NOTRE DAME OF TACURONG COLLEGE

COLLEGE OF NURSING
Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines
Telephone No.: (064) 200-3631 Fax No.: (064) 200-4131

Subject: Fundamentals of Nursing

nd
Placement: 2 Semester, BSN 1 Course Credit: 3units lecture

Instructor: PHIL B. MANGUIAT, RN, MAN

GROUP 4
“MEDICATION”

Fatima Janna Alpharhan Adtog Zyryle Egcao Bembeth Abdullah

Paguital
 “MEDICATION”
II. Objectives:

After completing this chapter, you will be able to:

1. Define selected terms related to the administration of medications.
2. Describe actions of drugs on the body.
3. Describe various routes of medication administration.
4. Identify essential parts of a medication order.
5. List examples of various types of medication orders.
6. State systems of measurement that are used in the administration of medications.
7. Describe converting units of weight and measure.
8. Sated the "rights" to accurate medication administrations.

III. CONTENT:

INTRODUCTION
A medication is a substance administered for the diagnosis, cure, treatment, or relief of a
symptom or for prevention of disease. In the health care context, the words medication and drug
are generally used interchangeably

DEFINITIONS
● The term drug also has the connotation of an illicitly obtained substance such as heroin,
cocaine, or amphetamines. Medications have been known and used since antiquity.
Crude drugs, such as opium, castor oil, and vinegar, were used in ancient times. Over
the centuries the number of drugs available has increased greatly, and knowledge about
these drugs has become correspondingly more accurate and detailed
● Prescription- The written direction for the preparation and administration of a drug.
● One drug can have as many as four kinds of names: its generic name, trade name (or
brand name), official name, and chemical name
● The generic name is assigned by the United States Adopted Names (USAN) Council
and is used throughout the drug’s lifetime
 ● A drug’s trade name (sometimes called the brand name) is the name given by the drug
manufacturer and identifies it as property of that company.
● The official name is the name under which a drug is listed in one of the official
publications (e.g., the United States Pharmacopeia).
● The chemical name is the name by which a chemist knows it; this name describes the
constituents of the drug precisely
● Pharmacology is the study of the effect of drugs on living organisms.
● The licensed pharmacist prepares, makes, and dispenses drugs as ordered by a
physician, dentist, nurse practitioner, or physician assistant. A clinical pharmacist is a
specialist who often guides the primary care provider in prescribing drugs. A pharmacy
technician is a member of the health team who in some states administers drugs to
clients.
● Pharmacy is the art of preparing, compounding, and dispensing drugs. The word also
refers to the place where drugs are prepared and dispensed

TYPES OF DRUGS PREPARATION

● Aerosol spray or foam- A liquid, powder, or foam deposited in a thin layer on the skin
by air pressure
● Aqueous solution- One or more drugs dissolved in water
● Aqueous suspension- One or more drugs finely divided in a liquid such as water
● Caplet- A solid form, shaped like a capsule, coated and easily swallowed
● Capsule- A gelatinous container to hold a drug in powder, liquid, or oil form
● Cream- A non greasy, semisolid preparation used on the skin
● Elixir- A sweetened and aromatic solution of alcohol used as a vehicle for medicinal
agents
● Extract- A concentrated form of a drug made from vegetables or animals
● Gel or jelly- A clear or translucent semi solid that liquefies when applied to the skin.
● Liniment- A medication mixed with alcohol, oil, or soapy emollient and applied to the
skin
● Lotion- A medication in a liquid suspension applied to the skin
● Lozenge (troche)- A flat, round, or oval preparation that dissolves and releases a drug
when held in the mouth
● Ointment (salve, unction)- A semisolid preparation of one or more drugs used for
application to the skin and mucous membrane
 ● Paste- A preparation like an ointment, but thicker and stiff, that penetrates the skin less
than an ointment
● Pill- One or more drugs mixed with a cohesive material, in oval, round, or flattened
shapes
● Powder- A finely ground drug or drugs; some are used internally, others externally
● Suppository- One or several drugs mixed with a firm base such as gelatin and shaped
for insertion into the body
● Syrup- An aqueous solution of sugar often used to disguise unpleasant-tasting drugs
● Tablet- A powdered drug compressed into a hard small disk; some are readily broken
along a scored line; others are enteric coated to prevent them from dissolving in the
stomach
● Tincture- An alcoholic or water-and-alcohol solution prepared from drugs derived from
plants
● Transdermal patch- A semipermeable membrane shaped in the form of a disk or patch
that contains a drug to be absorbed through the skin over a long period of time

A. EFFECTS OF DRUGS
● Drugs Misuse- is the improper use of common medications in ways that lead to acute
and chronic toxicity. Both OTC drugs and prescription drugs may be misused. Laxatives,
antacids, vitamins, headache remedies, and cough and cold medications are often self-
prescribed and overused. Most people suffer no harmful effects from these drugs, but
some do. For example, a client might use an OTC cough medicine to treat a cough that
might be caused by a serious underlying problem such as throat cancer.
● Drug abuse- is the inappropriate intake of a substance, either continuously or
periodically. By definition, drug use is abusive when society considers it abusive. For
example, the intake of alcohol at work may be considered alcohol abuse, but intake at a
social gathering may not. Drug abuse has two main facets, drug dependence and
habituation
● Drug dependence- is a person’s reliance on or need to take a drug or substance. The
two types of dependence, physiological and psychological, may occur separately or
together
● Physiological dependence- is due to biochemical changes in body tissues, especially
the nervous system. These tissues come to require the substance for normal
 functioning. A dependent person who stops using the drug experiences withdrawal
symptoms.
● Psychological dependence- is emotional reliance on a drug to maintain a sense of
well-being, accompanied by feelings of need or cravings for that drug. There are varying
degrees of psychological dependence, ranging from mild desire to craving and
compulsive use of the drug.
● Drug habituation- denotes a mild form of psychological dependence. The individual
develops the habit of taking the substance and feels better after taking it. The habituated
individual tends to continue the habit even though it may be injurious to health.
● Illicit drugs, also called street drugs, are those sold illegally. Illicit drugs are of two types:
(a) drugs unavailable for purchase under any circumstances, such as heroin (in the
United States), and (b) drugs normally available with a prescription that are being
obtained through illegal channels. Illicit drugs often are taken because of their mood
altering effect; that is, they make the person feel happy or relaxed.

ACTIONS OF DRUGS ON THE BODY

Because the purpose of most drug therapy is to maintain a constant drug level in the body,
repeated doses are required to maintain that level. When an orally administered drug is
absorbed from the gastrointestinal (GI) tract into the blood plasma, its concentration in the
plasma increases until the elimination rate equals the rate of absorption. This point is known as
the peak plasma level. When a drug is given intravenously (IV), its level is high immediately
after administration and decreases through time. Another dose is given in order to maintain
therapeutic levels. If the client does not receive another dose of the drug (either orally or IV), the
concentration steadily decreases. Key terms related to drug actions are as follows:
● Onset of action: the time after administration when the body initially responds to the
drug
● Peak plasma level: the highest plasma level achieved by a single dose when the
elimination rate of the drug equals the absorption rate
● Drug half- life (elimination half-life): the time required for the elimination process to
reduce the concentration of the drug to one-half what it was at initial administration
● Plateau: a maintained concentration of a drug in the plasma during a series of
scheduled doses
● Pharmacodynamic- is the mechanism of drug action and the relationships between
drug concentration and responses in the body (Adams & Urban, 2013, p. 56)
 ● A receptor- is the drug’s specific target, usually a protein located on the surface of a cell
membrane or within the cell. As the drug binds to the receptor, it enhances or inhibits the
normal cellular function. The binding is usually reversible and the action of the drug
terminated once the drug leaves the receptor (Adams & Urban, 2013, p. 60).
● Most drugs exert their effects by chemically binding with receptors at the cellular level.
When a drug binds to its receptor, the pharmacologic effects are either agonism or
antagonism. When a drug produces the same type of response as the physiological or
endogenous substance, it is referred to as an agonist. For example, epinephrine like
drugs act on the heart to increase the heart rate.
● Pharmacodynamics- Conversely, a drug that inhibits cell function by occupying
receptor sites is called an antagonist. The antagonist prevents natural body substances
or other drugs from activating the functions of the cell by occupying the receptor sites.
For example, naloxone (Narcan) is an opioid antagonist used as an antidote for
respiratory depression caused by an opioid drug (e.g., morphine). This drug competes
with opioid receptor sites in the brain and thereby prevents the opioid from binding to its
receptors. By blocking the effect of the opioid, respiratory depression is reversed.
● Pharmacokinetics- is the study of the absorption, distribution, biotransformation, and
excretion of drugs.

B. ROUTES OF ADMINISTRATION
Pharmaceutical preparations are generally designed for one or two specific routes of
administration. The route of administration should be indicated when the drug is ordered. When
administering a drug, the nurse should ensure that the pharmaceutical preparation is
appropriate for the route specified.
● Oral administration- is the most common, least expensive, and most convenient route
for most clients. In oral administration, the drug is swallowed. Because the skin is not
broken as it is for an injection, oral administration is also a safe method. The major
disadvantages can include an unpleasant taste of the drugs, irritation of the gastric
mucosa, irregular absorption from the GI tract, slow absorption, and, in some cases,
harm to the client’s teeth. For example, the liquid preparation of ferrous sulfate (iron) can
stain the teeth.
● In sublingual administration- a drug is placed under the tongue, where it dissolves. In
a relatively short time, the drug is largely absorbed into the blood vessels on the
 underside of the tongue. The medication should not be swallowed. Nitroglycerin is one
example of a drug commonly given in this manner.
● Buccal- means “pertaining to the cheek.” In buccal administration, a medication (e.g., a
tablet) is held in the mouth against the mucous membranes of the cheek until the drug
dissolves. The drug may act locally on the mucous membranes of the mouth or
systemically when it is swallowed in the saliva.
● The parenteral route- is defined as other than through the alimentary or respiratory
tract; that is, by needle. The following are some of the more common routes for
parenteral administration:
• Subcutaneous (hypodermic)—into the subcutaneous tissue, just below the skin
• Intramuscular (IM)—into a muscle
• Intradermal (ID)—under the epidermis (into the dermis)
• Intravenous (IV)—into a vein
● Topical applications are those applied to a circumscribed surface area of the
body. They affect only the area to which they are applied. Topical applications include
the following:
• Dermatologic preparations—applied to the skin
• Instillations and irrigations—applied into body cavities or orifices, such as the urinary
bladder, eyes, ears, nose, rectum, or vagina

TYPES OF MEDICATION ORDER

● A stat order indicates that the medication is to be given immediately and only once
(e.g., morphine sulfate 10 milligrams IV stat).
● The single order or one-time order is for medication to be given once at a specified
time (e.g., Seconal 100 milligrams at bedtime before surgery)
● The standing order may or may not have a termination date. A standing order may be
carried out indefinitely (e.g., multiple vitamins daily) until an order is written to cancel it,
or it may be carried out for a specified number of days (e.g., KCl twice daily × 2 days). In
some agencies, standing orders are automatically canceled after a specified number of
days and must be reordered.
● A prn order , or as-needed order, permits the nurse to give a medication when, in the
nurse’s judgment, the client requires it (e.g., Amphojel 15 mL prn). The nurse must use
good judgment about when the medication is needed and when it can be safely
administered.
ESSENTIAL PART OF MEDICATIONS
● Full name of the client- The client’s full name, that is, the first and last names and
middle initials or names, should always be used to avoid confusion between two clients
who have the same last name. In some agencies, the client’s identification number and
primary care provider’s name are placed on the order as further identification. Some
hospitals imprint the client’s name, identification number, and room number on all forms;
some agencies use stickers with similar information
● Date and time the order is written- In addition to the day, the month, and the year the
order was written, some agencies also require that the time of day be written. Writing the
time of day on the order can eliminate errors when the nursing shifts change and makes
clear when certain orders automatically terminate.
● Name of the drug to be administered- The name of the drug to be administered must
be clearly written. In some settings only generic names are permitted; however, trade
names are widely used in hospitals and health agencies
● Dosage of the drug- The dosage of the drug includes the amount, the times or
frequency of administration, and in many instances the strength; for example,
tetracycline 250 mg (amount) four times a day (frequency); potassium chloride 10%
(strength) 5 mL (amount) three times a day with meals (time and frequency). Dosages
can be written in apothecary or metric systems. The metric system, however, is strongly
suggested for safety reasons because many practitioners are unfamiliar with apothecary
units.
● Frequency of administration- The dosage of the drug includes the amount, the times
or frequency of administration, and in many instances the strength; for example,
tetracycline 250 mg (amount) four times a day (frequency); potassium chloride 10%
(strength) 5 mL (amount) three times a day with meals (time and frequency). Dosages
can be written in apothecary or metric systems. The metric system, however, is strongly
suggested for safety reasons because many practitioners are unfamiliar with apothecary
units
● Route of administration- Also included in the order is the route of administration of the
drug. This part of the order, like other parts, is frequently abbreviated. It is not unusual
for a drug to have several possible routes of administration; therefore, it is important that
the route be included in the order.
 ● Signature of the person writing the order- The signature of the ordering primary care
provider or nurse makes the drug order a legal request. An unsigned order has no
validity, and the ordering physician or nurse practitioner needs to be notified if the order
is unsigned.

PARTS OF PRESCRIPTION
● Descriptive information about the client: name, address, and sometimes age
● Date on which the prescription was written
● The Rx symbol, meaning “take thou”
● Medication name, dosage, and strength
● Route of administration
● Dispensing instructions for the pharmacist, for example, “Dispense 30 capsules”
● Directions for administration to be given to the client, for example, “take on an empty
stomach”
● Refill and/or special labeling, for example, “Refill × 1”
● Prescriber’s signature

C. SYSTEMS OF MEASUREMENT
Three systems of measurement are used in North America: the metric system, the
apothecaries’ system, and the household system, which is similar to the apothecaries’ system.
● The metric system- devised by the French in the latter part of the 18th century, is the
system prescribed by law in most European countries and in Canada. The metric system
is logically organized into units of 10; it is a decimal system. Basic units can be multiplied
or divided by 10 to form secondary units. Multiples are calculated by moving the decimal
point to the right, and division is accomplished by moving the decimal point to the left.
● The apothecaries’ system- older than the metric system, was brought to the United
States from England during the colonial period. Many now consider the apothecaries’
 system out of date and have replaced it with the metric system. The basic unit of weight
in the apothecaries’ system is the grain (gr), likened to a grain of wheat, and the basic
unit of volume is the minimum, a volume of water equal in weight to a grain of wheat.
The word minim means “the least.”
● Household measures- may be used when more accurate systems of measure are not
required. Included in household measures are drops, teaspoons, tablespoons, cups, and
glasses. Although pints and quarts are often found in the home, they are defined as
apothecaries’ measures.
● Converting Units of Weight and Measure- Sometimes drugs are dispensed from the
pharmacy in grams when the order specifies milligrams, or they are dispensed in
milligrams though ordered in grains. For example, a primary care provider orders
morphine gr 1/4. The medication is available labeled only in milligrams. The nurse knows
that 1 mg = 1/60 gr or 60 mg = 1 grain.
● Approximate Volume Equivalents: Metric, Apothecaries’, and Household Systems

Metric Apothecaries’ Household

1 mL = 15 minims (min or m) = 15 drops (gtt)

4–5 mL = 1 fluid dram = 1 teaspoon

15 mL = 4 fluid drams = 1 tablespoon (Tbsp)

30 mL = 1 fluid ounce = same

500 mL = 1 pint (pt) = same

1,000 mL = 1 quart (qt) = same

4,000 mL = 1 gallon (galon) = same

● Ten “Rights” of Medication Administration

RIGHT MEDICATION
• The medication given was the medication ordered.

RIGHT DOSE
• The dose ordered is appropriate for the client.
• Give special attention if the calculation indicates multiple pills/ tablets or a large
quantity of a liquid medication. This can be an indication that the math calculation may
be incorrect.
• Double-check calculations that appear questionable.
• Know the usual dosage range of the medication.
• Question a dose outside of the usual dosage range.

RIGHT TIME
• Give the medication at the right frequency and at the time ordered according to agency
policy.
• Medications should be given within the agency guidelines.

RIGHT ROUTE
• Give the medication by the ordered route.
• Make certain that the route is safe and appropriate for the client.

RIGHT CLIENT
• Medication is given to the intended client.
• Check the client’s identification band with each administration of a medication.
• Know the agency’s name alert procedure when clients with the same or similar last
names are on the nursing unit.

RIGHT CLIENT EDUCATION

• Explain information about the medication to the client (e.g., why receiving, what to
expect, any precautions).

RIGHT DOCUMENTATION
• Document medication administration after giving it, not before.
• If time of administration differs from prescribed time, note the time on the MAR and
explain the reason and follow-through activities (e.g., pharmacy states medication will be
available in 2 hours) in nursing notes.
• If a medication is not given, follow the agency’s policy for documenting the reason why.

RIGHT TO REFUSE
• Adult clients have the right to refuse any medication.
 • The nurse’s role is to ensure that the client is fully informed of the potential
consequences of refusal and to communicate the client’s refusal to the health care
provider.
RIGHT ASSESSMENT
• Some medications require specific assessments prior to administration (e.g., apical
pulse, blood pressure, lab results).
• Medication orders may include specific parameters for administration (e.g., do not give
if pulse less than 60 or systolic blood pressure less than 100).

RIGHT EVALUATION
• Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the
client experience any side effects or adverse reactions?).

IV. VIDEO LINKS (OPTIONAL)

https://www.youtube.com/watch?v=Sh_Be9-9UxU

V. DOCUMENTATION (PICTURES OF GROUP OR MEMBERS WORKING)

VI. REFERENCES
● 4.- MEDICATIONS.pdf
● " Kozier ,., Erb,G. Berman ,a. Snyder, S. J(. (2011) "Fundamentals of Nursing:
Concepts, Process, and Practices" 7th Prentice Hall