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Study Guide for Pharmacology: A Patient-Centered Nursing Process Approach PDF

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Study Guide Pharmacology A Patient-Centered Nursing Process Approach 8th Edition Joyce LeFever Kee, MS, RN Associate Professor Emerita School of Nursing College of Health Sciences University of Delaware Newark, Delaware Evelyn R. Hayes, PhD, MPH, FNP-BC Professor School of Nursing College of Health Sciences University of Delaware Newark, Delaware Linda E. McCuistion, PhD, RN, ANP, CNS Professor South University Richmond Campus Richmond, Virginia Study Guide prepared by Lisa A. Hollett, BSN, RN, MA, MICN, CFN Trauma Program Manager Department of Trauma Services St. John Medical Center Tulsa, Oklahoma ELSEVIER SAUNDERS ELSEVIER SAUNDERS 3251 Riverport Lane St. Louis, Missouri 63043 STUDY GUIDE FOR PHARMACOLOGY: A PATIENT-CENTERED NURSING PROCESS APPROACH ISBN: 978-1-455-77053-3 Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. All rights reserved. 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. Although for mechanical reasons all pages of this publication are perforated, only those pages imprinted with an Elsevier Inc. copyright notice are intended for removal. 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. Notices .nowledge and best practice in this ¿eld are constantly changing. As new research and e[perience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own e[perience and knowledge in evaluating and using any information, methods, compounds, or e[periments described herein. In using such informa- tion or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. :ith respect to any drug or pharmaceutical products identi¿ed, 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 e[perience 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 e[tent 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. International Standard Book Number 978-1-455-77053-3 Executive Content Strategist: Lee Henderson Content Manager: Jennifer Ehlers Content Development Specialist: Jacqueline Twomey Publishing Services Manager: Jeffrey Patterson Project Manager: Clay S. Broeker Publishing Services: Lisa Hernandez Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 Preface This comprehensive Study Guide is designed to pro- have questions that relate to assessment data, including vide the learner with clinically based situation practice laboratory data and side effects, planning and implement- problems and questions. This book accompanies the te[t ing care, patient/family teaching, cultural and nutritional Pharmacology: A Patient-Centered Nursing Process considerations, and effectiveness of the drug therapy Approach, Eighth Edition, and may also be used indepen- regimen. dently of the te[t. Because of the ever-e[panding number of drugs Opportunities abound for the enhancement of criti- available, pharmacology can be an overwhelming sub- cal thinking and decision-making abilities. Hundreds of ject. To help students grasp essential content without study questions and answers are presented on nursing re- becoming overwhelmed, chapters have been divided into sponsibilities in therapeutic pharmacology. For e[ample, multiple smaller sections. The result is a layout that is Chapter 14 is composed of si[ sections, each devoted to user-friendly. a speci¿c area of medications and calculations. Multiple To underscore the importance of the nurse’s role practice opportunities are provided in the areas of mea- in patient safety, a new safety icon has been added to surement, methods of drug calculations, calculation of call attention to questions concerning safe patient care. oral and injectable dosages (including pediatrics), and As one of the si[ core competencies of the 4uality and calculation of intravenous Àuids. Each chapter follows a Safety Education for Nurses (4SEN) initiative, patient format that includes study questions (including multiple safety has never been more at the forefront of nursing choice, matching, word searches, crossword puzzles, and education. completion e[ercises), NCLE; review questions (includ- Answers to all questions are presented in the Answer ing alternate-item format questions), and case studies. Key to make studying easier. New to this edition are ra- There are more than 160 drug calculation problems tionales for selected application-level questions and case and questions, many relating to actual patient care situa- study questions. tions and enhanced with real drug labels. The learner is The Study Guide is part of a comprehensive phar- also e[pected to recognize safe dosage parameters for the macology package, including the te[tbook and Instructor situation. The combination of the instructional material and Student Resources available on the companion in the te[t and the multiplicity of a variety of practice Evolve website. This package and each of its components problems in this Study Guide preclude the need for an ad- were designed to promote critical thinking and learn- ditional drug dosage calculation book. ing. :e are e[cited about this edition of the Study Guide The nursing process is used throughout the patient because it offers the learner a variety of modalities for situation–based questions and case studies. Chapters mastering the content. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. iii This page intentionally left blank Contents Chapter 1 Drug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases . . . . . . . . . . . . . . . . . . . . .1 Chapter 2 The Drug Approval Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Chapter 3 Cultural and Pharmacogenetic Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Chapter 4 Drug Interactions and Over-the-Counter Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Chapter 5 Drugs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Chapter 6 Herbal Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Chapter 7 Pediatric Pharmacology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Chapter 8 Geriatric Pharmacology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Chapter 9 Collaboration in Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Chapter 10 The Role of the Nurse in Drug Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Chapter 11 The Nursing Process in Patient-Centered Pharmacotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Chapter 12 Safety and 4uality in Pharmacotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Chapter 13 Medication Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Chapter 14 Medications and Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Chapter 15 Vitamin and Mineral Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Chapter 16 Fluid and Electrolyte Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Chapter 17 Nutritional Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Chapter 18 Adrenergic Agonists and Adrenergic Blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Chapter 19 Cholinergic Agonists and Anticholinergics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93 Chapter 20 Central Nervous System Stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 Chapter 21 Central Nervous System Depressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 Chapter 22 Anticonvulsants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102 Chapter 23 Drugs for Neurologic Disorders: Parkinsonism and Alzheimer’s Disease . . . . . . . . . . . . . . . . . . . . . . .106 Chapter 24 Drugs for Neuromuscular Disorders: Myasthenia Gravis, Multiple Sclerosis, and Muscle Spasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 Chapter 25 AntiinÀammatory Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Chapter 26 Nonopioid and Opioid Analgesics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Chapter 27 Antipsychotics and An[iolytics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Chapter 28 Antidepressants and Mood Stabilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122 Chapter 29 Penicillins and Cephalosporins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Chapter 30 Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones . . . . . . . . . . . . . . . . . . . . . . . . . . .129 Chapter 31 Sulfonamides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 Chapter 32 Antituberculars, Antifungals, Peptides, and Metronidazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. v vi Contents Chapter 33 Antivirals, Antimalarials, and Anthelmintics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 Chapter 34 Drugs for Urinary Tract Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140 Chapter 35 HIV- and AIDS-Related Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143 Chapter 36 Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146 Chapter 37 Anticancer Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150 Chapter 38 Targeted Therapies to Treat Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155 Chapter 39 Biologic Response Modi¿ers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158 Chapter 40 Drugs for Upper Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161 Chapter 41 Drugs for Lower Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163 Chapter 42 Cardiac Glycosides, Antianginals, and Antidysrhythmics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 Chapter 43 Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Chapter 44 Antihypertensives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176 Chapter 45 Anticoagulants, Antiplatelets, and Thrombolytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180 Chapter 46 Antihyperlipidemics and Peripheral Vasodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184 Chapter 47 Drugs for Gastrointestinal Tract Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Chapter 48 Antiulcer Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 Chapter 49 Drugs for Eye and Ear Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 Chapter 50 Drugs for Dermatologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196 Chapter 51 Endocrine Drugs: Pituitary, Thyroid, Parathyroid, and Adrenal Disorders. . . . . . . . . . . . . . . . . . . . . . .198 Chapter 52 Antidiabetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Chapter 53 Female Reproductive Cycle I: Pregnancy and Preterm Labor Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . .207 Chapter 54 Female Reproductive Cycle II: Labor, Delivery, and Preterm Neonatal Drugs . . . . . . . . . . . . . . . . . . . 211 Chapter 55 Postpartum and Newborn Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 Chapter 56 Drugs for Women’s Reproductive Health and Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .218 Chapter 57 Drugs for Men’s Health and Reproductive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221 Chapter 58 Drugs for Disorders in Women’s Health, Infertility, and Se[ually Transmitted Infections . . . . . . . . . .223 Chapter 59 Adult and Pediatric Emergency Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226 Answer Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .230 Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. #HAPTERsDrug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases 1 Drug Action: Pharmaceutic, 1 Pharmacokinetic, and Pharmacodynamic Phases Study Questions &URVVZRUGSX]]OH8VHWKHGH¿QLWLRQWRGHWHUPLQHWKHSKDUPDFRORJLFWHUP 1 2 3 4 5 6 7 8 9 10 11 Across Down 1. Dissolution of the drug 1. Effect of drug action on cells 5. Effect of drug action because of hereditary 2. Drug that blocks a response inÀuence 3. Toxic effect as a result of drug dose or therapy 6. Four processes of drug movement to achieve drug 4. Located on a cell membrane to enhance drug action action 8. Drug that produces a response 7. Drug tolerance to repeated administration of a drug 9. Psychologic bene¿t from a compound that may not 10. One-half of the drug concentration to be eliminated have the chemical structure of a drug effect 11. Drug bound to protein Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 1 #HAPTERsDrug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases 0DWFKWKHWHUPVLQ&ROXPQ,ZLWKWKHLUGHVFULSWLRQVLQ&ROXPQ,, Column I Column II ____ 12. Protein-bound drug a. Breakdown of a drug into smaller particles b. Proceeds directly from intestine to the liver ____ 13. Unbound drug c. Drugs that affect various receptors ____ 14. Hepatic ¿rst pass d. Free active drug causing a pharmacologic response e. Causes inactive drug action/response ____ 15. Dissolution f. Drug absorbed by diffusion ____ 16. Passive absorption g. Drug requiring a carrier for absorption ____ 17. Nonselective receptors 0DWFKWKHWHUPVLQ&ROXPQ,ZLWKWKHLUGHVFULSWLRQVLQ&ROXPQ,, Column I Column II ____ 18. Onset a. Length of time a drug has a pharmacologic effect b. The margin of safety of a drug ____ 19. Peak action c. Occurs when a drug has reached its highest plasma ____ 20. Duration of action concentration d. Time it takes a drug to reach minimum effective ____ 21. Therapeutic index concentration NCLEX Review Questions 6HOHFWWKHEHVWUHVSRQVH 22. Which drug form is most rapidly absorbed from the 25. Which statement places the four processes of phar- gastrointestinal (GI) tract? macokinetics in the correct sequence? a. Capsule a. Absorption, metabolism, distribution, excretion b. Sublingual b. Distribution, absorption, metabolism, excretion c. Suspension c. Distribution, metabolism, absorption, excretion d. Tablet d. Absorption, distribution, metabolism, excretion 23. Where does disintegration of enteric-coated tablets 26. Which type of drug passes rapidly through the GI occur? membrane? a. Colon a. Lipid-soluble and ionized b. Liver b. Lipid-soluble and nonionized c. Small intestine c. Water-soluble and ionized d. Stomach d. Water-soluble and nonionized 24. Usually food has what effect on dissolution and 27. Which factor(s) most commonly affect(s) a drug’s absorption of medication? absorption? (Select all that apply.) a. Accelerates a. Body mass index b. Decelerates b. Hypotension c. Has no effect c. Pain d. Prevents d. Sleep e. Stress Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. #HAPTERsDrug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases 3 28. The patient is taking diazepam (Valium) for anxi- 34. The older adult patient has a creatinine clearance of ety. Two days later she is started on dicloxacillin 30 mL/min. He has been prescribed trimethoprim for an infection. What does the nurse know will (Proloprim) for a urinary tract infection. If the nor- happen to the diazepam in the patient’s body? mal dose is 200 mg per day, what does the nurse a. The diazepam remains highly protein bound. anticipate will occur with the dosing regimen? b. The diazepam is deactivated. a. The dose will double. c. Most of the diazepam is released, and it be- b. The dose will decrease by one-half. comes more active. c. The dose will stay the same. d. The diazepam is excreted in the urine d. The dose will increase to three times per day. unchanged. 35. Which is the best determinant of the biologic activ- 29. Which body organ is the major site of drug ity of a drug? metabolism? a. The ¿t of the drug at the receptor site a. Kidney b. The mis¿t of the drug at the receptor site b. Liver c. Inability of the drug to bind to a speci¿c c. Lung receptor d. Skin d. Ability of the drug to be rapidly excreted 30. What route of drug absorption has the greatest 36. Which type of drug prevents or inhibits a cellular bioavailability? response? a. Intramuscular a. Agonist b. Intravenous b. Antagonist c. Oral c. Cholinergics d. Subcutaneous d. Nonspeci¿c drug 31. Which is the best description of a drug’s serum 37. A receptor located in different parts of the body half-life? may initiate a variety of responses depending on a. The time required for half of a drug dose to be the anatomic site. Which type of receptor responds absorbed in this manner? b. The time required after absorption for half of the a. Ligand-gated drug to be eliminated b. Nonselective c. The time required for a drug to be totally c. Nonspeci¿c effective d. Placebo d. The time required for half of the drug dose to be completely distributed 38. Which indicator measures the margin of safety of a drug? 32. The patient is taking a drug that has a half-life of a. Therapeutic range 24 to 30 hours. In preparing discharge teaching, b. Therapeutic index what is the dosing schedule the nurse anticipates c. Duration of action will be prescribed for this medication? d. Biologic half-life a. Daily b. Every other day 39. The nurse has just given the patient her prescribed c. Twice per day antibiotic. Which measurement checks for the d. Three times per day highest plasma/serum concentration of the drug? a. Peak level 33. Which type of drug can be eliminated through the b. Minimal effective concentration kidneys? c. Half-life a. Enteric-coated d. Trough level b. Lipid-soluble c. Protein-bound d. Water-soluble Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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