Essentials for Medication Safety

Transcription

1 ELSEVIER Essentials for Medication Safety M. Linda Workman, PhD, RN, FAAN Linda LaCharity, PhD, RN Susan C. Kruchko, MS, RN With Jennifer Ponto, RN, BSN Instructor Department of Vocational Nursing South Plains College Levelland, Texas

2 PART ONE: Overview of Pharmacology 1 Orug Actions and Body Responses, 1 Drug Therapy, 2 Overview, 2 Drug Names, 3 Drug Categories, 4 Drug Regulation, 5 Ways in Which Drugs Affect the Body (Pharmacodynamics), 6 Mechanisms of Action, 6 Physiologie Effects, 8 How the Body Uses and Changes Drugs (Pharmacokinetics), 11 Absorption, 12 Distribution, 14 Metabolism, 15 Elimination, 16 Life Span Considerations, 18 Size, 18 Organ Health, 19 Pregnancy and Breastfeeding, 21 Drug Interactions, 24 2 Safely Preparing and Giving Drugs, 28 Overview, 29 The Six Rights of Safe Drug Administration, 29 The Right Patient, 29 The Right Drug, 29 The Right Dose, Route, and Time, 30 The Right Documentation, 30 The Right Diagnosis, 30 The Right to Refuse, 30 Types of Drug Orders, 30 Drug Errors, 31 Preventing Drug Errors, 31 Reporting Drug Errors, 32 Principles of Administering Drugs, 32 Getting Ready to Give Drugs, 33 Giving Enteral Drugs, 33 Oral Drugs, 33 Oral Drugs Given by Feeding Tube, 35 Giving Rectal Drugs, 36 Giving Parenteral Drugs, 36 Giving Intradermal Drugs, 37 Giving Subcutaneous Drugs, 37 Giving Intramuscular Drugs, 38 Giving Intravenous Drugs, 40 Giving Percutaneous Drugs, 41 Giving Topical or Transdermal Drugs, 41 Giving Drugs Through the Mucous Membranes, 42 3 Teaching Patients About Drug Therapy, 45 Overview, 45 Communication for Teaching and Learning, 45 Cultural Sensitivity and Communication, 46 Domains of Learning, 48 Teaching and Learning, 49 Principles of Adult Learning: Patient Teaching, 50 Believe in the Need to Know, 51 Start with the Known Before Moving to the Unknown, 51 Learning Goes from the Simple to the Complex, 51 Active Participation is Needed, 52 Practice Makes Perfect, 52 Reinforce Learning, 53 Provide Early Feedback and Corrections, 53 Life Span Considerations, 53 PART TWO: Mathematics in Pharmacology 4 Medical Systems of Weights and Measures, 57 Overview, 57 Measuring Systems, 58 Temperature: Fahrenheit and Celsius, 58 Household System for Liquid and Dry Measurements, 59 Metric System, 60 Switching Between Household and Metric Systems, 61 The Milliequivalent System, 63 The Unit System, 63 Two-Step Drug Dosage Calculations, 64 5 Mathematics Review and Introduction to Dosage Calculation, 67 Why Do Nurses Need Mathematics?, 68 Talking About Numbers: A Whole Number Versus a Part of a Number, 68 Fractions, 68 Decimals, 72 Rounding Parts of Numbers, 75 Percents, 75 Solving Dosage and Calculation Problems, 76 Introduction, 76 Usine ProoorrionR tr> Q^Kro ( v v?

3 6 Dosage Calculation of Intravenous Solutions and Drugs, 83 Overview, 83 IV Mechanics, 84 Regulating IV Fluids, 85 IV Calculations, 86 Maintaining IV Therapy, 88 Infusion Control Devices, 88 IV Therapy Responsibilities, 88 Life Span Considerations, 91 PART THREE: Clinical Categories and Uses of Drugs 7 Drugs for Pain and Sleep Problems, 94 PAIN, 95 Pathophysiology, 97 Pain Origin and Transmission, 97 Pain Perception, 99 Types of Pain, 99 General Issues Related to Analgesic Drug Therapy, 101 Opioids (Narcotics), 103 Nonsteroidal Anti-Inflammatory Drugs, 107 Nonopioid Miscellaneous Pain-Control Drugs, 110 Acetaminophen, 110 Antidepressants, 110 Anticonvulsants, 111 INSOMNIA, 112 Pathophysiology, 112 Drugs for Insomnia, 113 NARCOLEPSY, 116 Pathophysiology, 116 Drugs for Narcolepsy, Anti-Inflammatory Drugs, 120 Pathophysiology, 121 Stage I: Vascular, 122 Stage II: Exudate, 122 Stage III: Tissue Repair, 122 Types of Anti-Inflammatory Drugs, 123 Corticosteroids, 123 Nonsteroidal Anti-Inflammatory Drugs, 128 Antihistamines, 132 Leukotriene Inhibitors, Anti-Infectives: Antibacterial Drugs, 138 Pathophysiology, 139 Bacterial Features, 139 Protection Against Infection, 140 Antibacterial Therapy, 141 Spectrum of Efficacy, 141 General Issues in Antibacterial Therapy, 142 Types of Antibacterial Drugs, 144 Penicillins, Cephalosporins, and Other Cell Wall Synthesis Inhibitors, 144 Aminoglycosides, Macrolides, Tetracyclines, and Other Protein Synthesis Inhibitors, 149 Metabolism Inhibitors: Sulfonamides and Trimethoprim, 156 DNA Synthesis Inhibitors: Fluoroquinolones, 159 Antibacterial Drug Resistance, 161 Examples of MDR Organisms, Anti-Infectives: Antiviral Drugs, 165 VIRAL INFECTION, 165 Pathophysiology for Common Viruses, 166 General Issues in Antiviral Therapy, 168 Types of Antiviral Drugs, 169 Acyclovir and Valacyclovir, 169 Amantadine and Rimantadine, 171 Ribavirin, 172 Oseltamivir and Zanamivir, 174 RETROVIRAL INFECTION, 175 Pathophysiology, 175 General Issues in Antiretroviral Therapy, 176 Types of Antiretoviral Drugs, 178 Nucleoside Analog Reverse Transcriptase Inhibitors, 178 Non-Nucleoside Analog Reverse Transcriptase Inhibitors, 180 Protease Inhibitors, 181 Fusion Inhibitors, 182 Entry Inhibitors, 183 Integrase Inhibitors, Anti-Infectives: Antitubercular and Antifungal Drugs, 188 TUBERCULOSIS, 188 Pathophysiology, 188 Types of Drugs for Tuberculosis, 190 First-Line Antitubercular Drugs, 190 FUNGAL INFECTIONS, 195 Pathophysiology, 195 Types of Antifungal Drugs, 195 Drugs for Superficial Fungal Infections, 195 Drugs for Deep or Systemic Fungal Infections, Drugs That Affect Urine Output, 205 DlURETICS, 205 Pathophysiology, 206 Tcciioc in

4 Types of Diuretics, 208 Thiazide Diuretics, 208 Loop Diuretics, 210 Potassium-Sparing Diuretics, 213 OVERACTIVE BLADDER, 214 Pathophysiology, 214 Types of Drugs for Overactive Bladder, 215 Urinary Antispasmodics, 215 BENIGN PROSTATIC HYPERPLASIA, 217 Pathophysiology, 218 Types of Drugs for Benign Prostatic Hyperplasia, 217 DHT Inhibitors and Selective Alpha-1 Blockers, Drugs for Hypertension, 223 Overview, 224 Pathophysiology, 225 Arteriosclerosis and Atherosclerosis, 225 Primary (Essential) Hypertension, 225 Secondary Hypertension, 225 General Issues for Antihypertensive Therapy, 226 Types of Antihypertensive Drugs, 227 Diuretics, 228 Angiotensin-Converting Enzyme Inhibitors, 229 Angiotensin II Receptor Antagonists, 232 Calcium Channel Blockers, 234 Beta Blockers, 236 Alpha Blockers, 239 Alpha-Beta Blockers, 241 Central-Acting Adrenergic Agents, 242 Direct Vasodilators, Drugs for Heart Failure, 247 Overview, 248 Pathophysiology, 248 Left Heart Failure, 250 Right Heart Failure, 251 Compensatory Mechanisms for Heart Failure, 251 Treatment for Heart Failure, 253 General Issues in Heart Failure Therapy, 253 Types of Drugs Used to Treat Heart Failure, 254 ACE Inhibitors, 254 Beta Blockers, 255 Vasodilators, 255 Cardiac Glycosides (Digoxin), 258 Diuretics, 260 Human B-Type Natriuretic Peptides, 260 Positive Inotropes (Heart Pump Drugs), 261 Potassium and Magnesium, 263 Other Drugs Used to Treat Heart Failure, Antidysrhythmic Drugs, 267 Pathophysiology, 268 Pacemakers and the Cardiac Conduction System, 268 Heart Rate, 269 General Issues Related to Antidysrhythmic Therapy, 272 Types of Antidysrhythmic Drugs, 273 Atropine for Bradydysrhythmias, 273 Digoxin, 275 Drugs for Tachydysrhythmias, 277 CLASS I: SODIUM CHANNEL BLOCKERS, 277 Class Ia Drugs, 277 Class Ib Drugs, 280 Class Ic Drugs, 282 CLASS II: BETA BLOCKERS, 283 CLASS III: POTASSIUM CHANNEL BLOCKERS, 286 CLASS IV: CALCIUM CHANNEL BLOCKERS, 288 Unclassified Antidysrhythmic Drugs, 289 Adenosine, 289 Magnesium Sulfate, 290 Other Drugs Used to Treat Dysrhythmias, Drugs for High Blood Lipids, 294 Overview, 294 Pathophysiology, 295 Coronary Artery Disease, 295 Familial Hyperlipidemia, 295 General Issues for Antihyperlipidemic Therapy, 296 Types of Lipid-Lowering Drugs, 298 Statins, 298 Bile Acid Sequestrants, 300 Cholesterol Absorption Inhibitors, 302 Fibrates, 303 Nicotinic Acid Agents, Drugs That Affect Blood Clotting, 309 Overview, 310 Pathophysiology, 310 Clot Formation, 310 Thrombosis, 310 Embolus, 311 General Issues for Anticoagulant Therapy, 312 Types of Drugs That Affect Blood Clotting, 313 ANTICOAGULANT DRUGS, 313 Thrombin Inhibitors, 313 Clotting Factor Synthesis Inhibitors, 316

5 Antiplatelet Drugs, 319 Thrombolytic Drugs, 321 DRUGS THAT IMPROVE BLOOD CLOTTING, 323 Colony-Stimulating Factors, Drugs for Asthma and Other Respiratory Problems, 327 Overview, 327 Pathophysiology, 328 Asthma, 328 Chronic Obstructive Pulmonary Disease, 330 Types of Drugs for Asthma and COPD, 330 Bronchodilators, 331 Anti-Inflammatory Drugs, 336 Combination Bronchodilator and Anti-Inflammatory Drugs, 338 Mucolytics, Drugs for Nausea, Vomiting, Diarrhea, and Constipation, 340 OVERVIEW, 340 NAUSEA AND VOMITING, 341 Pathophysiology, 341 Types of Drugs for Nausea and Vomiting, 342 Antiemetic Drugs, 342 CONSTIPATION, 346 Pathophysiology, 346 Types of Drugs for Constipation, 348 Laxatives, Lubricants, and Stool Softeners, 348 DIARRHEA, 351 Pathophysiology, 351 Types of Drugs for Diarrhea, 351 Antimotility, Adsorbent / Absorbent, and Antisecretory Drugs, Drugs for Gastric Ulcers and Reflux, 357 Overview, 357 Pathophysiology, 358 Gastrointestinal Ulcers, 358 Gastroesophageal Reflux Disease, 360 General Issues for Drugs for PUD and GERD, 363 Types of Drugs for PUD and GERD, 363 Histamine H 2 Blockers, 363 Proton Pump Inhibitors, 365 Antacids, 367 Cytoprotective Drugs, 369 Promotility Drugs, 370 Other Drugs Used to Treat Ulcers, 372 Antibiotics for H. Pylori Infection, Drugs for Seizures, 375 Overview, 375 Pathophysiology, 376 Causes of Seizures, 376 Types of Seizures, 376 Treatment of Seizures, 379 Types of Anti-Seizure Drugs, 380 First-Line Drugs for Partial and Generalized Seizures, 380 First-Line Drugs for Absence Seizures, 383 Second-Line (Alternative) Drugs for Seizures, Drugs for Depression, Anxiety, and Psychosis, 390 OVERVIEW, 391 DEPRESSION, 391 Pathophysiology, 393 Types of Drugs for Depression, 394 Antidepressants, 394 ANXIETY, 398 Pathophysiology, 400 Types of Drugs for Anxiety, 400 Antianxiety Drugs, 400 PSYCHOSIS, 404 Pathophysiology, 405 Types of Drugs for Psychosis, 405 Antipsychotics, Drugs for Parkinson's and Alzheimers Disease, 411 OVERVIEW, 411 ALZHEIMERS DISEASE, 411 Pathophysiology, 412 Types of Drugs for Alzheimers Disease, 413 Cholinesterase/Acetylcholinesterase Inhibitors and Memantine, 413 PARKINSONS DISEASE, 415 Pathophysiology, 415 Types of Drugs for Parkinson's Disease, 417 Dopaminergic/Dopamine Agonists, COMT Inhibitors, MAO-B Inhibitors, Anticholinergics, Drugs for Endocrine Problems, 424 OVERVIEW, 425 HYPOTHYROIDISM, 425 Pathophysiology, 425

6 25 26 Types of Thyroid Hormone Replacement Drugs, 427 Levothyroxine and Liothyronine, 427 HYPERTHYROIDISM, 431 Pathophysiology, 431 Types of Thyroid-Suppressing Drugs, 432 Methimazole and Propylthiouracil, 432 MENOPAUSE, 434 Pathophysiology, 434 Types of Perimenopausal Hormone Replacement Drugs, 436 Conjugated Estrogens, 436 Drugs for Diabetes, 440 Overview, 440 Pathophysiology, 441 Normal Physiology, 441 Pathophysiology, 444 Types of Drugs for Diabetes, 446 Insulin Therapy, 446 Oral Antidiabetic Drugs, 453 Oral Combination Drugs, 458 Drugs That Increase Incretins and Amylin, 459 Drugs for Glaucoma, 465 Overview, 465 Pathophysiology, 466 Physiology, 466 Pathophysiology, 468 General Issues for Local Eye Drug Therapy, 469 Types of Drugs for Glaucoma, 472 Prostaglandin Agonists, 472 Beta Adrenergic Blocking Agents, 473 Adrenergic Agonists, 475 Cholinergic Drugs, 477 Carbonic Anhydrase Inhibitors, Drugs for Cancer Therapy, 482 Pathophysiology, 482 Features of Normal Cells, 483 Features of Cancer Cells, 485 Cancer Development, 486 Cancer Classification, 487 Cancer Causes, 487 Types of Cancer Treatment, 488 Chemotherapy, 488 Hormone Manipulation, 496 Immunotherapy: Biological Response Modifiers, 498 Targeted Therapy, 499 Bibliography, 503 Illustration Credits, 506 Answer Key, Inside back cover and facing page