Preface

Customization

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Art Attribution

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Errata

All OpenStax textbooks undergo a rigorous review process. However, like any professional-grade textbook, errors sometimes occur. In addition, the wide range of topics, data, and legal circumstances in pharmacology change frequently, and portions of the textbook may become out of date. Since our books are web-based, we can make updates periodically when deemed pedagogically necessary. If you have a correction to suggest, submit it through the link on your book page on OpenStax.org. Subject matter experts review all errata suggestions. OpenStax is committed to remaining transparent about all updates, so you will also find a list of past and pending errata changes on your book page on OpenStax.org.

Format

You can access this textbook for free in web view or PDF through OpenStax.org, and for a low cost in print. The web view is the recommended format because it is the most accessible—including being WCAG 2.1 AA compliant—and most current. Print versions are available for individual purchase, or they may be ordered through your campus bookstore.

Summary

Pharmacology for Nurses aims to provide a fundamental understanding of the therapeutic use of drugs so the nurse can provide safe and effective care to the client. It is important for nursing students to comprehend not only the mechanisms by which drugs impact the human body, but also how the individual’s physiological factors influence drug responses. Along with a discussion of each body system, the text also reviews the pathophysiology of various disease processes and medications used in treatment. The textbook is intended for nursing students in an introductory program. Pharmacology for Nurses helps students prepare for the licensing exam by offering applicable, real-life content in short, manageable sections; it focuses on common client conditions that nurses will encounter throughout their career and embraces a skills orientation (what does a nurse do). Most importantly, Pharmacology for Nurses will give students the confidence to safely administer medications to clients as well as provide medication education to clients and their caregivers.

Pharmacology is often considered one of the more challenging courses in nursing school; however, this book presents the information in a holistic manner that ties the disease process to its pharmacological treatment. This approach will assist students in connecting the pathophysiology of the disease process to the nursing care of the client. Being an effective caregiver requires the nurse to have a solid understanding of the disease process, allowing for the proper assessment and treatment of the client. Due to the number of drugs that are used in clinical practice, one drug is used for each class of medication as a representative drug prototype to help facilitate student learning.

Organizational Framework

The table of contents presents 40 chapter topics organized into 11 units. The first unit, consisting of 3 chapters, provides a broad overview of pharmacology, with the following 10 units focused on specific body systems. In each unit, after a review of the body system anatomy, the following chapters discuss pathological conditions and how they are managed and treated with medications.

One of the primary reasons for nurses to learn about pharmacology is to provide safe, effective care of the client; however, it is also important for nurses to be able to educate the client and family about the drugs that have been prescribed. Each chapter has integrated nursing implications and client teaching as features of each class of drugs.

Although the chapters in Pharmacology for Nurses are written to be mostly independent, they do generally build on the understanding gained in the previous chapters, including occasional cross-references, particularly within a body system unit. (Please bear this in mind when considering alternate sequence coverage.) Instructors may pair the chapters from this pharmacology textbook with similar body system topics in a disease course.

A working knowledge of basic microbiology, chemistry, and anatomy and physiology will be helpful to students reading this book. To develop sound clinical judgement, students will also need an understanding of the nursing process to link the disease process to the recommended pharmacological treatment.

• Unit 1 (Chapters 1–3) introduces an overview of pharmacology, drug administration, and quality and safety. Unit 1 also emphasizes the crucial role of ethics in medication administration with a focus on safety, informed consent, and the prevention of medication errors. These ethical considerations are vital in today’s health care context, especially given the current legal implications and potential consequences of drug administration errors.
• Unit 2 (Chapters 4–5) discusses homeostasis within the body and the importance of fluids, electrolytes, vitamins, and minerals in the maintenance of homeostasis. Unit 2 also covers alternative/complementary therapies.
• Unit 3 (Chapters 6–8) discusses inflammatory response within the body. Unit 3 includes coverage of drugs to treat certain alterations within the immune system, such as infections, cancer, HIV and AIDS, and organ transplants.
• Unit 4 (Chapters 9–15) discusses the nervous system and provides comprehensive coverage of medications for pain management, substance abuse, and psychotropics for mental health (including anxiety, depression, insomnia, mood stabilization, and psychosis).
• Units 5–11 (Chapters 16–40) cover medications for system disorders for the cardiovascular, respiratory, endocrine, digestive, renal and urinary, reproductive, sensory, and dermatologic systems. This section of the book also features the topics of weight management, treatment of transgender and nonbinary individuals, and sexually transmitted infections.

Pharmacology Features

To further enhance learning, key in-chapter, medication-related features of Pharmacology for Nurses may include:

• Drug Emphasis Tables: These tables list common medications in a drug class with typical administration routes and adult dosing. When relevant, pediatric dosing is listed (as an exception). Both generic and brand names of medications are provided, when applicable, to facilitate nurse communication with clients.
• Drug Prototype Tables: These tables feature a single representative medication from the preceding drug emphasis table, listing drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications. (When there is only one relevant drug in a class, only a drug prototype table is provided.)
• FDA Black Box Warnings: These feature boxes summarize the boxed warning required by the U.S. Food and Drug Administration (FDA) for medications with serious, permanent, or fatal side effects.
• Safety Alerts: These feature boxes summarize additional safety considerations in drug administration and client care, supporting Quality and Safety Education for Nurses (QSEN) standards.

Nursing Features

Key in-chapter nursing-related features of Pharmacology for Nurses, depending on chapter content, may include:

• Nursing Implications Sections: These sections, found throughout the book, emphasize client care considerations, such as which vital signs, medication interactions, and adverse effects to monitor.
• Client Education Boxes: These feature boxes list points the nurse should emphasize in client education, such as foods and medications to avoid, symptoms to report, and when to notify the health care provider.
• Clinical Tips: These brief feature boxes are practical tips that an experienced nurse might share with a less experienced colleague—for example, the necessity of monitoring a client's blood pressure to evaluate the effectiveness and safety of a drug or assisting clients in making lifestyle adjustments to enhance their blood pressure.
• Special Considerations Boxes: These feature boxes highlight differing drug administration and client teaching considerations related to certain client categories, including age/life stage, race/ethnicity/culture, or sex/gender. This feature may serve as an in-class discussion prompt.
• Case Studies: These feature boxes present a hypothetical client scenario, listing the client’s medical history, current medications, vital signs, and physical examination results. Each scenario is followed by two multiple-choice questions for students to apply their knowledge of evidence-based client care. Some case studies unfold in several parts throughout the chapter, with new information presented on the same client. Case studies can be used as an in-class discussion prompt. The question answers, with explanations, are included in the Answer Key for students at the end of the book.
• Link to Learning: These feature boxes provide online resources, videos, and podcasts that are pertinent to students’ deeper exploration of the topics. The resources improve nursing students’ understanding of how to educate clients about pertinent diseases and medications.
• Trending Today: These feature boxes present general health care trends and news from a variety of sources. Boxes may contain online resources and videos. This feature may serve as an in-class discussion prompt.
• Off-Label Uses: In some instances, if an “off-label” use (using an FDA-approved drug for an unapproved indication) is common for a certain medication (such as the prescription of beta blockers for anxiety), the text may mention this so nurses can be aware of the practice.

Pedagogical Features

To support student learning, Pharmacology for Nurses includes these standard elements:

• Learning Outcomes: Every chapter section begins with a set of clear and concise student learning outcomes. These outcomes are designed to help the instructor decide what content to include or assign and can guide students on what they can expect to learn and be assessed on.
• Review Questions: This end-of-chapter feature presents at least 10 multiple-choice questions for students to apply their learned knowledge and integrate the chapter (and unit) concepts. The questions focus on client scenarios, body system and pharmacological concept review, and medication dosing calculations, as relevant to the chapter material. The question answers, with explanations, are included in the Answer Key for students at the end of the book.
• Chapter Summary: Chapter summaries assist both students and instructors by outlining the primary subtopics addressed within the chapter.
• Key Terms: Key terms are presented in bold text and are followed by an explanation in context. Definitions of key terms are also listed in the end-of-chapter glossary.
• References: Key drug information is derived from the manufacturer’s FDA-approved labeling via DailyMed, national guidelines, and peer-reviewed literature when possible. References are listed at the end of the book, organized by chapter.
• Appendices: Provided at the end of the book, the appendices include the international system of units, common abbreviations and lab values, and drug conversion tables.
• Index: Provided at the end of the book, the index indicates the medications and key topics covered in the book.

Senior Contributing Authors

Senior Contributing Authors (left to right): Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver.

Tina Barbour-Taylor, University of West Florida. Dr. Barbour-Taylor holds a BS and MS in Nursing from the University of Mobile and a PhD in Instructional Design and Development from the University of South Alabama. Her nursing career spans over 25 years, encompassing medical-surgical, intensive care, emergency, and rheumatology nursing. Dr. Barbour-Taylor initially entered academia in 2015 at Fortis Institute, then transitioned to the University of West Florida in 2020, where she now serves as Assistant Professor of Clinical Practice and DEMSN Program Director. She currently teaches across TBSN, DEMSN, and MSN programs, including Patient-Centered Care II, Introduction to Pharmacology, Pharmacology Across the Lifespan, and Population Health. She is a member of the Alabama State Nurses Association, American Nurses Association, Society for Simulation in Healthcare, Transcultural Nursing Society, and National League for Nurses. Dr. Barbour-Taylor has coauthored numerous articles and has presented at various regional, national, and international conferences.

Leah Mueller (Sabato), Middle Tennessee State University. Dr. Mueller holds a BS in Biochemistry and Doctor of Pharmacy from Ohio State University and completed a postgraduate Pharmacy Practice Residency at University of Cincinnati Medical Center in 2015 and a PGY-2 Cardiology Pharmacy Residency at Vanderbilt University Medical Center in 2016. Dr. Mueller has worked in various clinical pharmacist and specialist roles since completion of residency. She has been teaching for approximately 15 years, first science and pharmacy courses while in graduate school, then nursing courses since 2019, when she joined the School of Nursing faculty at Middle Tennessee State University. She teaches advanced pharmacology and psychopharmacology courses to nurse practitioner students. Dr. Mueller has coauthored several peer-reviewed journal publications and peer reviewed for several journals.

Donna Paris, Texas Tech University Health Sciences Center School of Nursing. Dr. Paris holds a BS in Nursing from the University of Central Oklahoma and an MS in Nursing Education and a Doctor in Nursing Practice from Texas Tech University Health Sciences Center. Her nursing career spans over 35 years, with particular experience in cardiovascular medicine, including the coronary care unit, transplantation, cardiac rehabilitation, cardiovascular case management, and electrophysiology. Dr. Paris has been teaching since 2012, when she joined Texas Tech University Health Sciences Center faculty, where she serves as Associate Professor at TTUHSC and teaches in the traditional undergraduate Bachelor of Science in Nursing (BSN) program. She also serves as a consultant to Hendrick Medical Center’s education department. Dr. Paris’s professional memberships include the Texas Nurses Association, American Nurses Association, Society for Simulation in Healthcare, National League for Nurses, and the American Association for Critical Care Nurses.

Dorie Weaver, Francis Marion University. Dr. Weaver holds a BS in Nursing from Allentown College, an MS in Nursing from DeSales University, and a Doctor in Nursing Practice from Chatham University. Her nursing career spans over 30 years, encompassing medical-surgical, emergency, neuro/trauma ICU, and pediatrics. Dr. Weaver practices as a Family Practice NP and Psychiatric Mental Health NP. She is NLN certified in nursing education. Dr. Weaver has been teaching pharmacology, nutrition, pathophysiology, and assessment courses for over 20 years. She joined the faculty of Francis Marion University in 2015, where she serves as Assistant Professor of Nursing and Coordinator of the MSN/Nurse Educator Track. Her professional memberships include the National Organization of Nurse Practitioner Faculty (NONPF), National League for Nursing, and American Psychiatric Nurses Association. The focus of Dr. Weaver’s academic work is incorporating interdisciplinary education through the use of simulation to enhance collaboration and promote positive client outcomes.

The senior contributing authors would like to particularly thank Dr. Allison Mann, PharmD, BCPS, Clinical Associate Professor of Pharmacy Practice, University of Wyoming, and Dr. Alicia Gesenheus, PharmD, BCOP, Clinical Pharmacy Lead, Oncology Pipeline, Humana, for reviewing the medication-related content of the textbook. Thank you also to nursing consultants Amy B. Britt, Bon Secours Mercy Health, and Marcy Caplin, Associate Professor, Kent State University College of Nursing, for their expertise and assistance with content review and development.

Contributing Authors

Stacey Amick, Midlands Technical College
Patricia Bartzak, Lahey Hospital & Medical Center
Amy B. Britt, Bon Secours Mercy Health
Brenda Brown, Georgia Department of Public Health
Jake Bush, University of West Florida
Denise E. King, Dominican University
Jennifer Richter, University of West Florida
Marjorie G. Webb, Metropolitan State University
Adam Wood, Nova Southeastern University

Reviewers

Valerie O’Toole Baker, Gannon University (Retired)
Amy B. Britt, Bon Secours Mercy Health
Marcy Caplin, Kent State University
Janice Ceccucci, Utica University
Joseph Chamness, The University of Alabama in Huntsville
Ileen Craven, Wilkes University
Karen Crosby, Endicott College
Diane Daddario, Wilkes University
Robin Hill, Hagerstown Community College
Veela Hughes, Albany State University
Kynthia James, Valdosta State University
Kara Jones, The University of Texas at Tyler
Laura Lewicki, Hillsborough Community College
Carole Lorup, Eastern University
Cheryl Miller, Arizona College of Nursing
Lee Anne Oliver, Beaufort County Community College
Tressa Quayle, Weber State University
Margaret Riley (Retired)
Angela Thompson, North Dakota State University
Audrey Tolouian, The University of Texas at El Paso (Retired)
Emily Vitale, University of South Florida
Cynthia Wagner, University of North Georgia
Antay Waters, East Texas Baptist University
Marjorie G. Webb, Metropolitan State University
Nancy Whitehead, Milwaukee Area Technical College
Christine Wollenhaup, Brenau University
Matthew Zinder, Georgetown University

Academic Integrity

Academic integrity builds trust, understanding, equity, and genuine learning. While students may encounter significant challenges in their courses and their lives, doing their own work and maintaining a high degree of authenticity will result in meaningful outcomes that will extend far beyond their college career. Faculty, administrators, resource providers, and students should work together to maintain a fair and positive experience.

We realize that students benefit when academic integrity ground rules are established early in the course. To that end, OpenStax has created an interactive to aid with academic integrity discussions in your course.

(attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Visit our academic integrity slider. Click and drag icons along the continuum to align these practices with your institution and course policies. You may then include the graphic on your syllabus, present it in your first course meeting, or create a handout for students.

At OpenStax we are also developing resources supporting authentic learning experiences and assessment. Please visit this book’s page for updates. For an in-depth review of academic integrity strategies, we highly recommend visiting the International Center of Academic Integrity (ICAI) website at https://academicintegrity.org/.

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Special Thanks

The Division of Digital Learning at the Texas Higher Education Coordinating Board (THECB) has a history of dedicated research initiatives, services, and programs that have advanced open education in Texas by providing support, advocacy, and resources to Texas institutions in their OER efforts. The Division maintains a diverse OER portfolio including OERTX, a digital library and community space for open education work. The leadership and collaboration of the Division of Digital Learning staff made the OER Nursing Essentials (ONE) project possible, throughout research, planning, and development phases of the eight-textbook series.

This work was supported in whole or in part by the THECB. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policies of the THECB.