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Группа авторов. Fundamentals of Pharmacology for Children's Nurses
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Fundamentals of Pharmacology for Children’s Nurses
Contributors
Preface
Terminology
References
Acknowledgements
Prefixes and Suffixes
Abbreviations
About the Companion Website
1 Introduction to Pharmacology, Children and Young People
Aim
Learning Outcomes
Test Your Knowledge
Introduction to Pharmacology
Professional Framework
The Importance and Value of Medicine Within Healthcare
Therapeutic Pharmacology
Social Prescribing
Safety Within Paediatric Care
Episode of Care
Medicines Optimisation
Medicines
Medicine Management
Safety: Rights of Medication Administration
Specific Considerations for Babies, Children and Young People
Infancy
Clinical Consideration
Clinical Consideration
Clinical Consideration
Clinical Consideration
Adolescents
Episode of Care
Tablets
Distraction Techniques
Clinical Consideration
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
2 How to Use Pharmaceutical and Prescribing Reference Guides
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Skills in Practice
The British National Formulary and the British National Formulary for Children
Practice Consideration
Paper Copy BNFc
How to navigate the BNFc
Front Matter
Chapters
Box 2.1Paracetamol Sales
Skills in Practice
Back Matter
Interactions
Borderline Substances
Clinical Consideration
Cautionary and Advisory Labels for Dispensed Medication
Skills in Practice
Emergency Care Protocols, Units, Conversions and Abbreviations
Online and Mobile Application BNFc
Monthly Index of Medical Specialities (MIMS)
How to Use MIMS Online
Skills in Practice
Clinical Consideration
Electronic Medicines Compendium
What Can Be Prescribed on an NHS Prescription?
The Drug Tariff
What the Drug Tariff Does
How to Tell if a Medicinal Product is Allowed on Prescription
Skills in Practice
Other Guides to Prescribing. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Guidelines
Clinical Consideration
The Evidence Base to Prescribing: Prescribing Guidelines
NICE Prescribing Guidance
Clinical Consideration
Scottish Intercollegiate Guidelines Network (SIGN)
Conclusion
References
Further Resources
Multiple Choice Questions
3 Legal and Ethical Issues
Aim
Learning Outcomes
Test Your Knowledge
Introduction
The Law
Statute Law
Common Law
Criminal Law
Civil Law
Tort Law
The Bolam Test
Box 3.1The Bolam Test Tested. Case Law: Montgomery v Lanarkshire Health Board [2015]
The Children Act 2004
Principles of the Children Act 2004
Box 3.2Daniel Pelka
Duty of Care and Healthcare
Regulation of Healthcare
Ethical Principles and Theories
Box 3.3Immunisations and the Law
Research
Box 3.4Ethical Research Involving Children and Young People. Harm and Benefits
Informed Consent
Privacy and Confidentiality
Payment and Compensation
Clinical Consideration: Consent to Treatment
Children and Young People who are under 16 years – Gillick and Fraser Guidance
Assessing and Promoting Competence
Box 3.5Competence in Children and Young People
Parental Responsibility
Medication Adherence and Administration
Conclusion
Skills in Practice: KidzMed Project
References
Further Resources
Multiple Choice Questions
Find Out More
4 Medicines Management and the Role of the Healthcare Provider Working with Children, Young People and Families
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Box 4.1The NMC’s Seven Platforms
Being an Accountable Professional
Nursing and Midwifery Council
Employer and Colleagues
Clinical Consideration
Promoting Health and Preventing Ill Health
Holistic Assessment
Skills for Practice
Clinical Consideration
Assessing Needs and Planning Care
Episode of Care
Self‐Medication
Complementary and Alternative Medication (CAM)
Clinical Consideration
Planning
Providing and Evaluating Care
Checking
Evaluation
Clinical Consideration
Leading and Managing Nursing Care and Working in Teams
Skills for Practice
Improving Safety and Quality
Coordinating Care
Episode of Care
Conclusion
References
Further Resources
Multiple Choice Questions
Find Out More
5 Pharmacodynamics and Pharmacokinetics
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Royal Pharmaceutical Society
The Nursing and Midwifery Council
Pharmacokinetics
Pharmacokinetic Principles (the ADME Process)
Box 5.1 Four Stages of Pharmacokinetics: ADME
Phase 1: Absorption
How Drugs Cross the Cell Membrane
The Concept of Drugs Crossing the Cell Membrane
Methods of Drug Movement Across the Cell Membrane. Passive Transport
Active Transport
Enteral
Clinical Consideration
Parenteral
Topical
Phase 2: Distribution
Protein Binding
Blood–Brain Barrier
Placenta and Breast Milk
Phase 3: Metabolism (Biotransformation)
Rate
First‐Pass Metabolism
Hepatic First‐Pass Effect
Phase 4: Elimination
Excretion
Box 5.2 Clinical Trials and Off‐Label Medication Use in Paediatrics
Think Paediatrics
An Example of the Pharmacokinetics of Paracetamol
Clinical Consideration
Clinical Consideration
Clinical Consideration
Clinical Consideration
Pharmacodynamics
Agonists and Antagonists
Agonist
Antagonists
Episode of Care
Clinical Consideration
Therapeutic Index
Adverse Effects
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
6 Drug Formulations
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Licensing of Paediatric Medicines
Types of Formulations
Oral Route of Administration
Liquid Formulations for Oral Administration
Episode of Care
Clinical Consideration
Solid Dosage Formulations for Oral Administration
Clinical Consideration
Formulations for Administration Via Mucous Membranes
Formulations for Topical Administration
Formulations for Inhalation Administration
Formulations for Parenteral Administration
The Intravenous Route
Excipients
Factors Affecting Excipient‐Related Toxicity
Enteral Feeding Tubes
Clinical Consideration
Displacement Values
Clinical Consideration
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
7 Medications Used in the Cardiovascular System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Clinical Consideration
Gross Anatomy Related to Cardiovascular System (CVS) Pharmacology
Structure
Heart Valves
Layers of the Heart
Function
Right Side of the Heart
Left Side of the Heart
Cardiovascular Drugs Affecting Chronic Conditions. Statins
Clinical Consideration
Ezetimibe
Evolocumab
Anticoagulant Medications. Aspirin
Clinical Consideration
Warfarin
Angiotensin Converting Enzyme (ACE) Inhibitors
Clinical Consideration
Angiotensin II Receptor Antagonists
Peripheral Alpha Antagonist or Alpha‐Adrenergic Blockers: ‘Alpha Blockers’
Cardiovascular Drugs for Use in Acute Clinical Scenarios
Electrophysiological System Recap
Clinical Consideration
Antidysrhythmic Drugs
Class 1 – 1a Quinidine, 1b Lidocaine, 1c Propafenone
Class 2 – Atenolol, Metoprolol, Labetalol
Class 3 – Amiodarone and Sotalol Hydrochloride
Class 4 – Verapamil and Diltiazem
Drugs with an Inotropic Effect. Positive Inotropes
Milrinone
Adrenaline (Epinephrine)
Skills in Practice
Dopamine Hydrochloride
Dobutamine Hydrochloride
Noradrenaline (Norepinephrine)
Drugs with a Chronotropic Effect
Positive Chronotropes. Atropine Sulfate
Adrenaline (Epinephrine)
Episode of Care
Dopamine Hydrochloride
Negative Chronotropes. Beta Blockers (BB)
Digoxin (Digitalis)
Diltiazem Hydrochloride
Vasoactive Drugs. Noradrenaline
Episode of Care
Vasopressin (Pitressin)
Additional Haemodynamic Effectors. Diuretics
Clinical Consideration
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
8 Medications Used in theRenal System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Anatomy and Physiology of the Renal System
Common Renal Conditions
Skills in Practice
Nephrotic Syndrome
Clinical Consideration
Episode of Care
Treatment of MCNS. Initial Presentation – Prednisolone
Recommendations for Management of SRNS
Clinical Consideration
Contraindications
Furosemide
Calcineurin Inhibitors
Drugs Used to Treat Electrolyte Disorders
Phosphate Binders, Calcium Supplements and Vitamin D Supplements
Potassium Binders and Supplements
Bicarbonate Supplements
Clinical Consideration
Skills in Practice
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
9 Medications Used in the Endocrine System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
The Endocrine System
Medications Used in Endocrine Disorders Affecting Growth. Somatropin: (Growth Hormone) (GH)
Uses: as Licensed by NICE (2010)
Clinical Consideration
Mecasermin (Increlex®)
Skills in Practice
Endocrine Disorders of Puberty
Direct Hormone Replacements
Oestrogen and Progesterone
Testosterone
Dihydrotestosterone (DHT)
Human Chorionic Gonadotrophin (HCG)
Menotrophin or Follicle‐Stimulating Hormone (FSH)
Drugs Used to Block Puberty or the Action of Sex Steroids. Gonadotrophin‐Releasing Hormone Analogues (GnRha)
Drugs Used to Reduce the Action of Sex Steroids
Episode of Care
Levothyroxine
Medications Used in Disorders of the Adrenal Glands
Medications Used in the Management of Diabetes
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
10 Medications Used in the Respiratory System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Asthma
Skills in Practice
Clinical Consideration
Croup
Clinical Consideration
Episode of Care
Bronchiolitis
Pneumonia
Cystic Fibrosis
Non‐Pharmaceutical Management
Pharmaceutical Management
Clinical Consideration
Skills in Practice
Clinical Considerations
Respiratory Medicines
Oxygen Therapy
Bronchodilators
Adrenoceptor Agonists
Antimuscarinic Bronchodilators
Leukotrienes
Xanthines
Corticosteroids
Clinical Considerations
Antibiotics
Mucolytics
Other Respiratory Drugs. Monoclonal Antibodies
CFTR Modulators
Episode of Care
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
11 Medications Used in the Gastrointestinal System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Overview of the Anatomy and Physiology of the Gastrointestinal System
The Stomach
Small Intestines
Duodenum
Jejunum
Ileum
The Liver
The Gallbladder
The Pancreas
The Large Intestine
Gastro‐Oesophageal Reflux Disease (GORD)
Episode of Care
Management of GOR and GORD
Pharmacological Treatment for GORD
Proton Pump Inhibitors
Pharmacokinetic Properties of PPIs
Pharmacodynamics of PPIs
Enteral Feeding Tubes and Medication Administration
Skills for Practice
Constipation
Suppositories
Clinical Skill
Osmotic Laxatives
Stimulant Laxatives
Pharmacokinetics
Crohn’s Disease
Treatment of Crohn’s Disease
Pharmacological Treatment for Crohn’s Disease
Episode of Care
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
12 Medications Used in the Nervous System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Epilepsy
Antiepileptic Drugs (AEDs)
Clinical Consideration
Clinical Consideration
Sodium Valproate
Lamotrigine
Levetiracetam
Cannabidiol
Episode of Care
Emergency Medications
Guillain–Barré Syndrome
IVIG
Clinical Consideration
Therapeutic Plasma Exchange
Episode of Care
Migraine
Rescue Treatment
Preventative Treatments
Beta Blockers
Clinical Consideration
Calcium Channel Blockers
Serotonin Modulators
Antiepileptic Drugs
Melatonin
Antidepressant Drugs
Neurotoxins
Clinical Consideration
Status Migrainosus
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Appendix 1: AEDs Used in Treatment of Childhood Epilepsy
13 The Immune System and Immunisations
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Types of Immunity
How Immunisations Work
Live Attenuated Vaccines
Inactivated Vaccines
Conjugate Vaccines
Immunisation and Public Health
Immunisation Schedule
Vaccine Uptake
The ‘Cold Chain’
Clinical Considerations
Patient Specific Directions and Patient Group Directives
Administration of Vaccines
Skills in Practice
Clinical Considerations
Common Reactions and Anaphylaxis
Communication with the Child and Family
Episode of Care
The Green Book
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
14 Medications and the Integumentary System
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Anatomy and Physiology of the Integumentary System
The Epidermis
The Dermis
Common Skin Conditions
Impetigo
Presentation
Treatment
Hydrogen Peroxide
Treatment Course
Clinical Consideration
Antibiotic Creams. Fusidic Acid
Oral Antibiotics
Flucloxacillin
Side Effects of Flucloxacillin
ADME of Flucloxacillin
Clarithromycin
Side Effects
Cellulitis
Ringworm
Presentation
Treating Ringworm
Topical Antifungals
Side effects
Drug Interactions
Clinical Consideration
Eczema
Episode of Care Impetigo
Assessing and Diagnosing Atopic Eczema
Topical Treatments
Bandages and Dressings. Skills in Practice
Systemic Treatments. Narrow Band Ultraviolet (UV) Light Therapy/Psoralen and Long Wave Ultraviolet Light (PUVA)/Phototherapy
Immunosuppressive Drugs
Psoriasis
Assessment and Diagnosis
Emollients/Topical Therapy
Clinical Consideration
Corticosteroids
Vitamin D Preparations
Salicylic Acid
Coal Tar Products
Dithranol
Phototherapy
Systemic/Disease‐Modifying Drugs
Biologic Therapies
Episode of Care
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
15 Medications Used in Children and Young People’s Mental Health
Aim
Learning Outcomes
Introduction
Skills for Practice 1
What Is Psychopharmacology?
Medications. Anxiety Disorders
Anxiolytics
Other Antidepressants Used in the Treatment of Anxiety. Sertraline
Benzodiazepines
Diazepam
Stimulants and Non‐Stimulants
Stimulants
Methylphenidate
Non‐Stimulant Medication
Hypnotic Medication
Melatonin
Box 15.1 Sleep Hygiene Recommendations
Antidepressants
Moderate and Severe Depression in CYP. Selective Serotonin Reuptake Inhibitors (SSRIs)
Absorption
Side Effects of Fluoxetine
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors (MAOI)
Clinical Considerations
Other Antidepressants. Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
Considerations with Antidepressants
Adverse Effects From Antidepressants. Suicidal behaviour
Hyponatraemia
Serotonin Syndrome
Antidepressant Withdrawal
Box 15.2 Antidepressant Discontinuation Symptoms
Antipsychotics
Clinical Consideration
Aripiprazole
Risperidone
Olanzapine (Zyprexa®)
Mood Stabilisers
Sodium Valporate
Skills for Practice 2
Drug Interactions
Teratogenesis
Lithium
Toxicity (Taylor et al., 2019; Goodwin et al., 2016; MHRA, 2018a; NPIS, 2016)
Baseline Monitoring (Taylor et al., 2019; Goodwin, 2016; NICE, 2018)
Ongoing Monitoring (Taylor et al., 2019; Goodwin, 2016)
Discontinuation
Conclusion
Episode of Care
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
16 Medications Used in Children and Young People’s cancer
Aims
Learning Outcomes
Test Your Knowledge
Introduction
Cancer
Cell Cycle
Chemotherapies
Clinical Considerations
Preparations of Chemotherapy
Types of Chemotherapy
Alkylating Drugs
Antimetabolites
Anthracyclines and Other Antibiotics
Vinca Alkaloids
Side Effects of Chemotherapy
Clinical Considerations
Prescription and Administration of Chemotherapy
Drug Resistance
Cyclophosphamide
Episode of Care
Immunotherapies in Treating Cancer. The Immune System
Immunotherapy
The Use of Immunotherapy
Targeted Antibodies
Checkpoint Inhibitors
Bone Marrow and Stem Cell Transplant
Adoptive Cell Transfer (ACT)
Cytokines
Side Effects of Immunotherapy
Clinical Considerations
Episode of Care
Corticosteroid Use in Cancer. Steroids
Using Corticosteroids to Treat Cancer
Side Effects of Corticosteroids
Clinical Considerations
Clinical Considerations
Episode of Care
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
17 Analgesics
Aim
Learning Outcomes
Introduction
Pain Pathways
Definitions and Categories of Pain
Importance of Individualised Pain Assessments
Assessment Tools
Clinical Consideration 1
Multimodal Management Strategies
Clinical Consideration 2
Pharmacological Management
Non‐opioids
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Clinical Consideration 3
Non‐Steroidal Anti‐Inflammatory Drugs (NAIDs)
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Opioid Agonists
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Clinical Consideration 4
Clinical Consideration 5
Codeine Phosphate
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Dihydrocodeine
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Common Side Effects
Tramadol
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Morphine
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Fentanyl
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Adjuvants and Co‐analgesics – Gabapentinoids
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Side Effects
Inhalation Analgesics
Pharmacodynamics and Pharmacokinetics
Contraindications, Cautions and Common Side Effects
Local, Regional and Topical Analgesia
Pharmacodynamics and Pharmacokinetics
Toxicity
Clinical Consideration 6
Skills in Practice
Episode of Care 1
Episode of Care 2
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
18 Antimicrobial Medications
Aims
Learning Outcomes
Test Your Knowledge
Introduction
Microorganisms
Bacteria
Viruses
Fungi
Protozoa
Antimicrobial Medications
Antibacterial Medications
Clinical Consideration
Penicillins
Clinical Consideration
Cephalosporins
Aminoglycosides
Clinical Consideration
Tetracyclines
Macrolides
Fluoroquinolones
Clinical Consideration
Antiviral Medications
Anti‐Herpes Medications
Anti‐Retrovirus Medications
Anti‐Influenza Medications
Non‐Selective Antivirals
Skills in Practice
Antifungal Medications
Azoles
Episode of Care
Polyenes
Echinocandins
Skills in Practice
Antiprotozoal Medications
Antimalarials
Other Antiprotozoal Medications
Antimicrobial Resistance
Antimicrobial Stewardship
Antimicrobial Education for Patients and Their Parents/Carers
Episode of Care
Prescribing Antimicrobials
Conclusion
Glossary
References
Further Resources
Multiple Choice Questions
Find Out More
19 Adverse Drug Reactions
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Clinical Considerations
Adverse Events
Side Effects
Clinical Consideration
Preventing ADRs
Recognising ADRs
Clinical Consideration
Clinical Consideration
Clinical Consideration
ADRs and Immunisations
Episode of Care
Allergic Reactions
Anaphylaxis
Clinical Consideration
Clinical Consideration
Episode of Care
Medicines Safety and Reporting ADRs
Episode of Care
Reporting ADRs via The Yellow Card System
Clinical Consideration
Clinical Consideration
Conclusion
References
Further Resources
Multiple Choice Questions
Answers
Index
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