Text Book of Pharmacology, Pathology and Genetics for Nurses

1. Introduction to Pharmacology 5
Puneet Dhamija, Suresh K Sharma
• Introduction 5
• Terms and Definitions 5
• Sources of Drugs 6
• Systems of Measurement 7
• Calculations of Doses 9
• Forms of Drugs 9
• Routes of Drug Administration 10
• Pharmacokinetics 14
• Pharmacodynamics 17
• Indian Pharmacopeia (IP) 21
• Drug Laws 21
• Schedules of Drugs 22
• Rational Use of Drugs 23
2. Chemotherapy 25
Parul Saini, Manisha Bisht, Suresh K Sharma
• Introduction 25
• Classification of Antimicrobials 25
• Characteristics of Ideal Antimicrobial Drug 27
• Basic Pharmacodynamics of Antimicrobial Drugs 27
• Antimicrobial Drug Interactions and Drug Combination 29
• Bacterial Susceptibility and Sensitivity to Antibiotics 30
• Antimicrobial Resistance 30
• Types of Antimicrobial Therapy 31
• Factors Affecting Antimicrobial Selection 32
• Rational use of Drug/Principle of Antimicrobial Therapy 35
• Problems that Arise with the use of Antimicrobials 36
• Causes for Failure of Chemotherapy 36
• Superinfection 37
• Chemoprophylaxis 37
• Probiotics 38
xviii Textbook of Pharmacology, Pathology and Genetics for Nurses
• General Nursing Implications while using Antimicrobials 38
• Beta-Lactams and b-Lactam Related Agents 39
• Sulfonamides 54
• Quinolones 58
• Tetracycline 61
• Chloramphenicol 64
• Aminoglycoside 66
• Macrolide Antibiotics 69
• Glycopeptide Antibiotic: Vancomycin 71
• Oxazolidinone 73
• Lincosamide Antibiotic: Clindamycin 75
• Polypeptides 76
• Urinary Antiseptics 78
• Antimalarial Drugs 79
• Antihelminthic Drugs 84
• Antiscabies Agents 87
• Antiviral Drugs 89
• Antifungal Drugs 98
• Antituberculosis Drugs 103
• Antileprosy Drugs 112
• Anticancer Drugs 116
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
3. Antiseptics, Disinfectants and Insecticides 123
Vasantha Kalyani, Ashi Chug, Suresh K Sharma
• Introduction 123
• Antiseptics and Disinfectants 123
• Commonly used Antiseptics And Disinfectants 127
• Phenol and Others 130
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
4. Drugs Acing on Gastrointestinal System 132
Shaina Sharma, Ravi Kant, Suresh K Sharma
• Antacids 132
• Histamine Type 2 (H2
) Antagonists 134
• Proton Pump Inhibitors 137
• Mucosal Protective Agents 139
• Prostaglandin Analog 141
Contents xix
• Anticholinergics/Antimuscarinic 142
• Antimicrobial Agents (Anti-Helicobacter Pylori Drugs) 143
• Emetics 145
• Antiemetics 146
• Antidiarrheal Drugs 150
• Newer Strategies to Control Diarrhea 155
• Purgatives 156
• Fluids and Electrolytes 159
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
5. Drugs used on Respiratory System 161
Parul Saini, Suresh K Sharma, Mayank Mishra, Subodh Kumar
• Antiasthmatics 161
• Bronchodilators 161
• Mast Cell Stabilizers 170
• Leukotriene Antagonists 172
• Corticosteroids 174
• Anti-Ige Antibody 179
• Mucolytics 180
• Nasal Decongestants 186
• Expectorant 188
• Antitussives 190
• Bronchoconstrictors 196
• Antihistamines 200
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
6. Drugs used on Urinary System 206
Farhanul Huda, Suresh K Sharma
• Diuretics 206
• Antidiuretics 213
• Urinary Antiseptics 218
• Acidifiers 220
• Alkalinizers 223
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
7. Miscellaneous Drugs 227
Vasantha Kalyani, Suresh K Sharma
• Drugs used in De-Addiction 227
• Drugs used in Emergencies 228
xx Textbook of Pharmacology, Pathology and Genetics for Nurses
• Vitamins 231
• Minerals 235
• Immunosuppressants 237
• Immunestimulants 239
• Vaccines and Sera 240
• Management of Common Poisoning 243
• Treatment of Snake Bite 248
• Food Poisoning 249
Vaccines and Sera (Immunization Schedules, General Principles of Treatment of
Poisoning, Antidotes, Treatment of Snake Bite Poisoning and Antivenom)
8. Drugs used on Skin and Mucous Membranes 252
Jagdeesh Goyal, Suresh K Sharma
• Emollients 252
• Demulcents 252
• Adsorbants and Protectives 252
• Caustics and Escharotics 252
• Astringents 253
• Counter-Irritants 253
• Keratolytics 253
• Antiseborrheics 253
• Melanizing Agents 253
• Drugs for Acnevulgaris 254
• Nursing Responsibilities 255
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
9. Drugs Acting on Nervous System 256
Raj Kumar, Suresh K Sharma, Rajneesh Arora, Poonam Arora
• Non-Steroidal Anti-Inflammatory Drugs and Anti Pyretic–Analgesics 256
• Non-Selective Cox Inhibitors 257
• Preferential Cox-2 Inhibitors 260
• Selective Cox Inhibitors 261
• Analgesic-Antipyretics with Poor Anti-Inflammatory Action 261
• Opioid Analgesics 262
• Sedative-Hypnotics 265
• Anesthesia 268
• General Anesthesia 268
• Local Anesthetics 273
• Cholinergic Drugs 277
Contents xxi
• Indirect Acting Cholinergic Drugs 277
• Guanidine 281
• Cholinergic Drugs used in Gi System and Urinary System 282
• Anticholinergics 283
• Natural Alkaloids 286
• Semisynthetic Alkaloids 287
• Synthetic Alkaloids 288
• Muscle Relaxants 290
• Peripherally Acting Muscle Relaxants 290
• Centrally Acting Muscle Relaxants 297
• Antipsychotics 299
• Antidepressants 307
• Antianxiety Drugs 313
• Anticonvulsants 320
• Adrenergic Drugs 326
• Nasal Decongestants 329
• Bronchodilator 330
• Smooth Muscle Relaxants 331
• Cns Stimulants 331
• Mood Stabilizers 332
• Stimulants 336
• Antiparkinsoniam Drugs 358
Composition, Action, Dosage, Route, Indications, Contraindications, Drug
Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
10. Cardiovascular Drugs 362
Anshuman Darbari, Maneesh Sharma, Suresh K Sharma
• Haematinics 362
• Iron 362
• Vitamin B12 369
• Folic Acid 372
• Cardiac Glycosides 374
• Drugs used in Angina Pectoris 378
• Antiarrhythmic Drugs 383
• Antihypertensive Drugs 392
• Diuretics 393
• Calcium Channel Blockers 399
• Sympatholytic Drugs 401
xxii Textbook of Pharmacology, Pathology and Genetics for Nurses
• Ace Inhibitors 412
• Angiotensin–II Antagonist 414
• Renin Inhibitors 416
• Vasodilators 416
• Nitrates 421
• Coagulants 425
• Anticoagulants 427
• Hypolipidemics 436
• Antiplatelets 440
• Thrombolytic (Fibrinolytics) 448
• Plasma Expanders 452
Composition, Action, Dosage, Route, Indications, Contraindications,
Drug Interactions, Side Effects, Adverse Effects Toxicity and Role of Nurse
11. Drugs used for Hormonal, Disorders and Supplementation,
Contraception and Medical Termination of Pregnancy 460
Prasuna Jelly, Suresh K Sharma
• Hormone 460
• Hypoglycemic Agents 462
• Insulin 463
• Oral Hypoglycemic Agents 471
• Thyroid Drugs 478
• Thyroid Inhibitors 480
• Steroids 483
• Adrenal Steroid Inhibitor 490
• Anabolic Steroids 491
• Uterine Stimulants and Relaxants 493
• Oxytocin 493
• Ergot Derivatives 496
• Prostaglandins 498
• Uterine Relaxants (Tocolytics) 501
• Magnesium Sulfate 503
• Hormonal Contraceptives 503
• Estrogen and Progestrone 510
• Gonadotropins 519
• Adrenocorticotropic Hormone (Acth), Corticotropin 522
• Calcium Salts and Regulators 526
• Vitamin D 530
Contents xxiii
• Calcitonin 534
• Bisphosphonates 536
Composition, Actions Dosage Route Indications Contraindications, Drugs
Interactions, Side Effects, Adverse, Effects, Adverse Effects, Toxicity and
Role of Nurse
12. Introduction to Drugs used in Alternative Systems of Medicine 540
Raj Kumar, Suresh K Sharma
• Introduction 540
• Ayurveda 540
• Siddha System 542
• Homeopathy 544
• Unani System 545
• Yoga 546
• Naturopathy 547
• Department of Ayush under the Ministry of Health and Family Welfare 547
Volume 2: PATHOLOGY and GENETICS
Division A: Pathology
Section 1: General Pathology
13. Introduction to Pathology 555
Neha Singh, Suresh K Sharma
• Introduction 555
• Definition of Pathology 555
• Basic Terminologies in Pathology 555
• Subdivisions of Pathology 556
• Importance of Pathology in the Nursing Curriculum 557
14. Methods and Techniques in Pathology 560
Neha Singh, Suresh K Sharma
• Histopathology (Surgical Pathology) 560
• Autopsy Pathology 563
• Microscopy 563
• Immunofluorescence 565
• Immunohistochemistry 565
• Cytogenetics 565
• Molecular Pathology 566
• Flow Cytometry 566
xxiv Textbook of Pharmacology, Pathology and Genetics for Nurses
15. Cellular and tissue Changes 567
Neha Singh, Suresh K Sharma
• Introduction 567
• Cellular Adaptation 568
16. Cell injury, Cell Dealth, Regeneration and Healing 573
Neha Singh, Suresh K Sharma
• Cell Injury 573
• I. Autolysis 576
• II. Necrosis 576
• Gangrene 579
• Pathological Calcification 580
• Intracellular Accumulations/Infiltration 580
17. Inflammation 583
Neha Singh, Suresh K Sharma
• Introduction 583
• Acute Inflammation 583
• Chronic Inflammation 587
18. Regeneration and wound healing 590
Neha Singh, Suresh K Sharma
• Regeneration 590
• Wound Healing 591
19. Infectious diseases 595
Neha Singh, Suresh K Sharma
• Introduction 595
• Techniques for Diagnosing Infectious Agents 595
• Routes of Infection 596
• Categories of Common Infectious Agents 596
20. Cellular Growth and Neoplasm 599
Neha Singh, Suresh K Sharma
• Introduction 599
• Neoplasms 599
• Carcinoma In Situ 599
• Nomenclature 600
• Characteristics of Benign and Malignant Tumors 600
• Normal Cells and Cancer Cells 602
• Metastasis 602
Contents xxv
• Factors Predisposing to Development of Neoplasia 603
• Carcinogenic Agents 604
• Signs and Symptoms of Neoplasms 605
• Laboratory Diagnosis 606
21. Fluid and electrolyte disturbance 608
Neha Singh, Suresh K Sharma
• Homeostasis 608
• Disturbances in Fluid Balance 609
• Disturbances in Electrolyte Balance 611
• Abnormalities in PH of Blood 612
22. Disorders of immune System 614
Neha Singh, Suresh K Sharma
• Introduction 614
• Types of Immunity 614
• Components of Immune Response 614
• Disorders of Immune System 614
• Hypersensitivity Reactions 615
• Autoimmune Diseases 616
• Immunodeficiency Disorders 616
Section 2: Systemic Pathology
23. Respiratory system 618
Neena Sood, Suresh K Sharma
• Tuberculosis 618
• Pleural Effusion 620
• Pneumonia 623
• Lung Abscess 627
• Chronic Obstructive Pulmonary Disease 629
• Tumors of Lungs 636
24. Cardiovascular system 640
Neena Sood, Suresh K Sharma
• Pericardial Effusion 640
• Rheumatic Heart Disease 641
• Endocarditis 644
• Atherosclerosis 646
• Infarction 650
• Aneurysm 651
xxvi Textbook of Pharmacology, Pathology and Genetics for Nurses
25. Gastrointestinal System 657
Ram Nawal Rao, Suresh K Sharma
• Peptic Ulcer Disease 657
• Typhoid Fever or Enteric Fever 660
• Carcinoma of Gastrointestinal Tract 662
• Buccal Carcinoma 662
• Esophageal Carcinoma 663
• Tumors of Stomach 665
• Tumors of Small and Large Intestine 669
26. Liver, Gallbladder and Pancreas 676
Ram Nawal Rao, Suresh K Sharma
• Hepatitis 676
• Chronic Liver Abscess 680
• Cirrhosis 681
• Tumors of Liver 686
• Carcinoma of Gallbladder 688
• Tumors of Pancreas 689
• Cholecystitis 690
27. Kidney and urinary system 694
Aminder Singh, Suresh K Sharma
• Glomerulonephritis 694
• Secondary Glomerular Disease 699
• Pyelonephritis 701
• Urinary Calculi 704
• Renal Failure 706
• Tumors of Kidney 708
• Cystitis 711
28. Male reproductive system 715
Aminder Singh, Suresh K Sharma
• Cryptorchidism 715
• Testicular Atrophy 717
• Prostatic Hyperplasia 717
• Carcinoma of Penis 720
• Carcinoma of Prostate 721
29. Female reproductive system 723
Neena Sood, Suresh K Sharma
• Fibroids (Uterine Leiomyomas) 723
Contents xxvii
• Carcinoma Cervix 725
• Endometrial Cancer 726
• Vesicular Mole (Hydatidiform Mole) 728
• Choriocarcinoma 729
• Ectopic Gestation 730
• Ovarian Cysts 732
• Ovarian Cancer 733
• Breast Cancer 738
30. Central Nervous system 742
Neena Sood, Suresh K Sharma
• Hydrocephalus 742
• Meningitis 743
• Encephalitis 745
• Thrombosis 746
• Embolism 748
• Stroke 749
• Paraplagia 755
• Quadriplegia 756
• Cns Tumors 757
• Metastatic Tumors 759
31. Skeletal system 762
Aminder Singh, Suresh K Sharma
• Bones 762
• Osteoporosis 763
• Osteomyelitis 765
• Osteoarthritis 767
• Bone Tumors 769
Section 3: Clinical Pathology
32. Blood and bone marrow tests 774
Rajeev Goyal, Monil Singhai, Suresh K Sharma
• Blood Tests 774
• Hemoglobin 774
• Blood Cell Counts 776
• Hemogram 776
• Bleeding Time, Clotting Time and Prothrombin Time 781
xxviii Textbook of Pharmacology, Pathology and Genetics for Nurses
• Blood Grouping and Crossmatching 782
• Blood Biochemistry 784
• Blood Gases 785
• Disturbance in Acid-Base Balance 785
• Blood Culture 786
• Bone Marrow Examination 787
• Serological and Immunological Tests and Other Blood Tests 787
• Specimen Collection for Laboratory Analysis 790
33. Body cavity fluids, transudates and exudates tests 793
Neena Sood, Suresh K Sharma
• Cerebrospinal Fluid Analysis 793
• Examination of Sputum 795
• Analysis of Gastric Constituents 797
• Analysis of Duodenal Contents 798
• Analysis of Peritoneal Fluid 799
• Analysis of Pericardial Fluid 800
• Analysis of Semen 802
• Transudates and Exudates 804
34. Urine and Feces Analysis 806
Gagandeep Singh, Suresh K Sharma
• Urine Examination 806
• Fecal Examination 809
Division B: Genetics
35. Introduction to Genetics 817
Suresh K Sharma, Sohinder Kaur
• Introduction 817
• Concept of Genetics 817
• Basic Genetic Terms 818
• Practical Applications of Genetics in Nursing 819
• Impact of Genetic Conditions on Families 823
• Review of Cellular Division 827
• Genes 841
• Protein Biosynthesis 849
• Genetic Code 851
• Naming Genes 853
Contents xxix
• Chromosome 853
• Chromosomal Aberrations Chromosomal Mutation 857
• Mechanism of Inheritance 860
• Laws of Inheritance 861
• Autosomal Dominant 863
• Autosomal Recessive 865
• Sex-Linked Inheritance 867
• Codominant Pattern of Inheretance 872
• Mitochondrial Pattern of Inheritance 873
• Multifactororial Pattern of Inheritance 874
• Facts About Transmission of Genetic Disorders 874
• Multiple Allots and Blood Groups 876
• Gene Mutation (Errors of Transmission) 879
• Reduced Penetrance and Variable Expressivity 886
• Anticipation 886
36. Emerging Paradigm of Genetics in Nursing 889
Suresh K Sharma
• Ntroduction 889
• Genetic Nursing Practice Milestones 890
• Roles of Nurses in Genetics 891
• Importance of Genetics in Nursing Curriculum 891
• Barriers and Approaches for Implementation of Genetics in Nursing 893
• Assumptions Regarding Genetics and Health Care in Future 894
37. Maternal and Prenatal Genetics 897
Suresh K Sharma, Vandana Mehta
• Introduction 897
• Genetics and Infection 897
• Consanguinity Atopy 901
• Prenatal Nutrition and Food Allergies 904
• Role of Prenatal Nutrition in Prevention of Genetic Disorders 907
• Maternal Age 908
• Maternal Drug Therapy 911
• Effects of Radiation, Drugs and Chemicals 916
• Prenatal Testing and Diagnosis 924
• Non-Invasive Tests 926
• Invasive Tests 928
xxx Textbook of Pharmacology, Pathology and Genetics for Nurses
• Preimplantation Prenatal Diagnosis 936
• Infertility 938
• Spontaneous Abortions 946
• Neural Tube Defects (Ntd) 949
• Down Syndrome 956
38. Neonatal and Children Testing or Screening 964
Suresh K Sharma, Jyoti Arora
• Introduction 964
• Meaning and Purpose 964
• Newborn Screening 965
• Genetic Testing and Screening in Children 967
• Congenital Abnormalities 971
• Developmental Delay 973
• Dysmorphism 977
• Role of Nurses in Genetic Testing for Neonates and Children 978
39. Genetic Conditions of Adolescents and Adults 980
Suresh K Sharma, Kumar Satish Ravi
• Genetic Statistics 980
• Naming Genetic Conditions 980
• Common Genetic Conditions Discussed in Chapter 981
• Cancer Genetics: Familial Cancer 981
• Inborn Errors of Metabolism 984
• Phenylketonuria 987
• Maple Syrup Urine Disease 988
• Gaucher’ Disease 989
• Blood Group Alleles and Hematological Disorders 991
• Genetic Hemochromatosis 1008
• Huntington’s Disease 1011
• Mental Illness 1014
• Therapeutic Approaches for Genetic Disorders 1016
• Nursing Management in Genetic Disorders 1018
40. Services Related to Genetics 1028
Suresh K Sharma, Mohd Salahuddin Ansari
• Introduction 1028
• Genetic Testing 1028
• Human Genome Project 1036
Contents xxxi
• The Genomic Era 1040
• Gene Therapy 1043
• Eugenic Movement 1049
• Genetic Counseling 1050
• Pharmacogenomics 1053
Glossary 1055
• Terms Related to Pathology 1055
• Terms Related to Genetics 1063
Index