Pharmacology. for Nursing Practice. Kathleen Gutierrez, PhD, RN, ANP, CNS

Pharmacology for Nursing Practice Kathleen Gutierrez, PhD, RN, ANP, CNS Adult Nurse Practitioner Private Practice; Associate Professor Regis University and University of Colorado Health Sciences Center Denver, Colorado Sherry F. Queener, PhD Professor 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 Mosby An Affiliate of Elsevier Science

PART BASIC CONCEPTS AND PRINCIPLES 1 Drugs in the Body: Pharmacodynamics and Pharmacokinetics, l SHERRY F. QUEENER Mechanisms of Drug Action: Pharmacodynamics, 2 How Drug Dosage Relates to Drug Action: Pharmacokinetics, 6 2 Perinatal Pharmacotherapeutics, 21 KATHLEEN GUTIERREZ Maternal Pharmacokinetic Considerations, 21 Fetal-Placenta! Pharmacokinetic Considerations, 23 Pharmacodynamics, 26 Drugs and Lactation, 27 APPLICATION TO PRACTICE, 29 Assessment, 29 Goals of Therapy, 30 Intervention, 30 Evaluation, 32 3 Pediatric Pharmacotherapeutics, 33 KATHLEEN GUTIERREZ Anatomic and Physiologic Variables, 34 Pharmacokinetic Considerations, 36 Pharmacodynamic Considerations, 38 APPLICATION TO PRACTICE, 39 Assessment, 39 Goals of Therapy, 39 Intervention, 40 Evaluation, 43 4 Older Adult Pharmacotherapeutics, 45 KATHLEEN GUTIERREZ Anatomic and Physiologic Variables, 46 Pharmacokinetic Considerations, 48 Pharmacodynamic Considerations, 50 APPLICATION TO PRACTICE, 51 Assessment, 51 Goals of Therapy, 53 Intervention, 54 Evaluation, 55 PART 11 IMPLICATIONS OF DRUG THERAPY 5 Role of the Nurse in Drug Therapy, 57 KATHLEEN GUTIERREZ Collaborative Nature of Drug Therapy, 58 Sources of Drug Information, 58 APPLICATION TO PRACTICE, 60 Assessment, 60 Goals of Therapy, 62 Intervention, 62 Evaluation, 69 6 Evidence-Based Practice and Pharmacoeconomics, 73 KATHLEEN GUTIERREZ Evidence-Based Practice, 75 EBP's Link to Pharmacoeconomics, 77 Future of Pharmacoeconomics, 83 Summary, 83 XI

Legal Implications of Drug Therapy, 85 LYNN ROGER WILLIS Establishment of Safety and Efficacy of Drugs, 85 Drug Testing, 89 Controlled Substances, 91 Canadian Drug Legislation, 92 Over-the-Counter Drugs and Herbal Remedies, 95 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ Regulation of Over-the-Counter Drugs, 95 Resurgence of Herbal Remedies, 97 Regulation of Herbal Remedies, 97 Herbal Remedies Go Beyond the Scope of OTC Drugs, 98 Pseudoscience and Herbal Remedies, 98 Pharmacology of Widely Used Herbal Remedies, 99 Potentially Dangerous Herbal Remedies, 103 Nonherbal Dietary Supplements, 104 APPLICATION TO PRACTICE, 106 Assessment, 106 Goals of Therapy, 106 Intervention, 106 Evaluation, 107 3 Substance Abuse, in General Characteristics of Dependence- Producing Drugs, 111 Diagnosis of Drug Dependence, 112 Opioids, 115 CNS Depressants, 117 CNS Stimulants, 118 Hallucinogens, 120 Inhalants, 122 APPLICATION TO PRACTICE, 123 Assessment, 123 Goals of Therapy, 126 Intervention, 127 Evaluation, 127 HI utonomic NERVOUS SYSTEM DRUGS ) Introduction to Autonomic Nervous System Pharmacology, 129 Overview of the Autonomic Nervous System, 130 Confusing Terminology of Drugs Acting through the Autonomic Nervous System, 137 11 Parasympathetic Nervous System Drugs, 139 PHYSIOLOGY: Muscarinic Cholinergic Mechanisms, 140 Eye, 140 Exocrine Glands, 140 Smooth Muscle of Gastrointestinal Tract and Bladder, 140 Airways, 140 Heart, 140 Bloodvessels, 140 DRUG CIASS: Muscarinic Receptor Agonists or Cholinomimetics, 141 DRUG CLASS: Muscarinic Receptor Antagonists or Anticholinergics, 143 PHYSIOLOGY: Nicotinic Cholinergic Mechanisms, 145 DRUG CLASS: Ganglionic Nicotinic Receptor Antagonist (Ganglionic Blocker), 145 PHYSIOLOGY: Acetylcholinesterase, 146 DRUG CIASS: Acetylcholinesterase Inhibitors, 146 APPLICATION TO PRACTICE, 148 Assessment, 148 Goals of Therapy, 150 Intervention, 150 Evaluation, 151 12 Drugs Affecting Adrenergic Mechanisms, 153 PHYSIOLOGY: Alpha-Adrenergic Receptors, 154 DRUG CLASS: Alpha-Adrenergic Receptor Agonists, 156 DRUG CLASS: Alpha-Adrenergic Receptor Antagonists (Alpha Blockers), 158 PHYSIOLOGY: Beta-Adrenergic Receptors, 160 DRUG CLASS: Beta-Adrenergic Receptor Agonists, 160 DRUG CLASS: Beta-Adrenergic Receptor Antagonists (Beta Blockers), 162 Other Drugs Acting on Sympathetic Mechanisms, 163 APPLICATION TO PRACTICE, 164 Assessment, 164 Goals of Therapy, 165 Intervention, 165 Evaluation, 165

XIII PART V CENTRAL NERVOUS SYSTEM DRUGS 13 Opioid Analgesics, 167 History of Opioids, 168 PHYSIOLOGY: Pain, 168 Pain Pathways, 169 Types of Pain, 170 DRUG CLASS: Opioid Agonists, 171 DRUG CLASS: Mixed Agonist-Antagonists and Partial Agonists, 180 DRUG CLASS: Opioid Antagonists, 182 DRUG CIASS: Miscellaneous Drugs, 183 APPLICATION TO PRACTICE, 183 Assessment, 183 Goals of Therapy, 185 Intervention, 185 Evaluation, 187 14 Nonsteroidal Antiinflammatory Drugs (NSAIDs) and Disease-Modifying Antirheumatic Drugs (DMARDs), 191 PATHOPHYSIOLOGY: Inflammation, 192 PATHOPHYSIOLOGY: Pain, 193 PATHOPHYSIOLOGY: Fever, 194 Additional Actions of Prostaglandins, 194 DRUG CIASS: Salicylates, 195 DRUG CIASS: Other NSAIDs, 200 DRUG CIASS: Cyclooxygenase-2 Inhibitors, 202 ACETAMINOPHEN, 202 DRUG CIASS: Disease-Modifying Antirheumatic Drugs, 204 DRUG CIASS: Gold Salts, 205 DRUG CLASS: Miscellaneous Drugs for Osteoarthritis, 206 PATHOPHYSIOLOGY: Gout, 207 DRUG CLASS: Antigout Drugs, 207 DRUG CIASS: Uricosuric Drugs, 208 APPLICATION TO PRACTICE, 209 Assessment, 209 Goals of Therapy, 211 Intervention, 211 Evaluation, 215 15 Drugs to Treat Headaches, 217 PATIIOPHYSIOLOGY: Headaches, 218 DRUG CLASS: Triptans, 220 DRUG CLASS: Ergot Derivatives, 221 APPLICATION TO PRACTICE, 22.1 Assessment, 223 Goals of Therapy, 224 Intervention, 225 Evaluation, 226 16 Anesthetics and Related Drugs, 229 Anesthesia Defined, 230 PHYSIOLOGY: Local Anesthesia,ind the Transmission ot Painful Stimuli, 230 DRUG CLASS: Local Anesthetics, 230 PHYSIOLOGY: General Anesthesia, 234 DRUG CLASS: Inhaled Anesthetics, 235 DRUG CLASS: Intravenous Anesthetics, 237 PI lysioi.ogy: Neuromuscular Transmission, 239 DRUG CLASS: Neuromuscular Blockers, 240 APPLICATION TO PRACTICE, 242 Assessment, 242 Goals of Therapy, 243 Intervention, 244 Evaluation, 245 17 Anxiolytic and Sedative-Hypnotic Drugs, 247 PATHOPHYSIOLOGY: Anxiety, Sleep, and Their Disorders, 248 DRUG CLASS: Benzodiazepines and Related Drugs, 250 DRUG CIASS: Benzodiazepine Antagonists, 252 DRUG CLASS: Barbiturates, 252 DRUG CLASS: Atypical Anxiolytic, 254 DRUG CIASS: Older Sedative-Hypnotics, 254 APPLICATION TO PRACTICE, 255 Assessment, 255 Goals of Therapy, 258 Intervention, 258 Evaluation, 260 18 Antidepressant and Antimania Drugs, 263 PATHOPHYSIOLOGY: Depression, 264 DRUG CLASS: Selective Serotonin Reuptake Inhibitors (SSRIs), 268 DRUG CLASS: Tricyclic Antidepressants (I(As), 270 DRUG CLASS: Atypical Antidepressants, 271 DRUG CLASS: Monoamine Oxidase Inhibitors (MAOIs), 273 PAIIIOPI lysioi.ogy: Bipolar Disorders, 273 DRUG CLASS: Antimania or Mood-Altering Drugs, 27b APPLICATION TO PRACTICE, 278 Assessment, 278 Goals of Therapy, 281 Intervention, 281 Evaluation, 282

XII Table of Contents 7 Legal Implications of Drug Therapy, 85 LYNN ROGER WILLIS Establishment of Safety and Efficacy of Drugs, 85 Drug Testing, 89 Controlled Substances, 91 Canadian Drug Legislation, 92 8 Over-the-Counter Drugs and Herbal Remedies, 95 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ Regulation of Over-the-Counter Drugs, 95 Resurgence of Herbal Remedies, 97 Regulation of Herbal Remedies, 97 Herbal Remedies Go Beyond the Scope of OTC Drugs, 98 Pseudoscience and Herbal Remedies, 98 Pharmacology of Widely Used Herbal Remedies, 99 Potentially Dangerous Herbal Remedies, 103 Nonherbal Dietary Supplements, 104 APPLICATION TO PRACTICE, 106 Assessment, 106 Goals of Therapy, 106 Intervention, 106 Evaluation, 107 9 Substance Abuse, ill General Characteristics of Dependence- Producing Drugs, 111 Diagnosis of Drug Dependence, 112 Opioids, 115 CNS Depressants, 117 CNS Stimulants, 118 Hallucinogens, 120 Inhalants, 122 APPLICATION TO PRACTICE, 123 Assessment, 123 Goals of Therapy, 126 Intervention, 127 Evaluation, 127 PART HI AUTONOMIC NERVOUS SYSTEM DRUGS 10 Introduction to Autonomic Nervous System Pharmacology, 129 Overview of the Autonomic Nervous System, 130 Confusing Terminology of Drugs Acting through the Autonomic Nervous System, 137 11 Parasympathetic Nervous System Drugs, 139 PHYSIOLOGY: Muscarinic Cholinergic Mechanisms, 140 Eye, 140 Exocrine Glands, 140 Smooth Muscle of Gastrointestinal Tract and Bladder, 140 Airways, 140 Heart, 140 Bloodvessels, 140 DRUG CIASS: Muscarinic Receptor Agonists or Cholinomimetics, 141 DRUG CIASS: Muscarinic Receptor Antagonists or Anticholinergics, 143 PHYSIOLOGY: Nicotinic Cholinergic Mechanisms, 145 DRUG CIASS: Ganglionic Nicotinic Receptor Antagonist (Ganglionic Blocker), 145 PHYSIOLOGY: Acetylcholinesterase, 146 DRUG CIASS: Acetylcholinesterase Inhibitors, 146 APPLICATION TO PRACTICE, 148 Assessment, 148 Goals of Therapy, 150 Intervention, 150 Evaluation, 151 12 Drugs Affecting Adrenergic Mechanisms, 153 PHYSIOLOGY: Alpha-Adrenergic Receptors, 154 DRLIG CIASS: Alpha-Adrenergic Receptor Agonists, 156 DRUG CLASS: Alpha-Adrenergic Receptor Antagonists (Alpha Blockers), 158 PHYSIOLOGY: Beta-Adrenergic Receptors, 160 DRLIG CIASS: Beta-Adrenergic Receptor Agonists, 160 DRLIG CLASS: Beta-Adrenergic Receptor Antagonists (Beta Blockers), 162 Other Drugs Acting on Sympathetic Mechanisms, 163 APPLICATION TO PRACTICE, 164 Assessment, 164 Goals of Therapy, 165 Intervention, 165 Evaluation, 165

XIII PART V CENTRAL NERVOUS SYSTEM DRUGS 13 Opioid Analgesics, 167 History of Opioids, 168 PHYSIOLOGY: Pain, 168 Pain Pathways, 169 Types of Pain, 170 DRUG CIASS: Opioid Agonists, 171 DRUG CLASS: Mixed Agonist-Antagonists and Partial Agonists, 180 DRUG CIASS: Opioid Antagonists, 182 DRUG CLASS: Miscellaneous Drugs, 183 APPLICATION TO PRACTICE, 183 Assessment, 183 Goals of Therapy, 185 Intervention, 185 Evaluation, 187 14 Nonsteroidal Antiinflammatory Drugs (NSAIDs) and Disease-Modifying Antirheumatic Drugs (DMARDs), 191 PATHOPHYSIOLOGY: Inflammation, 192 PATHOPHYSIOLOGY: Pain, 193 PATHOPHYSIOLOGY: Fever, 194 Additional Actions of Prostaglandins, 194 DRUG CIASS: Salicylates, 195 DRUG CIASS: Other NSAIDs, 200 DRUG CIASS: Cyclooxygenase-2 Inhibitors, 202 ACETAMINOPHEN, 202 DRLIG CIASS: Disease-Modifying Antirheumatic Drugs, 204 DRUG CLASS: Gold Salts, 205 DRUG CIASS: Miscellaneous Drugs for Osteoarthritis, 206 PATHOPHYSIOLOGY: Gout, 207 DRUG CIASS: Antigout Drugs, 207 DRUG CIASS: Uricosuric Drugs, 208 APPLICATION TO PRACTICE, 209 Assessment, 209 Goals of Therapy, 211 Intervention, 211 Evaluation, 215 15 Drugs to Treat Headaches, 217 PATHOPIIYSIOLOGY: Headaches, 218 DRUG CIASS: Triptans, 220 DRUG CLASS: Ergot Derivatives, 221 APPLICATION TO PRACTICE, 223 Assessment, 223 Goals of Therapy, 224 Intervention, 225 Evaluation, 226 16 Anesthetics and Related Drugs, 229 Anesthesia Defined, 230 PHYSIOLOGY: Local Anesthesia and the Transmission of Painful Stimuli, 230 DRUG CLASS: Local Anesthetics, 230 PHYSIOLOGY: General Anesthesia, 234 DRUG CLASS: Inhaled Anesthetics, 235 DRUG CIASS: Intravenous Anesthetics, 237 PI IYSIOLOGY: Neuromuscular Transmission, 239 DRUG CIASS: Neuromuscular Blockers, 240 APPLICATION TO PRACTICE, 242 Assessment, 242 Goals of Therapy, 243 Intervention, 244 Evaluation, 245 17 Anxiolytic and Sedative-Hypnotic Drugs, 247 PATHOPI lysioi.ogy: Anxiety, Sleep, and Their Disorders, 248 DRUG CLASS: Benzodiazepines and Related Drugs, 250 DRUG CIASS: Benzodiazepine Antagonists, 252 DRUG CLASS: Barbiturates, 252 DRUG CLASS: Atypical Anxiolytic, 254 DRUG CLASS: Older Sedative-I lypnotics, 254 APPLICATION TO PRACTICE, 255 Assessment, 255 Goals of Therapy, 258 Intervention, 258 Evaluation, 260 18 Antidepressant and Antimania Drugs, 263 PATHOPHYSIOLOGY: Depression, 264 DRUG CIASS: Selective Serotonin Reuptake Inhibitors (SSRIs), 268 DRUG CIASS: Iricyclic Antidepressants (TCAs), 270 DRUG CIASS: Atypical Antidepressants, 271 DRUG CIASS: Monoamine Oxidase Inhibitors (MAOIs), 273 PATHOPHYSIOI.OCY: Bipolar Disorders, 275 DRUG CIASS: Antimania or Mood-Altering Drugs, 276 APPLICATION TO PRACTICE, 278 Assessment, 278 Goals of Therapy, 281 Intervention, 281 Evaluation, 282

XIV Table of Contents 19 Antipsychotic Drugs, 285 PATHOPHYSIOLOGY, 286 Psychoses, 286 Schizophrenia, 286 DRUG CIASS: Antipsychotics, 287 APPLICATION TO PRACTICE, 295 Assessment, 295 Goals of Therapy, 297 Intervention, 297 Evaluation, 299 20 Central Nervous System Stimulants, 303 PATHOPHYSIOLOGY: Narcolepsy, 303 PATHOPHYSIOLOGY: Attention-Deficit Hyperactivity Disorder, 304 DRUG CLASS: CNS Stimulants, 305 PATHOPHYSIOLOGY: Obesity, 308 DRUG CLASS: Antiobesity Drugs, 309 DRUG CLASS: Analeptics, 311 APPLICATION TO PRACTICE, 312 Assessment, 312 Goals of Therapy, 313 Intervention, 314 Evaluation, 315 PART V NERVOUS SYSTEM DRUGS 21 Skeletal Muscle Relaxants, 317 MICHAEL R. VASKO and SUSAN SCIACCA PATHOPHYSIOLOGY: Spasms and Spasticity, 318 Spasms, 318 Spasticity, 319 DRUG CLASS: Drugs Used to Treat Spasticity, 320 DRUG CLASS: Skeletal Muscle Relaxants, 323 APPLICATION TO PRACTICE, 324 Assessment, 324 Goals of Therapy, 325 Intervention, 325 Evaluation, 327 22 Anticonvulsants, 329 MICHAEL R. VASKO and SUSAN SCIACCA PATHOPHYSIOLOGY: Epilepsy, 330 Classification of Epilepsy, 330 Mechanisms Underlying Epilepsy, 332 DRUG CLASS: Hydantoins, 332 DRUG CIASS: Iminostilbenes, 334 DRUG CLASS: Barbiturates, 335 DRUG CLASS: Succinimides, 336 DRUG CLASS: Valproates, 336 DRLIG CLASS: Benzodiazepines, 337 DRUG CLASS: Oxazolidinediones, 338 DRUG CLASS: Miscellaneous Anticonvulsants, 339 APPLICATION TO PRACTICE, 342 Assessment, 342 Goals of Therapy, 343 Intervention, 344 Evaluation, 346 23 Drugs to Treat Movement Disorders, Myasthenia Gravis, and Alzheimer's Disease, 349 MICHAEL R. VASKO and SUSAN SCIACCA PATHOPHYSIOLOGY: Parkinson's Disease, 350 DRUG CLASS: Anticholinergic Drugs, 353 DRUG CIASS: Dopaminergic Drugs, 354 DRUG CIASS: Dopamine Receptor Agonists, 355 DRLJC CLASS: Miscellaneous Drugs Used to Treat Parkinson's Disease, 356 APPLICATION TO PRACTICE, 357 Assessment, 357 Goals of Therapy, 359 Intervention, 359 Evaluation, 361 PATHOPHYSIOLOGY: Myasthenia Gravis, 362 DRUG CIASS: Acetylcholinesterase Inhibitors, 364 DRLIG CIASS: Immunosuppressive Drugs, 365 APPLICATION TO PRACTICE, 366 Assessment, 366 Goals of Therapy, 367 Intervention, 367 Evaluation, 369 PATHOPHYSIOLOGY: Alzheimer's Disease, 369 DRUG CIASS: Acetylcholinesterase Inhibitors LIsed to Treat Alzheimer's Disease, 370 APPLICATION TO PRACTICE, 371 Assessment, 371 Goals of Therapy, 372 Intervention, 372 Evaluation, 373 PART VI ANTIMICROBIAL DRUGS 24 Introduction to the Use of Antimicrobial Drugs, 377 PATHOPHYSIOLOGY: Infectious Disease, 377 Strategies for Controlling Infectious Disease, 379 Measures of Antibiotic Effectiveness, 379 Factors Affecting Outcomes of Antibiotic Therapy, 381 Problems in Antibiotic Therapy, 384 Misuse of Antibiotics, 385 APPLICATION TO PRACTICE, 386 Assessment, 386 Goals of Therapy, 387 Intervention, 387 Evaluation, 388

XV 25 Penicillins, Cephalosporins, and Related Drugs, 389 PATHOPHYSIOLOGY, 389 DRUG CIASS: Beta-Lactam Antibiotics, 390 DRUG CLASS: Narrow-Spectrum Antibiotics, 393 DRUG CLASS: Penicillinase-Resistant Penicillins, 395 DRUG CLASS: Extended-Spectrum Penicillins, 395 DRUG CLASS: Anti-Pseudomonas Penicillins, 396 DRUG CLASS: Cephalosporins, 396 DRUG CIASS: Miscellaneous Beta-Lactam Antibiotic, 398 DRUG CLASS: Carbapenems, 399 DRUG CIASS: Carbacephems, 399 APPLICATION TO PRACTICE, 400 Assessment, 400 Goals of Therapy, 401 Intervention, 401 Evaluation, 403 26 Macrolides: Erythromycin and Related Drugs, 405 PATHOPHYSIOLOGY, 405 DRUG CLASS: Macrolides, 406 APPLICATION TO PRACTICE, 409 Assessment, 409 Goals of Therapy, 410 Intervention, 410 Evaluation, 411 27 Fluoroquinolones and Related Drugs, 413 PATHOPHYSIOLOGY, 413 DRUG CLASS: Fluoroquinolones, 414 APPLICATION TO PRACTICE, 417 Assessment, 417 Goals of Therapy, 417 Intervention, 418 Evaluation, 418 28 Tetracydines and Chloramphenicol, 421 PATHOPHYSIOLOGY: Nonbacterial Infections, 421 DRUG CIASS: Tetracydines, 422 DRLIG CIASS: Acetamides, 425 APPLICATION TO PRACTICE, 426 Assessment, 426 Goals of Therapy, 428 Intervention, 428 Evaluation, 428 29 Aminoglycosides, 431 PATIIOPHYSIOLOCY, 432 DRUG CLASS: Aminoglycosides, 432 APPLICATION TO PRACTICE, 434 Assessment, 434 Goals of Therapy, 435 Intervention, 435 Evaluation, 437 30 Antibacterial Drugs for Special Purposes, 439 PATHOPHYSIOLOGY: Urinary Tract Infections, 440 DRUG CIASS: Sulfonamides, 441 DRUG CIASS: Dihydrofolate Reductase Inhibitors, 444 DRUG CLASS: Urinary Tract Antiseptics, 445 PATHOPHYSIOLOGY: Anaerobic Infections, 447 DRUG CLASS: Nitroimidazoles, 448 DRUG CIASS: Lincosamine, 448 PATHOPHYSIOLOGY: Nosocomial Infections, 449 DRUG CLASS: Glycopeptides, 450 DRUG CLASS: Streptogramins, 451 DRUG CIASS: Oxazolidinone, 452 APPLICATION TO PRACTICE, 452 Assessment, 452 Goals of Therapy, 455 Intervention, 455 Evaluation, 457 31 Antiviral Drugs, 459 PATHOPHYSIOLOGY: Viral Infections, 459 DRUG CIASS: Nucleoside Reverse Transcriptase Inhibitors (NRTls) for HIV, 462 DRLIG CLASS: Nucleotide Reverse Transcriptase Inhibitors (NtRTIs) for HIV, 464 DRUG CIASS: Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) for HIV, 465 DRLIG CIASS: HIV Protease Inhibitors, 466 DRUG CLASS: Acyclic Nucleoside Analogs for Systemic Viral Diseases Other than AIDS, 467 DRUG CLASS: Neuraminidase Inhibitors of Influenza, 468 DRUG CLASS: Amantidines for Influenza, 469 DRUG CIASS: Nucleoside Analog for Systemic Viral Diseases, 470 DRUG CIASS: Alfa Interierons for Systemic Viral Diseases, 470 APPLICATION TO PRACTICE, 471 Assessment, 471 Goals of Therapy, 473 Intervention, 473 Evaluation, 476

XVI Table of Contents 32 Antifungal Drugs, 479 PATHOPHYSIOLOGY: Systemic Fungal Infections, 480 DRLIG CLASS: Polyenes, 481 DRUG CLASS: Antimetabolites, 483 DRUG CIASS: Azole Antifungal Drugs, 484 DRUG CLASS: Echinocandin, 486 APPLICATION TO PRACTICE, 486 Assessment, 486 Goals of Therapy, 488 Intervention, 488 Evaluation, 490 33 Antitubercular and Other Mycobacterial Drugs, 493 PATHOPHYSIOLOGY: Tuberculosis, 493 DRUG CIASS: Primary Drugs Used to Treat Tuberculosis, 496 DRUG CIASS: Miscellaneous Drugs Used to Treat Tuberculosis, 499 APPLICATION TO PRACTICE: Tuberculosis, 500 Assessment, 500 Goals of Therapy, 502 Intervention, 502 Evaluation, 504 PATHOPHYSIOLOGY: Leprosy, 504 DRUG CLASS: Drugs Used to Treat Leprosy, 505 DRUG CIASS: Miscellaneous Drugs Used to Treat Leprosy, 506 PATHOPHYSIOLOGY: Mycobacterium avium Complex, 507 DRUG CIASS: Drugs Used to Treat Mycobacterium avium Complex, 507 APPLICATION TO PRACTICE: Leprosy, 508 Assessment, 508 Goals of Therapy, 509 Intervention, 509 Evaluation, 509 34 Antiprotozoal and Antihelminthic Drugs, 511 PATHOPHYSIOLOGY: Malaria, 512 DRUG CLASS: Antimalarial Drugs, 513 DRUG CLASS: Drugs Used Primarily to Treat Chloroquine-Resistant Malaria, 515 PATHOPHYSIOLOGY: Amebic Disease, 516 DRUG CIASS: Drugs Used to Treat Amebic Disease, 516 PATHOPHYSIOLOGY: Selected Parasitic Diseases, 517 Cryptosporidiosis and Microsporidiosis, 517 Giardiasis, 518 Leishmaniasis, 518 Pneumocystosis, 518 Toxoplasmosis, 519 Trichomoniasis, 519 DRUG CLASS: Primary Drugs Used to Treat Selected Parasitic and Opportunistic Diseases, 519 DRLIG CLASS: Miscellaneous Drugs Used to Treat Selected Parasitic and Opportunistic Diseases, 520 PATHOPHYSIOLOGY: Diseases Caused by Helminths, 521 Ascariasis, 521 Enterobiasis, 521 Whipworm Infestation, 521 Threadworm Infestation, 523 Hookworm Infestation, 523 Trichinosis, 523 Tapeworm Infestation, 523 DRUG CLASS: Drugs Used to Treat Diseases Caused by Helminths, 523 APPLICATION TO PRACTICE, 525 Assessment, 525 Goals of Therapy, 527 Intervention, 527 Evaluation, 528 PART VII IMMUNE SYSTEM DRUGS 35 Immunizing Drugs, 531 SUSAN SCIACCA PHYSIOLOGY: Immunostimulation, 532 Types of Immunity, 533 DRUG CLASS: Vaccines and Toxoids, 534 DRUG CLASS: Antisera and Antitoxins, 539 APPLICATION TO PRACTICE, 542 Assessment, 542 Goals of Therapy, 543 Intervention, 544 Evaluation, 548 36 Biologic Response Modifiers, 551 PATHOPHYSIOLOGY: Immune System Dysfunction, 552 DRUG CLASS: Colony-Stimulating Factors, 555 DRUG CLASS: Growth Factors that Stimulate Platelet or Erythrocyte Production, 556 DRUG CLASS: Interleukins, 556 DRUG CLASS: Interleukin Receptor Blockers and Other Immunosuppressant Antibodies, 557

XVII DRUG CLASS: Cytokine Release Inhibitors, 558 DRUG CLASS: Interferons, 559 DRUG CIASS: Antagonists of'tumor Necrosis Factor (TNF-alpha), 560 DRUG CLASS: Biologic Response Modifiers Targeted to Oil-Specific Markers, 561 DRUG CLASS: Miscellaneous Modulators of Immune Function, 563 APPLICATION TO PRACTICE, 564 Assessment, 564 Goals of Therapy, 566 Intervention, 566 Evaluation, 567 37 Antineoplastic Drugs, 569 PATHOPHYSIOLOGY: Cancer, 570 DRLIG CIASS: Cytotoxic Drugs that Directly Attack DNA, 576 DRUG CIASS: Drugs that Block DNA Synthesis, 579 DRUG CIASS: Drugs that Block RNA or Protein Synthesis, 582 DRLIG CLASS: Drugs that Prevent or Arrest Mitosis, 584 DRLIG CIASS: Androgens and Anabolic Steroids, 586 DRLIG CLASS: Antiandrogens, 588 DRUG CIASS: LH-FH Analogs, 589 DRUG CIASS: Estrogens, 589 DRLJG CIASS: Antiestrogens, 590 DRUG CIASS: Aromatase Inhibitors, 591 DRUG CLASS: Progestins, 591 DRUG CLASS: Retinoids, 592 DRLIG CIASS: Tyrosine Kinase Inhibitor, 592 DRUG CIASS: Lympholytic Drugs, 593 DRUG CIASS: Tissue-Directed Drugs and Isotopes, 593 DRUG CLASS: Photosensitizing Drugs, 594 APPLICATION TO PRACTICE, 594 Assessment, 594 Goals of Therapy, 595 Intervention, 596 Evaluation, 603 PART VI11 CARDIOVASCULAR SYSTEM DRUGS 38 Drugs Used to Treat Heart Failure, 605 PATHOPHYSIOI.OGY: Heart Failure, 606 DRUG CLASS: Angiotensin-Converting Enzyme (ACE) Inhibitors, 608 DRUG CIASS: Cardiac Glycosides, 609 DRUG CLASS: I'hosphodiesterase Inhibitors, 611 DRUG CLASS: Diuretics, 611 DRUG CIASS: Vasodilators, 611 DRUG CLASS: Alpha Antagonists, 612 DRUG CLASS: Beta Agonists, 612 DRUG CLASS: Beta-Adrenergic Antagonists (Beta Blockers), 612 APPLICATION'TO PRACTICE, 612 Assessment, 612 Goals of Therapy, 614 Intervention, 614 Evaluation, 617 39 Antianginal and Other Vasodilating Drugs, 619 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ PATHOPHYSIOI.OGY: Angina Pectoris, 620 Cardiac Ischemia and Angina Pectoris, 620 DRUG CLASS: Organic Nitrovasodilators, 622 DRUG CIASS: Beta Blockers, 626 DRUG CLASS: Calcium Channel Blockers, 627 DRUG CIASS: Other Vasodilating Drugs, 628 APPLICATION TO PRACTICE, 630 Assessment, 630 Goals of Therapy, 632 Intervention, 633 Evaluation, 636 40 Antiarrhythmic Drugs, 639 JOSEPH A. DiMICCO and ELIZABETH KISSELL PHYSIOLOGY: Normal Cardiac Function, 640 PATHOPHYSIOLOGY: Cardiac Rhythm Disturbances, 643 DRUG CLASS: Sodium Channel Blockers (Class I Antiarrhythmics), 645 DRUG CLASS: Beta Blockers (Class II Antiarrhythmics), 648 DRUG CLASS: Drugs Prolonging Action Potential Duration (Class III Antiarrhythmics), 648 DRUG CIASS: Calcium Channel Blockers (Class IV Antiarrhythmics), 650 DRUG CLASS: Adenosine Receptor Agonists, 650 DRUG CLASS: Cardiac Glycosides, 650 APPLICATION TO PRACTICE, 651 Assessment, 651 Goals of Therapy, 652 Intervention, 652 Evaluation, 653

XViii Table of Contents 41 Antihypertensive Drugs, 657 JOSEPH A. DiMICCO and ELIZABETH KISSELL PATHOPHYSIOLOGY: Hypertension, 658 Essential Hypertension, 659 Secondary Hypertension, 659 Isolated Systolic Hypertension, 660 Malignant Hypertension, 660 Preeclampsia, 660 Effects of Hypertension, 660 Summary of Drug Therapy for Hypertension, 660 DRUG CIASS: Diuretics, 661 DRLIG CIASS: Beta Blockers, 662 DRLIG CIASS: Angiotensin-Converting Enzyme (ACE) Inhibitors, 662 DRLIG CIASS: Angiotensin 11-Receptor Blockers, 663 DRLIG CLASS: Calcium Channel Blockers, 664 DRUG CIASS: Alpha Blockers, 664 DRLIG CLASS: Centrally Acting Antihypertensives, 664 DRUG CIASS: Adrenergic Neuron-Blocking Drugs, 665 DRUG CLASS: Direct-Acting Vasodilators, 667 'TREATMENT OF HYPERTENSIVE EMERGENCIES, 667 APPLICATION TO PRACTICE, 668 Assessment, 668 Goals of Therapy, 671 Intervention, 671 Evaluation, 674 42 Antilipemic Drugs, 677 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: Hyperlipoproteinemia, 678 Types of Hyperlipoproteinemia, 681 ANTILIPEMIC DRUGS, 681 DRUG CIASS: Bile Acid Resins, 682 DRUG CIASS: Fibric Acid Derivatives, 684 DRUG CIASS: HMG-CoA Reductase Inhibitors, 685 DRUG CIASS: Nicotinic Acid, 686 APPLICATION TO PRACTICE, 687 Assessment, 687 Goals of Therapy, 688 Intervention, 688 Evaluation, 691 PART X HEMATOLOGIC SYSTEM DRUGS 43 Anticoagulant and Antiplatelet Drugs, 693 LYNN ROGER WILLIS and SUSAN SCIACCA PATHOPHYSIOLOGY: Coagulation, 694 DRLIG CIASS: Anticoagulant Drugs, 694 DRLIG CLASS: Direct-Acting Anticoagulants, 694 DRLIG CLASS: Oral Anticoagulants, 699 DRUG CLASS: Antiplatelet Drugs, 701 APPLICATION TO PRACTICE, 703 Assessment, 703 Goals of Therapy, 705 Intervention, 705 Evaluation, 708 44 Thrombolytic and Sclerosing Drugs, 711 LYNN ROGER WILLIS and SUSAN SCIACCA PATHOPHYSIOLOGY: Thromboembolytic Diseases, 712 DRUG CLASS: Thromboembolytic Drugs, 714 APPLICATION TO PRACTICE, 716 Assessment, 716 Goals of Therapy, 718 Intervention, 718 Evaluation, 719 PATHOPHYSIOLOGY: Varicosities, 720 DRUG CLASS: Sclerosing Drugs, 720 DRUG CIASS: Antihemorrhagic Drugs, 721 APPLICATION TO PRACTICE, 721 Assessment, 721 Goals of Therapy, 722 Intervention, 722 Evaluation, 723 45 Blood and Blood Products, 725 KATHLEEN GUTIERREZ BASIC PRINCIPLES OF IMMUNOHEMATOLOGY, 726 BLOOD PRODUCT: Whole Blood, 727 BLOOD PRODUCT: Packed Red Blood Cells, 731 BLOOD PRODUCT: Plasma, 732 BLOOD PRODUCT: Platelets, 733 BLOOD PRODUCT: Granulocytes, 734 BLOOD PRODUCT: Cryoprecipitate AHF, 735 APPLICATION TO PRACTICE, 736 Assessment, 736 Goals of Therapy, 738 Intervention, 738 Evaluation, 739

xix PARTX RENAL SYSTEM DRUGS 46 Diuretics, 741 LYNN ROGER WILLIS and ELIZABETH KISSELL PHYSIOLOGY: Renal Function, 741 Maintenance of Extracellular Fluid Volume, 741 DRUG CLASS: Loop Diuretics, 744 DRUG CLASS: Thiazide Diuretics, 749 DRUG CLASS: Potassium-Sparing Diuretics, 751 DRUG CLASS: Carbonic Anhydrase Inhibitors, 752 DRUG CLASS: Osmotic Diuretics, 753 APPLICATION TO PRACTICE, 754 Assessment, 754 Goals of Therapy, 755 Intervention, 756 Evaluation, 758 47 Drugs to Treat Renal Dysfunction, 761 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: Renal Failure, 762 Acute Renal Failure, 762 Chronic Renal Failure, 763 PHARMACOTHERAPEUTIC OFFIONS, 764 DRUG CLASS: Angiotensin-Converting Enzyme (ACE) Inhibitors, 764 DRUG CLASS: Antianemia Drug, 766 DRUG CLASS: Iron Supplements, 767 DRUG CLASS: Heavy Metal Antagonist, 767 DRUG CLASS: Antihemorrhagic Drug, 768 DRUG CLASS: Phosphate-Binding Drugs, 769 DRUG CLASS: Vitamin D Supplement, 769 DRUG CLASS: Cation-Exchange Resin, 770 DRUG CLASS: Systemic Antacids, 771 DRUG CLASS: Diuretics, 771 DRUG CLASS: Renal Vasodilator, 772 APPLICATION TO PRACTICE, 772 Assessment, 772 Goals of Therapy, 774 Intervention, 775 Evaluation, 777 PART XI GASTROINTESTINAL SYSTEM DRUGS 48 Hyperacidity and Related Drugs, 779 ALAN P. AGINS and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: GERD and Ulcers, 779 DRUG CLASS: Histamine (H 2 ) Receptor Antagonists, 783 DRUG CIASS: Proton (Acid) Pump Inhibitors, 784 DRUG CIASS: Antacids, 785 DRUG CLASS: Prokinetic Drugs, 787 DRUG CIASS: Miscellaneous Drugs, 787 APPLICATION TO PRACTICE, 788 Assessment, 788 Goals of Therapy, 790 Intervention, 791 Evaluation, 792 49 Laxatives and Antidiarrheal Drugs, 795 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: Constipation, 796 DRLIG CIASS: Stimulant Laxatives, 796 DRUG CIASS: Stool Softeners, 799 DRUG CLASS: Bulk-Forming Laxatives, 799 DRLIG CLASS: Hyperosmotic Laxatives, 800 DRUG CLASS: Lubricant Laxatives, 802 APPLICATION TO PRACTICE, 802 Assessment, 802 Goals of Therapy, 804 Intervention, 804 Evaluation, 806 PATHOPHYSIOLOGY: Diarrhea, 806 DRUG CIASS: Opioids, 807 DRUG CIASS: Absorbents, 808 DRUG CIASS: Miscellaneous Antidiarrheal Drugs, 809 APPLICATION TO PRACTICE, 810 Assessment, 810 Goals of Therapy, 811 Intervention, 812 Evaluation, 813 50 Antiemetic Drugs, 815 PATHOPHYSIOLOGY: Emesis, 816 DRLIG CIASS: Serotonin Receptor Antagonists, 819 DRUG CLASS: Dopamine Receptor Antagonists, 819 DRUG CIASS: Cannabinoids, 820 DRUG CIASS: Muscarinic Receptor Antagonist, 821 DRLIG CLASS: Histamine Receptor Antagonists, 822 DRLIG CIASS: Miscellaneous Drugs, 822 APPLICATION TO PRACTICE, 823 Assessment, 823 Goals of Therapy, 825 Intervention, 825 Evaluation, 828

XX Table of Contents 51 Drugs to Treat Liver, Gallbladder, and Pancreatic Diseases, 829 PATHOPHYSIOLOGY: Gallbladder Disease, 830 DRUG CLASS: Anticholelithic Drugs, 831 APPLICATION TO PRACTICE, 832 Assessment, 832 Goals of Therapy, 833 Intervention, 833 Evaluation, 833 PATHOPHYSIOLOGY: Pancreatic Diseases, 833 DRUG CLASS: Pancreatic Enzymes, 834 APPLICATION TO PRACTICE, 834 Assessment, 834 Goals of Therapy, 835 Intervention, 835 Evaluation, 836 PATHOPHYSIOLOGY: Liver Disease, 836 DRUG CLASS: Ammonia-Detoxifying Drugs, 838 APPLICATION TO PRACTICE, 839 Assessment, 839 Goals of Therapy, 840 Intervention, 840 Evaluation, 841 PART XII RESPIRATORY SYSTEM DRUGS 52 Drugs to Treat Asthma and Other Pulmonary Diseases, 843 ALAN P. AG1NS, LYNN ROGER WILLIS, and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: Asthma, 844 DRUG CLASS: Beta Agonist Bronchodilators, 848 DRUG CLASS: Leukotriene Modifiers, 850 DRUG CLASS: Inhaled Corticosteroids, 851 DRUG CLASS: Inhaled Nonsteroidal Antiallergy Drugs, 852 DRUG CLASS: Xanthines, 853 DRUG CLASS: Anticholinergic Drugs, 854 PATHOPHYSIOLOGY: Other Airflow-Obstructive Lung Diseases, 854 DRUG CLASS: Drugs for Chronic Obstructive Pulmonary Disease, 855 APPLICATION TO PRACTICE, 856 Assessment, 856 Goals of Therapy, 858 Intervention, 858 Evaluation, 864 53 Antihistamines, 867 PATHOPHYSIOLOGY: Allergies, 868 PHYSIOLOGY: Allergic Reactions, 869 DRUG CLASS: Antihistamines (Histamine H, Receptor Antagonists), 872 APPLICATION TO PRACTICE, 875 Assessment, 875 Goals of Therapy, 877 Intervention, 877 Evaluation, 879 54 Expectorants, Antitussives, Decongestants, and Mucolytics, 883 LYNN ROGER WILLIS and KATHLEEN GUTIERREZ PHYSIOLOGY: Origin of Secretions, 884 PATHOPHYSIOLOGY, 884 Common Cold, 884 Rhinitis, 884 Cough, 884 DRUG CLASS: Expectorants, 885 DRUG CLASS: Antitussives, 886 DRUG CLASS: Decongestants, 888 DRUG CLASS: Mucolytic Drugs, 889 APPLICATION TO PRACTICE, 891 Assessment, 891 Goals of Therapy, 892 Intervention, 892 Evaluation, 895 PART XI11 ENDOCRINE SYSTEM DRUGS 55 Pituitary Drugs, 897 PHYSIOLOGY: Endocrine System, 897 Posterior Pituitary, 899 Anterior Pituitary, 900 PATHOPHYSIOLOGY: ADH Deficiency or Excess, 903 DRUG CLASS: Posterior Pituitary Replacement Drug, 904 DRUG CLASS: Miscellaneous Drugs Used to Treat Diabetes Insipidus, 904 PATHOPHYSIOLOGY: Growth Hormone Deficiency or Excess, 905 DRUG CLASS: Growth Hormones, 906 DRUG CLASS: Somastatin, 906 APPLICATION TO PRACTICE, 907 Assessment, 907 Goals of Therapy, 908 Intervention, 908 Evaluation, 910

XXI 56 Thyroid and Parathyroid Drugs, 911 PHYSIOLOGY: Thyroid Hormones, 912 Regulation of Synthesis and Release of Thyroid Hormones, 912 PATHOPHYSIOLOGY: Hypothyroidism, 914 DRUG CLASS: Thyroid Hormones, 916 APPLICATION TO PRACTICE, 917 Assessment, 917 Goals of Therapy, 918 Intervention, 918 Evaluation, 920 PATHOPHYSIOLOGY: Hyperthyroidism, 920 DRLIG CLASS: Antithyroid Drugs, 921 DRLIG CLASS: Iodine, 922 APPLICATION TO PRACTICE, 923 Assessment, 923 Goals of Therapy, 924 Intervention, 925 PHYSIOLOGY: Parathyroid Hormones, 925 PATHOPHYSIOLOGY: Hypoparathyroidism, 926 APPLICATION TO PRACTICE, 927 Assessment, 927 Goals of Therapy, 928 Intervention, 928 Evaluation, 929 PATHOPHYSIOLOGY: Hyperparathyroidism, 929 DRUG CLASS: Drugs Used to Treat Hypercalcemia, 929 APPLICATION TO PRACTICE, 931 Assessment, 931 Goals of Therapy, 932 Intervention, 932 Evaluation, 933 57 Adrenalcortical Steroids and Drugs Affecting the Adrenal Cortex, 935 DRUG CLASS: Adrenal Cortex, 936 DRLIG CLASS: Glucocorticoids, 939 DRLIG CLASS: Mineralocorticoids, 945 DRUG CLASS: Adrenocortical Inhibitors, 945 DRUG CLASS: Adrenocortical Stimulants, 946 APPLICATION TO PRACTICE, 947 Assessment, 947 Goals of Therapy, 949 Intervention, 949 Evaluation, 952 'Type 2 Diabetes Mellitus, 956 Gestational Diabetes, 957 Impaired Glucose Tolerance/Impaired lasting Glucose, 957 Metabolic Derangements, 957 PHYSIOLOGY: Regulation of Glucose Metabolism, 959 Insulin and Glucose Metabolism, 959 Role of Insulin in Fat and Protein Metabolism, 960 Regulation of Insulin Secretion, 960 DRUG CLASS: Insulin and Insulin Analogs, 960 DRUG CLASS: Sulfonylureas and Related Drugs, 963 DRUG CLASS: Biguanides, 965 DRLIG CLASS: Thiazolidinediones, 966 DRLIG CLASS: Alpha-Glucosidase Inhibitors, 966 DRLIG CIASS: Antihypoglycemic Drugs, 967 APPLICATION TO PRACTICE, 968 Assessment, 968 Goals of Therapy, 972 Intervention, 972 Evaluation, 975 PART XIV REPRODUCTIVE SYSTEM DRUGS 59 Estrogens, Progestins, and Contraceptives, 977 PHYSIOLOGY: Menses and Menopause, 978 Hormones Affecting Ovulation, 978 Hormones Affecting Endometrial Function, 978 Hormones in Pregnancy, 979 Menopause, 979 DRUG CIASS: Estrogens, 979 DRUG CLASS: Estrogen Antagonists and Selective Estrogen Receptor Modulators, 983 DRUG CIASS: Progestins, 983 DRUG CIASS: Progesterone Antagonists, 985 DRUG CLASS: Oral Contraceptives, 985 DRUG CIASS: Contraceptive Implants, Depot Injections, and Intrauterine Devices, 988 APPLICATION TO PRACTICE, 989 Assessment, 989 Goals of Therapy, 990 Intervention, 991 Evaluation, 993 58 Drugs to Treat Diabetes Mellitus, 955 PATHOPHYSIOLOGY: Diabetes Mellitus, 956 Type 1 Diabetes Mellitus, 956

XXii Table of Contents 60 Drugs Affecting Uterine Motility, 995 PHYSIOLOGY: Labor and Delivery, 995 DRUG CLASS: Oxytocic Drugs, 996 DRLIG CLASS: Ergot Alkaloids LIsed as Oxytocics, 997 DRUG CLASS: Prostaglandins, 998 DRUG CLASS: LIterine Relaxants (Tocolytics), 999 DRUG CLASS: Other Tocolytic Drugs, 1000 APPLICATION TO PRACTICE, 1001 Assessment, 1001 Goals of Therapy, 1002 Intervention, 1003 Evaluation, 1004 61 Fertility Drugs, 1005 PATHOPHYSIOLOGY: Infertility, 1005 Disorders of Female Fertility, 1005 Disorders of Male Fertility, 1007 DRUG CLASS: Gonadotropin-Releasing Hormone and Analogs, 1008 DRUG CLASS: Gonadotropins, 1009 DRUG CLASS: Antiprolactin Drugs, 1010 DRUG CLASS: Antiestrogen, 1011 DRUG CLASS: Male or Female Steroid Hormones, 1012 APPLICATION TO PRACTICE, 1012 Assessment, 1012 Goals of Therapy, 1014 Intervention, 1014 Evaluation, 1016 62 Androgens, Anabolic Steroids, and Related Drugs, 1017 PHYSIOLOGY, 1017 PATHOPHYSIOLOGY: Hypogonadism, 1019 DRUG CLASS: Androgens and "Anabolic Steroids," 1019 DRLIG CLASS: Antiandrogens, 1021 DRUG CLASS: 5-Alpha-Reductase Inhibitors, 1022 APPLICATION TO PRACTICE, 1023 Assessment, 1023 Goals of Therapy, 1024 Intervention, 1024 Evaluation, 1025 PART XV NUTRITIONAL BALANCE DRUGS 63 Vitamins and Minerals, 1027 SHERRY F. QUEENER and SUSAN SCIACCA PHYSIOLOGY: Vitamins and Minerals, 1027 PATHOPHYSIOLOGY: Calcium and Vitamin D Metabolism, 1030 DRUG CLASS: Calcium Supplements, 1030 DRUG CLASS: Vitamin D, 1031 DRLIG CLASS: Biphosphonates, 1032 DRUG CLASS: Selective Estrogen Receptor Modulator, 1032 PATHOPHYSIOLOGY: Fat-Soluble Vitamins, 1033 DRUG CLASS: Vitamin A Family, 1033 DRLIG CLASS: Vitamin E, 1034 DRUG CLASS: Vitamin K, 1035 PATHOPHYSIOLOGY: Water-Soluble Vitamins, 1036 DRUG CLASS: Water-Soluble Vitamins, 1037 PATHOPHYSIOLOGY: Macrominerals, 1039 DRUG CLASS: Macrominerals (Selected), 1039 PATHOPHYSIOLOGY: Microminerals, 1041 DRUG CLASS: Micronutrients, 1041 APPLICATION TO PRACTICE, 1042 Assessment, 1042 Goals of Therapy, 1044 Intervention, 1044 Evaluation, 1049 64 Fluids, Electrolytes, and Acid-Base Balance, 1051 LYNN ROGER WILLIS, SHERRY F. QUEENER, and KATHLEEN GUTIERREZ PATHOPHYSIOLOGY: Fluid or Electrolyte Imbalances, 1052 Regulation of Salt and Water Balance, 1052 Clinical Indications for Fluid Therapy, 1054 DRUG CLASS: Hydrating Solutions, 1058 DRUG CLASS: Alkalinizing Drugs, 1059 DRUG CLASS: Acidifying Drugs, 1061 DRUG CLASS: Parenteral Nutrition Formulations, 1062 DRUG CLASS: Solutions to Correct Specific Electrolyte Imbalances, 1063 APPLICATION TO PRACTICE, 1063 Assessment, 1063 Goals of Therapy, 1066 Intervention, 1067 Evaluation, 1073

XXlH PART XVI SENSORY SYSTEM DRUGS 65 Ophthalmic Drugs, 1075 PHYSIOLOGY: Preparing the Eye for Examination, 1076 DRUG CLASS: Muscarinic Antagonists, 1077 DRUG CLASS: Alpha-Adrenergic Drugs, 1078 PATHOPHYSIOLOGY: Glaucoma, 1078 DRLIG CLASS: Adrenergic Agonists Used to Treat Glaucoma, 1079 DRLIG CIASS: Beta-Adrenergic Blockers Used to Treat Glaucoma, 1081 DRLIG CLASS: Cholinomimetics Used to Treat Glaucoma, 1081 DRUG CLASS: Anticholinesterase Miotics, 1082 DRLIG CLASS: Carbonic Anhydrase Inhibitors Used to Treat Glaucoma, 1083 DRUG CLASS: Prostaglandin Analogs, 1084 DRLIG CLASS: Specific Osmotic Agents Used to Treat Glaucoma, 1084 PATHOPHYSIOLOGY: Inflammation and Infection of the Eyes, 1085 DRUG CIASS: Antibacterial Drugs LIsed to Treat Ophthalmic Diseases, 1086 DRLIG CLASS: Antifungal Drug LIsed to Treat Ophthalmic Diseases, 1086 DRLIG CIASS: Antiviral Drugs LIsed to Treat Ophthalmic Diseases, 1087 DRUG CLASS: Antiinflammatory Drugs, 1088 DRUG CLASS: Ocular Antihistamines and Decongestants, 1089 APPLICATION TO PRACTICE, 1089 Assessment, 1089 Goals of Therapy, 1091 Intervention, 1091 Evaluation, 1094 66 Otic Drugs, 1095 PATHOPHYSIOLOGY: Ear Infections, 1095 DRLIG CIASS: Antibiotics Used to Treat Ear infections, 1097 DRLIG CLASS: Antibacterial and Drying Drugs, 1098 DRUG CLASS: Steroids and Steroid-Antibiotic Combinations, 1098 DRUG CLASS: Otic Anesthetics, 1099 PATHOPI lysioi.ogy: Cerumen Impaction, 1100 DRUG CLASS: Certiminolytics, 1100 PATIIOPIIYSIOI.OCY: Ototoxieity, 1100 APPLICATION TO PRACTICE, 1101 Assessment, 1101 Goals of Therapy, 1102 Intervention, 1102 Evaluation, 1105 67 Dermatologic Drugs, 1107 SHERRY F. QUEENER and ELIZABETH KISSELL PHYSIOLOGY: Structure and Function of Skin, 1108 PATHOPI IYSIOLOGY: Skin Disorders, 1110 Infectious Inflammatory Dermatoses, 1111 Skin Trauma, 1113 Drug Reactions, 1113 Stings, Bites, and Infestations, 1113 Ulcerations, 1114 DRUG CLASS: Antiseptics, 1115 DRUG CLASS: Topical Antibacterial Drugs, 1116 DRUG CLASS: Topical Antifungal Drugs, 1117 DRUG CLASS: Systemic Antifungals for Fungal Skin Infections, 1118 DRUG CLASS: Topical Antiviral Drugs, 1118 DRLIG CLASS: Scabicides and Pediculicides, 1119 DRLIG CLASS: Proteolytic Enzymes, 1119 DRLIG CLASS: Antiinflammatory Drugs, 1120 DRUG CIASS: Melanizing and Demelanizing Drugs, 1121 DRUG CIASS: Sunscreens, 1121 APPLICATION TO PRACTICE, 1122 Assessment, 1122 Goals of Therapy, 1124 Intervention, 1125 Evaluation, 1130 Appendices A Dietary Considerations, 1131 B Selected Daig-lnduced Adverse Reactions, 1139 Answer Guidelines for Critical Thinking Questions, 1141