Table Of Content

Brief Contents Unit 1 Fundamental Principles of Pharmacology 42 Immunostimulants and Immunosuppressants 741 43 Immunizing Agents 762 1 Introduction to Pharmacology: Concepts and Connections 2 2 Drug Regulations 13 Unit 7 Pharmacology of the Respiratory System and Allergy 3 Pharmacokinetics 26 4 Pharmacodynamics 45 44 Pharmacotherapy of Asthma and Other Pulmonary 5 Adverse Drug Effects and Drug Interactions 55 Disorders 786 6 Medication Errors and Risk Reduction 70 45 Pharmacotherapy of Allergic Rhinitis and 7 The Role of Complementary and Alternative Therapies in the Common Cold 810 Pharmacotherapy 84 Unit 8 Pharmacology of Infectious and Neoplastic Diseases Unit 2 Pharmacology and the Nurse–Patient Relationship 46 Basic Principles of Anti-Infective Pharmacotherapy 834 8 Pharmacotherapy During Pregnancy and Lactation 98 47 Antibiotics Affecting the Bacterial Cell Wall 848 9 Pharmacotherapy of the Pediatric Patient 110 48 Antibiotics Affecting Bacterial Protein Synthesis 868 10 Pharmacotherapy of the Geriatric Patient 123 49 Fluoroquinolones and Miscellaneous Antibacterials 887 11 Individual Variations in Drug Responses 133 50 Sulfonamides and the Pharmacotherapy of Urinary Tract Infections 900 Unit 3 Pharmacology of the Autonomic Nervous System 51 Pharmacotherapy of Mycobacterial Infections 915 52 Pharmacotherapy of Fungal Infections 934 12 Review of Neurotransmitters and the Autonomic Nervous 53 Pharmacotherapy of Protozoan and Helminthic Infections 952 System 142 54 Pharmacotherapy of Non-HIV Viral Infections 975 13 Cholinergic Agonists 155 55 Pharmacotherapy of HIV Infection and AIDS 996 14 Cholinergic Antagonists 170 56 Basic Principles of Antineoplastic Therapy 1020 15 Adrenergic Agonists 185 57 Pharmacotherapy of Neoplasia 1036 16 Adrenergic Antagonists 201 Unit 9 Pharmacology of the Gastrointestinal System Unit 4 Pharmacology of the Central Nervous System 58 Review of the Gastrointestinal System 1074 17 Review of the Central Nervous System 218 59 Pharmacotherapy of Peptic Ulcer Disease 1082 18 Pharmacotherapy of Anxiety and Sleep Disorders 227 60 Pharmacotherapy of Bowel Disorders and Other 19 Pharmacotherapy of Mood Disorders 253 Gastrointestinal Conditions 1103 20 Pharmacotherapy of Psychoses 281 61 Vitamins and Minerals 1130 21 Pharmacotherapy of Degenerative Diseases of the Central 62 Enteral and Parenteral Nutrition 1147 Nervous System 304 63 Weight Reduction Strategies and the Pharmacotherapy of 22 Pharmacotherapy of Seizures 330 Obesity 1162 23 Pharmacotherapy of Muscle Spasms and Spasticity 358 24 Central Nervous System Stimulants and Drugs for Unit 10 Pharmacology of the Endocrine System Attention-Deficit/Hyperactivity Disorder 375 25 Pharmacotherapy of Severe Pain and Migraines 392 64 Review of the Endocrine System 1176 26 Anesthetics and Anesthesia Adjuncts 422 65 Hypothalamic and Pituitary Drugs 1183 27 Pharmacology of Substance Abuse 447 66 Pharmacotherapy of Diabetes Mellitus 1200 67 Pharmacotherapy of Thyroid Disorders 1229 Unit 5 Pharmacology of the Cardiovascular System 68 Corticosteroids and Drugs Affecting the Adrenal Cortex 1245 69 Estrogens, Progestins, and Drugs Modifying Uterine 28 Review of the Cardiovascular System 474 Function 1262 29 Pharmacotherapy of Hyperlipidemia 488 70 Drugs for Modifying Conception 1287 30 Pharmacotherapy with Calcium Channel Blockers 510 71 Drugs for Disorders and Conditions of the Male 31 Drugs Affecting the Renin-Angiotensin-Aldosterone Reproductive System 1307 System 523 32 Diuretic Therapy and the Pharmacotherapy of Chronic Unit 11 Additional Drug Classes Kidney Disease 539 33 Pharmacotherapy of Fluid Imbalance, Electrolyte, 72 Pharmacotherapy of Bone and Joint Disorders 1328 and Acid–Base Disorders 561 73 Pharmacotherapy of Dermatologic Disorders 1364 34 Pharmacotherapy of Hypertension 582 74 Pharmacotherapy of Eye and Ear Disorders 1389 35 Pharmacotherapy of Angina Pectoris and Myocardial 75 Emergency Preparedness: Bioterrorism and Management of Infarction 602 Poisoning 1409 36 Pharmacotherapy of Heart Failure 622 37 Pharmacotherapy of Dysrhythmias 641 Appendices 38 Pharmacotherapy of Coagulation Disorders 661 A Answers to Chapter Review 1425 39 Pharmacotherapy of Hematopoietic Disorders 691 B ISMP List of High-Alert Medications in Acute Care Settings 1457 Unit 6 Pharmacology of Body Defenses Glossary 1458 40 Review of Body Defenses and the Immune System 714 Credits 1477 41 Pharmacotherapy of Inflammation and Fever 723 Index 1478 This page intentionally left blank Pharmacology Connections to Nursing Practice FOURTH EDITION Michael Patrick Adams Adjunct Professor of Anatomy and Physiology Hillsborough Community College Formerly Dean of Health Professions Pasco-Hernando State College Carol Quam Urban Director, School of Nursing Associate Dean, College of Health and Human Services Associate Professor George Mason University Rebecca E. Sutter Assistant Professor, College of Health and Human Services, School of Nursing George Mason University 330 Hudson Street, NY NY 10013 Publisher: Julie Alexander Full-Service Project Management and Executive Portfolio Manager: Pamela Fuller Composition: iEnergizer Aptara®, Ltd. Editorial Assistant: Erin Sullivan Full-Service Project Management: Sudip Sinha, Managing Content Producer: Melissa Bashe iEnergizer Aptara®, Ltd. Content Producer: Michael Giacobbe Project Monitor: Susan Hannahs, SPi Global Development Editor: Teri Zak Manufacturing Buyer: Maura Zaldivar-Garcia, Design Coordinator: Mary Siener LSC Communications, Inc. Vice President of Sales and Marketing: David Cover Designer: StudioMontage Gesell Cover Art: Shutterstock, © jijomathaidesigners Vice President, Director of Marketing: Text Printer/Bindery: LSC Communications, Inc. Brad Parkins Cover Printer: Lehigh Phoenix Color Director, Digital Studio: Amy Peltier Font: Palatino LT Pro Digital Project Manager: Jeff Henn Copyright © 2019, 2016, 2013 by Pearson. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. For information regarding permissions, request forms and the appropriate contacts within the Pearson Education Global Rights & Permissions Department, please visit www.pearsoned.com/permissions/ Pearson® is a registered trademark of Pearson plc Notice: Care has been taken to confirm the accuracy of information presented in this book. The authors, editors, and the publisher, however, cannot accept any responsibility for errors or omissions or for consequences from application of the information in this book and make no warranty, express or implied, with respect to its contents. The authors and publisher have exerted every effort to ensure that drug selections and dosages set forth in this text are in accord with current recommendations and practice at 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 inserts of all drugs for any change in indications of dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Library of Congress Cataloging-in-Publication Data Names: Adams, Michael, author. | Urban, Carol Q. (Carol Quam), author. Title: Pharmacology: connections to nursing practice / Michael Patrick Adams, Carol Quam Urban. Description: Fourth edition. | Boston : Pearson, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017026174| ISBN 9780134867366 | ISBN 013486736X Subjects: | MESH: Drug Therapy—nursing | Drug Administration Schedule | Medication Errors—prevention & control | Nursing Records | Pharmacology—methods Classification: LCC RM300 | NLM WY 100.1 | DDC 615.1—dc23 LC record available at https://lccn.loc.gov/2017026174 10 9 8 7 6 5 4 3 2 1 ISBN-10: 0-13-486736-X ISBN-13: 978-0-13-486736-6 About the Authors Michael Patrick Adams, PhD, is an accomplished and has worked with Dr. Rebecca Sutter to open three educator, author, and national speaker. The National Insti- nurse-managed health clinics, academic–community part- tute for Staff and Organizational Development in Austin, nerships that care for uninsured patients and provide edu- Texas, named Dr. Adams a Master Teacher. He has pub- cational opportunities for Mason nursing students. She has lished two other textbooks with Pearson Education: Core published the Pearson textbook Pharmacology for Nurses: A Concepts in Pharmacology and Pharmacology for Nurses: A Pathophysiologic Approach with Dr. Adams and Dr. Holland. Pathophysiologic Approach. To my daughter, Joy, an extraordinary and resilient Dr. Adams obtained his master’s degree in pharmacol- woman who continues to change the world for the better, ogy from Michigan State University and his doctorate in and in memory of my son, Keith, and my husband, Mike. education from the University of South Florida. Dr. Adams —CQU was on the faculty of Lansing Community College and St. Rebecca E Sutter, DNP, BC-FNP, is Assistant Profes- Petersburg College, and was Dean of Health Professions at sor in the School of Nursing and one of the directors of an Pasco-Hernando State College for over 19 years. He is cur- academic nurse-managed clinic within the College of rently Adjunct Professor of Anatomy and Physiology at Health and Human Services at George Mason University Hillsborough Community College. in Fairfax, Virginia. She has been on the nursing faculty for I dedicate this book to nursing educators, who contribute over 15 years at community colleges and universities, and every day to making the world a better and more caring has practiced for over 20 years as a pediatric ICU nurse place. and a board-certified family nurse practitioner. —MPA To my husband, Lee, and my parents, Jane and Ellis, who Carol Quam Urban, PhD, RN, Associate Professor, is have given me the foundation to reach for my dreams, and the Director of the School of Nursing and an Associate to my amazing children Andrew, Sarah, and Emily, who Dean in the College of Health and Human Services at have made me stronger, better, and more fulfilled than I George Mason University in Fairfax, Virginia. She has been could have ever imagined. I love you to the moon and back. on the faculty in the School of Nursing for over two decades —RES iii Thank You First Edition Contributors We extend a heartfelt thanks to our contributors, who gave foster our goal of preparing student nurses for evidence- their time, effort, and expertise so tirelessly to the develop- based practice. ment and writing of chapters and resources that helped Diane Benson, RN, EdD Denise Marie McEnroe-Ayers, RN, Janice Lynn Reilley, RN, C, MSN, Humboldt State University, Arcata, MSN EdD California Kent State University at Tuscarawas, Widener University, Chester, Chapter 29 New Philadelphia, Ohio Pennsylvania Rebecca Boehne, RN, PhD Chapters 67, 72, 75, 76, and 77 Chapter 63 Linfield College, Portland, Oregon Mariann Montgomery, RN, MSN Luann G. Richardson, RN, PhD Chapter 74 Kent State University at Tuscarawas, Duquesne University, Pittsburgh, Jacqueline Rosenjack Burchum, New Philadelphia, Ohio Pennsylvania APRN, BC Chapters 66, 67, 68, 75, 76, and 77 Chapter 60 The University of Tennessee Health Kim Alexander Noble, RN, PhD Roberta Shea, RN, CCNS, MSN Science Center, Memphis, Tennessee Temple University, Philadelphia, Indiana University School of Nursing, Chapter 73 Pennsylvania Bloomington, Indiana Pamela Evans-Smith, RN, MSN Chapter 46 Chapters 9, 66, 67, and 68 University of Missouri–Columbia, G. Elaine Patterson, RNC, MA, Pat Teasley, RN, MSN, APRN, BC Columbia, Missouri FNP-C EdD Central Texas College, Killeen, Texas Chapter 57 Ramapo College of New Jersey, Chapters 22, 23, 24, 25, 57, and 58 Geralyn Frandsen, RN, MSN, EdD Mahwah, New Jersey Maryville University, St. Louis, Missouri Chapters 10, 11, 12, 70, and 71 Chapters 26, 27, 28, 30, and 44 Third Edition Reviewers Our heartfelt thanks go out to our colleagues from schools Practice has reaped the benefit of your collective knowl- of nursing across the country who have given their time edge and experience as nurses and teachers, and we have generously to help create this exciting new edition of our improved the materials due to your efforts, suggestions, pharmacology textbook. These individuals helped us plan objections, endorsements, and inspiration. Among those and shape our book and resources by reviewing chapters, who gave their time generously to help us are the art, design, and more. Pharmacology: Connections to Nursing following: Wanda Barlow, MSN, RN, FNP-BC Dearborn, Michigan Trinity Valley Community College Instructor Staci M. Boruff, PhD, RN Kaufman, Texas Winston-Salem State University Professor Katrina Coggins, MSN, RN, CEN Winston-Salem, North Carolina Walters State Community College Assistant Professor Carole Berube, MA, MSN, BSN, RN Morristown, Tennessee Western Carolina University Professor Emerita Sharon Burke, EdD, MSN, RNC Cullowhee, North Carolina Bristol Community College Assistant Professor Tamara Condrey, DNP, RN, Fall River, Massachusetts The Pennsylvania State University ACNS-BC, CCRN, CNE Sophia Beydoun, MSN, RN Abington, Pennsylvania Assistant Professor Instructor Judy Callicoatt, RN, MS, CNS Columbus State University Henry Ford College ADN Instructor Columbus, Georgia iv Thank You v Rebecca A. Crane, MSN, RN, CHPN, Chattanooga State Community Vanderbilt University Medical Center, CLNC College School of Nursing Assistant Professor Chattanooga, Tennessee Nashville, Tennessee Ivy Tech Community College Susan Growe, DNP, RN Elizabeth L. Law, MSN, NP-C, RN Bloomington, Indiana Lecturer Assistant Professor Lynette DeBellis, RN, MA Nevada State College Ivy Tech Community College Assistant Professor Henderson, Nevada Indianapolis, Indiana Westchester Community College Jeanne Hately, PhD, MSN, RN Connie Lawrence, MS, FNP-BC, Valhalla, New York Owner DNP Debra Dickman, MS, RN, CNE Professional Nurse Consultants, LLC Director of RN-BSN Program Assistant Professor Aurora, Colorado The College at Brockport Blessing-Rieman College of Nursing Antonie Hiemer, MS, RN Brockport, New York Quincy, Illinois Assistant Professor Dr. Euphemia Marlene C. Lazarus Teresa Dobrzykowski, PhD, APRN, Morrisville State College Professor BC Morrisville, New York Camden County College Assistant Professor Susan Holland, MSN, APRN, Blackwood, New Jersey Indiana University GNP-BC Carol Isaac MacKusick, PhDc, RN, South Bend, Indiana Clinical Assistant Professor CNN, CNE Deborah Dye, RN, MSN Sam Houston State University Assistant Professor Department Chair and Assistant Huntsville, Texas Western Carolina University Professor Molly Jackson, RN, MSN APRN, NP-C Cullowhee, North Carolina Ivy Tech Community College Instructor Shayne A. Mason, RN, BSN, Lafayette, Indiana Case Western Reserve University PMHNP(BC) Nancy W. Ebersole, PhD, RN Cleveland, Ohio Instructor Direct-Entry MSN Program Sara K. Kaylor, EdD, RN University of San Francisco Coordinator Assistant Professor San Francisco, California Salem State University The University of Alabama Vicki McCalmont RN, MS, ANP-BC, Salem, Massachusetts Tuscaloosa, Alabama CNS, CCTC Anita Fitzgerald, RN, A/GNP Amy Mitchell Kennedy, MSN, RN Professor Lecturer, Director, Learning Center Adjunct Faculty, RN and PN Program San Diego State University California State University ECPI University San Diego, California Long Beach, California Newport News, Virginia Bethany Mello, DNP, MS, NP-C Suzanne Franzoni-Kleeman, MSN, Alice Kindschuh, DNP, RN, Assistant Professor RN, CEN APRN-CNS, CNE University of Jamestown Assistant Professor Adjunct Instructor Jamestown, North Dakota American International College Nebraska Methodist College James Mendez, MSN, CRNP Springfield, Massachusetts Omaha, Nebraska Adjunct Instructor Lola Goodson, RN, MSN, CRNI Vicky J. King, RN, MS, CNE Villanova University Instructor Nursing Faculty Villanova, Pennsylvania Ivy Tech Community College Cochise College Toby Nishikawa, MSN, RN Sellersburg, Indiana Sierra Vista, Arizona Assistant Professor Amy C. Graham, RN, MSN, FNP-BC Julie Ann Koch, DNP, RN, FNP-BC Weber State University Assistant Professor Assistant Professor and DNP Program Ogden, Utah James Madison University Coordinator Nola Ormrod, RN, MSN Harrisonburg, Virginia Valparaiso University Department Chair Crystal Graham, RN, CHSE, MSN-Ed Valparaiso, Indiana Centralia College Simulation Lab Director/Instructor of Angela M. Koller, DNP, MSN, RN Centralia, Washington Nursing Dean Mechelle Perea-Ryan, MS, FNP-BC, Francis Marion University Ivy Tech Community College PHN Florence, South Carolina Indianapolis, Indiana Associate Professor Yolanda J. Green, RN, MSN Stephen D. Krau, PhD, RN, CNE California State University, Stanislaus Associate Professor Associate Professor Turlock, California vi Thank You Beth Rowlands, DNP, GNP-BC Sabra H. Smith, DNP, MS, FNP-BC Florida SouthWestern State College Clinical Professor Clinical Assistant Professor Fort Myers, Florida University of Massachusetts University of South Carolina Diana White, RN, MS Boston, Massachusetts Columbia, South Carolina Professor Janet Czermak Russell, APN-BC Rebecca E. Sutter, DNP, APRN, BC- Tuskegee University Professor FNP Tuskegee, Alabama Essex County College Assistant Dean and Assistant Carol S. Whiteman, MSN, RN, Newark, New Jersey Professor CCRN Jennifer Brindisi Sipe, MSN, George Mason University Assistant Professor RN Fairfax, Virginia Ivy Tech Community College Assistant Professor Nanci Swan, RN, MSN, CCRN South Bend, Indiana LaSalle University Instructor Toni C. Wortham, RN, BSN, MSN Philadelphia, Pennsylvania The University of Alabama Part-time Instructor Michelle Taylor Skipper, DNP, Birmingham, Alabama Madisonville Community College FNP-BC Valerie Taylor, RN, C, MEd, MSN Madisonville, Kentucky Clinical Associate Professor Assistant Professor Benson Kar Leung Yeung, MSN, Director, A/GNP and FNP Lorain County Community College RN Concentrations Elyria, Ohio Full-time Instructor East Carolina University Angela Trawick, MSN, RN California State University Greenville, North Carolina Clinical Coordinator Los Angeles, California Preface Pharmacology is one of the most challenging and dynamic drugs. The role of complementary and alternative thera- subjects for professional nurses. Each month new drugs pies, which are used by many patients, is included in the are being introduced, and new indications are continually context of holistic care. being developed for existing medications. Some medica- Unit 2 connects pharmacology, the nurse, and the tions that were considered preferred drugs only a decade patient, with an emphasis on positive patient outcomes. ago are now rarely prescribed. Current knowledge of drug The four chapters in this unit recognize the essential role of actions, mechanisms, interactions, and legislation is man- nurse–patient interactions in providing optimal patient datory for nurses to provide safe and effective patient care care throughout the lifespan. The fact that individuals vary in all healthcare settings. Pharmacotherapeutics remains a in their responses to drug action is an important theme critical and ever-changing component of patient care. introduced in this unit. The subtitle of this text, Connections to Nursing Practice, Units 3 through 11 provide the concepts and connections has guided its continued development. At a fundamental that are necessary to understand the actions and adverse level, pharmacology is a series of interrelated essential con- effects of individual drugs on different body systems. Many cepts. Some key concepts are shared with the natural and of the units begin with a chapter that briefly reviews relevant applied sciences. Prediction of drug action requires a thor- anatomy and physiology, which is a useful feature for the ough knowledge of anatomy, physiology, chemistry, and student when studying drug actions. Each chapter clearly pathology as well as the social sciences of psychology and identifies the concepts and connections necessary for safe sociology. This interdisciplinary nature of pharmacology and effective pharmacotherapy. Pharmacology is intimately makes the subject difficult to learn but fascinating to study. related to the study of disease processes. The connections However, the discipline of pharmacology is far more between pharmacology and pathophysiology are clearly than a collection of isolated facts. To effectively learn this established for each drug class in every chapter. discipline, the student must make connections to nursing practice and, ultimately, connections to patient care. Resources for Faculty and Student Patients expect to receive effective and safe medication administration from a nurse who is competent in the study Success of pharmacology. Pharmacology: Connections to Nursing Practice identifies key pharmacologic concepts and mecha- Resources for Faculty nisms and clearly connects them to current nursing theory and practice for providing optimal patient care. Pearson is pleased to offer a suite of resources to support Pharmacology: Connections to Nursing Practice recognizes teaching and learning, including: that pharmacology is not an academic discipline to be learned • TestGen Test Bank for its own sake but is a critical tool to prevent disease and promote healing. This connection to patients, their assess- • Lecture Note PowerPoints ment, diagnoses, and interventions supports basic nursing • Instructor’s Resource Manual practice. Like other core nursing subjects, the focus of pharmacology must be to teach and promote wellness for patients. Resources for Students Online Resources for students that are available include: Structure of the Text • Making the Patient Connection case studies and This text is organized according to body systems (units) answers and diseases (chapters). Unit 1, the first seven chapters, • Additional Case Studies and answers identifies fundamental pharmacologic principles that are applied throughout the text. Although new drugs are con- • Answers to Patient Safety Questions stantly being developed, these chapters build the struc- • Suggested answers to Connection Checkpoints, and tural framework for understanding the applications of all more! vii