Professional Documents
Culture Documents
COURSE OUTLINE
1. Abbreviations
2. Drug Action
3. Principles of Drug Administration
4. Medication and Calculations
5. Drug Interaction and Drug Abuse
6. Nutrition and Electrolytes
7. Neurologic and Neuromuscular Agents
8. Antiinflammatory and Antiinfective Agents
9. Antineoplastic Agents
10. Respiratory Agents
11. Cardiovascular Agents
12. Gastrointestinal Agents
13. Eye, Ear, and Skin Agents
14. Endocrine Agents
15. Reproductive and Gender-Related Agents
16. Emergency Agents
SPECIFIC CONTENTS
1. Cultural Considerations
2. Drug Interaction and Drug Abuse
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2. Central Nervous System Depressants
3. Nonnarcotic and Narcotic Analgesics
4. Anticonvulsants
5. Antipsyschotics, Anxiolytics, and Antidepressants
6. Autonomic Nervous System
7. Adrenergics and Adrenergic Blockers
8. Cholinergics and Anticholinergics
9. Drugs for Neuromuscular Disorders: Parkinsonism, Myasthenia Gravis, Multiple Sclerosis, and
Muscle Spasms
1. Antiinflammatory Drugs
2. Antibacterials: Penicillins and Cephalosporins
3. Antibacterials: Macrolides, Tetracyclines, Aminoglycosides, Fluroquinolones
4. Antibacterials: Sulfonamides
5. Antitubercular Drugs: Antifungal Drugs, Peptides
6. Antiviral, Antimalarial, and Anthelmintic Drugs
7. Drugs for Urinary Tract Disorders
1. Anticancer Drugs
2. Biologic Response Modifiers
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2. Antidiabetic Drugs
1. Drugs Associated with the Female Reproduction: Pregnancy, Labor, and Delivery
2. Drug Associated with the Postpartum and the Newborn
PHARMACOLOGY
UNIT 1 PERSPECTIVE OF PHARMACOLOGY
Drugs taken by mouth undergoes three (3) phases – pharmaceutic (dissolution), pharmacokinetic,
and pharmacodynamic.
A. Pharmaceutic Phase
Pharmaceutic phase is the dissolution of drugs in order for the drugs to be absorbed by the GI tract. This
is the phase that drugs in solid form (tablet or capsule) must disintegrate into small particles in order for
it to be dissolved into a liquid.
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Some Drug Form in order to Delay Disintegration
Enteric – coated (EC) drugs are drugs that delays disintegration that will disintegrate at the small
intestine. They are made of hard shells.
NOTE: ALL ENTERIC COATED, SUSTAINED RELEASE AND TIME RELEASED DRUGS SHOULD NOT BE
CRUSHED.
ABSORPTION is the movement of drug particles from the GI tract to body fluids absorption (passive
or active) , or pinocytosis
What do you call as the movement of a drug from a higher concentration to a lower
concentration?
What is the process by which cells carry drug across the membrane?
NOTE : SOME DRUGS ARE ABSORBED WELL WITH FOOD AS THEIR CARRIER SOME DRUGS ARE BEST
ABSORBED WITHOUT FOOD.
DRUGS THAT ARE FAT SOLUBLE AND NON INIONIZED (no positive or negative charges) ARE ABSORBED
FASTER THAN THE WATER SOLUBLE AND IONIZED DRUGS.
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What do you call the process by which a drug passess first the liver after
the intestinal lumen?
Bioavailability is the percentage of the administered drug dose that reaches the systemic circulation.
Highly protein bound drugs will have likely less drug effects.
Free drugs are the drugs that can cause pharmacologic effects.
DISTRIBUTION is the process by which the drug becomes available to body fluids and body tissues.
Protein- binding effect are drugs that may bind to plasma protein (primarily albumin). Drugs that are highly
protein bound will have less drug effect. Free drugs are drugs that are not bound to protein are active and
can cause pharmacologic response.
NOTE: PATIENTS WITH LIVER OR KIDNEY DISEASE OR WHO ARE MALNOURISHED ARE LIKELY TO HAVE EXCESS
FREE DRUGS BECAUSE OF LOW LEVEL OF ALBUMIN OR GLOBULIN. THEY ARE PRONE TO DRUG TOXICITY.
Who are likely to develop drug toxicity? Pt with low albumin or Pt with
normal albumin?
METABOLISM is the transformation of the drugs into either active or inactive metabolites. Liver is
the primary site of metabolism. Drugs transformed into inactive metabolites will have less pharmacologic
response while active metabolites have increased effect.
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T or F: Free drugs are eliminated though the urine.
C. PHARMACODYNAMICS
Pharmacodynamics is the study of the effect on cellular physiology and biochemistry and the drug’s
mechanism of action.
Drug Response:
Onset of Action = is the time it takes to reach the minimum effective concentration (MEC) after a drug is
administered.
Peak Action = occurs when the drug reaches its highest blood or plasma concentration.
Duration of Action = is the length of time the drug has a pharmacologic effect.
RECEPTOR THEORY
Receptors are found in cell membranes. Drugs bind to receptors to cause or block a response. The better
the drug fits at the receptor site, the more biologically active the drug is.
Thearapeutic Index (TI) estimates the margin of safety of a drug by using a ratio that measures the
effective therapeutic dose in 50% (ED50) and the lethal dose in 50% (LD50)
Peak drug level is the highest plasma concentration of the drug at a specific time. If the drug is given
orally, the peak time might be 1 to 3 h after drug administration. If drug is given IV peak time might
occur in 10 min. It indicates the rate of absorption.
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Trough level is the lowest plasma concentration of a drug and measures the rate at which the drug is
eliminated. It indicates the rate of drug elimination.
LOADING DOSE
Loading dose is a large initial dose of the drugein order to achieve a rapid MEC in the plasma. After a
large initial dose, a prescribed dosage per day s ordered.
Side Effect are physiologic effects not related to the desired effects. Some side effects are called also a
adverse reactions. Adverse reactions are more severe than side effects.
Toxic Effects, or toxicity of the drug can identified by the plasma (serum) therapeutic range of the drugs
Laboratory Tests
Diagnostic Tests or studies
Physical Assessment
NURSING DIAGNOSIS
Nursing diagnosis is made based on the analysis of the assessment data. See separate table for
North American Nursing Diagnosis Association (NANDA)
PLANNING
Planning is characterized by identifying your goal or outcomes. Outcomes should include the
following:
Client-centered
Acceptable to both client and nurse (dependent on client decision)
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Realistic and measurable
Time bounded
This is the phase that will describe nursing action to carry out the established goals or outcomes.
Client teaching and education as well as SO’s are key nursing actions during this phase. It is
important in this phase that the client and SO’s understand the purpose of the medication as well as
its effect. Questions about the medication must be encouraged from the client.
EVALUATION
Evaluation is the review of the effectiveness of implementation . When to evaluate depends on the
time frame as described in the goals. This is also the phase that the nurse and the health team may
revised plan of care.
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g. The right assessment
h. The right education
i. The right evaluation
j. The right approach
k. The right to refuse medication
Check the client’s identification band, or by asking the client’s name or the SO
Check the client’s chart and the bed number
1. Standing – maybe an ongoing order, may have special instructions, may include PRN
2. One-time (single) – given only once at a specific time
3. PRN – given at the client’s request and nurse’s judgment
4. STAT – given once and immediately
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THE RIGHT DOCUMENTATION
The nurse must record immediately about administered drugs and countersigned it
Document clients response to drugs especially narcotics, sedatives, and other reactions
Careful assessment of the client before adiministration, for example apical pulse rate must be
checked before giving digitalis or blood sugar level before giving insulin.
The client deserve the right to be informed of the information about the drug, its purpose and its
possible effect to the client prior to administration
This include dosage, frequency and duration of the drug therapy
This must be always incorporated to the planning in the nursing process
The nurse should get correctly the client response to medication as to its effectives or side effects.
The nurse should use friendly approach to client under drug therapy
The nurse should establish trust to the client to have effective drug therapy
The nurse must show confidence in his or her obligations
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BASIC UNITS OF METRIC MEASUREMENT
1 meter = 1000 mm
1 measuring cup = 8 oz
1 g = 15 gr
1 L = 1000 ml = 1 qt = 32 oz
1 glass = 8 oz = 240 ml
1 cup = 6 oz = 180 ml
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1 oz = 30 ml
1 t = 5 ml
METHODS OF CALCULATION
1. BASIC FORMULA
D
x V =A
H
H : V ≡ D : x
3. BODY WEIGHT
BSA is the most accurate way to calculate the drug dose for infants, children, older adults, and
clients who are on antineoplastic agents or whose body weight is low.
Nomogram Scale
Nomogram Scale is a graph where you have the ordinates of height in cm and in inches,weight in
pounds and in kg, and the Surface Area (SA) in m 2 located somewhere in between of the previous
two ordinates. The scale is to determine the SA of a client by connecting the point of the weight and
height to form a line and reading its intersection with the SA ordinate.
BSA unit is in square meters (sq m, or m2) is taken from a nomogram scale.
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ORAL DOSAGES CALCULATIONS, INCLUDING FOR PEDIATRICS
TABLETS = are solid drugs that come in many forms. Tablets that can be broken into half or smaller
are usually scored.
CAPSULES = are solid drugs that are enclosed in a gelatin shell. It may contain powder or pellets
(time released). It can be opened by separating the shells but should not be broken if it is in pellet
form.
The value of Vehicle (V) in the drug formula is one (1) for one tablet or capsule.
LIQUID MEDICATIONS = are measured through a medicine cup that is calibrated in ounces or ml.
NOTE: You should be extra careful when using the above formulas or methods as to the choice of
units. All units in a particular method must be all consistent, i.e. metric or english units.
Parenteral route is the route of choice if the client has nursing diagnosis of “impaired swallowing,
altered oral mucous membranes, altered tissue perfusion gastric, or activity intolerance”
INJECTABLE PREPARATIONS
Syringes come in various types and sizes. Most common sizes are 3 ml, and 5-ml.
Tuberculin syringe is a 1-ml, slender syringe with markings in tenths (0.1) and hundreths
(0.01)
Insulin syringe has a capacity of 1 ml; but it is calibrated in Units, 100 units is equivalent
to 1 ml. Avoid using tuberculin for insulin injection. They are color coded, i.e. orange is
for 100 units/ml and red for 40 units /ml.
Prefilled Drug Cartridges and Syringes are syringes with prefilled amount of medication.
Care should be taken in opening and aspirating the prefilled syringe to avoid spillage.
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3. Needles
Needle size is important. There are two specifications for the needle- the gauge ( lumen
diameter) and the length. The larger the gauge number the smaller is the lumen diameter.
MIXING INSULINS
Method
Step 2. Draw up from 35 to 45 Units of air and inject into the NPH insulin bottle. Avoid letting the
needle contact the NPH insulin solution. Withdraw the needle.
Step 3. Draw up 10 Units of air and inject into the regular insulin bottle.
Step 4. First, withdraw the ordered Units of regular insulin. Regular insulin is always drawn up first.
Step 5. Insert needle into NPH bottle and withdraw the ordered Units of NPH insulin.
Step 6. Administer the two insulins immediately after mixing. Do not allow the insulin mixture to
stand.
INTRAMUSCULAR INJECTIONS
Muscle has more blood vessels than the fatty tissue. The volume of solution for an IM injection is 0.5
t0 3 ml, with the average 1 to 2 ml. A volume of drug solution greater than 3 ml can possibly
cause tissue damage. 5 ml of selected drugs may be injected into large muscle, such as the
dorsogluteal. A dose greater than 3 ml is usually divided and given at two different sites.
Subsections of IM
Drug solutions are medications in liquid form as in some vials and ampules.
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Drugs in powdered form need to be reconstituted using a diluent (sterile water, or saline)
prior to administration. The amount of diluent is sometimes indicated in the drug leaflet or
in the drug label.
Example: Order defazolin (Ancef) 500 mg, IM, q6h. Available is the stock with label below.
DV
A=
H
Where: D = 500 mg
H = 1000 mg
V = 3 ml
500 X 3
A= =1.5 ml
1000
NOTE: ANCEF is a powder medicine in vial it is reconstituted by a 2.5 ml of either water for
injection or by NS.
DILUENT ADDED
15
ml UNITS/ml
18 250,000
8 500,000
3 1,000,000
SOLUTION: Compute first for V. For 250,000 Units the diluent is 18 ml. The drug powder is
equivalent to 2 ml.
V = 18 ml + 2 ml = 20 ml
DXV
A=
H
250,000 x 20
A= =1ml
5,000,000
Drugs mixed in one syringe must be compatible. Check compatibility with drug leaflet or
pharmacist.
1. Order: Heparin 4000 Units, SC; see figure 1 for the available stock label.
How many mL should the client receive?
2. Order: Heparin 7500 Units, SC; see figure 1 for the available stock label.
How many mL should the client receive?
3. Order: Atropine Sulfate 0.5 mg, SC; see figure 2 for the available stock label.
How many mL should the client receive?
4. Order: Digoxin 0.25 mg, IM, q.d. (find the drug and read its label)
How many mL would you give? What should be done with the excess digoxin solution?
5. Order: Chlorpromazine (Thorazine) 50 mg, IM , STAT ( fine the drug and read its label)
How many mL would you give? Can the vial be used again?
6. Order: Ampicillin 250 mg, q6h, IM
How many mL of diluents would you add to the ampicillin vial?
How many mL of ampicillin should the client receive per dose?
How many mg should the client receive per day?
7. Order: amikacin (Amikin) 7.5 mg/kg, q12h, IM; Child’s weight is 15 kg
a. How many mg should the child receive per dose?
b. How many mL should the child received per dose?
8. Order: regular insulin 15 Units and NPH insulin 25 Units, SC.
The patient is very thin due to lack of appetite.
Available drug: regular insulin 100 U/ml and NPH insulin 100 U/mL, and insulin syringe 100 U/mL
a. Explain the procedure of mixing the two insulins.
b. What syringe shall the nurse use?
c. What is the color code of the insulin bottles of regular insulin?
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d. What is the color code of the insulin bottle of NPH insulin?
e. What is the color code of the syringe?
f. How much total insulin in all be given to the client?
g. How many degrees shall the SC be given?
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ANSWERS TO PROBLEMS:
1. 0.4 mL 3. 1.25 mL 5. 2 mL yes 7. 112 mg, 0.5 mL
2. 0.75 mL 4. 1 mL 6. 4 mL, 250 mg, 1000 mg/d 8. 40 Units,
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CALCULATIONS OF INTRAVENOUS FLUIDS
CONTINUOUS IV ADMINISTRATION
The order of the health care provider is amount in liter over a 24-h period. The nurse calculates the
IVF flow rate.
INTRAVENOUS SETS
Intravenous set and its drop factor depend on the specifications of the manufacturer such as Abbot,
McGaw, etc.
Macrodrip set = is for infusing from 100 ml/h or more (10 to 20 gtt/ml)
Microdrip set = is for infusing below 100 ml/h and for pediatric client (60 gtt/ml)
KVO (keep vien open) or TKO (to keep open) = ordered for client potential to emergency situation.
KVO or TKO is usually regulated to deliver 10 ml/h.
cc ml ml per h
b. min = min = 60
Amount of Solution
a. Administer ¿ x drop factor =gtts/min
Minutes ¿
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