An Overview of

Nursing
Pharmacology
Prepared by:
Maria Andrea L. Endeno, R.N., M.A.N.
September 24, 2020
Learning Objectives:
› Introduce the Concept of Pharmacology
› Review the Types of Drug Preparation and the Routes of
Medication Administration
› Recall the 10 RIGHTS OF MEDICATION ADMINISTRATION
and its importance in enduring safe administration of
medications to patients
› Interpret a Drug Order
› Describe the importance of utilizing the Nursing Process
in ensuring Safe Medication Administration
 “Why should a
nursing student learn
pharmacology?”
DEFINITION OF TERMS
› PHARMACOLOGY - the study of the effect of drugs on
living organisms.
› DRUGS – any chemical that alter or affects the function
or physiologic processes of living organisms
– It has the connotation of an illicitly obtained
substance such as heroin, cocaine, or
amphetamines.

› MEDICATIONS - are drugs given for therapeutic

purposes
–a substance administered for the diagnosis,
cure, treatment, or relief of a symptom or for
prevention of disease.
DEFINITION OF TERMS
› PHARMACY - the art of preparing, compounding, and
dispensing drugs.
– also refers to the place where drugs are prepared and
dispensed.
– The LICENSED PHARMACIST - prepares, makes, and
dispenses drugs as ordered by a physician, dentist,
nurse practitioner, or physician assistant.
› PHARMACOGENETICS - branch of pharmacology that
examines the role of genetics in drug response
› ETHNOPHARMACOLOGY - the study of the effect of
racial and ethnic differences/responses to prescribed
medication.
Relationship of PK and PD

DOSE CONC Therapeutic

PK PD EFFECTS
Prescribed
Dispensed Adverse
Administered

A I
Min Toxic Conc
B
II
Conc Min Effective Conc
III

Time
 EPEKTO ng GAMOT?

Ginhawa (Symptomatic)
Alisin ang sanhi (Curative)
Maibalik sa normal (Restorative)
Umiwas (Preventive)
Tukuyin ang dahilan ng pagkakasakit (Diagnostic)
 THERAPEUTIC ACTIONS OF DRUGS
DRUG TYPE DESCRIPTION EXAMPLES

PALLIATIVE Relieves the symptoms of Morphine sulfate - for pain

a disease but does not
affect the disease itself.
CURATIVE Cures a disease or Penicillin, for infection
condition
SUPPORTIVE Supports body function Norepinephrine bitartrate - for
until other treatments or low BP
the body’s response can Aspirin – for high body
take over. temperature
SUBSTITUTIVE Replaces body fluids or Thyroxine - for hypothyroidism,
substances Insulin - for diabetes mellitus

CHEMOTHERAPEUTIC Destroys malignant cells Busulfan - for leukemia

RESTORATIVE Returns the body to Vitamin - mineral supplements

health.
 Types of Drug Preparation
TYPE DESCRIPTION

AEROSOL A liquid, powder, or foam deposited in a thin layer

SPRAY OR FOAM on the skin by air pressure
AQUEOUS One or more drugs dissolved in water
SOLUTION
AQUEOUS One or more drugs finely divided in a liquid such as
SUSPENSION 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 nongreasy, 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 semisolid that liquefies when
applied to the skin
 Types of Drug Preparation
TYPE DESCRIPTION

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 A flat, round, or oval preparation that dissolves

(TROCHE) and releases a drug when held in the mouth

OINTMENT A semisolid preparation of one or more drugs

(SALVE, used for application to the skin and mucous
UNCTION) 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
 Types of Drug Preparation
TYPE DESCRIPTION

SUPPOSITORY One or several drugs mixed with a firm base

such as gelatin and shaped for insertion into
the body
(e.g., the rectum); the base dissolves gradually
at body temperature, releasing the drug
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 A semipermeable membrane shaped in the

PATCH form of a disk or patch that contains a drug to
be absorbed
through the skin over a long period of time
 THE ROUTES OF
MEDICATION
ADMINISTRATION
 ORAL ADMINISTRATION
› Most common route by which medications are given
› The route of choice - As long as a client can swallow and retain
the drug in the stomach
› Contraindicated when:
– a client is vomiting,
– has gastric or intestinal suction, or
– is unconscious and unable to swallow.
› In hospital they are usually on orders for “nothing by
mouth”
(Latin term is nil per os: NPO).
› Medications that are inactivated in the stomach or toxic to it are
prescribed using an alternative route
 ORAL ADMINISTRATION
ADVANTAGES
› Most convenient
› Usually least expensive
› Safe, does not break skin
barrier
› Administration usually does
not cause stress
› Some new oral medications
are designed to rapidly
dissolve on the tongue,
allowing for faster
absorption and action
DISADVANTAGES
› Inappropriate for clients with nausea or
vomiting
› Drug may have unpleasant taste or odor
› Inappropriate when GI tract has reduced
motility
› Inappropriate if client cannot swallow or
is unconscious
› Cannot be used before certain diagnostic
tests or surgical procedures
› Drug may discolor teeth, harm tooth
enamel Drug may irritate gastric mucosa
› Drug can be aspirated by seriously ill
clients
 SUBLINGUAL / BUCCAL ADMINISTRATION

› Sublingual and buccal medications

– should not be swallowed, but
rather held in place so that
complete absorption can occur.
› Before administering a sublingual
or buccal drug, offer the patient a
drink of water (if the patient is
permitted to have fluids) or oral
care (if the patient is NPO).
– This ensures that the tablet will
dissolve appropriately.
 SUBLINGUAL / BUCCAL ADMINISTRATION
SUBLINGUAL
› 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.”
› A medication (e.g., a tablet) is
held in the mouth against the
mucous membranes of the cheek
until the drug dissolves. (between
the cheek and gum)
› The drug may act locally on the
mucous membranes of the mouth
or systemically when it is
swallowed in the saliva.
 SUBLINGUAL/BUCCAL ADMINISTRATION
ADVANTAGES DISADVANTAGES

› Same as for oral, plus: › If swallowed, drug may be

› Drug can be inactivated by gastric juice
administered for local › Drug must remain under
effect tongue until dissolved and
absorbed.
› More potent than oral › May cause stinging or
route irritation of the mucous
–because drug directly membranes
enters the blood and › Drug is rapidly absorbed into
bypasses the liver the bloodstream
 OPHTHALMIC MEDICATIONS
› Medications may be administered to the eye using irrigations or
instillations.
– EYE IRRIGATION - administered to wash out the conjunctival sac
to remove secretions or foreign bodies or to remove chemicals
that may injure the eye
– EYE INSTILLATIONS - ophthalmic medications (medications for
the eyes), are instilled in the form of liquids or ointment
› Eyedrops - are packaged in monodrip plastic containers that are used to
administer the preparation.
› Ointments - are usually supplied in small tubes.
– All containers must state that the medication is for ophthalmic use.
– Sterile preparations and sterile technique are indicated.
– Prescribed liquids are usually dilute, for example, less than 1%
strength.
– Ointments are often soothing to the eye, but some liquid preparations
may sting initially→ give proper instruction to clients
 OPHTHALMIC MEDICATIONS

› Holding the medication in the

dominant hand, place hand on
client’s forehead to stabilize hand.
› Approach the eye from the side and
instill the correct number of drops
onto the outer third of the lower
conjunctival sac.
– Hold the dropper 1 to 2 cm (0.4 to
0.8 in.) above the sac.
 OPHTHALMIC MEDICATIONS
› For liquid medications, press
firmly or have the client press
firmly on the nasolacrimal
duct for at least 30 seconds.
– Rationale: Pressing on the
nasolacrimal duct prevents the
medication from running out of
the eye and down the duct,
preventing systemic absorption.
 OPHTHALMIC MEDICATIONS
› Holding the tube above the
lower conjunctival sac, squeeze
2 cm (0.8 in.) of ointment from
the tube into the lower
conjunctival sac from the inner
canthus outward.
–Instruct the client to close the
eyelids but not to squeeze
them shut.
 OTIC MEDICATIONS
› OTIC - Instillations or irrigations of the external auditory canal
– Are generally carried out for cleaning purposes.
– Sometimes applications of heat and antiseptic solutions are
prescribed.
› Irrigations performed in a hospital require aseptic technique so
that microorganisms will not be introduced into the ear.
– Sterile technique is used if the eardrum is perforated.
› The position of the external auditory canal varies with age.
– Child under 3 years of age - it is directed upward.
– In the adult - it is an S-shaped structure about 2.5 cm (1 in.)
long.
 Administering Otic Instillations
› Administer the ear medication.
– Warm the medication container in your hand or
place it in warm water for a short time.
› Rationale: This promotes client comfort and
prevents nerve stimulation and pain.
– Partially fill the ear dropper with medication.
– Straighten the auditory canal.
› Pull the pinna upward and backward for
clients over 3 years of age.
– Rationale: The auditory canal is
straightened so that the solution can flow
the entire length of the canal.
– Instill the correct number of drops along the
side of the ear canal.
 Administering Otic Instillations
› Press gently but firmly a few times on the tragus of the ear (the
cartilaginous projection in front of the exterior meatus of the ear).
– Rationale: Pressing on the tragus assists the flow of medication
into the ear canal.
› Ask the client to remain in the side-lying position for about 5
minutes.
– Rationale: This prevents the drops from escaping and allows the
medication to reach all sides of the canal cavity
› Insert a small piece of cotton fluff loosely at the meatus of the
auditory canal for 15 to 20 minutes. Do not press it into the canal.
– Rationale: The cotton helps retain the medication when the
client is up.
› If pressed tightly into the canal, the cotton would interfere
with the action of the drug and the outward movement of
normal secretions
RECTAL VAGINAL
 ROUTE ADVANTAGES DISADVANTAGES
Rectal • Can be used when drug has • Dose absorbed is
objectionable taste or odor unpredictable
• Drug released at slow, • May be perceived as
steady rate unpleasant by the
• Provides a local client
therapeutic effect • Limited use

Vaginal • Provides a local effect • May be messy and

may soil clothes
 TRANSDERMAL

TOPICAL
 ROUTE ADVANTAGES DISADVANTAGES
Topical • Few side effects • Drug can enter body
through abrasions and
cause systemic effects
• Leaves residue on the skin
that may soil clothes
Transdermal • Prolonged systemic effect • Rate of delivery may be
• Few side effects variable
• Avoids GI absorption • Verify that the previous
problems patch has been removed
• Onset of drug action and disposed of
faster than oral appropriately to avoid
overdose
 ROUTE ADVANTAGES DISADVANTAGES
Inhalation • Introduces drug throughout • Drug intended for localized
respiratory tract effect can have systemic
• Rapid localized relief effect
• Drug can be administered to • Of use only for the respiratory
unconscious client system
INHALATION ROUTES OF MEDICATION ADMINISTRATION
› METERED DOSE INHALER
– Dosing may require two puff
– 1 minute interval between puff
– Pt. needs to HOLD his breath for 10
seconds after inhalation
› DRY POWDER INHALER
– After the system is loaded, teach pt. to
cover mouthpiece and inhale deeply
– Medication delivery is significantly more
efficient
› NEBULIZER
– Teach pt. to seal his mouth over the
mouthpiece and start a SLOW, DEEP
BREATHS and hold the breath for a few
seconds and EXHALE slowly
– Rinse mouth piece after every use
PARENTERAL ROUTE OF
MEDICATION
ADMINISTRATION
 ROUTE ADVANTAGES DISADVANTAGES
Sub-cutaneous • Absorption is slower (an • Must involve sterile technique
advantage for insulin because breaks skin barrier
(SQ) and heparin • More expensive than oral
administration) • Can administer only small volume
• Some drugs can irritate tissues and
cause pain
• Can produce anxiety
• Breaks skin barrier

Intra- • Can administer larger • Can produce anxiety

volume than • Breaks skin barrier
Muscular (IM) subcutaneous
• Drug is rapidly absorbed
 ROUTE ADVANTAGES DISADVANTAGES

Intradermal • Absorption is slow (this is an • Amount of drug administered

(ID) advantage in testing for must be small
allergies) • Breaks skin barrier

Intravenous • Rapid effect • Limited to highly soluble drugs

(IV) • Drug distribution inhibited by
poor circulation
RIGHTS OF MEDICATIONS
ADMINISTRATION
 EVOLUTION OF NURSING
RESPONSIBILITIES REGARDING DRUGS
› IN THE PAST focused on the Five Rights of Drug Administration (the 5 Rights)—
namely,
– Give the Right Drug
– To the Right Patient
– In the Right Dose
– By the Right Route
– At the Right Time

› More recently, various other rights—

– Right Assessment,
– Right Documentation,
– Right Evaluation,
– The Patient’s Rights to Education, and
– The Patient’s Right of Refusal
10 Rights of MEDICATION ADMINISTRATION

›RIGHT ASSESSMENT
–requires appropriate data be
collected before administration of
the drug.
10 Rights of MEDICATION ADMINISTRATION
› RIGHT DOCUMENTATION – nurses immediately record
appropriate info. About
› drug administration
› Name of the drug
› Dose of the drug
› Route of administration
› Time and Date
› Nurse’s initials or signature
› document client’s response to medications (note for S.E
or A.R.)
› Delay in charting = Failure to chart medication
10 Rights of MEDICATION ADMINISTRATION
› RIGHT TO EDUCATION
–requires that client’s receive accurate and
thorough info.
– About medications and how it relates to
his/her particular situation
–includes drug action, therapeutic response,
S.E., A.R., Diet restrict.
10 Rights of MEDICATION ADMINISTRATION

›RIGHT EVALUATION
–requires that the effectiveness of
the medication be determined by
client’s response to the
medication
10 Rights of MEDICATION ADMINISTRATION
› RIGHT TO REFUSE – respect client’s
decision to refuse treatment
–nurse's responsibility to determine reasons
for refusal
–take reasonable measures to facilitate
client’s taking of the drug
–explain to client risk-benefit ratio
–Document refusal and inform senior nurse or
doctor
 APPLICATION
of NURSING
PROCESS in
PHARMACOLOGY
 Nurses, together with
healthcare providers & pharmacists,
participate in a
system of checks and balances
designed to
promote beneficial effects
and minimize harm
 Most Important Nurses Role in Safe
Administration of Medication
› AS PATIENT ADVOCATE – it is our legal responsibility to detect mistakes
made by pharmacists and prescribers
– Nurses are the one who administers drugs – thus, it is the nurse who is the
last person to check medications before they are given.
– Consequently, you are the patient’s last line of defense against medication errors.

****It is ethically and legally unacceptable for you to administer

a drug that is harmful to the patient—
even though the medication has been prescribed by a licensed
prescriber and dispensed by a licensed pharmacist****
 Eight aspects of drug therapy:
1) Preadministration assessment - All drug therapy begins with assessment of the patient.
› Three basic goals:
1. Collecting baseline data needed to evaluate therapeutic and adverse (i.e., undesired)
responses
– Without these data, we would have no way of determining the effectiveness of
our drug.
2. Identifying high-risk patients
– Multiple factors can predispose an individual to adverse reactions from specific
drugs such as:
› Pathophysiology (especially liver and kidney impairment), Genetic factors,
Drug allergies, and Life span considerations such as pregnancy or very young
or advanced age.
– To identify such high risk patients, we use 3 principal tools:
› the patient history,
› physical examination, and
› laboratory data.
3. Assessing the patient’s capacity for self-care
THE DRUG ORDER
 The ESSENTIAL PART of a Drug Order
› The drug order consists of seven parts:
1. Name of the patient
2. Name of the drug to be administered
3. Dosage of the drug
4. Route by which the drug is to be administered
5. Frequency, time and special instructions related to administration
6. Date and time when the order was written
7. Signature and licensure of the person writing the order

*** If any of the seven parts is missing or unclear, the order is considered
incomplete and is therefore not a legal drug order.***
The Drug Order
› Each drug order should follow a specific sequence: The name of the drug is written first
followed by the dosage, route, and frequency
– Example: Procan SR(procainamide) 500mg p.o. q.6h
› Procan SR – Brand name of the drug and procainamide – generic name
› 500mg – the dosage prescribed
› p.o. – route desired
› q.6h – the intended frequency of administration
– This order means: Give 500milligrams of Procan SR (procainamide) orally every 6
hours

***If the nurse has difficulty understanding and interpreting the drug order, the nurse
must clarify the order with the writer (physician or another authorized practitioner
such as advanced registered nurse practitioner)***
***Understanding drug orders requires interpreting common medical abbreviations***
 Types of Medication Order
› STAT ORDER - indicates that the medication is to be given immediately and only once
– e.g., morphine sulfate 10 milligrams IV stat
› SINGLE ORDER OR ONE-TIME ORDER - is for medication to be given once at a
specified time
– e.g., Seconal 100 milligrams at bedtimebefore surgery
› STANDING ORDER - may or may not have a termination date.
– It 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.
› 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.
Sample Prescription and it’s Part/Content
Interpreting Drug Order
› The prescription or medication order conveys the therapeutic drug plan
for the patient
› It is the responsibility of the nurse to:
– Interpret the order
– Prepare the exact dosage of the prescribed drug
– Identify the right patient
– Administer the proper dosage by the prescribed route, at the prescribed time
intervals
– Record the administration of the prescribed drug
– Monitor the patient’s response for the desired (therapeutic) and adverse effects
› Example of a typical written drug order:
9/4/19 @ 0730 Amoxil 500 mg p.o. q.i.d.
J. Physician, M.D.
MEDICATION
SHEET
 Sample Medication Sheet

DATE MEDICATION, DOSAGE, FREQUENCY, ROUTE TIME TO 7 7 7 REMARKS

ORDERED OF ADMINISTRATION BE GIVEN 14 15 16
7/13/16 Omeprazole 40 mg/IV OD 9am AE
7/14/16 Cefuroxime 1.5 gm/IV infusion every 8 hours 6am Decreased
2pm AE Frequency
10pm NOD’s Name
& Signature
7/14/16 Cefuroxime 1.5 gms/iv infusion every 12 9am
hours 9pm AE

AS for this column the color of ink of pen

used by nurses depends on their shift
Color of Ink of pen used on this two Column is BLUE – Morning shift
BLUE or BLACK only BLACK – Afternoon shift
RED – Night Shift
STAT-Single Orders
DATE MEDICATION 7/14
7/14/16 Furosemide 20mg/IV now 10/ AE

PRN medications
DATE MEDICATION 7/14
7/14/16 Catapres 75mcg/tab SL for BP > or = to 6/ AE
160/100mmHg

Pre-Operative Medications
DATE MEDICATION 7/14
7/14/16 Cefuroxime 1.5gm /IV infusion 5:30/VL
ANST (-) to be given 1 hour Prior to OR (PTOR)
Nurse’s Specimen Signature

DATE Shift Signature of Medicine Ward Nurse

7/14/16 6-2 AE
AMBIENT EXHAUST
SN-PLM (batch 2017
 MEDICATION CARDS
(Color coding/Time)
(ORANGE) (YELLOW)

ONCE A DAY and OD @ HS (9:00 am) EVERY 4 HOURS (ROUND THE CLOCK)
(9:00 pm) (8am –12nn-4pm-8pm-12mn-4am)

(PINK) (BLUE)

TWICE A DAY and EVERY 12 HRS FOUR TIMES A DAY and EVERY 6 HRS
(9:00 am – 6:00 pm) (9:00am-9:00pm) (9am –1pm-5pm-9pm) (6am-12nn-6pm-12mn)

(WHITE)
(GREEN)
Pro Re Nata (PRN) - As Necessary
THREE TIMES A DAY and EVERY 8 HRS
STAT medications
(9am –1pm-6pm) (6am-2pm-10pm)
 Sample Medication Card DATA

Bed 1 Date

JOSE RIZAL
Omeprazole 40 mg/IV OD
9:00 am NOD
 REFERENCES
› Abrams, Anne Collins, “Clinical Drug Therapy” 7th Edition @
› Adams, Michael Patrick; Leland Norman Holland Jr. and Carol Quam Urban, “Pharmacology for
Nurses, A Pathophysiologic Approach; 4th Edition @ 2014 by Pearson Education Inc.
› Bertram, Katzung G., “Basic and Clinical Pharmacology” 14th Edition, @2018 by McGraw-Hill
Education
› Burchum, Jacqueline Rosenjack and Laura D. Rosenthal, “Lehne’s Pharmacology for Nursing Care”,
10th Edition@2019 by Elsevier Inc.
› Kee, Joyce LeFever; Evelyn R. Hayes; and Linda E. McCuistion, “Pharmacology: A Patient-Centered
Nursing Process Approach”, 8th Edition, @2015 by Saunders an Imprint of of Elsevier Inc.
› Lilley, Linda Lane; Shelly Rainforth Collins; Julie S. Snyder and Diane Sevoca, “Pharmacology and the
Nursing Process” 7th Edition, @ 2014 by Mosby, an imprints of Elsevier Inc.
› Tripathi, KD, MD, “Essentials of Medical Pharmacology” 6th Edition, @2008 by Jaypee Brothers
Medical Publishers (P) Ltd.
› http://www.osmosis.org/Pharmacology