(Test Bank) Pharmacology For Nurses

Smith, 2

Pharmacology

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2nd Edition

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SECOND EDITION Pharmacology for Nurses The Pedagogy Pharmacology for Nurses drives comprehension through various strategies that meet the learning needs of stu - dents while also generating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following :Pharmacology for Nurses Key Terms Found in a list at the beginning of each chapter, these items will create an expanded vocabulary. Use the access code at the front of your book to find additional resources online. Central N ervous S ystem Drugs Dion M. M ayes-Burnett Acetylcholine Aff erent Alzheimer disease Analgesics Anesthetic Antispasmodics Autonomic ner vous sy stem Axons Brain stem Central ner vous sy stem ( CNS) Cerebellum Cerebrum COX-2 inhibitors Cycloo xygenase ( COX ) Dendrites Dopamine Eff erent Epilepsy Forebrain Gamma-aminobutyric acid (GABA ) Glutamate Hindbrain Hypothalamus Medulla oblongata Midbrain Muscle relaxant Muscle spasm Narcotic Ner ve processes Neurodegeneration Neuromuscular blockers Neurons N -meth yl-D -aspar tate (NMDA) Nociceptiv e Noncompetitiv e antagonist Nonsteroidal anti- infl ammator y drugs (NSAIDs) Opioids Parasympathetic ner vous system Parkinson ’s disease Peripheral ner vous sy stem (PNS) Pons Prostaglandin Salicylates Somatic ner vous sy stem Spasmolytics Spasticity Spinal column Spinal cord Sympathetic ner vous sy stem Thalamus At the end of the chapter , the reader will be able to: 1. List the key components that make up the central ner vous system ( CNS). 2. Describe the func tion of the CNS. 3. Identify common disorders and diseases of the CNS. 4. List f our primar y symptoms of P arkinson ’s disease , Alzheimer disease , and am yotrophic lateral sclerosis . 5. Discuss fi ve myths associated with chronic pain. 6. List three complications associated with narcotic administration. 7. Identify the major drug classes used to treat CNS disorders . 8. Describe the indication and mechanism of ac tion f or each of the drug classes used to treat CNS disorders . 9. Discuss the long-term eff ects of chronic acetaminophen therap y. 10. Describe symptoms of overdose f or each class of CNS drug . 11. Explain how each CNS drug ac ts to alleviate or eliminate symptoms . KEY TERMS CHAPTER OB JE CTIVES 105 CHAPTER 4 Chapter Objectives These objectives provide instructors and students with a snapshot of key information they will encounter in each chapter. They serve as a checklist to help guide and focus study. iiBest Practices Key concept notes reinforce correct methods and techniques and provide information on matters in day-to-day practice. Critical Thinking Questions Analyze and evaluate content from each chapter using these end-of-chapter questions.benefi cial in both regards, as we shall see later in this chapter . Acute Versus Chronic P ain One person’ s pain perception may be very different from another person’ s, but the one commonality is that a sensory pathway spans from the affected organ to the brain. Anal-gesics work at the level of the nerves, either by blocking the signal from the PNS or by distorting the perception by the CNS. Select-ing an appropriate analgesic is achieved with consideration of the risks and benefi ts to the patient, the type and severity of pain the pa- tient may be suffering, and the risk of adverse effects. The healthcare provider would also want to examine whether the type of pain the patient is experiencing would be catego-rized as acute or/uni00A0chronic. Acute pain is self-limiting in duration and includes postoperative pain or pain due to an injury or infection. Given that pain of this type is expected to be short term (usually less than 12 weeks’ duration), the long-term side effects of analgesic therapy may be ignored. These patients may be treated with narcot- ics without concern of possible addiction. One important consideration with patients in se- vere pain is that they should not be subject to the return of pain. Analgesics should be dosed routinely to ensure constant blood levels of analgesic, rather than waiting to provide patients with appropriate medications until a response; agonists mimic the actions of en-dogenous opioid ligands. The best-known drugs with mixed agonist–antagonist activity are the opioids. For example morphine is an agonist of opioid re- ceptors, while naloxone is an antag- onist to morphine and other opiate drugs (and therefore a receptor an- tagonist ). The drugs buprenorphine and pentazocine have both agonist and antagonist effects ( TABLE 4 /uniF6BA 1 ). Among the class of NSAIDs are COX-2 inhibitors. These drugs are selective in that they directly tar - get COX-2, an enzyme responsi-ble for infl ammation and pain, yet have a less severe impact on the gas-trointestinal (GI) tract than trad-itional NSAIDs such as salicylates ( aspirin ). The more benign GI ef- fects of COX-2 inhibitors reduce the risk of peptic ulceration asso-ciated with the traditional NSAIDs (Chan et al., 2017; Whittle, 2000), al-though overall gastrointestinal toxic-ity of selective COX-2 inhibitors has been questioned (Hima & V enkat, 2016). Celecoxib is an example of a COX-2/uni00A0inhibitor . Analgesics provide symptom- atic pain relief but do not alleviate the cause of that pain. The NSAIDs, due to their dual activity , may be Best Practic es Selec ting an appr o- priate analgesic is achieved with con-sideration of the risks and benefi ts to the patient, the type and severity of pain the patient may be suf-fering , and the risk of adverse eff ects. Best Practic es Analgesics should be dosed routinely to en-sure constant blood levels of analgesic so that pain relief is uninterrupted . Best Practic es The risk of side ef-fects with long-term use of NSAIDs means treatment of chronic pain requires a com-bination of drugs , life- style modifi cations , and other treatment modalities . Most Common Opioids TABLE 4-1 Generic Trade N ame Administration R outes Natural/ Other Agonist /Antagonist Morphine MS Contin Subcut./IM/IV/PO Natural Agonist Codeine Lodine PO/IM/Subcut. Natural Agonist Hydromorphone Dilaudid Subcut./IM/IV/PO/REC Semi-synthetic Agonist Meperidine Demer ol Subcut./IM/IV/PO/REC Synthetic Agonist Fentan yl Duragesic IV/IM/lozenge/buccal tab/transdermal patch Synthetic Agonist Methadone Dolophine Subcut./IM/IV/PO Synthetic Agonist Tramadol Ultram PO Synthetic Agonist Nalo xone Narcan Subcut./IM/IV Semi-synthetic Antagonist110 CHAPTER 4 C entral Nervous S ystem D rugs Critic al Thinking Questions 1. What are the advantages and disadvantages of NSAID analgesia versus opioid analgesia? 2. What distinguishes epilepsy from non- epileptic seizures? Why would therapy for each type of seizure disorder be diff erent? 3. Name three common m yths surrounding pain medications . How do these medications po - tentially affec t therapy and clinical response to the patient? 4. In Alzheimer disease , the key diagnostic symp - tom is dementia; in P arkinson ’s disease , the most frequent identifying symptom is tremor and changes in gait. How do these diff erences alter the therapeutic approach to patients with these diseases? 5. What is the principal func tion of glutamate? 6. What are the roles of prostaglandins in inflam- mator y diseases? How do NSAIDs aff ect prosta- glandin produc tion? 7. Which of the f ollowing medications is most ap - propriate f or a patient with a spinal cord injur y who has a histor y of benzodiazepine addic - tion: cyclobenzaprine , diazepam , aspirin , or dantrolene ? 8. ALS is a progressive neurodegenerative dis-ease with varied etiology . What are typically the first symptoms seen in the progression of this disease? 9. What are the key symptoms or lab findings that would indicate to xicity in a patient on long-term acetaminophen therapy? effects. When the procedure is over , remind the patient not to arise too quickly to avoid possible dizziness due to orthostatic hypoten-sion. Remind patients to call immediately if they experience side effects or notice areas of irritation or increased bleeding, warmth, or swelling at area of injection. CHAPTER SUMMAR Y This chapter has explored the CNS, touched briefl y on the PNS, and discussed key conditions aff ecting the CNS as w ell as the drug classes most commonly used as treatments f or specifi c CNS diseases and disorders . If there is one all- encom- passing theme to this chapter , it is the principal necessity to suppor t patients ’ ability to maintain ph ysiological function and a sense of “normalc y” as they cope with the neurologic disorders f or which they are being treated. Whether the problem is pain centered or f ocused on loss of memor y (as in Alzheimer disease), ph ysical capability (as in P arkinson ’s or ALS disease), or simply a matter of suppressing seizures , the therapeutic goal is the same: manage the condition with the goal of restoring normalc y to the ex tent possible. Wher e disease and/or symptom progression is inevitable , the goal becomes maintenance of high func tion and independence for as long as possible . In such cases (and, indeed, in an y CNS disorder), medication is rarely used alone; it is most of ten suppor ted with multiple adjunct therapies (or sometimes is better regarded as an adjunc t to other modalities). Key concepts include the impor tance of neurotransmitters such as dopamine and acetylcholine in brain- centered pr o- gressive disorders such as Alzheimer and P arkinson ’s disease , the func tion of glutamate and NDMA in memor y and cogni- tion, and the central role that prostaglandins play in infl am- mator y conditions . Management of pain is a challenging objec tive f or the clinician because it is so of ten per formed ineff ectually . However , maintaining ph ysiological function and suppor ting patients ’ ability to cope with various diseases and symptoms is as impor tant as pain control. 144 CHAPTER 4 C entral Nervous S ystem D rugs Pharmacology for Nurses iiiCase Studies Scenarios encourage active learning and promote critical thinking skills. Students can read about real-life scenarios and analyze each situation presented. Case Sc enario 1 Ms. Smith, a 78-year- old woman with a histor y of gastric ulcers and str oke, comes into the clinic following an accident wher e her car was r ear-ended . She is complaining of headache and pain in her neck and shoulders . The nurse tak es the patient ’s vital signs: B/P , 123/68; P , 88; R, 18; T, 98.9. Ms. Smith states that she has allergies to penicillin and c odeine, and has been tak ing Coumadin since her str oke thr ee years ago . After a brief examination, the physician ’s assistant tells Ms . Smith that he believes she has whiplash and pr escribes her cyclobenzaprine and aspirin . Case Q uestion 1. Is aspirin the best or most appr opriate medication that should have been or dered? a. Yes, because it ac ts both as an anti-infl ammator y and a pain medication. b. No, the patient would do better tak ing ibupr ofen because it is less upsetting to the stomach. c. No, the patient should take acetaminophen because she has both a histor y of peptic ulcers and is cur- rently tak ing war farin. d. None of the above. Answ er : T he ans wer is c. Because Ms . Smith has a histor y of ulcers and is r eceiving anticoagulant therapy post str oke, aspirin should be avoided because it would both incr ease the anticoagulant eff ects of the warfarin and incr ease her risk of gastric ulcers . CASE STUDIES Case Sc enario 2 Nathaniel , an EMT and girls ’ soccer coach in Connec ticut, was fl ying home to Tulsa f or a visit. When his father , Louis, pick ed him up at the airpor t, Nathaniel noticed that L ouis seemed diff erent. He didn ’t think much of it at the time, but as the week pr ogressed , he noticed that his father was frequently confused , had diffi culty organizing and planning , and was quite moody when normally he was always laughing and telling jok es. He had always loved mak ing fl ies for his favorite hobb y, fl y-fi shing , but Nathaniel’ s mother r epor ted that he no longer made the fl ies or even went into his workshop anymor e. She also stated that she noticed when they watched TV, Louis had diffi culty following the plot of any of the shows they wer e watching . Nathaniel f elt that his father might have some mild dementia, which concerned him because his father was only 58. He made an appointment f or his father with his doc tor; following examination and testing , Louis was diagnosed with early-stage Alzheimer disease. Case Q uestions 1. Because Louis is relatively young , and has been diagnosed with early-stage Alzheimer disease with what appear to be only mild symptoms , which medication would be best to star t him on? CASE STUDIES Case studies 145iv Pharmacology for NursesSECOND EDITION Pharmacology for Nurses Blaine Templar Smith, RPh, PhD Pharmacy Consultant Editor and Author Former Chair Department of Pharmaceutical Sciences, Saint Joseph College School of Pharmacy Former Assistant Professor Massachusetts College of Pharmacy and Health Sciences – Worcester College of Pharmacy, University of OklahomaDiane F. Pacitti, RPh, PhD Pharmacy Educator Editor and Author Adjunct Pharmacology Faculty Manchester Community College Capitol Community College Former Chair Holyoke Community College Former Assistant Professor Department of Pharmaceutical Sciences, Saint Joseph College School of Pharmacy Department of Pharmacology, Springfield College Massachusetts College of Pharmacy and Health Sciences – WorcesterWorld Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 info@jblearning.com www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to specialsales@jblearning.com. Copyright © 2020 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including pho - tocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Ref - erence herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement pur - poses. All trademarks displayed are the trademarks of the parties noted herein. Pharmacology for Nurses, Second Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. T reatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindica - tions, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. 14734-6 Production Credits VP, Product Management: Amanda Martin Director of Product Management: Matthew Kane Product Specialist : Christina Freitas Project Specialist : Alex Schab Senior Marketing Manager: Jennifer Scherzay Production Services Manager: Colleen Lamy Product Fulfillment Manager: Wendy Kilborn Composition: S4Carlisle Publishing ServicesCover Design: Michael O’Donnell Text Design: Michael O’Donnell Rights & Media Specialist: John Rusk Media Development Editor: Troy Liston Cover Image (Title Page, Part Opener, Chapter Opener): © Foxie/Shutterstock Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress Cataloging-in-Publication Data Names: Smith, Blaine T., editor. Title: Pharmacology for nurses / [edited by] Blaine Templar Smith. Description: Second edition. | Burlington, Massachusetts : Jones & Bartlett    Learning, [2019] | Includes bibliographical references. Identifiers: LCCN 2018023083 | ISBN 9781284141986 (hardcover) Subjects: | MESH: Pharmacological Phenomena | Drug Therapy | Nurses ’    Instruction Classification: LCC RM301.28 | NLM QV 37 | DDC 615.1--dc23 LC record available at https://lccn.loc.gov/2018023083 6048 Printed in the United States of America 22 21 20 19 18 10 9 8 7 6 5 4 3 2 1This book is dedicated to the memory of my mother, Joan (Joanna) Lou Templar Smith, PhD (1927–2013), my life-long editor and editorial advisor . – Blaine T. Smith Dedicated to my mother as well: the single strongest, most faithful, and resilient person I have ever known. – Diane F. PacittiDedication viiPharmacology for Nurses ................................................... ii Introduction ............................................................ xxiv About the Editor .......................................................... xxv Contributors ............................................................ xxvi Reviewers ............................................................. xxviii Section I Pharmacology for Nurses: Basic Principles ....................... 1 Chapter 1 Introduction to Pharmacology .................................... 3 Jean Nicholas , MSN Introduction .................................................. 4 Nursing and Pharmacology ...................................... 4 Drug Classifications ............................................ 5 Drug Names .................................................. 5 Prescription and Nonprescription Drugs ............................ 5 Controlled Substances .......................................... 5 Sources of Drug Information ..................................... 6 QSEN Competencies ............................................ 7 Overview of the Nursing Process .................................. 7 Assessment ................................................... 8 Nursing Diagnosis .............................................. 8 Planning ..................................................... 8 Intervention .................................................. 9 Evaluation ................................................... 9 Cultural Aspects of Drug Therapy ................................. 10 Legal–Ethical Aspects of Drug Therapy ............................. 10 Medication Errors .............................................. 11 How Often Do Medication Errors Occur? ........................... 11 How Can Medication Errors Be Prevented? .......................... 11 Conclusion: Pharmacology in Nursing Practice ....................... 13 Chapter Summary ............................................. 13 References ................................................... 13 Chapter 2 Introduction to Drug Action: The Interplay of Pharmacodynamics and Pharmacokinetics ........................................... 15 Diane F. Pacitti, RPh, PhD Introduction .................................................. 16 What Happens After a Drug Is Administered? ........................ 16 Making the Connection: Pharmacology in Clinical Nursing Practice ....... 17Contents viiiPharmacokinetics Versus Pharmacodynamics ........................ 18 The Relationship Between the Drug and the Body .................... 18 What Is a Drug? ............................................... 18 Advances in New Drug Development: Personalized Medicine ........... 19 Drug Nomenclature ............................................ 19 Chemical Name ................................................... 20 Generic Name ..................................................... 20 Brand Name ...................................................... 20 The Liver: Anatomical First Stop for Orally Administered Drugs . . . . . . . . . . 21 Nursing Considerations ............................................. 23 Drug Meet Patient; Patient Meet Drug .............................. 23 Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Nursing Considerations ............................................. 25 What, Then, Is the Right Dose? ................................... 25 The Interplay of Pharmacokinetics and Pharmacodynamics ............. 25 Pharmacodynamics ............................................ 26 Pharmacokinetics .............................................. 26 Biopharmaceutics .............................................. 26 Nursing Considerations ............................................. 26 Clinical Pharmacology .......................................... 27 Pharmacodynamics ............................................ 28 What the Drug Does to the Body .................................. 28 The Mechanism of Drug Action ................................... 29 The Receptor Molecule .......................................... 29 The Nature of Ligand-Receptor Interactions: Chemical Bonding Interactions/Forces ......................................... 30 Nursing Considerations ............................................. 31 The Drug–Receptor Complex ..................................... 31 The Drug–Receptor Interaction and Therapeutic Response .............. 33 Types of Receptors ............................................. 33 Transmembrane Receptor Activation and Response ................... 33 Signal Transduction ............................................ 33 The Dose-Response Relationship .................................. 34 Pharmacodynamic Parameters Obtained from the Dose-Response Curve ... 35 Efficacy ...................................................... 35 Potency ...................................................... 36 Potency vs. Efficacy: A Source of Confusion ......................... 36 Nursing Considerations ............................................. 36 Limitations of a Dose-Response Curve .............................. 37 The Drug Activity Profile ........................................ 37 Pharmacodynamic Parameters Obtained from the Drug Activity Profile .... 38 Duration of Action ............................................. 38 Onset of Action ................................................ 38 Therapeutic Index ............................................. 38 Classes of Medications .......................................... 39 Agonist Drugs ................................................. 39 Mimic Ligand-Receptor Activation Responses ............................ 39 Antagonist Drugs .............................................. 39 Block the Receptor’s Activation Response ............................... 39 Different Types of Antagonists ........................................ 40 Nursing Considerations ............................................. 40 Contents ixVariability in Pharmacodynamics .................................. 41 Pharmacokinetics .............................................. 41 How the Body Affects the Drug ................................... 41 Overview of the Pharmacokinetic Processes, ADME ................... 42 Absorption ................................................... 42 Distribution .................................................. 42 Metabolism ................................................... 43 Elimination ................................................... 43 Nursing Considerations ............................................. 43 Overview of Pharmacokinetic Terminology .......................... 43 The Pharmacokinetic Parameters Used to Characterize the Rate of Drug Movement .................................. 43 Nursing Considerations ............................................. 43 Pharmacokinetic Studies and Determination of Kinetic Parameters ....... 43 The Plasma Level-Time Curve .................................... 43 Rate Processes of Pharmacokinetics ................................ 44 Zero-Order Rate Process ............................................. 44 Nursing Considerations ............................................. 44 The First-Order Rate Process ......................................... 45 Further Explanation of Rate Constants in Pharmacokinetics . . . . . . . . . . . . . 45 Half-Life in Pharmacokinetics ........................................ 46 Nursing Considerations ............................................. 46 Drug Absorption: The “A” in ADME ............................... 46 The Pharmacokinetics of Oral Absorption ........................... 47 Bioavailability ................................................. 48 Factors Affecting the Rate and Extent of Absorption ................... 49 Impact of First-Pass Effect on Bioavailability ......................... 50 Steady-State Drug Levels ........................................ 50 Nursing Considerations ............................................. 51 Distribution: The “D” in ADME ................................... 51 Pharmacokinetics: Rate of Drug Distribution ......................... 51 Pharmacokinetic Models: Compartmental Model Theory ............... 52 One-Compartment Model ........................................... 52 Multicompartment Model ........................................... 53 Volume of Distribution .......................................... 54 Drug Binding to Plasma Proteins .................................. 55 Competition for Binding Sites ........................................ 56 Ramifications of Protein Binding on Therapy ............................ 57 Metabolism: The “M” in ADME ................................... 57 Enzyme Reactions in the Liver .................................... 58 Metabolism and Liver Blood Flow ................................. 58 Drug Interactions Involving Drug Metabolism ........................ 59 Nursing Considerations ............................................. 59 Elimination: The “E” in ADME ................................... 59 Biliary Excretion of Drugs ....................................... 59 Drug Clearance ................................................ 60 Glomerular Filtration ............................................... 60 Active Renal Secretion .............................................. 60 Tubular Reabsorption ............................................... 61 Case Study: Making the Connection to Clinical Nursing ................ 62 Considerations Affecting Drug Delivery: Dosing Frequency, Timing, and Route .......................................... 62x ContentsChronic Medication Use: Long-Term Dosing Regimens ................. 63 Chapter Summary ............................................. 64 References ................................................... 66 External Links ................................................ 66 Chapter 3 Medication Administration ....................................... 67 Tara Kavanaugh, RN, MSN, MPH, ANP-BC, FNP-BC, WHNP-BC Introduction .................................................. 68 Before Administering Medications: The Eight Medication “Rights” ....... 69 Procedures for Administering Medications .......................... 70 Which Factors Hamper Safe Medication Administration? ............... 70 Systemic Factors in Medication Errors .............................. 71 Proper Procedure for Administering All Medications .................. 72 Administering Oral Medications .................................. 73 Injecting Medications Safely ...................................... 74 Giving Subcutaneous Injections ................................... 74 Preparing the Medication for a Subcutaneous Injection .................... 75 Injectable Pens .................................................... 76 Rotating Injection Sites for Subcutaneous Injections ....................... 77 General Guidelines for Subcutaneous Injections .......................... 77 Intramuscular Injections ........................................ 78 Anatomic Locations for Administering Intramuscular Injections ............. 79 Supplies Needed for Administering Intramuscular Injections ................ 81 General Procedure for Administering Intramuscular Injections .............. 82 Intravenous and Intraosseous Medications .......................... 83 IV Medication Safety Issues ...................................... 83 Matters of Key Concern When Administering IV Medications ............... 84 Administering an IV Medication .................................. 84 Identifying a Site .................................................. 84 Inhaled Medications ............................................ 86 Proper Procedure for Using a Metered-Dose Inhaler or Dry-Powder Inhaler ........................................ 86 Delivering Medication with an Inhaler ................................. 86 Proper Procedure for Administering a Nasal Spray .................... 88 Using a Nebulizer .............................................. 89 Preparing for Nebulizer Therapy ...................................... 89 Using the Nebulizer ................................................ 90 Medication Transfer Across Permeable Tissues ....................... 90 Administering a Transdermal Patch ................................ 90 Applying Topical Preparations .................................... 92 Vaginal Rings ................................................. 93 Administering Vaginal Rings ......................................... 93 Administering Rectal Suppositories ................................ 94 Buccal and Sublingual Administration .............................. 95 Administering a Sublingual or Buccal Medication ......................... 96 Medication Errors .............................................. 97 What are Medication Administration Errors? ........................ 97 Causes and Prevention of Medication Errors ......................... 98 Conclusion: Medication Administration in Nursing Practice ............. 99 Chapter Summary ............................................. 99 Suggested Readings ............................................ 99 References ................................................... 100 Contents xiSection II The Pharmacology of Physiological Systems ................... 103 Chapter 4 Central Nervous System Drugs .................................... 105 Dion M. Mayes-Burnett, RN Nervous System Physiology ...................................... 106 Conditions Affecting CNS Function ................................ 108 Drugs Used for Conditions of the Central Nervous System .............. 109 Classes of Medications for Treating CNS Disorders .................... 109 Analgesics and Pain Management ................................. 109 Acute Versus Chronic Pain ....................................... 110 Narcotics ..................................................... 113 Nursing Process ................................................... 115 Nonsteroidal Anti-Inflammatory Drugs ............................. 117 Nursing Process ................................................... 120 Seizure Disorders and Epilepsy ................................... 121 Anticonvulsants ............................................... 122 Valproic Acid ..................................................... 122 Phenobarbital ..................................................... 123 Levetiracetam ..................................................... 123 Phenytoin ........................................................ 123 Benzodiazepines ................................................... 123 Anticonvulsant Side Effects .......................................... 124 Nursing Process ................................................... 124 Neurodegenerative Diseases ...................................... 125 Parkinson’s Disease ............................................. 126 Carbidopa–Levodopa ............................................... 127 Nursing Process for Carbidopa–Levodopa ............................... 128 Ropinirole ........................................................ 129 Nursing Process for Ropinirole ........................................ 129 Benztropine ...................................................... 130 Nursing Process for Benztropine ...................................... 131 Amantadine ...................................................... 132 Nursing Process for Amantadine ...................................... 132 Alzheimer Disease ............................................. 133 Nursing Process ................................................... 135 Amyotrophic Lateral Sclerosis .................................... 136 Nursing Process ................................................... 137 Musculoskeletal Dysfunction ..................................... 138 Muscle Relaxants .............................................. 138 Specific Drugs and Their Uses ........................................ 139 Side Effects and Contraindications ..................................... 140 Nursing Process ................................................... 140 Local Anesthetics .............................................. 141 Specific Drugs and Uses ............................................. 142 Nursing Process ................................................... 143 Chapter Summary ............................................. 144 Suggested Readings ............................................ 146 References ................................................... 147 Chapter 5 Autonomic Nervous System Drugs ................................. 149 William Mark Enlow, DNP , ACNP , CRNA, DCC, Sue Greenfield, PhD, RN , and Cliff Roberson , DNP , CRNA, APRN Introduction .................................................. 150 The Three Systems of the ANS .................................... 150xii ContentsAnatomy of the Autonomic Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . 150 Integration of ANS Systems .......................................... 151 Sympathetic Nervous System ......................................... 151 Parasympathetic Nervous System ..................................... 152 Neurotransmitters in the Autonomic Nervous System ................. 153 Adrenergic Receptors ........................................... 154 Drugs That Affect the ANS ....................................... 154 Adrenergic Agonist Drugs ....................................... 156 Nonselective Agents ................................................ 156 Selective Adrenergic Agents .......................................... 158 Nursing Considerations for Adrenergic Drugs ............................ 160 Adrenergic Antagonists ......................................... 161 Alpha-Adrenergic Antagonists ........................................ 161 Selectivity ........................................................ 162 Nursing Considerations for α-Receptor Antagonists ....................... 164 Beta-Adrenergic Antagonists ......................................... 164 Selectivity ........................................................ 164 Nursing Considerations for β-Adrenergic Antagonists . . . . . . . . . . . . . . . . . . . . . . 166 Cholinergic Drugs .............................................. 166 Cholinergic Agents ............................................. 166 Directly Acting Acetylcholine Receptor Agonist .......................... 167 Acetylcholinesterase Inhibitors ....................................... 167 Nursing Considerations for Cholinergic Agonists ......................... 169 Nursing Interventions .............................................. 169 Cholinergic Antagonists ......................................... 170 Clinical Indications for Use .......................................... 170 Individual Cholinergic Antagonists .................................... 170 Nursing Process for Cholinergic Antagonists ............................. 171 Nursing Interventions .............................................. 172 Chapter Summary ............................................. 172 Suggested Readings ............................................ 174 References ................................................... 174 Chapter 6 Cardiovascular Medications ...................................... 175 Diane F. Pacitti, RPh, PhD , and Blaine Templar Smith, RPh, PhD Introduction .................................................. 176 The Cardiovascular System ...................................... 176 Treatment of High Blood Pressure ................................. 178 What Is High Blood Pressure? .................................... 181 JNC 7: “Older” Guidelines for Treatment of Hypertension .................. 181 JNC 8: Updated Guidelines for Treatment of Hypertension .................. 181 The Renin–Angiotensin–Aldosterone System (RAAS) .................. 181 Direct Renin Inhibitors .............................................. 183 Angiotensin-Converting-Enzyme Inhibitors (ACE Inhibitors) ............... 183 Angiotensin II Receptor Blockers (ARBs) ............................... 185 Aldosterone Antagonists (AAs) ....................................... 185 The Role of the Autonomic Nervous System in Blood Pressure Regulation ................................. 186 Adverse Effects of Beta-Blockers ...................................... 190 Blockade of α1-Receptors ........................................ 190 Adverse Effects of Alpha-Blockers ..................................... 191 Drug–Drug Interactions ............................................. 191 Calcium-Channel Blockers ....................................... 191 Adverse Effects of Calcium Channel Blockers ............................ 191 Contents xiiiDiuretics ..................................................... 192 Thiazide Diuretics .................................................. 194 Loop Diuretics .................................................... 194 Potassium-Sparing Diuretics ......................................... 195 Hypertensive Emergencies ....................................... 195 Cardiac Agents ................................................ 197 Coronary Artery Disease ........................................ 197 Chest Pain/Angina ............................................. 197 Exertional Angina ................................................. 197 Variant Angina .................................................... 198 Unstable Angina ................................................... 199 Antianginal Agents ................................................. 199 Nursing Considerations ......................................... 200 Hyperlipidemia ................................................ 200 Statin Drugs .................................................. 201 Fibrates ...................................................... 201 Niacin ....................................................... 202 Bile Acid Sequestrants .......................................... 203 Congestive Heart Failure ........................................ 203 Inotropic Agents ............................................... 204 Cardiac Glycosides ............................................. 204 Nursing Considerations ............................................. 204 Prevention of Thrombosis and Stroke: Anticoagulant Therapy ........... 205 Anticoagulants ................................................ 205 Heparin .......................................................... 205 Low-Molecular-Weight Heparin ...................................... 206 Oral Anticoagulants ............................................ 207 Warfarin ......................................................... 207 Direct Thrombin Inhibitors .......................................... 209 Direct Factor Xa Inhibitors ........................................... 209 Antiplatelet Agents ................................................. 210 Antiarrhythmic Agents .......................................... 210 Group I Antiarrhythmics: Sodium-Channel Blockers ...................... 211 Group II Antiarrhythmics: Beta-Blockers ............................... 212 Group III Antiarrhythmics: Potassium-Channel Blockers ................... 212 Group IV Antiarrhythmics: Calcium-Channel Blockers . . . . . . . . . . . . . . . . . . . . . 213 Group V Antiarrhythmics: Miscellaneous ............................... 213 Chapter Summary ............................................. 213 References ................................................... 216 Chapter 7 Respiratory Medications ......................................... 219 Amy Rex Smith, DNSc, RN, ACNS, BC , and Blaine Templar Smith, RPh, PhD Introduction .................................................. 220 Assessment of Lung Function .................................... 221 Asthma ...................................................... 222 Approach to the Treatment of Asthma .............................. 223 Oral Preventive Medications ..................................... 224 Leukotriene-Receptor Antagonists ..................................... 225 Thromboxane Antagonists ........................................... 225 Oral Corticosteroids ................................................ 225 Inhaled Preventive Medications ................................... 226 Inhaled Corticosteroids ............................................. 227xiv Contents