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Basic Pharmacology For Nurses, 15th Edition Solution Manual

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    Chapter 1 : Definitions, Names, Standards, and Information Sources Answers to Critical Thinking Questions 1. 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 used by any manufacturer and in any country. The first letter is not capitalized. Nurses are strongly encouraged to learn and refer to drugs by their generic name, b e cause formularies are maintained by generic names. When a therapeutically equivalent drug is available in generic form, a generic medicine is routinely substituted for the brand name medicine. The trademark, brand name, or propriety name is followed by the symbol ®. This indicates that the name is registered and that its use is restricted to the owner of the drug, who is usually the manufacturer. These names are easier to pronounce, spell, and remember, and the first letter is capitalized. 2. Describe the different ways drugs may be classified.  Body system that they 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 drugs require 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 in a pharmacy or the health section of department or grocery stores.  Illegal drugs , sometimes referred to as recreational drugs , are used for nontherapeutic purposes, have been obtained illegally, or have not received approval for use by the U.S. Food and Drug Administration ( FD A) . 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 Products 4. 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 important for patients to understand the uses, safety, effectiveness, mechanism of action , active ingredients, adverse reactions, interactions, and dosage and administration. This information can be obtained through sources such as the Natural 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 s tudies require 20 to 100 subjects who take the drug for 4 to 6 weeks. Phase 2 studies involve smaller patient populations who have the condition that the drug is designed to treat. Phase 3 studies use larger populations to ensure statistical significance of results; also , proper dosing and safety are addressed. c. New Drug Application. When sufficient data demonstrate that the experimental drug is both safe and effective, the investigator submits a New Drug Application to the FDA. This is reviewed by a team of pharmacologists, toxicologists, chemists, physicians, and others (as appropriate) , wh o then make a recommendation to the FDA. Once it is approved by the FDA, it is 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 as periodic inspections of the manufacturing facilities and products. Studies completed during the fourth phase include identifying other patient populations for whom the drug may be useful, refining dosing recommendations, or exploring potential drug interactions. Health care practitioners make a significant contribution to the knowledge of drug safety by reporting adverse effects of drugs to the FDA by using MEDWATCH.

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    Clayton: Basic Pharmacology for Nurses, 15 th Edition Chapter 2 : Principles of Drug Action and Drug Interactions Answers to Critical Thinking Questions 1. 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 only if the drug and its receptor have similar shapes. This relationship is similar to that of a key and a lock — the better the fit between the receptor and the drug molecule, the better the response. The intensity of a drug response is related to how well the drug molecule fits into the receptor and to the number of receptor sites that are occupied. 2. Explain the differences among a drug agonist, partial agonist, and antagonist, and give examples of each. Agonist: Drugs that interact with a receptor to stimulat e a drug response. Epinephrine - like drugs act on the heart to increase the heart rate, and acetylcholine - like drugs act on the heart to slow the heart rate. Partial agonist: Drugs that interact with a receptor to stimulate a response but inhibit other responses. 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 process where by a drug is transferred from its site of entry into the body to the circulating fluids of the body for distribution. Distribution: The ways in which drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, and excretion. Metabolism: Also called biotransformation ; the process where by the body inactivates drugs. The primary site is the liver. Excretion: Elimination of drug metabolites. Two primary routes are the GI tract to the feces and through the renal tubules into the urine. 5. Discuss the effects of adverse drug reactions ( ADRs ) on individual patients and on the costs of health care. Adverse drug reactions can contribute to death, cause admission to hospitals, and increase suffering 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, and health professionals should not hesitate to report possible reactions. The FDA’s MEDWATCH program 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 drug therapy? Weight: Overweight patients may require an increase in dosage to attain the same therapeutic response. Patients who are underweight tend to require lower dosages for the same therapeutic response. Body surface area : Important when calculating chemotherapeutic agents. Metabolic rate: Patients with a higher than average metabolic rate tend to metabolize drugs more rapidly, thus requiring larger doses or more frequent administration. The opposite is true for those with lower than average metabolic rates. Illness: Any pathologic condition that could alter the rate of absorption, distribution, metabolism, and excretion (see p. 22 ). 8. Discuss the difference between bound and unbound drugs and the resultant effects on drug action. Once a drug is absorbed into the blood, it is usually bound to plasma proteins. A drug that is highly bound (e.g., 90%) to a protein - binding site may be displaced by another drug that has a higher affinity for the binding site. Significant interactions can take place this way because little displacement is required to have a major impact. Only the unbound drug is pharmacologically active. If a drug is 90% bound to a protein, then 10% of the drug is providing the physiologic effect. If another drug is administered with a strong affinity for the protein - binding site and displaces just 5% of the bound drug, there is now 15% unbound for physiologic activity. This is the equivalent of a 50% increase in dosage.

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    Clayton: Basic Pharmacology for Nurses, 15 th Edition Chapter 3 : Drug Action Across the Life Span Answers to Critical Thinking Questions 1. What terms are used to describe people at different points of the life cycle? Premature infant, newborn or 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 nonsteroidal anti - inflammatory drug, the same drug that the prescriber has recommended for his treatment of joint pain. Discuss the gender differences that could affect this patient's outcome. Gender differences may affect drug absorption . A woman’ s stomach empties solids more slowly than a man’s, thus slowing the absorption of certain types of medicines absorbed in the small intestine. NSAIDs, for example, may potentiate gastric irritation with possible ulceration by remaining in contact with the stomach mucosa for a longer period of time. A slower gastric emptying time may allow a drug to stay in contact with the absorptive tissue longer, allowing more 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 differing concentrations of enzyme systems based on gender differences will affe ct the rate of drug metabolism. 3. Discuss variations of transdermal medication absorption of a patient categorized as “the very old.” Transdermal administration in geriatric patients is often difficult to predict. Although dermal thickness decreases with aging and may enhance absorption, factors that may diminish absorption occur, such as drying and wrinkling. With aging, decreased cardiac output and diminishing tissue perfusion may also affect transdermal drug absorption. 4. Contrast the drug absorption of phenobarbital in the GI system of an 8 - month - old infant with 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 not absorbed 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 with that of the male patient. Metabolism is controlled by factors such as genes, diet, age, disease process, and maturity of enzyme systems. Enzyme systems, primarily in the liver, are the major pathway of drug metabolism. All enzyme systems are present at birth but mature at different rates, taking several weeks to a year to develop fully . Liver weight, the number of functioning hepatic cells , and hepatic 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 enzyme systems throughout life. The CYP3A4 component of the cytochrome P - 450 system of enzyme metabolizes more than 50% of all drugs and is 40% more active in women. Some drugs are metabolized 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 the possible effects on drug therapy? The primary routes of excretion of metabolites are through the renal tubules into the urine and through the GI tract into the feces. At birth, a preterm infant has up to 15% of the renal capacity of an adult and a full - term newborn has approximately 35%. The filtration capacity of an infant increases to about 50% of adult capacity at 4 weeks of age and is equivalent to full adult function at 9 to 12 months. Drugs excreted primarily by the kidneys must be administered in increased dosages or given more often to maintain adequate therapeutic serum concentrations as renal function matures. In older adults, physiologic changes take place in the kidneys , such as decreased renal blood flow caused by atherosclerosis and reduced cardiac output, a loss of glomeruli, and decreased tubular function and concentrating ability. There is a great degree of individual variation in changes in renal function and no prediction of renal function can be made solely on the basis of a person’s age. With diminished renal function, lower drug dosages may be indicated.

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    Clayton: Basic Pharmacology for Nurses, 15 th Edition Chapter 4 : The Nursing Process and Pharmacology Answers to Critical Thinking Questions 1. The nurse is updating patient care plans and determining appropriate nursing diagnoses for each patient and his or her drug therapy. Write a nursing diagnosis for each of the following patient disorders specific to drug therapy: (1) sleep disorder; (2) advanced heart failure; 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, or economic resources  Sleep disorder o Anxiety related to conflict as evidenced by sleep disturbance o Fatigue related to sleep deprivation as evidenced by increase in rest requirements  Advanced heart failure o Decreased cardiac output related to altered stroke volume as evidenced by fatigue, edema, shortness of breath o Fluid volume excess related to compromised regulatory mechanism as evidenced by edema and jugular vein disten t ion  Dyslipidemia o Deficient k nowledge related to lack of information about dietary guidelines for increased lipids 2. Explain the components for performing a focused assessment on patients with each of the three conditions identified in question 1. Sleep disorder  How much sleep d o 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 events recently?  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 help you sleep? 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 your medications and the consequences of discontinuing them?  Do you have any dietary or fluid restrictions? If so, do you understand the purpose for this?

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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 and when 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 an antibiotic. Explain the rationale for these tests. When used to adjust drug dosages, the sample for first blood test is drawn at a specific time after the medicine is administered intravenously, such as 20 or 30 minutes after administration or 60 minutes after oral administration. This drug level measures the peak serum concentration of the drug. 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 the trough level . The peak and trough levels are important to assess because they determine whether peak levels are high enough to kill the specific bacterial pathogen being treated. Trough levels determine whether the drug levels have fallen low enough between dosages to prevent toxicity. Peak and trough levels are particularly important to assess for aminoglycoside antibiotic therapy (e.g., gentamicin, tobramycin). Blood tests, or diagnostic parameters, are frequently used to monitor drug therapy, establish dosages, and identify the most effective medication for pathogenic microorganisms. The nurse reviews laboratory values for liver and kidney function, culture and sensitivity reports, therapeutic drug levels, and peak and trough levels, as well as others specific to the prescribed drug. The nurse and pharmacist review diagnostic tests to identify values that could have an influence on drug therapy, such as problems in absorption, distribution, metabolism, and elimination of the prescribed drug. 4. The nurse is concerned that the patient is experiencing adverse effects of a recently prescribed drug. Identify appropriate resources that the nurse should use. The nurse should begin this process when ob taining the drug history from the patient, including any history of drug allergies, and review all medications for potential drug interactions. The nurse should consult available drug resources and the pharmacist before administering any drugs if there is a concern about potential interactions.

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    Clayton: Basic Pharmacology for Nurses, 15 th Edition Chapter 5 : Patient Education and Health Promotion Answers to Critical Thinking Questions 1. The nurse is preparing discharge education for a Native American patient. Discuss nursing considerations in planning for this educational session. The nurse should expand his or her knowledge of the Native American culture , including the basic tenets of that culture’s belief system. Once known, planning for patient education includes the following: focusing the learning; determining learning style; using organization and motivation; determining the patient’s readiness to learn; spacing content; and using repetition to enhance learning. Communication is vitally important within any cultural group, yet verbal and nonverbal communication mean different things to different cultures. For example, direct eye contact 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 education for the older adult, the nurse should assess the patient’s vision, hearing, and short - and long - term memory. If a task is to be taught, fine and gross motor abilities must be evaluated. The older adult may have concerns regarding the cost of the proposed treatments, so financial resources should be reviewed. Investigate the older patient’s ability and readiness to learn new information and the availability of family support.

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    Clayton: Basic Pharmacology for Nurses, 15 th Edition Chapter 6 : A Review of Arithmetic Answers to Critical Thinking Questions 1. State the formulas for converting dosages in the metric system. Rule: Converting grams (metri c) to milligrams (metric). 1 g = 1000 mg Multiply the number of grams by 1000; move the decimal point of the grams three places to the right. 0.25 g = 250 mg Rule: Converting milligrams (metri c) to grams (metri c). 1000 mg = 1 g Divide the number of milligrams by 1000 or move the decimal point of the milligrams three places to the left. 2. State the formulas associated with performing IV infusion rate calculations. Number of mL = mL/hr Number of hours The nurse must be able to convert infusion rates given in minutes to milliliters per hour because volumetric pumps are calibrated in milliliters. The formula is as follows — the volume of solution ordered times 60 minutes per hour divided by time (in minutes) to administer. Total volume (milliliters) to infuse × 60 min/hr = mL/hr Time (minutes) 3. Perform conversions of patient temperatures between the Fahrenheit and centigrade (Celsius) measurements. (Fahrenheit – 32) × 5/9 = centigrade (centigrade × 9/5) + 32 = Fahrenheit 98° F (98 - 32) × 5/9 = 36.6° C 100° F (100 – 32) × 5/9 = 37.7° C 37° C (37 × 9/5) + 32 = 98.6° F 39° C (39 × 9/5) + 32 = 102.2° F ANSWERS FOR CHAPTER 6: A REVIEW OF ARITHMETIC

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    Page 61 Roman Numerals Express the following in Roman numerals: 3 = III 9 = IX 10 = X 20 = XX 18 = XVIII 49 = XLIX 101 = CI 499 = CDXCIX 1979 = MCMLXXIX Express the following in Arabic numerals: iv = 4 vi = 6 xxxix = 39 ix = 9 xix = 19 xv = 15 Page 63 Fra c tions: Reducing to Lowest Terms Reduce the following: 5/100 = 1/20 6/36 = 1/6 2/4 = 1/2 3/21 = 1/7 12/44 = 3/11 Page 67 Multiplying Decimals: Rounding the Answer Multiply the following: 1200 × 0.009 = 11 575 × 0.02 = 12 515 × 0.02 = 10 510 × 0.04 = 2 0 Page 68 Changing Decimals to Common Fractions Change the following: 0.3 = 1/3 0.4 = 2/5 0.5 = 1/2 0.05 = 1/20 0.25 = 1/4

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    0.50 = 1/2 0.75 = 3/4 0.002 = 1/500 Changing Common Fractions to Decimal Fractions Change the following: 1/2 means 0.5 1/6 means 0.167 2/3 means 0.67 3/4 means 0.75 1/50 means 0.02 Changing Percents to Fractions Change the following: 25% = 25/100 = 1/4 15% = 15/100 = 3/20 10% = 10/100 = 1/10 20% = 20/100 = 1/5 50% = 50/100 = 1/2 2% = 2/100 = 1/50 12 1/2% = 12.5/100 = 1/8 ¼% = ¼/100 = 1/400 150% = 150/100 = 3/2 or 1½ 4% = 4/100 = 1/25 Changing Percents to Decimal Fractions Change the following: 4% = 0.04 1% = 0.01 2% = 0.02 25% = 0.25 50% = 0.5 10% = 0.1 Page 69 Changing Common Fractions to Percents Change the following: 1/400 = 0.25% 1/8 = 12.5% Changing Decimal Fractions to Percents Change the following: 0.05 = 5% 0.25 = 25% 0.15 = 15% 0.125 = 12.5%

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    0.0025 = 0.25% Changing Ratio to Percent Change the following: 1:5 = 20% Page 70 Changing Percent to Ratio Change the following: 2% = 1:50 50% = 1:2 75% = 3:4 Simplifying Ratios Simplify the following: 4:12 = 3/4 5:10 = 1/2 10:5 = 2 75:100 = 3/4 1/4:100 = 1/400 15:20 = 3/4 3:9 = 1/3 Proportions Solve the following: a. 9: x : : 5:300 = 540 b. x :60 : : 4:120 = 2 c. 5:3000 : : 15: x = 9000 d. 0.7:70 : : x :1000 = 10 e. 1/400: x : : 2:1600 = 2 f. 0.2:8 : : x :20 = ½ g. 100,000:3 : : 1,000,000: x = 30 h. ¼: x : : 20:400 = 5 Page 72 Metric System Differentiate between metric weight (MW) and metric volume (MV): 1. microgram = MW 2. milliliter = MV 3. liter = MV 4. gram = MW Converting Milligrams (Metric) to Grams (Metric) Convert the following milligrams to grams: 0.4 mg = 0.0004 g 0.12 mg = 0.00012 g

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    0.2 mg = 0.0002 g 0.1 mg = 0.0001 g 500 mg = 0.5 g 125 mg = 0.125 g 100 mg = 0.1 g 200 mg = 0.2 g 50 mg = 0.05 g 400 mg = 0.4 g Convert the following grams to milligrams: 0.2 g = 200 mg 0.25 g = 250 mg 0.125 g = 125 mg 0.0006 g = 0.6 mg 0.004 g = 4 mg Page 74 Converting Weight to Kilograms Convert the following: 35 kg = 77 lb 16 kg = 35 lb 65 kg = 143 lb Convert the following: 125 lb = 56.8 kg 9 lb = 4.09 kg 180 lb = 81.8 kg Page 77 Calculatin g Milliliters per Hour Calculate the following problems: Health Care Provider’s Order Duration of Infusion Rate (mL/hr) 1000 mL 5% dextrose in water 12 hr = 83 mL/hr 1000 mL lactated Ringer’s 6 hr = 167 mL/hr 500 mL 0.9% sodium chloride 4 hr = 125 mL/hr

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    Calculating Rates of Infusion for Other Than 1 Hour Calculate the following problems: Health Care Provider’s Order Duration of Infusion Rate (mL/hr) 50 mL 0.9% NaCl with ampicillin 1 g 20 min = 150 mL/hr 150 mL D5W with gentamicin 80 mg 30 min = 300 mL/hr 50 mL 0.9% NaCl with ondansetron 32 mg 15 min = 200 mL/hr Drops per Minute Calculate the following problems: Health Care Provider’s Order Duration of Infusion Rate (gtt/min) 125 mL D5W 60 min = 31 gtt/min 100 mL lactated Ringer’s 60 min = 25 gtt/min 50 mL 0.9% NaCl 20 min = 150 gtt/min Page 78 Drugs Ordered in Units Per Hour or Milligrams Per Hour Calculate the following problems: Heparin 20,000 units in 1 L lactated Ringer’s solution infused at 120 units/hr = 6 mL/hr Regular insulin 100 units in 100 mL normal saline (NS) infused at 15 units/hr = 15 mL/hr Page 79 Converting Fahrenheit Temperature to Centigrade Temperature Convert the following: 98.6º F = 37º C 102.4 º F = 39.1º C 95.2 º F = 35.1º C Converting Centigrade Temperature to Fahrenheit Temperature Convert the following:

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