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1. Patient with Cancer Nurse Medication Error Case Discussion
Patient with Cancer Nurse Medication Error Case Discussion ON Patient with Cancer
Nurse Medication Error Case DiscussionMrs. Murphy is a cancer patient in the hospital. She
is there to get two doses of chemotherapy treatment. Her first IV treatment started at 0700
and ran for 10 hours. The second IV treatment was to be startedat 1900 and to be run for 10
hours. The nurse hung the correct medication at 0700 but after a 12-hour shift, she was
exhausted and forgot to hang the second bag. Because timely administration of
chemotherapy is key to a successful outcome, this patient’s treatment was less than
optimal.Is this considered an adverse drug reaction or a medication error? Explain.Which
pages in the textbook were utilized for this response?A nurse from a local nursing home
transcribed a residents’ medication on a different person’s chart. Her colleague also failed to
properly match the drug with the patient’s Medication Administration Record. Two nurses
neglected to follow established faculty procedures for handling the drug in question.
Additional team members failed to catch the error for nine days. The resident was taking
the drug, an anticoagulant, because they had a history of developing blood clots. During the
nine-day window, the resident developed clots in her brain and eventually caused a large
and fatal ischemic stroke.Patient with Cancer Nurse Medication Error Case
DiscussionPlease list the traditional five rights of medication administration and discuss
which one(s) are applicable to this scenario. Which ones were correctly utilized and which
one(s) were not used?Discuss 2 ways this error could have been avoided.Which pages in the
textbook were utilized for this response?Patient with Cancer Nurse Medication Error Case
Discussionattachment_1Unformatted Attachment PreviewLehne’s PHARMACOLOGY for
NURSING CARE This page intentionally left blank 10 TH EDITION Lehne’s PHARMACOLOGY
for NURSING CARE Jacqueline Rosenjack Burchum, DNSc, FNP-BC, CNE Associate Professor,
College of Nursing Department of Advanced Practice and Doctoral Studies University of
Tennessee Health Science Center Memphis, Tennessee Laura D. Rosenthal, RN, DNP, ACNP-
BC, FAANP Associate Professor, College of Nursing University of Colorado, Anschutz Medical
Campus Denver, Colorado 3251 Riverport Lane St. Louis, Missouri 63043 LEHNE’S
PHARMACOLOGY FOR NURSING CARE, TENTH EDITION ISBN 978-0-323-51227-5
Copyright © 2019, Elsevier Inc. All Rights Reserved. No part of this publication may be
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2. organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions. This book and the individual
contributions contained in it are protected under copyright by the Publisher (other than as
may be noted herein). Notices Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information, methods, compounds
or experiments described herein. Because of rapid advances in the medical sciences, in
particular, independent verification of diagnoses and drug dosages should be made. To the
fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or
contributors for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein. Previous editions copyrighted 2016,
2013, 2010, 2007, 2004, 2001, 1998, 1994, 1990. International Standard Book Number:
978-0-323-51227-5 Executive Content Strategist: Sonya Seigafuse Senior Patient with
Cancer Nurse Medication Error Case DiscussionContent Development Manager: Luke Held
Content Development Specialist: Jennifer Wade Publishing Services Manager: Jeff Patterson
Senior Project Manager: Jodi M. Willard Design Direction: Paula Catalano Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contents UNIT I INTRODUCTION 1
Orientation to Pharmacology 1 2 Application of Pharmacology in Nursing Practice 5 3 Drug
Regulation, Development, Names, and Information 14 UNIT II BASIC PRINCIPLES OF
PHARMACOLOGY 4 5 6 7 8 Pharmacokinetics 24 Pharmacodynamics 44 Drug Interactions
55 Adverse Drug Reactions and Medication Errors 63 Individual Variation in Drug
Responses 74 UNIT III DRUG THERAPY ACROSS THE LIFE SPAN 9 Drug Therapy During
Pregnancy and Breast-Feeding 82 10 Drug Therapy in Pediatric Patients 90 11 Drug
Therapy in Older Adults 94 UNIT IV PERIPHERAL NERVOUS SYSTEM DRUGS SECTION 1
Introduction 12 Basic Principles of Neuropharmacology 100 13 Physiology of the Peripheral
Nervous System 105 SECTION 2 Cholinergic Drugs 14 Muscarinic Agonists and Antagonists
118 15 Cholinesterase Inhibitors and Their Use in Myasthenia Gravis 131 16 Drugs That
Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents 139 SECTION 3
Adrenergic Drugs 17 Adrenergic Agonists 147 18 Adrenergic Antagonists 159 19 Indirect-
Acting Antiadrenergic Agents 174 UNIT V CENTRAL NERVOUS SYSTEM DRUGS SECTION 4
Introduction 20 Introduction to Central Nervous System Pharmacology 179 SECTION 5
Drugs for Neurodegenerative Disorders 21 Drugs for Parkinson Disease 182 22 Drugs for
Alzheimer’s Disease 199 23 Drugs for Multiple Sclerosis 206 SECTION 6 Neurologic Drugs
24 Drugs for Seizure Disorders 223 25 Drugs for Muscle Spasm and Spasticity 250 SECTION
7 Drugs for Pain 26 Local Anesthetics 259 27 General Anesthetics 265 28 Opioid Analgesics,
Opioid Antagonists, and Nonopioid Centrally Acting Analgesics 274 29 Pain Management in
Patients With Cancer 300 30 Drugs for Headache 318 SECTION 8 Psychotherapeutic Drugs
31 Antipsychotic Agents and Their Use in Schizophrenia 330 32 Antidepressants 352 33
Drugs for Bipolar Disorder 376 34 Sedative-Hypnotic Drugs 384 35 Management of Anxiety
Disorders 399 36 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity
Disorder 406 SECTION 9 Drug Abuse 37 Substance Use Disorders I: Basic Considerations
417 38 Substance Use Disorders II: Alcohol 424 39 Substance Use Disorders III: Nicotine
and Smoking 435 40 Substance Use Disorders IV: Major Drugs of Abuse Other Than Alcohol

3. and Nicotine 443 UNIT VI DRUGS THAT AFFECT FLUID AND ELECTROLYTE BALANCE 41
Diuretics 459 42 Agents Affecting the Volume and Ion Content of Body Fluids 471 UNIT VII
DRUGS THAT AFFECT THE HEART, BLOOD VESSELS, AND BLOOD 43 Review of
Hemodynamics 476 44 Drugs Acting on the Renin-Angiotensin-Aldosterone 45 46 47 48 49
50 51 52 53 54 55 56 System 482 Calcium Channel Blockers 497 Vasodilators 505 Drugs for
Hypertension 510 Drugs for Heart Failure 529 Antidysrhythmic Drugs 546 Prophylaxis of
Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and
Triglyceride Levels 568 Drugs for Angina Pectoris 591 Anticoagulant, Antiplatelet, and
Thrombolytic Drugs 604 Management of ST-Elevation Myocardial Infarction 633 Drugs for
Hemophilia 640 Drugs for Deficiency Anemias 648 Hematopoietic Agents 663 UNIT VIII
DRUGS FOR ENDOCRINE DISORDERS 57 Drugs for Diabetes Mellitus 674 58 Drugs for
Thyroid Disorders 711 59 Drugs Related to Hypothalamic and Pituitary Function 723 60
Drugs for Disorders of the Adrenal Cortex 732 UNIT IX WOMEN’S HEALTH 61 Estrogens
and Progestins: Basic Pharmacology and Noncontraceptive Applications 739 62 Birth
Control 753 63 Drug Therapy for Infertility 770 64 Drugs That Affect Uterine Function 778
UNIT X MEN’S HEALTH 65 Androgens 789 66 Drugs for Erectile Dysfunction and Benign
Prostatic Hyperplasia 797 86 Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines,
Macrolides, and Others 1050 87 Aminoglycosides: Bactericidal Inhibitors of Protein
Synthesis 1061 88 Sulfonamides and Trimethoprim 1068 89 Drug Therapy for Urinary
Tract Infections 1076 90 Antimycobacterial Agents: Drugs for Tuberculosis, 91 92 93 UNIT
XI 94 ANTI-INFLAMMATORY, ANTIALLERGIC, AND IMMUNOLOGIC DRUGS 95 Review of the
Immune System 809 Childhood Immunization 820 Immunosuppressants 836
Antihistamines 844 Cyclooxygenase Inhibitors: Nonsteroidal Anti-Inflammatory Drugs and
Acetaminophen 852 72 Glucocorticoids in Nonendocrine Disorders 871 67 68 69 70 71
UNIT XII DRUGS FOR BONE AND JOINT DISORDERS 73 Drug Therapy for Rheumatoid
Arthritis 881 74 Drug Therapy for Gout 894 75 Drugs Affecting Calcium Levels and Bone
Mineralization 900 UNIT XIII 96 UNIT XVII CHEMOTHERAPY OF PARASITIC DISEASES 97
98 99 100 Disease 925 77 Drugs for Allergic Rhinitis, Cough, and Colds 948 UNIT XIV
GASTROINTESTINAL DRUGS 78 Drugs for Peptic Ulcer Disease 956 79 Laxatives 972 80
Other Gastrointestinal Drugs 981 UNIT XV NUTRITION 81 Vitamins 996 82 Drugs for
Weight Loss 1007 Anthelmintics 1183 Antiprotozoal Drugs I: Antimalarial Agents 1189
Antiprotozoal Drugs II: Miscellaneous Agents 1199 Ectoparasiticides 1206 UNIT XVIII
CANCER CHEMOTHERAPY 101 Basic Principles of Cancer Chemotherapy 1212 102
Anticancer Drugs I: Cytotoxic Agents 1226 103 Anticancer Drugs II: Hormonal Agents,
Targeted Drugs, and Other Noncytotoxic Anticancer Drugs 1245 RESPIRATORY TRACT
DRUGS 76 Drugs for Asthma and Chronic Obstructive Pulmonary Leprosy, and
Mycobacterium avium Complex Infection 1081 Miscellaneous Antibacterial Drugs:
Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Rifaximin, and Fidaxomicin 1097
Antifungal Agents 1102 Antiviral Agents I: Drugs for Non-HIV Viral Infections 1113
Antiviral Agents II: Drugs for HIV Infection and Related Opportunistic Infections 1133 Drug
Therapy for Sexually Transmitted Infections 1167 Antiseptics and Disinfectants 1176 UNIT
XIX MISCELLANEOUS DRUGS AND THERAPIES 104 105 106 107 108 Drugs for the Eye
1272 Drugs for the Skin 1284 Patient with Cancer Nurse Medication Error Case

4. DiscussionDrugs for the Ear 1304 Additional Noteworthy Drugs 1311 Complementary and
Alternative Therapy 1328 UNIT XX TOXICOLOGY 109 Management of Poisoning 1343 110
Potential Weapons of Biologic, Radiologic, and Chemical Terrorism 1349 UNIT XVI
APPENDIX A CHEMOTHERAPY OF INFECTIOUS DISEASES Canadian Drug Information 1359
83 Basic Principles of Antimicrobial Therapy 1014 84 Drugs That Weaken the Bacterial Cell
Wall I: Penicillins 1029 85 Drugs That Weaken the Bacterial Cell Wall II: Cephalosporins,
Carbapenems, Vancomycin, Telavancin, Aztreonam, and Fosfomycin 1039 APPENDIX B
Prototype Drugs and Their Major Uses 1363 To my son, Jade Charmagan, BSN, RN.
Congratulations, and welcome to the world of nursing! JRB For Ashley, Christine, Courtney,
Erica, Laura B., Laura P., and Stacy—my official support team in life. LDR This page
intentionally left blank About the Authors Laura D. Rosenthal, RN, DNP, ACNP-BC, FAANP,
has been a registered nurse since graduating with her Bachelor of Science in Nursing degree
from the University of Michigan in 2000. She completed her Master of Science in Nursing
degree in 2006 at Case Western Reserve University in Cleveland, Ohio. She finished her
nursing education at the University of Colorado, College of Nursing, graduating with her
Doctor of Nursing Practice degree in 2011. Her background includes practice in acute care
and inpatient medicine. While working as a nurse practitioner at the University of Colorado
Hospital, she assisted in developing one of the first fellowships for advanced practice
clinicians in hospital medicine. Dr. Rosenthal serves as an associate professor at the
University of Colorado, College of Nursing, where she teaches within the undergraduate and
graduate programs. She received the Dean’s Award for Excellence in Teaching in 2013. She
serves on the board of the Colorado Nurses Association, remains a member of the NP/PA
committee for the Society of Hospital Medicine, and volunteers as a Health Services RN for
the Red Cross. In her spare time, Dr. Rosenthal enjoys running, skiing, and fostering retired
greyhounds for Colorado Greyhound Adoption. Jacqueline Rosenjack Burchum, DNSc, FNP-
BC, CNE, has been a registered nurse since 1981 and a family nurse practitioner since 1996.
She completed her Doctor of Nursing Science degree in 2002. Dr. Burchum currently serves
as an associate professor for the University of Tennessee Health Science Center (UTHSC)
College of Nursing. She is credentialed as a certified nurse educator (CNE) by the National
League for Nursing. She is a two-time recipient of the UTHSC Student Government
Association’s Excellence in Teaching Award and a recipient of the 2014 UT Alumni
Association’s Outstanding Teacher Award. Dr. Burchum was also the 2016–2017 Faculty
Innovation Scholar for the UTHSC Teaching and Learning Center. Dr. Burchum has a special
interest in online teaching and program quality. To this end, she serves as an on-site
evaluator for the Commission on Collegiate Nursing Education (CCNE), a national agency
that accredits nursing education programs. In addition, she is a peer reviewer for Quality
Matters, a program that certifies the quality of online courses. As a nurse practitioner, Dr.
Burchum’s primary interests have centered on addressing the needs of vulnerable
populations. She is a member of the National Organization for Nurse Practitioner Faculties,
Sigma Theta Tau International Honor Society, the American and Tennessee Nurses
Associations, and the National League for Nursing. ix This page intentionally left blank
Contributors and Reviewers CONTRIBUTOR Joshua J. Neumiller, PharmD, CDE, FASCP
Assistant Professor of Pharmacotherapy Washington State University Spokane, Washington

5. Chapter 57 REVIEWERS Laura Brennan, MS, RN Assistant Professor Elmhurst College
Elmhurst, Illinois Lisa Miklush, PhD, RNC, CNS Adjunct Faculty Nursing Department
Gonzaga University Spokane, Washington Joan Parker Frizzell, PhD, CRNP, ANP-BC
Associate Professor School of Nursing and Health Sciences La Salle University; Nurse
Practitioner Roxborough Memorial Hospital Philadelphia, Pennsylvania Janet Czermak
Russell MA, MS, APN-BC Associate Professor of Nursing Nursing Department Essex County
College Newark, New Jersey James Graves, PharmD Clinical Pharmacist University of
Missouri Inpatient Pharmacy Columbia, Missouri Carin Tripodina, Patient with Cancer
Nurse Medication Error Case DiscussionEdD, MS, RN, CPN, CNE Assistant Professor of
Nursing Nursing Department American International College Springfield, Massachusetts
Ellen Ketcherside, RN, MA Nursing Professor Allied Health Department Mineral Area College
Park Hills, Missouri Jennifer J. Yeager, PhD, RN Assistant Professor Department of Nursing
Tarleton State University Stephenville, Texas xi This page intentionally left blank Preface
Pharmacology pervades all phases of nursing practice and relates directly to patient care
and education. Yet despite its importance, many students—and even some teachers—are
often uncomfortable with the subject. Why? Because traditional texts have stressed
memorizing rather than understanding. In this text, the guiding principle is to establish a
basic understanding of drugs, after which secondary details can be learned as needed. This
text has two major objectives: (1) to help you, the nursing student, establish a knowledge
base in the basic science of drugs, and (2) to show you how that knowledge can be applied
in clinical practice. The methods by which these goals are achieved are described in the
following sections. LAYING FOUNDATIONS IN BASIC PRINCIPLES To understand drugs, you
need a solid foundation in basic pharmacologic principles. To help you establish that
foundation, this text has major chapters on the following topics: basic principles that apply
to all drugs (Chapters 4 through 8), basic principles of drug therapy across the life span
(Chapters 9 through 11), basic principles of neuropharmacology (Chapter 12), basic
principles of antimicrobial therapy (Chapter 83), and basic principles of cancer
chemotherapy (Chapter 101). REVIEWING PHYSIOLOGY AND PATHOPHYSIOLOGY To
understand the actions of a drug, it is useful to understand the biologic systems influenced
by the drug. Accordingly, for all major drug families, relevant physiology and
pathophysiology are reviewed. In almost all cases, these reviews are presented at the
beginning of each chapter rather than in a systems review at the beginning of a unit. This
juxtaposition of pharmacology, physiology, and pathophysiology is designed to help you
understand how these topics interrelate. TEACHING THROUGH PROTOTYPES Within each
drug family we can usually identify a prototype—a drug that embodies the characteristics
shared by all members of the group. Because other family members are similar to the
prototype, to know the prototype is to know the basic properties of all family members. The
benefits of teaching through prototypes can be appreciated with an example. Let’s consider
the nonsteroidal antiinflammatory drugs (NSAIDs), a family that includes aspirin, ibuprofen
[Motrin], naproxen [Aleve], celecoxib [Celebrex], and more than 20 other drugs.
Traditionally, information on these drugs is presented in a series of paragraphs describing
each drug in turn. When attempting to study from such a list, you are likely to learn many
drug names and little else; the important concept of similarity among family members is

6. easily lost. In this text, the family prototype—aspirin—is discussed first and in depth. After
this, the small ways in which individual NSAIDs differ from aspirin are pointed out. Not only
is this approach more efficient than the traditional approach, it is also more effective in that
similarities among family members are emphasized. LARGE PRINT AND SMALL PRINT: A
WAY TO FOCUS ON ESSENTIALS Pharmacology is exceptionally rich in detail. There are
many drug families, each with multiple members and each member with its own catalog of
indications, contraindications, adverse effects, and drug interactions. This abundance of
detail confronts teachers with the difficult question of what to teach and confronts students
with the equally difficult question of what to study. Attempting to answer these questions
can frustrate teachers and students alike. Even worse, basic concepts can be obscured in the
presence of myriad details. To help you focus on essentials, two sizes of type are used in this
text. Large type is intended to say, “On your first exposure to this topic, this is the core of
information you should learn.” Small type is intended to say, “Here is additional information
that you may want to learn after mastering the material in large type.” Patient with Cancer
Nurse Medication Error Case DiscussionAs a rule, we reserve large print for prototypes,
basic principles of pharmacology, and reviews of physiology and pathophysiology. We use
small print for secondary information about the prototypes and for the discussion of drugs
that are not prototypes. This technique allows the book to contain a large body of detail
without having that detail cloud the big picture. Furthermore, because the technique
highlights essentials, it minimizes questions about what to teach and what to study. The use
of large and small print is especially valuable for discussing adverse effects and drug
interactions. Most drugs are associated with many adverse effects and interactions. As a
rule, however, only a few of these are noteworthy. In traditional texts, practically all adverse
effects and interactions are presented, creating long and tedious lists. In this text, we use
large print to highlight the few adverse effects and interactions that are especially
characteristic; the rest are noted briefly in small print. Rather than overwhelming you with
long and forbidding lists, this text delineates a moderate body of information that is truly
important, thereby facilitating comprehension. USING CLINICAL REALITY TO PRIORITIZE
CONTENT This book contains two broad categories of information: pharmacology (the basic
science about drugs) and therapeutics (the clinical use of drugs). To ensure that content is
clinically relevant, we use evidence-based treatment guidelines as a basis for deciding what
to stress and what to play down. Unfortunately, clinical practice is a moving target.
Guidelines change when effective new drugs are introduced and when clinical trials reveal
new benefits or new risks of older drugs, and so we need to work hard to keep this book
current. Despite our xiii Preface resource that includes interactive self-study modules, a
collection of interactive learning resources, and a media-rich library of supplemental
resources. • The Study Guide, which is keyed to the book, includes study questions; critical
thinking, prioritization, and delegation questions; and case studies. best efforts, the book
and clinical reality may not always agree: Some treatments discussed here will be
considered inappropriate before the 11th edition is published. Furthermore, in areas where
controversy exists, the treatments discussed here may be considered inappropriate by
some clinicians right now. NURSING IMPLICATIONS: DEMONSTRATING THE APPLICATION
OF PHARMACOLOGY IN NURSING PRACTICE TEACHING SUPPLEMENTS FOR

7. INSTRUCTORS • The Instructor Resources for the tenth edition are available online and
include TEACH® for Nurses Lesson Plans, a Test Bank, a PowerPoint Collection, and an
Image Collection. The principal reason for asking you to learn pharmacology is to enhance
your ability to provide patient care and education. To show you how pharmacologic
knowledge can be applied to nursing practice, nursing implications are integrated into the
body of each chapter. That is, as specific drugs and …Purchase answer to see full
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