1.
Discovery or synthesis of a new drug
.6+\NCM 106 PHARMACOLOGY
MODULE 1
PHARMACOLOGY
1. It is the branch of medical science.
2. It is the science that deals with the
mechanism of action, uses, adverse
effects, and fate of drugs in animals and
humans.
3. It involves the study of description of the
actions of drugs and chemical on cells,
tissues, and the whole body.  response of a tissue to its environment.
Drug sources
1. Plants
2. Minerals
3. Animal and human substances
4. Synthetic   Species internal cells such as
Drug names
1. Chemical name of a compound
 Gives the complete description of
the molecule (using law of
organic chemistry).
 It is often extremely complex and
describes the atomic molecular
structure of the drug.  action: Chemical, enzymes, receptors,
 Chemical name of a compound
gives the complete description of
the molecule .  
2. Generic name
 indicates the class of drug to
which the individual drug.
 The specify chemicals and are
used as public domain. 
3. Brand name of a drug species
 a particular formulation assigned
by the manufacturer of a generic
product.
 The use of brand names is
restricted to the original copyright
holder.
Steps in drug development
molecule and correlating it with a
biological target.
2. In vitro and animal studies to assess the
safety and efficacy of the drugs.
3. Human testing or clinical trials.
4. Safety monitoring after approval for
general use. 
Pharmacodynamics
 The action of a drug on the body,
including receptor interactions, dose-
response phenomena and mechanism
of therapeutic and toxic action. 
 A drug is compound that can modify the
 A drug will exert its activity through
interactions at one or more molecular
targets.
 The macromolecular species that
controls the functions of the cells.
enzymes or nucleic acids. 
 Other sites of drug binding
 Proteins ( in patient or microbes),
genome ( cyclophosphamide),
microtubules           ( vincristine)
Drug actions
 Processes by which drugs make their
ion channels, second messengers.
Uses
1. Rational therapeutic use of drugs
2. Design of new and superior chemical
agents
Mechanism and Specificity of Drug Binding
1. The majority of binding and recognition
occurs through non-covalent
interactions.
2. These govern:
 The folding of proteins and DNA
 The association of membranes
 Molecular recognition
3. They are generally weak and operate
only over short distances.
4. So for an effect to occur, you need:
 Large numbers of interactions for
stability
  High degree of complementary
Bonds
1. Covalent Bonds. The sharing of a pair of
electrons between two atoms. 
 These electrons largely occupy
the space between nuclei of the
two atoms.
 Very stable thus very strong.
 Requires hundreds of kilojoules
to disrupt. 
2. Non-covalent interactions
 Hydrogen bonds
 Hydrophobic interactions
 Ionic interactions
Effects of Binding
After binding, two things happen:
 Confirmation effects
 Binding locks a mobile, flexible
molecule into restricted
conformation.
 Configuration effects
 Differences in configuration can
lead to starting differences in the
biological effect.   They are known as the G-protein
NON-RECEPTOR MEDIATED
INTERACTIONS
 Acid base reaction.
o Outcomes does not need a
receptor, just a simple acid-base
equilibrium. Example- antacid-
hyperacidity vulnerable to
gastritis. Relief from antacid.
 Counterfeit incorporation.
o A form of poisoning, it is utilized
in cancer chemotherapy by
feeding the patient/cell with false
nucleotides so as to cheat cancer
cells. 
 Colligative mechanism.
o This elicits effect by means of
numbers.  Acetylcysteine. Break
the disulfide bonds of bronchial
mucus in bronchial asthma.
Diuretic: mannitol. If brain has
edema, mannitol is used to
decongestant the brain.  maintain cell integrity
DRUG RECEPTOR
 A macromolecular component of a cell
with which a drug interacts to produce a
response.
 Usually protein- requires translation to
have an effect. 
PROTAGONIST - A drug that triggers the
same events in the receptor as the native
ligands, mimics the natural ligand.
ANTAGONIST- A drug that stops the binding
of the native agent without eliciting a response.
There are 4 types of receptors
1. Ionotropic receptors.
o There are 4 or 5 members-
spanning subunits.
o Their N- and C- termini are found
in the extracellular fluid.
o This family includes ion channel.
2. Metabotropic receptors.
 Their N-terminal is extracellular
and the C-terminal in intracellular.
 This family is coupled to the
action of G-proteins.
coupled receptors. 
3. Kinase-linked receptors.
 These are tyrosine kinase linked
receptors with a single
transmembrane helix.
 The insulin and growth factor
receptors fall within this family.
4. Steroid receptors.
 These receptors are found in cell
nucleus and are transcription
factors. They have looped
regions held together by a group
of 4 cysteine residues
coordinating to a zinc ion. 
CLASSIFICATION OF PROTEIN
RECEPTORS ACCORDING TO FUNCTION
1. Regulatory- change the activity of
cellular enzymes
2. Enzymes- may be inhibited or activated
3. Transport- e.g., Na+/ATP
4. Structural –these from cell parts and
ENZYMES
 Proteins that catalyzes the reactions
required cellular function.
 Generally specific for a particular
substrate or closely related family of
substrates.
 Control a number of metabolic
processes.
 Inhibitors – molecules that restrict
the action of enzyme on its substrate  regulatory ligands ( e.g. Hormones,
 Action of drugs is mostly inhibitory in
nature. It can be
1. Reversible- very common mode of
action of many drugs. In the patient (
ACE inhibitors), In microbes ( sulfas,
penicillins) and In cancer cells ( 5-
FU, 6-MP)
2. Irreversible- enzyme inhibitors may
be seen to allow very fine control
cellular processes (e.g. 6-methyl
purines- death of CA cells).  safe. Ex. Epinephrine
DRUG RECEPTOR
A. Concept of a receptor
1. For most drugs the site of action is at a
specific macromolecule, generally
termed a receptor (a membrane protein,
a cytoplasmic or extracellular enzyme or
a nucleic acid).
2. Not all drug actions and effects are
mediated through receptors. An average
10% of them is not.
3. For most drugs the magnitude of
pharmacological response increases as
the drug concentration (dose) increases
at the site.  target and other molecules can lead to
B. Drug receptor
1. Responsible for selectivity of drug
action.
2. Mediate the actions of
pharmacologic agonist and
antagonists.
3. The term receptor is usually
reserved for proteins which are
embedded in a cellular or subcellular
membrane and facilitates
communication between the two
sides of the membrane.
C. Proteins receptor
1. Proteins serving structural roles
( e.g., tubulin)
2. Enzymes in transport process ( e.g., 
N/K)
3. Receptors for endogenous
factors and neurotransmitter)
4. Enzymes of crucial metabolic or
regulatory pathways (e.g.,
acetylcholinesterase)
Three important properties of a drug:
1. Efficacy- maximum desirable effect.
The effect would be a scale of
response 
2. Safety- no drug is actually 100%
3. Quality- tests bioavailability. How
much of the drug will enter the
system? 
SELECTIVITY, TOXICITY AND
THERAPEUTIC INDEX
1. Drugs may bind to both their desired
target and to other molecules in an
organism.
2. A drug is said to be specific if
interactions with other targets are
negligible.
3. Selective drugs (more common than
specific) will show a non-exclusive
preference for their target.
4. The interaction with both their intended
undesirable side effects.
5. Anti-cancer drugs have a narrow
therapeutic margin (they also target
normal cells even if they eradicate the
rapidly proliferating cancer cells).
6. Concentrations at which drugs exerts its
beneficial effect and where the level of
side effects becomes unacceptable
must be established.  
THERAPEUTIC INDEX=MARGIN OF SAFETY
 1. A key factor in classifying a drug as prescribed. It also called desired
easy or difficult to use is the range effect. 
between the concentrations (dose) 2. Side effect.
needed to produce a therapeutic  The effect of the drug that is
response and that which procedure a unintended. Also called
toxic response define the separation secondary effect.
between toxic dose and therapeutic 3. Drug allergy.
dose.  The immunologic reaction to the
2. The ratio of these concentrations is drug.
called the therapeutic index or 4. Anaphylactic reaction.
therapeutic ratio.  A severe allergic reaction which
3. TI or TR is expressed as the minimum usually occurs immediately
concentration (dose) that produces following administration of the
toxicity divided over the minimum drug.
concentration (dose) that produces the 5. Drug tolerance.
effective response in a patient  A decreased physiologic
population.  response to the repeated
administration of a drug
chemically related substance. 
PHARMACODYNAMICS  6. Cumulative effect.
 Refers to the mechanism by which  It is the increasing response to
drugs produce biochemical and the repeated doses of a drug that
physiologic changes in the body.  occurs when the rate of
administration exceeds the rate
Pharmacodynamics events of metabolism or excretion. 
 A drug modify cell function or the rate of 7. Idiosyncratic effect.
cell function.  It is unexpected peculiar
 A drug may interact with specific response to the drug; either
receptor sites. overresponse, under response,
different response than expected,
 Agonist drugs stimulate receptors
unpredicted or unexplained
to produce an effect.
responses.
 Antagonist drugs inhibit receptors
8. Drug abuse.
and prevent a response from
 Inappropriate intake of
occurring.
substance, either continually or
 A drug may work on various receptors
periodically.
(non-selectivity) and produce multiple,
9. Drug dependence.
widespread. 
 It is a person’s reliance to take a
STAGES OF DRUG MOVEMENT drug or substance. Intense,
physical or emotional disturbance
1. Absorption is produced if the drug is
2. Distribution withdrawn.
3. Metabolism 10. Addiction.
4. Excretion   It is due to biochemical changes
in body tissues, especially the
MODULE 2 nervous system. These tissues
come to require the substance for
EFFECTS OF THE DRUG normal functioning. Also called
physical dependence. 
1. Therapeutic effect.
11. Habituation.
 The primary effects intended, that
is the reason the drug is
  It is the emotional reliance on a
drug to maintain a sense of well
-being accompanied by feelings
of need or craving for the drug.
Also called psychological
dependence.  diabetes mellitus.
12. Drug interaction.
 Effects of one drug are modified
by the prior or concurrent
administration of another drug,
thereby increasing or decreasing
the pharmacologic action.
13. Drug antagonism.
 Conjoint effect of two drugs is
less than the drugs acting
separately.
14.  Summation.
 The combined effect of two drugs
produces a result that equals the
sum of the individual effects of
each agent.
15. Synergism.
 The combined effects of drugs is
greater than the sum of each
individual agent acting
independently.
16. Loading dose.
 Refers to administration of one or
more doses at the onset of
therapy to quickly reach the
therapeutic blood level and
hasten a therapeutic effect.  2. Drugs in general exert multiple actions
17. Therapeutic drug levels.
 Refer to drug levels that provide
adequate action but minimal
adverse effects.  physiochemical interaction between the
18. Potentiation.
 The concurrent administration of
two drugs in which one drug
increases the effect of the other
drug.
THERAPEUTIC ACTION OF DRUGS
1. Palliative. Relieves the symptoms of a
disease but not affect the disease itself.
E.g., antineoplastic agents for cancer.
2. Curative. Treats the disease condition.
E.g. antibiotic for infection.
3. Supportive. Sustains body functions
until other treatment of the body’s
response can take over. E.g. Mannitol to
reduce/ ICP (intracranial pressure) in a
client for surgery due to brain tumor. 
4. Substitutive. Replaces body fluids or
substances. E.g., insulin injection for
5. Restorative. Returns the body to
health. E.g. multivitamins for elderly
clients. 
TYPES OF ADVERSE REACTIONS
1. Dose-related factors. Reactions to the
drug’s primary or secondary effects
2. Sensitivity related. Reaction due to
hypersensitivity or allergy.
3. Iatrogenic. Mimics a pathologic
condition.
4. Toxicity. Reaction when drug level
exceed therapeutic range.
5. Idiosyncrasy. Reaction that’s
unexpected or peculiar.
6. Miscellaneous. Include blood
dyscrasias, nephrotoxicity, hepatic
toxicity, carcinogenicity, teratogenicity,
photosensitivity and disease-related
effects. 
GENERAL PROPERTIES OF DRUGS
1. Drugs do not confer any new functions
on a tissue or organ in the body. They
only modify existing functions.
rather than single effect. Therefore, no
drug is free from side effect.
3. Drug interaction results from
drug and a functionally importance
molecule in the body. 
PHARMACOKINETICS FACTORS IN
DRUG THERAPY
1. Absorption. Is the process by which a
drug passes from its site of
administration into the bloodstream.
Factors that affect drug absorption
1. Blood flow. Rich blood supply
enhances absorption. IM injection
promotes faster absorption than
subcutaneous injection
2. Pain. Slows gastric emptying rate, so clients with kidney or liver
the drug remains longer in the stomach. disease.
3. Stress. Causes vasoconstrictions, so b. Volume distribution
the drug taken orally will be absorbed  Client with edema has
slowly. enlarged area in which a drug
4. Foods. Interferes with drug absorption. can be distributed, and may
5. Exercise. In can decrease blood need an increased dose.
circulation to the GI tract causing more  Smaller dose may be needed
blood flow to the muscles. Oral drugs for a client with dehydration. 
will be absorbed more slowly. c. Barriers to drug distribution
6. Nature of the absorbing surface.  Prevent to some medication
Transport of drug molecules is faster from entering certain body
through a single layer of cells. Drugs organs 
applied to the mucous membrane will be 1. Blood brain barrier. To
absorbed faster than those applied on pass through this barrier,
the skin. drug must be lipid soluble
7. Solubility of the drug. The drug must and loosely attached to
be in solution. Liquid drugs are plasma proteins.
absorbed faster than the solid drugs. 2. Placental barrier. Shields
8. pH. Acidic drugs are best absorbed in from the possibility of
the acidic environment. Alkaline drugs adverse drug effects.
are best absorbed in alkaline Many substances like
environment.  drugs, nicotine, and
9. Drug concentration. Drug alcohol do cross the
administration in high concentration tend placental barrier. 
to be more rapidly absorbed than the d. Obesity 
drugs administered in low  Body weight plays a role in
concentrations. Bolus dose is given to drug distribution because
obtain rapid effect of a drug.  blood flows through fat slowly,
10. Dosage form. An active drug may be thus increasing time before
combined with another substance from drug is released.
which it is slowly released or may be e. Receptor combination
prepared in a vehicle that offers relative  A receptor is an area on a cell
resistance to the digestive action of the where drug attaches and
stomach contents. E.g. enteric coated response takes places. 
drugs like erythromycin.   A receptor is usually protein
or nucleic acid. Other
receptors are enzymes, lipids,
and carbohydrates residues.
2. Distribution. Is the transport of a drug
 Drugs can have agonist or
from its site of absorption to its site of
antagonist effect.
action. 
 Agonist will connect itself to
a. Plasma-protein binding
the receptor site and cause
 Medications connect with
pharmacological response.
plasma proteins (albumin) in
 Antagonist will attempt to
vascular system.
attach but because
 Strong attachments have a
attachment is uneven, there is
longer period of drug action.
no drug response.
 Clients with reduces plasma
 There can be competition at
proteins could receive a
receptor site when more than
heightened drug effect. E.g.
one drug tries to occupy it. 

3. Metabolism or Biotransmission
 A sequence of chemical
events that change a drug to a
less active form after it enters
the body. Also called
detoxification.
 The liver is the principal site of
drug metabolism.
 Oral medications. Go directly
to the liver via portal
circulation before entering the
systematic circulation.
 Many medications become
entirely inactivated by the liver
the first time they go through
it.  toxicity.
Factors that Affect Drug Metabolism
1. Age. Infant and elderly have reduced
ability to metabolize some drugs.
2. Nutrition. Liver enzymes involved in
metabolism rely on adequate amounts of
amino acids, lipids, vitamins and
carbohydrates.  are achieved.
3. Insufficient amounts of major body
hormones.  schedules
4. Excretion
 Is the process by which drugs are
eliminated from the body.
 Most important route of excretion
for most drugs is kidneys.
Factors that Affect Drug Excretion
1. Renal excretion. Carried out by
glomerular filtration and tabular
secretion, which increases, which
increase quantity of drug excreted.  4. Duration of action. Length of time a drug
2. Drugs can affect elimination of other
drugs.  5. Bioavailability. Percentage of a drug
 Probenecid prevents excretion of
penicillin.
 Antacid increases elimination of
ASA.
3. Blood concentration levels. When peak
level of the drug is reached, excretion
level become greater than absorption
and blood levels of drugs begin to drop. 
3. Half-life. It is time required for the total
amount of drug to decrease by 50%. 
Physiologic Changes Associated with
Aging that Influence Medication
Administration and Effectiveness
1. Altered memory
2. Less acute vision
3. Decreased in renal function resulting in
slower elimination of drugs.
4. Less complete and slower absorption
from gastrointestinal tract.
5. Increased proportion of fat to lean body
mass which facilitates retention of fat
soluble drugs and increases potential for
 
6. Decreased liver function, which hinders
biotransformation of drug.
7. Decreased organ sensitivity. These may
lead to under response to drugs. 
8. Altered quality of organ responsiveness,
resulting in adverse effects becoming
pronounced before therapeutic effects
 
Factors that determine proper dosing
 
1. Route of administration. Area of body
where drug absorption will take, place,
bioavailability may change when route
of administration is changed.
2. Onset of action. Time interval from
where the drug is administered until is
therapeutic effects begin.
3. Peak concentration level. Maximum
blood concentration level achieved
through absorption; at this level, most of
the drug reaches the site of action and
provides the therapeutic response.
produces its therapeutic effect.
absorbed into systematic circulation for
activity, drugs injected I.V. have 100%
bioavailability.
Five schedule of controlled substances.
1. Schedule I: Highest risk for abuse.
 2. Schedule II: High potential for abuse,
may lead to physical and psychological
dependence. 
3. Schedule III: Lesser abuse potential
4. Schedule IV: Least abuse potential
Assessment for drug administration
1. Determine food or drug allergies
2. Obtain a drug history
3. Obtain a medical history
4. Perform a physical examination  patients.
MODULE 3
The Philippine National Drug Policy is the
government’s response to the problem of
inadequate provision of good quality essential
drugs to the people.  3. Permits the writing of the generic
The 5 pillars
1. The assurance of the safety, efficacy
and usefulness of pharmaceutical
products through quality control.
2. The promotion of the rational use of
drugs by both health professionals and
the general public.
3. The development of self-reliance in the
local pharmaceutical industry. 
4. Tailored or targeted procurement of
drugs by government, such as the best
drugs are available to the lower-income
sectors of society and the lowest
possible cost.
5. People empowerment. Cuts across
other 4 pillars and aims to assist people
in making informed choices.  physical and mental well-being and to defend
Relevant Laws:
GENERIC ACT – (RA 6675)
An act to promote, require and ensure the
production of an adequate, supply, distribution,
use and acceptance of drugs and medicines
identified by their generic names:
1. To promote, encourage and require the
use of generic terminology in the
importation, manufacture, distribution,
marketing, advertising and promotion,
prescription and dispensing drugs. 
2. To ensure the adequate supply of drugs
with generic names at the lowest
possible cost and endeavor to make
them available for free to indigent
3. To emphasize the scientific basis for the
use of drugs, in order that health
professionals may become more aware
and cognizant of their therapeutic
effectiveness. 
Provisions
1. Permits erroneous and impossible
prescriptions. 
2. Use of generic names in all
prescriptions, generic name written in
full, generic name to be written after
Rx sign in prescription, other details
to be included in the prescriptions
names of more than one drug product
in one prescription form.
4. All drug outlets to practice generic
dispensing with some exceptions,
modifications or qualifications specific
to drug stores, boticas, and other
drug outlets and hospital
pharmacies. 
COMPREHENSIVE DANGEROUS DRUG
ACT OF 2002 (RA 9165)
It is policy of the state: to safeguard the
integrity of its territory and well-being of its
citizenry, particularly the youth from the
harmful effects of dangerous drugs on their
the same against acts or omissions detrimental
to their development and
preservation.  
Unlawful Acts and Penalties 
Section 4. Importation of Dangerous Drugs
&/or Controlled Precursors & Essential
Chemical: Offenders Penalty:
1. Importer Life to Death + 500,000- 10 M
2. Importer Death + 10 M using Diplomat
passport
3. Financer, Organizer, Death+ 10M
Manager of importation  of the victim
4. Protector/Coddler, 12 year 1 day to
100,000 to 500,000
Section 5. Sale, Trading, Administration,
Dispensation, Delivery, Distribution and
Transportation of Dangerous Drugs &/ or
Controlled Precursors and Essential
Chemicals.
Elements
Identity of the buyer and the seller, the object
and the consideration
Delivery of the thing sold and the payment
thereof
Maximum Penalty Imposed on:  paramethoxyamphetamine,
Committed within 100 m from a school
 Use of minors or mentally incapacitated
persons as runners, couriers and
messengers, or in any other capacity
 If the victim is a minor or mentally
incapacitated 
 Dangerous drug is the proximate cause
 Organizer, manages the unlawful act,
financier 
Sec 11 Possessions of Dangerous Drugs
 Life imprisonment to Death and fine 500
K-10 M 
1. 10 grams or more of opium
2. 10 grams or more of morphine
3. 10 grams or more of heroin
4. 10 grams or more cocaine
5. 50 grams or more of methamphetamine
HCL/shabu
6. 10 grams or more of marijuana resin or
marijuana resin oil
7. 500 grams or more of marijuana
8. 10 grams or more of other dangerous
drugs such as ecstasy,
methylenedioxymethamphetamine,
gamma hydroxyamphetamine,
trimethoxyamphetamine, lysergic acid,
diethylamine and others.
ORPHAN DRUGS
 Designation program status to drugs
and biologics which are defined as
those intended for the treatment prevent
or diagnosis of a rare disease or
condition which is one that affects less
 than 200,000 person in US or meets Conditions can be treated using OTC
cost recovery provision of the act. 
1. Minor aches and pains- Acetaminophen
 Orphan drugs are medicinal products
Nonsteroidal Anti-inflammatory drugs
intended for diagnosis, prevention or
( NSAIDs), Aspirin
treatment of life threatening or very
2. Fever- Paracetamol 
serious disease or disorders that are
3. Diarrhea-Loperamide
rare. 
4. Cough/Colds- Guaifenesin 
Top 20 orphan drugs by 2018 5. Sore throat- Strepsils 
6. Allergies- Dipenhydramine 
1. Rituxan 
2. Revlimid
3. Soliris MODULE 4
4. Afinitor NURSING PROCESS IN DRUG
5. Tasigna ADMINSITRATION
6. Velcade
7. Avonex ASSESSMENT
8. Alimta
1. Determine whether patient has food
9. Yervoy
allergies; document clearly on the
10. Sprycel
patient’s chart all food and drug
11. Rebif
allergies.
12. Kalydeco
2. Find out:
13. Jakavi
a. Which prescription and
14. Sutent
nonprescription medications
15. Kryprolis
patient currently intakes
16. Kogenate
b. The frequency of administration
17. Novoseven
c. The purpose of each medication
18. Nexavar
for the patient
19. Capoxane
d. Whether the patient has
20. Ibrutinib 
experienced adverse effects
3. Obtain a history of the patient’s medical
RAREDISEASES conditions, socio-economic status, and
psychosocial support.
1. Gigintism 4. Perform physical examination; pay
2. Maple syrup urine disease particularly to body systems that may be
3. Ochoa syndrome affected by current by current or newly
4. Foreign accent syndrome prescribed medications or to areas
5. Carcinoid syndrome where the patient has complaints or
6. Situs inversus concerns.  
7. Wilson disease
8. Peeling syndrome
NURSING DIAGNOSIS 
9. Acoustic neuroma
10. BetaThalassemia  1. Develop a nursing diagnosis of the
patient’s disease and its etiology.
2. Begin by addressing problems that pose
OVER-THE COUNTER immediate threats to the patient’s
health. 
 Also known as OTC or nonprescription
3. Commonly listed nursing diagnoses
medicine. All these terms refer to
related to drug administration include:
medicine that you can buy without
a. Deficient knowledge
prescription.
b. Risk for injury
 c. Ineffectivetherapeutic PARTS OF LEGAL DOCTOR’S ORDER
regimen management
d. Noncompliance  1. Name of Patient
2. Date and Time
PLANNING 3. Name of drug
4. Dose of drug
1. Developing outcomes using the nursing 5. Route of administration
diagnosis; if possible, obtain input from 6. Time or Frequency
the patient and his/her family. 7. Signature of the Physician 
2. Use these goals as outcome criteria for
evaluation. PRINCIPLES OF MEDICATIONS
IMPLEMENTATION
1. Put care plan into action. 1. THE 14 RIGHTS OF MEDICATIONS 
2. Include all relevant nursing
interventions, including drug therapy, to  Right drug/medication
meet patient’s health care needs.  Right client/patient
3. A multidisciplinary team approach is  Right route
usually needed. 
 Right dose
EVALUATION  Right frequency/time
 Right assessment
1. Evaluation whether interventions enable
 Right approach
the patient to achieve the desired
 Right education
outcomes.
2. Include appropriate evaluation  Right evaluation
statements, such as:  Right documentation
a. The patient experiences expected  Right to refuse
effects of the prescribe medications.  Right principle
b. The patient avoids adverse effects or  Right prescription
interactions with other drugs, foods  Right nurse clinician 
or alcohol.
c. The patient demonstrates an
2. PRACTICE ASEPSIS. Wash hands
understanding of information.
before and after preparing medications
d. Patient complies with therapeutic
3. Nurses who administer medications are
regimen. 
responsible for their own actions.
e. Therapeutic drug levels are
Questions any order that you consider
maintained
incorrect. (May be unclear or
3. Based on the evaluation, modify
inappropriate).
outcomes and interventions, as
4. Be knowledgeable about the
needed. 
medications that you administer. A
fundamental rule of safe drug
TYPES OF DOCTORS ORDER 
administration is never administer an
1. Standing Order. It is carried out until unfamiliar medication.
the specified period of time or until it is 5. Keep narcotics in locked place. 
discontinued by another order. 6. Use only medications that are clearly
2. Single order. It is carried out for one labeled containers. Relabeling of drugs
time only. is the responsibility of the pharmacists.
3. STAT order. It is carried out at once or 7. Return liquid that are cloudy in color to
immediately. the pharmacy.
4. PRN order. It is carried out as the 8. Before administering the medication at
patient requires.   the bedside. Stay with the client until he
actually takes the medications.
9. Before administering the medication,  Drug may be aspirated by
identify the client correctly. seriously ill patient.
10. The nurse prepares the drug
administers it. Only the health care Drug forms for oral administration
provider prepared the drug knows the
drugs is. Do not accept endorsement of  Solid form: Tablet; capsule; pill and
medications powder
11. If the client vomits after the medication,  Liquid: syrup, suspension, emulsion,
report this to the nurse in charge or the elixir, milk
physician  Syrup: sugar- base liquid
12. Pre-operative medications are usually medications
discontinued during the post-operative  Suspension: water based liquid
period unless ordered to be continued. medication. Shake the bottle
13. When a medication error is mad, report before use of medication to
it immediately to the nurse in charge or properly mix it.
physician. To implement necessary  Emulsion: oil- based liquid
measures immediately. This may medication
prevent any adverse effect of the drug.   Elixir: alcohol- based liquid
medication. After administration
ROUTES OF DRUGS of elixir allow 30 minutes to
ADMININISTRATION  elapse before giving water.  This
allow maximum absorption of the
medication 
1. Oral
2. Sublingual
3. Buccal
4. Topical 2. SUBLINGUAL. A drug that is placed under
5. Ophthalmic the tongue, where it dissolves. When a
6. Parenteral  medication is in capsule and ordered
sublingually, the fluid must be aspirated from
the capsule under the tongue. 
1. ORAL MEDICATIONS 
 Advantages Advantages
 most convenient 
 usually less expensive  Same as oral.
 safe, does not break skin  Drug can be administered for local
barrier effect.
 Disadvantages  Drug is rapidly absorbed in the
 Inappropriate for client bloodstream.
with nausea and vomiting. 
 Drugs may have
unpleasant taste or odor.
 Inappropriate if client
cannot swallow and if GIT Disadvantages
has been reduced.  If swallowed, drug may be
 Drug may discolor the inactivated by gastric juices
teeth.  Drug can remain under the tongue
 Drug may irritate the until dissolved and absorbed.
gastric mucosa.
3. BUCCAL.  A medication is held in the mouth
against the mucosa membranes of the cheek is for proper absorption of the
until the drug dissolves. The medication should medication. 
not be chewed, swallowed, or placed under the  Avoid dropping a solution onto the
tongue. E.g. sustained release of cornea directly because it cause
nitroglycerine, opiates, anti-emetics, discomfort. 
tranquilizers, and sedatives.   Instruct the patient to close the eyes
Advantages gently. Shutting the eyes tightly
causes spillage of the medication.
 Same as oral.
 For liquid eye medication, press on
 Drug can be administered for local
the nasolacrimal duct (inner canthus)
effect.
for at least 30 seconds to prevent
 Ensures greater potency because systemic absorption of the
drug directly enters the blood and medication.
bypass the liver.
Disadvantages 6. OTIC. Includes instillations and
irrigations 
 If swallowed, drug may be inactivated by  Instillations 
gastric juice. 1. To soften earwax
2. To reduce inflammation and
4. TOPICAL. The application of treat infection.
medications to a circumscribed area of 3. To relieve pain
the body. Includes lotions, liniments,  Irrigation 
and ointments. 1. To remove cerumen or pus
 Wash and pat dry area well before 2. To apply heat
application to facilitate absorption. 3. To remove foreign body
 Use surgical asepsis when open  Warm solution at the room
wound is present. or body temperature. Using
 Remove previous application before hot or cold solution into the
the next application. ear can cause nausea,
 Apply only thin layer of medication to vertigo and pain
prevent systemic absorption  Side-lying position with the
 Use gloves when applying the ear being treated
medication over a large surface. E.g. uppermost
large area of burns.   Clean the pinna and the
5. OPTHALMIC. Includes instillations and meatus of the ear canal
irrigations. with cotton-tipped
1. Instillations. To provide an eye applicator.
medication that the client requires.  Straighten the ear-canal
2. Irrigation.  To clear the eye of noxious 
or other foreign material.  0-3 years old; pull pinna
 Position client either sitting or lying downward and backward.
 Use of sterile technique 
 Clean the eyelid and eyelashes with  Older than 3 years old pull down
sterile cotton balls moistened with the pinna backward and
sterile normal saline from inner to backward.
outer canthus.   Instill eardrops on the side of the
 Instill eye drops into lower auditory canal to allow drops to flow
conjunctiva sac. in and continue to adjust to body
 Instill a maximum of two drops at a temperature
time.  Wait for 5 minutes of additional
drops need to be administered. This
  Press gently but firmly a few times
on the tragus of the ear to assist
the flow into the ear canal.
 Ask the client to remain in side-lying
position for about 5 minutes.
 Insert a small piece of cotton fluff
loosely at the meatus of the
auditory canal for 15-20 minutes.
To prevent spillage of the
medication out of the ear.
7. NASAL. Nasal instillations usually are
instilled for their astringent effect (to
shrink swollen mucous membrane), to
loosen secretions and facilitate drainage
or treat infections of the nasal cavity or
sinuses. E.g. decongestants
 Have the client blow, the nose or
prior to nasal instillations.
 Assume back-lying position, or sit
up and lean head back.
 Elevate nares slightly by pressing
the thumb against the client’s tip of
the nose. While the client inhales,
squeeze the bottle.  is to prevent oral fungal infection.
 Keep head backward for 5 minutes
after instillation of nasal drops.
9. VAGINAL
 When the medication is used on a
daily basis, alternate nares to
prevent irritation.
  For sinus instillations
1. Parkinson’s position for frontal and
maxillary sinuses.
2. Proetz position for ethmoid and
sphenoid sinuses.
8. INHALATION Use of nebulizers,
metered –dose-inhaler
 Semi or high-fowler’s position or
standing position. To enhance full
chest expansion allowing deeper
inhalation of the medication
 Shake the canister several times.
To mix the medication and ensure
uniform dosage of delivery
 Position the mouthpiece 1 to 2
inches from the client’s open
mouth. As the client starts inhaling,
press the canister down to release
one dose of medication. This allows
delivery of the medication more
accurately into the bronchial tree
rather than being trapped in the
oropharynx then swallowed.
 Instruct the client to hold breath for
10 seconds. To enhance complete
absorption of the medication.
 If bronchodilator, administer a
maximum of 2 puffs, for at least 30
seconds interval. Administer
bronchodilator before other inhaled
medication. This opens airway and
promotes greater absorption of the
medication.
 Wait at least 1 minute before
administration of the second dose
or inhalation of a different
medication by MDI
 Instruct client to rinse mouth, if
steroid had been administered. This
 
 
Advantage 
 Provides local therapeutic effect.
Disadvantages
 Has limited use.
 Drug forms: tablet, liquid (douches),
cream, jelly. Foam and suppository.
 Use of applicator or sterile gloves
for vaginal administration of
medications.
 Vaginal irrigation. Is the washing of
the vagina by a liquid at low
pressure. It is also called douche.
1. Empty the bladder before the
procedure.
2. Position and drape the client
 Instillation back-lying
position with knees flexed
and hips rotated laterally.
 Irrigation: back –lying
position with the hips higher
 than the shoulder (use  The administration of a drug into the
bedpan). dermal layer of the skin beneath the epidermis.
3. Irrigating container should be
30 cm (12 inches) above. 1. The sites are the inner lower arm,
3. Ask the client to remain in bed upper chest and back and beneath
for 5-10 minutes following the scapulae.
administration of vaginal 2. Indicated for allergy and tuberculin
suppository, cream, foam, jelly testing and for vaccinations.
for irrigation  3. Use left arm for tuberculin test: use
right arm for all other tests.
4. Use the needle gauge 25, 26,27,
10.  RECTAL   needle length 3/8”, 5/8” or ½ 
Advantage  5. Needle at 10-15 degree angle;
bevel up.
 Can be used when the drug has
6. Inject a small amount of drug slowly
objectionable taste or odor.
over 3 to 5 seconds to form a wheel
Disadvantage 
or bleb.
1. Dose absorbed is unpredictable 
 Need to be refrigerated so as not to
soften. B. SUBCUTENOUS
 Use of glove for insertion of Drugs administered subcutaneously are as
suppositories.  follows vaccines, pre-operative medications
 Have client lie on the left-side and and insulin.
breath through the mouth to relax the
anal sphincter.
 Insert suppository until a sensation of 1. The sites are the outer aspect of the
as if something has grabbed it away, upper arms, anterior aspect of the
occurs. This indicates that the thighs, abdomen, scapular areas of the
suppository has been inserted past upper back and ventrogluteal and
the internal anal sphincter. dorsogluteal.
 Ensure that the suppository comes in 2. Only small dose of medication should be
contact with the rectal wall. This injected via SC route (0.5 to 1 ml).
ensures accurate absorption of the 3. Rotate sites of injection to minimize
medication. tissue damage
 Client must remain on side for 20 4. Use needle 5/8 for adults when the
minutes after insertion. To promote injection is administered at 45 degree
adequate absorption of the angle; ½ is used at 90 degree angle.
medication.  5. For thin patient 45 degree angle of
needle.
6. For obese patient 90 degree angle of
needle.
11.  PARENTERAL  7. For insulin injection. Do not massage to
a. Intradermal – under the epidermis (ID). prevent rapid absorption which may
b. Subcutaneous. Into the subcutaneous result to hypoglycemic reaction. Always
tissue inject insulin at 90 degrees angle to
c. Intramuscular. Into the muscle ( IM) administer the medication in the packet
d. Intravenous- into the vein IV between the subcutaneous and muscle
e. Intraarterial- into the artery layer. Adjust the length of the needle
f. Intraosseous- into the bone depending on the size of the client. 
8. For other medication aspirate before
A.  INTRADERMAL INJECTION injection of medication to check if blood
vessels had been hit. If blood appears
 on pulling back of the plunger of the
syringe remove the needle and discard
the medication and equipment.  trochanter to the posterior superior iliac
C. INTRAMUSCULAR INJECTIONS
1.  Needle length is 1”, 1 ½ “and 2”. To
reach the muscle layer.
2.  Use needle gauge 20,21,22,23.
Depending on the viscosity of
medication.
3.  Clean the injection site with alcohol
cotton balls. To reduce microorganism
in the area.
4. Inject the medication slowly to allow
tissues to accommodate volume.
SITES
1. Ventrogluteal site (von Hochesteter’s
site)
1. Use gluteus- medius which lies over the
gluteus minimus muscle.
2. The area contains no large nerves or
blood vessels and less fat. It is farther
from the rectal area, so it less
contaminated  it is very close to the radial nerve and
3.  Position the client in prone or side lying.
When in prone position curl toes inward.
When side-lying position flex the knee
and hip. These ensure relaxation of
gluteus muscles and minimize
discomfort during injections.
4. To locate the site, place the heel of the
hand over the greater trochanter, point
the index finger towards anterior
superior iliac spine, and then abduct the
middle finger (third) finger. The triangle
formed by the index finger, the third
finger and the crest of the Ilium is the
site.  prevent permanent staining of the skin.
2. Dorsogluteal site
1. Uses of the gluteus medius muscle
2. Position of the client is similar to
ventrogluteal site.
3. The site should not be used for infants
under 3 years, because the gluteal
muscles are not well- developed yet.
4. To locate the site, the nurse draws
imaginary line from the greater
spine. The injection site is lateral and
superior to this line. 
5. Another method of locating this site is to
imaginary divide the buttock into four
quadrants. The upper outer quadrants is
the site of injection. Palpate the crest of
the ilium to ensure that the site is high
enough. 
3. Vastus lateralis
1. Recommended site injection for infants.
2. Located at the middle third of the
anterior aspect of the thigh.
3. Assume back-lying or sitting position.
4. Rectus femoris site
1. Located at the middle third, anterior
aspect of the thigh.
5. Deltoid site
1. Not used often for IM injection because
radial artery. 
2. To locate the site, palpate the lower
edge of the acromonion process and the
midpoint on the lateral aspect of the arm
that is in line with the axilla. This
approximately 5 cm (2 inches) or 2 to 3
fingerbreadths below the acromonion
process. 
Variations of the IM injection:  Z-track
technique
1. Used for parenteral iron preparation. To
seal the drug deep into the muscles and
2. Retract the skin laterally, inject the
medication slowly. Hold retraction of skin
until the needle is withdrawn.
3. Do not massage the site of injection. To
prevent leakage into subcutaneous. 
D. INTRAVENOUS 
1. Direct IV, IV push and IV infusion.
 2. Most rapid route of absorption of 14. Massage the site of injection to hasten
medications. absorption. 
3. Predictable, therapeutic blood levels of 15. Apply pressure at the site for few
medications can be obtained. minutes. To prevent bleeding.
4. The route can be used for clients with 16. Evaluate effectiveness of the procedure
compromised gastrointestinal function or and make relevant documentation.
peripheral circulation.
5. Larger doses of medications can be
administered by this route.  MODULE 5
Types of Reporting
GENERAL PRINCIPLES IN PARENTERAL
ADMINISTRATION OF MEDICATIONS 1. Change-of-shift reports or
endorsement 
1. Check the doctor’s order. To ensure for  For continuity of care.
proper procedure.   It is based on health care needs
2. Identify the client properly. To ensure of the client.
that the medications is administered to  It is not mere reciting the content
the right client. of the Kardex.
3. Practice asepsis. To prevent infection.
4. Use appropriate needle size. To
minimize tissue injury. 2. Telephone 
5. Plot the site if injection properly. To  Provide clear, accurate, and
prevent hitting the nerves and blood concise information.
vessels.
 The nurse documents telephone
6. Use separate needles for aspirations
report by including the following
and injections of medications. To prevent
information:
irritation of tissues.
1. When the call is made.
7. Introduce air into the vial before
2. Who was the call/report.
aspiration. To create positive pressure
3. Who was called.
within the vial and to allow easy
4. To whom information was
withdrawal of the medication.
given. 
8. Allow a small air bubble 0.2 ml in the
5. What information was given.
syringe to push the medication that may
6.  What information was
remain in a hub and lumen of the needle.
received. 
9. Introduce the needle in quick thrust. To
3. Telephone orders
lessen discomfort.
 Only RN’s may receive telephone
10. Either spread or pinch muscle when
order.
introducing the medication. Depending
the size of the client.   The order needs to be verified by
11. Minimize discomfort by applying cold reporting it clearly and precisely.
compress over the injection site before  The order should be
the introduction of medication to numb countersigned by the physician
nerve endings; apply warm compress to who made the order within
improve circulation in the area. prescribed period of time (within
12. Aspirate before introduction of 24 hours).
medication. To check if blood vessel had 4. Transfer reports.
been hit.  This is done when transferring a
13. Support the tissues with cotton swab client from one unit to another. 
before withdrawal of needle. To prevent
discomfort pulling tissues as needle is
withdrawn.
Commonly Used Abbreviations 

Abbreviation Latin English

a.c. ante cebum Before meals
ad. Lib. ad libitum As desired
ADL Activities of daily living
Ax. Axillary
Bid Bis in die Twice a day
BMR Basal metabolic rate
BP Blood pressure
c.c. cum With
Cap  capsula Capsule
Gtt gutta Drop
h.s. Hora somni Hours of sleep
IM Intramuscular
IV Intravenous
mcgtt Microdrop
Od Omnie die Once a day
OD Oculus dexter Right eye
OS Oculus sinister Left eye
OU Oculus uterque Both eye
o.m. Omni mane Every morning
p.c. Post cebum After meal
p.o. Per orem By mouth
p.r.n. Pro re nata As necessary/needed
q.h. Quaque hora Every hour
q.i.d. Quarter in die Four times a day
s.s. Sine Without
s.c Sub cutem Subcutaneously
ss. Semis One-half 
Stat.  Statim  Immediately 
Tid.  Ter in die Three times a day

MODULE 6 2. Helps to induce labor in clients

with maternal diabetes,
preeclampsia, eclampsia and
MATERNAL AND NEWBORN erythroblastosis fetalis.
MEDICATIONS  3. Should be used only in carefully
selected items in labor after
1. OXYTOCIN ( PITOCIN) cervix has dilated and
A. Overview presentation of fetus has
1. Enhances uterine contractions in occurred. 
client who are at term or provides 4. Stimulates letdown reflex in
stimulation of contractions with breast-feeding mother and
uterine inertia. relieves pain from breast
engorgement.
 5. Controls postpartum hemorrhage
and promotes postpartum uterine
involution.
B. Administration considerations
1. Dilute as ordered in IV solution
and hang as a titratable IV drip
using an IV pump.
2. Use normal saline as a primary
line, with medication piggy back
at secondary port or stopcock.
3. Monitor effects on contractions
while titrating dosage.
4. Keep magnesium sulfate on hand
for use if needed to relax the
myometrium.
5. Do not confuse Pitocin (oxytocin)
with Pitressin (vasopressin).
C. Side/adverse effects
1. Maternal: rare and with IV use,
causes increased pain with
contractions from increased
uterine motility; also
hypersensitivity, cardiac
dysrhythmias, hypotension,
hypertension if given following
use of vasopressors, water
intoxication (hyponatremia and
hypochloremia), nausea and
vomiting.
D. Nursing considerations
1. Use flowsheets to record
baseline maternal BP and other
vital signs, weight, I and O,
contractions (frequency, duration,
and strength) and fetal heart
tones and rate.
2. Continue to monitor maternal
pulse and BP, fetal heart tone,
contractions, and resting uterine
tone every 15 minutes.
3. Record time medication was
initiated and any changes in
dosage.
4.  Monitor for hypertonic
contractions  ( less than 2 minute
apart, greater than 90 seconds in
length, and 50 mmHg in strength)
, and shut off IV drip if uterine
hyperstimulation or
nonreassuring fetal heart rate
occurs, turn client onto left side,
increase rate of normal saline IV
and apply oxygen via face mask
as appropriate.
5.  Effects of drug will diminish 2 to
3 minutes after discontinuing the
medication.
6.  Watch for hypertensive crisis in
clients also receiving local or
regional anesthesia ( caudal,
spinal); sign include sudden
onset of intense occipital
headache, palpitations,
hypertension, stiff neck, nausea
and vomiting, fever and sweating,
photophobia, and dilated pupils,
constricting chest pain, and
bradycardia or tachycardia. 
7. Monitor I and O; report signs of
water intoxication (drowsiness,
headache, confusion, anuria, and
weight gain); also report
decreasing urine output with
adequate intake.
8.  Keep emergency resuscitation
equipment available.
E. Client teaching
1. Purpose and effect of medication.
2. Importance of reporting sudden,
severe headache immediately. 
II. UTERINE RELAXANTS
A. Overview
1. Inhibits contractions and therefore
arrest labor for at least 48 hours so
that corticosteroids (betamethasone)
can be given to facilitate fetal lung
maturity.
2. Used for cessation of contractions to
allow uterine fetal resuscitation when
uterine hyperstimulation is present.
3. Used to delay delivery in preterm
labor
4. Common medications
1. Terbatuline sulfate ( Brethine)
2. Ritrodine ( Yutopar)
3. Nifedipine ( Procardia)
4. Indomethacin ( Indocin) 
B. Administration considerations
1. Start medication at lowest possible
dose and increase as indicated until
contraction cease. 
2. Be certain about recommended
dose.
 3. If GI symptoms occur, advise client
to take medication with food.
4. Dilute IV terbutaline by adding each
5 mg to 1000 ml D5W or NS to yield
a concentrations of 5 micrograms/ml.
5. Infuse medication via microdrip using
an infusion pump.  B.
C. Side/ adverse effects
1. Beta-adrenergics: maternal and fetal
tachycardia, palpitations, tremors,
jitteriness, and anxiety, pulmonary
edema.  hypertension.
2. May cause exacerbate constipation.
3. Nausea and vomiting
4. Nifedipine ( Procardia) and
Indomethacin  ( Indocin) can cause
oligohydramnios
5. Indomethacin (Indocin) can cause
premature closure of ductus
arteriosus, leading fetal death.
D. Nursing considerations
1. Beta- adregenics; if client delivers
after receiving uterine relaxant
medications, be prepared with
oxytocic if needed to treat
postpartum hemorrhage.
2. Monitor vital signs and I and O.
3. Nifedipine (Procardia): avoid
grapefruit juice during administration
(interferes with effect).
4. Use indomethacin for a short period
of time (2 to 3 days).  breath, itching).
5. If mother uses terbutaline during
pregnancy; monitor neonate for
hypoglycemia.  caused by ergot.
E. Client teaching
1. Possible side effects and coping
strategies.
2. Use and dose of oral medications
and importance of taking them on
time.
3. Nifedipine (Procardia): encourage
client to change position slowly due
to possible orthostatic hypotension.
III. ERGOTS
A. Overview
1. Used to control postpartum
hemorrhage; should not used before
delivery of placenta.
2. Cause clonic contractions of uterus.
3. Produce arterial vasoconstrictions
and possible vasospasm of coronary
arteries.
4. Common medications
1. Ergonovine ( Ergotrate)
2. Methylergonovine ( Methergine)
Administration considerations:
causes rebound uterine relaxation.
B. Side effects/Adverse effects
1. Contraindicate in pregnancy or
hypersensitivity to ergot,
2. Should be used cautiously in
unstable angina and recent
myocardial infarction.
3. Significant increase of BP
4. Decreased milk production
5. Ergotism or overdose; nausea,
vomiting, weakness, muscle, pain,
insensitivity to cold, paresthesia of
extremities.
D. Nursing consideration 
1. Closely monitor blood pressure after
administration; if hypertension noted,
withhold dose and notify prescriber.
2. Monitor lochia after administration
and uterine contractions (strength,
durations, and frequency).
3. Assess and report as indicated
hypertension, chest pain, ergotism,
or hypersensitivity (shortness of
 
4. Administer analgesics as needed to
control pain of uterine contractions
 
E. Client teaching
1. Indication for administration.
2. Route of administration (oral, IM,
possible IV in emergency) and
possible side effects, such as
cramping.
3. Report increased blood loss,
increased temperature, or foul
smelling lochia.
4.  Perform pad count to monitor
bleeding.
5. Do not smoke because of increased/
additive vasoconstriction with
ergonovine use. 
IV. PROTAGLANDINS
A. Overview
 1. Prostaglandins terminate pregnancy develop; count fetal movement as an
from 12th week through second indication of fetal well-being.
trimester and can also be used to 2. Postpartum: prepare client for route
stimulate myometrium to promote of administration and possible
delivery. effects.
1. Prostaglandin E2- Dinosprostone
( Prepidil, Cervidil); Route
( Prepidil- intracervical gel and V. MAGNESIUM SULFATE
Cervidil- vaginal insert). A. Overview
Indications: Ripening of cervix 1. When given parentally, act as
prior to induction of labor. central nervous system
2. Prostaglanding F2- Carboprost depressant and also
tromethanine (Hemabate) depresses smooth, skeletal
(Hemabate- IM) Indications:  and cardiac muscle functions. 
Postpartum Hemorrhage.  2. Used to arrest preterm labor
B. Administration considerations and to prevent or treat
1. Client should remain in supine seizures with preeclampsia
position for 20 to 30 minutes after and eclampsia.
administration of dinosprostone.  B. Administration considerations
2. Before dinosprostone, client should 1. Use in conjunction with beta-
receive antiemetic and antidiarrheal adrenergics increases risk of
medications. pulmonary edema.
C. Side effects/Adverse effects 2. A -4 gram loading dose is
1. Diarrhea, nausea, vomiting, possible often utilized, which must be
increase in BP given over 20 to 30 minutes
2. Uterine cramping via infusion pump.
3. Tension headache C. Side/adverse effects
4. Flushing, cardiac dysrhythmias  1. Flushed warm feeling,
5. Hypertension drowsiness
6. Uterine tetany may develop with 2. Decreased or absent deep
prelabor or intrapartum tendon reflexes
administration 3. Decreased strength or
7. Uterine rupture absence of hand grasp
8. Contraindicated with acute pelvic 4. Fluid and electrolyte
inflammatory disease and history of imbalance, hyponatremia
pelvic surgery; use cautiously in 5. Nausea and vomiting
hypertension and with history of 6. Respiratory depression
asthma.  leading to respiratory arrest
D. Nursing considerations 7. Contraindicated in fetal
1. Prenatal: follow manufacturer’s anomaly incompatible with
instruction for placement of life, pulmonary edema or
medication; client must remain CHF, anuria, renal failure and
recumbent for 20 to 30 minutes after organic CNS disease.
administration and have fetal D. Nursing considerations
monitoring during this time. 1. Check patellar reflex prior to
2. Postpartum: monitor lochia and BP, initial dose and subsequent
be prepared for client to develop doses; depression of reflex
diarrhea.  could indicate risk for
E. Client teaching respiratory arrest.
1. Prenatal: report long or continuous 2. Monitor hand grasps and
contractions as uterine tetany may deep tendon reflexes hourly
for signs of toxicity.
 3. Monitor vital signs every 30 to 1. Do not administer in early
60 minutes, especially labor because it could slow
respiratory rate (needs to be labor.
16/min or greater for 2. Birth should occur more than
additional doses to be safe). 4 hours or less than 1 hour
4. Call prescriber for respiratory after dose of meperidine to
depression if respiration less minimize neonatal CNS
than 12/minute. depression.
5. Ensure that calcium gluconate 3. Agonist-antagonist provide
(antidote) is available at adequate analgesia, less
bedside.  respiratory depression, less
6. IV infusion flow rate is nausea and vomiting, but
generally adjusted to maintain equal or greater sedation
urine flow at least 30 t0 50 ml when compared to
per hour, monitor I and O meperidine. 
carefully; be certain to use 4. Do not use agonist-antagonist
infusion pump. for women with opioid
7. Monitor IV site closely to dependence because
avoid extravasation. antagonist activity could
8. Monitor serum magnesium precipitate withdrawal
level for target range of 4 to 7 (abstinence) symptoms in
mEq/L and call the doctor if mother and neonate
greater than 7 mEq. (irritability, hyperactive
9. Take accurate daily weight.  reflexes, tremors, seizures,
E. Client teaching yawning, sneezing, vomiting
1. Side effects of medication and diarrhea; and excessive
2. Report signs of preeclampsia, crying in neonate).
including headache, epigastric C. Side/adverse effects
pain, and visual disturbances 1. Meperidine, fentanyl, and
3. Report any signs of confusion sufentanil; nausea and
vomiting, sedation,
drowsiness or confusion,
VI. ANALGESICS  tachycardia or bradycardia,
A. Overview hypotension, dry mouth,
1. Used to manage moderate to urinary retention, pruritus,
severe pain in labor. respiratory depression.
2. Common opiod agonist 2. Butorphanol or nalbuphine:
analgesic is meperidine confusion, sedation, nausea
(Demerol). and vomiting, sweating,
3. Common opiod agonist- respiratory depression less
antagonist are butorphanol likely to occur. 
tartrate (Stadol) and D. Nursing considerations
nalbuphine (Nubain). 1. Meperidine, fentanyl and
4. Epidural or intrathecal opioid sufentanil
agents commonly include a. Assess FHT and uterine
fentanyl (Sublimaze) and contractions.
sufentanil (Sufenta). b. Assess for respiratory
5. Antidote to opioids is naloxone depression less than 12
(Narcan). breaths/minute.
B. Administration considerations c. Assess newborn for
respiratory depression if
 born in 1 to 4 hours of gestation and within 72 hours
dose. of delivery.
d. Keep naloxone available 5. Do not administer to newborn
as antidote. infant. 
e. Keep siderails raised for C. Side/adverse effects
safety. 1. Tenderness at injection site.
f. Supplement pain relief 2. Slight elevation in
using nonpharmacologic temperature.
methods, such as deep 3.  Contraindicated with
breathing and imagery. hypersensitivity to human
immunoglobulins and in Rh-
positive women. 
D. Nursing considerations:
2. Butorphanol or nalbuphine
Administer as described
a. Similar to opioid analgesics. 
previously.
b. Watch for withdrawn symptoms if
D. Client teaching: purpose and effects of
administered to opioid-dependent
medication and needed for repeat
women and neonates.
injections with subsequent pregnancies. 
E. Client teaching
1. Purpose and expected
effects of medication. VIII. LUNG SURFACTANTS 
2. Use of A. Overview 
nonpharmacological pain 1. Surfactant lowers surface
relief measures.  tension on alveolar surfaces
during respiration, which
improves gas exchange.
VII. RHₒ(D) IMMUNE GLOBULIN
Lung surfactants are
( RHOGAM) 
berectant (Survanta) and
A. Overview
colfosceril palmitate
1. Prevents anti RHₒ(D) antibody
(Exosurf).
formation ( isoimmunization)
2. Stabilize alveoli against
in Rh-negative women.
collapse at resting pressure.
2. Used when there is potential
3. Prevents or treats respiratory
or actual exposure to Rh-
distress syndrome (RDS) in
positive blood: pregnancy,
premature infants. 
labor and delivery,
B. Administration considerations
amniocentesis, chorionic villus
1. Given by intratracheal route
sampling, termination of
into endotracheal tube using
pregnancy, abdominal trauma
#5 French catheter with end
or transfusion.
hole.
B. Administration
2. Do not suction within 1 hour
1. Administer within 72 hour of
after dose unless significant
potential or actual exposure to
airway obstruction occurs. 
Rh- positive blood.
C. Side effects/adverse effects
2. Administer with each
1. Oxygen desaturation
subsequent possible or actual
2. Transient bradycardia
exposure.
3. Crackles and moist breath
3. Do not administer if client has
sounds occur transiently after
developed positive antibody
dose; does not necessarily
titer to Rh antigen.
indicate suctioning is needed.
4. In typical pregnancy,
D. Nursing considerations
administer at 28 weeks
 1. Ensure proper endotracheal
tube placement prior to
dosing. X. PHYTONADIONE OR VITAMIN K
2. Monitor heart rate, chest ( AQUAMEPHYTON)
expansion, and facial A. Overview
expression during 1. Fat-soluble vitamins that aids
administration. synthesis of clotting factors II,
3. Monitor oxygen saturation VII, IX, and X in premature
and periodically assess newborn liver.
arterial or transcutaneous 2. Prevents and treats
oxygen and carbon dioxide hemorrhagic disease of
level. newborn until neonate has
E. Client teaching: purpose and intestinal flora to absorb
intended effects of medication to vitamin K from GI tract.
parents. B. Administration considerations
1. Give IM at the time of delivery
in vastus lateralis muscle of
IX. BETHAMETHASONE leg.
( CELESTONE) 2. Protect from light.
A. Overview C. Side effects/adverse effects:
1. Synthetic glucocorticoid Hyperbilirubinemia
( corticosteroid) C.  Nursing considerations
2. Prevention of neonatal RDS 1. Monitor for signs of bleeding,
as an unlabeled use such as bruising at the
3. Enhances production of injection site or actual
surfactant bleeding from umbilical cord.
B. Administration consideration 2. Assess for jaundice and
1. Administer to a client in monitor results of bilirubin
preterm labor between 28 to levels to detect
32 weeks gestation. hyperbilirubinemia.
2. Used if client and fetus can E. Client teaching: purpose and
safely tolerate inhabitation of intended effects of medication to
labor for 48 hours. parents. 
3. Administer as once-daily dose
IM.
C. Side effects/adverse effects
XI. NEONATAL EYE PROPHYLAXIS
1. Contraindicated during
A. Overview
lactation.
1. Mandated by law for
2. Typically those of other
prophylaxis against Neisseria
corticosteroids, with risk of
gonorrhea and Chlamydia
infection and delayed wound
trachomatis, which could be
healing.
transmitted to neonate during
D. Nursing considerations
birth.
1. Monitor maternal vital signs
2. Common agents include
and fetal well-being.
erythromycin ophthalmic
2. Monitor for increased
ointment and tetracycline
temperature and WBC as
ophthalmic ointment or
general indicators of
solution.
infection. 
3. Previously silver nitrate (1%)
E. Client teaching: Purpose and
solution used, but this practice
intended effects of medication of
is outdated because of
parents.
 irritating effects on eyes and
insufficient prophylaxis
against chlamydia infection.
B. Administration considerations
1. Apply up to but within 1 hour
of delivery (allow time for eye
contact that promotes parent-
infant bonding).
2. Cleanse eyes before
application of dose.
3. Administer 0.5 to 1 cm ribbon
of ointment into each
conjunctival sac.
4. Do not rinse eyes following
dose.
5. Use a new tube of ointment
dose
C. Side/adverse effects: Blurring of
vision possible after application of
ointment.
C. Nursing considerations: as noted
previously.
C. Client teaching: purpose and intended
effects of medications to parents.