PHARMACOLOGY LECTURE

S KEY TERMS:  PACKAGE INSERT - printed information about

a pharmaceutical product.
 ACTION- A drug chemical effect on body cells.  PALLIATIVE DRUGS - drugs used to improve
 ADMINISTRATION - How a drug is given. quality of life but not to cure or treat a
 ADVERSE REACTION- An unintended and condition.
undesirable effect of a drug.  PHYSICIAN'S DESK REFERENCE - a widely used
 ANATOMY -The study of the structure of the drug reference book that gives information
body parts. about the drug products of major
 BRAND NAME-Licensed name under which a pharmaceutical companies.
drug prepared by a specific manufacturer is  PRESCRIPTION DRUGS - drugs that can be
sold; also known as propriety or trade name. dispensed only with physician order or any
 CHEMICAL NAME-describes the chemical other designated health care provider.
structure of a drug.  NOTE: ONLY DOCTORS AND NURSES WERE
 CONTRACEPTIVES - drugs used to control ALLOWED TO ADMINISTER MEDICATIONS. But
fertility and prevent pregnancy times are changing; many other members of
 CONTRAINDICATIONS - conditions in which the health occupations are now asked to give
the use of certain drug is dangerous or ill- or know about medications.
adviced.
 CONTROLLED SUBSTANCES - potentially WHAT IS PHARMACOLOGY?
dangerous or habit-forming drugs whose sale  The study of interaction between chemicals
and use are strictly regulated by law. and living systems.
 DIAGNOSTIC DRUGS - drugs used to diagnose  Is the study of drugs and their uses,
a disease. preparations, routes and laws.
 DRUG - chemical substance used in the
diagnosis, treatment, cure or prevention of a WHAT IS A DRUG?
disease; also called medication.  A drug is a broadly defined as any chemical
 DRUG CARD - index card on which you write agent that affects the biologic systems.
drug information for your own reference.  A chemical substance used in the diagnosis,
 FOOD and DRUGS ADMINISTRATION (FDA) - treatment, cure or prevention of a disease.
ENFORCEMENT AGENCY
 GENERIC NAME - official non- propriety name THE FOUR SUBDIVISIONS OF
assigned to a drug by the manufacturer with PHARMACOLOGY
the approval of United states Adopted Names
Council.
 HEALTH MAINTENANCE - developing a healthy
lifestyle; keeping existing diseases under
control, and getting regular checkups.
 INDICATIONS - diseases and disorders for
which a certain drug may be used.
 LEGEND - prescription drugs
 NONPROPRIETY NAME - generic name of the
drug
 OFFICIAL NAME - generally, the same as the
generic name of a drug; name of drug as it
appears in the official reference, the United
States Pharmacopoeia/national Formulary
(USP/NF)
 OVER THE COUNTER (OTC) DRUGS - drugs
avallable without prescription.
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PHARMACOLOGY LECTURE

ABSORPTION orally. EXCRETION

 Refers to the movement of a drug from its
administration site through or across tissue  Refers to elimination of a drug from the
into the systemic circulation. circulation.
 The percentage of drug absorbed into the  A drug may be excreted in various ways:
systemic circulation for the activity is known as  Most drugs are excreted by the kidney via
BIOAVAILABILITY, drugs injected intravenously urine, by the liver via the bile, then into the
(IV) have 100% bioavailability. feces, by the lungs via exhaled air, or in the
 The degree and rate of drug absorption breast milk.
depend on the administration route, the  Minor excretion route include saliva, tears, and
patient's age, physical condition, the lipid or sweat.
water solubility of the drug, and any potential 2.PHARMACODYNAMICS
drug interactions with other drugs or food.
 The degree and rate of absorption, such as  PHARMACODYNAMICS EVENTS
passive transport (including diffusion, passive
diffusion and carrier mediated diffusion),  A GIVEN DRUG INTERACTS WITH SPECIFIC
active transport or pinocytosis. RECEPTOR SITES. Agonists drugs stimulate
receptors, antagonists drug inhibit receptors.
DISTRIBUTION
 It causes general interaction with cell
 Refers to the movement of a drug from the metabolism.
systemic circulation into the tissues.  The cellular environment and functions are
 Distribution may be affected by several altered to produce the desired response.
physiologic factors including the blood brain
2.PHARMACOTHERAPEUTICS
barrier, cardiac output. Body composition
(amount of adipose tissue). Blood supply to  The study of uses and effects of drugs.
target tissues, the degree of vessel constriction  Pharmacotherapeutics is the clinical purpose
or dilation, and the degree to which the drug or indication for giving a drug.
binds to plasma proteins such as albumin.
WHAT IS A THERAPEUTIC EFFECT OF A
 Blood brain barriers refers to limited
DRUG?
distribution of drugs into the central nervous
system (CNS), ONLY HIGLY LIPID SOLUBE  Health care professionals are particularly
DRUGS CAN PASS THROUGH TIGHTLY PACKED interested in the
GLIAL CELLS  Desired or predicted physiological response
that a drug cause.
METABOLISM
WHAT IS A DRUG SIDE EFFECTS?
 Refers to the alteration of a drug to a more
active or less active form, usually in the liver.  Pharmacology attempts to describe a drug's
 Metabolism may be affected by genetic factors, desirable or undesirable effects apart from the
the patient's age and physical condition and primary reason for giving the drug.
the drug itself. (e.g. the suitability of the
DRUG SOURCES
metabolites for drug activity or drug lipid
solubility)  Drugs come from four sources: plants, animals,
 Orally administered drugs pass through the minerals and from chemicals (synthetic drugs)
liver and are partially metabolized before by means of biotechnology or genetic
entering the systemic circulation. The first pass engineering.
effect usually requires higher doses. Some
drugs have almost complete first pass
metabolism and are ineffective when given

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PHARMACOLOGY LECTURE

DRUG SOURCES  Precautions - specific warnings to consider

when administering drugs to patients with
DRUGS FROM PLANTS specific conditions or diseases
COFFEE CAFFEINE  Side effects/adverse reactions - unintended or
COCOA,TEA,COLA THEOPHYLLINE undesirable effects of a drug
POPPY CODEINE  Dosage and administration - correct dose for
TOBACCO NICOTINE each a possible route of administration.
MINT MENTHOL
PHYSICIAN'S DESK REFERENCE (PDR)
FOXGLOVE DIGITALIN, DIGITOXIN
BELLADONNA ATROPINE  Which is available in most health facilities. The
YEW TAXOL PDR gives information about the drug products
THYME THYMOL of major. Pharmaceutical companies. It is
DRUGS FROM ANIMALS useful of checking description, clinical
ANIMAL PART DRUG USE pharmacology, mechanism of actions,
1. COW Pancreas Insulin Antidiabetic contraindications, warnings precautions,
hormaone adverse reactions, over-dosage, dosage,
2. FISH Sperms Protamine Antidote of administration and how the product is
sulphate heparin supplied.
3. PIG Intestine Heparin Anticoagulants UNITED STATES PHARMACOPEIA
4. OX Lungs Heparin Anticoagulants DISPENSING INFORMATION (USPDI)

SOURCES OF DRUGS  Is another drug reference. Published in 1980 in

three volumes. It provides pharmacists and
 Synthetic drug sources:
other health care workers with easy-to-follow
 Examples of synthetic drugs:
information about official drugs and products.
1. Adrenalin
 Synthesized epinephrine for treating DOSING SCHEDULE
hypersensitivity and asthma attacks
 Are determined by the drug's pharmacokinetic
2. Amoxicillin, ampicillin, and piperacillin
properties.
 Semi-synthetic pencillins to treat various
 Frequency- How often a medication should be
infections
given
DRUG REFERENCE - Example: B.ID.,T.I.D, Q15
 Timing- Doing schedule
 Are useful information about drugs. Doctors,
- Example: Before lunchtime or after, with or
nurses, pharmacist and others in the health
without food.
care occupations often refer to them when
 Interval- time between doses.
planning, and administering drug therapy.
 Duration- How long the patient should
Drug reference can help you understand why
continue the medication
and how a particular drug is administered.
 Special Instruction- special consideration
 For each drug, they usually include the
- Example: Avoid alcohol
following information:
 Titration- Gradual adjustment of medication
 Description - what the drug is made of.
overtime
 Action - how drug works o Indications - what
the drug is used for. DRUG FORM
 Interactions - undesirable effects produced
 Dosage forms are pharmaceutical drug
when drugs are taken with certain foods, drugs
products in the form in which they are
or chemicals.
marketed for use, with a specific mixture of
 Contraindications - conditions under which the
active ingredients and inactive components, a
drug should not be used

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PHARMACOLOGY LECTURE

particular configuration, and apportioned into  Provide expected therapeutic effect

a particular dose  Extent, drug release, onset, intensity, duration
 The manner in which drug substance are of action predictable
presented in the market (e.g- solids, liquids or  Economical and elegant
semi solids)
THE FOLLOWING FACTORS ARE
CONSIDERED WHEN ESTABLISHING
DOSING SCHEDULES:
 Route of administration-Tthe area of the body
where the drugs' absorption will take place,
bioavailability may be change when the route
of administration is changed.
 Onset of action- Time when a drugs' effect
first come noticeable.
 Peak concentration level- The maximum blood
concentration level achieved through
absorption. At this level most of the drugs
reaches the site of action and provides
therapeutic response.
 Duration of action- The length of time a drug
acts on the body.
 Half-life- The time required for a drug's plasma
concentration to decrease by 50%.
NEED FOR CONVENT DRUG TO DOSAGE
FORMS:
1. Accurate dose.
2. Protection e.g. coated tablets, sealed
ampoules.
3. Protection from gastric juice.
4. Masking taste and odor (to make palatable).
5. Placement of drugs within body tissues.
6. Sustained release medication.
7. Controlled release medication.
8. Optimal drug action.
9. Insertion of drugs into body cavities (rectal,
SITE OF APPLLCATION:
vaginal Use of desired vehicle for insoluble 1. Skin- Ointments, creams, lotions, liniments
drugs. 2. Eye- Solutions, ointments, creams
 Need for different dosage form of same drug: 3. Tooth- Tooth powder, tooth paste
 To minimize discomfort and instant relief and 4. Hand- Hand creams, lotions, hand washings
improve patient compliance 5. Foot- Creams, ointments, dusting powders
DESIRABLE PROPERTIES OF DOSAGE 6. Hair- Hair cream, hair lotions, shampoos, hair
fixing
FORM SHOULD:
7. Nasal- Solutions, sprays, inhalations
 Convenient to handle, use and store
 Stable during storage and use
 Withstand mechanical shock during transport
 Flexibility in different drug strength
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PHARMACOLOGY LECTURE

SOLID DOSAGE FORMS INTRODUCTION

1) Powders- Solid dosage forms containing finely  Dosage form (Medicines) = API +Excipients
divided particles in micron size - The means (or the form) by which drug molecules
2) Tablets- Solid dosage form containing are delivered to sites ofaction within the body.
medicaments with or without excipients  Drug (Active pharmaceutical ingredients )
3) Granules- Aggregate of particles -Chemical compound intended for used in
4) Capsules- Drug enclosed with gelatin capsule diagnosis, treatment prevention, of disease."
5) Cachets- Drugs enclosed with wafer sheet of OR
rice - The Active Pharmaceutical Ingredient (API) is the
6) Pills- Small tablet containing excipients part of any drug that produces its effects.
7) Lozenges- Solid preparations containing sugar  Excipients
and gum used to medicate mouth and throat -Do not increase or affect the therapeutic action of
LIQUID DOSAGE FORMS the active ingredient o Inactive ingredients may
also be referred to as inert ingredients o excipients,
1. Collodions- Liquid preparations for external and generally have no pharmacological effect.
use having nitro cellulose used to protect the -Examples of inactive ingredients include binding
skin materials, dyes, preservatives, and flavoring
2. Droughts- Liquid preparations for oral agents,sweetening agents, coloring agents etc.
containing medicaments available in single Direct clinical use of the active drug substances is
dose or multiple dose rare:
3. Elixirs- Liquid preparation for oral containing  Why?
medicaments with suitable excipients  API handling and Accurate dosing can be
4. Emulsions- Biphasic liquid dosage form for oral difficult or impossible (e.g ., potent drugs: low
containing medicaments in which fine oil mg and ug doses).
globules dispersed in continuous phase  API administration can be
5. Suspensions- Biphasic liquid dosage form for impractical/unfeasible because of size, shape,
oral containing medicaments in which fine smell/odour, taste and low activity.
solid particles suspended in continuous phase  Some API are chemically unstable in light,
6. Enemas- Liquid preparation for rectal moisture, O2
containing medicaments  API can be degraded at the site of
administration (e.g ., low pH in stomach).
DOSAGE FORMS
 API may cause local irritations or injury when
 Dosage forms are pharmaceutical drug they are present at high concentrations at the
products in the form in which they are site of administration.
marketed for use, with a specific mixture of  Administration of active substance would
active ingredients and inactive components, in mean to have no chance for modification
a particular configuration, and apportioned (improvement) of its PK profile.
into a particular dose
NEED OF DOSAGE FORMS
 Provide safe and convenient delivery of
accurate dosage.
Example - Tablets, capsules, syrups
 Protection of a drug substances from
atmospheric oxygen or moisture.
Example - Coated capsules, sealed ampules
 Protection of a drug substances from gastric
acid after oral administration.
Example - Enteric coated tablets
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PHARMACOLOGY LECTURE

 Conceal bitter taste, or odor of a drug

substances.
Example - Capsules, coated tablets, flavored
syrups
 Provide liquid preparation of drug that
insoluble or unstable in the desired vehicle.
Example -Suspension
 Provide liquid dosage forms of substances
soluble in desired vehicle.
Example - Solution.
 Provide optional drug action from topical
administration sites.
Example - Ointment, cream, ear and nasal
preparations.
 Provide for insertion of a drug into one of
the body's orifices.
Example - Rectal and vaginal suppositories.
 Provide extended drug action through
controlled release mechanisms.
Example- Controlled release tablets, capsules,
suspensions.
 Provide for the placement of drugs within
body tissues.
Example - Implants.
 Provide for the optimal drug action
through inhalation therapy.
Example - Inhalants.

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PHARMACOLOGY LECTURE

 Tablet immediately dissolve or dispersed

 Pleasant taste of carbonated drink
4. CHEWABLETABLET
 They are tablets that chewed prior to
swallowing
 They are designed for administration to
children e.g. vitamin products
5. CAPSULES
 Solid unit dosage form that contain a solid,
semi-solid, and liquid fill and a gelatin shell.
 Common excipients used in capsules are :
SOLID DOSAGE FORMS  Gelatin - Commonly used as gelling agent.
1. TABLET  Plasticizers - To ensure elasticity or mechanical
A tablet is unit dose of one or more medicament stability.
Prepare by compression ormould method  Additional Additives - Eleservative, coloring
 Common excipients used in tablet are : and opacifying agents.
 Diluents - Provide bulkiness of tablet.  They are mainly two types are :
 Disintegrants - To ensure that the tablet  Hard gelatin capsules used for dry powder
breaks up in the digestive tract. Binder - ingredients.
Important for granulation of powder.  Soft gelatin capsules used for semi-solid and
 Glidants and Lubricants - Provide good flow for active ingredients that are dissolved or
and ensure efficient tabletting suspended in oil.
 Sweeteners and Flavors - To mask the taste of 6. LOZENGE
APIs.  It is a solid preparation that used to medicate
 Pigments - To mask uncoated tablets visually the mouth and throat for the slow
attractive. administration of indigestion or cough
 A coating may be applied to mask taste, remedies.
smooth tablet for easyswallow, expending  It consisting of sugar and gum, the latter giving
shelf life, and prevent gastric degradation of strength and cohesiveness to the lozenge and
drug. facilitating slow release of the medicament
2. BUCCAL AND SUBLINGUAL TABLET 7. PASTILLES
 Buccal tablets- placing be ween the gum and  It is a solid medicated pill or candy preparation
the check. that design to dissolve slowly in the mouth.
 Sublingual tablets- placing under the tongue.  They are softer than lozenge and their base are
 Medicaments of both systems rapidly dissolve glycerol, gelatin, acacia and sugar.
in mouth and absorbed through the mucous 10. ORAL GRANULES
membrane of mouth.  They are consisting of solid, dry aggregates of
 Drug reaches in systemic circulation without powder particles with irregular shape often
affecting by gastric juices and metabolizing supplied in single-dose sachets.
enzymes of the liver.  Some granules are placed under the tongue
 Examples - Vasodilators, Steroidal hormones. and swallowed with water and other are
3. EFFERVESCENTIABLET intended to be dissolved in water before
 Effervescent tablets are uncoated and taking.
generally contain acid and tartaric acids) and  Effervescente granules evolve carbon dioxide
carbonates or bicarbonates , which react when added to water.
presence of water and release carbon dioxide. 11. ORALPOWDER
 They are intended to be dissolved or  Bulk Powders are multi dose preparations
dispersed in water before use, it provide : consisting of solid, loose, dry particles of
varying degrees of fineness.
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PHARMACOLOGY LECTURE

 Contain one or more active ingredients, with  The dose volume is small (5ml) and, to prolong
or without excipients and, if necessary, the demulcent action, they should be taken
coloring matter and flavoring substances. undiluted
 Usually contain non-potent medicaments such 8. ORALDROPS
as antacids since the patient measures a dose  Oral drops are liquid preparations for oral use
by volume using a 5 ml medicine spoon that are intended to he administered in small
volumes with the aid of a suitable measuring
LIQUID DOSAGE FORMS device.
1. ORAL SOLUTION  They may be solutions, suspensions or
Oral solutions are clear Liquid preparations for oral emulsions.
use containing one or more active ingredients 9. GARGLES
dissolved in a suitable vehicle. They are prepared in a concentrated solution with
2. ORAL EMULSION directions for the patient to dilute with warm
Oral emulsions are stabilized oil-in-water water before use.
dispersion, either or both phases of which may They are aqueous solutions used in the prevention
contain dissolved solids either oil is dispersed in or treatment of throat infections.
finely divided form in water or vice versa. 10. LOTIONS
3. ORAL SUSPENSION It is mono-phasic liquid preparations (aqueous) for
Biphasic liquid preparations for oral use containing external application without friction either dabbed
one or more active ingredients suspended in a on the skin or applied on a suitable dressing and
suitable vehicle. It sediment which is readily covered with a water proof dressing to reduce
dispersed on shaking to give a uniform suspension evaporation.
which remains sufficiently stable to enable the 11. NASALDROPS & SPRAYS
correct dose to be delivered. Drugs in aqueous solution may be instilled into the
4. SYRUP nose from a dropper or fro plastic squeeze bottle.
 It is a concentrated aqueous solution of a Used for local effect, e.g. antihistamine,
sugar, usually sucrose to which medicaments decongestant.
are added. GASEOUS DOSAGE FORMS
 Flavored syrups are a convenient form of
masking disagreeable tastes. 2. NEBULIZER OR ATOMIZER
5. ELIXIR  It is commonly used in treating asthma, and
 It is pleasantly flavored clear liquid oral other respiratory diseases.
preparation of potent or nauseous drugs  It is a device used to administer medication in
 The vehicle may contain a high proportion of forms of a liquid mist to the air ways.
ethanol or sucrose together with antimicrobial  It pumps air or oxygen through a liquid
preservatives which confers the stability of the medicine to turn it into a vapor, which is then
preparation. inhaled by the patient.
6. MOUTHWASHES  Generally prefer to inhalers for patients, due
 These are similar to gargles but are used for to advantages such as:
oral hygiene and to treat infections of the 1.Cheaper
mouth 2.More portable
7. LINCTUSES 3.Less risk of side effects
 It is viscous, liquid oral preparations that are  For that reason, are usually reserved only for
usually prescribed for the relief of cough. It serious cases of respiratory disease or severe
contain high proportion of syrup and glycerol attacks.
which have a demulcent effect on the
membranes of the throat.

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PHARMACOLOGY LECTURE

RECTAL&VAGINAL DOSAGE FORMS 1.

1. SUPPOSITORY
 It is a semi solid medicated mas: , usually conc
shaped, that is inserted either into the rectum,
vagina where it melts at body temperature.
2. ENEMA
 An enema is the procedure of introducing
liquids into the rectum and colon via the anus.
 Evacuant Enema:
 Used as a bowel stimulant to treat
constipation.
 Their volume up to 2 liters.
 Warmed to body temperature.
 Example - soft soap enema & Magnesium
sulphate enema
 Retention Enema:
 Their volume does not exceed 100 ml.
 No warming needed.
 Example - barium enema & nutrient enema.
3. PESSARY
 Pessaries are solid medicated preparations
designed for insertion into the vagina where
they melt or dissolve.

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PHARMACOLOGY LECTURE

PRINCIPLES OF DRUG ADMINISTRATION

10 RIGHTS OF DRUG ADMINISTRATION 4. RIGHT ROUTE

 Understanding the 10 Rights of Drug  Check the order if it`s oral, IV, SQ, IM, etc.
Administration can help prevent many
5. RIGHT TIME & FREQUENCY
medication errors.
 Nurses, who are primarily involved in the  Check the order for when it would be given
administration of medications, benefit from and when was the last time it was given.
this simplified memory aid to help guide them
6. RIGHT DOCUMENTATION
to administer medications safely
 Nurses are responsible for ensuring safe and  Make sure to write the time and any remarks
quality patient care at all times. As many on the chart correctly.
nursing tasks involve a degree of risk,
7. RIGHT HISTORY AND ASSESSMENT
medication administration arguably carries the
greatest risk.  Secure a copy of the client's history to drug
 Research on medical administration errors Interactions and allergies.
(MAEs) showed that there is a 60% error rate
10. RIGHT EDUCATION AND
mainly in the form of wrong time, rate, or dose,
Some medication error cause permanent INFORMATION
disability and for others the errors are fatal.  Provide enough knowledge to the patient of
Follow these 10 rights of drug administration what drug he/she would be taking and what
to ensure safe patient care. are the expected therapeutic and Side effects.

1. RIGHT DRUG The TEN GOLDEN RULES FOR SAFE DRUG

 The first right of drug administration is to ADMINISTRATION
check and verify if it's the right name and form. 1. Take a complete drug history
Beware of look-alike and sound-alike 2. Find out if the patient has any drug allergies
medication names. Misreading medication 3. Be aware of potential drug-drug or drug-food
names that look similar is a common mistake. interaction and compatibilities
These look-alike medication names may also 4. Teach your patient about the drug he is
sound alike and can lead to errors associated receiving
with verbal prescriptions. 5. Administer the right drug
 Check out The Joint Commission's list of look- 6. Administer the right drug to the right patient
alike sound-alike drugs. 7. Administer the right dose to the right patient
2. RIGHT PATIENT
8. Administer the right drug by the right route
9. Administer at the right time & frequency
 Ask the name of the client and check his/her ID 10. Administer at the right documentation and
band before giving the medication. Even if you frequency
know that patient's name, you stil need to ask NOTE: NEVER CHART A MEDICATION BEFORE
just to verify. ADMINISTERING
3. RIGHT DOSE KEY TERMS:

 Check the medication sheet and the doctor's  Agonists- Drug with a certain affinity for a
order before medicating. Be aware of the receptor to produce a predictable response
difference between an adult and a pediatric  Antagonists- Drug that exerts opposite action
dose. to others or compete for the same receptor
site.

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PHARMACOLOGY LECTURE

 MAINTENANCE DOSE- Are given to keep the

plasma drug concentration in the therapeutic
range.
 Toxic effect- Undesirable or unintended effect
of a drug when range.
 Toxicity- Blood level above therapeutic effect.

 Onset of Action- When the concentration of a

drug at the site of action is sufficient to start a
physiologic (Pharmacologic) response.
 Peak action- The time at which drug reaches
the highest concentrations on the target
receptor sites, inducing the maximal
pharmacologic response for the dose given
 Duration of Action- Is how long the drug has
pharmacologic effect  Extrapyramidal effect- Exhibiting movement
 THE ONSET, PEAK, DURATION OF ACTION OF disorders, especially postural, supporting,
A DRUG ARE OFTEN ILLUSTRATED BY A TIME static, and locomotor ) mechanisms similar to
RESPONSE CURVE, ALSO KNOWN AS A DRUG those Parkinson's disease. Example: dystonia,
CONCENTRATION-TIME PROFILE impaired muscle tone, akathisia, restlessness,
 Peak Drug Level- Is the highest plasma agitation, inability to sit still, akinesia:
concentration of a drug at a specific time hypoactivity or non-movement as in muscular
 The peak level indicates the rate of absorption paralysis
of drugs.
 Trough Level- Is the lowest plasma
concentration of a drug and measures the rate
at which drug is eliminated
 If tough level is too high, toxicity can occur.
 Drug Blood Level- When a drug circulating in
the blood, a blood sample may be drawn and
assayed to determine the amount of drug
present.
 Therapeutic Index- It is the ratio that
measures the effective therapeutic dose and
lethal dose.
 Therapeutic Range- Is the drug concentration
in plasma between the minimum effective
concentration (MEC) and the toxic effect.
 LOADING DOSE- When immediate drug
response is desired a large initial dose of drug
is given to achieve a rapid MEC (minimum  latrogenic effect- Caused by treatment or
effective concentration) in the plasma. diagnostic procedure
 It is administered to "PRIME" the blood stream  Idiosyncrasy- An individual sensitivity to
with a level sufficient to quickly induce a effects of a drug caused by inherited or bodily
therapeutic response. constitution factors.

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PHARMACOLOGY LECTURE

 Idiosyncrasy is a condition in which a side  Communicates any concerns about the

effect of any drug is seen only in very less medication orders with other members of the
population so such effects is known as inter professional team.
idiosyncratic effects and it may be related to  Ensures that the medication orders are
only few numbers of drugs. transcribed appropriately, according to
employer policy.
INTRODUCTION
 Has knowledge about the medication(s) being
 The practice of registered nursing is evidence administered, including therapeutic actions,
informed and applies knowledge, skills and possible risks, adverse effects,
critical thinking to ensure the safety of clients. contraindications and interactions with other
Registered Nurses (RN) are expected to adhere substances.
to practice standards, entry-level  Administers medications correctly.
competencies and the code of ethics when  Obtains informed consent from the client
providing care. before administering medications
 RNs are accountable to clients and families for  Monitors the client to assess the effectiveness
the safe administration of medications. This of medications.
guideline provides examples of best practices  Manages any adverse reaction the client may
in medication management such as medication experience.
reconciliation, administration of medication,  Consults with the appropriate health care
refusal of medication by the client, reporting professional when the client outcome is not as
of medication errors and client education. expected. ? consults with the appropriate
 RN Responsibilities Medications are one of health care professional when the client's
several elements of a client's plan of care. needs exceed the scope of practice of the RN.
 Prior to the administration of medications, RNs  Accurately documents the client outcomes
determine that theyhave the competencies related to medication.
and knowledge to safely administer  Educates the client how to manage their
medication. medications, as well as their health.
 Evidence-informed best practices should be  (Adapted from NOja Scotia College of Nursing,
used when administering medications. It is 2020)
imperative that RNs know the limits of their
MEDICATION RECONCILIATION
knowledge and seek help when necessary.
To safely and competently administer medications,  All efforts should be made to reduce
the RN: medication errors. Medication reconciliation is
 Completes and/or reviews a medication one practice that has been shown to help
history for the client including the medication reduce medication errors and adverse events.
reconciliation (see medication reconciliation Medication reconciliation is the
below). comprehensive collection and review of all
 Reviews the medication order for clarity and medications a client is taking
accuracy to ensure the medication order is  The medication reconciliation process isa
current and complete. If the order is not clear collaborative effort initiated by an RN or other
the RN contacts the prescriber and clarifies the health care professional and includes the client,
order. their family and any other care providers
 Assesses the appropriateness of a medication involved with the client's medication. RNs
for a client taking into consideration the gather information about the client's previous
client's age, weight, pathophysiology, and current medications.
laboratory data, medication history, allergies,  This information is documented and added to
vital signs, and knowledge/beliefs about drugs. the client's health care record. Medication
reconciliation is completed to ensure that any
medications that are added, changed or
12 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

discontinued in the client's plan of care are  Over-the-counter (OTC) drugs

carefully evaluated and documented. Drug specifics:
 This information is communicated across 1) Name
transitions in the client's care and helps 2) Amount
prescribers make the most appropriate 3) Route
prescribing decisions for the client. RNs follow 4) Frequency
employer policies regarding medication  Allergies to drugs
reconciliation. Ask: What exactly the medicine do?
SAFETY ADMINISTRATION OF 2. Identify diseases in the body system that may
MEDICATIONS
affect the following:
a. Drug absorption through the gastrointestinal
DRUG SAFETY ADMINISTRATION tract, lungs, mucous membranes
The three checks occur when: b. Distribution by the circulatory system
1. The medication is removed from its storage c. Metabolism by the hepatic system
area, i.e ., medication cart, automated d. Excretion by the renal system
dispenser; 3.Assess the use of illegal drugs
2. The medication is being prepared for the client; 4. Identify special considerations for the older adult,
and, pediatric and pregnant client.
3. Finally, just prior to the medication being given
A. DIAGNOSIS
to the client. (Vera, 2019)
1. Identify nursing diagnosis related to the
KEY TERMS:
medications currently use
 Brand name or chemical name- The propriety 2. Begin a plan of care related to client's drug
name by the manufacturing company. regimen side effects, dietary factors and
Example Tylenol compliance
 Chemical name- The chemical nomenclature. 3. Apply nursing diagnoses taken from the North
Example: N-acetyl-para-aminophenol American Nursing diagnoses Association
 Controlled substance-Drugs that have the (NANDA) specific to drug therapy O
potential for physical or psychological a. Knowledge deficit related to drug treatment
dependence regimen
 Enteral route- By way of the gastrointestinal b. Noncompliance related to side effects of
tract medication or financial difficulty
 Generic name- The non-propriety name c. Risk for injury related to side effects of
assigned by the United States Adapted Names medications
Council d. Alteration in bowel elimination: constipation
Example: Acetaminophen related to narcotic use secondary to pain.
 Inhalation route- By the ways of respiratory
tract with inspired air. B. PLANNING
 Parenteral route- By the way other than in or 1. Identify outcome criteria to document patient
through the digestive tract. responses to the drug therapy
 Topical route- By the way a body surface such 2. Determine the best schedule to administer the
as the skin, mucous membranes, or cornea. prescribed drugs
a. Consider drugs to be administered with and
NURSING PROCESS (PHARMACOLOGY)
without meals
C. ASESSMENT b. Plan diuretics and laxatives early in the
morning to avoid unnecessary interruptions in
1. Obtain a drug history include each of the sleep during the night
following c. Identify potential drug interactions and
 Prescription drugs schedule accordingly
13 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

d. Establish nursing observations and  Oxycodone (OxyContin),

interventions for safe drug therapy  Fentanyl, Dexedrine, Adderall, and Ritalin
e. Identify necessary client teaching for safe drug
administration at home SCHEDULE III

D. IMPLEMENTATION
 Schedule III drugs, substances, or chemicals
1. Provide drug therapy as directed on the plan of are defined as drugs with a moderate to low
care potential for physical and psychological
2. Prepare the medication with consideration to dependence.
the proper technique for the ordered route  Schedule III drugs abuse potential is less than
and drug calculation Schedule I and Schedule Il drugs but more than
3. Consider the 10 rights of drug administration Schedule IV
4. Monitor the effectiveness of the drug and for Some examples of Schedule III drugs are: products
adverse side effects containing less than 90 milligrams of:
5. Teach appropriate information for home drug  Codein per dosage unit (Tylenol with codeine),
therapy Ketamine,
 Anabolic steroids,
DRUG SCHEDULES
 Testosterone
 Drugs, substances, and certain chemicals used SCHEDULE IV
to make drugs are classified into five (5)
distinct categories or schedules depending  Schedule IV drugs, substances, or chemicals
upon the drug's acceptable medical use and are defined as drugs with a low potential for
the drug's abuse or dependency potential. abuse and low risk of dependence.
Some examples of Schedule IV drugs are:
SCHEDULE I
 Xanax
 Schedule I drugs, substances, or chemicals are  Soma
defined as drugs with no currently accepted  Darvon
medical use and a high potential for abuse.  Darvocet
Some examples of Schedule I drugs are:  Valium
 Heroin,  Ativan
 Lysergic acid diethylamide (LSD),  Talwin
 Marijuana (cannabis),  Ambien
 3,4-methylenedioxymethamphetamine  Tramadol
(ecstasy),
SCHEDULE V
 Methaqualone, and peyote.
 Schedule V drugs, substances, or chemicals are
SCHEDULE II
defined as drugs with lower potential for
 Schedule Il drugs, substances, or chemicals are abuse than Schedule IV and consist of
defined as drugs with a high potential for preparations containing limited Quantities of
abuse, with use potentially leading to severe certain narcotics.
psychological or physical dependence.  Schedule V drugs are generally used for
These drugs are also considered dangerous. Some antidiarrheal, antitussive, and analgesic
examples of Schedule Il drugs are: purposes.
 Combination products with less than 15 Some examples of Schedule V drugs are:
milligrams of hydrocodone  Cough preparations with less than 200
 per dosage unit (Vicodin) milligrams of codeine or per 100 milliliters
 Cocaine, methamphetamine, methadone, (Robitussin AC),
 Hydromorphone (Dilaudid).  Lomotil
 Meperidine (Demerol),  Motofen
14 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

 Lyrica
 Parepectolin

 NOTE: “SUCCESS IS NOT FINAL. FAILURE IS

NOT FATAL. IT IS THE COURAGE TO CONTINUE
THAT COUNTS” - WINSTON CHURCHILL

15 BUCU, KATE ANN V. NUR03B

PHARMACOLOGY LECTURE

DRUG INTERACTIONS
WHAT IS DRUG INTERACTION? Example: Ampicillin ,chlorpromazine & barbituates
interact with dextran in solutions and are broken
 Drug interacton is defined as the down or from chemical compounds
pharmacological activity of one drug is altered
PHARMACOKINETIC INTERACTIONS:
by the concominant use of another drug or by
the presence of some other substance  "These interactions are those in which adme
 Object drug- The Drug whose Activity is properties of the object drug is altered by the
effected by such an interaction precipitant and hence such interactions are
 Precipitant- The agent which precipitates such also called as ADME interactions "".
an interaction  The resultant effect is altered plasma
concentration of the object drug.
TYPES OF DRUG INTERACTION
 These are classified as:
1. Drug-drug interactions. 1. Absorption interactions
2. Drug-food interactions. 2. Distribution interactions
3. Chemical-drug interactions. 3. Metabolism interactions
4. Drug-laboratory test interactions. 4. Excretion interactions.
5. Drug-disease interactions.  Absorption interactions
 The Net effect of a Drug Interaction is:
1. ABSORPTION INTERACTION
 Generally quantitative i.e.increased or
decreased effect. Are those where the absorption of the object drug
 Seldom qualitative i.e.rapid or slower effect. is altered. The net effect of such an interaction is:
 Precipitation of newer or increased adverse  Faster or slower drug absorption.
effect.  More, or, less complete drug absorption.
Drug interactions are thus. Mostly undesirable:
 Mostly undesirable MAJOR MECHANISMS OF ABSORPTION
 Rarely desirable(beneficial): for eg ., INTERACTION ARE:
enhancement of activity of penicillins when
administered with probenecid. 1. Complexation and adsorption.
2. Alteration in GI pH.
FACTORS CONTRIBUTING TO DRUG
3. Alteration in gut motility.
INTERACTIONS:
4. Inhibition of Gl enzymes,
1. Multiple drug therapy. 5. Alteration of GI micro flora.
2. Multiple prescribers. 6. Malabsorption syndrome.
3. Multiple pharmacological effects of drug.
4. Multiple diseases/predisposing illness.
5. Poor patidat compliance.
6. Advancing age of patient.
7. Drug-related factors.
PHARMACEUTICAL INTERACTIONS:

 Also called as incompatibility.it is a

physicochemical interaction that occous when
drugs are mixed in i.v . Infusions causing
precipitation or inactivation of active
principles .

16 BUCU, KATE ANN V. NUR03B

PHARMACOLOGY LECTURE

3. DISTRIBUTION INTERACTION 2. EXCRETION INTERACTION

 Are these where the excretion pattern of the
 Are those where the distribution pattern of the object drug is altered. Major mechanisms of
object_drug is altered : excretion interactions are-
 The major mechanism for distribution  Alteration in renal blood flow
interaction is alteration in protein-drug binding.  Alteration of urine PH
 Competition for active secretions
 Forced diuresis

4. METABOLISM INTERACTION

 Are those where the metabolism of the object

drug is altered.
 Mechanisms of metabolism interactions
include: PHARMACODYNAMIC INTERACTION
1. Enzyme induction- Increased rate of
metabolism.  Are those in which the activity of the object
2. Enzyme inhibition- Decreased rate of drug at its site of action is altered by the
metabolism. It is the most significant precipitant. Such interactions may be direct or
interaction in comparison to other interactions indirect.
and can be fatal.  These are of two types:
1. Direct pharmacodynamic interactions.
2. Indirect pharmacodynamic interactions.
DIRECT PHARMACODYNAMIC
INTERACTION
 In which drugs having similar or opposing
pharmacological effects are used concurrently.
 The three consequences of direct interactions
are:
17 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

1. Antagonism. INFLUENCE OF SMOKING ON DRUG

2. Addition or summation. INTERACTIONS:
3. Synergism or potentiation.
 Antagonism- The interacting drugs have  Smoking increases the activity of drug
opposing actions metabolizing enzymes in the liver, With the
Example: Acetylcholine and noradrenaline have result that certain therapeutic agents.
opposing effects on heart rate. Example: Diazepam, propoxyphene, theophylline,
 Addition or summation- The interacting drugs olanzapine. Are metabolized more rapidly,and their
have similar actions and the resultant effect is effect is decreased.
the some of individual drug responses INFLUENCE OF ALCOHOL ON DRUG
Example: CNS depressants like sedatives and INTERACTIONS:
hypnotics, etc.
 Synergism or potentiation- It is an  Chronic use of alcohol beverages may
enhancement of action of one drug by another increases the rate of metabolism of drugs such
Example: Alcohol enhances the analgesics activity as warfarin and phenytoin, probably by
of aspirin. increasing the activity of hepatic enzymes.
 Acute use of alcohol by non alcoholic
INDIRECT PHARMACODYNAMIC individuals may cause an inhibition of hepatic
INTERACTION enzymes.
 In which both the object and the precipitant  Use of alcoholic beverages with sedatives and
drugs have unrelated effects.but the latter in other depressants drugs could result in an
Some way alerts the effects but latter in some excessive depressant response.
way alerts the effects of the former. INFLUENCE OF FOOD ON DRUG
Example: Salicylatesdecrease the ability of the
INTERACTIONS:
platelets to aggregate thus impairing the
Homeostasis if warfarin indused bleeding occurs  Food effects the rate and extent of absorption
of drugs from the GI tract.
CONSEQUENCES OF DRUG INTERACTION:
Example: Many anti biotics should be given atleast
 The consequences of drug interactions may be: 1hr before or 2hr after meals to achieve Optimal
 Major: Life threatening. absorption.
 Moderate: Deteriotion of patients status.  The type of food may be important with regard
 Minor: Little effect. to the absorption of concurrently administered
Drugs.
REDUSING THE RISK OF DRUG
Example: Dietary items such as milk and other
INTERACTIONS: dairy products that contain calcium may decrease .
1. Identify the patients risk factors.  The absorption of tetracycline and
2. Take through drug history. flouroquinolone derivatives.
3. Be knowledge about the actions of the drugs  Diet also may influence urinary pH values.
being used.
4. Consider therapeutic alternatives,
5. 5Avoid complex therapeutic regiments when
possible.
6. Educate the patient.
7. Monitor therapy.

18 BUCU, KATE ANN V. NUR03B

PHARMACOLOGY LECTURE

MEDICATION ADMINISTRATION
PRINCIPLES:

 Assess medication order.

 Assess the client about a history of allergies.
 Assess the client's current condition and the
purpose for the medication or intravenous
solution.
 Determine the client's understanding  Volume less than 5 ml- measured by using a
regarding the purpose of the prescribed syringe.
medication or need for intravenous solution.  Calibrated dropper- Use for giving medicine to
 Teach the client about the medication and children or for adding small amounts of liquid
about self administration at home. to water or juice.
 Identify and address concerns (Social, Cultural,  Sublingual- Placed under the tongue and the
Religious) that the client may have about self fluid must aspirated from the capsule.
administration at home.  Buccal- Should not be chewed, swallowed, or
 Assess the need for conversion when placed under the tongue.
preparing a dose of medication for
administration to the client. Assess the rights
of medication administration.
 Assess the vital signs before administering
medication.
 Document the administration of the prescribed
therapy and client's response to the therapy.

ORAL MEDICATIONS
TOPICAL ROUTES
 Scored tablets contain an indented mark to be
used for possible breakage into partial doses,  DERMATOLOGIC (Lotions, liniments, and
when necessary, scored tablets (those marked ointments)
for division) can be divided into halves or  Wash and Pat dry area well before application
quarters. to facilitate absorption.
 Enteric-coated tablets and sustained released  Use surgical asepsis when open wound is
capsules delay absorption until the medication present.
reaches the small intestine.  Remove previous application before the next
 Capsules contain a powder or oily medication application.
in a gelatin cover. Orally administered liquids  Apply only thin layer of medication to prevent
are supplied in solution form and contain systemic absorption. Use gloves when applying
specific amount of medication in a given the medication over a large surface.
amount of solution, as stated on a label.  Opthalmic (insillation & irrigation)
 Medicine Cup  Position client either sitting or lying.
 Has capacity of 30 ml or 1 oz.  Use sterile technique.
 Use for orally administered liquids. Pour  Clean eyelids and eyelashes with sterile cotton
medication at eye level. balls moistened with sterile normal saline from
 CLEAR LIQUID- LOWER MENISCUS inner to outer canthus. ? Instill eye drops into
 OPAQUE LIQUID- UPPER MENISCUS lower conjunctival sac.

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PHARMACOLOGY LECTURE

 Instill a maximum of two drops at a time. Wait  Elevate Nares slightly by pressing the thumb
for 5 minutes if additional drops need to be against the tip of the nose. While the client
administered. This is for proper absorption of inhales, squeeze the bottle.
medication.  Keep head tilted backward for 5 minutes after
 Avoid dropping a solution onto the cornea instillation of nasal drops. When medication is
directly. use on a daily basis, alternate the route of
 Instruct the patient to close the eyes gently. medication.
Shutting the eyes tightly causes spillage of the
medication.
 For liquid eye medications, press firmly on the
nasolacrimal duct (inner canthus) for at least
30 seconds.
OTIC MEDICATION (INSTILLATION
AND IRRIGATION)

 Warm solution at room or body temperature.

 Side lying position with the ear being treated
uppermost.
 Clean the pinna and the meatus of the ear
canal with cotton-tip applicator.
 Straighten the ear canal PROETZ PARKINSON
 3 years old- Pull pinna downward and
backward. (CHILD) INHALATION (Nebulizer/ Metered-dose
 3 years old- Pull pinna upward and backward. inhalers)
(ADULT)
 Instill eardrops on the side of the auditory  Semi/ high fowler's position or standing
canal to allow the drops to flow in and to position.
continue to adjust to body temperature.  Shake the canister several times. To mix the
 Press gently but firmly a few times on the medication and ensure uniform dosage
tragus of the ear to assist the flow of delivery.
medication into the ear canal.  Position the nouthpiece 1-2 inches from the
 Ask the client to remain in side lying position client's open mouth. As the client starts
for about 5 minutes. Insert a small piece of inhaling, press the canister down to release
cotton fluff loosely at the meatus of auditory one dose of medication.
canal for 15-20 minutes.  Instruct the client to hold breath for 10
seconds.
NASAL  If bronchodilator, administer maximum 2 puffs,
for at least 30 second interval. Administer
 Usually instilled for their astringent effect ( to bronchodilator before other inhaled
Shrink swollen mucous membrane), to loosen medication. Wait at least 1 minute before
secretions and facilitate drainage or treat administration of the second dose or
infections of the nasal cavity or sinuses. inhalation of a different medication by meter
 Have the client blow the nose prior to dose inhaler.
instillation.  Instruct the client to rinse mouth if steroid had
 Assume back lying position, or sit up and lean been administered.
head back.

20 BUCU, KATE ANN V. NUR03B

PHARMACOLOGY LECTURE

VAGINAL  The medication cartridge slips into the

cartridge holder, which provide a plunger for
 Forms in tablet, liquid (douches), cream jelly, injection of medication. The cartridge is
foam, and suppository. designed to provide sufficient capacity to allow
 Use applicator and/or sterile gloves! for the addition of a second medication when
 Empty the bladder before the procedure. combined dosages are prescribed.
 Position and drape the client.  Prefilled medication cartridge is to be used
 Back-lying position with the hips higher than once!!!
the shoulders (use bedpan).  Standard medication doses for adults are to be
 Irrigating container should be 30 cm (12 inches) rounded to the nearest tenth (0.1 ml) of a
above. millilitre and measured on the millilitre scale.
 Ask the client to remain in bed for 5-10  When volumes larger than 3 ml are required,
minutes following administration of vaginal the nurse may use a 5 ml syringe, these
suppository, cream, foam, jelly, and irrigation. syringes are calibrated in fifths (0.2 ml).

PARENTAL MEDICATION
 Parenteral always means an iniaction route.
Administered by Intravenous, Intramuscular,
Subcutaneous, or Intradermal injection.
 Parenteral medications are packaged in single-
use ampules, in single and multi-used rubber
stoppered and premeasured syringes and
cartridges.
 The nurse should NOT administered more than
3 ml per intramuscular or 1 ml per
subcutaneous injection site. Always question
and verify excessively large or small volumes of
medication.  TUBERCULIN SYRINGE
 The calibrations on a syringe are read from the  The tuberculin syringe holds 1 ml and is used
top black ring on the syringe, not the middle to measure small amounts of medication, such
section and not the bottom ring. as allergen extract, vaccine, or a child's
 Subcutaneous/ Hypodermis Route uses medication.
needle gauge 2527 and inserted 5/8 to 1 inch  The syringe is calibrated in hundredths (0.01)
in length for 45-60 degrees angle or 1/2 inch of a millilitre, with each one tenth (0.1) marked
needle at 90 degrees angle. Massage to on the metric scale.
increase absorption EXCEPT FOR HEPARIN.  INSULIN SYRINGE
EVEN ASPIRATION of this medication is  The standard 100 unit insulin syringe is
CONTRAINDICATED!!! calibrated for 100 units of insulin (100 unit = 1
 For Intramuscular Route, needle gauge 20-22 ml).
is used and inserted 1-1/2 inches in length at  Insulin should not be measured in any other
90 degrees angle. Factors depends on client's type of syringe.
muscle site. For IRON-DEXTRAN, ZTRACK  When the insulin order states to combine
Method is used. Avoid IM route in edematous regular and NPH
area.  (intermediate acting insulin). DRAW REGULAR
 For Intradermal Route, Needle gauge 26 is INSULIN FIRST.
used and inserted 3/8 to 1/2 inches in length  INJECTABLE MEDICATIONS IN POWDER FORM
and it should be BEVEL UP!!!  Some medications become unstable when
 Prefilled Medication cartridge stored in solution form and are therefore
packaged in powder form.
21 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

 Powders must be dissolved with a sterile  Provides immediate access to the vascular
diluent before use, usually, sterile water or system for the rapid delivery of specific
normal saline is used. The dissolving procedure solutions without the time required for the
is called Reconstitution. GASTROINTESTINAL TRACT absorption. To
 RECONSTITUTION provide a vascular route for medication and
 A.k.a. DILUTION blood products.
 Locate the instructions on the label or in the  To create LIFELINE.
vial package insert.  Protocol provided by Association of Nursing
 Read and follow directions carefully. Services Administrators of the Philippines
 Instructions will state the volume of diluent to (ANSAP).
be used and the resulting volume of the
reconstituted medication. TYPES OF SOLUTION
 Often,the powdered medication adds volume 1. ISOTONIC SOLUTION
to the solution in addition to the amount of  Have the same osmolality as body fluids.
diluent added.  Increase extracellular fluid volume
 When reconstituting a multi-dose vial, label  Do not enter the cells because no osmotic
the medication vial with the DATE, TIME OF pressure or force exists to shift the fluids.
PREPARATION, YOUR INITIAL, and DATE OF  Examples: 0.9 Normal Saline (PNSS), 5%
EXPIRATION. Indicating the STRENGTH PER Dextrose in Water
VOLUME on the medication label is also  (D5W), 5% Dextrose in 0.225 % saline (D5W/
important. 1/4 NSS), Lactated Ringer's Solution (PLRS)
 The total volume of the prepared solution will 2. HYPOTONIC SOLUTION
exceed the volume of the diluent added.  Are more dilute solutions and have a lower
 TRANSDERMAL PREPARATIONS osmolality than body fluids.
 Medications should not be touched during  Cause the movement of water into cells by
preparation for administration, gloves should osmosis.
be worn with certain medications.  Should be administered slowly to prevent
 Medication should be applied to a smooth, cellular edema.
hairless body surface, sites should be rotated.  Examples: 0.45 % Saline (1/2 NS), 0.33 % Saline
Remove old transdermal application before (1/3 NS), 0.225 % Saline (1/4 NS).
applying new one.  HYPERTONIC SOLUTION
 24 hours of duration.  Are more concentrated solutions and have a
 Contraindicated at OR. higher osmolality than body fluids.
 Concentrate extracellular fluid and cause
movement of water from cells into the
extracellular fluid by osmosis.
 Examples: 10 % Dextrose in Water (D10W), 5%
Dextrose in 0.9 % Saline (D5NSS), 5% dextrose
in 0.45 % Saline, 5% dextrose in Lactated
Ringer's Solution (D5LR), D5NM.

DRIP CHAMBER
INTRAVENOUS THERAPY (IVT) 1. MACRODRIP CHAMBER
 Use if the solution is thick or is to be infused
 Purpose: Use to sustain clients who are unable rapidly.
to take substances orally.  The drop factor varies from 10-20 drops/mL.
 Replaces water, electrolytes, and nutrients  Read the tubing package to determine how
more rapidly than oral administration. many drops per millilitre are delivered.

22 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

2. MICRODRIP CHAMBER  Select vein that is:

 Has a short vertical metal piece where the  Easily palpated and feels soft and full.
drop forms.  Large enough to allow adequate circulation
 It delivers about 60 drops/mL. around the catheter.
 Microdrip chambers are used if fluid will be  Naturally splinted by bone.
infused at a slow rate (<50 mL/hr).  Avoid using the following veins:
 It is also use if the solution contains potent  Those in areas of flexion.
medication that needs to be titrate such as in  Those that are highly visible.
paediatrics or ICU's.  Those damage by previous use, phlebitis, or in
 For adults, vein in the arm are commonly use.
 For infants, veins in the scalp and dorsal foot
veins are often use.

 REMEMBER:
 "The SMALLER the gauge number, the LARGER
the diameter of the lumen."
 "Do not write on the plastic IV bag with a
marking pen because the ink may be absorbed
through the plastic into the solution." (Potter
and Perry 2006)

 CONTRAINDICATIONS FOR FLUID

ADMINISTRATION
 Affected arm of a post -mastectomy client.
 Arm with a functioning ARTERIOVENOUS
FISTULA.
 Affected arm by a paralyze client.
 Signs of infection, infiltration, or thrombosis.

NURSING INTERVENTIONS IN IV
THERAPY
 Verify doctor's order.
 Know the type, amount and indication of IV
Therapy.
VEIN SELECTION
 Practice STRICT ASEPSIS.
 Use distal veins of the arm.  Inform the client and explain purpose of IV
 Use the client's non-dominant arm whenever therapy.
possible. Use veins in the feet and legs only  Prime the IV tubing to expel air.
when arm veins are inaccessible.  Clean the insertion site of the IV needle.
23 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

 Shave the area of needle insertion if hairy.  Manifestation:

 Change IV tubing, needle insertion site every  Pain along the course of the vein
72 hours.  Vein may feel hard and cord-like
 Regulate IV every 15-20 minutes. Observe  Edema and redness at insertion site
potential complication  Arm feel warmer than the other arm
 Intervention
COMPLICATION OF IV INFUSION  Change the IV site
1. INFILTRATION- the needle is out of  Use large veins for irritating fluids
vein,thefluids accumulate in the subcutaneous  Stabilize venepuncture at area of flexion
tissue.  Apply cold compress immediately to relieve
 Manifestation: pain and inflammation, then follow warm
 Pain compress.
 Swelling
 Skin is COLD at needle site Pallor at site
 Flow of IV decreases/ stops
 Absence of backflow
 INTERVENTION:
 Change IV site
 Apply Warm compress to reabsorb edema of
fluids.
2. CIRCULATORY OVERLOAD
 Results from administration of excessive
volume of IVF
 Manifestation: 5. AIR EMBOLISM
 Headache  Air manages to get into the circulatory system.
 Flushed skin  Manifestation
 Rapid pulse, increase BP  Chest, shoulder, back pain
 Engorged neck veins  Hypotension, dyspnea, cyanosis, tachycardia,
 Syncope, pulmonary edema, coughing, Loss of consciousness
Shortness of Breath,  Intervention
 Tachypnea  Do not allow IV bottle to run dry.
 Intervention:  Prime the tubing before the starting of infusion.
 Slow infusion to KVO  Turn the patient on Left side T-Burg Position.
 Place patient in high fowler's position  Administer medication and oxygen as
 Administer diuretics and bronchodilators as prescribed.
ordered 6. Nerve Damage
3. DRUG OVERLOAD  May result from tying the arm too Tightly to
 Client receives an excessive amount of fluid the splint.
containing drugs.  Manifested with numbness of hands and
 Manifestation fingers
 Dizziness  Intervention
 Fainting  Massage the area and move shoulder (ROM).
 Shock  Instruct the patient to open and close hand
 Intervention several times.
 Slow infusion to KVO  If severely damaged, PT may be required.
 Notify physician immediately 7. SPEED SHOCK
4. SUPERFICIAL THROMBOPHLEBITIS  Rapid administration of IVP medications
 Due to overuse of vein, irritating solutions or  Manifestation
drugs. Clot formation or large bore catheters.  Flushed face
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PHARMACOLOGY LECTURE

 Headache  The client is asked to state his name which is

 Tight feeling of chest compared with the name on the client's
 Loss of consciousness identification band or bracelet.
 Cardiac Arrest  The recipient's ABO type and Rh Type are
 Intervention identified.
 Give most IVP meds over at least 3-5 minutes.  An antibody screen is done to determine the
 Discontinue drug infusion. presence of antibodies other than anti-A and
 Notify physician immediately. anti-B.
 Crossmatching is done wherein the donor RBC
BLOOD TRANSFUSION THERAPY are combined with the recipient's serum and
 PURPOSE: coombs' serum.
 To administer the required blood component  The universal donor is O negative, the
to the patient. universal recipient is AB positive.
 To restore blood volume.
 To improve oxygen-carrying capacity of blood.

1.
TYPES OF BLOOD DONATION

1. AUTOLOGOUS
 Donation of the client's own blood before a
scheduled procedure.
 It reduces the risk of disease transmission and
potential transfusion complications.
 It is not an option for a client with leukemia or
bacteremia,  CLIENT ASSESSMENT:
 Can be made every 3 days.  Assess for any cultural or religious beliefs
 Donation should begin within 5 weeks of the regarding blood transfusions.
transfusion date and end at least 3 days before  A Jehovah's Witness cannot receive blood and
he date of transfusion. blood products.
2. BLOOD SALVAGE  Ensure that the INFORMED CONSENT has been
 Is an autologous donation that involves obtained. Determine whether the client has
suctioning blood from the body cavities, joint ever experienced any previous transfusion
spaces, or other closed body sites. reactions. Check the client's vital signs
 Blood may need to be "Washed". A special  Assess renal, circulatory, and respiratory status
process that removes tissue debris before and client's ability to tolerate intravenously
reinfusion. administered fluids.
3. DESIGNATED DONOR  If the client's temperature is elevated, notify
 Occurs when recipients select their own physician before beginning the transfusion, a
compatible donors. fever may be cause for delaying the
 Donation does not reduce the risk of transfusion in addition to masking a possible
contracting infections transmitted by the blood, symptom of an acute transfusion reaction.
however, recipients feel more identifying their  INTERVENTION DURING ADMINISTRATION OF
donors. BT:
4. COMPATIBILITY  Verify doctor's order.
 Client blood samples are drawn and labelled at  Inform client and explain purpose of the
the client's bedside at the time the blood procedure.
sample is drawn.  Check for Cross-Matching and Blood Typing.
 Obtain a record, baseline vital sign.
 Practice Strict ASEPSIS.
25 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

 At least 2 nurses check the label of the blood  Sudden chills and fever
transfusion. Check the following:  Flushing
 Serial Number Blood Component  Headache
 Blood Type  Anxiety
 Rh Factor  Warm to touch
 Expiration Date  Muscle pain
 Screening test (VDRL for STD, HBSAg for Hepa 4. SEPTIC REACTION
B ., Malarial Smear for Malaria). Caused by the transfusion of blood component
 Warm blood at room temperature before contaminated by bacteria.
transfusion.  Manifestation
 Identify client properly.  Rapid onset of chills
 Use IV cath gauge 18 or 19. Use BT set with  Vomiting
filter to prevent administration of blood clot  Diarrhea Hypotension
and other particulates.  Shock
 Start transfusion slowly at 10 gtts/min. Remain 5. SEPTIC REACTION
at bedside for 15-30 minutes. Caused by the transfusion of blood component
 Monitor VS. contaminated by bacteria.
 DO NOT MIX MEDICATION TO Blood  Manifestation
Transfusion.  Rapid onset of chills
 Administer 0.9 % NaCl before, during, or after  Vomiting
BT. Never administer IVF with Dextrose.  Diarrhea Hypotension
 Administer BT for 4 hours (Whole Blood, PRBC).  Shock
For Plasma, Platelets, cryoprecipitate transfuse 6. CIRCULATORY OVERLOAD
quickly (20 minutes). Observe potential  Caused by administration of blood volume at a
complications, notify physician. rate greater than the circulatory system can
COMPLICATIONS OF BLOOD accommodate.
 Manifestation
TRANSFUSION
 Rise in venous pressure
1. TRANFUSION REACTION  Dyspnea
Is an adverse reaction that occurs as a result of  Crackles or Rales
receiving a blood transfusion.  Distended neck vein
Delayed transfusion reactions can occur days to  Cough
years after transfusion. Signs include fever, mild  Elevated BP
jaundice, and decreased hematocrit level. 7. HEMOLYTIC REACTION
2. ALLERGIC REACTION  Caused by infusion of incompatible blood
 Caused by sensitivity to plasma protein or products.
donor antibody which reacts with recipient  Manifestation
antigen.  Low back pain (First Sign) Chills
 Manifestation:  Feeling of fullness
 Flushing  Tachycardia / Tachypnea
 Rashes  Hypotension/ vascular collapse
 Pruritus  Flushing
 Laryngeal Edema  Bleeding
 DOB  NURSING INTERVENTION
3. FEBRILE, NON HEMOLYTIC  STOP BLOOD TRANSFUSION IMMEDIATELY
 Caused by hypersensitivity to donor white  Start an IV line (0.9 % NaCl or PNSS)
blood cells, platelets, or plasma protein.  Collect urine specimen to detect presence of
 MOST symptomatic complication of BT. bacteria, which may be causing the adverse
 Manifestation: reaction.
26 BUCU, KATE ANN V. NUR03B
PHARMACOLOGY LECTURE

 Monitor Vital signs

 Send unused blood or BT set to the blood bank
for laboratory examination. Administer
ANTIHISTAMINE, DIURETICS,
CORTICOSTEROIDS, and BRONCHODILATORS as
ordered. Notify Physician.
 Make relevant documentation.

27 BUCU, KATE ANN V. NUR03B