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PHARMACOLOGY
IN NURSING
3RD
AUSTRALIAN &
NEW ZEALAND
EDITION
Bonita E. Broyles
Gayle McKenzie
Sussan Pleunik
Rachel Page
Barry S. Reiss
Mary E. Evans
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
PHARMACOLOGY
IN NURSING
PHARMACOLOGY
IN NURSING
3RD
AUSTRALIAN &
NEW ZEALAND
EDITION
Bonita E. Broyles
Gayle McKenzie
Sussan Pleunik
Rachel Page
Barry S. Reiss
Mary E. Evans
Pharmacology in nursing: Australian and New Zealand © 2020 Cengage Learning Australia Pty Limited
3rd Edition
Bonita E. Broyles Copyright Notice
Barry S. Reiss This Work is copyright. No part of this Work may be reproduced, stored in a
Mary E. Evans retrieval system, or transmitted in any form or by any means without prior
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include: Restricting the copying to a maximum of one chapter or 10% of this
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regarding any of the products described in this publication and does not perform
any independent analysis in connection with any of the product information This third edition published in 2020 [Adaptation of Pharmacological Aspects of
contained in this publication. The Publisher expressly disclaims any obligation to Nursing Care, 8th Edition, Delmar Cengage Learning, 2013]
obtain and include information other than the information provided to it by the
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hazards. Particularly to note that the clinical cases used are examples only and
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v

BRIEF CONTENTS
SECTION 1 INTRODUCTION TO DRUGS AND 31. Diuretics 489

MEDICATION ADMINISTRATION 1 32. Agents used in the treatment of hyperlipidaemia 497
1. Medications: from herbs to researched treatments 2
SECTION 7 AGENTS USED TO TREAT
2. Pharmacokinetics and pharmacodynamics 21
RESPIRATORY DISORDERS 505
3. Pharmacogenetics and pharmacogenomics 39 33. Antihistamines and nasal decongestants 506
4. Calculating medication dosages 50 34. Antitussive agents and medications affecting
5. Principles and methods of medication respiratory secretions 521
administration 66 35. Bronchodilators and prophylactic respiratory agents 531
6. Intravenous medication therapy 98
7. Medication therapy for paediatric clients 116 SECTION 8 AGENTS USED TO TREAT
8. Medication therapy for aged-care clients 131 GASTROINTESTINAL DISORDERS 546
36. Vitamins, minerals and other nutritional agents 547
9. Prevention of medication errors 143
37. Agents used to treat hyperacidity and gastro-
10. Legal and ethical considerations for medication
oesophageal reflux disease 564
administration 154
38. Anti-emetics and emetics 578
SECTION 2 AGENTS THAT INTERFERE WITH 39. Laxatives and antidiarrhoeals 588
MICROBIAL GROWTH 167
11. Antimicrobial therapy and antibacterial agents 168 SECTION 9 AGENTS USED TO CORRECT
12. Antiparasitic, antiviral and antifungal agents 202 ENDOCRINE IMBALANCE 602
40. Agents affecting thyroid, parathyroid and pituitary
SECTION 3 AGENTS USED TO CONTROL PAIN function 603
AND INFLAMMATION 228 41. Agents used to treat hyperglycaemia and
13. Anaesthetics 229 hypoglycaemia 619
14. Analgesics and antipyretics 247
SECTION 10 AGENTS AFFECTING THE
15. Anti-inflammatory agents 273
REPRODUCTIVE SYSTEM 638
16. Agents used to treat hyperuricaemia and gout 294 42. Sex hormones 639
SECTION 4 AGENTS AFFECTING THE NERVOUS 43. Agents used in obstetrical care 658
SYSTEM 302
SECTION 11 AGENTS AFFECTING IMMUNITY 667
17. Autonomic nervous system agents 303
44. Agents affecting immunity 668
18. Central nervous system sedatives and hypnotics 320
45. Agents used in the treatment of cancer 682
19. Antidepressant, antipsychotic and mood
stabiliser agents 330 SECTION 12 AGENTS USED TO TREAT EYE,
20. Agents used as central nervous system stimulants 353 EAR AND SKIN DISORDERS 702
21. Agents used to treat Alzheimer’s disease 360 46. Agents used in the treatment of eye disorders 703
22. Antiparkinson’s agents 366 47. Agents used in the treatment of ear disorders 718
23. Anticonvulsants 377 48. Agents used in the treatment of skin disorders 725
24. Agents used in musculoskeletal disorders 391 SECTION 13 COMPLEMENTARY MEDICATIONS 743
25. Substance abuse 400 49. Common complementary medications 744
SECTION 5 AGENTS USED TO TREAT Appendix 1: Diagnostic agents 755
HAEMATOLOGICAL DISORDERS 423 Appendix 2: Approximate normal values 757
26. Agents used to treat anaemias 424 Appendix 3: Toxicology overview 758
27. Agents affecting blood clotting 434 Appendix 4: Common medication/food/herbal
SECTION 6 AGENTS USED TO TREAT interactions761
CARDIOVASCULAR DISORDERS 451 Appendix 5: Solutions to review questions 778
28. Cardiac stimulants and depressants 452 Glossary 782
29. Agents that dilate blood vessels 469 Index801
30. Antihypertensives 479
vi
CONTENTS
Guide to the text xii Chapter 6 Intravenous medication therapy 98

Guide to the online resources xvi Introduction 99
Preface xviii Intravenous infusion therapy 99
About the authors xix Practical and professional application for intravenous
Acknowledgements xxi infusion therapy 103
SECTION 1 INTRODUCTION TO DRUGS AND Electronic infusion devices 109
MEDICATION ADMINISTRATION 1 Chapter 7 Medication therapy for paediatric clients 116
Chapter 1 Medications: from herbs to Introduction 117
researched treatments 2 Paediatric medication therapy 117
Introduction 3 Administration of medication to children 120
History 3 Practical and professional application for children
Sources of drugs 4 receiving medications 125
The use of drugs as medications 4 Chapter 8 Medication therapy for aged-care clients 131
Dosage forms 5 Introduction 132
Medication names 8 Aged-care medication therapy 133
Classification of drugs 9 Practical and professional application for nursing
Medication information resources 16 care of elderly clients receiving medication therapy 136
The product insert 17 Chapter 9 Prevention of medication errors 143
Chapter 2 Pharmacokinetics and pharmacodynamics 21 Introduction 144
Introduction 22 The costs of medication errors 144
Pharmacokinetics 22 The causes of medication errors 145
Pharmacodynamics 30 How can medication safety be improved? 148
Individual variation of pharmacological response 35 Chapter 10 Legal and ethical considerations
Chapter 3 Pharmacogenetics and pharmacogenomics 39 for medication administration 154
Introduction 40 Introduction 155
Human genome 40 History 155
Future prospects 45 The difference between laws and guidelines 156
Chapter 4 Calculating medication dosages 50 Nurses and social media 158
Introduction 51 Medication schedules 159
Interpreting medication prescriptions 51 Common law 161
Ratio and proportion 52 SECTION 2 AGENTS THAT INTERFERE WITH
Conversion between metric quantities 54 MICROBIAL GROWTH 167
Calculation of fractional doses 56 Chapter 11 Antimicrobial therapy and
Calculation of dosages based on weight 56 antibacterial agents 168
Paediatric dosage calculations 57 Introduction 169
Calculations involving intravenous administration 58 Susceptibility of the body to infection 169
Calculations related to solutions 62 Identification of the infecting organism 172
Chapter 5 Principles and methods of Selection of antimicrobial agents 173
medication administration 66 Classification of antimicrobial agents 175
Introduction 67 Adverse effects 176
The nursing process and medication administration 67 Antibacterial agents 177
Administering medications 68 Urinary tract anti-infectives 188
Nursing process in client teaching 92 Medications used to treat tuberculosis 188
Fostering compliance and cooperation with Leprostatic agents 190
medication regimens 93 Practical and professional application for
Nursing process approach to improving cooperation 95 treating infections 190
Contents vii
Practical and professional application for clients Analgesics used to treat headaches 260
receiving penicillins 193 Neuropathic pain 262
Practical and professional application for clients Practical and professional application for the
receiving cephalosporins 194 treatment of pain 263
Practical and professional application for clients Practical and professional application for the use
receiving tetracyclines 194 of paracetamol and aspirin 264
Practical and professional application for clients Practical and professional application for opioid
receiving aminoglycosides 195 analgesics 266
Practical and professional application for clients Practical and professional application for the
receiving chemotherapy for tuberculosis 196 treatment of migraines 267
Practical and professional application for clients Practical and professional application for control
receiving sulfonamides and urinary tract of chronic pain 268
anti-infectives 197 Practical and professional application for pain
Chapter 12 Antiparasitic, antiviral and antifungal agents 202 management in end-of-life care 269
Introduction 203 Chapter 15 Anti-inflammatory agents 273
Antiparasitic medications 203 Introduction 274
Antiprotozoal agents 203 Non-steroidal anti-inflammatory medications 274
Antimalarial agents 206 Disease-modifying antirheumatic medications
Anthelmintic agents and intestinal parasitic disorders 207 (DMARMs) 280
Dermatological parasitic disorders 208 Slow-acting antirheumatic agents 282
Antiviral medications 209 Corticosteroids 283
Antifungal medications 215 Practical and professional application for the use
Practical and professional application for of anti-inflammatory agents 285
antimalarial medications 219 Practical and professional application for clients
Practical and professional application for clients receiving non-steroidal anti-inflammatory
receiving medications for amoebiasis and medications 286
trichomonal infections 220 Practical and professional application for
Practical and professional application for clients clients receiving disease-modifying antirheumatic
receiving anthelmintics 221 medications 287
Practical and professional application for clients Practical and professional application for clients
receiving medications for dermatological parasites 221 receiving slow-acting antirheumatic medications 288
receiving antifungal agents 223 receiving corticosteroids 288
Practical and professional application for clients Chapter 16 Agents used to treat hyperuricaemia
receiving antiviral agents 224 and gout 294
SECTION 3 AGENTS USED TO CONTROL PAIN Introduction 295
AND INFLAMMATION 228 Management of acute gouty arthritis 296
Chapter 13 Anaesthetics 229 Control of hyperuricaemia 296
Introduction 230 Practical and professional application for gout 298
General anaesthesia 230 SECTION 4 AGENTS AFFECTING THE NERVOUS
Local anaesthesia 236 SYSTEM 302
Practical and professional application to anaesthesia 239 Chapter 17 Autonomic nervous system agents 303
Practical and professional application for clients Introduction 304
with malignant hyperthermia 240 The nervous system 304
Practical and professional application for nursing Adrenergic pharmacology 306
care following general anaesthesia 241 Sympathomimetic medications 307
Practical and professional application for nursing Sympatholytic medications 311
care following local anaesthesia 242 Cholinergic pharmacology 312
Chapter 14 Analgesics and antipyretics 247 Parasympathomimetic medications 313
Introduction 248 Parasympatholytic medications 314
Pain 249 Acetylcholinesterase inhibitors 315
Opioid analgesics 252 Nicotinic receptor agonists 315
Opioid antagonists 258 Practical and professional application for clients
Non-opioid analgesics 259 receiving autonomic nervous system medication 316
viii C o n t e n t s
Chapter 18 Central nervous system sedatives Chapter 24 Agents used in musculoskeletal disorders 391
and hypnotics 320 Introduction 392
Introduction 321 Neuromuscular blocking agents 392
Barbiturates 321 Centrally acting skeletal muscle relaxants 393
Benzodiazepines 321 Direct-acting skeletal muscle relaxants 394
Non-benzodiazepines 322 Skeletal muscle stimulants 394
Alcohol (ethanol) 323 Practical and professional application for clients
Other sedative-hypnotics 323 taking neuromuscular blocking agents 396
Practical and professional application for Practical and professional application for clients
clients receiving sedative-hypnotics 324 taking centrally acting skeletal muscle relaxants 397
Practical and professional application for clients Practical and professional application for clients taking
receiving barbiturates 325 direct-acting skeletal muscle relaxants 397
receiving non-barbiturates 326 taking skeletal muscle stimulants 398
Chapter 19 Antidepressant, antipsychotic and Chapter 25 Substance abuse 400
mood stabiliser agents 330 Introduction 401
Introduction 331 Opiate abuse 402
Antidepressant agents 333 Central nervous system depressant abuse 404
Antipsychotic agents 336 Central nervous system stimulants 408
Mood stabiliser agents 341 Cannabis abuse 409
Practical and professional application for clients Psychedelic agents 410
receiving medication therapy for psychiatric ‘Ecstasy’ 411
conditions 343 Tobacco 411
Practical and professional application for clients Inhalant abuse 412
receiving antidepressants 344 Alcohol and substance abuse in indigenous communities 415
Practical and professional application for clients Practical and professional application for substance
receiving antipsychotic agents 345 abusers 416
Practical and professional application for clients SECTION 5 AGENTS USED TO TREAT
receiving the mood stabilising agent lithium 348 HAEMATOLOGICAL DISORDERS 423
Chapter 20 Agents used as central nervous Chapter 26 Agents used to treat anaemias 424
system stimulants 353 Introduction 425
Introduction 354 Iron deficiency anaemia 426
Anorexiants 354 Megaloblastic anaemias 427
Agents used to treat ADHD 355 Practical and professional application for a
Analeptics 355 client with anaemia 429
Toxicity of CNS stimulants 355 Chapter 27 Agents affecting blood clotting 434
receiving central nervous system stimulants 356 Anticoagulants 436
Chapter 21 Agents used to treat Alzheimer’s disease 360 Antiplatelet agents 440
Introduction 361 Thrombolytic agents 441
Agents used to treat Alzheimer’s disease 361 Tissue plasminogen activator (tPA) 441
Practical and professional application for clients Haemorrheologic agents 441
receiving medications to treat Alzheimer’s disease 363 Haemostatic agents 442
Chapter 22 Antiparkinson’s agents 366 Practical and professional application for clients
Introduction 367 receiving anticoagulants 443
Dopaminergic agents 367 Practical and professional application for nursing
Antimuscarinic agents 371 care following intracoronary thrombolysis 447
Overall management of Parkinson’s disease 371 SECTION 6 AGENTS USED TO TREAT
Practical and professional application to using CARDIOVASCULAR DISORDERS 451
antiparkinson’s medications 373
Chapter 28 Cardiac stimulants and depressants 452
Chapter 23 Anticonvulsants 377 Introduction 453
Introduction 378 Cardiac glycosides 454
Types of anticonvulsants 380 Milrinone 456
Practical and professional application for Anti-arrhythmic/antidysrhythmic agents 457
anticonvulsants 385 Cardiac stimulants used to treat shock 461
Contents ix
Practical and professional application for clients SECTION 8 AGENTS USED TO TREAT
receiving cardiac glycosides 463 GASTROINTESTINAL DISORDERS 546
Practical and professional application for clients Chapter 36 Vitamins, minerals and other nutritional
receiving antidysrhythmic agents 464 agents 547
in cardiac emergencies and shock 465 Protein 548
Chapter 29 Agents that dilate blood vessels 469 Fat 548
Introduction 470 Carbohydrates 550
Coronary vasodilators 470 Vitamins 550
Myocardial infarction 472 Minerals 554
Peripheral vasodilators 473 Total parenteral nutrition 558
receiving coronary vasodilators 474 taking vitamins and minerals 559
Practical and professional application for Chapter 37 Agents used to treat hyperacidity and
peripheral vasodilators 476 gastro-oesophageal reflux disease 564
Chapter 30 Antihypertensives 479 Introduction 565
Introduction 480 Upper gastrointestinal tract disorders 565
Antihypertensive agents 480 Hydrochloric acid secretion 566
Practical and professional application for measuring Antacids 566
blood pressure 486 H2-receptor antagonists 569
Chapter 31 Diuretics 489 Antimuscarinics 570
Introduction 490 Proton pump inhibitors 570
Diuretics 490 Sucralfate 571
Practical and professional application for meeting Misoprostol 572
sodium and potassium needs 494 Prokinetic medications 572
Chapter 32 Agents used in the treatment of Pancreatic enzymes 572
hyperlipidaemia 497 Practical and professional application for clients
Introduction 498 taking antacids 572
Hyperlipidaemia 498 Practical and professional application for clients
Practical and professional application for clients receiving H2-receptor antagonists, proton pump
with hyperlipidaemia 502 inhibitors and sucralfate 574
SECTION 7 AGENTS USED TO TREAT Chapter 38 Anti-emetics and emetics 578
RESPIRATORY DISORDERS 505 Introduction 579
Anti-emetics 580
Chapter 33 Antihistamines and nasal decongestants 506
Emetics 583
Introduction 507
Practical and professional application for clients
Histamine and its role in immunological response 507
taking anti-emetics 584
Antihistamines 508
Decongestants 514
taking emetics 585
receiving antihistamines and decongestants 516 Chapter 39 Laxatives and antidiarrhoeals 588
Introduction 589
Chapter 34 Antitussive agents and medications
Laxatives 589
affecting respiratory secretions 521
Antidiarrhoeal agents 594
Introduction 522
Antitussives 522
receiving laxatives 596
Medications affecting respiratory secretions 524
Practical and professional application for administration
receiving antidiarrhoeal agents 598
of antitussive, expectorant and mucolytic agents 527
Chapter 35 Bronchodilators and prophylactic SECTION 9 AGENTS USED TO CORRECT
respiratory agents 531 ENDOCRINE IMBALANCE 602
Introduction 532 Chapter 40 Agents affecting thyroid, parathyroid
Obstructive airways disease 532 and pituitary function 603
Bronchodilators 535 Introduction 604
Prophylactic respiratory medications 538 Thyroid disorders 604
Practical and professional application for treatment Parathyroid disorders 608
of chronic obstructive pulmonary diseases (COPD) 540 Pituitary disorders 608
x Contents
Practical and professional application for clients Chapter 45 Agents used in the treatment of cancer 682
taking thyroid medication 611 Introduction 683
Practical and professional application for clients Alkylating agents 685
taking antithyroid medication 612 Antimetabolites 685
Practical and professional application for clients Mitotic inhibitors 685
taking parathyroid medication 614 Antibiotics 685
Practical and professional application for clients Hormones 686
taking pituitary hormones 615 Corticosteroids 686
Chapter 41 Agents used to treat hyperglycaemia and Radioactive medications 686
hypoglycaemia 619 Biological-response modifiers 686
Introduction 620 Miscellaneous antineoplastic agents 686
Regulation of blood glucose levels 620 Monoclonal antibodies 686
Diabetes mellitus 620 Protease inhibitors 686
Insulin therapy 624 Combination therapy 686
Oral hypoglycaemic agents 628 Anti-emetics 687
Parenteral therapy for type 2 diabetes 631 Practical and professional application for
Practical and professional application for clients cancer treatment 694
with diabetes 632 Practical and professional application for
Practical and professional application for clients receiving investigational agents 698
hypoglycaemia and diabetic ketoacidosis 633 SECTION 12 AGENTS USED TO TREAT EYE, EAR AND
SECTION 10 AGENTS AFFECTING THE SKIN DISORDERS 702
REPRODUCTIVE SYSTEM 638 Chapter 46 Agents used in the treatment of eye disorders 703
Chapter 42 Sex hormones 639 Introduction 704
Introduction 640 Mydriatic agents 704
Female sex hormones 640 Practical and professional application for using
Oral contraceptives 644 eye drops 705
Treatments for female hormonal conditions 646 Ophthalmic anti-infectives 706
Male sex hormones 647 Antiseptics 707
Impotence 648 Local anaesthetics 708
Miscellaneous androgen agents 649 Corticosteroids 708
Practical and professional application for Non-steroidal anti-inflammatory agents 708
sex hormones 652 Miscellaneous agents 708
Chapter 43 Agents used in obstetrical care 658 Glaucoma 709
Introduction 659 Agents that decrease the formation of aqueous humour 710
Uterine stimulants 659 Agents that increase the outflow of aqueous humour 711
Uterine relaxants 660 Agents that decrease formation and increase outflow
Lactation suppressants 661 of aqueous humour 711
Rho(D) immune globulin 661 Practical and professional application for ophthalmic
Post partum contraception 661 medications 712
Practical and professional application for clients Chapter 47 Agents used in the treatment of ear disorders 718
taking medications that influence labour Introduction 719
and delivery 662 Medications used in otic therapy 719
SECTION 11 AGENTS AFFECTING IMMUNITY 667 Antimicrobials 720
Anti-inflammatory agents and analgesics 721
Chapter 44 Agents affecting immunity 668
Wax emulsifiers 721
Introduction 669
Practical and professional application for otic
Agents that provide active or passive immunity 669
preparations 722
Interferons and interleukins 673
Immunosuppressant agents 674 Chapter 48 Agents used in the treatment of
Antiviral agents for human immunodeficiency virus 675 skin disorders 725
receiving agents to enhance the immune system 676 Anatomy of the skin 726
Practical and professional application for clients Medications used in dermatological therapy 727
receiving agents to suppress the immune system 678 Diabetic foot ulcers 733
Antineoplastic agents 733
Contents xi
Agents used to treat eczema 734 Use of herbs 745

Agents used to treat burns 734 Common herbs 746
Minoxidil 735 Appendix 1: Diagnostic agents 755
Practical and professional application for clients Appendix 2: Approximate normal values 757
with skin disorders requiring care 736 Appendix 3: Toxicology overview 758
Practical and professional application for clients Appendix 4: Common medication/food/
receiving antifungal agents 737 herbal/interactions 761
Practical and professional application for burn clients 738 Appendix 5: Solutions to review questions 778
SECTION 13 COMPLEMENTARY MEDICATIONS 743 Glossary782
Chapter 49 Common complementary medications 744 Index801
Introduction 745
xii
Guide to the text

As you read this text you will find a number of features in every
chapter to enhance your study of Pharmacology in Nursing and help
you understand how the theory is applied in the real world.
PART OPENING FEATURES
SECTION
1
INTRODUCTION TO DRUGS AND
MEDICATION ADMINISTRATION
A Chapter list outlines the chapters
contained in each Section for easy
CHAPTER 1 MEDICATIONS: FROM HERBS TO RESEARCHED TREATMENTS 2
reference.
CHAPTER 2 PHARMACOKINETICS AND PHARMACODYNAMICS 21
CHAPTER 3 PHARMACOGENETICS AND PHARMACOGENOMICS 39
CHAPTER 4 CALCULATING MEDICATION DOSAGES 50
CHAPTER 5 PRINCIPLES AND METHODS OF MEDICATION ADMINISTRATION 66
CHAPTER 6 INTRAVENOUS MEDICATION THERAPY 98
CHAPTER 7 MEDICATION THERAPY FOR PAEDIATRIC CLIENTS 116
CHAPTER 8 MEDICATION THERAPY FOR AGED-CARE CLIENTS 131
CHAPTER 9 PREVENTION OF MEDICATION ERRORS 143
CHAPTER 10 LEGAL AND ETHICAL CONSIDERATIONS FOR MEDICATION

ADMINISTRATION 154
CHAPTER-OPENING FEATURES
1
1
CHAPTER
MEDICATIONS: FROM HERBS TO

RESEARCHED TREATMENTS
Identify the key concepts that the chapter
LEARNING OBJECTIVES
will cover with the Learning objectives at
After studying this chapter, the student will be able to:
1 describe the scope of the science of pharmacology, including sources of chemicals for medications; the the start of each chapter.
properties, advantages and disadvantages of a wide variety of dosage forms and their use in the healthcare
context; and medication information sources
2 compare the significance of the chemical name, generic name and brand name of a medication; identify the
different medicine classifications and component parts of a written prescription; and briefly describe the
role of the Australian Therapeutic Goods Administration (TGA) and the New Zealand Medicines and Medical
Devices Safety Authority (Medsafe)
3 identify and describe the significance of each controlled substance schedule as defined in ‘drugs, poisons
and controlled substances’ legislation for each Australian State and Territory, and in New Zealand.
the symptoms associated with allergic reactions. the development of a dermatological reaction (hives,
SECTIO
Many antihistaminic agents also depress the CNS and rash and so on) or, in some cases, a severe allergic
therefore produce adverse effects such as drowsiness, response (anaphylaxis), which may include breathing
dizziness or weakness. Likewise, many antibiotics difficulty,P circulatory collapse or both.
R i n C i P l E s A n d m E T H o d s o f m E d i C AT i o n A d G mU i nI iDs E
T RTO
AT i oTnH E TE X T
95 xiii
that are administered orally may disrupt the normal ADRs are categorised into four types in Australia
bacterial content of the gastrointestinal tract and and New Zealand:
produce adverse effects such as gastrointestinal distress ■ Type A – augmented. The reaction is related to
and diarrhoea. The Because promotion
adverseofeffects patient arecooperation
generally is clearlythe a medication’s
measures pharmacological
to foster cooperation action. have It isbeen noted.
predictable challenge
(since they forareallduehealthcare practitioners, but one that
to the pharmacological Specific measures
easily predicted because itto is improve
related tocooperation
how the must be
FEATURES WITHIN CHAPTERS
CHAPTER 5
action of the must be aggressively
medication), they can addressed
usuallyifbe medication therapy medication individualised
works in the forbody.
each This clientreaction
and are,isof course,
for ambulatory
identified rapidly and appropriatelyclients is to be justified and effective.
managed. generally logical outcomes ofand
dose-dependent assessment,
is the most diagnosis
common and
IdentifyMedication
importanttoxicity client ishealth and safetyadverse
also a predictable issues Learn
of the to educate
planning.
ADRs. Evaluationclients for healthy
of nursing outcomes
interventions then– both
Type B –can be directed towards assessing the degree and of
and drug effect that is related to the dose of medication
the appropriate NURSING PROCESS APPROACH TO generallycooperation
response to critical situations in bizarre.
clinical The reaction
facilities and is unpredictable
once the client has returned
■
administered. Virtually all medications are capable of not relatedand to the themedication
achievement of therapeutic goals
action,
the Safety
withproducing toxic in Nursing
IMPROVING effects. Practice COOPERATION boxes. buthomerathersuch –tousing
as information
theprevention,
way the body alleviation
dealsin withthe or Client
cure
the of illnessTeaching and
boxes.
medication; its symptoms.
for example, allergic reactions. It is not
As previously noted, many clients do not cooperate
dose-dependent.
SAFETYwith IN NURSING
their medication PRACTICE therapy. You can be helpful
■ Type C – continuous. This reaction is related to
to clients taking medications by assessing the degree Client Teaching
long-term use of a medication and continues long
of cooperation,
Adverse drug reactions determining the reasons for lack of
after use of the medication has ceased; for example,
1 Adversecooperation,
effects are those andresulting
planning from strategies
the normal for improving Client teaching for medical administration
tardive dyskinesia in clients who took some older-
cooperation.
pharmacological effects of a medication; for example, 1 You should ask to see all of the prescription and OTC
generation psychotropic medications years ago.
drowsinessInitially,
caused byinantihistamine
efforts to improve use. cooperation, the medications used by the client.
■ Type D – delayed. The reaction does not emerge
focusare
2 Toxic effects is onthoseassessment.
related to the Is the
dosage client taking the correct 2 You should assess the sensory and cognitive status of
until long after the medication was taken; for
dosageAllinmedications
administered. the correctare manner
capableatofthe times prescribed the client. This assessment should include the client’s
example, infertility in young adults who were
producing fortoxic
the length
effects. of time prescribed? In determining the ability to read prescription labels and use of corrective
exposed to chemotherapy at a young age during
3 Allergicdegree
reactions of are
cooperation,
not a result it of is
theimportant that you be lenses for reading vision, noting whether the client
the treatment of leukaemia. The risks were known
non-judgemental
pharmacological effects of the and explore the
medication, but factors
rather related to the actually wears the corrective lenses. Also, you should
but the delayed ADR was considered acceptable in
lack of of
are a response cooperation. It is usefulsystem
a client’s immunological to initiateto discussions assess the client’s understanding of the medications he
the face of patient mortality. Teratogenic effects are
aboutofcooperation
the presence the medication. with Priorgeneral questions
sensitisation to regarding or she is taking. Does the client understand what each
also noted as Type D ADR.
the client’s
the medication treatment
is generally required.(for example, ‘Have you found medication is prescribed for? Does the client understand
586 Athat
G E Nthe
T S Utreatment
S E D T O T R Ethat AT Gyour ASTRO I N T E S T I N Aprovider
L DISORDERS Allergic reactions do not occur unless the client has
4 Idiosyncratic reactions are the healthcare
result of abnormal the dosing according to the prescriber’s orders?
been previously exposed to the agent or a chemically
reactivityhas to prescribed
a medicationhas made
caused byany
geneticdifference to your 3 You should assess the support system the client has
related compound. Such previous exposure or T E N S I V E S 481
symptoms?’).
differences between theYou then
client ask
andissues more-specific questions
non-reacting in the the home.importance
Do other members A N T I H y P EofR the
Take note of key information and within the sensitisation Learntoabout the agent may take placeof legalhousehold
without and ethical
the
such
individuals. as, ‘What difficulties related
This combined neurokinin-receptor antagonist knowledge to your medicationand algorithm understand developed the medication
in Canada regimenfor andtreatment
the take part in
Pharmacology
5 A teratogenic
Highlight
treatment do you
medication
boxes. have?’
is one thatIfwillit cause
appears a thatin the client concerns
of the in
assuring
pharmacology
client. For example, sensitisation
that the regimen
in nursing with the
is followed?
serotonin-receptor antagonist is effective the with some of nausea
antibiotic and
agents vomiting
may result during from pregnancy
ingesting (see the
Ethical and Legal Considerations boxes.that
SECTION 8
congenitalhas problems
defect in an
prevention with
of infant cooperation,
acute whoseand delayed mother took you
nausea assess the
the and vomiting reasons 4 An assessment
‘Ethical should also include factors
dosage
meat increases
that contains areand legal considerations’
agenerally
residue ofbest initiated
antibiotic inbox).
evening
administered
medicationfor these problems
while pregnant. by andfocusing oncourses
common reasons might inhibit the client from filling prescriptions;
PHARMACOLOGYassociated withHIGHLIGHT
initial repeat of cancer doses,
to rather than
the animal priormorningto slaughter. or afternoon
The sensitisationdoses. Other,
CHAPTER 30
6 Medication for lack
chemotherapy, of cooperation,
tolerance occurs whenincluding
especially the
with client an assessment of
requires
moderate-to-high that is, transportation, insurance and other financial
the
a higheremetic factors
dose risk listed.
orchemotherapeutic
more This data
frequent administration is then used
to gain to
lessclients
of
formulate
frequent Ethical
adverse
preparing and and
effects
considerations.
Legal
reported
administering Considerations
with the use of
antibiotics
Cardiovascular factors agents (Aschenbrenner, methyldopa
may also occur sesquihydrate
through theinclude carelessCoombs’-positive
handling of the
a nursing
the desired
2015). medication
Commondiagnosis,
effect. sucheffects
adverse as ineffective
are headache, management 5 Once the listed assessments have been completed
haemolytic and
medication anaemia and hepatic
contamination
Anti-emetics during of dysfunction.
the surrounding
pregnancy
RISK FACTORSof therapeutic
asthenia, dyspepsia, CONDITIONS
regimen related
fatigue, to experiencing
constipation and environment. An and addressed, a medication record listing the names,
Nausea allergic
and reaction
vomiting may occur
commonly occur in pregnancy. It
Smoking unpleasantItside effects
Left or toto monitor
deficient knowledge about
Clonidine dosages and frequency of use should be prepared.
erythema.
Unpredictable ADRs is such asventricular
important allergic hypertrophy
reactions for
and serotonin immediately after
is always exposureimportant of the
to aim sensitised
for not having individual
to administer
the illness
syndrome. and the intended effects of treatment. Clonidine appearsagent At each
to act byin visit, you should
stimulating alpha- note any changes in the
idiosyncratic
High serum drug reactions
cholesterol are seen
Angina or priorless frequently
myocardial to the offending medication (as during anaphylaxis) or it may
pregnancy. Non-pharmacological
Once the nursing diagnosis has been made, adrenergic you use ofinthese medications, question the client about
than predictable ones, but they may be considerably
infarctions be delayed receptorsforoptions
hoursshould or the
even CNS, resulting
be days.
employed Allergic in a decrease
first inreactions
helping pregnant
and the client discuss
Miscellaneous agents the goals for the treatment in sympathetic side effects
outflow from andthe adverse
brain. effects,
Its and assess
action the
more serious.
Age olderprogram
Allergic or hypersensitivity
than 60 years Diabetes
reactions can vary from mild skin rash, hives
women experiencing nausea and vomiting and itching toisbefore moving
and the
which intervention
is only strategies thatiscan apparent within therapeutic
30–60 effectiveness
minutes after of the medications.
administration
to medication Emetrol,
are not the result ofavailable
the medication’sin Australia, adifficulty breathing (dyspnoea) and
on to pharmacological anaphylactic
measures. Pharmacological
primary
lead to meeting
Men pharmacological
phosphorated these
carbohydrate
action(s)
goals. solution.
Prior cardiac A number of general
but rather a It is an oral of an oral dose. Its maximum antihypertensive effect
shock. treatment should not be withheld because there is fear of
response ofphysiological revascularisation
solution containing
the client’s immunological systembalanced to amountsoccurs within 3–5 hours. As the action of medication
clonidine is
When an causing
allergic reaction
harm to theoccurs,
foetus; in the fact, it has been shown that
the Postmenopausal
presence ofof thewomen
fructose medication. HeartSuch
and glucose failure
with orthophosphoric acid
reactions relatively
should be transient,
discontinued
early treatment
clients should be advised
immediately,
can reduce the theseverity
supervisorto not or
of symptoms.
are Family
relatively stabilised
history uncommon.
of heart at optimalHowever,
Stroke pH. Studies
when they
or transient indicatedo that itmedical miss
acts doses or discontinue
officer or care team therapy
notified, without
and consulting
appropriate
There are ethical issues in regard to carrying out
occur, theydirectly
disease often appear on thewith hyperactive
only low
ischaemic gastrointestinal
levels of the tracttreatment,
attack their healthcare such provider;
as rebound hypertension
the administration ofpregnant
adrenaline or
randomised controlled trials in women as well
medicationto
that is unlike
CHAPTER RESOURCES
ininhibit
the body
in vomiting.
smooth muscle contractions
and produce
Nephropathy
the normalItpharmacological
works immediately
a response functional
to control both
response
rapid elevation
(epinephrine) and
as
ofantihistamines,
blood pressure initiated.
ascertaining levels of
may occur.
nausea andIn some
vomiting. Australia
Medication tables throughout the text help to summarise institutions A N TaI has
important m medical b I Aemergency
R Omedication
I C adapted l Tan Ateam
R A P y information,
H Eevidence-based Nd AN call I bmay be
A C T Eindications,
T treatment l A g E N T S active
R I Aalgorithm 185
nausea and active Peripheral
vomiting. vascular
Theredisease are negligiblePeripherally acting anti-adrenergic agents
developed by the Motherisk teratology information
ingredients and nursing
SUMMARY
adverse considerations.
effects. Retinopathy (eye damage) The related agents prazosin and alfuzosin exert their
service (Einarson et al., 2007) in Canada. The variety of
Glucocorticoids, especially dexamethasone, are antihypertensive effect by selectively blocking
medications available in the guidelines for treating nausea
used Theas
TABLE 11.5 Quinolones
■ nursing
an process
adjunct in has
the five steps
treatment – assessment,
of nausea nursing
postsynaptic
and allergy
alpha identification,
1-adrenergic
right expiry
receptors. This date,
resultsrightinresponse and
and vomiting in pregnancy (Taylor, 2014) do not lead to
diagnosis,
vomiting due planning,
to implementation
chemotherapy or and evaluation
post-operatively. the dilation of the
– all of both client’s right to
arterioles and refuse.
veins and a lowering
C H A P T E R 11
Note: Report evidence of allergic reactions, such as rashes or itching. Report symptomatic miscarriage
improvement. orReview
causeadministration
birth defects,and premature
storage labour or
PHARMACOLOGY
instructions which
Dexamethasone playHIGHLIGHT
that accompany an product.
important Avoidrole
is an anti-inflammatoryin medication
rapid administration.
IV infusion todrug prevent of
and blood IVpressure.
peripheral
■
siteany Enteric-coated,
Clinical experience
irritation.
othermonitor
adverse IVsustained-release,
infusion
outcomes andwith
site
in
these
hourly.
pregnancy.
encapsulated
Always finish beads,
appears
■
the course The 12 rights of medication administration
to reduce irritation/inflammation from medications
of antibiotic. are: right the wax-matrix medications,
has revealed the possibility of a ‘first-dose’ sublingual and buccal products
Hypertension medication,
risk groups
cytotoxic agents right anddose, right client,
therefore right time,
reduces righteffect
stimulus/trigger route, when these should agents not be aredisrupted
used. This for is
oral administration.
characterised
MEDICATION ADVERSE EFFECTS
right documentation, rightRecent
reason,studies NURSING CONSIDERATIONS
right preparation, right
for nausea and vomiting. indicate bythat the adevelopment of significant hypotension and
RISK GROUPS NUMBER
ciPROFLOXAcin
combinationNausea
OF
andRISK
vomiting,
of a corticosteroid
FACTORS
diarrhoea,
with a 5-HT
EMETICS
● Aluminium- or magnesium-containing
syncope with sudden loss antacids or products containing
of consciousness with irontheshould not be
3-receptor
A No suchskin rash, bronchospasm
cardiovascular risk factors or administered within fourEmetics hours before areor two hours
agents afterare
that oralused
dosingto induce vomiting.
antagonist as granisetron or palonosetron first
is few doses or if
● may increase theophylline levels by 15–30 per cent
the dosage is increased rapidly.
more effective conditions and safe for controlling chemotherapy- Alfuzosin Theyis used areto used treatexclusively
symptomatic in thebenign treatment
prostaticof oral
● may increase prothrombin time for clients receiving warfarin
B induced One nausea and vomiting

cardiovascular (Uchida
risk factor but no et al., 2018).
● Route hyperplasia medication
(BPH). It acts overdose
to reduce
of administration is oral via tablets or suspension and IV infusion
and other
symptoms kinds
and of poisoning,
diabetes or other risk conditions ● Avoid alcohol increase urinethough
and exposure flow
to UVratesnot
light with acid oralpha
by blocking corrosive
1-adrenergic
poisoning.
Anti-emetics
C gatifloxacin Diabetes
Nausea, and
and/or pregnancy
local any the other risk● monitor receptors
ofreactions,
IV site
Rather
clients takinginboth
than thereby
thegatifloxacin
bladder, inducing vomiting (for example, using
and digoxinreducing bladder
Women conditionsoften experience nausea
cardiac dysrhythmias, dizziness, and vomiting
● obstruction
during something
without like
affecting
dilute contents of single-dose vials before administration Ipecac
bladder syrup), which was for a long
contractility.
pregnancy. Itnervousness, is best not to use
tendon painany and anti-emetics
● Administer during time the way of dealing with unknown poisoning,
IV over 60 minutes
pregnancy, and inflammation,
especially photosensitivity,
not in the first Beta-adrenergic
● do not infuse IV with any
trimester, activated blocking
other medicationscharcoal isagents the preferred treatment strategy
due to a higher pseudomembranous
probability of colitis
teratogenicmay
● cause
effects Awithdizziness; take
number of care if driving or operating
forbeta-adrenergic
poisonings. It was
blocking machinery
found that Ipecac
agents are syrup was
Centrally medication
acting anti-adrenergic
treatment. Sometimes agentshospitalisation ● Report symptoms of tendon disorders immediately
employed in being misused. The
the treatment misuse/abuse Their
of hypertension. arose due to people
CentrallyMOXifloxacin
acting Nausea,
anti-adrenergic
is necessary due to diarrhoea,
agents
severe cardiac
are generally
nausea ● monitor clients taking both
and vomiting mechanismusing ofmOXifloxacin
this medication
antihypertensive and digoxinactionfor binge-purging.
is not yet clear If continually
potentHCl antihypertensive dysrhythmias,
agents that dizziness,
(hyperemesis gravidarum) (Taylor, 2014), monitor frequently cause●
and but for adverse effects
is believed usedtoover time, ipecac
be partially due syrup
to their couldability lead toto toxicity
nervousness, tendon pain and ● may cause visual disturbances; do not drive or operate machinery if affected
including
sedation astreatment
a major adverse with an effect.
anti-emetic and other medications reduce cardiac outputmuscle by producing weakness and cardiotoxicity. Also,
beta-adrenergic
inflammation, photosensitivity, ● Avoid excessive UV or sun exposure, grapefruit juice or complementary medicines
is unavoidable in these circumstances (BPJ blockade. These
NZ, 2011; there agents was noappear clear evidence to show value
to be of greatest good outcomes
Methyldopa pseudomembranous colitis
Taylor, 2014). Metoclopramide is a commonly when used in
used in relation
conjunction to thewith use aofdiuretic
Ipecac syrup agent.and They hence a
Although NORfloxacin
its mechanismNausea, of action headache,is not dizziness
entirely clear, ● give one hour before or two hours after meals with a glass of water
changefew in practice dealing with overdosing/poisonings
anti-emetic in pregnancy and is classified as exhibit
Pregnancy relatively serious side effects.
methyldopa appears to act by being metabolised to● Administer
Copyright 2020 Cengage Learning. All Rights Reserved. May fluids liberally
not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
PropRANOLol occurred; andthat is, theinhibit
pindolol use of both activated the charcoal.
Category A, which is considered safe for● use. minimiseHowever,
caffeine intake
alpha-methylnoradrenaline. This metabolite is believed
its effectiveness in treating nausea and ●vomiting Avoid exposure to excessiveActivated
beta-adrenergic receptors
natural charcoal
(located
or artificial light absorbs
primarily almost any toxic agent
in cardiac
ANTImICRObIAl THERAPy ANd ANTIbACTERIAl AgENTS 177
xiv
kidneys, central
G U I D EtoTOa level
T H E that
TE X results
T in the appearance of symptoms
is particularly likely of infection.
C H A P T E R 11
ired organ function As bacterial cells generally grow rapidly, have
ple, the elderly). a different cell structure than human cells, and
to and during undergo different biochemical reactions than human
xicity by providing a FEATURES WITHIN CHAPTERS
cells, it is possible to successfully design a variety of
ning the appropriate chemical ways of destroying the bacterial cell without
nursing accountabilities 263

destroying human cells.
Understand the practical and professional applications of pharmacology theoryA Nand ALGESICS AND ANTIPyRE TICS
l tract is the Antibacterial agents either destroy or inhibit
served with oral through the Practical
the growth of both pathogenicand Professional
and non-pathogenic Application sections.
ts as nausea, bacteria. In other words, they exert a bactericidal
otoxicity can result or bacteriostatic effect. Major antibacterial
PRACTICAL AND PROFESSIONAL APPLICATION FOR THE TREATMENT OF PAIN
CH A P T ER 14
is a special concern agents include the penicillins, cephalosporins,
e of their fragile carbapenems, tetracyclines, macrolides, aminoglycosides
INTRODUCTION Some clients are unable to describe the pain experience.
ally is exhibited in and quinolones.
Pain is universal and you must always remember that ‘pain Other clients who are unable to communicate include infants
, in which clients
is what the client says it is’. When assessing a client’s pain, and young children, persons not fully conscious, those who
ace and neck. Penicillins are confused, and persons with communication barriers. In
it is important that you do so without preconceived ideas
with aminoglycoside The penicillins are among the most widely used
of how the client should act or look when in pain. You will such cases, you must depend on someone else, such as a
n in clients who antibiotic agents; however, an increasing use of
encounter people experiencing pain in every type of clinical family member, to aid in pain assessment. Providing a list of
gentamicin and is cephalosporins has been occurring in the last decade.
and community setting. adjectives from which the client can select may be helpful to
anial nerve. Penicillins are also called beta-lactams, which is a term
A variety of pain-relieving tools are available. These conscious adults who are able to communicate.
relating to their chemical structure. They are all
include positioning, massage and distraction, as well as The assessment also includes observations for signs
virtually bactericidal agents with a similar chemical
medication. Use of the nursing process can assist you in of pain. Indicators of pain include perspiration, nausea,
ystem of a client, structure and therefore a similar mechanism of action.
determining what pain-relieving tools are most effective for anxiety, restlessness, tension and changes in vital signs.
enon, has been Penicillins exert their antimicrobial effect by
a particular client. Pain is often undertreated in children, perhaps because
antimicrobial agents, inhibiting the synthesis of the bacterial cell wall,
health professionals are not familiar with the common
agent is available resulting in ASSESSMENT
the destruction of the organism. As these
indicators of pain demonstrated by children of different
nder medical agents do An notassessment
disrupt the of existing bacterial cell
the pain experience mustwall,
precede ages. It is important to be sure that the pain-assessment tool
ections. It has been but only newly
selection forming and actively measures.
of any pain-relieving growing cell When assisting used provides an objective and consistent measurement of
emia in a small walls, theya are most
client effective
in pain or one inwho destroying bacteria pain
is likely to experience client pain. Pain scales (for example, the Wong-Baker Faces
15). that are growing
becauseand multiplying
of injury, disease or rapidly
surgery,(see
you must assess the Scale – see Chapter 7) have been developed for assessing
Figure 11.7). It is generally inadvisable to use a
nature of the pain and rate it on a scale from 1 to 10. This pain in young children. It is important the tool used provides
bactericidal agent and
is known a bacteriostatic
as developing agent Inquiries
a pain history. (for are made
S example, tetracycline)
about the onset, at location,
the same time inintensity
duration, the same and nature
an objective and consistent measurement of client pain.
Indications of pain in the neonate depend on how close to
hat generally have client, as the
of thebacteriostatic
pain (cramping, agent may slow
stabbing, the throbbing
shooting, rate and term the child was when born. Children born preterm often
hey have a cell
age of nutrients into
ICONSof growth so of on),
with the action
the as microbial cell symptoms
well as other wall and interfere
(such as nausea) that show no signs of discomfort and little movement with invasive
may beof the bactericidal
associated with the agent
pain. You should ask about procedures, such as the insertion of catheters and needles.
the cell. Also, they (Ocampo et al., 2014).factors, such as position and activity that
predisposing Near-term neonates, on the other hand, may respond with
vides rigidity and The various
preceded penicillins
the onset of pain. Pastdiffer in severalwith pain
experience general body movement and crying. Other indicators of pain
lly, the cell also has respects (see the
often affects how‘Pharmacology
a client respondshighlight’
to recently perceived in neonates include eye rolling, breath holding with cyanosis,
ds RNA and DNA, box).
pain orSome (for example,
the threat benzylpenicillin)
of pain. Clients with chronic pain should seizures, slow heart rate, and vomiting. Infants up to 12 months
ell to replicate itself. are very unstable in the presence of acids and
be questioned about their usual means of pain relief; are
show pain through body movements, crying, coughing and
varieties of bacteria rapidly destroyed
techniques in the
that stomach;
have proven others
useful(for example,
in the past should be withdrawing the affected area. Toddlers from one to three
dy (for example, amoxicillin)usedare whenever
acid-stable and are well absorbed when
possible. years old may
Identify indicate pain
material thatbyexplains
aggressive behaviour,
the pathways such as and
per respiratory given orally. Many penicillins are susceptible to being
biting, by quiet withdrawal and by regression (for example,
ese organisms do destroyed by penicillinase
SAFETY (also termed
IN NURSING β-lactamase
PRACTICE mechanisms of action for medications with the
rocking). Once language skills are mastered, children can
ay an important or beta-lactamase), an enzyme released by some Biochemical pathway icon
begin to express pain using their own throughout
words for discomfort. relevant
nctions (for microorganisms. Pain It destroys the chemical structure
a within the body of these agents and renders the penicillin incapable
chapters.
In addition, children often exhibit guarding of the painful area.
1 Pain-relieving measures include positioning, If the child shows one or more indications of pain, you may
pability to cause of eradicating the microorganism.
massage, distraction and Otherusepenicillins
of analgesics. administer a prn analgesic that has been prescribed for the
ficient number to (for example,2 flucloxacillin)
Assess the onset, are considered to be intensity
location, duration, child. The child’s response is assessed carefully. If pain relief
of competition for penicillinase-resistant and can be successfully
and nature of pain, as well as other symptoms employed
occurs and the child becomes less anxious and restless, a
When this balance in combating such organisms.
associated with theFinally,
pain. some penicillins note should be made on the care plan about the response to
mple, because of have a narrow 3 spectrum
If the clientofis antimicrobial
unable to provide action, and
information pain and pain relief measures.
a change of diet), others have a broad about spectrum,
pain, obtainwhich makes
information them
from the family and As noted earlier, clients react to pain in different ways,
ms may increase useful in the treatment
observe the of client
a wide forrange of infections.
such signs of pain as anxiety, based on their age, sex, ethnic group membership, early
restlessness and changes in vital signs. childhood socialisation and past experiences with pain.
END-OF-CHAPTER FEATURES
4 The response to pain depends on the client’s For example, older persons often tolerate chronic pain
developmental level, sex, ethnic group membership, because they believe it isCaAnatural
l C u l AToccurrence
i n g m E d i CinATgrowing
ion dosAgEs 63
early childhood socialisation and past experiences older. These factors must be taken andinto account when
At the end of each chapter you will find several tools to help you to review, practise extend your knowledge
with pain. assessing pain.
of the key learning 5 Analgesicsobjectives,
are most including:
effective when given before
NURSING DIAGNOSES
CHAPTER RESOURCES
pain becomes severe.
• Summary6 Do not undertreat pain because of a fear of Nursing diagnoses include but are not limited to:
CHAPTER 4
■ acute pain related to health alteration

producing medication addiction.
■ chronic pain related to disease process
SUMMARY
→
■■ For correct interpretation of medication prescriptions, it is height of a client. There are specific nomograms for
important to know the abbreviations for units of measure children and adults.
and concentration, routes of administration, preparations ■■ Formulas are available to determine flow rate in drops
and dose forms, dose frequency and timing, and Roman per minute or millilitres per hour, for the administration of
numeral values. IV solutions.
■■ Nomograms, which are used to determine the body ■■ Some medications prepared in solution are expressed as
surface area (BSA) of a client, require the weight and weight-per-volume, weight-to-weight, or volume-to-volume
percentage.
REVIEW QUESTIONS
CHAPTER
SUMMARY
G U I D E TO T H E TE X T xv
For correct interpretation of medication prescriptions, it is
■■ height of a client. There are specific nomograms for
important to know the abbreviations for units of measure children and adults.
and concentration, routes of administration, preparations ■■ Formulas are available to determine flow rate in drops
and dose forms, dose frequency and timing, and Roman per minute or millilitres per hour, for the administration of
numeral values. IV solutions.
END-OF-CHAPTER
■■
FEATURES
Nomograms, which are used to determine the body ■■ Some medications prepared in solution are expressed as
surface area (BSA) of a client, require the weight and weight-per-volume, weight-to-weight, or volume-to-volume
• Review questions percentage.
REVIEW QUESTIONS
1 Your 10.5 kg paediatric patient is prescribed rifaMPICin dextrose containing the medication over one hour, 500 mL
20 mg/kg orally. It is to be administered once a day. The of 5% dextrose to run over the next four hours, and 1 L of
M E D I C AT I O N T H E R A P y F O R A G E D - C A R E C L I E N T S 141
oral syrup, once reconstituted, contains 100 mg in 5 mL. 5% dextrose to run over the next 16 hours.
How many millilitres need to be administered to this child? a How much more fluid can the patient have during this
a 9.5 mL 24-hour period?
9 Owing b 10.5tomL the alteration of body processing, aged clients i none
laboratory tests is the most important to appraise when
need12close
c mL monitoring following medication administration. ii 300Mr
evaluating mLCostas’ renal function?
CHAPTER 8
d True
a 8 mL a iii Blood 200ureamL nitrogen
2 A b client
Falseis prescribed 35 mg of clorpromazine b iv 100 mL filtration rate
Glomerular
10 hydrochloride.
Mr Costas is a 79-year-old You have 50client mg in taking
2 mL on hand. How many
multiple bc At what osmolality
Plasma rate will the 500 mL infusion run in mL/hr?
38 I N T R O D U C T I O N T O D R U G S A N D M E D I C AT I O N A D M I N I S T R AT I O N
• Critical thinking
millilitres
medications willfor exercises
you administer? Which of the following
hypertension. d iSerum 100creatinine
mL/hr level
a 2 mL ii 200 mL/hr
b 1.8 mL iii 50 mL/hr
CRITICALc 1 mL THINKING EXERCISES iv 125 mL/hr
CASE d 1.4 STUDYmL
1 Research the percentage of the population aged over
c How many d/min will the 1 L infusion run when using a
5 Borrow two different ‘child-resistant’ medication
SECTION 1
3 1 L of intravenous normal saline is to be administered in macrodrip giving set which is calibrated at 20 d/mL?
65 who require health support. What are the available containers from a pharmacy and see if they can be easily
FACTORS
four hours. AFFECTING
How manyMEDICATION millilitres per hour will this flow at? 3 Looking i at21Blake’s
d/min drug regimen, what other possible
supports and what are the types provided? opened by elderly acquaintances.
Blake a is250 55mL/hr
years old and has a heart condition. The problems ii 19 d/min
could occur and what should be put in place to
2 Polypharmacy is common in the elderly. Identify and 6 Identify the ways in which membership in a particular
b 150 mL/hr
medications he is on at present are metoprolol, verapamil, mitigate 30 risk?
iii the d/min
discuss what can be done to reduce medication ethnic or cultural group might affect a person’s compliance
c 300and
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Stockley’s Drug except the Coloxyl
Interactions with
(6th edn). Senna,
London:
resulting from generalised arteriosclerosis. She spends are to have aPress. dose administered at 8 a.m. In what order
Australian Prescriber,
acetylcystine 37(6), 210–13.
regimen. They will receive 200 mL of 5% Pharmaceuticals
Eidelman, muchC.of&the day in her room
Abdel-Rahman, and shows
S. M. (2016). little interest in the
Pharmacokinetic wouldGoods
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(TGA).Why did you select this
http://www.tga.gov.au
SUGGESTED
activities taking
considerations when READINGS
place around
prescribing in her. She International
children. takes her meals Journal in the Wurzel,order? D. F., Marchant, J. M. & Chang, A. B. (2014). Drug treatments of
SUGGESTED READINGS
ofcommunal
Pharmacokinetics,dining 1(1),room. 69–80. 2childhood
Which coughs. Australian Prescriber, 41(6),
for an7–9.
A1B2C3 Drug Information. Drug terminology. http://www.a1b2c3.com/ MIMS. (2015).site(s)
Monthly would
Indexbe preferred
of Medical Specialities injection
(MIMS) of Annual.
Hilmer,
A1B2C3 In addition
S.Drug
N. (2017). to the Drug
Prescribing
Information. arrayfor offrail
medications
terminology. that Mrs Chu
olderhttp://www.a1b2c3.com/
people. Australian Yang, N.
MIMS. J. & Hinner,
(2015).
penicillin, if itM.isIndex
Monthly J.required?
(2015). Getting
of Medical acrossstep-by-step
the cell
Specialities
Describe membrane:
(MIMS) Annual.
the
drugs/gen001.htm St Leonards, NSW: Author.
routinely
Prescriber,
drugs/gen001.htm receives,
40(5), 174–8. she is taking several others for a an overview
St Leonards,
procedure
for
NSW: small
youAuthor.
molecules,
would
peptides, and
use in administering
proteins. Methods in
Alternative Medicine Foundation. http://www.amfoundation.org New Zealand Medicines and Medical Devices Safety this injection,
Authority
Keith,
Alternative T. (2015).
respiratory Prescribing
Medicine infection for
Foundation. children.
that has InnovAiT,
been troubling8(10),her
http://www.amfoundation.org 599–606.
for a week. NewMolecular
Zealand Biology,
Medicines 1266, and29–53.
Medical Devices Safety Authority
Brophy, S. B., Kennedy, J., Fernandez-Gutierrez, F., John, A., Potter, R., paying particular
(Medsafe). attention to the client’s age and
http://www.medsafe.govt.nz
McGuire, HerS.8T.B.,
M.Kennedy,
a.m. (2018). Drugs affecting milk supply during lactation.
Brophy, Linehan, C. &medications
Kerr, M. J., (2018).are:
Fernandez-Gutierrez,
CharacteristicsF.,ofJohn, A., Potter,
children prescribedR., (Medsafe). http://www.medsafe.govt.nz
Pharmaceutical Management Agency of New Zealand (PHARMAC).
physical condition.
Australian
Linehan, Prescriber,
C. & Kerr, M. 41(6),
(2018). 7–9.
Characteristics of children prescribed
■ Coloxyl
antipsychotics: with Senna
Analysis of11 or 2 tablets
routinely twice
collected perJournal
data. day PO Child Pharmaceutical
of prn Management Agency of New Zealand (PHARMAC).
3 http://www.pharmac.govt.nz
What special considerations need to be taken into
Medical Letter on Drugs
antipsychotics: Analysis andofTherapeutics,
routinely collected The. (2013). New Rochelle,
data. Journal of Child http://www.pharmac.govt.nz
and (laxative)
Adolescent Psychopharmacology, 28(3), 180–91. PubMed.account http://www.ncbi.nlm.nih.gov/pubmed
when administering Fosamax?
NY:
and Medical Letter.
Charles,■ Adolescent
digoxin
B. (2014). Psychopharmacology,
0.125 every day28(3),
mg PO pharmacokinetics:
Population 180–91.
(cardiac an glycoside
overview. PubMed.
Stockley,http://www.ncbi.nlm.nih.gov/pubmed
I. H. (2004). Stockley’s Drug Interactions (6th edn). London:
Charles, B. (2014). Population pharmacokinetics: an overview. 4 What
Stockley, nursing measures areInteractions
associated(6th with theLondon:
safe
Australian Prescriber, 37(6), 210–13.
medication) Pharmaceuticals Stockley’s
I. H. (2004). Press. Drug edn).
Australian Prescriber, 37(6), 210–13. and effectivePress.
Pharmaceuticals administration of medications to this
Eidelman, C. & Abdel-Rahman, S. M. (2016). Pharmacokinetic Therapeutic Goods Administration (TGA). http://www.tga.gov.au
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Eidelman,
■ hydrOCHLOROTHIAZIDe 50 mg PO bd (diuretic)
C. & Abdel-Rahman, S. M. (2016). Pharmacokinetic client?
Therapeutic Goods Administration (TGA).A.http://www.tga.gov.au
considerations when prescribing in children. International Journal Wurzel, D. F., Marchant, J. M. & Chang, B. (2014). Drug treatments of
considerations
of Pharmacokinetics, when prescribing
1(1), A.
69–80. in children. International Journal Wurzel, D. F., Marchant,
childhood J. M. & Chang,
coughs. Australian A. B. (2014).
Prescriber, Drug treatments of
41(6), 7–9.
Bushra, R., Aslam, N. & Khan, Y. (2011) Ferner, R. E. (2016). Adverse drug reactions. O’Hara, K. (2016). Paediatric
of Pharmacokinetics,
Hilmer, S. N. (2017). 1(1), 69–80.
Prescribing for frail older people. Australian childhood
Yang, N. J. &coughs.
Hinner,Australian
M. J. Prescriber,
(2015). Getting 41(6), 7–9.
across the celldoses.
membrane:
Food–drug interactions. Oman Medical Medicine, 44(7), 416–20 pharmacokinetics and drug
Hilmer, S. N. (2017).
Prescriber, Prescribing for frail older people. Australian Yang, N. J. & Hinner, M. J. (2015). Getting acrossandtheproteins.
cell membrane:
Journal, 26(2),40(5), 174–8.
77–83. He, Y. & McLeod, H. L. (2016).an overview for small molecules,
Australianpeptides,
Prescriber, Methods in
39(6), 208–10.
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Prescriber,
Keith,
Chen, T. (2015).
M.,
40(5), READINGS
174–8.
Prescribing
Zhou, S.-Y., Fabriaga,forE.children.
& Zhang, InnovAiT, 8(10), 599–606.
Pharmacokinetics
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Pirmohamed,
and proteins. Methods in
M. (2013). Drug–grapefruit juice
Keith, T. (2015).
McGuire, T. M. Prescribing
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children.milk InnovAiT,
supply8(10),
during599–606.
lactation. Molecular Biology, 1266, 29–53.
P.-H. (2018). Food–drug interactions Medicine, 44(7), 407–11. interactions. BMJ 2013; 346:f1. doi: 10.1136/
Acello, B.
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T. M. Controlling
(2018). Drugs pain: Using
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supply aged care guideline.
lactation. DeLaune, S. C. & Ladner, P. K. (2011). Fundamentals of Nursing:
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xvi
Guide to the online resources

FOR THE INSTRUCTOR
Cengage is pleased to provide you with a selection of resources

that will help you to prepare your lectures and assessments
when you choose this textbook for your course.
Log in or request an account to access instructor
resources at cengage.com.au/instructors for Australia
or cengage.co.nz/instructors for New Zealand.
MINDTAP
Premium online teaching and learning tools are available on the MindTap platform – the personalised eLearning
solution.
MindTap is a flexible and easy-to-use platform that helps build student confidence and gives you a clear picture
of their progress. We partner with you to ease the transition to digital – we’re with you every step of the way.
The Cengage Mobile App puts your course directly into students’ hands with course materials available on their
smartphone or tablet. Students can read on the go, complete practice quizzes or participate in interactive real-
time activities.
MindTap for Broyles’s Pharmacology in Nursing is full of innovative resources to support critical thinking, and
help your students move from memorisation to mastery! Includes:
• Broyles’s Pharmacology in Nursing eBook
• Audio Glossary
• Nursing skills videos
• Case studies
• Revision quizzes
• Medication tables
• Nursing Care Plans.
MindTap is a premium purchasable eLearning tool. Contact your Cengage
learning consultant to find out how MindTap can transform your course.
INSTRUCTOR’S MANUAL
The Instructor’s manual includes: • Case question solutions
• Learning objectives • Suggested class discussions and projects
• Chapter outlines • Websites and readings.
• Key questions
COGNERO TEST BANK

A bank of questions has been developed in conjunction with the text for creating quizzes, tests and exams for
your students. Create multiple test versions in an instant and deliver tests from your LMS, your classroom, or
wherever you want using Cognero. Cognero test generator is a flexible online system that allows you to import,
edit and manipulate content from the text’s test bank or elsewhere, including your own favourite test questions.
G U I D E TO T H E ON L I NE R ESO U R C ES xvii
POWERPOINT™ PRESENTATIONS
Use the chapter-by-chapter PowerPoint slides to enhance your lecture presentations and to reinforce the key
principles of your subject, or for student handouts.
ARTWORK FROM THE TEXT

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student handouts or copy them into lecture presentations.
FOR THE STUDENT
MINDTAP
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xviii
PREFACE
The nurse’s role in the assessment, diagnosis, every medication on the market. It is assumed that
planning, implementation and evaluation of clients once you know the class of a specific medication, you
receiving medication is an integral function of nursing will be able to refer to this text for further information
care. Additionally, the role of educating clients about on that class.
their medication therapies is a critical component of This text focuses on the use of drugs as medications
the client’s care. within the healthcare environment in Australia and New
To function therapeutically and successfully in Zealand. We favour the term ‘medication’, rather than
these roles, you must understand: ‘drug’, throughout this book to refer to any medication
■■ the fundamental principles of medication action that is used in the healthcare context, although the
■■ the principles and methods of medication terms are generally interchangeable. The generic name
administration of the medication is the key ‘name’ to know. For this
■■ the impact of pharmacokinetic and pharmacogenetic edition we have removed brand names or trade names
factors on medication therapy for most medications in use in New Zealand or Australia.
■■ the accurate calculation of medication dosages A key role for you as a nurse is to always keep abreast of
■■ the special considerations of medication therapy the medications provided in your organisation, and it is
for paediatric and aged-care clients the generic name of a medication that does not change
■■ the normal and adverse responses by the client to and is the essential name for you to know.
medication therapy In this book, we also introduce some abbreviations
■■ the appropriate nursing interventions to achieve that are commonly used by healthcare providers and
the desired goals of medication therapy. pharmacists in writing and preparing medication
prescriptions. It is important to note that the use of
In addition, you must be able to assess a client’s abbreviations varies between organisations and is in
response to a medication therapy to provide feedback some areas discouraged completely. However, you
about its effectiveness to the medical provider. should become familiar with your organisation’s
approved list of abbreviations as they apply to
medications and their documentation.
ORGANISATION OF TEXT
The text begins with an introduction to medications
and medication therapies, including a brief history NEW TO THIS EDITION
of pharmacology, sources of medications and Chapter 1 of this third edition has been split into
dosage forms, medication legislation, principles two new chapters. Chapter 1 is an introduction to
of medication action, pharmacokinetic factors in medications, including the history of pharmacology,
medication therapy and medication interactions and and sources and classifications of medications.
incompatibilities, and the role of pharmacogenetics Chapter 2 concentrates on how the body reacts
in medication therapy. A discussion follows of the to the presence of medication in the body
principles and methods of medication administration, (pharmacokinetics) and how the medication acts in
with emphasis on the implications for nursing care. the body (pharmacodynamics).
A review of dosage calculations is included. Specific New figures and tables have been included
medication therapy considerations for paediatric throughout the textbook. The medications available
clients and aged-care clients as well as legal and ethical in New Zealand and Australia have been updated at
considerations for medication administration are the time of writing, however, the Pharmacology world
highlighted in separate chapters. changes quickly and it is important that you keep
The remainder of the text is organised according to abreast of new medications on a regular basis. Some
the major medication classifications, identified either sections of the textbook have also been expanded.
by their clinical use or by the body system they affect. All chapters now have a summary section at
For each classification of medications discussed in the end of each to highlight key points covered in
the text, the underlying pharmacological principles the chapter. Near the end of the chapter, there are
of medication action and the specific uses in clinical suggested readings for each subject matter as well as
practice are explained. While this text covers each a list of references cited in the chapter and associated
medication classification, it is not possible to cover with the topics discussed in the chapter.
xix

ABOUT THE AUTHORS
Dr Bonita Broyles began in nursing in 1968 working subjects, as well as lecturing and tutoring in many
as a student nursing assistant while pursuing her other subjects. She is a registered nurse with many
Bachelor of Science degree in Nursing from Ohio State years of clinical experience, including a decade
University in Columbus, Ohio. She graduated with her spent predominantly in the cardiothoracic intensive
BSN in 1970 and spent the next 13 years staffing and care unit at the Alfred Hospital in Melbourne. Her
teaching in obstetrics and gynaecology. From 1972 research interests include the increasing use of herbal
to 1976, she taught in the Associate Degree Nursing medications within the population and their effects
Education program at Columbus Technical Institute on patient care.
(which is now Columbus State). During this same Gayle has authored other texts, including the
period, she and her husband had two sons – Michael Clinical Companion – Medical–Surgical Nursing, and was
Richard and Jeffrey Allen Brown. the Australian author for the third edition of the ANZ
During her five-year position as Patient Teaching Nursing Drug Handbook.
and Discharge Planning Coordinator for Obstetrics at
Mt Carmel Medical Center in Columbus (1976–81), Sussan Pleunik is a lecturer at the Australian Nursing
Dr Broyles published her first professional work. and Midwifery Federation (ANMF, Vic. Branch) and
At this juncture, she decided to expand both her has an affiliation with La Trobe University. She is a
knowledge and nursing skills into the medical–surgical nurse adviser to the Australian Commission of Safety
arena, where she has staffed and taught nursing since and Quality in Health Care and, as a Fellow, she
1981. She and her husband, Roger Broyles, moved to represents the Australian College of Nursing in an
North Carolina in 1985. She is currently employed advisory capacity on government panels. She held the
at Piedmont Community College in Roxboro, North position of Clinical Liaison for the Northern Hospital
Carolina, and has been teaching in the nursing and Melbourne Health for La Trobe University, and
education department since June 1986. is also involved as an industry consultant, which
During her tenure at Piedmont Community includes teaching staff in a variety of clinical settings.
College, Dr Broyles has served in the capacities of She is a registered nurse with extensive clinical and
course coordinator and instructor in both the first- educational experience in many states of Australia.
and second-level nursing courses, including acting as Her educational experience includes teaching at all
the course coordinator for Paediatric Nursing (later tertiary levels. Sussan taught all three years of the
changed to Maternal-Child Nursing), Adult Nursing undergraduate program, including Pharmacology, and
II and Pharmacology, and instructor in Fundamentals teaches Medication Administration Updates to nurses
of Nursing, Nutrition and Pharmacology. She received for CPD. In the industry, she has taught personal
her Master of Arts degree from North Carolina Central care attendants (assistants in nursing) Medication
University in 1988. In 2005, Dr Broyles received her Administration. Her research interests include
doctorate from St Regis University with further study medication administration by all levels of care staff.
in adult education, and has written numerous other Sussan manages her own training organisation,
textbooks. which delivers competency-based education to both
Dr Broyles would like to thank Dr Barry S. Reiss acute- and extended-care facilities.
and Dr Mary E. Evans for such a wonderful manuscript
to continue to revise. She continues to try to maintain Rachel Page is an Associate Professor and Head of
the student-friendly, logical and professional style of the School of Health Sciences, College of Health,
Dr Reiss and Dr Evans. Massey University. Rachel has over 25 years of
research experience in the area of metabolism and
Gayle McKenzie is a lecturer and third-year disease process. Her passion is understanding the
coordinator of nursing students based at the La Trobe/ underlying molecular mechanisms involved in the
Alfred Health Clinical School in Melbourne. Gayle onset and development of disease, with the ultimate
has been employed at La Trobe University since aim of identifying therapeutic and diagnostic targets
2001 in a variety of roles, including coordinating for disease intervention. Rachel has been lead or
a Pharmacology unit and third-year acute nursing co-investigator in a number of intervention/clinical
xx A b o u t t h e au t h o r s
trials, in particular the WEST headache trial, SPIRIT Rachel has taught pharmacology at the
study, RICE study and GLARE study, which have undergraduate and postgraduate level for the past
involved diet, education, exercise and alternative 15 years to nursing, midwifery and health science
treatment strategies. Her current research is in students, and enjoys making the science of drugs
cardiovascular disease, prediabetes, diabetes, diabetic relevant and accessible to students at all levels.
nephropathy, regulation of blood pressure, stroke and
chronic pain.
xxi

ACKNOWLEDGEMENTS
We would like to thank Diane Housiaux (ICU, Alfred ■■ Matthew Barton, Griffith University – Gold Coast
Hospital) for contributing the list of commonly used ■■ Janet Coller, University of Adelaide – North Terrace
complementary medications for Chapter 49. ■■ Grant Williams-Pritchard, Griffith University –
Thanks also to Wilma Tielemans, Capital and Coast Gold Coast
District Health Board, Wellington Regional Hospital. ■■ Katherine Gillette, Queensland University of
Sussan would like to acknowledge the continued Technology – Kelvin Grove
support of her husband, Dr Peter Pleunik, and family, ■■ Nicole Blunt, Central Queensland University –
Alexander, Simon and Jillian; and her sister, Mrs Jill Bundaberg
Boehm OAM. ■■ Sean Parker, La Trobe University – Bundoora
Gayle would like to acknowledge the support of ■■ Andrea Miller, University of Tasmania – Launceston
her mother, Avis McKenzie, as well as to thank her ■■ Allison Roderick, University of South Australia –
students (past and present) for their inquisitive minds! City East
■■ Michael Shearsmith, Open Colleges
Cengage Learning and the authors would like to thank ■■ Bronwyn Smith, Western Sydney University –
the following reviewers for their incisive and helpful Hawkesbury
feedback: ■■ Tracey Frampton, Wodonga TAFE.
■■ Joclyn Neal, Australian Catholic University – Banyo
Every effort has been made to trace and
■■ Dean Whitehead, Flinders University – Bedford
acknowledge copyright. However, if any infringement
Park
has occurred, the publishers tender their apologies and
■■ Trish Burton, Victoria University – St Albans
invite the copyright holders to contact them.
SECTION
1
INTRODUCTION TO DRUGS AND
MEDICATION ADMINISTRATION
CHAPTER 1 MEDICATIONS: FROM HERBS TO RESEARCHED TREATMENTS 2
CHAPTER 2 PHARMACOKINETICS AND PHARMACODYNAMICS 21
CHAPTER 3 PHARMACOGENETICS AND PHARMACOGENOMICS 39
CHAPTER 4 CALCULATING MEDICATION DOSAGES 50
CHAPTER 5 PRINCIPLES AND METHODS OF MEDICATION ADMINISTRATION 66
CHAPTER 6 INTRAVENOUS MEDICATION THERAPY 98
CHAPTER 7 MEDICATION THERAPY FOR PAEDIATRIC CLIENTS 116
CHAPTER 8 MEDICATION THERAPY FOR AGED-CARE CLIENTS 131
CHAPTER 9 PREVENTION OF MEDICATION ERRORS 143
CHAPTER 10 LEGAL AND ETHICAL CONSIDERATIONS FOR MEDICATION

ADMINISTRATION154
1
CHAPTER
1
MEDICATIONS: FROM HERBS TO
RESEARCHED TREATMENTS
LEARNING OBJECTIVES
1 describe the scope of the science of pharmacology, including sources of chemicals for medications; the
properties, advantages and disadvantages of a wide variety of dosage forms and their use in the healthcare
context; and medication information sources
2 compare the significance of the chemical name, generic name and brand name of a medication; identify the
different medicine classifications and component parts of a written prescription; and briefly describe the
role of the Australian Therapeutic Goods Administration (TGA) and the New Zealand Medicines and Medical
Devices Safety Authority (Medsafe)
3 identify and describe the significance of each controlled substance schedule as defined in ‘drugs, poisons
and controlled substances’ legislation for each Australian State and Territory, and in New Zealand.
2
M e d ications : f rom her b s to researche d treatments 3
INTRODUCTION for food and shelter. In early civilisations, disease was

viewed with great superstition. The prevention and
CHAPTER 1
A medication can be broadly described as any treatment of illness were, therefore, often directed
chemical or natural herbal substance that affects to driving away evil spirits and invoking magical
living systems by altering their structure or function. powers. To enhance the mystical treatment of disease,
The study of pharmacology is the science concerned primitive cultures, some 10 000 to 20 000 years ago
with the historical sources and physical and chemical when people first started to live in communities,
properties of medications, as well as the ways in which began to experiment with the plants that grew around
medications affect living systems. This is the basis of them and discovered that the ingestion of particular
medication administration principles. It is because herbs had certain effects on the body. This led to the
of the complex nature of this science that various discovery of the first medicinal agents, some of which
subdivisions of pharmacology have evolved. (alcohol, opium etc.) are still used today. Even agents
Other important areas of study include the following: used as poisons to coat the tips of the arrows and
■■ Pharmacodynamics is the study of the biochemical
spears of ancient warriors (for example, curare) are still
and physiological effects of medications, the study used medicinally.
of medications’ mechanisms of action, and what Ancient Egypt is often credited with being the
medications do to the body (see Chapter 2). cradle of pharmacology. Papyri that have been
■■ Pharmacokinetics is the study of the absorption,
excavated from ancient Egyptian ruins are stored in
distribution, biotransformation (metabolism) and many areas around the world; in fact, they are named
excretion of medication. Each of these factors is according to where they are housed. One papyrus, the
related to the concentration of a medication or London Medical Papyrus (c. 1782–1570 BCE), discusses
its chemical by-products in various body sites, prescriptions for issues related to the eyes, skin,
as well as the time required for these medication burns and pregnancy (Mark, 2017). In approximately
concentrations to develop, change or both. It is 1600 BCE, the Hearst Papyrus was written, followed
also about what the body does to the medication. in 1551 BCE by the Ebers Papyrus. These documents
(See Chapter 2.) listed more than 700 different remedies that were
■■ Pharmacogenetics is the study of genetic factors
used to treat specific ailments. These were probably
that influence how a medication works on an the earliest documents devoted entirely to medicine,
individual. This area is being widely studied by although such medicinal recommendations were
research institutions all over the world (see Chapter uncovered in the writings of the Chinese scholar-
3 for further in-depth information concerning this emperor Shen Nung, who was alive around 2735 BCE;
burgeoning research). he compiled a book on herbs, a forerunner of
■■ Pharmacotherapeutics/therapeutics is the study
the medieval pharmacopoeias that listed all the
of how medications may best be used in the then-known medications. In the fourth century BCE,
treatment of illnesses. This area of study looks Hippocrates declared in Greece that knowledge about
at which medications would be most or least health and disease could only come through the study
appropriate to use to treat a specific disease, what of natural laws. This resulted in the first systematic
dose would be required, and in what form. dissections of the human body done to study the
■■ Pharmacognosy is the study of medications
functions of specific organs.
derived from herbal and other natural sources. By In the first century CE, Dioscorides prepared De
studying the compositions of natural substances Materia Medica, which scientifically described 600
and how the body reacts to them, one gains better different plants and classified them, for the first
knowledge for developing synthetic versions (see time, by substance rather than by the disease they
Section 13, ‘Complementary medications’, for were intended to treat. This work remained the main
more information concerning this topical area of source of pharmacological knowledge until the 16th
medication information and discussion). century. At that time, Paracelsus, a Swiss scientist, first
■■ Toxicology is the study of poisons and poisonings.
advocated the use of single drugs, rather than mixtures
As almost all medications are capable of being toxic or potions, as a means of treating diseases. He believed
under some circumstances, this science deals with that the dosage of single drugs could be regulated
the toxic effects of substances on the living organism. more precisely than that of complex mixtures and
recognised the dangers of giving too much or too little
HISTORY medicine to a specific person. He wrote that ‘all things
are poisons, for there is nothing without poisonous
The treatment and prevention of disease are nearly qualities. It is only the dose which makes a thing
as old as human history because they have always a poison’. For his contributions, Paracelsus is often
been considered as important to survival as the need considered to be the father of pharmacology.
It was not until the 17th century that the English whereby yeast or bacteria in the laboratory are
physiologist William Harvey first began to explain modified to produce human insulin.
SECTION 1
how drugs exert their beneficial or harmful effects. He The vast majority of medications currently in use
demonstrated the circulation of blood in the body and are entirely prepared by synthetic means; that is, they
introduced the intravenous method of administering are formed by chemical reactions in a laboratory.
medications. In the 200 years that followed Harvey’s Agents are synthesised after determination of how
work, drug products of greater purity gradually evolved. the chemical structure of a compound relates to
Using these purified medications, in the 19th century its pharmacological properties. Because synthetic
two French physiologists, François Magendie and medications are produced in the laboratory, it is often
Claude Bernard, demonstrated that certain medications possible to create compounds that have greater purity
work at specific sites of action within the body. than those drugs that are derived naturally.
Also in the 19th century, Joseph Lister and Ignaz The most exciting advances in the development
Semmelweis first introduced the use of antiseptics to of new medications have been in the area of
prevent infection during surgery. With Paul Ehrlich’s biotechnology. Biotechnology involves the
discovery of antibiotics and Frederick Banting and manipulation of proteins to permit the large-scale
Charles Best’s discovery of insulin, the golden age of industrial production of complex natural substances
pharmacology was ushered in. This culminated in the (for example, hormones) or genetically altered
development of literally thousands of drugs during biological substances. It is a science that utilises
the 20th century. Collectively, these medications have discoveries in the fields of molecular biology,
altered the practice of medicine and saved millions of recombinant DNA technology, genetic engineering,
human lives. immunology and pharmacology.
Aboriginal and Torres Strait Islander peoples have In pharmacology, the greatest potential for applying
their own forms of traditional medicine which involve biotechnology lay at one time in gene splicing. Recent
both physical and spirit healing. One example of a research now includes the use of the human genome
plant-based remedy is the use of snakevine (Tinospora to develop medicines that are more individual-centric.
smilacina) to treat a headache. The stem is wrapped Medications must be developed in mammalian cells to
around the head; the milky latex sap from this woody circumvent post-translational modifications.
stem has a cooling property. This sap is also used for Currently, hundreds of different biotechnology
other ailments. products are in various stages of development.
The traditional Māori healing system is called Products already approved include human insulin,
Rongoā Māori. This system includes the use of plants, human tissue plasminogen activator, human growth
massage and incantations. Some of these Māori hormone and hepatitis B vaccine. The next few
healing methods have been researched and are used decades of the new millennium promise to be a time
more widely today. These include the use of manuka when the introduction of biotechnology products will
honey for the treatment of wounds; the manuka plant be increasingly common and their benefits to humans
has other more extensive uses. More information almost too great to measure (see Chapter 3).
is available from the Museum of New Zealand at
https://www.tepapa.govt.nz/discover-collections/
read-watch-play/maori/maori-medicine. THE USE OF DRUGS AS MEDICATIONS
This text focuses on the use of drugs as medications
within the healthcare environments in Australia and
SOURCES OF DRUGS New Zealand. We use the term ‘medication’ rather
As discussed above, medications may be derived from than ‘drug’ throughout this book to refer to any drug
a number of different sources, some of them natural. that is used in the healthcare context, although the
For example, in the past, most insulin for human use terms are generally interchangeable.
was extracted from the pancreatic tissue of animals, Medications can be helpful to both the healthy
mainly pigs or cattle, whereas natural clays form the and the sick. They have six major uses:
basis of some skin therapies, and some bulk-forming 1 The most common medication use is symptomatic
laxatives (for example, Metamucil), cardiac medications treatment. Many medications are used to relieve
(for example, digitalis) and chemotherapeutic agents disease symptoms (for example, paracetamol to
(for example, vinCRISTine) are derived from plants. relieve fever and headache).
Some medications are produced semi-synthetically. 2 Preventive medications help the body avoid disease
For example, many antimicrobial agents are prepared (for example, hepatitis vaccine for serum hepatitis B).
by chemically modifying substances that are available 3 Diagnostic medications (for example, radiopaque
from a natural source. Likewise, today, most insulins dyes) help the healthcare provider determine
are produced using genetic engineering technology, whether a disease is present.
4 Curative medications (for example, antibiotics) assurance is incorporated into every stage of the
eliminate disease. manufacture.
CHAPTER 1
5 Health maintenance medications (for example, Most tablets contain a disintegrating agent, usually
insulin) help keep the body functioning normally. cornflour. The disintegrating agent swells when it
6 Contraceptive medications (for example, oral comes into contact with fluid in the stomach and
contraceptives) prevent pregnancy. causes the tablet to break apart into smaller particles,
which dissolve rapidly and release the active medicinal
ingredient. Many tablets are scored to facilitate
DOSAGE FORMS convenient division into halves or even quarters;
Medications are capable of being transported into see Figure 1.1(B). Unscored tablets are difficult to
the human body in a variety of ways. Rarely are they break evenly and this is often utilised deliberately by
administered in their pure chemical form, but rather pharmaceutical companies to discourage division of
in a formulation designed to maximise the stability tablets. If a tablet is not scored then it should not be
and usefulness of the medication. Some formulations, broken up as this can alter the absorption quality of
or dosage forms, may be simple solutions of the the medication and in many instances cause harm
medication in water and some may be more complex to the patient either by preventing the medication
combinations. Some of the most common dosage from functioning or allowing the medication to work
forms are explained in the next sections. at an enhanced speed. Some tablets are coated with
a substance that prevents the tablet from dissolving
Tablets in the stomach but permits it to dissolve in the small
The tablet is the most popular dosage form intestine; see Figure 1.1(C). Such tablets are enteric-
and usually the easiest to administer. Almost all coated (ec) and are designed to carry medications that
tablets now used in Australia and New Zealand are could irritate the stomach or be chemically destroyed
‘compressed’ tablets. They have been formed by by its acid environment. Since this coating is designed
compressing a mixture of pure medication(s) with to dissolve in a neutral or alkaline pH environment, it
inactive components that serve to add bulk, shape, is important to avoid administering such dosage forms
weight or other properties to the tablet. Compressed with antacids, milk or other alkaline substances, as
tablets are usually manufactured commercially these may cause the coating to dissolve in the stomach
because costly equipment is required to form them rather than in the small intestine. Enteric-coated
and the process is regulated to ensure that quality tablets should never be crushed or chewed.
A. B. C.
D. E. F.
FIGURE 1.1 Solid dosage forms. (A) Tablets. (B) Scored tablets. (C) Enteric-coated tablets. (D) Capsules. (E) Controlled-release capsules.
(F) Gelatine capsules
Timed, controlled or sustained-release tablets the powdered medicinal contents; see Figure 1.1(D).
Many different technologies exist for permitting They may be commercially manufactured or they may
SECTION 1
medications to be released from tablets in a controlled be prepared by the pharmacist to contain a precise
fashion. Some tablets (for example, Slow-K) have medicinal formulation. If necessary, in some instances
crystals of potassium chloride embedded in a wax they may be opened by you for administration
matrix. When these tablets come in contact with in food, liquids or tube feedings. To discourage
gastric fluid, the fluid causes small amounts of the tampering, some capsules are now manufactured in a
dissolved medication to leak through the channels way that makes it impossible to separate the two parts
in the wax matrix and promotes gradual release of the capsule without destroying its integrity.
of the medication over several hours. This helps Soft gelatine capsules (for example, colecalciferol)
reduce the irritating effect of the medication on the are usually designed to encapsulate medicinal
gastrointestinal lining. Controlled release of potassium liquids; see Figure 1.1(F). They are only prepared by
chloride and other medications is also accomplished commercial manufacturers and are completely sealed.
by preparing tablet products that contain a Some capsule products contain small medication-
microencapsulated drug; that is, small drug particles impregnated beads designed to release medication(s)
with a polymer coating. When the tablet disintegrates, at different rates while they pass through the
the microencapsulated medication particles are gastrointestinal tract, thereby producing a sustained-
released. Depending on the thickness of the polymer release action; see Figure 1.1(E).
coating, the particles release the medication over
varying periods. Lozenges
Osmotic pumps have also been employed to Lozenges, or troches, are solid dosage forms that are
provide a controlled-release feature in some tablets. generally disc-shaped and should be dissolved slowly
Osmotic pumps are polymer-coated tablets that allow in the mouth. They are often designed to release
water to enter into the tablet from the gastric fluid. medication that exerts an antiseptic, anaesthetic or
As the medication dissolves within the tablet, it forms absorption effect on the tissues of the oral cavity or
an osmotic gradient that forces medication solution throat (for example, Amphotericin b [amphotericin]).
out of a laser-drilled hole in the tablet’s surface. This
mechanism permits a slow and steady medication Wafers
release over a number of hours. Some medication can be administered in the form
Some tablets contain different layers or have of a wafer. This medication system uses the mouth
cores that separate different medications that might as both the entry point to the gastrointestinal tract
be incompatible with one another. These layers may and as the site of medication action and application.
separate different doses of the same medication that Three types of wafers are available: flash-release wafers,
are to be released at different times during the passage mucoadhesive melt-away wafers and mucoadhesive
of the tablet through the gastrointestinal tract. sustained-release wafers. There are many advantages in
Although most tablets are intended to be delivering medications in this way, including ease of
swallowed whole by the client, some are meant to be application (no additional water is needed), improved
chewed prior to being swallowed. Chewing provides bioavailability (allowing lower doses), swift systemic
a localised or topical medication effect in the mouth, effects after absorption through the mouth, restriction
as well as better distribution of the medication in the of local effects in the oral cavity, an effect on the
stomach. Other tablets are to be dissolved under the entire oral cavity (such as for mouth disinfection),
tongue (sublingual [subling]) or in the inner lining of and buccal absorption that bypasses hepatic first-pass
the cheeks (buccal [BC]). This permits the medication metabolism.
to directly enter the circulation without first passing
into the stomach. Suppositories/pessaries
A suppository, or pessary, is a dosage form that is
Capsules to be inserted into one of the external body orifices,
A capsule is a dosage form in which a medication is usually the rectum, vagina or urethra (although there
enclosed in either a hard or soft soluble shell, usually are currently no medications available in Australia
made of gelatine. When the capsule is administered or New Zealand that are inserted directly into the
orally, the shell generally dissolves in the stomach urethra). Any medication that may be required for use
within 10 to 20 minutes, releasing its contents. Hard within the bladder is generally administered via an
gelatine capsules (for example, codeine phosphate in/out disposable urinary catheter. Once pessaries or
hemihydrate, doxylamine succinate and paracetamol) suppositories are inserted, they either dissolve slowly
consist of two parts that slide together to enclose in the body fluids or melt at body temperature to
release the medicinal content. Such medications may avoiding disintegration by the stomach acid, and also
exert a localised effect on the tissue or they may enter allows topical application.
CHAPTER 1
the bloodstream and act throughout the body.
The most popular vehicle, or base, for suppositories Suspensions
is cocoa butter, a by-product of the chocolate industry. Suspensions are liquid dosage forms that contain solid
Cocoa butter is a waxy solid at room and refrigerator medication particles that are suspended in a suitable
temperatures, but melts at body temperature. This is a liquid medium. Most suspensions are administered
desirable characteristic for a suppository base. orally, although some are applied to the skin as lotions
or liniments, or administered by injection. Note: Oral
Solutions suspensions should never be administered intravenously.
A solution is a clear liquid preparation that contains Magmas are suspensions that contain relatively
one or more solvents, usually water, and one or more large drug particles. All suspensions must be shaken
dissolved components, or solutes. When used orally, thoroughly immediately before administration to assure
solutions are often flavoured and coloured to make dosage uniformity each time the product is used.
them more appealing to the client. Solutions offer
the advantage of easy administration, particularly for Emulsions
paediatric and aged-care patients, as well as the ability Emulsions are dispersions of fine droplets of an oil in
to infinitely vary the dose administered. water or water in oil. Those that contain an oil dispersed
Syrups are sweetened solutions that are often used in water are primarily used orally. By dispersing a
to mask the unpleasant taste of certain medication. medicinal oil (for example, castor oil or mineral oil) in
Syrups are also given for their soothing effect. water that contains flavouring agents, the objectionable
Sugar-free syrups are available for diabetics. Elixirs are taste and/or odour of the oil can be masked. Some
also solutions but contain a solvent mixture of alcohol sterile emulsions containing vegetable oils dispersed in
and water, as well as other components. They are water are used intravenously as an injectable nutrient
often used as vehicles to dissolve medication that does source. Emulsions containing water droplets dispersed
not dissolve in water alone. Tinctures are solutions in oil are used primarily for topical application to the
that contain alcohol as the primary solvent but which skin. The oily vehicle may provide a useful protective
may contain some water as well. Because tinctures are action for damaged skin, while the water droplets may
available for internal and external use, they should be carry dissolved medicinal agents to the application site.
stored separately from other liquid medication. Careful Emulsions must be shaken thoroughly just prior to their
label checks should be made before administering them. use because the oil and water phases, as well as solids that
Solutions have a wide variety of medicinal may be suspended in some emulsion products, may tend
applications. Most are given orally but some are to separate on standing.
administered by other routes. Solutions used for
injection (parenteral administration) or in the eye Topical dosage forms
(ophthalmic use) must be sterile and should be Topical preparations/formulations are very important
non-irritating to body tissues. When administered for treating localised areas. The advantage of applying
intravenously, the solution must also be free of solid a medication topically is that this reduces the systemic
particulate matter. adverse effects associated with the medication if it enters
A douche solution is one intended to be used in the blood system. Topical preparations can be used for
cleansing a body part or cavity, usually the vagina. It treating a variety of conditions, including dermatological,
is often prepared by diluting a liquid concentrate or ear and eye infections, asthma, sore throats and so on,
soluble powder with water to make a solution of an and come in a variety of dosage forms such as sprays,
appropriate strength. lozenges and solutions, as already discussed.
Unless they are prepared and stored carefully, most Semisolids are another dosage form that allows
solutions are subject to contamination by bacteria, medication to be applied to a local and targeted area
moulds or other microorganisms, as well as by dust. for treatment and are explained below in more detail.
If they are not kept in tightly capped containers,
the solvent of most solutions will evaporate, leaving Semisolids
behind a more concentrated medication solution. Many different semisolid dosage forms are utilised
to apply medications to the skin surface. Many are
Sprays used in the treatment of dermatological disorders (see
Medications can also be delivered in a spray form, Chapter 48). Some may be greasy and insoluble in
which is not to be confused with inhalations. A spray water (for example, petrolatum, lanoline and most
enables the medication to be absorbed by the mucosa ointments), while others (for example, creams and
and then to move rapidly into the bloodstream, gels) usually are not greasy and are easily washed from
the skin with water. Selection of the appropriate base often in the upper arm region. When the action of
to use for topically applied medications is based on the medication is to be discontinued, or when new
SECTION 1
such factors as: implants need to be inserted, the old implants are
■■ the desired rate of medication release from the base surgically removed. An example of such a system is
■■ whether to retain or remove moisture at the site of Etonogestrel, a product that releases contraceptive
medication application doses of progestogen for a period of up to three years.
■■ how stable the medication is in the base.
Parenteral products
Transdermal patch There are several different ways of packaging sterile
A number of medications (for example, glyceryl solutions or suspensions intended for use as an
trinitrate, oestrogen, clonidine, fentanyl, scopolamine and injection.
nicotine) are available in patch-like devices known as Ampoules are sterile, sealed, glass or plastic
transdermal therapeutic systems (see Figure 1.2). Most of containers containing a single liquid dose. Vials
these consist of a reservoir that contains the medication, are either single- or multiple-dose glass or plastic
a water-resistant surface covering, a thin membrane containers that are sealed with a rubber diaphragm.
that lies between the medication and the skin, and an Prefilled syringes containing a single dose also are
adhesive area that permits the secure application of the available. New ways of mixing powders and solutions
system to the skin. Once applied, the medication slowly are being proposed all the time, and before they can be
passes from the reservoir through the membrane into implemented within Australia or New Zealand, each
the skin. The medication then is absorbed into blood must be compliant with the country’s safety standards
vessels within the skin and carried to other parts of the and approved by the TGA in Australia or Medsafe in New
body. The patch should be applied to a clean area of Zealand, which undertake rigorous testing procedures.
the patient’s skin and the site of application should be
rotated to prevent the skin from forming a barrier or
thickening that inhibits absorption of the medication. MEDICATION NAMES
This rotation should be noted on the medication chart. By the time a medication becomes available for
Refer to Chapter 29 for a more detailed discussion of the commercial distribution in Australia or New Zealand,
use of glyceryl trinitrate transdermal therapeutic systems. it will already have several names. During the
earliest stages of development, the first name that
is likely to be applied is the chemical name. This
is a systematically derived name which identifies
the chemical structure of the medication. Since
the chemical name is often quite complex, a code
designation is sometimes chosen for the medication
at this time. This merely represents a temporary
name which is generally discarded once a medication
becomes commercially available. Investigational
medications – those that are not yet commercially
available but are undergoing experimental study – are
often labelled only with this code designation.
Once a medication is to be marketed, it is assigned a
relatively simple generic (non-proprietary) name. This
name is meant to be easier to pronounce and remember
than the chemical name, yet it reflects some important
pharmacological or chemical characteristic of the
SOURCE: NOVARTIS PHARMACEUTICALS AUSTRALIA PTY LIMITED
medication (American Medical Association, 2009).
Attention is also given to selecting a name unlikely to
FIGURE 1.2 You should wear gloves when removing the protective
be confused with the names of other medications.
outer layer to prevent self-medication. The patch should be dated,
timed and signed by the administering nurse before the safety backing When a medication is ready for commercial
is removed and the patch is applied to a clean patch of skin distribution in Australia or New Zealand, it may be
assigned a brand name, or trade name, usually
written as a proper noun and capitalised as a form of
Implants distinction. This name, which is usually followed by a
Medications may be administered for extended periods superscript®, is registered through a patent office and
of time, sometimes as long as five years, by using approved by the TGA in Australia or Medsafe in New
small, flexible capsules made of a Silastic® polymer. Zealand; only the company that has registered the
These capsules are surgically implanted subdermally, medication is permitted to use it. The brand name is
usually short and easy to recall. It often does not refer researcher Benjamin Teplitsky in the late 1960s.
to the medication alone but to the entire formulation In 1992, together with Neil Davis and Michael
CHAPTER 1
in which the medication is contained. When a single Cohen, Teplitsky published a list of 645 confusable
medication is manufactured by different companies, medicine name pairs in an effort to capture the
each company must market the medication under attention of regulators and start the process of
its own brand name. Examples of some of the names designing safer names.
currently used for a single medication are listed below: The Australian acknowledgement resulted in the
■■ Chemical name: di(±)-1-(isopropylamino)-3-(p- proposal in 2011 that packaging names be altered to
[2-methoxyethyl] phenoxy)-2 propanol L(+)-tartrate. accentuate the differences between similar names,
■■ Non-proprietary (generic) name: metoprolol tartrate. through the use of what is known as Tall Man lettering
■■ Brand name: Betaloc. (see Figure 1.3). In 2013, Tall Man lettering was
Once a manufacturer’s patent for a medication introduced in New Zealand as well. This topic will be
has expired (usually 20 years from the date it was first discussed further in Chapter 9, which deals with the
registered), other companies are free to market it under prevention of medication errors.
their own trademarked name or under its generic name
(Food and Drug Administration, 2006). Considerable
controversy has raged regarding the therapeutic
equivalence, or bioequivalence, of products containing
the same dose of a specific medication but in a different
formulation. This debate has been further intensified
by an acknowledgement that vast price differences may
exist between competing brand name products, as well
as those sold under the medication’s generic name. In
some instances, different products containing identical
medication and doses have been shown to produce
significantly different pharmacological responses,
even in the same client. In other cases, no significant
difference in response is noted when such competing
products are administered. It has become evident,
therefore, that no generalisation can be made regarding
the therapeutic effectiveness of competing medication
products containing the same dose of a medication.
Careful assessment must be made of a client’s response
when the source of that client’s medication product
is changed, to immediately recognise any variation
that may occur. It is also important for healthcare
providers to understand that, while generic medication
names remain the same for each differing brand,
the medication brand name will be different from
(although in some instances similar to) each different
medication manufacturer. This can lead to public SOURCE: WIKIMEDIA COMMONS/INTROPIN CC BY 3.0
confusion, and people may be unaware that they are FIGURE 1.3 Medicine bottle with Tall Man lettering
taking the same medication under a different name and
therefore may be duplicating their dosages. Pharmacists
are the first point of call for clients to ensure that this CLASSIFICATION OF DRUGS
does not occur, but nurses may also pick this up when In Australia, the earliest legislative action for the federal
discussing medications with their patients. regulation of therapeutic goods appears to have been
There is an exclusivity patent period for an amendment made to the Quarantine Act 1908 in
medication ingredients. Within Australia, this period November 1915. This amendment, which remains in
is two years. In New Zealand it is five years. the Act to this day, gave the governor-general the power
to create regulations ‘for prescribing the conditions
Use of Tall Man lettering in under which any prophylactic or curative vaccine or
medication packaging serum may be prepared and offered for sale’. However,
In 2011, Australia acknowledged the error risks as best can be determined, it seems that no regulations
associated with similar sounding and written were ever put in place using this power.
medication names. This issue was first raised by the
Later came the Therapeutic Substances Act 1937 and

the Therapeutic Substances Act 1938, but these were 3 For appropriate absorption, some tablets should be
SECTION 1
never proclaimed due to the disruption caused by the chewed or dissolved under the tongue (sublingual) or
Second World War. In fact, many of the ways in which in the inner lining of the cheek (buccal), rather than
issues were dealt with at that time remain in place being swallowed whole.
today. 4 Suspensions and emulsions must be shaken
The first Australian Therapeutic Goods Act was thoroughly immediately before use because the
proclaimed in 1970. Many amendments were made separation that occurs after standing for a short period
to this Act over the following two decades, with a will alter the dosage if used in the separated form.
number of States endeavouring to maintain control 5 Suspensions should never be administered
over the governance of medication, until finally the intravenously.
Act was repealed and replaced in 1989. Federalisation 6 Solutions administered parenterally or in the eye must
was considered the only solution. be sterile to prevent infection. Those administered
The TGA is currently the Australian regulatory intravenously must also be sterile and free of
body for the Therapeutic Goods Act 1989, utilising the particulate matter that could serve as an embolus.
standards of the British Pharmacopoeia as its guide 7 The proper storage of solutions is important to prevent
for the strength, purity and quality of medications. contamination and evaporation.
In New Zealand, it is Medsafe that administers the 8 Skin integrity should be assessed for rashes or
Medicines Act 1981 and Medicines Regulations 1984. open areas before applying topical medications, as
In both Australia and New Zealand, medications these conditions will alter the absorption time of the
may be classified using one of three categories: medication.
1 prescription medications 9 Transdermal therapeutic systems or patches
2 non-prescription or over-the-counter (OTC) permit medication to pass through the skin into the
medications bloodstream. Therefore, you must be very careful
3 complementary medications (generally only when applying them, to prevent self-medication.
ingestible substances). 10 Any existing transdermal patch should have been
removed, as per prescription, or be removed before the
Prescription medications next dosage patch is applied.
Before prescription medications can be marketed in 11 The proper disposal of transdermal patches is
Australia or New Zealand, the manufacturer must file important, to prevent children from applying used
an application with the TGA or Medsafe. The seven- patches to themselves, and house pets from chewing
stage application process includes the provision of a them.
detailed description of the medication, its toxicity and
SOURCE: DELAUNE, S. C. & LADNER, P. K. (2011). FUNDAMENTALS OF NURSING: STANDARDS AND PRACTICE (4TH EDN).
the results of all experimental clinical trials. Only if CLIFTON PARK, NY: DELMAR CENGAGE LEARNING.
the TGA or Medsafe determines that the medication

Prescription medications may be prescribed by
has been proven to be safe and effective, and that the
medical doctors, dentists, veterinarians or other
claims made for the medication by the manufacturer
legally authorised health practitioners, such as nurse
are supported by scientific data, is the medication
practitioners and endorsed midwives, as part of their
approved for general distribution. All newly
specific practice; that is, healthcare providers may
introduced products must be shown to be effective
only prescribe medications intended for human use,
prior to marketing.
veterinarians only those for animal use, and so on.
The usual method used to transmit the prescriber’s
SAFETY IN NURSING PRACTICE wishes to the pharmacist, who will compound or
dispense the medication, is the prescription.
General guidelines for medication administration Within the Australian healthcare setting, registered
1 Enteric-coated tablets should not be administered with nurses may initiate some medications. These are
antacids, milk or other alkaline substances because referred to as nurse-initiated medications and are
such agents require the acid environment of the documented as such on medication charts. They
stomach to start the process of removing the enteric include:
coating of the medication so that it can be absorbed ■■ paracetamol
via the small intestines. ■■ docusate sodium and docusate sodium sennosides
2 Enteric-coated tablets should not be crushed or ■■ Mylanta
broken before administration because this will affect ■■ glycerine suppositories
absorption. ■■ glyceryl trinitrate
■■ salbutamol via inhalation.
This is an indicative list which may alter according they vary between organisations. You should become
to the institution’s policy and procedures. It must be familiar with your own organisation’s approved list.
CHAPTER 1
remembered that enrolled nurses are not permitted Medication prescriptions intended for a hospital
to administer these medications, either by themselves inpatient or other institutional inpatients are generally
or under the direction of a registered nurse, even written by the prescriber on a form known as the
when medication administration has been endorsed. medication administration record (MAR), the design
Rather, under current Australian legislation, only of which may vary from acute-care institutions
nurse practitioners, who have had extra training to aged-care institutions; examples are given in
and experience in a particular field of nursing, have Figure 1.5. Usually when the prescriber writes a
the ability to prescribe medications directly for their prescription on such a form, no duplicate copies are
patients within their specialty. These nurses receive made. These records may be faxed to a pharmacy for
a Pharmaceutical Benefits Scheme (PBS) prescriber dispensing, but the original stays with the patient’s
number which enables people to purchase medications medical records within the institution.
at the government-subsidised rates. Australian
pharmacists also have a limited ability to prescribe Storage of medications
medications for people. All personnel responsible for the storage of
In New Zealand, nurse practitioners can be medications must be aware of the necessity for
authorised to prescribe some medications. The keeping them in secure areas away from the general
Pharmaceutical Management Agency (PHARMAC) flow of traffic in the institution. In addition, proper
determines which medications are subsidised by the control of the environment is essential. Most
New Zealand Government (visit http://www.pharmac. medications may be safely stored at normal room
govt.nz for more information). temperature. Some, however, require refrigeration or
must even be kept frozen to maintain their potency.
Prescription forms Every effort must be made to assess the storage
The prescription is an order for medication (or other requirements of each medication stored in the
forms of therapy) that specifies the name of the designated secure medication room and to discard
medication and the dosage regimen to be used by the medications that have been improperly stored for even
person for whom it is written (see Figure 1.4). Most brief periods.
prescriptions are printed forms that should include the Most medications have an expiration date printed
following details: on their label. This indicates the length of time the
■■ the practitioner’s name and address, and the preparation will remain stable when stored under
telephone number of the relevant hospital or recommended conditions. When the date is shown as a
surgery month and year (for example, ‘June 2016’), expiration
■■ the prescriber number refers to the last day of the month indicated. Beyond
■■ the patient’s name and residential address (do not the expiration date, the manufacturer cannot
use post-office box numbers) guarantee full medication potency or stability and the
■■ the date on which the prescription was written – product should be discarded. Note: Medications that are
forward- or backdating is not allowed stored for even brief periods at temperature extremes
■■ which scheme applies: the PBS or the Repatriation (for example, in a hot car during the summer months)
Pharmaceutical Benefits Scheme (RPBS) may dramatically lose their potency, regardless of the
■■ the name of the medicine (either its generic or expiration date on the label. Another example is the
brand name) that the client is to receive, as well storage of glyceryl trinitrate tablets. These should be kept
as its strength, form and quantity expressed as a refrigerated and will deteriorate quickly if exposed to
number, and the number of repeats direct sunlight or carried close to the body.
■■ instructions about the dose and frequency (to be A number of medications are classified as
printed on the label by the pharmacist). controlled substances. These are agents that have
Without this information, pharmacists may not been identified by the various State and Territory
be able to supply medicine that is subsidised by the Acts, guidelines or regulations as having the ability to
government. cause physical or psychological dependence, or both.
It should be noted that, by convention, some In Australia, controlled substances are classified in
parts of a prescription may be written in Latin. More nine different categories or schedules; see Chapter 10.
commonly, however, abbreviations for these terms are The classification of medicines in New Zealand differs
used. Some of the more common abbreviations are slightly from the Australian list (visit http://www.
listed in Chapter 4 (see Tables 4.1 to 4.4) and in the medsafe.govt.nz/profs/class/classintro.asp); see also
table at the very back of this book, though note that Chapter 10.
DOCTOR’S NAME: Doctor’s name,

(Initials) (Surname)
address and phone
ADDRESS:
Prescriber number Prescriber No.
number
SECTION 1
Block letters please
Patient’s Patient’s Patient Medicare

Medicare no. Ref no.
number
Patient’s full name
Patient name and
Patient’s address
address Postcode
Entitlement no.
E
PBS Safety Net Concessional or dependant, RPBS beneficiary
entitlement cardholder or PBS Safety Net concession cardholder
PL
(Tick appropriate boxes)
PBS PBS RPBS Brand substitution not permitted
Pharmacist/patient
M
SA
copy
Item, form,
strength, dosage,
quantity and
repeats
Privacy note
on reverse
Signature and date
Doctor’s signature Date / /
I declare that I have received Patient’s or agent’s signature Date of supply

this/these medicine(s) and
the information relating / /
to any entitlement to a
pharmaceutical benefit Agent’s address
is correct.
Prescriber no. Prescriber no.
Patient’s Medicare no. Patient’s Medicare no.
LE L E
Pharmaceutical Pharmaceutical
benefits benefits
MP P
entitlement Concessional or dependant
entitlement Concessional or dependant
Safety Net entitlement Safety Net entitlement
no. no.
M
cardholder RPBS beneficiary or Safety Net cardholder RPBS beneficiary or Safety Net
(cross relevant box) concession cardholder (cross relevant box) concession cardholder
SA A
Patient’s name Patient’s name
S
Address Address
Date Date
PBS RPBS Brand substitution not permitted PBS RPBS Brand substitution not permitted
Pharmac is t patient COPY
Medicare Aus tralia / DVA
L E L E
M P M P
S A S A
Turn over for privacy note Turn over for privacy note
Doctor to sign original and duplicate I declare that I have received this/these medicine(s) and the information relating to any
entitlement to a pharmaceutical benefit is correct.
P atient’s or agent’s s ignature Date of s upply
/ /
Agent’s address
4004_10/09
SOURCE: © COMMONWEALTH OF AUSTRALIA, DEPARTMENT OF HUMAN SERVICES. CREATIVE COMMONS ATTRIBUTION 3.0 AUSTRALIA LICENCE.
FIGURE 1.4 (A) Examples of Australian prescriptions that would be completed and signed by the healthcare provider
8 Day National Medication Chart
CHAPTER 1
Family Name: __________________________________________
Given Name: _________________________ Gender: ________
Chart of
AFFIX PATIENT LABEL HERE
Date of Birth: ___________________ NHI#: _______________
Date Recharted _________ Prescriber to write Patient’s name and NHI:
Day Month Year
_____________________________________________________
Allergies No Adverse Reactions No

Medication / Other Reaction Medication Reaction
Signature Date Signature Date
New on this admission New on this admission
Signature Date Signature Date
Special Care Required No Supplementary Charts No

DO NOT WRITE IN THIS AREA
Renal impairment Pregnancy Diabetic/Insulin Specialised analgesia

Hepatic impairment Breastfeeding Heparin Warfarin
Other: ______________________________________ Other: ______________________________________
Sample Signature – Prescribers Sample Initials – Administrators/Others

NAME & DESIGNATION SIGNATURE REG. No. NAME & DESIGNATION INITIAL REG. No.
(family & given) (family & given)
NMC8D September 2012 1
SOURCE: ADULT MEDICATION CHART, HEALTH QUALITY & SAFETY COMMISSION, NEW ZEALAND.
FIGURE 1.4 (B) An example of a New Zealand prescription form
Regular medicines
SECTION 1
Year 20 Date and month

PRESCRIBER MUST ENTER administration times
Continue on discharge? Yes / No

Yes / No
Date Medicine (print generic name) Tick if
slow
days Qty:
release
Route Dose Frequency and NOW enter times
Date:
Indication Pharmacy
Dispense?
Duration:
Prescriber signature Print your name Contact
SOURCE: REPRODUCED WITH PERMISSION FROM AUSTRALIAN COMMISSION ON SAFETY AND QUALITY IN HEALTH CARE, NATIONAL INPATIENT MEDICATION CHART (ACUTE), 2012. ACSQHC: SYDNEY.
FIGURE 1.5 (A) An example of a section from an Australian National Inpatient Medication Chart
Regular Medicine Circle or actual time
Date Medicine 0600
0800
Dose Units Route Frequency Dose calculation Prescriber’s signature
(eg. mg/kg per dose) 1400
Dose range if needed Pharmacy & special instructions Pharm Sign, date and time to cancel 1800
I 2200
SOURCE: HEALTH QUALITY & SAFETY COMMISSION NZ.
FIGURE 1.5 (B) An example of a section from a New Zealand adult medication chart
The prescribing, dispensing, manufacturing, been reformulated to gain acceptance. As a result of

administration and storage of controlled substances a TGA review, many ingredients previously available
are subject to considerably greater governmental only by prescription can now be sold as OTC products.
control than the use of conventional prescription These include ingredients used to treat colds and
medication. The procedures to be followed in allergies, certain strengths of hydrocortisone topical
virtually every step from the manufacture to the products, ibuprofen and naproxen in certain strengths,
administration of these agents are precisely defined by some topical antifungal products, medications
law. In handling such agents, you have special legal used to reduce acid secretion in the stomach, and
and ethical responsibilities. The legal responsibilities some fluoride dental-rinse products. It is likely that
include the maintenance of secure storage conditions more products will have their status changed from
for these medications. This often includes the use of prescription to OTC over the next few years.
double-locked storage cabinets, as well as the keeping Even though a prescription is not required for
of accurate records of the disposition of all doses of their purchase, OTC medications are capable of
controlled substances received or used, or both, during producing considerable toxicity if they are not used
each shift. in accordance with their labelled directions and/or
You also have a responsibility to carefully assess if they are used in combination with other OTC or
the progress of people receiving controlled substances prescription medications. Many OTC medications
to determine the development of physical and/or should not be used in the presence of certain
psychological dependency or possible abuse of the medical conditions. It is essential, therefore, that you
medication. make every attempt to assist clients in identifying
health problems that can be safely treated with
Non-prescription medications OTC medication and in selecting safe and effective
Medications that may be legally acquired by the client products. The pharmacist is an excellent resource for
without a prescription are known as non-prescription, information concerning the appropriate use of OTC
or over-the-counter (OTC), medications. Such agents medication, and people should be encouraged to
are considered to be relatively safe for the layperson to communicate with them.
use when taken according to the directions provided Once a client begins self-medication with an OTC
by the manufacturer and when given to treat the product, it is essential that continuous evaluation be
conditions for which they are intended. Many OTC made of the response to the medication to identify
products have been removed from the market or have the development of any adverse effects, including
those resulting from interaction with prescription designed to evaluate the usefulness of the medication
medication. It is equally important to avoid the in treating the disease for which it is claimed to
CHAPTER 1
masking of symptoms (for example, cough, pain or be effective. Phase IV involves post-marketing
fever) that could be the result of a serious underlying surveillance of the medication product’s activity.
disorder. During this phase, prescribers are encouraged to
submit to the manufacturer and/or the regulatory
Clinical trialling of new medications body (TGA or Medsafe) experience reports based on
To fulfil the requirements of the Australian TGA, a their clinical use of the product. This permits the
manufacturer that seeks to market a new medication detection of problems with the use of the product that
must perform a wide array of animal studies and would only be evident through widespread use by
carry out clinical testing of the medication in human many diverse people.
subjects. To accomplish this, the manufacturer must You are generally most involved in Phase III of the
follow the national regulatory body’s procedures clinical trial and may be responsible for administering
for clinical trials, which can be found in the TGA’s investigational medication to clients. In doing so, it
Australian Clinical Trial Handbook. It includes is essential that the clinical protocol to be followed
information on the principles of good clinical practice is readily available for inspection and that the
in the Australian context, and guidance documents proper method of medication administration and
concerning Australia’s National Statement on Ethical client evaluation is understood completely before
Conduct in Research Involving Humans (the National initiating therapy. In some instances, only clients
Statement), published by the National Health and identified in the clinical protocol as investigators
Medical Research Council (NHMRC). may administer the medication and obtain informed
The manufacturer must provide: consent from a subject. You should, therefore, be
■■ all known information regarding the chemical, familiar with the laws defining the extent to which a
biological, pharmacological and toxicological nurse may participate in the testing of investigational
properties of the new agent medication.
■■ precise details of how the medication is The personal response of the subject in whom
manufactured and how it must be stored to an investigational medication is being used may
preserve its stability vary considerably. Some clients may have unrealistic
■■ the name and qualifications of each investigator expectations of a medication’s usefulness, perhaps
who will participate in the clinical trial believing that it must be better than existing forms of
■■ a signed statement from each investigator therapy because it is ‘new’. Others may participate in
indicating awareness of the nature of the a trial with some reluctance because they believe that
medication to be studied, as well as assurances they are being used as a ‘guinea pig’. Understanding
that the investigator or an appointed agent will these feelings and assisting the client to deal with
adequately supervise every aspect of the study them are important for all those involved in the
and that the medication will be administered only clinical study.
to volunteers or patients who have been fully A clinical trial is referred to as blind when the
informed of the nature of the study and from participant is unaware of whether they are receiving
whom an informed written consent has been the real medication or a placebo. In double blind
obtained; consent forms must be read and signed studies, the administrator of the medication and study
by patients and witnesses staff are also unaware of whether the participant is
■■ protocols that clearly define how the medication receiving the real medication or a placebo.
is to be administered to experimental subjects; that Only subjects who have signed informed consent
is, in what doses, by what route, for how long, etc. forms should receive investigational medications.
Protocols also include what specific observations or They should fully understand the potential hazards
determinations will be made during the trial. associated with the intended therapy. In addition, as
Clinical studies performed on human subjects prior volunteers, subjects who are part of the study may
to the marketing of a medication are usually divided withdraw from a program at any time.
into four phases. Phase I is devoted to the evaluation Examples of forms that must be signed before
of the medication in healthy human volunteers to a client participates in clinical investigations of
determine if it is toxic and how it is metabolised and medications (medication trials) can be sourced at
excreted. Phase II involves a more detailed evaluation https://ww2.health.wa.gov.au/Articles/A_E/Consent-
of the medication in healthy subjects, and initial trials forms. This site gives a detailed description of the
with relatively small numbers of subjects who have types of wording that can be used to cover most
the disease state for which the medication is intended contingencies.
to be used. Phase III consists of broad clinical trials
The Office of the Public Advocate supplies principles, they quickly become outdated and do not
intended human research subjects with a detailed always meet the varied needs of the working health
SECTION 1
discussion of their rights (visit http://www. practitioner.

publicadvocate.vic.gov.au/medical-consent). In an institution, the most readily available source
of medication information may be the MIMS (Monthly
Complementary medications Index of Medical Specialities) Annual, which is available
Complementary medications (see Chapter 49), also in print, online and mobile versions for both Australia
referred to as ‘traditional’ or ‘alternative’ medicines, and New Zealand. This is a continually revised
include vitamin, mineral, herbal, aromatherapy and compendium of medications and medication products
homeopathic products. Complementary medications that are available for use. Accessing MIMS limits the
have been used since prehistoric times. They are number of duplicative medication products that must
still used today by up to 80 per cent of the world’s be stocked – the pharmacist need only supply the
population and generally involve natural plant generic medication that is stocked. Medications are
substances. Many complementary medications are listed in MIMS by their generic and brand names, as
sold in nutrition stores, chemists and discount retail well as by their manufacturers. A product information
stores – generally, wherever vitamins are sold. section contains virtually the same information that
Of primary concern to healthcare professionals is is provided with the original medication package.
that complementary medications, although regulated MIMS also contains a useful product-identification
by the TGA in Australia, are sometimes not correlated section comprising colour photographs of almost all
with the other medications that a client takes, and commercially available tablets, capsules and other
interaction is possible (Blumenthal, 2001). Medication dosage forms. This section makes MIMS perhaps the
interactions are discussed in more detail later in best source for identifying unknown drug products
this chapter. The TGA does, however, publish the by their appearance. However, while MIMS is an
Medicines Safety Update six times each year, which extremely useful resource for researching medications,
includes up-to-date information relating to medication some of the relevant nursing information is to be
interactions. Current and historical editions of these found within the technical and chemical data, which
bulletins can be accessed from the TGA website (visit can lead to a nurse missing relevant information.
http://www.tga.gov.au/hp/msu.htm). The SHPA Australian Injectable Drugs Handbook
(AIDH; 7th edition), published by the Society of
Illicit drugs Hospital Pharmacists of Australia, is a reference that
Illicit agents, or ‘street’ drugs, are those that are used is sometimes available in the medication preparation
and/or distributed illegally. They may be: (1) drugs room. This publication, which is updated regularly,
that are not legal for sale under any circumstances lists a variety of information about almost all drugs
in Australia or New Zealand (for example, heroin); in current use in Australia and New Zealand. It is now
or (2) drugs that may be sold legally under certain also available online.
circumstances (for example, with a prescription) but The Australia New Zealand Nursing & Midwifery Drug
that have been manufactured illegally or diverted or Handbook (see the ‘Suggested readings’ section at the
stolen from normal channels of distribution. Illicit end of the chapter) is a work published regularly that
drugs usually are used for non-medical purposes, lists basic drug information; that is, generic and brand
generally to alter mood or feeling. Illicit drugs and names, manufacturers, uses, dosages and dosage form
substance abuse are discussed in more detail in availability. It also provides other pharmacological
Chapter 25. information such as action, adverse reactions (listed
systemically), interactions and contraindications.
Havard’s Nursing Guide to Drugs contains similar
MEDICATION INFORMATION information and is also published regularly (again, see
RESOURCES ‘Suggested readings’).
Along with the explosion of scientific literature
Nurses, as well as other health professionals who may
related to medication action has come the need for
prescribe, dispense or administer medication, require
rapid retrieval of this medication information. This
reliable and current medication information. Such a
has been accomplished by the development of several
need is heightened when one considers the constant
computer services that permit the user to identify
dynamic changes in pharmacology. Dozens of new
journal articles on a given medication-related topic
medication products are released every year. Although
from literally hundreds of different journals. Once
textbooks of pharmacology may be useful as sources
the appropriate articles have been identified, copies
of information regarding basic pharmacological
or summaries of the articles can be accessed directly
without the need for maintaining a large journal

library. Systems that use such data-retrieval techniques
CHAPTER 1
are frequently available in hospital pharmacies or
in health-profession school libraries. In addition to
computer programs in facilities, nurses and healthcare
providers have access to a number of websites that
provide information about pharmaceutical agents as
well as health alterations (refer to the ‘Pharmacology
highlight’ box titled ‘Online medication references’).
Because these sites are also available to the general
public, healthcare professionals should be aware of
FIGURE 1.6 Insert for medication
which sites are the best references.
The following is a description of the meaning of
the categories that are often part of the product insert:
PHARMACOLOGY HIGHLIGHT ■■ Brand name – This is the name, approved by the
federal government, which the manufacturer may

Online medication references exclusively use to call the product. It is always
1 British National Formulary: http://www.bnf.org
followed by the superscript® on manufacturer’s
2 Corey Nahman Drug Database: http://www.
packaging.
coreynahman.com ■■ Generic name – This is the name, approved by the
3 Developmental Therapeutics Program NCI/NIH: http://
federal government, which is commonly used to
www.dtp.nci.nih.gov
describe the active medication(s) in the product.
4 HerbMed: http://www.herbmed.org
The name may be used by anyone.
5 Mayo Clinic: http://www.mayoclinic.com ■■ Description – This section describes the physical
6 MedlinePlus: http://www.medlineplus.gov
and chemical properties of the active medication
7 My Dr: http://www.mydr.com.au
in the product. It may include information about
8 New Zealand Database for Medicine Datasheets:
the appearance of the medication, its solubility,
http://www.medsafe.govt.nz
chemical formula and structure, and melting point.
9 New Zealand Pharmaceutical Management Agency:
Inactive ingredients may also be listed in this
http://www.pharmac.govt.nz
section.
10 Pharmainfo.net: http://www.pharmainfo.net ■■ Clinical pharmacology – This describes the
11 PharmWeb: http://www.pharmweb.net
mechanism of action of the active medication in
12 Therapeutic Goods Administration (TGA): http://www.
the human body.
tga.gov.au ■■ Indications and usage – The indication is a
description of the illnesses for which the

A pharmacist is often the best resource for medication is approved for use. The usage describes
medication information either in an institution or how and for how long the medication is generally
in the community. In addition to their education used.
and experience, pharmacists have access to the ■■ Contraindications – This describes the situations in
most complete and current library of medication which the medication product should not be used;
information available. for example, if the client is hypersensitive to any
components in the product.
■■ Warnings – These are the situations in which there
THE PRODUCT INSERT is a threat of imminent and serious danger if the
A product insert is a detailed description of a medication medication product is used; for example, during
product that is required to be included in the packaging pregnancy or in the presence of renal disease.
of all such products sold in Australia and New Zealand. ■■ Precautions – These are the suggested steps that
The contents of the product insert must be approved should be taken to use the medication product
by the TGA or Medsafe before the medication can be safely; for example, doing frequent renal function
marketed. The insert must be periodically updated testing while a client is using the product. This
to incorporate the latest information available about section also generally includes a statement of the
the medication. Most product inserts contain similar pregnancy category in which the medication has
information (see Figure 1.6). been placed; for example, Pregnancy Category X.
■■ Overdosage – This section lists the dangers, if any, address this matter during the assessment of all
of using excessive quantities of the medication patients. Two important facts healthcare professionals
SECTION 1
product. It may also provide a recommendation of need to remember are: (1) complementary medications
possible ways to treat toxic effects caused by the are regulated by the TGA; and (2) herbal supplements,
medication. like drugs, are chemicals and, consequently, they
■■ Dosage and administration – This is a listing chemically have an influence on the body. You need
of the dosage and administration techniques to be familiar with the complementary medications
recommended for the use of the medication that are in common use, and should ask clients if
product. It may indicate whether the product they use vitamins, mineral or herbal supplements,
should be administered with meals. which ones they use and how often, and assess their
■■ How supplied – This lists the dosage forms, strengths knowledge of why they are taking these supplements.
and package sizes of the medication product that You also need to assess clients for the presence of
are available from the manufacturer. It may also list potential adverse effects associated with the use of
the codes used on each form of the product and a specific complementary medicines. Reporting the
statement of how it should be stored; for example, information received to the healthcare provider is an
in a refrigerator. important nursing action, because complementary
In addition to the above information, the product medicines can influence the pharmacotherapeutics of
insert will also generally contain the names and medical treatment.
addresses of the manufacturer and distributor of the Another nursing concern is the interaction
product, as well as a date. The date is very important between complementary and prescription
because it indicates when the product insert was medications. As a result of this, many nursing
published. Because the information in the insert may medication references include herbal supplements
change, you should make every effort to refer to the within their ‘Interactions’ sections. Herbal
most current product insert for information about a supplements can enhance or decrease the effects of
particular medication. certain drugs; thus, the individual should be instructed
not to use such herbal supplements when taking the
Nursing considerations medications, or if compliance is a concern, medication
Because of the increased use of complementary dosages may need to be adjusted.
medicine in society, you need to make sure you
CHAPTER RESOURCES
SUMMARY
■■ Medications can be derived from natural sources (plants, ■■ Sources of medication information are varied and
animals and microorganisms), genetically engineered or include the ‘product insert’ and the ‘patient package
synthetically made. These medications can be used to insert’ (PPI) for medications, Monthly Index of Medical
alleviate symptoms, cure a condition, maintain a condition, Specialities (MIMS) Australia and Monthly Index of
diagnose a condition or prevent a condition from occurring. Medical Specialities (MIMS) New Zealand, and associated
■■ Examples of medication dosage forms are tablets, websites, databases and books.
capsules, lozenges, suppositories, solutions, suspensions, ■■ The TGA and Medsafe are important bodies that evaluate
emulsions, semisolid dosage forms (ointments, creams and the safety and effectiveness of all medications and
gels), transdermal patches, wafers, sprays and parenteral medical/dental products in Australia and New Zealand,
(ampoules, vials and prefilled syringes). respectively.
REVIEW QUESTIONS
1 The first recorded medical treatments are credited to: 2 The origin of most medications is:
a Australia a animal products
b New Zealand b plant products
c China c water products
d Egypt d food products
3 Medications are used to: 7 The most current medication information resource for the
a cure disease nurse in an acute-care health setting is:
CHAPTER 1
b treat symptoms a the MIMS quarterly handbook
c maintain health b the Nurse’s Drug Handbook
d all of these options c MIMS online
4 Tall Man lettering on medication packaging was d an Internet search
introduced in New Zealand in: 8 Medications are categorised as:
a the late 1960s a prescription medications
b 1996 b non-prescription or over-the-counter (OTC)
c 2011 medications
d 2013 c complementary medications (generally only ingestible
5 Both Australia and New Zealand have introduced national substances)
inpatient medication charts. d all of these options
a True 9 Controlled substances:
b False a can be left in patient’s locker
6 Before you apply a medication patch to a clean patch of b taken home by nurses
the patient’s skin, the patch should be: c are subject to considerable governmental control
a signed and dated, have the application time noted on d none of these options
it, and be applied to a different site of skin than is noted 10 Interactions between medications and complementary
on the medication chart therapies is not possible.
b dated only by the nurse a True
c left unlabelled by the nurse b False
d applied to the same area of skin to which the previous
patch was applied
CRITICAL THINKING EXERCISES

1 Discuss the history of the prevention and treatment of 4 Should you note reactions to complementary therapies on
disease as it applies to pharmacology. the medication chart when admitting a patient?
2 In how many different ways can medication be delivered? 5 Why should these reactions be noted?
3 What are the different routes of delivery?
CASE STUDY
FACTORS AFFECTING INTERACTIONS BETWEEN Questions for discussion
MEDICATION AND COMPLEMENTARY THERAPIES 1 Is there an issue for Mr Brown concerning these
Mr Brown has been admitted to your ward following a medications?
traumatic urinary catheter insertion. You note that in the 2 Should you bring this information to the treating doctors’
urinary drainage bag the urine is a ‘claret red’ colour. You’re attention?
administering his medications with your nurse preceptor and 3 Why?
you realise he is taking oral Dipyridamole and Enoxaparin 4 What can you advise Mr Brown in the first instance?
Sodium. On general discussion, you also realise that
Mr Brown is taking fish oil.
SUGGESTED READINGS
A1B2C3 Drug Information. Drug terminology. http://www.a1b2c3.com/ Beaubrun, G. & Gray, G. E. (2014). A review of herbal medicines for
drugs/gen001.htm psychiatric disorders. Psychiatric Services.
Alternative Medicine Foundation. http://www.amfoundation.org Betz, O., Kranke, P., Geldner, G., Wulf, H. & Eberhart, L. H. (2005). Is
Altman, R. D. & Marcussen, K. C. (2001). Effects of ginger extract on ginger a clinically relevant antiemetic? A systematic review of
knee pain in patients with osteoarthritis. Arthritis Rheumatology, randomized controlled trials. Forsch Komplementarmed Klass
44(11), 2461–2. Naturheilkd, 12(3), 168; author reply 168–9.
American Society of Health-System Pharmacists. (2004). Herbal
Companion to AHFS DI. Washington, DC: Author.
Bone, K. (2003). A Clinical Guide to Blending Liquid Herbs: Herbal Manno, M. S. (2006). Preventing adverse drug events. Nursing, 39(3).
Formulations for the Individual Patient. St Louis, MO: Churchill McEvoy, G. (ed.). (2007). AHFS Drug Information 2007. Bethesda, MD:
SECTION 1
Livingstone. American Society of Health-System Pharmacists.

Brotto, V. & Rafferty, K. (2012). Clinical Dosage Calculations for McKenna, l. & Mirkov, S. (2017). Australia New Zealand Nursing &
Australia and New Zealand. Melbourne: Cengage Learning Midwifery Drug Handbook (7th edn). Broadway, Australia: Lippincott
Australia. Williams & Wilkinson Pty Ltd.
Clarke, P. (2008). Aboriginal healing practices and Australian bush Medical Letter on Drugs and Therapeutics, The. (2013). New Rochelle,
medicine. http://www.friendsofglenthorne.org.au/wp-content/ NY: Medical Letter.
uploads/Clarke-Vol-33-2008.pdf MIMS. (2015). Monthly Index of Medical Specialities (MIMS) Annual.
Coon, J. T. & Ernst, E. (2002). Systematic review: Herbal medicinal St Leonards, NSW: Author.
products for non-ulcer dyspepsia. Alimentary Pharmacology and National Prescribing Service (NPS) MedicineWise. http://www.nps.
Therapeutics. October, 16(10), 1689–99. org.au
Davis, N. M., Cohen, M. R & Teplitsky, B. (1992). Look-alike and sound- New Zealand Medicines and Medical Devices Safety Authority
alike drug names: the problem and the solution. Hospital Pharmacy, (Medsafe). http://www.medsafe.govt.nz
27(2), 95–98, 102–5, 108–10. Pharmaceutical Management Agency of New Zealand (PHARMAC).
Drug Facts and Comparisons. (2004). St Louis, MO: Facts and http://www.pharmac.govt.nz
Comparisons. PubMed. http://www.ncbi.nlm.nih.gov/pubmed
Drug Interaction Facts. (2004). St Louis, MO: Facts and Comparisons. Society of Hospital Pharmacists of Australia (Publications). http://
Drug Watch. (2008). Understanding pharmacokinetics: Part 1: Drug www.shpa.org.au/Publications
absorption. American Journal of Nursing, 108(5). Sotaniemi, E. A., Haapakoski, E. & Rautio, A. (1995). Ginseng therapy in
Ernst, E. (2002). The risk-benefit profile of commonly used herbal non-insulin-dependent diabetic patients. Diabetic Care, 18, 1373–5.
therapies: Ginkgo, St. John’s wort, ginseng, echinacea, saw Spratto, G. R. & Woods, A. L. (2012). PDR Nurse’s Drug Handbook 2012.
palmetto, and kava. Annals of Internal Medicine, 136(1), 42–53. Clifton Park, NY: Delmar Cengage Learning.
Farnsworth, N. R., Kinghorn, A., Soejarto, D. & Waller, D. (1985). Stockley, I. H. (2004). Stockley’s Drug Interactions (6th edn). London:
Siberian gin-seng (Eleutherococcus senticosus): Current status as Pharmaceuticals Press.
an adaptogen. In Farnsworth, N. R. (ed.), Economic and Medicinal Therapeutic Goods Administration (TGA). http://www.tga.gov.au
Plant Research, vol. 1. London Academic Press, p. 178. Tiziani, A. (2013). Havard’s Nursing Guide to Drugs (9th edn).
Fry, L. M., Jones, A. N. & Swan, G. T. (1985). Prescription writing: Chatswood, NSW: Elsevier.
Incidence of errors and their effect on pharmacy workload. Wilt, R., Ishani, A., Stark, G., MacDonald, R., Mulrow, C. & Lau, J.
Australian Journal of Hospital Pharmacy, 15, 95–8. (2000). Serenoa repens for benign prostatic hyperplasia. Cochrane
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American Medical Association. (2009). Rules Practice (4th edn). Clifton Park, NY: Delmar Mark, J. J. (2017). Egyptian medicine. Ancient
for coining names. https://www.ama-assn. Cengage Learning. History Encyclopedia, 17 February. https://
org/about/united-states-adopted-names/ Food and Drug Administration. (2006). www.ancient.eu/Egyptian_Medicine/
procedure-usan-name-selection Frequently asked questions on patents and Museum of New Zealand. (2019). Maˉori
Behrman, R. E., Kleigman, R. M. & Arvin, A. M. exclusivity. http://www. fda.gov/cder/ob/ medicine. https://www.tepapa.govt.nz/
(2000). Nelson Textbook of Pediatrics (16th faqs.htm discover-collections/read-watch-play/
edn). Philadelphia: W.B. Saunders. Government of Western Australia Department maori/maori-medicine
Blumenthal, M. (2001). Asian ginseng: of Health. Patient consent forms. https:// Office of the Public Advocate. Medical
potential therapeutic uses. Advanced ww2.health.wa.gov.au/Articles/A_E/ consent. http://www.publicadvocate.vic.
Nurse Practitioner; 9(2), 26–8, 33. Consent-forms gov.au/medical-consent
DeLaune, S. C. & Ladner, P. K. (2011).
Fundamentals of Nursing: Standards and
CHAPTER
2
PHARMACOKINETICS AND
PHARMACODYNAMICS
LEARNING OBJECTIVES
1 describe factors that can have an impact on the four pharmacokinetic parameters of a medication –
absorption, distribution, metabolism and excretion – and discuss their impact on drug therapy
2 describe the main ways in which different drugs may exert their pharmacological actions and the
significance of receptors in mediating pharmacological effects, including both therapeutic and
adverse effects
3 describe how individual variation can affect pharmacological response of a medication and associated
client care.
21
INTRODUCTION moves (kinetics) through the body. All four phases –

absorption, distribution, metabolism and excretion –
SECTION 1
In this chapter we will examine how the body handles involve medication movement across membranes
medication once it enters the body (pharmacokinetics) (see Figure 2.1). Absorption involves movement
and what pharmacological action occurs of the medication from its administration site into
(pharmacodynamics) due to the medication. Once the the systemic circulation (blood) so it can then be
medication is in the body, there are many factors that distributed around the body. The medication will be
can alter its movement throughout the body and the distributed to the target tissue where it will carry out a
body’s pharmacological response. These factors will pharmacological action. It may also act on or be stored
be discussed in relation to their impact on medication in non-target tissues. For a medication to enter tissues,
therapy. it needs to cross membranes, including those of the
blood vessels in which it is being transported. The
PHARMACOKINETICS medication will also enter the main organs involved in
the elimination of the medication, which are the liver
Pharmacokinetics is ‘the way the body acts on the (metabolism) and kidney (excretion) (see Figure 2.1).
drug’ once it is administered. Understanding how the If a medication has to move across membranes
body handles the medication is very important as the to act, then it is important to understand what
body automatically treats the medication as foreign membranes are composed of, as this composition
and aims to remove or eliminate it as quickly as could hinder the movement of the medication. The
possible. Therefore, in order for nurses and midwives main membranes that medications have to move
to ensure that medication has the desired therapeutic across are plasma membranes (see Figure 2.2).
response, they need to understand a medication’s These have a lipid bilayer and proteins embedded
pharmacokinetics so that they administer correct in the membrane, with some proteins spanning the
dosages for a sufficient amount of time. membrane and some located on either side of the
As introduced in Chapter 1, pharmacokinetics membrane. These components play an important role
is the study of the absorption, distribution, in movement of the medication across the membrane
biotransformation (metabolism) and excretion of and the pharmacological action of the medication (see
the medication (Doogue & Polasek, 2013; He & the ‘Pharmacodynamics’ section later in this chapter).
McLeod, 2016). It is all about how the medication
Liver
Route of
administration METABOLISM
Medication
movement
Oral DISTRIBUTION
Target tissue
Other
routes (examples)
IM (intramuscular) Kidney
IV (intravenous)
EXCRETION
Transmembrane
Target tissue
SC Rectal Other
(subcutaneous) pharmacological
action
SL
(sublingual)
Therapeutic
ABSORPTION
Storage
Protein bound medication
(inactive)
Free medication 1 (active)
Free medication 2 (active) Blood vessel
FIGURE 2.1 Movement of medication across membranes
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Frauentriller, die sonst den Einzug jeder Expedition begleiten, nur
dünn gesät. Stramm schwenken die Askari auf dem Bomaplatz ein,
steif vom langen Ritt steige ich vom Tier, da endlich naht der erste
Weiße. Die Begrüßung ist freundlich, die Freude ehrlich. Jetzt tritt
der zweite herzu: „Herrgott, sehen Sie schlecht aus! Und Ihr Maultier
erst, das geht doch noch heute ein; ums Bezahlen werden Sie wohl
nicht herumkommen!“ Weg sind alle Illusionen; ich wende mich ab
und lasse den Gefreiten, der in strammer Haltung abseits gestanden
hat, nähertreten. „Ihr seid gute Soldaten gewesen, und du, Hemedi
Maranga, bist der beste von allen; ich werde euch ein großes Fest
geben. Aber jetzt geht heim zu euren Frauen.“ Ein Händedruck, ein
paar kurze Kommandos, im nächsten Augenblick verschwinden die
zwölf in ihrem Kasernenhof; ich selbst aber steige in meine alte
Klause nach oben. Nils Knudsen hat recht: bei den Schensi ist es
doch besser!
Von meinen Trägern habe ich in den wenigen Tagen, die ihnen in
Lindi noch verblieben, nur wenig gesehen; um so mehr aber sind sie
zu hören gewesen. Jetzt ist ihre Stunde gekommen; frei schwingt
der „Kaiser Wilhelm“ draußen auf dem Strom um seine Ankerkette.
Morgen früh bei Tagesanbruch soll die Reise nordwärts gehen,
heute abend um Sonnenuntergang sollen meine Leute an Bord. Für
5½ Uhr habe ich sie vor das Posthaus, in dessen Oberstock ich ein
nüchternes Zimmer bewohne, bestellt; ich will sie doch lieber selbst
zum Hafen bringen. Die festgesetzte Zeit ist gekommen, aber kein
Träger ist da; es wird 5¾ Uhr, schon werde ich unruhig, da erschallt
immer näher ein so furchtbares Getöse, daß die Diagnose ohne
weiteres gegeben ist. Aber haben sich die zwei Dutzend auf das
Dreifache vermehrt? Ein dichtes Rudel tobt und wallt dort unten auf
dem Platz herum, Bässe grölen, Triller schwirren; Ausschreitungen
kommen nicht vor, wie ich das auch gar nicht anders erwartet habe.
Regellos zieht der Haufe hinter mir her, die wenigen hundert Schritte
zum Wasser hinunter; dort liegt schon der Fährmann bereit. „Bwana,
ich möchte doch lieber hier bleiben“, sagt Kasi uleia, der Hübsche,
und wirft einen zärtlichen Blick auf die dunkle Schönheit an seiner
Seite. „Tu’, wozu dein Herz dich treibt, mein Sohn“, antworte ich
milde. „Und das hier ist mein Boy, Herr“, sagt Pesa mbili II., der jetzt
wieder sehr rundliche Jüngling aus Manyema. Die Bibi, die sich
etwas verlegen hinter seinem breiten Rücken verbirgt, stellt er mir
aber nicht vor.
Der Verfasser im Porikostüm.

„Nun singt sie noch einmal, die schönen Lieder!“
In geschlossenem Kreis stehen die Mannen um mich herum.
„Kulya mapunda“ geht ganz gut, sonor klingt die gefällige Weise
über den rauschenden Lukuledi dahin. Auch bei „Dasige murumba“
zieht sich der Sängerkreis noch leidlich aus der Affäre; als nun aber
das Standardlied anhebt: „Yooh ndērule“, da erscheint mir der Kreis
recht verdünnt und lückenhaft; dafür erschaut mein Auge im
Dämmerlicht in den Nischen des Ufergebüsches einzelne Pärchen.
„Aha, Abschiedsszenen“, denke ich, stelle aber sofort fest, daß ich
mich gründlich geirrt; nichts von Zärtlichkeit, sondern wie die Wölfe
haben sich diese Materialisten über das letzte Liebesmahl
hergemacht, das ihnen eine zarte Hand für die Seereise zugedacht.
„Wohl bekomm’s“, sage ich halblaut und konstatiere zu meiner
Befriedigung, daß auch beim Neger die Liebe durch den Magen
geht.
Ungeduldig meldet sich der Fährmann; ich treibe den
hagestolzen Teil der Sänger ins flache Wasser hinein. Lustig
plätschernd waten sie von dannen; rasch ist es dunkel geworden,
kaum unterscheide ich noch die weißen Gestalten, als sie ins Boot
klettern. Yooh nderule, yooh nderule, wabwana mkubwa nderule —
lang und gedehnt klingen die vertrauten Laute aus Pesa mbilis Kehle
über die schweigende Flut — kubwa sumbana wogi nderulewa, yooh
nderule hallt der Chor verklingend nach. Das Boot ist im Dunkel der
Nacht verschwunden; ich wende mich der Messe zu, zur
Hauptmahlzeit des Tages; in diesen Räumen gehöre ich wieder ganz
zur Vollkultur — d i e E x p e d i t i o n W e u l e i s t z u E n d e .
Am Eingang in das Rote Meer. Der Fels von Aden.
Zwanzigstes Kapitel.
Rückblick.
An Bord des Reichspostdampfers „König“.
Im Mittelmeer, vor den Nilmündungen,

20. Januar 1907.
Herrn Geheimrat K i r c h h o f f , Mockau bei Leipzig.
Vor wenigen Stunden haben uns die Palmen von Port Said den
letzten Gruß Afrikas herübergewinkt. Jetzt ist der flache, sandige
Strand des ägyptischen Deltagestades längst den Augen
entschwunden, und graue Wasserwüste liegt vor dem Schiff, das
immer mühseliger gegen den rasch aufkommenden Nordwestwind
ankämpft. Überhaupt das Mittelmeer zur Winterszeit! Wo ist der ewig
klare Himmel unserer Schulweisheit in Wirklichkeit! Kapitän Scharf,
der es doch wissen muß, sagt, daß er diese Meeresstrecke um
diese Jahreszeit gar nicht anders kennt als immer kalt, immer
stürmisch, kurz, als einen unangenehmen Übergang von der
herrlichen Temperatur des winterlichen Roten Meeres zu dem
nordischen Klima des Atlantischen Ozeans und der Nordsee. Wir
werden unmittelbar an Kreta entlang fahren müssen und werden so
dicht an Griechenland vorüberkommen, daß die schneeigen Gipfel
der Gebirge Spartas zu uns herüber grüßen, so schwer legt sich das
Wetter gegen den breiten Bug unseres etwas altmodischen
Dampfers, der für ein modernes Beförderungsmittel merkwürdig
wenig Fahrt macht. Um so mehr Muße hat der Reisende, im
behaglichen Rauchsalon in sich zu gehen und das Fazit zu ziehen
aus alledem, was er in den letzten dreiviertel Jahren gesehen,
gehört und gelernt hat.
War das ein vergnügter Abend am 2. Dezember an Bord des
„Kanzler“ auf der Reede von Lindi! Man begriff kaum, woher mit
einem Male die vielen weißgekleideten Europäer kamen. Ein
Witzbold meinte, das eisgekühlte Pilsner, das Ewerbeck und ich in
froher Abschiedslaune in unbegrenzten Mengen spendeten, sei der
Magnet; doch das ist ein schlechter Witz gewesen. Die Anwesenheit
eines deutschen Dampfers im Hafen ist in diesen Breiten immer ein
Fest, das männiglich feiert wie es fällt. Mit Recht, denn nichts ist
tötender als das Einerlei des Werktagslebens in Afrika.
Was den Dämpfling „Rufidyi“ mehr als drei Tage angestrengtester
Arbeit gekostet hatte, der schnellfahrende „Kanzler“ hat es in e i n e m
Tage gemacht. Schon am 4. Dezember früh stiegen Ewerbeck und
ich in Daressalam wohlgemut ans Land, Ewerbeck, um sich für
immer vom Schutzgebiet zu verabschieden, ich, um über den
verwaltungstechnischen Teil meiner Expedition höheren Orts
Rechenschaft abzulegen. Für einen Neuling wie mich ist jener
Aufenthaltswechsel belanglos gewesen, den Kaiserlichen
Bezirksamtmann hingegen bewegten sichtlich ernsthafte und
wehmütige Gedanken; er hatte den besten Teil seines Lebens, mehr
als fünfzehn Jahre, an die Entwicklung gerade des Südostens von
Deutsch-Ostafrika gesetzt; da geht man nicht gleichgültigen Herzens
von dannen.
Daressalam war noch entzückender als im Juni; jetzt gab es
„Embe“ in Mengen, in jeder Größe und jeder Beschaffenheit. Embe?
Was ist Embe? Nun, für den Nordländer, der auf sein prächtiges
Obst stolz sein kann, auf unsern unvergleichlichen Apfel, die saftige
Birne, das große Heer unseres herrlichen Beerenobstes und was
unser Garten an Köstlichkeiten sonst alles zu bieten gewohnt ist, für
den ist Embe ein leerer Schall; wer aber dauernd in der
Tropenregion des Indischen Ozeans lebt, für den ist diese Frucht der
Inbegriff alles Herrlichen und Schönen. Die Mango ist es, jene
indische Frucht, die seit langer Zeit ihre zweite Heimat in Äquatorial-
Ostafrika gefunden hat. Der Baum ist gleichsam der Vorläufer jener
ungezählten menschlichen Bewohner der großen Halbinsel
zwischen dem Arabischen Meer und dem Bengalischen Golf
gewesen, die heute alle größeren Orte in Britisch- und Deutsch-
Ostafrika, im portugiesischen Gebiet und selbst auf der Südspitze
des Erdteils als mehr oder minder unwillkommene Eindringlinge
bevölkern. Angenehmer als der Inder niederer Kaste ist der
Mangobaum allerdings; er gleicht im Habitus einigermaßen unserer
Linde und verleiht jeder Siedelung etwas Anheimelndes und
Gemütliches.
Und seine Frucht erst! Wie sie schmeckt, wenn sie vom Baume
kommt, kann ich mit dem besten Willen nicht sagen; der weiße
Bewohner von Daressalam genießt den großen Vorzug, in einem
Kulturzentrum zu leben, wo man gewohnt ist, die fast
kindskopfgroße, saftige Frucht nur auf Eis gekühlt serviert zu
bekommen. In dieser Aufmachung ist die Embe allerdings ein
Genuß, den man dem der Ananas fast an die Seite setzen könnte.
„Embe“ ist denn auch das Schlagwort, das man vom Weißen beim
Frühstück, beim Mittag- und beim Abendessen zum Boy
hinüberrufen hört; ich glaube, die Weißen träumen in dieser Zeit
sogar von jener Frucht.
Wie ein Blitz aus heiterm Himmel ist in dieses Schlaraffenleben
die Kunde von den Ereignissen des 13. Dezember gefahren.
Unmittelbar vor meiner Rückkehr nach Daressalam war dort der
„Kaiserhof“ eröffnet worden, ein vortreffliches, erstklassiges Hotel,
unter dessen erste Gäste zu gehören ich das große Vergnügen
hatte. Man erstickte förmlich in Komfort: elektrisches Licht, vor jedem
Zimmer eine breite, schattige Barasa, neben jedem Wohnzimmer die
bequemste Badegelegenheit, eine mehr als üppige Verpflegung —
nach den mageren Monaten in Busch und Pori war das des Guten
eigentlich zuviel. Erfreulicherweise gewöhnt sich der Mensch jedoch
an alles, selbst an ein gutes Leben.
In diese Ruhe und Behaglichkeit, die über der ganzen großen,
beneidenswert behäbigen Beamtenstadt lagerte, schlug die Kunde
von der jähen Auflösung des Reichstags wie eine Bombe ein. Selten
habe ich so viele lange Gesichter gesehen wie in jenen Tagen; es
war, als ob jeder einzelne Europäer bis zum letzten kleinen
Unterbeamten hinunter persönlich von dem Geschehnis betroffen
worden sei; in allen Messen und an allen Stammtischen ertönten die
Unkenrufe über die schwarze Zukunft oder richtiger über den Mangel
jeder Zukunft der Kolonie, deren ruhmloses Ende jetzt auch schon
deshalb über jeden Zweifel erhaben schien, weil jeder von uns bei
den Neuwahlen im Januar mindestens hundert „Sozi“ in den
Reichstag einziehen sah. „Und mit dem Bahnbau ist es natürlich ein
für allemal zu Ende“, das war der stereotype Refrain aller dieser
Klagelieder, die man in gerechter Betrübnis in einem Meer von
Whisky-Soda ertränkte. Ich persönlich bin der Überzeugung, daß es
ganz so schlimm gar nicht werden wird, sondern daß auch der
nächste Reichstag zum mindesten das gleiche koloniale Verständnis
entwickeln wird wie sein Vorgänger; hoffentlich noch mehr. Am 25.
Januar soll unser guter „König“ in Genua ankommen; das ist der
Termin der Reichstagswahlen; am nächsten Tage wird man im
großen und ganzen schon ersehen können, wie diese Wahlen zu
einem Teil ausgefallen sind, zum anderen ausfallen werden, und wie
sich das Schicksal unserer Kolonien für die nächste Zukunft
gestalten wird.
Daressalam habe ich am 20. Dezember an Bord des „Admiral“
verlassen. Es ist ein herrliches, fast ganz neues Schiff, das noch
weit ruhiger fährt als der „Prinzregent“. Auch sein Komfort ist noch
größer; kein Wunder, wenn die Kabinen vollzählig besetzt waren. Es
war jetzt noch mehr Old England an Bord als im Frühjahr, viel
Kapstadt und noch mehr Witwatersrand; demgemäß herrschte auch
ein erheblicher Toilettenluxus. Diesmal habe ich auch Tanga
genießen können und sogar ein Stück Usambarabahn. Der
umsichtige Kapitän Doherr hatte, wohl noch in Erinnerung an seine
Managerdienste, die er erst vor wenigen Monaten den acht
Reichstagsabgeordneten hatte widmen dürfen, einen Extrazug für
die Schiffsgesellschaft oder doch für jeden, der sich beteiligen wollte,
bereitstellen lassen, und mit dem „Zügle“ sind wir ins Innere bis
Muhesa gefahren, bis riesige Schüsseln mit Sandwiches und große
Servierbretter mit viel Whisky und Soda der Expedition ein rasches
Halt geboten. Es geschieht wirklich etwas hier im Nordosten der
Kolonie, das sieht man auch von den Abteilfenstern aus; zwar steht
noch nicht alles Land unter Kultur, doch ist bereits jedes Stückchen
in festen Händen, sogar weit über den Endpunkt des „Bähnle“
hinaus.
Hoch ging es am Abend in Tanga her. Die Stadt hat eine ganze
Reihe von Vorzügen. Zunächst liegt sie von allen Küstenorten
Deutsch-Ostafrikas dem Mutterland am nächsten; sie bleibt also
auch schon dadurch gewissermaßen das Einfallstor in die Kolonie.
Sodann ist der Hafen nicht schlecht; die weite Bucht ist freilich nicht
ganz so abgeschlossen wie die von Daressalam, doch gewährt auch
sie ausreichendes Fahrwasser bis dicht unter Land. Das Wichtigste
ist jedoch die Nähe Usambaras, dieser Perle an Klima und
Fruchtbarkeit. Usambara hat nur einen Fehler: es ist nicht groß
genug, um alle die aufzunehmen, die sich dort niederlassen
möchten. Jetzt soll bereits aller verfügbarer Boden aufgeteilt sein, so
daß für Nachzügler kein Land mehr vorhanden ist. Diese sitzen
unten in Tanga oder gehen weiter nach Süden, um andere Plätze für
ihre Betätigung zu suchen; auch der „Boom“ von Lindi war zum
großen Teil auf diese Überfüllung des Nordens zurückzuführen.
Wirtschaftlich liegt also der Schwerpunkt unseres ganzen
Kolonialbetriebes einstweilen noch in diesem Nordosten. Das tritt
übrigens schon im ganzen Habitus des Europäerlebens in Tanga
zutage; viele Monate lang hat der würdige Pflanzer dort oben in den
Bergen Usambaras gesessen, ohne rechte Gelegenheit, den
Nachbar zu begrüßen; jetzt hat’s ihn gepackt: er muß einmal unter
Menschen. — Wenig später sitzt er im Klub von Tanga.
Wo der Deutsche ist, gibt’s auch Musik. Daressalam genießt den
Vorzug zweier Kapellen, der Matrosenkapelle von den beiden
Kreuzern und der schwarzen Askarikapelle. Beide erfreuen sich
einer offiziellen Förderung; gleichwohl konnte ich mich den
schwarzen Musikanten gegenüber des Eindrucks nicht erwehren:
„sie kunnten’s nit gar schön“; in jedem Fall war die Musik sehr oft mit
viel Geräusch verbunden. In Tanga ist man nicht nur in
wirtschaftlicher Beziehung gewohnt, sich auf eigene Füße zu stellen;
auch die Knabenkapelle ist ein privates Unternehmen. Tanga ist
Schulstadt par excellence; Hunderte von Eingeborenenkindern
werden hier in die Anfänge europäischer Wissenschaft eingeführt
und in die Geheimnisse des Deutschen eingeweiht. Sie
radebrechen’s denn auch alle, die kleinen schwarzen Kobolde; die
Intelligenzen unter ihnen, bei denen die weißen Lehrer musikalische
Talente entdeckt zu haben glauben, werden in die berühmte
Knabenkapelle gesteckt. Dieser geht es augenblicklich
ausgezeichnet. Als wir Admiral-Reisenden uns am Abend auf dem
Platz vor dem Klub einstellten, empfing uns eine Musik, die mich
sogleich an eine deutsche Jägerkapelle erinnerte. Ich hatte recht,
von irgendwelcher Seite waren der Kapelle Waldhörner gestiftet
worden; diese gaben den ganzen Darbietungen jenen
unverkennbaren Charakter. Gespielt wurde von den kleinen Kerlen
gut, das läßt sich nicht leugnen; so gut, daß allen Ernstes die
Anregung fiel, man solle die Kapelle nach Uleia überführen, damit
doch wenigstens einmal etwas Ordentliches aus den Kolonien
importiert würde. Afrika reizt zu schlechten Witzen.
Es mag an zuviel Old England gelegen haben, daß Weihnachten
nicht so stimmungsvoll verlief, wie wir Deutsche das wohl männiglich
erwartet hatten. Der Tannenbaum, der im Speisesaal in hundert
elektrischen Lichtern erstrahlte, wurde von den Ladies und
Gentlemen stumm, aber ohne großes Erstaunen genossen, etwa mit
derselben Gemütsruhe wie das illuminierte Eis, das von jedem
hohen Festtag an Bord unzertrennlich ist, und ohne das man von
dem Dasein des Festtages gar nichts merken würde. Neujahr „liegt“
wieder uns Deutschen nicht; am Silvesterabend sind wir zwar
gewohnt, uns mehr oder minder tief unter Alkohol zu setzen, eine
tiefere Bedeutung sehen wir jedoch in dem bloßen Wechsel der
Jahreszahl nicht. Auch das neue Jahr wird uns genug Sorge
bringen, dessen können wir sicher sein! Getanzt haben freilich beide
Nationen mit gleicher Begeisterung und Ausdauer. Draußen brüllt
der Sturm, von Nordnordwest direkt dem Schiff entgegen, das am
nächsten Morgen vor Suez Anker werfen soll; hoch oben aber
schaut mein alter Freund von Mahuta, der Vollmond, vom Firmament
hernieder. Über den weißen Mann wundert er sich schon längst nicht
mehr; der hat das gräßliche Kelēle, das Geschrei der Schwarzen, für
schön befunden; jetzt springt er sogar höchstselbst wie ein wilder
Neger vom Makondehochland dort auf dem großen Schiff herum,
von dem so etwas wie Musik ertönt. Sie kommt zwar diesmal von
weißen Leuten, gleichwohl ist sie nicht viel schöner als der
Ngomenschall vom Rovuma. Es ist nur gut, daß sie so rasch vom
Sturme verweht wird. Schier verärgert deckt der alte Herr jetzt sein
Antlitz zu; weißgraue Wolken gleiten in rasender Eile vor ihm dahin;
vor ihm und gleichzeitig auch vor den zackigen, steilen Bergen der
Arabischen Wüste zur Linken, unter denen wir in fast unheimlicher
Nähe der Küste entlang nach Norden dampfen. Um Mitternacht die
übliche Versammlung im Speisesaal, ein Gratulieren von Tisch zu
Tisch, von Bekannten zu Bekannten, ein Anstoßen und Zutrinken mit
dem perlenden Naß der Champagne — man ist drin im neuen Jahr
und segelt in seine dunkeln Tiefen mit ebenderselben Eleganz hinein
wie das gute Schiff in den Golf von Suez.
Am 1. Januar gegen Mittag habe ich in Suez den Boden
Ägyptens betreten, um ihn erst vor wenigen Stunden wieder zu
verlassen. Mich hat es getrieben, die Stätten der altägyptischen
Kultur und diese Kultur selbst an Ort und Stelle zu studieren;
deshalb hat es mich bald von Kairo und seiner Umgebung
hinweggezogen nach Oberägypten hinauf, nach Luxor, Karnak und
Dehr el Bahri. Auch klimatisch war Kairo für den Übergang aus den
Tropen zum winterlich kalten Nordeuropa nur wenig geeignet; von
den Ägyptenreisenden des „Admiral“ wurde einer nach dem andern
unpäßlich, so daß die einen sich kurzerhand nach Deutschland
einschifften, indem sie sich sagten: „Den Schnupfen hast du dort
billiger“, wohingegen die anderen in Luxuszug und Schlafwagen
nilaufwärts steuerten, um im herrlichen Wüstenklima von Assuan
sich langsam und vorsichtiger wieder an das subarktische Klima von
Uleia zu gewöhnen.
Der Staudamm von Assuan ist kulturgeschichtlich eine Barbarei,
technisch eine anerkennenswerte Leistung, volkswirtschaftlich eine
Großtat. In scharfen Kurven schlängelt sich die Schmalspurbahn
zwischen Luxor und Assuan nilaufwärts. Der Nil fließt bald
unmittelbar am Bahndamm, bald legt sich eine schmale
Alluvialebene zwischen den alten, heiligen Strom und das neue,
unheilige Beförderungsmittel. Dabei hat man immerfort das Gefühl:
„Herrgott, ist das Ländchen schmal; wenn’s nur der Wind nicht
einmal überweht und zudeckt.“ Plötzlich treten die kahlen Hügel zur
Linken zurück; eine weite Fläche tut sich auf, erst ganz weit hinten
von den scharfen Konturen der arabischen Wüstenberge begrenzt.
Wüste ist auch diese Ebene selbst, doch wie lange noch! Wende
dein Antlitz zur Rechten, o Fremdling; dort erblickt dein Auge einen
großen Gebäudekomplex. Er ist gar nicht ägyptisch und gar nicht
arabisch; nichts vom Schmutz fellachischer Unkultur haftet ihm an,
er verkörpert vielmehr den reinsten europäisch-amerikanischen
Fabrikstil. Ihn zeigt auch der himmelhohe Schornstein, der das
Ganze krönt. Der schaut so fremd auf das Silberband des Stromes
zu seinen Füßen, auf den schmalen, grünen Streifen zu beiden
Seiten dieses Stromes, und auf das unendliche Sandmeer der
Wüste im Osten und Westen hernieder, als müßte er sich fragen:
„wie komme gerade ich mit meiner überschlanken Röhrenform in
dieses Land, wo alles so wuchtig, schwer und massig ist, die
Häuser, die Tempel, die Gräber und die Pyramiden?“ Eine dichte
Rauchwolke entquillt dem Schlot. Wende deine Augen nach vorn;
siehst du dort das Silberband strömenden Gewässers, das sich in
schnurgeradem Kanal in der Ebene verliert? Siehst du fernerhin die
Gräben und Rinnsale, in die sich von jenem Kanal aus das Wasser
des heiligen Stromes verteilt, vollkommen gesetzmäßig und
gehorsam dem Willen des menschlichen Geistes? Des Rätsels
Lösung ist einfach; der Gebäudekomplex ist eine Pumpstation,
angelegt, jene zur Wüste gewordene Ebene von neuem zu
bewässern. Jetzt ist die Ebene noch vollkommen kahl; in wenig
Monaten wird sie ein unabsehbares Ährenfeld sein, dessen Halme
hundertfältige Frucht tragen.
Die wirtschaftliche Erschließung der öden Sandflächen des
oberägyptischen Niltals ist die gegebene Parallele für unseren
eigenen Kolonialbetrieb. Ohne einen festen Willen, ohne Kapital und
ohne eine genaue Kenntnis des Landes und seiner Eigenschaften
würde auch jene englische oder amerikanische Gesellschaft im Niltal
nichts erreichen. Alle drei Faktoren tun auch uns not, sofern wir
weiterkommen wollen in Ostafrika, in Südwest, in Kamerun und
Togo. Nur e i n kleiner Unterschied ist dabei; der im Laufe vieler
Jahrzehntausende angehäufte Alluvialboden des Niltales bedarf
lediglich der Berieselung mit dem belebenden Wasser desselben
Stromes, dem er seine eigene Entstehung verdankt, um sofort
wieder ein Kulturboden allerersten Ranges zu sein. Der in seiner
Wasserführung weise geregelte Nilstrom ist der Zauberstab, der die
Verwandlung unfruchtbarsten Ödlandes in den besten Acker in
einem kurzen Augenblick vollzieht. Für das Pori und die Steppen
Deutsch-Ostafrikas fehlt uns dieser Zauberstab. Freilich hat das
Land Flüsse und Bäche in großer Anzahl, doch sind diese Flußläufe
in ihrer Wasserführung einstweilen noch nicht reguliert; keiner von
ihnen ist auch in jenem großartigen Maßstabe schiffbar wie die
Lebensader des Pharaonenlandes. Im Laufe der Zeit wird auch bei
ihnen das alles kommen; man wird den Pangani zu einer
Verkehrsader gestalten und auch den Rufidyi, vielleicht sogar den
Grenzfluß Rovuma; doch das ist Zukunftsmusik, die die lebende
Generation nicht mehr zu hören bekommen wird. Auch der Boden
Deutsch-Ostafrikas hält den Vergleich mit dem des Niltals nicht aus;
er ist kein abgesetzter, humusreicher Alluvialboden, sondern ein im
allgemeinen ziemlich mageres Verwitterungsprodukt anstehender
Gesteine; der Zauberstab des netzenden Wassertropfens allein tut’s
also bei ihm nicht. Gleichwohl ist die Wasserfrage, soweit ich es
beurteilen kann, die Kardinalfrage unserer ganzen kolonialen
Agrikultur. Bei Saadani sind sie gleich in die Vollen gegangen: mit
Dampfpflügen bearbeitet man dort gewaltige Flächen;
Baumwollkultur im großen soll dem amerikanischen Monopol ein
Ende bereiten. Das ist alles gut und schön gedacht; die
Temperaturverhältnisse sind günstig, auch der Boden ist für jene
Kultur vollauf geeignet; nur e i n Faktor ist unsicher: Deutsch-
Ostafrika kann ebensowenig wie Indien mit voller Gewißheit auf
normale Niederschlagsmengen rechnen; wenn aber einmal der
Regen ganz ausbleibt, was dann?
Man hat den dunkeln Weltteil oft und gern mit einem
umgekehrten Teller verglichen; sanft und sacht steigt das Land
ringsum vom Ozean aus an; allmählich wird der Neigungswinkel
größer; schließlich artet die Küstenebene in ein vollkommenes
Randgebirge von bedeutenden Abmessungen aus. Doch den
Gebirgscharakter haben diese Berge nur von der Küstenregion her;
ist man über sie hinweggeschritten, so ergeht es dem Wanderer wie
auf den Höhen des Harzes oder des Rheinischen Schiefergebirges:
die vordem so stattlichen Berge sind verschwunden, unbehindert
kann er den gesamten Horizont überschauen, denn auch jenseits
des Schollenrandes ist er auf nahezu gleicher Höhe geblieben. Um
bei dem Bilde des Tellers zu bleiben: er hat den schmalen
Aufsatzrand überschritten und spaziert nun auf der wagerechten
Fläche des Bodeninnern bequem dahin.
Mit dieser ganz eigenartigen Oberflächengliederung muß auch
unsere Kolonialwirtschaft stark rechnen. Zunächst ist die geringe
oder ganz fehlende Schiffbarkeit der Flüsse durch sie bedingt; des
weitern bringt es der Charakter unseres Luftmeeres mit sich, daß der
Hauptteil der Niederschläge an jenem Schollenrande niedergeht,
hinter dem dann die Zone einer Art von Regenschatten anhebt, die
manchen Landstrich, wie z. B. Ugogo und die Nachbargebiete, zu
nicht übermäßig üppigen Gefilden stempelt. Immerhin ist der größte
Teil dieses Innern von einer Bodenbeschaffenheit, die das
Fortkommen und Gedeihen aller für das äquatoriale Afrika überhaupt
in Betracht kommenden Nutzpflanzen sehr wohl gewährleistet. Der
Pflanzer ist dort in der glücklichen Lage, mit dem belebenden Einfluß
der ständig scheinenden Tropensonne zu rechnen; diese zaubert
selbst aus dem Sande wohlbestockte Fruchtfelder hervor. Dort unten
im Süden habe ich mich tagaus tagein davon überzeugen können.
Überhaupt jener Süden. Er ist bisher das Aschenbrödel unter
allen Bezirken unserer Kolonie gewesen, und ich fürchte, er wird es
auch fernerhin bleiben; auf ihm lastet das Vorurteil, er sei
unfruchtbar, und das schreckt die amtlichen und auch die privaten
Kreise von seiner Erschließung ab. Es ist richtig: fett ist weder der
Boden des Makondehochlandes noch des Mueraplateaus, noch der
weiten Ebenen, die sich hinter beiden Bergländern zwischen dem
Rovuma im Süden und dem Mbemkuru oder dem Rufidyi im Norden
erstrecken; Sand und Lehm und Lehm und Sand hier, und
Quarzgerölle dort, das ist die Signatur des Ganzen. Dennoch haben
wir durchaus keinen Anlaß, an diesem Süden zu verzweifeln; denn
wenn der Neger in ihm sein gutes Fortkommen findet, ohne
Düngung sogar und ohne jede andere Errungenschaft unserer
hochentwickelten intensiven Feldwirtschaft, wenn dieser selbe Neger
außerdem in der Lage ist, erhebliche Bruchteile seiner Ernten an
Sesam, Erdnüssen, Kautschuk, Wachs, Körner- und Hülsenfrüchten
auszuführen, so wäre es verwunderlich, wenn der Weiße aus jenem
Gebiet nicht noch mehr herausholen sollte.
Eins dürfen wir allerdings nicht vergessen: ein Schlaraffenland ist
weder der Süden, noch Afrika überhaupt; niemand fliegen die
gebratenen Tauben in den offenen Mund; Arbeit und immer wieder
Arbeit ist vielmehr hier die Devise genau wie in minder glücklichen
Klimaten auch. Gerade bei den Makonde, den Yao und den Makua
haben wir genugsam Gelegenheit gehabt, diesen unausgesetzten
Fleiß kennen und würdigen zu lernen. Des können wir jedenfalls
sicher sein: viel bequemer wird es auch der europäische Pflanzer
nicht haben, weder im Süden, noch im Norden, weder an der Küste,
noch im Innern. Das schadet aber auch gar nicht; aus Müßiggängern
sind noch niemals starke, lebensfähige Völker erstanden, auch in
Kolonien nicht; im Gegenteil, je stärker die Anspannung und der
Kampf um das Dasein gewesen ist, um so kraftvoller ist die
Entwicklung auch aller Tochtervölker im Laufe der ganzen
menschlichen Kolonialgeschichte gewesen. Die heutigen Vereinigten
Staaten sind der klassische Beleg für diese Behauptung; die in der
besten Entwicklung befindlichen Kolonien Südafrikas reden eine
nicht minder deutliche Sprache. Andere Belege würde man mit
Leichtigkeit zusammenstellen können.
Draußen gehen die Wogen immer höher; der „König“ ist mehr
breit als hoch; er geht ganz ruhig, doch muß er es sich gefallen
lassen, die Wasser des Mittelmeeres mehr, als ihm lieb ist, über sein
Deck fegen zu sehen. Habe ich bei dem grandiosen Schauspiel
wirklich die Pflicht, mich in unfruchtbare koloniale Ausblicke zu
vertiefen? Der Ausspruch meines Freundes Hiram Rhodes von den
„politischen Kindern“ war freilich mehr als hart, doch ein klein wenig
Berechtigung hat er gleichwohl, auch über den Sansibarvertrag
hinaus. Wir Deutschen sind 300 Jahre nach den anderen Völkern
auf die koloniale Schaubühne getreten; trotzdem eifern Hinz und
Kunz bei uns darüber, daß unsere vor ganzen 20 Jahren
erworbenen Kolonien noch keine Überschüsse abwerfen; am
liebsten möchten die braven Banausen, daß ihnen „Südwest“
womöglich ihre sämtlichen Steuern aufbrächte. Man könnte sich das
Haupthaar raufen ob solcher Torheit und solchem Mangel an
geschichtlichem Gefühl. In Deutschland werden die meisten Bücher
gedruckt, keine gekauft und nur wenige gelesen. Unter diesen
letzteren können kolonialgeschichtliche Werke kaum vertreten sein,
sonst wäre es nicht möglich, daß selbst koloniale Fachkreise so
wenig über jene tausend Kämpfe, Widerwärtigkeiten und
Rückschläge unterrichtet sind, auf welche die Engländer in Indien, in
der Südsee, in Afrika und Amerika mit wehmütigen Gefühlen
zurückzuschauen Veranlassung haben, und welche den
Niederländern, den Spaniern und den Portugiesen ihren
ausgedehnten Kolonialbesitz sooft bis zum Überdruß hätten
verleiden können. Uns schwebt unbewußt immer der Reichtum
Englands und die Wohlhabenheit Hollands vor, die ja allerdings
beide zum großen Teil auf dem Kolonialbesitz beruhen; dabei
vergessen wir stets, daß drei Jahrhunderte ein fünfzehnmal längerer
Zeitraum sind als unsere koloniale Ära, und daß bei beiden Völkern
nicht weniger als zehn Generationen in harter, mühseliger,
unausgesetzter Arbeit haben erringen und erkämpfen müssen, was
uns Emporkömmlingen von gestern nach unserer Meinung mühelos
in den Schoß fallen soll. Das ist ein Mangel an historischem Gefühl,
auf den man gar nicht kräftig genug hinweisen kann; ich bin der
festen Überzeugung, daß eine objektive Würdigung unseres
schönen, großen Kolonialbesitzes auch erst dann Platz greifen kann,
wenn wir diesem Mangel, der bei dem Volke der Denker doppelt
unangenehm auffällt, durch einen besseren Unterricht abgeholfen
haben werden.
Ein unfehlbares Mittel zur Gewinnung jenes historischen Sinnes
ist das Hineinstecken von zwei Arten von Kapital in die Kolonien; das
eine Kapital besteht in dem Menschenblut, das für ihre Erhaltung
und Entwicklung vergossen wird, das andere in dem baren Gelde,
das man für ihre Erschließung und Nutzbarmachung in ihnen selbst
anlegt. Um die Größe des englischen Kolonialreiches und seine
Verteilung über die ganze Oikumene zu veranschaulichen, wird
häufig darauf hingewiesen, daß das Mutterland zu keinem Zeitpunkt
ohne irgendeinen mehr oder weniger belangreichen Kolonialkrieg
sei. Das stimmt für die Gegenwart; es hat jedoch auch seine
Richtigkeit für die Vergangenheit; England hat in der Tat jederzeit um
seinen auswärtigen Besitz zu ringen gehabt. Unzweifelhaft ist dieser
dreihundertjährige Kampf um Haben und Nichthaben, der, auf
spezifisch englische Verhältnisse übertragen, oft auch ein Kampf um
Sein und Nichtsein gewesen ist, der Hauptgrund für das innige
Zusammenleben der ganzen großen Familie von Mutterland und
Tochterstaaten. Es hat wohl ein jeder einen Lieben da draußen in
indischer oder in afrikanischer Erde liegen; das schafft zunächst eine
schmerzliche Anteilnahme an jenem Lande; aus dieser aber
entsprießen sehr bald auch anders geartete Interessen.
Die Richtigkeit dieser Lehre hat uns der blutige Krieg in Deutsch-
Südwestafrika in ach so schmerzlicher Weise nur zu deutlich
bewiesen. Der großen Masse bei uns war jenes Land, sofern sie
überhaupt nur von ihm wußte, bestenfalls des neuen Deutschen
Reiches Streusandbüchse; heute schlafen in seinem harten Boden
ein paar tausend Söhne — und nicht die schlechtesten — den
ewigen Schlaf; von ihnen ist der eine aus dem Palast, der andere
aus der Hütte hinausgezogen an den Waterberg und in die
Omaheke. Ist es da verwunderlich, daß jenes Land dem Volk
seitdem ans Herz gewachsen ist? Wir möchten’s nicht missen,
schon weil unsere Söhne und Brüder dort ausruhen von dem harten,
schweren Kampf, der in der Reihe unserer größeren Kolonialkriege
der erste gewesen ist, der aber vermutlich nicht der letzte sein
dürfte. Das hat die Geschichte aller bisherigen
Kolonialunternehmungen gelehrt.
Von dem anderen Kapital, den materiellen Werten, kann man bei
unseren Kolonien nicht sprechen, ohne gleichzeitig die Bahnfrage zu
berühren. Was ist geklagt worden über die unbesiegbare
Zurückhaltung unseres deutschen Großkapitals den Kolonien
gegenüber! Ich gehöre leider nicht zu der beneidenswerten Klasse
glücksgütergesegneter Sterblicher; doch selbst wenn ich eine Million
zu verlieren hätte, so würde ich mich doch noch sehr besinnen, sie
in ein Land zu stecken, das durch keinerlei Verkehrswege
erschlossen ist, durch natürliche überhaupt nicht, durch künstliche
einstweilen nur mangelhaft. In der Heimat blickt man jetzt mit großen
Erwartungen auf den neuen Lenker unseres kolonialen Karrens;
Herr Dernburg ist ja Finanzmann; vielleicht erreicht er, was anderen
vor ihm stets noch fehlgeschlagen ist: den Ausbau des längst
geplanten großen Bahnsystems und den Zufluß der nicht minder
nötigen großen Geldmittel.
Nicht ohne Bedeutung für die Zukunft Deutsch-Ostafrikas ist
schließlich der Eingeborene; über ihn kann ich als Ethnograph auch
wesentlich sicherer urteilen als über die anderen Fragen, zu denen
unsereiner doch nur auf Grund seines gesunden
Menschenverstandes Stellung zu nehmen befugt ist. Ein
„unerzogenes Kind“ lautet das Urteil über den schwarzen Mann auf
der einen Seite; ein „ausgefeimter Galgenstrick und
unverbesserlicher Faulpelz“ auf der andern. Es gibt noch eine dritte
Partei, die dem Ostafrikaner wenigstens eine oder ein paar ganz
kleine Tugenden belassen will, doch diese wird niedergeschrien.
„Kasi“ heißt im Suaheli die Arbeit; in der „Lustigen Ecke“ der
„Deutsch-Ostafrikanischen Zeitung“ fand ich das Wort neulich
anders übersetzt, da verdeutschte es der Suaheli mit dem Begriff
„Gemeinheit“. Diese Auffassung vom schwarzen Mann ist an der
Küste tatsächlich herrschend; nicht ganz mit Unrecht, wie man billig
zugeben muß; der Stadtbevölkerung dort ist ernsthafte Arbeit
wirklich ein Greuel und eine Gemeinheit.
Von dem ganzen großen übrigen Teil der Bevölkerung Deutsch-
Ostafrikas glaube ich besser denken zu dürfen. Die zahlreichste
Völkerschaft der ganzen Kolonie sind die Wanyamwesi; mit
schätzungsweise vier Millionen Seelen füllen sie den ganzen
zentralen Teil östlich des großen zentralafrikanischen Grabens. An
ihrem Fleiß und an ihrer Kulturfähigkeit zu zweifeln hat bisher noch
niemand gewagt; sie sind ausgezeichnete Feldbauer, gleichzeitig
haben sie ein Jahrhundert hindurch den gesamten
Karawanenhandel von der Ostküste bis zum Herzen des Erdteils
aufrecht erhalten. In absehbarer Zeit wird dieser Trägerverkehr
unwiederbringlich zu Ende gehen; wird jenes Volk damit überflüssig
werden? Wirf, o Deutscher, einen Blick auf die Abschlußberichte der
Ugandabahn und begreife sodann, welch wirtschaftsfrohes Element
gerade du mit jenem starken Volke zu besitzen das Glück hast; sei
allerdings dann auch klug und weise genug, die andere Folgerung
zu ziehen, diese wirtschaftliche Tüchtigkeit für das eigene Volkstum
zu fördern, weiter zu entwickeln und vor allem für dich selbst
auszunutzen. Wir haben wahrlich keine Veranlassung, den Säckel
eines Volkes zu füllen, das mit uns im schärfsten ökonomischen
Wettkampf liegt.
Was den Wanyamwesi recht ist, ist der Mehrzahl der anderen
Völkerschaften billig; auch jetzt noch, auf schwankem Schiff im
Sturmestoben, komme ich nicht über den hohen Stand der
Feldkultur hinweg, den ich bei meinen Freunden da unten am
Rovuma als Norm vorgefunden habe. Völker, die bei aller
Beweglichkeit so an der Scholle kleben, müssen unbedingt einen
tüchtigen Kern in sich haben; all unsere Lehren der
Völkerpsychologie und der Völkergeschichte würden sonst
zuschanden werden. Erklären läßt sich diese unerwartet hohe
Kulturstufe lediglich durch eine unmeßbar lange Dauer ihrer
Entwicklung. Gegen das hohe Alter des Ackerbaues beim Neger
spricht nichts; er ist konservativ, wie auch sein Erdteil konservativ ist;
die paar fremden Elemente, die wir heute noch mit der
Wirtschaftsform des Sammlers und Jägers behaftet finden, den
Buschmann in den unfruchtbarsten Teilen des Südens, und den
Pygmäen in den unzugänglichsten Teilen des zentral- und
westafrikanischen Urwaldes, werden vermutlich schon vor sehr, sehr
langer Zeit durch die ackerbauenden Bantu abgedrängt worden sein.
Die Feldbauform unseres Negers ist der Hackbau; dieser führt
seinen Namen mit Recht nach der quergestellten schweren Hacke,
mit der der schwarze Landmann den Boden seines Feldes kultiviert,
lockert und reinigt, mit der er die Aussaat besorgt und zum großen
Teil auch die Ernte, die, mit einem Wort, sein Universalinstrument ist.
Wir sind nur zu sehr geneigt, in dieser Wirtschaftsform etwas
Minderwertiges, Urwüchsiges zu erblicken. Insofern als der Hackbau
keines Haustieres bedarf, weder zum Ziehen des Pfluges, der Egge,
der Walze und des Erntewagens, noch zum Zweck der
Dunglieferung, ist er wirklich rückständig; andererseits ist zu
bedenken, daß große Teile unserer Kolonien Herde der Tsetsefliege
sind, sodann, daß die mit dem Hackbau verbundene Beetkultur in
Wirklichkeit eine sehr hohe Wirtschaftsstufe bezeichnet. Der beste
Beleg dafür ist die Beibehaltung des schmalen Beetes auch in
unserem Hausgarten, den wir im Range unmöglich hinter unseren
Feldbau stellen können. Bezeichnenderweise nimmt der Feldbau,
wo immer er zu der intensivsten Stufe unserer Agrikultur, zur
Blumenzucht wie bei Erfurt, Quedlinburg, Haarlem usw., oder zur
Gemüsekultur wie bei Braunschweig, Mainz, Hannover, ferner bei
allen Großstädten, übergeht, sofort die Form des Beetes an. Zudem
wüßte ich nicht, wie anders der Neger z. B. bei unserer breiten,
unzugänglichen Feldform der Hauptgefahr seiner Pflanzung, dem
Unkraut, beikommen wollte; sein schmales Beet gestattet ihm den
Zugang von allen Seiten.
An die Form des negroiden Feldbaues wollen wir also nicht
rühren; sie ist alterprobt und gut. Eine andere Frage ist es: wie
machen wir unseren schwarzen Landsmann auf dieser Basis für uns
nutzbar? Meines Erachtens gibt es da zwei Wege, die beide
gleichviel für sich wie gegen sich haben; beide sind bereits seit
längerer Zeit beschritten, so daß sich die Möglichkeit ergibt, die
schließliche Entwicklung der ganzen Kolonie sehr wohl
vorauszusehen. Der eine Weg führt direkt zur Plantagenkolonie.
Dies geschieht in der Weise, daß man den Schwarzen in Haus und
Hof nicht weiter fördert, sondern ihn zum Arbeiter auf den
Pflanzungen der weißen Herren erzieht, die sich überall dort
anbauen, wo geeigneter Boden und erträgliches Klima eine gute
Kapitalsanlage versprechen. Die andere Methode hat den Neger und
seine Entwicklung selbst im Auge; sie will seine eigene
wirtschaftliche Produktionsfähigkeit nach Mannigfaltigkeit und Güte
der Erzeugnisse vergrößern, ihm selbst dabei gleichzeitig größere
Bedürfnisse anerziehen und ihn dergestalt auch kaufkräftiger
machen. Für seinen Export soll er den unsrigen eintauschen.
Ob sich das deutsche Volk nur für einen dieser beiden Wege
entscheiden, oder ob es, wie bisher, beide auch weiterhin
beibehalten wird, muß die Zukunft lehren. Für das Mutterland sind
beide Methoden gleich viel oder gleich wenig wert, je nach der
Intensität unserer gesamten kolonialen Betätigung; dem Neger
würde allerdings die zweite mehr bringen. Als Plantagenarbeiter ist
und bleibt er „Schensi“; als freier Besitzer seiner Scholle ist er
entwicklungsfähig. Freilich muß man den Punkt dabei im Auge
behalten, daß wir Kolonien gegründet haben in der Erwartung, für
unseren rasch wachsenden Bevölkerungsüberfluß
Auswanderungsgebiete zu bekommen; beansprucht der Neger die
fruchtbarsten Teile seiner Heimat selbst, so ist es mit jenem ver
sacrum nichts.
Von der durch uns einzuschlagenden Gesamtrichtung hängt es
ebenfalls ab, ob wir an der physischen Verbesserung des Negers
und seinem numerischen Anwachsen ein Interesse haben oder
nicht. Unter dem Hauch der Zivilisation konnte das eine oder andere
Naturvolk ganz oder nahezu dahinschwinden; die Tasmanier
gehören der Geschichte an; die Maori von Neuseeland und die
Kanaken von Hawaii nehmen an Zahl rasch ab; man spricht von den
letzten Wedda auf Ceylon. Zu diesen Todeskandidaten gehört die
Negerrasse nicht; im Gegenteil, wo immer sie mit den Weißen in
Berührung getreten ist, erstarkt sie in jeder Beziehung; ihr
Aussterben brauchen wir also nicht zu befürchten. Doch sollen wir
ihren Vermehrungskoeffizienten durch künstliche Zuchtwahl noch
zielbewußt heraufsetzen? Freilich sollen wir das, denn eine
zahlreiche eingesessene Bevölkerung ist uns unter allen Umständen
nutzbringend und dienlich; den Pflanzer befreit sie von der ewigen
Arbeiternot, für den europäischen Fabrikanten aber und den
Kaufmann ist eine große Kundschaft zweifellos angenehmer als eine
kleine. Wie diese Verbesserung in die Wege zu leiten sein wird,
darüber habe ich mich bereits früher (Seite 346 ff.), angesichts der

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Pharmacology in Nursing, 3rd

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Pharmacology: A Patient-Centered Nursing Process

SECTION 1 INTRODUCTION TO DRUGS AND 31. Diuretics 489

Guide to the text xii Chapter 6 Intravenous medication therapy 98

Agents used to treat eczema 734 Use of herbs 745

Guide to the text

PART OPENING FEATURES

CHAPTER 3 PHARMACOGENETICS AND PHARMACOGENOMICS 39

CHAPTER 4 CALCULATING MEDICATION DOSAGES 50

CHAPTER 5 PRINCIPLES AND METHODS OF MEDICATION ADMINISTRATION 66

CHAPTER 6 INTRAVENOUS MEDICATION THERAPY 98

CHAPTER 7 MEDICATION THERAPY FOR PAEDIATRIC CLIENTS 116

CHAPTER 8 MEDICATION THERAPY FOR AGED-CARE CLIENTS 131

CHAPTER 9 PREVENTION OF MEDICATION ERRORS 143

CHAPTER 10 LEGAL AND ETHICAL CONSIDERATIONS FOR MEDICATION

MEDICATIONS: FROM HERBS TO

B induced One nausea and vomiting

nursing accountabilities 263

■ acute pain related to health alteration

c 48 d/min 7 You have just emptied a wound drainage bag and it

Guide to the online resources

Cengage is pleased to provide you with a selection of resources

COGNERO TEST BANK

ARTWORK FROM THE TEXT

FOR THE STUDENT

ABOUT THE AUTHORS

CHAPTER 1 MEDICATIONS: FROM HERBS TO RESEARCHED TREATMENTS 2

CHAPTER 2 PHARMACOKINETICS AND PHARMACODYNAMICS 21

CHAPTER 3 PHARMACOGENETICS AND PHARMACOGENOMICS 39

CHAPTER 4 CALCULATING MEDICATION DOSAGES 50

CHAPTER 5 PRINCIPLES AND METHODS OF MEDICATION ADMINISTRATION 66

CHAPTER 6 INTRAVENOUS MEDICATION THERAPY 98

CHAPTER 7 MEDICATION THERAPY FOR PAEDIATRIC CLIENTS 116

CHAPTER 8 MEDICATION THERAPY FOR AGED-CARE CLIENTS 131

CHAPTER 9 PREVENTION OF MEDICATION ERRORS 143

CHAPTER 10 LEGAL AND ETHICAL CONSIDERATIONS FOR MEDICATION

INTRODUCTION for food and shelter. In early civilisations, disease was

Later came the Therapeutic Substances Act 1937 and

the TGA or Medsafe determines that the medication

2 Enteric-coated tablets should not be crushed or ■■ Mylanta

broken before administration because this will affect ■■ glycerine suppositories

absorption. ■■ glyceryl trinitrate

■■ salbutamol via inhalation.

DOCTOR’S NAME: Doctor’s name,

Block letters please

Patient’s Patient’s Patient Medicare

I declare that I have received Patient’s or agent’s signature Date of supply

Prescriber no. Prescriber no.

Patient’s Medicare no. Patient’s Medicare no.

Medicare Aus tralia / DVA

CHAPTER 1 MEDICATIONS: FROM HERBS TO RESEARCHED TREATMENTS 2

CHAPTER 2 PHARMACOKINETICS AND PHARMACODYNAMICS 21

CHAPTER 3 PHARMACOGENETICS AND PHARMACOGENOMICS 39

CHAPTER 4 CALCULATING MEDICATION DOSAGES 50

CHAPTER 5 PRINCIPLES AND METHODS OF MEDICATION ADMINISTRATION 66

CHAPTER 6 INTRAVENOUS MEDICATION THERAPY 98

CHAPTER 7 MEDICATION THERAPY FOR PAEDIATRIC CLIENTS 116

CHAPTER 8 MEDICATION THERAPY FOR AGED-CARE CLIENTS 131

CHAPTER 9 PREVENTION OF MEDICATION ERRORS 143