SECTION 1
Introduction to Drug Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 Introduction to Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
A Message to Students 2
Overview 2
Sources of Drugs 3
Drug Classifications and Prototypes 3
Drug Names 3
Drug Marketing 3
Pharmacoeconomics 4
Prescription and Nonprescription Drugs 4
Drug Approval Processes 4
Sources of Drug Information 7
Strategies for Studying Pharmacology 7
2 Basic Concepts and Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Overview 9
Cellular Physiology 9
Drug Transport Through Cell Membranes 10
Pharmacokinetics 10
Pharmacodynamics 15
Variables That Affect Drug Actions 17
Tolerance and Cross-Tolerance 20
Adverse Effects of Drugs 20
3 Administering Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Overview 29
General Principles of Accurate Drug Administration 29
Legal Responsibilities 30
Medication Errors 30
Medication Systems 31
Medication Orders 31
Drug Preparations and Dosage Forms 32
Calculating Drug Dosages 34
Routes of Administration 35
4 Nursing Process in Drug Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Overview 47
Nursing Process in Drug Therapy 48
Integrating Nursing Process, Critical Paths and Drug Therapy 51
General Principles of Drug Therapy 59
SECTION 2
Drugs Affecting the Central Nervous System . . . . . . . . . . . 71
5 Physiology of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . 72
Characteristics and Functions of the Central Nervous System 72
Drugs Affecting the Central Nervous System 77
6 Opioid Analgesics and Opioid Antagonists . . . . . . . . . . . . . . . . . . . . . 79
Overview 79
Pain 79
Endogenous Analgesia System 80
Opioid Analgesics 80
Individual Drugs 82
Principles of Therapy 89
7 Analgesic–Antipyretic–Anti-inflammatory and Related Drugs . . . . . 99
Overview 99
Pain, Fever, and Inflammation 100
Mechanism of Action 100
Indications for Use 102
Contraindications to Use 103
Subgroups and Individual Drugs 104
Principles of Therapy 114
8 Antianxiety and Sedative-Hypnotic Drugs . . . . . . . . . . . . . . . . . . . . . 124
Overview 124
Anxiety 125
Sleep and Insomnia 125
Drugs Used to Treat Anxiety and Insomnia 126
Principles of Therapy 134
9 Antipsychotic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Psychosis 144
Schizophrenia 145
Antipsychotic Drugs 145
Principles of Therapy 152
10 Drugs for Mood Disorders:
Antidepressants and Mood Stabilizers . . . . . . . . . . . . . . . . . . . . . . . . 163
Mood Disorders 163
Antidepressant Drugs 165
Types of Antidepressants and Individual Drugs 166
Principles of Therapy 171
11 Antiseizure Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Seizure Disorders 182
Antiseizure Drugs 183
Individual Antiseizure Drugs 184
Principles of Therapy 193
12 Antiparkinson Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Parkinson’s Disease 202
Antiparkinson Drugs 202
Individual Antiparkinson Drugs 203
Principles of Therapy 207
13 Skeletal Muscle Relaxants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Skeletal Muscle Relaxants 213
Individual Drugs 214
Principles of Therapy 217
14 Anesthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
General Anesthesia 220
Regional Anesthesia 221
Adjuncts to Anesthesia 221
Individual Anesthetic Agents 222
Principles of Therapy 222
15 Substance Abuse Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Substance Abuse 236
Dependence 236
Central Nervous System Depressants 237
Central Nervous System Stimulants 243
Principles of Therapy 249
16 Central Nervous System Stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Uses 251
Types of Stimulants 252
Individual Central Nervous System Stimulants 252
Principles of Therapy 255
SECTION 3
Drugs Affecting the Autonomic Nervous System . . . . . . 260
17 Physiology of the Autonomic Nervous System . . . . . . . . . . . . . . . . . . 261
Autonomic Nervous System 261
Characteristics of Autonomic Drugs 266
18 Adrenergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Description 268
Individual Adrenergic Drugs 272
Principles of Therapy 275
19 Antiadrenergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Description 283
Individual Antiadrenergic Drugs 285
Principles of Therapy 29020 Cholinergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Description 298
Individual Cholinergic Drugs 299
Principles of Therapy 303
21 Anticholinergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Description 308
Individual Anticholinergic Drugs 310
Principles of Therapy 314
SECTION 4
Drugs Affecting the Endocrine System . . . . . . . . . . . . . . . . . 320
22 Physiology of the Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Overview 321
Endocrine System–Nervous System Interactions 321
General Characteristics of Hormones 322
General Characteristics of Hormonal Drugs 324
23 Hypothalamic and Pituitary Hormones . . . . . . . . . . . . . . . . . . . . . . . 325
Overview 325
Therapeutic Limitations 327
Individual Hormonal Agents 328
Principles of Therapy 331
24 Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Overview 334
Endogenous Corticosteroids 334
Exogenous Corticosteroids (Glucocorticoid Drugs) 337
Principles of Therapy 343
25 Thyroid and Antithyroid Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Overview 353
Thyroid Disorders 354
Individual Drugs 356
Principles of Therapy 360
26 Hormones That Regulate Calcium and Bone Metabolism . . . . . . . . 366
Overview 366
Drugs Used for Calcium and Bone Disorders 368
Principles of Therapy 375
27 Antidiabetic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Overview 382
Endogenous Insulin 382
Diabetes Mellitus 384
Hypoglycemic Drugs 385
Principles of Therapy 394
28 Estrogens, Progestins, and Hormonal Contraceptives . . . . . . . . . . . 409
Overview 409
Estrogens 410
Progesterone 410
Estrogens and Progestins Used as Drugs 411
Individual Estrogens, Progestins, and Combination Products 413
Principles of Therapy 418
29 Androgens and Anabolic Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Overview 425
Testosterone 425
Anabolic Steroids 426
Abuse of Androgenic and Anabolic Steroid Drugs 426
Androgens and Anabolic Steroids Used As Drugs 427
Principles of Therapy 429
SECTION 5
Nutrients, Fluids, and Electrolytes . . . . . . . . . . . . . . . . . . . . . . 433
30 Nutritional Support Products and Drugs for Obesity . . . . . . . . . . . . 434
Overview 434
Nutritional Deficiency States 434
Nutritional Products 435
Pancreatic Enzymes 435
Obesity 436
Principles of Therapy 442
31 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
Overview 453
Description and Uses 454
Vitamin Supplements 454
Principles of Therapy 460
32 Minerals and Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Overview 469
Minerals as Nutrients 470
Individual Agents Used In Mineral–Electrolyte Imbalances 470
Principles of Therapy 483
SECTION 6
Drugs Used to Treat Infections . . . . . . . . . . . . . . . . . . . . . . . . . . 493
33 General Characteristics of Antimicrobial Drugs . . . . . . . . . . . . . . . . 494
Overview 494
Microorganisms and Infections 494
Host Defense Mechanisms 499
Characteristics of Anti-Infective Drugs 500
Principles of Therapy 50234 Beta-Lactam Antibacterials:
Penicillins, Cephalosporins, and Others . . . . . . . . . . . . . . . . . . . . . . 510
Overview 510
Penicillins 511
Cephalosporins 517
Carbapenems 518
Monobactam 519
Principles of Therapy 519
35 Aminoglycosides and Fluoroquinolones . . . . . . . . . . . . . . . . . . . . . . 527
Overview 527
Aminoglycosides 527
Fluoroquinolones 530
Principles of Therapy 531
36 Tetracyclines, Sulfonamides, and Urinary Agents . . . . . . . . . . . . . . 537
Overview 537
Principles of Therapy 543
37 Macrolides and Miscellaneous Antibacterials . . . . . . . . . . . . . . . . . . 548
Overview 548
Macrolides 548
Miscellaneous Antibacterial Drugs 550
Principles of Therapy 552
38 Drugs for Tuberculosis and Mycobacterium avium
Complex (MAC) Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
Overview 559
Epidemiology of Tuberculosis 560
Drug-Resistant Tuberculosis 561
Preventing the Development and Spread of Tuberculosis 561
Antitubercular Drugs 561
Treatment of Active Tuberculosis 567
Mycobacterium avium Complex Disease 567
Principles of Therapy 568
39 Antiviral Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576
Overview 576
Principles of Therapy 585
40 Antifungal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595
Overview 595
Fungal Infections 596
Principles of Therapy 606
41 Antiparasitics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614
Overview 614
Protozoal Infections 614
Helminthiasis 616
Scabies and Pediculosis 616
Antiparasitic Drugs 617
Principles of Therapy 623SECTION 7
Drugs Affecting Hematopoiesis and
the Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
42 Physiology of the Hematopoietic and Immune Systems . . . . . . . . . . 628
Overview 628
Hematopoietic Cytokines 628
Overview of Body Defense Mechanisms 630
Immunity 631
Immune Cells 632
Patient-Related Factors That Influence Immune Function 637
Immune Disorders 638
Drugs That Alter Hematopoietic and Immune Responses 638
43 Immunizing Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 640
Overview 640
Immunization 641
Agents for Active Immunity 641
Agents for Passive Immunity 641
Individual Immunizing Agents 642
Principles of Therapy 648
44 Hematopoietic and Immunostimulant Drugs . . . . . . . . . . . . . . . . . . . 657
Overview 657
General Characteristics of Hematopoietic and Immunostimulant Drugs 657
Principles of Therapy 663
45 Immunosuppressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671
Overview 671
Autoimmune Disorders 672
Tissue and Organ Transplantation 674
Immunosuppressant Drugs 675
Principles of Therapy 682
SECTION 8
Drugs Affecting the Respiratory System . . . . . . . . . . . . . . . 693
46 Physiology of the Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . 694
Overview 694
Summary 696
Disorders of the Respiratory System 696
Drug Therapy 696
47 Drugs for Asthma and Other Bronchoconstrictive Disorders . . . . . 697
Overview 697
Drug Therapy 700
Principles of Therapy 70648 Antihistamines and Allergic Disorders . . . . . . . . . . . . . . . . . . . . . . . . 715
Overview 715
Histamine and Its Receptors 715
Hypersensitivity (Allergic) Reactions 716
Antihistamines 718
Principles of Therapy 723
49 Nasal Decongestants, Antitussives, and Cold Remedies . . . . . . . . . . 728
Overview 728
The Common Cold 728
Sinusitis 729
Common Signs and Symptoms of Respiratory Disorders 729
Drugs for Respiratory Disorders 729
Individual Drugs 730
Principles of Therapy 733
SECTION 9
Drugs Affecting the Cardiovascular System . . . . . . . . . . . 738
50 Physiology of the Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . 739
Overview 739
Heart 739
Blood Vessels 740
Blood 741
Cardiovascular Disorders 742
Drug Therapy in Cardiovascular Disorders 742
51 Drug Therapy of Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 743
Overview 743
Drug Therapy 744
Principles of Therapy 750
52 Antidysrhythmic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758
Overview 758
Cardiac Electrophysiology 758
Cardiac Dysrhythmias 759
Antidysrhythmic Drugs 760
Classifications and Individual Drugs 760
Principles of Therapy 767
53 Antianginal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 774
Overview 774
Antianginal Drugs 777
Principles of Therapy 782
54 Drugs Used in Hypotension and Shock . . . . . . . . . . . . . . . . . . . . . . . 788
Overview 788
Antishock Drugs 789
Individual Drugs 789
Principles of Therapy 79255 Antihypertensive Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 797
Overview 797
Regulation of Arterial Blood Pressure 797
Hypertension 798
Antihypertensive Drugs 801
Individual Drugs 803
Principles of Therapy 804
56 Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818
Overview 818
Renal Physiology 818
Alterations in Renal Function 821
Diuretic Drugs 821
Principles of Therapy 824
57 Drugs That Affect Blood Coagulation . . . . . . . . . . . . . . . . . . . . . . . . 832
Overview 832
Hemostasis 833
Clot Lysis 833
Thrombotic and Thromboembolic Disorders 833
Drugs Used in Thrombotic and Thromboembolic Disorders 835
Principles of Therapy 843
58 Drugs for Dyslipidemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851
Overview 851
Atherosclerosis 851
Blood Lipids 852
Dyslipidemia 853
Initial Management of Dyslipidemia 853
Drug Therapy of Dyslipidemia 854
Principles of Therapy 857
SECTION 10
Drugs Affecting the Digestive System . . . . . . . . . . . . . . . . . . . 863
59 Physiology of the Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . 864
Overview 864
Organs of the Digestive System 864
Secretions of the Digestive System 866
Effects of Drugs on the Digestive System 866
60 Drugs Used for Peptic Ulcer and Acid Reflux Disorders . . . . . . . . . 867
Overview 867
Peptic Ulcer Disease 867
Types of Drugs 869
Principles of Therapy 87561 Laxatives and Cathartics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883
Overview 883
Defecation 883
Laxatives and Cathartics 884
Principles of Therapy 887
62 Antidiarrheals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892
Overview 892
Antidiarrheal Drugs 893
Principles of Therapy 897
63 Antiemetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902
Overview 902
Antiemetic Drugs 903
Principles of Therapy 907
SECTION 11
Drugs Used in Special Conditions . . . . . . . . . . . . . . . . . . . . . . . 912
64 Drugs Used in Oncologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 913
Overview 913
Normal and Malignant Cells 913
Cancer 914
Antineoplastic Drugs 916
Individual Drugs 919
Cytoprotectant Drugs 919
Principles of Therapy 920
65 Drugs Used in Ophthalmic Conditions . . . . . . . . . . . . . . . . . . . . . . . . 935
Overview 935
Disorders of the Eye 936
Types of Ophthalmic Drugs 937
Ophthalmic Drug Therapy 937
Individual Drugs 937
Principles of Therapy 938
66 Drugs Used in Dermatologic Conditions . . . . . . . . . . . . . . . . . . . . . . 949
Overview 949
Disorders of the Skin 950
Types of Dermatologic Drugs 952
Individual Drugs 953
Principles of Therapy 957
67 Drug Use During Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . 965
Overview 965
Pregnancy and Lactation 965
Maternal–Placental–Fetal Circulation 966
Drug Effects on the Fetus 966
Fetal Therapeutics 970
Maternal Therapeutics 970
Abortifacients 973
Tocolytics 973
Drugs Used During Labor and Delivery at Term 974
Neonatal Therapeutics 975
Principles of Therapy 976
APPENDIX A
Recently Approved and Miscellaneous Drugs . . . . . . . . . . . . . . . . . . 981
APPENDIX B
The International System of Units . . . . . . . . . . . . . . . . . . . . . . . . . . . 983
APPENDIX C
Therapeutic Serum Drug Concentrations for Selected Drugs . . . . . 984
APPENDIX D
Canadian Drug Laws and Standards . . . . . . . . . . . . . . . . . . . . . . . . . 985
APPENDIX E
Canadian Drug Names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 986
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 995
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