Two Questions. 100 word minimum.

Health Medical

Nightingale College. School of Nursing. School of Massage Therapy

Question Description

Mrs. Murphy is a cancer patient in the hospital. She is there to get two doses of chemotherapy treatment. Her first IV treatment started at 0700 and ran for 10 hours. The second IV treatment was to be startedat 1900 and to be run for 10 hours. The nurse hung the correct medication at 0700 but after a 12-hour shift, she was exhausted and forgot to hang the second bag. Because timely administration of chemotherapy is key to a successful outcome, this patient's treatment was less than optimal.

Is this considered an adverse drug reaction or a medication error? Explain.

Which pages in the textbook were utilized for this response?

A nurse from a local nursing home transcribed a residents' medication on a different person’s chart. Her colleague also failed to properly match the drug with the patient's Medication Administration Record. Two nurses neglected to follow established faculty procedures for handling the drug in question. Additional team members failed to catch the error for nine days. The resident was taking the drug, an anticoagulant, because they had a history of developing blood clots. During the nine-day window, the resident developed clots in her brain and eventually caused a large and fatal ischemic stroke.

  • Please list the traditional five rights of medication administration and discuss which one(s) are applicable to this scenario. Which ones were correctly utilized and which one(s) were not used?
  • Discuss 2 ways this error could have been avoided.
  • Which pages in the textbook were utilized for this response?

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Lehne’s PHARMACOLOGY for NURSING CARE This page intentionally left blank 10 TH EDITION Lehne’s PHARMACOLOGY for NURSING CARE Jacqueline Rosenjack Burchum, DNSc, FNP-BC, CNE Associate Professor, College of Nursing Department of Advanced Practice and Doctoral Studies University of Tennessee Health Science Center Memphis, Tennessee Laura D. Rosenthal, RN, DNP, ACNP-BC, FAANP Associate Professor, College of Nursing University of Colorado, Anschutz Medical Campus Denver, Colorado 3251 Riverport Lane St. Louis, Missouri 63043 LEHNE’S PHARMACOLOGY FOR NURSING CARE, TENTH EDITION ISBN 978-0-323-51227-5 Copyright © 2019, Elsevier Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2016, 2013, 2010, 2007, 2004, 2001, 1998, 1994, 1990. International Standard Book Number: 978-0-323-51227-5 Executive Content Strategist: Sonya Seigafuse Senior Content Development Manager: Luke Held Content Development Specialist: Jennifer Wade Publishing Services Manager: Jeff Patterson Senior Project Manager: Jodi M. Willard Design Direction: Paula Catalano Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contents UNIT I INTRODUCTION 1 Orientation to Pharmacology 1 2 Application of Pharmacology in Nursing Practice 5 3 Drug Regulation, Development, Names, and Information 14 UNIT II BASIC PRINCIPLES OF PHARMACOLOGY 4 5 6 7 8 Pharmacokinetics 24 Pharmacodynamics 44 Drug Interactions 55 Adverse Drug Reactions and Medication Errors 63 Individual Variation in Drug Responses 74 UNIT III DRUG THERAPY ACROSS THE LIFE SPAN 9 Drug Therapy During Pregnancy and Breast-Feeding 82 10 Drug Therapy in Pediatric Patients 90 11 Drug Therapy in Older Adults 94 UNIT IV PERIPHERAL NERVOUS SYSTEM DRUGS SECTION 1 Introduction 12 Basic Principles of Neuropharmacology 100 13 Physiology of the Peripheral Nervous System 105 SECTION 2 Cholinergic Drugs 14 Muscarinic Agonists and Antagonists 118 15 Cholinesterase Inhibitors and Their Use in Myasthenia Gravis 131 16 Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents 139 SECTION 3 Adrenergic Drugs 17 Adrenergic Agonists 147 18 Adrenergic Antagonists 159 19 Indirect-Acting Antiadrenergic Agents 174 UNIT V CENTRAL NERVOUS SYSTEM DRUGS SECTION 4 Introduction 20 Introduction to Central Nervous System Pharmacology 179 SECTION 5 Drugs for Neurodegenerative Disorders 21 Drugs for Parkinson Disease 182 22 Drugs for Alzheimer’s Disease 199 23 Drugs for Multiple Sclerosis 206 SECTION 6 Neurologic Drugs 24 Drugs for Seizure Disorders 223 25 Drugs for Muscle Spasm and Spasticity 250 SECTION 7 Drugs for Pain 26 Local Anesthetics 259 27 General Anesthetics 265 28 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 274 29 Pain Management in Patients With Cancer 300 30 Drugs for Headache 318 SECTION 8 Psychotherapeutic Drugs 31 Antipsychotic Agents and Their Use in Schizophrenia 330 32 Antidepressants 352 33 Drugs for Bipolar Disorder 376 34 Sedative-Hypnotic Drugs 384 35 Management of Anxiety Disorders 399 36 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder 406 SECTION 9 Drug Abuse 37 Substance Use Disorders I: Basic Considerations 417 38 Substance Use Disorders II: Alcohol 424 39 Substance Use Disorders III: Nicotine and Smoking 435 40 Substance Use Disorders IV: Major Drugs of Abuse Other Than Alcohol and Nicotine 443 UNIT VI DRUGS THAT AFFECT FLUID AND ELECTROLYTE BALANCE 41 Diuretics 459 42 Agents Affecting the Volume and Ion Content of Body Fluids 471 UNIT VII DRUGS THAT AFFECT THE HEART, BLOOD VESSELS, AND BLOOD 43 Review of Hemodynamics 476 44 Drugs Acting on the Renin-Angiotensin-Aldosterone 45 46 47 48 49 50 51 52 53 54 55 56 System 482 Calcium Channel Blockers 497 Vasodilators 505 Drugs for Hypertension 510 Drugs for Heart Failure 529 Antidysrhythmic Drugs 546 Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 568 Drugs for Angina Pectoris 591 Anticoagulant, Antiplatelet, and Thrombolytic Drugs 604 Management of ST-Elevation Myocardial Infarction 633 Drugs for Hemophilia 640 Drugs for Deficiency Anemias 648 Hematopoietic Agents 663 UNIT VIII DRUGS FOR ENDOCRINE DISORDERS 57 Drugs for Diabetes Mellitus 674 58 Drugs for Thyroid Disorders 711 59 Drugs Related to Hypothalamic and Pituitary Function 723 60 Drugs for Disorders of the Adrenal Cortex 732 UNIT IX WOMEN’S HEALTH 61 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications 739 62 Birth Control 753 63 Drug Therapy for Infertility 770 64 Drugs That Affect Uterine Function 778 UNIT X MEN’S HEALTH 65 Androgens 789 66 Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia 797 86 Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines, Macrolides, and Others 1050 87 Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis 1061 88 Sulfonamides and Trimethoprim 1068 89 Drug Therapy for Urinary Tract Infections 1076 90 Antimycobacterial Agents: Drugs for Tuberculosis, 91 92 93 UNIT XI 94 ANTI-INFLAMMATORY, ANTIALLERGIC, AND IMMUNOLOGIC DRUGS 95 Review of the Immune System 809 Childhood Immunization 820 Immunosuppressants 836 Antihistamines 844 Cyclooxygenase Inhibitors: Nonsteroidal Anti-Inflammatory Drugs and Acetaminophen 852 72 Glucocorticoids in Nonendocrine Disorders 871 67 68 69 70 71 UNIT XII DRUGS FOR BONE AND JOINT DISORDERS 73 Drug Therapy for Rheumatoid Arthritis 881 74 Drug Therapy for Gout 894 75 Drugs Affecting Calcium Levels and Bone Mineralization 900 UNIT XIII 96 UNIT XVII CHEMOTHERAPY OF PARASITIC DISEASES 97 98 99 100 Disease 925 77 Drugs for Allergic Rhinitis, Cough, and Colds 948 UNIT XIV GASTROINTESTINAL DRUGS 78 Drugs for Peptic Ulcer Disease 956 79 Laxatives 972 80 Other Gastrointestinal Drugs 981 UNIT XV NUTRITION 81 Vitamins 996 82 Drugs for Weight Loss 1007 Anthelmintics 1183 Antiprotozoal Drugs I: Antimalarial Agents 1189 Antiprotozoal Drugs II: Miscellaneous Agents 1199 Ectoparasiticides 1206 UNIT XVIII CANCER CHEMOTHERAPY 101 Basic Principles of Cancer Chemotherapy 1212 102 Anticancer Drugs I: Cytotoxic Agents 1226 103 Anticancer Drugs II: Hormonal Agents, Targeted Drugs, and Other Noncytotoxic Anticancer Drugs 1245 RESPIRATORY TRACT DRUGS 76 Drugs for Asthma and Chronic Obstructive Pulmonary Leprosy, and Mycobacterium avium Complex Infection 1081 Miscellaneous Antibacterial Drugs: Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Rifaximin, and Fidaxomicin 1097 Antifungal Agents 1102 Antiviral Agents I: Drugs for Non-HIV Viral Infections 1113 Antiviral Agents II: Drugs for HIV Infection and Related Opportunistic Infections 1133 Drug Therapy for Sexually Transmitted Infections 1167 Antiseptics and Disinfectants 1176 UNIT XIX MISCELLANEOUS DRUGS AND THERAPIES 104 105 106 107 108 Drugs for the Eye 1272 Drugs for the Skin 1284 Drugs for the Ear 1304 Additional Noteworthy Drugs 1311 Complementary and Alternative Therapy 1328 UNIT XX TOXICOLOGY 109 Management of Poisoning 1343 110 Potential Weapons of Biologic, Radiologic, and Chemical Terrorism 1349 UNIT XVI APPENDIX A CHEMOTHERAPY OF INFECTIOUS DISEASES Canadian Drug Information 1359 83 Basic Principles of Antimicrobial Therapy 1014 84 Drugs That Weaken the Bacterial Cell Wall I: Penicillins 1029 85 Drugs That Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenems, Vancomycin, Telavancin, Aztreonam, and Fosfomycin 1039 APPENDIX B Prototype Drugs and Their Major Uses 1363 To my son, Jade Charmagan, BSN, RN. Congratulations, and welcome to the world of nursing! JRB For Ashley, Christine, Courtney, Erica, Laura B., Laura P., and Stacy—my official support team in life. LDR This page intentionally left blank About the Authors Laura D. Rosenthal, RN, DNP, ACNP-BC, FAANP, has been a registered nurse since graduating with her Bachelor of Science in Nursing degree from the University of Michigan in 2000. She completed her Master of Science in Nursing degree in 2006 at Case Western Reserve University in Cleveland, Ohio. She finished her nursing education at the University of Colorado, College of Nursing, graduating with her Doctor of Nursing Practice degree in 2011. Her background includes practice in acute care and inpatient medicine. While working as a nurse practitioner at the University of Colorado Hospital, she assisted in developing one of the first fellowships for advanced practice clinicians in hospital medicine. Dr. Rosenthal serves as an associate professor at the University of Colorado, College of Nursing, where she teaches within the undergraduate and graduate programs. She received the Dean’s Award for Excellence in Teaching in 2013. She serves on the board of the Colorado Nurses Association, remains a member of the NP/PA committee for the Society of Hospital Medicine, and volunteers as a Health Services RN for the Red Cross. In her spare time, Dr. Rosenthal enjoys running, skiing, and fostering retired greyhounds for Colorado Greyhound Adoption. Jacqueline Rosenjack Burchum, DNSc, FNP-BC, CNE, has been a registered nurse since 1981 and a family nurse practitioner since 1996. She completed her Doctor of Nursing Science degree in 2002. Dr. Burchum currently serves as an associate professor for the University of Tennessee Health Science Center (UTHSC) College of Nursing. She is credentialed as a certified nurse educator (CNE) by the National League for Nursing. She is a two-time recipient of the UTHSC Student Government Association’s Excellence in Teaching Award and a recipient of the 2014 UT Alumni Association’s Outstanding Teacher Award. Dr. Burchum was also the 2016–2017 Faculty Innovation Scholar for the UTHSC Teaching and Learning Center. Dr. Burchum has a special interest in online teaching and program quality. To this end, she serves as an on-site evaluator for the Commission on Collegiate Nursing Education (CCNE), a national agency that accredits nursing education programs. In addition, she is a peer reviewer for Quality Matters, a program that certifies the quality of online courses. As a nurse practitioner, Dr. Burchum’s primary interests have centered on addressing the needs of vulnerable populations. She is a member of the National Organization for Nurse Practitioner Faculties, Sigma Theta Tau International Honor Society, the American and Tennessee Nurses Associations, and the National League for Nursing. ix This page intentionally left blank Contributors and Reviewers CONTRIBUTOR Joshua J. Neumiller, PharmD, CDE, FASCP Assistant Professor of Pharmacotherapy Washington State University Spokane, Washington Chapter 57 REVIEWERS Laura Brennan, MS, RN Assistant Professor Elmhurst College Elmhurst, Illinois Lisa Miklush, PhD, RNC, CNS Adjunct Faculty Nursing Department Gonzaga University Spokane, Washington Joan Parker Frizzell, PhD, CRNP, ANP-BC Associate Professor School of Nursing and Health Sciences La Salle University; Nurse Practitioner Roxborough Memorial Hospital Philadelphia, Pennsylvania Janet Czermak Russell MA, MS, APN-BC Associate Professor of Nursing Nursing Department Essex County College Newark, New Jersey James Graves, PharmD Clinical Pharmacist University of Missouri Inpatient Pharmacy Columbia, Missouri Carin Tripodina, EdD, MS, RN, CPN, CNE Assistant Professor of Nursing Nursing Department American International College Springfield, Massachusetts Ellen Ketcherside, RN, MA Nursing Professor Allied Health Department Mineral Area College Park Hills, Missouri Jennifer J. Yeager, PhD, RN Assistant Professor Department of Nursing Tarleton State University Stephenville, Texas xi This page intentionally left blank Preface Pharmacology pervades all phases of nursing practice and relates directly to patient care and education. Yet despite its importance, many students—and even some teachers—are often uncomfortable with the subject. Why? Because traditional texts have stressed memorizing rather than understanding. In this text, the guiding principle is to establish a basic understanding of drugs, after which secondary details can be learned as needed. This text has two major objectives: (1) to help you, the nursing student, establish a knowledge base in the basic science of drugs, and (2) to show you how that knowledge can be applied in clinical practice. The methods by which these goals are achieved are described in the following sections. LAYING FOUNDATIONS IN BASIC PRINCIPLES To understand drugs, you need a solid foundation in basic pharmacologic principles. To help you establish that foundation, this text has major chapters on the following topics: basic principles that apply to all drugs (Chapters 4 through 8), basic principles of drug therapy across the life span (Chapters 9 through 11), basic principles of neuropharmacology (Chapter 12), basic principles of antimicrobial therapy (Chapter 83), and basic principles of cancer chemotherapy (Chapter 101). REVIEWING PHYSIOLOGY AND PATHOPHYSIOLOGY To understand the actions of a drug, it is useful to understand the biologic systems influenced by the drug. Accordingly, for all major drug families, relevant physiology and pathophysiology are reviewed. In almost all cases, these reviews are presented at the beginning of each chapter rather than in a systems review at the beginning of a unit. This juxtaposition of pharmacology, physiology, and pathophysiology is designed to help you understand how these topics interrelate. TEACHING THROUGH PROTOTYPES Within each drug family we can usually identify a prototype—a drug that embodies the characteristics shared by all members of the group. Because other family members are similar to the prototype, to know the prototype is to know the basic properties of all family members. The benefits of teaching through prototypes can be appreciated with an example. Let’s consider the nonsteroidal antiinflammatory drugs (NSAIDs), a family that includes aspirin, ibuprofen [Motrin], naproxen [Aleve], celecoxib [Celebrex], and more than 20 other drugs. Traditionally, information on these drugs is presented in a series of paragraphs describing each drug in turn. When attempting to study from such a list, you are likely to learn many drug names and little else; the important concept of similarity among family members is easily lost. In this text, the family prototype—aspirin—is discussed first and in depth. After this, the small ways in which individual NSAIDs differ from aspirin are pointed out. Not only is this approach more efficient than the traditional approach, it is also more effective in that similarities among family members are emphasized. LARGE PRINT AND SMALL PRINT: A WAY TO FOCUS ON ESSENTIALS Pharmacology is exceptionally rich in detail. There are many drug families, each with multiple members and each member with its own catalog of indications, contraindications, adverse effects, and drug interactions. This abundance of detail confronts teachers with the difficult question of what to teach and confronts students with the equally difficult question of what to study. Attempting to answer these questions can frustrate teachers and students alike. Even worse, basic concepts can be obscured in the presence of myriad details. To help you focus on essentials, two sizes of type are used in this text. Large type is intended to say, “On your first exposure to this topic, this is the core of information you should learn.” Small type is intended to say, “Here is additional information that you may want to learn after mastering the material in large type.” As a rule, we reserve large print for prototypes, basic principles of pharmacology, and reviews of physiology and pathophysiology. We use small print for secondary information about the prototypes and for the discussion of drugs that are not prototypes. This technique allows the book to contain a large body of detail without having that detail cloud the big picture. Furthermore, because the technique highlights essentials, it minimizes questions about what to teach and what to study. The use of large and small print is especially valuable for discussing adverse effects and drug interactions. Most drugs are associated with many adverse effects and interactions. As a rule, however, only a few of these are noteworthy. In traditional texts, practically all adverse effects and interactions are presented, creating long and tedious lists. In this text, we use large print to highlight the few adverse effects and interactions that are especially characteristic; the rest are noted briefly in small print. Rather than overwhelming you with long and forbidding lists, this text delineates a moderate body of information that is truly important, thereby facilitating comprehension. USING CLINICAL REALITY TO PRIORITIZE CONTENT This book contains two broad categories of information: pharmacology (the basic science about drugs) and therapeutics (the clinical use of drugs). To ensure that content is clinically relevant, we use evidence-based treatment guidelines as a basis for deciding what to stress and what to play down. Unfortunately, clinical practice is a moving target. Guidelines change when effective new drugs are introduced and when clinical trials reveal new benefits or new risks of older drugs, and so we need to work hard to keep this book current. Despite our xiii Preface resource that includes interactive self-study modules, a collection of interactive learning resources, and a media-rich library of supplemental resources. • The Study Guide, which is keyed to the book, includes study questions; critical thinking, prioritization, and delegation questions; and case studies. best efforts, the book and clinical reality may not always agree: Some treatments discussed here will be considered inappropriate before the 11th edition is published. Furthermore, in areas where controversy exists, the treatments discussed here may be considered inappropriate by some clinicians right now. NURSING IMPLICATIONS: DEMONSTRATING THE APPLICATION OF PHARMACOLOGY IN NURSING PRACTICE TEACHING SUPPLEMENTS FOR INSTRUCTORS • The Instructor Resources for the tenth edition are available online and include TEACH® for Nurses Lesson Plans, a Test Bank, a PowerPoint Collection, and an Image Collection. The principal reason for asking you to learn pharmacology is to enhance your ability to provide patient care and education. To show you how pharmacologic knowledge can be applied to nursing practice, nursing implications are integrated into the body of each chapter. That is, as specific drugs and ...
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