Focus on Nursing Pharmacology Eighth Edition Focus on Nursing Pharmacology Eighth Edition Amy M. Karch, RN, MS, CNS Associate Professor of Clinical Nursing University of Rochester School of Nursing Rochester, New York Rebecca G. Tucker, PhD, ACNPC, MEd, RN Contributing Editor Assistant Professor of Clinical Nursing University of Rochester School of Nursing Rochester, New York Vice President and Publisher: Julie K. Stegman Director of Product Development: Jennifer K. Forestieri Acquisitions Editor: Kelley Squazzo Director of Nursing Content Publishing: Renee Gagliardi Supervisory Development Editor: Staci Wolfson and Greg Nicholl Marketing Manager: Brittany Clements Editorial Assistant: Leo Gray Editorial Coordinator: John Larkin Designer: Teresa Mallon Art Director: Jennifer Clements Manufacturing Coordinator: Karin Duffield Production Service: SPi Global Eighth Edition Copyright © 2020 Wolters Kluwer Copyright © 2017, 2013, 2011, 2008, 2006, 2003, 2000 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at shop.lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Cataloging-in-Publication Data available on request from the Publisher ISBN: 978-1-9751-0096-4 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer's package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com In memory of Amy M. Karch Amy was a prolific and brilliant author who was dedicated to her dream of facilitating the learning of nurses who wanted to be the best for their patients/families. We (the faculty at the University of Rochester) were blessed to work with her generous and humorous soul. I was additionally fortunate to have her as a mentor and friend. Amy started to revise this edition, but then asked me to help. I am extremely honored to be able to continue her work in hope that her dream will be ongoing. This edition is dedicated to Amy and her loving family. Rebecca G. Tucker Assistant Professor, Clinical Nursing University of Rochester School of Nursing Rochester, New York I met Amy Karch for the first time when I assumed the role of Publisher for Nursing Education at Wolters Kluwer several years ago. She immediately impressed me with her enthusiasm for nursing education and her clear devotion to her students. Amy also was passionate about online education, designing her own courses and ensuring she developed a relationship with her students no matter the type of class or learning modality, while also ensuring they were prepared and knowledgeable about nursing pharmacology. Amy was a consummate professional during her work on publications with us and an advocate for her profession. All of us at Wolters Kluwer will greatly miss Amy and are grateful we had the opportunity to work with and learn from her. We are proud that this eighth edition of Focus on Nursing Pharmacology is part of the great legacy she leaves behind. Julie K. Stegman Vice President and Publisher, Nursing Education Health Learning, Research & Practice Wolters Kluwer REVIEWERS Karen Atkins, MSN, RN Nursing Faculty Stratford University Woodbridge, Virginia Maria Brosnan, MNS, ACNP-BC Associate Professor Carroll College Helena, Montana Elicia S. Collins, MSN, RN Clinical Instructor of Nursing Clayton State University Morrow, Georgia Andrew M. Peterson, PharmD, PhD, FCPP John Wyeth Dean Emeritus Professor of Clinical Pharmacy Philadelphia College of Pharmacy University of the Sciences in Philadelphia Philadelphia, Pennsylvania Leslie Reifel, MSN, RN, CPNP, CNE Associate Professor Sentara College of Health Sciences Chesapeake, Virginia Missy Smiley, RN, MSN Nursing Instructor Wayne Community College Glassboro, North Carolina Laura Wallace, CNM, PhD Associate Professor of Nursing Brenau University Gainesville, Georgia PREFACE Pharmacology is a difficult course to teach in a standard nursing curriculum, whether it be a diploma, associate, baccalaureate, or graduate program. Teachers are difficult to find, and time and money often dictate that the invaluable content of such a course be incorporated into other courses. As a result, the content is often lost. At the same time, changes in medical care delivery—more outpatient and home care, shorter hospital stays, and more self-care—have resulted in additional legal and professional responsibilities for nurses, making them more responsible for the safe and effective delivery of drug therapy. Prevention of medication errors has become a national challenge. Pharmacology should not be such a formidable obstacle in the nursing curriculum. The study of drug therapy incorporates physiology, pathophysiology, chemistry, and nursing fundamentals—subjects that are already taught in most schools. A textbook that approaches pharmacology as an understandable, teachable, and learnable subject would greatly facilitate the incorporation of this subject into nursing curricula. Yet many nursing pharmacology texts are large and burdensome, mainly because they need to cover not only the basic pharmacology but also the particulars included in each area considered. The eighth edition of Focus on Nursing Pharmacology is based on the premise that students first need to have a solid and clearly focused concept of the principles of drug therapy before they can easily grasp the myriad details associated with individual drugs. Armed with a fundamental knowledge of pharmacology, the student can appreciate and use the specific details that are so readily available in the many annually updated and published nursing drug guides, such as the Lippincott Nursing Drug Guide. With this goal in mind, Focus on Nursing Pharmacology provides a concise, user-friendly, and uncluttered text for the modern student. This