Pharmacology for Nursing Practice - GBV · CNS Depressants, 117 CNS Stimulants, 118 Hallucinogens, 120 Inhalants, 122 APPLICATION TO PRACTICE, 123 Assessment, 123 Goals of Therapy,

Pharmacologyfor Nursing Practice

Kathleen Gutierrez, PhD, RN, ANP, CNSAdult Nurse Practitioner

Private Practice;Associate Professor

Regis University andUniversity of Colorado Health Sciences Center

Denver, Colorado

Sherry F. Queener, PhDProfessor of Pharmacology

Indiana University School of Medicine;Associate Dean

Indiana University Graduate School;and Director of the Graduate Office

Indiana University Purdue University Indianapolis (IUPUI)Indianapolis, Indiana

MosbyAn Affiliate of Elsevier Science

Table of Contents

PART |

BASIC CONCEPTS AND PRINCIPLES

1 Drugs in the Body: Pharmacodynamicsand Pharmacokinetics, l

SHERRY F. QUEENER

Mechanisms of Drug Action: Pharmacodynamics, 2How Drug Dosage Relates to Drug Action:

Pharmacokinetics, 6

2 Perinatal Pharmacotherapeutics, 21KATHLEEN GUTIERREZ

Maternal Pharmacokinetic Considerations, 21Fetal-Placenta! Pharmacokinetic Considerations, 23Pharmacodynamics, 26Drugs and Lactation, 27APPLICATION TO PRACTICE, 29Assessment, 29Goals of Therapy, 30Intervention, 30Evaluation, 32

3 Pediatric Pharmacotherapeutics, 33KATHLEEN GUTIERREZ

Anatomic and Physiologic Variables, 34Pharmacokinetic Considerations, 36Pharmacodynamic Considerations, 38APPLICATION TO PRACTICE, 39Assessment, 39Goals of Therapy, 39Intervention, 40Evaluation, 43

4 Older Adult Pharmacotherapeutics, 45KATHLEEN GUTIERREZ

Anatomic and Physiologic Variables, 46Pharmacokinetic Considerations, 48Pharmacodynamic Considerations, 50APPLICATION TO PRACTICE, 51Assessment, 51Goals of Therapy, 53Intervention, 54Evaluation, 55

PART 11IMPLICATIONS OF DRUG THERAPY

5 Role of the Nurse in Drug Therapy, 57KATHLEEN GUTIERREZ

Collaborative Nature of Drug Therapy, 58Sources of Drug Information, 58APPLICATION TO PRACTICE, 60Assessment, 60Goals of Therapy, 62Intervention, 62Evaluation, 69

6 Evidence-Based Practice andPharmacoeconomics, 73

KATHLEEN GUTIERREZ

Evidence-Based Practice, 75EBP's Link to Pharmacoeconomics, 77Future of Pharmacoeconomics, 83Summary, 83

XI

Table of Contents

Legal Implications of Drug Therapy, 85LYNN ROGER WILLIS

Establishment of Safety and Efficacy of Drugs, 85Drug Testing, 89Controlled Substances, 91Canadian Drug Legislation, 92

Over-the-Counter Drugs and HerbalRemedies, 95

LYNN ROGER WILLIS and KATHLEEN GUTIERREZ

Regulation of Over-the-Counter Drugs, 95Resurgence of Herbal Remedies, 97Regulation of Herbal Remedies, 97Herbal Remedies Go Beyond the Scope of OTC

Drugs, 98Pseudoscience and Herbal Remedies, 98Pharmacology of Widely Used Herbal

Remedies, 99Potentially Dangerous Herbal Remedies, 103Nonherbal Dietary Supplements, 104APPLICATION TO PRACTICE, 106Assessment, 106Goals of Therapy, 106Intervention, 106Evaluation, 107

3 Substance Abuse, inMICHAEL R. VASKO and KATHLEEN GUTIERREZ

General Characteristics of Dependence-Producing Drugs, 111

Diagnosis of Drug Dependence, 112Opioids, 115CNS Depressants, 117CNS Stimulants, 118Hallucinogens, 120Inhalants, 122APPLICATION TO PRACTICE, 123Assessment, 123Goals of Therapy, 126Intervention, 127Evaluation, 127

HIuTONOMic NERVOUS SYSTEM DRUGS) Introduction to Autonomic Nervous

System Pharmacology, 129JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

Overview of the Autonomic Nervous System, 130Confusing Terminology of Drugs Acting through

the Autonomic Nervous System, 137

11 Parasympathetic Nervous SystemDrugs, 139

JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

PHYSIOLOGY: Muscarinic CholinergicMechanisms, 140

Eye, 140Exocrine Glands, 140Smooth Muscle of Gastrointestinal Tract and

Bladder, 140Airways, 140Heart, 140Bloodvessels, 140DRUG CIASS: Muscarinic Receptor Agonists or

Cholinomimetics, 141DRUG CLASS: Muscarinic Receptor Antagonists

or Anticholinergics, 143PHYSIOLOGY: Nicotinic Cholinergic

Mechanisms, 145DRUG CLASS: Ganglionic Nicotinic Receptor

Antagonist (Ganglionic Blocker), 145PHYSIOLOGY: Acetylcholinesterase, 146DRUG CIASS: Acetylcholinesterase

Inhibitors, 146APPLICATION TO PRACTICE, 148Assessment, 148Goals of Therapy, 150Intervention, 150Evaluation, 151

12 Drugs Affecting AdrenergicMechanisms, 153


PHYSIOLOGY: Alpha-Adrenergic Receptors, 154DRUG CLASS: Alpha-Adrenergic Receptor

Agonists, 156DRUG CLASS: Alpha-Adrenergic Receptor

Antagonists (Alpha Blockers), 158PHYSIOLOGY: Beta-Adrenergic Receptors, 160DRUG CLASS: Beta-Adrenergic Receptor

Agonists, 160DRUG CLASS: Beta-Adrenergic Receptor

Antagonists (Beta Blockers), 162Other Drugs Acting on Sympathetic

Mechanisms, 163APPLICATION TO PRACTICE, 164Assessment, 164Goals of Therapy, 165Intervention, 165Evaluation, 165

Table of Contents XIII

PART |VCENTRAL NERVOUS SYSTEM DRUGS

13 Opioid Analgesics, 167MICHAEL R. VASKO and KATHLEEN GUTIERREZ

History of Opioids, 168PHYSIOLOGY: Pain, 168Pain Pathways, 169Types of Pain, 170DRUG CLASS: Opioid Agonists, 171DRUG CLASS: Mixed Agonist-Antagonists and

Partial Agonists, 180DRUG CLASS: Opioid Antagonists, 182DRUG CIASS: Miscellaneous Drugs, 183APPLICATION TO PRACTICE, 183Assessment, 183Goals of Therapy, 185Intervention, 185Evaluation, 187

14 Nonsteroidal Antiinflammatory Drugs(NSAIDs) and Disease-ModifyingAntirheumatic Drugs (DMARDs), 191

MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Inflammation, 192PATHOPHYSIOLOGY: Pain, 193PATHOPHYSIOLOGY: Fever, 194Additional Actions of Prostaglandins, 194DRUG CIASS: Salicylates, 195DRUG CIASS: Other NSAIDs, 200DRUG CIASS: Cyclooxygenase-2 Inhibitors, 202ACETAMINOPHEN, 202DRUG CIASS: Disease-Modifying Antirheumatic

Drugs, 204DRUG CIASS: Gold Salts, 205DRUG CLASS: Miscellaneous Drugs for

Osteoarthritis, 206PATHOPHYSIOLOGY: Gout, 207DRUG CLASS: Antigout Drugs, 207DRUG CIASS: Uricosuric Drugs, 208APPLICATION TO PRACTICE, 209Assessment, 209Goals of Therapy, 211Intervention, 211Evaluation, 215

15 Drugs to Treat Headaches, 217MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATIIOPHYSIOLOGY: Headaches, 218DRUG CLASS: Triptans, 220DRUG CLASS: Ergot Derivatives, 221APPLICATION TO PRACTICE, 22.1Assessment, 223Goals of Therapy, 224

Intervention, 225Evaluation, 226

16 Anesthetics and Related Drugs, 229JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

Anesthesia Defined, 230PHYSIOLOGY: Local Anesthesia ,ind the

Transmission ot Painful Stimuli, 230DRUG CLASS: Local Anesthetics, 230PHYSIOLOGY: General Anesthesia, 234DRUG CLASS: Inhaled Anesthetics, 235DRUG CLASS: Intravenous Anesthetics, 237PI lYSIOI.OGY: Neuromuscular Transmission, 239DRUG CLASS: Neuromuscular Blockers, 240APPLICATION TO PRACTICE, 242Assessment, 242Goals of Therapy, 243Intervention, 244Evaluation, 245

17 Anxiolytic and Sedative-HypnoticDrugs, 247


PATHOPHYSIOLOGY: Anxiety, Sleep, and TheirDisorders, 248

DRUG CLASS: Benzodiazepines and RelatedDrugs, 250

DRUG CIASS: Benzodiazepine Antagonists, 252DRUG CLASS: Barbiturates, 252DRUG CLASS: Atypical Anxiolytic, 254DRUG CIASS: Older Sedative-Hypnotics, 254APPLICATION TO PRACTICE, 255Assessment, 255Goals of Therapy, 258Intervention, 258Evaluation, 260

18 Antidepressant and Antimania Drugs, 263MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Depression, 264DRUG CLASS: Selective Serotonin Reuptake

Inhibitors (SSRIs), 268DRUG CLASS: Tricyclic Antidepressants

(I(As), 270DRUG CLASS: Atypical Antidepressants, 271DRUG CLASS: Monoamine Oxidase Inhibitors

(MAOIs), 273PAIIIOPI lYSIOI.OGY: Bipolar Disorders, 273DRUG CLASS: Antimania or Mood-Altering

Drugs, 27bAPPLICATION TO PRACTICE, 278Assessment, 278Goals of Therapy, 281Intervention, 281Evaluation, 282

XII Table of Contents

7 Legal Implications of Drug Therapy, 85LYNN ROGER WILLIS

Establishment of Safety and Efficacy of Drugs, 85Drug Testing, 89Controlled Substances, 91Canadian Drug Legislation, 92

8 Over-the-Counter Drugs and HerbalRemedies, 95


Regulation of Over-the-Counter Drugs, 95Resurgence of Herbal Remedies, 97Regulation of Herbal Remedies, 97Herbal Remedies Go Beyond the Scope of OTC

Drugs, 98Pseudoscience and Herbal Remedies, 98Pharmacology of Widely Used Herbal

Remedies, 99Potentially Dangerous Herbal Remedies, 103Nonherbal Dietary Supplements, 104APPLICATION TO PRACTICE, 106Assessment, 106Goals of Therapy, 106Intervention, 106Evaluation, 107

9 Substance Abuse, illMICHAEL R. VASKO and KATHLEEN GUTIERREZ

General Characteristics of Dependence-Producing Drugs, 111

Diagnosis of Drug Dependence, 112Opioids, 115CNS Depressants, 117CNS Stimulants, 118Hallucinogens, 120Inhalants, 122APPLICATION TO PRACTICE, 123Assessment, 123Goals of Therapy, 126Intervention, 127Evaluation, 127

PART HIAUTONOMIC NERVOUS SYSTEM DRUGS

10 Introduction to Autonomic NervousSystem Pharmacology, 129


Overview of the Autonomic Nervous System, 130Confusing Terminology of Drugs Acting through

the Autonomic Nervous System, 137

11 Parasympathetic Nervous SystemDrugs, 139


PHYSIOLOGY: Muscarinic CholinergicMechanisms, 140

Eye, 140Exocrine Glands, 140Smooth Muscle of Gastrointestinal Tract and

Bladder, 140Airways, 140Heart, 140Bloodvessels, 140DRUG CIASS: Muscarinic Receptor Agonists or

Cholinomimetics, 141DRUG CIASS: Muscarinic Receptor Antagonists

or Anticholinergics, 143PHYSIOLOGY: Nicotinic Cholinergic

Mechanisms, 145DRUG CIASS: Ganglionic Nicotinic Receptor

Antagonist (Ganglionic Blocker), 145PHYSIOLOGY: Acetylcholinesterase, 146DRUG CIASS: Acetylcholinesterase

Inhibitors, 146APPLICATION TO PRACTICE, 148Assessment, 148Goals of Therapy, 150Intervention, 150Evaluation, 151

12 Drugs Affecting AdrenergicMechanisms, 153


PHYSIOLOGY: Alpha-Adrenergic Receptors, 154DRLIG CIASS: Alpha-Adrenergic Receptor

Agonists, 156DRUG CLASS: Alpha-Adrenergic Receptor

Antagonists (Alpha Blockers), 158PHYSIOLOGY: Beta-Adrenergic Receptors, 160DRLIG CIASS: Beta-Adrenergic Receptor

Agonists, 160DRLIG CLASS: Beta-Adrenergic Receptor

Antagonists (Beta Blockers), 162Other Drugs Acting on Sympathetic

Mechanisms, 163APPLICATION TO PRACTICE, 164Assessment, 164Goals of Therapy, 165Intervention, 165Evaluation, 165

Table of Contents XIII

PART |VCENTRAL NERVOUS SYSTEM DRUGS

13 Opioid Analgesics, 167MICHAEL R. VASKO and KATHLEEN GUTIERREZ

History of Opioids, 168PHYSIOLOGY: Pain, 168Pain Pathways, 169Types of Pain, 170DRUG CIASS: Opioid Agonists, 171DRUG CLASS: Mixed Agonist-Antagonists and

Partial Agonists, 180DRUG CIASS: Opioid Antagonists, 182DRUG CLASS: Miscellaneous Drugs, 183APPLICATION TO PRACTICE, 183Assessment, 183Goals of Therapy, 185Intervention, 185Evaluation, 187

14 Nonsteroidal Antiinflammatory Drugs(NSAIDs) and Disease-ModifyingAntirheumatic Drugs (DMARDs), 191


PATHOPHYSIOLOGY: Inflammation, 192PATHOPHYSIOLOGY: Pain, 193PATHOPHYSIOLOGY: Fever, 194Additional Actions of Prostaglandins, 194DRUG CIASS: Salicylates, 195DRUG CIASS: Other NSAIDs, 200DRUG CIASS: Cyclooxygenase-2 Inhibitors, 202ACETAMINOPHEN, 202DRLIG CIASS: Disease-Modifying Antirheumatic

Drugs, 204DRUG CLASS: Gold Salts, 205DRUG CIASS: Miscellaneous Drugs for

Osteoarthritis, 206PATHOPHYSIOLOGY: Gout, 207DRUG CIASS: Antigout Drugs, 207DRUG CIASS: Uricosuric Drugs, 208APPLICATION TO PRACTICE, 209Assessment, 209Goals of Therapy, 211Intervention, 211Evaluation, 215

15 Drugs to Treat Headaches, 217MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPIIYSIOLOGY: Headaches, 218DRUG CIASS: Triptans, 220DRUG CLASS: Ergot Derivatives, 221APPLICATION TO PRACTICE, 223Assessment, 223Goals of Therapy, 224

Intervention, 225Evaluation, 226

16 Anesthetics and Related Drugs, 229JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

Anesthesia Defined, 230PHYSIOLOGY: Local Anesthesia and the

Transmission of Painful Stimuli, 230DRUG CLASS: Local Anesthetics, 230PHYSIOLOGY: General Anesthesia, 234DRUG CLASS: Inhaled Anesthetics, 235DRUG CIASS: Intravenous Anesthetics, 237PI IYSIOLOGY: Neuromuscular Transmission, 239DRUG CIASS: Neuromuscular Blockers, 240APPLICATION TO PRACTICE, 242Assessment, 242Goals of Therapy, 243Intervention, 244Evaluation, 245

17 Anxiolytic and Sedative-HypnoticDrugs, 247


PATHOPI lYSIOI.OGY: Anxiety, Sleep, and TheirDisorders, 248

DRUG CLASS: Benzodiazepines and RelatedDrugs, 250

DRUG CIASS: Benzodiazepine Antagonists, 252DRUG CLASS: Barbiturates, 252DRUG CLASS: Atypical Anxiolytic, 254DRUG CLASS: Older Sedative-I lypnotics, 254APPLICATION TO PRACTICE, 255Assessment, 255Goals of Therapy, 258Intervention, 258Evaluation, 260

18 Antidepressant and Antimania Drugs, 263MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Depression, 264DRUG CIASS: Selective Serotonin Reuptake

Inhibitors (SSRIs), 268DRUG CIASS: Iricyclic Antidepressants

(TCAs), 270DRUG CIASS: Atypical Antidepressants, 271DRUG CIASS: Monoamine Oxidase Inhibitors

(MAOIs), 273PATHOPHYSIOI.OCY: Bipolar Disorders, 275DRUG CIASS: Antimania or Mood-Altering

Drugs, 276APPLICATION TO PRACTICE, 278Assessment, 278Goals of Therapy, 281Intervention, 281Evaluation, 282

XIV Table of Contents

19 Antipsychotic Drugs, 285MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY, 286Psychoses, 286Schizophrenia, 286DRUG CIASS: Antipsychotics, 287APPLICATION TO PRACTICE, 295Assessment, 295Goals of Therapy, 297Intervention, 297Evaluation, 299

20 Central Nervous System Stimulants, 303MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Narcolepsy, 303PATHOPHYSIOLOGY: Attention-Deficit

Hyperactivity Disorder, 304DRUG CLASS: CNS Stimulants, 305PATHOPHYSIOLOGY: Obesity, 308DRUG CLASS: Antiobesity Drugs, 309DRUG CLASS: Analeptics, 311APPLICATION TO PRACTICE, 312Assessment, 312Goals of Therapy, 313Intervention, 314Evaluation, 315

PART VNERVOUS SYSTEM DRUGS21 Skeletal Muscle Relaxants, 317

MICHAEL R. VASKO and SUSAN SCIACCA

PATHOPHYSIOLOGY: Spasms and Spasticity, 318Spasms, 318Spasticity, 319DRUG CLASS: Drugs Used to Treat Spasticity, 320DRUG CLASS: Skeletal Muscle Relaxants, 323APPLICATION TO PRACTICE, 324Assessment, 324Goals of Therapy, 325Intervention, 325Evaluation, 327

22 Anticonvulsants, 329MICHAEL R. VASKO and SUSAN SCIACCA

PATHOPHYSIOLOGY: Epilepsy, 330Classification of Epilepsy, 330Mechanisms Underlying Epilepsy, 332DRUG CLASS: Hydantoins, 332DRUG CIASS: Iminostilbenes, 334DRUG CLASS: Barbiturates, 335DRUG CLASS: Succinimides, 336DRUG CLASS: Valproates, 336DRLIG CLASS: Benzodiazepines, 337DRUG CLASS: Oxazolidinediones, 338DRUG CLASS: Miscellaneous Anticonvulsants, 339APPLICATION TO PRACTICE, 342

Assessment, 342Goals of Therapy, 343Intervention, 344Evaluation, 346

23 Drugs to Treat Movement Disorders,Myasthenia Gravis, and Alzheimer'sDisease, 349

MICHAEL R. VASKO and SUSAN SCIACCA

PATHOPHYSIOLOGY: Parkinson's Disease, 350DRUG CLASS: Anticholinergic Drugs, 353DRUG CIASS: Dopaminergic Drugs, 354DRUG CIASS: Dopamine Receptor Agonists, 355DRLJC CLASS: Miscellaneous Drugs Used to Treat

Parkinson's Disease, 356APPLICATION TO PRACTICE, 357Assessment, 357Goals of Therapy, 359Intervention, 359Evaluation, 361PATHOPHYSIOLOGY: Myasthenia Gravis, 362DRUG CIASS: Acetylcholinesterase Inhibitors, 364DRLIG CIASS: Immunosuppressive Drugs, 365APPLICATION TO PRACTICE, 366Assessment, 366Goals of Therapy, 367Intervention, 367Evaluation, 369PATHOPHYSIOLOGY: Alzheimer's Disease, 369DRUG CIASS: Acetylcholinesterase Inhibitors

LIsed to Treat Alzheimer's Disease, 370APPLICATION TO PRACTICE, 371Assessment, 371Goals of Therapy, 372Intervention, 372Evaluation, 373

PART V IANTIMICROBIAL DRUGS

24 Introduction to the Use ofAntimicrobial Drugs, 377

SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Infectious Disease, 377Strategies for Controlling Infectious Disease, 379Measures of Antibiotic Effectiveness, 379Factors Affecting Outcomes of Antibiotic

Therapy, 381Problems in Antibiotic Therapy, 384Misuse of Antibiotics, 385APPLICATION TO PRACTICE, 386Assessment, 386Goals of Therapy, 387Intervention, 387Evaluation, 388

Table of Contents XV

25 Penicillins, Cephalosporins, andRelated Drugs, 389


PATHOPHYSIOLOGY, 389DRUG CIASS: Beta-Lactam Antibiotics, 390DRUG CLASS: Narrow-Spectrum Antibiotics, 393DRUG CLASS: Penicillinase-Resistant

Penicillins, 395DRUG CLASS: Extended-Spectrum Penicillins, 395DRUG CLASS: Anti-Pseudomonas Penicillins, 396DRUG CLASS: Cephalosporins, 396DRUG CIASS: Miscellaneous Beta-Lactam

Antibiotic, 398DRUG CLASS: Carbapenems, 399DRUG CIASS: Carbacephems, 399APPLICATION TO PRACTICE, 400Assessment, 400Goals of Therapy, 401Intervention, 401Evaluation, 403

26 Macrolides: Erythromycin and RelatedDrugs, 405


PATHOPHYSIOLOGY, 405DRUG CLASS: Macrolides, 406APPLICATION TO PRACTICE, 409Assessment, 409Goals of Therapy, 410Intervention, 410Evaluation, 411

27 Fluoroquinolones and RelatedDrugs, 413


PATHOPHYSIOLOGY, 413DRUG CLASS: Fluoroquinolones, 414APPLICATION TO PRACTICE, 417Assessment, 417Goals of Therapy, 417Intervention, 418Evaluation, 418

28 Tetracydines and Chloramphenicol, 421SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Nonbacterial Infections, 421DRUG CIASS: Tetracydines, 422DRLIG CIASS: Acetamides, 425APPLICATION TO PRACTICE, 426Assessment, 426Goals of Therapy, 428Intervention, 428Evaluation, 428

29 Aminoglycosides, 431SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATIIOPHYSIOLOCY, 432DRUG CLASS: Aminoglycosides, 432APPLICATION TO PRACTICE, 434Assessment, 434Goals of Therapy, 435Intervention, 435Evaluation, 437

30 Antibacterial Drugs for SpecialPurposes, 439


PATHOPHYSIOLOGY: Urinary Tract Infections, 440DRUG CIASS: Sulfonamides, 441DRUG CIASS: Dihydrofolate Reductase

Inhibitors, 444DRUG CLASS: Urinary Tract Antiseptics, 445PATHOPHYSIOLOGY: Anaerobic Infections, 447DRUG CLASS: Nitroimidazoles, 448DRUG CIASS: Lincosamine, 448PATHOPHYSIOLOGY: Nosocomial Infections, 449DRUG CLASS: Glycopeptides, 450DRUG CLASS: Streptogramins, 451DRUG CIASS: Oxazolidinone, 452APPLICATION TO PRACTICE, 452Assessment, 452Goals of Therapy, 455Intervention, 455Evaluation, 457

31 Antiviral Drugs, 459SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Viral Infections, 459DRUG CIASS: Nucleoside Reverse Transcriptase

Inhibitors (NRTls) for HIV, 462DRLIG CLASS: Nucleotide Reverse Transcriptase

Inhibitors (NtRTIs) for HIV, 464DRUG CIASS: Nonnucleoside Reverse

Transcriptase Inhibitors (NNRTIs) for HIV, 465DRLIG CIASS: HIV Protease Inhibitors, 466DRUG CLASS: Acyclic Nucleoside Analogs for

Systemic Viral Diseases Other than AIDS, 467DRUG CLASS: Neuraminidase Inhibitors of

Influenza, 468DRUG CLASS: Amantidines for Influenza, 469DRUG CIASS: Nucleoside Analog for Systemic

Viral Diseases, 470DRUG CIASS: Alfa Interierons for Systemic Viral

Diseases, 470APPLICATION TO PRACTICE, 471Assessment, 471Goals of Therapy, 473Intervention, 473Evaluation, 476

XVI Table of Contents

32 Antifungal Drugs, 479SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Systemic FungalInfections, 480

DRLIG CLASS: Polyenes, 481DRUG CLASS: Antimetabolites, 483DRUG CIASS: Azole Antifungal Drugs, 484DRUG CLASS: Echinocandin, 486APPLICATION TO PRACTICE, 486Assessment, 486Goals of Therapy, 488Intervention, 488Evaluation, 490

33 Antitubercular and Other MycobacterialDrugs, 493


PATHOPHYSIOLOGY: Tuberculosis, 493DRUG CIASS: Primary Drugs Used to Treat

Tuberculosis, 496DRUG CIASS: Miscellaneous Drugs Used to Treat

Tuberculosis, 499APPLICATION TO PRACTICE: Tuberculosis, 500Assessment, 500Goals of Therapy, 502Intervention, 502Evaluation, 504PATHOPHYSIOLOGY: Leprosy, 504DRUG CLASS: Drugs Used to Treat

Leprosy, 505DRUG CIASS: Miscellaneous Drugs Used to Treat

Leprosy, 506PATHOPHYSIOLOGY: Mycobacterium avium

Complex, 507DRUG CIASS: Drugs Used to Treat Mycobacterium

avium Complex, 507APPLICATION TO PRACTICE: Leprosy, 508Assessment, 508Goals of Therapy, 509Intervention, 509Evaluation, 509

34 Antiprotozoal and AntihelminthicDrugs, 511


PATHOPHYSIOLOGY: Malaria, 512DRUG CLASS: Antimalarial Drugs, 513DRUG CLASS: Drugs Used Primarily to Treat

Chloroquine-Resistant Malaria, 515PATHOPHYSIOLOGY: Amebic Disease, 516DRUG CIASS: Drugs Used to Treat Amebic

Disease, 516PATHOPHYSIOLOGY: Selected Parasitic

Diseases, 517

Cryptosporidiosis and Microsporidiosis, 517Giardiasis, 518Leishmaniasis, 518Pneumocystosis, 518Toxoplasmosis, 519Trichomoniasis, 519DRUG CLASS: Primary Drugs Used to Treat

Selected Parasitic and Opportunistic Diseases,519

DRLIG CLASS: Miscellaneous Drugs Used toTreat Selected Parasitic and OpportunisticDiseases, 520

PATHOPHYSIOLOGY: Diseases Caused byHelminths, 521

Ascariasis, 521Enterobiasis, 521Whipworm Infestation, 521Threadworm Infestation, 523Hookworm Infestation, 523Trichinosis, 523Tapeworm Infestation, 523DRUG CLASS: Drugs Used to Treat Diseases

Caused by Helminths, 523APPLICATION TO PRACTICE, 525Assessment, 525Goals of Therapy, 527Intervention, 527Evaluation, 528

PART VI IIMMUNE SYSTEM DRUGS35 Immunizing Drugs, 531

SUSAN SCIACCA

PHYSIOLOGY: Immunostimulation, 532Types of Immunity, 533DRUG CLASS: Vaccines and Toxoids, 534DRUG CLASS: Antisera and Antitoxins, 539APPLICATION TO PRACTICE, 542Assessment, 542Goals of Therapy, 543Intervention, 544Evaluation, 548

36 Biologic Response Modifiers, 551SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Immune SystemDysfunction, 552

DRUG CLASS: Colony-Stimulating Factors, 555DRUG CLASS: Growth Factors that Stimulate

Platelet or Erythrocyte Production, 556DRUG CLASS: Interleukins, 556DRUG CLASS: Interleukin Receptor Blockers and

Other Immunosuppressant Antibodies, 557

Table of Contents XVII

DRUG CLASS: Cytokine Release Inhibitors, 558DRUG CLASS: Interferons, 559DRUG CIASS: Antagonists of 'Tumor Necrosis

Factor (TNF-alpha), 560DRUG CLASS: Biologic Response Modifiers

Targeted to Oil-Specific Markers, 561DRUG CLASS: Miscellaneous Modulators of

I m m u n e Function, 563APPLICATION TO PRACTICE, 564Assessment, 564Goals of Therapy, 566Intervention, 566Evaluation, 567

37 Antineoplastic Drugs, 569SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Cancer, 570DRLIG CIASS: Cytotoxic Drugs that Directly

Attack DNA, 576DRUG CIASS: Drugs that Block DNA

Synthesis, 579DRUG CIASS: Drugs that Block RNA or Protein

Synthesis, 582DRLIG CLASS: Drugs that Prevent or Arrest

Mitosis, 584DRLIG CIASS: Androgens and Anabolic

Steroids, 586DRLIG CLASS: Antiandrogens, 588DRUG CIASS: LH-FH Analogs, 589DRUG CIASS: Estrogens, 589DRLJG CIASS: Antiestrogens, 590DRUG CIASS: Aromatase Inhibitors, 591DRUG CLASS: Progestins, 591DRUG CLASS: Retinoids, 592DRLIG CIASS: Tyrosine Kinase Inhibitor, 592DRUG CIASS: Lympholytic Drugs, 593DRUG CIASS: Tissue-Directed Drugs and

Isotopes, 593DRUG CLASS: Photosensitizing Drugs, 594APPLICATION TO PRACTICE, 594Assessment, 594Goals of Therapy, 595Intervention, 596Evaluation, 603

PART VI11CARDIOVASCULAR SYSTEM DRUGS

38 Drugs Used to Treat Heart Failure, 605JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

PATHOPHYSIOI.OGY: Heart Failure, 606DRUG CLASS: Angiotensin-Converting Enzyme

(ACE) Inhibitors, 608

DRUG CIASS: Cardiac Glycosides, 609DRUG CLASS: I'hosphodiesterase Inhibitors, 611DRUG CLASS: Diuretics, 611DRUG CIASS: Vasodilators, 611DRUG CLASS: Alpha Antagonists, 612DRUG CLASS: Beta Agonists, 612DRUG CLASS: Beta-Adrenergic Antagonists (Beta

Blockers), 612APPLICATION'TO PRACTICE, 612Assessment, 612Goals of Therapy, 614Intervention, 614Evaluation, 617

39 Antianginal and Other VasodilatingDrugs, 619


PATHOPHYSIOI.OGY: Angina Pectoris, 620Cardiac Ischemia and Angina Pectoris, 620DRUG CLASS: Organic Nitrovasodilators, 622DRUG CIASS: Beta Blockers, 626DRUG CLASS: Calcium Channel Blockers, 627DRUG CIASS: Other Vasodilating Drugs, 628APPLICATION TO PRACTICE, 630Assessment, 630Goals of Therapy, 632Intervention, 633Evaluation, 636

40 Antiarrhythmic Drugs, 639JOSEPH A. DiMICCO and ELIZABETH KISSELL

PHYSIOLOGY: Normal Cardiac Function, 640PATHOPHYSIOLOGY: Cardiac Rhythm

Disturbances, 643DRUG CLASS: Sodium Channel Blockers (Class I

Antiarrhythmics), 645DRUG CLASS: Beta Blockers (Class II

Antiarrhythmics), 648DRUG CLASS: Drugs Prolonging Action Potential

Duration (Class III Antiarrhythmics), 648DRUG CIASS: Calcium Channel Blockers (Class

IV Antiarrhythmics), 650DRUG CLASS: Adenosine Receptor

Agonists, 650DRUG CLASS: Cardiac Glycosides, 650APPLICATION TO PRACTICE, 651Assessment, 651Goals of Therapy, 652Intervention, 652Evaluation, 653

XViii Table of Contents

41 Antihypertensive Drugs, 657JOSEPH A. DiMICCO and ELIZABETH KISSELL

PATHOPHYSIOLOGY: Hypertension, 658Essential Hypertension, 659Secondary Hypertension, 659Isolated Systolic Hypertension, 660Malignant Hypertension, 660Preeclampsia, 660Effects of Hypertension, 660Summary of Drug Therapy for

Hypertension, 660DRUG CIASS: Diuretics, 661DRLIG CIASS: Beta Blockers, 662DRLIG CIASS: Angiotensin-Converting Enzyme

(ACE) Inhibitors, 662DRLIG CIASS: Angiotensin 11-Receptor

Blockers, 663DRLIG CLASS: Calcium Channel Blockers, 664DRUG CIASS: Alpha Blockers, 664DRLIG CLASS: Centrally Acting

Antihypertensives, 664DRUG CIASS: Adrenergic Neuron-Blocking

Drugs, 665DRUG CLASS: Direct-Acting Vasodilators, 667'TREATMENT OF HYPERTENSIVE

EMERGENCIES, 667APPLICATION TO PRACTICE, 668Assessment, 668Goals of Therapy, 671Intervention, 671Evaluation, 674

42 Antilipemic Drugs, 677LYNN ROGER WILLIS and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Hyperlipoproteinemia, 678Types of Hyperlipoproteinemia, 681ANTILIPEMIC DRUGS, 681DRUG CIASS: Bile Acid Resins, 682DRUG CIASS: Fibric Acid Derivatives, 684DRUG CIASS: HMG-CoA Reductase

Inhibitors, 685DRUG CIASS: Nicotinic Acid, 686APPLICATION TO PRACTICE, 687Assessment, 687Goals of Therapy, 688Intervention, 688Evaluation, 691

PART | XHEMATOLOGIC SYSTEM DRUGS

43 Anticoagulant and AntiplateletDrugs, 693

LYNN ROGER WILLIS and SUSAN SCIACCA

PATHOPHYSIOLOGY: Coagulation, 694DRLIG CIASS: Anticoagulant Drugs, 694DRLIG CLASS: Direct-Acting Anticoagulants, 694DRLIG CLASS: Oral Anticoagulants, 699DRUG CLASS: Antiplatelet Drugs, 701APPLICATION TO PRACTICE, 703Assessment, 703Goals of Therapy, 705Intervention, 705Evaluation, 708

44 Thrombolytic and Sclerosing Drugs, 711LYNN ROGER WILLIS and SUSAN SCIACCA

PATHOPHYSIOLOGY: ThromboembolyticDiseases, 712

DRUG CLASS: Thromboembolytic Drugs, 714APPLICATION TO PRACTICE, 716Assessment, 716Goals of Therapy, 718Intervention, 718Evaluation, 719PATHOPHYSIOLOGY: Varicosities, 720DRUG CLASS: Sclerosing Drugs, 720DRUG CIASS: Antihemorrhagic Drugs, 721APPLICATION TO PRACTICE, 721Assessment, 721Goals of Therapy, 722Intervention, 722Evaluation, 723

45 Blood and Blood Products, 725KATHLEEN GUTIERREZ

BASIC PRINCIPLES OFIMMUNOHEMATOLOGY, 726

BLOOD PRODUCT: Whole Blood, 727BLOOD PRODUCT: Packed Red Blood Cells, 731BLOOD PRODUCT: Plasma, 732BLOOD PRODUCT: Platelets, 733BLOOD PRODUCT: Granulocytes, 734BLOOD PRODUCT: Cryoprecipitate AHF, 735APPLICATION TO PRACTICE, 736Assessment, 736Goals of Therapy, 738Intervention, 738Evaluation, 739

Table of Contents xix

PARTXRENAL SYSTEM DRUGS

46 Diuretics, 741LYNN ROGER WILLIS and ELIZABETH KISSELL

PHYSIOLOGY: Renal Function, 741Maintenance of Extracellular Fluid Volume, 741DRUG CLASS: Loop Diuretics, 744DRUG CLASS: Thiazide Diuretics, 749DRUG CLASS: Potassium-Sparing Diuretics, 751DRUG CLASS: Carbonic Anhydrase Inhibitors, 752DRUG CLASS: Osmotic Diuretics, 753APPLICATION TO PRACTICE, 754Assessment, 754Goals of Therapy, 755Intervention, 756Evaluation, 758

47 Drugs to Treat Renal Dysfunction, 761LYNN ROGER WILLIS and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Renal Failure, 762Acute Renal Failure, 762Chronic Renal Failure, 763PHARMACOTHERAPEUTIC OFFIONS, 764DRUG CLASS: Angiotensin-Converting Enzyme

(ACE) Inhibitors, 764DRUG CLASS: Antianemia Drug, 766DRUG CLASS: Iron Supplements, 767DRUG CLASS: Heavy Metal Antagonist, 767DRUG CLASS: Antihemorrhagic Drug, 768DRUG CLASS: Phosphate-Binding Drugs, 769DRUG CLASS: Vitamin D Supplement, 769DRUG CLASS: Cation-Exchange Resin, 770DRUG CLASS: Systemic Antacids, 771DRUG CLASS: Diuretics, 771DRUG CLASS: Renal Vasodilator, 772APPLICATION TO PRACTICE, 772Assessment, 772Goals of Therapy, 774Intervention, 775Evaluation, 777

PART X IGASTROINTESTINAL SYSTEM DRUGS

48 Hyperacidity and Related Drugs, 779ALAN P. AGINS and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: GERD and Ulcers, 779DRUG CLASS: Histamine (H2) Receptor

Antagonists, 783DRUG CIASS: Proton (Acid) Pump Inhibitors, 784

DRUG CIASS: Antacids, 785DRUG CLASS: Prokinetic Drugs, 787DRUG CIASS: Miscellaneous Drugs, 787APPLICATION TO PRACTICE, 788Assessment, 788Goals of Therapy, 790Intervention, 791Evaluation, 792

49 Laxatives and Antidiarrheal Drugs, 795LYNN ROGER WILLIS and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Constipation, 796DRLIG CIASS: Stimulant Laxatives, 796DRUG CIASS: Stool Softeners, 799DRUG CLASS: Bulk-Forming Laxatives, 799DRLIG CLASS: Hyperosmotic Laxatives, 800DRUG CLASS: Lubricant Laxatives, 802APPLICATION TO PRACTICE, 802Assessment, 802Goals of Therapy, 804Intervention, 804Evaluation, 806PATHOPHYSIOLOGY: Diarrhea, 806DRUG CIASS: Opioids, 807DRUG CIASS: Absorbents, 808DRUG CIASS: Miscellaneous Antidiarrheal

Drugs, 809APPLICATION TO PRACTICE, 810Assessment, 810Goals of Therapy, 811Intervention, 812Evaluation, 813

50 Antiemetic Drugs, 815MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Emesis, 816DRLIG CIASS: Serotonin Receptor Antagonists, 819DRUG CLASS: Dopamine Receptor Antagonists,

819DRUG CIASS: Cannabinoids, 820DRUG CIASS: Muscarinic Receptor Antagonist,

821DRLIG CLASS: Histamine Receptor Antagonists,

822DRLIG CIASS: Miscellaneous Drugs, 822APPLICATION TO PRACTICE, 823Assessment, 823Goals of Therapy, 825Intervention, 825Evaluation, 828

XX Table of Contents

51 Drugs to Treat Liver, Gallbladder, andPancreatic Diseases, 829


PATHOPHYSIOLOGY: Gallbladder Disease, 830DRUG CLASS: Anticholelithic Drugs, 831APPLICATION TO PRACTICE, 832Assessment, 832Goals of Therapy, 833Intervention, 833Evaluation, 833PATHOPHYSIOLOGY: Pancreatic Diseases, 833DRUG CLASS: Pancreatic Enzymes, 834APPLICATION TO PRACTICE, 834Assessment, 834Goals of Therapy, 835Intervention, 835Evaluation, 836PATHOPHYSIOLOGY: Liver Disease, 836DRUG CLASS: Ammonia-Detoxifying Drugs, 838APPLICATION TO PRACTICE, 839Assessment, 839Goals of Therapy, 840Intervention, 840Evaluation, 841

PART XI IRESPIRATORY SYSTEM DRUGS52 Drugs to Treat Asthma and Other

Pulmonary Diseases, 843ALAN P. AG1NS, LYNN ROGER WILLIS, and

KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Asthma, 844DRUG CLASS: Beta Agonist Bronchodilators, 848DRUG CLASS: Leukotriene Modifiers, 850DRUG CLASS: Inhaled Corticosteroids, 851DRUG CLASS: Inhaled Nonsteroidal Antiallergy

Drugs, 852DRUG CLASS: Xanthines, 853DRUG CLASS: Anticholinergic Drugs, 854PATHOPHYSIOLOGY: Other Airflow-Obstructive

Lung Diseases, 854DRUG CLASS: Drugs for Chronic Obstructive

Pulmonary Disease, 855APPLICATION TO PRACTICE, 856Assessment, 856Goals of Therapy, 858Intervention, 858Evaluation, 864

53 Antihistamines, 867SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Allergies, 868PHYSIOLOGY: Allergic Reactions, 869DRUG CLASS: Antihistamines (Histamine H,

Receptor Antagonists), 872APPLICATION TO PRACTICE, 875Assessment, 875Goals of Therapy, 877Intervention, 877Evaluation, 879

54 Expectorants, Antitussives,Decongestants, and Mucolytics, 883


PHYSIOLOGY: Origin of Secretions, 884PATHOPHYSIOLOGY, 884Common Cold, 884Rhinitis, 884Cough, 884DRUG CLASS: Expectorants, 885DRUG CLASS: Antitussives, 886DRUG CLASS: Decongestants, 888DRUG CLASS: Mucolytic Drugs, 889APPLICATION TO PRACTICE, 891Assessment, 891Goals of Therapy, 892Intervention, 892Evaluation, 895

PART XI11ENDOCRINE SYSTEM DRUGS55 Pituitary Drugs, 897


PHYSIOLOGY: Endocrine System, 897Posterior Pituitary, 899Anterior Pituitary, 900PATHOPHYSIOLOGY: ADH Deficiency

or Excess, 903DRUG CLASS: Posterior Pituitary Replacement

Drug, 904DRUG CLASS: Miscellaneous Drugs Used to Treat

Diabetes Insipidus, 904PATHOPHYSIOLOGY: Growth Hormone

Deficiency or Excess, 905DRUG CLASS: Growth Hormones, 906DRUG CLASS: Somastatin, 906APPLICATION TO PRACTICE, 907Assessment, 907Goals of Therapy, 908Intervention, 908Evaluation, 910

Table of Contents XXI

56 Thyroid and Parathyroid Drugs, 911MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PHYSIOLOGY: Thyroid Hormones, 912Regulation of Synthesis and Release of Thyroid

Hormones, 912PATHOPHYSIOLOGY: Hypothyroidism, 914DRUG CLASS: Thyroid Hormones, 916APPLICATION TO PRACTICE, 917Assessment, 917Goals of Therapy, 918Intervention, 918Evaluation, 920PATHOPHYSIOLOGY: Hyperthyroidism, 920DRLIG CLASS: Antithyroid Drugs, 921DRLIG CLASS: Iodine, 922APPLICATION TO PRACTICE, 923Assessment, 923Goals of Therapy, 924Intervention, 925PHYSIOLOGY: Parathyroid Hormones, 925PATHOPHYSIOLOGY: Hypoparathyroidism, 926APPLICATION TO PRACTICE, 927Assessment, 927Goals of Therapy, 928Intervention, 928Evaluation, 929PATHOPHYSIOLOGY: Hyperparathyroidism, 929DRUG CLASS: Drugs Used to Treat

Hypercalcemia, 929APPLICATION TO PRACTICE, 931Assessment, 931Goals of Therapy, 932Intervention, 932Evaluation, 933

57 Adrenalcortical Steroids and DrugsAffecting the Adrenal Cortex, 935


DRUG CLASS: Adrenal Cortex, 936DRLIG CLASS: Glucocorticoids, 939DRLIG CLASS: Mineralocorticoids, 945DRUG CLASS: Adrenocortical Inhibitors, 945DRUG CLASS: Adrenocortical Stimulants, 946APPLICATION TO PRACTICE, 947Assessment, 947Goals of Therapy, 949Intervention, 949Evaluation, 952

58 Drugs to Treat Diabetes Mellitus, 955JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Diabetes Mellitus, 956Type 1 Diabetes Mellitus, 956

'Type 2 Diabetes Mellitus, 956Gestational Diabetes, 957Impaired Glucose Tolerance/Impaired lasting

Glucose, 957Metabolic Derangements, 957PHYSIOLOGY: Regulation of Glucose

Metabolism, 959Insulin and Glucose Metabolism, 959Role of Insulin in Fat and Protein Metabolism, 960Regulation of Insulin Secretion, 960DRUG CLASS: Insulin and Insulin Analogs, 960DRUG CLASS: Sulfonylureas and Related

Drugs, 963DRUG CLASS: Biguanides, 965DRLIG CLASS: Thiazolidinediones, 966DRLIG CLASS: Alpha-Glucosidase Inhibitors, 966DRLIG CIASS: Antihypoglycemic Drugs, 967APPLICATION TO PRACTICE, 968Assessment, 968Goals of Therapy, 972Intervention, 972Evaluation, 975

PART X I VREPRODUCTIVE SYSTEM DRUGS

59 Estrogens, Progestins, andContraceptives, 977


PHYSIOLOGY: Menses and Menopause, 978Hormones Affecting Ovulation, 978Hormones Affecting Endometrial Function, 978Hormones in Pregnancy, 979Menopause, 979DRUG CIASS: Estrogens, 979DRUG CLASS: Estrogen Antagonists and Selective

Estrogen Receptor Modulators, 983DRUG CIASS: Progestins, 983DRUG CIASS: Progesterone Antagonists, 985DRUG CLASS: Oral Contraceptives, 985DRUG CIASS: Contraceptive Implants, Depot

Injections, and Intrauterine Devices, 988APPLICATION TO PRACTICE, 989Assessment, 989Goals of Therapy, 990Intervention, 991Evaluation, 993

XXii Table of Contents

60 Drugs Affecting Uterine Motility, 995JOSEPH A. DiMICCO and KATHLEEN GUTIERREZ

PHYSIOLOGY: Labor and Delivery, 995DRUG CLASS: Oxytocic Drugs, 996DRLIG CLASS: Ergot Alkaloids LIsed as

Oxytocics, 997DRUG CLASS: Prostaglandins, 998DRUG CLASS: LIterine Relaxants (Tocolytics), 999DRUG CLASS: Other Tocolytic Drugs, 1000APPLICATION TO PRACTICE, 1001Assessment, 1001Goals of Therapy, 1002Intervention, 1003Evaluation, 1004

61 Fertility Drugs, 1005SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Infertility, 1005Disorders of Female Fertility, 1005Disorders of Male Fertility, 1007DRUG CLASS: Gonadotropin-Releasing

Hormone and Analogs, 1008DRUG CLASS: Gonadotropins, 1009DRUG CLASS: Antiprolactin Drugs, 1010DRUG CLASS: Antiestrogen, 1011DRUG CLASS: Male or Female Steroid

Hormones, 1012APPLICATION TO PRACTICE, 1012Assessment, 1012Goals of Therapy, 1014Intervention, 1014Evaluation, 1016

62 Androgens, Anabolic Steroids, andRelated Drugs, 1017


PHYSIOLOGY, 1017PATHOPHYSIOLOGY: Hypogonadism, 1019DRUG CLASS: Androgens and "Anabolic

Steroids," 1019DRLIG CLASS: Antiandrogens, 1021DRUG CLASS: 5-Alpha-Reductase Inhibitors, 1022APPLICATION TO PRACTICE, 1023Assessment, 1023Goals of Therapy, 1024Intervention, 1024Evaluation, 1025

PART X VNUTRITIONAL BALANCE DRUGS63 Vitamins and Minerals, 1027

SHERRY F. QUEENER and SUSAN SCIACCA

PHYSIOLOGY: Vitamins and Minerals, 1027PATHOPHYSIOLOGY: Calcium and Vitamin D

Metabolism, 1030DRUG CLASS: Calcium Supplements, 1030DRUG CLASS: Vitamin D, 1031DRLIG CLASS: Biphosphonates, 1032DRUG CLASS: Selective Estrogen Receptor

Modulator, 1032PATHOPHYSIOLOGY: Fat-Soluble Vitamins, 1033DRUG CLASS: Vitamin A Family, 1033DRLIG CLASS: Vitamin E, 1034DRUG CLASS: Vitamin K, 1035PATHOPHYSIOLOGY: Water-Soluble

Vitamins, 1036DRUG CLASS: Water-Soluble Vitamins, 1037PATHOPHYSIOLOGY: Macrominerals, 1039DRUG CLASS: Macrominerals (Selected), 1039PATHOPHYSIOLOGY: Microminerals, 1041DRUG CLASS: Micronutrients, 1041APPLICATION TO PRACTICE, 1042Assessment, 1042Goals of Therapy, 1044Intervention, 1044Evaluation, 1049

64 Fluids, Electrolytes, and Acid-BaseBalance, 1051

LYNN ROGER WILLIS, SHERRY F. QUEENER, and

KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Fluid or ElectrolyteImbalances, 1052

Regulation of Salt and Water Balance, 1052Clinical Indications for Fluid Therapy, 1054DRUG CLASS: Hydrating Solutions, 1058DRUG CLASS: Alkalinizing Drugs, 1059DRUG CLASS: Acidifying Drugs, 1061DRUG CLASS: Parenteral Nutrition

Formulations, 1062DRUG CLASS: Solutions to Correct Specific

Electrolyte Imbalances, 1063APPLICATION TO PRACTICE, 1063Assessment, 1063Goals of Therapy, 1066Intervention, 1067Evaluation, 1073

Table of Contents XXlH

PART XV ISENSORY SYSTEM DRUGS

65 Ophthalmic Drugs, 1075SHERRY F. QUEENER and KATHLEEN GUTIERREZ

PHYSIOLOGY: Preparing the Eye forExamination, 1076

DRUG CLASS: Muscarinic Antagonists, 1077DRUG CLASS: Alpha-Adrenergic Drugs, 1078PATHOPHYSIOLOGY: Glaucoma, 1078DRLIG CLASS: Adrenergic Agonists Used to Treat

Glaucoma, 1079DRLIG CIASS: Beta-Adrenergic Blockers Used to

Treat Glaucoma, 1081DRLIG CLASS: Cholinomimetics Used to Treat

Glaucoma, 1081DRUG CLASS: Anticholinesterase Miotics, 1082DRLIG CLASS: Carbonic Anhydrase Inhibitors

Used to Treat Glaucoma, 1083DRUG CLASS: Prostaglandin Analogs, 1084DRLIG CLASS: Specific Osmotic Agents Used to

Treat Glaucoma, 1084PATHOPHYSIOLOGY: Inflammation and

Infection of the Eyes, 1085DRUG CIASS: Antibacterial Drugs LIsed to Treat

Ophthalmic Diseases, 1086DRLIG CLASS: Antifungal Drug LIsed to Treat

Ophthalmic Diseases, 1086DRLIG CIASS: Antiviral Drugs LIsed to Treat

Ophthalmic Diseases, 1087DRUG CLASS: Antiinflammatory Drugs, 1088DRUG CLASS: Ocular Antihistamines and

Decongestants, 1089APPLICATION TO PRACTICE, 1089Assessment, 1089Goals of Therapy, 1091Intervention, 1091Evaluation, 1094

66 Otic Drugs, 1095MICHAEL R. VASKO and KATHLEEN GUTIERREZ

PATHOPHYSIOLOGY: Ear Infections, 1095DRLIG CIASS: Antibiotics Used to Treat Ear

infections, 1097DRLIG CLASS: Antibacterial and Drying

Drugs, 1098

DRUG CLASS: Steroids and Steroid-AntibioticCombinations, 1098

DRUG CLASS: Otic Anesthetics, 1099PATHOPI lYSIOI.OGY: Cerumen Impaction, 1100DRUG CLASS: Certiminolytics, 1100PATIIOPIIYSIOI.OCY: Ototoxieity, 1100APPLICATION TO PRACTICE, 1101Assessment, 1101Goals of Therapy, 1102Intervention, 1102Evaluation, 1105

67 Dermatologic Drugs, 1107SHERRY F. QUEENER and ELIZABETH KISSELL

PHYSIOLOGY: Structure and Functionof Skin, 1108

PATHOPI IYSIOLOGY: Skin Disorders, 1110Infectious Inflammatory Dermatoses, 1111Skin Trauma, 1113Drug Reactions, 1113Stings, Bites, and Infestations, 1113Ulcerations, 1114DRUG CLASS: Antiseptics, 1115DRUG CLASS: Topical Antibacterial Drugs, 1116DRUG CLASS: Topical Antifungal Drugs, 1117DRUG CLASS: Systemic Antifungals for Fungal

Skin Infections, 1118DRUG CLASS: Topical Antiviral Drugs, 1118DRLIG CLASS: Scabicides and Pediculicides, 1119DRLIG CLASS: Proteolytic Enzymes, 1119DRLIG CLASS: Antiinflammatory Drugs, 1120DRUG CIASS: Melanizing and Demelanizing

Drugs, 1121DRUG CIASS: Sunscreens, 1121APPLICATION TO PRACTICE, 1122Assessment, 1122Goals of Therapy, 1124Intervention, 1125Evaluation, 1130

AppendicesA Dietary Considerations, 1131B Selected Daig-lnduced Adverse Reactions, 1139

Answer Guidelines for Critical ThinkingQuestions, 1141

Pharmacology for Nursing Practice - GBV · CNS Depressants, 117 CNS Stimulants, 118 Hallucinogens, 120 Inhalants, 122 APPLICATION TO PRACTICE, 123 Assessment, 123 Goals of Therapy,

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