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PHARMACOLOGY DEMYSTIFIED

MARY KAMIENSKI, PhD, RN, FAEN, FNP, CEN

JIM KEOGH

McGRAW-HILL

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DOI: 10.1036/0071462082

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Introduction xiii

CHAPTER 1 An Inside Look at Pharmacology 1

What Is Pharmacology? 2

The Source of Drugs 4

Drugs Names 6 Prescription versus Over-the-Counter Drugs 7

Drug Effects 7

Drug Safety 8

Locating Drug Information 11

Drug Orders 12 The "Five Rights" Way of Drug Administration 16

Summary 20

Quiz 21

CHAPTER 2 Drug Action and Drug Interactions 23

Drug Actions 24

The First Pass Effect 33

Pharmacodynamics 33

Categories of Drug Action 35

Therapeutic Index and Therapeutic Range 35

Side Effects 36

Summary 38

Quiz 39

CHAPTER 3

CHAPTER 4

Pharmacology and the Nursing Process 41

The Nursing Process 42

Nursing Diagnosis 47

Patient Care Plan 48

Teaching the Patient About Drugs 50 Impact of Cultural Influences in

Drug Administration 52

Mother and the Fetus 54

Pediatrics 54

Elderly 55

Summary 57

Quiz 58

Substance Abuse 61

Drug Misuse and Abuse 61

Behavioral Patterns of Addiction 63 Healthcare Professionals and

Substance Abuse 64

Detecting Substance Abuse 65

Delayed Action 67

Substances That Can Be Abused 71

Dependence versus Tolerance 71 Pathophysiologic Changes Occurring in

Substance Abuse 72

Cultural Aspects of Substance Abuse 72

Commonly Abused Substances 73

Nursing Assessment 77

Summary 78

Quiz 79

CHAPTER 5 Principles of Medication Administration 81

The Nursing Process and

Medication Administration 82

Assessment Required for Specific Drugs 84

Administering Medication 87 Evaluating the Patient After

Administering Medication 92

Controlling Narcotics 93

Summary 94

Quiz 94

CHAPTER 6 Route of Administration

Medication and Routes Z-Track Injection Technique Tips for Minimizing Pain Summary Quiz

97 107

110 111

CHAPTER 7 Dose Calculations 113

The Metric System and Medication 113

Converting Metric Units 116 Formulas for Calculating the Desired Dose 117

Parenteral Medications 119

Summary 121

Quiz 122

CHAPTER 8 Herbal Therapy 125

Inside Herbal Therapy 125

Forms of Herbal Therapies 127

Hazards of Herbal Therapeutics 128 Herbals Therapy and the Nursing Process 129

The Do's and Don'ts about Herbs 130

Commonly Used Herbs 131

Summary 135

Quiz 135

CHAPTER 9

CHAPTER 10

CHAPTER 11

CHAPTER 12

Vitamins and Minerals 137

Vitamins 137

Vitamins and the Nursing Process 148

Summary 154

Quiz 154

Fluid and Electrolyte Therapy 157

Body Fluids 158

Electrolytes 158

Fluid Concentration 159

IV Fluids 160

Blood and Blood Products 161

Fluid Replacement 161

Summary 180

Quiz 181

Nutritional Support Therapies 183

Nutrition 183

Nursing Process 189 The Nursing Processing and

Parenteral Nutritional Therapy 192

Summary 193

Quiz 194

Inflammation 197

An Inside Look at Inflammation 197

Combating Inflammation 199

Summary 201

Quiz 201

Antimicrobials—Fighting Infection 203

Microorganisms—A Small Formidable

Opponent 204

Medication—A Formidable Defender 204

Superinfections 205

Preparing to Administer

Antimicrobial Medication 207

Penicillin, Nursing Diagnosis, and Collaborative Problems 214

Penicillin and Patient Education 215

Cephalosporins, Nursing Diagnosis, and Collaborative Problems 217

Macrolides and Drug-Drug Interactions 224 Macrolides, Nursing Diagnosis, and Collaborative Problems 224

Clindamycins and Drug-Drug Interactions 225 Lincosamides, Nursing Diagnosis, and Collaborative Problems 225

Vancomycin and Drug-Drug Interactions 227 Vancomycin, Nursing Diagnosis, and Collaborative Problems 228

Aminoglycosides and

Drug-Drug Interactions 229

Aminoglycosides, Nursing Diagnosis, and Collaborative Problems 230

Tetracyclines and Drug-Drug Interactions 233 Tetracyclines, Nursing Diagnosis, and Collaborative Problems 234

Chloramphenicol and

Drug-Drug Interactions 236

Chloramphenicol Nursing Diagnosis, and Collaborative Problems 236

Fluoroquinolones and

Drug-Drug Interactions 238

Fluoroquinolones, Nursing Diagnosis, and Collaborative Problems 238

Sulfonamides 241

CHAPTER 14

CHAPTER 15

Tuberculosis

243

Antifungal Drugs (Antimycotic Drugs)

246

Antimalarial

247

Anthelmintic

248

Summary

250

Quiz

251

Respiratory Diseases

253

A Brief Look at Respiration

253

Upper Respiratory Tract Disorders

256

Lower Respiratory Disorders

261

Summary

266

Quiz

267

Nervous System Drugs

269

A Brief Look at the Nervous System

269

Central Nervous System Stimulants

271

CNS Depressants

273

Autonomic Nervous System

281

Cholinergics

287

Anticholinergics

287

Antiparkinsonism-Anticholinergic Drugs

288

Antipsychotics

295

Phenothiazines

296

Depression

297

Summary

301

Quiz

302

Narcotic Agonists

305

A Close Look at Pain

305

Influences on Administrating

Pain Medication

306

Components of Pain

307

The Gate Control Theory

Defining Pain Pain Assessment

Pharmacologic Management of Pain

Summary

Quiz

Immunologic Agents

A Brief Look at Immunity Vaccines

Preventing Diseases

Summary

Quiz

CHAPTER 18 Gastrointestinal System

CHAPTER 19

CHAPTER 20

Cardiac Circulatory Medications

A Brief Look at the Cardiovascular System

Circulatory Disorders

Summary

Quiz

Skin Disorders

A Brief Look at the Skin Skin Disorders Summary Quiz

Endocrine Medications

A Brief Look at the Endocrine System

Drugs and Hormones

Summary

Quiz

A Brief Look at the Gastrointestinal System 329 Summary Quiz

347 364

CHAPTER 22

Disorders of the Eye and Ear 399

Eye Disorders 399

Patient Education for Eye Medication 403

Ear Disorders 405

Patient Education for Ear Medication 408

Summary 408

Quiz 409

Final Exam 411

Answers to Quiz and Final Exam Questions 425

Appendix 431

Index

One of the most important roles of the nurse is to administer medications. Understanding how a drug interacts with the human body will help a nurse administer drugs safely to patients.

Pharmacology Demystified shows you:

• How to calculate the proper dose

• How to administer drugs

• How to evaluate the drug's effectiveness

• How to avoid common errors when administering drugs

You might be a little apprehensive learning pharmacology, especially if you have little, if any, experience with drugs. Pharmacology can be mystifying. However, it becomes demystified as you read Pharmacology Demystified because your knowledge of basic science is used as the foundation for learning pharmacology.

As you'll see in Chapter 1, each element of pharmacology is introduced by combining just the pharmacology element with facts you already know from your study of basic science.

Pharmacology is different than other basic science that you've learned—but not so different that you won't be able to quickly build upon your present knowledge base. All you need is a working knowledge of basic science—and Pharmacology Demystified—to become knowledgeable in pharmacology.

By the end of this book, you'll have an understanding of drugs that are used to cure common disorders. You'll know how they work, their side effects, adverse effects, and when they are not to be administered to patients. Furthermore, you'll learn how long it takes the drug to take effect and how long the therapeutic effect lasts.

Copyright © 2006 by The McGraw-Hill Companies, Inc. Click here for terms of use.

A Look Inside

Pharmacology can be challenging to learn unless you follow the step-by-step approach that is used in Pharmacology Demystified. Topics are presented in a systematic order—starting with basic components and then gradually moving on to those features found on classy web sites.

Each chapter follows a time-tested formula that first explains the topic in an easy-to-read style and then shows how it is used in a working web page that you can copy and load yourself. You can then compare your web page with the image of the web page shown in the chapter to be sure that you've coded the web page correctly. There is little room for you to go wrong.

CHAPTER 1: AN INSIDE LOOK AT PHARMACOLOGY

The mere mention of drugs brings all sorts of images to mind. However, these impressions are based on our experience as patients. Healthcare providers have a different view because they see drugs as an arsenal to combat disease. A drug is more than a pill. It is a compound of chemical elements that interacts with the body's chemistry causing a chain reaction of events. Healthcare providers need a thorough understanding of a drug's action in order to effectively prescribe and administer the drug to the patient. Therefore you begin in Chapter 1 learning the basic concepts of pharmacology.

CHAPTER 2: DRUG ACTION AND DRUG INTERACTIONS

Drugs are not magical. They follow proven scientific principles to interact with cells in your body to bring about a pharmaceutical response—cure your ills. In this chapter you'll learn about the scientific principles that seem to miraculously make you better when you feel rotten all over. You will learn how drugs stimulate your body's own defense mechanism to stamp out pathogens that give you the sniffles or cause serious diseases.

CHAPTER 3: PHARMACOLOGY AND THE NURSING PROCESS

Remember from your last hospital stay being awakened from a deep sleep by a nurse saying, "time to take your medicine." The nurse didn't enjoy disturbing you. It was part of standard nursing procedures used to administer medication. You'll learn about those procedures in this chapter so you too can wake up your patients to give them medication.

CHAPTER 4: SUBSTANCE ABUSE

Drugs can wipe out microorganisms that attack our body. However, some drugs can be abused resulting in an individual becoming dependent on the medication. Substance abuse is the most publicized aspect of pharmacology—and the one least understood by patients and healthcare professionals. This chapter explores drugs that are commonly abused and discusses how to detect substance abuse.

CHAPTER 5: PRINCIPLES OF MEDICATION ADMINISTRATION

Administering medication can be downright dangerous unless you follow time-tested procedures that assure that the patient receives the right drug in the right dose at the right time using the right route. In this chapter, you'll learn how this is done and how to avoid common errors that could harm your patient.

CHAPTER 6: ROUTE OF ADMINISTRATION

The way a drug is administered to a patient is called a route. Your job is to administer medication using the best route to achieve the desired therapeutic effect. This depends on a number of factors that include the type of medication and the patient's condition. In this chapter, you'll learn how to administer drugs.

CHAPTER 7: DOSE CALCULATIONS

Although a prescriber specifies a dose of a medication for a patient, a different dose may be on hand requiring you to calculate the actual dose. With intravenous medication, the prescriber usually orders a dose to be infused over a specific period of time. You must calculate the drip rate to properly set the IV. This chapter shows you how to calculate doses of medication.

CHAPTER 8: HERBAL THERAPY

Herbal therapy is used to treat the common cold, infections, diseases of the GI tract, and about anything else that ails you. Herbs are naturally grown and don't have the quality standards found in prescription and over-the-counter medications. You'll learn about the therapeutic effect of herbal therapies in this chapter and the adverse reactions patients can experience when herbal therapy is combined with conventional therapy.

CHAPTER 9: VITAMINS AND MINERALS

Vitamins and minerals build a strong, healthy body, so you've been told when you were growing up. It is true. A balanced diet provides the vitamins and minerals you need to stay healthy. However, many patients don't have a balanced diet and therefore experience vitamin and mineral deficiencies. In this chapter, you'll learn about vitamins and minerals and how to provide vitamin therapy and mineral therapy for your patients.

CHAPTER 10: FLUID AND ELECTROLYTE THERAPY

Some diseases and treatment of disease can cause an imbalance in the body's fluids and electrolytes needed for muscle contraction and other functions. Administering electrolyte therapy to the patient restores balance. You'll learn how this is done.

CHAPTER 11: NUTRITIONAL SUPPORT THERAPIES

Nutrients are given to patients who are at risk for malnutrition caused by disease and by treatment given to cure the disease. Nutrients are also given to strengthen the patient following a trauma such as surgery. In this chapter, you'll learn about nutritional support therapies, how to prepare them, how to administer them, and how to avoid any complications that might arise.

CHAPTER 12: INFLAMMATION

Fortunately, most times the pain goes away and the inflammation subsides relatively quickly and doesn't interfere with daily activities. In this chapter, you'll learn about the process of inflammation and the medications that are prescribed to reduce the redness, swelling, warmth, and pain that is associated with inflammation.

CHAPTER 13: ANTIMICROBIALS-FIGHTING INFECTION

The immune system produces antibodies that seek out, attack, and kill microbials. However, this natural defense isn't sufficient for some patients leaving them with a runny nose, headache, and fever. They need to call in the cavalry. The cavalry is medication that kills the invading microbial. You'll learn about antimicrobial medication in this chapter.

CHAPTER 14: RESPIRATORY DISEASES

The common cold can be annoying. However, some respiratory diseases—such as emphysema—are debilitating and can slowly choke the life out of a person. In this chapter, we'll explore common respiratory diseases and learn about the medications that are used to manage the symptoms of the disease.

CHAPTER 15: NERVOUS SYSTEM DRUGS

The nervous system is our Internet over which sensory impulses travel the neural pathways to the brain where they are interpreted and analyzed for an appropriate response. Sometimes disease or other disorders cause the impulse to go astray or be misinterpreted. Drugs can be prescribed that restore the function of the nervous system. You'll learn about those drugs in this chapter.

CHAPTER 16: NARCOTIC AGONISTS

Make the pain go away. That's what most of us want when we hurt. However, pain is subjective and can be difficult for healthcare providers to manage with the appropriate medication. This chapter explores pain and how healthcare providers assess and manage pain. You'll also learn about narcotic and nonnarcotic analgesics and how they are used to treat pain.

CHAPTER 17: IMMUNOLOGIC AGENTS

When the immune system is compromised through diseases including HIV, the body loses its ability to fight off microorganisms and destroys its own abnormal cells, leaving the patient to experience more episodes of infection that can ultimately lead to death. In this chapter, you'll learn about the therapies used to assist the immune system combat preventable diseases and you'll also learn about medications that inhibit the growth of HIV.

CHAPTER 18: GASTROINTESTINAL SYSTEM

Problems with the gastrointestinal system can be vomiting, ingesting toxins, diarrhea, constipation, peptic ulcers, and gastroesophageal reflux disease. Each is treatable with the proper medication. In this chapter, you'll learn about common gastrointestinal disorders and the medications that are frequently prescribed to treat these conditions.

CHAPTER 19: CARDIAC CIRCULATORY MEDICATIONS

When blood vessels become clogged and the heart is unable to pump blood sufficiently, the body loses its ability to distribute oxygen, nutrients, and hormones and remove waste products placing the patient in grave danger. Fortunately, there are medications that can be taken to treat and prevent cardiovascular disorders. In this chapter, you'll learn about drugs that affect the heart and keep the cardiovascular system humming.

CHAPTER 20: SKIN DISORDERS

Acne, dry skin, a rash, and injuries such as cuts, scrapes, puncture wounds, and burns are some disorders that affect your skin. Some of these are more annoying than endangering to your existence. This chapter discusses using medications to relieve most of the disorders.

CHAPTER 21: ENDOCRINE MEDICATIONS

Hormones are messengers that influence how tissues, organs, and other parts of your body function. An overproduction or underproduction of hormones can cause the body to function improperly. Hormones are brought back into balance by using endocrine medications, which are discussed in this chapter.

CHAPTER 22: DISORDERS OF THE EYE AND EAR

Common eye and ear disorders rarely result in loss of sight and hearing once the disorder is diagnosed and treated with the proper medication. This chapter takes a look at common disorders that affect the eyes and the ears and discusses drugs that are used to treat those disorders.

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