1.1 Drug Classifications & Forms

GODDY M. MANZANO JR.,MAN, R.N.
Instructor
LEARNING OBJECTIVES
✔ Define the word pharmacology,
pharmacognosy, pharmacy,
pharmacotherapeutics, toxicology, pharmacy and
chemotherapy.
✔ Know the history of pharmacology.
✔What will need to know about drugs,
✔ Outline the steps involved in developing and
approving a new drug
PHARMACOLOGY
Etymologically, it is the science of drugs.
Pharmacology is derived from Greek words:
Pharmacon = Drug
Logos = Discourse in / study
✔It is the study of how chemical agents affect
living processes.
✔ It studies the effects of drugs and how they
exert their effects to the body.
PHARMACOLOGY
Pharmacology is the branch of biology
concerned with the study of drug
action.
It deals with interaction of exogenously

administered drugs with living
systems.
PHARMACOTHERAPEUTICS
✔ Otherwise known as clinical
pharmacology, the branch of
pharmacology that uses drugs to
treat, prevent, and diagnose disease.
✔ Addresses two key concerns: the
drug’s effects on the body and the
body’s response to the drug.
PHARMACOGNOSY
• branch of pharmacology
dealing with natural
drugs & their
constituents.
• deals with the sources,
procurement & chemistry
of natural products.
PHARMATHERAPEUTICS
⚫treatment of
diseases with
medicines.
TOXICOLOGY
⚫study of
poisons
CHEMOTHERAPY
⚫The use of
chemicals for the
treatment of any
disease.
⚫May also be
synonymous to
cancer treatment.
PHARMACY
⚫The science of
identification,
compounding and
dispensing of drugs.
⚫It also includes collection,
isolation, purification,
synthesis and
standardization of medical
substances.
PHARMACOLOGY HISTORY
⚫MATERIA MEDICA Latin
(medical material)
• Body of collected knowledge
about the therapeutic
properties of any substance
used for healing.• Derived
from work of ancient Greek
physician DIOSCORIDES in
1st century AD
⚫The term material
medica was used from
the Roman Empire until
the 20th century but
now has been replaced
in medical education
contexts by the term
P H A R M A C O L O G Y.
⚫1st extensive PHARMACOPEIA
commentary on 600 plants along
with therapeutically useful animal
and mineral products.
⚫De Materia Medica included
about a thousand natural product
drugs (mostly plant-based), 4,740
medicinal usages for drugs, and
360 medical properties
(antiseptic, anti-inflammatory
etc.)
ANCIENT EGYPT
⚫The EBERS PAPYRUS is
an Egyprtian Medical
Papyrus of herbal
knowledge..
⚫A scroll, some 60 feet
long and a foot wide,
contains 700 magical
formula and folk
ANCIENT EGYPT
⚫The EBERS PAPYRUS
is meant to cure
afflictions ranging
from crocodile bite to
toe nail pain and to
get rid of the pest
such as flies, rats, and
scorpions.
ANCIENT EGYPT
⚫The EBERS PAPYRUS also
includes an accurate
description of the
circulatory system, noting
the existence of blood
vessels throughout the
body and the hearths
function as center of the
blood supply.
ANCIENT EGYPT
⚫The EBERS PAPYRUS is an
ancient recipe book dated
to approximately 1552 BC.
It contains a mixture of
magic and medicine with
invocations to banish
disease and a catalogue of
useful plants, minerals,
magic amulets and spells.
⚫The most famous
Egyptian
physician was
IMHOTEP who
lived in Memphis
around 2500 B.C.
ANCIENT INDIA –
AYURVEDIC MEDICINE
⚫In India, the Ayurveda
is traditional medicine
that emphasizes plant-
based treatments,
hygiene, and balance in
the body’s state of being.
ANCIENT INDIA –
AYURVEDIC MEDICINE
⚫Indian materia medica
included knowledge of
plants, where they grow in all
season, methods for storage
and shelf life of harvested
materials. It also included
directions for making juice
from vegetables, dried
powders from herb, cold
infusions and extracts.
ANCIENT CHINA MEDICINE
⚫Compendium of Materia
Medica (also known by
the romanizations Bencao
Gangmu or Pen-tsao
Kang-mu) is a Chinese
herbology volume written
by Li Shizhen during the
Ming dynasty; its first
draft was completed in
1578.
⚫It is a work epitomizing the
materia medica known at the
time.
⚫The Compendium of
Materia Medica is regarded as
the most complete and
comprehensive medical book
ever written in the history of
traditional Chinese medicine.
⚫It lists all the plants, animals,
minerals, and other items that were
believed to have medicinal
properties.
⚫The text consists of 1,892 entries,
each entry with its own name
called a gang. The mu in the title
refers to the synonyms of each
name.
⚫HIPPOCRATES – Father of
Medicine
⚫He founded a school of
medicine that focused on
treating the causes of disease
rather than its symptoms.
⚫Disease was dictated by
natural laws and therefore
could be treated through
close observation of
symptoms.
DRUG
✔ According to WHO, “Any
substance or product which is
used or intended to be used to
modify or explore physiological
systems or pathological states for
the benefit of the recipient”.
DRUG
✔ It is a chemical
substance used in the
treatment, cure,
prevention or
diagnosis of disease or
used to otherwise
enhance physical or
mental wellbeing.
DRUG NOMENCLATURE
⚫Every DRUG has three
(3) of Names
1. Chemical Name
2.Non-proprietary Name
(Generic Name)
3.Proprietary Name
( Trade/Brand Name)
DRUG NOMENCLATURE
⚫Chemical Name – These are given according to the
chemical constitution of drug.
⚫Non-proprietary Name– (Official name) It is assigned
by the United States Adopted name (USAN) council. It
is uniform all over the world.
Generic Name – Typically derived from chemical
name. Usually shorter.
⚫Proprietary Name– It is given by the pharmaceutical
manufacturer.
Trade/Brand Name – Name registered by the
manufacturer; only be used by the single
manufacturer; The first letter of the name is
Capitalized,
CHEMICAL NON TRADE NAME
NAME PROPRIETARY
Acetyl Salycylic ASPIRIN DISPRIN (India)

Acid Bayer’s Asprin
(USA)
Ecospirin
(India)
CHARACTERISTICS
OF IDEAL DRUG
✔ It should be biocompatible and
biodegradable.
✔ No side effects.
✔ Shows the selectivity in its
action.
WISHLIST FOR A
PERFECT DRUG
✔ Reversible
✔ Predictable
✔ NO adverse effects
✔ NO interaction
✔ Cheap and simple
GOALS OF
PHARMACOLOGY
✔Maximum
benefit for the
patient.
✔Minimum
harm to the
patient.
NURSING RESPONSIBILITIES
IN DRUG THERAPY
✔ Administering drugs.
✔ Assessing drug effects.
✔ Intervening to make the drug regimen
more tolerable.
✔ Providing patient teaching about drugs
and the drug regimen.
✔ Monitoring the overall patient care plan
to prevent medication errors.
SOURCES OF
DRUGS
PLANT SOURCES
✔ Is the oldest source of drugs.
✔ Almost all parts of the plants
are used i.e. leaves, stem, bark,
fruits and roots.
✔Ex: Morphine, Digoxin, Quinine, Reserpine
etc.
ALKALOIDS
✔ Diverse group of bitter
tasting, organic, basic
substances found in plants
with examples such as
caffeine, morphine and
atropine.
✔ Digitalis
purpurea are
the source of
Digitoxin and
Digoxin, which
are cardiac
glycosides.
✔ Leaves of
Eucalyptus
give oil of
Eucalyptus,
which is
important
component of
cough syrup.
Tobacco leaves give nicotine.
Poppy
papaver
somniferum
gives
morphine
(opoid)
ANIMAL SOURCES
✔ Drugs obtained from animals
sources are whole animals,
glandular products
(thyroid organ), insulin,
heparin, liver extract,
polypeptide venoms, non-
peptide toxins and others.
Urine of
pregnant
women gives
hCG used for
the treatment
of infertility.
Thyroid of
sheep is a
source of
thyroxine,
used in
hypothyroidism
Cod liver is
used as a
source of
vitamin A
and D.
INORGANIC COMPOUNDS
SYNTHETIC SOURCES
✔ Drugs that are produced
upon alteration of chemical
compositions of exisiting
plants and animals when
proven to have therapeutic
activity.
SYNTHETIC SOURCES
Advantage:
1.Quality can be controlled.
2.Process is easier and cheaper.
3.More potent and safer.
4.Large scale production.
MINERAL SOURCES and EARTH
SOURCES
DRUG
EVALUATION
PHASES
PRE-CLINICAL TRIALS
✔ A study to test a drug, a procedure,
or another medical treatment in
animals. The aim of
a preclinical study is to collect data in
support of the safety of the new
treatment.
✔Preclinical studies are required
before clinical trials in humans can
be started
PRE-CLINICAL TRIALS
✔ In this stage, chemicals that may
have therapeutic value are tested
on laboratory animals for two main
purposes:
▪ To determine whether they have the
presumed effects in living tissue.
▪ To evaluate any adverse effects.
PRE-CLINICAL TRIALS
✔ 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 is too toxic to living
animals to be worth the risk of
developing into a drug.
PRE-CLINICAL TRIALS
✔ The chemical is highly
teratogenic (causing adverse
effects to the fetus).
✔ The safety margins are so
small that the chemical would
not be useful in the clinical
setting.
NOTE:
✔ Some chemicals, however, are
found to have therapeutic effects
and reasonable safety margins.
✔ This means that the chemicals
are therapeutic at doses that are
reasonably different from doses
that cause toxic effects.
PHASE 1 STUDIES
✔ Uses human volunteers to test the
drugs.
✔ More tightly controlled than preclinical
trials and are performed by specially
trained clinical investigators.
✔ The volunteers are fully informed of
possible risks and may be paid for their
participation.
PHASE 1 STUDIES
✔ Usually, the volunteers are
healthy, young men.
✔ Women are not good
candidates because the
chemicals may exert unknown
and harmful effects on a
woman’s ova.
PHASE 1 STUDIES
✔ Many chemicals are dropped from the
process for the following reasons:
▪ They lack therapeutic effect in
humans.
▪ They cause unacceptable adverse
effects.
▪ They are highly teratogenic.
▪ They are too toxic.
NOTE:
✔ Some chemicals move to the next stage of
testing despite undesirable effects.
✔ For example, the antihypertensive drug
minoxidil (Loniten) was found to effectively
treat malignant hypertension, but it caused
unusual hair growth on the palms and other
body areas.
✔ Now, its hair-growing effect has been
channeled for therapeutic use into various
hair-growth preparations such as Rogaine.
PHASE 2 STUDIES
✔ Allows clinical investigators to try out the
drug in patients who have the disease that
the drug is designed to treat to evaluate the
drug’s effects.
✔ Usually, phase II studies are performed at
various sites across the country—in
hospitals, clinics, and doctors’ offices—and
are monitored by representatives of the
pharmaceutical company studying the drug.
PHASE 2 STUDIES
✔ 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.
PHASE 2 STUDIES
▪ It has a low benefit-to-risk ratio,
meaning that the therapeutic
benefit it provides does not
outweigh the risk of potential
adverse effects that it causes.
▪ It is no more effective than other
drugs already on the market.
PHASE 3 STUDIES
✔ Involves use of the drug in a vast
clinical market.
✔ Prescribers are informed of all the
known reactions to the drug and
precautions required for its safe use.
✔Prescribers observe patients very
closely, monitoring them for any
adverse effects.
PHASE 3 STUDIES
✔ Prescribers ask patients to keep
journals and record any
symptoms they experience.
✔ Prescribers then evaluate the
reported effects to determine
whether they are caused by the
disease or by the drug.
PHASE 3 STUDIES
✔ A drug that produces
unacceptable adverse effects is
usually removed from further study
by the drug company.
✔ In some cases, the FDA may have
to request that a drug be removed
from the market.
FDA APPROVAL
✔ Drugs that finish phase III
studies are evaluated by the Food
and Drug Administration, which
relies on committees of experts
familiar with the specialty area in
which the drugs will be used
before marketing in the public.
FDA APPROVAL
✔ An approved drug will be
given generic name, brand
name, and chemical name.
PHASE 4 STUDIES
✔ Stage of continual evaluation.
✔ Prescribers are obligated to
report to the FDA any
untoward or unexpected
adverse effects associated with
drugs.
PHASE 4 STUDIES
✔ Some drugs cause
unexpected effects that are not
seen until wide distribution
occurs.
✔ Sometimes, those effects are
therapeutic.
PHASE 4 STUDIES
✔ For example, patients taking the
antiparkinsonism drug amantadine
(Symmetrel) were found to have
fewer cases of influenza than other
patients, leading to the discovery
that amantadine is an effective
antiviral agent.
PHASE 4 STUDIES
✔ In other instances, the unexpected
effects are dangerous.
✔ The diet drug dexfenfluramine
(Redux) may develop serious heart
problems.
✔ NSAID Rofecoxib (Vioxx) show an
increase in cardiovascular mortality.
SUMMARY
✔ To be approved for marketing, a
drug must pass through animal
testing, testing on healthy
humans, selected testing on
people with the disease being
treated, and then broad testing on
people with the disease being
treated.
ACTIVITY
✔ Using an appropriate
graphic organizer, outline
the steps involved in
developing and approving a
new drug.
DRUG
CLASSIFICATIONS
ORPHAN DRUGS
✔ Drugs that have been discovered but are not
financially viable and therefore have not been
“adopted” by any drug company.
✔ It may be useful in treating a rare disease, or
they may have potentially dangerous adverse
effects.
✔ These are often abandoned after preclinical
trials or phase I studies.
OVER-THE-COUNTER DRUGS
✔ Products that are available without
prescription for self-treatment of a variety
of complaints.
✔ OTC drugs have been found to be safe
when taken as directed, nurses should
consider several problems related to OTC
drug use:
OVER-THE-COUNTER DRUGS
1. Taking these drugs could mask the signs
and symptoms of underlying disease,
making diagnosis difficult.
2. Taking these drugs with prescription
medications could result in drug interactions
and interfere with drug therapy.
3. It could result in serious overdoses.
GENERIC DRUGS
✔ These are drugs no longer
protected by patent and can be
produced by companies other
than the one that developed
it.
OTHER WAYS TO
CLASSIFY DRUGS
BODY SYSTEM CLASSIFICATION
✔ It answer the question, “Which
system of the body is the drug for?”
✔ Examples include drugs intended
for the cardiovascular system,
respiratory, genitourinary,
gastrointestinal etc.
THERAPEUTIC USE/
CLINICAL INDICATION
✔ It answer the question, “What
disease or illness is being treated”
✔ Examples include drugs intended
for diabetes, hypertension, kidney
problems etc.
PHYSIOLOGICAL/
CHEMICAL ACTION
✔ It answer the question, “What
does the drug do in the body”
✔ Examples include drugs to reduce
cholesterol, lower down blood
pressure, relieve pain, etc.
PRESCRIPTION / NONPRESCRIPTION
✔ It answer the question, “Does the
medication require a prescription or can
be availed OTC?”
✔ Examples include prescription drugs such
as for hypertension, anti-cancer drugs or
nonprescriptions drugs such as some pain
relievers, supplements, etc.
ILLEGAL DRUGS
✔ It answer the question, “Is the
drug use for non therapeutic
reasons?”
✔ Examples include some controlled
substances such as cannabis.
DRUG FORMS/
PREPARATIONS
1. SOLID FORMS
✔ The entire dose is contained in
the preparation minimizing
measuring errors.
✔ Difficult to swallow, slower onset
and may be degraded by acidic
content of the stomach.
TABLET / CAPLET
✔ The active ingredient is
combined with another substance
and pressed into a round or oval
solid shape.
✔ Soluble or dispersible tablets
can safely be dissolved in water.
TABLET / CAPLET
✔ Buccal or Sublingual Tablets
These are held in the cheek
(buccal) or underneath the
tongue (sublingual) so the mouth
lining absorbs the active
ingredient.
FORMS OF TABLET
A.) Chewable Tablets - designed
to be chewed and contain a base
that is flavored or colored.
✔ Covenient for patients who
have difficulty swallowing tablets.
B.) Oral Disintegrating Tablets (ODT) -
designed to dissolve in the mouth
without water; useful for pedia and
geriatric clients who have difficulty
swallowing and for those who are
experiencing nausea and vomitting.
✔ Can not be “cheeked” by patients who
are not compliant with the drug regimen.
C.) Enteric- Coated Tablets - with
coating to mask the unpleasant flavor or
odor, and to protect the drug from the
stomach contents.
✔ The coat prevents dissolution in the
stomach and are meant to dissolve in the
intestines.
✔ Protects as well the stomach lining with the
effects of the drug (i.e. KCl and ASA)
D.) Film- Coated Tablets - are
coated with a thin outer layer of water
soluble material that dissolves rapidly
in the stomach.
✔ The coat is designed to cover the
unpleasant taste or smell and protect
sensitive drugs from deterioration due
to air and light (i.e. Erythromycin).
E.) Sugar- Coated Tablets -
are coated with outside layer of
sugar that protects the
medication and improves the
taste and the appearance of the
medication.
CAPSULES
✔ The active part of the medicine is
contained inside a plastic shell (transparent,
semi-transparent, or opaque) that dissolves
slowly in the stomach.
✔ It contains liquid, powder, granule, or
crushed tablet and are formulated with
delayed-release characteristics to allow for
less-frequent dosing and or side effects.
FORMS OF CAPSULES
A.) Spanules - capsules that are filled
with granules that dissolves at different rates, in
effect causing sustained-release of the active
ingredient.
B.) Sprinkle Capsule - similar to
spanules but unique in that it is designed to be
pulled apart and the contents are sprinkled into
foods.
Dosage
Formulations to
Designed to Alter
Rate of Release
1. Immediate- Release Formulation
✔ The medication is released within a
short period of time after the drug is
taken.
2. Delayed- Release Formulation
✔ The release of the medication is extended
or delayed until it has passed through the
stomach.
3. Controlled- Release Formulation
✔ It regulate the rate of release of the
active ingredient.
✔ They are designed to vary the
dissolution rate or release of the active
drug.
✔ Also referred to as long-acting and
timed-released formulations.
4. Sustained- Release Formulation
✔ It allows the frequency of the
dosing to be reduced compared to
that of immediate- release dosage
forms.
5. Extended- Release Formulation
✔ The active ingredient is released at
a constant rate for a prolonged period
so that the frequency of dosing is less
than the immediate-release dosage form.
✔ Usually for once daily dosing and the
medication is available over an
extended period of time.
❖ Compared to immediate-release
preparations, advantages of extended-
release dosage forms include the following:
✔ Constant drug level following long-term
administration
✔ Reduction of side effects
✔ Reduction in administration frequency
✔ Increased patient compliance
LOZENGES / TROCHES / PASTILLES
✔ Identified as flat, hard, oval, or

discoid disks containing a
medicinal agent in a suitable
flavoured base which is held in
the mouth to dissolve slowly.
POWDERS
✔Consists of fine mineral dusts such as talc
and are applied by dusting.
✔ This is used to absorb moisture from the
skin thereby altering conditions favorable
to the growth of microorganisms.
✔ It can be used internally and should be
dissolved in water prior to ingestion.
GRANULES
✔ Larger than powders and are wetted,
allowed to dry, and ground into
coarse, irregularly shaped pieces.
✔ More stable than powders and are
more suitable in solutions because
they will less likely to float in liquids.
2. SEMI SOLID FORMS
✔ They come in tubs, bottles or
tubes depending on the type of
medicine.
✔ The active part of the medicine is
mixed with another substance,
making it easy to apply to the skin.
✔ These are creams, lotions or ointments
applied directly onto the skin (topical
application).
✔ Maybe placed in nasal, vaginal, rectal,
and anorectal cavities.
✔ The dosage are too thick not to be
considered a liquid form and not solid
enough to be considered solid form.
EMULSIONS
✔ A type of semi-solid dosage form wherein a
mixture is unblendable.
✔ One substance is dispersed in the other.
✔ An Oil-in-Water (O/W) emulsion contains
small amount of oil dispersed in water.
✔ A Water-in-Oil (W/O) emulsion contains
small amount of water dispersed in oil.
EMULSIFYING AGENT
✔ A chemical that is used to bind
subtances that normally do not
mix.
✔ It has water-loving and oil-
loving properties that keep oil and
water together.
OINTMENTS
✔ Applied externally to the skin or mucous
membranes or can be formulated and sterilized
for use in the eyes.
✔ It is an example of water-in-oil emulsion.
✔ It contain medication in a glycol or oil base
and can effectively cover the skin.
✔ Generally greasier and can leave oily residue
at the site of application.
CREAMS
✔ It contains suspension or solutions of drug
intended for external use.
✔ An example of oil-in-water emulsion and can
easily be massaged into the skin without leaving
oily residue.
✔ It can be formulated for vaginal or rectal use.
✔ Examples include hydrocortisone cream, benzoyl
peroxide cream, and betamethasone valerate
cream.
LOTIONS
✔ An oil-in-water emulsion that is thinner
than a cream because it contains more
water.
✔ It can penetrate in the skin and can cover
large areas without leaving an oily residue.
✔ Examples are calamine lotion and
hydrocortisone lotion.
GELS
✔ Contain solid medication like a suspension in
a thick liquid that can be used internally or
externally.
✔ Particles are ultrafine and form semisolid.
✔ Can penetrate the skin without leaving
residue.
✔ Examples are aluminum hydroxide gel and
benzocaine gel.
PASTES
✔ It contains more solid material
and less liquid base than a solid.
✔ They are like ointments, but
stiffer, less greasy, and applied
more thickly.
✔ An example is zinc oxide.
SUPPOSITORIES
✔ The active part of the medicine is combined
with another substance and pressed into a
“bullet shape” so it can be inserted in the anal,
rectal, vaginal or urethral area and melts in a cavity,
releasing the medication.
✔ It can be for local action and vehicle for systemic
drugs.
✔ Suppositories must not be swallowed.
✔ Used for children with difficulty taking oral
medications.
✔ Rectal suppositories by- pass stomach and
helpful to patients with nausea and vomitting.
✔ Used to treat inflammatory bowel disease
or pain.
✔ Vaginal suppositories are for yeast infections
and vaginal athropy.
✔ Examples are miconazole (vaginal) and
bisacodyl (rectal) suppositories.
3.) LIQUID FORMS
✔ The active part of the medicine
is combined with a liquid to
make it easier to take or better
absorbed.
✔It is also called a “mixture”,
“solution” or “syrup”.
DROPS
✔ These are often used where the
active part of the medicine works
best if it reaches the affected
area directly.
✔ They tend to be used for eye, ear
or nose.
SOLUTIONS
✔ A homogenous mixture of
solute and solvent where it is
in aqueous (water-based),
alcoholic or hydroalcoholic
form.
A.) Aromatic Solution
✔ Aqueous solution that contains oil or
other volatile substance. They usually have
pleasant smell.
B.) Elixir
✔ It is a clear, sweet solution that contains
dissolved medication in a base of water and
ethanol (hydroalcoholic).
C.) Syrup
✔ Sugar-based solution that may masked
the taste of the drug.
D.) Extract
✔ It is a powder or liquid derived from
animal or plant sources in which all or
most of the solvent has been evaporated.
E.) Tincture
✔ An alcoholic or hydroalcoholic solution
that contains plant extract.
F.) Spirit
✔ It is an alcoholic or hydroalcoholic
solution that contains volatile, aromatic
ingredients.
G.) Irrigating Solution
✔ A solution that is used for
cleansing an area of the
body.
DISPERSIONS
✔ The medication is not dissolved in
a liquid but is “dispersed”
throughout.
SUSPENSION- a mixture of
undissolved, fine, solid particles
throughout the solid, liquid, or gas.
AQUEOUS SUSPENSION- a
mixture of medication in which
solids are dispersed in a water
medium.
NOTE: Suspension needs to be
shaken before use and must have
“shake well” auxillary label.
INJECTABLE
SUSPENSION
✔ allows insoluble drugs to be
administered using a syringe.
✔ Often used for depot
therapy- the drug is released
✔ Subcutaneous or SC injections
are given just under the surface of
the skin.
✔ Intramuscular or IM injections
are given into a muscle.
✔ Intrathecal injections are given
into the fluid around the spinal
cord.
✔ Intravenous or IV injections are
given into a vein.
ENEMAS
✔ Deliver medications rectally, a way
that by-passes the stomach.
✔ Water-based medication used to
evacuate intestinal contents as a
preparation for surgeries and
examinations of the intestines.
4. INHALATION FORMS
✔ The active part of the
medicine is released under
pressure directly into the
lungs via the nose or mouth.
AEROSOLS
✔ It is a spray that contains very
fine liquid or solid particles in a
gas propellant that is packaged
under pressure.
✔ It has a rapid onset of action
SPRAYS
✔ It consists of a container that has a
valve assembly unit that contains
various bases, such as alcohol or
water, in pump-type dispenser.
✔ When activated, it emits fine liquid,
solid or gaseous material.
5. TRANSDERMAL FORMS
Patch or Disk
✔ Designed to hold medication to be released in
the skin and absorbed into the blood stream.
✔ It contains backing, drug reservoir, control
membrane and adhesive layer.
✔ Drugs are absorbed slowly, easily applied, and
minimized stomach upset.
✔ Examples are nitroglycerine,
fentanyl, scopolamine, and
nicotine for their systemic effects.
Note: Gels are also in transdermal
forms which are slowly absorbed in
the skin.
IMPLANTS
✔ Placing a drug form or a device
in the desired site by insertion in
a body tissue or cavity by surgical
or appropriate insertion
techniques.
SOURCES OF
DRUG
INFORMATION
DRUG LABEL
PACKAGE INSERTS
✔ It contains all of the chemical and
study information that led to the
drug’s approval.
✔ It is diffi cult to understand and are
almost always in very small print,
making them difficult to read.
REFERENCE BOOKS
❖ The Physician’s Desk Reference (PDR) is
a compilation of the package insert
information from drugs along with some drug
advertising.
✔ Information is not refereed and is not the
best source of information about a drug.
✔ This information is heavily cross-referenced.
✔ The book may be difficult to use.
❖ The Drug Facts and Comparisons
✔ It provides a wide range of drug information,
including comparisons of drug costs, patient
information sections, and preparation and
administration guidelines.
✔ This book is organized by drug class and can
be more user-friendly than the PDR.
✔ However, it is cumbersome and very
expensive.
❖ The AMA Drug Evaluations
✔ It contains detailed monographs in an
unbiased format and includes many new
drugs and drugs still in the research stage.
❖ The Lippincot's Nursing Drug Guide
✔ It has drug monographs organized
alphabetically and includes nursing
implications and patient teaching points.
JOURNALS
❖ 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.
ONLINE SOURCES
OTHER SOURCES
✔ The American Hospital Formulary Service
Dug Information
✔ Drug Interaction Facts
✔ Handbook of Nonprescription Drugs
✔ Natural Medications Comprehensive
Database
SAMPLE
DRUG
MONOGRAPH
GLOSSARY OF TERMS
PHARMACODYNAMICS
✔ The study of the interactions
between the chemical components
of living systems and the foreign
chemicals, including drugs, that
enter those systems.
✔ “how the drug affects the body”.
THERAPEUTIC
INDEX
AND
DRUG SAFETY
THERAPEUTIC INDEX
✔ Also known as therapeutic
window or ratio.
✔ It is the comparison between the
amount of drug that causes
harm (toxicity) and the amount of
drug providing therapeutic
effect.
✔ Mathematically expressed as:
TD50 / ED50
✔ Where:
ED = median effective dose, a
dose where 50% effect is reached.
TD = toxic dose, a dose where
50% experience toxicity is
reached.
What conclusion can be derived ?
A. It is not a safe drug.

B. It is a very safe drug.
INTERPRETATIONS
✔ LOW therapeutic index
=not safe drugs
= needs monitoring
✔ HIGH or WIDE therapeutic index
= safer drugs
GRADED DOSE
RESPONSE
RELATIONSHIP
DOSE - RESPONSE CURVE
✔ An illustration that
evaluates and compares
efficacy and potency of
related drugs.
DRUG
POTENCY
AND
EFFICACY
DRUG POTENCY
✔ It refers to the concentration or
amount of drug needed to achieve a
therapeutic effect.
✔ The lesser the amount of drug
needed to achieve a therapeutic
effect, the more potent the drug is.
DRUG EFFICACY
✔ The level as to which a drug
reaches a therapeutic effect.
✔ The higher the effect, the
more efficacious the drug is.
CALCULATING
PERCENT
ADHERENCE
PERCENT ADHERENCE
✔ The extent to which a persons
behavior when taking medication,
following a diet or executing lifestyle
changes, corresponds with agreed
recommendations from health care
provider.
✔ Non-adherent behaviors include
missing doses, taking drug
holidays, taking extra doses
when not feeling well, changing
the timing of doses or
inconsistently not taking
medications.
REASONS FOR NON ADHERENCE
✔ Complex instructions
✔ Asymptomatic diseases
✔ Side effects of medications
✔ Cognitive impairment
✔ Poor insight to illness
REASONS FOR NON ADHERENCE
✔ Cost of medication
✔ Poor nurse-patient relationship
✔ Inadequate discharge planning
✔ Lack of follow up
✔ Lack of belief in the regimen
GENERAL FORMULA
Sample Problem # 1
✔ If the prescription was filled on August 10,
how long will this fill last and when should
Jacob be back for a refill?
✔ The instruction is to take 1 tablet PO 3x a
day.
✔ Jacob should be back in about 3 months

(November 10)
✔ If Jacob comes back after 110 days for
the next refill, what is the percent
adherence?
Sample Problem # 2
Problem # 1
Problem # 2
CELLULAR RECEPTOR
SITES AND DRUG
ACTION
Drugs usually work in one of four ways:
✔ To replace or act as substitutes for
missing chemicals.
✔ To increase or stimulate certain cellular
activities.
✔ To depress or slow cellular activities.
✔ To interfere with the functioning of
foreign cells, such as invading
microorganisms or neoplasms.
RECEPTOR SITES
✔ Areas on the cell membrane where
drugs or chemical react to cause an
effect within the cell.
✔ Nearby enzymes break down the
reacting chemicals and open the
receptor site for further stimulation.
RECEPTOR SITES
✔ 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.
AGONIST
✔ These are drugs that interact directly
with receptor sites to cause the same
activity that natural chemicals would
cause at that site.
✔ For example, insulin reacts with specific
insulin-receptor sites to change cell
membrane permeability, thus promoting the
movement of glucose into the cell.
ANTAGONIST
✔ These are drugs act to
prevent the breakdown of
natural chemicals that are
stimulating the receptor site.
EXAMPLE
✔ Monoamine oxidase (MAO) inhibitors block the
breakdown of norepinephrine by the enzyme MAO.
✔ Normally, MAO breaks down norepinephrine.
✔ The blocking action of MAO inhibitors allows
norepinephrine to stay on the receptor site,
stimulating the cell longer and leading to prolonged
norepinephrine effects.
✔ Those effects can be therapeutic (e.g., relieving
depression) or adverse (e.g., increasing heart rate
and blood pressure).
COMPETITIVE ANTAGONIST
✔ Drugs react with receptor sites to
block normal stimulation, producing no
effect.
✔ EXAMPLE: Curare occupies receptor sites
for acetylcholine, which is necessary for
muscle contraction and movement.
✔ Curare prevents muscle stimulation,
causing paralysis.
NON COMPETITIVE ANTAGONST
✔ Drugs that react with specific
receptor sites on a cell and by
reacting there, prevent the
reaction of another chemical
with a different receptor site
on that cell.
DRUG- ENZYME INTERACTION
✔ Drugs can interfere with the enzyme
systems that act as catalysts for various
chemical reactions.
✔ Enzyme systems work in a cascade fashion,
with one enzyme activating another until a
cellular reaction eventually occurs.
✔ If a single step in one of the many enzyme
systems is blocked, normal cell function is
disrupted.
EXAMPLE
✔ Acetazolamide (Diamox) is a
diuretic that blocks the enzyme
carbonic anhydrase, which
subsequently causes alterations in
the hydrogen ion and water
exchange system in the kidney, as
well as in the eyes.
SELECTIVE TOXICITY
✔ The ability of a drug to attack only
those systems found in foreign cells.
✔ Penicillin, an antibiotic affects an
enzyme system unique to bacteria,
causing bacterial cell death without
disrupting normal human cell
functioning.
TYPES OF
INTERACTIONS
1. Drug–Drug / Drug–Alternative Therapy Interactions
2. Drug–Food Interactions
3. Drug–Laboratory Test Interactions
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.
Drug–Drug /
Drug–Alternative Therapy Interactions
✔ If there is very little difference
between a therapeutic dose and a
toxic dose of the drug (margin of
safety), interference with the drug’s
pharmacokinetics or pharmacodynamics
can produce serious problems.
Drug–drug interactions can occur
in the following situations:
1. At the site of absorption: One drug
prevents or accelerates absorption of the
other drug.
✔ For example, the antibiotic tetracycline is
not absorbed from the GI tract if calcium or
calcium products (milk) are present in the
stomach.
2. During distribution: One
drug competes for the protein-
binding site of another drug, so
the second drug cannot be
transported to the reactive tissue.
✔For example, aspirin competes with the
drug methotrexate (Rheumatrex) for
protein-binding sites.
✔ Because aspirin is more competitive
for the sites, the methotrexate is
bumped off, resulting in increased
release of methotrexate and increased
toxicity to the tissues.
3. During biotransformation: One
drug stimulates or blocks the metabolism
of the other drug.
✔ For example: Warfarin (Coumadin), an oral
anticoagulant, is biotransformed more quickly
if it is taken at the same time as barbiturates,
rifampin, or many other drugs.
✔ Because the warfarin is biotransformed to an
inactive state more quickly, higher doses will be
needed to achieve the desired effect.
✔ Patients who use St. John’s wort may experience
altered effectiveness of several drugs that are
affected by that herb’s effects on the liver.
✔ Digoxin, theophylline, oral contraceptives,
anticancer drugs, drugs used to treat HIV, and
antidepressants are all reported to have serious
interactions with St. John’s wort.
4. During excretion: One drug
competes for excretion with the
other drug, leading to
accumulation and toxic effects of
one of the drugs.
✔For example, Digoxin (Lanoxin) and
quinidine are both excreted from the
same sites in the kidney.
✔ If they are given together, the
quinidine is more competitive for these
sites and is excreted, resulting in
increased serum levels of digoxin, which
cannot be excreted.
3. At the site of action: One
drug may be an antagonist of the
other drug or may cause effects
that oppose those of the other
drug, leading to no therapeutic
effect.
✔ Example, when an antihypertensive
drug is taken with an antiallergy drug
that also increases blood pressure.
✔ The effects on blood pressure are
negated, and there is a loss of the
antihypertensive effectiveness of the
drug.
✔ Example: If a patient is taking
antidiabetic medication and also
takes the herb ginseng, which
lowers blood glucose levels, he or
she may experience episodes of
hypoglycemia and loss of blood
glucose control.
NURSE'S RESPONSIBILITY
✔ Whenever two or more drugs are being
given together, first consult a drug guide
for a listing of clinically significant drug–
drug interactions.
✔ Sometimes problems can be avoided by
staggering the administration of the
drugs or adjusting their doses.
DRUG - FOOD INTERACTIONS
✔ It occurs when the drug and the food
are in direct contact in the stomach.
✔ Some foods increase acid
production, speeding the breakdown
of the drug molecule and preventing
absorption and distribution of the
drug.
EXAMPLES
1. Antibiotic tetracycline cannot be taken with
iron products. Tetracycline binds with calcium
and should not be taken with foods or other
drugs containing calcium.
2. Grapefruit juice has found to affect liver
enzyme systems for up to 48 hours after it has
been ingested. This can result in increased or
decreased serum levels of certain drugs.
✔ Food selection for ingestion with the
drug should be something that is known
not to interact with it.
✔ Drug monographs usually list important
drug–food interactions and give guidelines
for avoiding problems and optimizing the
drug’s therapeutic effects.
DRUG - LAB TEST INTERACTIONS
✔ It is caused by the drug being given
and not necessarily by a change in
the body’s responses or actions.
✔ If one test result is altered and does
not fit in with the clinical picture or other
test results, consider the possibility of
this interaction.
EXAMPLE:
✔ Dalteparin (Fragmin), a low-
molecular_x0002_weight heparin used to
prevent deep vein thrombosis after
abdominal surgery, may cause increased
levels of the liver enzymes aspartate
aminotransferase and alanine
aminotransferase with no injury to liver
cells or hepatitis.
OPTIMAL THERAPEUTIC EFFECT
✔ History taking and physical
assessment should be added in the
plan of care so that problems can be
handled promptly.
✔ If a drug just does not do what it is
expected to do, further examine the
factors that are known to influence
drug effects.
✔ Drug regimen can be modified to
deal with that influence.
✔ Rarely it is necessary to
completely stop drug regimen
because of adverse or intolerable
effects.
CELLULAR RECEPTOR
SITES AND DRUG
ACTION
Drugs usually work in one of four ways:
✔ To replace or act as substitutes for
missing chemicals.
✔ To increase or stimulate certain cellular
activities.
✔ To depress or slow cellular activities.
✔ To interfere with the functioning of
foreign cells, such as invading
microorganisms or neoplasms.
RECEPTOR SITES
✔ Areas on the cell membrane where
drugs or chemical react to cause an
effect within the cell.
✔ Nearby enzymes break down the
reacting chemicals and open the
receptor site for further stimulation.
RECEPTOR SITES
✔ 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.
AGONIST
✔ These are drugs that interact directly
with receptor sites to cause the same
activity that natural chemicals would
cause at that site.
✔ For example, insulin reacts with specific
insulin-receptor sites to change cell
membrane permeability, thus promoting the
movement of glucose into the cell.
ANTAGONIST
✔ These are drugs act to
prevent the breakdown of
natural chemicals that are
stimulating the receptor site.
EXAMPLE
✔ Monoamine oxidase (MAO) inhibitors block the
breakdown of norepinephrine by the enzyme MAO.
✔ Normally, MAO breaks down norepinephrine.
✔ The blocking action of MAO inhibitors allows
norepinephrine to stay on the receptor site,
stimulating the cell longer and leading to prolonged
norepinephrine effects.
✔ Those effects can be therapeutic (e.g., relieving
depression) or adverse (e.g., increasing heart rate
and blood pressure).
COMPETITIVE ANTAGONIST
✔ Drugs react with receptor sites to
block normal stimulation, producing no
effect.
✔ EXAMPLE: Curare occupies receptor sites
for acetylcholine, which is necessary for
muscle contraction and movement.
✔ Curare prevents muscle stimulation,
causing paralysis.
NON COMPETITIVE ANTAGONST
✔ Drugs that react with specific
receptor sites on a cell and by
reacting there, prevent the
reaction of another chemical
with a different receptor site
on that cell.
DRUG- ENZYME INTERACTION
✔ Drugs can interfere with the enzyme
systems that act as catalysts for various
chemical reactions.
✔ Enzyme systems work in a cascade fashion,
with one enzyme activating another until a
cellular reaction eventually occurs.
✔ If a single step in one of the many enzyme
systems is blocked, normal cell function is
disrupted.
EXAMPLE
✔ Acetazolamide (Diamox) is a
diuretic that blocks the enzyme
carbonic anhydrase, which
subsequently causes alterations in
the hydrogen ion and water
exchange system in the kidney, as
well as in the eyes.
SELECTIVE TOXICITY
✔ The ability of a drug to attack only
those systems found in foreign cells.
✔ Penicillin, an antibiotic affects an
enzyme system unique to bacteria,
causing bacterial cell death without
disrupting normal human cell
functioning.
TYPES OF
INTERACTIONS
1. Drug–Drug / Drug–Alternative Therapy Interactions
2. Drug–Food Interactions
3. Drug–Laboratory Test Interactions
INTERACTIONS
Drug–Drug /
Drug–Alternative Therapy Interactions
✔ If there is very little difference
between a therapeutic dose and a
toxic dose of the drug (margin of
safety), interference with the drug’s
pharmacokinetics or pharmacodynamics
can produce serious problems.
1. At the site of absorption: One drug
prevents or accelerates absorption of the
other drug.
✔ For example, the antibiotic tetracycline is
not absorbed from the GI tract if calcium or
calcium products (milk) are present in the
stomach.
2. During distribution: One
drug competes for the protein-
binding site of another drug, so
the second drug cannot be
transported to the reactive tissue.
✔For example, aspirin competes with the
drug methotrexate (Rheumatrex) for
protein-binding sites.
✔ Because aspirin is more competitive
for the sites, the methotrexate is
bumped off, resulting in increased
release of methotrexate and increased
toxicity to the tissues.
3. During biotransformation: One
drug stimulates or blocks the metabolism
of the other drug.
✔ For example: Warfarin (Coumadin), an oral
anticoagulant, is biotransformed more quickly
if it is taken at the same time as barbiturates,
rifampin, or many other drugs.
✔ Because the warfarin is biotransformed to an
inactive state more quickly, higher doses will be
needed to achieve the desired effect.
✔ Patients who use St. John’s wort may experience
altered effectiveness of several drugs that are
affected by that herb’s effects on the liver.
✔ Digoxin, theophylline, oral contraceptives,
anticancer drugs, drugs used to treat HIV, and
antidepressants are all reported to have serious
interactions with St. John’s wort.
4. During excretion: One drug
competes for excretion with the
other drug, leading to
accumulation and toxic effects of
one of the drugs.
✔For example, Digoxin (Lanoxin) and
quinidine are both excreted from the
same sites in the kidney.
✔ If they are given together, the
quinidine is more competitive for these
sites and is excreted, resulting in
increased serum levels of digoxin, which
cannot be excreted.
3. At the site of action: One
drug may be an antagonist of the
other drug or may cause effects
that oppose those of the other
drug, leading to no therapeutic
effect.
✔ Example, when an antihypertensive
drug is taken with an antiallergy drug
that also increases blood pressure.
✔ The effects on blood pressure are
negated, and there is a loss of the
antihypertensive effectiveness of the
drug.
✔ Example: If a patient is taking
antidiabetic medication and also
takes the herb ginseng, which
lowers blood glucose levels, he or
she may experience episodes of
hypoglycemia and loss of blood
glucose control.
✔ Whenever two or more drugs are being
given together, first consult a drug guide
for a listing of clinically significant drug–
drug interactions.
✔ Sometimes problems can be avoided by
staggering the administration of the
drugs or adjusting their doses.
DRUG - FOOD INTERACTIONS
✔ It occurs when the drug and the food
are in direct contact in the stomach.
✔ Some foods increase acid
production, speeding the breakdown
of the drug molecule and preventing
absorption and distribution of the
drug.
EXAMPLES
1. Antibiotic tetracycline cannot be taken with
iron products. Tetracycline binds with calcium
and should not be taken with foods or other
drugs containing calcium.
2. Grapefruit juice has found to affect liver
enzyme systems for up to 48 hours after it has
been ingested. This can result in increased or
decreased serum levels of certain drugs.
✔ Food selection for ingestion with the
drug should be something that is known
not to interact with it.
✔ Drug monographs usually list important
drug–food interactions and give guidelines
for avoiding problems and optimizing the
drug’s therapeutic effects.
DRUG - LAB TEST INTERACTIONS
✔ It is caused by the drug being given
and not necessarily by a change in
the body’s responses or actions.
✔ If one test result is altered and does
not fit in with the clinical picture or other
test results, consider the possibility of
this interaction.
EXAMPLE:
✔ Dalteparin (Fragmin), a low-
molecular_x0002_weight heparin used to
prevent deep vein thrombosis after
abdominal surgery, may cause increased
levels of the liver enzymes aspartate
aminotransferase and alanine
aminotransferase with no injury to liver
cells or hepatitis.
✔ History taking and physical
assessment should be added in the
plan of care so that problems can be
handled promptly.
✔ If a drug just does not do what it is
expected to do, further examine the
factors that are known to influence
drug effects.
✔ Drug regimen can be modified to
deal with that influence.
✔ Rarely it is necessary to
completely stop drug regimen
because of adverse or intolerable
effects.
PHARMACOKINETICS
✔ How the body acts on the drug

including absorption, distribution,
biotransformation, and excretion.
PHARMACOKINETICS
✔ In clinical practice, it include the
onset of drug action, drug half-life,
timing of the peak effect, duration of
drug effects, metabolism or
biotransformation of the drug, and
the site of excretion.
CRITICAL CONCENTRATION
✔ The amount of a drug that is needed to
cause a therapeutic effect (recommended
dose).
✔ Too much of a drug will produce toxic
(poisonous) effects.
✔ Too little will not produce the desired
therapeutic effects.
LOADING DOSE
✔ Some drugs may take a prolonged period to
reach a critical concentration.
✔ If their effects are needed quickly, a loading
dose is recommended.
✔ A higher dose than that usually used for
treatment to reach the critical concentration.
✔ The critical concentration then is maintained
by using the recommended dosing schedule.
EXAMPLE
✔ Digoxin (Lanoxin) - a drug used to
increase the strength of heart
contractions.
✔ Xanthine bronchodilators (e.g.,
aminophylline, theophylline) used to
treat asthma attacks are often started
with a loading dose.
DYNAMIC EQUILIBRIUM
✔ The actual concentration that a drug
reaches in the body results from a dynamic
equilibrium involving several processes:
❖ Absorption from the site of entry
❖ Distribution to the active site
❖ Biotransformation (metabolism) in the liver
❖ Excretion from the body
✔ These processes are key elements in
determining the amount of drug (dose) and the
frequency of dose repetition (scheduling)
required to achieve the critical concentration for
the desired length of time.
✔ When administering a drug, the nurse needs to
consider the phases of pharmacokinetics so that
the drug regimen can be made as effective as
possible.
PHASES OF
PHARMACOKINETICS
1.) LIBERATION
✔ The process in which a pharmaceutical
substance is released from the
formulation it is delivered in.
✔ The release of the drug from it's
dosage form.
✔ This must occur before the drug can
be absorbed into the body.
2.) ABSORPTION
✔ It refers to what happens to a drug from
the time it is introduced to the body
until it reaches the circulating fluids
and tissues.
✔ Site of absorption: GI tract either orally
or rectally, mucous membranes, skin,
lungs, muscles or subcutaneous tissues.
GENERAL CLASSIFICATION OF ROUTES
✔ ENTERAL- drugs administered directly
in the gastrointestinal tract.
✔ PARENTERAL- drugs administered
that by-pass the gastrointestinal tract.
✔ PERCUTANEOUS- drugs administered
through the skin or mucous membrane.
ROUTES OF ADMINISTRATION
✔ ORAL ROUTE - slow absortion, most
frequently used, less expensive, safest, and
patients can easily continue their drug
regimen at home when they are taking
medications.
✔ It subjects the drug to a number of barriers
aimed at destroying ingested foreign
chemicals.
✔ When food is present, stomach acidity is
higher and the stomach empties more slowly,
thus exposing the drug to the acidic
environment for a longer period.
✔ Certain foods that increase stomach acidity,
such as milk products, alcohol, and protein,
also speed the breakdown of many drugs.
✔ Oral drugs ideally are to be given 1 hour
before or 2 hours after a meal.
✔ INTRAVENOUS ROUTE - reach their
full strength at the time of injection, avoiding
initial breakdown, have an immediate onset
and are fully absorbed at administration
because they directly enter the blood stream.
✔ These drugs are more likely to cause toxic
effects because the margin for error in dose is
much smaller.
✔ INTRAMUSCULAR ROUTE -
absorbed directly into the capillaries
in the muscle and sent into
circulation.
✔ This takes time because the drug
must be picked up by the capillary
and taken into the veins.
✔ Men have more vascular muscles
than women do.
✔ As a result, drugs administered to
men via the IM route reach a peak
level faster than they do in women.
✔ SUBCUTANEOUS ROUTE -
deposit the drug just under the skin, where
it is slowly absorbed into circulation.
✔ Timing of absorption varies with
subcutaneous injection, depending on the
fat content of the injection site and the
state of local circulation.
✔ TOPICAL ROUTE - suitable
on intact skin and others that contain
a medication are used for the
treatment of broken skin or a wound.
✔ TRANSDERMAL- absorbed
from the surface of the skin.
✔ OPTHALMIC ROUTE -
medications are administered and
absorbed in the eyes.
✔ OTIC ROUTE- absorbed from the
ears.
✔ INHALATION ROUTE- absorbed
in the lungs via the nose.
✔ NGT BOLUS ROUTE
✔ INTRAVAGINAL ROUTE
✔ INTRAVENOUS PIGGY BACK
✔ RECTAL ROUTE
✔ BUCCAL AND SUBLINGUAL ROUTES
✔ INTRATHECAL
✔ INTRACARDIAL
✔ INTRA-ARTICULAR
✔ NASAL
✔ INTRADERMAL
ROUTE & FACTORS AFFECTING ABSORPTION
ABSORPTION PROCESSES
✔ PASSIVE DIFFUSION-
movement of drug from higher to lower
concentration and does not require energy.
✔ Occurs quickly to smaller molecules, soluble
in water & lipids, has no electrical charge that
could repel it from the cell membrane.
✔ ACTIVE TRANPOST - that
uses energy to actively move a molecule
across a cell membrane.
✔ The molecule may be large, or it may be
moving against a concentration gradient.
✔ It is a very important process in drug
excretion in the kidney.
✔ FILTRATION - involves movement
through pores in the cell membrane, either
down a concentration gradient or as a result
of the pull of plasma proteins (when pushed
by hydrostatic, blood, or osmotic pressure).
✔It is another process the body commonly
uses in drug excretion.
3.) DISTRIBUTION
✔ It involves the movement of a
drug to the body’s tissues.
✔ Factors that can affect
distribution include the drug’s lipid
solubility and ionization and the
perfusion of the reactive tissue.
EXAMPLE # 1
✔ Tissue perfusion is a factor in treating a patient with
diabetes who has a lower-leg infection and needs
antibiotics to destroy the bacteria in the area.
✔ In this case, systemic drugs may not be effective
because part of the disease process involves changes
in the vasculature and decreased blood flow to
some areas, particularly the lower limbs.
✔ If there is no adequate blood flow to the area, little
antibiotic can be delivered to the tissues, and little
antibiotic effect will be seen.
EXAMPLE # 2
✔ Patients in a cold environment may have
constricted blood vessels (vasoconstriction)
in the extremities, which would prevent blood
flow to those areas.
✔ The circulating blood would be unable to
deliver drugs to those areas, and the patient
would receive little therapeutic effect from
drugs intended to react with those tissues.
DISTRIBUTION PROCESSES
PROTEIN BINDING
✔ Some drugs are tightly bound and are
released very slowly.
✔ These drugs have a very long duration of
action because they are not free to be
broken down or excreted and are released
very slowly into the reactive tissue.
✔ Some drugs are loosely bound;
they tend to act quickly and to be
excreted quickly.
✔ Some drugs compete with each
other for protein binding sites,
altering effectiveness or causing
toxicity when the two drugs are
given together.
BLOOD- BRAIN BARRIER
✔ It is a protective system of cellular
activity that keeps foreign invaders,
poisons and similar materials away from
the CNS.
✔ Drugs that are highly lipid soluble are
more likely to pass through the blood–
brain barrier and reach the CNS.
✔ Almost all antibiotics are not lipid
soluble and cannot cross the blood–
brain barrier. Effective antibiotic
treatment can occur only when the
infection is severe enough to alter
the blood–brain barrier and allow
antibiotics to cross.
✔ Although many drugs can cause adverse
CNS effects, these are often the result of
indirect drug effects and not the actual
reaction of the drug with CNS tissue.
✔ For example, alterations in glucose levels
and electrolyte changes can interfere with
nerve functioning and produce CNS effects
such as dizziness, confusion, or changes in
thinking ability.
PLACENTA & BREAST MILK
✔ Many drugs readily pass through the
placenta and affect the developing fetus in
pregnant women.
✔ It is best not to administer any drugs to
pregnant women.
✔ Drugs should be given only when the
benefit clearly outweighs any risk.
4.) METABOLISM/
BIOTRANSFORMATION
✔ The liver is the most important site of this
process wherein drugs are changed into
new, less active chemicals.
✔ Everything that is absorbed from the GI
tract first enters the liver to be “treated.”
✔ The liver detoxifies many chemicals and
uses others to produce needed enzymes and
structures.
FIRST- PASS EFFECT
✔ The phenomenon in which drugs given
orally are carried directly to the liver after
absorption, where they may be largely
inactivated by liver enzymes before they can
enter the general circulation.
✔ Oral drugs frequently are given in higher
doses than drugs given by other routes
because of this early breakdown.
HEPATIC ENZYME SYSTEM
✔ Phase I biotransformation- involves
oxidation- reduction, or hydrolysis of the
drug via the cytochrome P450 system of
enzymes.
✔ Phase II biotransformation- usually
involves a conjugation reaction that makes
the drug more polar and more readily
excreted by the kidneys.
✔ Increased activity in an enzyme system
speeds the metabolism of the drug.
✔ This explains why some drugs cannot be
taken together effectively.
✔ The presence of one drug speeds the
metabolism of others, preventing them from
reaching their therapeutic levels.
✔ Some drugs inhibit an enzyme system,
making it less effective.
✔ As a consequence, any drug that is
metabolized by that system will not be
broken down for excretion, and the blood
levels of that drug will increase, often to
toxic levels.
✔ These actions also explain why liver
disease is often a contraindication or a
reason to use caution when administering
certain drugs. If the liver is not functioning
effectively, the drug will not be metabolized
as it should be, and toxic levels could
develop rather quickly.
5.) EXCRETION
✔ It is the removal of a drug
from the body.
✔ The kidneys, skin, saliva,
lungs, bile and feces are some
of the routes used to excrete
drugs.
✔ 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.
✔ Kidney dysfunction and urine acidity are
factors to consider in drug toxicity due to
inability to excrete poisonous substances.
NURSING RESPOSIBILITY
✔ Dose adjustment needs to be
considered if a patient has problems
with either the liver or the kidneys.
✔ Assessment should be done before
starting drug therapy.
DRUG HALF- LIFE
✔ The time it takes for the amount of drug
in the body to decrease to one half of the
peak level it previously achieved.
✔ This information is important in
determining the appropriate timing for a
drug dose or determining the duration of a
drug’s effect on the body.
✔ The half-life that is indicated in any
drug monograph is the half-life for a
healthy person.
✔ Using this information, one can estimate
the half-life of a drug for a patient with
kidney or liver dysfunction allowing the
prescriber to make changes in the dosing
schedule.
Factors Affecting
Responses to Drug
NOTE:
✔ 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.
✔ No two people react in exactly
the same way to any given drug.
WEIGHT
✔ People who are much heavier 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.
✔ Toxic effects may occur at the
recommended dose if the person is very
small.
AGE
✔ 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—less
effective absorption, distribution,
perfusion, altered biotransformation or
metabolism and less effective excretion.
AGE
✔ Children metabolize many drugs
differently than adults do, and they
have immature systems for handling
drugs.
✔ Many drugs come with recommended
pediatric doses, and others can be
converted to pediatric doses.
GENDER
✔ When giving IM injections, for it is important
to remember that men have more vascular
muscles, so the effects of the drug will be
seen sooner in men than in women.
✔ Women have more fat cells than men do,
so drugs that deposit in fat may be slowly
released and cause effects for a prolonged
period.
GENDER
✔ EXAMPLE, gas anesthetics
have an affinity for
depositing in fat and can
cause drowsiness and
sedation sometimes weeks
after surgery.
PHYSIOLOGIC 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.
PATHOLOGIC FACTORS
✔ 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.
✔ Body conditions can change the
basic pharmacokinetics of a drug.
EXAMPLES:
✔ GI disorders can affect the absorption of many
oral drugs.
✔ Vascular diseases and low blood pressure alter
the distribution of a drug, preventing it from
being delivered to the reactive tissue, thus
rendering the drug nontherapeutic.
✔ Liver or kidney diseases affect the way that a
drug is biotransformed and excreted and can
lead to toxic reactions when the usual dose is
given.
GENETICS
✔ 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.
✔ Others have differing metabolisms or
slightly different enzymatic makeups that
alter their chemical reactions and the effects
of a given drug.
PHARMACOERGONOMICS
✔ It is an area of study that explores the
unique differences in response to drugs
that each individual possesses based on
genetic makeup.
✔ Predictable differences in the
pharmacokinetics and pharmacodynamic
effects of drugs can be anticipated with
people of particular cultural backgrounds.
IMMUNOLOGIC FACTORS
✔ People can develop an allergy to a
drug.
✔ After exposure to its proteins, a
person can develop antibodies to a
drug.
✔ With future exposure to the same
drug, that person may experience a full-
blown allergic reaction.
PSYCHOLOGICAL FACTORS
✔ The patient’s attitude about a drug
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
PSYCHOLOGICAL FACTORS
✔ The patient’s personality also
influences compliance with the drug
regimen.
✔ Some people willingly follow a
prescribed regimen.
✔ Others do not trust the medical
system.
ENVIRONMENTAL FACTORS
✔ Some drug effects are
enhanced by a quiet, cool, non-
stimulating environment.
✔ Other drug effects may be
influenced by temperature.
ENVIRONMENTAL FACTORS
✔ EXAMPLE # 1: 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.
✔ EXAMPLE # 2: Antihypertensives that work
well during cold, winter months may become too
effective in warmer environments, when natural
vasodilation may lead to a release of heat that
tends to lower the blood pressure.
TOLERANCE
✔ 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 longer
causes the same reaction.
✔ Therefore, increasingly larger doses are
needed to achieve a therapeutic effect.
EXAMPLE:
✔ Morphine is an opiate used for pain relief.
✔ The longer morphine is taken, the more tolerant
the body becomes to the drug, so that larger and
larger doses are needed to relieve pain.
✔ It should be given in smaller doses or in
combination with other drugs that may also
relieve pain.
✔ Cross-tolerance—or resistance to drugs within
the same class may also occur in some situations.
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. This
can be avoided by following the drug
regimen precisely.
INTERACTIONS
DRUG
STANDARDS
LEARNING OBJECTIVES
✔ Describe the controls on drugs that have
abuse potential.
✔ Differentiate between generic and
brand-name drugs and over-the-counter and
prescription drugs.
✔ Explain the benefits and risks associated
with the use of over-the-counter drugs.
LEGAL REGULATIONS OF DRUGS
Pure Food and Drug Act of 1906
✔ The law that prevented the marketing of adulterated
drugs; required labeling to eliminate false or misleading
claims.
Federal Food, Drug and Cosmetic Act of 1938
✔ Mandated tests for drug toxicity and provided means
for recall of drugs; established procedures for introducing
new drugs; gave FDA the power of enforcement.
Durham- Humphrey Amendment of 1951
✔ Tightened control of certain drugs; specifi ed
drugs to be labeled “may not be distributed
without a prescription”.
Kefauver- Harris Act of 1962
✔ Tightened control over the quality of drugs;
gave FDA regulatory power over the procedure of
drug investigations; stated that efficacy as well as
safety of drugs had to be established.
Controlled Substances Act of 1970
✔ Defined drug abuse and classified drugs as
to their potential for abuse; provided strict
controls over the distribution, storage, and
use of these drugs.
Orphan Drug Act of 1983
✔ Provided incentives for the development of
orphan drugs for treatment of rare diseases.
SAFETY DURING
PREGNANCY
Food and Drug Administration
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 humans.
✔ 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
✔ Thereis 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
demonstrate fetal abnormalities or
adverse reaction; reports indicate
evidence of fetal risk.
✔ The risk of use in a pregnant woman
clearly outweighs any possible
benefit.
IMPORTANT NOTE
✔ Regardless of the designated
Pregnancy Category or presumed
safety, no drug should be
administered during pregnancy
unless it is clearly needed.
CONTROLLED
SUBSTANCES
CONTROLLED SUBSTANCES
✔ These are drugs with abuse
potential.
✔ Controlled Substances Act of
1970 established categories for
ranking of the abuse potential of
various drugs.
✔ This same act gave control over the
coding of drugs and the enforcement of
these codes to the FDA and the Drug
Enforcement Agency (DEA).
✔ The FDA studies the drugs and
determines their abuse potential; the DEA
enforces their control.
✔Each prescriber has a DEA
number, which allows the
DEA to monitor prescription
patterns and possible
abuse.
✔ These drugs are divided into
fi ve DEA schedules based on
their potential for abuse and
physical and psychological
dependence.
FIVE DEA SCHEDULES
✔ Schedule I (C-I): High abuse potential
and no accepted medical use (heroin,
marijuana, LSD)
✔ Schedule II (C-II): High abuse potential
with severe dependence liability
(narcotics, amphetamines, and
barbiturates).
FIVE DEA SCHEDULES
✔ Schedule III (C-III): Less abuse
potential than schedule II drugs and
moderate dependence liability
(nonbarbiturate sedatives,
nonamphetamine stimulants, limited
amounts of certain narcotics).
FIVE DEA SCHEDULES
✔ Schedule IV (C-IV): Less abuse
potential than schedule III and
limited dependence liability
(some sedatives, antianxiety
agents, and nonnarcotic
analgesics).
FIVE DEA SCHEDULES
✔ Schedule V (C-V): Limited abuse
potential.
✔ Primarily small amounts of narcotics
(codeine) used as antitussives or
antidiarrheals.
✔ Limited quantities of these drugs may be
purchased without a prescription.
FIVE DEA SCHEDULES
✔ The purchaser must be at least 18
years of age and must furnish
suitable identification.
✔All such transactions must be
recorded by the dispensing
pharmacist.
The Nursing
Process in Drug
Therapy and
Patient Safety
LEARNING OBJECTIVES
✔ List the responsibilities of the nurse in
drug therapy.
✔ Explain what is involved in each step of
the nursing process as it relates to drug
therapy.
✔ Describe key points that must be
incorporated into the assessment of a
patient receiving drug therapy.
THE NURSING PROCESS
✔ Application of the nursing
process with drug therapy
ensures that the patient
receives the best, safest, most
effi cient, scientifically based,
holistic care.
1.) ASSESSMENT
A.) Patient's history
❖ Knowledge of this important information
before beginning drug therapy will help to
promote safe and effective use of the drug
and prevent adverse effects, clinically
important drug–drug, drug–food, or drug–
alternative therapy interactions, and
medication errors.
✔ History of Chronic Conditions
⮚ It can affect the pharmacokinetics and
pharmacodynamics of a drug.
⮚ Certain conditions like renal disease, heart
disease, diabetes, chronic lung disease may be
contraindications to the use of a drug.
⮚ These conditions may require cautious use or
dose adjustment when administering a certain
drug.
✔ History of 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.
⮚ Always ask specifically about all types of
medications that the patient might use
including contraceptives.
✔ History of Allergies
⮚ Past exposure to a drug or other allergens can
provoke a future reaction or necessitate the need
for cautious use of the drug, food, or animal
product.
⮚ Obtain information about the allergic reaction
to determine whether the patient has
experienced a true drug allergy or was
experiencing an actual effect or adverse effect of
the drug.
✔ Level of Education and Understanding
⮚ It provides a baseline from which the
nurse can determine the appropriate
types of teaching information to use
with the patient.
⮚ Stress, disease, and environmental
factors can all affect a patient’s learning
readiness and ability.
✔ Social and Financial Support
⮚ Discharge planning involves determining
what support is available to the patient at
home.
⮚ Financial constraints may cause a patient
not to follow a prescribed drug regimen.
⮚ Referral to appropriate community
resources must be considered.
✔ Pattern of Healthcare
▪ Knowing how a patient seeks health care provides
the nurse with valuable information to include
when preparing the patient’s teaching plan.
▪ Does this patient routinely seek follow-up care, or
does he or she wait for emergency situations?
▪ Does the patient tend to self-treat many
complaints, or is every problem brought to a
health care provider?
1.) ASSESSMENT
B.) Physical Examination
These determine if any conditions exist
that would be contraindications or
cautions for using the drug and to
develop a baseline for evaluating the
effectiveness of the drug and the
occurrence of any adverse effects.
✔ Weight
▪ It 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, the responsiveness
of other organs and other existing
medical conditions.
✔ Age
▪ The child’s age and developmental
level will also alert the nurse to
possible problems with drug
delivery, such as the ability to
swallow pills or follow directions
related to other delivery methods.
✔ Physical Parameters Related to
Disease or Drug Effects
▪ 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.
✔ Physical Parameters Related to
Disease or Drug Effects
▪ If a patient is being treated for chronic
pulmonary disease, his or her
respiratory status and reserve need to
be assessed, especially if a drug is
being given that is known to affect the
respiratory tract.
2.) NURSING DIAGNOSIS
✔ It is simply a statement of the
patient’s status from a nursing
perspective.
✔ The nurse analyzes the information
gathered during assessment to arrive at
some conclusions that lead to a
particular goal and set of
interventions.
2.) NURSING DIAGNOSIS
✔ It shows actual or potential
alterations in patient function based
on the assessment of the clinical
situation.
✔ Diagnoses that are related to drug
therapy must be incorporated into a
total picture of the patient.
EXAMPLES:
✔ Knowledge deficit .....
✔ Impaired swallowing .....
✔ Risk for impaired liver function .....
✔ Impaired oral mucous
membrane .....
✔ Impaired memory .....
✔ Nausea .....
EXAMPLES:
✔ Non-compliance .....
✔ Risk for poisoning .....
✔ Ineffective role
performance .....
✔ Self-care deficit .....
✔ Stress overload .....
EXAMPLES:
✔ Ineffective therapeutic regimen
management .....
✔ Ineffective family therapeutic
regimen management .....
✔ Wandering .....
✔ Impaired urinary elimination .....
3.) IMPLEMENTATION
✔ Interventions involve ensuring effective
response to drug therapy, minimizing
adverse effects, and understanding the
drug regimen.
✔ Three types of nursing interventions:
drug administration, provision of
comfort measures, and patient/family
education.
A.) Proper Drug Administration
• Correct drug and patient
• Correct storage of drug
• Correct and most effective route
• Correct dose and preparation
• Correct timing
• Correct recording of administration
B.) Comfort Measures
• A patient is more likely to be
compliant with a drug regimen
if the effects of the therapy
are not too uncomfortable or
overwhelming.
PLACEBO EFFECT
• The anticipation that a drug will be helpful
has proved to have tremendous impact on
the actual success of drug therapy.
• The nurse’s attitude and support can be a
critical part of drug therapy. For example, a
back rub, a kind word, and a positive
approach may be as beneficial as the drug
itself.
MANAGING ADVERSE
EFFECTS
• Interventions can be directed at promoting
patient safety and decreasing the impact of
the anticipated adverse effects of a drug.
• Such interventions include environmental
control (e.g., temperature, light), safety
measures (e.g., avoiding driving, avoiding the
sun, using side rails), and physical comfort
measures (e.g., skin care, laxatives, frequent
LIFESTYLE ADJUSTMENT
• Some medications and their effects
require that a patient make changes in
his or her lifestyle.
• The change in lifestyle that is needed can
have a tremendous impact on the
patient and can affect his or her ability to
cope and comply with any medical
regimen.
C.) Patient and Family Education
• It is essential that they have all
of the information necessary to
ensure safe and effective drug
therapy at home.
• In fact patients are now given
written information.
4.) EVALUATION
✔ The patient is continually evaluated for
therapeutic response, occurrence of
adverse drug effects, and 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.
4.) EVALUATION
✔ 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.
MEDICATI
ON SAFETY
LEARNING OBJECTIVES
✔ Describe the essential elements of a
medication order.
✔ Describe the role of the nurse and the
patient in preventing medication errors.
✔ Outline the important points that must be
assessed and considered before administering
a drug, combining knowledge about the drug
with knowledge of the patient and the
environment.
PREVENTION OF ERRORS
✔ The 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.
✔ Right drug ✔ Right evaluation
✔ Right client/ patient ✔ Right documentation
✔ Right route ✔ Right to refuse
✔ Right dose ✔ Right principle of care
✔ Right frequency/ time ✔ Right prescription
✔ Right assessment ✔ Right nurse clinician
✔ Right approach ✔ Right education
PREVENTION OF ERRORS
✔ The Patient's Role- Encourage
patients to be their own advocates and
to speak up and ask questions.
✔ Only the patient really knows what is
being taken and when, and can report
the actual as opposed to the prescribed
drug regimen being followed.
TEACHING POINTS
✔ 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.
TEACHING POINTS
✔ When in doubt, do not hesitate to ask
questions.
✔ Never use adult medications to treat a
child.
✔ Measure liquid medications using
appropriate measuring devices.
✔ Call your health care provider immediately
if your child seems to get worse or seems to
be having trouble with a drug.
PRESCRIPTIONS
AND
MEDICATION
ORDERS
INTRODUCTION
✔ The primary means in which a physician
communicate with other health care
team members regarding the desired
treatment regimen for a patient.
✔ It can be handwritten, typed,
preprinted, verbal or entered in a
computer system.
INTRODUCTION
✔ Prescriptions are used in the OPD or
ambulatory setting whereas medication
orders and used in inpatient setting.
✔ A legal order that can be used for
medications, devices, laboratory test,
special procedures and the like.
COMPONENTS
✔ The following information must be present:
▪ Name, address, age, birthdate, date of issue
▪ Drug, dosage and form
▪ Frequency, route of administration
▪ Duration, quantity
▪ Height and weight (for pediatric client)
▪ Physician's DEA number (for controlled drugs)
SAMPLE PRESCRIPTION
SAMPLE MEDICATION ORDER
COMMONLY
USED
ABBREVIATIONS
RULES ON WRITING AN ORDER
✔ Do not use trailing zeros for doses expressed as
whole numbers.
✔ Use a decimal point when the dose is less than a
whole unit.
✔ Use commas for dosing units at or above 1,000
or use words such as 1 thousand to improve
readability.
✔ Place adequate space between entries.
TYPES OF MEDICATION ORDER
1.) PRN Order
✔ medications are given on "as
needed" or “when necessary” basis
for specific signs and symptoms
within a designated number of hours
✔ It can be prescription medications
or over-the-counter medications.
✔ Cannot have multiple
medications with same reason
such as both Tylenol and
morphine “PRN for pain”.
Example:
✔ Tylenol 650 mg PO every four hours
PRN for pain or fever.
✔ Mary complains of headache. You
have check the therapeutic or
medication sheet and found that she
have not received any Tylenol within
the past 4 hours.
✔ According to the order, the
medication is for “pain” and
“fever”.
✔ This means that you can give
Mary Tylenol for her headache.
2.) SINGLE/ ONE TIME
ORDER
✔ medications to be given only
once and are ordered to be given
at a specific time and then
discontinued.
Example:
✔ Pen-vee K 1000 mg PO 1
hour pre-op dental surgey
✔ Seconal 100 mg HS before
surgery
3.) STAT ORDER
✔ medications need to
be given immediately or
NOW.
Example:
✔ Demerol 100 mg IM now
✔ Tramadol 50 mg/ml
IV now
4.) ROUTINE/ STANDING
ORDER
✔ Detailed order for a
medication given on a
routine or regularly
scheduled basis.
Example:
✔ Ciprofloxacin 500 mg 1 tab
PO BID x 7 days
✔ Vancomycin 1500 mg IV q
12 hrs for 3 days
IMPORTANT NOTE
✔Do not accept medication orders
that state “continue previous
medications” or “same
medications” because they are
not complete medication orders.
5.) ANCILLARY ORDER
✔ It refers to information other
than medication that allow the
nurse to do certain things to
a patient.
EXAMPLES OF ANCILLARY ORDER
1. Catheterize with a 16 French, 5
ml, indwelling catheter. If residual
is greater than 75 ml, leave the
catheter in place and notify the
physician; if less than 75 ml,
remove and notify the physician.
2. Encourage fluids to 2000 ml
daily unless restricted by order;
keep accurate I and O; perineal
care with soap and water twice
daily; replace catheter every 30
days or if no drainage in 4 hours,
irrigate with 50 ml saline once.
3. Attempt irrigation with 60 ml
saline; if leaking continues,
remove the catheter and
replace with one size larger
except Supra Pubics.
6.) HIDDEN ORDER
✔ Drugs that have been administered outside
of the facility (Emergency Room visit, Dental
visits, specialist appointments).
✔ Drugs that may be administered during a
procedure in the facility but not documented
in the patient’s chart (example: Lidocaine w
Epi).
✔ Drugs that may be part of a
bundled procedure such as a Prep
kit for a colonoscopy.
✔ Drugs that may be used as part
of a protocol but not individually
documented on the chart.
STOP ORDER PROCEDURES
✔ Medications not specifically
prescribed as to time and
number of doses will be
automatically discountinued
on the following days:
VERBAL/ TELEPHONE ORDERS
✔ Are minimized whenever
possible.
✔ Immediately write down and
“read back” to verify (NOT
REPEAT).
✔ Must be counter signed within 24
hours.
Client Education
on Drug Therapy
ASPECTS OF EDUCATION
✔ The purpose of the medication
✔ The dosage of the medication
✔ The side effects of the medication
✔ The possible adverse effects of the medication
✔ When to call the doctor about any side effects
✔ How and where the medication should be safely
stored, such as in the refrigerator or in a dark
place, for example.
✔ The importance of and the method for checking
the medication's label for the name, dose, and
expiration date.
✔Special instructions such as shaking the
medication, taking the medication with meals or
between meals and on an empty stomach, for
example.
✔ The importance of taking the medication as
instructed.
✔ The need to continue the medication unless
the doctor discontinues it
✔Information about foods, supplements and
other medications, including over the counter
medications and preparations, that can
interact with the ordered medication
✔The safe disposal of unused and expired
medications.
✔ The importance of keeping medications in a
secure place that would not place a curious
child or a cognitively impaired adult at risk for
taking medications not intended for them.
✔The proper and safe disposal of any
biohazardous equipment such as used
needles that the client uses for insulin and
other medications.
Age Specific Route,
Forms & Dosage
Consideration
INFANTS
✔ Use a syringe, dropper for oral liquid
medications.
✔ Use the vastus lateralis, rectus
femoris and ventrogluteal muscle sites
for intramuscular injections and not the
deltoid or the gluteus maximus
muscles because these muscles have
not yet developed.
TODDLERS
✔ Liquid oral medications are given with a
spoon or a cup, the vastus lateralis, rectus
femoris and ventrogluteal sites are used for
intramuscular injections.
✔ The gluteus maximus muscle can be used
after the toddler has been walking for at least a
year, flavors can be used to improve the taste
of oral medications, and the dosages continue
to be based on kilograms of weight.
PRE SCHOOL/ SCHOOL-AGED CHILDREN
✔ Able to take capsules and tablets, the
gluteus maximus muscle and the deltoid
muscle can now be used for
intramuscular injections, in addition to
the vastus lateralis, rectus femoris and
ventrogluteal intramuscular injection
sites, and dosages continue to be based
on kilograms of weight.
ADOLESCENTS AND ADULTS
✔ Adolescents get adult dosages,
routes and forms of medications
as prescribed by the physician.
ELDERLY
✔ Dosages may be decreased
because the normal physiological
changes of the aging process
makes more susceptible to side
effects, adverse drug reactions,
and toxicity and over dosages.
Recording and
Reporting
KEY POINTS
✔ Use double locked cabinets to
secure controlled substances.
✔ Others use more sophisticated
bar coded entry systems to access
controlled substances.
KEY POINTS
✔ Double locked narcotics cabinet is
used, the contents are counted and
checked by the nurse at the beginning
of the shift; this count is then
compared to the documented count
that was done by the nurse from the
prior shift.
KEY POINTS
✔ If there are any discrepancies, these
are immediately addressed, explored
and corrected if it was a simple oversight
or mathematical error. When the
narcotics count cannot be corrected, a
report must be filed according to the
facility's policies and procedures.
KEY POINTS
✔ If a controlled substance is wasted
for any reason, either in its entirety or
only partially, this waste must be
witnessed or documented by the
wasting nurse and another nurse.
Both nurses document this wasting.
KEY POINTS
✔ Medications that are given, omitted,
held or refused by the patient must
be documented.
DRUG
ARITHMETIC
S
LEARNING OBJECTIVES
✔ Describe four measuring
systems that can be used in drug
therapy.
✔ Convert between different
measuring systems when given drug
orders and available forms of the
drugs.
NOTE:
✔ To determine the correct dose of a
particular drug for a patient, the
nurse must consider the patient’s
sex, weight, age, and physical
condition, as well as the other
drugs that the patient is taking.
MEASURING SYSTEMS
1.) Metric System- It is based on
the decimal system, so all units are
determined as multiples of 10.
✔ Uses the gram as the basic unit of
solid measure and the liter as the
basic unit of liquid measure.
2.) Apothecary System- Uses the
minim as the basic unit of liquid
measure and the grain as the basic unit
of solid measure.
✔ It uses Roman numerals placed after
the unit of measure to denote amount.
✔For example, 15 grains would be
written “gr xv.”
3.) Household System-
found in recipe books and uses
the teaspoon as the basic unit
of fluid measure and the
pound as the basic unit of solid
measure.
4.) Avoirdupois System- another
older system that was very popular when
pharmacists routinely had to compound
medications.
✔ It is seldom used by prescribers but
may be used for bulk medications that
come directly from the manufacturer.
5.) Other System- Some drugs are
measured in “units”that reflect
chemical activity or biological
equivalence.
✔ A “unit” usually reflects the
biological activity of the drug in 1
mL of solution.
✔ The unit is unique for the drug it measures; a unit of
heparin is not comparable to a unit of insulin. Why?
✔Heparin is measured in Units, but
these units are not the same volume as the Units used
to measure insulin or penicillin. Common concentrations
of heparin are 1000 units per mL, 5000 units per mL,
and 10,000 units per mL; these can be used for IM or s.q.
dosing or diluted in a diluent liquid for IV use.
✔For heparin administration as an IV flush, common
concentrations are 2 units per mL, 10 units per mL, 50
units per mL, or 100 units per mL.
✔Milliequivalents (mEq) are
used to measure electrolytes.
(e.g., potassium, sodium, etc).
✔The milliequivalent refers to
the ionic activity of the drug in
question; the order is usually
written for a number of
milliequivalents instead of a
volume of drug.
✔ International units are
sometimes used to measure
certain vitamins or enzymes.
✔ These are also unique to each
drug and cannot be converted
to another measuring form.
CONVERSION
BETWEEN
SYSTEMS
EXAMPLE # 1
✔ Convert 6 fl oz (apothecary
system) to the metric system.
✔ Given:
1 fl oz = 30 mL
SOLUTION:
1 fl oz 6 fl oz
30 mL X
1 fl oz (X) 6 fl oz (30 mL)
1 fl oz X 180 fl oz (mL)
1 fl oz 1 fl oz
180 mL
EXAMPLE # 2
✔ Convert 32 gr (apothecary) to its
equivalent in the metric system,
expressing the answer in milligrams.
✔ Given:
1 gr = 60 mg
SOLUTION:
1 gr 32 gr
60 mg X
1gr (X) = 60 mg (32 gr)
1 gr X = 1920 (mg) (gr)
1 gr 1 gr
x= 1920 mg
DOSAGE
CALCULATIO
NS
LEARNING OBJECTIVES
✔ Calculate the correct dose
of a drug when given
examples of drug orders
and available forms of the
drugs ordered.
Conversion Factors
• 1 kg = 2.2 lb
• 1 gallon = 4 quart
• 1 tsp = 5 mL
• 1 inch = 2.54 cm
• 1 L = 1,000 mL
• 1 kg = 1,000 g
• 1 oz = 30 mL = 2 tbsp
• 1 g = 1,000 mg
• 1 mg = 1,000 mcg
• 1 cm = 10 mm
• 1 tbsp = 15 mL
ORAL DRUGS
✔ Frequently, tablets or capsules for
oral administration are not available in
the exact dose that has been ordered.
✔ The easiest way to determine dose is
to set up a ratio and proportion
equation.
GENERAL
FORMULA:
• Desired dose (amount)
= ordered
• Stock dose = amount on
Hand
• Quantity
• For example, a physician orders Lorazepam 4 Mg IV Push for a
patient in severe alcohol withdrawal. The nurse has 2 mg/mL vials
on hand.
• Dose ordered is 4 mg; Stock Dose is 2 mg; Quantity is 1 mL.
• How many milliliters (mL.) should the nurse draws up in a syringe
to deliver the desired dose?
FORMULA: D x Q
S
Solution: 4 mg x 1 mL.
2 mg
Answer: 2 mL.
Example # 1 Solution:
✔ An order is written
for 10 grains of aspirin
(gr x, aspirin). The
tablets that are
available each contain
5 grains. How many
tablets should the
nurse give?
• An order is written
for 0.05 g Aldactone 1.) First is to convert
gram to milligram
(Spironolactone) to
be given orally (PO).
0.05 gram x 1000 mg
The Aldactone is
available in 25-mg 1 gram
tablets. How many = 50 mg /
25 mg per tab.
tablets would you
=2 tablets
have to give?
Example # 3
✔ An order has been
written for 250 mg of
sulfisoxazole. The
bottle states that the
solution contains 125
mg/5 mL. How much
of the liquid should
you give?
Solution:
PARENTERAL DRUGS
✔ All drugs administered parenterally
must be administered in liquid form.
✔ The person administering the drug
needs to calculate the volume of the
liquid that must be given to administer
the prescribed dose.
GENERAL
FORMULA:
Example # 1
✔ An order has been

written for 75 mg of
meperidine to be
given intramuscularly.
✔ The vial states that
it contains
meperidine, 1 mL =
50 mg
Solution:
INTRAVENOUS
SOLUTIONS
✔Used to deliver a
fluids, electrolytes,
vitamins, nutrients,
or drugs directly into
the bloodstream.
INTRAVENOUS
SOLUTIONS
✔To calculate the drops per minute, the drop factor is
needed. The formula for calculating the IV flow rate (drip
rate) is… total volume (in mL) divided by time (in min),
multiplied by the drop factor (in gtts/mL), which equals the
IV flow rate in gtts/min
✔MACRODRIP system delivers 15 drops per mililiter and is
used when a large volume must be delivered quickly.
✔MICRODRIP delivery system delivers 60 drops per
milliliter.
DRIP RATES IN DROPS PER
MINUTE
✔ There are two standard giving sets of drip
rates.
❖ Macro drop factor = 15 drops (divide by 4)
❖ Micro drop factor = 60 drops (divide by 1)
Formula if you are calculating for the DRIP
RATE
✔ It is when the infusion volume is
calculated into drops.
✔General formula is:

Drip Rate = Volume
Time x Drip Factor
Example # 1
✔ A patient is to receive 1 liter of PNSS
over the next 12 hours. What is the
rate of infusion in drops per minute, if
the drop factor is 60 drops per
milliliter.
Example # 1
✔ A patient is to receive 1 liter of PNSS over the next 12 hours.
What is the rate of infusion in drops per minute, if the drop
factor is 60 drops per milliliter.
Drip Rate = Volume
Time x Drip Factor
1000 mL X 60 drops = 60,000
12 hr 60 720
= 83.33 or 83 drops/minute
Example # 2
A patient is to receive an IVF of D5LR
1 liter over the next 8 hours. What is
the rate of infusion in drops per
minute, if the drop factor is 15 drops
per milliliter.
Example # 2
✔ A patient is to receive of D5LR 1 liter over the next 8 hours.
What is the rate of infusion in drops per minute, if the drop
factor is 15 drops per milliliter.
Drip Rate = Volume
Time x Drip Factor
1000 mL X 15 drops = 15,000
8 hr 60 480
= 31.25 or 31 drops/minute
Formula if you are calculating for the
volume per hour
Formula:
Volume/hour = Volume
Time
Example # 3
✔ A 50 yrs. Old patient is ordered to
receive 1000 mL of intravenous fluids
to run for 8 hours. Calculate the
volume per hour.
Solution: if you are calculating the
volume per hour
✔A 50 yrs. Old Formula:
patient is ordered Drip Rate = Volume
to receive 1000 mL
of intravenous Time
fluids to run for 8
hours. Calculate
the volume per
hour.
The formula in determining the number
of hours to complete before it runs out
is:
Example # 4
✔ The volume of the fluid is
1000 ml and the IV pump is set
at 62 ml / hr. How long will it
take for the fluid to run?
Solution:
✔ The volume of
the fluid is 1000 ml
and the IV pump is
set at 62 ml / hr.
How long will it take
for the fluid to run?
Solution:
✔ The volume of
the fluid is 1000 ml
and the IV pump is
set at 125 ml / hr. 1000 mL
How long will it take
for the fluid to run?
125 mL/hr
8 hours
Thank you for
listening
PEDIATRIC
CALCULATIO
NS
LEARNING OBJECTIVES
✔ Discuss why children require
different dosages of drugs than
adults.
✔ Explain the calculations used to
determine a safe pediatric dose of
a drug.
PEDIATRIC
CONSIDERATIONS
✔ An adult’s body handles drugs differently
and may respond to drugs differently than
a child.
✔A child’s body may handle a drug
differently in all areas of
pharmacokinetics—absorption,
distribution, metabolism, and excretion.
PEDIATRIC
CONSIDERATIONS
✔ The responses of the child’s organs to
the effects of the drug may vary because
of the immaturity of the organs.
✔ Most of the time a child requires a
smaller dose of a drug to achieve the
comparable critical concentration as that
for an adult.
FRIED'S RULE
✔ 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
PROBLEM # 1
✔ If an adult dose of a
particular medication is 50 mg,
what is the dosage of a 10
months old infant?
SOLUTION
PROBLEM # 2
✔ Calculate the dose for a 1
year old baby, where the adult
dose of the medicine is 400
mg.
SOLUTION
YOUNG'S RULE
✔ A calculation method that applies
to children 1 to 12 years of age.
✔ The general formula is:
PROBLEM # 1
✔ If an adult dose of a
particular medication is 100
mg, what is the dose for a 10
year old child?
SOLUTION
PROBLEM # 2
✔ A 3-year-old child weighing 30
lb is to receive a therapeutic
dose of aspirin. The average
adult dose is 5 grams, and the
dose to be given is the
unknown .
SOLUTION
CLARK'S RULE
✔ It uses the child’s weight in pounds to
calculate the dose and assumes that the
adult dose is based on a 150-lb person.
PROBLEM # 1
✔ A child weighs 40 lbs and is
5 years old. The adult dose is
250 mg. Calculate the
correct dose for the child?
SOLUTION
PROBLEM # 2
✔ A 2 years old child weighs
11.4 kg. The adult dose is
125 mg. Calculate the
correct dose for the child.
SOLUTION
SAFE
• Doctors orders Benadryl for a child that weighs 98
lbs. The safe dose for Benadryl is 5mg/kg/day. What
is the safe dose per day for this child/
98 lbs x 1 kg x 5mg/day = 490

1 2.2 lbs 1 kg 2.2
=222.7272 or 222.7 mg/day

• A child weighs 52 lbs. The child has a fever and the doctor
orders Tylenol. The safe dose range 10-15mg q6 hr. What is
the maximum safe dose for this child per dose?
52 lbs x 1 kg x 15 mg q/6 hr = 780 mg/q6 hr =354.5454

1 2.2 1 kg 2.2
=354.5454 mg/6hr
= 354.5 mg/q6hr
• A child weighs 52 lbs. The child has a fever and the doctor
orders Tylenol. The safe dose range 10-15mg q6 hr. What is
the maximum safe dose for this child per day?
52 lbs x 1 kg x 15 mg q/6 hr = 780 mg/q6 hr =354.5454

1 2.2 1 kg 2.2 = 354.5 mg/q6
24 hr x 354.5 mg = 8508 = 1,418 mg/day

1day q6hr 6
• The doctor orders 200 mg of Ibuprofen every 8 hrs. the child's weighs 49 lbs. the
safe dosage range for this medication is 5-10 mg /kg/dose. What is the safe
dosage for this particular child ? Is this a safe dose for this child?
49 lbs x 1 kg x 5mg/day = 245 = 111.3636 or 111.37 mg/day

1 2.2 lbs 1 kg 2.2
49 lbs x kg x 5mg/dose = 245 = 111.3636 or 111.4 mg/dose

1 2.2 lbs kg 2.2
49 lbs x kg x 10 mg/dose = 490 = 222.7272 = 222.7 mg/dose
1 2.2 lbs kg 2.2

• The doctor orders Digoxin 0.92 mg daily for a child that weighs
16 lbs. The safe dosage for this medication is 8-12 mcg/kg/day. Is
this a safe dose order?
16 lbs x kg x 8 mcg/day x 1 mg = 128 mg = 0.0581818

1 2.2 lbs 1kg 1000 mg 2,200 =0.06 mg/day
16 lbs x kg x 12 mcg/day x 1 mg = 192 mg = 0.087272

1 2.2 lbs 1kg 1000 mg 2,200 =0.09 mg/day
BODY SURFACE AREA
✔
RULE
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.
NOMOGRAM
✔ Draw a straight line
connecting the child’s
height to the child’s
weight.
✔ The BSA value, which is
calculated in square
meters, is found at the
point where the line
intersects the SA column.
PROBLEM # 1
SOLUTION
SOLUTION
PROBLEM # 2
SOLUTION
PROBLEM # 3
SOLUTION
SOLUTION
PROBLEM # 4
SOLUTION
SOLUTION
PROBLEM # 5
SOLUTION
SOLUTION
MILLIGRAMS/
KILOGRAMS
OF BODY WEIGHT RULE
✔ This method of prescribing takes
into consideration the varying
weights of children and the need
for a higher dose of the drug
when the weight increases.
PROBLEM # 1
✔ If a child with postoperative
nausea is to be treated with
Vistaril (hydroxyzine), the
recommended dose is 1.1 mg/kg
by intramuscular injection.
SOLUTION
✔ If the child weighs 22 kg:
✔ If the child weighs 6 kg:
SUMMARY

1.1 Drug Classifications & Forms

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1.1 Drug Classifications & Forms

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GODDY M. MANZANO JR.,MAN, R.N.

It deals with interaction of exogenously

Acetyl Salycylic ASPIRIN DISPRIN (India)

✔ Identified as flat, hard, oval, or

A. It is not a safe drug.

✔ Jacob should be back in about 3 months

✔ How the body acts on the drug

✔ An order has been

✔General formula is:

98 lbs x 1 kg x 5mg/day = 490

=222.7272 or 222.7 mg/day

52 lbs x 1 kg x 15 mg q/6 hr = 780 mg/q6 hr =354.5454

52 lbs x 1 kg x 15 mg q/6 hr = 780 mg/q6 hr =354.5454

24 hr x 354.5 mg = 8508 = 1,418 mg/day

49 lbs x 1 kg x 5mg/day = 245 = 111.3636 or 111.37 mg/day

49 lbs x kg x 5mg/dose = 245 = 111.3636 or 111.4 mg/dose

49 lbs x kg x 10 mg/dose = 490 = 222.7272 = 222.7 mg/dose

1 2.2 lbs kg 2.2

16 lbs x kg x 8 mcg/day x 1 mg = 128 mg = 0.0581818

16 lbs x kg x 12 mcg/day x 1 mg = 192 mg = 0.087272

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