PHARMACOLOGY COURSE OUTLINE

PHARMACOLOGY
NCM106
1st Semester 2020-2021
References:
1.Karch, Amy. Focus on Nursing Pharmacology, 6th
edition , Lippincott Williams & Wilkins, 2013
2.Adam, Holland Jr, & Urban. Pharmacology for
Nurses, A pathophysiologic Approach, Pearson, 2014

Concepts MIDTERM No. of Hours
VGMO 30 MINS
2 HRS 30 MINS
FUNDAMENTAL CONCEPTS OF PHARMA
A.Drug definitions
B.Drug standards
C.Pharmacodynamics
D. PHARMACOKINETICS 9 HOURS
E. FACTORS INFLUENCING RESPONSES TO
DRUGS
F. DRUG LEGISLATION
3 HOURS
NURSING PROCESS IN PHARMACOLOGY
A.ASSESSMENT-DRUG HISTORY
B.PLANNING
3 HOURS
C. INTERVENTION
•Drug administration
•Medication Order
•Medication Safety
•14 rights
•Dosage calculation (ORAL DRUGS & PEDIA)
9 HOURS
TOTAL 27 HOURS
COURSE OUTLINE
Concepts FINALS No. of Hours
DOSAGE CALCULATIONS
(PARENTERAL, IVF, BLOOD %
SOLUTION
9HOURS
D.CLIENT EDUCATION
E. EVALUATION
F. RECORDING & REPORTING
3 HOURS
DRUGS AFFECTING THE
BODY SYSTEM
APPROPRIATE
COMMUNICATION
TECHNIQUES
12 HOURS
INSTITUTIONAL POLICIES ON
SAFE DRUG ADMINISTRATION
INTERPROFESSIONAL
PRACTICE R/T PHARMA
CURRENT TRENDS AND
CLINICAL ALERTS IN NSG.
PHARM and CORE VALUES IN
NSG. PHARMACOLOGY
3 HOURS
TOTAL 27 HOURS

Concepts
MIDTERM
Hrs. % K C App. T
VGMO .5 2 1 1 1
FUNDAMENTAL CONCEPTS OF PHARMA 2.5 9 6 3 9
D. PHARMACOKINETICS 9 33 10 23 23
E. FACTORS INFLUENCING RESPONSES TO DRUGS
F. DRUG LEGISLATION
3 11 6 5 11
NURSING PROCESS IN PHARMACOLOGY 3 12 4 4 4 12
INTERVENTION 9 33 5 6 22 33
TOTAL 27 100 32 42 26 100
FINALS
Dosage calculations (parenteral, IVF, blood % solution 9 34 6 10 18 44
D. Client education
E. Evaluation
F. Recording & reporting
3 11 2 2 7 11
Drugs affecting the body system
Appropriate communication techniques
12 44 12 12 20 44
Institutional policies on safe drug administration
Inter-professional practice r/t pharmacology
Current trends and clinical alerts in nsg. PHARM and CORE VALUES
IN NSG. Pharmacology
3 11 2 2 7 11
TOTAL 27 100 22 26 52 100
TABLE OF SPECIFICS

EVALUATION
FINAL RATING %
MIDTERM 40 %
FINAL TERM 60 %
MIDTERM GRADE
MIDTERM EXAM 40 %
Written Output (quizzes, essay, case analysis..etc.) 30 %
Course Output/Project 20 %
Participation 10 %
TOTAL 100 %
FINAL TERM GRADE
Final EXAM 40 %
Written Output (quizzes, essay, case analysis..etc.) 30 %
Course Output/Project 20 %
Participation 10 %
TOTAL 100 %

Learning Outcomes
At the end of 54 hours the students shall be able to:
1.Integrate knowledge of physical, social, natural and
health sciences and humanities in nursing
pharmacology
2.Apply appropriate nursing concepts and actions
holistically and comprehensively
• Discuss the pharmacodynamics of specific
drugs
• Explain the pharmacokinetics of given drugs
• Analyze the factors affecting responses to drug
3. Adhere to ethico-legal considerations when
providing safe, quality and professional nursing care.
4. Assess with the client one’s health
status/competence in relation to drug administration
5. Formulate with the client with reference to the
prescribed medications a plan of care to address the
health needs/problems based on priorities

6.Determine specific nursing considerations/precautions
in safe drug administration
• Interpret a medication accurately
• Relate the rights in drug administration to patient
safety
• Compute accurately the drug dosage for a given
medication orders
• Practice correct decision making skills in safe drug
administration
7. Provide appropriate health education related to drug
therapy
8. Evaluate compliance and response of client to
medications prescribed
9. Use available clinical evidence that can ensure safe
medication administration
10. Document client’s condition , response & outcomes
related to drug therapy
11. Manage resources ( human, physical, financial, time)
efficiently & effectively in safe drug administration

• Its history likely began when humans first used plants to relieve symptoms of
disease.
• One of the oldest forms of health care, herbal medicine has been practiced in
virtually every culture dating to antiquity.
• The Babylonians recorded the earliest surviving “prescriptions” on clay tablets
in 3000 b.c. At about the same time, the Chinese recorded the Pen Tsao (Great
Herbal), a40-volume compendium of plant remedies dating to 2700b.c.
• The Egyptians followed in 1500 b.c. by archiving their remedies on a document
known as the Eber’s Papyrus
• Little is known about pharmacology during the Dark Ages. Although it is likely
that herbal medicine continued to be practiced, few historical events related to
this topic were recorded.
• The first recorded reference to the word pharmacology was found in a text
entitled “Pharmacologia sen Manuductio and Materiam Medicum,” by Samuel
Dale, in 1693.
HISTORY OF PHARMACOLOGY

• Before this date, the study of herbal remedies was called
“Materia Medica,” a term that persisted into the early 20th
century
• Modern pharmacology is thought to have begun in the early
1800s
• Friedrich Serturner, who first isolated morphine from opium in
1805, injected himself and three friends with a huge dose (100
mg) of his new product. He and his colleagues suffered acute
morphine intoxication for several days afterward.
• Pharmacology as a distinct discipline was officially recognized
when the first department of pharmacology was established in
Estonia in 1847
• John Jacob Abel, who is considered the father of American
pharmacology owing to his many contributions to the field,
founded the first pharmacology department in the United States
at the University of Michigan in 1890.
• In the 20th century, the pace of change in all areas of medicine
continued exponentially. Pharmacologists no longer needed to rely
on the slow, laborious process of isolating active agents from
scarce natural sources; they could synthesize drugs in the
laboratory.

Fundamental Concepts of
Pharmacology
A. Drug Definitions and Classification
A.1 Pharmacology
The term pharmacology is derived from two
Greek words: pharmakon, the Greek word for
drugs, and logos, the Greek word for science.
• It is the science of drug interactions between
living systems & molecules introduced from
outside the system
• It is the study of substances that interact
with living systems through chemical
processes, especially by binding to regulatory
molecules and activating or inhibiting normal
body processes.

The use of drugs to diagnose,
prevent and treat illness. Drugs
given for therapeutic purposes
are usually called medications
A.2 Therapeutics
A.3 Pharmacotherapy, or
pharmacotherapeutics, is
the application of drugs for the
purpose of disease prevention and
the treatment of suffering

A.I Classification of Therapeutic Agents
1. Substances applied for therapeutic purposes ( classification)
fall into one of the following three general categories:
1.Drugs - are chemical agents capable of producing biologic
responses within the body. These responses may be desirable
(therapeutic) or undesirable (adverse).
• After a drug is administered, it is called a medication.

3. Complementary and Alternative Medicine Therapies
Involve natural plant extracts, herbs,
vitamins, minerals, dietary supplements,
and many techniques considered by some
to be unconventional.
• manipulative and body-based practices
such as acupuncture, hypnosis,
biofeedback, and massage.
2. Biologics - are agents naturally
produced in animal cells, by
microorganisms, or by the body
itself.
Examples of biologics include
hormones, monoclonal
antibodies, natural blood
products and components,
interferons, and vaccines.
Biologics are used to treat a
wide variety of illnesses and
conditions.

2. Substances applied for pharmacologic purposes refers to
the way a drug works at the molecular, tissue, and body
system levels. It addresses a drug’s mechanism of action, or
how a drug produces its physiological effect in the body.

The Source of Drugs
Drugs can be purchased from a drug
store, but the origins are from one of
four sources.
PLANTS
A number of plants have medicinal
qualities and have been used for
centuries as natural remedies for
injuries and illnesses. Pharmaceutical
firms harvest these plants and
transform them into drugs that have a
specific purity and strength
sufficient to treat diseases.
An example of a drug that comes from a
plant is digitalis. Digitalis is made from
leaves of the foxglove plant and is used
to treat congestive heart failure and
cardiac arrhythmias. Digitalis also
strengthens the force of the contractions
of the heart.

ANIMALS
Byproducts of animals, including
humans, are a source for drugs
because they contain hormones that
can be reclaimed and given to
patients who need increased
hormonal levels to maintain
homeostasis.
For example, Premarin is a drug
that contains estrogen that is
recovered from mare urine. This is
used as hormonal therapy to
manage menopausal symptoms.
Insulin is another hormonal drug
that is used to regulate blood sugar
levels in patients with diabetes
mellitus. Insulin can be recovered
from humans using DNA technology
Pregnant Mare Urine

MINERALS
Our body requires trace elements of minerals
in order to maintain homeostasis.
Minerals are inorganic crystal substances
that are found naturally on earth.
Patients lacking an adequate level of these
materials may take specific mineral based
drugs to raise the level of minerals
For example, an iron supplement is a
common mineral-based drug that is given to
patients who suffer iron deficiency, a
condition which can lead to fatigue.
Iron is a natural metal that is an integral
part of body proteins such as hemoglobin
that carries oxygen throughout the body.
Minerals are obtained from animal and plant
sources.

SYNTHETIC/CHEMICAL DERIVATIVES
Great strides in molecular biology and biochemistry enable scientists to
create manmade drugs referred to as synthetic drugs.
A synthetic drug is produced using chemical synthesis, which rearranges
chemical derivatives to form a new compound.
Sulfonamides are a common group of synthesized drugs that are used to
treat many infections including bronchitis, pneumonia, and meningitis.
Sulfonamides are designed to prevent the growth of bacteria.

HERBALS
•Herbals are non-woody plants. Some
have medicinal qualities classified as a
dietary supplement—not a drug.
•Unlike drugs that are governed by the
Food and Drug Administration, dietary
supplements are not tested or
regulated and can be sold over-the-
counter without a prescription.
•This lack of monitoring means there
are no standards for purity and
strength for herbals.
•They can only state the effect of the
herbal on the body. For example, the
manufacturer can say that an herbal
increases blood flow to the heart, but
cannot say that the herb prevents
heart disease.

B. Drug Regulations and Standards
• The first standard commonly used by pharmacists was
the formulary, or list of drugs and drug recipes
U.S. Pharmacopoeia (USP), 1820. A pharmacopoeia is a medical
reference summarizing standards of drug purity, strength, and
directions for synthesis.

Food and Drug Administration (FDA):
Federal agency responsible
for the regulation and enforcement of
drug evaluation and distribution policies
Is involved with items that people put in
their bodies including food and
medicine.
It also monitors the cosmetic industry
and evaluates medical devices and some
consumer products.
The mission of FDA is to promote and
protect the public health by helping safe
and effective products reach the market
in a timely way and monitoring products
for continued safety after they are used.

B. SOURCES OF DRUG INFORMATION
The fields of pharmacology and drug therapy change so quickly that it
is important to have access to sources of information about drug doses,
therapeutic and adverse effects, and nursing-related implications.
1.Textbooks - provide valuable background and basic information to
help in the understanding of pharmacology, but not practical in clinical
practice.
2. Drug labels have specific information that identifies a specific drug

B. SOURCES OF DRUG INFORMATION

3. Package Inserts -All drugs come with a package
insert prepared by the manufacturer according to strict
FDA regulations. It contains all of the chemical and
study information that led to the drug’s approval
4. Reference Books
• The Physician’s Desk Reference (PDR) is a
compilation of the package insert information
from drugs used in this country, along with some
drug advertising.
• Drug Facts and Comparisons provides a wide
range of drug information, including
comparisons of drug costs, patient information
sections, and preparation and administration
guidelines.
• AMA Drug Evaluations contains detailed
monographs in an unbiased format and includes
many new drugs and drugs still in the research
stage.
• Lippincott’s Nursing Drug Guide

5. Journals
Various journals can be used to obtain drug
information.
• For example, the Medical Letter is a monthly
review of new drugs, drug classes, and
specific treatment protocols.
• The American Journal of Nursing offers
information on new drugs, drug errors, and
nursing implications
6. Internet Information Nurses need to become
familiar with
what is available on the Internet and what patients
may
be referencing. Alta Vista:
http://www.altavista.com
Hardin Meta Directory of Internet Health Sources:
http://www.lib.uiowa.edu/hardin/md/index.html

C - PHARMACODYNAMICS
how the drug affects the body
• Pharmacodynamics is the study of the interactions
between the chemical components of living systems
and the foreign chemicals, including drugs, that
enter those systems.
• When a new chemical enters the system, multiple
changes in and interferences with cell functioning
may occur.
Drugs usually work in one of four ways:
1. To replace or act as substitutes for missing chemicals
2. To increase or stimulate certain cellular activities
3. To depress or slow cellular activities
4. To interfere with the functioning of foreign cells, such
as invading microorganisms or neoplasms (drugs that act
in this way are called chemotherapeutic agents).

• A drug with a wide therapeutic index has a high
safety margin and is relatively safe; the lethal dose is
greatly in excess of the therapeutic dose.
• A drug with a narrow therapeutic index is more
dangerous for the patient because small increases
over normal doses may induce toxic reactions. Peak
and trough levels may need to be monitored
C.1 Therapeutic Index and Drug Safety
Administering a dose that produces an optimum therapeutic
response for each individual patient is only one component
of effective pharmacotherapy. Nurses must also be able to
predict whether the dose is safe for the patient.

Median lethal dose (LD50) is often determined in preclinical trials,
as part of the drug development process. LD50 is the dose of drug
that will be lethal in 50% of a group of animals.
Median Effective dose (ED50) a group of animals will exhibit
considerable variability in lethal dose; what may be a nontoxic dose
for one animal may be lethal for another

Figure 5.2b. Drug Z has the same ED50 as drug X but shows a
different LD50. The therapeutic index for drug Z is only 2 (20 mg ÷ 10
mg). The difference between an effective dose and a lethal dose is very
small for drug Z; thus, the drug has a narrow safety margin
The therapeutic index offers the nurse practical information on the
safety of a drug and a means to compare one drug with another.

C.2 The Graded Dose–Response Relationship &
Therapeutic Response
The graded dose–response relationship is a fundamental
concept in pharmacology. The graphical representation
of this relationship is called a dose–response curve,
Figure 5.3. By observing and measuring the patient’s response
obtained at different doses of the drug, one can explain several
important clinical relationships

Figure 5.3. By observing and measuring the patient’s response
obtained at different doses of the drug, one can explain several
important clinical relationships

C.3 POTENCY & EFFICACY
1st - the concept of POTENCY - is one way to compare the doses of
two independently administered drugs in terms of how much is needed
to produce a particular response.
There are two fundamental ways to compare medications
within therapeutic and pharmacologic classes.
For example, consider two agents, drug X and drug Y, that
both produce a 20-mm drop in blood pressure. If drug X
produces this effect at a dose of 10 mg and drug Y
produces it at 60 mg, then drug X is said to be more
potent.
A drug that is more potent will produce a therapeutic
effect at a lower dose, compared with another drug in
the same class.

In this example, drug A is more potent because it requires a
lower dose to produce the same effect.

2nd method used to compare drugs is called EFFICACY,
which is the magnitude of maximal response that can be
produced from a particular drug
drug A is more efficacious because it produces a higher
maximal response
Which is more important to the success of pharmacotherapy,
potency or efficacy

C.4 Cellular Receptors and Drug Action
• Drugs act by modulating or changing existing
physiological and biochemical processes. To exert
such changes requires that drugs interact with
specific molecules and chemicals normally found
in the body.
• A cellular macromolecule to which a medication
binds in order to initiate its effects is called a
RECEPTOR
• The concept that a drug binds to a receptor to
cause a change in body chemistry or physiology is a
fundamental theory in pharmacology
• RECEPTORS do not exist in the body solely to
bind drugs.
• Their normal function is to bind endogenous
molecules such as hormones, neurotransmitters,
and growth factors
• Although a drug receptor can be any type of
macromolecule, the vast majority are proteins

Many drugs are thought to act
at specific areas on cell
membranes called receptor
sites. The receptor sites react
with certain chemicals to
cause an effect within the cell.
To better understand this
process, think of how a key
works in a lock. The specific
chemical (the key) approaches
a cell membrane and finds a
perfect fit (the lock) at a
receptor site
key
lock
Next

The interaction
between the chemical and
the receptor site affects
enzyme systems within the
cell. The activated enzyme
systems then produce certain
effects, such as increased
or decreased cellular activity,
changes in cell membrane
permeability, or alterations in
cellular metabolism.

• The majority of drugs
are believed to exert
their effects by
combining with a
specialized area on the
cell or within the cell
called receptors. Drug
+ Receptor → Drug
receptor (binding) =
Response
C.5 Types of Drug Receptor Interactions
When a drug binds to a receptor, several therapeutic
consequences can result. In simplest terms, a specific activity
of the cell is either enhanced or inhibited. The actual
biochemical mechanism underlying the therapeutic effect,
however, may be extremely complex
Receptor

•A drug receptor may be on the cell surface or within the cell
Receptors come in many shapes that are specific for
particular drugs.
•The greater the degree of specificity and selectivity for
receptors, the fewer undesirable side effects and the greater
drug efficacy.

• Agonists: Drug that
has the ability to
produce a desired
therapeutic effect
when bound to the
receptor.
• Antagonists: Drugs
that bind well to the
receptor but
produce no receptor
response. This can
prevent other drugs
from having an
effect, thus they are
called blockers.
5. Types of Drug-Receptor Interactions

Competitive antagonist: agonist drug
and antagonist drug are each
competing for the same site.
• The drug present in the greatest
number will get bound.
•Therefore a higher dose of agonist is
required to overcome this response
Noncompetitive antagonist:
inactivates the receptor by binding
irreversibly with it. The drug with
agonist action cannot get to the
receptor site at all. A noncompetitive
antagonist can be used therapeutically
by blocking a natural body substance
such as dopamine when there is too
much dopamine being produced.
•

D. Pharmacokinetics
Pharmacokinetics is a branch of
Pharmacology that studies how a drug
interacts with the body, from drug
administration until elimination from the
body.
This can be defined as somewhat of a life
cycle for a specific drug. Every drug has
unique characteristics of interaction with
the body. Every drug has many
interactions with different parts of the
body as it completes this cycle. The
“ADME" four step (or LADME five step)
process of Pharmacokinetics is simple way
to outline the major aspects of the drug’s
activity from dose administration to dose
elimination.

Some of the common routes of
drug administration are:
1. Injection (the drug is
introduced directly into the
bloodstream or into tissue)
The process by which the
drug is released from its
pharmaceutical form
(e.g., capsule, tablet,
suppository, etc.)
D.1 Liberation

2. Inhalation
3. Per oral administration
4. Dermal administration
5. Rectal administration
Less common routes: buccal , sublingual,
and intra-articular administration

D. 2 Absorption
To reach reactive tissues, a drug must first make its way into the
circulating fluids of the body
Absorption refers to what happens to a drug from the
time it is introduced to the body until it reaches the
circulating fluids and tissues. Drugs can be absorbed
from many different areas in the body: through the
1. GI tract either orally or rectally,
2. mucous membranes,
3. skin,
4. lungs
5. muscle or subcutaneous tissues
Absorption is the primary pharmacokinetic factor determining
the length of time it takes a drug to produce its effect. In order
for a drug to be absorbed it must dissolve. The rate of
dissolution determines how quickly the drug disintegrates and
disperses into simpler forms; therefore, drug formulation is an
important factor of bioavailability.

Passive Diffusion -the drug moves from a region of
high concentration to one of lower concentration.
•does not involve a carrier, is not saturable, and
shows a low structural specificity.
•vast majority of drugs are absorbed by this
mechanism.
• Water-soluble drugs penetrate the cell membrane
through aqueous channels or pores
•lipid-soluble drugs readily move across most biologic
membranes due to their solubility in the membrane
lipid bilayers.
Facilitated diffusion: Other agents can enter the cell
through specialized transmembrane carrier proteins
that facilitate the passage of large molecules.
Active Transport . Energy-dependent active transport
is driven by the hydrolysis of adenosine triphosphate.
Endocytosis - type of absorption is used to transport
drugs of exceptionally large size across the cell
membrane. Involves engulfment of a drug by the cell
membrane and transport into the cell by pinching off
the drugfilled vesicle.

D2.1 Routes of Administration
Drug absorption is influenced by the route of
administration. Generally, drugs given by the oral route are
absorbed more slowly than those given parenterally. Of the
parenteral route, IV drugs are absorbed the fastest.
The oral route is the most frequently used
drug administration route in clinical
practice. Oral administration is not invasive,
and, as a rule, oral administration is less
expensive than drug administration by
other routes. It is also the safest way to
deliver drugs. Patients can easily continue
their drug regimen at home when they are
taking oral medications.
1. Acidity of stomach
2. Length of time in stomach
3. Blood flow to GIT
4. Presence of interacting foods or drugs
Factors affecting absorption

There are several types of drug–drug
interactions. These include the
following:
● Addition. The action of drugs taken
together as a total.
● Synergism. The action of drugs
resulting in a potentiated (more than
total) effect.
● Antagonism. Drugs taken together
with blocked or opposite effects.
● Displacement. When drugs are taken
together, one drug may shift another
drug at a nonspecific protein-binding
site (e.g., plasma albumin), thereby
altering the desired effect.
DRUG-DRUG INTERACTION
Is a change in a drug's effect on the body when the drug is taken
together with a second drug. A drug-drug interaction can delay,
decrease, or enhance absorption of either drug. This can decrease
or increase the action of either or both drugs or cause adverse
effects.

D. 3 Distribution
Distribution involves the
transport of drugs throughout
the body. The simplest factor
determining distribution is the
amount of blood flow to body
tissues. The heart, liver, kidneys,
and brain receive the most blood
supply. Skin, bone, and adipose
tissue receive a lower blood
supply; therefore, it is more
difficult to deliver high
concentrations of drugs to these
areas.
The physical properties of the drug greatly influence how it moves
throughout the body after administration

1. Lipid Solubility
Greater the lipid solubility, more is the
distribution and vice versa.
2. Molecular size
Larger the size, less is the distribution.
Smaller sized drugs are more extensively
distributed.
3. Degree of Ionization
Drugs exist as weak acids or weak bases
when being distributed. Drugs are trapped
when present in the ionized form, depending
upon
the pH of the medium. This fact can be used
to make the drug concentrated in specific
compartments.
4. Cellular binding
Drugs may exist in free or bound form.
Bound form of drugs exists as reservoirs.
The free and bound forms co-exist in
equilibrium.
Cellular binding depends on the plasma
binding proteins.

5. Tissue binding:
Different drugs have different affinity for different cells. All cells do not
bind the same drugs.
6. Duration of Action
The duration of action of drugs is prolonged by the presence of bound
form while the free form is released. This leads to a longer half life and
duration of action of drug.
7. Therapeutic Effects:
Bisphosphonate compounds bind with the bone matrix cells and
strengthen them. They are used in the treatment of osteoporosis.
8. Toxic Effects:
Chloroquinine can be deposited in the retina. Tetracycline can bind
the bone material. It may also get bound to the enamel of the teeth.

Factors Related to the Body:
1. Vascularity
Most of the blood passes through the highly perfused organs (75%)
while the remaining (25%) passes through the less perfused areas..
They are then redistributed to the less perfused areas like the skin and
the skeletal muscles. This phenomenon is common among the lipid
soluble drugs.
2. Transport Mechanism
Lipid soluble drug move by passive transport which is non specific.
Active transport occurs only where carrier proteins are present.
3. Blood Barriers
Blood brain barrier is present because of the delicacy of nervous tissue
to avoid chemical insult to the brain.
4. Structure:
Endothelial cells, and glial cells form the barrier through which drugs
cannot pass easily. Only selective passage takes place.
5. Transporters:
Certain efflux pumps or transporters exist through which drug can be
effluxed as well. Example includes p-glycoprotein.

D.4 METABOLISM
Metabolism, also called
biotransformation, is the process
of chemically converting a drug to a
form that is usually more easily
removed from the body.
Metabolism involves complex
biochemical pathways and
reactions that alter drugs,
nutrients, vitamins, and minerals.
The liver is the primary site of
drug metabolism, although the
kidneys and cells of the intestinal
tract also have high metabolic
rates.
Medications undergo many types of
biochemical reactions as they pass
through the liver, including
hydrolysis, oxidation, and
reduction. During metabolism, the
addition of side chains, known as
conjugates, makes drugs more
water soluble and more easily
excreted by the kidneys.

D. 5 EXCRETION
Excretion is the removal of
a drug from the body. The
skin, saliva, lungs, bile, and
feces are some of the routes
used to excrete drugs. The
kidneys, however, play the
most important role in drug
excretion. Drugs that have
been made water soluble in
the liver
are often readily excreted
from the kidney by
glomerular
filtration—the passage of
water and water-soluble
components
from the plasma into the
renal tubule.

Factors that can
affect drug
excretion.
These include the
following:
● Liver or kidney
impairment.
● Blood flow.
● Degree of ionization.
● Lipid solubility.
● Drug–protein
complexes.
● Metabolic activity.
● Acidity or alkalinity
(pH).
● Respiratory,
glandular or biliary
activity.

F. Factors influencing Responses to drugs
When administering a drug to a patient, the nurse must
be aware that the human factor has a tremendous influence
on what actually happens to a drug when it enters the body.
Things may be very different in the clinical setting hence the
nurse must consider a number of factors before administering
any drug.
1. Weight
1. Weight
• recommended dose of a drug is
targeted at a 150-pound person.
• Heavier patients may require larger
doses to get a therapeutic effect from
a drug because they have increased
tissues to perfuse and increased
receptor sites in some reactive
tissue.
• those who weigh less than the norm
may require smaller doses of a drug.
Toxic effects may occur at the
recommended dose if the person is
very small.

2. Age
•Age is a factor primarily in children and older
adults.
• Children metabolize many drugs differently than
adults do, and they have immature systems for
handling drugs
•Older adults undergo many physical changes that
are a part of the aging process. Their bodies may
respond very differently in all aspects of
pharmacokinetics (ADME)
3. Gender
•Physiological differences between men and women
can influence a drug’s effect.
•Men have more vascular muscles, drug effects are
sooner than in women.
•Women have more fat cells than men do, drugs
deposited in fat are slowly released and cause
effects for a prolonged period.
•The possibility of pregnancy- the use of drugs in
pregnant women is not recommended unless the
benefit clearly outweighs the potential risk to the
fetus.

4. Physiological Factors
Physiological differences such as diurnal rhythm of the nervous and
endocrine systems, acid–base balance, hydration, and electrolyte
balance can affect the way that a drug works on the body and the way
that the body handles the drug. If a drug does not produce the desired
effect, one should review the patient’s acid–base and electrolyte
profiles and the timing of the drug.
5. Pathological Factors
Drugs are usually used to treat disease or pathology. However, the
disease that the drug is intended to treat can change the
functioning of the chemical reactions within the body and thus
change the response to the drug.
6. Genetic Factors
Genetic differences can sometimes explain patients’ varied responses
to a given drug. Some people lack certain enzyme systems necessary
for metabolizing a drug, whereas others have overactive enzyme
systems that cause drugs to be broken down more quickly

7. Immunological Factors
People can develop an allergy to a
drug. Sensitivity to a drug can range
from mild (e.g., dermatological
reactions such as a rash) to more
severe (e.g., anaphylaxis, shock, and
death).
8. Psychological Factors
The patient’s attitude about a drug
has been shown to have an effect
on how that drug works.
A drug is more likely to be effective if
the patient thinks it will work than if
the patient believes it will not work.
This is called the placebo effect
.

9. Environmental Factors
The environment can affect the success of drug therapy. Some drug
effects are enhanced by a quiet, cool, non-stimulating environment.
For example, sedating drugs are given to help a patient relax or to
decrease tension. Reducing external stimuli to decrease tension and
stimulation help the drug be more effective
10. Tolerance
The body may develop a tolerance to some
drugs over time. Tolerance may arise
because of increased biotransformation
of the drug, increased resistance to its
effects, or other pharmacokinetic factors.
When tolerance occurs, the drug no long
causes the same reaction. Therefore,
increasingly larger doses are needed to
achieve a therapeutic effect

11. Cumulation
If a drug is taken in successive doses at intervals that are shorter
than recommended, or if the body is unable to eliminate a drug
properly, the drug can accumulate in the body, leading to toxic levels
and adverse effects.
12. Interactions
When two or more drugs or substances are taken together,
there is a possibility that an interaction can occur, causing
unanticipated effects in the body. Usually this is an increase or
decrease in the desired therapeutic effect of one or all of the
drugs or an increase in adverse effects.

RA 6675 GENERIC ACTS
An act to promote, require and ensure the
production of an adequate supply,
distribution, use and acceptance of drugs
and medicines identified by their generic
names.
Requires that the drug be written in their
generic names.
• Only when these orders are legal writing
and bear the doctor’s signature thus the
nurse have the legal right to follow them
• The nurse must not execute an order if
she is reasonably certain it will result in
harm to the patient.

RA 5921 (PHARMACY ACT)
All prescriptions must contain the following
information:
• Name of the prescriber
• Office address
• Professional registration number
• Professional tax receipt number
• Patient’s/client’s name, age , sex
• Date of prescription.
REPUBLIC ACT NO. 3720 “Food, Drug,
and Cosmetic Act”.
REPUBLIC ACT NO. 9502
An act to ensure the safety and purity of food, drugs and
cosmetics being made available to the public
“Universally Accessible Cheaper and Quality
Medicines Act of 2008” . It is an act providing for
cheaper and quality medicines

Drug Names
A drug is given three names. Each is used in a
different area of the drug industry. These
names are the drug’s chemical name, generic
name, and brand name.
1. CHEMICAL NAME
The chemical name identifies chemical elements
and compounds that are found in the drug.
A chemical name looks strange to anyone who
isn’t a chemist and is difficult for most of us to
pronounce. N-acetyl-p-aminophenol.
2. GENERIC NAME
The generic name of a drug is the universally
accepted name and considered the official
proprietary name for the drug. An example of a
generic name for a commonly used drug is
acetaminophen. The generic name is
differentiated from the trade name by having an
initial lowercase letter, the generic name is never
capitalized.

BRAND/TRADE NAME
Is the proprietary name assigned by the
manufacturing company. Drug companies often
select and copyright a trade or brand name for
their drug. This restricts the use of this name
to that particular company. A brand name for
acetaminophen is Tylenol (patented by Johnson
& Johnson Pharmaceuticals).
The trade name is going to be distinguished
from the generic name by the fact that the
initial letter is capitalized. The trade name is
often shown on the labels and the references
using a registered trademark symbol.
An orphan drug is a pharmaceutical agent that has been developed
specifically to treat a rare medical condition, the condition itself being
referred to as an orphan disease (is any disease that affects a small
percentage of the population )

Pulmozyme and Tobramycin –
orphan drugs for the treatment of
cystic fibrosis
Wilson’s Disease is a rare
hereditary disease that can lead to
a fatal accumulation of copper in
the body
The Kayser-Fleischer ring is the
single most important diagnostic
sign in Wilson's disease
Penicillamine was developed to
treat Wilson's Disease,

Prescription versus Over-the-
Counter Drugs
The 1952 Durham-Humphrey Amendment to the Food, Drug
and Cosmetic Act requires that certain classifications of
drugs be accessible only by prescription from a licensed
practitioner.
Drugs that fall under this classification are:
1. • Those given by injection.
2. • Hypnotic drugs (drugs that depress the nervous
system). Benzodiazepines (Midazolam), antihistamines (
promethazine)
3. • Narcotics (drugs that relieve pain, dull the senses and
induce sleep). Codeine, OxyCoqntin, Percocet and Vicodin
4. • Habit-forming drugs.
5. • Drugs that are unsafe unless administered under the
supervision of a licensed practitioner.
6. • New drugs that are still being investigated and not
considered safe for indiscriminate use by the public.

•Non-prescription
drugs are called over-
the-counter (OTC) drugs
and are available to the public
without prescription.
•Some over-the-counter drugs
were at one time available by
prescription, but later were
considered safe for use by the
public or reformulated for over-
the-counter use.

THE NURSING PROCESS
Nurses use the nursing
process—a decision-making,
problem-solving process—to
provide efficient and effective
care. The key elements of the
nursing process are:
assessment, nursing
diagnosis, implementation,
and evaluation.
Application of the nursing
process with drug therapy
ensures that the patient
receives the best, safest, most
efficient, scientifically based,
holistic care.

1. ASSESSMENT
Past history
• Chronic conditions
• Drug use
• Allergies
• Level of education
• Level of understanding of
disease and therapy
• Social supports
• Financial supports
• Pattern of health care
the first step of the nursing
process involves systematic,
organized collection of data about
the patient. Because the nurse is
responsible for holistic care, data
must include information about
physical, intellectual, emotional,
social, and environmental factors.
Past History:
Is important before beginning
drug therapy, this will help
promote safe and effective use
of the drug and prevent
adverse effects.
Chronic conditions: affect
the pharmacokinetics and
pharmacodynamics of a drug.
For example, certain
conditions (e.g., renal disease,
heart disease, diabetes,
chronic lung disease) may be
contraindicated to the use of
a drug.
Drug Use: Prescription
drugs, over-the-counter (OTC)
drugs, street drugs, alcohol,
nicotine, alternative
therapies, and caffeine may
have an impact on a drug’s
effect

Physical examination
Weight
Age
Physical parameters related
to the disease state or known
drug effects
1. ASSESSMENT
Physical Examination
to determine if any conditions
exist that may have an adverse
reaction to drug use
Weight
helps to determine whether the
recommended drug dose is
appropriate. Because the
recommended dose typically is
based on a 150-pound adult
man, patients who are much
lighter or much heavier
often need a dose adjustment.
Age
Patients at the extremes of
the age spectrum—children
and older adults—often
require dose adjustments
based on the functional level
of the liver and kidneys
and the responsiveness of
other organs
Physical Parameters Related
to Disease or Drug Effects
The specific parameters that
need to be assessed depend
on the disease process being
treated and on the expected
therapeutic and adverse effects
of the drug therapy. Assessing
these factors before drug
therapy begins provides a
baseline level to which future
assessments can be compared
to determine the effects of drug
therapy.
continuation

When applied to pharmacotherapy, the
diagnosis phase of the nursing process
addresses three main areas of
concern:
● Promoting therapeutic drug effects.
● Minimizing adverse drug effects and
toxicity.
● Maximizing the ability of the patient for
self-care, including the knowledge, skills,
and resources necessary for safe and
effective drug administration.
Nursing diagnoses that focus on drug administration may address
actual problems, such as the treatment of pain; focus on potential
problems, such as a risk for deficient fluid volume; or concentrate on
maintaining the patient’s current level of wellness.
Two of the most common nursing diagnoses for medication administration
are Deficient Knowledge and Noncompliance.
A nursing diagnosis is simply a statement of
the patient’s status from a nursing perspective

• The planning phase of the nursing process prioritizes
diagnoses, formulates desired outcomes, and selects
nursing interventions that can assist the patient to
establish an optimum level of wellness
• Short- or long-term goals are established that focus on
what the patient will be able to do or achieve, not
what the nurse will do
• With respect to pharmacotherapy, the planning phase
involves two main components:
1. drug administration and
2. patient teaching.
The overall goal of the nursing plan of care is the safe
and effective administration of medication.
To achieve this, the nurse focuses on safe medication
administration and monitoring of the patient’s condition
and planning for patient teaching needs related to the
drugs prescribed.
B. PLANNING

The primary role of the nurse in drug
administration is to ensure that
prescribed medications are delivered
in a safe manner
C. INTERVENTION
1.

RESPONSIBILITIES OF THE NURSE IN DRUG ADMINISTRATION
Whether administering drugs or supervising the use of drugs by
their patients, nurses are expected to understand the
pharmacotherapeutic principles for all medications .The nurse’s
responsibilities include knowledge and understanding of the
following:
● What drug is ordered.
● Name (generic and trade) and drug classification.
● Intended or proposed use.
● Effects on the body.
● Contraindications.
● Special considerations (e.g., how age, weight, body fat
distribution, and individual pathophysiological states affect
pharmacotherapeutic response).
● Side effects.
● Why the medication has been prescribed for this particular
patient.
● How the medication is supplied by the pharmacy.
● How the medication is to be administered, including dosage
ranges.
● What nursing process considerations related to the
medication apply to this patient.

The professional nurse can routinely avoid many
serious adverse drug effects in patients by
applying experience and knowledge of
pharmacotherapeutics to clinical practice. Some
adverse effects, however, are not preventable. It
is vital that the nurse be prepared to recognize
and respond to potential adverse effects of
medications.
An allergic reaction is an acquired hyper response
of body defenses to a foreign substance (allergen).
Signs of allergic reactions vary in severity and
include skin rash with or without itching, edema,
runny nose, or reddened eyes with tearing
Anaphylaxis is a severe type of allergic reaction that involves the massive,
systemic release of histamine and other chemical mediators of
inflammation that can lead to life threatening shock

The implementation phase is when the nurse applies
the knowledge, skills, and principles of nursing care to
help move the patient toward the desired goal and
optimal wellness.
Implementation (in general) involves action on the part
of the nurse or patient: administering a drug,
providing patient teaching and initiating other specific
actions identified by the plan of care.
When applied to pharmacotherapy, the
implementation phase involves
1. administering the medication,
2. continuing to assess the patient
3. and monitoring drug effects,
4. carrying out the interventions developed in the
planning phase to maximize the therapeutic
response and prevent adverse events,
5. and providing patient education to ensure safe and
effective home use of the medications.
4.
IMPLEMENTATION/INTERVENTION

ROUTES OF DRUG ADMINISTRATION
The three broad categories of routes of drug administration are
1.Enteral
2.Topical
3. parenteral
1. Enteral Drug Administration
The enteral route includes drugs given orally and those administered
through nasogastric or gastrostomy tubes.
•Oral drug administration is the most common, most convenient, and
usually the least costly of all routes.
• safest route because the skin barrier is not compromised.
•In cases of overdose, medications remaining in the stomach can be
retrieved by inducing vomiting.
•Oral preparations are available in tablet, capsule, and liquid forms.
• Medications administered by the enteral route take advantage of the
vast absorptive surfaces of the oral mucosa, stomach, or small
intestine.

Nasogastric & Gastrostomy Drug Administration
A nasogastric (NG) tube is a soft, flexible tube
inserted by way of the nasopharynx with the tip
lying in the stomach. A gastrostomy (G) tube is
surgically placed directly into the patient’s
stomach. Generally, the NG tube is used for
short-term treatment, whereas the G tube is
inserted for patients requiring long-term care.

2. Topical Drug Administration
Topical drugs are those applied locally to the skin or the
membranous linings of the eye, ear, nose, respiratory tract,
urinary tract, vagina, and rectum.
Transdermal Delivery System
The use of transdermal patches
provides an effective means of
delivering certain medications.
Examples include nitroglycerin
for angina pectoris &
scopolamine (Transderm-
Scop) for motion sickness
Drugs to be administered by this route
avoid the first-pass effect in the liver
and bypass digestive enzymes

Ophthalmic Administration
The ophthalmic route is used to treat
local conditions of the eye and
surrounding structures. Common
indications include excessive dryness,
infections, glaucoma, and dilation of the
pupil during eye examinations.
Ophthalmic drugs are available in the
form of eye irrigations, drops, ointments,
and medicated disks.
Otic Administration
The otic route is used to treat local
conditions of the ear, including infections
and soft blockages of the auditory canal.
Otic medications include eardrops and
irrigations, which are usually ordered for
cleaning purposes.

Nasal Administration
The nasal route is used for both local
and systemic drug administration. The
nasal mucosa provides an excellent
absorptive surface for certain
medications. Advantages of this route
include ease of use and avoidance of the
first-pass effect and digestive enzymes.
Vaginal Administration
The vaginal route is used to deliver
medications for treating local
infections and to relieve vaginal pain
and itching.
Vaginal medications are inserted as
suppositories, creams, jellies, or
foams.

Rectal Administration
It is a safe and effective means of delivering
drugs to patients who are comatose or who
are experiencing nausea and vomiting
3. Parenteral Drug Administration
Parenteral administration refers to the
dispensing of medications by routes other
than oral or topical. The parenteral route
delivers drugs via a needle into the skin
layers, subcutaneous tissue, muscles, or
veins.

3.1 Intradermal Administration
Injection into the skin delivers
drugs to the blood vessels that
supply the various layers of
the skin. Drugs may be
injected either intradermal or
subcutaneously. The major
difference between these
methods is the depth of
injection
ID injection is usually employed for allergy and disease screening or for
local anesthetic delivery. Tahe usual sites for ID injections are the
nonhairy skin surfaces of the upper back, over the scapulae, the high
upper chest, and the inner forearm

A subcutaneous injection is delivered
to the deepest layers of the skin. Body
sites that are ideal for subcutaneous
injections include
the following:
● Outer aspect of the upper arms, in
the area above the triceps muscle.
● Middle two thirds of the anterior
thigh area.
● Subscapular areas of the upper
back.
● Upper dorsogluteal and ventrogluteal
areas.
● Abdominal areas, above the iliac
crest and below the diaphragm, 1.5 to
2 inches out from the umbilicus.
3.2 Subcutaneous Administration

3.3 Intramuscular Administration
An intramuscular (IM) injection delivers
medication into specific muscles.
Because muscle tissue has a rich blood
supply, medication moves quickly into
blood vessels to produce a more rapid
onset of action than with oral, ID, or
subcutaneous administration. Injection
sites must be located away from bone,
large blood vessels, and nerves
The four common sites for intramuscular injections are as follows:
1. Ventrogluteal site. The preferred site for IM injections. Provides the
greatest thickness of gluteal muscles, contains no large blood vessels or
nerves, is sealed off by bone, and contains less fat than the buttock
area, thus eliminating the need to determine the depth of subcutaneous
fat. It is a suitable sitefor children and infants over 7 months of age.

2. Deltoid site. This site is used in
well-developed teens and adults for
volumes of medication not to exceed
1 mL. because the radial nerve lies
in close proximity
3. Dorsogluteal site. This site is
used for adults and for children who
have been walking for at least 6
months.
The site is rarely used due to the
potential for damage to the sciatic
nerve.
4. Vastus lateralis site. The vastus
lateralis is usually thick and well
developed in both adults and
children. The middle third of the
muscle is the site for IM injections.

3.4 Intravenous Administration Intravenous (IV) medications and
fluids are administered directly into
the bloodstream and are immediately
available for use by the body. The IV
route is used when a very rapid onset
of action is desired. As with other
parenteral routes, IV medications
bypass the enzymatic process of the
digestive
system and the first-pass effect of the
liver
The three basic types of IV
administration are as follows:
1.Large-volume infusion. This type
of IV administration is for fluid
maintenance, replacement, or
supplementation. Compatible drugs
may be mixed into a large- volume IV
container with fluids such as normal
saline or Ringer’s lactate.

2. Intermittent infusion. This is a small
amount of IV solution that is arranged in
tandem with or piggybacked to the primary
large-volume infusion. It is used to instill
adjunct medications, such as antibiotics or
analgesics, over a short time period.
3. IV bolus (push) administration.
This is a concentrated dose delivered
directly to the circulation via syringe to
administer single-dose medications.
Bolus injections may be given through
an intermittent injection port or
by direct IV push.

2. MEDICATION ORDER
A medication order is written directions provided by a
prescribing practitioner for a specific medication to be
administered to an individual. The prescribing practitioner
may also give a medication order verbally to a licensed person
such as a pharmacist or a nurse.
Examples of some different types of medication orders are:
• Copy of a written prescription
• Written order on a consultation form, signed by the practitioner
• Written list of medication orders, signed by the practitioner
• Copy of a pharmacy call-in order, given to you by the pharmacist*
• A verbal order given to a licensed person*
• Electronic prescriptions signed electronically via a secured system

MEDICATION ORDERS
• A STAT order refers to any medication that is needed immediately
and is to be given only once. It is often associated with emergency
medications that are needed for life- threatening situations.
• The term STAT comes from statim, the Latin word meaning
“immediately.”
• The health care provider normally notifies the nurse of any STAT
order so it can be obtained from the pharmacy and administered
immediately.
• The time between writing the order and administering the drug
should be 5 minutes or less
• ASAP order (as soon as possible) should be available for
administration to the patient within 30 minutes of the written order.

• The single order is for a drug that is to be given only once, and
at a specific time, such as a preoperative order.
• Standing order – protocols derived from guidelines created by
health care providers for use in specific settings, for treating
certain diseases or sets of symptoms
• Standard Order – may be an ongoing order, may be given for a
specific number of doses or days, may include PRN orders
• PRN medication orders are given on an "as needed"
basis for specific signs & symptoms

DRUG ADMINISTRATION ABBREVIATIONS
Abbreviations Meanings
ac before meals
ad lib as desired/as directed
AM Morning
bid (bie in die) twice a day
cap Capsule
gtt Drop
h or hr Hour
IM intramuscular
IV Intravenous
no number
pc ( post cebum) after meals; after eating
PO ( per orem) by mouth
PM Afternoon
PRN ( pro re nata) when needed/necessary
qid (quake in die) four times per day
q2h every 2 hours (even or when first given)
q4h every 4 hours (even)
q12h every 12 hours
Rx Take
STAT immediately; at once
tab tablet
tid three times a day
Note: The Institute for Safe Medical Practices recommends that the following abbreviations be
avoided because they can lead to medication errors: q: instead use “every”; qh: instead use
“hourly” or “every hour”; qd: instead use “daily” or “every day”; qhs: instead use “nightly”; qod:
instead use “every other day.” For other recommendations, see the official Joint Commission “Do
Not Use List” at http://www.jointcommission.org/facts_about_the_officia

Practice Exercise:
Translating Medication Orders
Write your answers under each numbered example.
1)Tegretol 200 mg 2 tabs po bid
a. How many milligrams of Tegretol are in each tablet?
b. What is the dosage of Tegretol that needs to be given in
milligrams?
c. What is the route?
d. How many times per day will you be giving the Tegretol?
2) Erythromycin 333 mg 1 tab po qid X 10 days.
a.What is the route?
b.b. How many times per day will you be giving the
Erythromycin?
c. Over the 10-day period, how many dosages (total) of the
Erythromycin will be given?

3) Digoxin 0.25 mg tab 1 po qam and hold for pulse less than 60
a. At what time of day is the Digoxin to be given?
b. What do you need to do before you can give the Digoxin?
c. How many times per day is the Digoxin given?
d. What do you need to do if the pulse rate is less than 60 beats
per minute?
4) Acetaminophen 325 mg tabs 2 po or 650 mg pr q4h prn for
headache or fever
a. How many milligrams are in each Acetaminophen tablet?
b. What is the Acetaminophen dosage that needs to be given
in milligrams?
c. Under what conditions would you give the Acetaminophen?
d. What routes could be used to administer the
Acetaminophen?

3. MEDICATION SAFETY
The drug regimen process, which includes prescribing, dispensing, and
administering a drug to a patient, has a series of checks along the way
to help to catch errors before they occur. These include the physician
or nurse practitioner who prescribes a drug, the pharmacist who
dispenses the drug, and the nurse who administers the drug.
Often the nurse is the final check in the process because the nurse
is the one who administers the drug and is the one responsible for
patient education before the patient is discharged to home.
• Nurse’s Role
The monumental task of ensuring medication
safety with all of the potential problems that
could confront the patient can best be managed
by consistently using the “rights” of medication
administration

• The Patient’s Role
Only the patient really knows what is being taken
and when, and only the patient can report the actual
as opposed to the prescribed drug regimen being
followed. Patient and family education plays a vital
role in the prevention of medication errors.
Encourage patients to be their own advocates and to
speak up and ask questions. Doing so helps to
prevent medication errors. Teach the patient to do
the ff:
• Keep a written list of all medications you are taking, Including
prescription, OTC, and herbal medications
• Know what each of your drugs is being used to treat.
• Read the labels, and follow the directions
• Store drugs in a dry place, away from children and pets
• Speak up – “you are the most important person in the health care
team”.

# 1 RIGHT DRUG
Means that the right client receives the
drug that was prescribed
For hospitalized clients, the drug
orders are written on the
• doctors order sheet
• signed by the duly authorized
person
A telephone order (TO) for medications
must be cosigned by the physician within
24 hours
Check the drug label 3 times before
administering the medication

• Check ID bracelet
• Have client state his or her
name
• Address the person by name
before giving the drug
• Always double check orders that
the client questions
• Verify patient’s allergies with
chart and with patient
#2 RIGHT CLIENT

#3 RIGHT ROUTE
• Is necessary for adequate and appropriate
absorption
• Includes the correct route of
administration, and administration in
such a way that the client is able to take
the entire dose od the drug and receive
maximal benefit from it
Nursing Implications
• Know the prescribed route of administration
• If no route is specified in the order, question
the physician about intended route
• Always gain the patient’s cooperation before
attempting to administer the medication
• Consider patient’s developmental level
• Assess the patient’s ability to swallow (for
oral meds.)
• Use aseptic technique in the preparation of
parenteral medications

Refers to the dose prescribed
for a particular client
NURSING IMPLICATION
Be familiar with the various measurement system and the conversion
from one system to another
Measuring devices:
• Medication cups
• Dropper
Syringe
• Tuberculin
• Insulin
#4 RIGHT DOSE

#5 RIGHT TIME/frequency
The time at which the prescribed dose should be
administered.
Nursing Implication
• To achieve maximum effectiveness, medications are
scheduled to be administered at a specific time
• Administer drugs that are affected by food, such as
tetracycline and penicillin before meals
• Administer drugs such as potassium and aspirin
after meal or with food
• It is the nurses’ responsibility ro check whether the
client is scheduled for diagnostic purposes such as
endoscopy, fasting blood sugar etc.,
• Check the expiration date. DISCARD /or return to
pharmacy if expired
• Antibiotic should be administered at even intervals
throughout a 24 hour period to maintain
therapeutic blood level.

#6
• Properly assess patient and tests to
determine if medication is safe and
appropriate.
• If deemed unsafe or inappropriate,
notify ordering physician and
document notification.
• Document that medication was not
administered and the reason that dose
was skipped.
Right assessment
•Check your patient actually needs the
medication.
•Check for contraindications.
•Baseline observations if required.

#7 RIGHT APPROACH
1. Gain client’s cooperation - A little solid proof that the drug is
actually working will go a long way. If the client is taking
medicine for hypertension, track his progress by listing down
his B/P readings. At home blood pressure monitoring (digital –
easy to use) can boost his motivation to continue taking the
drug
2. If the client is taking antibiotics-Explain the need to complete
the regimen. Most patients start to feel better long before they
get to the last pill. The first few pills will have killed the germs
that are especially sensitive to antibiotics, leaving the tougher
germs behind. If you don't finish off these stragglers, they
could rally to form a new, tough-to-treat infection.

# 9
After medication has been
administered…
• Assess patient for any adverse
side effects.
• Assess patient for effectiveness
of medication.
• Compare patient’s prior status
with post medication status.
• Document patient’s response to
medication.
# 9

#10 RIGHT DOCUMENTATION
Each time a medication is administered, it
must be documented. Your documentation
of medication administration must be done
at the time that you give the medication.
You must complete all of the
documentation that is required on the
medication log.
• Documentation should be done in blue
or black ink.
• No pencil or white out can be used.
• Never cross out or write over
documentation.
• If you make a mistake when you are
documenting on the medication log, circle
your mistake and write a note on the log to
explain what happened.
• Never document before medication is administered.

RIGHT DOCUMENTATION
Continuation

• The legally responsible party (patient,
parent, family member, guardian, etc.) for
patient’s care has the right to refuse any
medication.
• Inform responsible party of consequences
of refusing medication.
• Verify that responsible party understands
all of these consequences.
• Notify physician that ordered medication
and document notification.
• Document refusal of medication and that
responsible party understands
consequences.
#
11

Right Prescription
• The person’s name
• Name of medication
• Name and telephone number of
the licensed practitioner
• Time of administration
• Dosage, method and duration
of medication
# 13 Right Prescription

# RIGHT NURSE CLINICIAN
• Medications are only
administered by the licensed
nurse who has prepared them.
• Medications may be self-
administered by the patient
under licensed nurse specifically
ordered by a Licensed
Independent Practitioner.

Evaluation, the final step of the nursing process, is crucial to determine
whether, after application of the nursing process, the client’s condition or
well-being improves. In pharmacology, evaluation is part of the continuing
process of patient care that leads to changes in assessment, diagnosis,
and intervention.
•The patient is continually evaluated for therapeutic response
•The occurrence of adverse drug effects
•The occurrence of drug–drug, drug–food, drug–alternative therapy, or
drug–laboratory test interactions.
•Some drug therapy requires evaluation of specific therapeutic drug
levels.
•The efficacy of the nursing interventions and the education program also
are evaluated.
Evaluation
In some situations, the nurse evaluates the patient simply by reapplying
the beginning steps of the nursing process and then analyzing for
changes, either positive or negative.
The process of evaluation may lead to changes in the nursing
interventions being used to provide better and safer patient care.

READ & INTERPRET THE FOLLOWING PHYSICIAN’S ORDER’S
3. D/C lidocaine I.V drip
Discontinue the intravenous infusion of lidocaine
4. Benadryl 25 mg P.O STAT
Immediately administer 25 mg of Benadryl by mouth
5. D5W I.V. to 200 ml/h
Decrease the intravenous infusion rate of dextrose
5% in water to 200 ml each hour
1. Compazine 10 mg I.M q6h p.r.n for nausea & vomiting
Administer Compazine 10 mg intramuscularly q 6
hours as necessary for nausea & vomiting
2. Acetaminophen suppository 650 mg P.R q 4h p.r.n for T102
Administer a 650 mg acetaminophen suppository
rectally q 4h, as needed, for temperature above 102 F

MEASURING SYSTEMS
At least four different systems are currently
used in drug preparation and delivery:
1. the metric system,
2.the apothecary system,
3.the household system,
4.the avoirdupois system.
Metric System
The metric system is the most
widely used system of measure. It
is based on the decimal system, so
all units are determined as
multiples of 10. This system is
used worldwide and makes the
sharing of knowledge and research
information easier. The metric
system uses the gram as the basic
unit of solid measure and the liter
as the basic unit of liquid measure

Apothecary System
The apothecary system is a
very old system of measurement
that was specifically developed
for use by apothecaries or
pharmacists. The apothecary
system uses the minim as the
basic unit of liquid measure and
the grain as the basic unit of
solid measure. An interesting
feature of this system is that it
uses Roman numerals
placed after the unit of measure
to denote amount. For example,
15 grains would be written “gr
xv.”

Household System
The household system is
the measuring system that
is found in recipe books.
This system uses the
teaspoon as the basic unit
of fluid measure and the
pound as the basic unit of
solid measure. When a
patient is using a liquid
medication at home, it is
important to clarify that the
measures indicated in the
instructions refer to a
standardized measuring
device

Avoirdupois System
The avoirdupois system is another
older system that was very popular
when pharmacists routinely had to
compound medications. This
system uses ounces and grains, but
they measure differently than those
of the apothecary and household
systems. The avoirdupois system is
seldom used by prescribers but may
be used for bulk medications that
come directly from the
manufacturer compound
medications. This system uses
ounces and grains, but they
measure differently than those of
the apothecary and household
systems.

METHODS FOR CALCULATION
Two general methods for calculating drug doses are the basic
formula and the ratio and proportion. These methods will be used
for calculating oral and injectable drug doses. For drugs that
require individualized dosing, calculation by body weight (BW) or
body surface area (BSA) may be necessary
ADULT DRUG CALCULATION
1. BASIC FORMULA
Formula is D
H
X V = A
D is the desired dose : or the drug dose ordered by the physician
H is the on-hand dose: drug dose on the label of the container
V is the vehicle : drug form which the drug comes (tablet, capsule,
liquid)
A is the amount calculated to be given to the client

Examples
Order: Ampicillin .5 g P.O BID Available:
Ampicillin 250 mg/capsule
D x V = A
H = 2 capsules
500 mg
250 mg
X 1 capsule 500
250
Order: Dexamethasone (Hexadrol) 1 mg P.O
Available: .5 mg tablet
1mg
.5 mg
X 1 tab = 2 tablets

2. RATIO & PROPORTION
Formula
is
KNOWN DESIRE
H V : :
Means
D X
H is the drug on hand available
V is the vehicle or drug form
D is the desired dose (as ordered)
X is the unknown amount to give
and :: stands for “as” or “equal to”
Multiply the MEANS &
the EXTREMES and
solve for X which is the
divisor
Extremes

Order: Aspirin (ASA) gr. X q4h, PRN Available:
Aspirin 325mg/tablet Convert to one system & unit
of measure . Change grains to milligrams
Example
H V = vehicle D X
325mg 1 tab 600(650) mg
: : X
325X
325 325
X = 1.8 tab or 2 tab
= 600
Problem set:
A drug order calls for propanolol 100 mg P.O q.I.d, but the
only available form of propanolol is 40 mg tablets. How
many tablets must you administer?

Solution
40mg : 1 tab :: 100mg : X
40 X = 100
40 40 X = 2.5 tab
PEDIATRIC DRUG CALCULATION
The purpose of learning how to calculate pediatric dosages is
to ensure that children receive the correct dose within the
approved therapeutic range.
1. PEDIATRIC DOSAGE PER BODY WEIGHT
Example
Order: Cefaclor (Ceclor) 50 mg QID
Child weighs: 15 lbs or 6.8 kg (/ by
2.2)
Drug parameter: 30mg-40mg/day
Available: Cefaclor 125 mg/ 5ml
Is the prescribe dose safe?
Solution
1. Check drug parameters
2. Check against dose
orders
3. Compute using basic
formula or ratio &
proportion

Clark’s rule: a method of determining the correct drug dose for
a child based on the known adult dose (assumes that the adult
dose is based on a 150-lb person); it states
child’s dose = × weight of child (lb) = average adult dose
150 lb
For example: If an adult dose of medication calls for 30mg and
the child weighs 30lbs. Divide the weight by 150 (30/150) to get
1/5. Multiply 1/5 times 30mg to get 6mg.
PRACTICE PROBLEMS
1.A child, weighing 85 pounds, is prescribed hydrochlorothiazide,
and the normal adult dose is 50 mg. What is the appropriate
dosage for the child?________________
2. A child, weighing 70 pounds, is prescribed quinine sulfate, and
the normal adult dose is 325 mg TID. What is the appropriate
3. A child, weighing 112 pounds, is prescribed Kaletra®, a
protease inhibitor combination therapy. The normal adult dose is
400 mg lopinavir/100 mg ritonavir. What is the appropriate

Pediatric Dose = 15 (Age in months) X 1000 mg (Adult Dose)
150
An infant, 15 months old and weighing 20 pounds, needs
Streptomycin Sulfate, which is usually administered to adults
as 1 gm (1000 mg), as a daily IM injection. What is the
appropriate dosage for the infant?
Fried’s rule is a calculation method that applies to a child
younger than 1 year of age. The rule assumes that an adult
dose would be appropriate for a child who is 12.5 years (150
months) old. Fried’s rule states
Child’s dosage = Age in months X Adult dosage
150
Pediatric Dose = 15 /150 X 1000mg
Pediatric Dose = 0.1 X 1000 mg
Pediatric Dose = 100 mg
So, according to Fried’s Rule, the pediatric dosage appropriate
for a 15-month-old would be 100 mg.

PRACTICE PROBLEMS
1. A child, 24 months old, needs acetaminophen, and the normal
adult dose is 650 mg. What is the appropriate dosage for the
child?________________
2. An 18-month-old needs amikacin sulfate, and the normal adult
dose is 250 mg. What is the appropriate dosage for the child?
________________
3. A child, 30 months old, needs erythromycin, and the normal adult
dose is 250 mg QID. What is the appropriate dosage for the child?
________________

Young’s Rule uses age.
(which makes it easier to remember, the word young refers to age)
Here is the formula:
Adult Dose X (Age ÷ (Age+12)) = Child's Dose
Example
An 11 year old girl was prescribed with amoxicillin capsule
500mg. The girl weighs 70 Lbs
500mg X (11 ÷ (11+12)) = Child's Dose
500mg X (11 ÷ 23) = Child's Dose
500mg X .48 = Child's Dose
Child's Dose = 240mg

PRACTICE PROBLEMS
1. A 2-year-old child is prescribed amoxicillin, and the normal
adult dose is 500 mg. What is the appropriate dosage for the
child?________________
2. A 7-year-old needs propylthiouracil, and the normal adult
daily dose is 150 mg. What is the appropriate dosage for the
child?________________
3. A child, 10 years old, is prescribed Tavist® syrup, and the
normal adult dose is 1.34 mg BID. What is the appropriate
dosage for the

Body Surface Area
The surface area of a child’s body
may also be used to determine the
approximate dose that should be
used. To do this, the child’s
surface area is determined with
the use of a nomogram . The
height and weight of the child are
taken into consideration in this
chart. The following formula is
then used:

2. Now identify the adult dose.
1. First determine the BSA for this child. ______ M2
Adult dose = ______ mg
PRACTICE PROBLEM 1
The doctor orders Phenergan (Promethazine) PR 12.5 mg every 6
hours as needed for nausea. Calculate the dose for a child who
weighs 40 lbs and is 38 inches tall using Nomogram Method.
Now that you know what the child’s BSA is and the adult dose, you
can plug it into the formula
Child’s BSA in M2 x Adult Dosage 1.73M2 answer of 5.1 mg _____
mg
“The Nomogram reading for this child is 0.71M2 . Now plug it into
the formula:
0.71 M2 x 12.5mg = 195mg = 5.13 mg = 5.1 mg 1.73 M2 1.73
Because the dose is between 1 and 10 mg, you will round the
answer to the nearest tenths place. Therefore, the dose for this
child will be 5.1 mg of Pherergan (Promethazine)

ANSWER
Drug parameters
30 mg X 6.8 = 204 mg/day 40 mg X 6.8
= 272 mg/day
Dosage Order 50 mg X 4 = 200 mg/day
Compute
50 mg
125 mg X 5 ml
= 0.4 2 ml
Ratio and Proportion
125 mg : 5 ml : : 50 mg : X
125 X = 250 ml
125 125
2 ml
PERCENTAGE OF SOLUTIONS
When clients are unable to take food or fluids by mouth, they may
receive nutrients through a nasogastric tube (NGT).
Clients tolerate tube feedings better when the feeding are started at
low strength and the concentration is incrementally increased over
time
Cefaclor 50 mg 2 ml (give 2
ml 4X a day

The percentage of a solution indicates its strength. Tube feeding
solutions, such as Ensure, ensure Plus, Osmolite, Isomile and
others are considered to be 100%.
Fifty percent of the solution is 50% strength of the solution.
Following tube feeding, 30 ml of water should be given to cleat the
tubing. Usually the tube is clamped for 30 minutes. After feeding to
keep fluid content from backing out of the stomach into the tube.
The client should remain with head elevated at a 30-90 degree angle
after feeding for 30 minutes
FORMULA
D = stands for the desired percentage
H = represents the on hand strength which is 100%
V = represents the desired total volume
X = stands for the unknown amount solution
Order: 250 ml of 30 cc solution q 4h X 6 Calculate how much
Ensure & water is needed to make 250 ml of 30% solution
Note: 30% solution in 100 parts

When do we give parenteral medications?
1. When medications cannot be taken by
mouth
1) Intradermally (under the skin)
2) subcutaneously (into the fatty tissue)
3) Intramuscularly (within the muscle)
4) Intravenously (in the vein)
3. What formula will we use in calculating injectable dosages
A. Basic formula and the ratio and proportion methods for adults
B. Calculating body weight, body surface area and the adult dose for
children
1) Inability to swallow
2) decrease level of consciousness
3) when the drug is inactivated by gastric juices
4) to increase the effectiveness of the drug
2. How do we administer parenteral medications?

Administration of Parenteral liquids
Parenteral liquids maybe administered through syringes. In
some cases, the syringes are prefilled, which reduces
medication preparation time and decreases likelihood of
medication error – NARCOTIC drugs are supplied in this form
Patient situation:
The physician orders 75 mg of Demerol. The available
solution contains 100 mg/ml. You need to calculate the
number of ml of Demerol solution to administer
D
H
x V
75 mg
100 mg
X 1 ml 0.75 ml
H : V :: D : X
100 mg : 1 ml :: 75 mg : X
100 X : 75 ml
100 100
X = 0.75 ml

RECONSTITUTION OF A POWDER
Nursing Responsibility
• it will give the total quantity of drug in the vial or
ampule
• The amount & type of diluent
• The strength & shelf life
Patient situation:
The physician orders 500 mg of ampicillin fo a patient.
A 1 G vial of powdered ampicillin is availble. The label
states ADD 4.5 ml sterile water to yield 1G/5ml. How
many ml of reconstituted ampicillin should you give?
1 G(1000mg) : 5ml :: 500 mg : X
1000 X : 2500 ml
1000 1000
X = 2.5 ml
Will give 500 mg of
Ampicillin
1. When reconstituting powders for injection, consult
the drug label

CALCULATIONS FOR INTRAVENOUS FLUIDS
What is the purpose of administering IV fluids?
1. It is used of administering fluids containing water,dextrose,
vitamins, electrolytes, and drugs
2. As a route for administering drugs for direct absorption & fast
action
How are IV fluids administered ?
1. Continuous IV
infusion
Large volume infusion to
maintain fluid status & prevent
dehydration
Fluid replacement because of
drainage – gastric fluids draining
from NGT
2. Intermittent IV administration
What are the nursing responsibilities during IV administration
ion?1. Knowledge of intravenous sets & their drop factors
2. Calculating IV flow rates
3. Mixing & diluting drugs in IV fluids
4. Gathering equipment
5. Knowledge of the drugs & expected & untoward reactions
For KVO (keep vein open) for potential
emergency situation & to to keep an open
line for medication

INTRAVENOUS SETS
When calculating the drip rate of IV solutions, remember that
the number of drops required to deliver 1 ml varies with the
type of administration set used and the manufacturer.
A standard MACRODRIP set delivers from 10-20 gtt/ml
A MICRODRIP set delivers 60 gtt/ml
Manufacturer Drip factor
Abbot 15
Baxter-
Travenol
10
Cutter 20
IVAC 20
McGaw 15
INTRAVENOUS SOLUTIONS
1. 5% Dextrose in Water (D5W, 5% D/W)
2. 10% Dextrose in water (D10W, 10%
D/W
3. 0.9% NaCl, NSS
4. 0.45% NaCl, ½ NSS
5. 5% Dextrose in 0.9 Sodium chloride
(D5NSS, 5% NaCl
6. Lactated Ringers (LR)

CALCULATING INTRAVENOUS FLOW RATE
Method 1
A. To determine milliliters per hour (ml/h)
Amount of solution
Hours to administer
= milliliters/hour
1000 ml
8 hours = 125 ml/hour
B. To determine milliliters/min
(ml/min)
Milliliters per hour
60 minutes
= milliliters/min
125 ml
60 min
= 2.08
ml/min
C. To determine drops per min (gtt/min)
Milliliters X drops (IV set)
= 31.2 gtts/min
Involves 3 Steps
Step 1
Step 2
Step
3
60 min 1 ml
125 ml
60 min
X 15 gtts.
1 ml
= 2.08 ml/min X 15
gtts
= gtts/min

Method 2 1 step
Amount of fluid X drops/ml (IV set)
Hours to administer X minutes per hour (60)
1000 ml
8
hours
= 125 ml/h 125 ml/h
1 h (60 min)
= 2.0-2.1
ml/min
2.1 X 10
gtt/ml
= 21 gtts/min
1000 ml
8 hours
= 125 ml/h
125 ml/h X 10 gtt/ml
1 h (60 minutes)
= 1250
60
= 20-21 gtts/min
A.
B.
C. 1000 ml X 10 gtt/min
8 hours ( 60 min.)
= 1000
48
= 20 – 21 gtts/min

MIXING DRUGS FOR CONTINUOUS INTRAVENOUS
ADMINISTRATION
What are the
common drugs
that are frequently
added to IV fluids?
Potassium Chloride (KCl) and
vitamins ( Benutrex C,
Thiamine )
1. Drugs should be added to the bag or bottle
immediately before administering the IVF
2. Inject the drug into the rubber stopper on the
iv bag or bottle. Rotate bottle several times
3. Do not add drug while the infusion is
running unless the bag is rotated
What are the
nursing
responsibiliti
es when
adding drugs
into IVF
solutions?
Patient Situation
A patient is to receive 1,000 ml of D5W with 175 mg of
thiamine per liter over 10 hours. The thiamine is available
in a prepared syringe of 100 mg/ml. How many ml of
thiamine must you add to the solution?

Solution
H : V :: D : X
100 mg : 1 ml :: 175 mg : X
100 X : 175 ml
100 100
X = 1.75 ml
Patient situation
A physician’s order states Infuse D50.45NS with 30 mEq KCl
per liter at 100 ml/hour. The KCl is available in vials of 20
mEq/10 ml. How many ml of KCl should you add to the
solution
H : V :: D : X
20 mEq : 10ml :: 30 mEq : X
20 X : 300 ml
20 20
X = 15 ml

SMALL VOLUME INFUSION
Some medications are added to a small volume of IV solution and
the resultant solution is administered in less than 1 hour.
These small volume infusions are called “piggybacks” because they
are connected (piggybacked) to an existing IV line.
What medications are administered via piggyback?
Antibiotics
What are the necessary equipment needed for small volume
infusion?
Secondary IV sets 1. Calibrated cylinder chamber such as
Buretrol, Volutrol and Soluset
2. Secondary set used for infusing small
volumes of 50, 100 & 250 ml (Flagyl 205
ml, 25% D/W)
The prepared small
volume infusion is
attached to an existing
IV line with a Y type
attachment
Patient situation:
A patient is to receive 50 ml of an IV Penicillin solution over
30 minutes. The set has a drip factor of 15 gtt/ml. What is
the drip rate

Use Step 3 of Method 1
Milliliters/hour
1h (60 min)
= ml/min
50 ml
30 min
X 15 gtt/ml = 24.9 or 25
gtt/min
1 ml
X gtt/ml
A patient is to receive 30 ml of an IV dexamethasone
solution over 10 minutes. The set has a drip factor of 10
gtt/ml. What is the drip rate?
30 ml
10
mins
X 10 gtt/ml
1 ml
= 30 gtt/min
Seat work:
A patient is to receive 100 ml of an IV gentamycin
solution over 1 hour. The set has a drip factor of 20
gtt/ml. What is the drip rate?

BLOOD & BLOOD PRODUCTS
1. The transfusion of blood and blood products requires special
administration sets that contain FILTERS to remove agglutinated
cells.
3. The drip factor for blood administration sets is usually 10-15
gtt/ml and an 18 gauge or larger needle is used for the IV insertion
What are the nursing responsibilities when administering blood
and blood products (platelets, cryoprecipitate & granulocytes)
4. A unit of blood (250 ml) should infuse for no more than 4 hours
because significant deterioration and bacterial contamination of
the blood may occur after this time. Many institutions suggest
that transfusions should be completed in about 2 hours
5. Don’t add blood or blood products to an IV line that contains
dextrose or calcium solutions as they can cause cell hemolysis &
clotting. NORMAL SALINE is the only compatible solution with
blood & blood products
2. Only compatible and properly cross matched blood is
transfused. Check laboratory results for compatibility

Patient Situation
The physician’s order states Transfuse 1 unit packed RBC as soon
as available from blood bank. The patient is a young adult with no
known cardiac impairment. The transfusion set has a drip factor of
10 gtt/ml. What is the transfusion rate? What is the drip rate?
Amount of fluid X drops/ml (IV set)
Hours to administer X minutes per hour (60)
250 ml X 10 gtts/ml
2 hours x 60 mins
2500 gtts
120 min
= 20.8 or 21
gtts/min
Seat work:
1. The patient is to receive 50 ml of platelets over 10 minutes. The
set has a drip factor of 10gtt/min. Compute for the drip rate of the
transfusion
2. The physician orders 2 units of whole blood to infuse over 4
hours. The set has a drip factor of 20 gtts per ml. Compute for the
drip rate

Patient teaching is a vital component of the
nurse’s interventions for a patient receiving
medications. Knowledge deficit, and even
noncompliance, are directly related to the
type and quality of medication education that
a patient receives.
Because the goals of pharmacotherapy are
the safe administration of medications, with
the best therapeutic outcomes possible,
teaching is aimed at providing the patient
with the information necessary to ensure
that this occurs.
PATIENT
EDUCATION

SUPPORTING PATENT EDUCATION
1.Providing written material assists the patient to retain
the information and review it later.
2. Providing a small notepad or other writing material
allows the patient or family to keep a list of questions
related to the medications that they may not have thought
to ask at the time the drug is administered.
2.Some medications come with a self-contained teaching
program that includes videotapes. The nurse should always
assess whether the patient is able to read and
understand the material provided.
4.nurse may have the patient summarize key points after
providing the teaching to verify that the patient has
understood the information.

• is part of the continuing process of patient care that
leads to changes in assessment, diagnosis, and
intervention.
• The patient is continually evaluated for therapeutic
response, the occurrence of adverse drug effects, and
the occurrence of drug–drug, drug–food, drug–
alternative therapy, or drug–laboratory test
interactions.
• the efficacy of the nursing interventions and the
education program also are evaluated.
• the nurse evaluates the patient simply by reapplying
the beginning steps of the nursing process and then
analyzing for changes, either positive or negative.
• The process of evaluation may lead to changes in the
nursing interventions being used to provide better
and safer patient care.

F. Reporting and Documenting Medication Errors
When a health care provider commits or observes an error,
effects can be lasting and widespread. Although some errors go
unreported, it is always the nurse’s legal and ethical
responsibility to report all occurrences
A. Documenting in the Patient’s Medical Record
All facilities should have clear policies and procedures that
provide guidance on reporting medication errors.
1. Documentation of the error occur in a factual manner; avoid
blaming or making judgments in documentation
2.Document not only the a medical error that occurred, but also
the specific nursing interventions that were implemented following
the error to protect patient safety, such as monitoring vital signs
and assessing the patient for possible complications. Failure to
report nursing actions implies either negligence (i.e., no
interventions were taken) or lack of acknowledgment that the
incident occurred.
3.Document all individuals who were notified of the error.
4.The medication administration record (MAR) is another source
that should contain information about what medication was given
or omitted.

B. Reporting the Error
In addition to documenting in the patient’s medical record, the
nurse making or observing the medication error should complete
a written report of the error. Depending on the health care
agency, these reports may be called
•“Incident Reports,” “Occurrence Reports,” or similar titles.
Stated simply, a medication error is any error that occurs in the
medication administration process whether or not it harms the
patient. These errors may be related to misinterpretations,
miscalculations, misadministrations, handwriting
misinterpretation, and misunderstanding of verbal or phone
orders.
• In a health care facility, such as a hospital, nursing home, or
assisted living, an incident report or accident/occurrence
report is a form that is filled out in order to record details of an
unusual event that occurs at the facility, such as an injury to a
patient.

• The specific details of the error should be recorded in a
factual and objective manner.
• factors that contributed to the medication error and assists
in identifying any specific performance improvement
strategies that may need to be implemented.
• The written report is not included in the patient’s medical
record but is used by the agency’s risk management
personnel for quality improvement and assurance and may
be used by nursing administration and education to identify
common error occurrences and the need for performance
improvement or educational intervention.
• Accurate documentation in the medical record and in the
error report is essential for legal reasons.
B. Content of the Report

Strategies for Reducing Medication Errors
The most common types of errors usually involve administering
an improper dose, giving the wrong drug, and using the wrong
route of administration. The nurse can begin by following the
steps of the nursing process:
1. Assessment - (see previous slides in Nursing process). For all
medications taken prior to assessment, ensure that the patient
has been receiving the right dose, at the right time, and by the
right route.
2. Planning -Minimize factors that contribute to medication errors:
Avoid using abbreviations that can be misunderstood
3. Implementation - Eliminate potential distractions during
medication administration that could result in an error.
4. Evaluation. Assess the patient for expected outcomes and
determine if any adverse effects have occurred.

DRUGS AFFECTING THE BODY SYSTEM

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