Sue Jordan Includes Implications for Practice THE PRESCRIPTION DRUG GUIDE FOR NURSES THE PRESCRIPTION DRUG GUIDE FOR NURSES Sue Jordan THE PRESCRIPTION DRUG GUIDE FOR NURSES “This book is exceedingly timely. I am certain it will be invaluable to both undergraduate and postgraduate student nurses, and, also act as a continuing reference source. Thoroughly recommended.” Molly Courtenay, Reading University, UK “Sue Jordan has combined her deep understanding of her own discipline with her long experience of teaching nurses, to produce just the right type and level of information that nurses need, in a format that they will nd relevant to their practice and easy to use. This book will be an essential reference resource for every ward bookshelf.” Professor Dame June Clark, Swansea University, UK This popular Nursing Standard prescription drug series is now available for the rst time in book format! Organised by drug type and presented in an easy-to-use reference format, this book outlines the implications for practice of 20 drug groups: • ACE inhibitors • Antibacterial drugs • Anti-coagulants • Antidepressants • Anti-emetics • Anti-epileptic drugs • Antipsychotics • Beta blockers • Bronchodilators • Controlling gastric acidity Each drug group is presented in handy quick check format, and covers: • Drug actions • Indications • Administration • Adverse effects Sue Jordan is Senior Lecturer in the School of Health Science at Swansea University, UK. Cover designed by Pointing Design • Corticosteroids • Cytotoxic drugs • Diuretics • Insulin • Laxatives • NSAIDs • Opioids • Oral anti-diabetic drugs • Thyroid and anti-thyroid drugs • Vasodilators (calcium channel blockers and nitrates) • Practice suggestions • Cautions/contra-indications • Interactions. The Prescription Drug Guide for Nurses The Prescription Drug Guide for Nurses Sue Jordan Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: enquiries@openup.co.uk world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2008 Copyright © Sue Jordan All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of Saffron House, 6–10 Kirby Street, London, EC1N 8TS. A catalogue record of this book is available from the British Library ISBN-13: 978-0-33-522547-7 (pb) 978-0-33-522546-0 (hb) ISBN-10: 0-33-522547-0 (pb) 0-33-522546-2 (hb) Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by RefineCatch Limited, Bungay, Suffolk Printed in Great Britain by Bell & Bain Ltd, Glasgow Fictitious names of companies, products, people, characters and/or data that may be used herein (in case studies or in examples) are not intended to represent any real individual, company, product or event. The Publisher and Author make no representation, express or implied, with regard to accuracy of the information contained in this book, and cannot accept any legal responsibility or liability for any errors or omissions that may be made. Dedication: my family Acknowledgements Laura Downes, special projects manager RCN Publishing, Gwen Clarke, Art and Science editor Nursing Standard. Tim Madge, managing editor new media, RCN Publishing, for inspiration and support. Professor Melanie Jasper, Professor Gareth Morgan, Swansea University, Rachel Crookes, Jack Fray and James Bishop, Open University Press, for help and support. Jeffrey Aronson, editor of Meyler’s Side Effects of Drugs, for such a wonderful resource. Stephen Storey, librarian, School of Health Sciences, Swansea University, for tireless assistance. Peter Gardiner, medical illustrator, Clinical Skills Ltd. vii Contents Preface ix Using this book xi Abbreviations used in the text xiii List of contributors xv Introduction 1 1 Laxatives 6 2 Controlling gastric acidity 12 3 Diuretics 19 4 Beta blockers 27 5 ACE inhibitors 34 6 Vasodilators: calcium channel blockers and nitrates 41 7 Anticoagulants 50 8 Bronchodilators: selective beta 2 adreno-ceptor agonists 58 9 Corticosteroids 65 10 Antipsychotics 75 11 Antidepressants: focus on SSRIs 88 12 Anti-emetics 97 13 Opioid analgesics 108 14 Anti-epileptic drugs: focus on carbamazepine and valproate 117 15 Antibacterial drugs 128 16 Insulin 137 17 Oral anti-diabetic drugs 146 18 Thyroid and anti-thyroid drugs 153 19 Cytotoxic drugs 160 20 Non-steroidal anti-inflammatory drugs (NSAIDs) 168 21 Idiosyncratic drug reactions 175 Glossary 187 References 191 Bibliography/Further Reading 202 Index 203 ix Preface Prescription drugs: theory to practice This book applies pharmacology to nursing practice, with the overall aim of enhancing patient care. The main focus of the book is adverse drug reactions, and the implications for patient monitoring. Adverse drug reactions account for around 4% of UK hospital admis- sions. Over 70% of these problems are avoidable (Pirmohamed et al. 2004): the monitoring of prescribed medications has long been a cause for concern (Royal College of General Practitioners 1985, DH 2000, Audit Commission 2001, Committee of Public Accounts 2006). Regular, structured patient monitoring for adverse events, as outlined in our ‘Implications for Practice’ charts, has the potential to reduce the incidence and severity of these problems. However, this work lies on the inter-professional boundaries between doctors, pharmacists and nurses, and might become marginalised. As with other ‘boundary work’, responsibilities are not clearly allocated (Jordan 2002a, 2007). Consequently, potential adverse drug reactions are not always monitored in routine care. By developing the Nursing Standard Prescription Drug Series, we aim to offer practical nursing strategies to minimise the ill-health caused by adverse drug reactions. Informed patient monitoring Drug administration is one of the highest risk activities for nurses (Gladstone 1995). Any failure to consider the details of adverse reactions, drug interactions or administration schedules may compromise the efficacy of therapeutic regimens and even patient safety. Also, nurses’ professional status may be compromised if they fail to ensure that the highest standards of drug administration are observed. By considering the pedagogic interpretation of nursing pharmacology, and offering practical suggestions, this book aims to help profes- sionals reduce the number and severity of adverse drug reactions. It thereby aims to con- tribute to public and professional protection. Evidence-based practice: the state of the evidence Ideally, every practice activity would be based on the results of randomised, multiple blind, parallel group, placebo controlled pragmatic clinical trials of adequate size, supported by large cohort studies and service users’ views. While these standards are sometimes achieved by those investigating the benefits of drugs, there has been no comparable investment in research into the adverse effects of medications. There is even less research funding avail- able to explore strategies to monitor and minimise adverse drug reactions. Therefore, sug- gestions for practice are proffered from a theoretical, rather than a statistical, standpoint. Nevertheless, we hope that patients and practitioners will find them helpful in their day to day lives and practice. Professor Jane Robinson FRCN, MA, PhD, MCIPD, RN, RHV, HVT, ONC, Editor, International Nursing Review and Emeritus Professor University of Nottingham Sue Jordan MB BCh, PhD, PGCE (FE), FHEA, Senior Lecturer, School of Health Science, Swansea University September 2007 . Implications for Practice THE PRESCRIPTION DRUG GUIDE FOR NURSES THE PRESCRIPTION DRUG GUIDE FOR NURSES Sue Jordan THE PRESCRIPTION DRUG GUIDE FOR NURSES . Cautions/contra-indications • Interactions. The Prescription Drug Guide for Nurses The Prescription Drug Guide for Nurses Sue Jordan Open University Press McGraw-Hill