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NURSING
PHARMACOLOGY

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COURSE DESCRIPTION
This course deals with pharmacodynamics, pharmacokinetics, clinical/
therapeutic uses of drugs. Emphasis is given on how a drug works to anticipate
when giving a drug to a patient are of paramount importance since nursing
responsibilities include administering drugs, assessing drug effects, intervening
to make a drug more tolerable, and providing teaching about drugs and drug
regimen.

GENERAL OBJECTIVE
At the end of the semester, the students should be able to gain clearer
understanding on the different theories, concepts, history/evolution of
pharmacology and its various branches, evaluation of medication prescriptions,
application of the nursing process in drug administration and comprehensive
client teaching in the use of the medications.

SPECIFIC OBJECTIVES
1. Describe the scope of the science of pharmacology and its
various fields and branches.
2. Identify drug sources and the properties of each drug form.
3. Compare and contrast traditional drugs, biologics and alternative
therapies.
4. Describe the role of nurses and responsibilities in drug
administration.
5. Apply the steps of the nursing process in medication
administration and in client teaching.
6. Interpret and evaluate medication prescription and orders
accurately.
7. Calculate safe dosages for individual clients.
8. Characterize assessment data that is pertinent to medication
administration.
9. Discuss the appropriate nursing interventions in the
administration of different types of medicines.
10. Evaluate the major adverse effects associated with the use of
different drugs.

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DIRECTIONS/MODULE ORGANIZER
1. Read the lesson and as you do, you may have with you any of
thereference books to help you understand the topics which need further
explanation.
2. Complete the modules including the learning activities and
evaluationindicated at the end of each lesson.

COURSE CONTENT

MODULE I INTRODUCTION TO NURSING

PHARMACOLOGY
Definition of Pharmacology and
LESSON 1 Drugs
LESSON 2 Sources and Uses of Drugs
LESSON 3 Forms and Preparations of Drugs
MODULE II THE NURSING PROCESS AND
DRUG ADMINISTRATION

LESSON 1 Principles of Drug Administration

LESSON 2 Phases of Drug Action
LESSON 3 Dosage and Calculations

MODULE III DRUGS AFFECTING DIFFERENT

SYSTEMS OF THE BODY
Drugs Acting on the Cardiovascular
LESSON 1 System
LESSON 2 Drugs Acting on the PNS and CNS
System
LESSON 3 Drugs Acting on the Endocrine System
LESSON 4 Drugs to Control Infection
LESSON 5 Drugs Acting on the Renal System
LESSON 6 Drugs Acting on the Respiratory System
LESSON 7 Drugs Acting on the GIT System

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REFERENCES COURSE TEXTBOOKS

1. Karch, A. (2013). Focus on Nursing Pharmacology 6th edition. China.
Wolters Kluwer Health, Lippincott Williams & Wilkins.

SUGGESTED READINGS AND REFERENCES

1. Berman, A., Frandsen, G., Berman, Au. (2015) Kozier & Erb's
Fundamentals of Nursing Concepts, Process and Practice 10th Edition.
Pearson.
2. Boyer, M. (2013) Math for Nurses: A Pocket Guide to Dosage Calculation
andDrug Preparation 8th Edition. China. Wolters Kluwer Lippincott Williams
and Wilkins.
3. Kee, J., LeFever, H. (2015). Pharmacology: A Patient Centered Nursing
Process 8th edition.Canada. Elsevier Saunders.
4. Spratto, G., Woods, A. (2010) PDR Nurse's Drug Handbook: The
Information

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MODULE 1:
INTRODUCTION TO
NURSING PHARMACOLOGY

LESSON 1 Definition of Pharmacology and Drugs

LESSON 2 Sources and Uses of Drugs
LESSON 3 Forms and Preparation of Drugs

INTRODUCTION TO NURSING PHARMACOLOGY

INTRODUCTION

The human body works through a complicated series of chemical

reactions and processes. Drugs are chemicals that are introduced into the body
to cause some sort of change. When drugs are administered, the body begins a
sequence of processes designed to handle the new chemicals. These processes
which involve breaking down and eliminating the drugs, in turn affect the body’s
complex series of chemical reactions. These approaches facilitate nurses and
provide the pharmacological basis for understanding drug therapy for patients.
The physiology of a body system and the related actions of many drugs on that
system are presented in a way that allows a clear understanding of how drugs
work and what to anticipate when giving a particular type of drug. Thousands of
drugs are available for use, and this module addresses general drug information
which the nurse may utilize in providing patient care.

OBJECTIVES
After finishing this module, the students shall be able to:
1. Describe the scope of the science of pharmacology.
2. Identify drug sources and provide an example of each.
3. Identify the properties of each of the following dosage forms.
4. Compare and contrast traditional drugs, biologics and alternativetherapies.
5. Identify the advantages and disadvantages of the type of prescription.

DIRECTIONS/MODULE ORGANIZER
1. Read lessons and as you do, you may have with you any of the reference books
to help you understand topics which need further explanation.
2. Answer the evaluation activities at the end of the lessons.

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3. Consult or ask questions to a nursing instructor to further enhance the

understanding of the concepts you have learned from the module.

LESSON 1

DEFINITION OF PHARMACOLOGY AND DRUGS

For many reasons, understanding how drugs act on the body to cause
changes and applying that knowledge in the clinical setting are important aspects
of nursing practice. For instance, patients today often follow complicated drug
regimens and receive potentially toxic drugs.
Many also manage their own care at home. The nurse is in a unique
position regarding drug therapy, because nursing responsibilities are
encompassing which includes administration of drugs, assessment of drug
effects, nursing intervention in drug regimens as well as providing patient
teaching about drugs. Knowing all these things makes these tasks easier to
handle and thus enhancing drug therapy for the patient.

Pharmacology is a medical science that forms a backbone of the medical

profession as drugs form the corner stone of therapy in human diseases.
Therefore, it is of utmost importance to describe the pharmacological basis of
therapeutics to maximize the benefits and minimize the risks of drugs to
recipients.

DEFINITION OF Pharmacology
derived from Greek word
“pharmakon” – drugs, medicine, poison;
“logos” – science
-the science that deals with the origin, nature,
chemistry, effects & uses of drugs.
-It is a multi-disciplinary science with
subspecialties which includes clinical
pharmacology, pharmacogenetics,
pharmacodynamics, pharmacoeconomics, and
pharmacognosy.

PHARMACOGNOSY
• Branch of pharmacology dealing with natural drugs & their constituents.
• Deals with the sources, procurement & chemistry of natural products.
• The American Society of Pharmacognosy defines pharmacognosy as "the
study of the physical, chemical, biochemical and biological properties of drugs,
drug substances or potential drugs or drug substances of natural origin as well
as the search for new drugs from natural sources.” It is also defined as the
study of crude drugs.

PHARMACOKINETIC

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• The study of the movement of drugs in the body, including the processes of
absorption, distribution, localization in tissues, biotransformation and
excretion PHARMACODYNAMICS
• The study of the biochemical & physiological effects of drugs & the
mechanisms of their actions, including the correlation of their actions & effects
with their chemical structure.

PHARMACOTHERAPEUTICS
• Treatment of diseases with medicines.
• Also called clinical pharmacology which deals with the science of drugs and
their clinical use. The main objective is to promote the safety of prescription,
maximize the drug effects and minimize the side effects.

PHARMACOGENETICS
• Pharmacogenetics is the study of inherited genetic differences in drug
metabolic pathways which can affect individual responses to drugs, both in
terms of therapeutic effect as well as adverse effects.
• The term pharmacogenetics is often used interchangeably with the term
pharmacogenomics which also investigates the role of acquired and inherited
genetic differences in relation to drug response and drug behavior through a
systematic examination of genes, gene products, and inter- and intra-
individual variation in gene expression and function.

TOXICOLOGY
• Study of poisons.
• Toxicology is the study of the adverse effects of chemicals (including drugs)
on living systems and the means to prevent or ameliorate such effects.

DRUGS
• Derived from Dutch word “droog” – dry
• Any chemical compound used in the diagnosis, treatment, or prevention of
disease or other abnormal condition

Traditional medicine (also known as indigenous or folk medicine)

comprises knowledge systems that developed over generations within various
societies before the era of modern medicine.

The World Health Organization (WHO) defines traditional medicine as

"the sum total of the knowledge, skills, and practices based on the theories,
beliefs, and experiences indigenous to different cultures, whether explicable or
not, used in the maintenance of health as well as in the prevention, diagnosis,
improvement or treatment of physical and mental illness."

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A biopharmaceutical, also known as a biologic medical product or

biologic, is any medicinal product manufactured in, extracted from, or semi
synthesized from biological sources. Different from chemically synthesized
pharmaceuticals, they include vaccines, blood, or blood components,
allergenics, somatic cells, gene therapies, tissues, recombinant therapeutic
protein, and living cells used in cell therapy.
Biologics can be composed of sugars, proteins, or nucleic acids or complex
combinations of these substances, or may be living cells or tissues. They are isolated
from natural sources—human, animal, or microorganism
Alternative medicine is any
practice that is put forward as
having the healing effects of
medicine, but is not founded on
evidence gathered using the
scientific method.
It consists of a wide range of
health care practices, products and
therapies. Examples of these
complementary alternative
medicines
include new and traditional medicine practices
such as homeopathy, naturopathy, chiropractic, energy medicine, various
forms of acupuncture, traditional Chinese medicine, Ayurvedic medicine, and
Christian faith healing. The treatments are those that are not part of the
conventional, science-based healthcare system.

Complementary medicine is alternative medicine used together with

conventional medical treatment in a belief, not proven by using scientific
methods, that it "complements" the treatment. CAM is the abbreviation for
complementary and alternative medicine.

Integrative medicine (or integrative health) is the combination of the

practices and methods of alternative medicine with conventional medicine.

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PARTS OF A DRUG MONOGRAPH

1. GENERIC NAME OF DRUG: One or
more icons may be found here: black box
(side effects warning), camera (photo), ear
(soundalike drug).

2. PHONETIC PRONUNCIATION of the

generic name.

3. CLASSIFICATION: Defines the type

of drug or the class under which the drug is
listed.

4. PREGNANCY CATEGORY:
Assigned by the FDA. Defined in Appendix
6.
5. TRADE NAMES: names by which a
drug is marketed. If numerous forms of the
drug are available, the trade names are
identified by form. Rx denotes prescription drugs.

6. CONTROLLED SUBSTANCES: If the drug is controlled by the U. S. Federal

Controlled Substances Act, the schedule in which the drug is placed follows the
trade name listing. Controlled substance schedules are placed after Rx drugs.
(ex: C-II) (See Appendix 5.) CROSS REFERENCE (for selected drugs): "See
also:" directs the reader to the classification entry in Chapter 2 or to other parts
of Chapter 1 that give a complete profile of the drug.

7. APPROVED THERAPEUTIC USES: Some investigational uses are also listed

for selected drugs.

8. ACTION/KINETICS: Critical information about the rate of drug absorption,

distribution, time for peak plasma levels or peak effect, minimum effective serum
or plasma level, duration of action, metabolism, and excretion route(s).
Metabolism and excretion routes may be important for clients with systemic liver
disease, kidney disease, or both.

9. MAXIMUM PLASMA LEVELS: Achieved at therapeutic doses.

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10. BIOLOGICAL HALF-LIFE: The time

required for half the drug to be excreted
or removed from the blood, serum, or
plasma.

11. PLASMA PROTEIN BINDING: The

extent to which a drug is bound to plasma
protein, when applicable.

12. CONTRAINDICATIONS: Lists

disease states or conditions in which the
drug should not be used.

13. SPECIAL CONCERNS: When

appropriate, the FDA Black Box Warning
is included. Considerations for use with
caution in pediatric, geriatric, pregnant, or
lactating clients, and in unique situations
or disease states.

14. SIDE EFFECTS: Listed by the body

organ or system affected. Usually
presented with the most common side
effects first in descending order of
incidence. If potentially life-threatening,
the side effect is bold-italic.

15. LABORATORY TEST

CONSIDERATIONS: The manner in
which the drug may affect laboratory test
values is presented as increased values
(↑), false positive values (+) decreased
values (↓) or false negative values (-).
Also included, when available, are drug-induced changes in blood or urine levels
of endogenous
substances.
16. OVERDOSE MANAGEMENT: Symptoms observed following an overdose or
toxic reaction and treatment approaches and/or antidotes for the overdose.

17. DRUG INTERACTIONS: Alphabetical listing of drugs and herbals that may
interact with the drug. Legend: ↑ increase, ↓ decrease, → leading to.

18. HERBALS: Known or suspected drug interactions with herbal products.

19. HOW SUPPLIED: Dosage forms and amounts of the drug in each of the dosage
forms. One dosage form may be more appropriate for a client than another. This
information also allows the user to ensure the appropriate dosage form and
strength is being administered.

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20. DOSAGE: The dosage form and/or route of administration is followed by the
disease state or condition (in italics) for which the dosage is recommended.

21. NURSING CONSIDERATIONS: Guidelines to help the practitioner in applying

the nursing process to pharmacotherapeutics to ensure safe practice and patient
safety.

22. SOUND ALIKE WARNINGS

23. ADMINISTRATION/STORAGE: Guidelines for preparing medications for

administration, administering the medication, and proper storage and disposal of
the medication.

24. GUIDELINES FOR ADMINISTRATION BY IV

25. ASSESSMENT: Guidelines for monitoring/assessing client before, during, and

after prescribed drug therapy.

26. CLIENT/FAMILY TEACHING: Guidelines to promote education, active

participation, understanding, and adherence to drug therapy by the client and/or
family members. Precautions about drug therapy are also noted for
communication to the client/family.

27. OUTCOMES/EVALUATE: Desired outcomes of the drug therapy and client

response.

28. INTERVENTIONS (FOR SELECTED DRUGS): Guidelines for specific nursing

actions related to the drug being administered.

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LESSON 2 SOURCES AND USES OF DRUGS

Drugs are available from varied sources, both in natural and synthetic
forms. Chemicals that might prove useful as drugs can come from many natural
sources, such as plants, animals or inorganic compounds, or they may be
developed synthetically. To become a drug, a chemical must have a
demonstrated therapeutic value or efficacy without severe toxicity or damaging
properties.

A. SOURCES OF DRUGS

I. NATURAL SOURCES

A. Plants
Parts are processed -----> Crude Drugs ------> Active Principles:

1. ALKALOIDS
• are a diverse group of bittertasting,
organic, basic
substances found in plants
• generally given names that end in “INE”
Examples: Morphine, cocaine,
Atropine, Quinine, Nicotine, Caffeine

2. GLYCOSIDES - compounds that consist

of sugar units, usually glucose and a
nonsugar component called
AGLYCONE Example:
Digitalis – Digoxin

3. VOLATILE OIL may be used as aromatics & as flavoring agents such as

peppermint, menthol, cinnamon or wintergreen oil for antiseptic & for rubs.

4. RESINS - are complex substances of plant origin that are amorphous in

structure & insoluble in water but mostly soluble in alcohol
Ex: a. Podophyllum (mandrake) – laxative
b. Peruvian balsam – astringent used in Hemorrhoidal prep

5. GUMS - translucent, amorphous, hydrocolloidal masses

Ex: karaya, agar, carrageenan – bulk laxatives
6. TANNINS - their presence in many herbal teas as well as ordinary tea has
been linked to ocurrence of esophageal cancer.
Example: Tannic Acid – used as antiseptic & astringent for bed sores

B. Animals
- liver, thyroid, insulin, cortisone

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C. Mineral Products
Elementary substances
a. Oxygen
b. Iodine
c. Iron
Free acids
a. Boric acid
b. Hydrochloric Acid
Metallic hydroxide
a. Aluminum hydroxide
Salts
a. Magnesium sulphate-
Epsom salt, cathartic use
b. Magnesium trisilicate –gastric anatacid

II. SEMI-SYNTHETIC
• derived by chemical modification of natural substances
• Genetic Engineering – a new method of drug production based on recombinant
DNA tech.

III. SYNTHETIC
• made in the laboratory
• pure chemicals
• Medicinal Chemistry – branch of the pharmaceutical science most directly
concerned with the synthesis of new drug substances.

Examples: hematropine, barbiturates, sulphonamides

CLASSIFICATIONS OF DRUGS ACCORDING TO USE

A. THERAPEUTIC AGENTS
Do any of the following actions
1. Maintain Health
• Vitamins & minerals to regulate metabolism
• ASA for baby at risk for heart attack
2. Relieve Symptoms
• Anti-inflammatory like ibuprofen
• Narcotics – severe pain
• Diuretic – control excess fluids
3. Combat Illness
• Antibiotics to cure
pneumonia, strep throat
4. Reverse Disease Processes
• Drugs to control depression, BP, cholesterol
or diabetes
B. PHARMACODYNAMIC AGENTS
• Alter bodily functioning in a desired way

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• Muscle relaxant
• Pupil dilator/constrictor
• Increase/decrease BP
• Contraceptives
• Anaesthetics

C. DIAGNOSTIC AGENTS
• Facilitate an exam or conclusion as to the nature or extent of a disease condition
• Radioisotopes (technetium/iodine) – PET

D. PROPHYLACTIC AGENTS
• Prevent illness or disease from occurring
• IODINE – prepare skin preoperatively
• VACCINES

E. DESTRUCTIVE AGENT
Has a suicidal action; kills bacteria, fungi, virus, or even normal cells or
abnormal cells Antineoplastic drugs

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LESSON 3
FORMS AND PREPARATIONS OF DRUGS

After a chemical that might have therapeutic value is identified, it must

undergo a series of scientific tests to evaluate its actual therapeutic and toxic
effects. This process is controlled by the Food and Drug Administration (FDA),
an agency of the U.S. Department of Health and Human Services that regulates
the development and sale of drugs. FDA-regulated tests are designed to ensure
the safety and reliability of any drug approved in this country.
It’s Philippine counterpart, The Food and Drug Administration of the
Philippines (Filipino: Pangasiwaan ng Pagkain at Gamot, or FDA, formerly the
Bureau of Food and Drugs or BFAD) was created under the Department of
Health to license, monitor, and regulate the flow of food, drugs, cosmetics,
medical devices, and household hazardous waste in the Philippines.
The FDA's main goal is to ensure the health and safety of food and drugs
made available to the public.

PHASES OF DRUG DEVELOPMENT

Clinical trials involving new drugs are commonly classified into four phases.
The drug-development process typically takes many years to pass through all
four phases. If the drug successfully passes through Phases I, II, and III, it will
usually be approved by the FDA for use in the general population.
Phase I A new drug or treatment is tested for the first time on a small group
of people. During this phase researchers are evaluating the safety of the dosage
range and to identify any side effects.
Phase II The drug or treatment is then tested on a medium group of people
(100-500). During this phase researches are looking at the effectiveness of the
drug or treatment and they continue to evaluate the safety.

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Phase III The drug or treatment trials is tested on a large group of people
(300-3000). Researchers confirm the effectiveness, monitor side effects, and
compare it to common treatments.
Phase IV Phase IV trials are focused on the long-term effects of drugs over
an extended time period for a larger group of people, after a medication has been
approved by the FDA. It focuses on continued evaluation of the medication.

FORMS AND PREPARATIONS OF DRUGS

A. TOPICALS

1. CREAMS – are water soluble preparation

usually applied by rubbing into the skin; often
used as moisturizer
2. OINTMENT – oily or fatty suspension of
drugs; most commonly used ointment bases
are petrolatum & lanolin; not easily washed
away by water or sweat
3. PASTES – ointments that are especially thick
and viscous and that don’t soften
substantially from body heat.
4. GELS - aqueous suspensions of hydrated
particles
5. LOTIONS – aqueous suspensions of drugs & should be dabbed, not rubbed.
6. LINIMENTS - thinner than ointment,
consisting of fluid mixture of drugs with water, oil,
soap and other constituents; applied by rubbing
7. PLASTERS – are solid dosage forms
usually have a rubber mixture as their base
8. POWDERS – usually consist of fine mineral
dusts, such as talc & are applied by dusting. used
to absorb moisture from the skin thereby altering
conditions favorable to growth of microbes.
9. PATCHES – used to provide gradual transfer
of drug from the patch to the skin, usually for
drugs that’ll be absorbed through the skin to
provide systemic effects
10. TINCTURES – solutions of drugs in alcohol; often applied by painting.
11. AEROSOLS – used for topical application of drugs to both the skin & the
respiratory tract; consist of liquids applied under air pressure as sprays
12. FOAMS – aerated semisolid preparation applied under pressure in a manner
similar to aerosol.

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B. MUCOSAL MEMBRANES
• ointment, creams, drops
• urethra, vagina, conjunctiva, nose, throat,
rectum, mouth
• readily absorbed – both local & systemic

1. GARGLES – oral membrane

2. LOZENGES – flat disk containing a
medicinal agent in a suitable flavoured base;
held in the mouth to dissolve slowly

3. VAGINAL SUPPOSITORY
a. is usually supplied with an applicator to
facilitate easy & effective insertion; wipe
away excessive vaginal discharge & use
sterile technique; lie flat for 15 minutes.

C. INHALATION/INSUFFLATION
a. INHALATION - drugs can be administered to the
patient for either topical or systemic purpose; both
liquid & gases can be administered.

b. INSUFFLATION - fine powders administered to

the patient by blowing or spraying into the nose.

D. OCULAR INSTILLATION
• DROPS – solutions, or less commonly,
suspensions, that are instilled in the eye by the use of a dropper ; should be
kept sterile
• OINTMENT – usually placed on the inner mucosal surface of the lower
eyelid or in the conjunctival sac in the inner canthus
E. EAR DROPS1. DROPS – labelled as otic

F. ENTERAL ADMINISTRATION - alimentary tract; oral, rectal, sublingual,

buccal routes; systemic effects
G. ORAL ROUTE - most convenient, frequently used route

1. TABLETS – dried powdered drug

that has been compressed into
small disks; sometimes “scored” to
aid in subdividing them.some are
“enteric coated”; resist dissolution in
the acid medium of the stomach;
don’t chew

TYPES OF TABLETS:
1. CHEWABLE TAB
• Contain a base that is flavoured/colored

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• Preferred for antacids, antiflatulence, vitamins

2. EFFERVESCENT TAB
• Granular salts that release gas & so disperse active ingredients into solution
when placed in water or juice
• ALKA-SELTZER – relieve headache or hangover

3. BUCCAL TAB
Placed on the buccal pouches

4. SUBLINGUAL TAB
• Dissolved under the tongue & absorbed
• Nitroglycerin

5. VAGINAL TAB
• Placed by means of an applicator
• Less messy than equivalent cream formulations

2. CAPSULES – consist of powders or liquids in a gelatin container; don’t require

color or additives to improve taste

3. TIMED-RELEASE CAPSULES
granules w/in the capsule dissolve at different
rates.

4. SOLUTIONS – consist of substances dissolve in

water

5. SYRUPS – are sugar solutions used as vehicles

for various drugs

6. SUSPENSIONS – consist of fine drug particles suspended in a liquid vehicle;

shake well to ensure; thorough mixing

7. EMULSIONS – consist of a lipid substance dispersed in water by the action of

an emulsifying agent

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8. MAGMAS – often called milk, are thick

suspensions of white particles in water ex. Milk
of magnesia (MOM)

9. GELS – aqueous suspensions of hydrated

particles

10.ELIXIR – are vehicles containing alcohol,

sugar, & water; used primarily when the drug will
not dissolve in water

11.SPIRITS – alcohol solutions of volatile

substances

12.TINCTURES – consist of drugs dissolved in

alcohol or alcohol & water

H. SUBLINGUAL/BUCCAL ADMINISTRATION

a) NITROGLYCERIN – placed under the tongue

rapidly disintegrate absorbed thru thin epithelium
into the blood vessels

I. RECTAL SUPPOSITORY
• mixture of drugs in a base, e.g. cocoa butter, that is solid at room temp. but
which melts at body temp & dissolves in the body fluid; suitable substitute for
oral administration for comatose patients; evacuate the rectum by enema
before administration

BOUGIES – small suppositories inserted into the urethra

J. PARENTERAL DRUGS
1. AMPULES – glass containers that usually contain a single dose of
medication; may be scored or have a darkened ring around neck
2. VIALS – are glass containers that contain 1 or more doses of a sterile
med; may be a solution or it may be a sterile powder to be
reconstituted before the time of administration.

3. MIX-O-VIALS – glass containers with 2 compartments; lower

chamber contains he solute; upper chamber contains a sterile diluents; in
between the chambers is a rubber stopper.

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4. PREFILLED SYRINGE
premeasured amount of meds in
a disposable cartridge-needle
unit; cartridge is in a sealed unit;
drug name, concentration, and
the volume are clearly printed in
the cartridge; time saving,
diminished chance of
contamination

MODULE SUMMARY
Pharmacology is a multidisciplinary science that deals with the origin,
nature, chemistry, effect and uses of drugs. It has several subspecialties which
include clinical pharmacology, pharmacognosy, pharmacokinetics,
pharmacodynamics, pharmacogenetics and pharmacoeconomics.
Drugs are defined as any chemical compound used in the diagnosis,
treatment or prevention of disease or other abnormal conditions.
Parts of a Drug Monograph include the Generic Name of the drug, the
phonetic pronunciation, classification, pregnancy cateogry, trade names,
controlled substances, approved therapeutic uses, action/kinetics, half-life,
contraindications, side effects, management of symptoms, dosage forms as well
as nursing considerations.
Drugs are available in various sources. These include Plants, animals,
mineral products, semi-synthetic and synthetic sources.
Drugs are classified according to use which include therapeutic - maintain
health, relieve symptoms, combat illness and reverse disease process;
pharmacodynamic - alters bodily functioning accordingly; diagnostic - facilitate
an exam or conclusion as to the nature or extent of a disease condition;
prophylactic - prevent illness or disease from occurring; destructive - kills
bacteria, fungi, virus or organisms which deter bodily function.
Phases of Drug Development include several clinical trials before being
released in the market. Phase 1 is testing the product for the first time on a small
group of people. Phase 2 includes a testing of the product on a medium group of
people numbering to 100-500 and looking for the effectiveness of the treatment.
Phase 3 has a larger number of subjects and researchers confirm the
effectiveness, monitor the side effects and compare to common treatments.
Phase 5 trials are focused on the long term effects of the drug over an extended
period of time.
There are many forms and preparation of drugs. These include topical,
mucosal, inhalation, ocular instillation, enteral administration, oral, sublingual,
suppositories and parenteral.

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MODULE 2:
NURSING PROCESS AND DRUG ADMINISTRATION

LESSON 1 Principles of Drug Administration

LESSON 2 Phases of Drug Action
LESSON 3 Dosage and Calculations

MODULE II NURSING PROCESS AND DRUG ADMINISTRATION

INTRODUCTION

Nursing is a unique and complex science as well as a nurturing and

caring art. Nurses have had to assume increasing responsibilities that involve
not only nurturing and caring but also assessing, diagnosing, and intervening
with patients to treat, to prevent, and to educate in order to help patients cope
with various health states.
The nurse is the key health care provider who is in a position to assess
the whole patient, to administer therapy as well as medications, to teach the
patient how best to cope with the therapy so as to ensure the most favourable
outcome, and to evaluate the effectiveness of the therapy. Thus far, these are
the key elements in the nursing process which is also utilized in the decision
making and problem solving process of providing quality health care.

OBJECTIVES
After finishing this module, the students shall be able to:
1. Describe the role of nurses in drug administration.
2. Describe the importance of each of the following factors in the passage
of a drug through the body.
3. Relate the five steps of the nursing process to the administration of
medications.
4. Discuss the 10 “Rights of Medication Administration.”
5. Apply the steps of nursing process in client teaching.
6. Interpret the medication prescription accurately.
7. Calculate safe dosages for individual clients.

DIRECTIONS/MODULE ORGANIZER
1. Read lessons and as you do, you may have with you any of the
referencebooks to help you understand topics which need further
explanation.
2. Answer the evaluation activities at the end of the lessons.

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3. Consult or ask questions to a nursing instructor to further enhance

theunderstanding of the concepts you have learned from the module.

LESSON 1
PRINCIPLES OF DRUG ADMINISTRATION

The nurse, as the caregiver who most frequently administers

medications, must be constantly alert for signs of drug reactions of various
types. Patients and their families need to be taught what to look for when
patients are taking drugs at home. Some adverse effects can be countered with
specific comfort measures or precautions. Knowing that these effects may
occur and what actions can be taken to prevent or cope with them may be the
most critical factor in helping the patient to comply with drug therapy.
Before administering any drug to a patient, it is important to review the
contraindications and cautions associated with that drug, as well as the
anticipated adverse effects. This information will direct the nurse proper
assessment of the patient, facilitating the focus on particular signs and
symptoms that would alert contraindications or to proceed cautiously with the
drug administration.
Being alert to adverse effects- the nurse must be vigilant in knowing what
to assess and how to intervene appropriately. This lesson discusses the role of
the nurse in safe medication administration following the nursing process.

NURSING PROCESS
• A goal-directed series of activities whereby the practice of nursing is
approached in a systematic and orderly way.
• goal of the NP is to alleviate, minimize, or prevent actual and potential
health problems

5 SEQUENCIAL & CYCLICAL PHASES

1. ASSESSMENT
• is the collection of relevant information that defines the current health
situation for the particular client
• it encompasses the client’s medical and drug history, physical
examination, psychological, social, cultural, and environmental factors,
laboratory tests and current drug and nondrug orders and interventions

2. ANALYSIS/DIAGNOSIS
• is the critical study of the assessment data for the purposes of studying
the client’s needs and establishing nursing goals.
• includes the determination of appropriate nursing diagnoses and
identification of requirements for referral to other HCP

NURSING DIAGNOSES – are those problems for which nurses can

legally prescribe interventions independently
Ex. Anxiety r/t insufficient knowledge regarding surgical experience

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3. PLANNING
• is the designing of strategies, in cooperation with the client or those
responsible for the client, that will help to achieve the established the
nursing goals.
• includes setting priorities and determining nursing interventions
• plans are individualized to the unique requirements and capabilities of
each client
• plans are also dynamic – require frequent adjustments as the client
condition changes.

4. IMPLEMENTATION
• is the initiation and completion of the strategies developed during the
planning stage

5. EVALUATION
• is the process of determining the effects of the plan of care, both the
extent to which the goals have been achieved and the occurrence of
any unfavorable consequences.
• nurses observe and measure the extent to which a client is responding
to drug treatment, any side effects the client may be experiencing, &
any changes in physiological or psychological functioning

ADMINISTERING MEDICATIONS (10 RIGHTS)

1. Right Assessment
• Before any medication is administered to the client, it is important for
the nurse to conduct a thorough assessment of the client.

a. Take a medication history

• prescription,
OTC, herbals,
alcohol
• adverse drug effects
experienced
b. Assess the
client’s understanding
about illness,
including past experience
• What do you believe to
be the cause of your illness?
• What do you know about your condition?
c. Conduct a physical assessment
• Provides baseline info on height, weight, BP, temp., PR, RR
• Also provides general health and nutrition, about physical
condition.
d. Obtain information about social networks & resources
e. These factors influence whether individuals will have prescriptions
Filled and will comply with the treatment program.

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Nursing Diagnosis
A number of nursing diagnoses may be useful in guiding planning and
implementation. These may include:
State relevant nursing diagnoses
a. Ineffective health maintenance
b. Risk for injury
c. Noncompliance r/t drug regimens
d. Deficient knowledge (illness and its treatment)
e. Ineffective management of the therapeutic regimen

Planning
once the assessment has been completed and the nursing diagnoses
made, the nurse engages in identifying desired outcomes of nursing
intervention and in planning appropriate nursing actions to achieve these
outcomes
focus on:
• Why the drug is needed
• How the drug will be administered
• Common indications of adverse effects
• other nursing measure that will enhance the likelihood of achieving o
desired outcomes

Implementation
in preparing to administer medications, it is important for the nurse to
ensure cleanliness of all materials used
ensure availability of supplies
ensure adequate lighting
decrease environmental distractions
verify the prescription for the medication to be administered (date, time,
drug name, dosage, route, frequency, and duration of administration, and
required signature by the prescriber

NOTE: prescription must always be

written except in some emergency
situations. Once emergency has
been controlled, written
prescription must be obtained.

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PRESCRIPTIONS FREQUENTLY CONTAIN

ABBREVIATIONS
aa of each
ad lib freely, as desired
a.c. before meals
b.i.d, BID twice a day
c with
caps. capsule
dl, dL deciliter
elix. elixer
ext. extract
g gram
gr grain
gtt drop
h hour
H.S., h.s. at bedtime or hr of sleep
ID intradermal
Im intramuscular
inj. by injection
IV or I.V. intravenously
IVPB intravenous piggyback
kg kilogram
kvo keep vein open
L liter
mcg microgram
mEq milliequivalents
mg milligram
ml, mL milliliter
NGT nasogastric tube
O.D. right eye
O.S. left eye
o.u. both eyes
p after
p.c. after meals
p.o, by mouth
p.r.n., PRN as the occasion rises
q every
q.h. every hour
q2h every 2 hours
q.s. a sufficient quantity
q.i.d 4x a day
s without
S.C., sub q subcutaneously
S.L. sublingually
sol. solution
ss one-half

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stat immediately
susp. suspension
tab’ tablet
TID three times a day
TPN total parenteral nutrition
tr. tincture
tsp. teaspoon

2. The Right Drug

Read label 3x (non-unit dose)
a. When taking the container from its location
b. When removing the drug from its container
c. When returning the container to its storage place

THREE checks be carried out (unit dose)

a. When removing it from its location in the drawer/ref.
b. When comparing it with the client’s medication
administrationrecord
c. Before administering it

NOTES:
• Carefully check the
prescription
• Check the
medication against
the prescription
• Do not administer a
medication someone
else has prepared
• If using a unit dose
system, do not open
the unit packaging
until you are
• At the client’s bedside.
• Ask if this drug is “right” for the client. (e.g. allergy)
• Never leave medications unattended

3. In the Right Dose

a. Be familiar with the various measurement systems and the
conversionfrom one system to another
b. Always use the appropriate measuring device and read it correctly
c. Shake all suspensions and emulsions
d. When measuring drops of medication with a dropper, always hold the
e. Dropper vertically & close to the medication cup
f. When removing a drug from a multiple –dose vial, inject an amount of
air equal to the amount of fluid to be withdrawn
g. Do not attempt to divide unscored tablets & do not administer tablets

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that have been broken unevenly along the scoring

4. To the Right Client

a. Check the tag on
theclient’s bed
b. Check the client’s ID band
c. Ask the client to state
hisname
d. Ask parents to tell you
thename of their child
e. Always double-check
aprescription that the client
questions.

5. At the Right Time

a. to achieve maximum therapeutic effectiveness, medications are
scheduledto be administered at specific times
b. the nurse should adhere, as closely as possible to the scheduled time
ofadministration

NOTE: as a general rule, the nurse should always be certain that a

medication is administered within half an hour of the time it is ordered to
be given

6. By the Right Route

the method by which a drug is
administered affects such
factors as
the absorption, speed of
onset, dose, side effects &
adverse effects

a. Be sure you know

theprescribed route by which
a medication is to be given
b. If no route is specified in
thehealth care
provider’s
prescription, the MD
c. Should be questioned about the intended route
d. Always gain the client cooperation before attempting to administer a
doseof drug
e. Consider the client’s developmental level during administration
ofmedications
f. The nurse must know what vehicles may be used with various drugs to
achieve maximum effectiveness & client well-being, it is important to
plan
g. The order in which meds are administered.

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Correct Sequence of Oral Medications

1. Drugs that require special assessments such as those for which an
apicalpulse or BP is required
2. Other tablets & capsules
3. Liquid preparations except for syrups intended for local soothing
oranesthetic actions
4. Sublingual preparations
5. Antacids & liquid preparations intended for local soothing or
anestheticactions that are given with instructions not to eat or drink fluids
for 20-30 minutes

7. Right Documentation
A. Be sure to document the medication & time administered on appropriate
B. Facility document.
C. Document site location after administering ID, SC, or IM injection
D. Document if client refuses medication, client’s reason, & reporting
ofrefusal to health care provider

• The right documentation is not only a legal requirement, but also a safety
responsibility of the nurse.
• ‘If it isn’t documented, it wasn’t done”
• An inappropriate & illegal practice is for the nurse to “borrow” a drug from
o client ”A” to give to client “B” with the intent of replacing it later.

8. Client’s Right to Refuse

a. Be sure to assess client’s reason for refusing medication
b. If knowledge deficit underlies client’s reason for refusal,
provideappropriate explanation for why medication is prescribed, what
medication does, & the importance of medication for treatment of client’s
health alteration.
c. Document refusal

9. Right Evaluation
A. Is the comparison of actual client outcomes with expected outcomes.

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B. Includes assessing the effectiveness of the medication in alleviating

signsand symptoms of illness, determining adverse effects that result
from the use of the drug, & determining the client’s ability to self-
administer medication

10. Right Education

DRUG DISTRIBUTION SYSTEM

1. Floor or Ward System
• All but the most dangerous or rarely used medications are
stocked at the nursing station in stock containers
• This system has been used most often in a very small hospital
& hospitals where there are no charges directly to the patient
for medications.

Advantages:
• Ready availability of most drugs
• Fewer inpatient prescription orders
• Minimal returns of medications

Disadvantages:
• Increased potential for medication errors
• Increased danger of unnoticed drug deterioration
• Need for larger stocks & frequent total drug inventories
• Storage problems on the nursing units in many hospitals

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2. Individual Prescription System

• In this system,
medications are
dispensed from the
pharmacy on receipt of a
prescription or drug order
on individual patient

Advantages:
• Provides greater patient's safety
• Less danger of drug deterioration
• Easier inventory control

Disadvantage:
• Time consuming procedures used to schedule, prepare,
administer, control & record the drug distribution &
administration process.
3. Computer-controlled Dispensing System
• Is the safest and most economical method of drug distribution
in hospitals and long- term care facilities
• The system provides detailed listing of all medications
administered to a patient and charges the patient for the
medication as well.
• Controlled drug are kept in this cart, and the system provides
a detailed record of the controlled substance dispensed
including date, time, and by whom it was accessed.

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4. Unit-dose System
• use single packages of drugs dispensed to fill each
requirement as it is ordered. Each package is labelled with
generic & brand name, manufacturer, & expiry date

LEARNING ACTIVITY

A. List the 10 points to consider in the Safe and Effective administration of a

drug. What rights have been followed or violated in the clinical area that you have
observed? What measures should be noted to address the issues?

B. Fill in the blanks in the following nursing process chart.

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LESSON 2
PHASES OF DRUG ACTION

To understand what happens when a drug is administered, the nurse must

understand, the nurse must understand pharmacodynamics, or how the drug affects
the body, and pharmacokinetics, or how the body acts on the drug.
These processes form the basis for the guidelines that have been established
regarding drug administration – for example, why certain agents are given
intramuscularly (IM) and not intravenously (IV), why some drugs are taken with food
and others are not, and the usual dose to use.
Knowing the basic principles of pharmacodynamics and pharmacokinetics
helps the nurse to anticipate therapeutic and adverse effects and to intervene in ways
that ensure the most effective drug regimen for the patient. (Karch, 2013)

PHASES OF DRUG ACTION

I. PHARMACEUTIC PHASE
The science of formulating drug products & the study of the influence of
formulation characteristics on the ability of an administered drug product to
be dissolved in a body fluid

A. Disintegration
• The breaking up of a solid oral medication into small fragments
• Enteric-coated drugs resist disintegration in gastric acid; should not
be used when immediate effect is desired

B. Dissolution
• The rate that a
drug enters into a
solution
• The dispersal of
the substance as
solute particles in
the body fluid with
which the drug is
in contact
• Liquid drugs –
immediately
available for
absorption
• Capsule –
dissolve rapidly;
absorption nearly as quickly as liquid drugs
• Tablets – absorbed least rapidly
• Sustained-Release – requires varying amounts of time to be
dissolved; absorbed over 8-12 hrs

C. Rate limiting
The step leading up to bioavailability that occurs most slowly for a
given drug product will determine the overall rate @ which the drug
becomes bioavailable
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II. PHARMACOKINETIC PHASE

A. Absorption
• The act of the drug reaching the circulating fluids & tissues from
outside of the body
• Oral doses absorbed via small intestines (3-4 hrs)
• Mucus membrane, skin, lungs, muscles, & subcutaneous fats also
allow for absorption
• Massage or heat can be used to hasten absorption

1. PASSIVE ABSORPTION/DIFFUSION
the random movement of chemicals from an area of higher
concentration to an area of lower concentration across a
semipermeable membrane until equilibrium is reached
requires no energy

2. FACILITATED
DIFFUSION
the use of a carrier, sometimes
a hormone , enzyme or a protein, to
move a chemical across a
semipermeable membrane
the carrier moves across the
membrane by
passive
diffusion
the chemical cannot move
across the semi-permeable
membrane w/o attaching itself
to the carrier
requires no energy; selective and saturable

3. ACTIVE TRANSPORT
also requires a carrier, usually an ion or protein, to move across a
semipermeable membrane.
the chemical cannot move across the semi-permeable membrane w/o
attaching itself to the carrier.
requires energy
selective & saturable
limited to substances of small to moderate size

2. ENDOCYTOSIS
larger molecules & particles can be brought across lipid
membranes through this process
the engulfment by a cell of a droplet of the surrounding fluid,
complete with all its contents

a) Pinocytosis

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- a non-selective process by which membranes trap a small

quantity of adjacent fluid.
- The membrane invaginates to form a pocket & then closes
to engulf a bead of fluid complete with whatever solutes it
might contain

b) Receptor-mediated endocytosis
- similar in appearance to pinocytosis but is highly specific
- the receptors, consisting of membrane proteins, cluster in
pits in the membrane & bind a specific substance (ligand)
from the surrounding fluid
- once inside the cell, the ligand is released from the receptor
& the receptor is recycled for additional activity.
3. LIPID SOLUBILITY

drugs that have high lipid solubility are absorbed more rapidly than
those soluble in water because the penetration barriers are largely
composed of lipids
Neomycin is a highly water soluble antibiotic that can be used in
the treatment of intestinal bacterial infection

4. BIOAVAILABILITY
an important factor in the effectiveness of a drug product
absorption efficiency of a drug
bioavailability of a drug is influenced by its pharmaceutical
composition
plasma level of a drug are commonly accepted as an approximate
measure of bioavailability

B. Distribution
• the act of the drug being transported via circulation to the tissues
• most drugs distributed while bound w/ protein

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• some drugs tightly bound – slow release & excretion

• some drugs loosely bound – rapid release & excretion

WHY IS UNIFORM DISTRIBUTION UNLIKELY IN ALL PARTS OF THE

BODY?

a) differences in permeability of various penetration barriers

b) regional variations in pH & perfusion
c) differences in solubility of the drug in blood & various tissues
d) sequestering of drug by protein binding or carrier-mediated transport into specific
tissues

1. Apparent Volume of Distribution

• A measure of the extent to which a drug can penetrate into various fluid & tissue
compartments
• Influenced by body mass, & drug dosage therefore be adjusted in relation to
body mass

2. Protein Binding
• Occurs in plasma especially to albumin proteins
• For such drugs, a fraction of the total plasma conc. is bound to proteins & the
remainder is unbound or free.
• Protein binding slows absorption of a drug out of the plasma into tissues by
reducing the effective concentration of the drug.
• Only unbound fraction is immediately available for further distribution into
tissues by passive diffusion as free drug is removed from the circulation by
absorption into tissues or elimination, some of the bound drug is released to
restore equilibrium.
• One factor that influences protein binding of drug is competitive displacement
– a common type of drug-drug interaction that occurs whenever 2 drugs
capable of protein binding are given concurrently.

***the effect is most significant for drugs that are highly bound & that have low
therapeutic indexes – Warfarin &
Digitoxin

C. Metabolism

• the breakdown of a substance through chemical reactions that are controlled

by enzymes
• the chemical process of changing a toxin (drug) to a non-toxic chemical
• liver the single most important site
• more often than not, hepatic metabolism decreases the activity of drug

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Hepatic First-Pass Effect

Newly absorbed substances initially pass to the liver before entering the systemic
circulation through the enterohepatic portal circulation
Drugs that are largely cleared by first-pass extraction have short durations of action.

Enzyme Induction
• Occurs with chronic use of many drugs, typically after a period of a few days.
• Inducers include: alcohol, barbiturates, hypnotics, analgesics, steroids,
antihistamines

Half-Life
• The time it takes for the amount
of drug in the body to be
decreased to ½ of the peak
level it previously achieved
• This info is important in
determining the appropriate
timing for a drug dose or
determining the duration of a
drug’s effect in the body

C. Excretion
The kidneys rapidly excrete most of the products of liver metabolism that have
been reabsorbed into the blood, but they also excrete many drugs unchanged.

1. Filtration
- Small molecules pass by passive diffusion from the blood
vessels in the kidney into the tubule that collects the
materials that ultimately form the urine.

2. Active Secretion
- Is the energy-dependent removal of a drug from the renal
circulation into the tubule

III. PHARMACODYNAMIC PHASE

This is the stage at which the physiological & biochemical operation of a drug on the
body occurs. Drugs can wholly inhibit a process, activate a process, or they can
replace a missing element.

1. Physiochemical influences
• Osmotic diuretics act to increase the osmolarity of filtrate in the
nephron, holding water in the tubule & ultimately enhancing formation
of urine.
• Antacids produce a chemical neutralization of acid, thereby raising pH.

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2. Receptor theory
• Receptors are cellular
components
with which the
body’s own hormones
(sometimes drugs)
interact to produce
characteristic effects
• The body
of knowledge
and hypothesis
concerning
interactions between
drugs and receptors is called receptor theory
• Receptors exhibit specificity
• Drugs interact with receptors in either of 2 different ways:

a) AGONISTS
• also called activators
• bind to receptors & modify it to produce a pharmacologic effect

b) ANTAGONISTS
bind to the receptor & prevent it from producing an effect

3. Dose-Response Relationship
• A drug that produces a greater effect at a lower dose than another is said
to have a greater potency
• The intensity of a biological response to a drug is presumed to be related
either to the number of activated receptors or the rate of their activation.
• The concentration of the drug in the vicinity of the receptor as well as the
number, affinity, & sensitivity of the receptors themselves will determine
the magnitude of the response

THERAPEUTIC INDEX (TI) = lethal dose/effective dose

• General indicator of the margin of safety for a drug
• A large TI is favourable

4. Client Variable to Drug Action

a) AGE
• Primarily a factor in pediatrics and
geriatrics
• Inability or less efficient at
absorbing, transporting,
metabolizing and excreting drugs.

b) BODY WEIGHT
• More tissue means more of the
drug is needed
• Normal doses may cause toxic
effects on the small

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c) GENETIC and ETHNIC CHARACTERISTICS

• Enzyme characteristics vary slightly amongst different cultural
backgrounds
• Variances can lead to altered drug response
d) GENDER - drugs may have different effects
• Dependent on gender
• Males have more vascular musculature resulting in faster
absorption & transport
• Females have higher concentration of fats in cells

e) DISEASE ENTITIES
Affect the chemical make-up of the system & therefore may alter the
therapeutic effect of drugs

f) DRUG TAKING COMPLIANCE

• the individual’s attitude affects the effectiveness of drugs
• the placebo effect
• those who trust the system
• those in-between

5. Adverse Drug reactions

• covers a host of undesirable effects of drugs
• in assessing whether an observed symptom is an adverse drug
reaction or is due to some other cause, the nurse should be guided
by the following considerations:
a. is the
observed symptom
known to be a potential
reaction to a drug being
used by the client?
b. did the
symptom develop
after addition of a new
drug to the regimen or
an increase in dosage of
an existing treatment?
c. did the adverse eventsubside when the drug was
discontinued or the dosage reduced?
d. did the symptom reappear when the drug wasreintroduced?
e. are there alternative possible etiology?
f. has the client had similar reactions to the drug or related drugs
in the past?

PREDICTABLE, ACUTE ADVERSE DRUG REACTIONS

Side effects
- are predictable ADR that occur within the normal range of
therapeutic doses for a given drug
- identification is a major part of the nurse’s role

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Overdose toxicity
- predictable consequence of excessive drug effect due to
administration of doses above the normal limit

Functional overdose
- is one produced when the dose administered is within the
normal range, but when unusual pharmacokinetics produce
a higher than normal plasma conc.

Cumulative toxicity
- occurs when repeated dosing is used & drug elimination
between doses is less than the drug made available from
each additional dose

UNPREDICTABLE, ACUTE ADVERSE DRUG REACTIONS

• Hypersensitivity Reactions
• drugs can function as
antigens themselves or
they can function as
haptens, binding to
endogenous proteins to
create antigenic
complexes
• Skin Testing –
preventive

• Idiosyncratic Reactions
• are reactions of unusual intensity in an individual client,
outside of the normal range of responses usually genetically
determined.

CHRONIC ADVERSE DRUG REACTIONS

• Tolerance & Dependence - seldom develop in less than a few
months of regular drug use
• Iatrogenic diseases - are disease caused by drugs that are part
of medical treatment

FIVE MOST COMMON

1. Blood dyscrasias
2. Liver damage
3. Kidney damage
4. Teratogenic effects
5. Skin eruptions

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LEARNING ACTIVITY
Answer the following questions comprehensively.
1. In a diagram, trace the phases that a drug undergoes from the time that it is
administered to the patient until therapeutic effect is reached. Provide
illustrations.

2. What factors determine the actual effects of drugs? Explain how can these
influence the drug’s effectiveness on the patient?

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LESSON 3: DOSAGE AND CALCULATIONS

To determine the correct dose of a particular drug for a patient, one should
take into consideration the patient’s sex, weight, age, and physical condition, as well
as the other drugs that the patient is taking. Frequently, the dose that is needed for
a patient is not the dose that is available, and it is necessary to convert the dosage
form available into the prescribed dosage.
Doing the necessary mathematical calculations to determine what should be
given is the responsibility of the prescriber who orders the drug, the pharmacist who
dispenses the drug, and the nurse who administers the drug. This provides for a good
set of checks on the dosage being given before the patient actually receives the drug.

DRUG CALCULATIONS

A. NONPARENTERAL MEDS
• Capsules and unscored tablets are
rounded to the nearest whole tablet.
Scored tablets are rounded to the
nearest 1/2 tablet. Liquid medications
are rounded to one decimal place
(tenths).
• The dosage in which the drug is
manufactured is considered a
conversion factor; such as 1
tablet = 0.5 mg is 0.5 mg/tablet.

1. RATIO & PROPORTIONS

-Ratios indicate a relationship between two numbers with a colon
between the numbers. The colon represents division.
For example 3:4 = 3/4.
-Proportions are equations containing ratios of equal value.
For example 3:4 = 6:8. This may also be written as fractions, 3/4=6/8.

Means are the two inner numbers, in this case 4 & 6.

Extremes are the two outer numbers, 3 and 8.
3:4=6:8

The product of the means (4 X 6) must equal the product of the extremes (3 X 8).
Therefore when you do not know one value (x), you can determine it, if the
other three values are known. When setting up a ratio, the known factor (on hand)
is stated first, the desired is stated second. H = D x

3:4=x:8 multiply the means and

4x = 3 X 8 the extreme
4x = 24
x= 24/4
x=6
If you set this up as a fraction:

3 =x cross multiply to obtain

4 8 the product of the means
4x = 3 X 8 = 24 and extremes x = 24
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Example: Ordered: 600,000 units of penicillin po q6h

Available: 400,000 units per scored tablet

How many tablets will you administer?

400,000 units : 1 tablet = 600,000 units : x
600,000 = 400,000x
600,000 = x = 1.5 tablets
400,000

OR set it up as a fraction
400,000 = 600,000
1 x
400,000x = 600,000
x = 600,000
400,000
X = 1.5 tablets

When working with a complex fraction - either a fraction in the numerator or

denominator - it helps to simplify the fraction. When dividing by a fraction,
remember to invert and multiply.

2. THE FORMULA METHOD:

D/S x Q = X

D - dosage desired or ordered

S - what is on hand (available)
Q - unit of measure that contains the available dose.

When using solid products (tabs, caps) Q is always 1 and can be eliminated.
Q varies when using liquid measure.

X - the unknown dosage you need to administer

Example: Order: Potassium Chloride 20 mEq added to the IV
Available: 40 mEq per 10cc.
How much potassium will you add?
D = 20 mEq H = 40 mEq Q = 10 cc

20 mEq X 10 cc = X
40 mEq
0.5 X 10 = X
5 cc = X

Points to remember:

1. The maximum number of tablets and capsules administered to achieve a

desired dose is usually 3.
2. No more than 10% variation should exist between the dose ordered and the
dose administered.
3. Make sure your answer seems reasonable. Think about whether the dose
should be larger or smaller than what is available.

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B. PARENTERAL MEDICATIONS

Injectable medication guidelines:

1. Intradermal - the volume to be administered is 0.1 ml or less

2. Subcutaneous - the volume to be administer is 1.0 ml or less
3. Intramuscular - depends upon the size of the person
a. A healthy well developed person can tolerate 3.0 ml in large
muscles; this does NOT include the deltoid.
b. For elderly, thin clients or children the total amount should not
exceed 2.0ml.
c. No more than 1.0 ml should be given to young children and older
infants.

Calculating dosages in units (insulin, heparin, pitocin, vitamins, some

antibiotics)

Ex: Ordered: Heparin 8000 units sq q12h

Available: Heparin 10,000 units/ml How
much will you administer?

Formula: 8000 units X 1 ml = 0.8 ml

10,000 units

Ratio: 10,000 units : 1 ml = 8000 units : x

8000 units X 1 ml = 10,000 units x
8000 / 10,000 = x
0.8 ml = x

If the answer is greater than 1, you probably calculated the problem incorrectly.
Rarely, the desired dose is large and you will have to administer it in more than one
site.

Reconstituting powdered drugs:

Read the label for the amount of fluid to add, the type of fluid and the final
concentration of the reconstituted fluid. The label will also tell you how long the
mixture may be stored and what conditions are required for storage. The final volume
will be larger than the amount of fluid you add because the powder will take up some
room when diluted. If you are not given a final volume calculate the concentration
based on the amount of fluid you added. You will calculate the amount to administer
from the final concentration.

Insulin
Insulin is administered only using an insulin syringe. Most insulin vials contain
100 units/ml. Insulin may be administered subcutaneously, intramuscularly (rarely
used) and intravenously.

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Regular insulin is the only type that

may be given IV since it does not
contain any additives to prolong the
action.
Regular insulin is clear. If the vial
is cloudy, it has been contaminated
and should be discarded.
Longer acting insulin is cloudy
and may have a precipitate on
the bottom of the
vial. Be sure to mix the vial well by
rotating it between the hands.
Mixing regular insulin and a longer acting insulin is done in the same
syringe.

o Inject air into the longer acting insulin vial first - don't let the tip of the
needle touch the surface of the fluid.
o Using the same syringe, inject air into the regular insulin then invert the
bottle and withdraw the correct amount of regular insulin. Remove air
bubbles.
o Still using the same syringe, withdraw the correct amount of the longer
acting insulin. You cannot return any extra fluid withdrawn. If you withdraw
too much, you must start over.

Intravenous calculations
• Drop factor - IV tubing has a drip chamber that is used to count drops (gtts)
per minute. Each tubing is labeled with the number of drops per milliliter
(drop factor).

• Macrodrop tubing - has a drop factor of 10, 15 or 20 gtts/ml (drops per

milliliter).

• Microdrip tubing - has a drop factor of 60 gtts/ml.

• FLOW RATE FORMULA:

R= V x DF
• T
Where:
• R = rate ; expressed in gtts/min
• V = volume ; amount to be infused expressed in mL or cc
• DF = drop factor; expressed in gtts/mL ; either macro (10,15,20) or micro (60)
• T = time or duration of infusion ; expressed in minutes

Ex: Ordered: D5W 1000 ml to infuse in 6 hours.

The DF of your tubing is 10 gtts/ml.
How many gtts/min will you infuse?

R = 1000 mL x 10 gtts/mL
6 hr or 360 mins

= 10000 gtts
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360 mins
= 27.77 gtts/min
= 27.8 gtts/min

R= 27-28 gtts/min
The same formula may be used to calculate drop rates for fluids
administered in less than 1 hour:

When using an IV pump, the rate is in ml/hr. Therefore, you do not need to
determine a drop factor.

Example:
Infuse Ancef 1 g/50 ml IVPB q6h. The IV handbook states this can be given in 20
minutes. What rate will you set on the IV pump?

• 50 ml X 60 min = 50 X 3 = 150 ml/hr

20 min 1 hr
• You need to give 50 ml in 20 minutes. But you have to convert the minutes to
hours.

OTHER FORMULA:

T = V x DF R

V = R x T DF

DF = R x T
V
PEDIATRIC CALCULATIONS

Accurate doses are especially important in giving medications to infants and

children because even small errors can be dangerous due to their small body size.

Two methods are used to calculate pediatric dosages:

According to the weight in kilograms (kg)

According to the child's body surface area (BSA)

A. BASED ON BODY WEIGHT

1. The first step is to convert the child's body weight into kg. The formula is
2.2 lb. = 1 kg.
2. The second step is to calculate the medication dose. A.

Calculate the daily dose.

B. Divide the dailydose by the number of doses to be administered.

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C. Use either the ratio-proportion or formula method to calculate the

number of tablets/capsules or volume to be administered with each
dose.

Example: A child weighing 76 lbs. is ordered to receive 150 mg of Clindamycin

q6h. The pediatric drug handbook states the recommended dose is 8-20
mg/kg/day in four divided doses. The Clindamycin is supplied in 100 mg scored
tablets.

1. What is the weight in kg?

76 lbs. x 2.2 kg/lb. = 34.5 kg

2. What is the safe total daily dose?

Minimum: 8 mg/kg/day X 34.5 kg = 276 mg/day

Maximum: 20 mg/kg/day X 34.5 kg = 690 mg/day

3. Is this a safe dose?

150 mg/dose X 4 doses/day = 600 mg/day Yes this

is within the recommended safe range.

4. Calculate the number of tablets to give.

100 mg : 1 tablet = 150 mg : x

100 mg x = 150 mg tablets x
= 1.5 tablets

B. BASED ON BODY SURFACE AREA

BSA is determined from a nomogram using the child's height and weight. When
you know the child's BSA the dosage is determined by multiplying the BSA by the
recommended dose. To determine whether the dose is safe, compare the ordered
dose and the calculation based upon the BSA.

The formula for calculating child's dosage is

Child's BSA X adult dosage

1.7 M2

Example: The child has a BSA of 0.67 M2. the adult dose is 40 mg. The physician
ordered 8 mg. Is the dosage correct?

0.67 X 40 = 26.8 = 15.8 mg No, the dose is too small.

1.7 1.7

OTHER FOMULA:
1. FRIED’S RULE – below 1 yr

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Dose = age in months X average adult dose

150 months

The adult dose of tincture of digitalis is 1 mL. What should a 10 month old child
receive?
10/150 x 1mL = 0.07 mL

2. YOUNG’S RULE – 1 to 12 yrs

Dose = age in years X average adult dose

age in years + 12

An adult dose of drug is 500mg, what is the dose for a 2-year old child ?

2/2+12 x 500 mg = 71.4 or 70 mg

3. CLARK’S RULE

Dose = weight in pounds X average adult dose

150 lbs

If an adult dose of drug is 750mg, what is the dose for child weighing 20 lbs ?

20/150 x 750 mg = 100mg

Conversion Guide

* 1 Kilogram = 1000 grams

* 1 Gram = 1000 milligrams = 15 grain
60 mg = 1 grain
* 1 Milligram = 1000 micrograms
* 1 Microgram = 0.001 milligrams
* 1 Milligrams = 0.001 grams* 1 Microgram = 10 -6 grams
* 1 Nanogram = 10 -9 grams
* 1 Grain = 65 milligrams
60 Grain = 1 dram
8 dram = 1 oz
1 fluid dram = 60 minim
1 cc = 15-16 min
1 min = 0.06 cc
8 fluid dram = 1 fluid oz
2 fluid dram = 8 cc
240 cc = 8 fluid oz (f oz viii)
30 cc = 1 fluid oz (f oz i) = 2 tbsp 15-16
cc = 4 oz = 3 tsp = 1 tbsp
* 1 Litre = 1000 cc
* 1 OZ = 30 cc
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* 16 OZ = 480 cc = 1 Pint
16 oz = 1 lb
* 1 Pint = 480 cc
* 1 Quart = 960 cc = 2 Pints
* 1 Gallon = 3840 cc = 4 Quarts = 8 Pints
* 2.2 lbs = 1 kg
* 1 Teaspoonful = 5 cc = 60 gtts
* 1 Tablespoonful = 15 cc
* 1 Teacupful = 120 cc
* 1 Wineglassful = 60 cc
* 1 Tumblerful = 240 cc

MODULE SUMMARY
Nurses use the nursing process - a decision making, problem-solving process - to
provide efficient and effective care. Although not all nursing theorists completely
agree on this process that defines the practice of nursing, most include certain key
elements: assessment, nursing diagnosis, implementation and evaluation.
Application of the nursing process with drug therapy ensures that the patient receives
the best, safest, most efficient, scientifically based, holistic care.
Assessment (gathering information) is the first step of the nursing process.
This involves systematic, organized collection of data about the patient. Because the
nurse is responsible for holistic care, data must include information about physical,
intellectual, emotional, social and environmental factors.
Nursing Diagnosis is simply a statement of the patient's status from a nursing
perspective. The nurse analyzes the information gathered during assessment to
arrive at some conclusions that lead to a particular goal and set of interventions.
Implementation involves taking the information gathered and synthesized into
nursing diagnoses to plan the patient care. This process includes setting goals and
desired patient outcomes to assure safe and effective drug therapy.
Evaluation is part of the continuing process of patient care that leads to
changes in assessment, diagnosis, and intervention. The patient is continually
evaluated for therapeutic response, the occurrence of adverse drug effects, and the
occurrence of drug-drug, drug-food, drug-alternative therapy, or druglaboratory test
interactions.
Drug administrations are guided by the 10 Rights. These include Right
Assessment, Right Drug, Right Dose, Right Client, Right Time, Right Route, Right
Documentation, Right to Refuse, Right Evaluation and Right Education.
The basic principles of pharmacodynamics and pharmacokinetics help the
nurse to anticipate therapeutic and adverse effects and to intervene in ways to ensure
the most effective drug regimen for the patient. The phases of Drug Action include
Pharmaceutic Phase, Pharmacokinetics and Pharmacodynamics.
Pharmaceutics refers to the method by which a drug is administered and the
form in which it is administered. Pharmacokinetics involve the act of the drug
reaching the circulating fluids and tissues from outside of the body.
Pharmacodynamics is the stage at which the physiological and biochemical
operation of a drug on the body happens. Drugs can wholly inhibit a process, activate
a process or they can replace a missing element.
The metric system is the most widely used system of measure. It is important
to know how to convert doses from one system to another. The method of ratio and
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proportion, which uses basic principles of algebra to find an unknown, is the easiest
method of converting doses within and between systems.
Children require doses of most drugs different from those of adults due to the
way their bodies handle drugs and the way that drugs affect their tissues and organs.
Standard formulas include Fried's rule, Clark's rule and Young's rule. All of which can
be used to determine the approximate dose that should be given to a child when the
average adult dose is known. However, these rules must also be modified
accordingly on the body surface area, which requires the use of nomogram, and
milligrams per kilogram of body weight.

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