PHARMACOLOGY REVIEWER FOR MIDTERM
drug – drug, drug-food, or drug-alternative
FUNDAMENTALS CONCEPT OF PHARMACOLOGY
NURSING PROCESS - is the problem-solving
process used to provide efficient nursing car
 Essential core of practice for nurses.
 Supports the nurse in prioritizing the safe,
timely delivery of drug administration.
Purpose:
 To identify, diagnose, and treat human
responses to health and nurses.
FIVE STEPS IN NURSING PROCESS
1. ASSESSMENT
- Is an ongoing process that starts with the
admission of the patient & is completed at the time
of discharge
 Involves a systematic organized collection
of data about the patient
 Nurse collects a comprehensive information
base about the patient from physical,
examination, nursing history, medication
history, and professional observation.
Subjective data comprise what the patient
personally say about his/her:
o Medications
o Health problems
o Lifestyle
 In relating the nursing process to the
nursing functions associated with
medications, assessment includes taking a:
Drug History for 3 reasons:
 To evaluate the patient’s need for
medication
 To obtain his or her current & past use for
over-the-counter (OTC medication,
prescription medication, herbal products, &
street drugs)
 To identify problems related to drugs
therapy.
2 Major aspects associated with Assessment
I. Patient’s history
 Past experiences & illness can influence a
drug’s effect
 Knowledge of this important information
before beginning drug therapy will help to
promote safe & effective use of drug and
prevent adverse effects clinically important
therapy interactions and medications errors.
Chronic conditions:
a) Can affect the pharmacokinetics &
pharmacodynamics of a drug
b) Certain conditions such as renal disease,
heart disease, diabetes, chronic lung
disease, may require cautious use or dose
adjustment when administering a certain
drug.
Drug use
a) Ask clients specifically about over the
counter (OTC) drugs or alternative therapy
use prescription drugs that they routinely
take, and all types of medications that the
client might use.
b) Ask client about the use of alcohol, nicotine,
alternative therapies and caffeine that may
have an impact on a drug’s effect.
Allergies
a) 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.
b) Obtain specific information about the
patient’s 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 & Understanding
a) Information about the patient’s level of
education provides a baseline from which
the nurse can determine the appropriate
types of teaching information to use with the
patient.
b) Gathering information about the patient’s
level of understanding about his/her
condition, illness, or drug therapy helps the
nurse to determine where the patient is in
terms of his or her status & the level of
explanation that will be required.
c) It also provides additional baseline
information for developing a patient
education program.
d) Stress, disease and environmental factors
can affect a patient’s learning readiness &
ability
e) Direct assessment of actual learning
abilities is critical for good patient education.
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Social support Child’s age & As patients age, Older adults
a) A key aspect of discharge planning involves developmental the body may often
determining what support if any is available level will undergoes have a:
to the patient at home. many
b) It also involves referral to appropriate normal changes
community resources. that can affect
drug
Financial supports therapy such
a) The high cost of health care in general and as:
of medications in particular, must be
considered when initiating drug therapy & Alert the nurse to Decreased Variety of
promoting compliance. possible blood volume chronic
b) Financial constraints may cause a patient problems medical
not to follow through with a prescribed drug with drug Decreased conditions &
regimen delivery such as gastrointestinal could be
c) A nurse may need to refer the patient to the ability to absorption receiving a
appropriate resources that might offer swallow pills or number of
financial assistance follow directions Changes in medication
related to other receptor site that need to
Pattern of Health Care delivery responsiveness be evaluated
a) Knowing how a patient seeks health care methods. for possible
provides the nurse with valuable information Reduced blood interactions
to include when preparing the patient’s flow to muscles
teaching plan. or
b) Information about patterns of health care skin
also provides insight into conditions that the
patient may have but has not reported or Influence Central
medication use that has not been stated. pharmacokinetic nervous
s& system
II. Physical Examination pharmacodynami disorders,
 It is important to assess the patient’s cs; the immature like
physical status before beginning drug liver Alzheimer’s
therapy to: may not disease or
 Determine if any conditions exist that metabolize drugs Parkison’s
would be contraindications or cautions in the same disease
for using the drug. way as in the may develop
 Develop a baseline for evaluating the adult or the difficulty
effectiveness of the drug & the kidneys may swallowing &
occurrence of any adverse effects. not be as might require
efficient as those liquid forms
Weight of an adult. of
a) A patient’s weight helps to determine medication.
whether the recommended drug dose is
appropriate.
Physical Parameters Related to Disease or Drug
Age Effects.
b) Patients at the extremes of the age a. The specific parameters that need to be
spectrum-children & older adults-often assessed depend on the disease process
require dose adjustments based on the being treated on the expected therapeutic &
functional level of the liver & the kidneys & adverse effects of the drug therapy.
the responsiveness of other organs. b. Assessing these factors before drug therapy
begins provides a baseline level which
future assessments can be compared to
determine the effects of drug therapy.
PHARMACOLOGY REVIEWER FOR MIDTERM
2. NURSING DIAGNOSIS
 To deal effectively with identified problems
(diagnosis) the nurse must recognize the
etiologic & contributing factors.
 Etiologic & contributing factors are those
clinical & personal situations that can cause
the problems or influence its development.
 Commonly observed diagnoses are those
associated with drug treatment of a disease,
or the side effects from drug therapy.
 Nursing diagnoses can also originate from
pathophysiology by drug interactions.
Common nursing diagnoses related to drug
therapy include the following:
 Pain, acute or chronic related to surgery.
 Confusion, acute related to an adverse
reaction to medication
 Health Maintenance, Ineffective related to
not receiving recommended preventive
care.
 Knowledge, Deficient related to effects of
anticoagulant medication.
 Noncompliance related to foregetfulness.
 Health Management, ineffective related to
lack of finances
Use of nursing diagnoses is beneficial to
patient care because:
i. It facilitates the development of an
individualized care plan for each patient.
ii. It is important to note that a nursing
diagnosis is different from a medical
diagnosis, which identifies a disease
condition and the results of diagnostic
tests and procedures.
3. PLANNING
- Involves taking and prioritizing the information
gathered & synthesized in the nursing diagnoses to
plan the patient care.
Four Phases
1) Priority Setting
- After the nursing diagnosis & collaborative
problems have been identified, they must be
prioritized.
- Maslow’s hierarchy is used to perform
priority setting of an individual’s needs
focuses on organizing the needs in relation
to their direct effects on maintenance of
homeostasis.
2) Measurable goal statement
-Start with an action word (verb, followed by the
behaviors to be performed by the patient’s or
family with a specific time allocated for
attainment.
3) Nursing action
-Statement that describes nursing interventions
applicable to any patient.
4) Anticipated therapeutic expected outcome
statement
-Are developed to document the effectiveness
of the care delivered.
The nurse uses the data collected to set goals
or expected outcome and intervention:
 Goals or expected outcomes should
address the problems in the patient’s
nursing diagnosis.
 Goals are patient centered, describe the
specific activity and include a time frame for
achievement and reevaluation.
 Planning includes the development of
nursing interventions used to assist the
patient in meeting goals.
 In order to develop patient-centered goals
and outcomes collaboration with the patient
and/or family is necessary.
 The nurse uses the data collected to set
goals or expected outcome and
intervention:
 Effective goal setting has the following
qualities:
 The expected change is realistic,
measurable and includes reasonable
deadlines.
 The goal is acceptable to both the patient
and nurse.
 The goal is dependent on the patient’s
decision-making ability.
 The goal is shared with other health care
providers, including family or caregivers.
 The goal identifies components for
evaluation.
Example of well-written comprehensive
goals include the following:
 The patient will independently administer
the prescribed dose of 4 units of regular
insulin by the end of the fourth session of
instruction.
 The patient will prepare a 3-day medication
recording sheet that correctly reflects the
prescribed medication schedule by the end
of the second session of instruction.

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4. IMPLEMENTATION/ NURSING
INTERVENTIONS
- The implementation phase is the part of the
nursing process in which the nurse provides
education, drug administration, patient care, and
other interventions necessary to assist the patient
in accomplishing the established goals.
-Administration of drugs and assessment of the
drug’s effectiveness are important nursing
responsibilities.
3 types of nursing interventions frequently
Involved in drug therapy:
o Drug administration
o Provision of comfort measures
o Patient/Family education
o Proper Drug Administration
Nurse must consider Ten “Rights” to ensure
safe & effective drug administration. These
are:
 Right Patient
 Right Drug
 Right Dose
 Right Time
 Right Route
 Right Assessment
 Right Documentation
 Right Education
 Right Evaluation
 Right to Refuse
Provisions of Comfort Measures:
 Nurses should help the patient cope with
the effects of drug therapy.
 A patient is more likely to be compliant with
a drug regimen if the effects of the regimen
are not uncomfortable or overwhelming.
Placebo effect – the anticipation that a drug will be
helpful.
The nurse’s attitude and support can be
critical part of drug therapy
 back rub
 kind words
 beneficial as the drug itself
 positive approach
Managing Adverse Effects
Interventions can be directed at promoting patient
safety & decreasing the impact of the anticipated
adverse effects of a drug.
 Environmental control temperature, light
 Safety measures – avoiding driving,
avoiding the sun, using side rails.
 Physical comfort measures skin care,
laxatives, frequent meals.
 Life adjustment
Some medications & their effects require that a
patient make changes in his/her lifestyle.
 e.g. a patients taking diuretics may have to
rearrange their day so as to be near toilet
facilities when the drug action peaks.
SAFE MEDICATION ADMINISTRATION
“FIVE-PLUS-FIVE” RIGHT OF MEDICATION
ADMINISTRATION
- The “five-plus-five” rights of medication
administration are important goals for
medication safety.
The “plus five” refers to the five additional rights
that have been recommended:
1. Right assessment
2. Right documentation
3. The patient’s right to education
4. Right evaluation
5. Patient’s right to refuse
1) RIGHT PATIENT
Ask the patient to state his r her full name
and birthdate, and the medication
administration record (MAR)
Many facilities have electronic health
records (EHRs)
Most hospitals have color-coded ID bands
Verify the patient’s identification each time a
medication is given.
If the patient is an adult with a cognitive
disorder or a child, verify the patient’s name
with a family member.
Distinguish between two patients with the
same first or last name.
PHARMACOLOGY REVIEWER FOR MIDTERM
2) Right drug
- To prevent medication error, always check
to make sure the drug you are going to
administer is the one that was prescribed:
ask for generic as well as the brand name if
you are unsure.
always double check
avoid abbreviations and if you are not sure
about abbreviations that were used ask.
make sure the drug makes sense for the
patient for whom it is ordered.
3) Right dose
- The right dose refers to verification by the
nurse that the dose administered is the
amount ordered and that it is safe for the
patient for whom it is prescribed.
The right dose is based on the patient’s
physical status
 Many medications require the
patient’s weight in order to
determine the right dose.
The nurse determines if the drug is safe
to administer according to the drug’s
pharmacodynamics (action) and the
patient’s vital signs.
 Renal and hepatic functions are
important considerations because
many drugs are cleared through the
kidneys and metabolized by the
liver.
Prior to drug administration, it is
important that the nurse carefully review
the patient’s most current lab results.
 Chemistry panel includes renal and
liver function and sodium and
potassium levels
 The nurse should review the
hematology labs, which include a
complete blood count (CBC), red
blood cells (RBCs), hemoglobin,
hematocrit, and platelet.
In most cases, the right dose for a
specific patient is within the
recommended range for the particular
drug.
Nurses must calculate each drug dose
accurately.
Nurses use dimensional analysis or ratio
and proportion when calculating a drug
dose.
Always recheck the drug calculation if
he dose is within a fraction or if it is an
extremely large dose. Consult another
nurse or the pharmacist when in doubt.
An important nursing intervention
related to the right dose includes
calculating the dug dose correctly.
4. RIGHT TIME
- Refers to the time the prescribed dose is ordered
to be administered. Daily drug dosages are given at
specified intervals, such as:
 twice a day (bid)
 three times a day (tid)
 four time a day (qid)
 every 6 hours (every 6hrs); this is so the
plasma
level of the drug is maintained at a
therapeutic
level.
- Every drug cannot be given exactly when
ordered, therefore health care agencies
have policies that specify a range of times
within which drugs can be administered.
- When a drug has long half-life, it is usually
given once a day.
- Drugs with a short-life are given several
times a day at specified intervals.
- Some drugs are given before meals,
whereas others must be given with meals.
- Use of military time, which is based on a 24-
hours clock reduces administration errors
and decreases documentation.
- Many nursing settings use military time
rather than standard time.
Nursing interventions related to the right time
include the following:
Administer drugs at the specified times
(refer to agency policy).
Administer drugs that are affected by food,
such as tetracycline, 1 hour before or 2
hours after meals.
Give food with drugs that can irritate the
stomach (gastric mucosa) – for example,
potassium and aspirin. Some medications
are absorbed better after eating.
Adjust the medication schedule to fit the
patient’s lifestyle, activities, tolerances, or
preferences as much as possible.
Check whether the patient is scheduled for
any diagnostic procedures that
contraindicate the administration of
medications, such as endoscopy or fasting
blood tests. Determine whether the
medication should be given before or after
the test based on the policy.
PHARMACOLOGY REVIEWER FOR MIDTERM
Check the expiration date. If the date has
passed, discard the medication or return it
to the pharmacy, depending on the policy.
Administer antibiotics at even intervals (e.g.
every 8 hours rather than three times daily)
throughout the 24-hours period to maintain
therapeutic blood levels.
5. Right route
- The right route is necessary for adequate or
appropriate absorption.
- The right route is ordered by the health care
provider and indicates the mechanism by which the
medication enters the body.
The more common routes of absorption
include:
Oral with drug in the form of a liquid, elixit,
suspension, pill tablet, or capsule.
Sublingual, under the tongue for venous absorption
Buccal, between the cheek and gum
Via a feeding tube
Topical applied to the skin
By inhalation (aerosol sprays)
Via otic ear, ophthalmic eye, nasal (spray)
instillation
By suppository (rectal or vaginal)
Through the five parenteral routes:
Intradermal
Subcutaneous (subcut)
Intramuscular (IM)
Intravenous (IV)
Intraosseous (IO)
Nursing interventions related to the right route
include the following:
Assess the patient’s ability to swallow
before administering oral medications; make
sure the patient has not been ordered
nothing by mouth (NPO)
Do not crush or mix medications in other
substances without consulting a pharmacist
or a reliable drug reference. Do not mix
medications in an infant’s formula feeding.
If the medication must be mixed with
another substance, explain this to the
patient. For example, elderly patients may
use applesauce or yogurt to mix their
medications to make them easier to
swallow. Medications should be
administered one at a time in the substance.
- When administering many drugs at-one-
time, it is not recommended to mix drugs
together:
The correct practice is to administer one pill
at a time
When a patient has an enteral tube, it is
important to follow these guidelines; this
allows the nurse to flush the tube before
and after pill or liquid is administered to
prevent the tube from clogging.
In the event that a patient’s drug
inadvertently falls to the ground, the nurse
will be able to identify, discard and replace
the pill.
Instruct the patient that medications must be
swallowed with water and not juice, which
can interfere with the absorption of certain
medications; however, it is recommended
that iron be taken with orange juice or
vitamin C supplements to aid in the
absorption of the iron.
Use aseptic technique when administering
drugs. Sterile technique is required with the
parenteral routes.
Administer drugs at the appropriate sites for
the route.
Stay with the patient until oral drugs have
been swallowed.
6. Right assessment
- The right assessment requires the collection of
appropriate baseline data before administration of a
drug.
-Include both apical heart rate and potassium level
prior to administering digitalis, blood pressure level
prior to administering an antihypertensive drug;
blood glucose levels before insulin administration;
or respirations with blood pressure prior to
administering an opioid.
- It is also important for the nurse to identify high-
risk patients, such as patients with medication
allergies, patients on dialysis, diabetic patients,
cardiac and pulmonary patients, and the elderly
and pediatric population.
-If at-risk patients are identified, precautions can be
taken to reduce risk.
7. Right documentation
- The right documentation requires the nurse to
record immediately the appropriate information
about the drug administered.
-The most common is the paper medication
administration record (MAR), which the pharmacy
will furnish.
-Facility policies vary, but when nurses administer a
drug, they place their initials next to the name of the
drug on the paper MAR.
PHARMACOLOGY REVIEWER FOR MIDTERM
The nurse’s initials verify that the
medication was administered.
-Both paper and computerized MARs include
information about the drug to be administered,
including:
 The name of the drug
 The dose
 The route
 The time and date
 The nurse’s initials or signature.
8. Right to education
- The right to education requires that patients
receive accurate and thorough information about
the drugs they are taking and how each drug
relates to their particular condition.
Patient teaching also includes:
 Why the patient is taking the drug
 The expected result of the drug
 Possible side effects of the drug.
 Any dietary restrictions or requirements
 Skill of administration with return
demonstration.
 Laboratory test result monitoring.
9. Right evaluation
- This right is a principle of informed consent, which
is the individual having the necessary knowledge to
make a decision informed patients and families are
critical to preventing medication errors.
- The right evaluation determines the effectiveness
of the drug based on the patients response to the
drug.
- Evaluation in this context asks whether the
medication did for the patient what it was supposed
to do.
It is essential that the nurse evaluate the
therapeutic effect of the medication by
assessing the patient for side effects and
adverse drug reactions.
Evaluation is ongoing and is an important
aspect of patient safety.
 The patient has the right to refuse the
medication, and it is the nurse’s
responsibility to determine the reason for
the refusal, explain to the patient the risks
involved with refusal, and reinforce the
important benefits of and reasons for talking
the medication.
When a medication is refused, the refusal
must be documented immediately, and
follow-up is always required.
10. Right to refuse
- The primary nurse and health care provider,
should be informed because the omission may
pose a specific threat to the patient (e.g a change
in the lab values with insulin and warfarin)
- All medication errors are potentially serious. A
medication error may involve one or more types of
errors such:
 Incorrect dose or rate
 Administration to the wrong patient
 Incorrect route
 Incorrect scheduled interval
 Administration of a known allergic drug
 Omission of a dose
 Discontinuation of medication or IV fluid that
was not ordered to be discontinued.
Nurses’ rights when administering medication
There are six rights for nurses who administer
medications. These rights provide an additional
layer of safety by ensuring that the nurse has what
is needed to provide safe medication administration
1. The right to a complete and clear order
2. The right to have the correct drug, route (form)
and dose dispensed.
3. The right to have access to information
4. The right to have policies to guide safe
medication administration
5. The right to administer medications safely and to
identify problems in the system
6. The right to stop, think, and be vigilant when
administering medications
TYPES OF MEDICATION ORDERS
1) STAT order
 generally used in an emergency basis drug
should be administered as soon as possible
but only once.
2) SINGLE order
 administration of drugs at a certain time but
only one time
3) STANDING order
 indicates that a medication is to be given for
a specified number of closes.
 indicates that a drug is to be administered
until discontinued at a later date.
4) RENEWAL order
 must be written and signed by the physician
before the nurse can continue to administer
the medication
5) PRN order
 means administer if needed, allows the
nurse to judge when a medication should be
PHARMACOLOGY REVIEWER FOR MIDTERM
administered based on the patient’s need &
when it can be safely administered
6) VERBAL order
 All telephone orders or verbal orders for
medications are either handwritten by the
nurse taking the order or entered directly
into a computer and “read back” to ensure
accuracy.
7) ELECTRONIC TRANSMISSION of Patient
orders
 Many physician’s offices fax new order
these fax transmission must have an
original signature within a specified time,
often 24 hours.
Medications orders are prescribed by a
licensed health care provider (HCP) under
authority from the state to prescribe drugs.
Prescriptions may be handwritten by the
HCP, delivered as a telephone order (T/O)
or verbal order (V/O), or directly entered into
the patient’s HER. Hand-written
prescriptions are written on a provider’s
legal prescription pad are filled by a
pharmacist.
The Components of a drug order are as follows:
o Patient name and birth date
o Date the order is written
o Provider signature or name if an electronic
order, T/O or V/O
o Signature of licensed staff who took the T/O
or V/O, if
o applicable.
o HCPs who wish to prescribe controlled drug
must register with the federal Drug
Enforcement Agency (DEA). When
prescribing controlled substances, the
HCP’s DEA number must be on the
prescription.
o Drug name and strength
o Drug frequency or dose (e.g., once daily)
o Route of administration
o Duration of administration (e.g., x 7 days, x
3 doses, when applicable)
o Number of patient refills
o Number of pills to be dispensed
o Any special instructions for withholding or
adjusting dosage based on nursing
assessment, drug effectiveness, or
laboratory results.
NURSE’S RESPONSIBILITIES
1. Verification
- Once a prescription has been written for a
hospitalized patient, the nurse interprets it *
makes professional judgment on its
acceptability.
- Judgments must be made regarding the:
 type of drug
 therapeutic intent
 usual dose
 mathematical & physical preparation of the
dose
2. Nurse must also evaluate the method of
administration in relation to the patient’s physical
condition, as well as any allergies & the patient’s
ability to tolerate the dose form.
3. If any part of an order is vague, the physician
who wrote the order should be consulted for further
CLARIFICATION.
4. Patient safety is of primary importance & the
nurse assumes responsibility for Verification &
safety of the medication order
In administering medications safely the nurse
should:
a. Always assess the client’s physical status
prior to giving any medications.
b. Observe the “Rights” of drug administration
c. Read medication order, checks against
name on medicine card
5. EVALUATION
- Is part of the continuing of patient care that leads
to changes in assessment, diagnosis, planning and
intervention.
 In the evaluation phase of the nursing
process, the nurse determines whether the
goals and reaching objectives are being
met. The nurse continues to use ongoing
assessment data to evaluate the successful
attainment of the patient’s objectives and
goals. If the objectives and goals are not
met, the nurse will revise the objectives,
goal and interventions to ensure success. If
the objectives, goals, and interventions are
met, the nurse will document the successful
attainment in the nursing plan of care.
 The patient is continually evaluated for
therapeutic response, the occurrence of
adverse drug effects, & the occurrence of
drug-drug, drug-food, drug alternative
therapy or drug-laboratory test interactions.
PHARMACOLOGY REVIEWER FOR MIDTERM
 Some drugs requires evaluation of specific
therapeutic drug levels.
 The efficacy of the nursing interventions &
the education program are also evaluated.
Basic Ethical Principles that Govern
Drug Development
1) Respect for Persons
 Patient’s should be treated as independent
persons who are capable of making
decisions in their own best interests.
 When making health care decisions, patient
should be made aware of alternative
available to them as well as the
consequences that stem from those
alternatives.
 The patients choice should be honored
whenever possible.
NURSING RESPONSIBILITIES
 Nurses should recognize when patients are
not capable of making decisions in their own
best interest are entitled to protection.
 Nurses can assist with the determination of
decision-making capacity through frequent
assessment of the patient’s cognitive status.
2. Autonomy
 An integral component of respect for
persons.
 The right to self-determination.
 In health care settings, health care
personnel must respect the patient’s right to
make decisions in their own best interest.
 Patients can refuse any and all treatments
(right to autonomy), except when the
decision poses a threat to others.
 It is relevant to the conduct of research as it
is in health care decision making.
  Justice requires that the selection of
3. Informed Consent
 Has its roots in the 1947 Nuremberg Code
o Two most relevant aspects of the code are
the right to be informed and that
participation is voluntary, without coercion.
 If coercion is suspected, the nurse is
obligated to report this suspicion promptly.
 It is a mutual sharing of information, a
process of communication.

Informed consent has dimensions beyond
protection of the individual patient’s choice:
i. It expresses respect for the person.
ii. It gains the patient’s active involvement in
their care.
iii. It respects the patient’s right to self-
determination.
iv. It is the role of the health care provider, not
the nurse to explain the study and what is
expected of the patient to the patient and to
respond to questions from the patient.
v. When giving written consent, the patient
must be alert and able to comprehend.
vi. Consent forms should be written at or below
the eighth-grade reading level, and words
should be kept to fewer than three syllables.
vii. Nurses are patient advocates.
 In collaboration with the health care provider
and the pharmacist, the nurse must be
knowledgeable about all aspects of a drug
study – including all inclusion and exclusion
criteria for participants, study protocol, and
study-related documentation – in order to
promote participant safety and quality study
results.
4. Beneficence
 Duty to protect research subjects from
harm.
 Involves assessing potential risks and
possible benefits and ensuring the benefits
are greater risk.
5. Risk-Benefit Ratio
 The risk benefit ratio is one of the most
complex problems faced by the researcher.
 All possible consequences of a clinical
study must be analyzed and balanced
against the inherent risks and the
anticipated benefits.
 Physical, psychological, and social risks
must be identified and weighed against the
benefits.
6. Justice
research subjects be fair. Research must be
conducted so that the distribution of benefits
and burdens is equitable (i.e., research
subjects reflects all social classes and racial
and ethnic groups.)
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PHARMACOLOGY
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WHO CALCULATES THE DOSE?
Doctor, Nurse, and Pharmacist tab tablet

Nursing Responsibilities: cap capsule

• Interpret order hs Hours of sleep,
• Prepare exact dosage of prescribed drug before bedtime
• Identify the patient
• Administer dosage by prescribed route at
prescribed time intervals
Seven parts of a Drug Order
• Record the administration of the prescribed drug
• Date and time of order
• Monitor the patient’s response for desired and
• Patient name
possible adverse effects
• Drug name
• Dosage
Route of Drug Administration
• Route of administration
• Frequency/time and
Frequency Interpretation any special instructions
• Signature and license of
ac Before meals
person writing the order
pc After meals
Examining Drug Orders
prn When necessary, as Drug order must be written clearly
needed • If any part(s) is missing, it is incomplete
Stat Immediately • If ever in doubt, you MUST ask the prescribing
practitioner to clarify
bid 2 times a day
What’s Missing??
tid 3 times a day • Heparin 5,000 units IV
qid 4 times a day ANSWER: Frequency
• Lasix bid
min minutes ANSWER: Dose, route of administration
• Depakene 250 mg po
h hour ANSWER: Frequency
• Demerol 50 mg IV, prn for pain
qh, q2h, etc Every hour, every two
hour ANSWER: Frequency ( every what hour?)\
• Amoxicillin 250 mg po
ANSWER: Frequency
Common Symbol of Drug Administration
• Xanax 0.1 mg bid
ā before ANSWER: route of administration
• Gentamicin sulfate po q 12h
p^¯ after
ANSWER: dose
c^¯ with
Interpreting the Drug Order
s^¯ without Abbreviations derived from Latin are often used
by physicians and pharmacists in writing and
q every
preparing drug orders. The nurse must be able to
NPO Nothing by mouth interpret these abbreviations correctly when
they are encountered in the drug order.
PHARMACOLOGY
UNITS OF METRIC LENGTH
Interpreting the Drug Order
10 decimeter
EXAMPLE:
Caps. Diphenhydramine (Benadryl) 25 mg q4h 1 meter 100 centimeter
po
ANSWER: The patient should receive 25 mg of 1000 milliliters
diphenhydramine in a capsule, orally, every 4 hour.
Metric units most frequently used in drug
Four Different Measuring System notations are:
a. Metric system – is a decimal system based on 1 gm = 1000 mg
the power of 10. 1L = 1000 ml
b. Household system 1 mg = 1000 ug
c. Apothecary system- use by the physician in
prescribing medication METRIC CONVERSION
d. Avoirdupois system 1. When converting larger to smaller unit in a metric
system
Metric System • move the decimal point to the (R)
International System of Units (SI)
• Dev. In 18th century & is the internationally 2. When converting smaller to larger units
accepted system of measure. • move the decimal point to the (L)
Example: change 1000 mg to grams
The Basic Unit of Measure are: 1,000 mg = 1000 = 1 gram
1.Gram (g. G. gm.) – for weight
2. Liter (L) – for volume Common rules:
3.Meter (m, M) – for length • The metric abbreviation always follows the Arabic
Numeral
Kilo – is the prefix use for larger units 0.2 mL 10kg
centri, milli, micro & nano - are for smaller units • Fractional units are expressed as decimals
0.5 cc not 1⁄2 cc
UNITS OF METRIC WEIGHT • Zeros are only used in front of decimal point to
clarify the decimal. Omit unnecessary zeros so the
10 decigrams (dg)
dosage is not misread.
1 gram 100 centigrams (cg) 0.5 cc not 0.50 cc
1 cc not 1.0 cc
1000 milligrams (mg)

1 milligram 1000 micrograms(mcg) Larger units to Smaller units

Convert 22 g to milligrams.
1 microgram (mcg) 1000 nanograms (ng) ANSWER: 22000 mg

1 kilogram (kg) 1000 grams = 2.2 lbs Smaller unit to Larger units
Convert 150 mL to liters.
UNITS OF METRIC VOLUME ANSWER: 0.15 L
10 deciliters (dL)
2. Apothecary System
1 liter (L) 100 centiliters (cL) Dates back to the Middle Ages & has been used in
England since the 17th century.
1000 milliliters (mL) • uses Roman numerals instead of Arabic numbers
• the Roman numerals is placed after the symbol or
PHARMACOLOGY
abbreviation 3 pints ÷ 2 = 1.5 qt

The unit of measurement for Apothecary are: 3. Household System

1. Grain – for weight - Commonly used in home & community setting.
2. Ounce or fluid ounces The measurements are approximate & not as
3. Dram or fluid dram accurate as metric system.
4. Minim or M – min. - The unit or Household system are: Spoon, tsp.
cups & glasses.
(2 and 3 for volume)
Household Equivalents
Apothecary Equivalent
1 measuring cup 8 oz
Dry Weight
1 ounce 480 grains 1 medium size glass 8 oz or 240 mL
(tumble size)
1 ounce 8 drams
1 oz 2 tablespoons or 30ml
1 dram 60 grains
1 tablespoon 3 teaspoon or 15 ml
1 scruple 20 grains
1 teaspoon 60 gtts or 5 ml

Fluid Volume 2 tablespoons 1 ounce or 30 mL

1 pints 16 fluid ounce 60 gtts 1 mL
1 fluid ounce 8 fluid drams 1 Tbsp 3 tsps.
1 fluid dram 60 minims 1 gtt 1 minim
1 minim 1 gtt 1 cc 1 ml
1 quart 2 pint
Conversion:
A. When converting L units to smaller units multiply
APOTHECARY RULE
the no. by the basic equivalent value
A. When converting L unit to S unit - multiply the
e.g. 2 glasses to ounces 1 glass = 8 oz
measurement that is requested by the basic
equivalent value.
2 glasses x 8 oz = 16 oz
e.g. 3 fluid oz ____ fluid dram
1 fluid oz = 8 fluid dram fz
B. When converting S units to L units. Divide the
no. by the equivalent value. change 6 teaspoons to
3 fluid oz x 8 fluid dram = 24 fluid dram
tbsps. 1 tbsp. = 3 tsp.
6 ÷ 3 = 2 tsp.
Large to Small
1. 3 oz to tbsp. = 6 tbsp
2. 5 tbsp. to tsp = 15 tsp
B. When converting S unit to L unit - divide the
3. 3 coffee cups to oz = 24 oz
requested no. by the equivalent value.
Small to Large
e.g. 8 fluid ounces = ___ pint
3 tsp to oz = 0.5 oz
1 pint = 16 f oz
16 oz to cup = 2 cups
8 ÷ 16 = 0.5 pint or 1⁄2 pint
12 t to T = 4 tbsp
3 pints to qt
 PHARMACOLOGY
Volume Equivalent Approximate Metric Apothecary & Household
Equivalents
METRIC APOTHECARIES HOUSEHOLD
WEIGHT METRIC APOTHECARY
1 minim 1 drop
1g 1000 mg 15 (16) gr.
1 mL 15 -16 minims 15-16 drops
0.5 gm 500 mg 7 ½ gr
4-5 mL 1 fluidram (60 1 tsp
minims) 0.3 gm 300 mg 5 gr

15 mL 4 fluid drams 1 tbsp 0.1 gm 100 mg 1 ½ gr

(3-4 tsp)
0.06 gm 60 mg 1 gr
30 mL 1 fluid oz 2 tbsp
8 fluid drams 1 oz 0.03 gm 30 mg ½ gr

180 mL 6 0z 1 cup 0.01 gm 10 mg ⅙ gr

240 mL 8 oz 1 glass
MEASURING SYSTEM
500 mL 1 pint
SYSTEM SOLID LIQUID
1000 ml (1 L) 1 quart
Metric Kg, g L, mL

WEIGHT EQUIVALENT Apothecary gr Fld oz , minim

METRIC APOTHECARIES HOUSEHOLD Household lb Tbsp, tsp, gtt

30 mg ½ gr ( gr ss)
COMMON CONVERSION FACTORS
60-65 mg 1 grain ( gr i)
1 kg 2.2 lbs
1 g (1000 mg) 15 grains
16 oz 1 lb
1 kg 2.2 lbs
8 oz 1 cup
30 g 8 drams 1 oz
1 tsp 5 mL
454 g 1 lb
1 gr 60 mg

LIQUID EQUIVALENT
Interpreting Drug Labels
ENGLISH SYSTEM METRIC SYSTEM – Trade name
– Generic name
1 inch 2.5 cm
– Drug amount
12 in (1 ft.) 30 cm – Lot number
– Expiration date
39.4 in (1 yard + 3.4 in) 1m – Proper storage
– Whether it is a controlled substance
PHARMACOLOGY
Order: Cipro 0.5 g, po, q12h (0.5 g = 500 mg)
Reading Drug Label Precautions and Drug Available: Cipro 250-mg tablet
Reconstitution
› Precautions when reading drug labels H: V: D: X
– Be aware some drug names sound or look alike. 250 mg ∶ 1 tablet ∶: 500mg ∶ X
– Perform a minimum of three label checks with the
patient’s medication record. 250x = 500 tablet
x = 500/250
› Drug reconstitution x = 2 tablets of Cipro
– Diluent

METHODS OF CALCULATION
Calculation methods METHOD 2: FRACTIONAL EQUATION (FE)
– Usually calculations are made for one dose.
Formula: H) ÷ V = D) ÷ X
Three general methods for calculation of drug
dosage Example:
a. Basic formula Order: Cipro 0.5 g, po, q12h (0.5 g = 500 mg)
b. Ratio and proportion/fractional equation Available: Cipro 250-mg tablet
c. Dimensional analysis
250 mg ÷ 1 tab = 500 mg ÷ X (cross multiply)
Nurses should select one method and use it 250x = 500 tablet
consistently. x = 500/250
x = 2 tablets of Cipro
METHODS 1: BASIC FORMULA (BF)

Formula: (D ÷ H) ✖ V = A
Where: METHOD 3: DIMENSIONAL ANALYSIS (DA)
D = drug dose Formula: V( form) = V /H x C (H) / C (D) x D / 1
H = dose on hand
V= vehicle or drug form ( tabl, cap, liquid) Example:
A= amount to be given Order: ciprofloxacin (Cipro) 0.5 g, po, q12h (0.5 g =
500 mg)
Example: Available: Cipro 250-mg tablet
Order: Ciprofloxacin (Cipro) 0.5 g, po, q12h
Available: Cipro 250 mg tablet tab = 1 tablet / 250 mg × 1000 mg / 1 g × 0.5 g / 1
Change 0.5 g to 500 mg (move decimal point 3 tab = 2 tablet
spaces to right)

(500 mg ÷ 250 mg ) ✖ 1 tab

= 2 tablets of Cipro METHOD 4: BODY WEIGHT

STEPS:
METHOD 2: RATIO AND PROPORTION (RP) 1. Convert pounds to kg. when – necessary
2. Multiply drug dose x BW = client’s dose/day
Formula: H : V : D : X 3. Follow the basic formula or ratio & proportion to
calculate drug dose
Example:
PHARMACOLOGY
Formula: METHOD 6: BODY SURFACE AREA (BSA) –
Convert pounds to kilograms, 2.2 lb. = 1 kg SQUARE ROOT METHOD
D (desired) × kg × 1 day or dose = X
Formula:
Example:
Order: Cipro 20 mg × kg × day in 2 divided doses
Patient’s weight: 88 pounds (88 lb. ÷ 2.2 = 40 kg)
Available: Cipro 100 mg/mL in oral suspension

20 mg × 40 kg × day = 800 mg/day or 400

mg/dose

METHOD 5: BODY SURFACE AREA – WEST

NOMOGRAM
Formula:
Find body surface area on the West Nomogram.
Measured in square meters To calculate the drug dosage using the BSA
Determined by patient’s height and weight method, multiply the drug dose ordered by the
number of square meters.
Example:
The patient is 178 cm tall and weight 73 kg.

Example:
The patient is 178 cm tall and weight 73 kg.

Order: cyclophosphamide (Cytoxan) 100

mg/m2 /day, IV
patient’s BSA: 1.8 m2

100 mg x 1.8 m2
(BSA) = 180 mg/day
Give 180 mg/day of Cytoxan

Rounding Rules
Rounding rules
– Tablets, caplets rounded to nearest half if scored
– Rounded to fourths if scored in fourths

› The general rounding rules are:

1.If the number to the right of the digit needs to be
rounded and is 4 or less, round down.
2.If a number to the right of the digit needs to be
rounded and is 5 or greater, round up.
PHARMACOLOGY
Considerations for Enteral Administration
– Oral drugs available in tablet, caplet, capsule,
powder, and liquid form are absorbed from GI tract
– Sustained release and enteric coated should not
be crushed and diluted
– Liquid forms include suspension, syrup, elixir,
tincture
Calculation of Oral Dosages
Formula: (D ÷ H) ✖ V = A or H : V = D : X
Example:
Give Prednisone 5 mg p.o. BID Available: 2.5
mg Prednisone/tab.
5 mg / 2.5 x 1 = 2 tabs
Considerations for Drugs Via Nasogastric Tube
Percentage of Solutions
• Patients who are not able to take fluids/food by
mouth receive nutrients thru NGT – this is called.
TUBE FEEDING.
• Solutions of tube feedings are ordered in
percentage & are started w/ low strength to prevent
diarrhea.
• The nurse calculates the amount of solution or
water that will be given
Example: Ensure, Isomil & others
Formula: (D ÷ H) ✖ V = X
Give: 250 ml of 30% Ensure solution q 4h x 6
feedings/NGT. Calculate how much Ensure &
water is needed to make 250 ml of 30% sol.?
Note: 30% solution in 100 parts
How much water should be added?
Total amount:
250 ml – 75 ml = 175 water to be added to 75
ml ensure to make 250 ml 30% ensure.
Considerations When Calculating Dosages of
Parenteral Drugs
Interpreting Injectable Drug Orders
Correct selection of needle & syringe are essential
when preparing the prescribed drug dose.
SYRINGE – is composed of a barrel, plunger & tip
where the needle joins the syringe. It is available in
3 ml, 5 ml & tuberculin & insulin syringe.
TUBERCULIN SYRINGE – is a 1 ml syringe
calibrated in tenths (0.1 ml) or marked in minims.
- used for intradermal injection in Pedia & Heparin
doses.
INSULIN SYRINGE – calibrated in units (2 units
mark)
100 units = 1 ml. Only used for adm. of Insulin
100 units/ml = orange color
40 units/ml = Red color
NEEDLE – has 2 components: the gauge & length.
The larger the gauge; the smaller the diameter of
lumen (g. 26 – smallest) (g – 18 largest lumen)
Length = 3/8 to 2 inches
Thin clients – needle length is 1 inch.
Obese & fat clients – needle 1.5 – 2 inches.
ANGLES FOR INJECTION
0.1 ml – Intradermal (ID)
- 90o skin test – inner forearm
0.5 ml – Subcutaneous (SQ)
- 45 – 60o
0.5 – 5 ml – Intramuscular (IM)
- 10 – 15o g. 19-20 deltoid, VL, Gluteal
Calculating Intravenous Flow Rate
Required information
› Volume to be infused
› Drop factor of infusion set
› Time frame
› Electronic infusion device
› Type and size of IV tubing
PHARMACOLOGY

Calculating Intravenous Fluids

2 Methods to Adm. IVF & Drugs

1. Continuous IV infusion – to replace fluid loss.
Maintain fluid balance, as vehicle for drug
administration.
2. Intermittent – primarily used for giving IV drugs.
Calculating Infusion Time:
INTRAVENUOUS SETS Infusion time = total volume / ml/ hr
Example: Abbot, McGRaw, Travenol Boxter
Drop Factor – the no. of drops / ml is printed on
the packaging of IV sets.
Macrodrip – 10, 15, 20 gtts/ml – Adult
Microdrip – 60 gtts/ml – Pedia & newborn

KVO rate – to give meds. slowly at calibrated drops

5 – 10 gtts

Commonly used Solutions are: Calculating for Rate, Volume & Time
1. D5W
2. NSS
3. 1⁄2 NSS
4. Lactated Ringers

CALCULATION OF INTRAVENOUS FLUIDS

Calculating Milliliters per Hour:

ml / hr = amount of solution / hrs to administer

Example:
1. Order: 1000 mL of 5% DW with .45% NaCl,
Q8h IV set: 10 gtt/mL
Find the rate in gtt/min? mL/hr?
Calculating Drops per Minute:
Gtts per minute = 2. D5W ī L @ 31 gtts/min. What will be the amt.
(amt of solution in mL x drop factor) / total time in consumed after 8o?
minute
Or
3. D5 1mb 500 cc @ 60 mgtts/min. Started @ 8
gtt/min = (total volume x drop factors) / hr (60 mins)
am. How many hrs. will it take the IVF to run?
PHARMACOLOGY

Calculating Intravenous Flow Rate: Drops Per

Minute

Formula: Amount of solution × gtt/mL (IV set) /

minutes to administer = gtt/min

Order: Ticarcillin (Ticar) 500 mg, IV, q6h

Available: Ticar 1 g (add 4 mL of diluent)
Set and solution: calibrated cylinder, drop factor: 60
gtt/mL
Instruction: dilute drug in 75 mL of D5W and infuse
over 40 min.

Calculating Critical Care Drugs

– Most critical care drugs are titrated to patient
response.
– Dimensional analysis

Goal is to prepare and administer drugs in safe and

correct manner.

Considerations:
• Think, focus on each step of the problem. This
applies to both simple and difficult problems.
• Read accurately. Pay particular attention to the
location of the decimal point and to the operation to
be performed, such as conversion from one system
of measurement to another.
• Picture the problem
• Identify an expected range of answer. The dose
should be reasonable.
• Seek to understand the problem. Do not merely
master the mechanics of the mathematical
operations. Seek a second opinion to ensure that
the calculation is correct.
• To decrease drug errors, always perform the three
checks prior to administering a drug to the patient.