 Pharmacology  Chinese: recorded the Pen Tao

(Great Herbal), a 40-volume

 PART I: Introduction to compendium of plant remedies
Nursing Pharmacology dating to 2700 B.C.
1. Introduction to drugs  Egyptians: archived their remedies
a. Nursing pharmacology and history on a document known as the Eber's
b. Sources and evaluation of drugs Papyrus in 1500 B.C.
c. Legal regulation of drugs
d. Over-the-counter drugs  a. Nursing pharmacology and history
e. Sources of drug information HISTORY
"Pharmacologia sen Manuductio and
 a. Nursing pharmacology and history Materia Medicum"
Definition of terms:  where the first recorded
 Pharmacology- the study of the reference to the word
biological effects of chemicals pharmacology was found by
 Clinical pharmacology - the branch Samuel Dale in 1693
of pharmacology involving drugs
used to treat, prevent, or diagnose  Early 1800s: when modern
disease pharmacology is thought to have
 Pharmacy- the art of preparing , begun
compounding, and dispensing drugs  Frederich Serturner: first isolated
 Pharmacopeia- a book containing a morphine from opium in 1805
list of products used in medicine,
with descriptions of the product,  a. Nursing pharmacology and history
chemical tests for determining HISTORY
identity and purity
 Medication - a substance  1847: when the first department of
administered for the diagnosis, cure, pharmacology was established in Estonia
treatment, or relief of a symptom or causing this discipline of pharmacology
prevention of disease (intended to be officially recognized by Rudolf
therapeutic effect) Bucheim
 Drugs - a chemical substance that
alters an organism's function and  Oswald Schmeideberg: Father of
may or may not have therapeutic Modern Pharmacology
effects  John Jacob Abel: Father of American
Pharmacology
 a. Nursing pharmacology and history
HISTORY : founded the first
pharmacology department in the United
 Herbal medicine: is one of the States at the
oldest forms of healthcare that has University of Michigan in 1890.
been practiced in virtually every
culture dating to antiquity  b. Sources and evaluation of drugs
 Babylonians: recorded the earliest b.1 Natural sources
surviving "prescriptions" on clay b.2 Semisynthetic
tablets in 3000 B.C. b.3 Synthetic
b.4 Biotechnology
 Natural sources  The safety margins are too small
 From plants: alkaloids which contain
nitrogen groups (morphine, cocaine,  Phase I Studies
atropine)  Use healthy human volunteers to test the
drugs
 Antibiotics: microorganisms such as  More tightly controlled and are
penicillium and streptomyces performed by specially trained clinical
 Semisynthetic investigators
 Medications that are prepared by
chemically modifying substances which  At the end of this phase, many chemicals
are available from a natural source. are dropped from the process for the ff
reasons:
 Synthetic  They lack therapeutic effect in
 Drugs that are formed by chemical humans
reactions in a laboratory  Cause unacceptable adverse effects
 Highly teratogenic
 These drugs are synthesized after  Too toxic
determination of how the chemical
structure of a compound relates to tis  Phase II Studies
pharmacological properties  Use patients with the disease that the
drug is meant to treat
 Biotechnology  Patients are told about the possible
 Involves manipulation of microorganisms benefits and are invited to participate.
for the production of medicinal  Performed in various sites: hospitals,
compounds clinics, doctor's offices- and are
 DRUG EVALUATION monitored by a representative of the
Preclinical Trials pharmaceutical company studying the
 Phase I Studies drug.
 Phase Il Studies  At the end of this, a drug may be
 Phase Ill Studies removed from further investigation for
 Continual Evaluation the ff reasons:
 Are less effective than expected
 Too toxic
 Preclinical Trials  Produce unacceptable side effects
 Tested on laboratory animals  Have a low benefit-to-risk ratio
 Purposes:  Are not as effective as available
 To determine whether they have drugs
the presumed effects in living
tissue  Phase III Studies
 To evaluate any adverse effects  Use of the drugs in a vast clinical market
 At the end of this study, some  Prescribers are informed of all the known
chemicals are discarded for the ff reactions to the drugs; they monitor the
reasons; patient very closely and are asked to keep
 Lack of therapeutic activity journals and record any symptoms they
 Too toxic to living animals experience;
 Highly teratogenic
 Evaluation of the reported effects c.3. Generic Drugs
(whether caused by the disease or by the c.4. Orphan Drugs
drug)
 the information is collected by the drug  c.1. Pregnancy Categories
company and is shared with the FDA.  c.2. Controlled Substances
 The Controlled Substances Act of 1970
 Food and Drug Administration also has established categories for the
Approval ranking of the abuse potential of various
 Drugs that finish phase Ill studies are drugs. The FDA studies the drugs and
evaluated by the FDA, which relies on determines their abuse potential while the
committees of experts. Drug Enforcement Agency (DEA)
 Only those drugs that receive FDA enforces their control.
committee approval may be marketed.
 The entire drug development and  c.2. Controlled Substances
approval process can take 5 to 6 years,  c.3. Generic Drugs
resulting in a so called drug lag.  When the drug receives approval for
marketing from the FDA, the drug
 Continual Evaluation formula is given a time-limited patient in
 After a drug is approved for marketing, it which the length depends on the type of
enters a phase of continual evaluation or chemical involved. When the patent runs
phase IV study. out on a brand name drug, the drug can
 An approved drug is given a brand be produced by other manufacturers.
name (trade name) by the
pharmaceutical company that developed  GENERIC DRUGS- are chemicals that
it. are produced by companies that just
 Prescribers are obligated to report to FDA manufacture drugs
any untoward or unexpected adverse  c.4. Orphan Drugs
effects associated with drugs they are  Drugs that have been discovered but are
using, and the FDA continually evaluates not financially viable and therefore have
this information. not been "adopted" by any drug company
because it can only treat rare diseases, or
they may have potentially dangerous
adverse effects.
 c. Legal regulation of drugs
 The Food and Drug  d. Over-the-counter drugs
Administration (FDA) regulates the
development and sale of drugs. OTC drugs are products that are available
without prescription for self-treatment of a
 The Drug Enforcement Agency variety of complaints.
(DEA) regulates the manufacturing,
distribution, and dispensing of drugs  d. Over-the-counter drugs
known to have abuse potential. Problems related to OTC drug use:
 Could mask the signs and symptoms
 c. Legal regulation of drugs of underlying disease, making
c.1. Pregnancy Categories diagnosis difficult. Taking this drug
c.2. Controlled Substances with prescription medications could
 result in drug interactions and  To interfere with the functioning of
interfere with drug therapy. foreign cells, such as invading
microorganisms or neoplasm
 Not taking these drugs are directed (Chemotherapeutic Agents)
could result in serious overdoses.
 b. Drug actions
 e. Sources of drug information Receptor Sites
e1. Package Inserts- e.g. drug literature -are specific areas on cell membranes
e.2. Reference Books- e.g. Physician's Drug where many drugs are thought to act.
Reference (PDR), Drug Facts and
Comparisons, AMA Drug Evaluations,  Agonists- are drugs that interact directly
*Lippincott's Nursing Drug Guide (LNDG) with receptor sites to cause the same
e.3. Journals- e.g. Medical Letter, American activity that natural chemicals would
Journal of Nursing cause at that site.
e.4. Internet Information  Competitive antagonists- are drugs that
 PART I: Introduction to Nursing react with receptor sites to block normal
Pharmacology stimulation, producing no effect.
2. Drugs and the body  Noncompetitive antagonists- are drugs
a. Pharmacodynamics that react with specific receptor sites on a
b. Drug actions cell and by reacting there, prevent the
c. Pharmacokinetics reaction of another chemical with a
d. Factors influencing Drug Effects different receptor site on that cell.
e. Achieving the Optimal
Therapeutic Effect
f. Drug uses  b. Drug actions
g. Drug forms Drug- Enzyme Interactions
h. Drug names  Drugs also can cause their effects by
interfering with the enzyme systems
that act as catalyst for various
chemical reactions.

 a. Pharmacodynamics Selective Toxicity

 is the science dealing with interactions  It is the ability of drug to attack
between the chemical components of only those systems found in
living foreign cells.
 systems and the foreign chemicals,  C. Pharmacokinetics
including drugs, that enter those systems. -It involves the study of absorption,
distribution, metabolism
 b. Drug actions (biotransformation), and excretion of drugs.
Drugs usually work in one of four ways: -Focuses on the changes of drug plasma
concentration.
 To replace or act as substitutes for
missing chemicals  C. Pharmacokinetics
 To increase or stimulate certain Critical Concentration
cellular activities  It is amount of drug that is needed to
 To depress or slow cellular activities cause a therapeutic effect.
Loading Dose  Aqueous diffusion: passage through
 Recommended for some drugs that take a aqueous pores of the cell membrane.
prolonged period to reach a critical Strict to the drugs with the low
concentration because effects are needed molecular weight, many drugs are
quickly. too large to be absorbed by this
Dynamic Equilibrium process
 The actual concentration that a drug  C. Pharmacokinetics
reaches in the body results from this and  Active Transport
involves the following:
 Absorption from the site of entry  Uses energy to actively move a
 Distribution to the active site molecule across a cell membrane
 Blotransformation (metabolism) in  The molecule may be large, or it may
the liver be moving against concentration
 Excretion from the body (mainly the gradient
kidneys)
 C. Pharmacokinetics
 C. Pharmacokinetics  Filtration
Absorption
 The transference of drug molecules  Involves movement through pores in
from the point of entry in the body the cell membrane, either down a
into the bloodstream concentration gradient or as a result
 Influenced by route, drug dosage, of the pull of plasma proteins
form and conditions at absorption
site  C. Pharmacokinetics
 C. Pharmacokinetics  Administration:
 Drugs can be absorbed into cells
through various processes, which  Oral Route
include the following:  Intravenous route
 Intramuscular route
 Passive diffusion  Subcutaneous route
 Active Transport  Oral Route
 Filtration  Most frequent used drug administration
route in clinical practice
 C. Pharmacokinetics  Not invasive and is less expensive
 Passive diffusion:  Safest way to deliver drugs
 Can be easily taken by patients at home
 Is the major process that occurs  The acidic environment of the stomach is
across a concentration gradient. This one of the first barriers to foreign
process does not require any cellular chemicals
energy.  ORAL DRUGS IDEALLY SHOULD BE
GIVEN 1-HOUR before or 2 hours after
 Lipid diffusion: drug dissolves in a meal
the lipid component of the cell
membranes. It is facilitated by the  Intravenous route
high lipid solubility of the drug  Reach their full strength at the same time
of injection, avoiding initial breakdown
 More likely to cause toxic effects because  Biotransformation (Metabolism)
the margin for error inn dosage is much  Excretion
smaller
 Organ Blood Flow
 Intramuscular route  Rate in which drugs is distributed
 Drugs injected IM are absorbed directly depends largely on the cardiac output
into circulation  Rapid onset on the tissues that have high
 This takes time because the drug must be perfusion: brain, heart, liver, kidney
picked up by the capillaries and taken
into the veins  Molecular Size
 Because men have more vascular muscles
than women do, IM drugs in men reach a  Lipid Solubility
peak level faster than in women.  Affects the extent of drug distribution in
the brain where the BBB restricts polar
 Subcutaneous route and ionized molecules
 Deposit the drug just under the skin,
where it is slowly absorbed into  Protein Binding
circulation  Most drugs are bound to some extent to
 Timing of absorption varies depending on proteins in the blood to be carried into
the fat content of the site and the state of circulation
local circulation  The protein-drug complex is relatively
large and cannot enter into capillaries and
then into tissues to react
First-Pass Effect  The drug must be freed from the protein's
binding site at the tissues
 A phenomenon when enzymes break
the drug into metabolites, some of  Blood-Brain Barrier
which are active and cause effects in  This is a protective system of cellular
the body and some of which are activity that keeps many things (e.g.,
deactivated and can be readily foreign invaders, poisons) away from the
excreted from the body. CNS

 C. Pharmacokinetics  Placenta and Breast Milk

 Distribution  Many drugs readily pass through the
placenta and affect the developing fetus
• The process of drug distribution in pregnant women
begins with absorption of a drug into  It is best not to administer any drugs to
the circulation and ends with its pregnant women because of the possible
arrival at the site of action risk to the fetus
 Factors that Affected Distribution:
 Organ Blood Flow  Biotransformation (Metabolism)
 Molecular Size  The process of inactivating and breaking
 Lipid Solubility down a medication
 Protein Binding  Enzymes chemically alter a drug's
 Blood-Brain Barrier structure, converting it to a less potent
 Placenta and Breast Milk substance
 Most drug metabolism occurs in the liver maintained, the client should receive the
by microsomes that trigger the enzymatic optimal therapeutic benefit
breakdown of drugs  Trough level is the term for the lowest
circulating level of a drug.
 Excretion
 The movement of a drug from the site of  d. Factors influencing Drug Effects
metabolism back into the circulation and  d.1. Weight
its transport to the site of exit from the  d.2. Age
body  d.3. Gender
 The route of exit is determined by the  d4. Physiological factors
chemical properties of the drug  d.5. Pathological factors
 The kidneys are responsible for excreting  d.6. Genetic factors
most drugs others include lungs, exocrine  d.7. Immunological factors
glands, and Gl Tract  d.8. Psychological factors
 Blood level; to be effective, the active  d.9. Environmental factors
component of a medication must be  d.10. Cumulative effects
present in the blood within a therapeutic  d.11. Drug tolerance
range
 Weight
 BILIARY EXCRETION  The recommended dosage of a drug is
 Drugs are taken up by the liver, released based on drug evaluation studies and is
into the bile and eliminated in the feces targeted at a 150- pound person
 The blood or serum level of medication is
the amount circulating in the bloodstream  Age
at a given time  Age is a factor primarily in children and
 Half-life: The amount of time the body older adults
needs to lower by half the drug's serum  Children metabolize many drugs
concentration by metabolism and differently than adults and have immature
excretion. This helps determine how systems for handling
frequently the drug should be given.  drugs
Drugs with a long half-time are given  Some drugs come with recommended
less frequently. pediatric dosages, while others can be
 Onset is the amount of time needed after converted to pediatric dosages using one
administration of a drug to produce the of several conversion formulas
desired effect.  Older adults respond very differently in
 Peak is the amount of time needed for a all aspects of pharmacokinetics-less
drug to reach the highest concentration of effective absorption, less efficient
effectiveness. distribution, altered blotransformation
 Duration is the span of time during which and less effective excretion
the serum drug concentration is high
enough to produce the intended effect.  Gender
 Plateau refers to the serum concentration  When giving IM injections, for example,
or level of a drug that has been reached men have more vascular muscles, so the
and sustained with a series of fixed doses. effects of the drug will be seen sooner
When the plateau is achieved and than with females.
 Women who are given any drug should  An example would be the longer that
always be questioned about the morphine is taken, the more tolerant the
possibility of pregnancy body becomes to the drug, so larger and
 Physiological factors larger doses are needed to relieve pain
 Acid-base balance, electrolyte balance,
hydration  Drug-Drug or Drug-Alternative
Therapy Interactions
 Pathological factors  When two or more drugs are taken
 Gl orders can affect the absorption of together, there is a possibility that the
many oral drugs drug will interact with each other to
 Vascular disease alter distribution cause unanticipated effects in the body;
 Liver and kidney disease affect drug even alternative therapies, such as herbal
biotransformation and excretion products, can cause these same
interactions.
 Genetic factors
 Some people lack certain enzyme  Drug-Drug interactions can occur in the
systems necessary for metabolizing a following situations:
drug, while others have overactive  At the site of absorption: one drug
enzymes and break down drugs very prevents or accelerates absorption of
quickly. anther drug.
 During distribution: one drug competes
 Immunological factors for the protein binding site of another
 People can develop an allergy to a drug drug, so the second drug cannot be
after exposure to its proteins transported to the reactive tissue.
 Sensitivity to a drug can range from  During biotransformation: one drug
dermatological effects to anaphylaxis, stimulates or blocks the metabolism of
shock and death the other drug.
 Drug excretion: one drug competes for
 Psychological factors excretion with other drug, leading to
 The patient's attitude about a drug has accumulation and toxic effects of one of
been shown to have a real effect on how the drugs.
that drug works  At the site of action: one drug may be an
antagonist of the other drug or may cause
 Environmental factors side effects that oppose those of the other
 Some drug effects are helped by a quiet, drug, leading to no therapeutic effect.
cool, non-stimulating environment

 Cumulative effects  Synergistic effect

 When a drug is taken in successive doses -effect is greater than the sum of their
at intervals that are shorter than actions
recommended, or when the body is not -Occurs when only one drug enhances or
able to eliminate a drug properly, the increases the effect of another drug
drug can accumulate in the body, leading -This may be either accidental or planned
to toxic levels and adverse effects purposefully by the prescriber

 Drug tolerance  Antagonistic effect

- Occurs when one drug reduces or negates examine the factors that are known to
the effect of another drug influence drug effects.
-A client who is taking multiple medications
(called polypharmacy) is more likely to  f. Drug uses
experience drug interactions f1. Symptomatic treatment- drugs that are
used to relieve symptoms
POTENTIATION f.2. Preventive drugs- help avoid disease
-one prolongs or multiplies the effect f.3. Diagnostic drugs- help in determining
of the other whether a disease is present
f.4. Curative drugs- eliminate disease
ADDITIVE f.5. Contraceptive drugs
-combined effect of 2 drugs is equal
to the sum of each drug ACUTE THERAPY
 needed to sustain life
POLYPHARMACY
-practice of taking multiple MAINTENANCE THERAPY
medications  ttt for chronic illness

SUPPLEMENTAL THERAPY
 Drug-Food Interactions  maintain normal body fxn
 Certain food can interact with drugs in
much the same way that drugs can PALLIATIVE THERAPY
interact with each other. This occurs  used in end stages of an illness
when the drug and the food are in direct
contact in the stomach. Examples: the SUPPORTIVE THERAPY
antibiotic tetracycline cannot be taken  maintains integrity of the body
with iron or calcium or calcium products.
 g. Drug forms
 ORAL DRUGS ARE BEST TAKEN ON  Medications are manufactured in a
AN EMPTY STOMACH variety of forms to make them more
useful or easy to administer.
 Drug-Laboratory Test Interactions  The form of a drug guides its route of
 Administration of a particular drug may administration and should not be
alter results of tests that are done on interchanged as the rate of absorption or
various chemical levels or reactions as bioavailability may differ among forms.
part of a diagnostic study.

 e. Achieving the Optimal Therapeutic  h. Drug names

Effect  Chemical name
 The nurse should incorporate basic  Generic name (nonpropriety name
history and physical assessment factors  Official name
into any care plan, so that obvious  Trade/Brand name
problems can be spotted and handled  h.1. Chemical name
promptly.  When a drug first discovered, it is given a
 If a drug just does not do what it is chemical name
expected to do, the nurse should further
 This name describes the atomic or  The intended effect or action of the
molecular structure of the drug medication
 It may be given a shorthand version of
the chemical name or a codename is  i.2. Side effects
developed for easy reference among  Effects of a medication that are not
researchers intended or planned but may occur as
a result of use
 h.2. Generic name (nonpropriety name)  Can range from mildly unpleasant to
 When the drug is approved by the FDA harmful
(Food and Drug Administration), it is  i.3. Adverse effect
given a generic (official) name.  À medication side effect that is
potentially harmful to a client
 h.3. Official name
 Is the name assigned by the FDA after  ¡4. Toxic effects
approval of a drug and is often the same  Are serious adverse effects of
as the generic name medications that may even threaten life
 Is the name under which the drug is,
listed in one f the official publications  i.5. Allergic responses
(e.g., United States Pharmacopeia)  Are antigen-antibody reactions to a drug

 h.4. Trade/Brand name  i.6. Anaphylaxis

 After FDA approval, the company  Life-threatening allergic reaction that
develops a brand or trade name and requires immediate intervention to
identifies it as an exclusive property of prevent possible death
that company
 A copyrighted name given by a specific  I.7. Idiosyncratic response
manufacturer to a medication  Is an unexplained and unpredictable
response to a medication
 Note:
Several manufacturers may produce the  i.8. Drug tolerance
same medication; a medication may have  Refers to the diminishing therapeutic
several trade names in addition to the effect of the same drug dosage over time,
generic name. a trend that requires increasing the drug
dosage to achieve the same therapeutic
 i. Monitoring drug therapy effect.
 i.1. Therapeutic effects  Tolerance occurs as the body becomes
 i.2. Side effects accustomed to a drug from prolonged
 i.3. Adverse effect use.
 ¡4. Toxic effects
 i.5. Allergic responses  3. Toxic effects of drugs
 i.6. Anaphylaxis a. Adverse Effects
 I.7. Idiosyncratic response These are undesirable effects that may be
 i.8. Drug tolerance unpleasant or even dangerous. They can
occur for many reasons, including the
 i.1. Therapeutic effects following:
 a.1. the drug may have other effects  Nursing responsibility is to assess
on the body besides the patient's drug allergy correctly and
therapeutic effect be able to intervene appropriately
a.2. the patient is sensitive to the
drug being given  DRUG ALLERGIES
a.3. the drug's action on the body  1. Anaphylactic reactions
causes other responses that are  2. Cytotoxic reactions
undesirable or unpleasant  3. Serum sickness.
a.4. the patient is taking too much or  4. Delayed reactions
too little of the drug, leading to
adverse effects  Anaphylactic reactions
 Involves an antibody that reacts with
 Types of adverse effects: specific sites in the body to cause the
 Primary action release of chemicals, including histamine,
that produce immediate reactions
 Due to simple overdose (mucous membrane swelling and
 Can be prevented by monitoring the swelling bronchi) that can lead to
patient carefully respiratory distress and even arrest.

 Types of adverse effects:  S/S: urticaria, vascular collapse, shock,

 Secondary action laryngeal edema, dyspnea, angioedema
 Are undesirable effects that happen
in addition to the drug's desirable  Cytotoxic reactions
pharmacologic effect.  Involves antibodies that circulate in the
 Patients have to be taught on ways to blood and attack antigens (the drug) on
cope with these undesirable effects cell sites, causing death of that cell. This
Hypersensitivity reaction is not immediate but may be
 Excessive response to either the seen over a few days
primary or the secondary effect of
the drug  Serum sickness.
 May result from a pathological or  Involves antibodies that circulate in the
underling condition blood and cause damage to various
 Example: a patient with kidney tissues by depositing in blood vessels,
problem cannot excrete the drug that This reaction may occur up to week or
may accumulate in the body causing more after exposure to the drug.
toxic effects
 Delayed reactions
 3. Toxic effects of drugs  Occurs several hours after exposure and
b. Drug Allergy involves antibodies that are bound to
specific white blood cells
 This occurs when the body forms
antibodies to a particular drug,  c. Drug induced tissue and organ
causing an immune response when damage
the person is re-exposed to the drug • Dermatological Reactions
 A patient cannot be allergic to a drug -Rashes, hives
that has never been taken -stomatitis
 Superinfections  b.i.d. = (bis in die) two times a day (given
 Blood Dyscrasia 10am and 4pm)
 Toxicity  buc = (inside cheek, cheek pocket (route
-Poisoning of administration; held inside the cheek)
 gtt. = (guttae) drops (given in forms of
 c. Drug induced tissue and organ drops)
damage  h= (hoora) hourly (given on each hour
v. Alteration in Glucose metabolism  ID = intradermal (route of administration;
-hypoglycemia injected into the skin)
-hyperglycemia  IM = (intramuscular (route of
vi. Electrolyte imbalances administration; injected into the muscle)
-hypokalemia  IV= (intravenously (route of
-hyperkalemia administration; given into the vein)
vii. Sensory effects
-Ocular toxicity  Abbreviations:
-Auditory damage  q.h., qgh. = every hour (given on each
 c. Drug induced tissue and organ hour, hourly)
damage  q2h., q2h = every 2 hours (given at 6am,
viii. Neurologic effects and continues on even hours day and
-General Central Nevous System night!)
Effects  q.3h., q3h =every 3 hours (given at 6, 9,
-Atropine like (Anticholinergic) 12, 3, day and night!)
effects  q.4h., q4h = every 4 hours (given at 8, 12,
-Parkinsons like Syndrome 4, day and nighti)
-Neuroleptic Malignant Syndrome  SC, sub-Q, SQ, subcu = subcutaneously
(route of administration; injected under
ix. Teratogenicity the skin, into fatty layer!)
 4. Nursing Management  Stat= immediate order (given
 a. The medication order immediately one time as ordered)
Medication orders contain 6 parts:  t.i.d., TID = (ter in die) three times a day
Date (given three times per day, usually with
Patient's name meals)
Medication name  ut dict. = (ut dictum) as directed (given as
Dosage or amount of explained by the physician or medical
medication staff, sometimes written as "as dir.")
Route or manner of
administration  Abbreviations:
Time to be administered and  p.C. = (post cibuma) after meals (given ½
frequency hour after a meal)
 p.m., P, PM = (post meridiem) afternoon
 Abbreviations: (given in the afternoon)
 a.c.= (ante cibum) before meals (given ½  p.o. = (per os) by mouth, orally (given
hour before a meal) into the mouth)
 ad lib. = (ad libitum) at pleasure (given  PO = Nothing by mouth (nothing is given
freely, as much as is wanted) into the mouth!)
 p.r., IR = by rectum, intrarectal, rectally -Placebo effect
(route of administration; inserted into the -Managing side effects
rectum) -Lifestyle adjustments
 p.r.n., PRN = (pro re nata) abbreviation -Patient and Family education
meaning "when necessary" (given when
needed)  Evaluation
 p.v. = by vagina, vaginal (route of The 10 golden rules of drug
administration; inserted into the vagina) administration
 q.d., QD = (quaque die) once a day (give 1. Administer the right drug
one time a day, also stand for daily) 2. Administer the drug to the right patient
 q.i.d. = (quarter in die) four times a day 3. Administer the right dose
(given at 8am, 12nn, 4pm, 8pm) 4. Administer the drug by the right route
 q. h. = (from "quaque", every and the "h" 5. Administer the drug on the right time
indicating the number of hours) 6. Document each drug you administer
7. Teach your patient about the drugs he is
 b. The nursing process and medication receiving
administration 8. Take a complete patient drug history
 The Steps of the Nursing Process 9. Find out if the patient has any drug
allergies
 ASSESSMENT 10. Be aware of potential drug to drug to
 NURSING DIAGNOSIS food interactions
 INTERVENTIONS
 EVALUATION  5. Dosage calculations
 Assessment
Past history  PART I: Introduction to Nursing
 Chronic condition, drug use, Pharmacology
allergies, level of education, level of 5. Dosage calculations
understanding of disease and a. Conversion between systems of
therapy, social supports, financial measurement
supports, pattern of health care b. Calculation of Dosages
c. Medication Errors
Physical Assessment
 Weight, age, Physical parameters
related to the disease state or know
drug effects

 Nursing Diagnosis  a. Conversion between systems of

 Hyperthermia measurement
 Risk for fluid volume deficit  a. COMMON APPROXIMATE
 Risk for infection EQUIVALENTS FOR LIQUID
MEASUREMENT
 Interventions  b. METRIC AND APOTHECARY
 Proper drug administration APPROXIMATE EQUIVALENTS FOR
- Drug, storage, route, dosage, SOLID MEASUREMENT
preparation, timing, recording
 Comfort measures  b. Calculation of Dosages
Guidelines:  Never assume anything about any drug
1. Check whether all measures are in order or prescription, including
the same system. Convert if necessary. medication route
2. Write the problem in equation  If a medication is questioned for any
form using the appropriate formula and reason, never assume that the prescriber
labeling all parts, and complete the is correct. Always act as a patient
necessary calculations. advocate
3. Check the accuracy of your  Do not try to decipher illegibly written
answer for reasonableness, and have orders
someone else verify your calculations.
 Nursing measures to prevent errors:
 Basic formula  Carefully read all labels for accuracy,
expiration dates and dilution requirement
Desired dose  Encourage the use of both trade and
On-hand dose × quantity on hand generic names. Relying heavily on trade
names especially increases the likelihood
 Prevention of medication errors of medication errors because many sound
c. Medication Errors (ME): alike and have similar spelling
 Listen to and honor any concerns
 Identifying, responding to and expressed by the patient. Should she be
preventing medication errors allergic to a medication, that a pill has
requires more than implementing the already been taken, or if the medication is
rights of drug administration not what the patient usually takes
 Attention must also be focused on all  Always double check medication label
persons involved in the
administration process, including the  Nursing measures to prevent errors:
prescriber, the transcriber of the  Never crush, chew or open extended
order, pharmacy and other ancillary released or long released dosage forms
staff involved in the process  Always compare the pharmacy label
 Common classes of drugs involved against the initial medication before
in serious errors: antibiotics, giving the first dose
anticoagulants, antidiabetic,  Provide a mandatory entry of weight of
antineoplastic, cardiovascular, CNS every patient into the medication
and vaccines administration record before the order
goes into the pharmacy
 Nursing measures to prevent errors:  Use computerized prescriber order entry
 Minimize the use of verbal or telephone and have that entry system integrated in
orders, if such order occurs must be the compute in the pharmacy
taken, repeat the order to confirm it  Be sure to provide a translator if the
 List the indication in any of the patient patient speaks a different language
material
 Avoid use of abbreviations, medical  PART I: Introduction to Nursing
shorthand and acronyms because they can Pharmacology
lead to confusion, 6. Drug therapy in the 21st century
 miscommunication and risk of error a. Consumer awareness
b. Over the Counter Drugs
 c. Off-label Uses  Accuracy/reliability- is the information
d. Health Care Crisis supported by other sites? Does the site
list other links that are reasonable and
reliable?

 b. Over-the-Counter Drugs
 OTC medications have allowed people to
 6. Drug therapy in the 21sT century take care of simple medical problems
a. Consumer awareness without seeking advice from their health
- Gone is the era when the health care providers. No prescription needed.
care provider was seen as omniscient and
always right  b. Over-the-Counter Drugs
 6. Drug therapy in the 21s century  Drawbacks of OTC drug intake:
Media Influence -Mask the signs and symptoms of an
underlying problem, making it difficult to
- The past 10 years have been an explosion arrive at an accurate diagnosis if the
of drug advertising in the mass media. It condition persists
became legal to advertise prescription drugs -The idea that "if one makes me feel
directly to the public in the 1990. It's seen better, two will really make me feel good"
in TV, radio, magazine, newspaper, etc. is not always safe in the use of these drugs
 6. Drug therapy in the 21s century -Patients who take doses of different
The Internet preparations to cover their various
- The internet and the World Wide symptoms could easily wind up with
Web are now readily accessible to most an unintended overdose or toxic
consumers. reaction
- Evaluating internet sites -Many patients do not consider OTC
drugs to be "real" drugs and do not
 Check address identification mention their use when reporting a
.com- commercial, advertising, selling, drug history to the health care
business site provider.
.edu- education site; school system  Herbal or alternative therapies are found
.gov- government site in ancient records and have often been
.net- part of a linked network system, may the basis for discovery of an active
include any of the above ingredient that is later developed into a
.org- sponsored by an organization regulated medication
(professional, charitable, educational  Currently, these products are not
groups) controlled or tested by the FDA; they are
considered as dietary supplements, and
 Site Evaluation therefore the advertising surrounding
 Navigation- is it easy to access or these products is not as restricted or as
navigate? Is it confusing? accurate as it would be with classic drugs
 Contributors- who prepared the site? Is
it reviewed? Is it purely commercial?  c. Off-label Uses
 Dates- is it updated frequently? When the  This refers to the use of the drug for
site was last updated? indications that are not approved by the
 FDA eve if the therapeutic indications are  PART I: Introduction to Nursing
stated Pharmacology
 Commonly done for groups of patients 3. Toxic effects of drugs
for which there is little premarketing a. Adverse effects
testing, particularly pediatric and geriatric b. Drug allergy
groups c. Drug induced tissue and organ
damage
 d. Health Care Crisis
- The reason why the cost of medical
care and drugs has skyrocketed in the
past few years is partly due to the
demand to have the best possible, most up-
to-date, safest care and drug therapies

 Health Maintenance Organizations

and Regulations
-Health Maintenance Organizations (HMOs)
run the medical care system like a business,
with the financial aspects of business
becoming the overriding concern; decisions
are often made by nonmedical personnel
with a keen eye on the bottom line

 Emergency Preparedness
 Interventions are done to prevent
exposure from biological weapons, so
called (germ warfare and to chemical
weapons as well
 Terrorist alerts, long lines of security at
airports, and increased inspection of bags
at malls; sporting events, and theme parks

 Drug Abuse
 Alcohol and Nicotine/are 2 most
commonly abused drugs that can cause
serious problems for the abuser
 Even famous movie stars are often part of
drug scene, using street drugs (non
prescription drugs with no known
therapeutic use) to enhance their moods
and increased pleasure
 The "everyone is doing it" argument is
hard to counter when today's heroes are
thought to be heavily involved