Pharmacotherapeutics for Nurse Practitioner Prescribers, Second Edition

1351 Pages·2007·25.46 MB·English

by  Wynne

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PHARMACOTHERAPEUTICS
for Nurse Practitioner
Prescribers
Second Edition
Anita Lee Wynne, PhD, FNP-C
Professor of Nursing
School of Nursing
University of Portland
Portland,Oregon
and
Family Nurse Practitioner
Private Practice
Portland,Oregon
Teri Moser Woo, RN, MS, CPNP
PhD candidate at University of Colorado Denver Health
Sciences Center School of Nursing
Denver,Colorado
and
Instructor
University of Portland
School of Nursing
Portland,Oregon
and
Pediatric Nurse Practitioner
Kaiser Permanente Northwest Region
Portland,Oregon
Ali J. Olyaei, PharmD, BCPS
Oregon Health Sciences University
Division of Nephrology,Hypertension and Clinical
Pharmacology
and
Department of Pharmacy Services
Portland,Oregon
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F.A.Davis Company
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Copyright © 2007 by F.A.Davis Company
Copyright © 2002 by F.A.Davis Company.All rights reserved.This book is protected by copyright.No part
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Printed in the United States of America
Last digit indicates print number:10 9 8 7 6 5 4 3 2 1
Acquisitions Editor,Nursing:Joanne Patzek DaCunha,RN,MSN
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As new scientific information becomes available through basic and clinical research,recommended
treatments and drug therapies undergo changes.The authors and publisher have done everything possi-
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fessional 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 infor-
mation 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
Wynne,Anita Lee,1941–
Pharmacotherapeutics for nurse practitioner prescribers / Anita Lee Wynne,
Teri Moser Woo,Ali J.Olyaei.— 2nd ed.
p.;cm.
Includes bibliographical references and index.
ISBN-10:0-8036-1361-X
ISBN-13:978-0-8036-1361-4
1. Pharmacology. 2. Therapeutics. 3. Nurse practitioners. I. Woo,Teri
Moser,1962– II. Olyaei,Ali J. III. Title.
[DNLM: 1. Pharmacology—Nurses’Instruction. 2. Drug Therapy—nursing.
3. Nurse Practitioners. 4. Pharmaceutical Preparations—Nurses’Instruction.
5. Prescriptions,Drug—Nurses’Instruction.QV 38 W988p 2007]
RM300.W96 2007
615′.1—dc22 2007004578
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Wynn(f)-FM 2/12/07 10:10 PM Page iii
To my loving husband and my esteemed col-
leagues at the University of Portland, without
whose patience and support this book never
would have been completed; to my parents,
especially in memory of my mother who died
this year, who consistently taught me to shoot
for the stars; and to my children and grandchil-
dren, who daily make my life complete.
ALW
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
iii
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PREFACE
The increasing volume of pharmacology-related infor- The pharmacology knowledge required for rational
mation presents a challenge to acquire and maintain drug selection requires more depth than that given in
current knowledge in the area of pharmacotherapeutics. undergraduate pharmacology,where the focus is on safe
The number of new drugs coming on the market each administration of drugs prescribed by someone else.
year,the changes in “the best”drugs to use for any given Advanced pharmacology information on receptor
disease state based on the latest research,the influence reserve and regulation, bioavailability and bioequiva-
on patient and practitioner alike of advertising and pro- lence, metabolism of drugs including a focus on the
motion,and the increasing incursion of managed care cytochrome P450 microsomal enzyme system,half-life,
and restricted formularies into practice decisions about and steady state are provided in Chapters 3, 4, and 6.
drug selection is phenomenal.This book is designed to New information not normally covered in undergraduate
provide nurse practitioner students and the nurse practi- nursing courses but central to the prescribing role
tioner in the primary care setting with a thorough,cur- includes an in-depth discussion of volume of distribution
rent, and usable pharmacology text and reference to and therapeutic drug monitoring.Volume of distribution
address this challenge. is important in prescribing drugs with very large or very
The design of this book assumes knowledge of basic small volumes of distribution and for selecting drugs for
pharmacology from one’s undergraduate education in patients with cardiac or renal failure,during pregnancy,
nursing.Although a brief review of basic pharmacology or when a patient is underweight or obese.Knowing what
is presented in Chapter 2, the focus of the book is on tests to order and when to order them to assess plasma
advanced pharmacology and the role of the advanced drug levels by bioassay and to monitor for adverse drug
practice nurse in pharmacotherapeutics.The authors of reactions are necessary to make choices about when or
the text are practicing nurse practitioners or selected if dosage alterations are required or drugs need to be
specialists in a field.The book is by nurse practitioners, stopped.These are also covered in Unit I.
for nurse practitioners and other health-care providers Legal aspects of the prescriber role are presented in
who prescribe. Chapter 7. Issues surrounding the legal authority of a
nurse practitioner and other health-care providers to pre-
ORGANIZATION scribe a drug,the conditions under which the prescrip-
tion may be written,and how to write the prescription
This book is organized around four distinct content are presented in both this chapter and Chapter 1. Risk
areas: The Foundation, Pharmacotherapeutics with management issues are also discussed including
Single Drugs,Pharmacotherapeutics with Multiple Drugs, informed consent,dealing with multiple providers,and
and Special Drug Treatment Considerations. substance abuse and drug-seeking behaviors.
Nurse practitioners have a history of high levels of
patient satisfaction with the care provided. This is
The Foundation
related,in part,to their holistic approach to each patient.
The 13 chapters in Unit I provide the foundation of Several chapters are devoted to information that reflects
advanced pharmacology and the link between this this approach. Cost, knowledge deficits, dealing with
knowledge and professional practice. Chapter 1 dis- complex treatment regimens,and negotiating a shared
cusses the role of the nurse practitioner and the roles of responsibility for drug management are discussed in
other advanced practice nurses and physician assistants Chapters 5 and 8. Many patients choose to use com-
as prescribers and the knowledge needed to actualize plementary therapies such as herbal remedies.Chapter
their role.Factors involved in clinical judgment related 11 discusses these complementary therapies and pro-
to prescribing are a central focus, and collaboration vides a list of resources in this area.This chapter is writ-
between health-care providers is also presented. ten by a nurse practitioner who has certification in
v
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vi • • • Preface
several complimentary therapies and uses them in his properties of each drug,drug interactions,clinical use
practice. and dosing,and available dosing forms are presented.
A relatively new area in pharmacotherapeutics is There is a major focus on rational drug selection and on
ethnopharmacology.As more research is occurring in monitoring parameters. Patient education specific to
this area,treatment guidelines are beginning to include each drug class is provided—designed around adminis-
which drugs are best for different racial groups.Cultural tration of the drug,adverse drug reactions to monitor for
considerations in prescribing drugs as well as racial dif- and what to do if they occur,and lifestyle modifications
ferences in patient responses to drugs are the subject of that complement the drug therapy.
Chapter 9. To provide the most up-to-date,accurate,and relevant
Consideration of drug and food interactions has long information possible,contributors to this unit are prac-
been a part of nursing knowledge,but the interrelation- ticing clinicians. Clinical pearls drawn from the daily
ship between nutrition and drug therapy beyond these practice world of these contributors are incorporated
interactions has been largely missed. Chapter 10 pro- throughout the text.Drugs currently in development that
vides an in-depth discussion of this interrelationship may influence drug choices in the near future are also
including nutritional supplementation and nutrition as included in the “On the Horizon”feature.
therapy.
In an age of increasing use of technology,the nurse Pharmacotherapeutics
practitioner must be able to acquire information about
with Multiple Drugs
drugs and to deliver care to patients using this technol-
ogy.Chapter 12 focuses on computers and the Internet Unit III chapters provide access to drug information from
as sources of information and for care delivery.Especially the viewpoint of the disease processes they are com-
helpful is a large table that presents up-to-date sites for monly used to treat.Patients often have complex health
drug information from government,commercial,organi- and illness issues and treatment needs. Health-care
zational,and other sources.Where it is possible to deter- provider students find these especially perplexing,and
mine,each site has a discussion of its content,reliability, these patients may have disease processes that extend
frequency of update,link to other sites,charges or fees, beyond those a given nurse practitioner commonly sees.
and who is the “owner or operator”of the site.If the site is The knowledge the student or provider needs to select
supported by advertising, this is also mentioned. the appropriate drug to treat a given disease may be lim-
Telehealth,the use of telecommunications technology to ited.Unit III facilitates acquisition of this knowledge by
provide health-care services,as well as the future use of providing access to information from a disease process
information technology in obtaining drug-related infor- format.The diseases in this unit are those commonly
mation and the delivery of health care services,is also seen in primary care and for which multidrug therapy
included. from more than one drug class may be recommended.
Over-the-counter drugs may be prescribed by the Pharmacotherapeutics is discussed in relation to the
practitioner or chosen by patients on their own.These pathophysiology of the disease and the goals of treat-
drugs are often erroneously perceived to be less power- ment.Each chapter explores how patient variables,eco-
ful and having fewer adverse reactions than prescription nomic considerations, concurrent diseases, and drug
drugs.Understanding their role in pharmacotherapeutics characteristics influence rational drug selection.
is the focus of Chapter 13. Outcome evaluation is presented with guidelines for con-
sultation and referral.Where relevant professional guide-
Pharmacotherapeutics lines exist,they are incorporated.Each patient is unique
with Single Drugs and no set of guidelines or treatment algorithm applies to
each patient.However,these tools,drawn from the clini-
The next two units are organized around specific drugs cal knowledge and experience of experts in a given spe-
and the diseases they are used to treat.The chapters in cialty,are helpful in rational drug selection,especially for
Unit II are organized to provide easy access to informa- the student and novice practitioner.Clinically based case
tion based on specific drug classes. Many health-care studies in each chapter also provide a framework for
providers have a personal formulary of drugs they use for application of pharmacotherapeutic knowledge.
disease processes that they commonly see.When pre-
sented with a patient requiring drug therapy,they know
Special Drug Treatment Considerations
the class of drug from which they will make a rational
drug choice.The information they seek is about drugs Unit IV focuses on special populations.Age-related vari-
within that class that would be most appropriate for this ables are explored in the chapters on pediatric and geri-
patient. atric patients, and variables specific to women are
Pharmacokinetics,pharmacodynamics,and pharma- discussed in the Women’s Health chapters.Information
cotherapeutics for each drug class are discussed.Tables on safe prescription of drugs for lactating patients is
with easy-to-access information on pharmacokinetic often difficult to find,and tables with the most current
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Preface • • • vii
information on the effect of drugs on the nursing infant Rational drug selection and monitoring parameters
are found in the pediatric chapter.The prevalence of Patient Education
chronic illness is increasing as acute illnesses that for- Clinical Pearls
merly accounted for most of the morbidity and mortality On-the-Horizon feature
in developed countries have been eradicated or come
under control.Chapter 52 discusses the modification of
Unit III chapters
pharmacotherapeutics in patient populations with
chronic illness or in long-term care facilities. Finally,
Integration of pathophysiology and pharmacothera-
Chapter 53,new to this edition,focuses on special con-
peutics
siderations of prescribing for patients at the end of life.
Integration of professional treatment guidelines
Drugs Commonly Used tables
FEATURES Patient Education displays
Case Study displays
Throughout the text,care has been taken to provide the
reader with a consistent and logical presentation of
material.Visual appeal is provided through the generous Unit IV chapters
use of tables,illustrations,and flowcharts.Other features
Variables related to special populations
are unique to the specific units:
Unit I chapters SUMMARY
In-depth pharmacology base for advanced pharma- Every effort has been made to make this text as compre-
cotherapeutics hensive,accurate,and user friendly as possible.The gen-
Herbal therapies erous use of tables for ease of access to information,the
Ethnopharmacology focus on rational drug selection,the inclusion of often
Nutrition as therapy hard to find monitoring parameters,and the integration
Information technology and telehealth of patient education throughout the text are examples of
this user-friendly approach.The authors hope that you
will find this a valuable resource both as a student and in
Unit II chapters
your practice.
Tables for ease of access to information ALW
Pharmacokinetics tables TMW
Drug Interactions tables AJO
Dosage Schedule tables
Available Drug Dosage Forms tables
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ACKNOWLEDGMENTS
I would like to acknowledge my mentors who have sup-
ported me throughout my nursing career.Included in this
list is Dr.Sheila Kodadek,who has been my mentor and
friend throughout my nursing career.Dr.Terry Misener,
the Dean of University of Portland School of Nursing,has
been a major support in my faculty role and pushes me
to be more than I had ever envisioned.I would also like
to acknowledge the faculty at University of Portland who
have offered me support,encouragement and advice as I
completed these chapters while teaching and complet-
ing my PhD program.
TMW
ix