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

288 Pages·2014·5.28 MB·English

by  Joyce LeFever Kee

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.