INTRODUCTION TO
PHARMACOLOGY
FOUR BASIC TERMS:
drug, pharmacology, clinical
pharmacology, and therapeutics.
Drug
A drug is defined as any chemical that
can affect living processes. By this
definition, virtually all chemicals can be
considered drugs, since, when exposure
is sufficiently high, all chemicals will
have some effect on life.
Pharmacology
Pharmacology can be defined as the
study of drugs and their interactions
with living systems. Under this
definition, pharmacology encompasses
the study of the physical and chemical
properties of drugs as well as their
biochemical and physiologic effects. In
addition, pharmacology includes
knowledge of the history, sources, and
uses of drugs as well as knowledge of
drug absorption, distribution,
metabolism, and excretion.
Clinical Pharmacology
Clinical pharmacology is defined as the
study of drugs in humans. This
discipline includes the study of drugs in
patients as well as in healthy volunteers
(during new drug development).
Therapeutics
Therapeutics, also known as
pharmacotherapeutics, is defined as
the use of drugs to diagnose, prevent, or
treat disease or to prevent pregnancy.
Alternatively, therapeutics can be
defined simply as the medical use of
drugs.
Drug Nomenclature is the systematic
naming of drugs, especially
pharmaceutical drugs. In the majority
of circumstances, drugs have 3 types
of names: chemical names, generic
names, and trade names/ brand/
propriety names.
DRUG NOMENCLATURE:
Chemical Name
It is the exact molecular formula of the
drug or chemical structure.
Generic Name
It is the official, nonproprietary name for
the drug; this name is not owned by any
drug company and is universally
accepted.
Brand Name
It is chosen by the drug company and is
usually a registered trademark. Drug
companies market a compound using its
brand name.

DRUG CLASSIFICATIONS
Drugs are classified according to their
effects on particular body systems, their
therapeutic uses.
Prescription Drugs
-Are those that have on their labels the
prescription legend.
-May be prescribed by the physicians,
dentists, veterinarians, or other legally
authorized health practitioner as part of
their specific practice.
Nonprescription Drugs
-The drugs that may be legally acquired
by the client without the prescription
order.
-Also known as over the counter drugs
(OTC).
Investigational Drugs
-The drugs that may be legally acquired
by the client without the prescription
order.
-Also known as over the counter drugs
(OTC).
Orphan Drug
-Are drugs that have been discovered
but are not financially viable and
therefore have not been “adopted” by
any drug company.
Elicit Drugs
-a.k.a. “street’ drugs are those which
are used and/or distributed illegally.
Understanding Drug Labels
All prescription medicine containers
include information on the label
including the patient’s name, the name
of the medicine, dosage and instructions
on how often to take the medicine.
More detailed printed information about
the medication is usually provided by the
pharmacy when prescription medicine is
dispensed. This Patient Medicine
Information (PMI) includes important
information such as instructions for use,
and warnings about side effects and
possible drug interactions.
During the implementation phase of the Pharmacodynamics involves the study of
nursing process for medication biological and therapeutic effects of drugs
administration, which procedure is and mechanisms of drug action.
considered essential?

Ans: Following the five rights of medication

administration

The nurse would recognize which of these as

the five rights of medication
administration?

Ans: right drug, right time, right patient,

right dose, right route

The nurse is reviewing a prescription for a

medication that a patient is to receive,
which component is recognized as being
required as a part of the prescription?

Ans: the prescriber signature

What is pharmacodynamics?

The action of drugs in living tissue or what

the drug does to the body, biological effects
produced by the interaction of a drug on the
target site of action.
 • Approximately 80% of drugs are
taken by mouth.
The word pharmacology is derived from
two Greek words:

pharmakon, which means “medicine,”

and logos, which means “study”

Thus, pharmacology is most simply defined

as the study of medicine.

• Pharmacology is an expansive
subject ranging from understanding
how drugs are administered, to
where they travel in the body, to the
actual responses produced.

• To learn the discipline well, nursing

students must acquire a broad • Tablets are NOT 100% drug.
knowledge base from various
• Fillers and inert substances,
foundation areas such as anatomy
generally called excipients, are
and physiology, chemistry,
used in drug preparation to allow
microbiology, and pathophysiology.
drug to take on a particular size and
shape and to enhance drug
dissolution.
DRUGS AND THE BODY
Example:
A tablet or capsule taken by mouth goes
through three phases- Penicillin is poorly absorbed by the GI tract
because of gastric acid. However by putting
1. Pharmaceutic additives in drugs, like Potassium (K) and
2. Pharmacokinetic Sodium (Na) increases the absorbability of
the drug.
3. Pharmacodynamic
• Drugs in liquid form are more
…as drug actions occur. rapidly available for GI absorption
than solid ones.

Pharmaceutic phase • Generally, drugs are both

• The first phase in drug action.
• Disintegration – breakdown of a
tablet into smaller particles
• Dissolution – dissolving of the
smaller particles in the GI fluid
before absorption.
disintegrated and absorbed faster in
acidic fluids with a pH of 1 or 2
rather than in alkaline fluids.
• Drug absorption is generally slower
for those drugs absorbed primarily in
the stomach.
 • Enteric-coated drugs resist
disintegration in the gastric acid
of the stomach, so disintegration
does not occur until the drug
reaches the alkaline environment
in the small intestine.
Pharmacokinetic phase
• Pharmacokinetics is the process of
drug movement to achieve drug
action.
• The nurse applies knowledge of
pharmacokinetics when assessing
the patient for possible adverse drug
effects.
Four processes:
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
I. ABSORPTION
-movement of drug particles from the GI
tract to body fluids by passive
absorption, active absorption and
pinocytosis.
a. Passive Absorption
-occurs mostly by fusion (movement
from higher to lower concentration)
b. Active Absorption
-requires a carrier such as an enzyme or
protein to move the drug against a
concentration gradient, energy is
required.
c. Pinocytosis
-process by which cells carry a drug
across their membrane by engulfing the
drug particles.
• GI membrane is composed
mostly of lipid (fat) and protein, so
drugs that are lipid soluble pass
rapidly through the GI membrane.
• Water-soluble drugs need a
carrier, either enzyme or protein,
to pass through the membrane.
• Large particles pass through the
cell membrane if they are
nonionized (have no positive or
negative charge).
• Certain drugs such as calcium
carbonate and many of the
antifungals need an acid
environment to achieve greater
drug absorption.

There are many factors that affect the drug
absorption.
• Blood flow
-Poor circulation to the stomach as a result
of shock, vasoconstrictor drugs, or disease
hampers absorption
may then be excreted, thus reducing
the amount of active drug.
• Some drugs do not undergo
metabolism at all in the liver, and
other may be metabolized to drug
metabolite, which may be equally or
more active than the original drug.

• Pain, stress and food that are

solid, hot or high in fat can slow
gastric emptying time, so the drug
remains in the stomach longer.

• Exercise can decrease blood flow

by causing more blood to flow to the
peripheral muscle, thereby
decreasing blood circulation to the
GI tract.

Medication route can also affect drug

absorption.

• Drugs given by IM are absorbed

faster in muscles that have more
blood vessels (e.g. deltoids) that in
those that have fewer blood vessels
(e.g. gluteals).

• Subcutaneous tissue has fewer

blood vessels, so absorption is
slower in such tissue.
• Some drugs do not go directly into
the systemic circulation following
oral absorption but pass from the
intestinal lumen to the liver via the
portal vein.
• The process in which the drug
passes to the liver first is called the
first-pass effect, or hepatic first
pass.
• In the liver, some drugs may be
metabolized to an inactive form that
Bioavailability
-a subcategory of absorption.
-it is the percentage of the administered
drug dose that reaches the systemic
circulation.
-For oral route of drug administration,
bioavailability occurs after absorption and
first-pass metabolism.
-The percentage of bioavailability of oral
route is always less than 100%, but for the
IV route, it is 100%.
-Oral drugs and first-pass hepatic
metabolism may have a bioavailability of
only 20% to 40% on entering systemic • 30% to 60% are moderately protein-
circulation. bound

• Less than 30% are low protein-

bound drugs
To obtain desired effect, the oral dose could
be higher than the drug dose for IV use. • Drug dose is prescribed according to
the percentage in which the drug
-Rapid absorption increases the binds to protein.
bioavailability of the drug and can cause an
increase in drug concentration. Drug toxicity • Protein Binding
man result.
• -Patients with liver or kidney disease
-Slow absorption can limit the or those who are malnourished may
bioavailability of the drug, thus causing a have an abnormally low serum
decrease in drug serum concentration. albumin level. This results in fewer
protein-binding sites, which in turn
. DISTRIBUTION leads to excess free drug and
-process by which the drug becomes eventually to drug toxicity.
available to the body fluids and body • -Older adults are more likely to have
tissues. hypoalbuminemia. With some health
-it is influenced by blood flow, the drug’s conditions that result in a low serum
affinity to the tissue, and the protein-binding protein level, excess free drug or
effect. unbound drug goes to nonspecific
tissue binding sites until needed and
-Volume of drug distribution (Vd) is excess free drug in the circulation
dependent on drug dose and its does not occur. Consequently, a
concentration in the body. decreased drug dose is needed as
a. Protein Binding there is not as much protein
circulated for the drug to bind to.
b. Blood Flow
To avoid possible toxicity:
c. Body Tissue Affinity
• -check the protein-binding
Protein Binding percentage of all drugs to be
administered
-As drugs are distributed in the plasma,
many are bound to varying degrees • -should also check the patient’s
(percentages) with protein (primarily plasma protein and albumin levels
albumin).
• Blood-Brain Barrier (BBB) and
• Greater than 89% bound to protein: Placental Barrier
highly protein-bound drugs
-semipermeable membrane in the CNS that
• 61% to 89% are moderately highly protects the brain from foreign substances
protein bound
-highly lipid-soluble drugs are able to cross
the BBB
HALF-LIFE OF 650 mg OF ASPIRIN

-when the drug metabolism rate is

Number Time of Dosage Percentage
decreased, excess drug accumulation can
Elimination remaining Left
(t ½) occur and lead to toxicity.
(h) (mg)

1 3 325 50
Half-Life (t ½) of a drug

2 6 162 25 -the time it takes for one half of the drug

concentration to be eliminated
3 9 81 12.5 -metabolism and elimination affect the half-
life of a drug
4 12 40 6.25
-for example: with liver or kidney
5 15 20 3.1 dysfunction, the half-life of the drug is
prolonged and less drug is metabolized
and eliminated. When the drug is taken
6 18 10 1.55
continually, drug accumulation may occur.
-drugs that are not bound to proteins and -by knowing the half-life, the time it takes for
are not lipid soluble are not able to cross a drug to reach a steady state of serum
the BBB, which makes it difficult to concentration can be computed.
distribute the drug

-During pregnancy, both lipid-soluble and

lipid-insoluble drugs are able to cross the
placental barrier, which can affect the fetus
and the mother.
-During lactation, drugs should be checked
which may cross into breastmilk before
administering to a lactating patient.
Metabolism or Biotransformation
-it is the process by which the body
inactivates or biotransforms drugs
-drugs can be metabolized in several
organs; however, the LIVER is the primary
site of metabolism
-Most drugs are inactivated by liver
enzymes and are then converted or
transformed by hepatic enzymes to inactive
metabolites or water-soluble substances for
excretion.
Excretion or Elimination
-main route is through the kidneys (urine)
-other routes include bile, feces, lungs,
saliva, sweat and breast milk
-The kidney filters free unbound drugs,
water-soluble drugs, and drugs that are
unchanged.
-The lungs eliminate volatile drug
substances and products metabolized to
CO2 and H2O.
-The urine influences drug excretion. Acidic
urine promotes elimination of weak base
drugs, and alkaline urine promotes
elimination of weak acid drugs.
PharmacoDYNAMIC phase
• is the study of the way drugs affect
the body
 • Drug response can cause primary or hydrochloride is not as great as it is with
secondary physiological effect or morphine.
both.
Onset, Peak and Duration of Action
• Primary Effect -desirable
• Important aspect of
• Secondary effect - desirable or pharmacodynamics
undesirable
• Onset of action
Example:
-the time it takes to reach the minimum
Dipenhydramine (Benadryl) effective concentration (MEC) after a drug is
administered.
-an antihistamine
• Peak Action
Primary Effect:
-occurs when the drug reaches its highest
• Treat symptoms of allergy
blood or plasma concentration
Secondary Effect:
• Duration of Action
• CNS depression that causes
-length of time the drug has a
drowsiness
pharmacologic effect.
The secondary effect is undesirable when
Onset, Peak and Duration of Action
the patient drives a car, but at bedtime it
could be desirable because it causes mild Some drugs produce effects in minutes, but
sedation. others may take hours or days.

Dose Response and Maximal Efficacy A time-response curve evaluates the three
parameters of drug action.
• Dose Response is the relationship
between the minimal versus the
maximal amount of drug dose
needed to produce the desired drug
response.

• Some patients respond to a lower

drug dose, whereas others need a
high drug dose to elicit desired
response.

For example:

Morphine and Tramadol Hydrochloride

(Ultram) are prescribed to relieve pain. The
maximum efficacy of morphine is greater
than Tramadol hydrochloride, regardless of Drug effects
how much tramadol hydrochloride is given.
• Side Effects
The pain relief with the use of tramadol
• Adverse Reactions
 • Toxic Effects

Side Effects

-are psychologic effects not related to

desired drug effects

-can be desirable and/or undesirable side

effects

-sometimes called adverse reactions in

literatures and in speaking, but they are
different

-the occurrence of expected undesirable

side effects is not a reason to discontinue
therapy

NURSING MANAGEMENT:

-teaching patients to report any side effects Toxic Effects or Toxicity

-can be identified by monitoring plasma

(serum) therapeutic range of the drug

-when the drug level exceeds the

therapeutic range, toxic effects are likely to
occur from over dosing or drug
accumulation

NURSING MANAGEMENT:

-should always be reported and

documented because they represent
variances from planned therapy
Adverse Drug Reactions (ADR)
Examples of Toxic Effects
-severe than side effects

-range of untoward effects (unintended and

occurring at normal doses) of drugs that
cause mild to sever side effects

-always undesirable Drug Interactions

NURSING MANAGEMENT:
-should always be reported and
documented because they represent
variances from planned therapy
Examples of Adverse Drug Reactions
Drug-Diet Interactions
• Food also may decrease absorption
by combining with a drug to form an
insoluble drug–food complex.
 • In other instances, however, certain
drugs or dosage forms are better
absorbed with certain types of
meals.
• Food may alter the absorption of oral
drugs. In many instances, food
slows absorption by slowing gastric
emptying time and altering GI
secretions and motility.
• When tablets or capsules are taken
with or soon after food, they dissolve
more slowly; therefore, drug
molecules are delivered to
absorptive sites in the small intestine
more slowly
• The action of a drug may be
increased or decreased by its
interaction with another drug in the
body. Most interactions occur
whenever the interacting drugs are
present in the body; some,
especially those affecting the
absorption of oral drugs, occur when
the interacting drugs are given at or
near the same time.
• Increased Drug Effects
Interactions that can increase the
therapeutic or adverse effects of drugs are
as follows:
a. Additive Effects
b. Synergism or potentiation
c. Inference
d. Displacement
ADDITIVE EFFECTS
Additive effects occur when two drugs with
similar pharmacologic actions are taken.
• Example: ethanol + sedative drug
→increased sedation
Synergism or potentiation
• Synergism or potentiation occurs
when two drugs with different sites
or mechanisms of action produce
greater effects when taken together
than either does when taken alone.
• Example: acetaminophen (non-
opioid analgesic) + codeine (opioid
analgesic) →increased analgesia
• Interference by one drug with the
metabolism or elimination of a
second drug may result in intensified
effects of the second drug.
• Example: cimetidine inhibits CYP
1A, 2C, and 3A drug-metabolizing
enzymes in the liver and therefore
interferes with the metabolism of
many drugs
• When these drugs are given
concurrently with cimetidine, they
are likely to cause adverse and
toxic effects.
DISPLACEMENT
• Displacement of one drug from
plasma protein-binding sites by a
second drug increases the effects of
the displaced drug. This increase
occurs because the molecules of the
displaced drug, freed from their
bound form, become
pharmacologically active.
• Example: aspirin (an anti-
inflammatory/ analgesic/ antipyretic
agent) + warfarin (an anticoagulant)
→increased anticoagulant effect
Drug-Drug Interactions
• Decreased Drug Effects
• Interactions in which drug effects are
decreased are grouped under the
term antagonism.
Example 1
• In some situations, a drug that is a
specific antidote is given to
antagonize the toxic effects of
another drug.
• Example: naloxone (a narcotic
antagonist) + morphine (a narcotic or
opioid analgesic) →relief of opioid
induced respiratory depression.
Naloxone molecules displace
morphine molecules from their
receptor sites on nerve cells in the
brain so that the morphine
molecules cannot continue to exert
their depressant effects.
Example 2
• Decreased intestinal absorption of
oral drugs occurs when drugs
combine to produce nonabsorbable
compounds.
• Example: aluminum or magnesium
hydroxide (antacids) + oral
tetracycline (an antibiotic) →binding
of tetracycline to aluminum or
magnesium, causing decreased
absorption and decreased
antibiotic effect of tetracycline
MEDICATION ADMINISTRATION
- The process by which a medicine is
administered to a patient
therapeutically.
Medications or Medicines
▸ are chemicals that are used for
diagnosis, treatment and prevention of
disease/s
All medicines are drugs but not all
drugs are medicines.
Routes of Administration
For small therapeutic molecules,
various routes for drug administration
are parenteral (intravenous,
intramuscular, and subcutaneous), oral,
nasal, ocular, transmucosal (buccal,
vaginal, and rectal), and transdermal.
Oral Route
Advantages include:
▸ Most convenient
▸ Usually least expensive
▸ Safe, does not break skin barrier
▸ Administration usually does not cause
stress
▸ Some new oral medications are
designed to rapidly dissolve on the
tongue, allowing for faster absorption
and action
Disadvantages include:
▸ Drug may have unpleasant taste or
odor ▸ Inappropriate when GI tract has
reduced motility
▸ Inappropriate if client cannot swallow
or is unconscious
▸ Cannot be used before certain
diagnostic tests or surgical procedures
▸ Drug may discolor teeth, harm tooth
enamel
▸ Drug may irritate gastric mucosa
 ▸ Drug can be aspirated by seriously ill ▸ Extract
clients
▸ Tincture
Sublingual and Buccal Ruote
Topical Route
Advantages include:
Topical applications are those applied to a
▸ Same as for oral, plus: circumscribed surface area of the body.
They affect only the area to which they are
▸ Drug can be administered for local effect
applied. Topical applications include the
▸ More potent than oral route because drug following:
directly enters the blood and bypasses the
01 Dermatologic preparations
liver
✔Applied to the skin
Disadvantages include:
02 Instillations and irrigations
▸ If swallowed, drug may be inactivated by
gastric juice ▸ Drug must remain under ✔Applied into body cavities or orifices, such
tongue until dissolved and absorbed. as the urinary bladder, eyes, ears, nose,
▸ May cause stinging or irritation of the rectum, or vagina
mucous membranes 03 Inhalations
▸ Drug is rapidly absorbed into the ✔Administered into the respiratory tract by a
bloodstream nebulizer or positive pressure breathing
Drug Preparation for these routes: apparatus. Air, oxygen, and vapor are
generally used to carry the drug into the
Solid lungs.
▸ Tablet (Sustainedrelease, Enteric coated, Advantages include:
Effervescent)
▸ Few side effects
▸ Capsule
▸ Painless
▸ Caplet
Disadvantages include:
▸ Pill
▸ Drug can enter body through abrasions
▸ Lozenge and cause systemic effects
▸ Powder ▸ Leaves residue on the skin that may soil
Liquid clothes

Drug Preparation for topical route:

▸ Aqueous Solution (Liquid Medicine)
Cream ▸ Lotions ▸ Liniment ▸ Ointment ▸
▸ Aqueous Suspension (Liquid Medicine
Gel / Jelly
with Granules)
Transdermal Route
▸ Syrup
Advantages include :
▸ Elixir
▸ Prolonged systemic effect
▸ Few side effects
▸ Avoids GI absorption problems
▸ Onset of drug action faster than oral 17
Disadvantages include :
▸ Rate of delivery may be variable
▸ Verify that the previous patch has been
removed and disposed of appropriately to
avoid overdose
▸ Medication leaves an oily or pasty
substance on skin sometimes soiling the
clothes
Mucous Membranes Route
Includes: Intranasal, Otic, Opthalmic,
Intraocular, Vaginal, Rectal Routes
Advantages include :
▸ Therapeutic effects provided by local
application to involved sites
▸ Aqueous solution readily absorbed and
capable of systemic effects
▸ Potential route of administration when
oral route is contraindicated
Disadvantages include :
▸ Mucous membranes are highly sensitive
to some medication concentrations
▸ Patients with ruptured eardrum cannot
receive ear irrigations
▸ Insertion of vaginal and rectal
suppositories can be embarrassing.
Drug Preparation for these routes:
Aqueous Solution (Liquid Medicine) ▸
Aqueous spray or foam ▸ Cream ▸ Gel /
Jelly ▸ Ointment ▸ Lotion ▸ Suppositories ▸
Vaginal Tablets
Given via:
✔Inhalation For aqueous spray Intranasal
(can be oral*)
✔Instillation Dropping medicine into the
mucous membrane
✔Irrigation Flushing mucous membranes
with large amounts of medicine
✔Insertion Inserting medicines into the
vagina or rectum
Medication Order
▸ A written direction provided by a
prescribing practitioner for a specific
medication to be administered to an
individual.
Should contain:
• Full name of the client
• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of administration
• Route of administration
• Signature of the person writing the order
Types of Medication Order
1. Standing/Routine Order
✔may or may not have a termination
date. A standing order may be carried
out indefinitely until an order is written to
cancel it, or it may be carried out for a
specified number of days
2. As needed Order (PRN order)
✔permits the nurse to give a medication
when, in the nurse’s judgment, the client
requires It. The nurse must use good
 judgment about when the medication is ✔Diphenhydramine HCl 50mg/capsule 1
needed and when it can be safely capsule 30 minutes prior to blood
administered. transfusion

✔Often ordered with the term “PRN” or a Stat Order

condition (“for”)
✔Tranexamic Acid 500mg/ ampule
3. Single Dose Order 2ampules IVTT STAT

✔Medication to be given once at a Now Order

specified time or situatio
✔Tranexamic Acid 500mg/ampule 2
4. Stat Order ampules IVTT now

✔indicates that the medication is to be given

immediately and only once

5. Now Order

✔Used when a patient needs a medication

quickly but not right away as in a STAT
order ✔The nurse has a maximum of 90
minutes to complete a Now order given only
at one time

✔Paracetamol 500mg/ta

Standing / Routine Order

✔Paracetamol 500mg/tab 1tab PO q4 RTC

✔KCl drip of PNSS 1L + 40 Meqs KCl to

run for 8 hours x 3 cycles

✔Furosemide 40mg IVTT q8 with BP

precautions

As needed/ PRN Order

✔Clonidine 75mcg/tab 1tab SL q6 for BP ˃

150/90 mmHg

✔Metoclopromide 10mg IVTT q8 PRN for

vomiting

Single Dose Order

Dosage Calculations
✔Ranitidine 50mg/ampule 1 ampule IVTT 1
hour prior to surgery ✔Math calculations done for preparing
appropriate doses of medicines, taking into
account conversions of WEIGHTS AND
MEASURES. Mistakes are one of the
sources of MEDICATION ERRORS.

Medication Order:

Paracetamol 250mg/5mL 3/4 tsp PO q4

for fever

✔Available: Paracetamol 250mg/5ml syrup

✔Desired: 3/4 tsp serving of PCM
250mg/5mL Need for conversion? YES!

1 teaspoon is 5ml

3/4 teaspoon is 3.75mL

Round off, give 3.8mL

- MFA 500mg/capsule PO QID

✔Available: MFA 250mg

✔Answer: 2 capsules

- Amoxicillin 100mg PO TID

✔Available: Amoxicillin 250mg/5mL

✔Answer: 2mL

One liter PNSS to infuse over 24 hours

using a microdrip.

✔Calculate the flow rate.

✔1000mL x 60gtts/mL 1440 min Some Practice Guidelines:

✔Answer: 41.66/ 42 gtts/min Nurses who administer medications are

responsible for their own actions .

▸ Be knowledgeable about the medications

10 Rights of Patients in Medication you administer.
1. Right Patient ▸ Use only medications that are in a clearly
2. Right Medication labeled container. Always check for
3. Right Dose expiration date.
4. Right Time
5. Right Route ▸ Do not use liquid medications that are
6. Right Assessment cloudy or any drug that have color changes.
7. Right Documentation ▸ Calculate drug doses accurately.
8. Right to Education ▸ Administer only medications personally
9. Right Evaluation prepared .
10. Right to Refuse
▸ Before administering a medication,
Medication Dispensing Systems always identify the client correctly. ▸ Do not
▸ Medication cart leave medications at the bedside.

▹ The medication cart is on wheels,

allowing the nurse to move the cart to
outside the client’s room.
▹ The cart contains small numbered
drawers that correlate to the room numbers
on the nursing unit.
▹ The small drawer is labeled with the name
of the client currently in that room and holds
the client’s medications for the shift or 24
hours.
Automation of Medication
Administration
Other Important Considerations:
Review agency protocol on
administration of narcotics . In preparing
medications, separate narcotics from other
drugs to remind you necessary assessment
must be done prior to administration
▸ Break only scored tablets if necessary
to obtain the correct dosage .
▸ Check if agency requires the pharmacy
to split the medication or if nurses can
do it . If nurses are allowed, use a cutting
or splitting device to cut the medication .

▸ Client records are all in the computer ▸ If the client has difficulty swallowing,
check if the medication can be crushed
▸ No longer requires the use of medicine then crush accordingly .
tickets
▸ Check the agency policy as to how
▸ Uses Automated Dispensing System unused portions of a medication are
(ADS) wherein Medication Administration
Record (MAR) of the patient is encoded.
The system uses

Drug therapy Across the lifespan
Pharmacokinetics
ABSORPTION
The degree and rate of drug absorption are
based on factors such as
• age
• health status
• weight
• route of administration
As children grow and develop, the absorption of
drugs generally becomes more effective;
therefore less developed absorption in
neonates and infants must be considered in
dosage and administration.
NEONATE- birth at 38 or more weeks
gestation to 27 days
INFANT/TODDLER- 28 days to 23 months
CHILDREN- 24 months to 11 years
Adolescent- 12 years to 16 or 18 years
(regional difference)
DISTRIBUTION
Drug distribution is affected by factors such
as:
• body fluid composition
• body tissue composition
• protein-binding capability
• effectiveness of various barriers to drug
Transport
In neonates and infants, the body is about
75% water,
compared with 60% in adults. This
increased body fluid proportion allows for a
greater volume of fluid in which to distribute
drugs, which results in a lower drug
concentration. Until about age 2 years, the
pediatric patient requires higher doses of
water-soluble drugs to achieve therapeutic
levels. Younger patients also have higher
levels of extracellular fluids, which
increases the tendency for children to
become dehydrated and changes the
distribution of water-soluble drugs.
METABOLISM
The metabolism of drugs depends greatly
on
the maturation level of the pediatric patient
and varies from child to child..
Metabolism is carried out primarily in the
liver, with the kidneys and lungs playing a
small part in metabolism. Infants have
reduced hepatic blood flow and drug-

metabolizing enzymes.

EXCRETION

Renal excretion is the predominant

means of drug elimination.

The glomerular filtration rate (GFR) in term

neonates is roughly 30% that of adults.

During infancy, the GFR rises, and by 12

months, it reaches adult levels.