Pharmacology for Health Professionals, 2nd Edition PDF 2

(BQ) Part 2 book Pharmacology for health professionals presentation of content: Drugs that affect the respiratory system, drugs that affect the cardiovascular system, drugs that affect the urinary system, drugs that affect the gastrointestinal system, drugs that affect the endocrine and reproductive systems,... and other contents.

DRUGS THAT AFFECT THE URINARY SYSTEM VI 25 Diuretics CHAPTER OBJECTIVES On completion of this chapter, students will be able to: Define the chapter’s key terms Explain how and where diuretics work Compare and contrast the actions and uses of the various diuretics Identify common fluid and electrolyte imbalances associated with the various diuretic categories and explain the signs and symptoms of each Identify common adverse reactions associated with the various diuretic categories Identify common contraindications, precautions, and interactions of diuretics Discuss important points to keep in mind when educating the patient or family members about the use of diuretics Identify which diuretic categories should be cautious of potassium intake and the signs and symptoms of hypokalemia and hyperkalemia that the patient and family members should watch for KEY TERMS dehydration—loss of too much water from the body diuretic—a drug that increases the secretion of urine (water, electrolytes, and waste products) by the kidneys edema—retention of excess fluid filtrate—fluid removed from the blood through kidney function hyperkalemia—high blood level of potassium nephron—long tubular structure that is the functional part of the kidney CHAPTER OVERVIEW Drug classes covered in this chapter are: • Carbonic anhydrase inhibitors • Loop diuretics • Osmotic diuretics • Potassium-sparing diuretics • Thiazides and related diuretics Drugs by classification are listed on page 255 thePOINT RESOURCES • Comprehensive Summary Drug Tables • Animations: Edema; Renal Function • Lippincott’s Interactive Tutorials: Drugs Affecting the Cardiovascular System • Interactive Practice and Review • Monographs of Most Commonly Prescribed Drugs 245 Acosta Main Book_Chap25.indd 245 1/28/2012 11:59:08 AM 246 UNIT VI Drugs That Affect the Urinary System A • • • • • diuretic is a drug that increases the secretion of urine (i.e., water, electrolytes, and waste products) by the kidneys The different types of diuretic drugs are Carbonic anhydrase inhibitors Loop diuretics Osmotic diuretics Potassium-sparing diuretics Thiazides and related diuretics The Summary Drug Table: Diuretics lists examples of the different types of diuretic drugs Most diuretics act on the tubules of the kidney nephron (Fig 25-1), the functional unit of the kidney Each kidney contains approximately one million nephrons, which filter the bloodstream to remove waste products During this process, water and electrolytes are also selectively removed The filtrate (the fluid removed from the blood) normally contains ions (potassium, sodium, chloride), waste products (ammonia, urea), water, and, at times, other substances that are being excreted, such as drugs The filtrate then passes through the proximal tubule, the loop of Henle, and the distal tubules At these points, selective reabsorption of amino acids, glucose, some electrolytes, and water occurs Ions and water that are required by the body to maintain fluid Proximal convoluted tubule Efferent arteriole Osmotic diuretics 25-1 Diuretic Selection Many conditions or diseases, such as heart failure, endocrine disturbances, and kidney and liver diseases, can cause retention of excess fluid (edema) When a patient shows signs of edema, the health care provider may order a diuretic, selecting one that best suits a patient’s needs and the specific disorder and that effectively reduces the amount of excess fluid in body tissues and electrolyte balance are returned to the bloodstream by means of the minute capillaries that surround the distal and proximal tubules and the loop of Henle Ions and water that are not needed are excreted in the urine Diuretics are used for a variety of medical disorders (Key Concepts 25-1) In some instances, hypertension may be treated with the administration of an antihypertensive drug and a diuretic The diuretics used for this combination therapy include loop diuretics and thiazides and related diuretics FACT CHECK 25-1 What is edema and what conditions cause it? 25-2 How diuretics reduce edema? K+-sparing diuretics Carbonic Anhydrase Inhibitors Carbonic anhydrase inhibitions Afferent arteriole KEY CONCEPTS Actions of Carbonic Anhydrase Inhibitors Distal convoluted tubule Bowman capsule Glomerulus Loop of Henle: Descending limb Ascending limb Thiazide diuretics Collecting duct Loop diuretics FIGURE 25-1 The nephron is the functional unit of the kidney Note the various tubules, the site of most diuretic activity The loop of Henle is the site of action for the loop diuretics Thiazide diuretics act at the ascending portion of the loop of Henle and the distal tube of the nephron Acosta Main Book_Chap25.indd 246 Carbonic anhydrase is an enzyme that produces free hydrogen ions, which are then exchanged for sodium ions in the kidney tubules Carbonic anhydrase inhibitors inhibit the action of the enzyme carbonic anhydrase This effect results in the excretion of sodium, potassium, bicarbonate, and water Carbonic anhydrase inhibitors also decrease the production of aqueous humor in the eye, which in turn decreases intraocular pressure (the pressure within the eye) Uses of Carbonic Anhydrase Inhibitors Glaucoma causes an increase in intraocular pressure that, if left untreated, can result in blindness Normally the eye is filled with aqueous humor in an amount that is carefully regulated to maintain the shape of the eyeball In glaucoma, aqueous humor is increased, which causes the intraocular pressure to rise and can, without treatment, damage the retina Acetazolamide (Diamox) is used in the treatment of simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma when the intraocular pressure is to be lowered before surgery These drugs are also used in the treatment of edema caused by congestive heart failure, drug-induced edema, and some forms of epilepsy Methazolamide (Neptazane) is used in the treatment of glaucoma 1/28/2012 11:59:09 AM 247 CHAPTER 25 Diuretics Adverse Reactions of Carbonic Anhydrase Inhibitors Adverse reactions associated with short-term therapy with carbonic anhydrase inhibitors are rare Long-term use of these drugs may result in drowsiness, fatigue, headache, malaise, seizures, irritability, decreased libido, vertigo, confusion, hyperuricemia, hyperchloremia, paresthesia (numbness, tingling), photosensitivity reactions (exaggerated sunburn reaction when the skin is exposed to sunlight or ultraviolet light), and crystalluria (crystals in the urine) On occasion, acidosis may occur, and oral sodium bicarbonate may be used to correct this imbalance Contraindications, Precautions, and Interactions of Carbonic Anhydrase Inhibitors • Carbonic anhydrase inhibitors are contraindicated in patients with known hypersensitivity, electrolyte imbalances, severe kidney or liver dysfunction, or anuria and for long-term use in patients with chronic noncongestive angle-closure glaucoma (may mask worsening glaucoma) • Diuretics are used cautiously in patients with renal dysfunction • The patient has an increased risk of cyclosporine toxicity when the drug is administered with acetazolamide • Decreased serum and urine concentrations of primidone occur when the drug is administered with acetazolamide FACT CHECK 25-3 What are the uses of carbonic anhydrase inhibitors? Loop Diuretics Actions of Loop Diuretics Loop diuretics, furosemide (Lasix) and ethacrynic acid (Edecrin), increase the excretion of sodium and chloride by inhibiting reabsorption of these ions in the distal and proximal tubules and in the loop of Henle This mechanism of action at these three sites appears to increase their effectiveness as diuretics Torsemide (Demadex) also increases urinary excretion of sodium, chloride, and water but acts primarily in the ascending portion of the loop of Henle Bumetanide (Bumex) primarily increases the excretion of chloride but also has some sodium-excreting ability This drug acts primarily on the proximal tubule of the nephron Uses of Loop Diuretics Loop diuretics are used in the treatment of edema associated with chronic heart failure, cirrhosis of the liver, and renal disease These drugs are particularly useful when a greater diuretic effect is desired Furosemide is the drug of choice when a rapid diuresis is needed or if a patient has renal insufficiency Furosemide and torsemide are also used to treat hypertension Ethacrynic acid is also used for the short-term management of ascites (accumulation of serous fluid in the peritoneal cavity) caused by a malignancy, idiopathic edema, or lymphedema Acosta Main Book_Chap25.indd 247 Adverse Reactions of Loop Diuretics Adverse reactions seen with loop diuretics may include anorexia, nausea, vomiting, dizziness, rash, postural or orthostatic hypotension, photosensitivity reactions, and glycosuria (glucose in the urine) Patients with diabetes who take these drugs may experience an elevated blood glucose level Contraindications, Precautions, and Interactions of Loop Diuretics • Loop diuretics are contraindicated in patients with known hypersensitivity to loop diuretics or to sulfonamides, severe electrolyte imbalances, hepatic coma, or anuria and in infants (ethacrynic acid) • Loop diuretics are used cautiously in patients with renal dysfunction • Furosemide should be used cautiously in children and in patients with liver disease, diabetes, lupus erythematosus (may exacerbate or activate the disease), or diarrhea • Patients with sensitivity to sulfonamides may have allergic reactions to furosemide, torsemide, or bumetanide • Loop diuretics may increase the effectiveness of anticoagulants or thrombolytics • There is an increased risk of glycoside toxicity and digitalis-induced arrhythmias if a patient experiences hypokalemia (low blood potassium) while taking a loop diuretic • Ototoxicity (damage to the hearing organs from a toxic substance) is more likely to occur if a loop diuretic is given with an aminoglycoside • Plasma levels of propranolol may increase when the drug is administered with furosemide • The patient has an increased risk of lithium toxicity when it is administered with a loop diuretic • Hydantoins (phenytoin) may reduce the diuretic effects of furosemide • The effects of loop diuretics may be decreased when they are administered with a nonsteroidal anti-inflammatory drug (NSAID) FACT CHECK 25-4 How loop diuretics act? Osmotic Diuretics Actions of Osmotic Diuretics Osmotic diuretics increase the density of the filtrate in the glomerulus (see Fig 25-1) This prevents selective reabsorption of water, which allows the water to be excreted Sodium and chloride excretion is also increased Uses of Osmotic Diuretics Mannitol (Osmitrol) is used for the promotion of diuresis in the prevention and treatment of the oliguric phase (low urine production) of acute renal failure, as well as for the reduction of intraocular pressure and the treatment of cerebral edema Urea (Ureaphil) is used to reduce cerebral edema and to reduce intraocular pressure 1/28/2012 11:59:10 AM 248 UNIT VI Drugs That Affect the Urinary System Adverse Reactions of Osmotic Diuretics The osmotic diuretics urea and mannitol are administered IV Administration by the IV route may result in a rapid fluid and electrolyte imbalance, especially when these drugs are administered before surgery to a patient in a fasting state Contraindications, Precautions, and Interactions of Osmotic Diuretics • Osmotic diuretics are contraindicated in patients with known hypersensitivity to the drugs, electrolyte imbalances, severe dehydration, or anuria and those who experience progressive renal damage after using mannitol • Mannitol is contraindicated in patients with active intracranial bleeding (except during craniotomy) • Osmotic diuretics are used cautiously in patients with renal or kidney impairment or electrolyte imbalances FACT CHECK 25-5 What adverse reaction may occur with IV administration of osmotic diuretics? Potassium-Sparing Diuretics Actions of Potassium-Sparing Diuretics Potassium-sparing diuretics work in either of two ways Triamterene (Dyrenium) and amiloride (Midamor) depress the reabsorption of sodium in the kidney tubules, therefore increasing sodium and water excretion Both drugs additionally depress the excretion of potassium and therefore are called potassium-sparing (or potassium-saving) diuretics Spironolactone (Aldactone), also a potassium-sparing diuretic, antagonizes the action of aldosterone Aldosterone, a hormone produced by the adrenal cortex, enhances the reabsorption of sodium in the distal convoluted tubules of the kidney When this activity of aldosterone is blocked, sodium (but not potassium) and water are excreted Uses of Potassium-Sparing Diuretics Amiloride (Midamor) is used in the treatment of chronic heart failure and hypertension and is often used with a thiazide diuretic Spironolactone and triamterene are also used in the treatment of hypertension and edema caused by chronic heart failure, cirrhosis, and the nephrotic syndrome Amiloride, spironolactone, and triamterene are also available with hydrochlorothiazide, a thiazide diuretic that enhances the antihypertensive and diuretic effects of the drug combination while still conserving potassium Adverse Reactions of Potassium-Sparing Diuretics Hyperkalemia (increased potassium in the blood), a serious event, may occur with the administration of potassium-sparing diuretics (Key Concepts 25-2) Hyperkalemia is most likely to occur in patients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the Acosta Main Book_Chap25.indd 248 KEY CONCEPTS 25-2 Potassium Intake and Diuretics All diuretics can cause hypokalemia except the potassium-sparing ones, which can cause hyperkalemia Patients taking any diuretics except the potassium-sparing ones will usually also take potassium supplements However, patients on potassium-sparing diuretics must be careful about the amount of potassium they take in, especially in their diet elderly, and severely ill patients In patients taking spironolactone, gynecomastia (breast enlargement in the male) may occur This reaction appears to be related to both dosage and duration of therapy The gynecomastia usually reverses when therapy is discontinued, but in rare instances some breast enlargement may remain When a potassium-sparing diuretic and a thiazide diuretic are given together, the adverse reactions associated with both drugs may occur Contraindications, Precautions, and Interactions of Potassium-Sparing Diuretics • Potassium-sparing diuretics are contraindicated in patients with known hypersensitivity to the drugs, serious electrolyte imbalances, significant renal impairment, or anuria and those receiving another potassium-sparing diuretic • Potassium-sparing diuretics are contraindicated in patients with hyperkalemia and are not recommended for children • Potassium-sparing diuretics are used cautiously in patients with renal or kidney impairment • Potassium-sparing diuretics are used cautiously in patients with liver disease, diabetes, or gout • When a potassium-sparing diuretic is administered to a patient taking an angiotensin-converting enzyme (ACE) inhibitor (see Chapter 21), the patient has an increased risk for hyperkalemia • When a potassium-sparing diuretic is administered with a potassium preparation, severe hyperkalemia may occur, possibly causing a cardiac arrhythmia or cardiac arrest • When spironolactone is administered with an anticoagulant drug or NSAID, the anticoagulant or NSAID has decreased effectiveness • When spironolactone or triamterene is administered with an ACE inhibitor, significant hyperkalemia may occur FACT CHECK 25-6 What are the two ways that potassium-sparing diuretics work? 25-7 Patients taking potassium-sparing diuretics are at risk for which electrolyte imbalance? What are the symptoms of this disorder? 1/28/2012 11:59:10 AM 249 CHAPTER 25 Diuretics Thiazides and Related Diuretics Actions of Thiazides and Related Diuretics Thiazides and related diuretics inhibit the reabsorption of sodium and chloride ions in the ascending portion of the loop of Henle and the early distal tubule of the nephron This action results in the excretion of sodium, chloride, and water Uses of Thiazides and Related Diuretics Thiazides and related diuretics are used in the treatment of hypertension, edema caused by chronic heart failure, hepatic cirrhosis, corticosteroid and estrogen therapy, and renal dysfunction Adverse Reactions of Thiazides and Related Diuretics Thiazides and related diuretics may be associated with numerous adverse reactions However, many patients take these drugs without experiencing adverse reactions other than excessive fluid and electrolyte loss, which often can be corrected with an adequate fluid intake, a balanced diet, supplemental oral electrolytes, or ingesting foods or fluids high in the electrolytes that are being lost Some of the adverse reactions that may occur, include gastric irritation, abdominal bloating, reduced libido, dizziness, vertigo, headache, photosensitivity, and weakness Contraindications, Precautions, and Interactions of Thiazides and Related Diuretics • Thiazide diuretics are contraindicated in patients with known hypersensitivity to thiazides or related diuretics, electrolyte imbalances, renal decompensation, hepatic coma, or anuria • A cross-sensitivity reaction may occur with thiazides and sulfonamides Some of the thiazide diuretics contain tartrazine, which may cause allergic reactions or bronchial asthma in individuals sensitive to tartrazine • These drugs should be used cautiously in children and in patients with liver or kidney disease, lupus erythematosus (may exacerbate or activate the disease), or diabetes • Concurrent use of thiazides with allopurinol may increase the incidence of hypersensitivity to allopurinol • The effects of anesthetics may be increased by thiazide administration • The effects of anticoagulants may be diminished when administered with a thiazide diuretic • Because thiazide diuretics may raise blood uric acid levels, dosage adjustments of antigout drugs may be necessary • Thiazide diuretics may prolong antineoplastic-induced leukopenia • Hyperglycemia may occur when a thiazide is administered with an antidiabetic drug • Synergistic effects may occur when a thiazide diuretic is administered concurrently with a loop diuretic, causing profound diuresis (excretion of urine) and serious electrolyte abnormalities Acosta Main Book_Chap25.indd 249 ALERT Common Drug Interactions: Additive Hypotensive Effects Additive hypotensive effects occur when alcohol, other antihypertensive drugs, or nitrates are given with the following diuretics: Loop diuretics Osmotic diuretics Potassium-sparing diuretics Thiazides • There is an increased risk of glycoside toxicity if a patient experiences hypokalemia while taking a thiazide diuretic • The administration of a thiazide diuretic and a digitalis glycoside may result in cardiac arrhythmias FACT CHECK 25-8 How are thiazides and related diuretics used? Patient Management Issues with Diuretics Before the first dose of a diuretic is given, the purpose of the drug, when diuresis may be expected to occur, and how long diuresis will last are explained to the patient (Table 25-1) These TABLE 25-1 Examples of Onset and Duration of Activity of Diuretics Drug Onset Duration of Activity Acetazolamide tablets Sustained-release capsules IV 1–1.5 h 8–12 h 2h 18–24 h 4–5 h Amiloride 2h 24 h Bumetanide 30–60 4–6 h Ethacrynic acid PO IV Within 30 Within 6–8 h 2h Furosemide PO IV Within h Within 6–8 h 2h Mannitol (IV) 30–60 6–8 h Spironolactone 24–48 h 48–72 h Thiazides and related diuretics 1–2 h Varies* Triamterene 2–4 h 12–16 h Urea (V) 30–45 5–6 h *Duration varies with drug used Average duration is 12–24 h with polythiazide and chlorthalidone Indapamide has a duration of more than 24 h 1/28/2012 11:59:10 AM 250 UNIT VI Drugs That Affect the Urinary System KEY CONCEPTS 25-3 Electrolyte Imbalance The most common adverse reaction of diuretics is the loss of fluid and electrolytes (see Signs and Symptoms Box), especially during initial therapy In some patients, the diuretic effect is moderate, whereas in others a large volume of fluid is lost Regardless of the amount of fluid lost, there is always the possibility of excessive electrolyte loss, which is potentially serious The most common imbalances are a loss of potassium and water Other electrolytes, such as magnesium, sodium, and chlorides, are also lost When too much potassium is lost, hypokalemia (low blood level of potassium) occurs In certain patients, such as those also receiving a digitalis glycoside or those with a cardiac arrhythmia, hypokalemia may cause a more serious arrhythmia Hypokalemia is treated with potassium supplements or foods with high potassium content or by changing the diuretic to a potassium-sparing diuretic In addition to hypokalemia, patients taking loop diuretics are prone to magnesium deficiency (see Signs and Symptoms Box) If too much water is lost, then dehydration occurs, which also can be serious, especially in elderly patients drugs are administered early in the day to prevent nighttime sleep disturbances caused by frequent urination Patients with Edema Patients with edema caused by heart failure or other causes are weighed daily or as ordered by the health care provider to monitor fluid loss A weight loss of approximately lb per day is desirable to prevent dehydration and electrolyte imbalances (Key Concepts 25-3) Fluid intake and output are measured and recorded every hours A critically ill patient or a patient with renal disease may require more frequent measurements of urinary output Blood pressure, pulse, and respiratory rate are taken every hours or as ordered by the health care provider Areas of edema are examined daily to evaluate the effectiveness of drug therapy Patients with Hypertension The blood pressure, pulse, and respiratory rate of patients with hypertension receiving a diuretic, or a diuretic along with an antihypertensive drug, are taken before the administration of the drug More frequent monitoring may be necessary if the patient is critically ill or the blood pressure excessively high Carbonic Anhydrase Inhibitors If a carbonic anhydrase inhibitor is given for glaucoma, then the patient’s response to drug therapy (relief of eye pain) is monitored every hours The health care provider should be notified immediately if eye pain increases or if it has not begun to decrease to hours after the first dose If the patient has acute closed-angle glaucoma, then the pupils of the affected eye are checked every hours for dilation and response to light A patient who can walk but has reduced Acosta Main Book_Chap25.indd 250 vision because of glaucoma may need help walking and with self-care activities If a carbonic anhydrase inhibitor is being given to control epileptic seizures, then the patient is checked frequently for the occurrence of seizures, especially early in therapy and in patients known to experience seizures frequently If a seizure does occur, then it should be documented in the patient’s chart, including time of onset and duration Accurate descriptions of seizures help the health care provider plan future therapy and adjust drug dosages as needed Loop Diuretics Because loop diuretics may cause GI upset, they should generally be taken with food or milk However, torsemide may be given without regard to meals, and ethacrynic acid should be given after a meal The health care provider should be notified if muscle weakness, cramps, nausea, or dizziness occurs Patients should be advised to rise slowly in order to avoid orthostatic hypotension In patients with diabetes mellitus, urine glucose tests may be affected because these drugs may increase blood glucose levels Some patients may experience photosensitivity, so provide teaching about the use of sunscreens or protective clothing during exposure to ultraviolet light or sunlight Patients with hypertension should be instructed to avoid medications that may increase blood pressure, including over-the-counter (OTC) appetite suppressants and cold remedies Osmotic Diuretics When an osmotic is prescribed, the disease or disorder and the symptoms being treated are closely monitored For example, if the patient has a low urinary output and the osmotic diuretic is given to increase urinary output, then the intake and output ratio and symptoms the patient is experiencing are recorded In addition, the patient is weighed and vital signs are taken before starting drug therapy Mannitol is administered only IV The patient’s urine output is monitored hourly When a patient is receiving the osmotic diuretic mannitol or urea for treatment of increased intracranial pressure caused by cerebral edema, the blood pressure, pulse, and respiratory rate are monitored every 30 to 60 minutes or as ordered by the health care provider Any increase in blood pressure, decrease in the pulse or respiratory rate, or any change in the patient’s neurologic status should be reported ALERT Potassium-Sparing Diuretics and Hyperkalemia Patients taking potassium-sparing diuretics are at risk for hyperkalemia Symptoms of hyperkalemia include paresthesia (numbness, tingling, or prickling sensation), muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, shock, and electrocardiographic (ECG) abnormalities (see Signs and Symptoms Box for additional symptoms) The drug is discontinued and the health care provider notified immediately if the patient experiences these symptoms 1/28/2012 11:59:10 AM 251 CHAPTER 25 Diuretics Patients taking potassium-sparing diuretics are at risk for hyperkalemia Serum potassium levels are monitored frequently, particularly during initial treatment SIGNS SYMPTOMS Common Fluid and Electrolyte Imbalances Associated with Diuretic Therapy Dehydration (Excessive Water Loss) • • • • • • • Thirst Poor skin turgor Dry mucous membranes Weakness Dizziness Fever Low urine output Hyponatremia (Excessive Loss of Sodium) • • • • • • Cold, clammy skin Decreased skin turgor Confusion Hypotension Irritability Tachycardia Hypomagnesemia (Low Levels of Magnesium) • • • • • • • • • Leg and foot cramps Hypertension Tachycardia Neuromuscular irritability Tremor Hyperactive deep tendon reflexes Confusion Visual or auditory hallucinations Paresthesias Hypokalemia (Low Blood Potassium) • • • • • • • • Anorexia Nausea Vomiting Depression Confusion Cardiac arrhythmias Impaired thought processes Drowsiness Hyperkalemia (High Blood Potassium) • • • • • • • Irritability Anxiety Confusion Nausea Diarrhea Cardiac arrhythmias Abdominal distress Acosta Main Book_Chap25.indd 251 CONSIDERATIONS Older adults LIFESPAN Potassium-Sparing Diuretics Older Patients and Electrolyte Imbalances Older adults are particularly prone to fluid volume deficits and electrolyte imbalances (see Signs and Symptoms Box) while taking a diuretic An older adult is carefully monitored for hypokalemia (when taking a loop or thiazide diuretic) and hyperkalemia (with a potassium-sparing diuretic) Thiazide and Related Diuretics When thiazide diuretics are administered, the patient’s renal function is monitored periodically These drugs may precipitate azotemia (accumulation of nitrogenous wastes in the blood) If the patient’s level of nonprotein nitrogen or blood urea nitrogen rises, then the health care provider may consider withholding or discontinuing the drug In addition, serum uric acid concentrations are monitored periodically during treatment with thiazide diuretics because these drugs may precipitate an acute attack of gout The patient also is monitored for joint pain or discomfort Because hyperglycemia may occur, insulin or oral antidiabetic drug dosages may require alterations Serum glucose concentrations are monitored periodically Educating the Patient and Family about Diuretics The patient or a family member should be given a full explanation of the prescribed drug therapy, including when to take the drug (diuretics taken once per day are best taken early in the morning), if the drug is to be taken with food, and the importance of following the dosage schedule The onset and duration of the drug’s diuretic effect are also explained The patient and family must also be made aware of the signs and symptoms of fluid and electrolyte imbalances and adverse reactions that may occur when using a diuretic To ensure compliance with the prescribed drug regimen, the importance of diuretic therapy in the treatment of the patient’s disorder should be emphasized Following are key points about diuretics that the patient and family members should know • Do not stop taking the drug and not skip doses except on the advice of your health care provider • If you experience gastrointestinal upset, take the drug with food or milk ALERT Warning Signs of Fluid and Electrolyte Imbalance Warning signs of a fluid and electrolyte imbalance include dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, confusion, gastrointestinal disturbances, hypotension, oliguria (decreased urinary output), tachycardia, and seizures 1/28/2012 11:59:11 AM 252 UNIT VI Drugs That Affect the Urinary System BOX 25.1 Diuretics High-Potassium Foods Numerous herbal diuretics are available as OTC products Most plants and herbal extracts available as OTC diuretics are nontoxic However, most are either ineffective or no more effective than caffeine The following are some of the herbals reported to have diuretic activity: celery, chicory, sassafras, juniper berries, St John’s wort, foxglove, horsetail, licorice, dandelion, digitalis purpurea, ephedra, hibiscus, parsley, and elderberry There is very little and in many instances no scientific evidence to justify the use of these plants as diuretics For example, dandelion root is a popular preparation once thought to be a strong diuretic, but scientific research has found dandelion root, although safe, to be ineffective as a diuretic No herbal diuretic should be taken unless approved by the health care provider Diuretic teas such as juniper berries and shave grass or horsetail should be avoided Juniper berries have been associated with renal damage, and horsetail contains severely toxic compounds Teas with ephedrine should also be avoided, especially byy individuals with hypertension MEDICINE COMPLEMENTARY & ALTERNATIVE • Take the drug early in the morning (with a once-a-day dosage) unless directed otherwise to minimize the effects on nighttime sleep Twice-a-day dosing should be administered early in the morning (e.g., 7.00 AM) and early afternoon (e.g., 2.00 PM) or as directed by your health care provider These drugs initially cause more frequent urination, which should subside after a few weeks • Avoid alcohol and nonprescription drugs unless your health care provider approves Hypertensive patients should be careful to avoid medications that increase blood pressure, such as OTC drugs for appetite suppression or cold symptoms • Notify your health care provider if you experience any of the following: muscle cramps or weakness, dizziness, nausea, vomiting, diarrhea, restlessness, excessive thirst, general weakness, rapid pulse, increased heart rate or pulse, or gastrointestinal distress • If you feel dizzy or weak, be careful while driving or performing hazardous tasks, rise slowly from a sitting or lying position, and avoid standing in one place for an extended time • Weigh yourself weekly or as recommended by your health care provider Keep a record of these weekly weights and contact your health care provider if your weight loss exceeds to lb per week • If your health care provider recommends foods or fluids high in potassium, then eat the amount recommended Do not exceed this amount or eliminate these foods Acosta Main Book_Chap25.indd 252 • Meats: beef, chicken, pork, turkey, veal • Seafood: flounder, haddock, halibut, salmon, flounder, canned sardines, scallops, tuna • Fruits: apricots, bananas, dates, raisins, fresh orange juice, tomato juice, oranges, dried fruit, cantaloupe, peaches, prunes, avocado • Vegetables: carrots, lima beans, potatoes, radishes, spinach, sweet potatoes, tomatoes • Other: gingersnaps, graham crackers, molasses, peanuts, peanut butter, coffee, tea, nuts • • • • • from your diet for more than day, except when told to so by your health care provider (Box 25-1) After a time, the diuretic effect of the drug may be minimal because most of the body’s excess fluid has been removed Continue taking the drug as directed to prevent further accumulation of fluid If you are taking a thiazide or related diuretic, loop diuretic, potassium-sparing diuretic, carbonic anhydrase inhibitor, or triamterene, then avoid exposure to sunlight or ultraviolet light (sunlamps, tanning beds) because exposure may cause exaggerated sunburn (photosensitivity reaction) Wear sunscreen and protective clothing until your tolerance is determined If you are taking a loop or thiazide diuretic and have diabetes mellitus, your blood glucometer test results for glucose may be elevated or your urine positive for glucose Contact your health care provider if the results of your home testing of blood glucose levels increase or if your urine tests positive for glucose If you are taking a thiazide diuretic, it may cause gout attacks Contact your health care provider if you experience significant, sudden joint pain If you are taking a carbonic anhydrase inhibitor for glaucoma, contact your health care provider immediately if your eye pain is not relieved or if it increases If you are being treated for seizures, a family member should keep a record of all seizures that occur Bring this record to your health care provider at your next visit Contact your health care provider immediately if your seizures increase TABLE 25-2 Combination Diuretics Generic Name Trade Name amiloride/HCTZ Moduretic spironolactone/HCTZ Aldactazide triamterene/HCTZ Maxzide, Dyazide 1/28/2012 11:59:11 AM 253 CHAPTER 25 Diuretics Chapter Review KEY POINTS • Diuretics are used for a variety of medical disorders Diuretics are administered early in the day to prevent any nighttime sleep disturbance caused by increased urination • Carbonic anhydrase inhibitors cause the excretion of sodium, potassium, bicarbonate, and water These drugs are commonly used in the treatment of glaucoma Carbonic anhydrase inhibitors are contraindicated in patients with known hypersensitivity, electrolyte imbalances, severe kidney or liver dysfunction, or anuria and for long-term use in chronic noncongestive angle-closure glaucoma • Loop diuretics, furosemide (Lasix) and ethacrynic acid (Edecrin), increase the excretion of sodium and chloride by inhibiting reabsorption of these ions in the distal and proximal tubules and in the loop of Henle Loop diuretics are used to treat edema associated with chronic heart failure, cirrhosis of the liver, and renal disease These drugs are contraindicated in patients with known hypersensitivity to loop diuretics or to sulfonamides, severe electrolyte imbalances, hepatic coma, or anuria and in infants (ethacrynic acid) • Osmotic diuretics increase the density of the filtrate in the glomerulus (Fig 25-1), thereby preventing selective reabsorption of water Sodium and chloride excretion is increased Administration by the IV route may result in a rapid fluid and electrolyte imbalance, especially when these drugs are administered before surgery to a patient in a fasting state • Potassium-sparing diuretics work in two ways Triamterene (Dyrenium) and amiloride (Midamor) depress the reabsorption of sodium, therefore increasing sodium and water excretion Both drugs depress the excretion of potassium and therefore are called potassium-sparing (or potassium-saving) diuretics Spironolactone (Aldactone), also a potassium-sparing diuretic, antagonizes the action of aldosterone, causing sodium (but not potassium) and water to be excreted Hyperkalemia, a serious event, may occur with the administration of potassium-sparing diuretics • Thiazides and related diuretics inhibit the reabsorption of sodium and chloride Thiazides and related diuretics are used to treat hypertension, edema caused by chronic heart failure, hepatic cirrhosis, corticosteroid and estrogen therapy, and renal dysfunction Thiazide diuretics are contraindicated in patients with known hypersensitivity to thiazides or related diuretics, electrolyte imbalances, renal decompensation, hepatic coma, or anuria CRITICAL THINKING CASE STUDIES CASE A Diuretic for Hypertension Mr Rodriguez, age 68 years, is taking amiloride for hypertension He and his wife have stopped by the clinic for a routine blood pressure check Mrs Rodriguez states that her husband Acosta Main Book_Chap25.indd 253 has been confused and very irritable for the past days He reports nausea and has had several “loose” stools Mrs Rodriguez asks about the adverse effects of amiloride She should be told that a irritability and confusion are not caused by amiloride unless it is combined with certain other drugs b nausea and loose stools may be adverse reactions to amiloride c there are no known adverse effects of amiloride use d both a and b are correct You ask Mrs Rodriguez if her husband is taking any other prescription drug She nods and says ACE inhibitor You know the health care provider has already considered that a amiloride and ACE inhibitors have no known interactive effects b there is an increased risk of hyperkalemia when the two drugs are combined c there is an increased risk of hypokalemia when the two drugs are combined d none of the above Mr Rodriguez asks if he should change his diet in any way because of his prescription drug use He should be told a not drink alcohol unless his health care provider approves it b when taking both an ACE inhibitor and amiloride, avoid foods high in potassium c drinking adequate fluids is an important component of diuretic use d all of the above Mrs Rodriguez asks which foods are high in potassium What should you tell her? CASE A Diuretic for Intraocular Pressure Mrs Salzman was recently diagnosed with glaucoma and was given a prescription for acetazolamide However, at her follow-up appointment, she stated that she does not understand why she is taking a diuretic for her eye How does acetazolamide help treat glaucoma? a It reduces the production of aqueous humor in the eye, which decreases intraocular pressure b It reduces the amount of sodium in the aqueous humor in the eye, thus drawing water out and decreasing intraocular pressure c It increases the production of aqueous humor in the eye, which decreases intraocular pressure d It reduces the amount of potassium in the aqueous humor in the eye, thus drawing water out and decreasing intraocular pressure Which other diuretic(s) is/are also used for glaucoma or reduction of intraocular pressure? a Methazolamide b Mannitol c Urea d All of the above 1/28/2012 11:59:12 AM 254 UNIT VI Drugs That Affect the Urinary System Mrs Salzman asks if she has to watch her diet because her friend who takes a diuretic has to eat a special diet Although she cannot remember the specifics, she knows it has something to with potassium What you tell her? Review Questions MULTIPLE CHOICE Which of the following drugs would be used for edema due to CHF? a mannitol b methazolamide c bumetanide d all of the above Which of the following drugs has the longest onset and duration of activity? a spironolactone b triamterene c mannitol d furosemide Which of the following adverse reactions would most likely be seen in patients on long-term therapy with acetazolamide? a Constipation b Nausea and vomiting c Crystalluria d None of the above When a diuretic is being given for heart failure, which of the following would be most indicative of an effective response to diuretic therapy? a Low urine flow b Daily weight loss of lb c Increased blood pressure d Increasing edema in the legs and feet Which electrolyte imbalance would most likely develop in a patient receiving a loop or thiazide diuretic? a Hypernatremia b Hyponatremia c Hyperkalemia d Hypokalemia Which of the following foods should patients include in their daily diet to prevent hypokalemia? a Green beans b Apples c Bananas d Corn Match each drug with its classification 17 Carbonic anhydrase inhibitor 18 Loop 19 Osmotic 20 Potassium-sparing 21 Thiazide TRUE OR FALSE 22 A patient taking an ACE inhibitor who receives amiloride is at increased risk for hyperkalemia 23 Diuretics effectively increase the amount of fluid in body tissues 24 A patient with diabetes who is taking a loop or thiazide diuretic may have increased blood glucose levels 25 Potassium-sparing diuretics are typically given to control epileptic seizures FILL IN THE BLANKS 26 27 28 29 Acosta Main Book_Chap25.indd 254 Mannitol is a(n) diuretic that is used to reduce pressure , a loop diuretic, should be used with caution in patients with lupus erythematosus A patient taking a diuretic who has leg and foot cramps, hypertension, neuromuscular irritability, and hallucinations is likely experiencing , an electrolyte disturbance Gout attacks may occur in patients taking diuretics SHORT ANSWERS 30 31 32 33 What are the different types of diuretic drugs? What are the most common fluid and electrolyte imbalances that patients taking diuretics may experience? Briefly explain each Why should patients taking certain diuretics avoid exposure to sunlight or ultraviolet light? What would you recommend to avoid this problem? Initial diuretic therapy may cause more frequent urination, disturbing a patient’s nighttime sleep How would you instruct a patient to take the drug to minimize these effects? Web Activities MATCHING Match each drug’s brand name with its generic name acetazolamide a Ureaphil furosemide b Demadex mannitol c Aldactone 10 amiloride d Diamox 11 chlorothiazide e Zaroxolyn 12 spironolactone f Neptazane 13 metolazone g Midamor 14 methazolamide h Diuril 15 urea i Osmitrol 16 torsemide j Lasix a mannitol b amiloride c acetazolamide d indapamide e furosemide Go to the National Library of Medicine Web site (www.nlm.nih.gov) and conduct a search on “heart failure.” How does fluid intake and diuretic therapy help with the treatment of heart failure? On the same Web site, conduct a search on “edema.” Where does edema usually occur in the body? What are some causes of edema? 1/28/2012 11:59:12 AM 567 Index FDA, 496–497 National Center for Complementary and Alternative Medicine, 497 Complementary therapies, 496 Comprehensive Drug Abuse Prevention and Control Act, COMT inhibitors (See Catechol-Omethyltransferase (COMT) inhibitors) Conduction block, 111 Conjugated estrogens (Premarin), 352t Constipation, 101, 285, 286, 286b, 287, 288, 290 Contraceptive hormones, 343t–344t, 345b adverse reactions, 346 contraindications, precautions, and interactions of, 346 patient education, 347, 348 patient management issues, 346, 347 uses, 342, 345 Controlled substances, 4–5, 5b Convulsion, 54 Corticosteroids, 312, 318, 319t, 321t, 322b, 323, 324, 453, 460t actions, 161 adverse reactions, 161 contraindications, precautions, and interactions of, 161 inhaled, 161 ophthalmic preparations, 477, 481t topical, 463–464, 466, 469t uses, 161 Corticotropin action and uses of, 315 adverse reactions of, 315–316 contraindications, precautions, and interactions of, 316 patient education, 316 patient management issues, 316 Cortisone (Florinef), 318, 324, 326t, 460t Cosyntropin (Cortrosyn), 315, 326t Coughing, 176b Cranberry, 260, 507 Crohn disease, 288, 290 Cromolyn (Nasalcrom), 162, 166t Cromolyn sodium (Crolom), 482t Cross-allergenicity, 367 Cross-sensitivity, 367 Crotalidae polyvalent immune FAB (Ovine origin, CroFab), 436t Cryptorchism, 313, 314, 323 Culture and sensitivity tests, 362 Cumulative drug effect, 10–11 Cushing syndrome, 319, 319b, 324 Cyanocobalamin (B12), 500 Cyclizine (Marezine), 124t Cyclobenzaprine (Amrix, Fexmid, Flexeril), 451, 452, 460t Cyclopentolate (Cyclomydril), 481t Cyclophosphamide, 442, 446t Cycloplegia, 476 Cycloplegic mydriatics, 476, 481t Cyclopropane, 114, 117t Cycloserine (Seromycin), 385, 391t Cyclosporine (Gengraf, Neoral, Sandimmune, Restasis), 402, 403, 460t, 482t Acosta Main Book_Index.indd 567 Cytarabine, 446t Cytochrome P450, 413 Cytomegalovirus (CMV), 394 Cytomegalovirus immune globulin IV, human (CMV-IGIV) (CytoGam), 436t Cytoprotective agents, 447t D Dacarbazine (DTIC; imidazole carboxamide), 446t Dactinomycin (Cosmegen), 442, 446t Dalfampridine (Ampyra), 460t Danazol, 351t Dantrolene sodium (Dantrium, Revonto), 452, 460t Dapsone (Aczone (topical) ), 388–389, 391t, 454 Darbepoetin alfa (Aranesp), 239, 244t Darifenacin (Enablex), 264, 266t Darunavir (Prezista), 398, 399b, 400, 409t Dasatinib (Sprycel), 447t Daunorubicin citrate liposome (DaunoXome), 442, 446t Daunorubicin HCl (Ceruibidine), 442, 446t Decimals adding decimals, 34 converting decimals to fractions, 34 converting fractions to decimals, 35 dividing decimals, 34 multiplying decimals, 34 reading decimals, 33 rounding of decimals, 35 subtracting decimals, 34 writing decimals, 33–34 Decitabine (Dacogen), 447t Decongestants actions, 170 adverse reactions, 170 and antihistamine products, 171 contraindications, precautions, and interactions of, 170 patient education, 170 patient management issues, 170 uses, 170 Deep (systemic) mycotic infections, 401, 403b Dehydration, 122b, 248, 250, 250b, 251 Delavirdine (Rescriptor), 398, 400, 409t Demeclocycline (Declomycin), 372, 373, 381t Dementia, 68 Denileukin diftitox (Ontak), 447t Denominator, 30 Dependency, 77, 105 Depolarization, 191, 191 Depression, 80 Dermatologic drugs anti-infectives, 462–463, 463, 469t antipsoriatics, 464, 464, 469t–470t antiseptics, 463, 469t corticosteroids, 463–464, 466, 469t enzymes, 464, 464–465, 470t germicides, 463, 469t keratolytics, 465, 465, 470t local anesthetics, 465–466, 470t Dermatologicdiseases, 319 Dermatologics, 316, 318, 320, 324 Dermis, 462 Desflurane (Suprane), 114, 117t Desipramine (Norpramin), 90t Deslansoprazole (Dexilant), 281t Desloratadine (Clarinex), 168, 169b, 173t Desmopressin acetate (DDAVP Stimate), 326t Desonide (Desonate, DesOwen, Desonil, LoKara, Verdeso), 469t Desoximetasone (Topicort, Topicort LP), 469t Dexamethasone (Maxidex, Baycadron, Intensol, DexPak, Ciprodex), 326t, 413, 460t, 481t Dexmedetomidine HCL (Precedex), 90t Dexmethylphenidate (Focalin), 52t Dexpanthenol, 274, 275, 278, 281t Dexrazoxane (Totect, Zinecard), 447t Dextroamphetamine (Dexedrine), 46, 52t Dextromethorphan (Delsym, Robitussin Pediatric, Sucrets), 180t Dextrose solutions, in body fluids management, 484, 485–486 Diabetes insipidus, 317, 318, 324 Diabetes mellitus, 296 Diabetic ketoacidosis, 298b Diarrhea adverse reactions, 441 antidiarrheals, 284–288, 290 Diazepam (Valium, Diazepam Intensol), 55, 57, 66t, 112t, 451, 452, 460t Diazoxide (Proglycem), 310t Dibucaine (Nupercainal), 110t, 465, 470t Diclofenac (Voltaren), 477, 482t Diclofenac potassium (Cataflam), 108t Diclofenac sodium (Solaraze, Flector, Voltaren, Pennsaid), 108t, 470t Dicloxacillin sodium, 381t Dicyclomine (Bentyl, Di-Spasz), 154t, 293t Didanosine (Videx, Videx EC), 398, 400, 409t Dietary supplement, 496 Dietary Supplement Health and Education Act (DSHEA), 6, 496–497 Diethylpropion HCl, 52t Difenoxin HCl with atropine (Motofen), 293t Diflorasone diacetate (ApexiCon, ApexiCon E), 469t Diflunisal, 107t Difluprednate (Durezol), 482t Digestive enzymes, 281t actions, 275 adverse reactions, 275 contraindications, precautions, and interactions of, 275 patient education, 276 patient management, 275–276 uses, 275 Digitalis toxicity, 185b Digitalization, 186 Digoxin (Lanoxin), 183–186, 188t, 192, 196t, 373, 387, 402, 403, 442, 456, 489 Digoxin immune fab, 185, 188t 1/28/2012 12:36:08 PM 568 Diltiazem (Cardizem), 192, 196t, 201, 206t, 209, 216t Dimenhydrinate (Dramamine), 124t Dimensional analysis, 39–40 Dinoprostone (Cervidil, Prepidil, Prostin E2), 359t actions, 354 adverse reactions, 355–356 contraindications, precautions, and interactions of, 356 patient education, 357 patient management issues, 357 uses, 355 Dipeptidyl peptidase-4 inhibitors actions, 302 adverse reactions, 303 contraindications, precautions, and interactions of, 304–305 patient management issues, 305 Diphenhydramine (Benadryl), 168, 169b, 173t, 176, 180t Diphenhydramine injection, 124t Diphenoxylate HCl with atropine sulfate (Logen, Lomanate, Lomotil, Lonox), 293t Diphtheria and tetanus toxoids adsorbed (Decavac), 430, 436t Diphyllobothrium latum (Fish tape worm), 412t Disopyramide (Norpace), 191, 193, 196t, 396 Disulfiram, 423, 424 Diuretics carbonic anhydrase inhibitors, 246–247, 249, 250, 253, 255t defined, 246 dehydration from, 251 drug combination, 252t drug table, 249t herbal, 252 herbal remedies, 508 loop, 247, 250 onset and duration of, 249t osmotic, 247–248, 250, 255t patient education, 251, 252b patient management issues, 249–250 potassium-sparing, 248, 251, 255t thiazides and related, 249–250 types of, 246 DNA demethylation agents, 447t DNA topoisomerase inhibitors, 447t Dobutamine (Dobutrex), 131, 133t Docetaxel (Taxotere), 446t Docosanol (Abreva), 462, 469t Docusate calcium (Kaopectate stool softener), 286, 293t Docusate sodium (Colace), 286, 293t Dofetilide (Tikosyn), 192, 193, 196t Dolasetron mesylate (Anzemet), 124t Donepezil, 68, 69, 72t Dopamine (Intropin), 131, 133t Dopamine receptor agonists actions, 62 adverse reactions, 62 contraindications, precautions, and interactions of, 62 uses, 62 Acosta Main Book_Index.indd 568 Index Dopaminergic drugs actions, 59 adverse reactions, 60 contraindications, precautions, and interactions of, 60 uses, 59–60 Doripenem (Doribax), 258, 259, 261, 262t Dorzolamide (Cosopt/Trusopt), 475, 481t Doxapram (Dopram), 46, 52t Doxazosin mesylate (Cardura), 216t Doxepin (Silenor), 90t Doxorubicin (Adriamycin), 400, 440, 441, 442, 446t Doxycycline (Vibramycin), 372, 374, 381t, 415 Doxylamine (Doxytex, Unisom, Aldex AN), 169b, 173t Dronabinol (Marinol), 124t Dronedarone (Multaq), 192, 194, 196t Droperidol (Inapsine), 112t, 115 Drug actions pharmaceutic phase, pharmacodynamic phase, 8–9 pharmacokinetic phase, 7–8, Drug administration considerations, 17–20 in the home, 25, 25b medication order, 16, 16b oral route, 21–22 parenteral route, 22–24 patient care considerations, 25 preparation, 21 principles, 20–21 six rights, 16–17 skin and mucous membranes, 24–25 Drug categories controlled substances, 4–5 nonprescription drugs, prescription drugs, Drug development FDA programs, 3–4 phases of, Drug dispensing systems computerized dispensing system, 20 floor stock, 20 unit dose system, 20 Drug dosages for children body surface area (BSA) nomogram, 41–42 calculations based on weight, 42 in standardized units, 40–41 Drug error, 17–18, 18t, 19t Drug idiosyncrasy, 10 Drug interactions drug–drug interactions, 11–12 drug–food interactions, 12 Drug reactions adverse drug reactions, 9, allergic drug reactions, 9–10, 11B cumulative drug effect, 10–11 drug idiosyncrasy, 10 drug tolerance, 10 pharmacogenetic reactions, 11 toxic reactions, 11 Drug response, factors influencing, 12–13, 12t Drug tolerance, 10 Drug–drug interactions, 11–12 Drug–food interactions, 12, 82b Drug–receptor interactions, Dry mouth, 63, 151, 152 Dutasteride (Avodart), 336, 338, 339, 351t Dyphylline (Lufyllin), 166t Dyscrasia, 55 Dysphoric, 80 Dyspnea, 178 Dystonia, 84 Dystonic movements, 60 Dysuria, 258b, 261 E Ear drops, 24b, 472 Echinacea, 509 Echothiophate (Phospholine Iodide), 481t Econazole, 408t, 462, 469t Edema, 246, 246b, 247–250, 253 Edrophonium (Enlon, Tensilon), 145, 148t Efavirenz (Sustiva), 398, 399b, 400, 409t Efavirenz/Emtricitabine/Tenofovir disoproxil fumarate (Atripla), 409t Efficacy, 497 Ejection fraction, 183 Elderberry, 509 Electrolyte disturbance, 316, 319 Electrolyte imbalance, 250b Electrolytes, 494t actions and uses, 487–488 adverse reactions, 488–489 combined solutions, 487b contraindications, precautions, and interactions of, 489–491 imbalance of, 487b signs and symptoms, 488b Emedastine (Emadine), 482t Emesis, 120, 121 Emetics, 281t actions, 276 adverse reactions, 276 contraindications, precautions, and interactions of, 276 educating patient, 276–277 patient management, 276 uses, 276 Emollients, 286 Emtricitabine (Emtriva), 398, 399b, 400, 409t Emtricitabine/Tenofovir disoproxil fumarate (Truvada), 409t Enalapril (Vasotec), 209, 211t, 216t Endocrine, 316, 318, 320 disorders, 318 herbal remedies, 508 Endogenous, 81, 209 Energy substrates actions and uses, 484 adverse reactions, 485 contraindications, precautions, and interactions of, 485–486 Enflurane (Ethrane), 114, 117t Enfuvirtide (Fuzeon), 398, 399, 400, 409t Entacapone (Comtan), 59, 61, 66t Entecavir (Baraclude), 410t 1/28/2012 12:36:08 PM 569 Index Enterobius vermicularis (Pinworm), 412t Enzymes (Granulex, Optase, Xenaderm, AllanDerm-T), 447t topical, 464, 464–465, 470t Ephedrine sulfate, 131, 133t, 166t Epidermis, 462 Epidural block, 111 Epidural pain management, 103 Epigastric distress, 168 Epilepsy, 54 Epinastine (Elestat), 482t Epinephrine (Adrenalin, Primatene Mist), 127, 129, 133t, 156, 159, 166t, 173t Epipodophyllotoxins, 447t Epirubicin HCl (Ellence), 446t Epoetin alfa (Epogen), 239, 241, 242, 244t Epoprostenol (Flolan, Veletri), 216t Eprosartan mesylate (Teveten), 216t Erectile dysfunction, 352t actions, 340 adverse reactions, 340 contraindications, precautions, and interactions of, 340–341 patient education, 341 patient management issues, 341 uses, 340 Ergonovine, 359t actions, 354 adverse reactions, 355 and calcium deficiency, 355 contraindications, precautions, and interactions of, 356 patient education, 357 patient management issues, 357 uses, 355 Ergotism, 355, 356 Eribulin mesylate (Halaven), 446t Erlotinib (Tarceva), 447t Erythromycin (Akne-Mycin, Emcin, Erymax, Ilotycin, Romycin), 372, 373, 374, 413, 462, 469t, 482t Erythromycin base (Ery-Tab, PCE), 381t Erythromycin ethylsuccinate, 362, 381t Erythromycin ethylsuccinate/sulfisoxazole, 382t Erythromycin lactobionate, 381t Erythromycin stearate (Erythrocin stearate), 381t Escitalopram (Lexapro), 90t Esmolol (Brevibloc, Brevibloc), 137, 142t, 191, 196t, 216t Esomeprazole, 273, 281t Essential hypertension, 208 Estazolam, 90t Esterified estrogens, oral (Menest), 352t Estradiol (Estrace, Femtrace), 341, 352t Estradiol cypionate in oil (Depo-Estradiol), 352t Estradiol transdermal (Divigel, Elestrin, EstroGel, Estrasorb, Evamist), 352t Estradiol transdermal patch (Alora, Climara, Estraderm, FemPatch, Vivelle), 352t Estradiol transdermal system, 348 Estradiol vaginal cream (Estrace), 352t Estradiol vaginal ring (Estring, Femring), 352t Estradiol vaginal tablet (Vagifem), 352t Acosta Main Book_Index.indd 569 Estradiol valerate in oil (Delestrogen), 352t Estramustine phosphate sodium (Emcyt), 440, 446t Estriol, 341 Estrogen and androgen, oral (Covaryx, Estratest), 352t Estrogens, 345t, 352t, 440, 442, 446t actions, 341 adverse reactions, 345 contraindications, precautions, and interactions of, 346 excess and deficiency, 345t patient education, 347–348 patient management issues, 346–347 uses, 342 Estrogens and progestin oral (Prempro, Activella, Femhrt, Prefest, Mimvey), 352t transdermal (Climara Pro, CombiPatch), 352t Estrone, 341 Estropipate (Ogen, Ortho-Est), 341, 352t Eszopiclone (Lunesta), 90t Etanercept (Enbrel), 460t Ethacrynic acid (Edecrin), 247, 249t, 250, 253, 255t Ethambutol (Myambutol), 391t adverse reactions, 386 contraindications, precautions, and interactions of, 386 patient education, 388 treatment regimens, 387 Ethionamide (Trecator), 385, 388, 391t Ethosuximide (Zarontin), 56, 66t Ethotoin (Peganone), 57, 66t Ethylene, 114, 117t Etidronate (Didronel), 450, 460t Etodolac, 108t Etomidate (Amidate), 114, 117t Etoposide (Etopophos, Toposar), 447t Etravirine (Intelence), 398, 399, 400, 409t Euthyroid, 328 Everolimus (Afinitor, Zortress), 447t Excretion of drug, Exemestane (Aromasin), 447t Exenatide (Byetta), 301, 302, 305, 310t Expectorants actions, 177 adverse reactions, 177 contraindications, precautions, and interactions of, 178 patient education, 178 patient management issues, 178 uses, 177 Expectoration, 169 Extrapyramidal effects, 84, 85 Extravasation, 23, 441–442 Extreme drowsiness, 85 Extrinsic (allergic) asthma, 158b Eye, 150b, 151 Ezetimibe (Vytorin) actions, 222 adverse reactions, 222 contraindications, precautions, and interactions of, 222 patient education, 223–224 patient management issues, 223 uses, 222 F Famciclovir (Famvir), 410t Famotidine (Pepcid), 269t, 271, 272, 281t Fat-soluble vitamins vitamin A, 498 vitamin D, 498–499 vitamin E, 499 vitamin K, 499 FDA programs accelerated programs, compassionate access program, 3–4 orphan drug program, Febuxostat (Uloric), 453, 460t Fecal softeners/surfactants, 286 Federal Drug Legislation and Enforcement, 4–6 Felbamate, 66t Felodipine, 216t Female hormones actions, 341–342 adverse reactions, 345–346 contraindications, precautions, and interactions of, 346 estradiol transdermal system, 348 intravaginal application, 348–349 oral contraceptives, 348 patient education, 347–348 patient management issues, 346–347 uses, 342, 343 Female reproductive system, 342 Fenofibrate (Tricor, Fenoglide, Lipofen, Lofibra, Triglide, Trilipix, Antara), 226t Fenoldopam mesylate (Corlopam), 216t Fenoprofen calcium (Nalfon), 108t Fentanyl (Sublimaze), 103, 108t, 112t, 115 Ferrous fumarate (Femiron, Ferrimin 150, Ferrocite, Ferro-Sequels, Hemocyte, Nephro-Fer), 244t Ferrous gluconate (Fergon), 238, 242, 244t Ferrous sulfate (Fer-In-Sol, Feosol), 238, 242, 244t Fesoterodine (Toviaz), 264, 266t Fexofenadine (Allegra), 168, 169b, 173t Fibric acid derivatives actions, 221 adverse reactions, 221 contraindications, precautions, and interactions of, 221 uses, 221 Fibrinolytic drugs, 228 Filtrate, 246 Finasteride (Propecia, Proscar), 336, 337, 338, 339, 351t Fingolimod (Gilenya), 460t First dose effect, 139 First-pass effect, Fish oil, 223 Flavoxate (Urispas), 154t Flavoxate HCl (Urispas), 266t Flecainide (Tambocor), 191, 196t Floxuridine (FUDR, Fludara, Oforta), 446t 1/28/2012 12:36:08 PM 570 Fluconazole (Diflucan), 408t adverse reactions, 402 contraindications, precautions, and interactions of, 402 older adults, 402b patient management issues, 404 Flucytosine (5-FC) (Ancobon), 408t adverse reactions, 402 contraindications, precautions, and interactions of, 402–403 patient education, 404 patient management issues, 404 Fludarabine, 446t Fludrocortisone acetate, 326t, 460t Fluid, 319, 321 Fluid overload defined, 486 older adults, 486b symptoms of, 486b Fluid volume management, 318 Flunisolide (AeroBid), 161, 166t Fluocinolone acetonide (Capex, DermaSmoothe/FS), 463, 469t Fluocinolone acetonide iol (DermOtic), 481t Fluocinonide (Vanos), 469t Fluorometholone (Flarex), 482t Fluoroquinolones, 382t, 489 actions, 375 adverse reactions, 376 contraindications, precautions, and interactions of, 376 patient education, 377 patient management issues, 377 uses, 375 Fluorouracil (5-FU) (Carac, Efudex, Fluoroplex, Adrucil), 440, 442, 446t Fluoxetine (Prozac), 90t Fluoxymesterone (Androxy), 336, 351t Flurandrenolide (Cordran, Cordran SP), 469t Flurazepam (Dalmane), 90t Flurbiprofen (Ocufen), 108t, 477, 482t Flutamide, 442, 447t Fluticasone propionate (Cutivate, FloVent Diskus), 166t, 469t Fluvastatin (Lescol), 226t Fluvoxamine (Luvox CR), 90t Folic acid (Folvite), 238t, 239–242, 244t Folic acid anemia, 239 Folinic acid rescue, 239, 242 Follitropin alfa, 312, 313, 326t Follitropin beta (Follistim AQ), 326t Follitropins, 312–314, 323 Food, Drug, and Cosmetic Act, Formoterol fumarate (Foradil Aerolizer), 160, 166t Fosamprenavir (Lexiva), 398, 400, 409t Fosaprepitant (Emend), 124t Foscarnet, 410t Fosfomycin tromethamine (Monurol), 262t Fosinopril sodium, 216t Fosphenytoin sodium, 66t Fospropofol (Lusedra), 114, 117t Fractions adding fractions, 32 constructing fractions, 32 Acosta Main Book_Index.indd 570 Index converting improper fractions to mixed numbers, 31 converting mixed numbers to improper fractions, 31 denominator, 32 dividing fractions, 33 factoring numbers, 31 multiplying fractions, 32–33 order of operations, 31 principles, 30–31 reciprocal numbers, 31 reducing fractions, 31 subtracting fractions, 32 Fulvestrant (Faslodex), 447t Fungicidal, defined, 401 Fungistatic, defined, 401 Fungus, defined, 401 Furosemide (Lasix), 247, 249t, 253, 255t Fusion inhibitors (FIs), 409t actions, 398 adverse reactions, 399 contraindications, precautions, and interactions of, 400 G Gabapentin (Neurontin), 66t Galantamine hydrobromide (Razadyne), 72t Gallstone-solubilizing agent, 284, 290, 293t actions of, 284 adverse reactions of, 284 contraindications, precautions, and interactions of, 284 patient education, 284–285 patient management issues, 284 uses of, 284 Ganciclovir (Cytovene, Vitrasert, Zirgan), 400, 410t, 477, 482t Garlic, 222, 506–507 Gastric stasis, 274 Gastroesophageal reflux disease, 274 Gastrointestinal bleeding, salicylate, 93b Gastrointestinal diseases, 319 Gastrointestinal stimulants, 281t actions, 274 adverse reactions, 274–275 contraindications, precautions, and interactions of, 275 patient education, 275 patient management, 275 uses, 274 Gastrointestinal system digitalis toxicity, 185b glucocorticoids, 319, 320, 322 gonadotropin, 314 herbal remedies, 507–508 Gastrointestinal tract, 150, 150b, 151 Gatifloxacin (Zymaxid), 376, 482t Gefitinib (Iressa), 447t Gemcitabine HCl (Gemzar), 446t Gemfibrozil (Lopid), 226t Gemifloxacin (Factive), 375, 382t General anesthesia muscle relaxants, 115t stages, 114b General anesthetics administration, 113, 113–115 adverse reactions, 115 patient education, 115 patient management issues, 115 uses, 113 Generic drug name, 4t Gentamicin, 462, 467, 469t Gentamicin (Garamycin), 375, 382t, 482t Germicides, topical, 463, 469t Ginger, 122b, 507–508 for nausea, 278b Gingival hyperplasia, 55 Gingko biloba, 501 Ginseng, 503t, 505 Glatiramer acetate (Copaxone), 460t Glaucoma, 137, 140, 146 alpha2-adrenergic drugs, 474, 481t b-adrenergic blocking drugs, 475, 481t carbonic anhydrase inhibitors for, 475– 476, 481t prostaglandin agonists for, 475, 479, 481t sympathomimetics for, 474, 481t Glimepiride (Amaryl), 302, 303t, 310t Glipizide (Glucotrol), 301, 302, 303t, 310t Globulin, 432 Glucagon (GlucaGen, Glucagon Emergency), 299, 310t Glucagon-like peptide receptor agonists actions, 302 adverse reactions, 303 contraindications, precautions, and interactions of, 304 glucagon-like peptide receptor agonist, 305 Glucocorticoids, 460t actions of, 318 activity, 319t adverse reactions of, 319–320 contraindications, precautions, and interactions of, 320 drug interaction, 321t patient management issues, 322 uses of, 318–319 Glucometer, 300 Glucosamine, 457b Glucose (Glutose (OTC), Insta-Glucose, Insulin Reaction Dex4 Glucose, BD Glucose), 310t Glyburide/glibenclamide (DiaBeta, Glynase), 302, 310t Glycerin (Zinotic), 286, 293t, 472, 481t Glycopyrrolate (Cuvposa, Robinul, Robinul Forte, Robinul), 112t, 154t, 274 Goiter, 328 Gold compounds, 454–455, 455b, 460t Gold sodium thiomalate (Myochrysine), 454, 460t Goldenseal, 509 Golimumab (Simponi), 460t Gonadotropin-releasing hormone analogs, 440, 447t Gonadotropins actions of, 312–313 adverse reactions of, 313–314 contraindications, precautions, and interactions of, 314 patient education, 314 patient management issues, 314 uses of, 313 1/28/2012 12:36:08 PM 571 Index Goserelin acetate (Zoladex), 440, 443, 447t Gout, 453, 453–454, 460t Granisetron (Granisol), 124t Grape seed extract, 507 Green tea, 443b, 509 Griseofulvin (Grifulvin-V, Gris-PEG), 401, 408t adverse reactions, 402 contraindications, precautions, and interactions of, 403 patient education, 404 patient management issues, 404 Growth hormone, 314–315, 326t Guaifenesin (Mucinex, Organidin), 180t Guanabenz acetate, 216t Guanethidine, 138 Guanfacine (Tenex), 209, 216t H Haemophilus B conjugate vaccine (ActHIB, Hiberix, Liquid PedvaxHIB), 436t Haemophilus influenzae type b conjugate vaccine (Comvax), 436t Halcinonide (Halog), 469t Half-life of drug, Half-normal saline, 488 Halobetasol propionate (Ultravate), 469t Haloperidol, 452 Harrison Narcotic Act, HCG (See Human chorionic gonadotropin (hCG) ) Health Insurance Portability and Accountability Act (HIPAA), Heart failure difined, 182, 182 left ventricular dysfunction, 182b, 183 right ventricular dysfunction, 182b symptoms, 182b Helicobacter pylori therapy, 273t bismuth subsalicylate, 274 helidac, 274 Helidac, 274 Helminthiasis, 412 Helminths, 412 Hematologic disorders, 319 Hemostasis, 228 Heparin, 442 actions, 231 adverse reactions, 231–232 contraindications, precautions, and interactions of, 232 dosages, 40 patient education, 232–233 patient management issues, 232 uses, 231 Hepatitis, 394 Hepatitis A (inactivated)/Hepatitis B (recombinant) vaccine (Twinrix), 436t Hepatitis A vaccine, inactivated (Havrix, Vaqta), 430, 436t Hepatitis B, immune globulin (human) (HBIG) (HepaGam B, HyperHEP BS/D, Nabi-HB), 436t Hepatitis B vaccine (Comvax), 436t Hepatitis B vaccine recombinant (Engerix-B, Recombivax HB), 430, 431, 436t Acosta Main Book_Index.indd 571 Hepatotoxic, 69 Herb, 497 Herbal therapy, 497, 502t–504t affect the cardiovascular system, 506–507 affect the endocrine and reproductive systems, 508 affect the gastrointestinal systems, 507–508 affect the immune system, 508–509 affect the neurologic system, 501, 502t–504t, 505–506 affect the urinary systems, 507–508 aloe vera, 510–511 bilberry, 510 black cohosh, 508 chamomile, 507 cranberry, 507 as diuretics, 508 echinacea, 509 elderberry, 509 garlic, 506–507 ginger, 507–508 gingko biloba, 501 ginseng, 505 goldenseal, 509 grape seed extract, 507 green tea, 509 hypertension, 212b, 507 kava, 505 lemon balm, 509 milk thistle, 508 saw palmetto, 508 St John’s wort, 505–506, 505b valerian, 506 willow bark, 506 Herpes simplex virus (HSV), 394 Herpes zoster (Shingles), 394 Hexachlorophene (pHisoHex), 465, 469t High-density lipoproteins (HDL), 218, 219 High-dose glucocorticoid therapy, 323 Histamine, 168, 168 Histamine H2 antagonists, 281t actions, 271 adverse reactions, 271 contraindications, precautions, and interactions of, 272 patient education, 272 patient management, 272 uses, 271 Histone deacetylase inhibitors, 447t Histrelin acetate (Supprelin LA, Vantas), 447t HMG-CoA reductase inhibitors actions, 220 adverse reactions, 221 contraindications, precautions, and interactions of, 221 uses, 221 H5N1 influenza vaccine, 436t Homatropine (isopto homatropine), 481t Hormones, 438, 447t–448t actions, 440 contraindications, precautions, and interactions of, 442 Household measurement system, 37 Human chorionic gonadotropin (HCG) (Novarel, Pregnyl), 313, 326t Human immunodeficiency virus (HIV), 398, 399, 399b, 401b Human papillomavirus (type S 16, 18) bivalent vaccine, recombinant (Cervarix), 430, 431, 436t Human papillomavirus quadrivalent vaccine, recombinant (Gardasil), 430, 436t Humoral immunity, 428, 429 Hyaluronic acid derivatives (Euflexxa, Hyalgan, Supartz, Orthovisc, Synvisc), 460t Hydantoins, 413 adverse reactions, 55–56 contraindications, precautions, and interactions of, 56–57 patient education, 58 Hydralazine (Apresoline), 209, 216t Hydrobromide (isopto homatropine), 481t Hydrochloric acid, 268 Hydrochlorothiazide, 248, 255t Hydrocortisone (Cortisol,Solu-Cortef, Cortenema, Colocort), 318, 321t, 326t, 460t, 463, 469t Hydrocortisone acetate (Caldecort, CortAlo, NuCort, NuZon), 469t Hydrocortisone buteprate (Pandel), 469t Hydrocortisone butyrate (Locoid), 469t Hydrocortisone, otic preparations (Cortisporin Otic), 472, 481t, 482t Hydrocortisone probutate (Pandel), 469t Hydrocortisone valerate (Westcort), 469t Hydromorphone, 99, 108t Hydroxyamphetamine (Paremyd), 481t Hydroxychloroquine (Plaquenil), 415, 420t, 455–457, 460t Hydroxyprogesterone caproate (Makena), 352t Hydroxyurea (Droxia, Hydrea), 448t Hydroxyzine (Vistaril), 112t, 173t Hyoscyamine sulfate, 281t l-Hyoscyamine sulfate (Anaspaz, Donnamar, Levbid), 154t Hyperglycemia, 298b, 298t vs hypoglycemia, 298t symptoms, 301 Hyperkalemia, 248, 248b, 250, 251, 251b, 253 Hyperlipidemia, 218, 221, 223 Hyperosmotic agents, 293t Hypersecretory, 271 Hypersensitivity reactions, to penicillins, 367, 367b sulfonamides, 363 Hyperstimulation syndrome, 314, 314b Hypertension, 208, 208b, 210 alpha/beta-adrenergic blocking drugs, 397–398 herbal remedies, 507 Hypertension/heart disease, 171 Hyperthyroidism defined, 328 signs and symptoms, 328t Hypnotics (See Sedatives and hypnotics) Hypocalcemia, 487, 488b Hypoglycemia, 298t, 306b vs Hyperglycemia, 298t 1/28/2012 12:36:08 PM 572 Hypokalemia, 212, 487, 488b Hyponatremia, 212, 488, 488b Hypotension, 139 Hypothyroidism defined, 328 older adults, 330 signs and symptoms, 328t I Ibandronate (Boniva), 460t Ibritumomab tiuxetan (Zevalin), 448t Ibuprofen (Advil/Motrin), 96, 97, 108t Ibutilide (Corvert), 192, 196t Idarubicin HCl (Idamycin PFS), 446t Ifosfamide (Ifex), 446t Imatinib mesylate (Gleevec), 447t Imidazotetrazine derivatives, 447t Imipramine (Tofranil), 90t Immune globulin (human) IM (IG, IGIM, IMIG, gamma globulin, IgG) (GamaSTAN S/D), 436t Immune globulin IV (human) (Carimune, Flebogamma, Flebogamma DIF, Gammagard), 436t Immune globulin (human) subcutaneous (IGSC, SCIG) (Hizentra, Vivaglobin), 436t Immune globulins, 432–433, 436t Immune system, herbal remedies, 508–509 Immunity, 429 active, 429–430, 430, 430b, 436t cell-mediated, 428–429 defined, 428 humoral, 428, 429 infants and children, 433b passive, 430, 430, 436t Immunization, 430 Immunocompromised, defined, 462 Immunologic agents active, 436t immune globulins and antivenins, 432–433 passive, 436t patient education, 433, 433b patient management issues, 432–433 vaccines and toxoids, 431–432 Immunomodulators, 455, 460t Improper fraction, 30 Inamrinone and milrinone, 185–187 Inamrinone lactate, 188t Indapamide, 249, 255t Indinavir (Crixivan), 398, 400, 409t Indomethacin (Indocin), 108t Induction drug, 111 Infiltration, 23 Infliximab (Remicade), 288, 290, 293t, 460t Influenza, 394 Influenza type A and B vaccine (Afluria, Agriflu, Fluarix, FluLaval, Fluvirin, FluMist), 430, 436t Inhalation, 25, 25 Insomnia, 75 Insulin actions, 297–298 adverse reactions, 298–299, 298t contraindications, precautions, and interactions, 299 Acosta Main Book_Index.indd 572 Index dosages, 40–41 patient education, 301 patient management issues, 299–300 preparations, 297 uses, 298 Insulin aspart solution (NovoLog Rx), 297t, 310t Insulin detemir (Levemir), 297t, 310t Insulin glargine solution (Levemir FlexPen Lantus (Rx), Lantus OptiClik, Lantus SoloStar), 297t, 310t Insulin glulisine (Apidra Rx), 297t, 310t Insulin injection (Humulin R (OTC), Novolin R (OTC), Novolin R InnoLet, Novolin R PenFill), 297t, 299, 300, 310t Insulin lispro (Humalog), 297, 310t Integrase inhibitors, 409t actions, 398 adverse reactions, 399 contraindications, precautions, and interactions of, 400 Interferon beta-1A (Avonex, Rebif), 460t Interferon beta-1b (Betaseron, Extavia), 460t Intermittent claudication, 203 Intra-articular administrations, 323 Intradermal route, 23–24, 24 Intralesional administrations, 323 Intramuscular route, 22, 23 Intraocular pressure (IOP), 473, 473b, 474–477, 479 Intravenous replacement solutions actions and uses, 485 adverse reactions, 485 contraindications, precautions, and interactions of, 486 Intravenous route, 22, 23 Intrinsic factor, 238t, 240, 242 Iodine 131I-tositumomab, 448t Iodine radioactive (131I) (Hicon), 334t adverse reactions, 331 contraindications, precautions, and interactions of, 331 patient education, 332 patient management issues, 331 uses, 330 Iodism, 330 Iodoquinol (Yodoxin), 420t adverse reactions, 416 contraindications, precautions, and interactions of, 416, 418 patient education, 418 IOP (See Intraocular pressure (IOP) ) Ipecac syrup, 281t Ipilimumab ofatumumab (Yervoy Arzerra), 448t Ipratropium bromide (Atrovent), 156, 166t Irbesartan (Avapro), 209, 211t, 216t Irinotecan HCl (Camptosar), 447t Iron deficiency anemia, 238 Iron dextran (DexFerrum, Infed), 238, 239, 241, 244t Iron salt, 238, 241, 242 Iron sucrose (Venofer), 244t Irritant or stimulant laxatives, 286 Ischemic heart disease, 182 Isocarboxazid (Marplan), 90t Isoflurane (Forane), 114, 117t Isolated systolic hypertension (ISH), 209b Isoniazid (INH), 391t adverse reactions, 386 combination products, 384b contraindications, precautions, and interactions of, 387 patient education, 388 treatment regimens, 387 uses, 385 Isophane insulin suspension (NPH), 297t, 310t Isopropyl alcohol, 472, 481t Isoproterenol (Isuprel, Medihaler-Iso), 129, 130, 133t, 166t Isosorbide dinitrate (Isordil), 198, 206t Isosorbide mononitrate (Imdur, Ismo, Monoket), 198, 206t Isoxsuprine, 203, 206t Isradipine (DynaCirc CR), 216t Itraconazole (Sporanox, Sporanox PulsePak), 408t adverse reactions, 402 contraindications, precautions, and interactions of, 403 patient education, 404 patient management issues, 404 Ivermectin (Stromectol), 420t actions, uses, and adverse reactions, 412 contraindications, precautions, and interactions of, 413 Ixabepilone (Ixempra Kit), 446t J Jacksonian seizure, 54 Japanese encephalitis virus vaccine (JE-Vax), 430, 436t K Kanamycin, 375, 378, 382t Kava, 505, 505b Keratolytics, topical, 465, 465, 470t Ketamine (Ketalar), 117t Ketoconazole (Extina (Rx), Kuric (Rx), Nizoral A-D (OTC), Xolegel), 399, 401, 408t, 413, 469t, 489 adverse reactions, 402 contraindications, precautions, and interactions of, 403 patient education, 404 patient management issues, 404 Ketoprofen, 108t Ketorolac (Acular), 108t, 477, 482t Ketotifen (Alaway), 482t Kinase inhibitors, 447t–448t L Labetalol (Normodyne), 138, 142t Lacosamide (Vimpat), 66t Lactulose (Kristalose), 293t Lamivudine (Epivir, Epivir HBV), 398, 399b, 400, 409t Lamivudine/Zidovudine (Combivir), 409t Lamotrigine, 56, 57, 66t Lansoprazole (Prevacid, Prevacid 24 HR (OTC), Prevacid SoluTab), 272, 273, 281t 1/28/2012 12:36:08 PM 573 Index Lapatinib (Tykerb), 447t L-Arginine, 204 Latanoprost (Xalatan), 481t Laxatives actions, 286 adverse reactions of, 286 bulk-producing, 286 contraindications, precautions, and interactions of, 286–287 emollient, 286 fecal softeners/surfactants, 286 hyperosmolar, 286 irritant or stimulant, 286 saline, 286 uses of, 286 Leflunomide (Arava), 460t Lemon balm, 398b, 509 Leprostatic drugs, 388–389, 391t Leprosy, 384 Letrozole (Femara), 447t Leucovorin, 239, 240–242 Leucovorin calcium, 244t Leucovorin rescue, 239 Leukopenia, 441 Leukotriene formation inhibitors actions, 161 adverse reactions, 162 contraindications, precautions, and interactions of, 162–163 uses, 161 Leukotriene receptor antagonists, 161–162 Leukotrienes, 161 Leuprolide (Eligard, Lupron, Lupron Depot), 442, 447t Levalbuterol HCl (Xopenex), 166t Levetiracetam, 66t Levobunolol (Betagan), 481t Levocetirizine (Xyzal), 173t Levodopa, 63 Levofloxacin (Levaquin, Quixin), 375, 377, 382t, 482t Levoleucovorin calcium (Fusilev), 447t Levonorgestrel (Next Choice, Plan B, Plan B One-Step), 344t Levorphanol tartrate, 108t Levothyroxine (T4) (Levothroid, Levoxyl, Synthroid, Tirosint), 328, 329 Lidocaine (Akten, Xylocaine), 110t, 111, 191, 193, 196t, 441, 443, 481t Linagliptin (Tradjenta), 301, 302, 310t Lincomycin (Lincocin), 372, 373, 374, 381t Lincosamides, 381t actions, 372 adverse reactions, 373 contraindications, precautions, and interactions of, 373 patient education, 374–375 patient management issues, 373–374 uses, 372 Linezolid (Zyvox), 426t actions and uses, 422 adverse reactions, 422 contraindications, precautions, and interactions of, 423 patient management issues, 424 Liothyronine sodium (T3) (Cytomel, Triostat), 334t Acosta Main Book_Index.indd 573 Lipids, 218 Lipodystrophy, 300 Lipoprotein, 218, 219 Liquid eye medication, 146 Liraglutide (Victoza), 301, 302, 305, 306, 310t Lisdexamfetamine dimesylate (Vyvanse), 52t Lisinopril (Prinivil), 209, 211t, 216t Lithium toxicity, 85 Local anesthetics patient education, 111 patient management issues, 111 topical, 465–466, 470t uses, 110–111 Local infiltration anesthesia, 111 Lodoxamide (Alomide), 482t Lomustine (CCNU) (CeeNU), 446t Long-term glucocorticoid therapy, 323 Loop diuretics, 247, 250 Loperamide HCl (Imodium A-D (OTC) ), 287, 293t Lopinavir/ritonavir (Kaletra), 399b, 409t Loratadine (Claritin), 168, 169, 169b, 173t Losartan (Cozaar), 209, 211t, 216t Loteprednol (Alrex, Lotemax), 482t Lovastatin (Mevacor), 226t Low-density lipoproteins (LDL), 218, 221 Lower respiratory tract diseases, antihistamines, 169 Low-molecular-weight heparins (LMWHs) (See Heparin) Lubiprostone (Amitiza), 288, 290, 293t Lumen, 198 Lutropin alfa (Luveris), 326t Lymphocyte immune globulin, antithymocyte globulin (equine) (LIG, ATG, ATG equine) (Atgam), 436t M Macrolides, 381t actions, 372 adverse reactions, 373 contraindications, precautions, and interactions of, 373 patient education, 374–375 patient management issues, 373–374 uses, 372 Macrominerals calcium, 500 potassium, 500 sodium, 501 Mafenide (Sulfamylon), 362, 363b, 364, 382t Magnesia (Milk of Magnesia, Phillips’ Chewable), 268, 269t, 272, 275, 281t Magnesium (Mg++), 494t actions and uses, 487 adverse reactions, 489 contraindications, precautions, and interactions of, 489 older adults, 490b symptoms of, 488b Magnesium chloride (Mag-64, Mag-SR), 489, 494t Magnesium gluconate (Mag-G), 494t Magnesium hydroxide (Milk of Magnesia), 286, 287, 293t Magnesium lactate (Mag-Tab SR), 494t Magnesium oxide (Phillips’ Cramp-Free, Uro-Mag 140, Mag-Ox), 293t, 494t Magnesium salicylate, 92, 107t Magnesium sulfate (Epsom salt), 66t, 293t, 487, 489, 490, 491, 494t Magnesium-containing antacids, 268 Major depressive disorder, 80 Malarial parasite, life cycle, 414 Male hormones actions, 336 adverse reactions, 337–338 contraindications, precautions, and interactions of, 338–339 patient educating, 339–340 patient management issues, 339 uses, 336–337 Malignant hypertension, 208 Mannitol (Osmitrol), 247–250, 255t Maprotiline, 90t Maraviroc (Selzentry), 398, 399, 409t Masoprocol (Actinex), 465 Mast cell stabilizer actions, 162 adverse reactions, 162 contraindications, precautions, and interactions of, 162–163 patient education, 163 patient management issues, 163 uses, 162 Math review apothecary system, 36 Arabic number and Roman numerals, 35 biological standard unit, 40 decimals, 33–35 dimensional analysis, 39–40 drug dosages for children, 41–42 fractions, 30–33 household measurement system, 36–38 metric system, 35–36 percentages, 35 ratios and proportions, 38–39, 39b Measles, Mumps, and Rubella virus vaccine, live (MMR II), 436t Measles, Mumps, Rubella, and Varicella virus vaccine, live, attenuated (ProQuad), 431, 436t Mebendazole (Vermox), 420t actions, uses, and adverse reactions, 412 contraindications, precautions, and interactions of, 413 Mechlorethamine hydrochloride (Mustargen), 446t Meclizine (Antivert), 124t Meclofenamate, 108t Medication administration record (MAR), 20 Medication order, 16 Medroxyprogesterone (Depo-Provera, Provera), 341, 346, 352t Medroxyprogesterone acetate (Depo-Provera), 447t Mefenamic acid (Ponstel), 108t Mefloquine HCL, 420t Megaloblastic anemia, 239–242 1/28/2012 12:36:09 PM 574 Megestrol acetate (Megace ES, Megace Oral), 352t, 440, 442, 447t Meglitinides actions, 302 adverse reactions, 303 contraindications, precautions, and interactions of, 304 drug table, 310 patient management issues, 305 Melphalan (L-PAM; L-Phenylalanine Mustard; L-Sarcolysin) (Alkeran), 440, 443, 446t Meningococcal vaccine (Menactra, Menomune), 436t Menotropins (Menopur), 312–314, 323, 326t Mepenzolate bromide (Cantil), 154t, 281t Meperidine, 99, 99, 100, 108t Meperidine hydrochloride (Demerol), 112t Mephobarbital (Mebaral), 90t Mepivacaine HCl (Carbocaine, Polocaine), 110t Meprobamate, 452 Mercaptopurine (Purinethol), 440, 446t Meropenem (Merrem), 426t actions and uses, 422 adverse reactions, 422 contraindications, precautions, and interactions of, 423 patient management issues, 424 Mesalamine (Asacol), 288, 290, 293t Mesna (Mesnex), 447t Metabolic, 316, 320 Metabolism of drug, Metaproterenol sulfate, 166t Metaxalone (Skelaxin), 460t Metformin, 302, 303t, 310t Methadone (Dolophine), 99, 100, 108t, 400 Methamphetamine (Desoxyn), 46, 52t Methazolamide (Neptazane), 246, 253, 255t Methenamine, 258–260, 262t Methimazole (Northyx, Tapazole), 334t adverse reactions, 330 contraindications, precautions, and interactions of, 331 patient education, 332 patient management issues, 331 uses, 330 Methocarbamol (Robaxin), 460t Methohexital sodium (Brevital sodium), 117t Methotrexate (Rheumatrex, Trexall), 440, 441, 442, 446t, 454, 455–457, 460t, 489 Methscopolamine (Pamine), 154t Methscopolamine bromide (Pamine Pamine Forte, Pamine FQ), 281t Methsuximide (Celontin), 56, 66t Methyclothiazide, 255t Methyldopa, 216t Methylergonovine (Mifeprex), 359t actions, 354 adverse reactions, 355 contraindications, precautions, and interactions of, 356 patient education, 357 Acosta Main Book_Index.indd 574 Index patient management issues, 357 uses, 355 Methylergonovine maleate (Methergine), 359t Methylhydrazine derivatives, 448t Methylphenidate HCL (Concerta), 52t Methylprednisolone (Medrol, A-Methapred, Solu-Medrol), 460t Methylprednisolone (Medrol, Solu-Medrol), 324, 326t Methyltestosterone (Android, Testred), 336, 339, 351t, 352t Metipranolol (Optipranolol), 481t Metoclopramide (Reglan), 272, 274, 275, 278, 281t Metolazone (Zaroxolyn), 255t Metoprolol (Lopressor), 209, 211t, 216t Metric system, 35–36 Metronidazole (Flagyl, Metro, MetroCream, Noritate, Nydamax, Vandazole), 372, 416, 420t, 425, 426t, 462, 469t actions and uses, 422 adverse reactions, 422 contraindications, precautions, and interactions of, 423 patient management issues, 424 Mexiletine, 191, 193, 196t, 466 Micafungin (Mycamine), 408t Miconazole (Monistat, Cruex, Desenex, Fungoid, Tincture), 401, 408t adverse reactions, 402 contraindications, precautions, and interactions of, 403 patient education, 404 patient management issues, 404 Miconazole nitrate, 462, 469t Midazolam (Versed), 112t, 114, 117t Midodrine, 131, 132, 133t Mifepristone actions, 354–355 adverse reactions, 356 contraindications, precautions, and interactions of, 356 patient education, 357 patient management issues, 357 uses, 355 Miglitol (Glyset), 302, 303, 305, 310t Milk thistle, 508 Milrinone lactate, 188t Mineralocorticoid, 460t actions of, 321 adverse reactions of, 321 contraindications, precautions, and interactions of, 321 patient education and therapy, 322–323 patient management issues, 322 uses of, 318–319 Mineralocorticoid (Fludrocortisone) therapy, 323 Minerals, 500–501 macrominerals, 500–501 oil, 286, 287, 293t trace minerals, 501 Minocycline (Minocin), 372, 373, 374, 381t Minoxidil (Loniten), 209, 216t Miosis, 100 Miosis (Flurbiprofen), 475, 477 Miotics, 475, 481t Mirtazapine (Remeron), 90t Misoprostol (Cytotec), 277–279, 281t Mitomycin, 442, 447t Mitotane (Lysodren Provenge Sclerosol Intrapleural), 448t Mitotic inhibitors (Antimitotics), 438, 446t actions, 440 contraindications, precautions, and interactions of, 442–443 Mitoxantrone (Novantrone), 442, 446t, 460t Mixed number, 30 Modafinil (Provigil), 46, 47, 52t Moexipril, 213, 216t Mometasone (Asmanex), 166t Mometasone furoate (Elocon), 469t Monoamine oxidase inhibitors (MAOIs) adverse reactions, 81 contraindications, precautions, and interactions of, 82 drug–food interactions, 82b headache and hypertensive crisis, 83b patient management issues, 83 Monoclonal antibodies, 448t Monophasic oral contraceptives, 342, 343t Montelukast sodium (Singulair), 161–163, 166t Morphine sulfate, 103, 108t, 112t Moxifloxacin (Avelox), 375, 376, 377, 382t Moxifloxacin (Moxeza), 482t Mucolytics actions, 177 adverse reactions, 177 contraindications, precautions, and interactions of, 178 patient education, 178 patient management issues, 178 uses, 177 Mumps vaccine, 431, 436t Mupirocin (Bactroban, Centany), 469t Muscular system digitalis toxicity, 185b Musculoskeletal system, 319 corticosteroids, 453, 460t defined, 450 disorders, 451t drug therapy, 452b drugs for, 460t gold compounds, 454–455, 460t gout, 453, 453–454, 460t hydroxychloroquine, 455–457, 460t methotrexate, 455–457, 460t osteoporosis, 450–451, 460t patient information, 457b penicillamine, 455–457, 460t skeletal muscle relaxants, 451–453, 460t Myasthenia gravis, 145, 146 Mycobacterium leprae, 384, 388 Mycobacterium tuberculosis, 384, 385 Mycotic infection, 401 Mydriasis, 476 Mydriatics cycloplegic, 476, 481t vasoconstrictors, 476, 482t Myoclonic seizures, 54 Myopia, 145 Myxedema, 328 1/28/2012 12:36:09 PM 575 Index N Nabilone (Cesamet), 124t Nabumetone, 108t Nadolol (Corgard), 137, 142t, 216t Nafcillin sodium, 381t Naftifine (Naftin), 408t, 469t Nalbuphine, 108t Naloxone, 105 Naloxone hydrochloride, 107t Naltrexone, 105 Naltrexone hydrochloride (ReVia), 107t Naphazoline (AK-Con), 482t Naphazoline (Privine), 173t Naproxen, 97, 108t Narcolepsy, 47, 49 Narcotic analgesics, 101 actions, 98–99 contraindications, precautions, and interactions of, 101–102 patient education, 103–104 patient management issues, 102–103 uses, 99–101 Narcotic antagonists actions, 104 adverse reactions, 105 contraindications, precautions, and interactions of, 105 opioid dependency, 105 patient education, 105 patient management issues, 105 respiratory depression, 105 uses, 104 Nasal decongestants, 171 Natalizumab (Tysabri), 460t Natamycin (Natacyn), 477, 482t Nateglinide (Starlix), 301, 310t National Center for Complementary and Alternative Medicine (NCCAM), 497 Nausea, 120, 121 and vomiting, adverse reactions, 441 Nebivolol (Bystolic), 216t Nebulization, 177 Necator americanus (Hookworm), 412t Necrotic, defined, 464 Nedocromil (Alocril), 482t Nefazodone, 90t Nelarabine (Arranon), 447t Nelfinavir (Viracept), 398, 400, 409t Neomycin, 375, 377, 382t, 463 Neomycin sulfate, 481t Neoplastic diseases, 319 Neostigmine (Prostigmin), 145, 148t Nepafenac (Nevanac), 482t Nephron, 246 Nephrotoxicity from aminoglycosides, 374b, 376 from cephalosporins, 371 Nervous system, 319 divisions of, 126, 126 neurotransmitters, 127–128, 127t, 128, 129 peripheral nervous system, 126–127 Neuroleptanalgesia, 115 Neuroleptic drugs, 83 Neuroleptic malignant syndrome, 85 Neurologic system, 320 herbal remedies, 501, 505–506 Acosta Main Book_Index.indd 575 Neurotoxicity from aminoglycosides, 374b, 376 Neurotransmitter, 127–128, 129 Nevirapine (Viramune, Viramune XR), 398, 399, 400, 409t Niacin (B3), 499 Niacin (Endur-Acin, Niacinol, Niacor, Niaspan, No Flush Niacin, Slo-Niacin) actions, 222 adverse reactions, 222 contraindications, precautions, and interactions of, 222 patient education, 223–224 patient management issues, 223 uses, 222 Nicardipine (Cardene), 201, 206t Nicardipine (Cardene IV, Cardene SR), 216t Nifedipine (Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia, Procardia XL), 201, 206t, 216t Nilotinib (Tasigna), 447t Nilutamide (Nilandron), 447t Nisoldipine (Sular), 216t Nitrates actions, 198 adverse reactions, 198–199 contraindications, precautions, and interactions of, 199 patient education, 199–201 patient management issues, 199 uses, 198 Nitrofurantoin (Furadantin), 258–261, 262t Nitroglycerin, 198–200, 206t Nitroglycerin, oral (Nitro-Time), 206t Nitroglycerin, topical (Nitro-Bid), 200, 206t Nitroglycerin transdermal systems, 200, 206t Nitroglycerin, translingual (Nitrolingual, NitroMist), 206t Nitroprusside sodium (Nitropress), 216t Nitrous oxide, 114, 117t Nizatidine (Axid, Axid AR (OTC) ), 271, 272, 281t Nomogram, 41–42 Nonnucleoside reverse transcriptase inhibitors (NNRTIs), 409t actions, 398 adverse reactions, 399 contraindications, precautions, and interactions of, 400 Nonpathogenic bacteria, 367 Nonprescription drugs, Nonproductive cough, 176 Nonsalicylate analgesics actions, 95 adverse reactions of, 95 contraindications, precautions, and interactions of, 96 patient education, 96 patient management issues, 96 uses, 95 Nonsteroidal anti-inflammatory drugs (NSAIDs) actions, 96–97 adverse reactions, 97 contraindications, precautions, and interactions of, 97 ophthalmic preparations, 477, 481t patient education, 98 patient management issues, 97–98 uses, 97 Norepinephrine (Levophed), 127–129, 129, 133t Norethindrone (Aygestin), 341, 343t, 344t, 352t Norfloxacin (Noroxin), 375, 377, 382t Normal flora, 367 Normal saline, 488 Nortriptyline (Pamelor), 90t Nosocomial pneumonia, 422 Nucleoside/nucleotide analog reverse transcriptase inhibitors (NRTIs), 409t actions, 398 adverse reactions, 399 contraindications, precautions, and interactions of, 400 Numerator, 30 Nutritional supplements minerals, 500–501 recommended dietary allowances (RDAs), 497b supplement use, 497–498 vitamins, 498–500 Nystagmus, 55 Nystatin (Bio-Statin, Pediaderm AF, Nyamyc, Nystop, Pedi-Dri), 401, 408t, 469t O Obesity, 47–48 Occupational Safety And Health Administration guidelines, 22 Ofloxacin (Floxin Otic, Moxeza, Ocuflox), 375, 382t, 481t, 482t Olopatadine (Pataday, Patanol), 482t Olsalazine sodium (Dipentum), 288, 290, 293t Omeprazole (Zegerid, Zegerid OTC), 272, 273, 281t, 400 Ondansetron (Zofran), 124t On–off phenomenon, 60 Onychomycosis, 401 Ophthalmic diseases, 319 Ophthalmic preparations alpha2-adrenergic drugs, 474, 481t antibiotics, 477, 482t antifungal drugs, 477, 482t antimuscarinics/cycloplegic mydriatics, 476, 481t antiviral drugs, 477, 482t b-adrenergic blocking drugs, 475, 481t carbonic anhydrase inhibitors, 475–476, 481t corticosteroids, 477, 482t mast cell stabilizers, 476–477, 482t miotics cholinesterase inhibitor, 475, 481t direct-acting, 475, 481t nonsteroidal anti-inflammatory, 477, 482t patient education, 478 patient management issues, 478 prostaglandin agonists, 475, 479, 481t sympathomimetics, 474, 481t Ophthalmic systems, 316, 319, 320, 326t 1/28/2012 12:36:09 PM 576 Opioid agonists, 99 Opioids, 99, 100, 104, 105 Opium, 98–100, 108t Oral electrolyte mixtures (Infalyte Oral Solution, Naturalyte Solution, Pedialyte), 494t Oral mucositis, 441 Oral route, 21–22 Oral suspensions penicillins, 369–370 Orlistat (Alli (OTC), Xenical (Rx) ), 288, 290, 293t Orphan drug program, Orphenadrine citrate (Norflex), 460t Orthostatic hypotension, 81, 130 Oseltamivir (Tamiflu), 410t adverse reactions, 395 contraindications, precautions, and interactions of, 396 patient education, 397–398 patient management issues, 397 Osmotic diuretics, 247–248, 250, 255t Osteoarthritis, 450, 450, 451t Otic preparations actions of, 472 adverse reactions of, 472 contraindications, precautions, and interactions of, 472 patient education, 472–473 patient management issues, 472 uses of, 472 Ototoxicity from aminoglycosides, 374b, 376 Overactivebladder, 264, 265 Oxacillin sodium (Bactocill), 381t Oxaloplatin (Eloxatin), 448t Oxandrolone (Oxandrin (CIII) ), 351t Oxaprozin, 108t Oxazolidinone, 422 Oxcarbazepine (Trileptal), 57, 66t Oxiconazole (Oxistat), 408t, 469t Oxybutynin chloride (Gelnique, Ditropan XL, Oxytrol), 264, 265, 266t Oxycodone (OxyContin), 99, 103, 108t Oxymetazoline (Afrin, Visine LR), 170, 173t, 482t Oxymetholone (Anadrol-50 (CIII), Opana), 351t Oxymorphone (Anadrol-50 (CIII), Opana), 99, 108t Oxytocic drugs defined, 354 drug table, 359t Oxytocin (Pitocin), 359t actions, 354 adverse reactions, 355, 355b contraindications, precautions, and interactions of, 356 patient education, 357 patient management issues, 356 uses, 355 P Paclitaxel (Abraxane), 440, 446t Pain, 92, 98, 99, 99, 100–103 Palonosetron (Aloxi), 124t Pamidronate disodium (Aredia), 460t Acosta Main Book_Index.indd 576 Index Pancrelipase (Creon, Pancrelipase, Zenpep, Dygase, Lipram, Pancreaze, Pancrecarb, Ultrase, Viokase), 275, 278, 281t Pancuronium bromide, 115t Panitumumab (Vectibix), 448t Pantoprazole sodium, 272, 281t Pantothenic acid (B5), 499 Papaverine, 206t Paralytic ileus, 274 Parasite, 412 Parasympathetic nervous system, 127, 144 Parenteral route, 22–24 intradermal route, 23–24, 24 intramuscular route, 23 intravenous route, 23 Occupational Safety And Health Administration guidelines, 22 patient care considerations, 22 subcutaneous route, 22–23 Parkinson disease, 58 Parkinsonism, 59 Paromomycin, 375, 377, 382t, 420t adverse reactions, 416 contraindications, precautions, and interactions of, 418 patient education, 418 Paroxetine (Paxil), 90t Partial agonist, 99 Passive immunity, 430, 430, 436t Patency, 115 Patient-controlled analgesia (PCA), 102, 102, 104b Pazopanib (Votrient), 447t Pegaspargase (PEG-asparaginase) (Oncaspar), 447t PEG-ESPolyethylene glycol-electrolyte solution (PEG-ES) (See Polyethylene glycol-electrolyte solution (PEG-ES) ) Pegloticase (Krystexxa), 453, 460t Pemetrexed (Alimta Nipent), 446t Pemirolast (Alamast), 482t Penbutolol sulfate (Levatol), 216t Penciclovir (Denavir), 410t, 462, 469t Penicillamine (Cuprimine, Depen Titratabs), 455–457, 460t Penicillin G (aqueous) (Pfizerpen-G), 381t Penicillin G benzathine (Bicillin L-A), 381t Penicillin G procaine, IM, 381t Penicillin V, 365, 369, 370, 381t Penicillinase-resistant penicillins, 365, 366, 381t Penicillins, 381t, 453 actions, 363, 366 adverse reactions, 367 aminopenicillins, 365, 381t contraindications, precautions, and interactions of, 368 drug resistance, 365–366 extended-spectrum penicillins, 365, 381t natural, 365, 381t older adults, 368b oral suspensions, 369–370 patient education, 369 patient management issues, 368–369 prophylaxis of, 366, 369 symptoms of, 367b uses, 366 Pentamidine isethionate (NebuPent, Pentam), 426t actions and uses, 422 adverse reactions, 422–423 contraindications, precautions, and interactions of, 423–424 patient management issues, 424 Pentazocine, 100, 104, 108t Pentobarbital (Nembutal), 112t Pentobarbital (Sodium nembutal), 90t Pentostatin, 446t Peptic ulcer, 152, 270 Percent, 35 Perindopril erbumine (Aceon), 216t Periodic drug dosing, 20 Peripheral vasodilating drugs actions, 203 adverse reactions, 203 contraindications, precautions, and interactions of, 203 patient education, 203–204 patient management issues, 203 uses, 203 Peripheral vasodilators, 209, 216t Pernicious anemia, 238, 238t, 240–242 actions and uses of, 240 adverse reactions of, 240 contraindications, precautions, and interactions of, 241 Perphenazine, 124t Pharmaceutic phase, Pharmacodynamics, 8–9, 8b Pharmacogenetic disorder, 11 Pharmacokinetics, 7, 8, 8b Pharmacology, 4-Phasic oral contraceptives, 342, 344t Phenazopyridine (Pyridate, Pyridium), 264, 265, 266t Phenazopyridine HCl (AZO Standard, Azo-Dine, Baridium, Pyridium (Rx), Re-Azo), 266t Phendimetrazine (Bontril), 46, 47, 52t Phenelzine (Nardil), 90t Pheniramine (Naphcon A), 482t Phenobarbital (Luminal), 55, 66t, 90t, 423 Phenothiazines, 396 Phentermine HCl, 46, 47, 52t Phentolamine (Regitine), 136, 142t Phenylephrine (Sudafed PE), 170, 173t Phenytoin, 55–58, 56, 60, 66t, 387, 402, 403, 413, 443, 455, 456 Phosphodiesterase (PDE5) inhibitors, 340–341, 352t Phosphorated (Emetrol), 124t Photophobia, 84 Photosensitivity, 81, 169 Physical dependence, Phytosterols, 223 Pilocarpine (Isopto carpine), 481t Pilocarpine hydrochloride (Isopto Carpine, Pilocar), 145, 148t Pindolol, 216t Pinworm, life cycle, 412 Pioglitazone HCl (Actos), 301, 302, 303t, 310t 1/28/2012 12:36:09 PM 577 Index Piperacillin sodium, 381t Piperacillin sodium and tazobactam sodium (Zosyn), 381t Piperazine, 413 Pirbuterol acetate (Maxair Autohaler), 166t Pitavastatin (Livalo), 226t Pituitary gland, 312, 313 Pituitary hormones anterior adrenocorticotropic hormone, 315, 320b, 322 gonadotropins, 312–314 growth hormone, 314–315, 326t posterior, 313, 317–318 (See also Vasopressin) Plasma expanders actions and uses, 485 adverse reactions, 485 contraindications, precautions, and interactions of, 486 Plasma protein fractions actions and uses, 484 adverse reactions, 485 contraindications, precautions, and interactions of, 485 Platinum coordination complex, 448t Plicamycin, 440, 442 Pneumococcal vaccine (Pneumova×23), 431, 436t Pneumococcal 7-valent conjugate vaccine (Prevnar), 436t Pneumococcal 13-valent conjugate vaccine (Prevnar 13), 436t Polarization, 191, 191 Poliovirus vaccine, inactivated (IPV) (Ipol), 436t Polycarbophil (FiberCon), 286, 293t Polydipsia, 296 Polyethylene glycol (PEG) (MiraLAX), 293t Polyethylene glycol-electrolyte solution (PEG-ES), 293t Polyphagia, 296 Polypharmacy, 13 Polyuria, 296 Polyvalent (Pneumova×23), 436t Porfimer sodium (Photofrin), 448t Posaconazole (Noxafil), 408t Postural hypotension, 139 Potassium (K+), 494t actions and uses, 487 adverse reactions, 489 contraindications, precautions, and interactions of, 489 symptoms of, 488b Potassium acetate, 494t Potassium bicarbonate (Klor-Con, Effer-K), 494t Potassium chloride, 487, 494t Potassium gluconate, 487, 494t Potassium iodide, 180t Potassium iodide solution (SSKI, Pima), 334t Potassium-sparing Diuretics, 248, 251, 255t Povidone–iodine (Betadine), 463, 469t PPIs (See Proton pump inhibitors (PPIs) ) Pralatrexate (Folotyn Tabloid), 446t Pramipexole (Mirapex), 66t Pramlintide (Symlin), 301, 302, 304, 310t Acosta Main Book_Index.indd 577 Pramoxine (Mediotic-HC, Sarna, Zinotic), 110t, 470t, 481t Pramoxine, calamine (Caladryl), 470t Pravastatin (Pravachol), 226t Praziquantel (Biltricide), 420t actions, uses, and adverse reactions, 412 contraindications, precautions, and interactions of, 413 Prazosin (Minipress), 139, 142t, 209, 211t, 216t Preanesthetic drugs contraindications, precautions, and interactions of, 112 patient management issues, 112 uses, 111–112 Prednicarbate (Dermatop), 469t Prednisolone (AsmaPred Plus, Millipred, Orapred, Econopred Plus, Prelone, Sterapred DS), 318, 326t, 460t, 482t Prednisone (Sterapred, Prednisone Intensol), 460t Pregabalin (Lyrica), 66t Pregnancy anticonvulsants, 55 categories, 6b drug use, and Insulin, 299b and sedatives and hypnotics, 77 Premature ventricular contractions (PVCs), 190t, 192 Prescription drugs, Prescription form, Priapism, 340 Prilocaine HCl (Citanest), 110t Primaquine phosphate, 420t Primidone (Mysoline), 57, 66t Proarrhythmic effect, 192 Probenecid, 396, 400, 423, 453, 454, 456, 460t Procainamide, 190, 193, 194, 196t, 376 Procaine HCl (Novocain), 110t Procarbazine HCl (Matulane), 448t Prochlorperazine, 124t Productive cough, 176, 176b Progesterone, 341 Progesterone oral (Prometrium), 352t Progesterone vaginal (Crinone, Endometrin, First Progesterone-VGS, Prochieve), 352t Progestins, 345t, 352t, 440, 447t actions, 341–342 adverse reactions, 345–346 contraindications, precautions, and interactions of, 346 excess and deficiency, 345t patient education, 347–348 patient management issues, 346–347 uses, 342 Promethazine (Emend), 124t Promethazine (Phenergan), 173t Propafenone (Rythmol), 191, 196t Propantheline bromide (Pro-Banthine), 154t, 281t Proparacaine (Alcaine), 481t, 482t Prophylaxis, 120, 198 defined, 366 penicillins for, 366, 369 Propofol (Diprivan), 114, 117t Proportion, 39, 39b Propranolol (Inderal), 137, 139, 142t, 191, 192, 193, 196t, 209, 211t, 216t Propylthiouracil (PTU), 334t adverse reactions, 330 contraindications, precautions, and interactions of, 331 patient education, 332 patient management issues, 331 uses, 330 Prostaglandin agonists, ophthalmic preparations, 475, 479, 481t Protease inhibitors (PIs), 409t actions, 398 adverse reactions, 399 contraindications, precautions, and interactions of, 400 Proteasome inhibitors, 448t Protein substrates actions and uses, 484 adverse reactions, 485 contraindications, precautions, and interactions of, 485 Proteolysis, 466 Prothrombin, 229 Proton pump inhibitors (PPIs), 273t, 281t actions, 272 adverse reactions, 273 contraindications, precautions, and interactions of, 273 and H pylori drugs, 273–274 patient education, 273–274 patient management, 273 uses, 272–273 Protriptyline (Vivactil), 90t Pseudoephedrine (Sudafed), 170, 173t Pseudomembranous colitis, 367 Psychological dependence, Psychomotor seizures, 54 Psychotherapeutic drug, 74 Psychotic disorder, 83 Psychotropic drug, 74 Psyllium (Metamucil), 286, 293t Pure Food and Drug Act, Purulent exudates, 464 Pyrantel (Antiminth) actions, uses, and adverse reactions, 413 contraindications, precautions, and interactions of, 413 Pyrantel pamoate (Pin-X, Reese Pinworm Medicine), 420t Pyrazinamide (PZA), 385, 391t adverse reactions, 386 combination products, 384b contraindications, precautions, and interactions of, 387 patient education, 388 treatment regimens, 387 uses, 385 Pyridostigmine bromide (Mestinon, Regonol), 145, 148t Pyridoxine (B6), 499–500 Pyridoxine (Vitamin B6), 122b Pyrimethamine, 420t 1/28/2012 12:36:09 PM 578 Q Quazepam (Doral), 90t Quinapril (Accupril), 211t, 216t Quinidine (Qualaquin), 190, 192, 193, 196t, 376, 396, 489 Quinine (Qualaquin), 412b, 414, 420t adverse reactions, 415 contraindications, precautions, and interactions of, 415 patient education, 416 R Rabeprazole sodium, 272, 281t Rabies immune globulin, human (RIGH) (HyperRAB S/D, Imogam RabiesHT), 436t Rabies vaccine (Imovax Rabies, RabAvert), 430, 436t Radioactive iodine (131I) (Hicon), 334t adverse reactions, 331 contraindications, precautions, and interactions of, 331 patient education, 332 patient management issues, 331 uses, 330 Radiopharmaceuticals, 448t Raltegravir (Isentress), 398, 399, 400, 409t Ramipril (Altace), 216t Ranitidine (Zantac), 268, 271, 272, 273t, 281t, 450 Rasagiline (Azilect), 66t Ratio, 38, 39b Rebound, 170 Receptor, Receptor sites, 127, 129 Receptor-mediated drug action, 8–9 Receptor-mediated drug effects, Reciprocal, 31 Recommended dietary allowances (RDAs), 497b Red man syndrome, 423b Refractory period, 190 Regional anesthesia, 111 Remifentanil (Ultiva), 108t, 115, 117t Repaglinide (Prandin), 301, 310t Repolarization, 191, 191 Reproductive systems, herbal remedies, 508 Reserpine, 138, 142t, 216t Respiratory diseases, 319 Respiratory syncytial virus (RSV), 394–395 Respiratory system, 157 Respiratory tract, 150b Retinoids, 448t Rexinoids, 448t Reye syndrome, 94b Rh0 (D) immune globulin IM (human) (HyperRHO S/D, MICRhoGAM), 436t Rh0 (D) immune globulin IV (human) (Rh [D] IGIV) (Rhophylac, WinRho SDF), 436t Rhabdomyolysis, 218, 221 Rheumatic disorders, 318, 324 Rheumatoid arthritis, 450, 451t, 452 Rhinitis, 168, 168 Rhinitis medicamentosa, 170 Acosta Main Book_Index.indd 578 Index Ribavirin (Virazole, Copegus, Rebetol, RibaPak), 395, 410t adverse reactions, 396 contraindications, precautions, and interactions of, 396 patient education, 398 patient management issues, 397 Riboflavin (B2), 499 Rifabutin (Mycobutin), 391t Rifamate, 384t Rifampin (RIF) (Rifadin), 346, 385, 389, 391t, 413, 423, 454 adverse reactions, 386 combination products, 384b contraindications, precautions, and interactions of, 387 patient education, 388 treatment regimens, 387 uses, 385 Rilpivirine, 400 Rimantadine HCL (Flumadine), 410t Rimexolone (Vexol), 482t Risedronate (Actonel, Atelvia), 450, 451, 460t Ritonavir (Norvir), 398, 399b, 400, 409t Rituximab (Rituxan), 448t Rivastigmine tartrate (Exelon), 72t Rocuronium bromide (Zemuron), 115t Romidepsin (Istodax), 447t Ropinirole HCL (Requip), 66t Ropivacaine HCl (Naropin), 110t Rosiglitazone maleate (Avandia), 301, 302, 303t, 310t Rosuvastatin (Crestor), 226t Rotavirus vaccine, live (Rotarix, Rota Teq), 430, 436t Rubella vaccine, 431, 436t Rufinamide (Banzel), 57, 66t S Salicylates, 450, 454, 455, 489 actions, 92–93 adverse reactions, 93–94, 93b contraindications, precautions, and interactions of, 94 gastrointestinal toxicity, 94 patient education, 94–95 patient management issues, 94 uses, 93 Salicylic acid, 465, 470t Salicylism, 93b, 94 Saline Laxatives, 286 Salmeterol (Serevent), 156–160, 166t Salsalate, 107t Samarium SM 153 lexidronam (Quadramet), 448t Saquinavir (Invirase), 398, 400, 409t Saquinavir/Ritonavir, 400 Saw palmetto, 508 for benign prostatic hypenrophy, 340b Saxagliptin (Onglyza), 301, 302, 303t, 305, 310t Scopolamine (Maldemar, Murocoll-2, Transderm-Scop), 112t, 124t, 481t Scopolamine hydrobromide, 154t Secobarbital (Seconal), 112t Secobarbital sodium (Seconal), 90t Secondary failure, 305 Secondary hypertension, 208 Sedatives and hypnotics actions, 75–76 adverse reactions, 75–76 contraindications, precautions, and interactions of, 76 with narcotic analgesics, 77 patient education, 77–78 patient management issues, 77 uses, 75 Seizure, 54 Selective serotonin reuptake inhibitors (SSRIs) adverse reactions, 81 contraindications, precautions, and interactions of, 82 patient management issues, 83 Selegiline (Eldepryl), 59, 60, 66t Selenium sulfide (Dandrex, Tersi), 470t Sennosides, 293t Sertaconazole (Ertaczo), 408t, 469t Sertraline (Zoloft), 90t Sevoflurane (Sojourn, Ultane), 114, 117t Shock, 130, 130t Short-term glucocorticoid therapy, 323 Sildenafil (Revatio, Viagra), 340, 352t Silver nitrate, 469t Silver sulfadiazine (Silvadene), 362, 363b, 364, 382t Simethicone (Mylicon), 269t, 271, 278, 281t Simvastatin (Zocor), 220, 222, 226t Sipuleucel-T, 448t Sitagliptin (Januvia), 301, 302, 303t, 305, 310t Skeletal muscle relaxants actions, 451 adverse reactions, 452 contraindications, precautions, and interactions of, 452 patient education, 453 patient management issues, 452 uses, 451 Skin and mucous membranes inhalation, 25, 25 topical route, 24, 24b transdermal route, 24–25 Sodium (Na+), 494t actions and uses, 488 adverse reactions, 489 contraindications, precautions, and interactions of, 489 symptoms of, 488b Sodium and water retention, 339b Sodium bicarbonate (Alka-Seltzer Heartburn Relief, Baros, Zegerid, Zegerid OTC), 268, 269t, 272, 281t, 487, 488, 489, 490, 491, 494t Sodium chloride (Slo-Salt, Slo-Salt-K, Sustain), 484, 487b, 488, 490, 491, 494t Sodium ferric gluconate complex (Ferrlecit), 244t Sodium hypochlorite (Dakin solution), 469t 1/28/2012 12:36:09 PM 579 Index Sodium iodide I 131 (Hicon), 448t Solifenacin (VESIcare), 264, 266t Somatic nervous system, 126 Somatotropic hormone, 314 Somatropin (Humatrope), 315, 324, 326t Sorafenib (NexAVAR), 447t Sotalol, 192, 196t, 376 Spinal anesthesia, 111, 113 Spironolactone (Aldactone), 248, 249t, 252t, 253, 255t St John’s Wort, 505–506, 505b Standard (Universal) precautions, 22 Status epilepticus, 55 Stavudine (Zerit), 398, 400, 409t Sterile talc powder, 448t Stevens–Johnson syndrome, 363 Stomatitis, adverse reactions, 441 Streptomycin, 375, 376, 377, 382t, 385, 391t Streptozocin (Zanosar), 446t Strong iodine solutions (Iosat, Lugol solution, Pima), 334t adverse reactions, 330–331 contraindications, precautions, and interactions of, 331 patient education, 332 patient management issues, 331 uses, 330 Strongyloides stercoralis (Threadworm), 412t Strontium-89 chloride (Metastron), 448t Subcutaneous route, 22–23 Sublingual nitroglycerin (Nitrostat), 198, 199, 206t Sublingual route, 22 Substituted ureas, 448t Substrate, 484 Succinimides adverse reactions of, 56 overdosage, 56 patient education, 58 Sucralfate (Carafate), 273, 277–279, 281t Sufentanil citrate (Sufenta), 108t Sulbactam, 366 Sulconazole (Exelderm), 408t, 469t Sulfacetamide (Blephamide), 482t Sulfacetamide sodium (Mexar, Ovace Plus, Seb-Prev, Klaron), 469t Sulfadiazine, 362, 382t Sulfamethoxazole (Bactrim, Septra), 259, 262t Sulfasalazine (Azulfidine), 288, 290, 293t, 460t Sulfisoxazole, 362, 382t Sulfonamides, 382t, 454 actions, 362 adverse reactions, 363–364 burns of, 363b contraindications, precautions, and interactions of, 364 older adults, 365b patient education, 365 patient management issues, 364–365 uses, 362 Sulfonylureas actions, 302 adverse reactions, 302–303 Acosta Main Book_Index.indd 579 contraindications, precautions, and interactions, 304 drug table, 310t patient management issues, 305 Sulindac (Clinoril), 108t Sunitinib (Sutent), 447t Superficial mycotic infections, 401, 403b Superinfection from antibacterial drugs, 367 candidiasis, 367b moniliasis, 367 symptoms of, 368b Sympathetic nervous system, 127 Sympathomimetic bronchodilators, 159 Sympathomimetics actions, 157–158 adverse reactions, 158 contraindications, precautions, and interactions of, 158–159 ophthalmic preparations, 474, 481t uses, 158 Synergism, 11 Synthetic conjugated estrogens, A (Cenestin), 352t Synthetic conjugated estrogens, B (Enjuvia), 352t T Tacrine (Cognex), 72t Tadalafil (Adcirca, Cialis), 340, 352t Taenia saginata (Beef tapeworm), 412t Taenia solium (Pork tapeworm), 412t Tamoxifen citrate, 440, 442, 447t Tapentadol (Nucynta), 108t Tardive dyskinesia, 84–85, 85 Tazobactam, 366, 381t Telbivudine (Tyzeka), 398, 400, 409t Telmisartan, 211t, 216t Temazepam (Restoril), 90t Temozolomide (Temodar), 447t Temperature conversions, 38b Temsirolimus (Torisel), 448t Teniposide (VM-26) (Vumon), 447t Tenofovir (Viread), 398, 399b, 400, 409t Tenofovir disoproxil fumarate (Viread), 409t Teratogen, Terazosin, 139, 142t, 216t Terbinafine (Lamisil, Terbinex), 408t Terbinafine HCl (Lamisil AT), 469t Terbutaline (Brethine), 156, 157, 166t Terconazole (Terazol, Zazole), 408t Testosterone, 336 Testosterone buccal (Striant), 351t Testosterone cypionate (Depo-Testosterone), 351t Testosterone enanthate (Delatestryl), 351t Testosterone implant (Testopel), 351t Testosterone transdermal (Androderm), 351t Tetanus toxoids, 436t Tetracaine (Tetcaine, TetraVisc), 482t Tetracaine HCl (Pontocaine), 110t Tetracyclines, 381t, 415, 456, 489 actions, 372 adverse reactions, 373 contraindications, precautions, and interactions of, 373 patient education, 374–375 patient management issues, 373–374 uses, 372 Tetrahydrozoline (Opti-Clear, Visine Original), 482t Tetrahydrozoline (Tyzine), 170, 173t Theophylline, 159, 160, 166t, 373, 376, 454 Theophylline toxicity, 160 Theophyllinization, 159 Therapeutic response, Thiamine (B1), 499 Thiazide diuretics, 454, 489 Thiazides and related Diuretics, 249–250 Thiazolidinediones actions, 302 adverse reactions, 303 contraindications, precautions, and interactions of, 304 drug table, 310t patient management issues, 306 Thioguanine (TG), 446t Thiopental sodium (Pentothal), 117t Thiotepa (Triethylenethiophosphoramide; TSPA: TESPA), 446t Thrombocytopenia, 441 Thrombolytic drugs actions of, 233 adverse reactions, 233 contraindications, precautions, and interactions of, 233–234 patient education, 234 patient management issues, 234 uses, 233 Thrombosis, 228 Thrombus, 228 Thyroid desiccated (Armour Thyroid, Nature-Thyroid, Westhroid), 334t Thyroid hormones, 334t actions, 328 adverse reactions, 328 contraindications, precautions, and interactions of, 329 hormone replacement therapy, 329b older adults, 330b patient education, 329–330 patient management issues, 329 signs and symptoms, 328t uses, 328 Thyroid storm, 328 Thyrotoxicosis, 328 Thyroxine, 328 Tiagabine hydrochloride (Gabitril), 57, 66t Ticarcillin/clavulanate (Timentin), 381t Tiludronate (Skelid), 460t Timolol (Cosopt), 475, 481t Timolol (Timoptic), 137, 142t Timolol maleate (Betimol, Istalol, Timoptic, Timoptic Ocudose, Timoptic-XE), 209, 211t, 216t Tinea corporis (ringworm), 401 Tinea cruris (Jock itch), 401 Tinea pedis (athlete’s foot), 401 Tinnitus, 93b 1/28/2012 12:36:09 PM 580 Tioconazole (Monistat-1, Vagistat-1), 408t Tipranavir (Aptivus), 398, 400, 409t Tissue integrity, adverse reactions, 441–442 Tizanadine (Zanaflex), 460t Tobramycin (AK-Tob, Tobi, Tobrex), 375, 382t, 482t Tocainide, 465 Tocilizumab (Actemra), 460t Tolazamide, 302, 304, 305, 310t Tolbutamide (Orinase), 364 Tolcapone (Tasmar), 61, 62, 64, 66t Tolerance, 78 Tolmetin sodium, 108t Tolnaftate (Tinactin, Blis-To-Sol, Lamisil AF Defense), 408t, 469t Tolterodine tartrate (Detrol), 266t Tonic–clonic seizure, 55 Topical drugs anti-infectives, 462–463, 463, 469t antipsoriatics, 464, 464, 469t–470t antiseptics, 463, 469t corticosteroids, 463–464, 466, 469t drug table, 469t–470t enzymes, 464, 464–465, 470t germicides, 463, 469t keratolytics, 465, 465, 470t local anesthetics, 465–466, 470t patient education, 466 patient management issues, 466 Topical route, 24, 24b Topiramate (Topamax), 66t Topotecan HCL (Hycamtin), 447t Toremifene citrate (Fareston), 447t Torsemide (Demadex), 247, 250, 255t Tositumomab (Bexxar), 448t Total parenteral nutrition, 491–492 Toxic reaction, 11 Toxin, 431 Toxoids, 431–432, 436t Trace minerals iron, 501 zinc, 501 Tramadol (Ultram), 108t Trandolapril (Mavik), 211t, 216t Transdermal route, 24–25 Transdermal system, 200 Transsacral block, 111 Tranylcypromine (Parnate), 90t Trastuzumab (Herceptin), 448t Travoprost (Travatan Z), 481t Trazodone, 90t Treprostinil (Remodulin), 216t Tretinoin (Vesanoid), 448t Triamcinolone (Aristospan, Kenalog, Triderm), 318, 326t, 460t Triamcinolone acetonide (Pediaderm, SP Rx 228, Triderm, Kenalog), 463, 469t Triamcinolone acetonide, augmented (Trianex), 463, 469t Triamterene (Dyrenium), 248, 249t, 252, 252t, 253, 255t Triazolam (Halcion), 90t Trichomonas, 422 Trichuris trichiura (Whipworm), 412t Triclosan, 469t Tricyclic antidepressants (TCAs), 396 Acosta Main Book_Index.indd 580 Index adverse reactions, 81 contraindications, precautions, and interactions of, 82 patient management issues, 83 Trifluridine (Viroptic), 482t Triglycerides, 219, 221 Trihexyphenidyl (Artane), 61, 154t Triiodothyronine, 328 Trimethobenzamide (Tigan), 124t Trimethoprim (Primsol), 258–261, 262t Trimethoprim and sulfamethoxazole (Bactrim), 362, 382t Trimethoprim and sulfamethoxazole (Bactrim, Septra), 382t Trimipramine (Surmontil), 90t Tripelennamine, 173t Triphasic oral contraceptives, 342, 343t Triptorelin pamoate (Trelstar Depot, Mixject, Trelstar LA), 447t Trospium (Sanctura), 264, 266t Tuberculosis, 384, 386b Typhoid vaccine (Typhim VI, Vivotif Berna), 436t U Ulcerative colitis, 287, 288, 289, 290 Ulipristal (Ella), 344t, 349 Undecylenic acid and derivatives, 469t Undecylenic acid and derivatives (Caldesene, Cruex, Phicon F, Gordochom), 408t Unit dose, 20 Urea (Ureaphil), 246–248, 249t, 250, 251, 255t Urge incontinence, 264, 265 Urinary anti-infective actions, 258 contraindications, precautions, and interactions of, 259 defined, 258 patient education, 260 patient management issues, 260 uses, 258 Urinary drugs, 264–265 action, 258 contraindications, precautions, and interactions of, 259 patient education, 260 patient management issues, 260 uses, 258 Urinary frequency, 258b, 261 Urinary system female, 258 herbal remedies, 507–508 male, 258 Urinary tract, 150b, 151 Urinary tract infection (UTI) cranberry for, 260 drugs for (See urinary drugs) female, 258 male, 258 symptoms, 258 Urinary urgency, 258b Urofollitropin (Bravelle), 312–314, 326t Ursodiol (Actigall), 284, 285, 293t Uterine atony, 355 Uterus, oxytocic drugs and hyperstimulation, 357 UTI (See urinary tract infection (UTI) ) V Vaccines, 431–432 bacterial, 436t VAERS, 433b viral, 436t Vaccinia immune globulin IV (VIGIV) (human), 436t Valacyclovir (Valtrex), 395, 410t adverse reactions, 396 contraindications, precautions, and interactions of, 396 patient education, 398 patient management issues, 397 Valerian, 506 Valganciclovir (Valcyte), 410t Valproic acid (Depakene), 57, 66t, 400 Valrubicin (Valstar), 447t Valsartan (Diovan), 209, 211t, 216t Vancomycin (Vancocin), 426t actions and uses, 422 adverse reactions, 423 contraindications, precautions, and interactions of, 424 patient management issues, 424 red man syndrome, 423b Vandetanib, 448t Vardenafil (Levitra, Staxyn), 340, 352t Varicella vaccine, 431, 436t Varicella virus vaccine (Varivax), 430, 432, 436t Vasoconstriction, 170 Vasoconstrictors, ophthalmic preparations, 476, 482t Vasodilation, 198 Vasopressin actions of, 317 adverse reactions of, 317 contraindications, precautions, and interactions of, 317 patient education, 318 patient management issues, 317–318 uses of, 317 Vasopressor, 131 Vecuronium bromide, 115t Venlafaxine, 90t Ventricular fibrillation, 190t, 192 Ventricular tachycardia (VT), 190t, 192 Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM), 192, 193, 196t, 201, 206t, 216t, 387 Vertigo, 120, 121 Vesicant, 441 Vestibular neuritis, 120 Vigabatrin (Sabril), 66t Vinblastine sulfate (VLB), 440, 441, 442, 443, 446t Vincristine (Vincasar PFS), 440, 441, 442, 446t Vinorelbine tartrate (Navelbine), 446t Viral load, 398 Virilization from androgens, 338, 338b 1/28/2012 12:36:09 PM 581 Index Virus, 394 Vitamin B6, 122b Vitamin B12 (Cyanocobalamin), 238t, 240–242, 244t Vitamin K, warfarin, 230 Vitamins fat-soluble vitamins, 498–499 water-soluble vitamins, 499–500 Volatile liquid, 113 Vomiting, 120, 121 Voriconazole, 408t Vorinostat (Zolinza), 447t W Warfarin (Coumadin), 402, 403, 415, 423, 442 actions, 229 adverse reactions, 229 contraindications, precautions, and interactions of, 229–230 dosing, 229 interaction, 230 patient education, 230 Acosta Main Book_Index.indd 581 patient management issues, 230 uses, 229 Water-soluble vitamins B vitamins, 499–500 vitamin C, 500 Willow Bark, 506, 506b Withdrawal, 75, 79 Word factors, 39 X Xanthine derivatives actions, 159 adverse reactions, 159 contraindications, precautions, and interactions of, 159–160 defined, 156 patient education, 160 patient management issues, 160 uses, 159 Y Yellow fever vaccine (YF-VAX), 430, 436t Z Zafirlukast (Accolate), 161–163, 166t Zalcitabine, 400 Zaleplon (Sonata), 90t Zanamivir (Relenza Diskhaler), 395, 410t adverse reactions, 396 contraindications, precautions, and interactions of, 396 patient education, 398 patient management issues, 397 Zidovudine (Retrovir), 396, 398, 399b, 400, 409t Zileuton (Zyflo), 161–163, 166t Zinc acetate (Ivy-Dry), 469t Zinc solution (Zinotic), 481t Zoledronic acid (Reclast, Zometa), 460t Zolpidem tartrate (Ambien), 90t Zonisamide (Zonegran), 66t Zoster vaccine, live, attenuated (Zostavax), 430, 436t Z-track, intramuscular drug administration, 23 1/28/2012 12:36:09 PM ... speer-on-oh-lak’-tone Acosta Main Book_Chap25.indd 25 5 Midamor, generic Aldactone, generic 1 /28 /20 12 11:59: 12 AM Acosta Main Book_Chap25.indd 25 6 1 /28 /20 12 11:59: 12 AM 26 Urinary Anti-Infectives CHAPTER... Maximum Strength, generic Cytotec, generic Carafate, generic 1 /28 /20 12 12: 00:33 PM Acosta Main Book_Chap28.indd 28 2 1 /28 /20 12 12: 00:33 PM 29 Drugs That Affect the Gallbladder and Intestines CHAPTER... Emollients mineral oil Acosta Main Book_Chap29.indd 29 3 Kondremul Plain, generic 1 /28 /20 12 12: 00:57 PM Acosta Main Book_Chap29.indd 29 4 1 /28 /20 12 12: 00:58 PM DRUGS THAT AFFECT THE ENDOCRINE AND