Focus on Nursing Pharmacology , Fifth Edition

1040 Pages·2009·85.62 MB·English

by  Amy M. Karch

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AMY M. KARCH, RN, MS
Associate Professor of Clinical Nursing
University of Rochester School of Nursing
Rochester, New York
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Fifth edition
Copyright ©2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright ©2008,2006,2003,2000 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copy-
right. No part of this book may be reproduced or transmitted in any form or by any means,including as photocopies or scanned-
in or other electronic copies,or utilized by any information storage and retrieval system without written permission from the
copyright owner,except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared
by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.
To request permission,please contact Lippincott Williams & Wilkins at 530 Walnut Street,Philadelphia,PA 19106,via email
at [email protected],or via our website at lww.com (products and services).
9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Karch,Amy Morrison,1949-
Focus on nursing pharmacology / Amy M. Karch. — 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-7817-8982-0 (alk. paper)
1. Pharmacology. 2. Nursing. I. Title.
[DNLM: 1. Pharmaceutical Preparations—Nurses’Instruction. 2. Drug Therapy—Nurses’Instruction.
3. Pharmacology—Nurses’Instruction. QV 4 K183f 2011]
RM300.K37 2011
(cid:2)
615.5 8—dc22
2009035438
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices.
However,the author,editors,and publisher are not responsible for errors or omissions or for any consequences from applica-
tion of the information in this book and make no warranty,expressed or implied,with respect to the currency,completeness,or
accuracy of the contents of the publication. Application of this information in a particular situation remains the professional
responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and uni-
versal recommendations.
The author,editors,and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are
in accordance with the current recommendations and practice at the time of publication. However,in view of ongoing research,
changes in government regulations,and the constant flow of information relating to drug therapy and drug reactions,the reader
is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and pre-
cautions. This is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for lim-
ited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug
or device planned for use in his or her clinical practice.
LWW.com
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Dedicated to the many wonderful men and women who are entering the
nursing profession today,to the hard-working faculty who are teaching them
the art and science of nursing,and to my family and colleagues,who have
offered so much support,humor,and sunshine.
AMY M. KARCH
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Reviewers
Candyce Antley Connie Evenson, RN, MSN, CNE Nancy Hutton Haynes, RN, PhD, CCRN
Midlands Technical College Associate Professor Associate Professor
Columbia,SC University of South Dakota Saint Luke's College
Sioux Falls,SD Kansas City,MO
Lisa R. Aymong, RN, BS, MPA, MS, ANP
Assistant Professor of Nursing Deborah L. Freyman, RN, MSN, MA Monica Holland, MS, RN
Suffolk County Community College Nursing Faculty Professor of Nursing
Selden,NY National Park Community College Oklahoma City Community College
Hot Springs,AR Oklahoma City,OK
Kristen Barbee
Cabarrus College Health Sciences Nicholas E. Frusciante, RN, MSN, Nancy Hutt
Concord,NC CCRN Portland Community College
Professor Nursing Portland,OR
Ilene M. Borze, MS, RN Luzerne County Community College
Nursing Faculty Naticoke,PA Maryan Jatczak, MS, RN
Gateway Community College Assistant Professor of Nursing
Phoenix,AZ Charlene Beach Gagliardi, RN, BSN, Moraine Valley Community College
MSN Palos Hills,IL
Judith Brock Assistant Professor,BSN Program
Mesa State College Mount St. Mary's College Deborah Jones
Grand Junction,CO Los Angeles,CA Trinity Valley Community College
Kaufman,TX
Mary Burroughs Sally Gaines
Bethune Cookman College West Texas A&M University Mini M. Jose, MSN, PhD, RN
Daytona Beach,FL Canyon,TX Director,Associate Degree Nursing
Mobility Program
Madelyn Danner, RN, MS, CCRN, CEN Manuel Gonzalez San Jacinto College
Assistant Professor of Nursing Laredo Community College Houston,TX
Harford Community College Laredo,TX
Bel Air,MD Julie Kendall
Judy L. Goodhart, MSN, RN North Harris College
Ellen B. Daroszewski, PhD, APRN Emeritus Professor of Nursing-Retired Houston,TX
Professor,DNP Program Director Mesa State College
Western University of Health Sciences Grand Junction,CO Rose Knapp, MSN, RN, APRN-BC
Pomona,CA Clinical Assistant Professor
Nancy Hamilton New York University
Nicholas DeFalco, MSN, RN Louisiana State University,Alexandria New York,NY
Director,Nursing Division Alexandria,LA
Scottsdale Community College Phyllis Magaletto, MS, RN, BC
Maricopa Community College Amy S. Hamlin, MSN, RN Instructor Nursing Medical Surgical
Scottsdale,AZ Associate Professor of Nursing Cochran School of Nursing
Austin Peay State University Yonkers,NY
Clarksville,TN
iv
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Reviewers v
Janet Gardner Marshall, PhD, RN Billie Rhea Phillips,PhD, RN, LNC Mark Stevens
Associate Professor Associate Professor & Chair,BSN Mercy College of Health Science
Florida A&M University Project Des Moines,IA
Tallahassee,FL Lincoln Memorial University
Caylor School of Nursing Debbie Summers, MSN, RN, ANP-BC
Janet Massoglia, RN, DNP, FNP-BC Harrogate,TN Assistant Professor
Assistant Professor,Nursing Discipline Ivy Tech Community College
Delta College Joan Pino-Talbot Indianapolis,IN
University Center,MI Rutgers University,Camden
Camden,NJ Diane Tomasic
Caron Martin, RN, MSN West Liberty State College
Associate Professor Elizabeth Pratt West Liberty,WV
Northern Kentucky University Southern Arkansas University
Highland Heights,KY Magnolia,AR Anne Vukadinovic, BS (Hon), CCPE
Professor Pharmacology
Dottie Mathers, MSN, RN Jacquelyn Reid, MSN, EdD, CNE Centennial College
Associate Professor Associate Professor of Nursing Toronto,Ontario
Pennsylvania College of Technology Indiana University Southeast
Williamsport,PA New Albany,ID Terri L. Walker, MSN, RN
Assistant Nursing Program
Jacquelyn P. Mayer, MN, RN Bonnie Savoldi, MS, RN Director/Professor of Nursing
Associate Professor in Nursing Senior Lecturer Oklahoma City Community College
Good Samaritan College of Nursing Baylor University Oklahoma City,OK
and Health Science Dallas,TX
Cincinnati,OH Arlinda Washington
Susan M. Seiboldt, MSN, RN, CNE College of the Mainland
Sally Louise McNay, RN, MSN Assistant Nursing Professor Texas City,TX
Professor of Nursing Carl Sandburg College
Cypress College Galesburg,IL Justin Welch
Cypress,CA North Dakota State University
Lyndi C. Shadbolt, MS, BSN, RN Fargo,ND
Cindy Neely, MSN, RN Associate Professor
Nursing Campus Clinical Lab Amarillo College Laura J. White, BSN, RN
Coordinator / Professor of Nursing Amarillo,TX Vocational Nursing Instructor
Oklahoma City Community College North Central Texas College
Oklahoma City,OK Harsha Sharma, PhD Bowie,TX
Associate Professor
Juanita Oppermann Nebraska Methodist College Dina Wilson
Galveston College Omaha,NE Johnson County Community College
Galveston,TX Overland Park,KS
Diane J. Sheets, MS, RN
Paulette Osterman Clinical Instructor Jane Winters, MS, RN
Community College of RI The Ohio State University Associate Professor
Warwick,RI Columbus,OH Columbus State Community College
Columbus,OH
VaLinda Pearson, PhD, RN, CRRN, CNE Mary Stedman,MS, RN-c, ANP, CNE
Professor of Nursing/Associate Degree Professor/Associate Chairperson K.L. Jean Yockey, MSN, FNP-BC, CNE
Nursing Program Director Farmingdale State College,SUNY Associate Professor of Nursing
St. Catherine University Farmingdale,NY University of South Dakota
St. Paul,MN Vermillion,SD
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Preface
P harmacology is a difficult course to teach in a standard case-study-based critical thinking exercises that incorporate
nursing curriculum, whether it be a diploma, associate, nursing process principles. The text incorporates study materi-
baccalaureate,or graduate program. Teachers are difficult to als that conclude each chapter. Check Your Understanding sec-
find, and time and money often dictate that the invaluable tions provide both new- and old-format National Council
content of such a course be incorporated into other courses. Licensure Examination (NCLEX)-style review questions, as
As a result, the content is often lost. At the same time, well as study guide review questions to help the student master
changes in medical care delivery—more outpatient and home the material and prepare for the national licensing exam.
care, shorter hospital stays, and more self-care—have
resulted in additional legal and professional responsibilities
Focus on Teaching/Learning Activities
for nurses, making them more responsible for the safe and
effective delivery of drug therapy. ThePoint (available at http://thepoint.lww.com/),a trademark
Pharmacology should not be such a formidable obstacle in of Wolters Kluwer Health,is a Web-based course and content
the nursing curriculum. The study of drug therapy incorporates management system that provides every resource instructors
physiology, pathophysiology, chemistry, and nursing funda- and students need in one easy-to-use site. ThePoint . . . where
mentals—subjects that are already taught in most schools. A teaching,learning,and technology click!
textbook that approaches pharmacology as an understandable,
Student Resources
teachable, and learnable subject would greatly facilitate the
incorporation of this subject into nursing curricula. Yet many Students can visit thePoint to access supplemental multimedia
nursing pharmacology texts are large and burdensome,mainly resources to enhance their learning experience, download
because they need to cover not only the basic pharmacology, content, upload assignments, and join an online study group.
but also the particulars included in each area considered. ThePoint offers a variety of free student resources, including
The fifth edition of Focus on Nursing Pharmacology is NCLEX-Style Student Review Questions (over 1,200 NEW to
based on the premise that students first need to have a solid this edition!),Watch and Learn video clips,Practice and Learn
and clearly focused concept of the principles of drug therapy activities,an Alternate-Format NCLEX Tutorial,and a Spanish-
before they can easily grasp the myriad details associated English Audioglossary. It also has free journal articles re-
with individual drugs. lated to topics discussed in the Focus on Safe Medication
Armed with a fundamental knowledge of pharmacology,the Administration boxes from the book. Also included are videos
student can appreciate and use the specific details that are so on preventing medication errors and three-dimensional ani-
readily available in the many annually updated and published mated depictions of pharmacology concepts. In addition, an
nursing drug guides,such as Lippincott’s Nursing Drug Guide. online course is available that includes interactive activities.
With this goal in mind, Focus on Nursing Pharmacology
Instructor Resources
provides a concise,user-friendly,and uncluttered text for the
modern student. This difficult subject is presented in a stream- Advanced technology and superior content combine at
lined, understandable, teachable, and learnable manner. thePoint to allow instructors to design and deliver online and
Because this book is designed to be used in conjunction with offline courses, maintain grades and class rosters, and com-
a handbook of current drug information, it remains stream- municate with students. In addition to housing the material
lined. This fifth edition of Focus on Nursing Pharmacology from the Instructor’s Resource DVD-ROM, thePoint also
continues to emphasize “need-to-know”concepts. provides additional resources,including Pre-lecture Quizzes,
The text reviews and integrates previously learned knowl- PowerPoints with Guided Lecture Notes,Discussion Topics,
edge of physiology, chemistry, and nursing fundamentals into Assignments, and over 1700 Test Generator questions—
chapters focused on helping students conceptualize what is almost 1200 of which are brand new to this edition!
important to know about each group of drugs. Illustrations,
sidebars, and tables sum up concepts to enhance learning.
Organization
Special features further focus student learning on clinical appli-
cation, critical thinking, patient safety, lifespan issues related Focus on Nursing Pharmacology is organized following a
todrug therapy,evidence-based practice,patient teaching,and “simple-to-complex” approach, much like the syllabus for a
vi
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Preface vii
basic nursing pharmacology course. Because students learn important to learn about each drug class. Important features
best “from the bottom up,”the text is divided into distinct parts. in the fifth edition focus on incorporating basic nursing skills,
Part Ibegins with an overview of basic nursing pharma- patient safety,critical thinking,and application of the mater-
cology,including such new challenges as bioterrorism,street ial learned to the clinical scenario, helping the student to
drugs,herbal therapies,and the information overload; each of understand the pharmacology material.
the other parts begins with a review of the physiology of the
system affected by the specific drugs being discussed. This
review refreshes the information for the student and provides Special Elements and Learning Aids
a quick and easy reference when he or she is reading about
Each chapter opens with a list of learning objectives for that
drug actions.
chapter,helping the student to understand what the key learn-
Part II of the text introduces the drug classes, starting
ing points will be. A list of featured drugs and a glossary of key
with the chemotherapeutic agents—both antimicrobial and
terms are also found on the opening chapter page. Key points
antineoplastic drugs. Because the effectiveness of these drugs
appear periodically throughout each chapter to summarize
depends on their interference with the most basic element of
important concepts. The text of each chapter ends with a sum-
body physiology—the cell—students can easily understand
mary of important concepts. This is followed by a series of
the pharmacology of this class. Mastering the pharmacother-
review exercises, Check Your Understanding, which includes
apeutic effects of this drug class helps the student to establish
NCLEX-style questions in the new format to focus student
a firm grasp of the basic principles taught in Part I. Once the
learning on the seminal information presented in the chapter.
easiest pharmacological concepts are understood,the student
is prepared to move on to the more challenging physiological • In the Nursing Considerationssection of each chapter,
and pharmacological concepts. italicshighlight the rationalefor each nursing intervention,
Part III focuses on drugs affecting the immune system helping the student to apply the information in a clinical
because recent knowledge about the immune system has situation. Elsewhere in the text,the rationale is consistently
made it the cornerstone of modern therapy. All of the immune provided for therapeutic drug actions,contraindications,
system drugs act in ways in which the immune system would and adverse effects.
act if it were able. Recent immunological research has con- • In the Drug Listat the beginning of each chapter,a special
tributed to a much greater understanding of this system,mak- icon appears next to the drug that is considered the
ing it important to position information about drugs affecting prototype drug of each class. In each chapter,prototype
this system close to the beginning of the text instead of at the summary boxes spotlight need to know information for
end as has been the custom. each prototype drug.
Parts IV and V of the text address drugs that affect the • Drugs in Focustables clearly summarize and identify the
nervous system, the basic functioning system of the body. drugs within a class,highlighting them by generic and
Following the discussion of the nervous system,and closely trade names,usual dosage,and indications. The icon
linked with it in Part VI, is the endocrine system. The appears in these tables next to each drug that is considered
sequence of these parts introduces students to the concept of to be the prototype for its specific class.
control,teaches them about the interrelatedness of these two • Web Linksalert the student to electronic sources of drug
systems, and prepares them for understanding many aspects information and sources of drug therapy information for
of shared physiological function and the inevitable linking of specific diseases.
the two systems into one:the neuroendocrine system. • Focus on Safe Medication Administration boxes present
Parts VII,VIII,and IXdiscuss drugs affecting the repro- important safety information to help keep the patient safe,
ductive,cardiovascular,and renal systems,respectively. The prevent medication errors,and increase the therapeutic
sequencing of cardiovascular and renal drugs is logical effectiveness of the drugs.
because most of the augmenting cardiovascular drugs (such • Focus on the Evidenceboxes compile information based
as diuretics) affect the renal system. on research to identify the best nursing practices associ-
Part X covers drugs that act on the respiratory system, ated with specific drug therapy.
which provides the link between the left and right ventricles • Focus on Herbal and Alternative Therapiesdisplays high-
of the heart. light known interactions with specific herbs or alternative
Part XI addresses drugs acting on the gastrointestinal therapies that could affect the actions of the drugs being
system. The gastrointestinal system stands on its own; it does discussed.
not share any actions with any other system. • Focus on Calculationsreviews are designed to help the
student hone calculation and measurement skills while
learning about the drugs for which doses might need to be
Text Features
calculated.
The features in this text are skillfully designed to support the • Focus on Drug Therapy Across the Lifespanboxes con-
text discussion,encouraging the student to look at the whole cisely summarize points to consider when using the drugs
patient and to focus on the essential information that is of each class with children,adults,and the elderly.
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viii Preface
• Focus onGender Considerations andFocus on Cultural student prepare for that exam. Other questions and activi-
Considerationsdiscussions encourage the student to think ties in this section are designed to help students test their
about cultural awareness and to consider the patient as a knowledge of the information that has been learned in the
unique individual with a special set of characteristics that chapter.
not only influences variations in drug effectiveness,but
also could influence a patient’s perspective on drug
To the Student Using This Text
therapy.
• Critical Thinking Scenariostie each chapter’s content As you begin your study of pharmacology, don’t be over-
together by presenting clinical scenarios about a patient whelmed or confused by all of the details. The study of drugs
using a particular drug from the class being discussed. fits perfectly into your study of the human body—anatomy,
Included in the case study are hints to guide critical think- physiology, chemistry, nutrition, psychology, and sociology.
ing about the case and a discussion of drug- and nondrug- Approach the study of pharmacology from the perspective of
related nursing considerationsfor that particular patient putting all of the pieces together; this can be not only fun,but
and situation. Most important,the case study provides a also challenging! Work to understand the concepts,and all of
plan of nursing carespecifically developed for that patient the details will fall into place and be easy to remember and
and specifically based on the nursing process. The care apply to the clinical situation. This understanding will help
plan is followed by a checklist of patient teaching points you in creating the picture of the whole patient as you are
designed for the patient presented in the case study. This learning to provide comprehensive nursing care. This text is
approach helps the student to see how assessment and the designed to help you accomplish all of this in a simple and
collected data are applied in the clinical situation. concise manner. Good luck!
• Check Your Understandingsections present NCLEX-style
questions,including alternate format questions,to help the Amy M. Karch, RN, MS