Table Of Content

YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! Evolve Student Resources for Edmunds: Introduction to Clinical Pharmacology, Eighth Edition, include the following: • Interactive NCLEX® Review Questions • Answer Keys to in-text Questions • Spanish/English Glossary • Dimensional Analysis Calculations • Drug Dosage Calculators • Math Review Chapters and Answer Keys • Patient Teaching Handouts • Videos • WebLinks Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Edmunds/LPN/ REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. Brief Contents UNIT I General Principles of Pharmacology, 1 1 Pharmacology and the Nursing Process in LPN Practice, 1 2 Patient Teaching and Health Literacy, 11 3 Legal Aspects Affecting the Administration of Medications, 19 4 Foundations and Principles of Pharmacology, 33 5 Lifespan and Cultural Modifications, 46 6 Self-Care: Over-the-Counter Products, Herbal Therapies, and Drugs for Health Promotion, 61 UNIT II Principles of Medication Administration, 73 7 Preparing and Administering Medications, 73 UNIT III Drug Groups, 121 8 Allergy and Respiratory Medications, 121 9 Antiinfective Medications, 149 10 Antivirals, Antiretrovirals, and Antifungal Medications, 177 11 Antineoplastic Medications, 190 12 Cardiovascular and Renal Medications, 198 13 Central and Peripheral Nervous System Medications, 238 14 Medications for Pain Management and Anesthesia, 286 15 Antiinflammatory, Musculoskeletal, and Antiarthritis Medications, 300 16 Gastrointestinal Medications, 324 17 Hematologic Products, 344 18 Hormones and Steroids, 358 19 Immunologic Medications, 396 20 Topical Medications, 408 21 Vitamins and Minerals, 422 Appendix A Special Medication Precautions, 439 Appendix B Pregnancy and Lactation Risk Categories, 440 Bibliography, 441 Glossary, 445 Index, 453 i This page intentionally left blank 8 EDITION Introduction to Clinical Pharmacology Marilyn Winterton Edmunds, PhD, ANP/GNP Adjunct Faculty Johns Hopkins University School of Nursing Baltimore, Maryland 3251 Riverport Lane St. Louis, Missouri 63043 INTRODUCTION TO CLINICAL PHARMACOLOGY ISBN: 978-0-323-18765-7 Eighth Edition Copyright © 2016 by Mosby, an imprint of Elsevier Inc. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby Inc., an affiliate of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices The content and procedures in this book are based on information currently available. They were reviewed by instructors and practicing professionals in various regions of the United States. However, agency policies and procedures may vary from the information and procedures in this book. In addition, research and new information may require changes in standards and practices. Standards and guidelines from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) may change as new information becomes available. Other federal and state agencies also may issue new standards and guidelines. So may accrediting agencies and national organizations. You are responsible for following the policies and procedures of your employer and the most current standards, practices, and guidelines as they relate to the safety of your work. To the fullest extent of the law, neither the Publisher nor the authors or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Edmunds, Marilyn W., author Introduction to clinical pharmacology / Marilyn Winterton Edmunds.—8 edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-18765-7 (pbk.) I. Title. [DNLM: 1. Pharmacology, Clinical—Nurses’ Instruction. 2. Drug Therapy—Nurses’ Instruction. QV 38] RM300 615.5’8—dc23 2014031230 Executive Content Strategist: Teri Hines Burnham Associate Content Development Specialist: Jacqueline Kiley Publishing Services Manager: Jeff Patterson Project Manager: Jeanne Genz Designer: Karen Pauls Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Reviewers Elizabeth J. McGinnis, RN, BSN Terry Bichsel, RN, BSN Program Coordinator, Assistant Professor of Nursing Practical Nursing Coordinator Ashland Community and Technical College Moberly Area Community College Ashland, Kentucky Moberly, Missouri Drew Case, MSN Tiffany Jakubowski, RN Instructor Gastroenterology Nurse Doane College—School of Graduate and Professional Longmont Clinic, PC Studies Longmont, Colorado Lincoln, Nebraska Sylvia V. Jupe, LVN Jacqueline Rosenjack Burchum, DNSc, FNP-BC, CNE Vocational Nurse Instructor Associate Professor Coastal Bend College University of Tennessee Health Science Center Pleasanton, Texas Memphis, Tennessee Paula Denise Silver, BS Bio, BS/PharmD Kathy J Dusthimer, RN, MSN, FNP-BC Medical Professor, Medical Assisting Associate Professor, LPN Program Coordinator ECPI University Black Hawk College Newport News, Virginia Moline, Illinois T. Camille Lindsey Killough, RN, MSN Kimberly Hurley, RN, MSN Instructor Instructor, Nursing Pearl River Community College Black Hawk College Hattiesburg, Mississippi Moline, Illinois Courtney Moore, MSN, RN Laura Higgs, RN-BC, MSN, Med Assistant Professor of Nursing Associate Professor of Nursing Jackson State Community College Chesapeake College Jackson, Tennessee Wye Mills, Maryland Holly B. Hayman, MS, RN, CHPN Laura Bevlock Kanavy, RN, MSN Nursing Instructor Director of Practical Nursing Chesapeake College Career Technology Center of Lackawanna County Wye Mills, Maryland Scranton, Pennsylvania Sallie Noto, RN, MS, MSN Laura Travis, RN, BSN, MSN Retired Director Health Careers Coordinator Careeer Technology Center Tennessee Technology Center at Dickson School of Practical Nursing Dickson, Tennessee Scranton, Pennsylvania Mary Ann Williams Cosgarea, RN, BSN, BA Sally Flesch, RN, BSN, MA, EdS, PhD Practical Nursing/Health Coordinator Professor Emerita Portage Lakes Career Center—W. Howard Nicol School Practical Nursing Program of Practical Nursing Black Hawk College Uniontown, Ohio Moline, Illinois v LPN Advisory Board Nancy Bohnarczyk, MA Hana Malik, RN, MSN, FNP-BC Adjunct Instructor Academic Director College of Mount St. Vincent Illinois College of Nursing New York, New York Lombard, Illinois Sharyn Boyle, MSN, RN-BC Toni L.E. Pritchard, RN, BSN, MSN, EdD LPN Instructor Department Head and Professor, Nursing and Passaic County Technical Institute Allied Health Wayne, New Jersey Central Louisiana Technical Community College Leesville, Louisiana Dolores Cotton, RN, MSN Practical Nursing Coordinator Barb Ratliff, RN, MSN Meridian Technology Center Associate Director of Health Programs Stillwater, Oklahoma Butler Technology and Career Development Schools Hamilton, Ohio Shelly R. Hovis, RN, MS Director, Practical Nursing Faye Silverman, RN, MSN/Ed, PHN, WOCN Kiamichi Technology Centers Director of Nursing Antlers, Oklahoma Kaplan College North Hollywood, California Dawn Johnson, RN, MSN, Ed Practical Nurse Administrator and Nurse Educator Russlyn A. St. John, RN, MSN Erie Business Center PN Program Professor and Coordinator, Practical Nursing Erie, Pennsylvania Practical Nursing Department St. Charles Community College Patty Knecht, PhD, RN, ANEF Cottleville, Missouri Director of Practical Nursing Practical Nursing Program and West Grove Fleur de Liza S. Tobias-Cuyco, BSc, CPhT Satellite Dean, Director of Student Affairs, and Instructor Chester County Intermediate Unit Preferred College of Nursing Downingtown, Pennsylvania Los Angeles, California Nancy Maebius, PhD, RN Community Relations Liaison & Education Consultant Galen College of Nursing San Antonio, Texas vi Preface Introduction to Clinical Pharmacology, 8th edition, is have used and evaluated the text. The last edition was designed specifically to provide the right level and modified based on faculty suggestions to remove depth of pharmacology content for LPN/LVN stu- dosing information for medications. This edition dents. Several continuing trends have dictated the faculty has suggested that we might reduce much of focus of this new edition. First, clinicians continue to the information on drug calculations. Because some see the removal of many of the drugs that have been programs require students to have additional drug cal- on the market for three to four decades as they are culation workbooks, drug calculation content has been gradually being retired from the market. Trade names abbreviated in the text and some of it moved to the known for many years have disappeared and even the Study Guide and Evolve Websites for students who variety of generic products has been reduced. Some- find they need additional information and more prac- times newer products take their places, but often times, tice with drug calculation problems. Several chapters older products are just no longer available in the United have been revised, refocused, and updated to keep States. In some cases this may lead to drug shortages them current with latest developments and guidelines. of some products. Second, many more drugs have Some additional content only taught in a few LPN/ become available over the counter. This means that LVN programs, such as dimensional analysis, are now patients may self-diagnose and treat and never have a only on the Evolve website. chance to benefit from nurse-directed patient educa- The broader use of the Internet has meant that tion. The move to OTC does not always mean that the teaching complex content including pharmacology medication is safer so patients may be at greater risk has changed forever. While students must continue to for medication errors, particularly in dosages, reactions pass NCLEX examinations, new research about how to some unsuspected ingredients, and lack of recog- students learn and retain information confirms that nition of adverse effects. Third, direct-to-consumer reading texts and listening to lectures does not always advertising has contributed to some patients demand- result in retained information. (See information about ing specific medications they believe they need. Finally, Eric Mazur, Twilight of the Lecture at http://harvard the Affordable Care Act is enrolling millions of more magazine.com/2012/03/twilight-of-the-lecture.) patients in the system just at a time when many nurses Active learning activities in which students must work and physicians are retiring or leaving the health care together to find answers to questions, participate in delivery system. This places great stress upon a system creative demonstrations, debate and defend their to care for patients but may leave less time in which to understanding of information, all lead to higher levels do so. Patient education about their medications may of “real learning.” Many universities are changing be a consequence of these factors unless nurses are their classroom format to incorporate active learning committed to doing this teaching. All of these factors activities. Thus, you will find some questions confirm that there has never been a time when nursing throughout the text, and more in the Study Guide knowledge about drugs and nurses concern for patients which accompanies this text, designed to begin the has been more important. transition to more of these innovative teaching meth- This new edition of Introduction to Clinical Pharma- odologies. We hope faculty will utilize these ques- cology reflects these changes in ways that will assist tions, develop other creative learning activities, and students in learning what they need to know. Up-to- students will embrace and learn from them. date information on many new drugs, procedures, We welcome your comments and feedback about regulations, and issues provides a strong foundation these and other changes. Feel free to contact the author of essential knowledge for the safe, effective adminis- with content you wish to see included. tration of drugs. To help in the transition to use of just generic names, in the chapters discussing medication ORGANIZATION AND FEATURES classes both older trade names and generic names are often included, except in the tables, where the empha- Pharmacology is a science; in it there are both right sis is on the generic names. Every effort has been made answers and wrong answers. Accuracy, safety, and pre- in this edition to incorporate the excellent suggestions cision are therefore extremely important, and nurses of instructors, students, and practicing nurses who are legally responsible and accountable for how they vii viii PREFACE administer drugs. The science of medication adminis- Drugs are then grouped by their therapeutic class tration for nurses is outlined in Unit One: General within body system chapters, allowing students to Principles of Pharmacology. This unit stresses the learn quickly about individual drugs by understand- nursing process, the importance of working with ing their drug class. The narrative content in the text patients to assess medication needs and actions, and the focuses on major drug groups, and coverage of specific differences among many types of medications. It also drugs appears in reference tables. All chapters have discusses establishing patient trust, teaching the patient been updated in this edition to represent the latest or family about drugs and how to take them appropri- clinical drug treatment information. Each drug class is ately, and evaluating patient responses to drugs. presented in a consistent format with a separate Nursing Implications and Patient Teaching section. As Chapter 1: Pharmacology and the Nursing Process in faculty have indicated that LPNs/LVNs who are using LPN Practice includes information on unique aspects the book also refer to drug formularies for specific of the contemporary LPN/LVN practice environment, information about each drug when administering it, including increased levels of responsibility, increased this edition has omitted specific drug dosages. resource constraints, safety, and common cultural mis- understandings. The United States has had a huge Many students feel overwhelmed when they realize effect on the world through education, research, and how much they need to know about the many drugs drug development. This book itself has been translated available for current therapy. It is often helpful for into several different languages and has been used nurses to learn one or two drugs in each drug class in many different countries. As I have traveled well, and then to be able to compare other drugs in the throughout the world, I have found both local nurses list to those drugs. and RNs and LPNs/LVNs from the United States To help students identify the drugs they should practicing, many in less than modern conditions. The master first, this text identifies a list of 35 “must know” foundational knowledge about drugs, how to calculate drugs now listed on the back inside cover. These drugs dosages, and how to correctly administer drugs has are also identified in the drug chapter tables with a been essential to the types of nursing care they were special icon. asked to deliver. Those nurses who expect and are A chapter-ending Case Study requires the student familiar only with high-tech environments will face to use information not only from the present chapter stiff challenges in such settings. but also from previous chapters. Suggested answers to the Case Studies are provided online in the TEACH Chapter 3: Legal Aspects Affecting the Administra- Instructor Resources on Evolve at http://evolve. tion of Medications and Chapter 7: Preparing and elsevier.com/Edmunds/LPN/. Administering Medications have been modified to address the growing impact of technology that influ- TEACHING AND LEARNING PACKAGE FOR ences how medications are ordered, administered, and THE INSTRUCTOR recorded in the electronic health record. LPN/LVNs often practice in assisted nursing centers, nursing TEACH INSTRUCTOR RESOURCES homes, and care centers where advanced drug administration systems may not be used. Thus, they need to TEACH Instructor Resources on Evolve, available at be able to give medications safely and accurately http://evolve.elsevier.com/Edmunds/LPN/, provide relying on their own ability to calculate the drug a wealth of material to help you make your pharmacol- dosages and connect the right medication and the right ogy instruction a success. In addition to all of the dose with the right patients. They also need to be able Student Resources, the following are provided for to use the newer computerized health records and faculty: bar-coded medication administration systems when • ExamView Test Bank contains approximately 450 they work in very sophisticated hospital centers and multiple-choice and alternate-format questions for clinics. These chapters have been updated to describe the NCLEX-PN® Examination. Each question is these systems, as well as other technology involving coded for correct answer, rationale, page reference, patient blood glucose testing equipment and insulin Nursing Process Step, NCLEX Client Needs Cate- pumps. gory, and Cognitive Level. • TEACH Lesson Plans, based on textbook chapter Unit Three: Drug Groups provides essential informa- Learning Objectives, serve as ready-made, modifi- tion on 14 specific groups of medications. Its consis- able lesson plans and a complete roadmap to link tent, practical format helps the student to develop all parts of the educational package. These concise critical thinking skills in preparing and administering and straightforward lesson plans can be modified medications. A brief review of anatomy and physiol- or combined to meet your particular scheduling and ogy is provided at the beginning of each drug chapter. teaching needs.