WEEK 01: INTRODUCTION TO

PHARMACOLOGY

HISTORICAL TRENDS DEFINTION OF TERMS

− Since the beginning people search to Pharmacopeia Is the total of all authorized
treat illness and cure disease the oldest drugs available within a
known prescription found on a clay (5000 country it contains
years ago). descriptions, recipes,
− Primitive people through the Egyptian strengths, standards of
period believe that evil spirit living in the purity, and dosage forms
for the drugs.
body.
Medication substance administered for
− Hippocrates (fifth century) advanced
the diagnosis, cure,
idea that disease resulted from natural
treatment, or relief of a
causes. symptom or for prevention
− The Arabs interest of in medicine, of disease.
pharmacy and chemistry was reflected in Drug same as medication; a
hospitals and schools. medicine or other
− In twenty first century, the emphasis on substance which has a
providing quality health care. physiological effect when
− Nursing role which include administering ingested or otherwise
medication in health care agency, introduced into the body.
community and home care setting, Non- drug that can be
teaching client safe and effective self- prescription or purchased without
administration to better care for their Over-the- prescription.
clients. counter drug
Prescription the written direction for the
PHARMACOLOGY preparation and
administration of a drug.
→ Is a science that studies the effects of Generic Name the name used throughout
drugs within the living system. the drug's lifetime.
→ Its deals with all legal and illegal drugs Trade (Brand) given by the drug
used in society today. Name manufacture and identifies
→ In Nursing Practice, it applies it as property of that
knowledge from many different disciplines company.
including anatomy physiology, pathology, Official Name this is the name which the
microbiology, chemistry, mathematics, and drug is listed in the official
psychology. publications.
Chemical Name the name by which a
PHARMACEUTICAL chemist knows it;
describes the constituents
→ Any kind of drug used for medicinal of the drug precisely.
purposes, such as cough syrup or The the primary/desired effect
sleeping pills. Therapeutic intended that is the reason
Effect the drug is prescribed such
WHAT THE NURSE DO? as morphine sulfate is
analgesia.
 Understanding any medication before Side Effect secondary effect of the
giving to a client drug is one that is
 Knowledge in the usual dosage, route of unintended, side effects
administration are usually predictable and
 Indication may be either harmless or
 Significant adverse effect potentially harmful.
 Major drug interaction
 Contraindication
 Nursing responsibilities
Adverse Effect negative side effect of a Index of poisoning and the higher
drug that undesirable and it is the safer of drug is.
potentially dangerous. Aspirin (3.5), digoxin (2)
 May justify the Bioavailability Means that the drug has
discontinuation of a reached the circulation and
drug. is therefore available for all
 The nurse should the tissues. (ex: aspirin
report this to the 600 mg).
healthcare provider. Tolerance A decreasing response to
Drug Toxicity harmful effect of the drug repetitive drug doses.
on an organism or tissue,
result from overdose or
external use drug, or BASIC CONCEPTS OF
buildup of drug in blood. PHARMACOLOGY
Drug Allergy immunological reaction to
Pharmacokinetics Study of
a drug
absorption,
distribution.
 Mild allergic reaction biotransformatio
 Severe allergic reactions n, and excretion
(anaphylaxis)- this of drugs. This is
response can be fatal how the body
Drug occurs when administration reacts to the
Interaction of one drug before or after drug
alter effect of one or both Pharmacodynamics the effect of
drugs. drug on the
Drug Misuse the improper use of body. This is
common medications in a how the drug
way that lead to acute and acts in the body
chronic toxicity for example Pharmacotherapeuti Is a clinical
laxative, antacid, and cs using of drug
vitamins.
Drug Abuse is an inappropriate intake
continually or periodically Pharmacognosy The study of
Drug a person's reliance on or natural (plant
Dependence need to take drug or and animal)
substance there are two drug sources.
type of dependence:
Physiological dependence: is due to BRANCHES OF PHARMACOLOGY
biochemical changes in the body tissue these
tissues come to require substance for normal  Pharmacognosy- Origin
function.  Pharmacokinetics- Movement through
Psychological dependence: is emotional body
reliance on a drug to maintain a sense of well-
 Pharmacodynamics- Effect
being accompanied with feeling of need.
 Pharmacotherapeutics- Use/Purpose
Drug denotes a mild form of
Habituation psychological dependence.  Toxicology- Side Effects
Illicit Drug also called street drug are PROPERTIES OF IDEAL DRUG
those sold illegally.
Dose The aim to give patient a
dose of the drug that
achieves the desired effect 1. EFFECTIVENESS
without causing with  A drug that elicits the response it
harmful side effect was meant to.
Therapeutic is a measure of the danger  It is the most important property.
  No effect = no justification of use
(FDA approved with appropriate
experiments).
2. SAFETY
 Pharmakon = poison in Greek
 Safe even at high concentrations and
for long periods of administration (no
such thing as a safe drug)
 Reduced by proper administration (iv,
im, sc, etc...)
 No habit-forming aspects
 No side effects (excessive dosage
of opioid analgesics carries a risk
of respiratory failure, cancer drugs
increase infections, aspirin causes
gastric ulcer etc...)
3. SELECTIVITY
 One that elicits only the response for
which it is given
 Selective for specific reaction with no
side effects (there is no such thing)
 Drowsiness can be caused by
antihistamines
 Morning sickness, cramps, and
depression can be caused by oral
contraceptives
 Constipation, urinary hesitance,
and respiratory depression can be
caused by morphine
ADDITIONAL PROPERTIES OF IDEAL
DRUG (No Drug is Ideal!!)
1. REVERSIBLE ACTION
 Effects be reversible, i.e.,
removal/subside w/i specific time (1/2
life is short but potent during that
time)
 Example: General Anesthetic;
Contraceptives
2. PREDICTABILITY
 Knows how patient will respond
3. EASE OF ADMINISTRATION
 Number of doses should be low and
easy to administer
- Drugs are substances that are used or
 Increase compliance & decrease
errors
 Diabetic patient: Multiple daily
injection of insulin
 Intravenous infusion
4. FREEDOM FROM DRUG
INTERACTIONS
 Should not augment or decrease
action of other drugs or have adverse
combined effects.
 Respiratory depression caused by
diazepam (Valium), which is
normally minimal, can greatly be
intensified by alcohol.
 Antibacterial effects of
Tetracycline can be greatly
reduced by taking iron or calcium
supplements
5. LOW COST
 Easy to afford (especially with
chronic illness)
 Growth hormone (somatrem)
costs between $10,000 and
$20,000
 Lifelong medication: hypertension,
arthritis, diabetes
6. CHEMICAL STABILITY
 No loss of effectiveness with storage
7. POSSESSION OF A SIMPLE
GENERIC NAME
 Easy to remember and pronounce
 Example: Viagra (sildenafil);
Tylenol (acetaminophen
Because No Drug is Ideal;
 No medications are ideal
 No drug is safe
 All drugs produce side effect
 Drug responses may be difficult to predict
 Drugs may be expensive
All
 members
Drugs mayofbehealth care
hard to team must
administer
exercise to promote therapeutic effects and
minimizing drug induced harm.
intended to be used in the diagnosis,
 prevention, treatment or cure of
diseases.
- In early times, these substances were
derived from natural sources, of which
plants took up the major share
- With the introduction of technology, most
drugs today are manufactured
synthetically in the laboratory.
SOURCES OF DRUGS
1. Plants And Plant Parts
 Plants are important chemicals that
develop into drugs.
 A number of plants have medicinal
qualities and have been used for
centuries as drugs or drug sources.
Although the earliest plant source for
drugs was the leaf, other parts of
plants (e.g., barks, fruits, roots, stem,
wood, seeds, blossoms, bulb, etc.)
were also later exploited for drug
extraction.
 Where the product is used without
further processing
 e.g., ground leaves or bark, boiled
concoctions or powdered sap, the
substance is called crude drug.
2. Animal Products
 are used to replace human chemicals
that are not produced because of
disease or genetic problems.
 Many important drugs are derived from
animal source. In most instances,
these medicinal substances are
derived from the animal’s body
secretions, fluid or glands. Insulin,
heparin, adrenaline, thyroxin, cod liver
oil, musk, beeswax, enzymes, and
antitoxins sera are some examples of
drugs obtained from animal sources.
Like plant products, drugs from animal
sources may be crude (unrefined) or
refined material.
 Insulin for treating diabetes is
exclusively obtained from cow
pancreas tissue.
 Now genetic engineering – the
process of altering DNA – permits
scientist to produce human insulin
by altering E. coli bacteria.
3. Microbial Sources
 Several life-saving drugs have been
historically derived from
microorganisms.
Examples include penicillin produced by
 Penicillium chrysogenum,
streptomycin from Streptomyces
griseus,
 Chloramphenicol from
Streptomyces venezuelae,
 Neomycin from Streptomyces
fradiae,
 Bacitracin from Bacillus subtilis etc.
 Xanthan (polysaccharide gum
secreted by Xanthomonas
campestris)
 Dextran (polysaccharide of glucose
synthesized by lactic acid bacteria.
4. Marine Sources
 Bioactive compounds from marine
flora and fauna have extensive past
and present use in the prevention,
treatment, or cure of many diseases.
Coral, sponges, fish, and marine
microorganisms produce biologically
potent chemicals with interesting anti-
inflammatory, anti-viral, and anticancer
activity.
 For example, curacin A from
marine cyanobacterium Lyngbya
majuscule, eleutherobin from coral
Eleutherobia sp., discodermolide
from marine sponge Discodermia
dissolute, etc. show potent anti-
tumor activity.
5. Mineral Sources
 Minerals (both metallic and
nonmetallic minerals) have been used
as drugs since ancient times. Our
body requires trace elements of
minerals in order to maintain
homeostasis. Patients lacking on
adequate level of these materials may
 take specific mineral-based drugs to
raise the level of minerals.
 Examples include ferrous sulfate in
iron deficiency anemia; magnesium
sulfate as purgative; magnesium
trisilicate, aluminum hydroxide and
sodium bicarbonate as antacids for
hyperacidity and peptic ulcer; zinc
oxide ointment as skin protectant, in
wounds and eczema; gold salts
(solganal, auranofin) as
antiinflammatory and in rheumatoid
arthritis; selenium as anti-dandruff.
6. Synthetic/Chemical Derivative
 A synthetic drug is produced using
chemical synthesis, which rearranges
chemical derivatives to form a new
compound. The synthetic sources of
drugs evolved with human skills in the
laboratory and advanced knowledge
and understanding of phytochemical
investigation. At present, majority of
drugs used in clinical practice are
exclusively prepared synthetically in
pharmaceutical and chemical
laboratory.
 One of the earliest synthetic drugs was
sulphonamide, which began with the
synthesis of prontosil dye. Other
examples include acetylsalicylic acid
(aspirin or ASA), oral antibiotics,
antihistamines, thiazide diuretics,
chloroquine, chlorpromazine, general
and local anesthetics, paracetamol,
phenytoin, etc.
 Synthetically manufactured drugs
generally have higher yields that are
significantly associated with quality,
purity, and low cost.
7. Semi-Synthetic Sources
 Semi-synthetic drugs are neither
completely natural nor completely
synthetic. They are a hybrid and are
generally made by chemically
modifying substances that are
available from natural source to
improve its potency, efficacy, and/or
reduce side effects. Sometimes, semi-
synthetic processes are used to
prepare drug when the natural sources
may yield impure compounds or when
the synthesis of drugs (complex
molecules) may be difficult, expensive,
and commercially unviable.
 In semi-synthetic drugs, the nucleus of
drug obtained from natural source is
kept intact but the chemical structure
is altered. Examples of semi-synthetic
medicine include heroin from
morphine, bromoscopolamine from
scopolamine, homatropine from
atropine, ampicillin from penicillin etc.
8. Biosynthetic Sources
(Genetically Engineered Drugs)
 This is relatively a new field which is
being developed by mixing discoveries
from molecular biology, recombinant
DNA technology, DNA alteration, gene
splicing, immunology, and immune
pharmacology. Drugs developed using
living organisms with the help of
biotechnology or genetic engineering
are known as biologics,
biopharmaceuticals, recombinant
DNA expressed products,
bioengineered, or genetically
engineered drugs.
 Examples include recombinant
Hepatitis B vaccine, recombinant
insulin and others.
Drugs for approval should pass
through…
4 STAGES OF NEW DRUG
DEVELOPMENT
1. Preclinical Study
 Starts with discovery, synthesis
and purification of drug
Functions:
 To know if with therapeutic value
 Safe in animals
2. Clinical Study
 “Testing in humans” stage
3 phases
 Phase I
- Tested in small # of
healthy volunteers.
 -
Initial info on the effects in
humans.
 Phase II
- Tested in small, selected
population (10-150 subjects)
- To evaluate the therapeutic
effect in treating specific
disease/pathologic condition.
 Phase III
- More clients (several hundred
thousand)
- Provides info on proper dosing and
safety.
3. New Drug Application (NDA) Review
 The drug is submitted to FDA for
new drug application.
4. Post Clinical Study
 Known as “post
marketing surveillance”
 Final stage of drug approval
process.
 It surveys the drug’s harmful
effects.
DRUG CLASSIFICATIONS
1. Therapeutic Use/Clinical Indications
2. Physiologic/Chemical Action
3. Prescribed (Ethical) Drug
4. Non-prescription (Non-Ethical)
Drugs
5. Illegal Drugs
Therapeutic Use/Clinical Indications
Treatment with any substance, other than
food, that is used to prevent, diagnose,
treat, or relieve symptoms of a disease or
abnormal condition.
Examples:
 Antibiotics
-Cefuroxime, penicillin, erythromycin
 Laxatives
- Bulk-forming
 Sterculia [Normacol], methylcellulose
(Citrusel)
- Stool softeners
 (Colace, Diocto)
- Lubricants or emollient
 Diuretics
 Antacids
Physiologic/Chemical Action
Examples:
 Beta-adrenergic blockers
- Management of cardiac arrhythmias
- Block the action of epinephrine and
norepinephrine
- Ex. Propranolol
Prescribed (Ethical) Drug
- Requiring prescriptions
- Ordered/dispensed only by an
authorize practitioner
Non-Prescription (Non-Ethical) Drug
- Drugs available over the counter
- Not requiring any prescription for
use
- Can be purchased directly by
consumer
- Used to treat relatively minor
problems and conditions
- Judged to be safe for used by the
consumer without direct medical
supervision
Illegal Drugs
- Use for non-therapeutic purposes.
- Also referred as "recreational
drugs"
- Drugs not approved by FDA/BFAD
Top 10 Most Popular Recreational Drugs
1. Cannabis or Marijuana, Grass,
Hemp, Weed, Pot, Hash, Dope
- Slightly drunken but euphoric
sensation
2. Heroin/Diamorphine
- Powerful painkiller and users
experience exhilaration,
euphoria, and a sense of well-
being.
3. Cocaine (Coca plant)
- Powerful stimulant, appetite
suppressant and anesthetic
4. Ecstasy
- psycho therapeutic drug;
produces euphoria and a
feeling of well-being,
 decreased levels of fear and
anxiety and a physical
stimulant and sensational
effect in users.
5. Amphetamines
- affecting the amount of
dopamine and serotonin in
the brain
6. Barbiturates/Benzodiazepines
- a prescription medicines
7. LSD (Lysergic Acid Diethylamide)
- most powerful hallucinogenic
8. Opium
- addictive painkiller
9. Psychedelic Mushrooms
- hallucinogenic mushrooms
10. Solvent
LEGAL REGULATIONS OF DRUGS
1. Pregnancy Categories
2. Controlled Substances
3. Generic Drugs
4. Orphan Drugs
Pregnancy Categories
Reviews drug labeling information on
pregnancy and risk effects to the fetus
Controlled Substances
Drug Enforcement Administration
(DEA)
- Organize to enforce the Controlled
Substance Act
- To gather intelligence, train and
conduct research in the area of
dangerous drug and drug abuse.
Generic Drugs
- Drug which is produced and
distributed without patent protection
- Drugs which may still have a patent on
the formulation but not on the active
ingredient.
- It must contain the same active
ingredients as the original formulation
- Identical/bioequivalent to the brand
name counterpart since these drugs
should be identical in dose, strength,
route of administration, safety, efficacy
and intended use.
Orphan Drugs
- Drugs that have been discovered but
not financially viable and therefore
have not been “adopted” by any drug
company.
LEGAL AND ETHICAL ASPECT OF
MEDICATION
Medical Prescriptions
1. It is not permissible to prescribe
restricted drugs except by authorized
doctors, and the restriction related to
these drugs should be followed.
2. The healthcare practitioner should not
write a prescription only for pleasing
his/her patient or the patient’s relatives.
3. The prescription should be written in
clear handwriting, with the healthcare
practitioner’s name, signature, the
name of the institution he/she works in,
date of prescription, patient’s
information, diagnosis, drug dose, its
pharmacological form, daily dose, and
duration of treatment. This all must be
reported in the patient’s record.
Note: It is prohibited for a pharmacist to
dispense any medication without a
prescription issued by a physician licensed
to practice. See the Law of Practicing
Healthcare Professors.
THERAPEUTIC OBJECTIVE
To provide maximum benefit with
minimum harm
Factors that determine Intensity of
Response:
 Administration- dosage size and
route
 Pharmacokinetics processes
 Pharmacodynamics
 Individual Variations
Administration- dosage size and route
 Because of errors in administration
routes and dosage and at wrong time
there are many discrepancies in what
 patient gets and could cause more 3) Inflammation
harm than good 4) Blocking of virus
 Errors could be made by pharmacists,
physicians, or nurses
 Should give patients complete Sources Of Individual Variation
instruction about their medication and
how to take it  Each patient is unique in ability to
respond and to how they each respond,
Pharmacokinetics processes
but formation of “IDEAL DRUG” will
 Determines how much of an lessen this variation.
administered dose gets to its sites of  Age – very important factor
action  Sex – due to hormonal differences
1) Drug absorption  Weight – less effective and longer
2) Drug distribution lasting in obese individuals (storage
3) Drug metabolism in fat)
4) Drug excretion  Kidney & liver functions –
elimination of drug
 Genetic variables – tolerance,
allergy (though not always genetic)
Summary
To promote desired effects and minimize
adverse effects, we need to understand:
 Pharmacokinetics
 Pharmacodynamics
 In addition
Sources of individual variations is rug
responses
Key Points
 The most important properties of an
ideal drug are: effectiveness, safety
and selectivity
Pharmacodynamics  If the drug is not effective, it should not
 Determine the type of response and be used.
intensity  There is no such drug as safe drug: all
drugs can cause harm
 Once a drug has reached its site of
 There is no such thing as selective
action, it must first bind to its specific drug: all drugs can cause side effects.
target site at (RECEPTOR)  The objective of drug therapy is to
provide maximum benefit within
Receptor: minimum harm.
 Because all patients are unique, drug
- May be a chemical, a protein on a cell or
therapy must be tailored to each
in blood or tissue spaces or on a bacteria
individual.
or virus.
- Ex. Heparin, antibody, leukotriene
DOCTOR PRESCRIPTION
receptor (new), penicillin, etc.
Components of prescription need to
Series of events that result in response
assessed:
such as inhibition of:

1) Clotting • Client
• Date
2) Peptidoglycan synthesis
 • Medication
• Dosage and frequency
• Route
Legal Requirements Need To Be Met
Before Administer A Drug
1. The Medication order must be valid
2. The physician/ prescriber and the
nurse must be licensed.
3. The nurse must know the purpose,
action, effects and major adverse
effects of the drug, and the teaching
required to enable the client or
caregiver to self-administer the drug
safely and accurately
Six Rights of Medication
Administration
1. The Right Medication (the one that
was prescribed and one that is not
contraindicated).
2. The Right Client (not someone else
medication by mistake, nor the
medication of the person in the next
bed).
3. The Right dose as prescribed and
appropriate (this may involve simple
mathematical computation.
4. The Right route, form of the drug, and
administration technique prescribed.
5. The Right time for the dose (usually
within 30 mins of the time indicated
and at beneficial intervals as ordered).
6. The Right documentation
PRINCIPLE OF DRUG ACTION
Four General Properties of Drugs:
1. Drugs only modify existing functions
on a tissue or body organ; they do not
create new functions
 The effects of drugs can be
recognized only by alternations of
a known physiologic function or
process such replacing,
interrupting or potentiating a
physiologic process in specialized
tissues.
 For example, drugs used to treat
anemia can replace iron to restore
the adequate production of red
blood cell.
2. Drugs in general exert multiple actions
rather than a single effect.
 Different tissues may use similar or
identical system process and a
drug that impacts such system or
processes affects multiple tissues.
 For example, Atropine – a drug
that has affinity for heart, lungs
gastrointestinal and other tissues if
administered to client with COPD
we observe the desired improved
bronchodilation but may also
observe elevated heart rate,
constipation dry mouth and urinary
retention.
3. Drug action results from a
physiochemical interaction between
the drug and a functionally important
molecule in the body
 Some drugs act by combining with
a small molecule in the cellular
environment like antacids
neutralize gastric acid. However,
majority of drugs work by
interacting with specific
macromolecular components in
tissues.
 Note: Pharmacodynamics is the
study of drug interaction.
4. For a drug to achieve its function and
interaction in the body, it must be
present in adequate quantities at its
specific site of action.
 If a drug has an effect in heart tissue,
an adequate quantity of that drug must
reach cardiac tissue to exert
pharmacologic effects.
Factors Affect Drug Absorption
1. Nature of the absorbing surface
(cell membrane) through which the
drug must cross.
2. Blood flow to the site of Time of Administration
administration
- Present or absence of food
3. Solubility of the drug
- Biologic rhythms- sleep-wake cycle,
4. pH-acidity vs alkalinity
circadian 24 hours cycle in absorption
5. Molecular weight- Vancomycin has
and urinary excretion
large molecular weight
- Insufficient fluid intake with solid dosage
administered IV when administered
form
orally is minimally absorbed into
systematic circulation in treating C. Pathological State
difficile diarrhea
6. Dosage form - Pain intensifies the need of opioids
- Anxiety may resist to large dose of
FACTORS CAN ALTER AN tranquilizing drugs
INDIVIDIAL'S RESPONSE TO DRUG - Presence of circulatory, hepatic and
THERAPY renal dysfunction interfere physiologic
1. Age process of drugs
2. Body Mass Index Genetic Factor
3. Gender
4. Environmental Milieu - genetic differences can sometimes
5. Time of Administration explain patients varied/ different
6. Pathological State responses to a given drug.
7. Genetic Factors - some people lack enzyme systems
8. Psychological Factors necessary for metabolizing a drug.

Age Psychological Factors

- Infants immature body system - The patient’s attitude about a drug has
- Children-dosage adjustment usually been shown to have an effect on how the
necessary drug works.
- Older adult-depressed hepatic and renal - A drug is more likely to be effective if the
system patient thinks it will work than if the
patient believes it will not work. This is
Body Mass Index called the Placebo effect.
- The greater the volume of distribution of Different Characteristic of Drug
the drug in body mass, the lower the Response
concentration of the drug in the body
compartment. 1. Tolerance
2. Tachyphylaxis
Gender 3. Cumulative Effect
- Woman smaller than men; definite 4. Idiosyncrasy
difference during pregnancy and in 5. Drug Dependence
relative proportion of fat and water; drugs 6. Drug Interaction
and vary by water or fat soluble 7. Drug Antagonism
8. Summation
Environmental Milieu 9. Synergism
10. Potentiate
Mood and behavior modified by:
 Drug itself Tolerance
 Personality of the user - refers to a decrease physiologic
 Environment of the user response that occurs after repeated
 Interaction of these three factors
 administration of a drug or a chemically
related substance.
Tachyphylaxis
- refers to a quickly developing tolerance
that occurs after repeated administration
of a drug.
Cumulative effect
- occurs when the body cannot metabolize
one dose of a drug before another dose
is administered.
Idiosyncrasy
- is any abnormal or peculiar response to
a drug which may manifest itself by;
 Overresponse or abnormal
susceptibility to a drug
 Under response, which demonstrate
abnormal tolerance
 A qualitatively different effect from
the one expected such an excitation
after administration of a sedative
 Unpredictable and unexplainable
Drug Dependence
- is the term preferred over the previous
terminology of “habituation” and
“addiction” it maybe physical or
psychological.
Drug Interaction
- occurs when the effects of one drug are
modified by the prior or concurrent
administration of another drug, thereby
increasing or decreasing the
pharmacologic action of each.
Drug Antagonism
- occur when the combination effects of
two drugs is less than the sum of the
drugs acting separately.
Summation
- (addition or additive effect) occurs when
the combined effect of two drugs
produces a result that equals the sum of
the individual effects of each agent.
Written as 1+1=2
Example codeine and aspirin both acts as
analgesic when given together they
provide greater pain relief than when
either one used alone.
Synergism
- describes a drug interaction in which
the combined effect of drugs is greater
than the sum of each individual agent
acting independently written as 1+1=3
or greater
Potentiate
− refers to the concurrent administration of
two drugs in which one drug increase the
effect of the other drug.
Various Types of Drug Orders
1. Routine/Standing Order
2. PRN Orders (as -needed)
3. One time or Single order
4. Stat Orders
Routine/Standing Order
- it may or may not have a termination
date.
- it may be carried out indefinitely until an
order is written to cancel it or maybe
carried out on a specified number of
dates.
Example:
Demerol 100 mg. IM every 4 hours for 5
days. Example: Multivitamins 1 tablet
daily.
PRN Orders (as -needed)
- given at the client's need and nurse's
judgment concerning need and safety.
Example:
Hyoscine butyl bromide 20 ml. prn.
One time or Single order
− given once immediately as a single dose
Example:
Nubain 10 mg. IM stat.
 Indicators for Evaluating the
Administration of Medication
 The drug is administered in the ordered
dose
 The drug is administered by the ordered
route
 The drug is administered by the ordered
site
 The drug is administered at the ordered
rate
 The drug is administered in the ordered
drug form
 The drug is administered in the ordered
schedule
 The drug is administered using the
correct technique