PHARMACOLOGY
Introduction • Plants
Drugs — are chemical that are introduce
into the body to cause some sort of
change.
Nursing responsibilities:
o Administering drugs
o Assessing drug effects
o Intervening to make the drug
regimen more tolerable.
o Providing patient teaching about
drugs and the drug regimen.
Pharmacology
— Is the study of the biological effects of
chemicals.
Pharmacotherapeutics or clinical
pharmacology
— The branch of pharmacology that
uses drugs to treat, prevent, and
diagnose disease.
2 key concerns:
• Pharmacokinetics – is the process of
drug movement throughout the body
necessary to achieve drug action.
• Pharmacodynamics – is the study of
the effects of drugs on the body. The
body’s response to the drug.
Adverse effects – negative or
undesirable effects of the drug.
Core Ethical Principles
There are core ethics principles are relevant
to research involving human subjects:
Respect for persons
Patients should be treated as independent
persons capable of making decisions in
their own best interest. Patients with
diminished decision making capacity are
entitled to protection. Patient’s choice
should be honored whenever possible.
• Informed consent – The right to be
informed and that participation is
voluntary, without coercion.
Beneficence
Is the duty to protect research subjects from
harm.
Justice
Requires that the selection of research of
subjects be fair. Research must be
conducted so that the distribution of
benefits and burdens is equitable.
Sources of Drugs
• Animal products
• Inorganic Compounds
➢ Aluminum – to decrease
gastric acidity, management
of hyperphosphatemia,
prevention of formation of
phosphate urinary stones.
➢ Fluoride – prevention of dental
cavities, prevention of
osteoporosis.
➢ Gold – treatment of
rheumatoid arthritis.
➢ Iron – treatment of iron
deficiency anemia.
Phases of Drug Development
Preclinical Trials
Chemicals that may have therapeutic
value are tested on laboratory animals for
two main purposes:
1. To determine whether they have the
presumed effects in living tissue.
2. To evaluate any adverse effects
At the end of the preclinical trials, some
chemicals are discarded for the following
reasons:
➢ The chemical lacks therapeutic
activity when used with living animals
➢ The chemical are too toxic
➢ The chemical is highly teratogenic
➢ The safety margins are so small
Phase I studies
- Use human volunteers to test the drugs
- Volunteers are fully informed of possible
risks and may be paid for their participation.
At the end of phase I Studies, many
chemicals are dropped from the process for
the following reasons:
➢ They lack therapeutic effect on
humans
➢ They cause unacceptable adverse
effects
➢ They are highly teratogenic
➢ They are too toxic
Phase II studies
Allow clinical investigators to try the drug in
patients who have the disease that the
drug is meant to treat.
At the end of phase II studies, a drug may
be removed from further investigation for
the following reasons:
➢ It is less effective than anticipated
➢ It is too toxic when used with patients
➢ It produces unacceptable adverse
effects
➢ It has low low benefit-to-risk ratio
➢ It is no more effective than other
drugs already on the market, making
the cost of continued research and
production less attractive to the drug
company
Phase III and Phase IV studies
Involve use of the drug in a vast clinical
market.
__________________________________________
o Continual evaluation of the drug
o An approved drug is given a brand
name (trade name) by the
pharmaceutical company that
developed it.
o The generic name is the original
designation that the drug was given
when the drug company applied for
the approval process.
o Chemical names are names that
reflect the chemical the chemical
structure of the drug.
FDA Pregnancy Categories
Category A
Adequate studies in pregnant women have
not demonstrated a risk to the fetus in the
first trimester of pregnancy, and there is no
evidence of risk in later trimesters
Category B
Animal studies have not demonstrated a risk
to the fetus but there are no adequate
studies in pregnant women, or animal
studies have shown an adverse effect, but
adequate studies in pregnant women have
not demonstrated a risk to the fetus during
the first trimester of pregnancy, and there is
no evidence of risk in later trimesters.
Category C
Animal studies have shown an adverse
effect on the fetus but there are no
adequate studies in the benefits from the
use of the drug in pregnant women may be
acceptable despite its potential risks, or
there are no animal reproduction studies
and no adequate studies in humans.
Category D
There is evidence of human fetal risk, but
the potential benefits from the use of the
drug in pregnant women may be
acceptable despite its potential risks.
Category X
Studies in animals or humans demonstrates
fetal abnormalities or adverse reactions;
reports indicate evidence of fetal risk. The
risk of use in a pregnant woman clearly
outweighs any possible benefit.
Drug Enforcement Agency (DEA)
Schedules of Controlled Substances
Schedule I (C-I)
• High abuse potential and no
accepted medical use (heroin,
marijuana, LSD.
• Lysergic acid Diethylamide
Schedule II (C-II)
• High abuse potential with severe
dependence liability (narcotics,
amphetamines, and barbiturates)
Schedule III (C-III)
• Less abuse potential than schedule II
drugs and moderate dependence
liability (nonbarbiturate sedatives,
nonamphetamine stimulants, limited
amounts of certain narcotics)
Schedule IV (C-IV)
• Less abuse potential than schedule III
and limited dependence liability
(some sedatives, antianxiety agents,
and non – narcotic analgesics)
Schedule V (C-V)
• Limited abuse potential. Primarily
small amounts of narcotics (codeine)
used as antitussives or antidiarrheals.
Controlled Substances
1. Heroin - A highly addictive analgesic
drug derived from morphine, often
 used illicitly as a narcotic producing 2. To increase or stimulate certain
euphoria. cellular activities.
2. Marijuana - “cannabis” is a 3. To depress or slow cellular activities.
psychoactive drug that produces 4. To interfere with the functioning of
pleasant feeling of being relaxed foreign cells, such as invading
microorganisms or neoplasm.
3. LSD - Psychedelic drug wherein its
effects typically include intensified
Receptor sites
thoughts, emotions, and sensory
- The receptor sites react with certain
perceptions.
chemicals to cause an effect within
4. Narcotics - Are also called opioid
the cell.
pain relievers. Often used for pain
- The interaction between the
that is severe.
chemical and the receptor site
5. Morphine - An analgesic and
affects enzyme systems within the
narcotic drug obtained from opium
cell.
and used medicinally to relieve pain.
- The activated enzyme systems then
6. Amphetamines - Stimulator of the
produce certain effects, such as
Central Nervous System.
increased or decreased cellular
7. Barbiturates - CNS depressants. They
activity, changes in cell membrane
reduce the activity of nerves causing
permeability, or alterations in cellular
muscle relaxation. Usually
metabolism.
barbiturates can reduce heart rate,
breathing, and blood pressure.
Pharmacokinetics
8. Sedatives - Promoting calm or
Involves the study of absorption, distribution,
inducing sleep.
metabolism, and excretion of the drugs.
9. Anti-Anxiety - Medications that
reduces anxiety.
Critical Concentration
10. Antitussive - Medicines that suppress
The amount of a drug that is needed to
coughing also known as cough
cause a therapeutic effect.
suppressants.
Dynamic Equilibrium
Drug Names
The actual concentration that a drug
Chemical name – describes the drug’s reaches in the body results from a dynamic
chemical structure. equilibrium involving several factors:
Generic name – is the official, • Absorption from the site of entry
nonproprietary, this name is not own by any
• Distribution to the active site
drug company and is universally accepted.
• Biotransformation (metabolism) in the
Brand name – proprietary, is chosen by the
liver
drug company and is usually a registered
• Excretion from the body
trademark.
Absorption
Over-the-counter Drugs
Refers to what happens to a drug from the
Are products that are available without
time it is introduced to the body until it
prescription for self treatment of a variety of
reaches the circulating fluids and tissues.
complaints.
Drugs can be absorbed into cells through
various processes, which include:
Drugs and the Body
1. Passive diffusion – the major process
Pharmacodynamics
through which the drugs are
Is the science dealing with interactions
absorbed in the body.
between the chemical components of
2. Active transport – is a process that
living systems and the foreign chemical,
uses energy to actively move a
including drugs that enter the systems.
molecule across a cell membrane.
3. Filtration – involves movement
Drugs usually work in four ways:
through pores in a cell membrane,
1. To replace or act as substitutes for
either down a concentration
missing chemicals.
gradient or as a result of the pull of
plasma protein.
 ▹ Drug’s lipid solubility
Administration ▹ Ionization
Route ▹ Perfusion of the reactive tissue
■ IV (Intravenous)
■ IM (Intramuscular) Blood-Brain Barrier
■ SC (Subcutaneous) The blood brain barrier is a protective
■ PO (oral) system of cellular activity that keeps foreign
■ PR (rectal) invaders, poison, etc away from the CNS.
■ Mucous membranes (sublingual, buccal)
■ Topical (skin) Placenta and Breast Milk
■ Inhalation Must be given if it outweighs the risk

Oral First Pass effect

Patients can easily continue their drug
regimen at home when they are taking oral
medications.
IV
Drugs that are injected IV reach their full
strength at the time of injection, avoiding
initial breakdown.
IM
Drugs that are injected IM are absorbed
directly into the capillaries in the muscle
and sent into circulation.
SC
Subcutaneous injections deposit the drug
just under the skin, where it slowly absorbed
into circulation.
o Oral drugs are absorbed from the
small intestine to Portal venous
system.
o With series of liver enzymes, these
enzymes breaks to metabolites, some
activated, some deactivates and
easily excreted.
o Large percentage of the oral dose is
destroyed and never reaches the
tissues
Hepatic-enzyme system
• Phase 1: oxidation reaction
• Phase 2: conjugation reaction

PR
Uses rectum as a route for medication
administration which are absorbed by the
rectum’s blood vessel and flow into the
body’s circulatory system which distributes
the drug to the body system.

Topical (Skin)
Topical administration can be made
available directly at the intended site of
action and because systemic circulation is
not reached in great concentration, the risk
of systemic side effects is reduced.

Inhalation
Medication administered through
inhalation are dispersed via an aerosol
spray, mist, or powder that patients inhale
Into their airways.

Distribution
Involves the movement of a drug to the
body tissues.
Factors affecting the distribution
EXCRETION
▪ Removal of drugs from the body. E.g
saliva, lungs, bile, and feces.
▪ Kidney plays important role -
Glomerular filtration – the passage of
water-soluble components from
plasma to renal tubules
▪ Others reabsorbed by active
ftransport system

Surface Area Rule

Active transport Nomogram – for estimating surface area of
▸ Move drugs into tubule often do by infants and young children.
exchanging it to acid or bicarbonates.
▸ Urine acidity play an important role in
drug excretion.

Half-life
▸ Time it takes for the amount of drugs in the
body to decrease to one half of peak level
it previously achieved.
Determining the Half-life
A patient is taking a drug that has a half-life
of 12 hours. You are trying to determine
when a 50-mg dose of the drug will be gone
from the body:

Medication Errors
Factors influencing the Drug Effect Nursing Considerations
▸ Weight ▸ Drugs in Focus tables clearly summarize
▸ Age and identify the drugs within a class,
▸ Gender highlighting them by generic and trade
▸ Physiologic factors names, usual dosage, and indications.
▸ Pathologic factors
▸ Genetics ▸ Focus on Safe Medication Administration
▸ Immunologic factors boxes present important safety information
▸ Psychological factors to help keep the patient safe, prevent
▸ Environmental factors medication errors, and increase the
▸ Drug tolerance therapeutic effectiveness of the drugs.
▸ Accumulation effects ▸Focus on Safe Medication Administration-
▸ Interactions It present important safety information to
Pediatric Doses help keep the patient safe, prevent
medication errors, and increase the
therapeutic effectiveness of the drugs.
➔ Right Patient
➔ Right Drug
➔ Right Storage
➔ Right Route
➔ Right Dose
➔ Right Preparation
➔ Right Time
➔ Right Recording

Patient’s Rule
• Keep a written and/or electronic 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.

Patient’s Rule — Children

• Keep a list of all medications you are
giving your child, including
prescription, OTC, and herbal
medications.
• Never use adult medications to treat
a child.
• Read all labels before giving your
child a drug.
• Measure liquid medications using
appropriate measuring devices.
• Call your healthcare provider
immediately if your child seems to get
worse or seems to be having trouble
with a drug.
• When in doubt, do not hesitate to ask
questions.

Precautions when Reading Drug Labels

Be aware of drug names that sound or look
alike;
for example, note the similarity between the
trade names Percodan and Percocet.
Percocet, which contains oxycodone and
acetaminophen, is the preparation most
commonly prescribed.
 THE NURSING PROCESS AND • Current health history, including
family history
PATIENT-CENTERED • Swallowing problems (dysphagia)
CARE • Signs and symptoms of the patient’s
Nursing Process illness verbalized by the patient
The purpose of the nursing process is to • Current concerns about the
identify, diagnose, and treat human patient’s:
responses to health and illness. • Knowledge about medications and
side effects
The nursing process is continuous and • Over-the-counter (OTC) remedies,
moves back and forth between the various nutritional supplements, herbal
steps. remedies, and contraceptives
• Knowledge of side effects to report to
5 Steps of the Nursing Process: the physician
1. Assessment • Attitude and beliefs about taking
The nurse is gathering information from the medications.
patient about the patients health and lifestyle. • Allergies
• This includes: Subjective and Objective • Financial barriers
data. • Use of tobacco, alcohol and caffeine
• Cultural dietary barriers
• Always perform a complete, systemic
• The patient’s home safety needs
assessment of the patient’s body
• Caregiver needs and support system
systems.
• The assessment phase is paramount
➔Enhancing the patient’s adherence to
because the nurse will use the the drug therapy regimen is an essential
information gathered to form the basis of component of health teaching.
the patient's plan of care. ➔The patient’s attitudes and values about
taking medication are important
considerations when determining readiness
to learn.
➔A support system can alert a patient to
side effects, encourage actions that
promote medication compliance, and
notify the health care provider if a problem
arises.

SUBJECTIVE DATA
Subjective data include information
provided verbally by the patient, family
members, friends, or other sources.
➔ The nurse may ask open-ended questions
that allow the patient to answer directly,
such as “Please tell me about your current
medications.”
➔ Subjective data comprise what the
patient personally has to say about his or
her medications, health problems, and
lifestyle.
EXAMPLES:
OBJECTIVE DATA
Objective Data are what the nurse directly
observes about the patient’s health status.
It involves collecting the patient’s health
information by using the senses: seeing,
hearing, smelling, and touching.
Objective Data collection provides
additional information about the patients
symptoms and the organ system most likely
affected by the drug.
Example of objective data concerning
medication administration
✘ Physical health assessment
✘ Laboratory and diagnostic test results
✘ Data from the physician’s noted(i.e.,
health history)
✘ Measurement of vital signs
✘ The patient's body language
2. Nursing Diagnosis
❑ A nursing diagnosis is made based on
analysis of the assessment data, and it
determines the type of care the patient will
receive.
❑ The nurse formulated nursing diagnoses
and uses them to guide the development
of a care plan to provide patient-centered
quality care.
❑ Identification of client’s or actual
potential health problems.
❑ Problems can be managed by
independent nursing actions
❑ Guide for identifying nursing priorities and
directing nursing.
COMMON NURSING DIAGNOSES RELATED
TO DRUG THERAPY INCLUDE THE
FOLLOWING:
✔ Pain, Acute or Chronic, related to surgery.
✔ Confusion, Acute related to an adverse
reaction to medication.
✔ Health Maintenance, Ineffective related
to not receiving recommended preventive
care.
✔ Knowledge, Deficient related to effects of
anticoagulant medication.
✔ Noncompliance related to forgetfulness
✔ Health Management, Ineffective related
to lack of finances.
3. Planning
The nurse uses the data collected to set
goals or expected outcomes and
interventions.
Includes a time frame for achievement and
reevaluation, the development of nursing
interventions used to assist the patient in
meeting goals to develop patient-centered
outcomes.
Collaboration with the patient and/or
family is necessary.
EFFECTIVE GOAL SETTING QUALITIES
✔ The expected change is realistic,
measurable, and includes reasonable
deadlines.
✔ The goal is acceptable to both the
patient and nurse.
✔ The goal is dependent on the patient’s
decision-making ability.
✔ The goal is shared with other health care
providers, including family or caregivers.
✔ The goal identifies components for
evaluation.
EXAMPLES OF A WELL-WRITTEN
COMPREHENSIVE GOALS INCLUDE THE
FOLLOWING:
✔ The patient will independently administer
the prescribed dose of 4 units of regular
insulin by the end of the fourth session of
instruction.
✔ The patient will prepare a 3-day
medication recording sheet that correctly
reflects the prescribed medication
schedule by the end of the second session
of instruction.
4. Implementation
Part of the nursing process in which the
nurse provides education, drug
administration, patient care, and other
interventions necessary to assist the patient
in accomplishing the established goals.
• Performance of nursing
• Continued data collection
• Communication with healthcare
team
• Documentation
PATIENT TEACHING
✔ The patient must be ready to learn and
must make an investment in learning the
nurse and the patient must become fully
engaged in the learning process.
✔ Timing is another important factor. What
is the best time for the patient to learn?
✔ The environment should be conducive to
learning.
✔ Pain is an obstacle, and the patient’s
teaching should be postponed until pain is
relieved.
✔ Be mindful of language barriers, an
interpreter may be needed.
✔ The patient’s age may be another
obstacle.
✔ Patient teaching is essential to the
patient’s recovery. It allows the patient to
become informed about his or her health
problems and to participate in creating
interventions that can lead to good health • Drug boxed obtained from a local
outcomes. pharmacy can be used to prepare a
day’s or week’s supply of medication.
IMPORTANT PRINCIPLES TO REMEMBER WHEN • A recording sheet may be helpful
TEACHING PATIENTS ABOUT THEIR
MEDICATIONS: 5. Evaluation
• General. Instruct the patient to take The nurse determines whether the goals
the drug as prescribed. and teaching objectives are being met. The
• Provide simple written instructions to nurse continues to use ongoing assessment
the patient with the doctor and data to evaluate the successful attainment
pharmacy names and telephone of the patient’s objectives and goals.
numbers.
• Instruct the healthcare provider if: The nurse revises objectives, goals, and
❖ The dose, frequency, or time of interventions if the objectives are not met to
the drug is adjusted. A female ensure success. The nurse will document the
patient becomes pregnant successful attainment in the nursing plan of
❖ An OTC medication or care.
supplement is added. • Successful responses to goals
• Side effects. Give the patient interventions: Yes or No?
instructions that will help minimize any o If “No”, modify the goals
side effects. and/or the interventions and
• Self-administration. Perform an rewrite the care plan.
ongoing assessment of the patient’s o If “Yes”, the goals and/or the
motor skills and abilities. interventions were successful
• Instruct the patient on drug and can be removed from the
administration according to the updated care plan.
prescribed route. • Identification of factors contributing
• The use of drug cards is a helpful to success or failure.
teaching tool. Drug cards can be • Future care planning.
obtained from the healthcare
provider or from the drug
manufacturer.
• Diet. Advise the patient about foods
to include in their diet and foods to
avoid.
• Cultural Considerations. A culturally
sensitive nurse is alert to the patient’s
cultural expectations.
• Space instruction over several
sessions if appropriate.
• Review community resources related
to the patient’s nursing and medical
diagnoses.
• Collaborate with the patient and
family and other health care staff and
agencies to mobilize resources to
meet the patient’s needs.
• Identify patients at risk for
noncompliance with the regimen.
• Evaluate the patient’s understanding
of the medication regimen on a
regular basis.
• Empower the patient to take
responsibility for drug management.
 PRINCIPLES OF DRUG
ADMINISTRATION
“Six Rights” of Medication Administration
The nurse following these guidelines will
verify the following:
1. the right patient
2. the right drug
3. the right dose
4. the right route
5. the right time
6. the right documentation.
RIGHT PATIENT
Ask the patient to state his or her full name
and birth date, and compare these with the
patient’s identification (ID) band and the
medication administration record (MAR).
Many facilities have electronic health
records (EHRs) that allow the nurse to
directly scan the bar code from the
patient’s ID band.
RIGHT DRUG
The nurse must accurately determine the
right drug before administration. When
working with an EHR, after scanning the
wristband, the patient’s drug profile
appears on the computer screen. The
nurse’s next step is to scan the medication
label, and it will automatically validate the
time, date, and nurse administering the
patient’s medication.
The components of a drug order are as
follows:
▪ Patient name and birth date
▪ Date the order is written
▪ Provider signature or name if an
electronic order, T/O, or V/O
▪ Signature of licensed staff who took
the T/O or V/O, if applicable
Drug name and strength
▪ Drug frequency or dose (e.g., once
daily)
▪ Route of administration
▪ Duration of administration (e.g., × 7
days, × 3 doses, when applicable)
▪ Number of patient refills
▪ Number of pills to be dispensed
▪ Any special instructions for
withholding or adjusting dosage
based on nursing assessment, drug
effectiveness, or laboratory results
It is the nurse’s responsibility to administer
the drug, as ordered, by the provider, and if
the drug order is incomplete, the drug
should not be administered. Verification of
a questionable order must be done in a
timely manner.
Medication administration is never
considered just a process of “passing”
drugs. Nurses must use critical thinking skills
and assess whether the medication is
correct for the patient’s diagnosis. The nurse
must ask critical questions: Is the dose
appropriate? What is the patient’s
expected response?
To avoid drug errors, the drug label should
be read three times: (1) when the nurse
picks up the drug and removes it from the
automatic dispensing cabinet (ADC), (2) as
the nurse prepares the drug for
administration, and (3) when the nurse
administers the drug.
RIGHT DOSE
The right dose refers to verification by the
nurse that the dose administered is the
amount ordered, and that it is safe for the
patient for whom it is prescribed. The right
dose is based on the patient’s physical
status. Many medications require the
patient’s weight to determine the right
dose.
An important nursing intervention related to
the right dose includes calculating the drug
dose correctly. If in doubt about the
amount to be administered, consult with a
nurse peer to validate the correct amount.

RIGHT TIME
The right time refers to the time the
prescribed dose is ordered for
administration. Daily drug dosages are
given at specified intervals, such as twice a
day (bid), three times a day (tid), four times
a day (qid), or every 6 hours (q6h); this is so
the plasma level of the drug is maintained
at a therapeutic level.

RIGHT ROUTE
The right route is necessary for adequate or
appropriate absorption. The right route is
ordered by the HCP and indicates the
mechanism by which the medication enters
the body.
RIGHT DOCUMENTATION
The right documentation requires the nurse
to record immediately the appropriate
information about the drug administered.
Many systems are available for
documenting drug administration.
Both paper and computerized MAR systems
include: Information about the drug to be
administered, including (1) the name of the
drug, (2) the dose, (3) the route, (4) the time
and date, and (5) the nurse’s initials or
signature.
The Joint Commission National Patient
Safety Goals
Additionally, TJC has taken steps to support
safety and quality care in the workplace.
TJC has developed National Patient Safety
Goals, which focus on problems in health
care safety and how to solve them. These
goals are updated and published annually.
Sharps Safety
Needlestick Safety and Prevention Act
(NSPA). The act requires that employers
implement safer medical devices for their
employees, provide a safe and secure
workplace environment with educational
opportunities, and develop written policies
to help prevent sharp injuries
Safety Risks with Medication
Administration
Tablet Splitting. In effort to counteract
steeply rising drug costs, some patients are
cutting their pills in half. However, this is not
recommended by the FDA. The only time
tablet splitting is advisable is when it is
specified by the pharmacist on the label.
Buying drugs over the Internet. Consumers
may find it convenient to order drugs over
the Internet, but precautions must be taken
because drugs sold online may be too old,
too strong, or too weak to be effective

Two important goals that have already

become standards for all TJC accredited
organizations are the “do not use”
abbreviations (Table 9.1) and the list of
acceptable abbreviations (Table 9.2)

Counterfeit drugs
Counterfeit drugs look like the desired drug
but may have no active ingredient, the
wrong active ingredient, or the wrong
amount of active ingredient.
Dosage Forms: To Crush or Not to Crush
Although some drugs can be crushed, there
are many that shouldn’t be crushed. Always
consult with the pharmacist or, when
possible, the HCP before crushing a
patient’s drug.
High-Alert Medications
High-alert drugs can cause significant harm
to the patient. If a high-alert medication is
given in error, it can have a major effect on
the patient’s organs; this includes cardiac,
respiratory, vascular, and neurologic
systems.
Lists are provided to reduce the risk of errors,
but specific strategies can optimize safety
when dealing with high-alert drugs:
1. Simplify the storage, preparation,
and administration of high-alert
drugs.
2. Write policies concerning safe
administration.
3. Improve information and education.
4. Limit access to high-alert
medications.
5. Use labels and automated alerts.
6. Use redundancies (automated or
independent double-checks).
Look-Alike and Sound-Alike Drug Names
Nurses should be aware that certain drug
names sound alike and are spelled similarly.
Examples of drugs involved in medication
errors and recognized as confusing drug
names include glipiZIDE with glyBURIDE;
caPTOPRIL with caRVEDILOL;
Drug Administration
Forms and Routes of Drug Administration
Tablets and Capsules
The most common drug forms; they are
convenient and less expensive and do not
require additional supplies for
administration.
Enteric-coated and timed-release capsules
must be swallowed whole to maintain a
therapeutic drug level, so the drug is
released gradually. If crushed, the initial
excessive drug release poses a risk of
toxicity such that it could lead to a
potentially fatal overdose. Crushing can
increase the rate of absorption, and it can
cause oropharyngeal irritation. These
medications should never be cut in half or
crushed for administration. Advise the
patient or family member to notify the
health care provider (HCP) or pharmacist if
the patient is having difficulty swallowing
the medication.
Drugs given via sublingual (under the
tongue) or buccal (between the cheek and
gum) routes remain in place until fully
absorbed, therefore no food or fluid should
be taken while the medication is in place.
• If patients have difficulty opening
child-resistant caps, have them
request non– child-resistant caps
from the pharmacist.
Liquids
Forms of liquid medication include elixirs,
emulsions, and suspensions. Elixirs are
sweetened, hydro-alcoholic liquids used in
the preparation of oral liquid medications.
Emulsions are a mixture of two liquids that
are not mutually soluble. Suspensions are
liquids in which particles are mixed but not
dissolved.
Transdermals
Transdermal medication is stored in a patch
placed on the skin and is absorbed through
the skin to produce a systemic effect. To
prevent skin breakdown, transdermal
patches should be rotated to different sites
and should not be reapplied over the exact
same area every time.
Topical medications
are most frequently applied to the skin by
painting or spreading the medication over
an area and applying a moist dressing or
leaving the area exposed to air.

Instillations
Instillations are liquid medications usually
administered as drops, ointments, or sprays
in the following forms:
• Eyedrops
• Eye ointments
• Ear-drops
• Nose drops and sprays

Inhalations
Metered-dose inhalers (MDIs) are handheld
devices used to deliver a number of
commonly prescribed asthma and
bronchitis drugs to the lower respiratory
tract via inhalation.
—————————————————————
 crushed drug should be placed into a
plastic dosing cup. A small amount of water
is added to liquefy the dry medication.

Remove the plunger from the syringe and

attach it to the feeding tube, pour liquefied
medication into syringe, release the clamp,
and allow the medication to flow in
properly by gravity.
• Ensure proper identification of each
drug up until the time of
administration. Do this by
administering one drug at a time.
Flush with 10 to 15 mL of water
between each administration to
maintain patency of the tubing.
• When finished with drug
administration, flush tubing with 30 mL
of water or whichever amount is
recommended by the agency’s
policy. Always record the amount of
water used with the administration of
drugs on the patient’s input sheet.
• Clamp the tube and remove the
syringe.

Parental Medications
Methods of parenteral administration
include intradermal, subcutaneous,
intramuscular, Ζ-track technique, and
intravenous administration

Intradermal (ID)
Action
• Local effect
• Administered for skin testing (e.g.,
tuberculin screening, allergy testing, and
testing for other drug sensitivities; some
immunotherapy for cancer).
Sites
• Locations are chosen so an inflammatory
reaction can be observed. Preferred areas
Nasogastric and Gastrostomy Tubes
are lightly pigmented, free of lesions, and
Before administering drugs, always check
hairless such as the ventral mid-forearm,
for proper tube placement of any feeding
clavicular area of the chest, or scapular
tube that enters the mouth, nose, or
area of the back
abdomen, and always assess the gastric
residual. Return any aspirated gastric fluid
Subcutaneous (subcut)
to the stomach.
Action
• Systemic effect
Place patient in a high Fowler position or
• Sustained effect; absorbed mainly
elevate the head of bed at least 30 degrees
through capillaries; usually slower in onset
to avoid aspiration.
than with the intramuscular (IM) route.
• Locations for subcutaneous injections are
Make sure the drug is crushable. If it is a
chosen for adequate fat-pad size. Areas
capsule, assess whether it can be opened
such as the upper outer aspect of the arms,
and administered through the tube. The
the abdomen, at least 2 inches from the
umbilicus, and the anterior thighs are
important subcutaneous sites
Equipment
• Needle: 25 to 27 gauges; 3⁄8 to 5⁄8 inch
long
• The length of the needle and the angle of
the needle insertion are based on the
amount of subcutaneous tissue present. The
shorter, 3⁄8-inch needle should be inserted
at 90-degree angle, and the longer, 5⁄8-
inch needle is inserted at a 45- degree
angle
• Syringe: 1 to 3 mL (injection of solution is
usually 0.5 to 1 mL)
• Insulin syringe measured in units for use
with only insulin
Intramuscular (IM)
Action
• Systemic effect
• Usually a more rapid effect of drug than
with a subcutaneous route
•Sites Locations are chosen for adequate
muscle size and minimal major nerves and
blood vessels in the area. Other
considerations include the volume of drug
administered, needle size, angle of
injection, patient position, site location, and
advantages and 314 disadvantages of the
site. Underweight patients should be
evaluated for sites with adequate muscle.
Equipment
• Needle: 18 to 25 gauges; 5⁄8 to 11⁄2 inches
long. Patient’s weight, age, and the
amount of adipose tissue influence needle
length. or solutions that are more viscous
and irritating for adults, children, and
infants.
Intravenous (IV)
Action
• Systemic effect
• More rapid than IM or subcutaneous
routes
Sites
Accessible peripheral veins are preferred
(e.g., cephalic or cubital vein of arm, dorsal
vein of hand.
When possible, ask the patient about his or
her preference, and avoid needless body
restriction. In newborns, the veins of the feet,
lower legs, and head may also be used
after other sites have been exhausted.
Rectal Suppositories
Medications administered as suppositories
or enemas can be given rectally for local
and systemic absorption. The numerous
small capillaries in the rectal area promote
medication absorption.

Vaginal Medications
Vaginal drugs are available as
suppositories, foams, jellies, or creams.

Advise patients to remain lying for a time

sufficient to allow medication absorption;
times vary depending on the medication.
After insertion, provide the patient with a
sanitary pad. If the patient is able, she may
want to insert vaginal drugs herself.