Chapter 1

Introduction to Pharmacology

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Summary

pharmacology: the study of medicines (or drugs) or the study of the biological effects of chemicals on the body drug: a chemical that exerts an effect on the living body; a compound used in the prevention, treatment, diagnosis, or cure of a condition or disease biosimilar: a drug that is synthetically produced and has similar properties to a specific biologic; although it does go through testing, it does not go through the same rigorous testing…

Key terms

pharmacology

the study of medicines (or drugs) or the study of the biological effects of chemicals on the body

drug

a chemical that exerts an effect on the living body; a compound used in the prevention, treatment, diagnosis, or cure of a condition or disease

biosimilar

a drug that is synthetically produced and has similar properties to a specific biologic; although it does go through testing, it does not go through the same rigorous testing…

counterfeit drug

a product that is illegally manufactured or mislabeled regarding the identity or source and appears to be a genuine product; may be harmful to the client

drug formulary

the list of prescription drugs that are covered by an insurance plan or carried by a medical institution

therapeutic effects

the effects that are expected and desired from a particular medication

adverse drug event

when an individual is harmed by a drug

adverse effect

an effect of a drug that is undesired

Chapter 2

Drug Administration

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Summary

bioavailability: the drug concentration available to bind to receptors at its target tissue or site of action; a subcategory of absorption pharmacodynamics: the way a drug interacts with receptors, target cells, body systems, and organs to produce effects, or what the drug does to the body therapeutic index: the ratio of the dose of a drug that produces a therapeutic effect to the dose that causes toxicity; sometimes known as the therapeutic window

Key terms

bioavailability

the drug concentration available to bind to receptors at its target tissue or site of action; a subcategory of absorption

pharmacodynamics

the way a drug interacts with receptors, target cells, body systems, and organs to produce effects, or what the drug does to the body

therapeutic index

the ratio of the dose of a drug that produces a therapeutic effect to the dose that causes toxicity; sometimes known as the therapeutic window

pharmacokinetics

the movement of a drug through the body, or what the body does to the drug

half-life

the time it takes for the serum drug concentration to be reduced by 50%

distribution

the transportation of medication to the sites of action via bodily fluids; it is influenced by the ability to travel to the site of action through the bloodstream

medication reconciliation

the process of identifying and verifying the most accurate list of medications that a client is taking, including the drug name, dosage, frequency, and route that the client is…

metabolism

where a drug is changed into a less active or an inactive form by the action of enzymes—usually in the liver—and then is excreted in the stool or urine; metabolism prepares a…

Chapter 3

Ethics, Legal Considerations, and Safety

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Summary

The ethical principles of autonomy, beneficence, and nonmaleficence were examined, as was their role in nursing practice. A thorough discussion of medication safety and strategies to prevent medication errors was provided.

Key terms

medication error

any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client, or…

nonmaleficence

an ethical principle that holds that individuals have an obligation to do no harm to others

beneficence

an ethical principle requiring an individual to “do good” to others

autonomy

being independent and having the freedom to choose

protected health information (PHI)

any information by which an individual can be identified (name, date of birth, Social Security number, phone number, address, etc.) as it relates to their health condition…

confidentiality

the assurance that the client will not have their personal health information (PHI) disclosed without their consent

side effects

secondary drug effects at the therapeutic drug level (e.g., sedation that occurs with a benzodiazepine or opioid)

Chapter 4

Introduction to Homeostasis

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Summary

Homeostatic equilibrium is maintained through negative feedback loops, which involve a stimulus, a control center, and an effector, and positive feedback loops, which amplify a signal and can lead to a runaway effect… One important component of homeostasis is the regulation of osmolality, which refers to the balance of solutes and water in the body. The body’s ability to maintain homeostasis is essential for proper functioning of cells and tissues

Key terms

effector

an organ or tissue that receives information from the control center and acts to bring about the changes needed for homeostasis

negative feedback

a homeostatic process that counteracts a change, bringing the parameter back toward its set point

feedback loop

a part of homeostasis that provides a mechanism for the body to maintain stability

osmolality

the number of solute particles per kilogram of solvent

body’s ability to maintain homeostasis

essential for proper functioning of cells and tissues

positive feedback

feedback that amplifies or magnifies a change

Chapter 5

Fluids and Electrolytes, Vitamins, Minerals, and Alternative Therapies

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Summary

Vitamins and minerals are essential nutrients that the body requires in small amounts. Electrolytes, such as sodium, calcium, and potassium, play a crucial role in maintaining fluid balance. The body relies on precise fluid balance to maintain healthy physiologic functions.

Key terms

electrolytes

essential minerals that carry an electric charge and are crucial for functions like nerve signaling, muscle contraction, and fluid balance in the body

minerals

inorganic substances that are essential for certain physiological functions

vitamins

essential organic compounds required for normal physiological function

complementary and alternative therapies

medical products and practices outside of conventional medical practice; complementary therapies are used as adjuncts to conventional therapies, and alternative therapies are…

cryoprecipitated anti-hemophilic factor (cryo)

a portion of plasma that is rich in clotting factors

platelets

cells that are responsible for clotting blood

colloidal oncotic pressure

osmotic pressure that causes fluid to pull back into the capillary by large molecules such as proteins

Chapter 6

Introduction to the Immune System and the Inflammatory Response

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Summary

It explained the differences between natural and active acquired immunity as well as active and passive immunity. The last section focused on understanding inflammation, its pathophysiology, and the five cardinal signs of inflammation.

Key terms

immune system

a complex network of cells, tissues, and organs that work together to defend the body against infections, diseases, and foreign substances

inflammatory response

the coordinated reaction of the immune system to injury, infection, or harmful stimuli, involving a series of cellular and biochemical processes aimed at eliminating the threat…

passive immunity

the temporary protection against a specific pathogen that is conferred to an individual by receiving pre-formed antibodies rather than producing them internally

biosimilar drugs

medications that are highly similar to an already approved biologic drug, known as the reference product

monoclonal antibodies

laboratory-produced molecules designed to mimic the immune system's natural ability to fight off specific pathogens or target specific cells

antibodies

Y-shaped proteins produced by B cells of the immune system, also known as immunoglobulins

inflammation

a natural response of the immune system to tissue injury, infection, or irritation

immunosuppressants

medications that suppress or weaken the immune system's activity

Chapter 7

Anti-infective Drugs

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Summary

A brief review of the immune system was provided to explain the basic forms of defense the body uses to prevent infections as well as what happens when these defenses fail.

Key terms

protozoa

unicellular organisms capable of causing parasitic infections

antibiogram

a document detailing local bacterial resistance patterns that is used to guide antibiotic choices

immunocompromised

the state in which the immune system is unable to effectively prevent infection

acquired immunodeficiency syndrome (AIDS)

a group of conditions associated with immune system dysfunction caused by the human immunodeficiency virus

bacteriostatic

having the property of preventing bacteria from actively replicating, although not killing them directly

parasitic infection

infection caused by parasites—organisms that derive nutrition from their host while causing it harm

viral load

the number of viral particles measured in a sample of body fluid or tissue (usually blood)

superinfection

infection caused by resistant bacteria after the use of broad-spectrum anti-infectives

Chapter 8

Introduction to Cancer Therapy and Cancer Drugs

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Summary

A summary of different major classes of chemotherapy and individual agents was included.

Key terms

mutation

a change in the nucleic acid sequence in a cell

chemotherapy

drug therapy focused on killing cancer cells

nadir

the point after a chemotherapy treatment at which a client’s blood cell counts are at the lowest level before recovery

febrile neutropenia

occurrence of a fever during a period of neutropenia, when the risk of infection is higher than normal

mucositis

inflammation and ulceration of oral and/or gastrointestinal mucous membranes; often a side effect of chemotherapy or radiation therapy

pancytopenia

a decrease below normal levels of all circulation blood cell lines including white blood cells, red blood cells, and platelets

tumor lysis syndrome

a condition occurring after administration of chemotherapy resulting in cell death that releases cellular contents into the blood

embolization

the introduction of a foreign object (bone fragments, cells, air, blood clot) into the bloodstream

Chapter 9

Introduction to the Nervous System

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Summary

Acetylcholine, epinephrine, and norepinephrine are the fundamental neurotransmitters within the autonomic nervous system. The peripheral nervous system consists of the autonomic nervous system and the somatic nervous system. The autonomic nervous system is further divided into the sympathetic nervous system (i.e., the fight or flight system) and the parasympathetic nervous system (i.e., the rest and digest system) Neurons are the fundamental units of the nervous system.

Key terms

nervous system

system that includes the brain and spinal cord (the central nervous system) and an intricate network of nerves (the peripheral nervous system)

autonomic nervous system

further divided into the sympathetic nervous system (i.e., the fight or flight system) and the parasympathetic nervous system (i.e., the rest and digest system)

neurotransmitter

a chemical messenger that results in action, inaction, or inhibition of a neuron

neurons

the basic units of the nervous system

parasympathomimetic

drugs that stimulate or mimic the parasympathetic nervous system (rest and digest)

sympathomimetics

drugs that stimulate or mimic the sympathetic nervous system (fight or flight)

homeostasis

maintenance of equilibrium and stability necessary for human life

neurotransmission

the transmission of electrochemical information between neurons

Chapter 10

Drugs to Treat Myasthenia Gravis and Alzheimer’s Disease

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Summary

The increase in ACh is important for these diseases due to the degeneration of neurons that release ACh, which leads to a deficiency in this neurotransmitter. The NMDA receptor antagonists are the exception to this. With one exception, the drug classifications used in both diseases—direct- and indirect-acting cholinergic agonists and AChE inhibitors—essentially make more ACh available for use by the body.

Key terms

increase in ACh

important for these diseases due to the degeneration of neurons that release ACh, which leads to a deficiency in this neurotransmitter

autoantibodies

produced by the immune system and are directed against one or more of the individual’s own cells, tissues, and proteins instead of foreign invaders

sympathetic nervous system (SNS)

a division of the autonomic nervous system that is responsible for the fight-or-flight response

microtubules

components of a cell skeleton that provide structure and shape to cells, facilitate cell movement and cell division, and transport nutrients/substances within cells

myasthenia gravis (MG)

a progressive autoimmune neuromuscular disorder characterized by fluctuating muscle weakness and the onset of rapid fatigue

parasympathetic nervous system (PSNS)

a division of the autonomic nervous system that carries the predominant tone in most organs with the exception of the blood vessels; responsible for the rest and digest functions

Stevens-Johnson syndrome

hypersensitivity response to certain drugs characterized by lesions of the skin and mucous membranes, fever, malaise, and toxemia

Chapter 11

Drugs to Treat Parkinson’s Disease and Multiple Sclerosis

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Summary

The medications for each condition are distinct based on the etiologies. Medications are essentially beneficial in reducing symptoms of these conditions. In addition, medications are helpful in preventing relapses in MS and delaying the progression of PD In PD, the medications are focused on increasing dopamine levels in the CNS by using dopamine replacement/dopamine agonist agents.

Key terms

medications

focused on increasing dopamine levels in the CNS by using dopamine replacement/dopamine agonist agents

medications for each condition

distinct based on the etiologies

oligodendrocytes

type of non-neuronal cells in the CNS that do not produce electrical impulses; main functions are to provide support and insulation to axons in the CNS

nystagmus

involuntary oscillating eye movements that are usually rapid, repetitive, and uncontrolled

micrographia

handwriting that is very small

akathisia

psychomotor restlessness; an intense sensation of uneasiness or inner restlessness that usually involves the lower extremities and results in a compulsion to move

autoimmune

when the body's immune system cannot tell the difference between its own cells and foreign cells, the immune components mistakenly attack healthy body cells

immunoglobulins

glycoprotein molecules produced by B lymphocytes (plasma cells) that act as a critical part of the immune response by specifically recognizing and binding to particular antigens…

Chapter 12

Anticonvulsant Drugs and Drugs to Treat Epilepsy, Migraine Headaches, and Intracranial Emergencies

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Summary

Additionally, drugs used in the treatment of intracranial hypertension and increased intracranial pressure during intracranial emergencies were presented, including CAIs and osmotic diuretics. Drugs used to treat migraine headaches were briefly presented. A brief pathophysiology was provided, as well as discussion on etiology, diagnostic testing, and clinical manifestations for each of the conditions

Key terms

migraine headaches

a type of headache that can be recurring and are often associated with a range of symptoms that can greatly affect quality of life

anticonvulsant drugs

drugs that are primarily used to treat seizures and epilepsy

intracranial emergencies

a range of sudden and serious medical conditions that affect the brain, its surrounding structures, or blood vessels within the skull

headaches

a prevalent medical condition that can cause pain or discomfort in the head or neck area

epilepsy

a neurological disorder characterized by recurrent seizures

increased intracranial pressure

a rise in the pressure within the skull that can cause various symptoms, such as headache, nausea, vomiting, visual changes, and altered mental status

intracranial hypertension

an elevated pressure within the skull that may or may not cause symptoms

focal seizures

seizures that begin in a specific area of the brain and can cause a wide range of symptoms depending on the area of the brain that is affected; also known as partial seizures

Chapter 13

Psychopharmacologic Drugs

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Summary

Some of these classifications can be used in more than one disorder. Likewise, multiple drug classifications can be used in treating a single mental health condition. Several of these classifications are associated with maintaining a balance of the neurotransmitters involved.

Key terms

catatonia

state in which someone is awake but does not appropriately respond to other people and their environment; can affect someone’s movement, speech, and behavior

cognitive-behavioral therapy

type of psychotherapeutic method that helps people identify maladaptive and negative patterns of thinking that cause a negative influence on behavior and mood; this thinking is…

hypnagogic hallucinations

sleep-related hallucinations that occur as a person is falling asleep; commonly visual and consist of vivid images of patterns, shapes, or people; occasionally may involve sounds…

prodrug

a drug that is pharmacologically inactive until it is ingested and metabolized into an active form

bipolar disorder

a disorder that causes intense changes in a person’s mood (ranging from manic to depressive), energy, and ability to function

cytochrome P450 enzyme system

enzymes responsible for breaking down drugs to their active or inactive metabolites; these can be inhibited or induced by drugs altering drug metabolism

dystonia

spasms of the tongue, neck, back, and legs; the spasms may cause unnatural positioning of the neck and eyes and excessive salivation

extrapyramidal symptoms (EPS)

variety of movement disorders, such as tardive dyskinesia, akathisia, or bradykinesia, experienced as a result of taking dopamine antagonists

Chapter 14

Pain Response Drugs

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Summary

The concept of the pain threshold and factors that can affect it were described Drug classes covered in this chapter include the nonopioid analgesics, opioid agonists, and opioid antagonists.

Key terms

pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

pain threshold

the point at which a stimulus is perceived as painful

withdrawal

physiologic effects that occur after discontinuation of a drug that has been used for a prolonged period

addiction

a persistent, compulsive dependence on a substance or behavior despite known harm

nonopioid analgesic

any analgesic that does not activate the opioid receptors to relieve pain

tolerance

physiologic adaptation to the effect of a drug after repeated exposure

nature of pain

subjective, different ways to assess a client’s pain were explained

opioid agonists

drugs that activate opioid receptors

Chapter 15

Substance Use Disorder Treatment Drugs

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Summary

Substance use and abuse were described in terms of the short-term effects of intoxication as well as more long-term effects such as physical dependence, tolerance, and withdrawal. Emphasis was placed on how the presence of things like tolerance and physical dependence does not always mean a client has a substance use disorder Medications used to treat opioid use disorders included agents to minimize withdrawal effects or to prevent opioid effects should a client relapse. Medications for alcohol use disorders included agents to minimize the withdrawal effects of alcohol.

Key terms

physical dependence

the homeostatic adaptation that occurs when the body is exposed to substances over a prolonged period

intoxication

the substance-specific physiologic effects that occur after exposure to a psychoactive substance

withdrawal

physiologic and psychological consequences of discontinuation or reversal of a substance

tolerance

the decrease in response to a drug after continuous use

psychological dependence

the cognitive and behavioral adaptations that occur when the body is exposed to substances chronically

downregulated

when a response to a stimulus is reduced or suppressed

delirium tremens

a psychotic state that occurs during alcohol withdrawal, causing tremors, hallucinations, anxiety, and confusion

substance use disorder (SUD)

patterns of symptoms caused by using a substance that an individual continues taking despite negative effects

Chapter 16

Introduction to the Cardiovascular System

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Summary

The heart consists of four chambers: the two upper chambers (atria) and the two lower chambers (ventricles). Arteries carry oxygenated blood away from the heart to the body, and veins carry deoxygenated blood back to the heart from the body. Systole is the contraction of the heart chamber for pumping, and diastole is relaxation of the heart chamber for filling. The heart is supplied with blood by the coronary arteries.

Key terms

systole

the phase of the cardiac cycle in which a chamber is contracting or pumping

diastole

the phase of the cardiac cycle in which a chamber is relaxing or filling

capillaries

small blood vessels that run between arteries and veins and allow oxygen perfusion and nutrient exchange; singular, capillary

arteries

blood vessels that carry oxygenated blood away from the heart and to the tissues for perfusion; singular, artery

veins

blood vessels that carry deoxygenated blood back to the heart

atria

the two upper chambers of the heart; singular, atrium

heart

supplied with blood by the coronary arteries

ventricle

one of the two lower chambers of the heart

Chapter 17

Antidysrhythmic Drugs

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Summary

Dysrhythmia s, also known as arrhythmias , occur when there is abnormal automaticity (spontaneous impulse generation) or abnormal conduction that results in a problem with the heart rate and/or rhythm. Medications address dysrhythmias by manipulating the electrolytes and other receptors involved in the cardiac conduction system to either treat the manifestations of the underlying arrhythmia or restore a normal heart…

Key terms

cardioversion

restoration of a normal heart rhythm in a client with a dysrhythmia

dysrhythmia

an abnormal heart rate or rhythm; also called arrhythmia

vagal maneuver

physical manipulation that can increase parasympathetic activation to treat various arrhythmias

torsade de pointes

a dangerous ventricular tachycardia associated with medications that prolong the QT interval

Vaughan Williams classification system

a method of classifying antidysrhythmic drugs based on their primary mechanism of action

supraventricular tachycardia

a dysrhythmia that originates from a location above the ventricle

ventricular tachycardia

a dysrhythmia that originates from a location in the ventricle

Chapter 18

Antihypertensive and Antianginal Drugs

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Summary

Drug classifications covered included ACE inhibitors, ARBs, beta-adrenergic blockers, calcium channel blockers, diuretics, and nitrates.

Key terms

angina

chest discomfort in the front of the chest, neck, shoulders, jaw, or arms that is precipitated by physical exertions and relieved by rest or sublingual nitrates

antianginal drugs

drugs used in the treatment of angina

hypertension

when an individual’s blood pressure is above the normal limits for a sustained period of time

aldosterone

a hormone made in the adrenal cortex that helps to control the balance of water and salts in the kidneys, retaining sodium and releasing potassium from the body

beta-adrenergic blocker

a classification of drug that inhibits chronotropic, inotropic, and vasoconstrictor response to catecholamine, epinephrine, and norepinephrine by exerting effects on adrenergic…

calcium channel blocker

a classification of drug that blocks calcium from entering cells by binding to long-acting voltage-gated calcium channels in the heart, smooth muscle, and pancreas

diuretic

a classification of drug that induces sodium loss and increases urine flow; typically used to treat hypertension, heart failure, and volume overload states

nitrate

a classification of drug that causes vasodilation of blood vessels by imparting nitric oxide, which relaxes smooth muscles

Chapter 19

Heart Failure Drugs

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Summary

Stroke volume is composed of preload, afterload, and contractility. Drug classifications covered included angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), angiotensin receptor/neprilysin inhibitors (ARNIs), mineralocorticoid receptor inhibitors… Heart failure is a decrease in cardiac output. Heart rate and stroke volume are two components of cardiac output.

Key terms

heart failure

a clinical syndrome that occurs when the heart does not generate adequate cardiac output

angiotensin II

a protein in the blood that causes the muscular walls of the arterioles to constrict and narrow, thereby increasing blood pressure

angiotensin-converting enzyme (ACE) inhibitor

a classification of drugs that block the body’s production of angiotensin II; causes vasoconstriction and inhibits the reuptake of norepinephrine, which stimulates catecholamine…

cardiac output

the product of the heart rate and stroke volume, or the amount of blood ejected with each heartbeat in a given period of time

stroke volume

the volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction

angiotensin I

a protein in blood that promotes aldosterone secretion and raises blood pressure

afterload

the amount of force the left ventricle must push against

contractility

the ability of the ventricle to squeeze or pump blood

Chapter 20

Anticoagulant, Antiplatelet, and Thrombolytic Drugs

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Summary

It examined the various medications for prevention and treatment of thromboembolism. Anticoagulant mediations were summarized, including both injectable and oral forms. Special attention was paid to client education on warfarin therapy and enoxaparin injection technique.

Key terms

thrombolytics

drugs that dissolve existing clots

complete blood count

laboratory blood test that measures the amount of red blood cells, white blood cells, hemoglobin, hematocrit, and platelets

partial thromboplastin time (PTT)

laboratory test obtained via venous blood sample that provides a measurement of the length of time the blood takes to clot

international normalized ratio

provides another measurement of the length of time the blood takes to clot, calculated using the prothrombin time (PT)

anticoagulants

drugs that work in different parts of the coagulation cascade to decrease the propensity of the blood to form a clot

heparin-induced thrombocytopenia (HIT)

major complication of heparin therapy characterized by a decrease in platelets and concomitant hypercoagulable state

prothrombin time (PT)

a measurement of the time it takes to form a clot; used to calculate the international normalized ratio (INR)

pulmonary embolism (PE)

a clot that has typically formed in a vein but has broken off and lodged in the vasculature of the lungs

Chapter 21

Lipid-Lowering Drugs

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Summary

It introduced lipoproteins, including their metabolism and their connection to CAD. Many classes of lipid-lowering medications were described, along with salient nursing implications and client education

Key terms

lipoproteins

combinations of lipids and proteins that carry cholesterol and triglycerides in the blood

cholesterol

major sterol in the body; important for the structure of cell membranes and the production of hormones, bile acids, and vitamin D

chylomicrons

lipoproteins produced by enterocytes in the gut; carry triglycerides to the tissues after dietary consumption

familial hypercholesterolemia

genetic disorder that manifests as very high cholesterol levels that can cause early cardiovascular disease

triglycerides

main dietary source of fat; composed of three long fatty acid chains attached to a glycerol backbone

pleiotropic effects

additional beneficial effects of statin medications unrelated to their lipid-lowering effects

Chapter 22

Cardiac Emergency and Shock Drugs

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Summary

Medications used include nitrates, opioid agonists, multiple types of antiarrhythmic drugs, adrenergic agonists, anticholinergics, and intravenous fluids to increase intravascular volume in a client in shock Cardiac emergencies can arise from problems within the heart’s electrical system or mechanical system and include AMI, unstable angina, and dysrhythmias. Both conduction problems and mechanical problems can affect cardiac output and become life-threatening.

Key terms

shock

decreased tissue perfusion to the point of hypoxia, which causes cells to undergo anaerobic metabolism; if not reversed, will lead to cell and tissue death

angina

discomfort in the front of the chest, neck, shoulders, jaw, or arms that is precipitated by physical exertion and is relieved by rest or sublingual nitrates

nitrate

a classification of drugs that cause vasodilation of blood vessels by imparting nitric oxide, which relaxes smooth muscles

anticholinergic

having the effect of inhibiting the cholinergic receptors, which then inhibits the parasympathetic nervous system

cardiac output

the product of the heart rate and stroke volume, or the amount of blood ejected with each heartbeat

adrenergic agonist

a drug that stimulates adrenergic receptors, resulting in sympathetic nervous system stimulation

opioid agonist

a drug that stimulates the opioid receptors and decreases pain sensations

dysrhythmia

an irregular heart rhythm

Chapter 23

Introduction to the Respiratory System

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Summary

Upper respiratory disorders include pharyngitis (sore throat), rhinitis, and sinusitis. The lungs are where gas exchange takes place to provide the body with oxygen and expel carbon dioxide The upper respiratory system brings air into the body and warms that air before it enters the lungs. The lower respiratory system consists of the trachea and the lungs, which include the bronchi and bronchioles.

Key terms

lungs

where gas exchange takes place to provide the body with oxygen and expel carbon dioxide

rhinitis

inflammation and swelling of mucous membranes in the nose

pharyngitis

inflammation of the pharynx; also known as a sore throat

gas exchange

when oxygen moves from the lungs into the bloodstream

sinusitis

infection of the lining of the sinuses

pulmonary function tests (PFTs)

noninvasive tests that show how well the lungs are working

chronic obstructive pulmonary disease (COPD)

a group of diseases that cause airflow blockage and breathing problems; includes emphysema and chronic bronchitis; also known as chronic obstructive pulmonary disorder

sinus cavities

four air-filled, interconnected cavities located between the eyes and nose; produce and circulate mucus

Chapter 24

Upper Respiratory Disorder Drugs

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Summary

Many of these medications are available over the counter and are widely used by clients. The nurse should remind clients to check the labels of medications that they are taking to avoid ingesting too much of a particular medication It is important to understand the appropriate use for each of these drugs and how they assist clients with respiratory disorders.

Key terms

histamines

chemicals in body cells that are responsible for many of the symptoms of allergies

mucolytics

drugs that help to clear mucus from the upper and lower airways of the respiratory system

decongestants

drugs used to relieve nasal congestion caused by respiratory disorders

expectorants

drugs that help to clear mucus from the airway

antitussives

drugs used to relieve nonproductive coughs

antihistamines

drugs used to treat symptoms of allergies

Chapter 25

Lower Respiratory Disorder Drugs

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Summary

Each medication class has its unique role in managing lower respiratory conditions, and a combination of these medications may be used for optimal control of symptoms, prevention of exacerbations, and improved quality… Health care professionals should carefully consider the client’s individual needs, characteristics, and treatment goals when selecting and prescribing these medications

Key terms

beta adrenergic

activation or stimulation of beta-adrenergic receptors, which are found in various tissues throughout the body

norepinephrine

neurotransmitter and hormone as well as a medication that is used to increase and maintain blood pressure

leukotrienes

a group of inflammatory mediators that are primarily responsible for bronchoconstriction

acetylcholine

a neurotransmitter that contracts smooth muscles, dilates blood vessels, increases bodily secretions, and reduces heart rate

sympathomimetic

producing physiological effects characteristic of the sympathetic nervous system by promoting the stimulation of sympathetic nerves

pulmonary fibrosis

a lung disease that occurs when lung tissue becomes damaged and scarred, making it difficult for lungs to work properly

asthma

a respiratory disease that affects the lungs and causes repeated episodes of wheezing, breathlessness, and coughing

mast cells

cells that play a role in the immune system and help control immune responses; contain chemicals such as histamine

Chapter 26

Hypothalamus, Pituitary, and Adrenal Disorder Drugs

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Summary

Overall, the hypothalamus, pituitary, and adrenal cortex play critical roles in the regulation of many physiological processes in the body. The hypothalamus is a small region of the brain that plays a key role in the regulation of many physiological processes in the body including hunger, thirst, and body temperature. It is also responsible for the regulation and release of pituitary hormones from the pituitary gland, which is sometimes referred to as the “master gland” because it controls the release of hormones from other…

Key terms

hypothalamus

a region in the forebrain that coordinates the autonomic nervous system and pituitary gland activity

pituitary gland

a pea-sized gland located at the base of the brain that is part of the endocrine system, also known as the master gland

adrenal cortex

the outer portion of the adrenal glands that produce hormones, which support vital body functions

diabetes insipidus

a disease in which the secretion of or response to vasopressin is impaired, resulting in the production of large quantities of hypotonic urine

mineralocorticoids

steroids that are involved in maintaining fluid, sodium, and potassium balance within the body

vasopressin

a nonapeptide synthesized by the hypothalamus and stored in the posterior pituitary, also known as ADH or human vasopressin, which helps to regulate fluid volume

endocrine system

a messenger system of glands and organs that produce and release hormones to maintain homeostasis within the body

Chapter 27

Thyroid and Parathyroid Disorder Drugs

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Summary

Thyroid, antithyroid, calcium, vitamin D, bisphosphonates, calcimimetics, and peptide hormone drugs were presented and discussed, along with nursing implications and client education The structure and function of the thyroid and parathyroid glands were covered, along with diagnostic testing that involves hormones associated with those structure functions. A brief pathophysiology was provided for hypothyroidism, hyperthyroidism, hypoparathyroidism, and hyperparathyroidism.

Key terms

thyroid gland

a butterfly-shaped gland located in front of the neck below the voice box that is responsible for metabolism and iodine homeostasis within the body

calcimimetics

drugs that mimic the action of calcium in the parathyroid glands or other tissues

bisphosphonates

pyrophosphate analogues that inhibit bone resorption and increase bone density

thyroglobulin

a protein present in the thyroid gland from which thyroid hormones are synthesized

myxedema coma

a rare life-threatening condition caused by advanced hypothyroidism that affects the body’s temperature, growth, heart rate, and metabolism

organification

the biochemical process that takes place in the thyroid gland, involving the incorporation of iodine into thyroglobulin for the production of thyroid hormone

thyroxine (T4)

a hormone released by the thyroid gland that contains iodine and that increases the rate of chemical reactions within cells

triiodothyronine (T3)

a hormone released by the thyroid gland that plays a role in controlling the body’s metabolic rate, heart and digestive functions, muscle control, brain development and function…

Chapter 28

Diabetic Drugs

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Summary

Type 1, type 2, and gestational diabetes were defined, along with the importance of recognizing the difference between hypoglycemia and hyperglycemia. Specific diagnostic tests for diabetes were described.

Key terms

hyperglycemia

a condition that occurs when the blood glucose level in the body is above the normal range of 70-110 mg/dL and the body has too little insulin or is insulin resistant, making it…

diabetes

a disease that results from a deficiency in insulin that leads to alterations in the metabolism of glucose, fats, and proteins

insulin

a hormone released by β cells from the islets of Langerhans in the pancreas after eating a meal that helps the body’s cells absorb glucose for energy

hypoglycemia

a condition that occurs when the blood glucose level in the body falls below the normal range of 70-110 mg/dL

basal insulin dosing

an important component in diabetes management because it acts as a background insulin that is designed to stabilize blood glucose levels during times of fasting

insulin pen

a pen-shaped injector device that combines insulin and a syringe in one unit; insulin pens are prefilled with an insulin cartridge or have a prefilled insulin reservoir

non-insulin injectable diabetes drugs

drugs that provide an alternative to insulin therapy for those with type 2 diabetes; they act on hormones that are secreted along with insulin by the pancreas to control glucose…

peak time

the time during which insulin is at its maximum strength in terms of lowering blood glucose levels; individuals are at a higher risk of developing hypoglycemic symptoms when…

Chapter 29

Introduction to the Digestive System

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Summary

The complex processes of ingestion, digestion, absorption, and metabolism require properly functioning GI structures. The overall process was described, from mastication of food through evacuation of stool. Medications are often essential to promote a healthy, functioning GI system and to augment nutrition

Key terms

digestion

the process by which food is broken down mechanically and chemically in the gastrointestinal tract and converted to absorbable forms

mastication

chewing; involves coordination of the large temporal, masseter, and pterygoid muscles as well as other smaller muscles of the mandible and tongue to grind food under the…

absorption

the passage of digested products from the intestinal lumen through mucosal cells and into the bloodstream or lacteals

ingestion

the process of taking substances (particularly food) into the gastrointestinal tract

metabolism

sum of all of the body’s chemical reactions

chyme

the mixture of partly digested food and digestive secretions found in the stomach and small intestine during the digestion of a meal; it is a varicolored, thick, nearly liquid mass

amylase

an enzyme in the saliva and pancreatic juice that catalyzes the breaking down of starch, glycogen, and related polysaccharides into more simple and readily usable forms of sugar

epiglottis

the uppermost cartilage of the larynx located immediately posterior to the root of the tongue; covers the entrance of the larynx when a person swallows and prevents food or…

Chapter 30

Gastrointestinal Disorder Drugs

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Summary

Antiemetics, antidiarrheals, and laxatives may only be temporary solutions until the primary cause is discovered and treated While treatment of the GI symptom is a priority, providers should explore the potential causes of the symptoms. The text also noted that the GI system is vulnerable to fluid and electrolyte imbalances from GI disturbances as well as GI medications.

Key terms

GI symptom

a priority, providers should explore the potential causes of the symptoms

antiemetics

medications that prevent or treat nausea and vomiting

antidiarrheals

medications used to treat and manage diarrhea

laxatives

medications used to treat constipation

anticholinergic effects

common effects such as dry mouth, dry eyes, blurred vision, urinary retention, constipation, and cognitive dysfunction resulting from the blockade of cholinergic receptors

chemoreceptor trigger zone (CTZ)

an area of neural receptors on the floor of the fourth ventricle of the brain within the dorsal surface of the medulla oblongata that communicates with the vomiting center for…

extrapyramidal symptoms

dysfunctional involuntary movements such as akathisia (restlessness and/or tapping or jiggling of fingers or legs), dystonia (painful involuntary muscle contractions)…

Chapter 31

Hyperacidity and Antiulcer Drugs

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Summary

The most common symptoms include heartburn, burning abdominal pain, and regurgitation, and they are often related to excess acidity in the GI tract.

Key terms

hyperacidity

a condition in which the level of gastric acid/hydrochloric acid is excessive, causing GI discomfort

hydrochloric acid (HCl)

a strong acid that is a component of gastric juices

neutropenia

abnormally few neutrophils in the blood, leading to possible infection; an undesirable side effect of some cancer treatments

peptic ulcer disease (PUD)

open sores that develop on the inside lining of the stomach and the upper portion of the small intestine from excessive acid or corrosive chemicals/medications

gastroesophageal reflux disease (GERD)

a condition in which acidic gastric fluid flows backward into the esophagus, resulting in frequent dyspepsia/heartburn

alopecia

loss of hair usually of the scalp in round patches, but may occur anywhere on the body where hair normally grows

prostaglandins

a naturally occurring compound in the body that protects the stomach lining from acid

Zollinger-Ellison syndrome

a rare medical condition characterized by excessive production of stomach acid

Chapter 32

Weight Management Drugs

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Summary

Despite the availability of OTC and prescribed weight-loss drugs and supplements, the chapter discussed how the best strategy for weight loss is lifestyle modifications, such as exercise and caloric restriction, as a… Once a healthy weight is achieved, clients must continue to practice healthy habits to maintain weight management

Key terms

overweight

a body mass index between 26 and 29 kg/m 2 ; having a weight higher than what is expected for a person’s age, sex, height, and build

healthy weight

achieved, clients must continue to practice healthy habits to maintain weight management

obesity

a body mass index of 30 kg/m 2 or higher; an unhealthy accumulation of body fat

lipase

an enzyme that breaks down ingested fat into fatty acids in the GI tract

best strategy for weight loss

lifestyle modifications, such as exercise and caloric restriction, as a…

lipase inhibitor

substances used to reduce the activity of lipases found in the GI tract

obesity hypoventilation syndrome

a respiratory consequence of obesity that is characterized by alveolar hypoventilation during sleep and wakefulness

clean eating

eating foods that are in their natural state with no chemical additives or preservatives

Chapter 33

Introduction to the Renal and Urinary Systems

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Summary

The text explained that the nephron is the functional unit of the kidney, and each section of the nephron is responsible for some part of filtration, reabsorption, or secretion. It is also responsible for removing metabolic waste products and excess water from the body. Common conditions affecting these systems were identified.

Key terms

renal pelvis

funnel-shaped area of the kidney that collects urine and is connected to the ureter

micturition

the process through which urine is released from the bladder

blood urea nitrogen (BUN)

a blood test that measures the amount of urea nitrogen in the blood; elevated levels can indicate decreased renal function

mesangial cells

cells that increase the body surface area for glomerular filtration by limiting the size of molecules that can be filtered

glomerular filtration rate (GFR)

the rate at which the kidneys filter the blood, calculated using the results of blood tests that measure renal function

hilum

indentation on the medial side of the kidney that allows blood vessels, lymphatic vessels, and nerves to enter and exit

vasa recta

long, hairpin-shaped blood vessels that run parallel to the loops of Henle and facilitate water reabsorption

Chapter 34

Diuretic Drugs

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Summary

The drugs are used individually or in combination with other diuretics to treat congestion associated with heart failure, ascites due to cirrhosis, pulmonary congestion, increased intracranial and intraocular pressure… Loop diuretics increase urinary output by blocking the reabsorption of sodium in the (thick) ascending loop of Henle. These drugs work by inhibiting the action of the Na-K-2Cl (NKCC2) cotransporters in the luminal membrane, thereby inhibiting sodium and chloride reabsorption and triggering losses of potassium and magnesium

Key terms

drugs

used individually or in combination with other diuretics to treat congestion associated with heart failure, ascites due to cirrhosis, pulmonary congestion, increased intr

loop diuretics

drugs that interrupt the reabsorption of sodium and water in the loop of Henle, resulting in increased urinary output

potassium-sparing diuretics

drugs that interrupt sodium and water reabsorption while retaining potassium and increasing urinary output

ascites

abnormal fluid present between the peritoneum and the abdominal organs

osmotic diuretics

drugs that draw fluid from the cells by increasing osmotic pressure

acute kidney injury (AKI)

a decrease in kidney function that has an abrupt onset and is possibly reversible, manifested by decreased urine output and/or increased serum creatinine; previously known as…

chronic renal disease (CRD)

a state of progressive decline of kidney function from a glomerular filtration rate of 59 mL/minute/1.73 m 2 to a glomerular filtration rate of less than 15 mL/minute/1.73 m 2

diuretic resistance

the state in which the maximum dose of a loop diuretic fails to produce the anticipated effect on fluid volume status because successive doses of the drug trigger hypertrophy of…

Chapter 35

Urinary and Bladder Disorder Drugs

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Summary

Urinary and bladder disorder drugs play a crucial role in the treatment of various conditions that affect the urinary system and bladder. These medications are designed to address specific symptoms or underlying conditions of these disorders, aiming to alleviate the individual’s discomfort and enhance the overall function of their urinary system In this chapter, a comprehensive analysis of commonly used urinary and bladder disorder drugs was presented.

Key terms

urinary analgesics

a class of drugs used to relieve pain and discomfort associated with the urinary tract

urinary stimulants

a class of drugs that stimulate the smooth muscles of the urinary bladder

anti-infectives

a class of drugs that work to prevent or treat infections

erythema multiforme

a skin disorder characterized by bulls-eye-shaped lesions (a pink center surrounded by a pale border and outer pink ring) that are painful and itchy

interstitial cystitis

a disorder that causes the bladder to store urine before it is passed out of the body, resulting in bladder pain and pressure

antispasmodics

a class of drugs that are used to control spasms of the stomach, intestines, and bladder

anticholinergics

a class of drugs that block the action of acetylcholine, thereby inhibiting nerve impulses responsible for involuntary muscle movements

antimuscarinics

a class of drugs that decrease smooth muscle motility in the urinary tract, increasing the tone of the urinary sphincter and controlling urination

Chapter 36

Reproductive Health Drugs

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Summary

Hormonal drugs are used to replace low levels of natural hormones, treat some types of cancers, prevent pregnancy, minimize symptoms of menopause, and treat debilitated clients who need tissue building and increased… Major ovarian hormones include estrogen, progestin, FSH, LS, and GnRH. Nurses must be aware of the intricate ways in which hormones are interrelated and affect health and illness overall

Key terms

estrogen

primary hormone released by the ovaries; initiates the development of female genitalia and breast tissue

pregnancy

the period of time a fetus grows inside the uterus

menopause

the cessation of monthly cycles for one year

combined oral contraceptives (COCs)

contraceptive drugs that contain both estrogen and progestin in varying dosages; the three categories are monophasic (contain a fixed ratio of estrogen and progestin), biphasic…

hypogonadism

condition in which testes are undeveloped and the development of sex organs and secondary sex characteristics is delayed or absent

sexually transmitted infections (STIs)

infections involving internal and external sex organs that are transmitted by sexual intercourse or intimate contact with sex organs; may be viral, bacterial, or fungal

implanted contraceptive devices

devices containing a hormone that are place under the skin of the inner upper arm for the purpose of contraception

Chapter 37

Transgender and Nonbinary Drugs

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Summary

The nurse who cares for transgender and nonbinary clients should determine which terms are appropriate or preferred for each client. The websites define terms, explore issues related to transgender and nonbinary individuals, and present information on community organizations that provide support

Key terms

transgender

a broad term used by individuals whose sex assigned at birth does not match the gender they feel they are

nonbinary

an individual whose gender identity does not fit into the man-woman dichotomy

gender identity

a person’s deeply held beliefs about who they are from a sexual perspective and with which, if any, gender they identify

gender nonconforming

a gender presentation that is outside the typical binary presentation; it can also define an individual who identifies outside the man-woman binary

cisgender

individuals whose sex assigned at birth and gender identity are congruent

gender dysphoria

a deep sense of unease, anxiety, or discomfort that may occur in people whose gender does not align with their sex assigned at birth

transsexual

a term that sometimes may be used interchangeably with transgender to indicate an individual whose sex assigned at birth and gender identity do not match

Chapter 38

Ophthalmic Drugs

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Summary

Medications covered in this chapter included ocular anti-inflammatories, anti-infectives (antibacterials, antivirals, antifungals), anesthetics, lubricants, and drugs used to treat or manage glaucoma. The eye itself can have ocular pathology, such as infection.

Key terms

glaucoma

group of diseases caused by obstruction or excess production of aqueous humor, resulting in loss of peripheral vision

astigmatism

when the cornea or lens is curved more steeply in one direction, causing light to focus on multiple points of the retina

aqueous humor

fluid typically produced in the posterior chamber of the eye, which nourishes the internal structures and maintains a homeostatic eye pressure

canaloplasty

eye surgery that uses a microcatheter to cannulate Schlemm’s canal in order to restore aqueous humor outflow to lower intraocular pressure

hyperopia

a condition in which light refracts behind the retina, resulting in close objects appearing blurry and far objects being clearly seen; also known as farsightedness

internal ocular structures

structures inside the eye responsible for light accommodation, eye color, fluid to support eye pressure homeostasis, and the optic nerve

myopia

a condition in which light refracts in front of the retina, resulting in far objects appearing blurry and near objects being clearly seen; also known as nearsightedness

presbyopia

a condition that occurs as one ages; the lens thickens and becomes less elastic, which makes it difficult for the eyes to accommodate

Chapter 39

Otic Drugs

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Summary

Decongestants are used to reduce swelling and congestion in the Eustachian tube, aiding in the treatment of middle ear problems. The middle ear contains the ossicles (small bones), which amplify sound, and the inner ear houses the cochlea, responsible for converting sound into electrical signals sent to the brain Otic anti-inflammatories are used to reduce inflammation and relieve pain in the ear, particularly for conditions like otitis externa. Oral antihistamines help alleviate allergy-related ear symptoms, such as itching and congestion.

Key terms

decongestant

a medication that shrinks swollen blood vessels and tissues in the nose to reduce nasal congestion and aid in relieving ear congestion

ossicles

three small bones in the middle ear, consisting of the malleus, incus, and stapes, that transmit oscillatory vibrations from one small bone to another; the stapes sends sound to…

otitis externa

inflammation and/or infection of the external ear canal characterized by itchiness, pain, and a red ear canal

ear

a complex organ divided into three main parts: the outer ear, middle ear, and inner ear

antihistamine

medication that relieves allergy symptoms, including stuffy nose and watery eyes

Eustachian tube

connects the middle ear to the nasal-sinus cavity

malleus

one of three small bones in the middle ear; it is located closest to the tympanic membrane and transmits auditory oscillations to the incus

cochlear nerve

one of two bifurcated nerves branching from the vestibulocochlear nerve; it transmits signals from the cochlea to the temporal lobe in the brain so sound can be heard

Chapter 40

Dermatologic Disorder Drugs

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Summary

A brief introduction to each condition, specific drug treatments, routes, dosages, adverse effects, nursing interventions, and client teaching have been discussed. Additionally, a special focus on disparities in the diagnosis and treatment of skin conditions and the psychological implications of skin disorders has been included

Key terms

contact dermatitis

an acute inflammatory skin reaction to an aggravating factor resulting in local redness, itching, and fluid-filled vesicles

impetigo

a cutaneous bacterial infection that develops as a honey-colored crust on the skin surface

rosacea

a reddened facial rash characterized by broken blood vessels and small red bumps

psoriasis

a systemic condition of the skin resulting from increased skin cell mitosis

atopic dermatitis (eczema)

a long-term, systemic inflammatory response mediated by both genetic and environmental factors expressed as patchy, red, inflamed lesions

acne vulgaris

a skin condition in which skin pores and hair follicles become blocked, resulting in inflamed skin lesions

dermis

the innermost layer of the skin, composed of two sublayers, found between the epidermis and hypodermis

papillae

fingerlike projections that extend from the dermis into the epidermis and hold the two layers together