Pharmacology and the
Nursing Process
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, BRIEF CONTENTS
PART 1 Pharmacology Basics, 1 33 A drenal Drugs, 518
34 W omen’s Health Drugs, 528
1 T he Nursing Process and Drug Therapy, 1 35 Men’s Health Drugs, 548
2 Pharmacologic Principles, 13
3 Lifespan Considerations, 33
4 Cultural, Legal, and Ethical Considerations, 46 PART 6 Drugs Affecting the Respiratory System, 557
5 Medication Errors: Preventing and Responding, 60 36 A ntihistamines, Decongestants, Antitussives, and
6 Patient Education and Drug Therapy, 72 Expectorants, 557
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Over-the-Counter Drugs and Herbal and Dietary
Supplements, 84
37 Respiratory Drugs, 570
8 Gene Therapy and Pharmacogenomics, 94
PART 7 Antiinfective and Antiinflammatory
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9 Photo Atlas of Drug Administration, 102
Drugs, 589
PART 2 Drugs Affecting the Central Nervous 38 Antibiotics Part 1, 589
System, 135
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Antibiotics Part 2, 614
Antiviral Drugs, 631
10 A nalgesic Drugs, 135 41 Antitubercular Drugs, 651
11 G eneral and Local Anesthetics, 165
12 Central Nervous System Depressants and Muscle
Relaxants, 183
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Antifungal Drugs, 662
Antimalarial, Antiprotozoal, and Anthelmintic Drugs, 671
Antiinflammatory and Antigout Drugs, 684
13 Central Nervous System Stimulants and Related
Drugs, 198
14 Antiepileptic Drugs, 214
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15 Antiparkinson Drugs, 231 Immune Modifiers, 700
16 Psychotherapeutic Drugs, 247
17 Substance Use Disorder, 274
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45 A ntineoplastic Drugs Part 1: Cancer Overview and Cell
Cycle–Specific Drugs, 700
46 Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and
PART 3 Drugs Affecting the Autonomic Nervous
System, 289
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Miscellaneous Drugs, 726
47 Biologic Response–Modifying and Antirheumatic
Drugs, 739
18 Adrenergic Drugs, 289
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Adrenergic-Blocking Drugs, 303
Cholinergic Drugs, 315
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48 Immunosuppressant Drugs, 761
49 Immunizing Drugs, 773
21 Cholinergic-Blocking Drugs, 326
PART 4 Drugs Affecting the Cardiovascular and
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PART 9 Drugs Affecting the Gastrointestinal
System and Nutrition, 788
Renal Systems, 335 50 Acid-Controlling Drugs, 788
51 Bowel Disorder Drugs, 801
22 Antihypertensive Drugs, 335 52 Antiemetic and Antinausea Drugs, 815
23 Antianginal Drugs, 356 53 Vitamins and Minerals, 827
24 Heart Failure Drugs, 370 54 Anemia Drugs, 848
25 Antidysrhythmic Drugs, 383 55 Nutritional Supplements, 858
26 Coagulation Modifier Drugs, 405
27 Antilipemic Drugs, 430
28 Diuretic Drugs, 445 PART 10 Dermatologic, Ophthalmic, and Otic
29 Fluids and Electrolytes, 458 Drugs, 869
ermatologic Drugs, 869
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PART 5 Drugs Affecting the Endocrine and 57 O phthalmic Drugs, 885
Reproductive Systems, 475 58 O tic Drugs, 907
30 P ituitary Drugs, 475 Appendix: Pharmaceutical Abbreviations, 913
31 T hyroid and Antithyroid Drugs, 483 Answers to Review Questions, 914
32 Diabetes Drugs, 492 Index, 916
, TO THE STUDENT
LEARNING STRATEGIES of the medication. As you read your pharmacology textbook
and listen to your instructors teaching on the subject, you will
Opening your pharmacology textbook and glancing at the table begin to understand why learning pharmacology is more than
of contents can seem overwhelming. You may wonder how you just memorizing drug facts.
ever will be able to remember so much information as well as
the best approach in tackling such a daunting topic. The good
news is that there are many learning strategies available to help NURSING PROCESS
you not only learn about pharmacology but also apply this In Chapter 1, you are introduced to the five phases of the
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knowledge to the nursing care of patients.
To the learner, as the title of the book implies, pharmacol-
Nursing Process. Throughout this textbook, you will see the
nursing process applied to each category of drugs. This is a very
ogy is very important to the nursing process. You will come to
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understand that learning in nursing is not about memorization from the introduction on learning strategies, administering
but rather about application of learning. While there will be medications to patients involves more that the physical act of
many times when memorization is required to begin to under- giving medications. The nurse needs to know the rationale and
stand a new field of knowledge, the ultimate goal will always apply critical thinking with each patient encounter. The nursing
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be to take your learning to a higher level. Learning strategies
will be presented here that will guide you with techniques and
process is a way to ensure that medications are administered
accurately and safely. Nurses effortlessly use the nursing pro-
suggestions on how to define and clarify the way you study and cess every day, and students who are new to the nursing process
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learn so that it will become second nature to transform your
thinking into deeper, long-term learning with subsequent appli-
learn best by using it frequently.
cation to your professional nursing practice. Assessment
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As you begin your nursing education, you will soon realize
that learning does not stop once you receive your degree and
Every patient encounter begins with an Assessment. As you
are learning pharmacology, the importance of the assessment
pass your state-licensing exam. As a professional nurse, you will become clear. You will want to ask yourself some questions:
will come to understand that new information is always being
added in the medical, pharmacology, and nursing professions.
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Why is this drug being prescribed for this patient? What symp-
toms does the patient have? What assessments do I need to per-
In the area of pharmacology, there are always new drugs being form prior to administering the medication (e.g., checking the
adopted, as well as discontinued, for use by the US Food and
Drug Administration. The strategies that you learn here can be
used again and again to assist you in remaining current in new
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patient’s blood pressure or laboratory values)? Does the patient
have any allergies to this medication? Has the patient taken this
medication before?
discoveries, new information, and new standards of practice
within the nursing profession.
You must be an active participant in your learning. Your
Human Need Statements
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Each patient will receive a Human Need Statement based on
instructor/faculty member acts more like a guide that assists you the assessment. These human need statements relate to the
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in attaining your fullest potential, allowing you to see the big- medical condition, such as freedom from pain, related to hip
ger picture or concept being taught. When students are taught surgery. There are also human need statements related to the
this way, they gain more from their lessons because they are actual medication the patient is receiving, such as altered safety
putting their learning into action. Also, that learning becomes needs, risk for injury, related to possible adverse reactions to
embedded in their long-term memory because it is connected drugs altering blood clotting. After the human need statement
to a more complex thought process and has associated actions. is identified, the nurse will administer the medication to relieve
You will need to be an active participant if you wish to fully the pain from hip surgery; the medication administration will
comprehend and be able to apply pharmacology to your nurs- be part of the implementation. In the second example, the med-
ing knowledge/practice. Nurses spend a large part of their day ication administration will be critically evaluated to watch for
giving medications to their patients. Anybody can open a pill the adverse effects of altered blood clotting.
packet, drop the pill in a cup, and give it to a person. However,
safe medication administration demands an enormous amount Planning: Outcome Identification
of knowledge and understanding about why a patient is receiv- Once you have established the human need statement, you need
ing a medication, specific actions that need to be taken before to decide on a Plan of care for the patient. What is the outcome
you give the medication, expected outcomes anticipated from that you want the patient to achieve? For our first example, pain
the dose of medication, and specific patient teaching needs. relief is an appropriate outcome. It may further be defined by
Other important things to know prior to giving medications the pain level (e.g., less than 5 out of 10 on the pain scale). For
include how to perform drug calculations for the correct dosage the second example, the outcome would state that the patient
and understanding the possible side effects or contraindications not experience any bleeding episodes. As explained in Chapter 1,
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these outcomes will be patient specific and have a time frame Taking your learning further, you may now associate this
associated with them. term with patient safety and the human need statement of
“Altered need for safety, risk for falls.” Suddenly, a simple key
Implementation term means so much more to you as a student. You can now
With Implementation, you devise the actions or interventions see the application to the nursing process.
that will provide the means by which the patient will achieve Other key terms are straightforward vocabulary words that
the outcome. For the patient with the human need of freedom may be learned and understood by looking at the prefix or suf-
from pain, an appropriate intervention would be to provide fix. For example, osteoarthritis and osteoporosis both begin with
pain medication as prescribed. For the patient with a risk of the prefix osteo, which means “bone.” Learning the meaning of
bleeding, educating the patient about signs and symptoms of prefixes like osteo will help you decipher other words too. The
unusual bleeding would be appropriate. In these two examples, words agonist and antagonist are similar; both have the word
you see that implementation may be something we do for/with agonist in them. You will want to question how these words are
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the patient, including patient education. Patient education is a
very important component of pharmacology and the nursing
related as well as what difference exists between the two words.
Many students find that writing out flash cards helps them
process. to study and learn the key terms. If you choose this method,
Evaluation
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or phrase. That way, you are not just memorizing but rather
The last step of the nursing process is Evaluation. This is when making connections to previous learning and relating it to the
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you look at the outcomes and determine the effectiveness of the
implementation phase. Did the patient with hip pain obtain
nursing process. Memorizing is lower-level learning, whereas
application is higher-level learning.
relief from the administration of the pain medication? Did the Some e-books have built-in flash cards of all the vocabulary
patient at risk for bleeding have any episodes of bleeding and/or words, making the process of self-quizzing easy. Just remember
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did he or she understand the teaching provided? If the outcome
was not met, you will need to reevaluate the outcome statement
that these may not be as in-depth as the flash cards you make
yourself. There are also applications that may be downloaded on
and/or the interventions. Now you can see how the nursing pro- a computer, smart phone, or tablet that will allow you to bring
cess is an ongoing and constantly evolving process.
E them up on your device anywhere to study instantly. That way,
you can learn at your own pace and at any time.
VOCABULARY
Learning pharmacology in nursing means that there is an
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TEXT NOTATION
abundance of new terminology that you, the student, will Text notation is a way for students to pick out the important con-
encounter in your reading. It is important that you study the
vocabulary so that you will have a deeper understanding of
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tent as they are reading the chapters. Many students accomplish
this by underlining or highlighting the text as they read. A major
the content being taught. You may already be familiar with mistake is to begin underlining or highlighting the text the first
some of the vocabulary from other courses. Each chapter time through. What happens on the first read through is that every-
opens with a list of Key Terms—significant vocabulary that
will be introduced in that chapter. Oftentimes these words
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thing seems important, and before you know it you have marked
whole paragraphs as important. The best way to prevent this from
will appear in future chapters, so it is imperative that time is occurring is to first read through the material once without under-
spent not just memorizing the terms but putting the terms
into use and applying their meaning. Remember that appli-
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lining or highlighting. You need to see where the author is leading
you and what content is being presented in the chapter. Then you
cation is important in nursing. The vocabulary words will need to be aware of the author’s language. You can usually tell when
appear in the text in blue boldface font, alerting you to the a concept is important. Many times, those key terms are part of the
fact that it is a key term. Each vocabulary word is defined content you will need to underline or highlight. While reading the
in the Key Terms section at the beginning of the chapter. text a second time, you will be able to be more selective in what
When you see the word again in the content of the chapter, you underline or highlight. When students highlight in an effective
it is further defined by either explanation or application. For manner, it makes the learning easier because they can just review
example, in Chapter 19, the term first-dose phenomenon is chunks of content versus studying entire sections. Highlighting is a
defined as a severe and sudden drop in blood pressure after the feature that is included in most online textbooks. Therefore, if you
administration of the first dose of an alpha-adrenergic blocker. read your textbook in online format, highlighting is very easy. In
When you see the term in the text, it is used under the head- some e-books, you can choose different highlight colors to mean
ing “adverse effects,” so it is helpful for you to realize that different things; for example, yellow is important, red needs clari-
the first-dose phenomenon is not something good. It is fur- fication, and blue is a definition. Some e-books also automatically
ther explained in the text that this adverse effect may cause take your highlighted text and place it into your notes, turning your
patients to fall or pass out. This example demonstrates that note taking into a study guide.
when you are learning a key term, it is helpful to fully com- When using e-books, students have the capability of adding
prehend the implications and application to nursing practice. notes as they read along. This will enhance learning and make
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