Оглавление
Группа авторов. Fundamentals of Pharmacology
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Fundamentals of Pharmacology. For Nursing and Healthcare Students
Contributor
Preface
References
Acknowledgements
Prefixes and suffixes
Abbreviations
Chapter 1 Introduction to pharmacology
Aim
Learning outcomes
Test your knowledge
Introduction
Patient assessment
The Code of Conduct
The Nursing and Midwifery Council's Standards of Proficiency
Medicine management and standards
Episode of care: Mental health
Clinical considerations. Managing medicines in care homes
Clinical considerations. Managing medicines for those receiving social care in the community
Clinical considerations. Managing oxygen in care homes
Medicines optimisation
Patient beliefs and medicines
Box 1.1 Reaching a shared decision
Clinical considerations. Medicines management
Conclusion
Glossary
References
Further reading
Multiple choice questions
Chapter 2 How to use pharmaceutical and prescribing reference guides
Aim
Learning outcomes
Test your knowledge
Introduction
Skills in practice
The British National Formulary
Paper copy BNF
How to navigate the BNF
Front matter
Chapters
Box 2.1 Paracetamol sales
Skills in practice
Back matter
Interactions
Borderline substances
Clinical considerations
Cautionary and advisory labels for dispensed medication
Skills in practice
Wound management products and elasticated garments
Emergency care protocols, units, conversions and abbreviations
Online and mobile application BNF
MIMS (Monthly Index of Medical Specialities)
How to use MIMS online
Skills in practice
Clinical considerations
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 considerations
Prescribing Drug Therapy
The evidence base to prescribing: prescribing guidelines
NICE prescribing guidance
Clinical considerations
Scottish Intercollegiate Guidelines Network (SIGN)
Conclusion
References
Further reading
Multiple choice questions
Chapter 3 Legal and ethical issues
Aim
Learning outcomes
Test your knowledge
Introduction
The law
Clinical considerations: The Bolam test
Ethical principles and theories
Clinical considerations
Clinical considerations: Consent to treatment (adults)
Clinical considerations: Consent to treatment – children
Regulatory bodies
Clinical considerations
Research
Skills in practice: How to use medical ethics
Episode of care
Episode of care
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 4 Medicines management and the role of the healthcare provider
Aim
Learning outcomes
Test your knowledge
Introduction
Clinical considerations
Medicines management
Manufacturing, marketing, and procurement and sale
Selection
Clinical considerations
Supply
Clinical considerations
Patient‐specific directions
Prescriptions
Patient group directions
Exemptions
Skills in practice
Prescribing
Handling and administration
Box 4.1 Example of a medicine administration procedure
Clinical considerations
Clinical considerations
Special consideration: Controlled drugs and critical medications
Groups requiring special considerations
Pregnancy and breast‐feeding
Older people
Clinical considerations
Monitoring for side effects
Medicine optimisation
Safety in medicines management
Storage and disposal
Conclusions
References
Further reading
Multiple choice questions
Chapter 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
Concept of drugs crossing the cell membrane
Methods of drugs crossing the cell membrane. Passive transport
Active transport
Enteral
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
An example of the pharmacokinetics of aspirin. Aspirin
Box 5.2 Pharmacokinetics of aspirin
Clinical considerations. Half‐life
Clinical considerations. Steady state
Clinical considerations. Termination of action
Clinical considerations. Therapeutic range
Routes of drug administration
Pharmacodynamics
Agonists and antagonists
Agonist
Antagonists
Clinical considerations. Confidence in the drug
Episode of care: Mental health
Clinical considerations
Drug potency and efficacy
Therapeutic index
Box 5.3 Narrow therapeutic index examples
Box 5.4 An example of the monitoring requirements of aminophylline (NICE, 2020)
Monitoring requirements (Therapeutic Drug Monitoring)
With oral use
Box 5.5 Phenytoin: An example of therapeutic drug monitoring (BNF, 2019b) Ethnicity
Adverse effects
Conclusion
References
Multiple choice questions
Chapter 6 Drug formulations
Aim
Learning objectives
Test your knowledge
Introduction
Tablets
Tablets are available in the following preparations: Dispersible (soluble/effervescent)
Enteric coated/gastro resistant tablets
Modified release tablets (slow release)
Immediate release tablets (IR)
Capsules
Clinical considerations. Medications administered via enteral feeding systems
Chewable
Buccal/sublingual
Oral. Liquid
Topical. Suspension. Eye drops and ointments
Ear drops and ointments
Nasal drops and sprays
Creams and lotions
Clinical considerations. Topical medications
Patches
Rectal. Suppositories
Enemata
Vaginal. Pessaries
Inhalation. Nebulisers
Clinical skills in practice
Equipment
Pre‐procedure actions
Procedure
Inhalers
Injection routes
Clinical skills in practice
Pre‐Procedure Actions
Procedure
Post‐Procedure
Clinical considerations. IV medications
Clinical considerations. Dosage differences across formulations
Episode of care: Surgical high dependency unit (HDU )
Conclusion
Glossary
References
Further reading
Multiple choice questions
Find out more
Chapter 7 Adverse drug reaction
Aim
Learning outcomes
Test your knowledge
Definition – what is an adverse drug reaction
The prevalence of adverse reactions
The ABCDE classification of adverse reactions
A – augmented (common)
B – bizarre (uncommon)
C – chronic (uncommon)
D – delayed effects (uncommon and difficult to detect)
E – end of treatment effect (uncommon)
The signs and symptoms of adverse effects
Clinical considerations. Predisposing factors
Physical signs of an adverse drug reaction may include the following. Acute anaphylaxis
Rashes
Serum Sickness
Renal Disorders
Adverse reaction diagnosis and management
Reporting incidents of adverse drug reactions
Skills in practice: What is pharmacovigilance?
Skills in practice: Completing a yellow card. How to report an ADR
What information is needed to report an ADR using the yellow card scheme?
Episode of care. Mr. Butterfield and Mr. Gent
Conclusion
References
Further reading
Multiple choice questions
Chapter 8 Analgesics
Aim
Learning outcomes
Test your knowledge
Introduction
Pain pathways
Definitions and categories of pain
Importance of individualised pain assessments
Assessment tools
Unidimensional tools
Multidimensional tools
Mnemonics
Clinical considerations. Person‐centred and tailored approach
Multimodal management strategies
Clinical considerations. Non‐pharmacological strategies
Pharmacological management
Non‐opioids
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and side effects
Clinical considerations. The right combination
Non‐steroidal anti‐inflammatories (NSAIDs)
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and side effects
Opioid agonists
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and side effects
Clinical considerations. Opioids and serious head injury
Clinical Considerations
Codeine phosphate
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and side effects
Dihydrocodeine
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and common side effects
Tramadol
Pharmacodynamics and pharmacokinetics
Notable 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
Notable Contraindications, Cautions and Side Effects
Inhalation analgesics
Pharmacodynamics and pharmacokinetics
Notable contraindications, cautions and common side effects
Local and regional anaesthesia
Pharmacodynamics and pharmacokinetics
Toxicity
Clinical considerations
Skills in practice. How to insert a peripheral cannula for the administration of intravenous analgesic medications
Episode of care 1: Regional block
Episode of care 2: Chronic pain
Conclusion
References
Multiple choice questions
Find out more
Chapter 9 Antibacterials
Aim
Learning outcomes
Test your knowledge
Introduction
Language and terminology
Bacteria
Antibacterial mechanisms of action
Disruption of the cell wall synthesis
Folate interference
Bacterial DNA inhibition
Protein synthesis interference
Choosing the right treatment
Antimicrobial resistance
Preventing antimicrobial resistance
Clinical consideration 1
Antimicrobial stewardship (AMS)
Clinical considerations 2. Medication consideration during adulthood
Antibacterials by action
Beta‐lactams
Penicillins
Indications (for all penicillins)
Benzylpenicillin (Penicillin G)
Contraindications and cautions (for all penicillins)
Benzylpenicillin sodium
Adverse effects (for all penicillins)
Benzylpenicillin
Drug–Drug interactions
Nursing actions
Clinical considerations 3. Medication consideration in the older adult
Cephalosporins
Indications (for all cephalosporins)
Cefalexin
Contraindications and cautions (for all cephalosporins)
Cefalexin
Adverse effects (for all cephalosporins)
Cefalexin
Drug–Drug interactions (for all cephalosporins)
Cefalexin
Nursing actions for cephalosporins
Carbapenams
Imipenem
Indications
Contraindications and cautions
Adverse effects (for all carbapenams)
Drug–Drug interactions
Nursing actions
Protein synthesis interference
Tetracyclines
Indications (for all tetracyclines)
Tetracycline
Contraindications and cautions (for all tetracyclines)
Tetracycline
Adverse effects (for all tetracyclines)
Tetracycline
Drug–Drug interactions
Nursing actions
Chloramphenicol
Indications
Skills in practice. Medication: eye administration
Contraindications and cautions
Adverse effects: dependent on route of administration
Drug–Drug interactions
Nursing actions
Skills in practice. Medication: Topical applications
Aminoglycosides
Indications (for all aminoglycosides)
Gentamicin
Contraindications and cautions (for all aminoglycosides)
Gentamicin
Adverse effects (for all aminoglycosides)
Gentamicin
Drug–Drug interactions (for aminoglycosides)
Gentamicin
Nursing actions
Macrolides
Indications
Erythromycin
Contraindications and cautions (for all macrolides)
Erythromycin
Adverse effects (for all macrolides)
Erythromycin
Drug–Drug interactions
Nursing actions
Lincosamides
Indications
Contraindications and cautions
Adverse effects
Drug–Drug interactions
Nursing actions
Episode of care
Episode of care
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 10 Medications used in the cardiovascular system
Aim
Learning outcomes
Test your knowledge
Introduction
Medications used in the management of cardiovascular diseases
Atheroma and the hyperlipidaemias
Medications used to regulate lipids: Antihyperlipidaemic medications
Statins: HMG‐CoA reductase inhibitors. Atorvastatin, Simvastatin, Rosuvastatin, Fluvastatin, Pravastatin
Clinical considerations for statins
Inhibitors of cholesterol absorption. Ezetimibe
Fibrates. Fenofibrate, Gemfibrozil
Clinical Considerations for Fibrates
Bile‐acid‐binding resins: Cholesterol absorption inhibitors. Cholestyramine, Colesevelam Hydrochloride
Clinical considerations. Bile‐acid‐binding resins
PCSK9 inhibitors. Alirocumab
Alternatives to statins. Nicotinic acid: Vitamin B3. Niacin
Omega‐3 Fatty Acids. Fish Oil
Medications used in management of hypertension
Skills in practice. A case of ‘white coat syndrome’
Recommendations
Medications used to manage hypertension
Angiotensin‐converting enzyme inhibitors (ACEi) Lisinopril, Enalapril, Captopril, Ramipril, Perindopril
Clinical considerations for ACEi
Calcium channel blockers (CCBs) Amlodipine, Felodipine, Nifedipine, Nicardipine Diltiazem and Verapamil
Clinical considerations for CCBs
Diuretics
Loop diuretics. Furosemide, Bumetanide
Thiazide diuretics. Hydrochlorothiazide, Chlortalidone, Indapamide
Clinical considerations for thiazides
Potassium‐sparing diuretics
Angiotensin receptor blockers (ARBs) Losartan, Candersartan, Irbesartan, Olemesartan, Valsartan
Clinical considerations for ARBs
Beta‐adrenoceptor antagonists (beta‐blockers)
Clinical considerations for beta‐blockers
Alpha‐adrenergic blockers: Alpha blockers. Prazosin, Doxazosin, Terazocin, Indoramin
Clinical considerations with ARBs
Vasodilators. Hydralazine, Minoxidil
Central acting agents. Clonidine, Methyldopa
Direct renin inhibitors (DRIs) Aliskiren
Episode of care
Medications used in managing ischaemic heart disease
Skills in practice
Using the PQRST pain assessment approach for angina
Glyceryl trinitrate (GTN)
Contraindications for nitrates (JFC, 2020)
Sublingual tablets
Safe storage and care of medication for patients taking sublingual GTN tablets
Metered aerosol GTN spray
Transdermal patches of GTN
Clinical considerations. GTN transdermal patches
GTN ointment
Parenteral (intravenous) GTN
Isosorbide dinitrate and isosorbide mononitrate
Potassium channel activators. Nicorandil
Medications used for cardiac arrhythmias
Disorders of heart rhythm and rate
Atrial fibrillation (AF)
Amiodarone
Clinical considerations. Amiodarone
Digoxin
Clinical considerations. Digoxin
Magnesium sulphate
Arrhythmias due to conduction defects
Atropine sulphate
Common side effects of atropine
Medications used in the management of heart failure
Medications used in heart failure
Controlling Excessive Fluid
Mineralocorticoid receptors antagonist (MRAs) Spironolactone, Eplerenone
Reducing the workload of the heart
Hyperpolarisation‐activated cyclic nucleotide‐gated (HCN) channel blockers. Ivabradine
Clinical considerations. Ivabradine
Angiotensin receptor neprilysin inhibitors. Sacubitril
Optimising contractility of the heart
Medications that affect haemostasis
Antiplatelet medications. Aspirin
Clinical considerations. Aspirin
Clopidogrel, Prasugrel and Ticagrelor
Dipyridamole
Glycoprotein 11b/111a inhibitors. Abciximab, Eptifibatide, Tirofiban
Overall clinical considerations for antiplatelet medications:
Anticoagulants
Heparin
Low molecular weight fragments of heparin (LMWH) Fondaparin, Tinzaparin, Dalterapin, Enoxaparin
Vitamin K inhibitors. Warfarin
Clinical considerations. Warfarin
Direct‐acting oral anticoagulants (DOACs) Dabigatran, Rivaroxaban, Apixaban, Edoxaban
The thrombolytics
First generation: Streptokinase
Second generation: Tissue plasminogen activator (tPA) Alteplase, Reteplase, Tenecteplase
Medications used in peripheral vascular disease. Phosphodiesterase inhibitors. Cilostazol
Medications used in cardiac arrest. Oxygen, Adrenaline, Amiodarone
Oxygen
Adrenaline
Amiodarone
Pharmacological interventions: The future
Conclusion
References
Further reading
Multiple choice questions
Chapter 11 Medications and the renal system
Aim
Learning Outcomes
Test your knowledge
Introduction
Anatomy and physiology of the renal tract
Common renal conditions
Skills in practice. Urinalysis: reagent strip procedure
How to perform urinalysis using reagent strips:
Acute kidney injury (AKI)
Chronic kidney disease (CKD)
Diabetic nephropathy
Electrolyte disorders
Urinary retention and incontinence
Clinical considerations. Estimating the glomerular filtration rate
Drug‐induced renal damage
Drug classes that act upon the renal system. Overview
Drugs used to treat fluid retention. Overview
Loop diuretics
Clinical considerations. Monitoring
Ototoxicity
Thiazide diuretics
Osmotic diuretics
Potassium‐sparing diuretics and aldosterone‐antagonists
Carbonic‐anhydrase inhibitors
Clinical considerations. Hyperkalaemia and spironolactone
Drugs used to treat electrolyte disorders
Phosphate binders, calcium supplements and vitamin D supplements
Potassium binders and supplements
Bicarbonate supplements
Drugs used to treat urinary retention and urinary incontinence
α1 receptor antagonists
Clinical considerations
Androgen‐synthesis inhibitors
Antimuscarinics
Drugs and dialysis
Skills in practice. Estimating glomerular filtration rate and adjusting drug dosages
Episode of care: Diabetic nephropathy. Mrs. Dixon
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 12 Medications and diabetes mellitus
Aim
Learning outcomes
Test Your Knowledge
Introduction
HbA1c
Blood glucose measurements
Box 12.1 Normal blood glucose levels for the majority of healthy people
Diagnosis and signs and symptoms. Type 1 diabetes
Type 2 diabetes
Being at risk
Importance of glycaemic control
Box 12.2 HbA1c levels used to detect diabetes
Individual assessment
Treatment guidelines
Types of antidiabetes medications
Treatment approaches in type 2 diabetes
Oral medications. Biguanides (Metformin)
Clinical consideration
Other second‐line treatment choices
HbA1c target aims
Clinical consideration
Self‐blood glucose monitoring in type 2 diabetes
Skills in practice
Insulin
The right insulin
The right dose
Clinical considerations
Clinical considerations
The right way
Clinical consideration. Disposal of sharps
The right time
Flash glucose testing
Hypoglycaemia
Clinical considerations. Treatment of hypoglycaemia
Glucagon
Sick day advice
Box 12.3 Blood ketone test results with people with type 1 diabetes
Episode of care: Type 2 diabetes. Mrs. Singh
Episode of care: Type 1 diabetes. Matt Jennings
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 13 Medications and the respiratory system
Aim
Learning outcomes
Test your knowledge
Introduction
Anatomy and physiology of the respiratory tract
Common respiratory conditions
Asthma
Skills in practice
Chronic obstructive pulmonary disease (COPD)
Bronchiectasis
Cystic fibrosis
Classes of respiratory drugs. Overview
Oxygen therapy
Bronchodilators
β2 adrenoceptor agonists
Short acting β2 adrenoceptor agonists (SABA)
Clinical considerations. Oxygen safety
Long acting β2 adrenoceptor agonists (LABA)
Muscarinic receptor antagonists
Short acting muscarinic antagonists (SAMA)
Long acting muscarinic antagonists (LAMA)
Xanthines
Corticosteroids
Clinical considerations
Skills in practice
Immune modulators
Skills in practice
Mast cell stabilisers
Clinical considerations
Adrenal suppression
Infections
Chickenpox
Measles
Psychiatric reactions
Leukotriene receptor antagonists
Mucolytics
Clinical considerations
Episode of care (Asthma) Mr. Wójcik
Supported self‐management
Monitoring
Non‐pharmacological management
Pharmacological management
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 14 Medications and the gastrointestinal system
Aim
Learning outcomes
Test your knowledge
Introduction
Gastroesophageal reflux disease
Clinical considerations. Initial non‐pharmacological management of dyspepsia
Clinical considerations. Specific adverse reactions to PPIs
Peptic ulcer disease
Clinical considerations. Testing for H. pylori
Clinical considerations. Compliance with eradication therapy
Episode of care: Peptic ulcer disease
Nausea and vomiting
Clinical considerations. Anti‐emetic prescriptions
Gut motility and defaecation
Constipation
The assessment of constipation should include
Medications used in constipation
Bulk laxatives
Emollients and faecal softeners
Saline laxatives
Peripheral opioid antagonists
Non‐pharmacological treatment of constipation
The neglect of the call to stool
Episode of care: Constipation
Skills in practice: How to administer a phosphate enema. Preparation and equipment
Procedure
Diarrhoea
Determine the onset, duration, frequency and severity of symptoms
Drugs used in the treatment of diarrhoea
Loperamide
Inflammatory bowel disease
Ulcerative colitis
Crohn's disease
Glucocorticoid
Aminosalicylates
Immunosuppression
Infliximab and adalimumab
Clinical considerations
Conclusion
References
Further reading
Multiple choice questions
Find out more
Chapter 15 Medications used in cancer
Aims
Learning Outcomes
Test Your Knowledge
Introduction
Cancer
Cell cycle
Chemotherapies
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
Episode of care. Jasmine
Drug resistance
Cyclophosphamide
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. Oluchi
Corticosteroid use in cancer. Steroids
Using corticosteroids to treat cancer
Side effects of Corticosteroids
Clinical considerations
Clinical considerations
Conclusion
Episode of care. Alex
Glossary
References
Further reading
Multiple choice questions
Find out more
Chapter 16 Medications and the nervous system
Aim
Learning Outcomes
Test your knowledge
Introduction
Epilepsy
Carbamazepine
Sodium valproate
Lamotrigine
Levetiracetam
Gabapentin
Clinical considerations. Branded and generic drugs
Clinical considerations. Medication concordance
Status epilepticus
Clinical considerations. Epilepsy and driving
Episode of care
Parkinson's disease
Dopamine replacement drugs
Dopamine agonists
Monoamine‐oxidase inhibitors (MAOI)
Anticholinergics
Catechol‐O‐methyltransferase (COMT) inhibitors
Amantadine
Clinical considerations. PD medication and impulse disorders
Clinical considerations. Deep brain stimulation
Episode of care
Clinical considerations. Timing of drugs
Strokes
Clinical considerations. FAST
Clinical considerations. Trans‐ischaemic attack (TIA)
Thrombolytic (clot busting) therapy
Antiplatelets
Oral anticoagulants
Antihypertensives
Statins
Episode of care
Multiple sclerosis
Corticosteroids
Disease‐modifying drugs
Symptom management
Episode of care
Conclusion
References
Further reading
Multiple choice questions
Chapter 17 Medications used in mental health
Aim
Learning Outcomes
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOI)
Clinical considerations. Dietary restrictions while taking MAOIs
Clinical considerations
Other antidepressants. Serotonin and noradrenaline reuptake inhibitors (SNRIs)
Mirtazapine
Vortioxetine
Agomelatine
Considerations with antidepressants
Adverse effects. Suicidal behaviour
Hyponatremia
Serotonin syndrome
Antidepressant withdrawal
Antipsychotics
Aripiprazole
Parenteral formulations
Clozapine
Clinical considerations
Initiation
Treatment breaks and reiteration
Adverse effects. Agranulocytosis and blood dyscrasias
Skills in practice
Constipation
Sedation
Weight gain
Hypersalivation
Interactions
High‐dose antipsychotic therapy
Physical health monitoring
Mood stabilisers. Lithium
Unipolar depression
Formulations
Therapeutic drug monitoring (TDM)
Side effects
Toxicity
Drug interactions
Physical health monitoring. Baseline monitoring
Ongoing monitoring
Discontinuation
Anticonvulsants. Valproate
Formulations
Side effects
Pharmacokinetics
Drug interactions
Teratogenesis
Discontinuation
Other anticonvulsant medicines. Carbamazepine
Lamotrigine
Clinical considerations
Anxiolytics and hypnotics
Benzodiazepines
Withdrawal
Place in therapy
Pregabalin
Adverse effects
Interactions
Risk of misuse and dependence
Hypnotics
Benzodiazepines
Z‐Drugs
Melatonin
Cautions
Drugs for dementia
Acetylcholinesterase inhibitors
Glutamate inhibitors
References
Further reading
Multiple choice questions
Find out more
Chapter 18 Immunisations
Aim
Learning Outcomes
Test Your Knowledge
Introduction
Ethics
Immunity
How vaccines work
The Green Book
Clinical considerations. Consent
Storage
Clinical considerations
The cold chain
Clinical considerations
Contraindications
Anaphylaxis
Patient group direction/patient specific direction
Skills in practice. Immunisation procedures
How to administer an immunisation
Episode of care
Episode of care
Conclusion
References
Further reading
Multiple choice questions
Find out more
Normal Values
Answers
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Index
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