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PHARMACOLOGY

BY: DENNIS D. MONTE, RN, MAN, PME

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

UNIT 1 PERSPECTIVE OF PHARMACOLOGY

1. DRUG ACTION: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic


Phases
2. Nursing Process
3. Principles of Drug Administration
4. Medication and Drug Calculations

UNIT 2 ISSUSES IN PHARMACOLOGY

1. Cultural Considerations
2. Drug Interaction and Drug Abuse

UNIT 3 NUTRITION AND ELECTROLYTES

1. Fluids and Electrolytes Replacement


2. Nutritional Support

UNIT 4 NEUROLOGIC AND NEUROMUSCULAR AGENTS

1. Central Nervous System Stimulants


2. Central Nervous System Depressants

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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

UNIT 5 ANTIINFLAMMATORY AND ANTIINFECTIVE AGENTS

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

UNITS 6 ANTINEOPLASTIC AGENTS

1. Anticancer Drugs
2. Biologic Response Modifiers

UNIT 7 RESPIRATORY AGENTS

1. Drugs for Common Respiratory Infections


2. Drugs for Acute and Chronic Lower Respiratory Disorders

UNIT 8 CARDIOVASCULAR AGENTS

1. Drugs for Cardiac Disorders


2. Diuretics
3. Antihypertensive Drugs
4. Drugs for Circulatory Disorders

UNITS 9 GASTROINTESTINAL AGENTS

1. Drugs for Gastrointestinal Tract Disorders


2. Antiulcer Drugs

UNIT 10 EYE, EAR, AND SKIN DISORDERS

1. Drugs for Disorders of the Eye and the Ear


2. Drugs for Dermatologic Disorders

UNIT 11 ENDOCRINE AGENTS

1. Endocrine Pharmacology: Pituitary, Thyroid, Parathyroids, and Adrenals


2. Antidiabetic Drugs

UNIT 12 REPRODUCTIVE AND GENDER-RELATED AGENTS

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1. Drugs Associated with the Female Reproduction: Pregnancy, Labor, and Delivery
2. Drug Associated with the Postpartum and the Newborn

UNIT 13 EMERGENCY AGENTS

1. Adult and Pediatric Emergency Drugs

PHARMACOLOGY
UNIT 1 PERSPECTIVE OF PHARMACOLOGY

CHAPTER 1 DRUG ACTION: Pharmaceutic, Pharmacokinetic, and


Pharmacodynamic Phases

THREE PHASES OF DRUG ACTION

ROUTE: PER OREM or By mouth

Drugs taken by mouth undergoes three (3) phases – pharmaceutic (dissolution),


pharmacokinetic, and pharmacodynamic.

What are the 3 phases a PO drugs undergoes?

What route of drug administration does not have pharmaceutic


phase?
Drugs administered through parenteral (subcutaneous, intramuscular, or
intravenous), there is no pharmaceutic phase.

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.

What phase is the dissolution of drugs in order to be


absorbed by the GI tract?
Tablets are not 100% drugs. It contained fillers and additives to enhance dissolution.

Some Common Drug Additives

Potassium (K) ions. Example – penicillin potassium

Sodium (Na) ions. Example – penicillin sodium

Some Drug Form in order to Delay Disintegration

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Enteric – coated (EC) drugs are drugs that delays disintegration that will disintegrate
at the small intestine. They are made of hard shells.

Sustained Release (SR) are beaded drugs that disintegrate slowly

Time released also disintegrates like the SR drugs

NOTE: ALL ENTERIC COATED, SUSTAINED RELEASE AND TIME RELEASED DRUGS
SHOULD NOT BE CRUSHED.

T OR F: Enteric coated drugs need to be crushed when


administered
Enteric coated drugs allow the drug to disintegrate in the
small intestine.
B. PHARMACOKINETICS
Pharmacokinetics is the process of drug movement to achieve drug action. It is
composed of absorption, distribution,metabolism, and excretion

ABSORPTION is the movement of drug particles from the GI tract to body fluids
absorption (passive or active) , or pinocytosis

Passive absorption is movement (diffusion) from higher concentration to lower


concentration.
Active absorption is a movement that requires a carrier such as enzyme or
protein to move the drug against a concentration gradient.
Pinocytosis is a process by which cells carry drug across the membrane.

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.

T or F: fat soluble and non-ionized drugs are faster to


absorb.
Water soluble drugs are faster to absorb.
First –pass effect is the process that drugs passes through the liver after the
intestinal lumen. Example of drugs undergoing first-pass effect are warfarin and

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morphine. Lidocaine and some nitroglycerins are extensively metabolized in the liver so
they are not given orally.

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.

ORAL ROUTE – has bioavailability of always less than 100%

IV ROUTE – has usually 100% absorption into the systemic circulation

T or F: IV route has usually 100% bioavailability.


Highly protein bound drugs will have likely less drug effects.
Free drugs are drugs that are not bound to protein.
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.

What organ of the body is the primary site of drug


metabolism?
Half-life (t1/2) is the time it take for one-half of the drug to be eliminated.

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What do call the time it take for one-half of the drug to
be eliminated?
EXCRETION, OR ELIMINATION is the process by which the drug is eliminated from
the body. The main route of elimination is through the urine. Other routes include bile,
feces, lungs, saliva, sweat, and breast milk. Drugs that are free drugs (freed from
protein) are eliminated through the urine.

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:

Primary Physiologic Effect – is the desireable effect

Secondary Physiologic Effect – maybe desireable or undesireable effect.

ONSET, PEAK, AND DURATION OF ACTION

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.

Agonist are drugs that produce a response

Antagonist are drugs that block a response

What do you call to drugs that produce a response?


What do you call to drugs that block a response?
THERAPEUTIC INDEX AND THERAPEUTIC RANGE

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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)

Low TI have a narrow margin of safety.

High TI have a wide margin of safety.

PEAK AND TROUGH LEVELS

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.

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 EFFECTS, ADVERSE REACTIONS, AND TOXIC EFFECTS

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

CHAPTER 2 Nursing Process


Drug therapy must also go through a nursing process which includes
assessment, nursing diagnosis, planning, implementation, and evaluation.

ASSESSMENT – SUBJECTIVE DATA

➢ Current health history


➢ Current medications: dosage, frequency, route, prescribing health care
provider
Client knowledge of the drug, Client perception of the drug effectiveness,
Client compliance, and reasons for Deviations.
Drug alllergies and other forms of allergies
➢ Past Health history
➢ Client’s environmen t: compliance, education, Significant others (SO),
Activities of Daily Living (ADL), Diet, Resources, Mental Status

ASSESSMENT – OBJECTIVE DATA

➢ Laboratory Tests
➢ Diagnostic Tests or studies

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➢ 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)
➢ Realistic and measurable
➢ Time bounded

SMART acronym maybe used as a guide for making objectives or goals

S = specific, answers the questions what, when, where and how

M = measurable, refers to quantity

A = Attainable, refers to possibility of compliance

R = Realistic, refers to compatibility to client and the environment

T = Time bound, refers to time limit

IMPLEMENTATION OR NURSING INTERVENTION

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.

CHAPTER 3 Principles of Drug Administration

NURSE RESPONSIBILITY IN DRUG ADMINISTRATION

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a. It’s a nurse basic activity to administer drugs correctly and safely.
b. The nurse is legally liable for any medication error.
c. The nurse must observe the client’s rights on drug administration.
d. Document administered drugs and its effect.

ELEVEN RIGHTS IN DRUG ADMINISTRATION

a. The right client


b. The right drug
c. The right dose
d. The right time
e. The right route
f. The right documentation
g. The right assessment
h. The right education
i. The right evaluation
j. The right approach
k. The right to refuse medication

THE RIGHT CLIENT

➢ 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

THE RIGHT DRUG

➢ Check the doctor’s order sheet, or the drug chart or kardex


➢ Check the drug label and read three (3) times
➢ Check drug expiration date
➢ Do not administer the drug if in doubt
➢ A telephone order (TO) or verbal order (VO) must be co-signed by the health care
provider within 24 hours

Components of the Drug Order


1. Date and time the order is written
2. Drug name (generic and brand name)
3. Drug dosage
4. Route of administration
5. Frequency and duration of administration
6. Any special intructions
7. Physician or provider’s signature or name if TO or VO
8. Signature of licensed practitioner taking the TO or VO

FOUR CATEGORIES OF DRUG ORDERS

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

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4. STAT – given once and immediately

THE RIGHT TIME

➢ The time at which the prescribed dose should be administered


➢ For drug interval over 2 hours drugs maybe given .5 h before or after prescribed
time

THE RIGHT ROUTE

➢ The right route ensures appropriate absorption for the client


➢ For PO meds check ability to swallow
➢ Do not crush enteric or time released drugs

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

THE RIGHT ASSESSMENT

➢ 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 RIGHT TO EDUCATION

➢ 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 RIGHT EVALUATION

➢ The nurse should get correctly the client response to medication as to its
effectives or side effects.

THE RIGHT APPROACH

➢ 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

GUIDELINES FOR SAFE DRUG ADMINISTRATION

(see table 3-3, p 28 Kee and Hayes)

THE “DON’TS” OF MEDICATION ADMINISTRATION

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(see table 3-4, p 29 Kee and Hayes)

FORMS AND ROUTES FOR DRUG ADMINISTRATION

1. Tablets and capsules


2. Liquids
3. Transdermal
4. Topical
5. Instillations
6. Inhilations
7. Nasogatric and gastrostomy
8. Suppositories (rectal, vaginal)
9. Parenteral (intradermal, Subcutaneous or SC, Intramuscular or IM, Intravenous or
IV)

CHAPTER 4 Medications and Drug Calculations


BASIC UNITS OF METRIC MEASUREMENT

a. Weight = grams (symbols are g, gm, G, or Gm)


b. Volume= liter ( symbols are l or L)
c. Length = meter (symbols are m or M)

SOME METRIC CONVERSION

1 Kilogram (kg) = 1000 gm 1 microgram (µg, mcg) = 0 .000001 g


or 1x10-6 g

1 gram (gm) = 1000 mg 1 mg = 0.001 g or 1x10-3 g

1 mg = 1000 mcg 1 ml = 1 cubic centimeter (cc)

1 liter (l, L) = 1000 ml 1 meter (m) = 100 cm

1 meter = 1000 mm

APOTHECARY SYSTEM –is an older unit of measurement

a. Weight = grain (gr)


b. Fluid volume = fluid ounce (fl oz), dram (fl dr), or minim (min)

APOTHECARY CONVERSION (Fluid Volume)

1 quart (qt) = 2 pints (pt) 1 pint (pt) = 16 fl oz 1 fl oz = 8 fl dr

1 fl dr = 60 minims (min) 1 minim (min) = 1 drop (gt)

HOUSEHOLD EQUIVALENTS IN FLUID VOLUME

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1 measuring cup = 8 oz

1 medium size glass = 8 oz

1 coffee cup (c) = 6 oz

1 table spoon (T) = 3 teaspoons (t)

1 teaspoon (t) = 60 gtts

COMMON CONVERSION FROM METRIC TO APOTHECARY OR HOUSEHOLD UNITS

1 g = 15 gr

1 L = 1000 ml = 1 qt = 32 oz

1 glass = 8 oz = 240 ml

1 cup = 6 oz = 180 ml

1 oz = 30 ml

1 t = 5 ml

METHODS OF CALCULATION

1. BASIC FORMULA

DH x V=A

Where: D is the desired dose: dose as ordered by the physician


H is the on-hand dose: dose printed on the label of container
V is the vehicle: drug form such as tablet, capsule, liquid
A is the amount to be administered as calculated

2. BY RATIO AND PROPORTION

H : V ≡ D : x

Where: D is the desired dose: dose as ordered by the physician

H is the on-hand dose: dose printed on the label or which is available

V is the vehicle or drug form such as tablet, capsule or liquid

x is the amount to be administered; unknown amount that is to be


calculated

3. BODY WEIGHT

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Drug dose per kg x body weight in kg = client’s dose per day

4. BODY SURFACE AREA (BSA)

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 m2 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.

Drug dose per sq m x BSA = Dosage per day

ORAL DOSAGES CALCULATIONS, INCLUDING FOR PEDIATRICS

TABLETS, CAPSULES, AND LIQUIDS

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.

PEDIATRIC DRUG CALCULATIONS METHODS

A. Body Weight Method


B. Body Surface Area (BSA) Method

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.

CALCULATIONS OF INJECTABLE DOSAGES, INCLUDING PEDRIATRICS

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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

1. Vials and ampules


a. Vials are small glass containers with a self-sealing rubber top
b. Ampules are glass containers with tapered neck for snapping open.
2. Syringes
Syringe is composed of a barrel (outer shell), plunger (the part that can
be pulled in or out), and the tip where the needle is joined with the
syringe.

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.

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.

Parts of the needle:

a. Bevel = is the tapered pointed end of the needle


b. Shaft = is the body of the needle
c. Hub = is the base of the needle that is fitted to the tip of the
syringe
1. Insulin bottles/medications
a. Regular insulin is clear color, is given only in IV and SC
b. NPH or lente are cloudy in color and are long acting because of
protamine (NPH) and zinc (lente)
N.B. Humulin means insulin derived from human and not from animals
Insulin is categorized as fast-acting, intermediate-acting, and long
acting

MIXING INSULINS

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Method

Step 1. Clean the rubber tops of the insulin bottles.

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

1. Drug solution for injection

Drug solutions are medications in liquid form as in some vials and


ampules.

2. Powder drug reconstitution

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.

DRUG POWDER MAY YIELD = 1 to 2 ml per Dose

Example: Order defazolin (Ancef) 500 mg, IM, q6h. Available is the stock
with label below.

How many ml would you give?

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Solution: convert 1 gram to mg: 1 gram = 1000 mg

A=DVH
Where: D = 500 mg
H = 1000 mg
V = 3 ml

A=500 X 31000=1.5 ml

NOTE: ANCEF is a powder medicine in vial it is reconstituted by a 2.5 ml of


either water for injection or by NS.

Example: Order aqueous penicillin 250,000 Units, IM, q4h


Available: aqueous penicillin 5,000,000 Units. The drug is in powdered form in
a vial. The drug label states:

DILUENT ADDED
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

A= DXVH

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A= 250,000 x 205,000,000=1 ml

3. Mixing injectable drugs

Drugs mixed in one syringe must be compatible. Check compatibility with


drug leaflet or pharmacist.

PROBLEMS SOLVING FOR INJECTABLE SOLUTIONS

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?
1. 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?
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:

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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,

CALCULATIONS OF INTRAVENOUS FLUIDS

TWO METHODS OF IVF THERAPY


1. Continuous IV infusion = for fluid loss replacement, maintaining fluid
balance, and as a vehicle for drug administration
2. Intermittent IV infusion = is for drug administration.

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.

CALCULATING IV FLOW RATE

a. mlh= Amount of Solution (ml)Hours to Administer

b. ccmin= mlmin= ml per h60

c. gttsmin= Amount of SolutionHours to Administer x 160 x drop factor

CALCULATING FLOW RATES FOR IV DRUGS

a. Amount of Solution Minutes to Administer x drop factor=gtts/min

b. Volumetric Regulators: mLhour= Amount of Solutionminutes to Administer


x 60minuteshour

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