Pharmacotherapeutics for Nurse Practitioner Prescribers

1517 Pages·2011·17.95 MB·English

by  Teri Moser Woo RN PhD CPNP

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THIRD EDITION
Pharmacotherapeutics
for Nurse Practitioner
Prescribers
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2235_FM-i-xvi 25/06/11 12:44 PM Page iii
THIRD EDITION
Pharmacotherapeutics
for Nurse Practitioner
Prescribers
Teri Moser Woo, RN, PhD, CPNP
Associate Professor of Nursing
University of Portland
School of Nursing
Portland, Oregon
and
Pediatric Nurse Practitioner
Kaiser Permanente Northwest Region
Anita Lee Wynne, PhD, FNP-retired
Professor Emeritus of Nursing
School of Nursing
University of Portland
Portland, Oregon
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Copyright © 2011 by F. A. Davis Company
Copyright © 2011 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be
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Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
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As new scientific information becomes available through basic and clinical research, recommended treatments and drug
therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up
to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or
implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in
accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation.
The reader is advised always to check product information (package inserts) for changes and new information regarding
dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently
ordered drugs.
Library of Congress Cataloging-in-Publication Data
Woo, Teri Moser, 1962–
Pharmacotherapeutics for nurse practitioner prescribers / Teri Moser Woo, Anita Lee Wynne. — 3rd ed.
p. ; cm.
Rev. ed. of: Pharmacotherapeutics for nurse practitioner prescribers / Anita Lee Wynne, Teri Moser Woo, Ali J. Olyaei.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-2235-7
ISBN-10: 0-8036-2235-X
1. Pharmacology. 2. Therapeutics. 3. Nurse practitioners. I. Wynne, Anita Lee, 1941– II. Wynne, Anita Lee, 1941–
Pharmacotherapeutics for nurse practitioner prescribers. III. Title.
[DNLM: 1. Pharmacological Phenomena—Nurses’ Instruction. 2. Drug Prescriptions—Nurses’ Instruction. 3. Drug
Therapy—nursing. 4. Nurse Practitioners. QV 38]
RM300.W96 2011
615'.1—dc22
2011006059
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted
by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service,
provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organiza-
tions that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code
for users of the Transactional Reporting Service is: 8036-2235-7/11 0 + $.25.
2235_FM-i-xvi 25/06/11 12:44 PM Page v
I would like to dedicate this book to my family.
My husband, John, and my three sons, Michael,
Patrick, and Nicholas, have been wonderfully
supportive as I have completed this project.
TMW
To my loving husband and my family without
whose patience and support this book never would
have been completed; and to my children and
grandchildren, who daily make my life complete.
In loving memory of my mother, who died in 2006,
and my father, who consistently taught me to shoot
for the stars and who died in 2010.
ALW
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PREFACE
T
he increasing volume of pharmacology-related infor- undergraduate pharmacology, where the focus is on
mation presents a challenge to acquire and maintain safe administration of drugs prescribed by someone else.
current knowledge in the area of pharmacotherapeutics. Advanced pharmacology information on receptor reserve
The number of new drugs coming on the market each and regulation, bioavailability and bioequivalence,metab-
year, the changes in “the best” drugs to use for any given olism of drugs including a focus on the cytochrome P450
disease state based on the latest research,the influence microsomal enzyme system, half-life, and steady state
on patient and practitioner alike of advertising and pro- are provided in Chapters 3 and8. Information central to
motion, and the increasing incursion of managed care the prescribing role includes an in-depth discussion of
and restricted formularies into practice decisions about volume of distribution and therapeutic drug monitoring.
drug selection are phenomenal. This book is designed to Volume of distribution is important in prescribing drugs
provide nurse practitioner students and the nurse practi- with very large or very small volumes of distribution and
tioner in the primary care setting with a thorough, current, for selecting drugs for patients with cardiac or renal fail-
and usable pharmacology text and reference to address ure, during pregnancy, or when a patient is underweight
these challenges. or obese. Knowing what tests to order and when to order
The design of this book assumes knowledge of basic them to assess plasma drug levels by bioassay and to mon-
pharmacology from one’s undergraduate education in itor for adverse drug reactions is necessary to make
nursing.Although a brief review of basic pharmacology choices about when or if dosage alterations are required
is presented in Chapter 2, the focus of the book is on or drugs need to be stopped. These are also covered
advanced pharmacology and the role of the advanced in Unit I.
practice nurse in pharmacotherapeutics. The authors of Legal and professional aspects of the prescriber role
the text are practicing nurse practitioners or selected are presented in Chapter 4. Issues surrounding the legal
specialists in a field. The book is by nurse practitioners, for authority of a nurse practitioner to prescribe a drug, the
nurse practitioners and other health-care providers who conditions under which the prescription may be written,
prescribe drugs and how to write the prescription are presented. Risk
management issues are also discussed, including informed
consent, dealing with multiple providers, and substance
ORGANIZATION
abuse and drug-seeking behaviors.
This book is organized around four distinct content areas: Nurse practitioners have a history of high levels of
The Foundation, Pharmacotherapeutics With Single Drugs, patient satisfaction with the care provided.This is related,
Pharmacotherapeutics With Multiple Drugs, and Special in part, to their holistic approach to each patient.Several
Drug Treatment Considerations. chapters are devoted to information that reflects this
approach. Cost, knowledge deficits, dealing with complex
treatment regimens, and negotiating a shared responsibil-
The Foundation
ity for drug management are discussed in Chapter 6.
The 13 chapters in Unit I provide the foundation of Many patients choose to use complementary therapies
advanced pharmacology and the link between this knowl- such as herbal remedies. Chapter 10 discusses herbal
edge and professional practice. Chapter 1discusses the therapy and other complementary therapies and provides
role of the nurse practitioner in both the United States of a list of resources in this area.
America and Canada as prescriber and the knowledge A relatively new area in pharmacotherapeutics is
needed to actualize this role. Current issues about the ethnopharmacology.As more research is occurring in this
evolving role and education of these providers are area, treatment guidelines are beginning to include which
also presented in this edition including discussion of the drugs are best for different racial groups. Cultural and eth-
Doctorate of Nursing Practice. nic considerations in prescribing drugs are the subject of
Discussion of the roles of other advanced practice Chapter 7.Pharmacogenomics involves the influence of
nurses and physicians assistants in prescribing has also both race/ethnicity and individual genetic makeup on drug
been added. Factors involved in clinical judgment related metabolism. Chapter 8provides a greatly expanded discus-
to prescribing are a central focus, and collaboration with sion of the role of pharmacogenomics in prescribing.
other health-care providers is also presented. Consideration of drug and food interactions has long
The pharmacology knowledge required for rational been a part of nursing knowledge, but the interrelation-
drug selection requires more depth than that given in ship between nutrition and drug therapy beyond these
vi
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Preface (cid:129) (cid:129) (cid:129) vii
interactions has been largely missed. Chapter 9provides of the drug, adverse drug reactions to monitor for and
a discussion of this interrelationship including nutritional what to do if they occur, and lifestyle modifications that
supplementation and nutrition as therapy. The third complement the drug therapy.
edition also includes discussion of nutraceuticals, in To provide the most up-to-date, accurate, and relevant
which foods are prescribed for their health benefits. information possible, contributors to this unit are practic-
In an age of increasing use of technology, the nurse ing clinicians and the newest published guidelines are
practitioner must be able to acquire information about consistently used. Clinical pearls drawn from the daily
drugs and to deliver care to patients using this technology. practice world of these contributors are incorporated
The push for use of electronic health records (EHRs) has throughout the text. Drugs currently in development that
made Chapter 11critical information with its discussion may influence drug choices in the near future are also in-
of computers and other data and communication devices cluded in the On-the-Horizon feature.
and the Internet as sources of information and for care
delivery This chapter has been restructured in the third
Pharmacotherapeutics With Multiple
edition to focus on the use of information technology
Drugs
directly related to patient encounters. Especially helpful
is a large table that presents up-to-date sites for drug infor- Unit IIIchapters provide access to drug information from
mation from government, commercial, organizational, and the viewpoint of the disease processes they are commonly
other sources. Where it is possible to determine, each used to treat. Patients often have complex health and
site has a discussion of its content, reliability, frequency of illness issues and treatment needs. Nurse practitioner
update, link to other sites, charges or fees, and who is the students find these especially perplexing, and these pa-
“owner or operator” of the site. If the site is supported by tients may have disease processes that extend beyond
advertising, this is also mentioned. The future use of in- those a given nurse practitioner commonly sees. The
formation technology in obtaining drug-related informa- knowledge the student or practitioner needs to select the
tion and the delivery of health-care services is also appropriate drug to treat a given disease may be limited.
included. Unit IIIfacilitates acquisition of this knowledge by provid-
Cost issues are increasingly central to prescribing ing access to information from a disease process format.
decisions. Chapter 12provides an expanded discussion The diseases in this unit are those commonly seen in
of pharmacoeconomics. Written by a nurse practitioner primary care and for which multidrug therapy from more
in the third edition, the focus is more directly on the pre- than one drug class may be recommended.
scriber’s role. Pharmacotherapeutics is discussed in relation to the
Over-the-counter drugs may be prescribed by the prac- pathophysiology of the disease and the goals of treatment.
titioner or chosen by patients on their own. These drugs Each chapter explores how patient variables, economic
are often erroneously perceived to be less powerful and considerations, concurrent diseases, and drug character-
having fewer adverse reactions than prescription drugs. istics influence rational drug selection. Outcome evalua-
Understanding their role in pharmacotherapeutics is the tion is presented with guidelines for consultation and
focus of Chapter 13. referral.Where relevant the newest published professional
guidelines are incorporated. Each patient is unique and
no set of guidelines or treatment algorithm applies to each
Pharmacotherapeutics With Single Drugs
patient. However, these tools, drawn from the clinical
The next two units are organized around specific drugs knowledge and experience of experts in a given specialty,
and the diseases they are used to treat. The chapters in are helpful in rational drug selection, especially for the stu-
Unit II are organized to provide easy access to informa- dent and novice practitioner.Clinically based case studies
tion based on specific drug classes. Many practitioners provide a framework for application of pharmacothera-
have a personal formulary of drugs they use for disease peutic knowledge and are provided in an online supple-
processes that they commonly see. When presented with ment to this edition.
a patient requiring drug therapy, they know the class of
drug from which they will make a rational drug choice.
Special Drug Treatment Considerations
The information they seek is about drugs within that class
that would be most appropriate for this patient. Unit IV focuses on special populations. Age-related
Pharmacokinetics, pharmacodynamics, and pharma- variables are explored in Chapter 50, Pediatric Patients,
cotherapeutics for each drug class are discussed. Tables and Chapter 51, Geriatric Patients. Gender variables are
with easy-to-access information on pharmacokinetic considered in Chapter 48, Women as Patients, and
properties of each drug, drug interactions,clinical use Chapter 49, Men as Patients. Chapter 49is a new addi-
and dosing, and available dosing forms are presented. tion to the book. Information on safe prescription of
There is a major focus on rational drug selection and on drugs for lactating patients is often difficult to find, and
monitoring parameters.Patient education specific to each tables with the most current information on the effect
drug class is provided—designed around administration of drugs on the nursing infant are found in Chapter 50.
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viii (cid:129) (cid:129) (cid:129) Preface
The prevalence of chronic illness is increasing as Dosage Schedule tables
acute illnesses that formerly accounted for most of the Available Drug Dosage Forms tables
morbidity and mortality in developed countries have Rational drug selection and monitoring parameters
been eradicated or come under control. Chapter 52dis- Patient Education
cusses the modification of pharmacotherapeutics in pa- Clinical Pearls
tient populations with chronic illness or in long-term On-the-Horizon feature
care facilities.
The final chapter in the book deals with one of the
Unit III Chapters
most common yet often perplexing issues with which
prescribers deal: pain. Chapter 53focuses on manage- Integration of pathophysiology and pharmacotherapeutics
ment of both acute and chronic pain across the age Integration of professional treatment guidelines
continuum. The third edition includes the most current Drugs Commonly Used tables
information on newer drugs used to treat chronic pain Patient Education displays
and new pain assessment tools for patients with demen-
tia. Expanded discussion of the legal aspects of Unit IV Chapters
prescribing related to drug dependent patients includes
Variables related to special populations
Material Risk Assessment and Pain Management Con-
Pediatrics
tract documents.
Geriatrics
Women
FEATURES Men
Chronically ill and long-term care
Throughout the text, care has been taken to provide the
Pain management
reader with a consistent and logical presentation of
material. Visual appeal is provided through the generous
SUMMARY
use of tables, illustrations, and flowcharts. Other features
are unique to the specific units: Every effort has been made to make this text as compre-
hensive, accurate, and user friendly as possible. The
generous use of tables for ease of access to information,
Unit I Chapters
the focus on rational drug selection, the inclusion of often
In-depth pharmacology base for advanced pharmacother- hard to find monitoring parameters, and the integration
apeutics of patient education throughout the text are examples of
Herbal and complimentary therapies this user-friendly approach.The authors hope that you
Ethnopharmacology and pharmacogenomics will find this a valuable resource both as a student and in
Nutrition and nutraceuticals as therapy your practice.
Pharmacoeconomics TMW
Information technolo gy including EHR and how it is used ALW
in a busy practice
Unit II Chapters
Tables for ease of access to information
Pharmacokinetics tables
Drug Interactions tables
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ACKNOWLEDGMENTS
I would like to acknowledge my mentors who have The authors would also like to acknowledge our
supported me throughout my nursing career.Included previous co-authors, Michael Millard, RPh and Ali
in this list are Dr.Sheila Kodadek, who has been my men- J.Olyaei,PharmD.They contributed to the development
tor and friend throughout my nursing career,and the late and refinement of multiple foundational chapters in
Dr.Terry Misener. I would also like to acknowledge the the first two editions of the text and their work is
faculty at University of Portland who have offered me acknowledged here.
support, encouragement, and advice as I completed TMW
these chapters while teaching full-time. ALW
TMW
ix