UNIT 2

PHARMCOLOGY
1. Safety and Quality in
Pharmacotherapy
2. Medication Administration
3. Medication Conversion

LORIE ANN S. BALILI, RN,CRN, MAN

 Safety and Quality in Pharmacotherapy
14 RIGHTS OF ADMINISTRATION NURSES’ RIGHTS WHEN ADMINISTERING
MEDICATIONS
(1) the right to a complete and clear order;
(2) the right to have the correct drug, route (form),
and dose dispensed;
(3) the right to have access to information;

(4) the right to have policies to guide safe medication

administration
(5) the right to administer medications safely and to
identify problems in the system; and
(6) the right to stop, think, and be vigilant when
administering medication.

These rights can assist in increasing the safety of

medication administration.
 The Two Most Frequently
Used Methods To Dispense Drugs
01 02
Stock Drug Method Unit Dose Method
the drugs are dispensed to all drugs are individually wrapped and
patients from the same labeled for single doses for each patient
containers.

Informed Consent Medication Reconciliation

* *is the process of comparing a patient’s medication
a principle of which is the individual
having the knowledge necessary to orders to all of the medications that the patient has
make a decision. An informed patient been taking. The purpose is to avoid errors (e.g.,
and family is critical to preventing omissions, duplications, dosing errors, drug
medication errors. interactions).
Disposal of Medications
General guidelines include the following:

1. Follow specific information on the drug

label or drug insert. Unless specifically
instructed, do not flush medications down
the toilet, where they will pollute the
environment and may be a danger to
humans and animals
3. Before disposing of medication
containers, all identifying information
should be removed or obscured.

2. It is recommended that you remove the drug from its

original container and dispose of it in a sealed bag with
an undesirable substance such as used cat litter or used
coffee grounds. This method is intended to make
medications less attractive to people and animals.
 Sharps Safety
The Occupational Safety and Health
Administration (OSHA) Needlestick Safety and
Prevention Act of 2000 resulted from the
American Nurses Association’s (ANA)
campaign, Safe Needles Save Lives.

Dosage Forms: To Crush

or Not to Crush
Some medications can be crushed; consult with
the health care provider or pharmacist. Do not
crush any medication that has the suffix ER, SR,
XR, SA, CR, MR, or XL; these are extended-
release or sustained-release drugs, and
crushing will change the location and speed of
absorption.
PREGNANCY CATEGORIES
The purpose of the changes is to optimize informed decision making
for pregnant patients and for patients of childbearing age who may
wish to become pregnant. Both the pregnancy and lactation
subsections will have three principal components: risk summary,
clinical considerations, and a data section.
 HIGH-ALERT MEDICATIONS

1. IV adrenergic agents 10. dextrose (hypertonic >20%)

2. IV adrenergic antagonists 11. dialysis solutions
3. IV antiarrhythmics 18. IV radiocontrast agents
12. epidural or intrathecal agents 19. total parenteral nutrition
4. IV inotropic agents 13. Hypoglycemics
5. IV moderate sedation solutions
14. liposomal forms of drugs 20. sterile water for injection
agents 15. moderate sedation agents
6. anesthetic agents inhalation and irrigation in
16. narcotics/opiates containers of >100 mL
7. antithrombotic agents 17. neuromuscular blocking
8. cardioplegic solutions 21. and sodium chloride for
agents. injection (hypertonic, >0.9%
9. chemotherapeutic agents,
concentration).
 SOUND-ALIKE DRUG NAMES
▪ Nurses should be aware that certain drug names sound alike and are spelled
similarly.
▪ Some drugs’ spellings look alike or sound alike but have different chemical
drug structures and are prescribed for different health problems.
▪ When ordering drugs, make sure the spelling of the drug is correct, and be
extremely careful when administering drugs whose names look alike.
Caution: Physicians’ handwriting of drug names.
LOOK-ALIKE DRUG NAMES
Pharmacology abbreviation
Pharmacology abbreviation
Images reveal large amounts of data,
so remember: use an image instead
of a long text. Your audience will
appreciate it
AWESOME
WORDS
AWESOME
WORDS
AWESOME
WORDS
 Medication Administration
FORMS AND ROUTES FOR
SELF- DRUG ADMINISTRATION
ADMINISTRATION OF A variety of forms and routes are used
for the administration of medications,
MEDICATION including:
SAM means that the nurse 1. Sublingual
gives the patient the 2. Buccal
appropriate medications 3. oral (tablets, capsules, liquids,
and instructions that are suspensions, elixirs)
4. transdermal
kept at the bedside and
then go home with the 5. Topical
patient on discharge. 6. instillation (drops and sprays)
Patients are responsible for 7. inhalation
taking their medication 8. nasogastric and gastrostomy
tubes
according to the
9. Suppositories
instructions.
10. parenteral
TECHNOLOGICAL
ADVANCES
• Pain-free delivery of insulin through
patch
• Insulin pumps that deliver insulin based
on monitoring of
serum glucose levels
• Drugs implanted in contact lenses
• Intelligent infusion technology that
programs IV infusions
based on scanned information.
• Electronic order entry system
• Computerized unit dose dispensing
cabinets
• Bar code technologies that scan
medications and reconcile
them with patient ID band
• Electronic medication administration
records
 UNIT 2
Medication Administration
❖Oral
❖treatment
❖Parenteral
 ORAL DRUG ADMINSTRATION
Eighty percent of all drugs consumed Oral medications have the following advantages:
are given orally. (1) the patient frequently can take oral medications
without assistance
Oral drugs are available in: (2) the cost of oral medications is usually less than
1. Tablet when given via other routes (e.g., parenteral),
2. Capsule and
3. powder, (3) oral medications are easy to store
4. liquid form. Oral medications have the following Disadvantages:
(1) variation in absorption as a result of food in the
GI tract and pH variation of GI secretions
(2) irritation of the gastric mucosa by certain drugs
(e.g., potassium chloride), and
(3) destruction or partial inactivation of the drugs by
liver enzymes.
 TABLETS, CAPSULES, AND LIQUIDS
Tablets
come in different forms and drug
strengths. Most tablets are
scored and thus can be
readily broken when half of
the drug amount is needed
Liquid form
-When the patient has difficulty
taking tablets, the liquid form of
the medication is given. The
liquid form can be in a
suspension, syrup, elixir, or
tincture.
-poured into a medicine cup that is
calibrated in ounces, teaspoons,
tablespoons, and milliliters
Capsules Sustained
release (pellet)
are gelatin shells that
contain powder or capsules and controlled-release
time-release pellets capsules should not be
(beads) crushed and diluted, because
the medication will be
absorbed at a much faster
Enteric-coated rate than indicated by the
(hard-shell) manufacturer
tablets must not be crushed, because
the medication could irritate the
gastric mucosa. Enteric-coated
drugs pass through the stomach
into the small intestine where the
drug’s coating dissolves and then
absorption occur.
 Medicine cup reading

The meniscus is the slightly concave curved

line of a dose of liquid. The bottom of the
meniscus should be used to measure the
desired dose of medication
DRUGS ADMINISTERED VIA NASOGASTRIC
TUBE
✓ Oral medications can be administered through a nasogastric tube
but should not be mixed with the entire tube feeding solution.
✓ Mixing the medications in a large volume of tube feeding solution
decreases the amount of drug the patient receives for a specific
time.
✓ The medication should be diluted in 1 ounce (30 mL) of warm water
unless otherwise instructed, administered through the tube,
✓ and followed with extra water to ensure that the drug reaches the
stomach and is not left in the tube.
✓ Check the policy at your institution.
 ENTERAL FEEDING
OGT PEG
Oro Gastric Tube Percutaneous Endoscopic Gastrostomy (PEG)
Percutaneous Endoscopy Gastrostomy Tube (PEG Tube; Non-balloon G-
tube)
NGT TUBE
 TREATMENT
ADMINSTRATION
❑ INHALATION
❑ NEBULIZATION

❑ PATCHES

❑ SUPPOSITORIES

❑ EYE & EAR DROPS

 EYE DROPS/OINTMENT

01 02
01 EAR DROPS/ OINTMENT
02
01 Transdermal Patch
is stored in a patch placed on the skin and
absorbed through skin, having a systemic effect.

Transdermal drugs provide more consistent 02

blood levels than oral and injection forms and
avoid GI absorption problems associated with
oral products.
Transdermal patches should be rotated to
different sites and not reapplied over the exact
same area when changed.

Additionally, the area should be thoroughly

cleansed before administration of a new
transdermal patch. This practice will prevent
errors in overdosing the patient.
Rectal tube
FOLEY CATHETER TUBE
SUPPOSITORIES
 PARENTERAL
ADMINITRATION
When medications cannot be taken by mouth because of :
(1) an inability to swallow
(2) a decreased level of consciousness
(3) an inactivation of the drug by gastric juices,
(4) a desire to increase the effectiveness of the drug, the
parenteral route may be the route of choice.
TYPES OF PARENTERAL ROUTES INCLUDE:

➢ Intradermal ID (under the skin)

➢ Subcutaneous SubQ (into the fatty tissue)
➢ Intramuscular IM (within the muscle)
➢ Z-track technique
➢ Intravenous IV (in the vein)
➢ Intraosseous (in the bone)
 Intramuscular
PARENTERAL
Systemic effect
Usually more rapid effect of drug than
with subQ route • Used for solutions in
oils and deep IM for irritating drugs
Locations are chosen for adequate
muscle size and minimal major nerves
and blood vessels in the area
The ventrogluteal is the preferred site
for adults and toddlers with gluteal
muscle development associated with
firmly established walking.
Needle: 20- to 23-gauge; 18-gauge for
blood products; 1 to 11 2 inches long
Subcutaneous Intradermal
Local effect
Systemic effect
Used for observation of an
Sustained effect; absorbed
inflammatory (allergic)
mainly through capillaries;
reaction to foreign protein
usually slower in onset
than with IM route Preferred areas are lightly
pigmented, thinly keratinized,
Locations for subQ
and hairless, such as the
injection should be rotated
ventral mid-forearm,
to avoid overuse of an
clavicular area of the chest, or
individual site.
scapular area of the back
Needle: 25- to 27-gauge; 1
Needle: 25- to 27-gauge; 3 8
2 to 5 8 inch long
to 5 8 inch long
Syringe: 1 to 3 mL (usually
Syringe: 1 mL calibrated
0.5 to 1 mL injected

Z-Track Injection
Technique
Local effect
prevents medication from
leaking back into the subQ
tissue. It is frequently advised
for medications that cause
visible and permanent skin
discoloration
The gluteal site is preferred.
Needle: 25- to 27-gauge; 1 2 to 5 8
inch long • Syringe: 1 to 3 mL
(usually 0.5 to 1 mL injected)
PARENTERAL
Intravenous
Systemic effect
More rapid than IM or subQ
routes
Accessible peripheral veins
(e.g., cephalic or cubital vein of
arm; dorsal vein of hand) are
preferred .When possible, ask
the patient about preference.
Avoid needless body restriction.
In newborns, the veins of the
feet, lower legs, and head may
also be used after the previous
sites have been exhausted.
Intraosseus
Systemic effect
Fluids, crystalloids, blood
products, and medications
administered via intraosseous
(IO) infusion into the bone
marrow enter circulation
through the network of venous
sinusoids
used when IV access is not
possible; it is removed within
24 hours. Contraindications
include fracture in insertion
limb, infection at insertion site
location: proximal tibia and
humerus
sternum
 A vial is usually a small glass
container with a self-sealing rubber
top. Some are multiple-dose vials,
and when properly stored, they can
be used over time

An ampule is a glass container with a

tapered neck for snapping open and
using only once
Powdered Drug Reconstitution
Certain drugs lose their potency in liquid form;
therefore manufacturers package these drugs in
powdered form. They are reconstituted using a
diluent (bacteriostatic water or saline) before
administration.
Drug labels on vials and ampules provide the following
information:
(1) generic and brand name of the drug,
(2) drug dose in weight (milligrams, grams,
milliequivalents) and amount (milliliters),
(3) expiration date, and
(4) directions about administration. If the drug is in
powdered form, mixing instructions and dose
equivalents (e.g., milligrams equal milliliters) may be
given
 THE SYRINGE
1. Syringes are available in various types and sizes, the most
common of which are the 3-mL and 5-mL tuberculin, insulin,
and metal and plastic syringes for prefilled cartridges.
2. Glass syringes may be used in the operating room and on
special instrument trays. The tip of the syringe and inside of
the plunger should remain sterile.
 Different kinds of syringes
1. The needleless syringes are used primarily for intermittent infusion therapy
to irrigate the intermittent infusion device for maintaining patency and to
administer IV medication through the IV tubing device.
2. The tuberculin syringe is a 1-mL slender syringe with markings in
tenths (0.1) and hundredths (0.01). It is also marked in minims

3. The insulin syringe has the capacity of 1 mL; however, insulin is

measured in units, and insulin dosage must not be calculated in milliliters.
Insulin syringes are calibrated as 2-unit marks, and 100 units equal 1 mL

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Needle size has two components: gauge
(diameter of the lumen) and length. The
larger the gauge number, the smaller the
diameter of the lumen, and the smaller the
gauge, the larger the diameter of the lumen.
The most common gauge numbers of
needles range from 18 to 26. Needle length
varies from 3 8 inch to 2 inches.
 INTRADERMAL INJECTIONS
An intradermal injection is usually used for skin testing to diagnose the
cause of an allergy or to determine the presence of a microorganism.
The choice of syringe for intradermal testing is the tuberculin syringe
with a 25-gauge needle.

The inner portion of the forearm is frequently used for diagnostic

testing because there is less hair in the area and the test results are
more visible. The upper back may also be used as a testing site. The
needle is inserted with the bevel pointing upward at a 10- to 15-
degree angle. Do not aspirate. Test results are read 48 to 72 hours
after the intradermal injection. A reddened or raised area is a
positive reaction.
 SUBCUTANEOUS INJECTIONS
Drugs injected into the subcutaneous (subQ) or fatty tissue are
absorbed slowly because there are fewer blood vessels in
fatty tissue. The amount of drug solution administered subQ
is generally 0.5 to 1 mL at a 45-, 60-, or 90-degree angle.

The two types of syringes used for subQ injections are the:
1. tuberculin syringe (1 mL), calibrated in 0.1 mL and 0.01 mL,
and the 3-mL syringe, calibrated in 0.1 mL. The needle gauge
commonly used is 25 or 26, and the length is 3 8 to 5 8 inch.
2. Insulin is also administered subQ.
 INSULIN INJECTIONS
✓ Insulin should be administered with an insulin syringe, which is calibrated to correspond
with the 100 units of insulin.
✓ Insulin bottles and syringes are color coded to avoid error.
✓ The 100 units/mL (or U-100) insulin bottle and the 100 units/mL syringe are coded orange.
Administering insulin with a tuberculin syringe should be avoided.
✓ Insulin is administered subQ at a 45-, 60-, or 90-degree angle into the subQ tissue. The
subQ absorption rate of insulin is slower because there are fewer blood vessels in the fatty
tissue than in muscular tissue. The angle for administering insulin depends on the amount
of fatty tissue. For an obese person, the angle may be 90 degrees; for a very thin person,
the angle may be 45 to 60 degrees.
 Types of Insulins
1. Insulins are clear (regular or crystalline insulin) and
2. cloudy (NPH) because of the substance protamine,
which is used to prolong the action of insulin in the
body.

Only clear (regular) insulin can be given IV as well as subQ.

The source of insulin is human (Humulin).

✓ Rapid-acting
Insulin is categorized as: (Humalog,
Aspart, Apidra) and fast-acting
❖ rapid-acting (Humulin R) regular insulin
❖ fast-acting can be given both
intravenously and
❖ intermediate- acting subcutaneously.
❖ long-acting ✓ Intermediate-acting and long-
acting insulins can only be
❖ commercial premixed insulin
administered subcutaneously
Fast-acting insulin (regular or Humulin R insulin)
is also clear but takes longer to start working compared with rapidacting insulins. It is
administered 15 to 30 minutes before meals and is effective for 6 to 8 hours. It is
usually given before the meal, but it is sometimes given during or after the meal.
Humulin R and Novolin R are brand names for fast-acting human insulin.

Intermediate-acting insulin (NPH, Humulin N, Novolin N)

is administered 30 minutes before the meal (breakfast) and becomes effective in 1 to 2

hours. Its duration of action in the body is 12 to 18 hours. This type of insulin contains
protamine, which prolongs the action in the body. It is cloudy because of the
protamine added to the regular insulin. It can only be given subcutaneously. Humulin N
can be mixed with Humulin R (regular insulin) or rapid-acting insulin in the same
syringe.
The long-acting insulin
acts within 1 to 2 hours and lasts in the body for 18 to 24 hours. The Levemir vial is tall and has a
green top. The Lantus vial is taller and narrower than the other types of insulin. It has a purple
top and purple print on the label. Levemir is usually administered in the evening or at bedtime;
however, it can be administered once or twice a day subcutaneously. Lantus is usually
administered at bedtime, and the incidence of nocturnal hypoglycemia is not common. Some
patients report more pain at the injection site with long-acting insulins than with Humulin N or
NPH insulin.

Lantus and Levemir cannot be mixed with other insulins or given intravenously.

The use of commercially premixed combination insulins

has become popular for patients with diabetes who mix fast-acting and intermediate-acting
insulins. Examples are two groups: the rapid-acting and intermediate-acting insulins are
Novolog mix 70/30 and Humalog mix 75/25. The fast-acting and intermediate-acting insulins are
Humulin 70/30, Novolin 70/30, and Humulin 50/50 (see Figure 14D-12). They are available in
vials or pens that resemble a fountain pen (Figures 14D-12 and 14D-13). Some patients need less
than 30 units of Humulin R and more Humulin N, so these combinations of insulins cannot be
used. They must mix their insulins according to the prescribed units of insulin.
❖ -
❖ -
❖ -
 INTRAMUSCULAR INJECTIONS
. injection.
❑ intramuscular (IM) injection are absorbed more rapidly than those given by subQ
❑ The volume of solution for an IM injection is 0.5 to 3 mL, with the average being 1 to 2 mL.
❑ A volume of drug solution greater than 3 mL causes increased muscle tissue displacement
and possible tissue damage. Occasionally 5 mL of selected drugs, such as magnesium
sulfate, may be injected into a large muscle, such as the dorsogluteal.
❑ A dose greater than 3 mL is usually divided and given at two different sites.
❑ The needle gauges for IM injections are 19 and 20 for thick solutions and 20 and 21 for thin
solutions.
❑ IM injections are administered at a 90-degree angle. The needle length depends on the
amount of adipose (fat) and muscle tissue; the average needle length is 11 2 inches.
 LEARN ABOUT
INTRAVENOUS (IV)
FLUID THERAPY
Intravenous (IV) fluid
is used to administer fluids that contain water, dextrose, vitamins,
electrolytes, and drugs.

increasing number of drugs are administered by the IV route

for direct absorption and fast action.
Some drugs are given by IV push (bolus).
Many drugs administered IV irritate the veins, so these drugs
are diluted in 50 to 100 mL of fluid.
Other drugs are delivered in a large volume of fluid over a
specific period, such as 4 to 8 hours.
Two methods are used to administer IV
fluids and drugs:

1. CONTINUOUS IV INFUSION
replaces fluid loss, maintains fluid balance, and serves as
a vehicle for drug administration.

2. INTERMITTENT IV INFUSION
is used primarily to give IV drugs.
 Nurses have an important role in the preparation and administration of IV solutions
and IV drugs. The nursing functions and responsibilities during drug preparation
include the following:

• Knowing IV sets and their drop factors

• Calculating IV flow rates
• Mixing and diluting drugs in IV fluids
• Gathering equipment
• Knowing the drugs and the expected and untoward reactions
Nursing responsibilities continue with assessment of the patient for effectiveness and untoward effects of
the therapy and assessment of the IV site.

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 The health care provider orders the type and amount of IV solution in liters over
a 24-hour period or in milliliters per hour. The nurse calculates the IV flow rate
according to the drop factor, the amount of fluids to be administered, and the
time period.

Intravenous Set
➢ The drop factor, the number of drops per milliliter, is
normally printed on the packaging cover of the IV set.
➢ macrodrip set, A set that delivers large drops per milliliter
(10 to 20 gtt/mL),
➢ microdrip (minidrip) set, is one that delivers small drops per
milliliter (60 gtt/mL).
Macro and Micro drip Tubing
At times, IV fluids are given at a slow rate to keep vein open (KVO), also
called to keep open (TKO).

The reasons for ordering KVO include:

a. a suspected or potential emergency situation for rapid administration of
fluids and drugs,
b. the need for an open line to give IV drugs at specified hours.

For KVO, a microdrip set (60 gtt/mL) and a 250-mL IV bag may be used.
KVO is usually regulated to deliver 10 mL/h.

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INTERMITTENT IV THERAPY.
● The drug solution is usually
infused over a period of 15
minutes to 1 hour.

Separate tubing for IV drugs, the

secondary IV line set, is inserted into
a port (rubber stopper) of the IV
connector on the continuous, or
primary IV line set.
Two IV sets available
to administer IV drugs
are:

(1) the calibrated

cylinder (chamber)
with tubing, such as
the Buretrol,
Volutrol, and
Soluset; and
(2) the secondary IV
set, which is similar
to a regular IV set
except the tubing is
shorter
INTERMITTENT INFUSION ADAPTERS/
DEVICE
 INFUSION SETS
1. INFUSION SET (I.V SET) 2. MEASURED VOLUME
ADMINISTRATION SET (BURRETE SET)
 INFUSION SETS
3. BLOOD SET 4. PLATELET SET
 INFUSION SETS
5. INFUSION SET (WITH Y 6. IV SET WITH FLOW REGULATOR
PORT) MICRODRIP
 DIRECT INTRAVENOUS
INJECTIONS
❖ Medications that are given by the IV injection route are calculated in the same
manner as medications for intramuscular (IM) injection.
❖ This route is often referred to as IV push.
❖ Clinically, it is the preferred route for patients with poor muscle mass or
decreased circulation or for a drug that is poorly absorbed from the tissues.
❖ Medications administered by this route have a rapid onset of action, and
calculation errors can have serious, even fatal, consequences.
❖ The nurse must read drug information inserts carefully and must give attention
to the amount of drug that can be given per minute.
 ELECTRONIC INTRAVENOUS REGULATORS
Pumps are electronic intravenous (IV) regulators used in hospitals and
some community settings. The electronic IV regulators are set to deliver a
prescribed rate of IV solution. If the flow rate is obstructed, an alarm B. PUMP SYSTEM
sounds.

Volumetric pumps
Syringe pumps
A. GRAVITY DEVICES
Patient-controlled analgesia
(PCA) pumps
pressure for the
infusion Anaesthesia pumps
Syringe drivers
the height of the liquid
above the infusion site Pumps for ambulatory use
NURSING IMPLICATIONS FOR ADMINISTRATION
OF PARENTERAL MEDICATIONS
 NURSING
IMPLICATIONS FOR
ADMINISTRATION
OF PARENTERAL
MEDICATIONS cont.
Pharmacology Suffixes
❖ -amil: calcium channel blockers
❖ -caine: local anesthetics
❖ -cycline: antibiotics
❖ -dine: anti-ulcer agents (H2 histamine blockers)
❖ -done: opioid analgesics
❖ -ine: antidepressants, calcium channel blockers
❖ -ide: oral hypoglycemics
❖ -pam: anti-anxiety agents
❖ -oxacin: broad spectrum antibiotics
Pharmacology Suffixes
❖ -mide: diuretics
❖ -mycin: antibiotics
❖ -nuim: neuromuscular blockers
❖ -olol: beta blockers
❖ -pam: anti-anxiety agents
❖ -pine: calcium channel blockers
❖ -pril: ace inhibitors
❖ -sone: steroids
❖ -statin: antihyperlipidemics
❖ -vir: anti-virals
Pharmacology Suffixes
❖ -xacin: antibiotics
❖ -zide: diuretics

❖ -zine: antipsychotics

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Thank you for LISTENING!!!
 References
E-Books:
1. Burchun and Rosenthal (2019). Lehne’s pharmacology for nursing care.
10th Edition. St. Louis, Missouri: Elsevier.
2. Edmund, M.W (2016). Introduction to Clinical Pharmacology 8th ed. St.
Louis, Missouri: Elsevier.
3. Ford, S.M. (2018). Roach’s Introductory: Clinical pharmacology. 11th
Edition. Philadelphia, Pennsylvania: Wolters Kluwer.
4. Hayes, Kee, and McCuistion (2015). Pharmacology: a patient-centered
nursing process approach. 8th Edition. St, Louis, Missouri: Saunders,
Elsevier.
 References
1. Hodgson and Kisior (2019). Saunders nursing drug handbook 2019. 27th Edition. St. Louis,
Missouri: Elsevier.
2. Lapham, R. (2016). Drug calculations for nurses: A Step-by-step approach. 4 th Edition. Boca
Raton, Florida: CRC Press.

Online Journals:
https://www.reliasmedia.com/articles/44548-joint-commission-ids-five-high-alert-meds
https://www.registerednursing.org/nclex/dosage-calculations/
https://parents-life.com/teratogens-in-pregnancy/
https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf