HOW TO USE

the Pearson Nurse’s Drug Guide 2010

Classifications and Prototype Drugs

The classifications used in this bookare based on the system used by theAmerican Hospital Formulary Service(AHFS). This book further classifiesdrugs by therapeutic uses, enablingthe nurse to identify drugs in thesame class that have similar indica-tions for use. Thus, the book pro-vides a framework for understandinghow drugs in a given class are usedin clinical practice. The pharmaco-logic classification appears immedi-ately after the

Classifications

head-ing, followed by the

Therapeutic

classification. In general, all drugs in aclass will have similar actions, uses, adverse effects, and nursingimplications. Therefore, we have selected certain drugs that are represen-

tative of a classification or its subclassification—

prototypedrugs

—to aid the nurse in understanding the classification ofdrugs. Prototype drug monographs are identified with a small

icon. The user can refer to the prototype drug to develop a betterunderstanding of drugs that belong within the same classification orsubclassification. When a drug belongs to a classification that has adesignated prototype drug, that prototype is identified directly below thetherapeutic classification. The table on pages xi–xviii identifies the drugprototype considered to be representative of each class. All prototypedrugs are highlighted in

bold

type in the index for quick identification.Some drugs have a unique mechanism of action or therapeutic effect. Inthese cases, there is no prototype drug to be identified.

Pregnancy Category

Drugs may be described as category A, B, C, D, or X according to therisk to the fetus, with A being the lowest and X the highest risk. If theFDA pregnancy category is known, it is indicated after the Therapeuticclassifications. Refer to Appendix C,

FDA Pregnancy Categories

, for amore complete description of each category.

Controlled Substances

In the United States, controlled substances are classified as belonging toone of five Schedules (I to V) according to abuse potential. If a drug isa controlled substance, then its Schedule number is listed below the

Pregnancy Category. Schedule I has the highest and Schedule V has thelowest potential for abuse. Refer to Appendix B,

U.S. Schedules ofControlled Substances

, for a more complete description of each schedule.

Availability

Because drugs come in a variety ofdosages and forms, the authors includea section devoted to Availability ineach monograph. This section identifies the available forms (e.g., tablets,capsules) and the available dosage strengths for every drug.

Action and

Therapeutic Effect

Each monograph describes themechanism by which the specificdrug produces physiologic andbiochemical changes at the cellular,tissue, and organ levels. This infor-mation helps the user understandhow the drug works in the bodyand makes it easier to learn its sideeffects, adverse reactions, and cau-tious uses. The

therapeutic effects

,which are set in italics for clarity

and ease of use, are the reasons why a drug is prescribed. Therapeuticeffectiveness of the drug can be determined by monitoring improvementin the condition for which the drug is prescribed.

Uses and Unlabeled Uses

The therapeutic applications ofeach drug are described in termsof approved (i.e., FDA-labeled)uses and unlabeled uses. An unla-beled use is one that does notappear on the drug label or in themanufacturer’s literature. Althoughcurrently supported by medicalliterature, unlabeled uses are notcurrently approved by the FDA.

Contraindications and Cautious Use

Many drugs have contraindicationsand therefore should not be usedin specific conditions, such as dur-ing pregnancy or with particulardrugs or foods. In other cases, thedrug should be used with greatcaution because of a greater thanaverage risk of untoward effects.

Route and Dosage

The routes and dosages are high-lighted in a gray box for easyaccess. Route of administration isspecified as SC, IM, IV, PO, PR,nasal, ophthalmic, vaginal, topical,aural, intradermal, or intrathecal.Dosages are listed according toindication or labeled use. One ofthe hallmarks of this drug guide isthe comprehensive dosage infor-mation it provides. The guideincludes adult, geriatric, and pedi-atric dosages, as well as dosagesfor neonates and infants wheneverapplicable. This section also indi-cates dosage adjustments for renalimpairment (based on creatinineclearance), patients undergoinghemodialysis, hepatic impairment,and obese patients (based on idealbody weight). Information aboutthe need for dosage adjustmentsbased on pharmacogenetic vari-ables is provided as available.

Administration

Drug administration is an importantprimary role for the nurse. Orga-nized by different routes, this sec-tion lists comprehensive instruc-tions for administering, handling,and storing medications.

Intravenous Drug Administration

Within the

Administration

sectionof appropriate monographs, theauthors highlight intravenous drugs,indicated by a vertical red bar.This section provides users withcomprehensive instructions on howto

Prepare

and

Administer

direct, intermittent, and continuousintravenous medications. When dif-ferent from adults, intravenousadministration and preparation forpediatric patients is provided. Italso includes

Solution/Additive

and

Y-Site

incompatibility for everymonograph, where appropriate, toindicate which drugs and solutionsshould not be mixed with theintravenous drug. This is crucialinformation for drug administra-tion. A chart for Y-Site compatibil-ity for common intravenous drugsis located inside the back cover ofthis drug guide. These enhance-ments eliminate the need for addi-tional resources for intravenousadministration.

Adverse Effects

Virtually all drugs have adverseside effects that may be bother-some to some individuals butnot to others. Adverse effectswith an incidence of

≥

1% arelisted by body system or organs.The most common adverseeffects appear in

italic

type,whereas those that are life-threatening are underlined.Users of the drug guide will finda key at the bottom of everypage as a quick reminder.

Diagnostic Test Interference

This section describes the effectof the drug on various diagnos-tic tests and alerts the nurse topossible misinterpretations oftest results when applicable.The name of the specific testaltered is highlighted in

bolditalic

type.

Interactions

When applicable, this section listsindividual drugs, drug classes,foods, and herbs that interact withthe drug discussed in the mono-graph. Drugs may interact toinhibit or enhance one another.Thus, drug interactions mayimprove the therapeutic response,lead to therapeutic failure, or pro-duce specific adverse reactions.Only drugs that have been shownto cause clinically significant anddocumented interactions with thedrug discussed in the monographare identified. Note that genericdrugs appear in

bold

type, anddrug classes appear in

SMALL

CAPS

.

Pharmacokinetics

This section identifies how thedrug moves throughout thebody. It lists the mechanisms ofabsorption, distribution, metabo-lism, elimination, and half-lifewhen known. It also providesinformation about onset, peak,and duration of the drug action.Where appropriate, informationappears for protein-binding andCYP450 metabolism.

Nursing Implications

Under the headings

Assessment & Drug Effects

and

Patient & FamilyEducation

, the nurse can quickly and easily identify needed informationand incorporate it into the appropriate steps of the nursing process.Before administering a drug, the nurse should read both sections todetermine the assessments that should be made before and after administra-tion of the drug, the indicators of drug effectiveness, laboratory testsrecommended for individual drugs, and the essential patient and/or familyeducation related to the drug.

Therapeutic Effectiveness

Therapeutic effectiveness of a drugcan be determined by monitoringimprovement in the condition forwhich the drug is prescribed, andby using the

Assessment & DrugEffects

section. Drugs have multi-ple uses or indications. Therefore, itis important to know why a drug isbeing prescribed for a specificpatient (

Uses

and

Unlabeled Uses

).In the italicized sentences at the endof the

Action &

TherapeuticEffect

section in all monographs,specific indicators of the effective-ness of the drug are provided.Additionally, in the

Route & Dos-age

table for each drug, the dosagesare listed according to the indica-tions for FDA-labeled use(s) of thedrug. Furthermore, the

Therapeu-tic

classifications listed within thered box at the beginning of the monograph provides the nurse withfurther assistance in determining and evaluating the therapeutic effective-ness of the drug.