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Pharmacology for the Primary Care Provider - E-Book

Pharmacology for the Primary Care Provider - E-Book

Marilyn Winterton Edmunds | Maren Stewart Mayhew

(2008)

Additional Information

Book Details

Abstract

Written by and for nurse practitioners, this practical textbook focuses on what primary care providers need to learn and practice drug therapy. With an overall emphasis on patient teaching and health promotion, you will learn how to provide effective patient teaching about medications and how to gain patient compliance. Drug coverage focuses on “key drugs” rather than “prototype drugs,” so you can find important information about the most commonly used drugs rather than the first drug in each class. You will also find discussions on the legal and professional issues unique to nurse practitioners and other primary care providers. The 3rd edition also features an expanded emphasis on established clinical practice guidelines and evidence-based practice, plus two new chapters that cover drugs for ADHD and drugs for dementia.

  • UNIQUE! Written specifically for nurse practitioners with an overall emphasis on patient teaching and health promotion.
  • UNIQUE! Covers specific topics such as prescriptive authority, role implementation, and writing prescriptions.
  • Presents comprehensive coverage of the drugs most commonly prescribed in – and the issues most relevant to – primary care practice.
  • UNIQUE! Identifies the Top 200 drugs in chapter openers with a special icon and covers them in-depth to familiarize you with the most important, need-to-know drug information.
  • Uses a consistent heading scheme for each prototype drug discussion to make it easier to learn and understand key concepts.
  • Includes an introductory chapter on “Design and Implementation of Patient Education” that highlights content on patient teaching and compliance.
  • Includes specific “Patient Education” sections in each drug chapter.
  • Provides extensive coverage of drug therapy for special populations to alert you to special considerations based on age, pregnancy, race and other factors.
  • A separate chapter on “Complementary and Alternative Therapies” discusses the available complementary and alternative modalities, including detailed information on actions, uses, and interactions of commonly used herbs.
  • Drug Overview tables at the beginning of each chapter outline the classifications of drugs discussed and provide a handy reference of drug classes and subclasses, generic names, and trade names.
  • Clinical Alerts highlight essential information that primary care providers must remember in order to avoid serious problems, including cautions for prescribing, information about drug interactions, or warnings about particularly ominous adverse effects.
  • An entire unit covers drugs for health promotion to introduce you to drugs commonly seen in outpatient primary care settings and to prepare you for practice in a society increasingly focused on health promotion and disease prevention.
  • Includes separate chapters on Immunizations and Biologicals, Weight Management, Smoking Cessation, Vitamins and Minerals, Over-the-Counter Medications, and Complementary and Alternative Therapies.

Table of Contents

Section Title Page Action Price
Front cover Cover
Evolve page ii
Pharmacology for the Primary Care Provider iii
Copyright page iv
Contributors v
Reviewers vi
Preface vii
Table of contents xi
ONE ESSENTIAL CONCEPTS FOR THE PRESCRIPTION OF MEDICATIONS 1
1 Foundations of Prescriptive Practice 1
1 Prescriptive Authority and Role Implementation: Tradition vs. Change 1
INCREASED FOCUS ON PRIMARY CARE 1
TRADITIONAL PROVISION OF PRIMARY CARE 1
IMPORTANCE OF PRESCRIPTIVE AUTHORITY IN HEALTH CARE DELIVERY 2
RESEARCH ON PRESCRIPTIVE PRACTICE OF PHYSICIANS 2
PROBLEMS IN THE PRESCRIBING PRACTICE OF PHYSICIANS 3
SUMMARY 4
2 Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants 5
OVERVIEW 5
THE PRESCRIPTIVE AUTHORITY OF NURSES 6
LEGAL FOUNDATION OF PRESCRIPTIVE AUTHORITY FOR NURSES IN ADVANCED PRACTICE ROLES 7
AN OVERVIEW OF THE PRESCRIBING OF ADVANCED PRACTICE NURSES 8
PRESCRIBING CONTROLLED SUBSTANCES 15
DISPENSING PRIVILEGES 16
RESEARCH ON THE PRESCRIPTIVE PRACTICES OF ADVANCED PRACTICE NURSES: NPs, CNMs, CRNAs, AND CNSs 16
BARRIERS TO PRACTICE FOR NURSES IN THE DIAGNOSING AND PRESCRIBING ROLES 17
PRESCRIPTIVE AUTHORITY AND THE PHYSICIAN’S ASSISTANT 18
ACKNOWLEDGMENTS 22
2 Pharmacokinetics and Pharmacodynamics 23
3 General Pharmacokinetic and Pharmacodynamic Principles 23
DRUG NOMENCLATURE 23
PHARMACOKINETICS 23
PHARMACODYNAMICS 34
PRACTICAL APPLICATION OF PHARMACOKINETICS AND PHARMACODYNAMICS TO DRUG PRESCRIBING 49
SUMMARY 51
4 Special Populations: Geriatrics 52
FUNCTIONAL ASSESSMENT 52
PHARMACOKINETIC CHANGES THAT AFFECT DRUG THERAPY 52
PHARMACODYNAMIC CHANGES IN THE ELDERLY THAT MAY AFFECT DRUG THERAPY 55
COMMON CONCERNS RELATED TO MEDICATION USE IN OLDER ADULTS 57
PROCESS MODEL OF PRESCRIBING FOR THE ELDERLY 60
5 Special Populations: Pediatrics 62
PHARMACOKINETICS OF DRUG THERAPY IN INFANTS AND CHILDREN 62
EFFECT OF DISEASE ON DRUG PROCESSES IN CHILDREN 65
CHOOSING A DRUG REGIMEN 65
ADVERSE DRUG REACTIONS IN CHILDREN 66
CALCULATIONS OF PEDIATRIC DOSAGES 66
STATUS OF DRUG DOSING AND POLICY REGARDING CHILDREN 69
SPECIAL COMPLIANCE PROBLEMS IN CHILDREN 71
SUMMARY 71
6 Special Populations: Pregnant and Nursing Women 72
DRUGS IN PREGNANT WOMEN 73
PRINCIPLES OF TERATOLOGY: INCIDENCE AND TYPES OF MALFORMATIONS 73
COMMON CONDITIONS REQUIRING TREATMENT DURING PREGNANCY 76
SPECIFIC INFECTIONS OF CONCERN 78
KNOWN HAZARDS TO MOTHERS AND THEIR CHILDREN 83
DRUGS IN BREASTFEEDING MOTHERS 85
3 The Art and Science of Pharmacotherapeutics 90
7 Establishing the Therapeutic Relationship 90
ESTABLISHING THERAPEUTIC RELATIONSHIPS IN TREATMENT 90
FAILURE OF THE THERAPEUTIC RELATIONSHIP 95
SUMMARY 97
8 Practical Tips on Writing Prescriptions 98
WHO MAY WRITE PRESCRIPTIONS? 98
DRUG SCHEDULES 98
COMPONENTS OF THE TRADITIONAL PRESCRIPTION 99
ELECTRONIC DRUG PRESCRIPTIONS OR E-SIGN 102
DRUG PRESCRIBING ETIQUETTE 102
AVOIDING MISTAKES 103
ADMINISTRATIVE CONCERNS 104
PREVENTING PROBLEMS IN DRUG USE 107
GOOD COMMUNICATION AND DEVELOPING A POSITIVE RELATIONSHIP WITH THE PHARMACIST 107
SUMMARY 108
9 Treatment Guidelines and Evidence-Based Decision Making 109
CRITICAL DECISION MAKING 109
CRITICAL THINKING 109
DECISION MAKING 111
EVIDENCE-BASED MEDICINE 117
CLINICAL GUIDELINES 121
SUMMARY 124
10 Design and Implementation of Patient Education 126
THE PROCESS OF PATIENT EDUCATION 126
EVALUATION OF LEARNING 131
SUMMARY 134
TWO DRUG MONOGRAPHS 136
4 Topical Agents 136
11 Dermatologic Agents 136
THERAPEUTIC OVERVIEW OF DERMATOLOGIC AGENTS 137
MECHANISM OF ACTION 138
THERAPEUTIC OVERVIEW OF TOPICAL CORTICOSTEROIDS 140
MECHANISM OF ACTION 140
TREATMENT PRINCIPLES 140
SPECIFIC DRUGS 142
THERAPEUTIC OVERVIEW OF TOPICAL ANTIINFECTIVES 143
MECHANISM OF ACTION 143
TREATMENT PRINCIPLES 143
SPECIFIC DRUGS 144
THERAPEUTIC OVERVIEW OF ANTIFUNGALS 146
MECHANISM OF ACTION 146
TREATMENT PRINCIPLES 146
5 Respiratory Agents 169
13 Upper Respiratory Agents 169
THERAPEUTIC OVERVIEW OF UPPER RESPIRATORY INFECTION AND ALLERGIC RHINITIS 171
MECHANISM OF ACTION 171
TREATMENT PRINCIPLES 172
SPECIFIC DRUGS 178
INTRANASAL STEROIDS 184
14 Asthma and COPD Medications 188
THERAPEUTIC OVERVIEW OF ASTHMA 189
THERAPEUTIC OVERVIEW OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE 191
MECHANISM OF ACTION 192
TREATMENT PRINCIPLES OF ASTHMA 193
TREATMENT PRINCIPLES OF COPD 196
SPECIFIC DRUGS 200
6 Cardiovascular Agents 209
15 Hypertension and Miscellaneous Antihypertensive Medications 209
THERAPEUTIC OVERVIEW OF HYPERTENSION 209
MECHANISM OF ACTION 211
TREATMENT PRINCIPLES 211
SPECIFIC DRUGS 217
16 Coronary Artery Disease and Antianginal Medications 221
THERAPEUTIC OVERVIEW OF CORONARY ARTERY DISEASE 221
MECHANISM OF ACTION 225
TREATMENT PRINCIPLES 225
SPECIFIC DRUGS 229
17 Chronic Heart Failure and Digoxin 233
THERAPEUTIC OVERVIEW OF CHRONIC HEART FAILURE 233
MECHANISM OF ACTION 236
TREATMENT PRINCIPLES 236
SPECIFIC DRUGS 240
18 β -Blockers 242
MECHANISM OF ACTION 242
TREATMENT PRINCIPLES 244
SPECIFIC DRUGS 249
19 Calcium Channel Blockers 251
THERAPEUTIC OVERVIEW 251
MECHANISM OF ACTION 251
TREATMENT PRINCIPLES 254
SPECIFIC DRUGS 256
20 ACE Inhibitors and Angiotensin Receptor Blockers 259
THERAPEUTIC OVERVIEW 259
MECHANISM OF ACTION 259
TREATMENT PRINCIPLES 261
SPECIFIC DRUGS 264
21 Antiarrhythmic Agents 268
THERAPEUTIC OVERVIEW OF ARRHYTHMIAS 268
MECHANISM OF ACTION 271
TREATMENT PRINCIPLES 273
SPECIFIC DRUGS 274
22 Antihyperlipidemic Agents 279
THERAPEUTIC OVERVIEW 280
MECHANISM OF ACTION 281
TREATMENT PRINCIPLES 282
SPECIFIC DRUGS 287
23 Agents That Act on Blood 292
THERAPEUTIC OVERVIEW 293
MECHANISM OF ACTION 295
TREATMENT PRINCIPLES 296
SPECIFIC DRUGS 302
7 Gastrointestinal Agents 310
24 Antacids and the Management of GERD 310
THERAPEUTIC OVERVIEW OF GASTROESOPHAGEAL REFLUX DISEASE 310
MECHANISM OF ACTION 311
TREATMENT PRINCIPLES 311
SPECIFIC DRUGS 313
25 Histamine-2 Blockers and Proton Pump Inhibitors 316
THERAPEUTIC OVERVIEW 316
MECHANISM OF ACTION 318
TREATMENT PRINCIPLES 318
SPECIFIC DRUGS 320
26 Laxatives 324
THERAPEUTIC OVERVIEW 325
MECHANISM OF ACTION 326
TREATMENT PRINCIPLES 326
SPECIFIC DRUGS 330
27 Antidiarrheals 335
THERAPEUTIC OVERVIEW 335
MECHANISM OF ACTION 336
TREATMENT PRINCIPLES 336
SPECIFIC DRUGS 337
28 Antiemetics 340
THERAPEUTIC OVERVIEW 340
MECHANISM OF ACTION 341
TREATMENT PRINCIPLES 342
SPECIFIC DRUGS 343
29 Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems 346
THERAPEUTIC OVERVIEW OF IRRITABLE BOWEL SYNDROME 346
MECHANISM OF ACTION 347
TREATMENT PRINCIPLES 347
SPECIFIC DRUGS 348
8 Renal/Genitourinary Agents 353
30 Diuretics 353
THERAPEUTIC OVERVIEW 353
MECHANISM OF ACTION 354
TREATMENT PRINCIPLES 355
SPECIFIC DRUGS 360
MECHANISM OF ACTION 366
TREATMENT PRINCIPLES 366
SPECIFIC DRUGS 367
31 Male Genitourinary Agents 368
THERAPEUTIC OVERVIEW 368
MECHANISM OF ACTION 369
TREATMENT PRINCIPLES 369
SPECIFIC DRUGS 370
THERAPEUTIC OVERVIEW 370
MECHANISM OF ACTION 373
TREATMENT PRINCIPLES 373
SPECIFIC DRUGS 374
32 Agents for Urinary Incontinence and Urinary Analgesia 376
THERAPEUTIC OVERVIEW 376
MECHANISM OF ACTION 377
DRUG TREATMENT PRINCIPLES 378
SPECIFIC DRUGS 379
9 Musculoskeletal Agents 383
33 Acetaminophen 383
THERAPEUTIC OVERVIEW 383
MECHANISM OF ACTION 383
TREATMENT PRINCIPLES 384
SPECIFIC DRUGS 385
34 Aspirin and Nonsteroidal Antiinflammatory Medications 387
THERAPEUTIC OVERVIEW 388
MECHANISM OF ACTION 390
TREATMENT PRINCIPLES 391
SPECIFIC DRUGS 394
NSAIDs 396
35 Disease-Modifying Antirheumatic Medications and Immune Modulators 400
THERAPEUTIC OVERVIEW 400
MECHANISM OF ACTION 401
TREATMENT PRINCIPLES 402
SPECIFIC DRUGS 404
36 Gout Medications 406
THERAPEUTIC OVERVIEW 406
MECHANISM OF ACTION 407
TREATMENT PRINCIPLES 407
SPECIFIC DRUGS 410
37 Osteoporosis Treatment 413
THERAPEUTIC OVERVIEW 413
MECHANISM OF ACTION 415
TREATMENT PRINCIPLES 415
SPECIFIC DRUGS 418
38 Muscle Relaxants 422
THERAPEUTIC OVERVIEW 422
MECHANISM OF ACTION 423
TREATMENT PRINCIPLES 424
SPECIFIC DRUGS 425
10 Central Nervous System Agents 428
39 Overview of the Nervous System 428
NERVE CELL (NEURON) AND SYNAPTIC TRANSMISSION 428
CENTRAL NERVOUS SYSTEM 428
PERIPHERAL NERVOUS SYSTEM 429
AUTONOMIC NERVOUS SYSTEM 431
FUNCTION 434
40 Medications for Attention-Deficit/Hyperactivity Disorder 436
THERAPEUTIC OVERVIEW 437
MECHANISM OF ACTION 438
TREATMENT PRINCIPLES 438
SPECIFIC DRUGS 440
41 Medications for Dementia 443
THERAPEUTIC OVERVIEW 443
MECHANISM OF ACTION 444
TREATMENT PRINCIPLES 444
SPECIFIC DRUGS 446
42 Analgesia and Pain Management 448
THERAPEUTIC OVERVIEW 449
MECHANISM OF ACTION 451
TREATMENT PRINCIPLES 452
SPECIFIC DRUGS 454
43 Migraine Medications 462
THERAPEUTIC OVERVIEW 462
MECHANISM OF ACTION 464
TREATMENT PRINCIPLES 465
SPECIFIC DRUGS 469
44 Anticonvulsants 474
THERAPEUTIC OVERVIEW 476
MECHANISM OF ACTION 477
TREATMENT PRINCIPLES 477
SPECIFIC DRUGS 482
45 Antiparkinson Agents 488
THERAPEUTIC OVERVIEW 488
MECHANISM OF ACTION 490
TREATMENT PRINCIPLES 490
SPECIFIC DRUGS 494
MAO-B INHIBITOR 495
COMT INHIBITOR 500
11 Psychotropic Agents 501
46 Antidepressants 501
THERAPEUTIC OVERVIEW 502
MECHANISM OF ACTION 505
TREATMENT PRINCIPLES 506
SPECIFIC DRUGS 512
47 Antianxiety and Antiinsomnia Agents 520
THERAPEUTIC OVERVIEW 521
MECHANISM OF ACTION 524
TREATMENT PRINCIPLES OF ANTIANXIETY AGENTS 524
TREATMENT PRINCIPLES OF ANTIINSOMNIA AGENTS 526
TREATMENT PRINCIPLES OF BENZODIAZEPINES 526
SPECIFIC DRUGS 527
48 Antipsychotics 532
THERAPEUTIC OVERVIEW 533
MECHANISM OF ACTION 535
TREATMENT PRINCIPLES 535
SPECIFIC DRUGS 539
49 Substance Abuse 545
THERAPEUTIC OVERVIEW 545
MECHANISM OF ACTION AND EFFECTS OF ALCOHOL TREATMENT 547
TREATMENT PRINCIPLES 547
SPECIFIC DRUGS 548
12 Endocrine Agents 552
50 Glucocorticoids 552
THERAPEUTIC OVERVIEW 552
MECHANISM OF ACTION 552
TREATMENT PRINCIPLES 554
SPECIFIC DRUGS 556
51 Thyroid Medications 559
THERAPEUTIC OVERVIEW 559
MECHANISM OF ACTION 560
TREATMENT PRINCIPLES 560
SPECIFIC DRUGS 562
THERAPEUTIC OVERVIEW 565
MECHANISM OF ACTION 565
TREATMENT PRINCIPLES 565
SPECIFIC DRUGS 566
52 Diabetes Mellitus Agents 568
THERAPEUTIC OVERVIEW 569
MECHANISM OF ACTION 570
TREATMENT PRINCIPLES 572
SPECIFIC DRUGS 577
13 Female Reproductive System Medications 584
53 Contraceptives 584
THERAPEUTIC OVERVIEW 586
MECHANISM OF ACTION 589
TREATMENT PRINCIPLES 592
SPECIFIC DRUGS 600
54 Menopause Hormone Therapy 604
THERAPEUTIC OVERVIEW OF HORMONE THERAPY 605
MECHANISM OF ACTION 607
TREATMENT PRINCIPLES 608
SPECIFIC DRUGS 610
55 Agents Used in Treating Breast Cancer 617
THERAPEUTIC OVERVIEW 617
MECHANISM OF ACTION 618
TREATMENT PRINCIPLES 618
SPECIFIC DRUGS 619
14 Antiinfectives 622
56 Principles for Prescribing Antiinfectives 622
THERAPEUTIC OVERVIEW 622
MECHANISM OF ACTION 626
TREATMENT PRINCIPLES 626
57 Treatment of Specific Infections and Miscellaneous Antibiotics 629
THERAPEUTIC OVERVIEW 629
SPECIFIC DRUGS 638
58 Penicillins 640
THERAPEUTIC OVERVIEW 640
MECHANISM OF ACTION 642
TREATMENT PRINCIPLES 642
SPECIFIC DRUGS 644
59 Cephalosporins 647
THERAPEUTIC OVERVIEW 647
MECHANISM OF ACTION 649
TREATMENT PRINCIPLES 649
SPECIFIC DRUGS 650
60 Tetracyclines 653
THERAPEUTIC OVERVIEW 653
MECHANISM OF ACTION 653
TREATMENT PRINCIPLES 654
SPECIFIC DRUGS 655
61 Macrolides 658
MECHANISM OF ACTION 658
TREATMENT PRINCIPLES 659
SPECIFIC DRUGS 660
62 Fluoroquinolones 663
THERAPEUTIC OVERVIEW 663
MECHANISM OF ACTION 663
TREATMENT PRINCIPLES 664
SPECIFIC DRUGS 665
NOTE 667
63 Aminoglycosides 668
THERAPEUTIC OVERVIEW 668
MECHANISM OF ACTION 669
TREATMENT PRINCIPLES 669
SPECIFIC DRUGS 670
64 Sulfonamides 672
THERAPEUTIC OVERVIEW 672
MECHANISM OF ACTION 673
TREATMENT PRINCIPLES 673
SPECIFIC DRUGS 674
65 Antitubercular Agents 676
THERAPEUTIC OVERVIEW 676
MECHANISM OF ACTION 678
TREATMENT PRINCIPLES 678
SPECIFIC DRUGS 680
66 Antifungals 687
THERAPEUTIC OVERVIEW 688
MECHANISM OF ACTION 689
TREATMENT PRINCIPLES 689
SPECIFIC DRUGS 691
67 The Immune System and Antiretroviral Medications 696
THERAPEUTIC OVERVIEW OF HIV AND RETROVIRUSES 697
MECHANISM OF ACTION 698
TREATMENT PRINCIPLES 701
SPECIFIC DRUGS 703
68 Antivirals and Antiprotozoal Agents 709
THERAPEUTIC OVERVIEW OF VIRUSES AND PROTOZOA 709
MECHANISM OF ACTION 710
TREATMENT PRINCIPLES 711
SPECIFIC DRUGS 713
15 Health Promotion 719
69 Immunizations and Biologicals 719
THERAPEUTIC OVERVIEW 720
MECHANISM OF ACTION 723
THERAPEUTIC OVERVIEW 723
TREATMENT PRINCIPLES 724
SPECIFIC VACCINES 727
70 Weight Management 740
THERAPEUTIC OVERVIEW 740
MECHANISM OF ACTION 742
TREATMENT PRINCIPLES 742
SPECIFIC DRUGS 745
71 Smoking Cessation 748
THERAPEUTIC OVERVIEW 748
MECHANISM OF ACTION 749
TREATMENT PRINCIPLES 749
SPECIFIC DRUGS 758
72 Vitamins and Minerals 760
VITAMINS 768
MINERALS 769
FAT-SOLUBLE VITAMINS 771
WATER-SOLUBLE VITAMINS 773
MINERALS 776
73 Over-the-Counter Medications 782
EXTENT OF OTC MEDICATION USE 782
ADVANTAGES AND DISADVANTAGES OF OTC USE 783
HOW CAN THE PRIMARY CARE PROVIDER BE HELPFUL TO PATIENTS WHO ARE TAKING OTC MEDICATIONS? 784
SUMMARY 786
74 Complementary and Alternative Therapies 787
DEFINING COMPLEMENTARY AND ALTERNATIVE THERAPIES 787
PRIMARY CARE PROVIDERS AND COMPLEMENTARY AND ALTERNATIVE THERAPIES 788
COMPLEMENTARY THERAPIES AND HERBAL MEDICINE 789
DRUG–HERB INTERACTIONS 792
PATIENT VARIABLES 794
SUMMARY 795
Readings and References 797
Index 824
Appendix: Economic Foundations of Prescriptive Authority 1