Pharma Prelim 2014 Intro

Pharmacology for Nurses
Michelle Encarnacion- Flores,

RN, MAN
1
OBJECTIVES
Pharmacology/terminologies
History of Pharma
Basic Importance of Pharma
Forms of Preparation of Medication
Ethicolegal
Guidelines for Correct Drug Administration
Michelle E. Flores,RN,MAN
Core Concept in Pharmacology

Characterization of:
Pharmacology
Is The Study of Medicine
Derived from two Greek words
Pharmakon medicine drug

Logos study
Pharmacology
Deals with the study of effects of drugs and their
actions on living organism
Drugs are substance used in diagnosis, cure on
prevention of disease in living organism
(therapeutic & side effect)
PHARMAKON = Drugs + LOGOS = study
Posology study of dosage or amount of drugs
given in the treatment of disease
HX. Of Pharmacology
One of the oldest form of healthcare, practiced in

virtually every culture dating to antiquity
Applying products to relieve suffering has been

recorded throughout history by virtually every culture
Modern pharmacology began in the early 19th century

through the isolation of specific active agents from
their complex mixtures
HISTORY
Primitive trial & error
Ancient
China,2700 BC (Codification of mixture)

Arab, 2200 BC (Code of Hammurabi)
Egypt, 1550 BC (Ebers Medical Papyrus)
Greece, 400 BC (Hippocrates father
medicine & hygiene importance)
India,200 BC (recognize meds used today)
HISTORY
Dawn of Christian Era (Roman Materia Medica)

Medieval to modern 1260 AD (Arab)
Renaissance Europe
1600 Aztecs
17th -18th Century
Early 19th Century
Middle 19th Century
Modern Times
Terminology
Medication substance a substance administered for the
diagnosis, cure, treatment or relief or prevention of disease.
Chemical(Generic) & Brand Name
Therapeutic Effect- desired effect
Side Effect secondary effect (unintended)
Drug Allergy immunologic reaction
Anaphylactic Reaction severe allergic reaction which
occur immediately following admin of drug
Terminology
Drug Tolerance decrease physiologic response to
repeated admin of drug or chemical related substance or
excessive increase in the dosage is required in order to
maintain the desired therapeutic effect
Cumulative effect increasing response to the repeated
doses of a drug either over response, under response,
different response than expected, unpredictable or
unexplained responses.
Idiosyncratic effect unexpected peculiar response
10
Terminology
Drug Abuse inappropriate intake
Drug dependence persons reliance and intense physical or

emotional disturbance is withdrawn
Addiction due to biochemical changes in the body tissue
especially nervous system(physical dependence
Habituation emotional reliance on drugs to maintain well being
Drug interaction- effects of one drug are modified by prior
concurrent administration of another drug w/c Inc or Dec pharma
action
11
Terminology
Summation
combined effects of two drugs produces

a result that equals the sum of the individual effects of
each agent
Synergism combined effects of two drugs is greater
the sum if each individual agent acting independently
Potentiation concurrent administration if two drugs
in which one drug increases the effect if the other
drug.
12
Therapeutic Actions of Drugs
Palliative relieves the symptoms of disease does not

affect the disease itself
Curative treat the condition of disease
Supportive sustains body functions until other
treatment of the bodys response can take over
Substitutive replaces body fluids or substance
Chemotherapeutic destroys malignant cells
Restorative returns the body to health
13
Therapeutic Objective
To provide maximum benefit
with minimum harm
Factors that determine Intensity of Response
Administration- dosage size and route

Pharmacokinetic processes
Pharmacodynamics
Individual Variations
14
Therapeutic Objective
1. Administration- dosage size and route
- Because of errors in administration routes and dosage and at wrong time
there are many discrepancies in what patient gets and could cause more
harm than good
- Errors could be made by pharmacists, physicians, or nurses
- Should give patients complete instruction about their medication and how
to take it
2. Pharmacokinetic processes
- Determines how much of an administered dose gets to its
sites of action
1) drug absorption
2) drug distribution
3) drug metabolism
4) drug excretion
15
Factors that determine the intensity of drug

response
16
Core Concept In Pharmacology

Concepts
Is a discipline devoted to patient therapy through the use

of drugs
Pharmacology utilizes concepts from human biology,

pathophysiology, and chemistry
17
Regulations and Standards
Created to protect the public from drug misuse
Regulatory agency are responsible for ensuring

that drugs and medical devices are safe and
effective
The regulatory agency responsible for ensuring

that drugs and medical devices are safe and
effective is the Food and Drug Administration
(FDA)
18
Regulations and Standards
R.A. 6125 Dangerous Drug Act
Formulary first standard commonly used by

pharmacists
Pharmacopoeia medical reference summarizing

standards of drug purity, strength and direction for
synthesis
19
Clinical Phase Trials
Large group of selected patients with the particular

disease are given the medicine
Clinical investigators from different medical

specialists address concerns, if drug appears effective
without serious side effects, maybe used immediately
in special cases with careful monitoring
20
Schedule of Controlled Substance
Schedule/Abuse
Potential
Therapeutic Use/
Example
Limited or no use/heroin,
LSD, Marijuana
With prescription/MS, PCP,
Cocaine
With prescript./Codeine,
ASA, Tylenol
With prescript/Darvon,
Librium, Valium
I/carries highest risk
II/carries high potential
III/moderate abuse risk
IV/low abuse risk
V/least abuse potential
Without prescription OTC
21
Methods of Dispensing Drugs
Two major methods
Purchase of prescriptions drugs with a physicians

order
Purchase of over the counter (OTC) drugs which

do not require a physicians order
There are advantages and disadvantages to both

methods of dispensing
22
PHARMACY
is the art of preparing,
compounding, and dispensing
drugs.
also refers to the place where the
drugs are prepared and
dispensed.
PHARMACIST
A person licensed to prepare and
dispense drugs
and to make up 23
prescriptions.
DRUG STANDARDS
developed to ensure uniform
quality of drugs
R.A. 6125 Dangerous Drug Act
PHARMACOPOEIA
Is a book containing list of
products used in medicine; the
descriptionMichelle
ofE.the
product;
Flores,RN,MAN
chemical test for determining
24
1. Chemical Name
is a precise description of a drugs chemical
composition
2. Generic Name
is the name assigned by the manufacturer
who first develop the drug
3. Official Name
is the name by which the drug is identified on
the official publication
4. Brand Name / Trademark Name
assigned nameMichelle
for E.aFlores,RN,MAN
certain drug when the25
pharmaceutical companies market the drug.
DRUG MISUSE
An improper use of common medications in ways
that lead to acute and chronic toxicity
a. Drug Abuse inappropriate intake of a substance,

either continually or periodically
2 Main Facets:
1. Drug Dependence a persons reliance on a
certain drug
1.1 Physiologic Dependence
1.2 Psychologic Dependence
2. Drug Habituation Michelle
a habit
of taking a drug
E. Flores,RN,MAN
and feels better after intake
26
b. Illicit Drug / Street Drug sold

Types:illegally
1. Drugs unavailable for purchase
under any circumstances
2. Drugs normally available with a
prescription that are being
obtained through illegal channels
27
Pharmacokinetics/ Pharmacodynamics
Molecules
Receptor Sites
28
Pharmacokinetics
Derived from the root words
Pharmaco medicine
Kinetics movement or motion
Focuses on the movement of drugs

throughout the body after they are
administered
Deals with how the body

metabolizes and excretes drugs
29
Factors that determine the intensity of drug response
30
Pharmacokinetics
31
Pharmacokinetics
Refers to the study of the
absorption, distribution,
metabolism, and excretion of
drugs to determine the
relationship between the dose of
the drug and the drugs
concentration in biological fluids.
32
Pharmacokinetics
Diffusion
33
Pharmacokinetics
a. Absorption the degree and rate of
passage of a drug from the site of
administration into the blood
Absorptionstream.
depends on several factors:
i. The drugs physicochemical effects
ii. The dosage & route of administration
and its interaction with other
substances in the digestive system
iii. Clients characteristics
b. Distribution is the transportation of a
Michelle E.the
Flores,RN,MAN
drug from
site of absorption34 to
the site of action.
Pharmacokinetics
The Processes of Pharmacokinetics
Absorption
Movement of the drug from its

administration site into systemic circulation
Many factors affect drug movement
Rate of Dissolution- how fast the drug dissolve
Surface Area- larger surface area = faster
absorption
Blood Flow: Greater blood flow = faster
absorption
Lipid Solubility- High lipid solubility = faster
absorption
pH Partitioning - ionize in the blood and not at
the site of administration
35
Pharmacokinetics
Pharmacokinetics Processes
Distribution
Represents how drugs are transported
throughout the body
Variables affecting distribution
Lipid solubility
Degree of ionization
Plasma protein binding
The blood-brain barriers
Fetal-placental barrier
36
Pharmacokinetics
Distribution
Amount of blood flow to body tissue is

the main factor determining distribution
Cardiac output
Body composition( amt. of adipose
tissue)
Presence and degree of vessel
constriction or dilatation
37
Pharmacokinetics
Metabolism (Biotransformation)
Is a process that changes a drugs
activity and makes it more likely to be
excreted.
Alters drug structure usually in the liver
First-Pass Effect- Hepatic inactivation of
certain oral drugs
Metabolic enzymes in the liver are less

active in infants and geriatric patients
38
Pharmacokinetics
Processes
Excretion
Elimination of drug from circulation

The main organ involved with excretion is
the kidney
Drugs are eliminate from the body by
Kidney via the urine
Lungs via exhaled air
Sweat glands via perspiration
Tears via crying
Mammary glands via breast milk and
Biliary system
39
Pharmacokinetics
Plasma Concentration
The therapeutic response of most drugs

are related to their plasma concentration
Minimum amount required to produce

therapeutic effect
Therapeutic -lies between the minimum
effective level and the toxic level.
Toxic result in serious adverse effects
40
Pharmacokinetics
Plasma half-life
Represents the duration of action for most

drugs
The length of time the body takes to
reduce the plasma level of a drug to 50%
of its peak value
Loading dose
Higher amount of drug

Given once or twice to
Quickly induce a therapeutic response
41
ACTIONS OF DRUGS IN THE BODY

The purpose of medication
management is to produce the
derived drug action by
maintaining a constant drug level.
Drug action is based on the drugs half life.

Ex. If a drugs half-life is 8 hrs, then
the amount of drug in the body is
as follows:
Initially 100%
After 8 hrs
50%
After 16 hrs
25%
After 24 hrs
12.5%
After 32 hrs
6.25%
42
c. Metabolism is the physical and

chemical processing of a drug
- Also known as
biotransformation or
detoxification
- Liver is the primary source
- The product of these
processes are called
metabolites
d. Excretion is the process in which
metabolites and drugs are
eliminated from the body
43
2. Peak Plasma Level the time it

takes for a drug to reach its
highest blood concentration
in a single dose.
3. Trough is the lowest blood serum
concentration of a drug in a
persons system.
it helps in adjusting drug
dosage to prevent toxicity
or drug buildup.
44
4. Duration the time in which the

drug remains in the system
in a concentration great
enough to have a
therapeutic effect.
5. Plateu a maintained
concentration of a drug
in the plasma during a
series of scheduled
doses.
45
Pharmacokinetics
Equilibrium state
The amount of drug administered is

equal to the amount excreted
Equilibrium state may be reached faster
through the use of loading doses
Maintenance dose
Given to keep plasma concentration in

therapeutic range
46
Pharmacodynamics
Is comprised of the root words
Pharmco medicine
Dynamics change
!
Pharmacodynamics the mechanism by which
drugs produce biochemical and physiologic changes
in the body
The differences in patient responses to

medications
47
Pharmacodynamics
Potency and Efficacy
Potency - the dose of medication required

to elicit a particular response
Efficacy - the magnitude of maximal

response to a drug
Efficacy of a drug is more important to

the patient and nurse than the potency
48
Pharmacodynamics
Pharmacology of the Future
Likely be customized to match the

genetic make-up of each patient
Pharmacogenetics - application of
genetics to pharmacology with the
objective of individualizing therapy
49
Therapeutic Effect / Desired Effec

EFFECTS OF DRUGS
Side Effect / Adverse Effect
is the primary effect intended for

the prescribed drug.
is the secondary effect of a drug

unintended
Usually predictable and maybe
either harmless or potentially
harmful
50
Drug Toxicity
Deleterious effect of a drug to an
organism
Results from overdosage,
ingestion of a drug intended for
external use, or cumulative effect
of a drug
Drug Allergy
is an immunologic reaction to a
drug
51
Common Mild Allergic

Responses
1. Skin Rash an epidermal vesicle,
urticarial wheal, or macular
eruption
2. Pruritus itching of the skin
with or without rash
3. Angioedema edema due to
increased permeability of
the blood capillaries
4. Rhinitis excessive watery
discharge from the nose
5. Lacrimal Tearing excessive tearing
52
Common Mild Allergic

Responses
6. Nausea / Vomiting
7. Wheezing due to accumulated
fluids and swelling of the
respiratory tissue.
8. Dyspnea difficulty of breathing
9. Diarrhea irritation of the large
mucosa of the intestine
53
Anaphylactic Reaction
A severe allergic reaction
usually occurs
immediately after the
administration of the
drug
Drug Tolerance
Exists in a person who has
unusually low physiologic
response to a drug and who
require an increase in the
dosage to maintain a given
54
Cumulative Effect
Is the increasing response to
a repeated dose of a drug
Occurs when the rate of
administration exceeds the
rate of metabolism or
excretion
Idiosyncratic Effect
Unexpected and individual
response to a drug
55
Drug Interaction
Effect of one drug to
another drug which are
taken at the same time
May have synergistic or
inhibiting effect
Iatrogenic Disease
Disease caused
unintentionally by medical
therapy
56
EFFECTS OF DRUGS
Therapeutic Effect / Desired Effect

is the primary effect intended
for the prescribed drug.
Side Effect / Adverse Effect
is the secondary effect of a drug

unintended
Usually predictable and maybe
either harmless or potentially
harmful
57
Drug Toxicity
Deleterious effect of a drug
to an organism
Results from overdosage,
ingestion of a drug
intended for external use,
or cumulative effect of a
drug
Drug
Allergy
is an immunologic reaction to a
drug
58
FACTORS AFFECTING MEDICATION

ACTION
1.
2.
3.
4.
5.
6.
7.
8.
Developmental Factor
Cultural, Ethnic, and Genetic Factor
Gender
Diet
Environment
Psychologic Factor
Illness & Diseases
Time of Administration
59
Variables that affect drug

actions
9. Age
10.Pregnancy
11.Body weight
12.Gender-hormonal effects
13.Pathologic conditions
14.Placebo response pyschological benefit
60
Variables that affect drug

actions
Dosage
Route
Drug-diet interactions. Food may slow
absorption or foods may actually interact with
certain medications (tyramine and MAO
inhibitors; tetracycline and milk products;
ingestion when taking certain antihypertensive
medications)
61
Variables affecting drug

actions
Drug-drug interations-additive effects such as
seen with sedatives and ethanol. Synergism as
seen with acetaminophen and codeine.
Antidotedrug can be given to antagonize the
toxic effects of another drug
62
General Principles cont.

Follow the rights consistentlypage 82
Learn essential information about each drug
Interpret prescribers orders correctly
Read labels for right medication and
concentration
63
Drug Administration
*****Seek information about the clients medical
diagnoses and condition in relation to drug
administration
Be especially vigilant with children to avoid
errors
64
Legal Responsibilities
Nurse is legally responsible for safe and accurate

administration of medications
Nurse is expected to have sufficient drug knowledge to

recognize and question erroneous orders
Unit dose wrappings of oral drugs should be left in place

until the nurse is in the presence of the client and ready
to administer the medication
65
Medication Orders
Include the full name of the patient
Generic or trade name of the drug
The dose, the route and frequency of administration
Date, time and signature of the prescriber
TYPES OF DRS ORDER
Standing Order
One time or Single Dose
PRN
STAT
66
Because No Drug is Ideal..
Because no drug is ideal.
No medications are not ideal

No drug is safe
All drugs produce side effects
Drug responses may be difficult to predict
Drugs may be expensive
Drugs may be hard to administer
All members of health care team must exercise

care to promote therapeutic effects and
minimize drug induced harm
67
NURSING FUNCTIONS:
MEDICATION
Dependent = Physicians role

Interdependent baseline & subsequent
assessment, collaborate with health team
Independent pt education including
meds, documentation, scheduling ,
verification, critical analysis & preparation
68
10 Principles of Drug Administration
Rights of Drug Administration

1.
Right patient /Client
2.
Right medication/drug
3.
Right dose
4.
Right route
5.
Right time
6.
Right documentation
69
10 Principles of Drug Administration

Additional
Rights
7. Right Assessment
8. Right Evaluation
9. Right to refuse
10. Right to receive medication education
70
Principles of Drug Administration

Abbreviation
prescribed
ac before meal
Po or per os by mouth
pc after meals
mEq milliequivalent
gtt - drop
hs hour of sleep, at bedtime
71
Do not use
U or u
IU
q.d. or QD
q.o.d. or QOD
MS
MSO4
Zero after decimal point
(1.0)
Use instead
Unit
International Unit
Daily
Every other day
Morphine
Morphine sulfate
1
72
MgSO4
mg
TIW or tiw
AS
AD
AU
No zero before decimal
dose (0.5mg)
Magnesium Sulfate
Micro gram
Three times weekly
Left ear
Right ear
Both ears
.5mg
73
Time Schedule
ASAP as soon as possible

STAT immediately
Single one time dose
Routine daily dose
Standing parameters left to follow
PRN when needed
Drug Orders
Clonidine .2mg po twice daily, hold for SBP<100

74

Drug
Orders
Vancomycin 750mg IV stat, followed by

Gentamycin 1gm IV
Lasix 40mg IV now and daily PO
Tylenol 650mg po or pr, q 4hr prn temp. > 101 or

mild pain
75
Time Schedules
OD once a day
BID - Twice daily
TID -Three times daily
q4 every 4 hrs , q12 every 12hrs
RTC Round the

clock
Michelle
E. Flores,RN,MAN
76

Documentation
If medication refused or omitted and reason

Any assessment
Dosage and time administered
Medication name and your signature
Example: Tylenol 650mg pr (rectally) given for temp. 101.6
orally at 1600. M. Davis-Kendrick RN
77

Nursing
Management
Assumes great responsibility for drug administration
Firm knowledge of drug
Name and classification

Intended or proposed use
Effects on body
Contraindication/special consideration
Side effects
78
PREPARATION AND ROUTE

1. Oral Route
Safest, most
convenient, and least
expensive
Disadvantage: slower action,
unpleasant taste, and irritation of
the gastric mucosa
a. Buccal (cheek)
b. Sublingual (SL)
79
2. Parenteral Route
injection
Has the fastest action
4 Parenteral Routes:
a. Intradermal (ID) injection into
the dermis
b. Subcutaneous (SC or SQ)
injection into the subcutaneous
tissue
c. Intramuscular (IM) injection into
the muscle
80
d. Intravenous
(IV) injection into
3. Topical Route
Large number of topical drugs are
applied to the skin, but others
include eye, nose, throat, ear,
rectal, and vaginal preparations.
81
TYPES OF DRUG
PREPARATION
1. Elixir a sweetened
and aromatic
solution of alcohol used as a
vehicle for medicinal agents.
2. Emulsion an aqueous preparation

in which an erogenous or
resinous material is suspended.
3. Capsule a small globular or
cylindrical container made of
some digestible or soluble
E. Flores,RN,MAN
materialMichelle
such
as gelatin for 82
4. Liniment solutions or irritant drugs

in an oily, soapy, or alcoholic
base which are applied by
rubbing on the skin.
5. Lotion an aqueous or alcoholic
solution or suspension of
insoluble
6. Spray
a jet ofsubstance.
fine medicated vapor
applied by an atomizer to an
affected part (nose or throat).
83
7. Ointment a semisolid preparation

readily spread at ordinary
temperature
8. Suppository a solid medicated body
with a fatty base adapted in
shape and weight for insertion
into cavity of the body and
melting at body temperature.
84
CLASSIFICATION OF DRUGS ACCDNG

TO ACTION & EFFECT
1. Amebicide destroys amebae

2. Analgesic allays pain without
affecting consciousness or
producing
narcosis
3. Anesthetic
causes
unconsciousness
or loss of sensation and
sensibility to pain or touch
4. Antacid counteracts or reduces the
acidity to secretions, usually of
the stomach and intestines
5. Antihelmintic
destroys or expels85
gastrointestinal worms.
6. Antibiotic inhibit the growth of

microorganism (bacteria, fungi,
molds)
7. Anticonvulsant prevents or allays
convulsion or spasm
8. Antidote neutralizes a poison or
counteracts its effect
9. Antipruritic prevents or allays itching
10. Antipyretic prevents, reduces, or
removes fever
11. Antiseptic prevents

or arrest the growth
86
or action of germs on a disease
12. Cathartic promotes defecation,

cleansing the bowels
13. Depressant lowers functional or vital
activity increases secretions
14. Diaphoretic
15. Diuretic increases secretion and
discharge of urine
16. Emetic induces vomiting

17. Emollient softens, soothes, and protects
irritated skin or mucous membrane
18. Expectorant Michelle
facilitates
E. Flores,RN,MAN the expulsion
87 of
mucus and exudates from the
19. Fungicide destroys fungi
20. Gonadotropic influences the growth and

activity of gonads
21. Hematinic increases the heme content
of the blood
22. Hemostatic arrest hemorrhage
23. Hypnotic causes asleep
24. Laxative promotes defecation by
loosening or opening the bowels
88
25. Mydriatic causes dilatation of the pupils
Routes of Drug Administration

Enteral
89

Enteral
Includes drugs given orally and those administered

through nasogastric or gastrostomy tubes
The sublingual and buccal routes are less commonly
used enteral routes, dissolved directly into blood
stream
Is the most common, convenient, and usually, the
least costly of all the routes
90

Enteral
Tablets
Maybe formulated to release the drug in a steady

controlled manner
Maybe scored for individual dosage,
Maybe enteric-coated (EC) to dissolve in alkaline
environment of sm. intestines
Sustained- Release also called extended release (XR),
long acting (LA), or slow-release (SR)
Do not crush EC or slow releasing tablets
91

Enteral
Capsules
Drug encased in shell of hard or soft gelatin
Also comes extended release
Extended-release capsules must not be opened
Sublingual
Placed under tongue and allowed to dissolve
Result in a rapid onset of action
92

Enteral
Buccal
Placed in oral cavity between gums and cheeks
Mucosa less preamble than sublingual
Slower absorption than sublingual
Preferred over Michelle

sublingual
for sustained release
E. Flores,RN,MAN
93
Troches (lozenge)
Commonly used to achieve local effect
Held within the mouth until dissolved
NGT/GT
Useful if patient unable to swallow
Medication is crushed
or dissolved
94

Enteral
Do not crush sustained release drugs or EC
If tube connected to suction, hold for 30 minutes

after giving medication
If drug interferes with tube feeding hold feeding

for 1 hour before and 2 hours after
95

Enteral
Advantages
Safe
Convenient
Least expensive
Disadvantages
Patient must be alert and able to swallow
Need to stay until medicine is taken
Greater chance for refusal and non compliance
96

Enteral
Nursing Consideration
Assess patient level of consciousness
Assess allergies
Monitor vital signs or lab result
Perform the 5 rights of administration and
The three checks before administering medication
Documentation
97

Topical
Application
Instillations and irrigations applied into body
cavity or orifices
These include the eyes, ears, nose bladder, rectum
and vagina
Inhalations drugs applied to the respiratory tract
by inhalers, nebulizers, or positive pressure
breathing machines
98

Topical
Transdermal
Effective way of delivering specific amounts of

medications
Patches are changed/rotated on a regular basis
Slow release and absorption
Ophthalmic
Used to treat local conditions of the eye and

surrounding structure
Available in the form of irrigation, drops, ointments,
and medicated disks
99

Topical
Otic
Used to treat local conditions of the ear and auditory

canal
Includes eardrops and irrigations
Perform carefully on infants and young children to
avoid injury to sensitive structures of the ear
Nasal
Used for both local and systemic drug administration

Drops or sprays often used for their local astringent
effect which is to shrink swollen mucous membranes
100

Topical
Vaginal
Used to treat local vaginal infections, and to relieve

pain and itching
Inserted in suppositories, creams, jellies, or foam
Rectal
Used for either local or systemic administration

Normally in suppository form
Slowest rate of absorption
101

Parenteral
Dispensing of medications via a

needle
Usually into the skin layers,
subcutaneous tissue, muscles or
veins
Advance deliveries include into
arteries, body cavities and organs
Aseptic technique must be strictly
applied
102
Parenteral
Intradermal (ID)
ID administered into the dermis (1st layer of skin)

Easily absorbed because of more blood vessels
Usually for allergies, TB, anesthetic, or prior to IV
insertion
Limited to small volumes (0.1 to 0.2ml)
Use only 25 or 27 gauge needle
Inject into non-hairy skin surfaces (inner forearm)
103
Parenteral
Subcutaneous (sub-q, SC, SQ)
Administered into fatty tissue

Less absorption than IM, distributed through
capillaries
Insulin, heparin, vitamins, some vaccines and narcotics
Sites used are upper, lateral arms, anterior thigh,
abdomen and mid back
Doses small in volume (0.5 1cc) per injection
104

Parenteral
Subcutaneous (sub-q, SC, SQ)

Not necessary to aspirate
Rotate sites
TB and Insulin syringes are not interchangeable
Use 5/8 inch needle
Size of individual determines angle of injection
(45 vs. 90 degree angle)
105

Parenteral
Intramuscular (IM)
Delivers medication injected into a certain muscle
Onset of action more rapid than SQ because of
rich blood supply
Many are dry power and must be reconstituted
before administration
106

Parenteral
Intramuscular (IM)
Most common sites
Deltoid
volume not to exceed
2 ml
Small volume vaccines
1 needle
107

Parenteral
Intramuscular (IM) Most common sites

Dorsogluteal
Up to 3ml/injection
1-1.5 needle
Aspirate
Inject slow & smooth
108

Parenteral
Intramuscular (IM)
Ventrogluteal
Preferred site
Contains no large
vessels or nerves
Suitable for children
and infants over seven
months
109

Parenteral
Intramuscular (IM)
Rectus femoris
Used for infants
Vastus lateralis
Middle
third used for injection

Used most often in children
110

Intravenous
111

Intravenous Administration
(I.V.)
Direct delivery into systemic

circulation, bypasses absorption
process
Rapid onset of action
Allows large volumes to be given
Acceptable when no other route
possible
112

(I.V.)
Three Basic Types
Large volume infusion

For
maintenance, replacement or supplement

Mixture of compatible drugs
Intermittent infusion
Intravenous
Piggy Back (IVPB)

Used to instill adjunct medication (analgesic,
antibiotics)
113

(I.V.)
Three Basic Types
IV Bolus or IV Push
Concentrated
Monitor
May
dose delivered via syringe
closely for adverse reaction
take several minutes depending on the drug

114
Adverse Drug Effects

Drug dependency
Idiosyncrasy
Carcinogenicity
teratogenicity
115
ToxicologyDrug
Overdosage
1.
2.
3.
4.
5.
6.
7.
General management
CPR
ETT
IV
Check blood sugar, drug screen, liver and kidney
function
Charcoal
Narcan or possibly antidotes
May alkalinize the urine to prevent kidney damage
116
Antidotes for Selected

Therapeutic Drugs
Acetaminophen-mucomyst
Digoxin-digibind
Beta blockers-Glucagon (increases myocardial
contractility)
Phenothiazines-benadryl (EPS)
Coumadin-vitamin K
Heparin-protamine sulfate
117
Antidotes cont.
Benzodiazepinesflumazenil
Cholinergics-atropine
Calcium channel blockerscalcium gluconate
118
Adverse effects of drugs
CNS
GI
Hematologic-anticonvulsants
Hepatic-acetaminophen, INH
Nephrotoxicity-aminoglycosides, NSAIDS
Hypersensitivity
Drug fever-fever associated w/administration of some
antimicrobials, atropine or TCAs
119
Pregnancy Categories
Cat. A-studies in pregnant women failed to show
risk to the fetus
Cat. B- animal studies have failed to show a risk
to the fetus but there are no adequate studies in
women
Cat. C-animal studies have shown an adverse
effect on the fetus, no adequate human studies,
benefits may outweigh risks
120
Pregnancy Categories cont.

Cat. D-positive evidence of human fetal risk
Cat. X-animal or human studies have shown fetal
abnormalities or toxicity
121
Excretion
Refers to the elimination of a drug from the body
Most are excreted by the kidneys although some
are excreted in the bile then the feces
122
Common abbreviations
PO
IM
IV
SL
Sub q
123
Times of Drug Administration

AC
Ad lib
bid, tid, qid
HS
PC
PRN
Stat
124
Drug Dosages
cc
g
Gr
gtt
mL
oz
Tsp
tbsp
125
Routes of Administration
Oral
Via GI tube
Parenteral-IM, IV and sub q
Topical
Rectal, ophthalmic
Otic
vaginal
126
Nursing Process in Drug

Therapy
Is a systematic way of gathering and using
information to plan and provide individualized
client care and to evaluate the outcomes of care
Five steps of the nursing process are: assessment,
nursing diagnosis, planning, interventions and
evaluation
127
General Principles of Drug

Therapy
Expected benefits should outweigh potential
adverse effects
Drug therapy should be individualized
Drug effects on quality of life should be
considered in designing a drug therapy regiment
128
Drug selection and dosage

Use as few drugs as possible
Fixed dose combinations increase compliance
Lowest dose with therapeutic effect
Follow guidelines but dosages must be
individualized
Drugs with long half-lives may require loading
doses then titrated lower maintenance doses
129
Drug Therapy in special

populations-pediatrics
Pediatrics-all aspects must be guided by the
childs age, weight and level of growth and
development
Safe therapeutic ranges are less well-defined
Choice of drug is restricted because many drugs
used in adults have not been sufficiently
investigated
130
Pediatric physiologic
characteristics affecting
Thin,pharmacokinetics
permeable skin increased absorption of
topicals
Immature blood-brain barrierincreased
distribution into the CNS until age 2
Altered protein binding until age 1
Decreased activity of metabolizing enzymes in
infants, increased in children
131
Pediatric physiologic effects

Increased percentage of body water
Decreased GFR until one year of age
132
Pediatrics
Oral route for meds is preferable
For injections, may wish to use EMLA (eutectic
mixture of lidocaine and prilocaine, local
anesthetics)
Site selection for injectionsinfants, use thigh
muscles; older than 18 months of age, use
deltoid; older than 3, use ventrogluteal muscle
133
Drug Therapy in Older Adults

Physiologic characteristics and
pharmacokinetic impact
Decreased GI motilityslower absorption

Decreased cardiac outputslower absorption
from site of administration, decreased
distribution to sites of action in tissues
Decreased blood flow to liver and kidneysdelayed metabolism and excretion
134

Decreased total body water and lean body massfat soluble meds stay with patient longer, water
soluble drugs are distributed in smaller area,
greater risk for toxicity
Decreased blood flow to liver-slowed
metabolism and detox of drugs
135

Decreased albumin-decreased availability of
protein for binding and transporting. Will also
have higher concentration of free active drug.
Decreased blood flow to kidneysimpaired drug
excretion, potential toxicity
136
Older Adults
Renal Impairment
Know baseline renal function
Tailor dosages
Avoid nephrotoxic medications
Be aware of need for additional dosing if patient
is receiving renal replacement therapy
137
Older Adults
Hepatic Impairment
Those with cirrhosis, hepatitis, receiving hepatotoxic

drugs, have heart failure, are undergoing major surgery
or have had trauma are at higher risk for toxicities r/t
medications
Know drug effects on hepatic function
Reduce dosages on medications that are extensively
metabolized by the liver such as: cimetidine, phenytoin,
ranitidine, theophylline
138
Older Adults
Critical Illnesses
Be aware that all medications may have variable
effects in this scenario
Know the actions, usual dosages and side effects
of medications
Closely monitor renal and liver function tests
Monitor serum protein and albumin levels
139
Older Adults
Critical Illness
Most drugs will be given IV-for this reason,
medications may have faster onset
Many factors may interfere with drug effects if
given orally
Considerations when giving medications via
feeding tube
Appropriate scheduling very important
140
Drug Therapy in Home Care

On patients turf
Schedule visit at convenient time for patient and
caregiver
Assess patients ability to perform self-care
Assess patients understanding and attitude
regarding medication regimen
Inquire if patient is taking any herbal
preparations
141
Drug Therapy in Home Care

Inquire if patient is taking any OTC meds
Assess environment for safety
Educate patient and caregiver indication, proper
administration and side effects of administered
medications
Between visits, maintain contact with patient to
monitor progress and serve as a resource
142
Herbal and Dietary

Supplements
Black cohosh-used to relieve menopausal s/s
Capsaicin-post-herpetic neuralgia
Echinacea-anti-infective, for common cold
Gingernausea. Not for morning sickness.
Garlic-cholesterol lowering
143
Herbal and Dietary

supplements
Feverfew-for migraines, menstrual complaints.
Can cause withdrawal s/s.
Ginseng-increase stamina, endurance and mental
acuity. Can affect bleeding time, BP, increase
hypoglycemia. No longer than 3 weeks use with
Siberian ginseng.
144
Calculation of dosages:
Desired/Have: 50 mg ordered,
have on hand 100 mg/2 cc
1.
Formula:
Desired dose
x Quantity = Dosage
to give
Have on hand
Example: 50 mg x 2 cc = 1 cc
100 mg
145
146
147
NEEDLES
A. Intradermal (ID)
26 gauge (g): or 3/8 inches
B. Intramuscular (IM)
22 g: 1 to 1 inches
16 to 18 g: 2 to 3 inches for
penicillin injections
C. Subcutaneous (SQ)
25 or 26 g: to 5/8 inches
D. Intravenous (IV)
18 to 22 g: general IV
14 to 20 g: blood transfusion
148
Pharmacotherapy across the

Lifespan
Pregnancy
Conducted only when the benefits to the
mother outweigh the potential risks to the
fetus
Pregnancy Categories guide the
practitioner in prescribing drugs for these
patients
Pregnancy Categories have been
developed by the FDA to assess potential
risk to the fetus
149

Lifespan
Pregnancy
Drugs and other substances can
appear in breast milk and affect infants
Refer to FDA Pregnancy Categories
(table 7.1 pg.69 text)
Infancy (birth 12 months)

Directed toward safety
Administer oral medication slowly
150

Lifespan
For suppositories hold buttocks
together for 5-10 minutes
Vastus lateralis preferred site for IM
injection
Medication prescribed in milligrams
per kilogram per day (mg/kg/24h)
151

Lifespan
Alternate method for calculating dosage is
to use the infants body surface area (BSA )
BSA refers to the total area exposed

Derived from height and weight
Two formulas used
A.Formula using metric system

Weight (kg) x Height (cm)
3600
152

Lifespan
B. Formula using pounds and inches
Weight (lb) x Height (in)
3131
BSA written in square meter (m2)
Maybe used to double check orders
for safe dosage
153

Lifespan
Toddlers (1-3)
Major concern, sense of curiosity
Can swallow liquid, maybe able to
solid medication
IM injection given in the vastus
lateralis
IV may use scalp or feet
154

Lifespan
Preschool (3-5)
Dorsogluteal site used for IM after 1
year of walking
Peripheral veins used for IV injections
Often resist medication
School Age (6-12)

Begin to realize the benefits of
medications and the reasons why
medications are needed
155

Lifespan
School Age (6-12)

Give the child a sense of control over
drug administration
At the same time be firm and giving
the child praise for cooperation
Can take chewable tablets, may
swallow tablets or capsules
Ventrogluteal site preferred for IM
156

Lifespan
Adolescence
Respect need for independence and

privacy
Concerned with physical appearance and
peer approval
Indications for pharmacotherapy
Skin conditions
Headaches
Menstrual irregularities
Sports injuries
157

Lifespan
Young (18-40) and Middle (40-65) Adulthood
Generally need little pharmacotherapy
Complications associated with pregnancy
are of major concern
Cardiovascular concerns become
important
Use of antidepressants and antianxiety
agents are prominent in the over-50
population
158

Lifespan
Older Adults
Take more medications (polypharmacy)
and experience more adverse drug
events than any other age group
Must make accommodations for agerelated changes in physiological and
biochemical functions
With numerous physical challenges,
which become targets for
pharmacotherapy
159

Lifespan
Older Adults
Changes in liver and kidney function make

pharmacotherapy more risky
Cardiovascular disease becomes a major
indication for pharmacotherapy
For drug therapy to be successful must make
accommodations for age-related changes in
physiological and biochemical functions
160
Legal and Ethical Issues

Ethics
Branch of philosophy dealing with the
moral principles that guide a persons
behavior or conduct
Are learned early in life through
religious affiliations, family, role
models, and peers
161

Moral
Principles such as beneficence, nonmaleficent behavior, veracity,
autonomy, justice, and fidelity are
necessary in medication
administration
When making ethical decisions in
clinical practice, the nurse uses
E. Flores,RN,MAN
fundamentalMichelle
moral
principles
162

Three most important principles
Beneficence - promote the most good
for the patient
Non-maleficent obligation not to
harm the patient
Autonomy - allowing the patient the
informed right to choose the course of
163
their care

Legal
Nurse Practice Act
Defines the scope of practice for professional
nursing
Defines the standard of care for practicing
nurses
State the minimum competency for
proficiency in nursing
Documentation of medication
administration, including any errors,
should be completed
immediately
164

Legal
Medication Errors
A preventable error that may cause or
lead to an adverse reaction
can result in serious injury to the patient
and litigation for the nurse and healthcare
agency
165

Legal
It is the ethical and legal responsibility of
the nurse to report any medication errors
Documentation necessary for patient
safety
Finding strategies to prevent of
medication errors involves many
different processes, including the nursing
process
166
Nursing Process
Is a systematic method of problem-solving
and consists of clearly defined steps
Assessment
First step in the nursing process
Baseline data gathered (subjective, objective)
Assessment includes health history information,
physical assessment data, lab values and other
measurable data
Includes an assessment of medication effects:
therapeutic, side or adverse effects
167
Nursing Process
Nursing Diagnosis
Are developed after an analysis of the
assessment data
Diagnoses are focused on the patients
problems or potential problems
Begin by addressing problems that pose
immediate threats to the patients health
168
Nursing Process
Goal
Developed from the nursing diagnoses
Focus on what the patient will be able to do or achieve
Outcomes
Objective measures of goals
Define what the patient will do
Under what circumstances and time frame
Goals and outcomes are prioritized to address

immediate need first
169
Nursing Process
Goals and outcomes may be developed for shortterm or long-term, depending on the specific
situation
Planning
Links strategies or interventions to goals and
outcomes
Interventions
Aimed at returning the patient to an optimum level
of wellness and limiting adverse effects
170
Nursing Process
Interventions
Key components of implementation include monitoring
and documentation of drug effects, and patient education
Monitoring drug effects is a primary intervention
Patient teaching is a vital component( considered primary
role
Documentation of both therapeutic and adverse effects is
complete during this phase
171
Nursing Process
Evaluation
Final step of the nursing process
Considers the effectiveness of interventions at
meeting goals and outcomes
Evaluation begins a new cycle as new
assessment data is gathered and analyzed
Nursing diagnoses are reviewed or rewritten,
goals and outcomes refined, and new
interventions are implemented
172
System of Measurement
Include the metric, apothecary,
and household systems
Michelle E.
Flores,RN,MAN
173
Metric
Preferred system of measurement
Also known as the International
System of Units (SI)
Basic unit of mass (weight) is the gram
Basic unit of volume (capacity) is the
liter
Milliliter (mL) and cubic centimeter (cc)
are used interchangeably
Michelle E.
Flores,RN,MAN
174
Metric
Equivalents frequently used (memorize)
Weight
1mg (milligram) = 1000mcg (microgram)
1g (gram)
= 1000 mg (milligrams)
1 kg (kilogram) = 1000 g or Gm (grams)
= 2.2 lbs
Volume
1L (liter) = 1000cc or 1000 ml
(milliliters)
Michelle E.
Flores,RN,MAN
175
Apothecary
Michelle E.
Flores,RN,MAN
176
Apothecary
Apothecary means Pharmacist
Imprecise, old English system of
measurement
Grain, basic unit of weight
Basic unit of volume is the minim,
which = one drop (gtt)
Michelle E.
Flores,RN,MAN
177
Apothecary
Abbreviation or symbol usually written
before amount or quantity ex gr 60 =
1 dram
Measures based on the minim
Fluidram (fl. dr.)
Fluid ounce (fl. Oz.)
Pint (pt.)
Quart (qt.)
Michelle E.
Flores,RN,MAN
178
Household
Michelle E.
Flores,RN,MAN
179
Household
Least accurate system of
measurement
Measurements approximate
Becoming increasingly more
important with the trend toward home
health care
Michelle E.
Flores,RN,MAN
180
Household
Household Measures
Tablespoon (Tbs or T)
Teaspoon (tsp or t)
Drop (gtt)
Michelle E.
Flores,RN,MAN
181
Units of Measurements
Measures drugs in terms of their action
Vitamins, antibiotics, insulin and
heparin are measured in units
Label indicates units per ml
No conversion exists for units
Michelle E.
Flores,RN,MAN
182
Milliequivalent (mEq)
Measures chemical combining power
of electrolytes such as potassium (K+)
Specific to medication used
Has no conversion to another system
Michelle E.
Flores,RN,MAN
183
Dosage measured in percentage
Commonly used in IV solutions
D5W, D5 NS, D10, .45NS, 0.9 NS
Often used with metric measures
Means part per hundred or number of
grams of drug per 100ml of solution
Often no conversion is necessary (give
10ml of 10% calcium gluconate)
Michelle E.
Flores,RN,MAN
184
Metric
House
1ml
15-16gtts
4-5cc
1tsp or
15-16ml 1Tbs or
30-32ml 2Tbs
240-250 1gl or cup
500ml 2gls or
cups
1L
1qt, or
Apothecary
Michelle E.
Flores,RN,MAN
15-16minims
1 fluid dram
4 fluid ounces
8fl. dr or 1oz
8 oz or pt.
1pint
32ounces or 1qt
185
Metric
1mg
60-64mg
300-325mg
1kg =2.2lbs
1gram
Apothecary
1/60 gr
1gr
5grs
15-16grs
Michelle E.
Flores,RN,MAN
186
Conversion between and within
systems
1 g = 1000mg 1000mcg 2.2lbs
1T =
0.5L
1kg = 1000g
1cc =
500mL
15mL
3tsp
1dr
2.2lb
1L
1mL
Michelle E.
Flores,RN,MAN
187
References
Adams, M, Josephson, D. & Holland, L.
(2005). Pharmacology for Nurses: A
pathophysiologic approach, Pearson
Prentice Hall, New Jersey
Aschenbrenner,D & Venable, S (2006).
Drug Therapy in Nursing. 2nd Edition,
Lippincott Williams & Wilkins,
Brown, M & Mulholland, J. (2004). Drug
Calculations: Process and Problems for
clinical Practice 7th Edition, Mosby, St.
Louis , Missouri
Michelle E.
Flores,RN,MAN
188
References
(2004).Straignt As in Pharmacology,
Lippincott Williams & Wilkins
(2005).Dosage Calculations Made
Incredible Easy, 3rd Edition, Lippincott
Williams & Wilkins
(2005).Nursing Pharmacology Made
Incredible Easy, Springhouse
www.crnasomeday.com/pharmacology.htm
Michelle E.
Flores,RN,MAN
189

Pharma Prelim 2014 Intro

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Pharmacology for Nurses

Michelle Encarnacion- Flores,

Core Concept in Pharmacology

Is The Study of Medicine

Derived from two Greek words

Pharmakon medicine drug

One of the oldest form of healthcare, practiced in

Applying products to relieve suffering has been

Modern pharmacology began in the early 19th century

China,2700 BC (Codification of mixture)

Dawn of Christian Era (Roman Materia Medica)

Drug dependence persons reliance and intense physical or

combined effects of two drugs produces

Therapeutic Actions of Drugs

Palliative relieves the symptoms of disease does not

Administration- dosage size and route

Factors that determine the intensity of drug

Core Concept In Pharmacology

Is a discipline devoted to patient therapy through the use

Pharmacology utilizes concepts from human biology,

Regulations and Standards

Created to protect the public from drug misuse

Regulatory agency are responsible for ensuring

The regulatory agency responsible for ensuring

Regulations and Standards

R.A. 6125 Dangerous Drug Act

Formulary first standard commonly used by

Pharmacopoeia medical reference summarizing

Clinical Phase Trials

Large group of selected patients with the particular

Clinical investigators from different medical

Schedule of Controlled Substance

I/carries highest risk

II/carries high potential

III/moderate abuse risk

IV/low abuse risk

V/least abuse potential

Without prescription OTC

Methods of Dispensing Drugs

Two major methods

Purchase of prescriptions drugs with a physicians

Purchase of over the counter (OTC) drugs which

There are advantages and disadvantages to both

a. Drug Abuse inappropriate intake of a substance,

b. Illicit Drug / Street Drug sold

Focuses on the movement of drugs

Deals with how the body

Factors that determine the intensity of drug response

Movement of the drug from its

Amount of blood flow to body tissue is

certain oral drugs

Metabolic enzymes in the liver are less

Elimination of drug from circulation

The therapeutic response of most drugs

Minimum amount required to produce

Represents the duration of action for most

Higher amount of drug

ACTIONS OF DRUGS IN THE BODY

Drug action is based on the drugs half life.

c. Metabolism is the physical and

2. Peak Plasma Level the time it

4. Duration the time in which the