Basic Pharmacology For Nurses, 15th Edition Solution Manual

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Chapter1:Definitions, Names, Standards, and Information SourcesAnswers to Critical Thinking Questions1. Differentiate among generic, trade, brand, and proprietary names assigned to medicines.The generic name or common name is given to a drug before it becomes official. It may be usedby any manufacturer and in any country. The first letter is not capitalized. Nurses are stronglyencouraged to learn and refer to drugs by their generic name,becauseformularies are maintainedby generic names. When a therapeutically equivalent drug is available in generic form, a genericmedicine is routinely substituted for the brand name medicine.The trademark, brand name, or propriety name is followed by the symbol ®. This indicatesthat the name is registered and that its use is restricted to the owner of the drug, who is usuallythe manufacturer. These names are easier to pronounce, spell, and remember, and the first letteris capitalized.2. Describe the different ways drugs may be classified.Body systemthatthey affect (e.g., drugs affecting the central nervous system)Therapeutic use or clinical indications (e.g., antacids, antibiotics)Physiologic or chemical actions (e.g., anticholinergics)Prescription or nonprescription (over-the-counter [OTC] drugs). Prescription drugsrequire an order by a health professional who is licensed to prescribe, such as a physician,nurse practitioner, or pharmacist. Nonprescription drugs are sold without a prescription ina pharmacy or the health section of department or grocery stores.Illegal drugs,sometimes referred to asrecreational drugs, are used for nontherapeuticpurposes, have been obtained illegally, or have not received approval for use by theU.S.Food and Drug Administration (FDA).3. Prepare a list of books used as drug resources.United States drug resources:American Drug IndexAmerican Hospital Formulary Service, Drug InformationDrug Interaction FactsDrug Facts and ComparisonsHandbook on Injectable DrugsMartindale—The Complete Drug ReferenceNatural Medicines Comprehensive DatabasePhysician’s Desk Reference (PDR)Canadian drug resources:Compendium of Pharmaceuticals and Specialties (CPS)Patient Self-Care: Helping Patients Make Therapeutic ChoicesCompendium of Self-Care Products4. Discuss implications of herbal product use and the importance of checking for drug-herbal interactions.

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Herbal products are being used to treat many diseases and nutritional deficiencies. It is importantfor patients to understand the uses, safety, effectiveness, mechanism of action,active ingredients,adverse reactions, interactions, and dosage and administration. This information can be obtainedthrough sources such as theNatural Medicines Comprehensive Database.5. Describe the drug approval process in the United States.a.Preclinical research.Discovery, synthesis, and purification of the drug.b.Clinical research and development.Phase 1 determines a drug’s pharmacologic properties.These studies require 20 to 100 subjects who take the drug for 4 to 6 weeks. Phase 2 studiesinvolvesmaller patient populations who have the condition that the drug is designed to treat.Phase 3 studiesuselarger populations to ensure statistical significance of results; also,properdosing and safety are addressed.c.New Drug Application.When sufficient data demonstrate that the experimental drug is bothsafe and effective, the investigator submits a New Drug Application to the FDA. This isreviewed by a team of pharmacologists, toxicologists, chemists, physicians, and others (asappropriate),who then make a recommendation to the FDA. Once it is approved by the FDA, itis the manufacturer’s decision as to when to bring a product to the marketplace.d.Postmarketing surveillance.Ongoing review of adverse effects of the new drug,as well asperiodic inspections of the manufacturing facilities and products. Studies completed during thefourth phase include identifying other patient populationsfor whomthe drug may be useful,refining dosing recommendations, or exploring potential drug interactions. Health carepractitioners make a significant contribution to the knowledge of drug safety by reportingadverse effects of drugs to the FDA by using MEDWATCH.

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Clayton: Basic Pharmacology for Nurses, 15thEditionChapter2:Principles of Drug Action and Drug InteractionsAnswers to Critical Thinking Questions1. How do drugs interact with receptor sites in the body?Drugs form chemical bonds with specific sites called receptors in the body. This bond forms onlyif the drug and its receptor have similar shapes. This relationship is similar to that of a key and alock—the better the fit between the receptor and the drug molecule, the better the response. Theintensity of a drug response is related to how well the drug molecule fits into the receptor and tothe number of receptor sites that are occupied.2. Explain the differences among a drug agonist, partial agonist, and antagonist, and giveexamples of each.Agonist:Drugs that interact with a receptor to stimulate a drug response. Epinephrine-like drugsact on the heart to increase the heart rate, and acetylcholine-like drugs act on the heart to slowthe heart rate.Partial agonist:Drugs that interact with a receptor to stimulate a response but inhibit otherresponses.Antagonist:Drugs that attach to a receptor but do not stimulate a response.3. How do you calculate a drug’s half-life?Half-life is a measure of the time required for 50% of the drug to be eliminated from the body.The half-life is determined by an individual’s ability to metabolize and excrete a particular drug.The approximate half-lives of most drugs are not known.4. What stages does a drug go through in the process of pharmacokinetics?Absorption:The processwhereby a drug is transferred from its site of entry into the body to thecirculating fluids of the body for distribution.Distribution:The ways in which drugs are transported by the circulating body fluids to the sitesof action (receptors), metabolism, and excretion.Metabolism:Also calledbiotransformation; the processwhereby the body inactivates drugs. Theprimary site is the liver.Excretion:Elimination of drug metabolites. Two primary routes are the GI tract to the feces andthrough the renal tubules into the urine.5. Discuss the effects ofadverse drug reactions (ADRs)on individual patients and on thecosts of health care.Adverse drug reactions can contribute to death, cause admission to hospitals, and increasesuffering for the patient, which all lead to excess costs for the patient and the institutions.6. Investigate mechanisms used at your clinical site to report adverse drug effects.All hospitals have an internal mechanism for reporting suspected adverse drug reactions, andhealth professionals should not hesitate to report possible reactions. The FDA’s MEDWATCHprogram is also available for voluntary reporting of adverse events.

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7. What effects do body weight, body surface area, metabolic rate, and illness have on drugtherapy?Weight:Overweight patients may require an increase in dosage to attain the same therapeuticresponse. Patients who are underweight tend to require lower dosages for the same therapeuticresponse.Body surface area:Important when calculating chemotherapeutic agents.Metabolic rate:Patients with a higherthanaverage metabolic rate tend to metabolize drugs morerapidly, thus requiring larger doses or more frequent administration. The opposite is true forthose with lowerthanaverage metabolic rates.Illness:Any pathologic condition that could alter the rate of absorption, distribution, metabolism,and excretion (seep.22).8. Discuss the difference between bound and unbound drugs and the resultant effects ondrug action.Once a drug is absorbed into the blood, it is usually bound to plasma proteins. A drug that ishighly bound (e.g., 90%) to a protein-binding site may be displaced by another drug that has ahigher affinity for thebindingsite. Significant interactions can take place this way because littledisplacement is required to have a major impact. Only the unbound drug is pharmacologicallyactive. If a drug is 90% bound to a protein, then 10% of the drug is providing the physiologiceffect. If another drug is administered with a strong affinity for the protein-binding site anddisplaces just 5% of the bound drug, there is now 15% unbound for physiologic activity. This isthe equivalent of a 50% increase in dosage.

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Clayton: Basic Pharmacology for Nurses, 15thEditionChapter3:Drug Action Across the Life SpanAnswers to Critical Thinking Questions1. What terms are used to describe people at different points of the life cycle?Premature infant, newbornor neonate, infant (baby), young child, older child, adolescent, adult,older adult, elderly, the aged, the very old.2. The male patient would like to use his wife's prescription of a nonsteroidalanti-inflammatory drug, the same drug that the prescriber has recommended for his treatmentof joint pain. Discuss the gender differences that could affect this patient's outcome.Gender differences may affect drug absorption.Awoman’s stomach empties solids more slowlythan a man’s, thus slowing the absorption of certain types of medicines absorbed in the smallintestine. NSAIDs, for example, may potentiate gastric irritation with possible ulceration byremaining in contact with the stomach mucosa for a longer period of time.A slower gastricemptying time may allow a drug to stay in contact with the absorptive tissue longer, allowingmore absorption with a higher serum concentration. Adult women have a higher total body fat,which may potentiate drug toxicity for those drugs that are lipid soluble. The effect of differingconcentrations of enzyme systems based on gender differences willaffect the rate of drugmetabolism.3. Discuss variations of transdermal medication absorption of a patient categorized as “thevery old.”Transdermal administration in geriatric patients is often difficult to predict. Although dermalthickness decreases with aging and may enhance absorption, factors that may diminishabsorption occur, such as dryingandwrinkling. With aging, decreased cardiac output anddiminishing tissue perfusion may also affect transdermal drug absorption.4. Contrast the drug absorption of phenobarbital in the GI system of an 8-month-old infantwith that of a 73-year-old adult. Which patient would require a higher dose?Phenobarbital is a drug that depends on an acidic environment for absorption. This drug is notabsorbed as well in the older adult, resulting in lower serum concentrations of the drug.5. Compare the effect of enzyme systems on drug metabolism of the female patient withthat of the male patient.Metabolism is controlled by factors such as genes, diet, age,disease process,and maturity ofenzyme systems. Enzyme systems, primarily in the liver, are the major pathway of drugmetabolism. All enzyme systems are present at birth but mature at different rates, taking severalweeks to a year to developfully. Liver weight, the number of functioning hepatic cells,andhepatic blood flow decrease with age. This results in slower metabolism of drugs in older adults.Reduced metabolism can be seriously aggravated by the presence of liver disease or heart failure.It is recognized that males and females differ in the concentrations of some of these enzymesystems throughout life. The CYP3A4 component of the cytochrome P-450 system of enzymemetabolizes more than 50% of all drugs and is 40% more active in women. Some drugs aremetabolized more rapidly in women than in men.

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6. Discuss renal function levels in newborns, infants, adults, and older adults. What are thepossible effects on drug therapy?The primary routes of excretion of metabolites are through the renal tubules into the urine andthroughthe GI tract into the feces. At birth, a preterm infant has up to 15% of the renal capacityof an adult and a full-term newborn has approximately 35%. The filtration capacity of an infantincreases to about 50% of adult capacity at 4 weeks of age and is equivalent to full adult functionat 9 to 12 months. Drugs excreted primarily by the kidneys must be administered in increaseddosages or given more often to maintain adequate therapeutic serum concentrations as renalfunction matures. In older adults, physiologic changes take place in the kidneys,such asdecreased renal blood flow caused by atherosclerosis and reduced cardiac output, a loss ofglomeruli, and decreased tubular function and concentrating ability. There is a great degree ofindividual variation in changes in renal function and no prediction of renal function can be madesolely on the basis of a person’s age.With diminished renal function, lower drug dosages may beindicated.

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Clayton: Basic Pharmacology for Nurses, 15thEditionChapter4:The Nursing Process and PharmacologyAnswers to Critical Thinking Questions1. The nurseis updating patient care plans and determining appropriate nursing diagnosesfor each patient and his or her drug therapy. Write a nursing diagnosis for each of thefollowing patient disorders specific to drug therapy: (1) sleep disorder; (2) advanced heartfailure; and (3) dyslipidemia.The following could be used for all three disorders:Knowledge deficit related to the medication regimenNoncompliance related to the patient’s value system, cognitive ability, cultural factors, oreconomic resourcesSleep disorderoAnxiety related to conflict as evidenced by sleep disturbanceoFatigue related to sleep deprivation as evidenced by increase in rest requirementsAdvanced heart failureoDecreased cardiac output related to altered stroke volume as evidenced by fatigue,edema, shortness of breathoFluid volume excess related to compromised regulatory mechanism as evidencedby edema and jugular vein distentionDyslipidemiaoDeficient knowledge related to lack of information about dietary guidelines forincreased lipids2. Explain the components for performing a focused assessment on patients with each ofthe three conditions identified in question 1.Sleep disorderHow much sleepdo you average per night?How many times do you awaken each night?What types of food and beverages do you consume before bedtime?What type of environment facilitates sleeping or interferes with your sleep?Are you under any severe stress or have you experienced any life-changing eventsrecently?Are you feeling anxious or depressed?How long (days, weeks, months) has this problem been going on?What medications are you currently taking and have you taken any medications(including OTC or herbal medicines) to helpyousleep?Advanced heart failureDo you have any problems with breathing, edema, or fatigue?Are these problems aggravated by certain activities? If so, what are the activities?Do you understand the importance of taking yourmedicationsand the consequences ofdiscontinuing them?Do you have any dietary or fluid restrictions? If so, do you understand the purpose forthis?

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Do you know when to call the doctor if problems arise?If you are taking digoxin (Lanoxin), do you understand how to monitor your pulse andwhen to call the doctor?DyslipidemiaDo you understand the factors that lead to this problem?What is your normal dietary intake, including your daily fat intake?Do you understand the importance of regular exercise?What and how often do you exercise?Do you understand the complications that can occur from dyslipidemia?Is there a history of cardiac disease in your family?3. A patient inquires about the need for two blood tests to determine the dosage of anantibiotic. Explain the rationale for these tests.When used to adjust drug dosages, thesample forfirst blood test isdrawnat a specific time afterthe medicine is administered intravenously, such as 20 or 30 minutes after administration or 60minutes after oral administration. This drug level measures thepeak serum concentrationof thedrug. The other blood sample is drawn at a specific time (e.g., 30 minutes) before the next dose.The blood level at this time is known as thetrough level. The peak and trough levels areimportant to assess becausethey determinewhether peak levels are high enough to kill thespecific bacterial pathogen being treated. Trough levels determine whether the drug levels havefallen low enough between dosages to prevent toxicity. Peak and trough levels are particularlyimportant to assessforaminoglycoside antibiotic therapy (e.g., gentamicin, tobramycin).Blood tests, or diagnostic parameters, are frequently used to monitor drug therapy, establishdosages, and identify the most effective medication for pathogenic microorganisms. The nursereviews laboratory values for liver and kidney function, culture and sensitivity reports,therapeutic drug levels,andpeak and trough levels, as well as others specific to the prescribeddrug. The nurse and pharmacist review diagnostic tests to identify values that could have aninfluence on drug therapy, such as problems in absorption, distribution, metabolism, andelimination of the prescribed drug.4. The nurse is concerned that the patient is experiencing adverse effects of a recentlyprescribed drug. Identify appropriate resources that the nurse should use.The nurse should begin this process when obtaining the drug history from the patient, includingany history of drug allergies, and review all medications for potential drug interactions. Thenurse should consult available drug resources and the pharmacist before administering any drugsif there is a concern about potential interactions.

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Clayton: Basic Pharmacology for Nurses, 15thEditionChapter5:Patient Education and Health PromotionAnswers to Critical Thinking Questions1. The nurse is preparing discharge education for a Native American patient. Discussnursing considerations in planning for this educational session.The nurse should expand his or her knowledge of the Native American culture,including thebasic tenets of that culture’s belief system. Once known, planning for patient education includesthe following:focusing the learning; determining learning style; using organization andmotivation; determining the patient’s readiness to learn; spacing content; and using repetition toenhance learning. Communication is vitally important within any cultural group, yet verbal andnonverbal communication mean different things to different cultures. For example, direct eyecontact in Native American culture is a sign of disrespect or rudeness.2. Describe strategies to use when teaching the older adult patient.Before beginning any health educationfor the older adult, the nurse should assess the patient’svision, hearing, and short-and long-term memory. If a task is to be taught, fine and gross motorabilities must be evaluated. The older adult may have concerns regarding the cost of theproposed treatments, so financial resources should be reviewed. Investigate the older patient’sability and readiness to learn new information and the availability of family support.

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Clayton: Basic Pharmacology for Nurses, 15thEditionChapter6:A Review of ArithmeticAnswers to Critical Thinking Questions1. State the formulas for converting dosages in the metric system.Rule: Converting grams (metric)to milligrams(metric).1 g = 1000 mgMultiply the number of grams by 1000; move the decimal point of the grams three places to theright.0.25 g = 250 mgRule: Converting milligrams (metric)to grams (metric).1000 mg = 1 gDivide the number of milligrams by 1000 or move the decimal point of the milligrams threeplaces to the left.2. State the formulas associated with performing IV infusion rate calculations.Number of mL= mL/hrNumber of hoursThe nurse must be able to convert infusion rates given in minutes to milliliters per hour becausevolumetric pumps are calibrated in milliliters. The formula is as follows—the volume of solutionordered times 60 minutes per hour divided by time (in minutes) to administer.Total volume (milliliters) to infuse×60 min/hr= mL/hrTime (minutes)3. Perform conversions of patient temperatures between the Fahrenheit and centigrade(Celsius) measurements.(Fahrenheit–32) × 5/9 = centigrade(centigrade × 9/5) + 32 = Fahrenheit98°F (98-32) × 5/9 = 36.6° C100° F (100–32) × 5/9 = 37.7° C37° C (37 × 9/5) + 32 = 98.6° F39° C (39 × 9/5) + 32 = 102.2° FANSWERS FORCHAPTER 6: A REVIEW OF ARITHMETIC

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Page 61Roman NumeralsExpress the following in Roman numerals:3 = III9 = IX10 = X20 = XX18 = XVIII49 = XLIX101 = CI499 = CDXCIX1979 = MCMLXXIXExpress the following in Arabic numerals:iv = 4vi = 6xxxix = 39ix = 9xix = 19xv = 15Page 63Fractions: Reducing to Lowest TermsReduce the following:5/100 = 1/206/36 = 1/62/4 = 1/23/21 = 1/712/44 = 3/11Page 67Multiplying Decimals: Rounding the AnswerMultiply the following:1200 × 0.009 = 11575 × 0.02 = 12515 × 0.02 = 10510 × 0.04 =20Page 68ChangingDecimals to Common FractionsChange the following:0.3 = 1/30.4 = 2/50.5 = 1/20.05 = 1/200.25 = 1/4

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0.50 = 1/20.75 = 3/40.002 = 1/500ChangingCommon Fractionsto Decimal FractionsChange the following:1/2 means 0.51/6 means 0.1672/3 means 0.673/4 means 0.751/50 means 0.02ChangingPercents to FractionsChange the following:25% = 25/100 = 1/415% = 15/100 = 3/2010% = 10/100 = 1/1020% = 20/100 = 1/550% = 50/100 = 1/22% = 2/100 = 1/5012 1/2% = 12.5/100 = 1/8¼% = ¼/100 = 1/400150% = 150/100 = 3/2 or 1½4% = 4/100 = 1/25ChangingPercents to Decimal FractionsChange the following:4% = 0.041% = 0.012% = 0.0225% = 0.2550% = 0.510% = 0.1Page 69ChangingCommon Fractions to PercentsChange the following:1/400 = 0.25%1/8 = 12.5%ChangingDecimal Fractions to PercentsChange the following:0.05 = 5%0.25 = 25%0.15 = 15%0.125 = 12.5%

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0.0025 = 0.25%ChangingRatio to PercentChange the following:1:5 = 20%Page 70ChangingPercent to RatioChange the following:2% = 1:5050% = 1:275% = 3:4Simplifying RatiosSimplify the following:4:12 = 3/45:10 = 1/210:5 = 275:100 = 3/41/4:100 = 1/40015:20 = 3/43:9 = 1/3ProportionsSolve the following:a.9:x: : 5:300 = 540b.x:60 : : 4:120 = 2c.5:3000 : : 15:x= 9000d.0.7:70 : :x:1000 = 10e.1/400:x: : 2:1600 = 2f.0.2:8 : :x:20 = ½g.100,000:3 : : 1,000,000:x= 30h.¼:x: : 20:400 = 5Page 72Metric SystemDifferentiate between metric weight (MW) and metric volume (MV):1.microgram = MW2.milliliter = MV3.liter = MV4.gram = MWConverting Milligrams (Metric) to Grams (Metric)Convert the following milligrams to grams:0.4 mg = 0.0004 g0.12 mg = 0.00012 g

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0.2 mg = 0.0002 g0.1 mg = 0.0001 g500 mg = 0.5 g125 mg = 0.125 g100 mg = 0.1 g200 mg = 0.2 g50 mg = 0.05 g400 mg = 0.4 gConvert the following grams to milligrams:0.2 g = 200 mg0.25 g = 250 mg0.125 g = 125 mg0.0006 g = 0.6 mg0.004 g = 4 mgPage 74Converting Weight to KilogramsConvert the following:35 kg = 77 lb16 kg = 35 lb65 kg = 143 lbConvert the following:125 lb = 56.8 kg9 lb = 4.09 kg180 lb = 81.8 kgPage 77CalculatingMilliliters per HourCalculate the following problems:Health CareProvider’sOrderDurationofInfusionRate(mL/hr)1000 mL 5%dextrose inwater12 hr= 83 mL/hr1000 mLlactatedRinger’s6 hr= 167 mL/hr500 mL 0.9%sodium chloride4 hr= 125 mL/hr

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Calculating Rates of Infusion for Other Than 1 HourCalculate the following problems:Health CareProvider’sOrderDurationofInfusionRate(mL/hr)50 mL 0.9%NaCl withampicillin 1 g20 min= 150 mL/hr150 mL D5Wwith gentamicin80 mg30 min= 300 mL/hr50 mL 0.9%NaCl withondansetron 32mg15 min= 200 mL/hrDrops per MinuteCalculate the following problems:Health CareProvider’sOrderDurationofInfusionRate(gtt/min)125 mL D5W60 min= 31 gtt/min100 mL lactatedRinger’s60 min= 25 gtt/min50 mL 0.9%NaCl20 min=150gtt/minPage 78Drugs Ordered in Units Per Hour or Milligrams Per HourCalculate the following problems:Heparin 20,000 units in 1 L lactated Ringer’s solution infused at 120 units/hr =6 mL/hrRegular insulin 100 units in 100 mL normal saline (NS) infused at 15 units/hr =15 mL/hrPage 79Converting Fahrenheit Temperature to Centigrade TemperatureConvert the following:98.6º F = 37º C102.4º F = 39.1º C95.2º F = 35.1º CConverting Centigrade Temperature to Fahrenheit TemperatureConvert the following:

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