(BQ) Part 1 book “Boh’s pharmacy practice manual - A guide to the clinical experience” has contents: Patient safety, the law and the clinical practice of pharmacy, patient consultation in the cycle of patient care , providing drug information, physical examination, diagnostic procedures, drug administration,… and other contents.
0002068260.INDD 1/21/2014 10:35:10 AM Boh’s Pharmacy Practice Manual: A Guide to the Clinical Experience FOURTH EDITION 0002068260.INDD 1/21/2014 10:35:08 AM 0002068260.INDD 1/21/2014 10:35:08 AM Boh’s Pharmacy Practice Manual: A Guide to the Clinical Experience FOURTH EDITION EDITOR Susan M Stein, DHEd, MS, BS Pharm, RPh Associate Dean, College of Health Professions Professor, School of Pharmacy Pacific University Hillsboro, Oregon 0002068260.INDD 1/21/2014 10:35:09 AM Acquisitions Editor: Sirkka Howes Product Development Editor: Stephanie Roulias Production Project Manager: David Orzechowski Senior Designer: Stephen Druding Manufacturing Coordinator: Margie Orzech Production Services/Compositor: SPi Global Fourth Edition Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Third Edition Copyright © 2010 by Lippincott Williams & Wilkins All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the abovementioned copyright To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via website at lww.com (products and services) 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Boh’s pharmacy practice manual : a guide to the clinical experience / editor, Susan M Stein.—Fourth edition p ; cm Pharmacy practice manual Includes bibliographical references and index ISBN 978-1-4511-8967-4 I Stein, Susan M (Susan Marie), 1966- editor of compilation. II Title: Pharmacy practice manual [DNLM: Pharmacy Service, Hospital—methods—Handbooks. Clinical Clerkship—methods— Handbooks. Pharmacy—methods—Handbooks QV 735] RS122.5 615.1068—dc23 2013035992 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 0002068260.INDD 1/21/2014 10:35:10 AM Larry E Boh 1953–2001 Larry E Boh passed away days before the publication of the second edition Larry was respected and much admired by his students and fellow professors for his immeasurable contributions to the pharmacy profession 0002068260.INDD 1/21/2014 10:35:10 AM 0002068260.INDD 1/21/2014 10:35:10 AM Preface Pharmacy practice and our health care system are evolving before our eyes: our education and practice standards must keep pace Pharmacists are inspired by an inherent desire to care for patients, a fascination with pharmacokinetics and pharmacotherapy, and a passion to help We have a wonderful profession, and each of us carries a responsibility to nurture and support the next generation of pharmacists and the practice it becomes We proudly bring you the fourth edition of Boh’s Pharmacy Practice Manual: A Guide to the Clinical Experience The title maintains a link to honor an inspiring, brilliant mentor: Larry Boh Larry had a powerful, lasting impact on many successful clinical pharmacists practicing today As editor of the first edition (Clinical Clerkship Manual) and the second edition (Pharmacy Practice Manual: A Guide to the Clinical Experience), he motivated knowledgeable, talented contributing editors to create an anthology that provided practitioners a valuable reference throughout their career The fourth edition further expanded and restructured chapters to support current as well as emerging practitioners A purposeful emphasis was placed on providing resources to practitioners of all degrees Many chapters were expanded to include updated standards of care while others were condensed and focused to maximize value The pharmacy profession provides us a unique opportunity to improve the quality and value of our patients’ lives We hope you find this book an indispensable tool in that endeavor and encourage you to never stop learning, questioning, or striving to expand your knowledge and impact on patient care Susan M Stein vii 0002068260.INDD 1/21/2014 10:35:10 AM 0002068260.INDD 1/21/2014 10:35:10 AM Chapter Drug Administration 345 Table 9.5 Oral Dosage Forms That Should Not Be Crushed (continued) Drug Product Active Ingredient(s)a Dosage Form(s) Reasons/Commentsb Treximet combination Tablet Note: Unique drug matrix enhances rapid drug absorption Trilpix fenofibric Capsule Extended release Tylenol Arthritis acetaminophen Tablet Controlled release Uceris budesonide Tablet Note: Coating on tablet is designed to break down at pH of 7.0 or above Ultram ER traMADol Tablet Extended release Note: Tablet disruption may cause a potentially fatal overdose of drug Ultrase pancrealipase Capsule Enteric coated Uniphyl theophylline Tablet Slow release Urocit‐K potassium citrate Tablet Wax coated; prevents upper GI release Uroxatral alfuzosin Tablet Extended release Valcyte valGANCiclovir Tablet Teratogenic and irritant potentiale,g Verapamil SR — Tablet Extended released Verelan verapamil Capsule Sustained releasec Verelan PM verapamil Capsule Extended releasec Videx EC didanosine Capsule Delayed release Vimovo naproxen/ esomeprazole Tablet` Delayed release Viramune XR nevirapine Tablet Extended releasee Voltaren XR diclofenac Tablet Extended release VoSpire ER albuterol Tablet Extended release Votrient pazopanib Tablet Note: Crushing significantly increases the AUC and Tmax; crushed or broken tablets may cause dangerous skin problems (continued) 0002046821.INDD 345 1/21/2014 9:42:22 AM Table 9.5 Oral Dosage Forms That Should Not Be Crushed (continued) Drug Product Active Ingredient(s)a Dosage Form(s) Reasons/Commentsb Wellbutrin SR, XL buPROPion Tablet Extended release Xanax XR ALPRAZolam Tablet Extended release Zegerid OTC omeprazole/ NaHCO3 Capsule Delayed releasee Zenpep pancrealipase Capsule Delayed releasec Zolinza vorinostat Capsule Note: Irritant; avoid contact with the skin or mucous membranes; avoid contact with crushed or broken tablets Zortress everolimus Tablet Note: Crushed powder may cause dangerous effects to mucous membranes Zyban buPROPion Tablet Slow release Zyflo CR zileuton Tablet Extended release Disclaimer: This listing is not meant to represent all products, either by a generic or trade name The author encourages manufacturers, pharmacists, nurses, and other health professionals to notify him of any change or updates Correspondence regarding this list may be addressed to John F Mitchell, PharmD, FASHP; Email: rxmitchell@att.net a The generic name is provided merely as a reference point and is only listed for single-ingredient medications; it should not be assumed that drugs with the same generic are equivalent to the specific brand name listed relative to crushing or chewing If questions arise, please check with your pharmacist b Two official USP terms are used to designate the special-release medication form: “extended release” and “delayed release.” Others such as “sustained release” and “controlled release” are commonly used on package labeling The term “slow release” is being used here to signify all such drugs with a special-release mechanism c The capsule may be opened and the contents taken without crushing or chewing; soft food such as applesauce or pudding may facilitate administration; contents may generally be administered via a nasogastric tube using an appropriate fluid, provided entire contents are washed down the tube d The tablet is scored and may be broken in half without affecting release characteristics e Liquid dosage forms of the product are available; however, dose, frequency of administration, and manufactures may differ from those of the solid dosage form f Antacids and/or milk may prematurely dissolve the coating of the tablet g Skin contact may enhance tumor production; avoid direct contact h The capsule may be opened and the liquid contents removed for administration i Effervescent tablets must be dissolved in the amount of diluent recommended by the manufacturer j Tablets are made to disintegrate under the tongue k The taste of this product form would likely be unacceptable to the patient; administration via nasogastric tube should be acceptable Reprinted with permission from Dr John Mitchell Oral Dosage Forms That Should Not Be Crushed http://www.ismp.org/tools/DoNotCrush.pdf © Copyright 2011, 2012, 2013 No part of this list may be reproduced in any format without the expressed permission of the author 346 0002046821.INDD 346 1/21/2014 9:42:22 AM Chapter Drug Administration 347 Intramuscular Intradermal Subcutaneous Intravenous Epidermis Dermis Subcutaneous tissue Subcutaneous adipose tissue Muscle Vein Figure 9.1 Diagram of various routes of drug administration i ntravenous (IV) route Other less common methods of administration are also available The following discussion describes these routes in more detail, and Figure 9.1 provides a visual display Not all parenteral drugs may be given by SQ, IM, and IV routes Table 9.6 lists examples of route limitations When using the SQ or IM route of administration, it is important to alleviate patient discomfort when possible The site of administration Table 9.6 Examples of Drugs Restricted to Specific Routes of Administration Drug SQ IM IV Insulin Yes Yes Yes Midazolam No Yes Yes Erythropoietin Yes No Yes Heparin Yes No Yes Bleomycin Yes Yes Yes 0002046821.INDD 347 1/21/2014 9:42:23 AM 348 boh’s pharmacy practice manual: a guide to the clinical experience should be rotated for repeat doses, and the smallest needle should be used Needle sizes are characterized by bore size or gauge (abbreviated as “G”) as well as length in inches A smaller-gauge needle is reflected by a larger number size, with gauges ranging from to 34 The length of the needle reflects the depth of the target tissue, with lengths ranging from 0.25 to 3.5 inches Subcutaneous Routes A SQ injection is delivered directly under the skin, between the dermal layer and the muscle The SQ route results in slow, steady drug absorption.3 Absorption must occur prior to systemic circulation of the drug, which results in delayed effect.4 A shorter needle is used for a SQ injection Generally, a 24- to 27-G, 5/8- to 1/2-inch needle is used The volume administered should be