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Names: Gersch, Carolyn J., editor. | Heimgartner, Nicole M., editor. | Rebar, Cherie R., editor. | Willis, Laura M., 1969- ,
editor.
Title: Pharmacology made incredibly easy! / clinical editors, Carolyn Gersch, Nicole Heimgartner, Cherie R. Rebar, Laura
Willis.
Other titles: Nursing pharmacology made incredibly easy!
Description: Fourth edition. | Philadelphia : Wolters Kluwer Health, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016012901 | ISBN 9781496326324
Subjects: | MESH: Drug Therapy—nursing | Pharmacology—methods | Handbooks
Classification: LCC RM301 | NLM WY 49 | DDC 615.1—dc23 LC record available at http://lccn.loc.gov/2016012901
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any
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This work is no substitute for individual patient assessment based on health care professionals’ examination of each patient
and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history,
laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this
work is merely a reference tool. Health care professionals, and not the publisher, are solely responsible for the use of this
work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of
medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made,
and health care professionals should consult a variety of sources. When prescribing medication, health care professionals are
advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify,
among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic
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8
9
Dedication
For nursing students everywhere who will carry forward the traditions of our profession,
coupled with the future’s greatest evidence.
For Michael, Gillian, Mom, and Dad—my endless ‘Best Yeses’ and hope for tomorrow.
Cherie
10
Contributors
Amy Beckmann, CMN
Advanced Practice Midwife
Austin, Texas
Victoria Wilson, RN
Hospice of Dayton
Dayton, Ohio
11
Sharon Wing, PhDc, RN, CNL
Associate Professor
School of Nursing
Cleveland State University
Cleveland, Ohio
12
Previous Edition Contributors
Kathleen C. Banks, MSN
13
Foreword
Let’s cut right to the chase! Here’s why this book is so terrific:
1. It will emphasize the important things you need to know about nursing pharmacology.
2. It will help you remember what you’ve learned.
3. It will make you smile as it enhances your knowledge and skills.
Special logos highlight important points:
Pharm function—explains and illustrates the way drugs act in the body.
Before you give that drug—alerts you to important drug warnings that should be
considered before administration.
Education edge—provides important information you should share with your
patient.
Look for Nurse Joy, Nurse Jake, and the other playful cast of characters in the margins
throughout this book. They will be there to explain key concepts, provide important care
reminders, offer reassurance, and teach in a way that no other resource can.
I hope you find this book helpful. Best of luck throughout your career!
Connect: RN2ED
Beavercreek, Ohio
14
Contents
1 Fundamentals of nursing pharmacology
Victoria Wilson, RN
2 Autonomic nervous system drugs
Sharon Wing, PhDc, RN, CNL
3 Neurologic and neuromuscular drugs
Sarah Clark, RN, BA
4 Pain medications
Adair Lattimer, DNP, RN
5 Cardiovascular drugs
Katrin Moskowitz, DNP, APRN
6 Respiratory drugs
Katrin Moskowitz, DNP, APRN
7 Gastrointestinal drugs
Margaret M. Gingrich, CRNP
8 Genitourinary drugs
Amy Beckmann, CNM
9 Hematologic drugs
Emily Sheff, MSN, CMSRN, FNP-BC
10 Endocrine drugs
Tracy Taylor, MSN, RN
11 Psychotropic drugs
Sarah Clark, RN, BA
12 Anti-infective drugs
Charity L. Hacker, MSN-Ed, RN
13 Anti-inflammatory, antiallergy, and immunosuppressant drugs
Tracy Taylor, MSN, RN
14 Antineoplastic drugs
Sarah Clark, RN, BA
15 Drugs for fluid and electrolyte balance
Emily Sheff, MSN, CMSRN, FNP-BC
15
16
Chapter 1
Fundamentals of nursing
pharmacology
Pharmacology basics
Pharmacology is the scientific study of the origin, nature, chemistry, effects, and uses
of drugs. This knowledge is essential to providing safe and accurate medication
administration to your patients.
17
• The chemical name is a scientific name that precisely describes the drug’s atomic
and molecular structure.
• The generic, or nonproprietary, name is an abbreviation of the chemical name.
• The trade name (also known as the brand name or proprietary name) is selected
by the drug company selling the product. Trade names are protected by copyright.
The symbol ® after a trade name indicates that the name is registered by and
restricted to the drug manufacturer.
To avoid confusion, it’s best to use a drug’s generic name because any one drug
can have a number of trade names.
Making it official
In 1962, the federal government mandated the use of official names so that only one
official name would represent each drug. The official names are listed in the United
States Pharmacopeia and National Formulary.
Class act
Drugs that share similar characteristics are grouped together as a pharmacologic class
(or family). Beta-adrenergic blockers are an example of a pharmacologic class.
A second type of drug grouping is the therapeutic class, which categorizes drugs
by therapeutic use. Antihypertensives are an example of a therapeutic class.
18
Where drugs come from
Traditionally, drugs were derived from natural sources, such as:
• plants
• animals
• minerals.
Today, however, laboratory researchers have used traditional knowledge, along
with chemical science, to develop synthetic drug sources. One advantage of
chemically developed drugs is that they’re free from the impurities found in natural
substances. Also, researchers and drug developers can manipulate the molecular
structure of substances such as antibiotics so that a slight change in the chemical
structure makes the drug effective against different organisms. The first-, second-,
third-, and fourth-generation cephalosporins are an example.
19
• Resins, of which the chief source is pine tree sap, commonly act as local irritants or
as laxatives and caustic agents.
• Oils, thick and sometimes greasy liquids, are classified as volatile or fixed.
Examples of volatile oils, which readily evaporate, include peppermint, spearmint,
and juniper. Fixed oils, which aren’t easily evaporated, include castor oil and olive
oil.
Many minerals
Metallic and nonmetallic minerals provide various inorganic materials not available
from plants or animals. Mineral sources are used as they occur in nature or they’re
combined with other ingredients. Examples of drugs that contain minerals are iron,
iodine, and Epsom salts.
Lab report
Today, most drugs are produced in laboratories. Examples of such drugs include
thyroid hormone (from natural sources) and cimetidine (from synthetic sources).
20
How drugs are administered
A drug’s administration route influences the quantity given and the rate at which the
drug is absorbed and distributed. These variables affect the drug’s action and the
patient’s response.
Buccal, sublingual, and translingual
Certain drugs, such as nitroglycerin, are given buccally (in the pouch between the
cheek and teeth), sublingually (under the tongue), or translingually (on the tongue) to
prevent their destruction or transformation in the stomach or small intestine.
Gastric
The gastric route allows direct administration of a drug into the GI system. This route
is used when patients can’t ingest the drug orally. This route is accessed through a
tube placed directly into the GI system, such as a “G-tube.”
Intradermal
In intradermal administration, drugs are injected into the skin. A needle is inserted at a
10- to 15-degree angle so that it punctures only the skin’s surface. This form of
administration is used mainly for diagnostic purposes, such as testing for allergies or
tuberculosis.
Intramuscular
The IM route allows drugs to be injected directly into various muscle groups at
varying tissue depths. This form of administration provides rapid systemic action and
allows for absorption of relatively large doses (up to 3 mL). Aqueous suspensions and
solutions in oil as well as drugs that aren’t available in oral forms are given IM.
Intravenous
The IV route allows injection of drugs and other substances directly into the
bloodstream through a vein. Appropriate substances to administer IV include drugs,
fluids, blood or blood products, and diagnostic contrast agents. Administration can
range from a single dose to an ongoing infusion that’s delivered with great precision.
21
Oral
Oral administration is usually the safest, most convenient, and least expensive route.
Oral drugs are administered to patients who are conscious and able to swallow.
Subcutaneous
In subcutaneous (subcut) administration, small amounts of a drug are injected beneath
the dermis and into the subcutaneous tissue, usually in the patient’s upper arm, thigh,
or abdomen. This allows the drug to move into the bloodstream more rapidly than if
given by mouth. Drugs given by the subcut route include nonirritating aqueous
solutions and suspensions contained in up to 1 mL of fluid, such as heparin and
insulin.
Topical
The topical route is used to deliver a drug via the skin or a mucous membrane. This
route is used for most dermatologic, ophthalmic, otic, and nasal preparations.
Specialized infusions
Drugs may also be given as specialized infusions. These are given directly to a
specific site in the patient’s body. Specific types of infusions include:
22
• epidural—injected into the epidural space
• intrapleural—injected into the pleural cavity
• intraperitoneal—injected into the peritoneal cavity
• intraosseous—injected into the rich vascular network of a long bone
• intra-articular—injected into a joint
• intrathecal—injected into the spinal canal.
Only after reviewing extensive animal studies and data on the safety and
effectiveness of the proposed drug does the FDA approve an application for an
Investigational New Drug (IND). (See Phases of new drug development.)
Phase I
In phase I, the drug is tested on healthy volunteers to make sure the drug can be given
safely to people.
Phase II
Phase II involves trials with human subjects who have the disease for which the drug is
thought to be effective.
Phase III
Large numbers of patients in medical research centers receive the drug in phase III. This
larger sampling provides information about infrequent or rare adverse effects. The FDA
23
approves a new drug application if phase III studies are satisfactory.
Phase IV
Phase IV is voluntary and involves postmarket surveillance of the drug’s therapeutic
effects at the completion of phase III. The pharmaceutical company receives reports from
doctors and other health care professionals about the therapeutic results and adverse
effects of the drug. Some drugs, for example, have been found to be toxic and have been
removed from the market after their initial release.
Pharmacokinetics
The term kinetics refers to movement. Pharmacokinetics deals with a drug’s actions as
it moves through the body. Therefore, pharmacokinetics discusses how a drug is:
• absorbed (taken into the body)
• distributed (moved into various tissues)
• metabolized (changed into a form that can be excreted)
• excreted (removed from the body).
This branch of pharmacology is also concerned with a drug’s onset of action, peak
concentration level, and duration of action.
Absorption
Drug absorption covers the progress of a drug from the time it’s administered, through
24
the time it passes to the tissues, until it becomes available for use by the body.
How drugs are absorbed
On a cellular level, drugs are absorbed by several means—primarily through active or
passive transport.
No energy required
Passive transport requires no cellular energy because the drug moves from an area of
higher concentration to one of lower concentration (diffusion). It occurs when small
molecules diffuse across membranes. Diffusion stops when the drug concentrations
on both sides of the membrane are equal. Oral drugs use passive transport; they move
from higher concentrations in the GI tract to lower concentrations in the bloodstream.
Get active
Active transport requires cellular energy to move the drug from an area of lower
concentration to one of higher concentration. Active transport is used to absorb
electrolytes, such as sodium and potassium, as well as some drugs, such as levodopa.
25
Slow but steady
Absorption occurs at slower rates when drugs are administered by the oral, IM, or
subcut routes because the complex membrane systems of GI mucosal layers, muscle,
and skin delay drug passage.
At a snail’s pace
At the slowest absorption rates, drugs can take several hours or days to reach peak
concentration levels. A slow rate usually occurs with rectally administered or
sustained-release drugs.
Intestinal interference
Several other factors can affect absorption of a drug. For example, most absorption of
oral drugs occurs in the small intestine. If a patient has had large sections of the small
intestine surgically removed, drug absorption decreases because of the reduced
surface area and the reduced time the drug is in the intestine.
Liver-lowered levels
Drugs absorbed by the small intestine are transported to the liver before being
circulated to the rest of the body. The liver may metabolize much of the drug before it
enters circulation. This mechanism is referred to as the first-pass effect. Liver
metabolism may inactivate the drug; if so, the first-pass effect lowers the amount of
active drug released into the systemic circulation. Therefore, higher drug dosages
must be administered to achieve the desired effect.
26
More blood, more absorption
Increased blood flow to an absorption site improves drug absorption, whereas reduced
blood flow decreases absorption. More rapid absorption leads to a quicker onset of
drug action.
For example, the muscle area selected for IM administration can make a difference
in the drug absorption rate. Blood flows faster through the deltoid muscle (in the
upper arm) than through the gluteal muscle (in the buttocks). The gluteal muscle,
however, can accommodate a larger volume of drug than the deltoid muscle.
Whatcha eatin’?
High-fat meals and solid foods slow the rate at which contents leave the stomach and
enter the intestines, delaying intestinal absorption of a drug.
27
Form factors
Drug formulation (such as tablets, capsules, liquids, sustained-release formulas,
inactive ingredients, and coatings) affects the drug absorption rate and the time
needed to reach peak blood concentration levels. For example, enteric coated drugs
are specifically formulated so that they don’t dissolve immediately in the stomach.
Rather, they release in the small intestine. Liquid forms, however, are readily
absorbed in the stomach and at the beginning of the small intestine.
Combo considerations
Combining one drug with another drug or with food can cause interactions that
increase or decrease drug absorption, depending on the substances involved.
Distribution
Drug distribution is the process by which the drug is delivered to the tissues and fluids
of the body. Distribution of an absorbed drug within the body depends on several
factors, including:
• blood flow
• solubility
• protein binding.
28
Breaching the barrier
The ability of a drug to cross a cell membrane depends on whether the drug is water-
or lipid- (fat-) soluble. Lipid-soluble drugs easily cross through cell membranes,
whereas water-soluble drugs can’t. Lipid-soluble drugs can also cross the blood-brain
barrier and enter the brain.
In a bind
As a drug travels through the body, it comes in contact with proteins, such as the
plasma protein albumin. The drug can remain free or bind to the protein. The portion
of a drug that’s bound to a protein is inactive and can’t exert a therapeutic effect. Only
the free, or unbound, portion remains active. A drug is said to be highly protein-bound
if more than 80% of it binds to protein.
Metabolism
Drug metabolism, or biotransformation, refers to the body’s ability to change a drug
from its dosage form to a more water-soluble form that can then be excreted. Drugs
can be metabolized in several ways:
• Most commonly, a drug is metabolized into inactive metabolites (products of
metabolism), which are then excreted.
• Some drugs can be converted to active metabolites, meaning they’re capable of
exerting their own pharmacologic action. These metabolites may undergo further
metabolism or may be excreted from the body unchanged.
• Other drugs can be administered as inactive drugs, called prodrugs, and don’t
become active until they’re metabolized.
29
Metabolism busters
Certain diseases can reduce metabolism. These include liver disease, such as cirrhosis,
and heart failure, which reduces circulation to the liver.
In the genes
Genetics allow some people to be able to metabolize drugs rapidly, whereas others
metabolize them more slowly.
Environmental effects
Environment, too, can alter drug metabolism. For example, if a person is surrounded
by cigarette smoke, the rate of metabolism of some drugs may be affected. A stressful
environment, such as one involving prolonged illness or surgery, can also change how
a person metabolizes drugs.
Age alterations
Developmental changes can also affect drug metabolism. For example, infants have
immature livers that reduce the rate of metabolism, and elderly patients experience a
decline in liver size, blood flow, and enzyme production that also slows metabolism.
Excretion
Drug excretion refers to the elimination of drugs from the body. Most drugs are
excreted by the kidneys and leave the body through urine. Drugs can also be excreted
through the lungs, exocrine glands (sweat, salivary, or mammary glands), skin, and
intestinal tract.
30
A drug that’s given only once is eliminated from the body almost completely after
four or five half-lives. A drug that’s administered at regular intervals, however,
reaches a steady concentration (or steady state) after about four or five half-lives.
Steady state occurs when the rate of drug administration equals the rate of drug
excretion.
31
Pharmacodynamics
Pharmacodynamics is the study of the drug mechanisms that produce biochemical or
physiologic changes in the body. The interaction at the cellular level between a drug
and cellular components, such as the complex proteins that make up the cell
membrane, enzymes, or target receptors, represents drug action. The response
resulting from this drug action is called the drug effect.
Stimulating response
An agonist is an example of a drug that interacts with receptors. An agonist drug has
an attraction, or affinity, for a receptor and stimulates it. The drug then binds with the
receptor to produce its effect. The drug’s ability to initiate a response after binding
with the receptor is referred to as intrinsic activity.
Preventing response
If a drug has an affinity for a receptor but displays little or no intrinsic activity, it’s
called an antagonist. The antagonist prevents a response from occurring.
Antagonists can be competitive or noncompetitive:
• A competitive antagonist competes with the agonist for receptor sites. Because this
type of drug binds reversibly to the receptor site, administering large doses of an
agonist can overcome the antagonist’s effects.
• A noncompetitive antagonist binds to receptor sites and blocks the effects of the
32
agonist. Administering large doses of the agonist can’t reverse its action.
Not so choosy
If a drug acts on a variety of receptors, it’s said to be nonselective and can cause
multiple and widespread effects.
Potent quotient
Drug potency refers to the relative amount of a drug required to produce a desired
response. Drug potency is also used to compare two drugs. If drug X produces the
same response as drug Y but at a lower dose, then drug X is more potent than drug Y.
Dose-response curve
This graph shows the dose-response curve for two different drugs. As you can see, at low
doses of each drug, a dosage increase results in only a small increase in drug response
(e.g., from point A to point B). At higher doses, an increase in dosage produces a much
greater response (from point B to point C). As the dosage continues to climb, an increase
in dose produces very little increase in response (from point C to point D).
This graph also shows that drug X is more potent than drug Y because it results in the
same response, but at a lower dose (compare point A to point E).
33
On the dose-response curve, a low dose usually corresponds with a low response.
At a low dose, an increase in dose produces only a slight increase in response. With
further increases in dose, there’s a marked rise in drug response. After a certain point,
an increase in dose yields little or no increase in response. At this point, the drug is
said to have reached maximum effectiveness.
Pharmacotherapeutics
Pharmacotherapeutics is the use of drugs to treat disease. When choosing a drug to
treat a particular condition, health care providers consider the drug’s effectiveness as
well as such factors as the type of therapy the patient will receive.
34
patient’s condition. Therapy types include:
• acute therapy, if the patient is critically ill and requires acute intensive therapy
• empiric therapy, based on practical experience rather than on pure scientific data
• maintenance therapy, for patients with chronic conditions that don’t resolve
• supplemental or replacement therapy, to replenish or substitute for missing
substances in the body
• supportive therapy, which doesn’t treat the cause of the disease but maintains other
threatened body systems until the patient’s condition resolves
• palliative therapy, used for end-stage or terminal diseases to make the patient as
comfortable as possible.
35
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kölcsönös megvitatás, hanem a főnök és papok egyedül gyakorolták
a parancsolás és a dogmatizmus monopóliumát.
«Hogyan engedett helyet, – kérdezi Tarde, – az embervadászat
az emberi háborúnak, a hiszékenység a szabad vizsgálódásnak és a
dogmatizmus a kölcsönös felvilágosításnak? az engedelmesség a
szabad beleegyezésnek és az abszolutizmus az önkormányzatnak?
a privilégium a törvény előtti egyenlőségnek, a donáczió vagy a
lopás a cserének? a szolgaság az igazi kooperácziónak? és végül a
kezdetleges házasság, amely a nő eltulajdonítása volt, minden
kölcsönösség nélkül, a mai házasságnak, amely a férfinak a nő által
és a nőnek a férfi által való eltulajdonítása? Válaszom ez: az
utánzásnak minden formájában való lassú és elkerülhetetlen hatása
következtében.»96)
A felsőbbnek tömeges utánzása az alsóbb által általánosította az
előbbinek privilégiumait. Az a szükséglet, hogy utánozzuk a felsőket,
hogy épp úgy higyjenek bennünk, épp úgy engedelmeskedjenek,
épp úgy szolgáljanak nekünk, mint neki: mérhetetlen erő volt, amely
lassan létrehozta azokat az átalakulásokat, amelyeket látunk. A
népfelség, amint ma érvényesül, nem egyéb, mint ezernyi
példányban való megsokszorozódása a monarchikus felségnek, és
ez utóbbi példája nélkül, amely különösen XIV. Lajosban testesült
meg, ki tudja, vajjon egyáltalán kigondolható lett-e volna?
Egy harmadik törvény, amelyet az utánzás korolláriumának kell
tekintenünk, a visszatérhetetlenség törvénye a történelemben.
Tarde szerint az, ami a társadalmak történetében lényeges,
visszatérhetetlen, vagyis nem ismétlődhetik megfordított sorrendben.
– Valamely létező társadalmi evoluczió visszatérhetetlen, mert az oly
tények, aminő például a monopóliumról a kereskedelmi
szabadságra, a szolgaságról a szolgálatok kölcsönösségére való
áttérés az utánzás törvényeinek korolláriumai. Vagyis, ezek a
törvények megszünhetnek részben vagy teljesen működni és ez
esetben valamely társadalom részben vagy teljesen kimulik, de a
törvények nem fordulhatnak fel. Tegyük hozzá ehhez, hogy az
utánzás áramlásai kereszteződnek és egymásba olvadnak, hogy úgy
mondjuk, maguk között. És ez az összebogozódás soha többé nem
oldható fel. Ha azt akarjuk feltételezni, hogy feloldódtak, akkor a
czivilizáczió teljes felfordulását, teljes kataklizmáját kellene
elfogadnunk.
Foglalkozzunk most röviden az evolucziónak egy másik
törvényével, amely szintén az utánzás törvényének korolláriuma. Ez
a fokozatos asszimiláczió törvénye a társadalmakban.
Tarde szerint, az utánzások felhalmozódása következtében a
társadalmi élet jelenségei egyöntetüségre törekszenek. Példa erre a
férfi és női ruházat, amely miután hajdan nagyon differencziálódott
volt úgy szabásban, mint szövetben a népesség különböző osztályai
és az ország különböző tartományai szerint, egyre jobban törekszik
immár az egyöntetüségre.
Tarde szerint ez a törvény érvényes a társadalmi tevékenység
minden ágában, sőt átalakítani igyekszik még a versenyt és a
küzdelmet is, ezek különböző formáiban. «Az utánzás
következtében, amelynek kisugárzása szakadatlanul és titkon
működik, hogy úgy mondjuk, a társadalmi mező kiszélesítésére, a
társadalmi jelenségek kiszélesednek és részt vesz ebben a
mozgásban a háború is. Végtelen sok, igen apró, de igen
elkeseredett háború után kis törzsek között, sokkal kisebb számú,
valamivel nagyobb háborúk következnek, de más kevésbbé
gyülölködők, kis városok, majd pedig nagy városok között, még
később növekvő népek között és végül elérkezünk oly korszakhoz,
amelyben nagyszabásuak, de igen ritkák az összeütközések,
minden kegyetlenség nélkül, a nemzeti kolosszusok között, amelyek
már nagyságuknál fogva is békeszeretők.»97)
«A verseny, ez a gazdasági és többé már nem politikai jellegü
társadalmi ellenkezés, ugyanezt a törvényt követi. Mint a háború, a
verseny is kicsiből nő nagygyá, igen számos kicsiből igen kevés
számú nagygyá…»
A társadalmi harcz harmadik nagy formája, a vitatkozás, szintén
ugyane törvény szerint fejlődik… Apró kotériák, apró törzsek, apró
egyházak, apró fórumok, apró iskolák szóharczai helyét nagy
polémiák után egypár nagy pártnak, egypár nagy parlamenti
csoportnak, egypár nagy filozófiai vagy művészeti iskolának az
ellentétessége foglalja el, amelyek felséges csatákat vívnak
egymással.98)
Ezért van az, hogy bizonyos társadalmi dolgok: dogma,
szólásmód, tudományos elv, erkölcsi rovás, ipari eljárás, stb. utánzó
ismétlés folytán geometriai arányban igyekeznek terjeszkedni, a
társadalmi hatások és kölcsönhatások tere mindjobban bővül, az
ellenkezések kiszélesedve elgyengülnek és úgy látszik, az
emberiség egyszerre megbékülés és általános egyöntetűség felé
halad.
Ezzel végeztünk a fejlődés különböző törvényeivel, melyek
mindmegannyi korollariumként kapcsolódnak az utánzás
alaptörvényéhez. Az utánzással kapcsolatban érdekes tanulmányt
lehetne még folytatni. Meg kellene vizsgálni, hogy melyek kedvező
vagy kedvezőtlen feltételei az utánzó sugallásnak, melyet egyik lélek
a másikra gyakorol. Tarde utánzás-elméletét érdekes és pontos
vizsgálattal egészítette ki, melyet az utánzás problémája e szubjektiv
szempontjának szentel.99)
Tarde megvizsgálja a lelki kölcsönhatás különféle: fizikai, élettani,
vagy pszichológiai feltételeit, vagyis egyik lélek hatását egy másik
lélekre. Hogy melyek a távolság, a kor, a nem, a termet, a fizikai
energia, az egészség, a faj ama feltételei, melyek az utánzás
társadalmi jelenségében hatással vannak egyesek
szuggesztivitására és mások szuggesztibilitására? Nem követhetjük
Tarde-ot érdekes fejtegetéseiben, melyeket e kérdéseknek szentel.
Csak azokra az individualista következtetésekre mutatunk rá,
amelyek a következő idézetből bontakoznak ki: «Magasabb
szuggesztivitás kiváltsága nem kapcsolódik állandó módon egyetlen
fajba; koronként vándorol és ama történeti körülményektől függ,
melyekben ez vagy az a faj részesedett. Ebből következik az is,
hogy adott pillanatban az a tény, hogy magasabb tekintélyü fajhoz
tartozik, szuggesztivabbá, befolyásolhatóbbá, az eszmék és
cselekedetek terjesztésére alkalmasabbá teszi az embert. De ez a
magasabb szuggesztivitás, mely a fajtól függ, mindinkább alá van
rendelve annak, mely egyéni felsőbbségből ered. Tegyük hozzá: ha
nincs faj, mely arra született, hogy folyvást feltaláljon, hogy
parancsoljon és tanítson minden tekintetben és örökké, épp így
állandó és föltétlen egyéni fensőbbség sincs. Aki köztünk a
legtudósabb, az is tanulhat valamit a legtudatlanabbtól, példát vehet
a legjobb is valamiben a legrosszabbtól. Azt is látjuk, hogy fejlődő
társadalomban a parancsolás épp úgy, mint az engedelmesség
széttagolódik és így mindinkább kölcsönös lett. Az általánosított
munka és csere folytán mindegyikünk szolgálója azoknak, akikért
dolgozik és ura azoknak, akik érte dolgoznak.100)
IV. FEJEZET.
A társadalmi ellenkezés és differencziáltság
törvényei.
V. FEJEZET.
A társadalmi asszimiláczió és differenciálódás
törvényeinek ellentéte.
VI. FEJEZET.
A társadalmi alkalmazkodás és a haladás.