Additional Information
Book Details
Abstract
A favorite among nursing students, Pharmacology for Nursing Care, 8th Edition, features a uniquely engaging writing style, clear explanations, and unmatched clinical precision and currency to help you gain a solid understanding of key drugs and their implications -- as opposed to just memorization of certain facts. Compelling features such as a drug prototype approach, use of large and small print to distinguish need-to-know versus nice-to-know content, and a focus on major nursing implications save you study time by directing your attention on the most important, need-to-know information. The new edition also features an abundance of content updates to keep you ahead of the curve in school and in professional practice.
- UNIQUE! Engaging writing style with clear explanations makes content easy to grasp and even enjoyable to learn.
- A drug prototype approach uses one drug within each drug family to characterize all members of its group to help you learn about related drugs currently on the market and drugs that will be released once you begin practice.
- UNIQUE! Special Interest Topic boxes address timely issues in pharmacology and connect pharmacology content with current trends.
- Large print/small print design distinguishes essential "need-to-know" information from "nice-to-know" information.
- Limited discussion of adverse effects and drug interactions keeps your limited study time focused on only the most clinically important information.
- Reliance on up-to-date evidence-based clinical guidelines ensures that therapeutic uses are clinically relevant.
- Integrated and summarized nursing content demonstrates the vital interplay between drug therapy and nursing care.
- Coverage of dietary supplements and herbal interactions equips you to alert patients and caregivers to the potential dangers of certain dietary supplements, including interactions with prescribed and over-the-counter drugs and herbal therapies.
- Additional learning features provide a touchstone for study and review as you complete reading assignments and build a foundation of pharmacologic knowledge.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| IFC facing page | i | ||
| Evolve page | ii | ||
| Lehne's Pharmacology for Nursing Care | iii | ||
| Copyright page | iv | ||
| Dedication | v | ||
| About the Authors | vi | ||
| Contributors and Reviewers | vii | ||
| Preface | viii | ||
| Laying Foundations in Basic Principles | viii | ||
| Reviewing Physiology and Pathophysiology | viii | ||
| Teaching Through Prototypes | viii | ||
| Using Clinical Reality to Prioritize Content | ix | ||
| Nursing Implications: Demonstrating the Application of Pharmacology in Nursing Practice | ix | ||
| What’s New in the Book? | ix | ||
| Learning Supplements for Students | ix | ||
| Teaching Supplements for Instructors | ix | ||
| Ways to Use This Textbook | ix | ||
| Acknowledgments | x | ||
| Unit I Introduction | 1 | ||
| 1 Orientation to Pharmacology | 1 | ||
| Four Basic Terms | 1 | ||
| Drug. | 1 | ||
| Pharmacology. | 1 | ||
| Clinical Pharmacology. | 1 | ||
| Therapeutics. | 1 | ||
| Properties of an Ideal Drug | 1 | ||
| The Big Three: Effectiveness, Safety, and Selectivity | 1 | ||
| Effectiveness. | 2 | ||
| Safety. | 2 | ||
| Selectivity. | 2 | ||
| Additional Properties of an Ideal Drug | 2 | ||
| Reversible Action. | 2 | ||
| Predictability. | 2 | ||
| Ease of Administration. | 2 | ||
| Freedom from Drug Interactions. | 2 | ||
| Low Cost. | 2 | ||
| Chemical Stability. | 2 | ||
| Possession of a Simple Generic Name. | 2 | ||
| Because No Drug Is Ideal | 2 | ||
| The Therapeutic Objective | 2 | ||
| Factors That Determine the Intensity of Drug Responses | 3 | ||
| Administration | 3 | ||
| Pharmacokinetics | 3 | ||
| Pharmacodynamics | 3 | ||
| Sources of Individual Variation | 3 | ||
| Key Points | 4 | ||
| 2 Application of Pharmacology in Nursing Practice | 5 | ||
| Evolution of Nursing Responsibilities Regarding Drugs | 5 | ||
| Application of Pharmacology in Patient Care | 6 | ||
| Preadministration Assessment | 6 | ||
| Collecting Baseline Data. | 6 | ||
| Identifying High-Risk Patients. | 6 | ||
| Dosage and Administration | 6 | ||
| Evaluating and Promoting Therapeutic Effects | 7 | ||
| Evaluating Therapeutic Responses. | 7 | ||
| Promoting Patient Adherence. | 7 | ||
| Implementing Nondrug Measures. | 7 | ||
| Minimizing Adverse Effects | 7 | ||
| Minimizing Adverse Interactions | 7 | ||
| Making PRN Decisions | 7 | ||
| Managing Toxicity | 7 | ||
| Application of Pharmacology in Patient Education | 8 | ||
| Dosage and Administration | 8 | ||
| Drug Name. | 8 | ||
| Dosage and Schedule of Administration. | 8 | ||
| Technique of Administration. | 8 | ||
| Duration of Drug Use. | 8 | ||
| Drug Storage. | 8 | ||
| Promoting Therapeutic Effects | 8 | ||
| Minimizing Adverse Effects | 8 | ||
| Minimizing Adverse Interactions | 9 | ||
| Application of the Nursing Process in Drug Therapy | 9 | ||
| Review of the Nursing Process | 9 | ||
| Assessment. | 9 | ||
| Analysis: Nursing Diagnoses. | 9 | ||
| Planning. | 9 | ||
| Implementation. | 9 | ||
| Evaluation. | 9 | ||
| Applying the Nursing Process in Drug Therapy | 9 | ||
| Preadministration Assessment | 9 | ||
| Baseline Data Needed to Evaluate Therapeutic Effects. | 10 | ||
| Baseline Data Needed to Evaluate Adverse Effects. | 10 | ||
| Identification of High-Risk Patients. | 10 | ||
| Assessment of the Patient’s Capacity for Self-Care. | 10 | ||
| Analysis and Nursing Diagnoses | 10 | ||
| Planning | 11 | ||
| Defining Goals. | 11 | ||
| Setting Priorities. | 11 | ||
| Identifying Interventions. | 11 | ||
| Establishing Criteria for Evaluation. | 12 | ||
| Implementation | 12 | ||
| Evaluation | 12 | ||
| Use of a Modified Nursing Process Format to Summarize Nursing Implications | 12 | ||
| Preadministration Assessment. | 12 | ||
| Implementation: Administration. | 13 | ||
| Implementation: Measures to Enhance Therapeutic Effects. | 13 | ||
| Ongoing Evaluation and Interventions. | 13 | ||
| Patient Education. | 13 | ||
| What About Diagnosis and Planning? | 13 | ||
| Key Points | 13 | ||
| 3 Drug Regulation, Development, Names, and Information | 14 | ||
| Landmark Drug Legislation | 14 | ||
| New Drug Development | 15 | ||
| The Randomized Controlled Trial | 15 | ||
| Use of Controls. | 15 | ||
| Randomization. | 15 | ||
| Blinding. | 16 | ||
| Stages of New Drug Development | 16 | ||
| Preclinical Testing | 16 | ||
| Clinical Testing | 16 | ||
| Phase I. | 16 | ||
| Phases II and III. | 16 | ||
| Phase IV: Postmarketing Surveillance. | 16 | ||
| Limitations of the Testing Procedure | 16 | ||
| Limited Information on Women and Children | 16 | ||
| Women. | 16 | ||
| Children. | 17 | ||
| Failure to Detect All Adverse Effects | 17 | ||
| Exercising Discretion Regarding New Drugs | 17 | ||
| Drug Names | 18 | ||
| The Three Types of Drug Names | 18 | ||
| Chemical Name. | 18 | ||
| Generic Name. | 18 | ||
| Trade Name. | 18 | ||
| Which Name To Use, Generic or Trade? | 18 | ||
| Problems with Trade Names | 18 | ||
| A Single Drug Can Have Multiple Trade Names. | 18 | ||
| Over-the-Counter (OTC) Products with the Same Trade Name May Have Different Active Ingredients. | 19 | ||
| Trade Names Can Endanger International Travelers. | 19 | ||
| Generic Products Versus Brand-Name Products | 20 | ||
| Are Generic Products and Brand-Name Products Therapeutically Equivalent? | 20 | ||
| Conclusions Regarding Generic Names and Trade Names | 20 | ||
| Over-the-Counter Drugs | 20 | ||
| Sources of Drug Information | 21 | ||
| Newsletters. | 21 | ||
| Reference Books. | 21 | ||
| The Internet. | 21 | ||
| Key Points | 21 | ||
| Unit II Basic Principles of Pharmacology | 22 | ||
| 4 Pharmacokinetics | 22 | ||
| Application of Pharmacokinetics in Therapeutics | 22 | ||
| A Note to Chemophobes | 22 | ||
| Passage of Drugs Across Membranes | 23 | ||
| Membrane Structure | 23 | ||
| Three Ways to Cross a Cell Membrane | 23 | ||
| Channels and Pores | 23 | ||
| Transport Systems | 23 | ||
| P-Glycoprotein. | 24 | ||
| Direct Penetration of the Membrane | 24 | ||
| Polar Molecules | 24 | ||
| Ions | 25 | ||
| Quaternary Ammonium Compounds | 25 | ||
| pH-Dependent Ionization | 25 | ||
| Ion Trapping (pH Partitioning) | 26 | ||
| Absorption | 26 | ||
| Factors Affecting Drug Absorption | 26 | ||
| Rate of Dissolution. | 26 | ||
| Surface Area. | 26 | ||
| Blood Flow. | 26 | ||
| Lipid Solubility. | 26 | ||
| pH Partitioning. | 26 | ||
| Characteristics of Commonly Used Routes of Administration | 27 | ||
| Intravenous | 28 | ||
| Barriers to Absorption. | 28 | ||
| Absorption Pattern. | 28 | ||
| Advantages | 28 | ||
| Rapid Onset. | 28 | ||
| Control. | 28 | ||
| Permits Use of Large Fluid Volumes. | 28 | ||
| Permits Use of Irritant Drugs. | 28 | ||
| Disadvantages | 28 | ||
| High Cost, Difficulty, and Inconvenience. | 28 | ||
| Irreversibility. | 28 | ||
| Fluid Overload. | 29 | ||
| Infection. | 29 | ||
| Embolism. | 29 | ||
| The Importance of Reading Labels. | 29 | ||
| Intramuscular | 29 | ||
| Barriers to Absorption. | 29 | ||
| Unit III Drug Therapy Across the Life Span | 81 | ||
| 9 Drug Therapy During Pregnancy and Breast-Feeding | 81 | ||
| Drug Therapy during Pregnancy: Basic Considerations | 81 | ||
| Physiologic Changes During Pregnancy and Their Impact on Drug Disposition and Dosing | 81 | ||
| Placental Drug Transfer | 82 | ||
| Adverse Reactions During Pregnancy | 82 | ||
| Drug Therapy during Pregnancy: Teratogenesis | 82 | ||
| Incidence and Causes of Congenital Anomalies | 82 | ||
| Teratogenesis and Stage of Development | 82 | ||
| Identification of Teratogens | 82 | ||
| FDA Pregnancy Risk Categories | 85 | ||
| Minimizing the Risk of Drug-Induced Teratogenesis | 85 | ||
| Responding to Teratogen Exposure | 85 | ||
| Drug Therapy during Breast-Feeding | 86 | ||
| Key Points | 87 | ||
| 10 Drug Therapy in Pediatric Patients | 88 | ||
| Pharmacokinetics: Neonates and Infants | 88 | ||
| Absorption | 89 | ||
| Oral Administration. | 89 | ||
| Intramuscular Administration. | 89 | ||
| Transdermal Absorption. | 89 | ||
| Distribution | 89 | ||
| Protein Binding. | 89 | ||
| Blood-Brain Barrier. | 89 | ||
| Hepatic Metabolism | 89 | ||
| Renal Excretion | 90 | ||
| Pharmacokinetics: Children 1 Year and Older | 90 | ||
| Adverse Drug Reactions | 90 | ||
| Dosage Determination | 90 | ||
| Promoting Adherence | 91 | ||
| Key Points | 91 | ||
| 11 Drug Therapy in Geriatric Patients | 92 | ||
| Pharmacokinetic Changes in Older Adults | 92 | ||
| Absorption | 92 | ||
| Distribution | 92 | ||
| Metabolism | 92 | ||
| Excretion | 92 | ||
| Pharmacodynamic Changes in Older Adults | 93 | ||
| Adverse Drug Reactions and Drug Interactions | 93 | ||
| Promoting Adherence | 93 | ||
| Key Points | 95 | ||
| Unit IV Peripheral Nervous System Drugs | 96 | ||
| Introduction | 96 | ||
| 12 Basic Principles of Neuropharmacology | 96 | ||
| How Neurons Regulate Physiologic Processes | 96 | ||
| Basic Mechanisms by Which Neuropharmacologic Agents Act | 96 | ||
| Sites of Action: Axons Versus Synapses | 96 | ||
| Axonal Conduction | 97 | ||
| Synaptic Transmission | 97 | ||
| Receptors | 97 | ||
| Steps in Synaptic Transmission | 97 | ||
| Step 1: Transmitter Synthesis. | 97 | ||
| Step 2: Transmitter Storage. | 97 | ||
| Step 3: Transmitter Release. | 97 | ||
| Step 4: Receptor Binding. | 98 | ||
| Step 5: Termination of Transmission. | 98 | ||
| Effects of Drugs on the Steps of Synaptic Transmission | 98 | ||
| Transmitter Synthesis. | 98 | ||
| Transmitter Storage. | 98 | ||
| Transmitter Release. | 98 | ||
| Receptor Binding. | 99 | ||
| Termination of Transmitter Action. | 99 | ||
| Multiple Receptor Types and Selectivity of Drug Action | 99 | ||
| An Approach to Learning About Peripheral Nervous System Drugs | 100 | ||
| Key Points | 100 | ||
| 13 Physiology of the Peripheral Nervous System | 102 | ||
| Divisions of the Nervous System | 102 | ||
| Overview of Autonomic Nervous System Functions | 102 | ||
| Functions of the Parasympathetic Nervous System | 102 | ||
| Functions of the Sympathetic Nervous System | 103 | ||
| Basic Mechanisms by Which the Autonomic Nervous System Regulates Physiologic Processes | 103 | ||
| Patterns of Innervation and Control | 103 | ||
| Feedback Regulation | 103 | ||
| Baroreceptor Reflex. | 104 | ||
| Autonomic Tone | 104 | ||
| Anatomic Considerations | 104 | ||
| Parasympathetic Nervous System | 104 | ||
| Sympathetic Nervous System | 104 | ||
| Somatic Motor System | 105 | ||
| Introduction to Transmitters of the Peripheral Nervous System | 105 | ||
| Introduction to Receptors of the Peripheral Nervous System | 105 | ||
| Primary Receptor Types: Cholinergic Receptors and Adrenergic Receptors | 105 | ||
| Subtypes of Cholinergic and Adrenergic Receptors | 106 | ||
| Exploring the Concept of Receptor Subtypes | 106 | ||
| What Do We Mean by “Receptor Subtype”? | 106 | ||
| How Do We Know That Receptor Subtypes Exist? | 106 | ||
| How Can Drugs Be More Selective Than Natural Transmitters at Receptor Subtypes? | 107 | ||
| Why Do Receptor Subtypes Exist, and Why Do They Matter? | 108 | ||
| Locations of Receptor Subtypes | 108 | ||
| Functions of Cholinergic and Adrenergic Receptor Subtypes | 108 | ||
| Functions of Cholinergic Receptor Subtypes | 108 | ||
| Functions of Adrenergic Receptor Subtypes | 109 | ||
| Alpha1 Receptors | 109 | ||
| Alpha2 Receptors | 109 | ||
| Beta1 Receptors | 110 | ||
| Beta2 Receptors | 110 | ||
| Dopamine Receptors | 110 | ||
| Receptor Specificity of the Adrenergic Transmitters | 111 | ||
| Transmitter Life Cycles | 112 | ||
| Life Cycle of Acetylcholine | 112 | ||
| Life Cycle of Norepinephrine | 112 | ||
| Life Cycle of Epinephrine | 113 | ||
| Key Points | 113 | ||
| Cholinergic Drugs | 115 | ||
| 14 Muscarinic Agonists and Antagonists | 115 | ||
| Introduction to Cholinergic Drugs | 115 | ||
| Muscarinic Agonists and Antagonists | 115 | ||
| Muscarinic Agonists | 116 | ||
| Bethanechol | 116 | ||
| Mechanism of Action | 116 | ||
| Pharmacologic Effects | 116 | ||
| Pharmacokinetics | 116 | ||
| Therapeutic Uses | 116 | ||
| Urinary Retention. | 117 | ||
| Investigational GI Uses. | 117 | ||
| Adverse Effects | 117 | ||
| Cardiovascular System. | 117 | ||
| Gastrointestinal System. | 117 | ||
| Urinary Tract. | 117 | ||
| Exacerbation of Asthma. | 117 | ||
| Dysrhythmias in Hyperthyroid Patients. | 117 | ||
| Preparations, Dosage, and Administration | 117 | ||
| Other Muscarinic Agonists | 117 | ||
| Cevimeline | 117 | ||
| Actions and Uses. | 117 | ||
| Adverse Effects. | 118 | ||
| Drug Interactions. | 118 | ||
| Preparations, Dosage, and Administration. | 118 | ||
| Pilocarpine | 118 | ||
| Acetylcholine | 118 | ||
| Muscarine | 118 | ||
| Toxicology of Muscarinic Agonists | 118 | ||
| Sources of Muscarinic Poisoning. | 118 | ||
| Symptoms. | 118 | ||
| Treatment. | 118 | ||
| Muscarinic Antagonists (Anticholinergic Drugs) | 118 | ||
| Atropine | 118 | ||
| Mechanism of Action | 119 | ||
| Pharmacologic Effects | 119 | ||
| Heart. | 119 | ||
| Exocrine Glands. | 119 | ||
| Smooth Muscle. | 119 | ||
| Eyes. | 119 | ||
| Central Nervous System. | 119 | ||
| Dose Dependency of Muscarinic Blockade. | 119 | ||
| Pharmacokinetics | 119 | ||
| Therapeutic Uses | 119 | ||
| Preanesthetic Medication. | 119 | ||
| Disorders of the Eyes. | 119 | ||
| Bradycardia. | 119 | ||
| Intestinal Hypertonicity and Hypermotility. | 119 | ||
| Muscarinic Agonist Poisoning. | 120 | ||
| Peptic Ulcer Disease. | 120 | ||
| Unit V Central Nervous System Drugs | 173 | ||
| Introduction | 173 | ||
| 20 Introduction to Central Nervous System Pharmacology | 173 | ||
| Transmitters of the CNS | 173 | ||
| The Blood-Brain Barrier | 173 | ||
| How Do CNS Drugs Produce Therapeutic Effects? | 173 | ||
| Adaptation of the CNS to Prolonged Drug Exposure | 174 | ||
| Increased Therapeutic Effects. | 174 | ||
| Decreased Side Effects. | 174 | ||
| Tolerance and Physical Dependence. | 174 | ||
| Development of New Psychotherapeutic Drugs | 174 | ||
| Approaching the Study of CNS Drugs | 174 | ||
| Key Points | 175 | ||
| Drugs for Neurodegenerative Disorders | 176 | ||
| 21 Drugs for Parkinson’s Disease | 176 | ||
| Pathophysiology That Underlies Motor Symptoms | 176 | ||
| Overview of Motor Symptom Management | 177 | ||
| Therapeutic Goal | 177 | ||
| Drugs Employed | 177 | ||
| Clinical Guidelines | 178 | ||
| Drug Selection | 178 | ||
| Initial Treatment. | 178 | ||
| Management of Motor Fluctuations. | 178 | ||
| Neuroprotection. | 178 | ||
| Pharmacology of the Drugs Used for Motor Symptoms | 178 | ||
| Levodopa | 178 | ||
| Use in Parkinson’s Disease | 178 | ||
| Beneficial Effects. | 178 | ||
| Acute Loss of Effect. | 179 | ||
| Mechanism of Action | 179 | ||
| Pharmacokinetics | 179 | ||
| Adverse Effects | 179 | ||
| Nausea and Vomiting. | 179 | ||
| Dyskinesias. | 179 | ||
| Cardiovascular Effects. | 180 | ||
| Psychosis. | 180 | ||
| Central Nervous System Effects. | 181 | ||
| Other Adverse Effects. | 181 | ||
| Drug Interactions | 181 | ||
| First-Generation Antipsychotic Drugs. | 181 | ||
| Monoamine Oxidase Inhibitors. | 181 | ||
| Anticholinergic Drugs. | 181 | ||
| Pyridoxine. | 181 | ||
| Food Interactions | 181 | ||
| Preparations | 181 | ||
| Levodopa/Carbidopa | 181 | ||
| Mechanism of Action | 182 | ||
| Advantages of Carbidopa | 182 | ||
| Disadvantages of Carbidopa | 183 | ||
| Preparations, Dosage, and Administration | 183 | ||
| Levodopa/Carbidopa: Sinemet. | 183 | ||
| Levodopa/Carbidopa: Parcopa. | 183 | ||
| Carbidopa Alone. | 183 | ||
| Dopamine Agonists | 183 | ||
| Nonergot Derivatives: Pramipexole, Ropinirole, Rotigotin, and Apomorphine | 183 | ||
| Pramipexole | 183 | ||
| Actions and Uses. | 183 | ||
| Pharmacokinetics. | 183 | ||
| Adverse Effects and Interactions. | 183 | ||
| Unit VI Drugs that Affect Fluid and Electrolyte Balance | 447 | ||
| 41 Diuretics | 447 | ||
| Review of Renal Anatomy and Physiology | 447 | ||
| Anatomy | 447 | ||
| Physiology | 447 | ||
| Overview of Kidney Functions | 447 | ||
| The Three Basic Renal Processes | 447 | ||
| Filtration. | 447 | ||
| Reabsorption. | 447 | ||
| Active Tubular Secretion. | 448 | ||
| Processes of Reabsorption That Occur at Specific Sites Along the Nephron | 448 | ||
| Proximal Convoluted Tubule. | 448 | ||
| Loop of Henle. | 448 | ||
| Distal Convoluted Tubule (Early Segment). | 449 | ||
| Distal Nephron: Late Distal Convoluted Tubule and Collecting Duct. | 449 | ||
| Sodium-Potassium Exchange. | 449 | ||
| Introduction to Diuretics | 449 | ||
| How Diuretics Work | 449 | ||
| Adverse Impact on Extracellular Fluid | 450 | ||
| Classification of Diuretics | 450 | ||
| Loop Diuretics | 450 | ||
| Furosemide | 450 | ||
| Mechanism of Action | 450 | ||
| Pharmacokinetics | 450 | ||
| Therapeutic Uses | 450 | ||
| Adverse Effects | 450 | ||
| Hyponatremia, Hypochloremia, and Dehydration. | 450 | ||
| Hypotension. | 451 | ||
| Hypokalemia. | 451 | ||
| Ototoxicity. | 451 | ||
| Hyperglycemia. | 451 | ||
| Hyperuricemia. | 451 | ||
| Use in Pregnancy. | 451 | ||
| Impact on Lipids, Magnesium, and Calcium. | 451 | ||
| Drug Interactions | 451 | ||
| Digoxin. | 451 | ||
| Ototoxic Drugs. | 451 | ||
| Potassium-Sparing Diuretics. | 451 | ||
| Lithium. | 451 | ||
| Antihypertensive Agents. | 452 | ||
| Nonsteroidal Antiinflammatory Drugs (NSAIDs). | 452 | ||
| Preparations, Dosage, and Administration | 452 | ||
| Oral. | 452 | ||
| Parenteral. | 452 | ||
| Other Loop Diuretics | 452 | ||
| Thiazides and Related Diuretics | 452 | ||
| Hydrochlorothiazide | 452 | ||
| Mechanism of Action | 452 | ||
| Pharmacokinetics | 452 | ||
| Therapeutic Uses | 452 | ||
| Essential Hypertension. | 452 | ||
| Edema. | 452 | ||
| Diabetes Insipidus. | 452 | ||
| Protection Against Postmenopausal Osteoporosis. | 452 | ||
| Adverse Effects | 453 | ||
| Hyponatremia, Hypochloremia, and Dehydration. | 453 | ||
| Hypokalemia. | 453 | ||
| Hyperglycemia. | 453 | ||
| Hyperuricemia. | 453 | ||
| Impact on Lipids and Magnesium. | 453 | ||
| Drug Interactions | 453 | ||
| Preparations, Dosage, and Administration | 453 | ||
| Other Thiazide-Type Diuretics | 453 | ||
| Potassium-Sparing Diuretics | 453 | ||
| Spironolactone | 454 | ||
| Unit VII Drugs that Affect the Heart, Blood Vessels, and Blood | 464 | ||
| 43 Review of Hemodynamics | 464 | ||
| Overview of the Circulatory System | 464 | ||
| Components of the Circulatory System | 464 | ||
| Distribution of Blood | 464 | ||
| What Makes Blood Flow? | 464 | ||
| How Does Blood Get Back to the Heart? | 464 | ||
| Regulation of Cardiac Output | 465 | ||
| Determinants of Cardiac Output | 465 | ||
| Heart Rate. | 465 | ||
| Stroke Volume. | 466 | ||
| Preload. | 466 | ||
| Afterload. | 466 | ||
| Starling’s Law of the Heart | 466 | ||
| Factors That Determine Venous Return | 467 | ||
| Starling’s Law and Maintenance of Systemic-Pulmonary Balance | 467 | ||
| Regulation of Arterial Pressure | 467 | ||
| Overview of Control Systems | 468 | ||
| Steady-State Control by the ANS | 468 | ||
| Rapid Control by the ANS: The Baroreceptor Reflex | 468 | ||
| The Renin-Angiotensin- Aldosterone System | 468 | ||
| Renal Retention of Water | 468 | ||
| Postural Hypotension | 468 | ||
| Natriuretic Peptides | 469 | ||
| Key Points | 469 | ||
| 44 Drugs Acting on the Renin-Angiotensin-Aldosterone System | 470 | ||
| Physiology of the Renin-Angiotensin-Aldosterone System | 470 | ||
| Types of Angiotensin | 470 | ||
| Actions of Angiotensin II | 470 | ||
| Vasoconstriction. | 470 | ||
| Release of Aldosterone. | 470 | ||
| Alteration of Cardiac and Vascular Structure. | 470 | ||
| Actions of Aldosterone | 472 | ||
| Regulation of Blood Volume and Blood Pressure. | 472 | ||
| Pathologic Cardiovascular Effects. | 472 | ||
| Formation of Angiotensin II by Renin and Angiotensin-Converting Enzyme | 472 | ||
| Renin | 472 | ||
| Regulation of Renin Release. | 472 | ||
| Angiotensin-Converting Enzyme (Kinase II) | 472 | ||
| Regulation of Blood Pressure by the Renin-Angiotensin-Aldosterone System | 472 | ||
| Tissue (Local) Angiotensin II Production | 473 | ||
| Angiotensin-Converting Enzyme Inhibitors | 473 | ||
| Mechanism of Action and Overview of Pharmacologic Effects | 473 | ||
| Pharmacokinetics | 473 | ||
| Therapeutic Uses | 474 | ||
| Hypertension. | 474 | ||
| Heart Failure. | 475 | ||
| Myocardial Infarction. | 475 | ||
| Diabetic and Nondiabetic Nephropathy. | 475 | ||
| Prevention of MI, Stroke, and Death in Patients at High Cardiovascular Risk. | 475 | ||
| Diabetic Retinopathy. | 476 | ||
| Adverse Effects | 476 | ||
| First-Dose Hypotension. | 476 | ||
| Cough. | 476 | ||
| Hyperkalemia. | 476 | ||
| Renal Failure. | 476 | ||
| Fetal Injury. | 476 | ||
| Angioedema. | 476 | ||
| Neutropenia. | 476 | ||
| Drug Interactions | 476 | ||
| Diuretics. | 476 | ||
| Antihypertensive Agents. | 477 | ||
| Drugs That Raise Potassium Levels. | 477 | ||
| Lithium. | 477 | ||
| Nonsteroidal Antiinflammatory Drugs (NSAIDs). | 477 | ||
| Preparations, Dosage, and Administration | 477 | ||
| Angiotensin II Receptor Blockers | 477 | ||
| Mechanism of Action and Overview of Pharmacologic Effects | 477 | ||
| Therapeutic Uses | 477 | ||
| Hypertension. | 477 | ||
| Heart Failure. | 478 | ||
| Diabetic Nephropathy. | 478 | ||
| Myocardial Infarction. | 478 | ||
| Stroke Prevention. | 478 | ||
| Prevention of MI, Stroke, and Death in Patients at High Cardiovascular Risk. | 478 | ||
| Diabetic Retinopathy. | 478 | ||
| Adverse Effects | 478 | ||
| Angioedema. | 478 | ||
| Fetal Harm. | 478 | ||
| Renal Failure. | 478 | ||
| Drug Interactions | 478 | ||
| Preparations, Dosage, and Administration | 478 | ||
| Aliskiren, a Direct Renin Inhibitor | 479 | ||
| Mechanism of Action | 479 | ||
| Therapeutic Use | 479 | ||
| Pharmacokinetics | 479 | ||
| Adverse Effects | 479 | ||
| Angioedema and Cough. | 480 | ||
| Gastrointestinal Effects. | 480 | ||
| Unit VIII Drugs for Endocrine Disorders | 667 | ||
| 57 Drugs for Diabetes Mellitus | 667 | ||
| Diabetes Mellitus: Basic Considerations | 667 | ||
| Types of Diabetes Mellitus | 667 | ||
| Type 1 Diabetes | 668 | ||
| Type 2 Diabetes | 668 | ||
| Short-Term Complications of Diabetes | 669 | ||
| Long-Term Complications of Diabetes | 669 | ||
| Macrovascular Damage | 669 | ||
| Microvascular Damage | 669 | ||
| Retinopathy. | 669 | ||
| Nephropathy. | 669 | ||
| Sensory and Motor Neuropathy. | 669 | ||
| Autonomic Neuropathy: Gastroparesis. | 669 | ||
| Amputations Secondary to Infection. | 670 | ||
| Erectile Dysfunction. | 670 | ||
| Diabetes and Pregnancy | 670 | ||
| Diagnosis | 670 | ||
| Tests Based on Blood Levels of Glucose | 670 | ||
| Fasting Plasma Glucose Test. | 670 | ||
| Casual Plasma Glucose Test. | 671 | ||
| Oral Glucose Tolerance Test. | 671 | ||
| Hemoglobin A1c | 671 | ||
| Increased Risk for Diabetes (Prediabetes) | 671 | ||
| Overview of Treatment | 671 | ||
| Type 1 Diabetes | 671 | ||
| Dietary Measures. | 671 | ||
| Physical Activity. | 671 | ||
| Insulin Replacement. | 672 | ||
| Managing Hypertension and Dyslipidemia. | 672 | ||
| Type 2 Diabetes | 672 | ||
| Determining Appropriate Glycemic Goals | 672 | ||
| Type 1 Diabetes | 672 | ||
| Benefits. | 672 | ||
| Drawbacks. | 673 | ||
| Type 2 Diabetes | 673 | ||
| Monitoring Treatment | 673 | ||
| Self-Monitoring of Blood Glucose | 673 | ||
| Monitoring of Hemoglobin A1c | 674 | ||
| Insulin | 674 | ||
| Physiology | 675 | ||
| Structure | 675 | ||
| Biosynthesis | 675 | ||
| Secretion | 675 | ||
| Metabolic Actions | 675 | ||
| Metabolic Consequences of Insulin Deficiency | 676 | ||
| Preparations and Administration | 676 | ||
| Sources of Insulin | 676 | ||
| Types of Insulin | 676 | ||
| Short Duration: Rapid Acting | 676 | ||
| Insulin Lispro. | 676 | ||
| Insulin Aspart. | 678 | ||
| Insulin Glulisine. | 678 | ||
| Short Duration: Slower Acting | 678 | ||
| Regular Insulin Injection. | 678 | ||
| Intermediate Duration | 679 | ||
| Neutral Protamine Hagedorn (NPH) Insulin Suspension. | 679 | ||
| Long Duration | 679 | ||
| Insulin Glargine. | 679 | ||
| Insulin Detemir. | 679 | ||
| Appearance | 679 | ||
| Concentration | 679 | ||
| Mixing Insulins | 679 | ||
| Administration | 680 | ||
| Subcutaneous Injection | 680 | ||
| Preparing for Injection. | 680 | ||
| Injection Sites. | 680 | ||
| Injection Devices | 680 | ||
| Syringe and Needle. | 680 | ||
| Pen Injectors. | 680 | ||
| Jet Injectors. | 681 | ||
| Subcutaneous Infusion | 681 | ||
| Portable Insulin Pumps. | 681 | ||
| Implantable Insulin Pumps. | 681 | ||
| Intravenous Infusion | 681 | ||
| Inhalation | 681 | ||
| Storage | 681 | ||
| Therapeutic Use | 681 | ||
| Indications | 681 | ||
| Insulin Therapy of Diabetes | 682 | ||
| Dosage | 682 | ||
| Dosing Schedules | 682 | ||
| Twice-Daily Premixed Regimen. | 682 | ||
| Intensive Basal/Bolus Strategy. | 682 | ||
| Continuous Subcutaneous Insulin Infusion. | 682 | ||
| Achieving Optimal Glucose Control | 682 | ||
| Complications of Insulin Treatment | 683 | ||
| Hypoglycemia | 683 | ||
| Other Complications | 683 | ||
| Hypokalemia. | 683 | ||
| Lipohypertrophy. | 683 | ||
| Allergic Reactions. | 683 | ||
| Drug Interactions | 683 | ||
| Hypoglycemic Agents. | 683 | ||
| Hyperglycemic Agents. | 683 | ||
| Beta-Adrenergic Blocking Agents. | 683 | ||
| Non-Insulin Medications for the Treatment of Diabetes | 684 | ||
| Oral Drugs | 684 | ||
| Biguanides: Metformin | 684 | ||
| Mechanism of Action. | 684 | ||
| Pharmacokinetics. | 684 | ||
| Therapeutic Uses | 684 | ||
| Glycemic Control. | 684 | ||
| Prevention of Type 2 Diabetes. | 684 | ||
| Gestational Diabetes. | 684 | ||
| Polycystic Ovary Syndrome (PCOS). | 686 | ||
| Side Effects. | 686 | ||
| Toxicity: Lactic Acidosis. | 686 | ||
| Drug Interactions | 686 | ||
| Alcohol. | 686 | ||
| Cimetidine. | 686 | ||
| Iodinated Radiocontrast Media. | 686 | ||
| Preparations, Dosage, and Administration. | 686 | ||
| Sulfonylureas | 686 | ||
| Mechanism of Action. | 687 | ||
| Therapeutic Use. | 687 | ||
| Adverse Effects | 687 | ||
| Hypoglycemia. | 687 | ||
| Cardiovascular Toxicity. | 687 | ||
| Use in Pregnancy and Lactation. | 687 | ||
| Drug Interactions | 688 | ||
| Alcohol. | 688 | ||
| Drugs That Can Intensify Hypoglycemia. | 688 | ||
| Beta-Adrenergic Blocking Agents. | 688 | ||
| Unit IX Women's Health | 733 | ||
| 61 Estrogens and Progestins: | 733 | ||
| The Menstrual Cycle | 733 | ||
| Ovarian and Uterine Events. | 733 | ||
| The Roles of Estrogens and Progesterone. | 733 | ||
| The Role of Pituitary Hormones. | 734 | ||
| Estrogens | 734 | ||
| Biosynthesis and Elimination | 734 | ||
| Females. | 734 | ||
| Males. | 734 | ||
| Mechanism of Action | 735 | ||
| Physiologic and Pharmacologic Effects | 735 | ||
| Effects on Primary and Secondary Sex Characteristics of Females | 735 | ||
| Metabolic Actions | 735 | ||
| Bone. | 735 | ||
| Cholesterol. | 735 | ||
| Blood Coagulation. | 735 | ||
| Clinical Pharmacology | 735 | ||
| Adverse Effects | 735 | ||
| Endometrial Hyperplasia and Carcinoma. | 735 | ||
| Breast Cancer. | 735 | ||
| Ovarian Cancer. | 736 | ||
| Cardiovascular Events. | 736 | ||
| Nausea. | 736 | ||
| Other Adverse Effects. | 736 | ||
| Therapeutic Uses | 736 | ||
| Menopausal Hormone Therapy. | 736 | ||
| Female Hypogonadism. | 736 | ||
| Acne. | 736 | ||
| Routes of Administration | 736 | ||
| Oral. | 736 | ||
| Transdermal. | 736 | ||
| Intravaginal. | 736 | ||
| Parenteral. | 736 | ||
| Selective Estrogen Receptor Modulators (SERMs) | 736 | ||
| Progestins | 737 | ||
| Biosynthesis | 737 | ||
| Mechanism of Action | 737 | ||
| Physiologic and Pharmacologic Effects | 737 | ||
| Effects During the Menstrual Cycle. | 737 | ||
| Effects During Pregnancy. | 737 | ||
| Other Effects. | 737 | ||
| Clinical Pharmacology | 737 | ||
| Adverse Effects | 737 | ||
| Teratogenic Effects. | 737 | ||
| Gynecologic Effects. | 737 | ||
| Breast Cancer. | 740 | ||
| Other Adverse Effects. | 740 | ||
| Therapeutic Uses | 740 | ||
| Menopausal Hormone Therapy. | 740 | ||
| Dysfunctional Uterine Bleeding. | 740 | ||
| Amenorrhea. | 740 | ||
| Infertility. | 740 | ||
| Prematurity Prevention. | 740 | ||
| Endometrial Carcinoma and Hyperplasia. | 740 | ||
| Preparations and Routes | 740 | ||
| Menopausal Hormone Therapy | 740 | ||
| Landmark Studies: WHI and HERS | 741 | ||
| Benefits and Risks of Hormone Therapy | 741 | ||
| Benefits of Hormone Therapy | 741 | ||
| Relief of Vasomotor Symptoms. | 742 | ||
| Management of Urogenital Atrophy. | 742 | ||
| Prevention of Osteoporosis and Related Fractures. | 742 | ||
| Cardioprotection. | 742 | ||
| Improved Quality of Life? | 742 | ||
| Prevention of Colorectal Cancer? | 742 | ||
| Other Benefits. | 742 | ||
| Adverse Effects of Hormone Therapy | 742 | ||
| Cardiovascular Events. | 742 | ||
| Endometrial Cancer. | 743 | ||
| Breast Cancer. | 743 | ||
| Ovarian Cancer. | 743 | ||
| Lung Cancer. | 743 | ||
| Gallbladder Disease. | 743 | ||
| Dementia. | 743 | ||
| Urinary Incontinence. | 744 | ||
| Minor Adverse Effects. | 744 | ||
| Warnings | 744 | ||
| Recommendations on Hormone Therapy Use | 744 | ||
| General Recommendations | 744 | ||
| Use for Approved Indications | 745 | ||
| Treatment of Vasomotor Symptoms. | 745 | ||
| Treatment of Symptoms of Vulvar and Vaginal Atrophy. | 745 | ||
| Prevention of Osteoporosis. | 745 | ||
| Inappropriate Uses: Attempted Prevention of Heart Disease and Dementia | 745 | ||
| Heart Disease. | 745 | ||
| Alzheimer’s Disease. | 745 | ||
| Safety in Younger Women Who Don’t Have a Uterus | 745 | ||
| Discontinuing Hormone Therapy | 745 | ||
| Open Questions | 746 | ||
| Drug Products for Hormone Therapy | 746 | ||
| Preparations | 746 | ||
| Dosing Schedules | 746 | ||
| Key Points | 748 | ||
| Summary of Major Nursing Implications* | 749 | ||
| Estrogens | 749 | ||
| Preadministration Assessment | 749 | ||
| Therapeutic Goal | 749 | ||
| Baseline Data | 749 | ||
| Identifying High-Risk Patients | 749 | ||
| Implementation: Administration | 749 | ||
| Routes | 749 | ||
| Administration | 749 | ||
| Transdermal Patch. | 749 | ||
| Transdermal Emulsion. | 749 | ||
| Transdermal Gel. | 749 | ||
| Transdermal Spray. | 749 | ||
| Intravaginal Cream. | 749 | ||
| Intravaginal Ring. | 749 | ||
| Intravaginal Tablet. | 749 | ||
| Dosing Schedules for Hormone Therapy | 749 | ||
| Ongoing Evaluation and Interventions | 749 | ||
| Monitoring Summary | 749 | ||
| Minimizing Adverse Effects | 749 | ||
| Nausea. | 749 | ||
| Endometrial Hyperplasia and Cancer. | 749 | ||
| Breast Cancer. | 749 | ||
| Ovarian Cancer. | 749 | ||
| Lung Cancer. | 750 | ||
| Cardiovascular Events. | 750 | ||
| Effects Resembling Those Caused by Oral Contraceptives. | 750 | ||
| Minimizing Adverse Interactions | 750 | ||
| Progestins | 750 | ||
| Preadministration Assessment | 750 | ||
| Therapeutic Goal | 750 | ||
| Baseline Data | 750 | ||
| Identifying High-Risk Patients | 750 | ||
| Implementation: Administration | 750 | ||
| Routes | 750 | ||
| Administration | 750 | ||
| Ongoing Evaluation and Interventions | 750 | ||
| Minimizing Adverse Effects | 750 | ||
| Gynecologic Effects. | 750 | ||
| Teratogenic Effects. | 750 | ||
| 62 Birth Control | 751 | ||
| Effectiveness of Birth Control Methods | 751 | ||
| Selecting a Birth Control Method | 751 | ||
| Oral Contraceptives | 752 | ||
| Combination Oral Contraceptives | 752 | ||
| Mechanism of Action | 752 | ||
| Components | 753 | ||
| Estrogens. | 753 | ||
| Progestins. | 753 | ||
| Effectiveness | 753 | ||
| Overall Safety | 753 | ||
| Adverse Effects | 753 | ||
| Thromboembolic Disorders. | 754 | ||
| Cancer. | 754 | ||
| Hypertension. | 754 | ||
| Abnormal Uterine Bleeding. | 754 | ||
| Use in Pregnancy and Lactation. | 755 | ||
| Stroke in Women with Migraine. | 755 | ||
| Benign Hepatic Adenoma. | 755 | ||
| Effects Related to Estrogen or Progestin Imbalance. | 755 | ||
| Hyperkalemia. | 755 | ||
| Glucose Intolerance. | 755 | ||
| Other Adverse Effects. | 756 | ||
| Noncontraceptive Benefits of OCs | 756 | ||
| Drug Interactions | 756 | ||
| Drugs and Herbs That Reduce the Effects of OCs. | 756 | ||
| Drugs Whose Effects Are Reduced by OCs. | 756 | ||
| Drugs Whose Effects Are Increased by OCs. | 756 | ||
| Preparations | 756 | ||
| Beyaz and Safyral. | 756 | ||
| Natazia. | 756 | ||
| Dosing Schedules | 756 | ||
| 28-Day-Cycle Schedules. | 756 | ||
| Extended-Cycle and Continuous Schedules. | 756 | ||
| What to Do if Doses Are Missed | 759 | ||
| Progestin-Only Oral Contraceptives | 759 | ||
| Combination Contraceptives with Novel Delivery Systems | 759 | ||
| Transdermal Contraceptive Patch | 759 | ||
| Vaginal Contraceptive Ring | 760 | ||
| Long-Acting Contraceptives | 760 | ||
| Subdermal Etonogestrel Implants | 760 | ||
| Description. | 760 | ||
| Mechanism of Action. | 760 | ||
| Pharmacokinetics. | 760 | ||
| Drug Interactions. | 760 | ||
| Adverse Effect: Irregular Bleeding. | 760 | ||
| Use During Breast-feeding. | 760 | ||
| Depot Medroxyprogesterone Acetate | 760 | ||
| Intrauterine Devices | 761 | ||
| Spermicides | 761 | ||
| Barrier Devices | 761 | ||
| Drugs for Medical Abortion | 764 | ||
| Mifepristone (RU 486) with Misoprostol | 764 | ||
| Mechanism of Action. | 764 | ||
| Clinical Trials. | 764 | ||
| Adverse Effects. | 764 | ||
| Contraindications. | 764 | ||
| Preparations, Dosage, and Administration. | 764 | ||
| FDA-Approved Protocol for Abortion. | 764 | ||
| Day 1. | 764 | ||
| Day 3. | 764 | ||
| Day 14. | 764 | ||
| Methotrexate with Misoprostol | 764 | ||
| Prostaglandins: Misoprostol, Carboprost, and Dinoprostone | 764 | ||
| Nomenclature | 765 | ||
| Physiologic and Pharmacologic Effects | 765 | ||
| Uterine Stimulation. | 765 | ||
| Cervical Softening. | 765 | ||
| Therapeutic Uses | 765 | ||
| Abortion. | 765 | ||
| Control of Postpartum Hemorrhage. | 765 | ||
| Induction of Labor. | 765 | ||
| Cervical Ripening. | 765 | ||
| Adverse Effects | 765 | ||
| Precautions and Contraindications | 765 | ||
| Preparations, Dosage, and Administration | 765 | ||
| Dinoprostone. | 765 | ||
| Carboprost Tromethamine. | 765 | ||
| Misoprostol. | 765 | ||
| Key Points | 765 | ||
| Summary of Major Nursing Implications* | 766 | ||
| Combination Oral Contraceptives | 766 | ||
| Preadministration Assessment | 766 | ||
| Therapeutic Goal | 766 | ||
| Baseline Data | 766 | ||
| Identifying High-Risk Patients | 766 | ||
| Implementation: Administration | 766 | ||
| Dosing Schedule | 766 | ||
| Responding to Missed Doses | 766 | ||
| Postpartum Use | 767 | ||
| Promoting Adherence | 767 | ||
| Ongoing Evaluation and Interventions | 767 | ||
| Minimizing Adverse Effects | 767 | ||
| Thrombotic Disorders. | 767 | ||
| Hypertension. | 767 | ||
| Abnormal Uterine Bleeding. | 767 | ||
| Use in Pregnancy and Lactation. | 767 | ||
| Glucose Intolerance. | 767 | ||
| Stroke in Women with Migraine. | 767 | ||
| Hyperkalemia. | 767 | ||
| Minimizing Adverse Interactions | 767 | ||
| Agents That Reduce OC Levels. | 767 | ||
| Drugs Whose Effects Are Reduced by OCs. | 767 | ||
| Drugs Whose Effects Are Increased by OCs. | 767 | ||
| Drugs That Elevate Potassium. | 767 | ||
| Progestin-Only Oral Contraceptives | 768 | ||
| Preadministration Assessment | 768 | ||
| Therapeutic Goal | 768 | ||
| Implementation: Administration | 768 | ||
| Dosing Schedule | 768 | ||
| Responding to Missed Doses | 768 | ||
| Ongoing Evaluation and Interventions | 768 | ||
| Minimizing Adverse Effects | 768 | ||
| Menstrual Irregularities. | 768 | ||
| 63 Drug Therapy of Infertility | 769 | ||
| Infertility: Causes and Treatment Strategies | 769 | ||
| Female Infertility | 769 | ||
| Anovulation and Failure of Follicular Maturation | 769 | ||
| Unfavorable Cervical Mucus | 769 | ||
| Hyperprolactinemia | 769 | ||
| Endometriosis | 770 | ||
| Polycystic Ovary Syndrome | 770 | ||
| Male Infertility | 770 | ||
| Hypogonadotropic Hypogonadism | 770 | ||
| Erectile Dysfunction | 770 | ||
| Idiopathic Male Infertility | 770 | ||
| Drugs Used to Treat Female Infertility | 770 | ||
| Drugs for Controlled Ovarian Stimulation | 770 | ||
| Clomiphene | 770 | ||
| Therapeutic Use. | 770 | ||
| Mechanism of Fertility Promotion. | 770 | ||
| Monitoring. | 771 | ||
| Adverse Effects. | 771 | ||
| Preparations, Dosage, and Administration. | 771 | ||
| Menotropins | 771 | ||
| Therapeutic Actions and Uses | 771 | ||
| Anovulatory Women. | 771 | ||
| Ovulatory Women. | 772 | ||
| Men. | 772 | ||
| Unit X Men's Health | 788 | ||
| 65 Androgens | 788 | ||
| Testosterone | 788 | ||
| Biosynthesis and Secretion | 788 | ||
| Males. | 788 | ||
| Females. | 788 | ||
| Mechanism of Action | 788 | ||
| Physiologic and Pharmacologic Effects | 788 | ||
| Effects on Sex Characteristics in Males | 788 | ||
| Pubertal Transformation. | 788 | ||
| Spermatogenesis. | 789 | ||
| Effects on Sex Characteristics in Females | 789 | ||
| Anabolic Effects | 789 | ||
| Erythropoietic Effects | 789 | ||
| Clinical Pharmacology of the Androgens | 789 | ||
| Classification | 789 | ||
| Therapeutic Uses | 789 | ||
| Male Hypogonadism. | 789 | ||
| Replacement Therapy. | 790 | ||
| Delayed Puberty. | 790 | ||
| Replacement Therapy in Menopausal Women. | 790 | ||
| Wasting in Patients with AIDS. | 790 | ||
| Anemias. | 790 | ||
| Adverse Effects | 792 | ||
| Virilization in Women, Girls, and Boys. | 792 | ||
| Premature Epiphyseal Closure. | 792 | ||
| Hepatotoxicity. | 792 | ||
| Effects on Cholesterol Levels. | 792 | ||
| Use in Pregnancy. | 792 | ||
| Prostate Cancer. | 792 | ||
| Edema. | 792 | ||
| Abuse Potential. | 793 | ||
| Androgen Preparations for Male Hypogonadism | 793 | ||
| Oral Androgens | 793 | ||
| Transdermal Testosterone | 793 | ||
| Patches. | 793 | ||
| Gels. | 793 | ||
| Topical Solution. | 793 | ||
| Implantable Testosterone Pellets | 793 | ||
| Testosterone Buccal Tablets | 793 | ||
| Intramuscular Testosterone Esters | 794 | ||
| Androgen (Anabolic Steroid) Abuse by Athletes | 794 | ||
| Key Points | 794 | ||
| Summary of Major Nursing Implications* | 795 | ||
| Androgens | 795 | ||
| Preadministration Assessment | 795 | ||
| Therapeutic Goals | 795 | ||
| Males. | 795 | ||
| Females. | 795 | ||
| Males and Females. | 795 | ||
| Identifying High-Risk Patients | 795 | ||
| Implementation: Administration | 795 | ||
| Routes | 795 | ||
| Administration | 795 | ||
| Oral. | 795 | ||
| Transdermal Gel and Solution. | 795 | ||
| Buccal. | 795 | ||
| Implantable Pellets. | 795 | ||
| Ongoing Evaluation and Interventions | 795 | ||
| Minimizing Adverse Effects | 795 | ||
| Virilization. | 795 | ||
| Premature Epiphyseal Closure. | 795 | ||
| Hepatotoxicity. | 795 | ||
| Edema. | 795 | ||
| Teratogenesis. | 795 | ||
| Prostate Cancer. | 795 | ||
| Injury from Skin-to-Skin Transfer of Topical Testosterone. | 795 | ||
| 66 Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia | 796 | ||
| Erectile Dysfunction | 796 | ||
| Physiology of Erection | 796 | ||
| Oral Drugs for ED: PDE5 Inhibitors | 796 | ||
| Sildenafil | 796 | ||
| Mechanism of Action | 797 | ||
| Pharmacokinetics | 797 | ||
| Sexual Benefits | 797 | ||
| In Men with ED. | 797 | ||
| In Men Without ED. | 797 | ||
| In Women. | 797 | ||
| Adverse Effects | 799 | ||
| Hypotension. | 799 | ||
| Priapism. | 799 | ||
| Nonarteritic Ischemic Optic Neuropathy (NAION). | 799 | ||
| Sudden Hearing Loss. | 799 | ||
| Other Adverse Effects. | 799 | ||
| Drug Interactions | 799 | ||
| Nitrates. | 799 | ||
| Alpha Blockers. | 799 | ||
| Inhibitors of CYP3A4. | 799 | ||
| Is Sildenafil Safe for Men with CHD? | 799 | ||
| Preparations, Dosage, and Administration | 799 | ||
| Vardenafil, Tadalafil, and Avanafil | 799 | ||
| Vardenafil | 799 | ||
| Actions and Use. | 799 | ||
| Unit XI Antiinflammatory, Antiallergic, and Immunologic Drugs | 806 | ||
| 67 Review of the Immune System | 806 | ||
| Introduction to the Immune System | 806 | ||
| Natural Immunity Versus Specific Acquired Immunity | 806 | ||
| Cell-Mediated Immunity Versus Antibody-Mediated (Humoral) Immunity | 806 | ||
| Introduction to Cells of the Immune System | 806 | ||
| B Lymphocytes (B Cells). | 806 | ||
| Cytolytic T Lymphocytes (Cytolytic T Cells, CD8 Cells). | 806 | ||
| Helper T Lymphocytes (Helper T Cells, CD4 Cells). | 808 | ||
| Macrophages. | 808 | ||
| Dendritic Cells. | 808 | ||
| Mast Cells and Basophils. | 808 | ||
| Neutrophils. | 808 | ||
| Eosinophils. | 808 | ||
| Antibodies | 808 | ||
| Antigens | 808 | ||
| Characteristic Features of Immune Responses | 809 | ||
| Specificity. | 809 | ||
| Diversity. | 809 | ||
| Memory. | 809 | ||
| Time Limitation. | 810 | ||
| Selectivity for Antigens of Nonself Origin. | 810 | ||
| Phases of the Immune Response | 810 | ||
| Recognition Phase. | 810 | ||
| Activation Phase. | 810 | ||
| Effector Phase. | 810 | ||
| Major Histocompatibility Complex Molecules | 810 | ||
| Cytokines, Lymphokines, and Monokines | 810 | ||
| Antibody-Mediated (Humoral) Immunity | 811 | ||
| Production of Antibodies | 811 | ||
| Overview of Antibody Production | 811 | ||
| Specific Cellular Events in Antibody Production | 811 | ||
| B Cells. | 811 | ||
| Antigen-Presenting Cells. | 811 | ||
| Helper T Cells (CD4 Cells). | 811 | ||
| Antibody Effector Mechanisms | 811 | ||
| Opsonization of Bacteria | 812 | ||
| Activation of the Complement System | 812 | ||
| Neutralization of Viruses and Bacterial Toxins | 813 | ||
| Cell-Mediated Immunity | 813 | ||
| Delayed-Type Hypersensitivity (Type IV Hypersensitivity) | 813 | ||
| Activation of Helper T Cells. | 813 | ||
| Activation of Macrophages. | 814 | ||
| Cytolytic T Lymphocytes | 814 | ||
| Activation of Cytolytic T Cells. | 814 | ||
| Recognition of Virally Infected Target Cells. | 815 | ||
| Mechanisms of Cell Kill. | 815 | ||
| Key Points | 815 | ||
| 68 Childhood Immunization | 817 | ||
| General Considerations | 817 | ||
| Definitions | 817 | ||
| Vaccine. | 817 | ||
| Killed Vaccines Versus Live Vaccines. | 817 | ||
| Toxoid. | 817 | ||
| Vaccination. | 817 | ||
| Immunization: Active Versus Passive. | 817 | ||
| Specific Immune Globulins. | 818 | ||
| Public Health Impact of Immunization | 818 | ||
| Reporting Vaccine-Preventable Diseases | 818 | ||
| Immunization Records | 818 | ||
| Adverse Effects of Immunization | 819 | ||
| Vaccine Information Statements | 820 | ||
| Childhood Immunization Schedule | 820 | ||
| Target Diseases | 820 | ||
| Measles, Mumps, and Rubella | 820 | ||
| Measles. | 820 | ||
| Mumps. | 820 | ||
| Rubella. | 820 | ||
| Diphtheria, Tetanus, and Pertussis | 820 | ||
| Diphtheria. | 820 | ||
| Tetanus (Lockjaw). | 820 | ||
| Pertussis (Whooping Cough). | 821 | ||
| Poliomyelitis | 821 | ||
| Haemophilus influenzae Type b | 821 | ||
| Varicella (Chickenpox) | 821 | ||
| Hepatitis B | 821 | ||
| Hepatitis A | 821 | ||
| Pneumococcal Infection | 822 | ||
| Meningococcal Infection | 822 | ||
| Influenza | 822 | ||
| Rotavirus Gastroenteritis | 822 | ||
| Genital Human Papillomavirus Infection | 822 | ||
| Respiratory Syncytial Virus | 823 | ||
| Specific Vaccines and Toxoids | 823 | ||
| Measles, Mumps, and Rubella Virus Vaccine | 823 | ||
| Description. | 823 | ||
| Efficacy. | 823 | ||
| Adverse Effects | 823 | ||
| Mild. | 823 | ||
| Severe. | 823 | ||
| Precautions and Contraindications. | 823 | ||
| Route, Site, and Immunization Schedule. | 824 | ||
| Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine | 824 | ||
| Preparations. | 824 | ||
| Efficacy. | 825 | ||
| Adverse Effects | 825 | ||
| Mild. | 825 | ||
| Moderate. | 825 | ||
| Severe: Encephalopathy. | 826 | ||
| Precautions and Contraindications. | 826 | ||
| Unit XII Drugs for Bone and Joint Disorders | 879 | ||
| 73 Drug Therapy of Rheumatoid Arthritis | 879 | ||
| Pathophysiology of Rheumatoid Arthritis | 879 | ||
| Overview of Therapy | 879 | ||
| Nondrug Measures | 879 | ||
| Drug Therapy | 880 | ||
| Classes of Antiarthritic Drugs | 880 | ||
| Drug Selection | 880 | ||
| Nonsteroidal Antiinflammatory Drugs | 881 | ||
| Therapeutic Role. | 881 | ||
| NSAID Classification. | 881 | ||
| Drug Selection. | 881 | ||
| Efficacy. | 881 | ||
| Safety and Cost. | 881 | ||
| Dosage. | 881 | ||
| Glucocorticoids | 881 | ||
| Nonbiologic (Traditional) DMARDS | 881 | ||
| Methotrexate | 881 | ||
| Sulfasalazine | 882 | ||
| Leflunomide | 882 | ||
| Actions and Uses. | 882 | ||
| Pharmacokinetics. | 882 | ||
| Adverse Effects. | 883 | ||
| Leflunomide and Pregnancy. | 883 | ||
| Drug Interactions. | 883 | ||
| Preparations, Dosage, and Administration. | 883 | ||
| Hydroxychloroquine | 883 | ||
| Minocycline | 883 | ||
| Other Nonbiologic DMARDs | 883 | ||
| Penicillamine. | 883 | ||
| Gold Salts. | 883 | ||
| Azathioprine. | 883 | ||
| Cyclosporine. | 883 | ||
| Protein A Column [Prosorba]. | 883 | ||
| Biologic DMARDs | 883 | ||
| Tumor Necrosis Factor Antagonists | 884 | ||
| Etanercept | 884 | ||
| Mechanism of Action. | 884 | ||
| Therapeutic Uses. | 885 | ||
| Pharmacokinetics. | 885 | ||
| Adverse Effects | 885 | ||
| Mild Effects. | 885 | ||
| Serious Infections. | 885 | ||
| Severe Allergic Reactions. | 885 | ||
| Heart Failure. | 885 | ||
| Cancer. | 885 | ||
| Hematologic Disorders. | 885 | ||
| Liver Injury. | 885 | ||
| Central Nervous System (CNS) Demyelinating Disorders. | 885 | ||
| Drug Interactions. | 885 | ||
| Preparations, Dosage, and Administration. | 885 | ||
| Infliximab | 886 | ||
| Actions and Uses. | 886 | ||
| Adverse Effects. | 886 | ||
| Preparations, Dosage, and Administration. | 886 | ||
| Adalimumab | 886 | ||
| Golimumab | 886 | ||
| Certolizumab Pegol | 886 | ||
| Rituximab, a B-Lymphocyte–Depleting Agent | 886 | ||
| Actions and Uses | 886 | ||
| Adverse Effects | 886 | ||
| Infusion Reactions. | 886 | ||
| Mucocutaneous Reactions. | 887 | ||
| Hepatitis B Reactivation. | 887 | ||
| Progressive Multifocal Leukoencephalopathy (PML). | 887 | ||
| Other Adverse Effects. | 887 | ||
| Preparations, Dosage, and Administration | 887 | ||
| Abatacept, a T-Cell Activation Inhibitor | 887 | ||
| Therapeutic Uses. | 887 | ||
| Mechanism of Action. | 887 | ||
| Adverse Effects. | 887 | ||
| Drug Interactions. | 887 | ||
| Preparations, Dosage, and Administration. | 887 | ||
| Intravenous. | 887 | ||
| Subcutaneous. | 887 | ||
| Tocilizumab, an Interleukin-6 Receptor Antagonist | 887 | ||
| Actions and Therapeutic Use | 887 | ||
| Adverse Effects | 887 | ||
| Serious Infections. | 887 | ||
| GI Perforation. | 887 | ||
| Liver Injury. | 888 | ||
| Neutropenia and Thrombocytopenia. | 888 | ||
| Drug Interactions | 888 | ||
| Preparations, Dosage, and Administration | 888 | ||
| Anakinra, an Interleukin-1 Receptor Antagonist | 888 | ||
| Key Points | 888 | ||
| Summary of Major Nursing Implications* | 889 | ||
| Tumor Necrosis Factor Antagonists | 889 | ||
| Preadministration Assessment | 889 | ||
| Therapeutic Goal | 889 | ||
| Identifying High-Risk Patients | 889 | ||
| Implementation: Administration | 889 | ||
| Routes | 889 | ||
| Subcutaneous. | 889 | ||
| Intravenous. | 889 | ||
| Administration | 889 | ||
| Adalimumab, Certolizumab, Etanercept, Golimumab. | 889 | ||
| Infliximab. | 889 | ||
| Golimumab. | 889 | ||
| Ongoing Evaluation and Interventions | 889 | ||
| Minimizing Adverse Effects | 889 | ||
| Serious Infections. | 889 | ||
| Allergic Reactions. | 889 | ||
| Heart Failure. | 889 | ||
| Cancer. | 889 | ||
| Hematologic Disorders. | 889 | ||
| Liver Injury. | 889 | ||
| CNS Demyelinating Disorders. | 890 | ||
| Injection-Site Reactions: Adalimumab, Certolizumab, Etanercept, and Golimumab. | 890 | ||
| Infusion Reactions: Infliximab. | 890 | ||
| Minimizing Adverse Interactions | 890 | ||
| Immunosuppressants. | 890 | ||
| Live Virus Vaccines. | 890 | ||
| 74 Drug Therapy of Gout | 891 | ||
| Pathophysiology of Gout | 891 | ||
| Overview of Drug Therapy | 891 | ||
| Drugs for Acute Gouty Arthritis | 891 | ||
| Nonsteroidal Antiinflammatory Drugs | 891 | ||
| Glucocorticoids | 891 | ||
| Colchicine | 892 | ||
| Therapeutic Use | 892 | ||
| Acute Gouty Arthritis. | 892 | ||
| Prophylaxis of Gouty Attacks. | 892 | ||
| Mechanism of Action | 892 | ||
| Pharmacokinetics | 892 | ||
| Adverse Effects | 892 | ||
| Gastrointestinal Effects. | 892 | ||
| Myelosuppression. | 892 | ||
| Myopathy. | 892 | ||
| Drug Interactions | 892 | ||
| Statins. | 892 | ||
| Drugs That Can Increase Colchicine Levels. | 892 | ||
| Precautions and Contraindications | 892 | ||
| Preparations, Dosage, and Administration | 892 | ||
| Preparations. | 892 | ||
| Dosage. | 892 | ||
| Drugs for Hyperuricemia (Urate-Lowering Therapy) | 892 | ||
| Xanthine Oxidase Inhibitors: Allopurinol and Febuxostat | 892 | ||
| Allopurinol | 892 | ||
| Therapeutic Uses. | 892 | ||
| Mechanism of Action. | 893 | ||
| Pharmacokinetics. | 893 | ||
| Adverse Effects. | 893 | ||
| Drug Interactions. | 893 | ||
| Preparations, Dosage, and Administration. | 893 | ||
| Febuxostat | 894 | ||
| Probenecid, a Uricosuric Agent | 894 | ||
| Actions and Uses. | 894 | ||
| Unit XIII Respiratory Tract Drugs | 918 | ||
| 76 Drugs for Asthma and Chronic Obstructive Pulmonary Disease | 918 | ||
| Basic Considerations | 918 | ||
| Pathophysiology of Asthma | 918 | ||
| Pathophysiology of COPD | 919 | ||
| Overview of Drugs for Asthma and COPD | 919 | ||
| Administering Drugs by Inhalation | 921 | ||
| Metered-Dose Inhalers | 921 | ||
| Respimats | 921 | ||
| Dry-Powder Inhalers | 921 | ||
| Nebulizers | 921 | ||
| Antiinflammatory Drugs | 922 | ||
| Glucocorticoids | 922 | ||
| Mechanism of Antiasthma Action | 922 | ||
| Use in Asthma | 922 | ||
| Inhalation Use. | 922 | ||
| Oral Use. | 923 | ||
| Adverse Effects | 923 | ||
| Unit XIV Gastrointestinal Drugs | 947 | ||
| 78 Drugs for Peptic Ulcer Disease | 947 | ||
| Pathogenesis of Peptic Ulcers | 947 | ||
| Defensive Factors | 947 | ||
| Mucus. | 947 | ||
| Bicarbonate. | 947 | ||
| Blood Flow. | 947 | ||
| Prostaglandins. | 947 | ||
| Aggressive Factors | 947 | ||
| Helicobacter pylori. | 947 | ||
| Nonsteroidal Antiinflammatory Drugs. | 948 | ||
| Gastric Acid. | 948 | ||
| Pepsin. | 948 | ||
| Smoking. | 948 | ||
| Summary | 948 | ||
| Overview of Treatment | 948 | ||
| Drug Therapy | 948 | ||
| Classes of Antiulcer Drugs | 948 | ||
| Drug Selection | 949 | ||
| Helicobacter pylori–Associated Ulcers. | 949 | ||
| NSAID-Induced Ulcers | 949 | ||
| Prophylaxis. | 949 | ||
| Treatment. | 949 | ||
| Evaluation | 949 | ||
| A Note About the Effects of Drugs on Pepsin | 949 | ||
| Nondrug Therapy | 950 | ||
| Diet. | 950 | ||
| Other Nondrug Measures. | 950 | ||
| Antibacterial Drugs | 950 | ||
| Tests for Helicobacter pylori | 950 | ||
| Antibiotics Employed | 950 | ||
| Clarithromycin. | 950 | ||
| Amoxicillin. | 950 | ||
| Bismuth. | 950 | ||
| Tetracycline. | 950 | ||
| Metronidazole. | 950 | ||
| Tinidazole. | 950 | ||
| Antibiotic Regimens | 950 | ||
| Histamine2 Receptor Antagonists | 951 | ||
| Cimetidine | 951 | ||
| Mechanism of Action | 951 | ||
| Pharmacokinetics | 952 | ||
| Therapeutic Uses | 952 | ||
| Gastric and Duodenal Ulcers. | 952 | ||
| Gastroesophageal Reflux Disease (GERD). | 952 | ||
| Zollinger-Ellison Syndrome. | 952 | ||
| Aspiration Pneumonitis. | 952 | ||
| Heartburn, Acid Indigestion, and Sour Stomach. | 952 | ||
| Adverse Effects | 953 | ||
| Antiandrogenic Effects. | 953 | ||
| CNS Effects. | 953 | ||
| Pneumonia. | 953 | ||
| Other Adverse Effects. | 953 | ||
| Drug Interactions | 953 | ||
| Interactions Related to Inhibition of Drug Metabolism. | 953 | ||
| Antacids. | 953 | ||
| Unit XV Nutrition | 987 | ||
| 81 Vitamins | 987 | ||
| Basic Considerations | 987 | ||
| Dietary Reference Intakes | 987 | ||
| Recommended Dietary Allowance. | 987 | ||
| Adequate Intake. | 987 | ||
| Tolerable Upper Intake Level. | 987 | ||
| Estimated Average Requirement. | 987 | ||
| Acceptable Macronutrient Distribution Range. | 987 | ||
| Classification of Vitamins | 987 | ||
| Should We Take Multivitamin Supplements? | 988 | ||
| Fat-Soluble Vitamins | 988 | ||
| Vitamin A (Retinol) | 988 | ||
| Actions. | 988 | ||
| Sources. | 988 | ||
| Units. | 988 | ||
| Requirements. | 988 | ||
| Pharmacokinetics. | 988 | ||
| Deficiency. | 988 | ||
| Toxicity. | 988 | ||
| Therapeutic Uses. | 988 | ||
| Preparations, Dosage, and Administration. | 990 | ||
| Vitamin D | 990 | ||
| Vitamin E (Alpha-Tocopherol) | 990 | ||
| Forms of Vitamin E. | 990 | ||
| Sources. | 990 | ||
| Requirements. | 990 | ||
| Unit XVI Chemotherapy of Infectious Diseases | 1001 | ||
| 83 Basic Principles of Antimicrobial Therapy | 1001 | ||
| Selective Toxicity | 1001 | ||
| How Is Selective Toxicity Achieved? | 1001 | ||
| Disruption of the Bacterial Cell Wall. | 1002 | ||
| Inhibition of an Enzyme Unique to Bacteria. | 1002 | ||
| Disruption of Bacterial Protein Synthesis. | 1002 | ||
| Classification of Antimicrobial Drugs | 1002 | ||
| Classification by Susceptible Organism | 1002 | ||
| Classification by Mechanism of Action | 1002 | ||
| Acquired Resistance to Antimicrobial Drugs | 1003 | ||
| Microbial Mechanisms of Drug Resistance | 1003 | ||
| Reduction of Drug Concentration at Its Site of Action. | 1003 | ||
| Alteration of Drug Target Molecules. | 1003 | ||
| Antagonist Production. | 1004 | ||
| Drug Inactivation. | 1004 | ||
| New Delhi Metallo-Beta-Lactamase 1 (NDM-1) Gene. | 1004 | ||
| Mechanisms by Which Resistance Is Acquired | 1004 | ||
| Spontaneous Mutation. | 1004 | ||
| Conjugation. | 1005 | ||
| Relationships Between Antibiotic Use and Emergence of Drug-Resistant Microbes | 1005 | ||
| How Do Antibiotics Promote Resistance? | 1005 | ||
| Which Antibiotics Promote Resistance? | 1005 | ||
| Does the Amount of Antibiotic Use Influence the Emergence of Resistance? | 1005 | ||
| Healthcare-Associated Infections. | 1005 | ||
| Superinfection | 1005 | ||
| Delaying the Emergence of Resistance in Hospitals | 1005 | ||
| Selection of Antibiotics | 1007 | ||
| Empiric Therapy Before Completion of Laboratory Tests | 1007 | ||
| Identifying the Infecting Organism | 1009 | ||
| Determining Drug Susceptibility | 1009 | ||
| Disk Diffusion. | 1010 | ||
| Serial Dilution. | 1010 | ||
| Gradient Diffusion. | 1010 | ||
| Host Factors That Modify Drug Choice, Route of Administration, or Dosage | 1010 | ||
| Host Defenses | 1010 | ||
| Site of Infection | 1010 | ||
| Other Host Factors | 1010 | ||
| Previous Allergic Reaction. | 1010 | ||
| Genetic Factors. | 1011 | ||
| Dosage and Duration of Treatment | 1011 | ||
| Therapy with Antibiotic Combinations | 1011 | ||
| Antimicrobial Effects of Antibiotic Combinations | 1011 | ||
| Indications for Antibiotic Combinations | 1011 | ||
| Initial Therapy of Severe Infection. | 1011 | ||
| Mixed Infections. | 1012 | ||
| Preventing Resistance. | 1012 | ||
| Decreased Toxicity. | 1012 | ||
| Enhanced Antibacterial Action. | 1012 | ||
| Disadvantages of Antibiotic Combinations | 1012 | ||
| Prophylactic Use of Antimicrobial Drugs | 1012 | ||
| Surgery. | 1012 | ||
| Bacterial Endocarditis. | 1012 | ||
| Neutropenia. | 1012 | ||
| Other Indications for Antimicrobial Prophylaxis. | 1012 | ||
| Misuses of Antimicrobial Drugs | 1012 | ||
| Attempted Treatment of Viral Infection. | 1012 | ||
| Treatment of Fever of Unknown Origin. | 1012 | ||
| Improper Dosage. | 1013 | ||
| Treatment in the Absence of Adequate Bacteriologic Information. | 1013 | ||
| Omission of Surgical Drainage. | 1013 | ||
| Monitoring Antimicrobial Therapy | 1013 | ||
| Key Points | 1013 | ||
| 84 Drugs That Weaken the Bacterial Cell Wall I: | 1015 | ||
| Introduction to the Penicillins | 1015 | ||
| Mechanism of Action | 1015 | ||
| Mechanisms of Bacterial Resistance | 1015 | ||
| The Gram-Negative Cell Envelope | 1015 | ||
| Penicillinases (Beta-Lactamases) | 1016 | ||
| Altered Penicillin-Binding Proteins | 1017 | ||
| Chemistry | 1018 | ||
| Classification | 1018 | ||
| Properties of Individual Penicillins | 1018 | ||
| Penicillin G | 1018 | ||
| Antimicrobial Spectrum | 1018 | ||
| Therapeutic Uses | 1019 | ||
| Pharmacokinetics | 1019 | ||
| Absorption. | 1019 | ||
| Oral. | 1019 | ||
| Intramuscular. | 1019 | ||
| Intravenous. | 1019 | ||
| Distribution. | 1019 | ||
| Metabolism and Excretion. | 1019 | ||
| Side Effects and Toxicities | 1020 | ||
| Penicillin Allergy | 1020 | ||
| General Considerations. | 1020 | ||
| Types of Allergic Reactions. | 1020 | ||
| Development of Penicillin Allergy. | 1020 | ||
| Skin Tests for Penicillin Allergy. | 1020 | ||
| Management of Patients with a History of Penicillin Allergy. | 1021 | ||
| Drug Interactions | 1021 | ||
| Aminoglycosides. | 1021 | ||
| Probenecid. | 1021 | ||
| Bacteriostatic Antibiotics. | 1021 | ||
| Preparations, Dosage, and Administration | 1021 | ||
| Preparations and Routes of Administration. | 1021 | ||
| Dosage. | 1021 | ||
| Administration. | 1021 | ||
| Penicillin V | 1021 | ||
| Penicillinase-Resistant Penicillins (Antistaphylococcal Penicillins) | 1021 | ||
| Nafcillin | 1022 | ||
| Oxacillin and Dicloxacillin | 1022 | ||
| Methicillin | 1022 | ||
| Broad-Spectrum Penicillins (Aminopenicillins) | 1022 | ||
| Ampicillin | 1022 | ||
| Amoxicillin | 1022 | ||
| Extended-Spectrum Penicillins (Antipseudomonal Penicillins) | 1023 | ||
| Ticarcillin | 1023 | ||
| Piperacillin | 1023 | ||
| Penicillins Combined with a Beta-Lactamase Inhibitor | 1023 | ||
| Key Points | 1023 | ||
| Summary of Major Nursing Implications* | 1024 | ||
| Penicillins | 1024 | ||
| Preadministration Assessment | 1024 | ||
| Therapeutic Goal | 1024 | ||
| Baseline Data | 1024 | ||
| Identifying High-Risk Patients | 1024 | ||
| Implementation: Administration | 1024 | ||
| Routes | 1024 | ||
| Dosage | 1024 | ||
| Administration | 1024 | ||
| Ongoing Evaluation and Interventions | 1024 | ||
| Evaluating Therapeutic Effects | 1024 | ||
| Monitoring Kidney Function | 1024 | ||
| Minimizing Adverse Effects | 1024 | ||
| Allergic Reactions. | 1024 | ||
| Sodium Loading. | 1024 | ||
| Hyperkalemia. | 1024 | ||
| Effects Resulting from Incorrect Injection. | 1024 | ||
| Minimizing Adverse Interactions | 1024 | ||
| Aminoglycosides. | 1024 | ||
| 85 Drugs That Weaken the Bacterial Cell Wall II: | 1025 | ||
| Cephalosporins | 1025 | ||
| Chemistry | 1025 | ||
| Mechanism of Action | 1025 | ||
| Resistance | 1025 | ||
| Classification and Antimicrobial Spectra | 1025 | ||
| First Generation. | 1026 | ||
| Second Generation. | 1026 | ||
| Third Generation. | 1026 | ||
| Fourth Generation. | 1026 | ||
| Fifth Generation. | 1026 | ||
| Pharmacokinetics | 1026 | ||
| Absorption. | 1026 | ||
| Distribution. | 1026 | ||
| Elimination. | 1027 | ||
| Adverse Effects | 1027 | ||
| Allergic Reactions. | 1027 | ||
| Bleeding. | 1027 | ||
| Thrombophlebitis. | 1027 | ||
| Hemolytic Anemia. | 1027 | ||
| Other Adverse Effects. | 1027 | ||
| Drug Interactions | 1027 | ||
| Probenecid. | 1027 | ||
| Alcohol. | 1027 | ||
| Drugs That Promote Bleeding. | 1027 | ||
| Calcium and Ceftriaxone. | 1027 | ||
| Therapeutic Uses | 1027 | ||
| First-Generation Cephalosporins. | 1028 | ||
| Second-Generation Cephalosporins. | 1028 | ||
| Third-Generation Cephalosporins. | 1028 | ||
| Fourth-Generation Cephalosporins. | 1028 | ||
| Fifth-Generation Cephalosporins. | 1028 | ||
| Drug Selection | 1028 | ||
| Antimicrobial Spectrum. | 1028 | ||
| Adverse Effects. | 1028 | ||
| Pharmacokinetics. | 1028 | ||
| Route of Administration. | 1028 | ||
| Duration of Action. | 1028 | ||
| Distribution to CSF. | 1028 | ||
| Route of Elimination. | 1028 | ||
| Dosage and Administration | 1028 | ||
| Routes. | 1028 | ||
| Dosage. | 1028 | ||
| Administration | 1028 | ||
| Oral. | 1028 | ||
| Intramuscular. | 1028 | ||
| Intravenous. | 1029 | ||
| Carbapenems | 1029 | ||
| Imipenem | 1029 | ||
| Mechanism of Action. | 1029 | ||
| Antimicrobial Spectrum. | 1029 | ||
| Pharmacokinetics. | 1029 | ||
| Adverse Effects. | 1029 | ||
| Interaction with Valproate. | 1030 | ||
| Therapeutic Use. | 1030 | ||
| Unit XVII Chemotherapy of Parasitic Diseases | 1182 | ||
| 97 Anthelmintics | 1182 | ||
| Classification of Parasitic Worms | 1182 | ||
| Nematodes (Roundworms) | 1182 | ||
| Cestodes (Tapeworms) | 1182 | ||
| Trematodes (Flukes) | 1182 | ||
| Helminthic Infestations | 1182 | ||
| Nematode Infestations (Intestinal) | 1182 | ||
| Ascariasis (Giant Roundworm Infestation). | 1182 | ||
| Enterobiasis (Pinworm Infestation). | 1182 | ||
| Ancylostomiasis and Necatoriasis (Hookworm Infestation). | 1182 | ||
| Trichuriasis (Whipworm Infestation). | 1182 | ||
| Strongyloidiasis (Threadworm Infestation). | 1183 | ||
| Nematode Infestations (Extraintestinal) | 1183 | ||
| Trichinosis (Pork Roundworm Infestation). | 1183 | ||
| Wuchereriasis and Brugiasis (Lymphatic Filarial Infestation). | 1183 | ||
| Onchocerciasis (River Blindness). | 1183 | ||
| Cestode Infestations | 1183 | ||
| Taeniasis (Beef and Pork Tapeworm Infestation). | 1183 | ||
| Diphyllobothriasis (Fish Tapeworm Infestation). | 1183 | ||
| Trematode Infestations | 1183 | ||
| Schistosomiasis (Blood Fluke Infestations). | 1183 | ||
| Fascioliasis (Liver Fluke Infestation). | 1183 | ||
| Fasciolopsiasis (Intestinal Fluke Infestation). | 1183 | ||
| Drugs of Choice for Helminthiasis | 1184 | ||
| Mebendazole | 1184 | ||
| Unit XVIII Cancer Chemotherapy | 1206 | ||
| 101 Basic Principles of Cancer Chemotherapy | 1206 | ||
| What is Cancer? | 1206 | ||
| Characteristics of Neoplastic Cells | 1207 | ||
| Persistent Proliferation. | 1207 | ||
| Invasive Growth. | 1208 | ||
| Formation of Metastases. | 1208 | ||
| Immortality. | 1208 | ||
| Etiology of Cancer | 1208 | ||
| The Growth Fraction and Its Relationship to Chemotherapy | 1208 | ||
| The Cell Cycle | 1208 | ||
| The Growth Fraction | 1208 | ||
| Impact of Tissue Growth Fraction on Responsiveness to Chemotherapy | 1208 | ||
| Obstacles to Successful Chemotherapy | 1209 | ||
| Toxicity to Normal Cells | 1209 | ||
| Cure Requires 100% Cell Kill | 1209 | ||
| Kinetics of Drug-Induced Cell Kill. | 1209 | ||
| Host Defenses Contribute Little to Cell Kill. | 1209 | ||
| When Should Treatment Stop? | 1209 | ||
| Absence of Truly Early Detection | 1210 | ||
| Solid Tumors Respond Poorly | 1210 | ||
| Drug Resistance | 1211 | ||
| Heterogeneity of Tumor Cells | 1212 | ||
| Limited Drug Access to Tumor Cells | 1212 | ||
| Strategies for Achieving Maximum Benefits from Chemotherapy | 1212 | ||
| Intermittent Chemotherapy | 1212 | ||
| Combination Chemotherapy | 1212 | ||
| Benefits of Drug Combinations | 1212 | ||
| Suppression of Drug Resistance. | 1212 | ||
| Increased Cancer Cell Kill. | 1212 | ||
| Reduced Injury to Normal Cells. | 1212 | ||
| Guidelines for Drug Selection | 1213 | ||
| Optimizing Dosing Schedules | 1213 | ||
| Regional Drug Delivery | 1214 | ||
| Intra-arterial Delivery. | 1214 | ||
| Intrathecal Delivery. | 1214 | ||
| Other Specialized Routes. | 1214 | ||
| Major Toxicities of Chemotherapeutic Drugs | 1214 | ||
| Bone Marrow Suppression | 1214 | ||
| Neutropenia | 1214 | ||
| Thrombocytopenia | 1215 | ||
| Anemia | 1215 | ||
| Digestive Tract Injury | 1215 | ||
| Stomatitis. | 1215 | ||
| Diarrhea. | 1215 | ||
| Nausea and Vomiting | 1215 | ||
| Other Important Toxicities | 1215 | ||
| Alopecia. | 1215 | ||
| Reproductive Toxicity. | 1216 | ||
| Hyperuricemia. | 1216 | ||
| Local Injury from Extravasation of Vesicants. | 1216 | ||
| Unique Toxicities. | 1216 | ||
| Carcinogenesis. | 1216 | ||
| Making the Decision to Treat | 1216 | ||
| Looking Ahead | 1217 | ||
| Key Points | 1218 | ||
| 102 Anticancer Drugs I: | 1220 | ||
| Introduction to the Cytotoxic Anticancer Drugs | 1220 | ||
| Mechanisms of Cytotoxic Action | 1220 | ||
| Cell-Cycle Phase Specificity | 1220 | ||
| Cell-Cycle Phase–Specific Drugs. | 1220 | ||
| Cell-Cycle Phase–Nonspecific Drugs. | 1220 | ||
| Toxicity | 1223 | ||
| Dosage, Handling, and Administration | 1223 | ||
| Handling Cytotoxic Drugs. | 1223 | ||
| Administering Vesicants. | 1223 | ||
| Alkylating Agents | 1223 | ||
| Shared Properties | 1223 | ||
| Mechanism of Action. | 1223 | ||
| Resistance. | 1225 | ||
| Toxicities. | 1225 | ||
| Properties of Individual Alkylating Agents | 1225 | ||
| Nitrogen Mustards | 1225 | ||
| Cyclophosphamide. | 1225 | ||
| Mechlorethamine. | 1225 | ||
| Bendamustine. | 1225 | ||
| Chlorambucil. | 1225 | ||
| Melphalan. | 1225 | ||
| Ifosfamide. | 1225 | ||
| Nitrosoureas | 1225 | ||
| Carmustine (Bcnu). | 1225 | ||
| Lomustine (Ccnu). | 1225 | ||
| Streptozocin. | 1225 | ||
| Other Alkylating Agents | 1226 | ||
| Busulfan. | 1226 | ||
| Temozolomide | 1226 | ||
| Therapeutic Uses. | 1226 | ||
| Pharmacokinetics and Mechanism of Action. | 1226 | ||
| Adverse Effects. | 1226 | ||
| Platinum Compounds | 1226 | ||
| Cisplatin | 1226 | ||
| Carboplatin | 1226 | ||
| Oxaliplatin | 1226 | ||
| Actions and Uses. | 1226 | ||
| Toxicity | 1226 | ||
| Peripheral Sensory Neuropathy. | 1226 | ||
| Other Toxicities. | 1226 | ||
| Antimetabolites | 1227 | ||
| Folic Acid Analogs | 1227 | ||
| Methotrexate | 1227 | ||
| Mechanism of Action. | 1227 | ||
| Unit XIX Miscellaneous Drugs and Therapies | 1267 | ||
| 104 Drugs for the Eye | 1267 | ||
| Drugs for Glaucoma | 1267 | ||
| Pathophysiology and Treatment Overview | 1267 | ||
| Primary Open-Angle Glaucoma | 1267 | ||
| Characteristics. | 1267 | ||
| Risk Factors. | 1267 | ||
| Screening. | 1267 | ||
| Management. | 1267 | ||
| Angle-Closure Glaucoma | 1268 | ||
| Drugs Used to Treat Glaucoma | 1269 | ||
| Beta-Adrenergic Blocking Agents | 1269 | ||
| Actions and Use in Glaucoma. | 1269 | ||
| Adverse Effects | 1270 | ||
| Local. | 1270 | ||
| Systemic. | 1270 | ||
| Prostaglandin Analogs | 1270 | ||
| Latanoprost. | 1270 | ||
| Other Prostaglandin Analogs. | 1270 | ||
| Alpha2-Adrenergic Agonists | 1270 | ||
| Brimonidine. | 1270 | ||
| Apraclonidine. | 1271 | ||
| Alpha2 Agonist/Beta Blocker Combination | 1271 | ||
| Pilocarpine, a Direct-Acting Muscarinic Agonist | 1271 | ||
| Unit XX Toxicology | 1330 | ||
| 109 Management of Poisoning | 1330 | ||
| Fundamentals of Treatment | 1330 | ||
| Supportive Care | 1330 | ||
| Poison Identification | 1330 | ||
| Prevention of Further Absorption | 1330 | ||
| Promotion of Poison Removal | 1330 | ||
| Use of Specific Antidotes | 1331 | ||
| Drugs and Procedures Used to Minimize Poison Absorption | 1331 | ||
| Reducing Absorption of Ingested Poisons | 1331 | ||
| Activated Charcoal | 1331 | ||
| Gastric Lavage and Aspiration | 1331 | ||
| Whole-Bowel Irrigation | 1331 | ||
| Surface Decontamination | 1331 | ||
| Drugs and Procedures Used for Poison Removal | 1331 | ||
| Drugs That Enhance Renal Excretion | 1331 | ||
| Nondrug Methods of Poison Removal | 1331 | ||
| Specific Antidotes | 1332 | ||
| Heavy Metal Antagonists | 1332 | ||
| Chelators for Iron Toxicity | 1332 | ||
| Deferoxamine | 1332 | ||
| Appendix Canadian Drug Information | 1346 | ||
| International System of Units | 1346 | ||
| Drug Serum Concentrations | 1346 | ||
| Canadian Drug Legislation | 1346 | ||
| Prescription Drugs (Schedule F) | 1346 | ||
| Nonprescription Medications | 1348 | ||
| National Drug Schedules | 1348 | ||
| New-Drug Development in Canada | 1348 | ||
| Patent Laws | 1348 | ||
| References | 1349 | ||
| Index | 1351 | ||
| A | 1351 | ||
| B | 1360 | ||
| C | 1363 | ||
| D | 1368 | ||
| E | 1372 | ||
| F | 1375 | ||
| G | 1377 | ||
| H | 1379 | ||
| I | 1382 | ||
| J | 1385 | ||
| K | 1385 | ||
| L | 1386 | ||
| M | 1388 | ||
| N | 1391 | ||
| O | 1394 | ||
| P | 1396 | ||
| Q | 1401 | ||
| R | 1402 | ||
| S | 1404 | ||
| T | 1407 | ||
| U | 1410 | ||
| V | 1411 | ||
| W | 1413 | ||
| X | 1413 | ||
| Y | 1413 | ||
| Z | 1413 | ||
| Inside back cover | ibc1 |