Table Of Content

http://evolve.elsevier.com/Lilley Evolve Student Resources for Pharmacology and the Nursing Process, 7th edition, include the following features: • Interactive Review Questions for the NCLEX® Examination Interactive NCLEX® Examination−style review questions are divided by chapter to help you review and apply important content and to help you study for the NCLEX® Examination. • Expanded Key Points Downloadable, printable files for each chapter provide a convenient way to review essential chapter content and study for exams. • Interactive Unfolding Case Studies Interactive Unfolding Case Studies offer an engaging way to apply important pharmacology concepts to true-to-life patient scenarios to develop your clinical reasoning skills. • Critical Thinking and Prioritization Questions Critical Thinking and Prioritization Questions (with answer guidelines) help you focus on the most important actions and considerations necessary for safe and effective drug administration. • Answer Keys for Textbook Case Studies Answer Keys for Textbook Case Studies allow you to gauge your mastery of textbook content and readiness for exams and clinical practice. • Additional Resources Additional resources include Animations, IV Therapy Safety Checklists, Medication Safety Checklists, and periodic Content Updates! 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BRIEF CONTENTS PART 1: PHARMACOLOGY BASICS, 1 PART 6: DRUGS AFFECTING THE RESPIRATORY SYSTEM, 573 Study Skills Tips: Introduction to Study Skills Concepts, PURR, and Pharmacology Basics Study Skills Tips: Study on the Run and PURR 1 The Nursing Process and Drug Therapy, 6 36 Antihistamines, Decongestants, Antitussives, 2 Pharmacologic Principles, 17 and Expectorants, 575 3 Lifespan Considerations, 37 37 Respiratory Drugs, 588 4 Cultural, Legal, and Ethical Considerations, 50 5 Medication Errors: Preventing and Responding, 64 PART 7: ANTIINFECTIVE AND ANTIINFLAMMATORY 6 Patient Education and Drug Therapy, 74 DRUGS, 607 7 Over-the-Counter Drugs and Herbal and Dietary Supplements, 84 8 Gene Therapy and Pharmacogenomics, 94 Study Skills Tips: Nursing Process, Assessment, Nursing Diagno- 9 Photo Atlas of Drug Administration, 102 ses, and Evaluation 38 Antibiotics Part 1, 609 PART 2: DRUGS AFFECTING THE CENTRAL NERVOUS 39 Antibiotics Part 2, 633 SYSTEM, 137 40 Antiviral Drugs, 650 41 Antitubercular Drugs, 672 Study Skills Tips: Vocabulary, Text Notation, and Language Con- 42 Antifungal Drugs, 682 ventions 43 Antimalarial, Antiprotozoal, and Anthelmintic 10 Analgesic Drugs, 139 Drugs, 692 11 General and Local Anesthetics, 169 44 Antiinflammatory and Antigout Drugs, 706 12 Central Nervous System Depressants and Muscle Relaxants, 188 13 Central Nervous System Stimulants and Related Drugs, 203 PART 8: IMMUNE AND BIOLOGIC MODIFIERS 14 Antiepileptic Drugs, 219 AND CHEMOTHERAPEUTIC DRUGS, 720 15 Antiparkinson Drugs, 237 16 Psychotherapeutic Drugs, 253 Study Skills Tips: Manage Time, Evaluate Prior Performance, 17 Substance Abuse, 281 Anticipate the Test, and Plan for Distributed Study 45 Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle– PART 3: DRUGS AFFECTING THE AUTONOMIC Specific Drugs, 722 NERVOUS SYSTEM, 296 46 Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and Miscellaneous Drugs, 748 Study Skills Tips: PURR Application and Study Groups 47 Biologic Response–Modifying and Antirheumatic Drugs, 762 18 Adrenergic Drugs, 298 48 Immunosuppressant Drugs, 784 19 Adrenergic-Blocking Drugs, 312 49 Immunizing Drugs and Biochemical Terrorism, 795 20 Cholinergic Drugs, 324 21 Cholinergic-Blocking Drugs, 334 PART 9: DRUGS AFFECTING THE GASTROINTESTINAL SYSTEM AND NUTRITION, 813 PART 4: DRUGS AFFECTING THE CARDIOVASCULAR AND RENAL SYSTEMS, 343 Study Skills Tips: Active Questioning, What Are the Right Questions, Kinds of Questions, and Questioning Application Study Skills Tips: Linking Learning and Text Notation 50 Acid-Controlling Drugs, 815 22 Antihypertensive Drugs, 347 51 Bowel Disorder Drugs, 829 23 Antianginal Drugs, 368 52 Antiemetic and Antinausea Drugs, 844 24 Heart Failure Drugs, 382 53 Vitamins and Minerals, 856 25 Antidysrhythmic Drugs, 396 54 Anemia Drugs, 877 26 Coagulation Modifier Drugs, 418 55 Nutritional Supplements, 888 27 Antilipemic Drugs, 443 28 Diuretic Drugs, 459 PART 10: DERMATOLOGIC, OPHTHALMIC, AND OTIC 29 Fluids and Electrolytes, 473 DRUGS, 899 PART 5: DRUGS AFFECTING THE ENDOCRINE SYSTEM, 491 Study Skills Tips: Time Management, PURR, and Repeat the Steps 56 Dermatologic Drugs, 901 Study Skills Tips: Questioning Strategy 57 Ophthalmic Drugs, 916 30 Pituitary Drugs, 493 58 Otic Drugs, 937 31 Thyroid and Antithyroid Drugs, 501 32 Antidiabetic Drugs, 510 Appendix: Pharmaceutical Abbreviations, 943 33 Adrenal Drugs, 533 34 Women’s Health Drugs, 543 Case Study Photo Credits, 944 35 Men’s Health Drugs, 564 Index, 945 ABOUT THE AUTHORS Linda Lane Lilley, RN, PhD pediatric clinical pharmacist (neonatal specialist) at Memorial Linda Lilley received her diploma from Medical Center before moving to Mobile, Alabama. She was Norfolk General School of Nursing, the Assistant Director of Clinical Pharmacy Services at Mobile BSN from the University of Virginia, Infirmary Medical Center. She currently serves as the Clinical Master of Science (Nursing) from Old Pharmacy Specialist/Coordinator of Clinical Pharmacy Ser- Dominion University, and PhD in Nurs- vices at Chesapeake Regional Medical Center in Chesapeake, ing from George Mason University. As Virginia. Her practice focuses on developing and implement- an Associate Professor Emeritus and ing clinical pharmacy services as well as medication safety and University Professor at Old Dominion Joint Commission medication management standards and University, her teaching experience in national patient safety goals. She also works as staff pharma- nursing education spans over 25 years, cist at Chesapeake Regional Medical Center. She is president including almost 20 years at Old Dominion. Linda’s teaching of Drug Information Consultants, a business offering consulta- expertise includes drug therapy and the nursing process, adult tion and expert witness review for attorneys on medical mal- nursing, physical assessment, fundamentals in nursing, oncology practice cases. Shelly was awarded the Clinical Pharmacist of nursing, nursing theory, and trends in health care. The awarding the Year Award in 2007 from the Virginia Society of Healthsys- of the University’s most prestigious title of University Professor tem Pharmacists. She led a multidisciplinary team that won the reflects her teaching excellence as a tenured faculty member. She Clinical Achievement of the Year Award from George Mason has also been a two-time university nominee for the State Council University School of Public Health in 2007 for promoting safety of Higher Education in Virginia award for excellence in teaching, with narcotics in patients with sleep apnea; this program has service, and scholarship. Linda received the 2012 Distinguished also received national recognition. She was awarded the Service Nursing Alumni Award from Old Dominion University School of Excellence Award from Chesapeake Regional Medical Center. Nursing for her “continued work on the successful pharmacology Shelly’s professional affiliations include the American Society of textbook published by Elsevier” and to recognize her “extraordi- Healthsystem Pharmacists and the Virginia Society of Health- nary work and the impact [the book] has had on baccalaureate system Pharmacists. education.” While at Old Dominion University, Linda mentored and taught undergraduate and graduate students as well as regis- tereded nurses returning for their BSN. Linda authored the MED Julie S. Snyder, MSN, RN-BC ERRORS column for the American Journal of Nursing between Julie Snyder received her diploma 1994 and 1999 as well as numerous other peer-reviewed, published from Norfolk General Hospital School articles in professional nursing journals. Since retirement in 2005, of Nursing and her BSN and MSN Linda has continued to be active in nursing, serving as a member from Old Dominion University. After on dissertation committees with the College of Health Sciences working in medical-surgical nursing, and maintaining membership and involvement in numerous she worked in nursing staff develop- professional and academic organizations. Dr. Lilley has served as ment and community education. After a consultant with school nurses in the city of Virginia Beach, a 8 years, she transferred to the aca- member on the City of Virginia Beach’s Health Advisory Board, demic setting and has since taught and currently a member of the City of Virginia Beach’s Commu- fundamentals of nursing, pharmacology, physical assessment, nity Health Advisory Board and the Youth Community Action gerontologic nursing, and adult medical-surgical nursing. She Team (YCAT). Linda also served as an appointed member on the has been certified by the ANCC in Nursing Continuing Educa- national advisory panel on medication errors prevention with the tion and Staff Development and currently holds ANCC certifi- U.S. Pharmacopeia in Rockville, Maryland. She continues to education in Medical-Surgical Nursing. She is a member of Sigma cate nursing students and professional nurses about drug therapy Theta Tau International and was inducted into Phi Kappi Phi and the nursing process and speaks on the topics of drug therapy, as Outstanding Alumni for Old Dominion University. She has safe medication use, humor and healing, and grief and loss. worked for Elsevier as a reviewer and ancillary writer since 1997. Julie’s professional service has included serving on the Virginia Shelly Rainforth Collins, PharmD Nurses’ Association Continuing Education Committee, serving Shelly Rainforth Collins received her as Educational Development Committee chair for the Epsilon Doctor of Pharmacy degree from the Chi chapter of Sigma Theta Tau, serving as an item writer for University of Nebraska, College of the ANCC, working with a regional hospital educators’ group, Pharmacy in 1985, with High Dis- and serving as a consultant on various projects for local hospital tinction. She then completed a clini- education departments. cal pharmacy residency at Memorial Medical Center of Long Beach in Long Beach California. She worked as a Pharmacology and the Nursing Process th 7 Linda Lane Lilley, RN, PhD Associate Professor Emeritus School of Nursing EDITION Old Dominion University Norfolk, Virginia Shelly Rainforth Collins, PharmD Clinical Pharmacy Specialist Coordinator of Clinical Pharmacy Services Chesapeake Regional Medical Center Chesapeake, Virginia President Drug Information Consultants Chesapeake, Virginia Julie S. Snyder, MSN, RN-BC Adjunct Faculty School of Nursing Old Dominion University Norfolk, Virginia With Study Skills Tips by Diane Savoca Coordinator of Student Transition St. Louis Community College at Florissant Valley St. Louis, Missouri 3251 Riverport Lane St. Louis, Missouri 63043 PHAMACOLOGY AND THE NURSING PROCESS ISBN: 978-0-323-08789-6 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2005, 2001, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, elec- tronic 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 Pub- lisher’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). Nursing Diagnoses—Definitions and Classifications 2012-2014. Copyright © 2012, 1994-2012 by NANDA International. Used by arrangement with Blackwell Publishing Limited, a company of John Wiley & Sons, Inc. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, 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 Lilley, Linda Lane. Pharmacology and the nursing process/Linda Lane Lilley, Shelly Rainforth Collins, Julie S. Snyder; with study skills tips by Diane Savoca. -- 7th ed. p. ; cm. Rev. ed. of: Pharmacology and the nursing process/Linda Lane Lilley ... [et al.]. 6th ed. c2011. Includes bibliographical references and index. ISBN 978-0-323-08789-6 (pbk. : alk. paper) I. Collins, Shelly Rainforth. II. Snyder, Julie S. III. Savoca, Diane. IV. Pharmacology and the nursing process. V. Title. [DNLM: 1. Pharmacology--Nurses’ Instruction. 2. Drug Therapy--Nurses’ Instruction. 3. Pharmaceutical Preparations--administration & dosage--Nurses’ Instruction. QV 4] LC classification not assigned 615’.1--dc23 2012036416 Executive Content Strategist: Lee Henderson Content Development Specialist: Jacqueline Twomey Publishing Services Manager: Jeff Patterson Senior Project Manager: Clay S. Broeker Designer: Amy Buxton Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 CONTRIBUTORS TO TEACHING/LEARNING RESOURCES Critical Thinking and Prioritization Questions TEACH® for Nurses Lesson Plans Julie S. Snyder, MSN, RN-BC Sharon Souter, RN, PhD, CNE Adjunct Faculty Dean and Professor School of Nursing College of Nursing Old Dominion University University of Mary Hardin-Baylor Norfolk, Virginia Belton, Texas Key Points—Downloadable Test Bank Peggy Slota, DNP, RN, FAAN Julie S. Snyder, MSN, RN-BC Associate Professor Adjunct Faculty Director, DNP and Graduate Nursing Leadership Programs School of Nursing Carlow University School of Nursing Old Dominion University Pittsburgh, Pennsylvania Norfolk, Virginia PowerPoint® Slides Unfolding Case Studies Valerie Baker, ACNS, BC Donna D. Ignatavicius, MS, RN, ANEF Assistant Professor Speaker and Curriculum Consultant for Academic Nursing Programs Villa Maria School of Nursing Founder, Boot Camp for Nurse Educators® Morosky College of Health Professions and Sciences President, DI Associates, Inc. Gannon University Placitas, New Mexico Erie, Pennsylvania Jennifer D. Powers, MSN, FNP-BC, RN Review Questions for the NCLEX® Examination Assistant Professor Stephanie C. Butkus, MS, RN National University Nevada Associate Professor Henderson, Nevada Division of Nursing Kettering College Kettering, Ohio v REVIEWERS Linda K. Bennington, RN, MS, MSN, PhD Paula Hopper, MSN, RN Senior Lecturer Professor of Nursing Old Dominion University Jackson Community College School of Nursing Jackson, Mississippi Norfolk, Virginia Donna Walker Hubbard, MSN, RN, CNN Sophia Beydoun, RN, MSN Assistant Professor Instructor, Nursing University of Mary Hardin-Baylor Henry Ford Community College Belton, Texas Dearborn, Michigan Susie McGregor-Huyer, RN, MSN Billie E. Blake, EdD, MSN, RN CEO/CLNC Associate Dean of Nursing MH Consultants St. Johns River State College Mahtomedi, Minnesota Orange Park, Florida Tara McMillan-Queen, RN, MSN, ANP, GNP Teresa S. Burckhalter, MSN, RN, BC Faculty II Nursing Instructor Mercy School of Nursing Technical College of the Lowcountry Charlotte, North Carolina Beaufort, South Carolina Kristin Oneail, MSN, RN Nancy W. Ebersole, RN, PhD Assistant Professor Associate Professor Lourdes University School of Nursing Sylvania, Ohio Salem State University Salem, Massachusetts Denise A. Sevigny, MSN, RN Associate Professor Margie L. Francisco, EdD(c), RN, MSN Sentara College of Health Sciences Nursing Professor Chesapeake, Virginia Illinois Valley Community College Oglesby, Illinois Virginia (Jennie) Shaw, MSN, RN Clinical Associate Professor Cindy Gilbert, MS, RN, CNE School of Nursing Associate Professor University of Texas Health Science Center at San Antonio Department of Nursing San Antonio, Texas University of Arkansas at Little Rock Little Rock, Arkansas Courtney Chad Alan Singrey, MSN, RN Faculty, Nursing Mariann M. Harding, RN, MSN, CNE Saint Louis University Assistant Professor of Nursing Saint Louis, Missouri Kent State University at Tuscarawas New Philadelphia, Ohio Marcia Welsh, CNM, MSN, DL Assistant Professor LaWanda Herron, PhD, MSA, MSN, FNP-BC West Chester University Instructor West Chester, Pennsylvania Associate Degree Nursing Program Holmes Community College Grenada, Mississippi vi PREFACE Now in its seventh edition, Pharmacology and the Nursing Pro- ORGANIZATION cess provides the most current and clinically relevant nursing This book includes 58 chapters presented in 10 parts, organized pharmacology content in a visually appealing, understandable, by body system. The 9 “concepts” chapters in Part 1 lay a solid and practical format. The accessible size, clear writing style, foundation for the subsequent drug units and address the fol- and full-color design of Pharmacology and the Nursing Process lowing topics: are ideal for today’s busy nursing student. The book not only • The nursing process and drug therapy presents drug information that the nursing student needs to • Pharmacologic principles know but also provides information on what the professional • Lifespan considerations related to pharmacology nurse may encounter during drug administration in a variety of • Cultural, legal, and ethical considerations health care settings, including accounts of real-life medication • Preventing and responding to medication errors errors and tips for avoiding those errors. Edition after edition, • Patient education and drug therapy the book has become increasingly inviting and engaging for the • Over-the-counter drugs and herbal and dietary supplements adult learner to read and study. Features that help set the book • Gene therapy and pharmacogenomics apart include: • Drug administration techniques, including more than 100 • A focus on the role of prioritization in nursing care drawings and photographs • A strong focus on drug classes to help students acquire a bet- Parts 2 through 10 present pharmacology and nursing man- ter knowledge of how various drug classes work in the body, agement in a time-tested body systems/drug function frame- allowing them to apply this knowledge to individual drugs work. This approach facilitates learning by grouping functionally • Ease of readability to make this difficult content more related drugs and drug groups. It provides an effective means of understandable integrating the content into medical-surgical/adult health nurs- • Integrated study skills content that helps students under- ing courses or for teaching pharmacology in a separate course. stand and learn the particularly demanding subject of phar- The 49 drug chapters in these 9 Parts constitute the main macology while also equipping them with tools that they can portion of the book. Drugs are presented in a consistent format use in other courses and as lifelong learners who are building with an emphasis on drug classes and key similarities and dif- an evidence-based practice. ferences among the drugs in each class. Each chapter is subdi- The use of color has continued to complement the text by vided into two discussions, beginning with (1) a brief overview making the book more engaging for nursing students. Color is of anatomy, physiology, and pathophysiology and a complete used throughout to: discussion of pharmacology, followed by (2) a comprehensive • Highlight important content yet succinct application of the nursing process. • Illustrate how drugs work in the body in numerous anatomic Pharmacology is presented for each drug group in a consis- and drug process color illustrations tent format: • Improve the visual appearance of the content to make • Mechanism of Action and Drug Effects it more engaging and appealing to today’s more visually • Indications sophisticated reader • Contraindications We believe that the use of color and other visual engagement • Adverse Effects (often including Toxicity and Management devices in these ways significantly improves students’ involve- of Overdose) ment and understanding of pharmacology. • Interactions For this edition, the author team has focused even more • Dosages closely on providing the most “need-to-know” information, Drug class discussions conclude with specially highlighted enhancing readability, and emphasizing the nursing process Drug Profiles—brief narrative “capsules” of individual drugs in and prioritization throughout. Many of the updates for this the class or group, including Pharmacokinetics tables for each edition are in response to actual questions posed by students. drug. Key drugs (prototypical drugs within a class) are identi- Sharing the goal of creating a nursing pharmacology textbook that is not only academically rigorous but also practical fied throughout with a ♦ symbol for easy identification. The pharmacology section is followed by a Nursing Process and easy to use, the authors bring together a unique combina- discussion that relates to the entire drug group. This nursing con- tion of experience. The author team is comprised of an Associ- tent is covered in the following, familiar nursing process format: ate Professor Emeritus with a PhD in nursing and more than • Assessment 25 years of teaching experience, a clinical pharmacist with a • Nursing Diagnoses PharmD and 28 years of experience in hospital pharmacy • Planning (including Goals and Outcome Criteria) practice, and a nursing clinical instructor who holds a Mas- • Implementation ter of Science in Nursing degree and has 25 years of teaching • Evaluation experience. vii viii PREFACE At the end of each Nursing Process section is a Patient Teach- cognitive connections among nursing diagnoses, goals, and ing Tips box that summarizes key points for nursing students outcome criteria. and/or practicing nurses to include in the education of patients This edition also integrates the six Quality and Safety Educa- about their medications. These boxes focus on teaching how tion for Nurses (QSEN) competencies. Funded by the Robert the drugs work, possible interactions, adverse effects, and other Wood Johnson Foundation, the QSEN project has the overall information related to the safe and effective use of the drug(s). goal of addressing the challenge of preparing future nurses with The role of the nurse as patient educator and advocate contin- knowledge, skills, and attitudes needed to continually improve ues to grow in importance in professional practice, so there is the quality and safety of healthcare systems. The QSEN com- emphasis on this key content in each chapter in this edition. petencies are together aimed at reducing the 1.9 million drug- Additionally, each Part begins with a Study Skills Tips sec- related hospitalizations seen in the United States at the outset tion that presents a study skills topic and relates it to the unit of the initiative. Leading the integration of QSEN competencies being discussed. Topics include time management, note tak- into prelicensure nursing pharmacology textbooks, Pharma- ing, studying, test taking, and others. This unique feature is cology and the Nursing Process addresses the safety and quality intended to aid students who find pharmacology difficult and competencies through the following special boxes: to provide a tool that may prove beneficial throughout their • Evidence-Based Practice nursing school careers. This arrangement of content can be • Patient-Centered Care: Cultural Implications especially helpful to faculty who teach pharmacology through • Patient-Centered Care: Lifespan Considerations for the an integrated approach because it helps the student identify key Elderly Patient content and concepts. • Patient-Centered Care: Lifespan Considerations for the Pediatric Patient • Safety: Herbal Therapies and Dietary Supplements NEW TO THIS EDITION • Safety: Laboratory Values Related to Drug Therapy To further improve the hallmark readability and user- • Safety and Quality Improvement: Preventing Medication friendliness of Pharmacology and the Nursing Process, each Errors line of the text has been edited for this edition with a special • Teamwork and Collaboration: Legal and Ethical Principles focus on an active, direct-address writing style. This refreshing • Teamwork and Collaboration: Pharmacokinetic Bridge to and engaging writing style helps students navigate more easily Nursing Practice through the textbook and thus the difficult subject of pharma- The QSEN initiative is also highlighted in the new TEACH cology and the nursing process. for Nurses Lesson Plans provided for this edition (see Supple- The seventh edition of Pharmacology and the Nursing Process mental Resources). also features an enhanced focus on “need-to-know” content. The pharmacology and nursing content in each of the 58 The information on drug adverse effects has been streamlined chapters has been thoroughly revised and critically reviewed by to reflect only the most common and most serious adverse nursing instructors, practicing nurses, and a PharmD to reflect the effects rather than listing all reported adverse effects. These latest drug information and nursing content. Key updates include: adverse effects are also now listed in order of those most com- • A more effectively organized classification of psychotherapeu- monly seen. Another area that has been reduced for an opti- tic drugs in Chapter 16 into 3 subcategories: (1) anxiolytics, mized focus is that of drug dosages; only those dosages that are (2) mood stabilizers and antidepressants, and (3) antipsy- seen in most common indications are included in the text and chotic drugs tables. (For other dosages, the student should refer to an up- • The most recent evidence-based guidelines on management to-date drug handbook or drug reference.) This need-to-know of diabetes mellitus in Chapter 32, with an emphasis on new approach to drug indications and adverse effects is crucial in diabetes drugs helping the adult learner focus on the most essential content • The most recent evidence-based guidelines on the treatment needed for safe drug administration. of rheumatoid arthritis in Chapter 47 It is important to remember that although this textbook • Revision of Chapter 48 on immunosuppressant drugs to provides all of the need-to-know pharmacology content that provide an emphasis on transplant therapy students will need for an entry level of practice, it is first and • Revised NCLEX® Examination Review Questions at the end foremost a nursing textbook rather than a pharmacology text- of each chapter, including alternate-item format and new book, with a strong emphasis on the nursing process and pro- dosage calculation questions fessional nursing practice. Nursing care related to the specifics of drug therapy has been further prioritized in this edition by ADDITIONAL TEACHING/LEARNING FEATURES numbering the nursing diagnoses and corresponding goals and outcome criteria in the coverage of the planning phase of the The book also includes a variety of innovative teaching/learn- nursing process. The section on implementation also offers all ing features that prepare the student for important content to be of the most essential information, followed by a section on the covered in each chapter and encourage review and reinforcement evaluation of therapeutic and adverse effects. These changes of that content. Chapter-opener features include the following: highlight the significance of the nursing process as a founda- • Learning Objectives tion in drug therapy while helping the student to make strong • List of Evolve Resources available to students