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2019v1.0
High Alert header highlights
drugs that pose the greatest
Siarnouddubmitcheianestaiesdt rvianatgrioiosnus I • •n • • •h • w U • M I Aa • ShDs Pn i Ill(haen o Cnleradt 5 •ioy Da oesernlW sn •iLtl ewku sse Yriep rfifla0 ,aa Iodcsad efcrlvm ra Gmno-fi.bnm ut0atno penre e9attos w cxici riir.clmittrnhict vnp%vainn 9 cseaidrirtaereceefwehaecaetfdht)oame,eoufc%oc z doflt eoDl nyinei;5atlec ,eaiiNseurciaulNuf bi,Nht ennetr odtnrfrt itn fl0diOz maa flraaaN ttaipnE gruupa otm ,b e eolrvhnerwtii0osrhuxe nCeuctPm,iear,lPucdmo,bleo lteaapxu spse a siv adai rilIemdaimsaCoodnoHmmmc(ieuulodbptdu;itemeooVb,miocsndm,c ulnho mmahl peailp,xr lopdoo;ienulsercomf tihpsn,i ,ge,o irmC nfeo c elua ichaiao pai n pznirIexicirillaiesnacmd ahn ,,wnxcdeItntdyaennxiNmbmnbueimooo lihsoaet,e/aeafoinbSeine,p yute,hfe, at eauedirolguunesthif omsarct on bcu e,icpcl,niFieieo e,n t,l rttl,, zen pmiD ld ifnnanCmeteyl pmie iSocreairol ny uln h gdf,or euoe,opinoaddmefaa,bi efet orcfyy,kr Adie ntrgzkay , ic inbop-,aeTn l nflmaeppcoots,r,co leon ppvneaceditiaeoCaaonai e iaditcuTiRttlo,een ilrbr nnddunflaerenfch hnrxtme olr irstTurrnrtohem tEeslamdiiooca,si Imsgno,A,,t)ueu m fmteyeliuytipnli odFIlnlpe nA im oaotoon Cf,w,eettooll,iMM,aNpnccicoaAbipde, anaiheilm hdm tXniveanrrennAn flvrtwktil lna iginroZietorr te rtio/nlieIedolAinozeida,igcfRtouhmyoiNid eendiek,ns1Nrie tom ousaroa,n sblnezeds aZeniemadexiyttatdu me,em d Yfn0mmoElsrtpdlor,aitttpe a,½ecm lIecybeiytr/i siroolre s aLoda,0mi,nNnur htdlrpt,torhgce,o,ee aiu soydaa o m um,ata -miDvoo-:tce,iral,Eoifieorlt crpcidrcno1peb p2 neemu Omnnczo oeip,lIei2m pcOive,iniwy onces a A ruparnr0piLonc el,drbfinsaemXehc fon,iLi,a eht icx,BHcnc-m ieeaoi0,uae o,nn io1trll rD fiirdlOd em,2n ,anliefgawyenn,,gntaUlrglne rYd eo;op-mo ietae m1eccA,o,rt pveoRileolad2a,ninflaTiaP,, Da ,ldrrsn aobvya lu,no t- ,Pr ,isfentyxs taas,o cAieoorchl ec2 imbchstiRcp,he r imtm eT tbclimeoizamo tavrClrolwtc omiomi iuetams,shhdrlOooceiDoOlPehdiiueron rdyaloLpet,mftlln rntiiiaiepoeCplsn n ra,fiHierimcenmgee, l5pnigemtly, I an t nmf fbothaWwlo As tez,l l,c,eboroTiVeeeaEo,h oy, a ,eonmtityytlR re,m cAnl ;n,xXxircicD, l, ol,SlcDo a roneednf D, haoflBe iPZt eeA,o pfbPtie mnrp,aole ceaatOlurlppnumOrlRei OaNlinrth,uOont,,etdidc,lceiitnr rait,csat iopsX bEmCnnaiptoptvnroi -yeifixoi roRmaecnaoplorsldr -mdoOcuEozDaa ,adra,nl,aep,pbN-as,ioato cItna a ro iG,ottnetmpfln dnerito,vreeNNoo-rleo aaggevl Icnll-e azbpxataadulah,oi,ongtoE,mp P Di,xtsrns,alIhEp •-ot ,ize n asi-sai ahvraibiixSoeaa i-inP rmtde •po ldAl,hdsotn,tadI uGi-aioczcenolna-onaei amcr toIdsuDe, AeloieZ pem-aetelcrhin-dcoz trsentolciiaansne B,c An,edlli,orsukO,Ahepmoeii iy C,r upieaen temon cp,enenl-dtt ntevLtinmolt-iae ltcbnh,LantArrid,hofs,aiae Ersneiog 5,v Pre Ancr yh,en •;ulnEszitea so,ti(cid:29)rp-r ,i Rgo , rnai.,dr e sye,evoa •iip oW soCe lmms 5,p in-e hpc,npztnll-De r e T ,ne mpn-c AyWspcs oaKami rh1 pt,/oro,at,bm,,aa nrfrI airag Rtt h rbehi opieeA 0RaniiitniftlhiiyosttceinpoBevnscsodaameaysEtuiscfmiaatvi ,eeeChei,norgeciela,uaei0vsiploesoqO ad :tEtl De , (ngninsc,emaena dr:idi,s Mvrnioh bse an0x o/r F A M oen niXui Cfitdg;icgemctMddirpiLiycAadoitulaoeb-0 o uranunupectmpry reiea hitimmy pueei sip,StnniWwlnuec/miCoi,dhotmcimr te whar loelsom er,c mTnho cber:aiioliltnynS oonitIaoedelr pmylna-thir cd l o.A,eatyA nfr,hLTUm mnixalfnsl kt mu mpMrec haoator icused,aen (cid:28)oc i.ymRczaaaeeroFa si erqo nmcrr ivnhteooeeralmIv3,itonst ohscmtiP,eleeaiioNsrp ecMound oOhtdnf,et gdleehugT,rllaE nhpua rp hEousst,dr eaeirsumtsnnlailictcmIua-Up d nnutalasrt,enl aeosei MrIN,;ursizatruNa iebtsNiven eso LoXiz.guciiiiixdeemrtindresoia/cnec:oarnoddaeGati,regEneotoiv fpc,,tisw.n ginbbkrtfm i sni rgnaseae: :mpe, Tley;teech:lfiptrrnha Pi iey suies,a r, hc e,;besnmms)ifi f,n M itapabr oa ,fy Ietuoe srWna Pd hm n lti, R ueos ne nteabinpiodaotm afpdtnx:sPectap(iyy neiaotch ooEusshcN,manige ntsimeocriOccnipepRHtr rneeteoctlu etnSapiitooerlsda,n-iraLeelisetioiblrp,eic rh r oEmliidsnsf pPor cll smdla; 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High Alert header highlights
drugs that pose the greatest
Siarnouddubmitcheianestaiesdt rvianatgrioiosnus I • •n • • •h • w U • M I Aa • ShDs Pn i Ill(haen o Cnleradt 5 •ioy Da oesernlW sn •iLtl ewku sse Yriep rfifla0 ,aa Iodcsad efcrlvm ra Gmno-fi.bnm ut0atno penre e9attos w cxici riir.clmittrnhict vnp%vainn 9 cseaidrirtaereceefwehaecaetfdht)oame,eoufc%oc z doflt eoDl nyinei;5atlec ,eaiiNseurciaulNuf bi,Nht ennetr odtnrfrt itn fl0diOz maa flraaaN ttaipnE gruupa otm ,b e eolrvhnerwtii0osrhuxe nCeuctPm,iear,lPucdmo,bleo lteaapxu spse a siv adai rilIemdaimsaCoodnoHmmmc(ieuulodbptdu;itemeooVb,miocsndm,c ulnho mmahl peailp,xr lopdoo;ienulsercomf tihpsn,i ,ge,o irmC nfeo c elua ichaiao pai n pznirIexicirillaiesnacmd ahn ,,wnxcdeItntdyaennxiNmbmnbueimooo lihsoaet,e/aeafoinbSeine,p yute,hfe, at eauedirolguunesthif omsarct on bcu e,icpcl,niFieieo e,n t,l rttl,, zen pmiD ld ifnnanCmeteyl pmie iSocreairol ny uln h gdf,or euoe,opinoaddmefaa,bi efet orcfyy,kr Adie ntrgzkay , ic inbop-,aeTn l nflmaeppcoots,r,co leon ppvneaceditiaeoCaaonai e iaditcuTiRttlo,een ilrbr nnddunflaerenfch hnrxtme olr irstTurrnrtohem tEeslamdiiooca,si Imsgno,A,,t)ueu m fmteyeliuytipnli odFIlnlpe nA im oaotoon Cf,w,eettooll,iMM,aNpnccicoaAbipde, anaiheilm hdm tXniveanrrennAn flvrtwktil lna iginroZietorr te rtio/nlieIedolAinozeida,igcfRtouhmyoiNid eendiek,ns1Nrie tom ousaroa,n sblnezeds aZeniemadexiyttatdu me,em d Yfn0mmoElsrtpdlor,aitttpe a,½ecm lIecybeiytr/i siroolre s aLoda,0mi,nNnur htdlrpt,torhgce,o,ee aiu soydaa o m um,ata -miDvoo-:tce,iral,Eoifieorlt crpcidrcno1peb p2 neemu Omnnczo oeip,lIei2m pcOive,iniwy onces a A ruparnr0piLonc el,drbfinsaemXehc fon,iLi,a eht icx,BHcnc-m ieeaoi0,uae o,nn io1trll rD fiirdlOd em,2n ,anliefgawyenn,,gntaUlrglne rYd eo;op-mo ietae m1eccA,o,rt pveoRileolad2a,ninflaTiaP,, Da ,ldrrsn aobvya lu,no t- ,Pr ,isfentyxs taas,o cAieoorchl ec2 imbchstiRcp,he r imtm eT tbclimeoizamo tavrClrolwtc omiomi iuetams,shhdrlOooceiDoOlPehdiiueron rdyaloLpet,mftlln rntiiiaiepoeCplsn n ra,fiHierimcenmgee, l5pnigemtly, I an t nmf fbothaWwlo As tez,l l,c,eboroTiVeeeaEo,h oy, a ,eonmtityytlR re,m cAnl ;n,xXxircicD, l, ol,SlcDo a roneednf D, haoflBe iPZt eeA,o pfbPtie mnrp,aole ceaatOlurlppnumOrlRei OaNlinrth,uOont,,etdidc,lceiitnr rait,csat iopsX bEmCnnaiptoptvnroi -yeifixoi roRmaecnaoplorsldr -mdoOcuEozDaa ,adra,nl,aep,pbN-as,ioato cItna a ro iG,ottnetmpfln dnerito,vreeNNoo-rleo aaggevl Icnll-e azbpxataadulah,oi,ongtoE,mp P Di,xtsrns,alIhEp •-ot ,ize n asi-sai ahvraibiixSoeaa i-inP rmtde •po ldAl,hdsotn,tadI uGi-aioczcenolna-onaei amcr toIdsuDe, AeloieZ pem-aetelcrhin-dcoz trsentolciiaansne B,c An,edlli,orsukO,Ahepmoeii iy C,r upieaen temon cp,enenl-dtt ntevLtinmolt-iae ltcbnh,LantArrid,hofs,aiae Ersneiog 5,v Pre Ancr yh,en •;ulnEszitea so,ti(cid:29)rp-r ,i Rgo , rnai.,dr e sye,evoa •iip oW soCe lmms 5,p in-e hpc,npztnll-De r e T ,ne mpn-c AyWspcs oaKami rh1 pt,/oro,at,bm,,aa nrfrI airag Rtt h rbehi opieeA 0RaniiitniftlhiiyosttceinpoBevnscsodaameaysEtuiscfmiaatvi ,eeeChei,norgeciela,uaei0vsiploesoqO ad :tEtl De , (ngninsc,emaena dr:idi,s Mvrnioh bse an0x o/r F A M oen niXui Cfitdg;icgemctMddirpiLiycAadoitulaoeb-0 o uranunupectmpry reiea hitimmy pueei sip,StnniWwlnuec/miCoi,dhotmcimr te whar loelsom er,c mTnho cber:aiioliltnynS oonitIaoedelr pmylna-thir cd l o.A,eatyA nfr,hLTUm mnixalfnsl kt mu mpMrec haoator icused,aen (cid:28)oc i.ymRczaaaeeroFa si erqo nmcrr ivnhteooeeralmIv3,itonst ohscmtiP,eleeaiioNsrp ecMound oOhtdnf,et gdleehugT,rllaE nhpua rp hEousst,dr eaeirsumtsnnlailictcmIua-Up d nnutalasrt,enl aeosei MrIN,;ursizatruNa iebtsNiven eso LoXiz.guciiiiixdeemrtindresoia/cnec:oarnoddaeGati,regEneotoiv fpc,,tisw.n ginbbkrtfm i sni rgnaseae: :mpe, Tley;teech:lfiptrrnha Pi iey suies,a r, hc e,;besnmms)ifi f,n M itapabr oa ,fy Ietuoe srWna Pd hm n lti, R ueos ne nteabinpiodaotm afpdtnx:sPectap(iyy neiaotch ooEusshcN,manige ntsimeocriOccnipepRHtr rneeteoctlu etnSapiitooerlsda,n-iraLeelisetioiblrp,eic rh r oEmliidsnsf pPor cll smdla; 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SKIDMORE
MOSBY’S
DRUG GUIDE
NURSING
for
STUDENTS
FOURTEENTH EDITION
Linda Skidmore-Roth, RN, MSN, NP
Consultant
Littleton, Colorado
Formerly, Nursing Faculty
New Mexico State University
Las Cruces, New Mexico
El Paso Community College
El Paso, Texas
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
MOSBY’S DRUG GUIDE FOR NURSING STUDENTS, ISBN: 978-0-323-69405-6
FOURTEENTH EDITION ISSN: 2213-4409
Copyright © 2021 by 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 Copy-
right Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by
the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors,
or editors, assume any liability 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 2019, 2017, 2015, 2013, 2011, 2009, 2007, 2005, 2003, 2001,
1999, 1997, 1996.
International Standard Book Number: 978-0-323-69405-6
Executive Content Strategist: Sonya Seigafuse
Senior Content Development Manager: Luke Held
Senior Content Development Specialist: Sarah Vora
Publishing Services Manager: Julie Eddy
Senior Project Manager: Jodi M. Willard
D esign Direction: Ryan Cook
Printed in the United States of America and China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Consultants iii
Consultants
James Graves, Pharm D Meera K. Shah, PharmD, AAHIVP
Clinical Pharmacist Clinical Pharmacist
Inpatient Pharmacy Saint Louis, Missouri
University of Missouri Health Center
Travis E. Sonnett, PharmD
Columbia, Missouri
Inpatient Pharmacy Supervisor
Kathleen S. Jordan, DNP, MS, FNP-BC, Mann-Grandstaff VA Medical Center
ENP-BC, ENP-C, SANE-P Spokane, Washington
Nurse Practitioner Residency Program Director
Mid-Atlantic Emergency Medicine Associates Pharmacy
Clinical Assistant Professor Washington State University
School of Nursing College of Pharmacy
The University of North Carolina Spokane, Washington
Charlotte, North Carolina
Wm. Kendall Wyatt, MD, RN, EMT-P
Janis McMillan, MSN, RN, CNE Chief resident Physician
Associate Clinical Professor West Virginia University
School of Nursing Charleston Area Medical Center
Northern Arizona University Charleston, West Virginia
Flagstaff, Arizona
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Preface v
Preface
Mosby’s Drug Guide for Nursing Students, fourteenth edition, is the most in-depth handbook
available for nursing students! Since its first publication in 1996, more than 100 U.S. and Canadian
pharmacists and consultants have reviewed the book’s content closely. Today, Mosby’s Drug Guide
for Nursing Students is more up-to-date than ever—with features that make it easy to find critical
information fast!
NEW FEATURES regularly used in the United States and Canada,
• Over 50 recent FDA-approved drugs for with drugs available only in Canada identified
2021 are located throughout the book and in by a maple leaf icon ( ). Select monographs,
Appendix A. important to learn and know for the NCLEX
• A new appendix with commonly used herbs examination, have been identified by a .
and natural supplements delivers easy-to- You’ll see drug-specific information within
reference information about these commonly monographs identified with a . A special
mentioned products. icon highlights drugs that may have genetic
• New Patient Problems subheading under
contraindications .
Nursing Considerations provides International
Each monograph provides the following in-
Classification for Nursing Practice (ICNP) classi-
formation, whenever possible, for safe, effective
fications that are applicable to individual drugs..
administration of each drug:
NEW FACTS High-alert status: Identifies drugs with
This edition features thousands of new drug the most potential to cause harm to patients if
facts, including: administered incorrectly.
• New drugs and new dosage information “Tall Man” lettering: Uses the capitaliza-
• Newly researched adverse effects tion of distinguishing letters to avoid medication
• Updated Black Box Warnings errors and is required by the FDA for drug
• The latest precautions, interactions, and manufacturers.
contraindications
• IV therapy updates Pronunciation: Helps the nurse master
• Revised nursing considerations complex generic names.
• Updated patient/family education guidelines Rx, OTC: Identifies prescription or over-the-
• Updates on key new drug research counter drugs.
Functional and chemical classifica-
ORGANIZATION
tions: Helps the nurse recognize similarities
This handbook is organized into four main
and differences among drugs in the same
sections:
functional but different chemical classes.
• Individual drug monographs (in alphabetical
order by generic name) Do not confuse: Presents drug names that
• Drug Categories might easily be confused within each appropri-
• Appendixes ate monograph.
• Illustrated mechanisms and sites of action
Action: Describes pharmacologic properties
The guiding principle behind this book is to
concisely.
provide fast, easy access to drug information
and nursing considerations. Every detail—from Therapeutic outcome: Details all pos-
the cover, binding, and paper to the typeface, sible results of medication use.
four-color design, and appendixes—has been
Uses: Lists the conditions the drug is used to treat.
carefully chosen with the user in mind. Here’s
what you’ll find in each section of the handbook: Unlabeled uses: Describes drug uses that
may be encountered in practice but are not yet
Individual Drug Monographs
FDA approved.
This book includes monographs for more than
4000 generic and trade medications—those Dosages and routes: Lists all available
most commonly administered by students. and approved dosages and routes for adult,
Common trade names are given for all drugs pediatric, and geriatric patients.
vi Preface
Available forms: Includes tablets, Appendixes
capsules, extended release, injectables (IV, IM,
Selected new drugs: Includes com-
SUBCUT), solutions, creams, ointments, lotions,
prehensive information on 201 key drugs
gels, shampoos, elixirs, suspensions, supposito-
approved by the FDA during the last 12 months.
ries, sprays, aerosols, and lozenges.
Ophthalmic, nasal, topical, and
Adverse effects: Groups these reactions
otic products: Provides essential informa-
by alphabetical body system, with common side
tion for 140 ophthalmic, nasal, topical, and otic
effects italicized and life-threatening reactions
products commonly used today, grouped by
in red type for emphasis.
chemical drug class.
Contraindications: Lists conditions under
Vaccines and toxoids: Features an easy-
which the drug absolutely should not be given.
to-use table with generic and trade names, uses,
Precautions: Lists conditions that require dosages and routes, and contraindications for
special consideration when the drug is prescribed. 39 key vaccines and toxoids.
Black Box Warnings: Identifies FDA Abbreviations: Lists abbreviations alpha-
warnings that highlight serious and life-threaten- betically with their meanings and explains the
ing adverse effects. five FDA pregnancy categories.
Pharmacokinetics/pharmacody- Immunization schedules: Recom-
namics: Features a quick-reference chart of mended childhood and adolescent immuniza-
concise facts of pharmacokinetics (absorption, tion schedules.
distribution, metabolism, excretion, half-life)
Standard Precautions: Used in the care
and pharmacodynamics (onset, peak, duration).
of all patients regardless of their diagnosis or
Interactions: Lists confirmed drug, food, disease.
herb, and lab test interactions.
Illustrated mechanisms and sites of
Nursing considerations: Identifies action: These 13 detailed, full-color illustra-
key nursing considerations for each step of the tions are added to help enhance the understand-
nursing process: Assessment, Patient Problem, ing of the mechanism or site of action for the
Implementation, Patient/Family Education, following drugs and drug classes:
and Evaluation, including positive therapeutic • Anticholinergic bronchodilators
outcomes. Instructions for giving drugs by vari- • Antidepressants
ous routes (e.g., IV, PO, IM, SUBCUT, topically, • Antidiabetic agents
rectally) appear under Implementation, with • Antifungal agents
route subheadings in bold. • Antiinfective agents
• Antiretroviral agents
Compatibilities: Lists syringe, Y-site, and
• Benzodiazepines
additive compatibilities and incompatibilities.
• Diuretics
If no compatibilities are listed for a drug, the
• Laxatives
necessary compatibility testing has not been done
• Narcotic agonist-antagonist analgesics
and that compatibility information is unknown.
• Narcotic analgesics
To ensure safety, assume that the drug may not
• Phenytoin
be mixed with other drugs unless specifically
• Sympatholytics
stated.
Treatment of overdose: Lists drugs and Photo atlas of drug administration:
treatments for overdoses where appropriate. This practical resource for students and practi-
tioners lists standard precautions and provides
Drug Categories
more than 20 full-color illustrations depicting
The Drug Categories section, following the
the physical landmarks and administration
individual drug monographs, provides general
techniques used for IV, IM, SUBCUT, and ID drug
information about the various functional classes
delivery.
to promote learning about the similarities
and differences among drugs in the same Common Herbs
functional class. It summarizes action, uses, This appendix, new to the fourteenth edition,
adverse effects, contraindications, precautions, provides easy-to-reference information for
pharmacokinetics, interactions, and nursing the most commonly used herbs and natural
considerations for each functional class. supplements.
