Pharmacotherapeutics for Nurse Practitioner Prescribers PDF
Preview Pharmacotherapeutics for Nurse Practitioner Prescribers
2235_FM-i-xvi 25/06/11 12:44 PM Page i THIRD EDITION Pharmacotherapeutics for Nurse Practitioner Prescribers 2235_FM-i-xvi 28/06/11 2:49 PM Page ii . . . Online Resource Center DavisPlus is your online source for a wealth of learning resources and teaching tools, as well as electronic and mobile versions of our products. StudentS InStructorS Unlimited free access. Upon Adoption. No password. Password-protected library of No registration. title-specific, online course content. No fee. Visit http://davisplus.fadavis.com explore more online resources from f.a.davis... www.drugguide.com is Davis’s Drug Guide Online, the complete Davis’s Drug Guide for Nurses® powered by database of over 1,100 monographs on the web. Unbound Medicine® www.tabersonline.com delivers the power of Taber’s Cyclopedic Medical Dictionary on the web. Find powered by more than 60,000 terms, 1,000 images, and more. Unbound Medicine® www.davisptnetwork.com is the PT community’s source for online continuing education, social networking, professional information, and more. www.fadavis.com 2235_FM-i-xvi 25/06/11 12:44 PM Page iii THIRD EDITION Pharmacotherapeutics for Nurse Practitioner Prescribers Teri Moser Woo, RN, PhD, CPNP Associate Professor of Nursing University of Portland School of Nursing Portland, Oregon and Pediatric Nurse Practitioner Kaiser Permanente Northwest Region Anita Lee Wynne, PhD, FNP-retired Professor Emeritus of Nursing School of Nursing University of Portland Portland, Oregon 2235_FM-i-xvi 25/06/11 12:44 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2011 by F. A. Davis Company Copyright © 2011 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher: Joanne Patzek DaCunha, RN, MSN Director of Content Development: Darlene D. Pedersen Project Editor: Jamie M. Elfrank Design & Illustration Coordinator: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Woo, Teri Moser, 1962– Pharmacotherapeutics for nurse practitioner prescribers / Teri Moser Woo, Anita Lee Wynne. — 3rd ed. p. ; cm. Rev. ed. of: Pharmacotherapeutics for nurse practitioner prescribers / Anita Lee Wynne, Teri Moser Woo, Ali J. Olyaei. Includes bibliographical references and index. ISBN-13: 978-0-8036-2235-7 ISBN-10: 0-8036-2235-X 1. Pharmacology. 2. Therapeutics. 3. Nurse practitioners. I. Wynne, Anita Lee, 1941– II. Wynne, Anita Lee, 1941– Pharmacotherapeutics for nurse practitioner prescribers. III. Title. [DNLM: 1. Pharmacological Phenomena—Nurses’ Instruction. 2. Drug Prescriptions—Nurses’ Instruction. 3. Drug Therapy—nursing. 4. Nurse Practitioners. QV 38] RM300.W96 2011 615'.1—dc22 2011006059 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organiza- tions that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-2235-7/11 0 + $.25. 2235_FM-i-xvi 25/06/11 12:44 PM Page v I would like to dedicate this book to my family. My husband, John, and my three sons, Michael, Patrick, and Nicholas, have been wonderfully supportive as I have completed this project. TMW To my loving husband and my family without whose patience and support this book never would have been completed; and to my children and grandchildren, who daily make my life complete. In loving memory of my mother, who died in 2006, and my father, who consistently taught me to shoot for the stars and who died in 2010. ALW 2235_FM-i-xvi 25/06/11 12:44 PM Page vi PREFACE T he increasing volume of pharmacology-related infor- undergraduate pharmacology, where the focus is on mation presents a challenge to acquire and maintain safe administration of drugs prescribed by someone else. current knowledge in the area of pharmacotherapeutics. Advanced pharmacology information on receptor reserve The number of new drugs coming on the market each and regulation, bioavailability and bioequivalence,metab- year, the changes in “the best” drugs to use for any given olism of drugs including a focus on the cytochrome P450 disease state based on the latest research,the influence microsomal enzyme system, half-life, and steady state on patient and practitioner alike of advertising and pro- are provided in Chapters 3 and8. Information central to motion, and the increasing incursion of managed care the prescribing role includes an in-depth discussion of and restricted formularies into practice decisions about volume of distribution and therapeutic drug monitoring. drug selection are phenomenal. This book is designed to Volume of distribution is important in prescribing drugs provide nurse practitioner students and the nurse practi- with very large or very small volumes of distribution and tioner in the primary care setting with a thorough, current, for selecting drugs for patients with cardiac or renal fail- and usable pharmacology text and reference to address ure, during pregnancy, or when a patient is underweight these challenges. or obese. Knowing what tests to order and when to order The design of this book assumes knowledge of basic them to assess plasma drug levels by bioassay and to mon- pharmacology from one’s undergraduate education in itor for adverse drug reactions is necessary to make nursing.Although a brief review of basic pharmacology choices about when or if dosage alterations are required is presented in Chapter 2, the focus of the book is on or drugs need to be stopped. These are also covered advanced pharmacology and the role of the advanced in Unit I. practice nurse in pharmacotherapeutics. The authors of Legal and professional aspects of the prescriber role the text are practicing nurse practitioners or selected are presented in Chapter 4. Issues surrounding the legal specialists in a field. The book is by nurse practitioners, for authority of a nurse practitioner to prescribe a drug, the nurse practitioners and other health-care providers who conditions under which the prescription may be written, prescribe drugs and how to write the prescription are presented. Risk management issues are also discussed, including informed consent, dealing with multiple providers, and substance ORGANIZATION abuse and drug-seeking behaviors. This book is organized around four distinct content areas: Nurse practitioners have a history of high levels of The Foundation, Pharmacotherapeutics With Single Drugs, patient satisfaction with the care provided.This is related, Pharmacotherapeutics With Multiple Drugs, and Special in part, to their holistic approach to each patient.Several Drug Treatment Considerations. chapters are devoted to information that reflects this approach. Cost, knowledge deficits, dealing with complex treatment regimens, and negotiating a shared responsibil- The Foundation ity for drug management are discussed in Chapter 6. The 13 chapters in Unit I provide the foundation of Many patients choose to use complementary therapies advanced pharmacology and the link between this knowl- such as herbal remedies. Chapter 10 discusses herbal edge and professional practice. Chapter 1discusses the therapy and other complementary therapies and provides role of the nurse practitioner in both the United States of a list of resources in this area. America and Canada as prescriber and the knowledge A relatively new area in pharmacotherapeutics is needed to actualize this role. Current issues about the ethnopharmacology.As more research is occurring in this evolving role and education of these providers are area, treatment guidelines are beginning to include which also presented in this edition including discussion of the drugs are best for different racial groups. Cultural and eth- Doctorate of Nursing Practice. nic considerations in prescribing drugs are the subject of Discussion of the roles of other advanced practice Chapter 7.Pharmacogenomics involves the influence of nurses and physicians assistants in prescribing has also both race/ethnicity and individual genetic makeup on drug been added. Factors involved in clinical judgment related metabolism. Chapter 8provides a greatly expanded discus- to prescribing are a central focus, and collaboration with sion of the role of pharmacogenomics in prescribing. other health-care providers is also presented. Consideration of drug and food interactions has long The pharmacology knowledge required for rational been a part of nursing knowledge, but the interrelation- drug selection requires more depth than that given in ship between nutrition and drug therapy beyond these vi 2235_FM-i-xvi 25/06/11 12:44 PM Page vii Preface (cid:129) (cid:129) (cid:129) vii interactions has been largely missed. Chapter 9provides of the drug, adverse drug reactions to monitor for and a discussion of this interrelationship including nutritional what to do if they occur, and lifestyle modifications that supplementation and nutrition as therapy. The third complement the drug therapy. edition also includes discussion of nutraceuticals, in To provide the most up-to-date, accurate, and relevant which foods are prescribed for their health benefits. information possible, contributors to this unit are practic- In an age of increasing use of technology, the nurse ing clinicians and the newest published guidelines are practitioner must be able to acquire information about consistently used. Clinical pearls drawn from the daily drugs and to deliver care to patients using this technology. practice world of these contributors are incorporated The push for use of electronic health records (EHRs) has throughout the text. Drugs currently in development that made Chapter 11critical information with its discussion may influence drug choices in the near future are also in- of computers and other data and communication devices cluded in the On-the-Horizon feature. and the Internet as sources of information and for care delivery This chapter has been restructured in the third Pharmacotherapeutics With Multiple edition to focus on the use of information technology Drugs directly related to patient encounters. Especially helpful is a large table that presents up-to-date sites for drug infor- Unit IIIchapters provide access to drug information from mation from government, commercial, organizational, and the viewpoint of the disease processes they are commonly other sources. Where it is possible to determine, each used to treat. Patients often have complex health and site has a discussion of its content, reliability, frequency of illness issues and treatment needs. Nurse practitioner update, link to other sites, charges or fees, and who is the students find these especially perplexing, and these pa- “owner or operator” of the site. If the site is supported by tients may have disease processes that extend beyond advertising, this is also mentioned. The future use of in- those a given nurse practitioner commonly sees. The formation technology in obtaining drug-related informa- knowledge the student or practitioner needs to select the tion and the delivery of health-care services is also appropriate drug to treat a given disease may be limited. included. Unit IIIfacilitates acquisition of this knowledge by provid- Cost issues are increasingly central to prescribing ing access to information from a disease process format. decisions. Chapter 12provides an expanded discussion The diseases in this unit are those commonly seen in of pharmacoeconomics. Written by a nurse practitioner primary care and for which multidrug therapy from more in the third edition, the focus is more directly on the pre- than one drug class may be recommended. scriber’s role. Pharmacotherapeutics is discussed in relation to the Over-the-counter drugs may be prescribed by the prac- pathophysiology of the disease and the goals of treatment. titioner or chosen by patients on their own. These drugs Each chapter explores how patient variables, economic are often erroneously perceived to be less powerful and considerations, concurrent diseases, and drug character- having fewer adverse reactions than prescription drugs. istics influence rational drug selection. Outcome evalua- Understanding their role in pharmacotherapeutics is the tion is presented with guidelines for consultation and focus of Chapter 13. referral.Where relevant the newest published professional guidelines are incorporated. Each patient is unique and no set of guidelines or treatment algorithm applies to each Pharmacotherapeutics With Single Drugs patient. However, these tools, drawn from the clinical The next two units are organized around specific drugs knowledge and experience of experts in a given specialty, and the diseases they are used to treat. The chapters in are helpful in rational drug selection, especially for the stu- Unit II are organized to provide easy access to informa- dent and novice practitioner.Clinically based case studies tion based on specific drug classes. Many practitioners provide a framework for application of pharmacothera- have a personal formulary of drugs they use for disease peutic knowledge and are provided in an online supple- processes that they commonly see. When presented with ment to this edition. a patient requiring drug therapy, they know the class of drug from which they will make a rational drug choice. Special Drug Treatment Considerations The information they seek is about drugs within that class that would be most appropriate for this patient. Unit IV focuses on special populations. Age-related Pharmacokinetics, pharmacodynamics, and pharma- variables are explored in Chapter 50, Pediatric Patients, cotherapeutics for each drug class are discussed. Tables and Chapter 51, Geriatric Patients. Gender variables are with easy-to-access information on pharmacokinetic considered in Chapter 48, Women as Patients, and properties of each drug, drug interactions,clinical use Chapter 49, Men as Patients. Chapter 49is a new addi- and dosing, and available dosing forms are presented. tion to the book. Information on safe prescription of There is a major focus on rational drug selection and on drugs for lactating patients is often difficult to find, and monitoring parameters.Patient education specific to each tables with the most current information on the effect drug class is provided—designed around administration of drugs on the nursing infant are found in Chapter 50. 2235_FM-i-xvi 25/06/11 12:44 PM Page viii viii (cid:129) (cid:129) (cid:129) Preface The prevalence of chronic illness is increasing as Dosage Schedule tables acute illnesses that formerly accounted for most of the Available Drug Dosage Forms tables morbidity and mortality in developed countries have Rational drug selection and monitoring parameters been eradicated or come under control. Chapter 52dis- Patient Education cusses the modification of pharmacotherapeutics in pa- Clinical Pearls tient populations with chronic illness or in long-term On-the-Horizon feature care facilities. The final chapter in the book deals with one of the Unit III Chapters most common yet often perplexing issues with which prescribers deal: pain. Chapter 53focuses on manage- Integration of pathophysiology and pharmacotherapeutics ment of both acute and chronic pain across the age Integration of professional treatment guidelines continuum. The third edition includes the most current Drugs Commonly Used tables information on newer drugs used to treat chronic pain Patient Education displays and new pain assessment tools for patients with demen- tia. Expanded discussion of the legal aspects of Unit IV Chapters prescribing related to drug dependent patients includes Variables related to special populations Material Risk Assessment and Pain Management Con- Pediatrics tract documents. Geriatrics Women FEATURES Men Chronically ill and long-term care Throughout the text, care has been taken to provide the Pain management reader with a consistent and logical presentation of material. Visual appeal is provided through the generous SUMMARY use of tables, illustrations, and flowcharts. Other features are unique to the specific units: Every effort has been made to make this text as compre- hensive, accurate, and user friendly as possible. The generous use of tables for ease of access to information, Unit I Chapters the focus on rational drug selection, the inclusion of often In-depth pharmacology base for advanced pharmacother- hard to find monitoring parameters, and the integration apeutics of patient education throughout the text are examples of Herbal and complimentary therapies this user-friendly approach.The authors hope that you Ethnopharmacology and pharmacogenomics will find this a valuable resource both as a student and in Nutrition and nutraceuticals as therapy your practice. Pharmacoeconomics TMW Information technolo gy including EHR and how it is used ALW in a busy practice Unit II Chapters Tables for ease of access to information Pharmacokinetics tables Drug Interactions tables 2235_FM-i-xvi 25/06/11 12:44 PM Page ix ACKNOWLEDGMENTS I would like to acknowledge my mentors who have The authors would also like to acknowledge our supported me throughout my nursing career.Included previous co-authors, Michael Millard, RPh and Ali in this list are Dr.Sheila Kodadek, who has been my men- J.Olyaei,PharmD.They contributed to the development tor and friend throughout my nursing career,and the late and refinement of multiple foundational chapters in Dr.Terry Misener. I would also like to acknowledge the the first two editions of the text and their work is faculty at University of Portland who have offered me acknowledged here. support, encouragement, and advice as I completed TMW these chapters while teaching full-time. ALW TMW ix
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