Republic of the Philippines

Bulacan State University

City of Malolos

NCM 106 - Pharmacology

Introduction to Nursing Pharmacology

Prepared by:

Christopher E. Olipas, Ph.D.

Carmina O. Fabonan, RN

Marlyn Molina Cabungcal, MAN

A.Y. 2020-2021- 1st Semester

Introduction

Welcome to the pharmacology of nursing. Congratulations on getting this far in the

midst of the global pandemic that we are facing. Go ahead and get a tap on your shoulder.
This module will help you understand the basic knowledge of pharmacology. Nurses
operate on a regular basis to prescribe medicines to patients. It is important for you, as a
potential nurse, to know the therapeutic effect of drugs on the body, the reaction of the
body, the anticipated and unforeseen effects of drugs on your patients.
It will also instruct you on how to integrate the nursing method into the correct
dose of medications. You are encouraged to respond to pre-test and post-test based on
your own understanding and make it a habit to brace yourself by reading the particular
topic of your resource book in advance. It will help you to understand your weakness and
power, and at the same time evaluate your own success.

This particular module is divided into 5 lessons:

● Lesson 1 Introduction to Drugs
● Lesson 2 Drugs and the Body
● Lesson 3 Toxic Effects of Drugs and Effects of Drug
Interactions
● Lesson 4 Nursing Management
● Lesson 5 Dosage Calculations

As you navigate at the end of this module, you are expected to accomplish
competencies given below.

Objectives/Competencies
Upon completion of this module, you are expected to:
1. Explain the importance of drugs, its sources and steps in drug evaluation.
2. Explain the effects of drugs in the body and compare the different toxic effects of
drugs.
3. Apply the nursing process in drug therapy and patient safety.
4. Calculate correct dosage as ordered by the Physician using the different unit of
measurements.
Pre-test
Let’s define some terms based on your own understanding. Fill in the table below
and match the word inside the box that best describes the statement.

Pharmacokinetics Nursing Process Absorption

Pharmacodynamics Generic name Brand Name

Pharmacology Therapeutic effect Adverse drug effect

Assessment Nursing Diagnosis Intravenous drug

Statement Term

1. Absorption, delivery, metabolism and

excretion by the body of drugs.

2. Biochemical and physical effects of

medicines and drug action pathways.

3. Name that reflects the abbreviation of

chemical structure of a drug.

4. Name that represents the abbreviation

of a drug's chemical structure.
5. Studies of medications, its usage
to cure, diagnose, or avoid a disease.
6. Drug usage to prevent and cure
diseases.
7. A harmful undesirable response

8. Involve the collection of knowledge, the

formulation of a nursing diagnosis
statement, the prioritization of diagnosis,
the development of priorities and
outcomes for the patient, the
implementation of treatments and the
evaluation of the process.
Title of the Lesson: Introduction to Drugs
Duration: 2 hours
Drugs are chemical compounds that induce changes in our body after our system
has been consumed. Pharmacology is a scientific study of the sources, existence,
chemistry, effects and use of drugs. This information is important to ensure that your
patients receive safe and correct medication (Gersch et al., 2017).

Nurses are mainly involved in the administration of medications. Knowing how

medicines operate and where they come from guarantees the patient's wellbeing at all
times. Table 1.1 displays the various origins of natural and synthetic drugs.

Table 1.1 Sources of Drugs

I. Natural ● Active chemical substances that demonstrate therapeutic
Sources importance by preventing harmful effects
.

Source Use/Classification Drug

Plant
Penicillium chrysogenum Antibiotics Penicillin
(mould)

Madagascar periwinkle Chemotherapy Vincristine and

plant (Catharanthus vinblastine
roseus)

Salix alba (white willow) Pain management Aspirin (Salicylic

Acid)

Animal Product Pig-derived products Anticoagulant Heparin sodium

Cattle Insulin preparations Insulin, isophane
Chinese Hamster Ovary Antineoplastic agent Rituximab
(CHO) cells

Inorganic Bromide (Br) Sedative Sodium Bromide

Compound Mercury (Hg) Antiseptic Mereurochrome
Magnesium (Mg) Antacid/Laxative Magnesium Oxide

II. Synthetic Scientists use genetic modification to modify bacteria in order to create
Sources chemicals that are therapeutic and efficient. Changes in chemical rings
or attachments to the structure

Cimetidine sulfoxide H2 blockers cimetidine

(C10H16N6S)
 When a chemical has a medicinal value, it must undergo a series of experimental
tests to determine its true therapeutic and toxic effects. Pursuant to the rules and
regulations enforcing Republic Act No. 9711 in the Philippines, FOOD AND DRUG
ADMINISTRATION (FDA) grants recognition and requires mandatory participation in all
clinical trials (Phases I, II, III, IV). See figure 1.1

Figure 1.1 Phase of Drug Development

Now, you've got the idea of how the drug was made. Let 's talk about naming and
classifying various substances. Drug Classification is dependent on the chemical form of
the active ingredient or on how it is used for treatment. The next Unit of our course will
address each classification in depth. Drugs have a particular structure and can be named
in three different names.

1. Chemical name is a scientific name that precisely describes the drug’s atomic and
molecular structure.
2. Generic Name is an abbreviation of the chemical name produced by companies
involved solely in the manufacturing of drugs.
3. Branded Name selected by the drug company selling the product. Brand names
are protected by copyright.

Figure 1.2 Drug Label

 For additional / optional reading, you may consult Chapter 1 of the book "Emphasis
on Nursing Pharmacology" (7th ed.). By Kark, A. M., (2013) or any other reference you
have. You can also recommend watching this related simple pharmacology video
https:/www.youtube.com/watch? 3SvSEI6ZlrI.

Great! Great! Great! You're finished with the lesson now, but before you launch
our lesson 2. Take your well-deserved 5-minute break!
Self-Check 1

1. Your patient Lola Anita has been taking Amlodipine (Provasc) as a maintenance
drug for hypertension for five years, but upon picking up the prescription for this
month, she found that the tablets looked different and became worried. Upon
checking with the pharmacist, you found out that Provasc
had just become available in the generic form and the
prescription had been filled with the generic product. You as
a nurse should tell Lola Anita:
a. The new tablet has different therapeutic effects so
Lola Anita should carefully monitor response.
b. Generic drugs are available and they are just as safe
as the brand name medication.
c. Ask Lola Anita’s doctor to change her medication.
d. The pharmacy dispenses the wrong drug and should
be given back for replacement.
2. In your own understanding explain the steps involved in drug evaluation by filling the
diagram below.
Title of the Lesson: Drugs and the Body
Duration: 2 hours
Do you remember Lola Anita? To make you understand what happens when Lola
Anita takes her medicine. You need to understand what pharmacodynamics and
pharmacokinetics are. These two mechanisms are the foundation of the administration of
drugs. It will help you in predicting the therapeutic and adverse drug effects and in
mediating ways to ensure the efficacy of the drug regimen given to your patient.

Pharmacokinetics involves the study of absorption, distribution, metabolism, and

excretion of drugs. In simple terms, it is how the BODY ACTS ON THE DRUG, while
Pharmacodynamics is the study of the interactions between the chemical components
of living systems and the foreign chemicals, including drugs, that enter those systems.
(Kach 2017). This explains how the DRUG AFFECTS THE BODY.

MEMORY TRICK!

PharmacoKinetics= Katawan sa drugs

“How the body acts on the drug by KICK” Pharmaco-
KICK-netics

PharmacoDynamics= Drugs sa katawan

“How the drug affects the body by DD’s” Pharmaco D-
Dynamics

Now, Let’s dive deeper on each process.

Pharmacokinetics explores how a drug works in the body through the processes of
usage of ADME mnemonics. Great! Great! Great! For you, another memory trick.
• Absorption (taken into the body)
• Distribution (moved into various tissues)
• Metabolized (changed into a form that can be excreted)
• Excreted (removed from the body).

You may then calculate the amount of medication (dose) and the frequency of
dose repetition (scheduling) needed to obtain the essential dosage for the desired period
of time. Close your eyes and center your brain on all the subjects you've studied from the
class of microbiology. It's going to help you understand the concepts below.
 Absorption refers to what happens when Lola Anita takes the medication and
adds it to her body until it enters the fluids and tissues that circulate. Absorption defines
the different route of drug use that we had, namely: oral, intravenous, intramuscular,
subcutaneous, topical, inhalation. Drugs can be absorbed into cells through a number of
mechanisms, including passive diffusion (a higher concentration of the drug on one side
of the cell membrane the drug passes through the membrane to a lower concentration
area), active transport (uses energy to actively transfer the molecule through the cell
membrane) and filtration (movement through the pores in the cell membrane, either
through the concentrate)

Distribution, the mechanism by which the drug is distributed to tissues and fluids.
The body relies on several factors: blood flow (the greater the blood supply in the organ
the faster the drug is distributed), solubility (the ability of the drug to cross the cell
membrane. Lipid-soluble drugs easily move through the cell membrane, while water-
soluble drugs cannot. Lipid-soluble drugs can also cross the blood-brain barrier and reach
the brain) and protein binding (drugs are bound together).

Metabolism or biotransformation is where the drug is converted into a new, less

active chemical that is a more water-soluble form that can then be excreted. Think of the
Liver, where much of the metabolism goes. Liver detoxifies several chemicals and uses
others to make the required enzymes and structures. These acts often clarify why liver
disease is always a contraindication or a justification to take care while prescribing such
medications. If the liver does not function efficiently, the drug will not be metabolized as
it should be, and toxic levels will grow quite rapidly.

Excretion is the removal of drugs from the body. Most drugs are excreted by the
kidneys, leaving the body through the urine. This principle is crucial to note when
attempting to get a drug out of the system quickly.

That's a lot of recalling, but understanding it influences how you describe the
function of a medication to your patients and how it is helpful to them. A further factor in
the pharmacokinetics of the drug in deciding the level, route and timing of the drug dose
is as follows: half-life of a drug it takes time for one half of the medication to be
eliminated by the body. This is especially important for your patients undergoing insulin
therapy. Drug onset of action, peak of concentration and duration of action. The
timing of drug administration is critical in order to achieve the most successful drug
therapy. You will use this information to illustrate how important it is to observe the routine
of substance use in the hospital or at home with your patient. Now, you should
demonstrate to Lola Anita how the body is working on a drug that is determined by its
pharmacokinetics.
 Remember Lola Anita's hypertension maintenance medication that uses
amlodipine to decrease her blood pressure, right? Pharmacodynamic causes desired
drug effect.

Pharmacodynamics is the analysis of drug pathways that cause biochemical or

physiological changes in the body. So, the drug effect of amlodipine to Lola Anita is to
lower her blood pressure by calming her coronary vascular smooth muscle and coronary
vasodilation by inhibition of Ca ion transmembrane inflow into her cardiac and vascular
smooth muscles. This is one example of a concept-pharmacodynamics.
So, how do drugs achieve this effect on our body? What are different ways?
Here it is:

1. Receptor sites - receptor sites react with such chemicals in order to have an effect
within the cell. Visualized this about how the key and the lock work together. The
interaction between the chemical site and the receptor site influences the enzyme
mechanism within the cell. So some drugs act as a "agonist" which means that
they induce response, while a "antagonist" prevents response.
Drug Enzyme Interaction - Enzyme systems function in cascade fashion.
One enzyme activating another, and then that enzyme activating another, before
a cellular reaction occurs.
2. Selective toxicity - The drug's ability to target only certain systems located in
foreign cells.

There are several factors influencing the impact of drugs on the body. Involvement
in nursing is that you must be mindful that the human aspect has an effect on what
ultimately happens when a drug reaches the body. These include weight, age,
physiological factors, pathological factors, genetic, immunological, physiological,
environmental, drug tolerance, cumulative effects and drug interactions. This
demonstrates how important the cornerstone of your nursing process is-Do you know
what it is? Yes , yes! Your evaluation process, which contains all details on your patient
history..
If you need more detail, you can read Chapter 2 of the book "Emphasis on Nursing
Pharmacology" (7th ed.). By Kark, A. M., (2013) or any other reference you have. You
can also check out these similar videos if you like learning while watching.
Pharmacokinetics: https://www.youtube.com/watch?time_continue=5&v=-jZf-
eZWcKY&feature=emb_logo
Part 1: Topical and Systemic Drugs https://www.youtube.com/watch?v=x_JaFhWlOZo
Part 2: Lipophilic and Hydrophilic drugs
https://www.youtube.com/watch?v=WDb8ncTklmg

Pharmacodynamics
Part 1: How Drugs Act on the Body https://www.youtube.com/watch?v=PhfhMBO-w9Q
Part 2: Dose-Response Relationship https://www.youtube.com/watch?v=VzrvklX5Wmw

Oh, YEY! You're now halfway to finish Unit 1 of your course. I'd like you to take a
deep breath and relax for a while before going to our next class.

Self-Check 2

1. Differentiate pharmacokinetics and pharmacodynamics based on your own

understanding.

2. Upon considering the pharmacokinetics of Lola Anita’s drug (amlodipine), what

points would you consider as her nurse? Select all that apply.
a. Half-life of the drug
b. The way the drug affects the body
c. How the drug metabolized
d. How the drug excreted
e. Receptor site activation and suppression
f. How the drug will be absorbed
Title of the Lesson: Toxic Effects of Drugs and Effects of Drug Interactions
Duration: 2 hour
Now, you've heard how medications function in the therapeutic response of our
body. It is therefore important to know the toxic effects of drugs and their effects on drug
interactions. Why do you think so, huh? If you have any idea about that?

Knowing these effects can arise and what steps can be done to avoid or deal with
them may be the most important factor in encouraging the patient to comply with drug
therapy. Imagine Lola Anita again, she's been taking amlodipine for five years, and she's
getting dizzy, tired, and she sees some swelling on her legs, and she asks you, is it
because of the drug? What's your answer to her?

An adverse drug reaction often referred to as a side effect or adverse effect, is a

negative, unwanted reaction. These symptoms can be due to individual drug reactions,
high or low body weight , age, or underlying disease that affects the drug's effects. So,
as part of your nursing intervention, you will involve taking care of the adverse drug
reactions that may affect your patient. When a drug is known to have toxic effects the
benefit of the medication to the patient must be weighed against the risk of adverse effects
that could cause damage to the patient.

Drug interactions can occur between drugs or between drugs and foods.
Potential drug interactions shall include:
● additive effects-two drugs with similar action given to increase its therapeutic
effect.
● synergistic effect- when one of the drugs enhances the effect of the other drug
● antagonistic effects-drug interaction occurs when two drugs taken together
lessen than the response produced by either drug alone.
● decreased or increased absorption
● decreased or increased metabolism and excretion.

Let’s take Lola Anita’s amlodipine drug interaction with another drug as an example.

➢ Additive effects (Amlodipine and valsartan)

➢ Synergistic effect (Amlodipine and erythromycin) Increased exposure with
CYP3A4 enzyme inhibitors. Can increase the risk of hypotension or shock.
➢ Antagonist effect (Amlodipine and Rifampicin) -Decreased plasma concentration
with CYP3A4 inducers. Can decrease the effectiveness of amlodipine.
➢ Amlodipine and cyclosporin -increase the blood levels and effects of both
medications.
 ➢ Amlodipine and simvastatin- Increased serum concentration of simvastatin, might
cause side effects like liver damage.
That is a lot of deep thinking and I know you learned a lot from it. 3 out of 5. 2 more
to go! Let’s go! If you need more readings, you can check Chapter 3 of the book entitled
“Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references
and watch this video about Drug Toxicity
https://www.youtube.com/watch?v=2gZiDx9i1do and Drug Interactions
https://www.youtube.com/watch?v=-lqWIE4lqqw for a quick review.
Self-Check 3

Lola Anita has been taking Amlodipine (Provasc) as a hypertension maintenance drug
for five years. She experiences dizziness, fatigue, and finds some swelling on her legs.
At the same time, Lola Anita has some pain in her throat and takes erythromycin with her
daughter's advice without consulting her doctor. React to the following questions and
write your answers below.

a. What are the important nursing implications in this case?

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
b. What are the effects of this drug and what issues should be considered?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

c. What specific issues should be discussed?

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

d. What teaching points need to be clarified?

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Title of the Lesson: Nursing Management
Duration: 2 hours

Have you ever learned that Nursing is an Art? I've been betting yes. Indeed,
nursing is an art that requires a mechanism that ensures patient safety. Nursing theorist
has established what we have called NURSING PROCESS. It is a systematic guide to
patient centered care that involves 5 phases (ADPIE) namely: Assessment, Diagnosis,
Planning, Implementation and lastly Evaluation. In this lesson, you will learn how to
incorporate your nursing obligation into the care of your patient through the use of the
nursing process.

From your previous class, you've discovered that there are many variables that
influence the effect of drugs on the body. These include weight, age, physiological factors,
pathological factors, genetic, immunological, physiological, environmental, drug
tolerance, cumulative effects and drug interactions. These data have been used in your
evaluation process. The table below summarizes the data included in each phase.

Table 1.2 Nursing Process

Phases Definition Pharmacology Nursing

Process

ASSESSMENT Systematic and structured Drug use

data collection, including
background records and
physical inspection.
Allergies
Chronic condition
Gather the data of
therapeutic effect
Data related to adverse
reaction
Patients capability in self
administration
Assess patient risk factor

DIAGNOSIS Identify the health concern Identify possible drug

and formulate a diagnosis reaction
of nursing dependent on Health complications
NANDA

PLANNING Setting goals and desired Patient achieved

outcome for your patient therapeutic effect well

IMPLEMENTATION Nursing intervention to Administering drug

achieve the desired medication
outcome of your patient Nursing responsibility
 before, during and after
administration
Patient Education about
taking the medication,
possible side effects.

EVALUATION Evaluate the efficacy of Determine presence and

nursing intervention done absence of therapeutic
to your patient effect
Patients followed the
medication regimen.

Now, you are equipped to administer the prescribed medication to your patient. To
ensure safety, you need to bear in mind the 10 rights of drug administration. It will be your
focus on Unit 14.

1. Right Dosage
2. Right Route
3. Right Time
4. Right Refuse
5. Right Assessment
6. Right Medication
7. Right Patient
8. Right Evaluation
9. Right Education (Client)
10. Right Documentation

Meanwhile, Let's talk about Lola Anita, Look at the sample nursing care plan and
drug study below.

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Readiness for Short term Goal: Independent: Short term Goal
Enhanced Self
“Mukang HealthManageme After 30 minutes Identify basic Provide baseline After 30 minutes
magkaiba ang nt related to of nursing knowledge about data for of nursing
itsura ng gamot identifying her intervention her medications evaluation intervention
ko”- As verbalized own health care patient can taking patient identify
by the patient needs. identify different different name of
name of her Provide health Prevent possible her medication
Objective: medication teaching about adverse effect
drug-drug and result from drug- / Met
Long term goal: drug-food drug-food ___Partialy met
interaction interaction ___ Unmet
After 2 hours of
nursing Monitor patient for Determine
 intervention possible side medication Long term goal
patient will adhere effect like effectiveness.
to therapeutic dizziness, and After 2 hours of
regimen to nausea nursing
maintain her intervention
health Dependent: patients adhere
to therapeutic
regimen to
Interdependent: maintain her
health.
Collaborate with Helps maintain
significant others the patient to / Met
to provide follow the health ___Partialy met
support. management. ___ Unmet

Drug Study
Medication Date Route of Mechanism Indication Contraindicat Clients Nursing
ordered/ Administrati of Action ion Response Responsibilities
Given/ on/
Taken Dosage/
Frequency

Generic Date Dosage: Ca-channel Hypertension Severe drug cause Before:

Name: ordered: blocker, hypotension, dizziness,
5 mg reduces cardiogenic headache, Check patient
Amlodipine (Sample peripheral shock, fatigue or liver function
only) Route: vascular left nausea
Brand resistance ventricular Instruct the
Name: Date PO and BP by outflow tract patient it can
given: relaxing obstruction take with or
Provasc Frequency: coronary (e.g. high- without food.
vascular grade aortic
Classificati Date OD smooth stenosis), Monitor blood
ons: Taken: muscle and heart failure pressure
coronary after acute
Calcium vasodilatio MI.
Antagonists n through During:
inhibition of
Ca ion Monitor heart
transmemb rate, rhythm,
rane influx blood pressure
into cardiac
and
vascular After:
smooth
muscles. Monitor patient
response to
medication

Identify possible
side effects the
patient is
experiencing.

Instruct the
patient of any
drug
interactions
possible.
 Tip: A good NANDA book will guide you in making your Nursing Care Plan and a
good Nurse’s drug Handbook will come handy with your Drug Study.

If you feel a need for deeper comprehension, you can go back to our lesson and
read Chapter 4 of the book "Emphasis on Nursing Pharmacology" (7th ed.). By Karch, A.
M., (2013) or any other guide. You can also watch this video of the 5 Steps Nursing
Process: Pharmacology accessible at:
https://www.youtube.com/watch?v=_c1aRNmS1hU for a quick insight.

Self-Check 4.
Multiple Choice. Circle the option that best answers the question or completes the
statement.
1. Assessment is the systematic and structured data collection, including background
records and physical inspection.
a. True
b. False
c. Partly true
d. Partly false

2. Diagnosis is the process of dentification of the health concern and formulate a

diagnosis of nursing dependent on NANDA
a. True
b. False
c. Partly true
d. Partly false

3. Planning is the setting goals and desired outcome for your patient
a. True
b. False
c. Partly true
d. Partly false

4. Nursing intervention is done to achieve the desired outcome of your patient

a. True
b. False
c. Partly true
d. Partly false
Title of the Lesson: Dosage Calculations
Duration: 2 hours

Hurray! Hurray! Now you're on the last lesson for Unit 1 dose calculations. With
your knowledge of how drugs function in the body as well as its potential negative effects,
you have learned how important it is for a future nurse like you to prescribe the correct
dosage of drugs along with a nursing method to help your patient achieve optimal well-
being.
Always note that you need to consider the sex, weight , age and physical condition
of your patient when deciding the correct dose of a specific medicine. For these reasons,
much of the dosage that your patient requires is not readily available. You therefore need
to convert the usable dose to the recommended dose. To do this, you need to consider
the various measurement methods used in the preparation of medicines. I hope that this
table will help you recall the following:

Units of Measurement
Measuring
Description
System
Solid Measure Liquid Measure

Metric The most widely gram (g) liter (L)

used system of 1 milligram (mg) = 0.001 g 1 milliliter (mL) =
measure. 1 microgram (mcg) = 0.001 L
0.000001 g 1 mL = 1 cubic
1 kilogram (kg) = 1,000 g centimeter = 1 cc

Apothecary Very old system grain (gr) minim (min)

of measurement 60 gr = 1 dram (dr) 60 min = 1 fluidram (fl
that was 8 dr = 1 ounce (oz) dr)
specifically 8 fl dr = 1 fluid ounce
developed for (fl oz)
use by pint (pt)
apothecaries or
pharmacists.

Household Measuring pound (lb) 2 pt = 1 quart (qt)

system that is 1 lb = 16 ounces (oz) 4 qt = 1 gallon (gal)
found in recipe 16 oz = 1 pt = 2 cups
books (c)
32 tablespoons
(tbsp) = 1 pt 3
teaspoons (tsp) = 1
tbsp 60 drops (gtt) =
1 tsp
 Avoirdupoi Another older ounces grains
s system that was
very popular
when
pharmacists
routinely had to
compound
medications.

Other Some drugs are Unit. Reflects the biological activity of the drug in 1
Systems measured in mL of solution. The unit is unique for the drug it
units other than measures; a unit of heparin is not comparable to a
those already unit of insulin.
discussed.
These measures Milliequivalents (mEq). Are used to measure
may reflect electrolytes (e.g., potassium, sodium, calcium,
chemical activity fluoride). The milliequivalent refers to the ionic
or biological activity of the drug in question; the order is usually
equivalence. 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.
Having familiarized yourself with these measurement systems, you may now
understand that the best way to translate measurements from one system to another is
to set up a ratio and a proportion equation. The ratio containing two known equal
quantities is placed on one side of the equation and the ratio containing the sum you want
to convert and its unknown equal is placed on the other. To do this, you can refer to the
generally agreed conversions between measurement systems , i.e.:

Metric System Apothecary System Household System

Solid Measure
1 kg 2.2 lb
454 g 1.0 lb
1 g = 1,000 mg 15 gr (gr xv)
60 mg 1 gr (gr i)
30 mg 1⁄2 gr (gr ss)

Liquid Measure
1 L = 1,000 mL about 1 qt
240 mL 8 fl oz (fl oz viii) 1c
30 mL 1 fl oz (fl oz i) 2 tbsp
15–16 mL 4 fl dr (fl dr iv) 1 tbsp = 3 tsp
 8 mL 2 fl dr (fl dr ii) 2 tsp
4–5 mL 1 fl dr (fl dr i) 1 tsp = 60 gtt
1 mL 15–16 min (min xv
or min xvi)
0.06 mL 1 min (min i)
Now let us convert 12 fl oz (Apothecary System) to the Metric System as an
example number 1.

Step 1: Ratio and Step 2: Cross Step 3. Step 4. Cancel

Proportion. Put Multiply. Multiply Rearrange. Out. Whenever
the ratio containing the numerator from Rearrange the possible, cancel
two known one side of the terms to let the out numbers, as
equivalent equation by the unknown quantity well as units of
amounts on one denominator from stand alone on one measure.
side of an the other side, and side of the
equation, and the vice versa. equation
ratio containing the
amount you wish to
convert and its
unknown
equivalent is
placed on the other
side.

= 1 fl oz = 12 fl oz = (1 fl oz) x X = (12 X = 360(mL) (fl oz) X = 360mL

30 mL X fl oz) x (30 mL) 1 fl oz

= (1 fl oz) X = 360
(fl oz) (mL)
As there are many accessible measuring systems that may be used when a
prescription is ordered and since the medications are only accessible in certain types or
doses, it might be appropriate to measure what should be administered by the patient,
you must therefore use the following formula:

Type of Medication Formula

Oral Drugs amount of drug available = amount of drug prescribed

one tablet or capsule number of tablets or capsules to
give

Example Number 2 An order is written for 20 grains of aspirin (gr x, aspirin). The
tablets that are available each contain 10 grains. How many
tablets should the nurse give? Follow steps number 1 to 4 on
example number 1.
Step 1: Step 2: Step 3: Step 4:
10gr = 20gr = 10(gr) X = 20(gr) X = 20(gr)(tab) X = 2 tablets
one tablet X (tab) 10(gr)

X = 2(gr) (tab)
(gr)

Parenteral Drugs amount of drug available = amount of drug prescribed

volume available volume to administer

Example Number 3 An order has been written for 150 mg of meperidine to be

given intramuscularly. The vial states that it contains
meperidine, 1.0 mL = 100.0 mg. Follow steps number 1 to 4
on example number 1.

Step 1: Step 2: Step 3: Step 4:

100mg = 150mg = 100(mg) X = X = 1.5(mg)(mL) X = 1.5 mL

1mL X (150x1)(mg)(mL) (mg)

X = 150(mg) (mL)
100 (mg)

Intravenous Solutions (mL of solution prescribed per hour)

Drop Factor: drops = (drops delivered per mL
Micro: 60μgtts/min minute (60 min)/(1h)
Macro: 15gtts/min *gtts = drops; μgtts = micro drops

Example Number 4 An order has been written for a patient to receive 400 mL of
5% dextrose in water (D5W) over a period of 4 hours in a
standard microdrip system (i.e., 60 drops/mL). Calculate the
correct setting (drops per minute):

Step 1: Step 2: Step 3: Step 4:

X=(400mL/4h)(60drop X=(100mL/h)(60dro X=(6,000)(60drops X=

s/min) ps/min) /hr) 100drops/min
(60 min)/(1h) (60 min)/(1h) (60 min)/(1h)

X=(100)(drops/hr)
(min)/(1h)
In the meantime, children need different doses from adults. It is therefore equally
necessary to know the measurement methods used to assess the pediatric dosage,
taking into account the age , weight or body surface of the child as follows:
Calculation Method Description Formula

Fried’s Rule A calculation child’s dose (age <1y) = childs’ age

method that (mo)
applies to a 150 mo
child younger x average adult
than 1 year of dose
age.The rule
assumes that
an adult dose
would be
appropriate for
a child who is
12.5 years (150
months) old.

Young’s rule A calculation child’s dose (age <1y) = child’s age

method that (mo)
applies to child’s age (y)
children 1 to 12 + 12
years of age. x average adult
dose

Clark’s rule Uses the child’s child’s dose = weight of child

weight to 150 lb
calculate the x average adult dose
appropriate
dose and
assumes that
the adult dose is
based on a 150-
lb person.

Example Number 5 a 3-year-old child weighing 30 lb is to receive a therapeutic

dose of aspirin.The average adult dose is 5 gr, and the dose
to be given is the unknown (X).

Solution using X = 3 y × 5 gr X = 15 (y)(gr) X = 1 gr

Young’s rule 3 + 12 y 15 y

Solution using X = 30 lb x 5gr X = 150 (lb)(gr) X = 1 gr

Clark’s rule 150 lb 150 lb

Body Surface Area The child’s child’s dose =surface area (m2) x
surface area is average adult dose
determined with 1. 73
 the use of a
nomogram. The
height and
weight of the
child are taken
into
consideration in
using the chart.
I hear you, don't worry about that. I really understand that these drug equations
can be daunting. Believe me, I've been in your shoes. Just don't ask me when it was! :p
Although figures can be daunting and difficult to see, bear in mind that, as a
potential nurse, it is vital to be professional to measure doses as your mistake can harm
the health of your patient.
What kind of tips can I give you? Don't be discouraged and practice a lot of stuff!
Create your own plans to master these skills. More importantly, when you're in doubt, you
can always ask people you meet who can help you. Your clinical teachers and senior
nurses will be more than pleased and able to assist you all the time. Know, you're not
alone on this trip.
For more examples, you may read chapter 5 of the book entitled “Focus on nursing
pharmacology” (7th ed.). by Karch, A. M., (2013) pages 57-60.
You may also consider watching “How to do Basic Medication Dosage and
Calculations” accessible at https://www.youtube.com/watch?v=ndtXW8ZkWHU for
additional technique in making dosage calculations.

Self-Check 5

Situation number An IV infusion containing 900ml is to be administered at a

1 drop rate of 15gtts/min with 20gtts/min drop factor. How
long will it take to administer the entire infusion?

Step 1: Step 2: Step 3: Step 4:

Situation number The doctor ordered 50mg of Tramadol IV for a client. How
2 many ml of Tramadol solution containing 100 mg/ml must be
given to the client?
Step 1: Step 2: Step 3: Step 4:

Situation number 2 g of Ceftazidime was ordered to be given to the client prior

3 to surgery. The stock dose is 1000mg/10ml per vial. How
many ml should be administered to the client?

Step 1: Step 2: Step 3: Step 4:

Situation number A recommended dose of Streptomycin sulfate is 10

4 mg/lb/day. How many mg of this drug may be administered
daily to a 63 kg adult?

Step 1: Step 2: Step 3: Step 4:

Situation number An IV solution of 1L of D5W is to infuse over 8 hours. The IV

5 set is calibrated to deliver 15 gtts/min. How many drops per
minute the client should receive?

Step 1: Step 2: Step 3: Step 4:

Post-test
Multiple choice. Encircle the best answer.
1. Doctor Ana order paracetamol syrup, 650 mg orally every 4 hours as needed for
pain. The medication label reads: 500 mg/mL. The nurse prepares how many
milliliters to administer one dose?
a. 29.5 mL
b. 25 mL
c. 19.5 mL
d. 15 mL
2. Nurse Anabelle is developing goals for the postpartum client who is at risk for uterine
infection. Which goal would be most appropriate for the client to be included in your
Nursing Care Plan.
a. The client will verbalize a reduction of pain.
b. The client will report how to treat an infection.
c. The client will no longer have a positive Homan sign
d. The client will be able to identify measures to prevent infection.
3. Which of the following statements made by the patient understand about generic name
and brand name?
a. Generic name and Brand name are different names for the same type of drug
producing the same therapeutic effect to the body.
b. Generic name is less effective with brand name.
c. Brand name are given for rich person and generic name are given for poor patient
d. Drugs with Brand names are more effective than Drugs with generic names.
4. Doctors order for paracetamol 3 mg/kg by mouth every 6 hours for pain for an eight
year old child. The child weighs 73 lb. Available dose given is 50 mg/2 ml. How many ml
will you administer per dose?
1. 2 ml/dose
2. 3.9 ml/dose
3. 4.9 ml/dose
4. 5 ml/dose

5. Which of the following statements described the evaluation process?

a. Evaluation includes collecting data about patient drug use and chronic condition.
b. Statement that described clients health needs.
c. Determine whether to continue, modify, or terminate the plan of care.
d. Develop an individualized care plan that specifies client goals.
6. Patient Danny is about to have a vaccination for covid-19. You are explaining the
process of Drug development to him. Which of the statements indicate an understanding
of the process.

a. Phase I study includes the continuous evaluation of a drug after it has been
released for marketing.
b. Phase II study includes clinical study of a proposed drug by selected physicians
using actual patients who have the disorder the drug is designed to treat; patients
must provide informed consent.
c. Phase III study includes a pilot study of a potential drug using a small number of
selected, usually healthy humans.
d. Phase IV study includes use of a proposed drug on a wide scale in the clinical
setting with patients who have the disease the drug is thought to treat.

7. Nurse Ana is giving health education to patient Danny that amlodipine mechanism of
action helps lower his blood pressure by relaxing coronary vascular smooth muscle and
coronary vasodilation. Which of the following best described the mechanism of drug
action?

a. Pharmacokinetics
b. Pharmacology
c. Pharmacodynamics
d. Pharmacotherapy

8. Patient Danny was at home with discharge medication of Maalox 30 mL by mouth. He

called you on the phone asking how to measure the dose using ordinary household
measuring devices?

a. 1 tbsp
b. 2 tbsp
c. 3 tbsp
d. 4 tbsp

9. The nurse prepares a discharge plan of care for a postoperative client who had a
cystectomy and a urinary diversion. The nurse identifies which nursing diagnosis as a
priority?

a. Risk for infection related to a direct opening into the bladder

b. Risk for disturbed body image related to the presence of a pouch
c. Risk for toileting self-care deficit related to poor hand-eye coordination
d. Impaired Urinary elimination related to urinary diversion and the loss of the ability
to void normally.
 10. Patient Danny is curious and asks you what drugs are made of. Which of the following
statements is true about drug sources?.

a. All drugs are made from plant derivatives.

b. Drugs are available from varied sources, both natural and synthetic.
c. Drugs made from animals are not safe.
d. Inorganic compounds are not a safe source of medication.

Final Requirement
Formulate your own Nursing Care Plan and Drug study for Lola Anita following the format
below. (You can use a separate paper for this one).

Case Scenario:
Lola Anita, a 63 years old patient widow and living with her daughter. Complains
of sudden onset of right-sided weakness, difficulty of breathing, nausea and vomiting.
She has hypertension for five years and takes Amlodipine (Provasc) 5 mg once a
day daily. She recently retired from employment and pays her health care through the
help of social service and from her children. Her both parents have a history of
hypertension and diabetes. Upon admission her vital signs are as follows BP; 160/100
PP. 108, RR 23, Temp. 36.5. Weight: 55 kg, Height 5’5’’. Three days ago, she
experienced dizziness, weakness, and noticed some swelling on her feet.
She also reports having a throat pain and she takes erythromycin by the advice of
her daughter without consulting a doctor. She was admitted and the doctor ordered
Amlodipine 5 mg twice a day by mouth and Atorvastatin 10 mg once a day by mouth.

Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Short term Goal: Independent: Short term Goal

___ Met
Objective: Long term goal: Dependent: ___Partialy met
___ Unmet

Long term goal

Interdependent:

___ Met
___Partialy met
___ Unmet
Drug Study
Route of
Medication Date ordered/
Administration/ Mechanism Clients Nursing
Given/ Indication Contraindication
Dosage/ of Action Response Responsibilities
Taken
Frequency

Generic Name: Date ordered: Dosage: Before:

Brand Name: Date given:

Route; During:

Classifications: Date Taken:

Frequency: After:

Suggested Readings and Website

Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto, George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

AMBOSS: Medical Knowledge Distilled (2019, September, 13). Pharmacokinetics - Part

1: Topical and Systemic Drugs. https://www.youtube.com. Retrieved August 23,
2020, from https://www.youtube.com/watch?v=x_JaFhWlOZo

AMBOSS: Medical Knowledge Distilled (2019, September, 13). Part 2: Lipophilic and
Hydrophilic drugs. https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=WDb8ncTklmg

AMBOSS: Medical Knowledge Distilled (2019, October, 03). Pharmacodynamics Part 1:

How Drugs Act on the Body. https://www.youtube.com. Retrieved August 23,
2020, from https://www.youtube.com/watch?v=PhfhMBO-w9Q
AMBOSS: Medical Knowledge Distilled (2019, October, 10). Part 2: Dose-Response
Relationship. https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=VzrvklX5Wmw

Ausned (2019, September 05, 2019). Pharmacokinetics. https://www.youtube.com.

Retrieved Retrieved August 23, 2020, from
https://www.youtube.com/watch?time_continue=5&v=-jZf-
eZWcKY&feature=emb_logo

CancerQuest-EmoryUniversity. (2019, August 03). Drug Toxicity.

https://www.youtube.com. Retrieved Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=2gZiDx9i1do

McCormick, S., (2012, February, 17). Basic Pharmacology. https://www.youtube.com.

Retrieved August 23, 2020, from https://www.youtube.com/watch?v=3SvSEI6ZlrI.

MedicEne (2016, April, 18). Drug Interactions. https://www.youtube.com. Retrieved

Retrieved August 23, 2020, from https://www.youtube.com/watch?v=-lqWIE4lqqw

RN Kid. (2017, July, 10). How to do Basic Medication Dosage and Calculations.
https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=ndtXW8ZkWHU

The Nomad Nurse (2018, January, 09). 5 Steps Nursing Process: Pharmacology.
https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=_c1aRNmS1hU

References
Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto, George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Web Sources
AMBOSS: Medical Knowledge Distilled (2019, September, 13). Pharmacokinetics - Part
1: Topical and Systemic Drugs. https://www.youtube.com. Retrieved August 23,
2020, from https://www.youtube.com/watch?v=x_JaFhWlOZo
AMBOSS: Medical Knowledge Distilled (2019, September, 13). Part 2: Lipophilic and
Hydrophilic drugs. https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=WDb8ncTklmg

AMBOSS: Medical Knowledge Distilled (2019, October, 03). Pharmacodynamics Part 1:

How Drugs Act on the Body. https://www.youtube.com. Retrieved August 23,
2020, from https://www.youtube.com/watch?v=PhfhMBO-w9Q

AMBOSS: Medical Knowledge Distilled (2019, October, 10). Part 2: Dose-Response

Relationship. https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=VzrvklX5Wmw

Ausned (2019, September 05, 2019). Pharmacokinetics. https://www.youtube.com.

Retrieved Retrieved August 23, 2020, from
https://www.youtube.com/watch?time_continue=5&v=-jZf-
eZWcKY&feature=emb_logo

CancerQuest-EmoryUniversity. (2019, August 03). Drug Toxicity.

https://www.youtube.com. Retrieved Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=2gZiDx9i1do

McCormick, S., (2012, February, 17). Basic Pharmacology. https://www.youtube.com.

Retrieved August 23, 2020, from https://www.youtube.com/watch?v=3SvSEI6ZlrI.

MedicEne (2016, April, 18). Drug Interactions. https://www.youtube.com. Retrieved

Retrieved August 23, 2020, from https://www.youtube.com/watch?v=-lqWIE4lqqw

RN Kid. (2017, July, 10). How to do Basic Medication Dosage and Calculations.
https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=ndtXW8ZkWHU

The Nomad Nurse (2018, January, 09). 5 Steps Nursing Process: Pharmacology.
https://www.youtube.com. Retrieved August 23, 2020, from
https://www.youtube.com/watch?v=_c1aRNmS1hU