is characterized by insulin resistance in the target cells.
Symptoms and Diagnosis of Diabetes
66.3 The classic signs and symptoms of diabetes include polyuria, polydipsia, and polyphagia.
Complications of Diabetes Mellitus
66.4 Acute complications of diabetes include diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia.
CONNECTION Checkpoint 66.1
PROTOTYPE DRUG Glucagon (GlucaGen)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Glucagon (GlucaGen)
66.5 Serious complications of chronic diabetes include neuropathy, nephropathy, retinopathy, and vascular disease.
Insulin Therapy
66.6 Insulin is the cornerstone of therapy for patients with type 1 and gestational diabetes.
Insulin Adjunct
PROTOTYPE DRUG Human Regular Insulin (Humulin R, Novolin R)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Herbal/Food:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Human Regular Insulin (Humulin R, Novolin R)
Antidiabetic Drugs for Type 2 Diabetes
66.7 Antidiabetic drugs from multiple classes are used to treat type 2 diabetes.
Alpha-Glucosidase Inhibitors
Biguanides
Incretin Enhancers (GLP-1 Agonists)
Incretin Enhancers (DPP-4 Inhibitors)
Meglitinides
Sulfonylureas, First Generation
Sulfonylureas, Second Generation
Thiazolidinediones
Miscellaneous Drugs
Implementation
Sulfonylureas
PROTOTYPE DRUG Glyburide (DiaBeta, Glynase, Micronase)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Glyburide (DiaBeta, Glynase, Micronase)
First-generation sulfonylureas:
Chlorpropamide (Diabinese):
Tolazamide (Tolinase):
Tolbutamide (Orinase):
Second-generation sulfonylureas:
Glimepiride (Amaryl):
Glipizide (Glucotrol):
CONNECTION Checkpoint 66.2
Biguanides
PROTOTYPE DRUG Metformin (Glucophage, Glumetza, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Metformin (Glucophage, Glumetza, Others)
Meglitinides
PROTOTYPE DRUG Repaglinide (Prandin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Repaglinide (Prandin)
Thiazolidinediones
PROTOTYPE DRUG Rosiglitazone (Avandia)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Rosiglitazone (Avandia)
Alpha-Glucosidase Inhibitors
PROTOTYPE DRUG Acarbose (Precose)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Acarbose (Precose)
Incretin Enhancers
66.8 Incretin therapies offer a different approach to treating type 2 diabetes.
PROTOTYPE DRUG Sitagliptin (Januvia)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Sitagliptin (Januvia)
Albiglutide (Tanzeum):
Alogliptin (Nesina):
Dulaglutide (Trulicity):
Exenatide (Byetta):
Linagliptin (Tradjenta):
Liraglutide (Victoza):
Saxagliptin (Onglyza):
Miscellaneous Antidiabetic Drugs
Description
History and Claims
Standardization
Evidence
Implementation
CHAPTER 66 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 67 Pharmacotherapy of Thyroid Disorders
LEARNING OUTCOMES
KEY TERMS
Physiology of the Thyroid Gland
67.1 Thyroid hormones contain iodine and stimulate the basal metabolic rate of nearly all tissues.
Diagnosis of Thyroid Disorders
67.2 An accurate diagnosis of thyroid hormone dysfunction is based on the patient’s symptoms and the results of diagnostic tests.
PharmFACT
Pathophysiology of Hypothyroid Disorders
67.3 Hypothyroidism, or thyroid deficiency, can occur as a congenital or acquired disorder.
CONNECTION Checkpoint 67.1
Pharmacotherapy of Hypothyroid Disorders
67.4 Hypothyroidism is treated by replacement therapy with thyroid hormone.
PROTOTYPE DRUG Levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Levothyroxine (Levothroid, Levoxyl, Synthroid, Others)
Pathophysiology of Hyperthyroid Disorders
67.5 Hyperthyroidism, or Graves’ disease, is an autoimmune disorder accompanied by ophthalmopathy and goiter.
Implementation
PharmFACT
Pharmacotherapy of Hyperthyroid Disorders
67.6 Hyperthyroidism is treated with surgery or drugs that reduce the production of thyroid hormone.
CONNECTION Checkpoint 67.2
PROTOTYPE DRUG Propylthiouracil (PTU)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Propylthiouracil (PTU)
CHAPTER 67 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 68 Corticosteroids and Drugs Affecting the Adrenal Cortex
LEARNING OUTCOMES
KEY TERMS
Physiology of the Adrenal Gland
68.1 The adrenal glands secrete gonadocorticoids, mineralocorticoids, and corticosteroids.
Overview of Corticosteroid Pharmacotherapy
68.2 Corticosteroids are widely used, and all drugs in the class have very similar indications, actions, and adverse effects.
Description
History and Claims
Standardization
Evidence
Adverse Effects of Corticosteroids
68.3 Long-term therapy with corticosteroids has the potential to cause serious adverse effects in multiple body systems.
CONNECTION Checkpoint 68.1
Replacement Therapy with Corticosteroids
68.4 Adrenocortical insufficiency is treated by administering physiological levels of corticosteroids.
PharmFACT
CONNECTION Checkpoint 68.2
PROTOTYPE DRUG Hydrocortisone (Cortef, Solu-Cortef, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Hydrocortisone (Cortef, Solu-Cortef, Others)
Corticosteroids for Nonendocrine Conditions
68.5 Corticosteroids are frequently used to suppress the inflammatory and immune responses.
Mineralocorticoids
68.6 Patients with adrenal insufficiency often require replacement therapy with mineralocorticoids.
CONNECTION Checkpoint 68.3
PROTOTYPE DRUG Fludrocortisone
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Fludrocortisone
Antiadrenal Drugs
68.7 Antiadrenal drugs may be administered to lower serum corticosteroid levels in patients with Cushing’s syndrome.
PharmFACT
CHAPTER 68 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 69 Estrogens, Progestins, and Drugs Modifying Uterine Function
LEARNING OUTCOMES
KEY TERMS
Hormonal Regulation of Female Reproductive Function
69.1 Regulation of the female reproductive system is achieved by hormones from the hypothalamus, pituitary gland, and ovary.
Estrogens
69.2 Estrogens are administered as replacement therapy, to prevent conception, and for certain neoplasms.
PROTOTYPE DRUG Conjugated Estrogens (Cenestin, Enjuvia, Premarin)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Estrogens
Progestins
Estrogen–Progestin Combinations
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Conjugated Estrogens (Cenestin, Enjuvia, Premarin)
CONNECTION Checkpoint 69.1
Progestins
69.3 Progestins are administered to treat dysfunctional uterine bleeding, to prevent conception, and for certain neoplasms.
PharmFACT
PROTOTYPE DRUG Medroxyprogesterone (Depo-Provera, Depo- SubQ-Provera, Provera)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Implementation
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Medroxyprogesterone (Depo-Provera, Depo-SubQ-Provera, Provera)
Hormone Replacement Therapy
69.4 Hormone replacement therapy provides relief from menopause symptoms but may have serious long-term negative effects.
PharmFACT
Implementation
Uterine Stimulants: Oxytocics
69.5 Oxytocics are drugs used to stimulate the uterus and promote labor and delivery.
Stimulants (Oxytocics)
Ergot Alkaloid
Prostaglandins
Relaxants (Tocolytics)
PROTOTYPE DRUG Oxytocin (Pitocin)
Classification:
Therapeutic Effects and Uses:
Description:
History and Claims:
Standardization:
Evidence:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Oxytocin (Pitocin)
Uterine Relaxants: Tocolytics
69.6 Uterine relaxants are used to suppress preterm labor.
Pharmacotherapy of Female Infertility
69.7 Female infertility may be treated with drugs that promote oocyte maturation and ovulation.
PharmFACT
CHAPTER 69 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 70 Drugs for Modifying Conception
LEARNING OUTCOMES
KEY TERMS
Options and Choices for Birth Control
70.1 Selection of a contraceptive is based on effectiveness, safety, and personal choice.
Combination Oral Contraceptives
70.2 The most effective oral contraceptives include combinations of low-dose estrogens and progestins.
Hormonal Methods
Barrier and Miscellaneous Methods
Description
History and Claims
Standardization
Evidence
PharmFACT
Monophasic
Biphasic
Triphasic
Four-phasic
Progestin Only
Emergency Contraceptive
CONNECTION Checkpoint 70.1
PROTOTYPE DRUG Estradiol and Norethindrone (Ortho-Novum, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Estradiol and Norethindrone (Ortho-Novum, Others)
Progestin-Only Oral Contraceptives
70.3 Oral contraceptives that contain only progestin are often used when estrogen is contraindicated.
Adverse Effects of Combined Oral Contraceptives
70.4 The adverse effects of combined oral contraceptives are uncommon but may be serious in some women.
CONNECTION Checkpoint 70.2
Drugs for Long-Term Contraception and Newer Contraceptive Delivery Methods
70.5 Long-acting contraceptives and novel delivery methods offer women additional birth control choices.
Spermicides
70.6 Spermicides are safe but should be combined with barrier protection for maximum effectiveness.
PROTOTYPE DRUG Nonoxynol-9
Classification:
Therapeutic Effects and Uses:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Patient and Family Education:
Drugs Similar to Nonoxynol-9
Emergency Contraception
70.7 Emergency contraception provides a reproductive option for women who have unprotected sex or contraceptive failure.
Implementation
Drugs for Pharmacologic Abortion
70.8 Abortifacients are drugs that are used to terminate pregnancy.
Drugs for Emergency Contraception
Drugs for Pharmacologic Abortion
PROTOTYPE DRUG Mifepristone (Mifeprex)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Mifepristone (Mifeprex)
CHAPTER 70 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 71 Drugs for Disorders and Conditions of the Male Reproductive System
LEARNING OUTCOMES
KEY TERMS
Regulation of Male Reproductive Function
71.1 Male reproductive function is controlled through the secretion of androgens.
Pharmacotherapy with Androgens
71.2 Androgens are used to treat hypogonadism and delayed puberty in males and breast cancer in females.
Anabolic Steroids
71.3 Often abused by athletes, anabolic steroids can cause serious adverse effects.
Implementation
PharmFACT
CONNECTION Checkpoint 71.1
Etiology of Male Sexual Dysfunction
71.4 Male sexual dysfunction may have both medical and psychological etiologies.
Antihypertensives
Nervous System Drugs
Other Drugs
Pharmacotherapy of Male Infertility
71.5 Male infertility is treated with endocrine drugs that boost sperm production.
CONNECTION Checkpoint 71.2
Pharmacotherapy of Erectile Dysfunction
71.6 Erectile dysfunction is a common disorder that may be successfully treated with inhibitors of the enzyme phosphodiesterase-5.
PROTOTYPE DRUG Sildenafil (Viagra)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Sildenafil (Viagra)
Pathophysiology of Benign Prostatic Hyperplasia
71.7 Benign prostatic hyperplasia is an enlargement of the prostate that occurs in older men.
PharmFACT
Pharmacotherapy of Benign Prostatic Hyperplasia
71.8 In its early stages, benign prostatic hyperplasia may be treated successfully with drug therapy.
Alpha1-Adrenergic Blockers
5-Alpha Reductase Inhibitors
Phosphodiesterase-5 Inhibitors
CONNECTION Checkpoint 71.3
PROTOTYPE DRUG Finasteride (Proscar)
Classification:
Therapeutic Effects and Uses:
Description
History and Claims
Standardization
Evidence
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Finasteride (Proscar)
CHAPTER 71 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
UNIT 11 Additional Drug Classes
CHAPTER 72 Pharmacotherapy of Bone and Joint Disorders
LEARNING OUTCOMES
KEY TERMS
Role of Calcium in Body Homeostasis
72.1 Adequate levels of calcium in the body are necessary to transmit nerve impulses, to prevent muscle spasms, and for proper bone health.
PharmFACT
Regulation of Calcium Balance
72.2 Calcium balance is regulated by parathyroid hormone, calcitonin, and vitamin D.
Pharmacotherapy of Hypocalcemia
72.3 Hypocalcemia is a condition that requires therapy with calcium supplements, often concurrently with vitamin D.
PROTOTYPE DRUG Calcium Salts
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Calcium Salts
Pathophysiology of Metabolic Bone Disease
72.4 Metabolic bone disease is characterized by abnormal bone structure.
Implementation
Osteoporosis:
Osteomalacia:
Paget’s disease:
Pharmacotherapy of Metabolic Bone Disease
72.5 Vitamin D therapy is indicated for treating osteomalacia, hypoparathyroidism, and osteoporosis.
PROTOTYPE DRUG Calcitriol (Calcijet, Rocaltrol)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Calcitriol (Calcijet, Rocaltrol)
Pathophysiology and Pharmacotherapy of Joint Disorders
72.9 Osteoarthritis is treated with a combination of analgesics and nonpharmacologic therapies.
PharmFACT
72.10 Pharmacotherapy for rheumatoid arthritis includes analgesics, anti-inflammatory drugs, corticosteroids, and disease-modifying antirheumatic drugs.
Description
History and Claims
Standardization
Evidence
Biologic Therapies
Nonbiologic Therapies
PROTOTYPE DRUG Hydroxychloroquine (Plaquenil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Hydroxychloroquine (Plaquenil)
Pharmacotherapy of Gout and Hyperuricemia
CONNECTION Checkpoint 72.3
72.11 Gout is treated with drugs that decrease joint pain and inflammation and lower uric acid levels.
PROTOTYPE DRUG Colchicine (Colcrys)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Colchicine (Colcrys)
PharmFACT
72.12 Hyperuricemia is treated with drugs that reduce serum levels of uric acid.
PROTOTYPE DRUG Allopurinol (Lopurin, Zyloprim)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Allopurinol (Lopurin, Zyloprim)
CHAPTER 72 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 73 Pharmacotherapy of Dermatologic Disorders
LEARNING OUTCOMES
KEY TERMS
Anatomy of the Integumentary System
73.1 Three layers of skin, known as the epidermis, dermis, and subcutaneous layers, provide effective barrier defenses for the body.
Classification of Skin Disorders
73.2 The etiology of skin disorders may be classified as infectious, inflammatory, or neoplastic.
Pharmacotherapy of Skin Infections
73.3 When the integrity of the skin is compromised, microbes can gain entrance and cause infections that require anti-infective therapy.
CONNECTION Checkpoint 73.1
Scabicides and Pediculicides
73.4 Scabicides and pediculicides are used to treat parasitic skin infestations.
PROTOTYPE DRUG Permethrin (Acticin, Elimite, Nix)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Permethrin (Acticin, Elimite, Nix)
Pharmacotherapy of Acne and Rosacea
73.5 The pharmacotherapy of acne includes treatment with benzoyl peroxide, retinoids, and antibiotics; pharmacotherapy for rosacea includes retinoids and metronidazole.
Acne Vulgaris
Implementation
CONNECTION Checkpoint 73.2
Rosacea
PROTOTYPE DRUG Tretinoin (Avita, Retin-A, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Tretinoin (Avita, Retin-A, Others)
Pharmacotherapy of Dermatitis
73.6 The most effective treatment for dermatitis is topical corticosteroids, which are classified by their potency.
PharmFACT
Implementation
Very High Potency
High Potency
Medium Potency
Low Potency
CONNECTION Checkpoint 73.3
Pharmacotherapy of Psoriasis
73.7 Psoriasis is a chronic, inflammatory disease that is treated with topical and systemic medications.
PharmFACT
Topical Drugs
Systemic Drugs
Pharmacotherapy of Minor Skin Burns
73.8 The pharmacotherapy of sunburn includes prevention with sunscreens and treatment with lotions, topical anesthetics, and analgesics.
PROTOTYPE DRUG Benzocaine (Americaine, Anbesol, Others)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Lifespan and Diversity Considerations:
Patient and Family Education:
Drugs Similar to Benzocaine (Americaine, Anbesol, Others)
Pharmacotherapy of Alopecia
73.9 Several drugs are able to stimulate moderate hair regrowth in patients with male- and female-pattern alopecia.
CHAPTER 73 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 74 Pharmacotherapy of Eye and Ear Disorders
LEARNING OUTCOMES
KEY TERMS
Anatomy of the Eye
74.1 Knowledge of basic eye anatomy is fundamental to understanding eye disorders and their pharmacotherapy.
Pathophysiology of Glaucoma
74.2 The two principal types of glaucoma, closed-angle glaucoma and open-angle glaucoma, are characterized by increased intraocular pressure.
PharmFACT
Pharmacotherapy of Glaucoma
74.3 The primary goal of glaucoma pharmacotherapy is to prevent damage to the optic nerve by lowering intraocular pressure.
74.4 Prostaglandin analogs are the first-line drugs for treating high intraocular pressure because of their long durations of action and high safety profiles.
PROTOTYPE DRUG Latanoprost (Xalatan)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Treatment of Overdose:
Nursing Responsibilities:
Drugs Similar to Latanoprost (Xalatan)
Miscellaneous Drugs for Treating Glaucoma
74.6 Carbonic anhydrase inhibitors and osmotic diuretics are occasionally used for treating glaucoma.
Pharmacotherapy for Eye Examinations
74.7 Drugs that are routinely used for eye examinations include mydriatics, cycloplegics, diagnostic dyes, and local anesthetics.
Description
History and Claims
Standardization
Evidence
Mydriatics: Sympathomimetics
Cycloplegics: Anticholinergics
Anesthetics
Lubricants
Vasoconstrictors
PharmFACT
Pharmacotherapy for Other Eye Conditions
74.8 Numerous pharmacologic agents are used to treat minor eye irritation and redness.
Anatomy of the Ear
Mast Cell Stabilizers
Antihistamines
74.9 Knowledge of basic ear anatomy is fundamental to understanding ear disorders and pharmacotherapy.
Pharmacotherapy with Otic Preparations
74.10 Otic preparations treat infections, inflammation, and earwax buildup.
PharmFACT
Implementation
CHAPTER 74 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
CHAPTER 75 Emergency Preparedness: Bioterrorism and Management of Poisoning
LEARNING OUTCOMES
KEY TERMS
Emergency Preparedness, Bioterrorism, and Nursing
75.1 Emergency preparedness has become an essential competency for all health care professionals.
75.2 Bioterrorism is the intentional release of a virus or microorganism to cause human harm.
75.3 Nurses may have the first opportunity to recognize and initiate a response to bioterrorism.
75.4 The Strategic National Stockpile has large quantities of medicine to protect the public if there is a health emergency.
Biologic Agents
75.5 Highly infectious bacteria or viruses could be used as bioterrorist threats.
CONNECTION Checkpoint 75.1
PharmFACT
Chemical and Physical Agents
75.6 There are 13 categories of toxic chemicals that could cause mass casualties if released into the environment.
Nerve Agents
Vesicants (Blister Agents)
Chemical Asphyxiants (Blood agents)
75.7 Ionizing radiation produces immediate and long-term effects on human tissue.
CONNECTION Checkpoint 75.2
PharmFACT
Management of Poisoning
75.8 The general management of poisoning includes contacting the poison control center or emergency medical services as soon as possible.
PharmFACT
CONNECTION Checkpoint 75.3
75.9 Activated charcoal is effective at adsorbing (binding) most poisons if administered within 60 minutes of ingestion.
PROTOTYPE DRUG Activated Charcoal (CharcoAid)
Classification:
Therapeutic Effect and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Nursing Responsibilities:
Drugs Similar to Activated Charcoal (CharcoAid)
75.10 Ion trapping with forced diuresis may be helpful for some poisonings.
75.11 Chelating agents are capable of forming bonds with heavy metals.
PROTOTYPE DRUG Edetate Calcium Disodium (Calcium EDTA)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Nursing Responsibilities:
PROTOTYPE DRUG Dimercaprol (BAL in Oil)
Classification:
Therapeutic Effects and Uses:
Mechanism of Action:
Pharmacokinetics:
Adverse Effects:
Contraindications/Precautions:
Drug Interactions:
Pregnancy:
Nursing Responsibilities:
Implementation
CHAPTER 75 Understanding the Chapter
Key Concepts Summary
Case Study: Making the Patient Connection
Additional Case Study
Chapter Review
References
Selected Bibliography
Appendix B ISMP List of High-Alert Medications in Acute Care Settings
Glossary
Index
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