NCM 106 NURSING PHARMACOLOGY

Level 2 First Semester 2020 – 2021

Central Luzon Doctors Hospital – Educational Institution

PRELIMINARY TOPICS OF MODULES:

1. Introduction to Pharmacology
2. Nursing Process in Administering Medications
3. Drug Orders, Time Schedule, Abbreviations, Drug and Intravenous (IV) Fluid
Computations

TOPIC: Introduction to Pharmacology

OVERVIEW: Nursing Pharmacology deals with the science of drugs affecting the living
system. This first module focuses on the commonly used terms for you to have a foundation.
Furthermore, it gives you the basic ideas on drug legislation, drug names and other important
basic concepts. Drugs have classifications and principles which affect drug action. Each drug
goes through three phases – pharmaceutic, pharmacokinetic, and pharmacodynamic – as drug
actions occur. The nurse should also have the idea of checking drugs for their therapeutic
index and therapeutic range.

OBJECTIVES OF THE LESSON:

After completing the module, the learner shall be able to:
1. Learn a brief history of Pharmacology.
2. Define Pharmacology.
3. Identify the different branches of Pharmacology.
4. Know a brief historical background of Pharmacology.
5. Describe Pharmacokinetics and its four processes.
6. Describe Pharmacodynamics and know the difference to Pharmacokinetics, including other
useful terms.
7. Identify drug standards and legislation of drugs.
8. Learn the different FDA pregnancy categories.
9. Identify the different drug names.
10. Identify the basic dosage forms, drug interactions and adverse drug
effects. 11. Differentiate the prescription and nonprescription drugs.
12. Identify the principles of Drug Action.
13. Enumerate the individual variation of pharmacological response.
14. Differentiate the three phases of drug action.
15. Differentiate the therapeutic index and range.
16. Apply the principles of therapeutic range, half-life, peak, and trough to nursing
responsibilities when administering drugs.

LEARNING CONTENT:
HISTORY
Drug History & Development
The world’s oldest known pharmacological or therapeutic writings come from India and
China. The earliest Indian records are the Vedas. Although there are medical descriptions in
Rigveda (3000 B.C). It was Charaka, a renowned ancient Indian physician, and later Sushruta
and Vagbhata, who described various medicinal preparations included in Ayurveda, Charaka
described about 300 herbal drugs and classified them according to their effects,
The Chinese material medica ‘Pan Tsao’ was probably written in (2735 B.C) and contained
many plant and metallic preparations and a few animal products. Modern medicine is
considered to date from Hippocrates, a Greek physician (450 B.C), who for the first time
introduced the concept of disease as a pathologic process and tried to organize the science of
medicine on the basis of observation, analysis and deduction.

Herbs:
(The word herb comes from the Latin word ‘herba’ meaning grass, green stalks or blades). In
general use, herbs are plants with savory or aromatic properties that are used for in medicine,
flavoring food or as fragrances. Herbs have a variety of uses including medicinal and in some
cases, spiritual. The term "herb" differs between culinary herbs and medicinal herbs; in
medicinal or spiritual use, any parts of the plant might be considered as "herbs", including
leaves, roots, flowers, seeds, root bark, inner bark (and cambium), resin and pericarp. Herbs
have long been used as the basis of traditional Chinese herbal medicine, with usage dating as
far back as the first century CE and far before. In India, the Ayurveda medicinal system is
based on herbs. Which plant parts (flower, fruit, root, leaves stem, bark and seed) contain
medicinal properties that are called herbs.

Ayurvedic medicine:
The word "ayurveda" is Sanskrit, Ayurveda, meaning knowledge of life and longevity.
Ayurvedic medicine is one of the world's oldest holistic healing systems. It was developed
more than 3,000 years ago in India. It's based on the belief that health and wellness depend on
a delicate balance between the mind, body, and spirit. Ayurveda names seven basic tissues,
which are plasma, blood, muscles, fat, bone, marrow and semen. Ayurveda has historically
divided bodily substances into five classical elements (Sanskrit panchabhuta, viz. earth, water,
fire, air and ether. Ayurveda also names three elemental substances (called Vata, Pitta and
Kapha). Ayurveda has eight ways to diagnose illness, called pulse, urine, stool, tongue,
speech, touch, vision and appearance. After all it is a type of traditional Hindu medicine
system that treats illness/disease using a combination of food, herbs and breathing exercise.

Homeopathy:
The term "homeopathy" was coined by Hahnemann (respected doctor in Germany) and
derived from two Greek words that mean “like disease”. Homeopathy is a system of
alternative medicine created in 1796 by Samuel Hahnemann, based on his doctrine of like
cures like. Homeopathy is an alternative medical practice in which extremely dilute amounts
of certain natural substances are used to treat various ailments. It is a medical system based
on the belief that the body can cure itself. Those who practice it use tiny amounts of natural
substances, like plants and minerals. It is a system of treating disease or disease like
condition, where we have using a very small amount of the drug/ chemical
substance/compound in high amount, which cause the disease or disease like condition.

Allopathy:
(A western system of medicine, Western-American culture).
The term "allopathy" was coined in 1842 by C.F. Samuel Hahnemann. The system of medical
practice which treats disease by the use of remedies which produce effects different from
those produced by the disease under treatment. Allopathic medicine refers to the practice of
traditional or conventional Western medicine. The term allopathic medicine is most often used
to contrast conventional medicine with alternative medicine or homeopathy.
PHARMACOLOGICAL INTRODUCTION
Pharmacology – is derived from two Greek words, pharmakon, which means “medicine”,
and logos, which means “study”.
-Understanding on how drugs are administered, to where they travel in the body to actual
response produced.
-Further complicating, is the fact that drugs may elicit different responses depending on
individual client factors such as age, sex, body mass, health status and genetics.
-Learning the applications of existing medications and staying current with new drugs
introduced every year is an enormous challenge for a nurse
-If applied properly, drugs can dramatically improve the quality of life. If applied improperly,
can produce devastating consequences.
-The ‘father of pharmacology’- Oswald Schmiedeberg.

Pharmacology and therapeutics

- all nurses are directly involved with client care and are active educating, managing and
monitoring the proper use of drugs.
- It is necessary that individuals have a thorough knowledge of pharmacology to perform their
duties.
Another important area of study for the nurse, sometimes difficult to distinguish from
pharmacology, is the study of therapeutics. Therapeutics is slightly different from the field of
pharmacology, although the disciplines are closely connected.

Therapeutics – is the branch of medicine concerned with the prevention of disease and
treatment of suffering.

Pharmacotherapy or Pharmacotherapeutics - preapplication of drugs for the purpose of

disease prevention and treatment of suffering.
Drugs are just one of many tools available to the nurse for preventing or treating human
suffering.

THE NATURE AND SOURCES OF DRUGS

Various sources of drugs are:
I. Natural Source
a. Plant (Morphine, digoxin, quinine, atropine, nicotine, reserpine and caffeine
etc.)
b. Animal (Insulin, thyroid extract, heparin, antivenom, gonadotropins and
antitoxic etc)
c. Mineral (Liquid paraffin, magnesium sulfate, magnesium trisilicate, kaolin,
Ca, I and Cl etc)
d. Microorganism (Bacteria and fungi, isolated from soil are important sources
of antibacterial substances, e.g., penicillin)

II. Synthetic Source

a. Laboratory sources (e. g Analgesics, hypnotics, anticancer drugs, e.g.
Paracetamol, Aspirin etc).

III. Other Sources

a. Genetic engineering (DNA recombinant technology) e.g insulin and growth
hormones, genes.
b. Hybridoma technique (e. g monoclonal antibodies).
DRUG NOMENCLATURE
Three Basic Type of Drug Names
I. Chemical name
⮚ Described the drugs chemical structure
II. Generic name
⮚ The official or non-proprietary name for the drug; this name is not
owned by any pharmaceutical (drug) company and is universally
accepted
⮚ Usually lowercased
III. Trade name
⮚ Also known as propriety name; also chosen by the drug company and is
usually a registered trademark owned by that specific manufacturer
⮚ Written capitalized
Combination Drug – contains more than one active generic ingredient.

Differences Between Brand-Name Drugs and their Generic Equivalents The key to
comparing brand-name drugs and their generic equivalents lies in measuring the
bioavailability of the two preparations.

Bioavailability – the physiological ability of the drug, to reach each target cells and produce
its effect. It may indeed be affected by inert ingredients and tablet compression.

CLASSIFICATION OF THERAPEUTIC AGENTS

Substance applied for therapeutic purposes fall into one of the following three general
categories:
I.Drug or Medication
Drug
>Is a chemical agent capable of producing biological response within the
body. >These responses maybe desirable (therapeutic) or undesirable
(adverse).

Medication
>After a drug is administered

II. Biologics
>Agents naturally produced in animal cells, by microorganisms, or by the body
itself. >Used to treat a wide variety of illness and conditions.
Examples of biologics include hormones, monoclonal antibodies, natural blood products, and
components, interferon, and vaccines.

III.Alternative Therapies
>Therapeutic approaches
>Involve natural plant extracts, herbs, vitamins, minerals, dietary supplements, and many
techniques considered by some to be unconventional
>Therapies include acupuncture, hypnosis, biofeedback, and massage

METHODS OF DISPENSING DRUGS

Legal drugs are obtained either by a prescription or Over-the-counter (OTC) drugs.
I.Prescription Drugs
>An order must be given, authorizing the client to receive the drug.
>The practitioner can maximize therapy by ordering the proper drug for the client’s condition,
and by controlling the amount and frequency of drug to be dispensed.
>Health care provider has an opportunity to teach the client the proper use of drug and what
side effects to expect.
Prescription forms: an order for medication (or other forms of therapy). It contains the
following:
● Descriptive client information (name, address, age)
● The date on which the prescription was written
● The Rx symbol
● Name and dosage strength of the prescribed meds
● Dispensing instruction for the pharmacist
● Direction for the client
● Refill and or specialized labeling instruction
● The prescriber’s signature, address, license number

II. Over-the-counter Drugs (OTC)

>Drugs do not require a physician’s order.
>Clients may treat themselves safely if they follow instructions included with the
medications. >Preferred by the clients
>Easily obtained than prescription drugs
>No appointment with a physician is required

However,
>OTC drugs may react with food, herbal products, prescription medications, or other OTC
drugs.
>Clients may not be aware that some drugs may impair their ability to function safely. >Self
treatment is sometimes ineffective, and the potential for harm may increase if the disease is
allowed to progress.

Investigational drugs: drugs that are for studies and for clinical testing.
Illicit drugs or street drugs: drugs that are used and /or distributed illegally.

ROUTES OF DRUG ADMINISTRATION

I.Enteral Drug Administration
II.Topical Drug Administration
III.Parenteral Drug Administration

Enteral Drug administration

>Drugs given orally and those administered though nasogastric or gastrostomy tubes.
>most common, most convenient, and usually the least costly of all routes.
>considered the safest route because the skin barrier is not compromised.
>in case of overdose, medications remaining in the stomach can retrieved by inducing
vomiting.
>take advantage of the vast absorptive surfaces of the oral mucosa, stomach, or small intestine.

a. Tablet and Capsules

-Most common forms of drugs
Enteric coated – tablets that have a hard, waxy coating that enables them to resist the acidity,
are designed to dissolve in the alkaline environment of the small intestine.
Sustained-release – designed to dissolve very slowly, release the medication over the
extended time and results in a longer duration of action for the medication.
a.Sublingual and Buccal Drug
- The tablet is not swallowed but kept in the mouth
- Medications given by this route are not subjected to destructive digestive enzymes, nor do
they undergo hepatic first-pass metabolism
b.Nasogastric and Gastrostomy
- Drugs administered through these tubes are usually in liquid form

Topical Drug Administration

>applied locally to the skin or the membranous linings of the eye, ear, nose, respiratory tract,
urinary tract, vagina, and rectum.
>dermatologic preparations – these include creams, lotions, gel, powders, and sprays.
>installations and irrigations – applied into the body cavities or orifices
>inhalations – applied to the respiratory tract by inhalers, nebulizers, or positive-pressure
breathing apparatuses; a number of illegal, abused drugs are taken by this route because it
provides a very rapid onset of drug action.
>some drugs are given thru this route to provide for slow release and absorption of the drug in
the general circulation, these agents are administered for their systemic effects.

a.Transdermal delivery system

- Transdermal patches provides an effective means of delivering certain medication. -
Although patches contain a specific amount of drug, the rate of delivery and the actual dose
received may be variable.
- Drugs to be administered by this route avoid the first-pass effect in the liver and bypass
digestive enzymes.
b.Ophthalmic
- Used to treat local conditions of the eye and surrounding structures.
- Common indications include excessive dryness, infections, glaucoma, and dilation of the
pupil during eye examinations.
- Available in the form of eye irrigations, drops, ointments, and medical
disk.
c. Otic
- Used to treat local conditions of the ear, including infections and soft blockages of the
auditory canal
- Include eardrops and irrigations, which are usually ordered for cleaning
purposes.

d. Nasal
- Used for both local and systemic drug administration
- Nasal mucosa provides an excellent absorptive surface for a certain medications. -
Advantages of this route include ease of use and avoidance of the first-pass effect and
digestive enzymes.
- There is a potential damage to the cilia within the nasal cavity, and mucosal irritation is
common

e. Vaginal
- Used to deliver medications for treating local infections and to relieve vaginal pain and
itching - Are inserted as suppositories, creams, jellies, or foams

f. Rectal
- Used for either local or systemic drug administration
- Safe and effective means of delivering drugs to clients who are comatose or who are
experiencing nausea and vomiting
- Normally in suppository form, although laxatives and diagnostic agents are given via enema.
- Absorption is slower than by other routes, it is reliable provided the medication can be
retained by the client;
- Venous blood from the lower rectum is not transported by way of the liver; thus, the first
pass effect is avoided, as are the digestive enzymes of the upper GI tract.

Parenteral Drug Administration

>Refers to the dispensing of medications by routes other than oral or
topical >Delivers drugs via a needle into the skin layers.
>Much more invasive than enteral and topical
>Because of the potential for introducing pathogenic microbes directly into the blood or body
tissues, aseptic techniques must be strictly applied.

a. Intradermal Administration
- Administered into the dermis layer of the skin
- Dermis contains more blood vessels than the deeper subcutaneous layer, drugs are more
easily absorbed
- Usually employed for allergy and disease screening or for local anesthetic delivery prior to
venous cannulation
- Limited to very small volumes of drug, usually only 0.1 to 0.2 mL.
- Sites are the none hairy skin surfaces

b. Subcutaneous Administration
- Delivered to the deepest layers of the skin
- Sites are easily accessible and provide rapid absorption.
- Dose are small in volume, usually ranging from 0.5 to 1 mL
- Needle size varies with the client’s quantity of body fat

c. Intramuscular Administration
- Delivers medication into specific muscles
- Because muscle tissue has rich blood supply, medication moves quickly into blood vessels
to produce a more rapid onset of action than with oral, ID, or SC administration - An adult
with well-developed muscles can safely tolerate up to 4 mL of medication in a large muscle,
although only 2-3mL is recommended.
- Deltoid and triceps muscles should receive a max of 1 mL
- Sites must be located away from bone, large blood vessel, and nerves

d. Intravenous Administration
- Medications and fluids are administered directly into the bloodstream and are immediately
available for use by the body
- Used when a very rapid onset of action is desired
- IV medication bypass the enzymatic process of the digestive system and the first-pass effect
of the liver

e. Intrathecal Administration
f. Intracardiac Administration
TYPES OF PHARMACOLOGY
I. Pharmacokinetic
> from the root words pharmaco, which means “medicine” and kinetics, which means
“movement or motion”
> The study of drug movement throughout the body.
> Describes how the body handles medications.
> To better understand and predict the actions and side effects of medications > For most
medications, the greatest barrier is crossing the many membranes that separate the drug from
its target cells.
> Pharmacokinetics refers to how drugs travel through the body where they undergo a variety
of biochemical processes that result in absorption, distribution, metabolism, and excretion.

Absorption of Medication
>is a process involving the movement of substance from its site of administration,across body
membranes, to circulating fluids. Drugs may be absorbed across the skin and associated
mucous membranes, or they may move across membranes that line the GI or respiratory tract.
>The primary pharmacokinetic factor determining the length of time it takes to produce to its
effect.
>Is conditional on many factors.
>Digestive motility, exposure to enzymes in the digestive tract, and blood flow to the site of
drug administration also affect absorption.

4 Mechanisms of Absorption
1. Passive Diffusion
2. Facilitated Diffusion
3. Active Transport
4. Endocytosis

Distribution of Medication
>the transport of pharmacologic agents throughout the body. The simplest factor determining
distribution is the amount of blood flow to body tissues. The heart, liver, kidneys, and brain
receive the most blood supply; skin, bone, and adipose tissue receive a lower blood flow;
therefore, it is more difficult to deliver high concentrations of drugs to these areas.
>The physical properties of the drug greatly influence how it moves throughout the body after
administration.
>Lipid solubility is an important characteristic, because it determines how quickly a drug is
absorbed, mixes within the bloodstream, crosses the membrane, and becomes localized in
body tissues.
>Bone marrow, teeth, eyes, and adipose tissue have an especially high affinity or attraction.

Drug-protein complexes – too large to cross capillary membranes; thus, the drug is not
available to distribution to body tissues.

The brain and placenta possess special anatomical barriers that inhibit many chemicals and
medication from entering. These barriers are referred to as;
>Blood-brain Barrier – some medications such as sedatives anti-anxiety agents, and
anticonvulsants readily across the blood-brain barrier to produce their actions on the central
nervous system. In contrast, most antitumor medications do not easily cross this barrier,
making brain cancers difficult to treat.
>Fetal-placental Barrier – serves an important protective function, because it prevents
potentially harmful substances from passing from the mother’s bloodstream to the fetus.
Substances such as alcohol, cocaine, caffeine, and certain prescription medications, however,
easily cross the placental barrier and can potentially harm the fetus.
Factor affecting drugs distribution are:
1. Physiochemical properties of drug
a) Particle size
b) Aqueous/lipid solubility
c) pKa value of drug
d) Diffusion of drug
e) Ph
f) Mass
2. Pharmaceutical factor
a) Lipid: water partition
b) Drug interaction
c) Coefficient of the drug
d) Binding of drug to blood components

3. Biological factors
a) Organ/tissue size
b) Age
c) Diet
d) Obesity
e) Pregnancy
f) Degree of plasma protein binding
g) Fat lean body mass ratio
h) Disease state

Metabolism of Medications
>also called biotransformation
>Process of chemically converting a drug to a form that is usually more easily to remove from
the body.
>Liver is the primary site of drug metabolism, although the kidney and the cells of the
intestinal tract also have high metabolic rates.
>Medications undergo many biochemical reactions as they pass through the liver, including
hydrolysis, oxidation, and reduction.
>Various enzymes oxidize (add oxygen to), reduce (remove oxygen from), or hydrolyze (add
water to) the drug. These changes produce new chemicals or metabolites that may continue to
be medically active in the body or may have no activity at all.

Conjugates – makes drugs more water soluble and more easily excreted by the kidney.

First-pass effect – an important mechanism, since a large number of oral drugs are rendered
inactive by hepatic metabolic reactions. Alternative routes of delivery that bypass the first-
pass effect (e.g., sublingual, rectal, or parenteral routes) may need to be considered for these
drugs.

Factors affecting drugs metabolism are:

1. Physiochemical properties of drugs
a) Induction & inhibition of drug metabolizing enzymes
b) Environmental chemicals
2. Biological factors
a) Species differences
b) Strain differences
c) Sex differences
d) Age
e) Diet
f) Pregnancy
g) Hormonal imbalance
h) Disease states

Excretion of Medication
>the process by which the drugs removed from the body
>The rate at which medications are excreted determines their concentration of drugs in the
bloodstreams determines their duration of action.
>Kidney is the primary site of excretion ( approx. 180L of blood is filtered by the kidneys
each day)
>most drugs or their metabolites circulate through the kidney, where they are discharged, or
eliminated, into the urine. Drugs can also be excreted in the body’s solid waste products, or
evaporated through perspiration or the breath.

Glandular Activity – is another elimination mechanism

-water-soluble drugs maybe secreted into the saliva, sweat, or breast milk -the “funny taste”
that client sometimes experience when given IV drugs is an example of the secretion of
agents into the saliva.

Biliary Excretion – drugs that are secreted in the bile

-drugs secreted into bile, will enter the duodenum and eventually leave the body in the feces

Factor affecting drugs excretion are:

1. Physiochemical properties of drugs
2. Plasma concentration of the drug
3. Distribution & binding characteristics of the drug
4. Urine Ph
5. Blood flow to the kidney
6. Drug interaction
7. Biological factors
a.Age
b.Diet
c.Pregnancy
d.Hormonal imbalance
e.Disease states

Half Life - is the time it takes after a drug enters the body to decrease in amount by half. This
decrease reflects how quickly and efficiently a drug is metabolized and then excreted. Drugs
are considered to be excreted from the body when approximately five half-lives have
occurred. Drugs with a short half-life may need to administered several times a day as
compared to drugs with a long half-life which may only need to be administered once a day.
>Since most drugs are metabolized in the liver and are excreted by the kidneys; a decrease in
functioning in either of these organs increases the half-life of a drug. Subsequently, patients
with liver or kidney dysfunction may experience toxic effects of drugs much more easily if
the dosage or frequency of administration is not decreased. The nurse
should also monitor labs that reflect liver function including alanine transaminase (ALT),
aspartate transaminase, (AST), alkaline phosphatase (ALP) and kidney function including
blood urea nitrogen (BUN) and creatinine. The provider should be notified should an increase
in any of the values occur.

Onset, Peak, Trough, and Duration

>Onset of action is the time it takes for a drug to exert its therapeutic effect. Onset of action
is influenced by the route of administration and patency of patient’s gastrointestinal tract and
circulatory system.
>Peak level of a drug is the point in time when a drug is at its highest level in the body.
>Duration of action is the length of time a drug is in the blood in sufficient amounts to elicit
a response. Duration of action is influenced by the rate of excretion from the body. >Trough
level of a drug is the point in time when a drug is at its lowest, non-therapeutic level in the
body.

Peak and Trough Levels

>The peak and trough level of a drug is very important in regard to maintaining a therapeutic
level of a drug in a patient’s body.
>If the peak level of a drug is too high the patient runs a risk of toxicity. If the peak level of a
drug is too low the patient runs the risk of receiving a non-therapeutic amount of the drug
negating its intended effect.
>Determination of the amount of drug in the body during the time when it should be peaking
is done by taking a sample of blood and having a laboratory measure the amount of drug in
the blood at that point in time. It is the nurse’s responsibility to monitor the peak and trough
level of a drug to ensure the patient is receiving a therapeutic and not a toxic amount of the
drug.

Pharmacodynamics
>are the biochemical changes that occur in the body as a result of taking a drug. After a drug
has been introduced into the body it enters the circulation and comes into contact with the
cells of almost all of the organs and tissues in the body. The cells that are the target site for a
drug are impacted in one of three ways: alteration in cellular function, alteration in cellular
environment, and action of enzymes in the body.

Alteration in Cellular Function

>When a drug comes into contact with a cell it can modify its function by either enhancing or
blocking the way in which the cell functions. The joining or binding of a drug with a cell is
called the drug – receptor interaction. Drugs bind with receptors on a cell through the
formation of chemical bonds between the receptor and the active site on the drug molecule.
>Drugs given to enhance a physiologic response are called agonists. Agonists are drugs that
bind with a receptor and enhance the typical response. Morphine is an example of an agonist
because it binds with receptors that produce the desirable effect of analgesia. Antagonists are
drugs that bind with receptors and either block or lessen the typical response. An example is a
histamine-2 (H2) blocker such as ranitidine which blocks the histamine induced gastric acid
secretion from the parietal cell of the gastric mucosa.
Changes in Cellular Environment
>Changes in the cellular environment occur when a drug changes the structure of a cell.
Changes may be made in the cell wall or one of a cell’s critical processes such as replication.
For example, penicillin-type antibiotics inhibit cell wall synthesis of certain types of bacteria
resulting in the destruction and death of the bacteria. Sulfa-type antibiotics inhibit the
replication of certain types of bacteria by preventing folic acid from helping to make DNA
and RNA.

Changes in Enzymatic Action

>Through a process called selective interaction a drug may change a target molecule’s typical
response by inhibiting or enhancing the action of an enzyme that affects the target molecule.
ACE inhibitors such as lisinopril block the “angiotensin converting enzyme” which is needed
to create the hormone angiotensin II. Blocking this hormone relaxes blood vessels making it a
good drug to treat hypertension.

Drug-drug and drug-food interactions can dramatically change the action of a drug in the
body. Precautions should be taken to limit or restrict certain types of food or concurrent
administration of certain types of drugs rather than restricting the drug itself.

Drug-Drug Interaction
>When 2 or more drugs are taken together, there is a possibility that these drugs will interact
with each other to cause unanticipated effects in the body.

Drug-Food Interactions
>Occurs when the drug and the food are in direct contact with the stomach >Some foods
increase acid production, speeding up the breakdown of the drug and preventing absorption
and distribution.
>Oral drugs are best taken on an empty stomach
Antibiotics vs Citrus fruit &caffeine

Tetracycline Calcium-rich food

Anticoagulants Vitamin K-rich food

MAO Inhibitors Tyramine-rich food

CLASSIFICATION OF DRUGS
Two Classification of Drugs
I. Therapeutic Classification
II. Pharmacological Classification

A.Therapeutic Classification
>Method of organizing drugs is based on their therapeutic usefulness in treating particular
diseases.
>The key to therapeutic classification is to clearly state what a particular drug does clinically.
Examples are Anti-depressants, Anti-psychotics, drugs for erectile dysfunctions, and Anti
neoplastic

B.Pharmacological Classification
>Refers to the way an agent works at a molecular, tissue, and body system level. >Addresses
a drug’s mechanism of action (MOA), or how a drug produces it’s effect in the body.
>More specific than Therapeutic classification and requires and understanding of
biochemistry and physiology.
DRUG REGULATION AND STANDARDS
>Until the 19th century, there were few standards or guidelines to protect the public from drug
misuse. The archive of drug regulatory agencies are filled with examples of medicines,
including rattlesnake oil for rheumatism; epilepsy treatment for spasms, hysteria and
alcoholism; and fat reducers for a slender, healthy figure. Many of these early concoctions
proved ineffective, though harmless. At their worst, some contained hazardous levels of
dangerous or addictive substances. It may became quite clear that drug regulations were
needed to protect the public.
>The United Pharmacopeia National Formulary (USP-NF)
>The current authoritative source for drug standards (revised every 5 years by a group of
experts in nursing: pharmaceutics, pharmacology, chemistry and microbiology.

Formulary
>The first standard commonly used by pharmacists.
>List of drugs and drug recipes

Pharmacopeia
>Medical reference summarizing standards of drug purity, strength, and directions of synthesis

Drugs included in the USP-NF standards:

⮚ Therapeutic use
⮚ Client safety
⮚ Quality
⮚ Purity
⮚ Strength
⮚ Packaging
⮚ Safety
⮚ Dosage

International Pharmacopeia
⮚ First published in 1951 by WHO
⮚ Provides basis for standards in strength and composition of drugs
worldwide ⮚ Published in English, Spanish, and French (revised every 5
years)

Legal Regulation of Drugs

1. RA 6425: Dangerous Drug Act of 1972
2. RA 9165: Comprehensive DDA of 2002
3. RA 6675: Generics Act of 1988
4. RA 8203: Special Law on Counterfeit Drugs

ROLE OF THE FOOD AND DRUG ADMINISTRATION

>The Food and Drug Administration is responsible for protecting the public health by
ensuring the safety, efficacy, and security of human and veterinary drugs, biological products,
and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and
products that emit radiation.
>Any pharmaceutical laboratory, whether private, public, or academic, must solicit FDA
approval before marketing a drug.
 FDA PREGNANCY CATEGORIES

A No risk to fetus. Studies have not shown evidence of

fetal harm.

B No risk in animal studies, and well-controlled studies in

pregnant women are not available. It is assumed there
is no little to no risk in pregnant women.

C Animal studies indicate a risk to the fetus. Controlled

studies on pregnant women are not available. Risk
versus benefit of the drug must be determined.

D A risk to the human fetus has been proved. Risk versus

benefit of the drug must be determined. It could be
used in life-threatening conditions.

X A risk to the human fetus has been proved. Risk

outweighs the benefits and should be avoided during
pregnancy.

MEDICATION KNOWLEDGE, UNDERSTANDING AND RESPONSIBILITIES OF

THE NURSE
Whether administering drugs or supervising drug use, the nurse is expected to understand the
pharmacotherapeutic principles for all medications given to each client. Given the large
number of different drugs and the potential consequences of medication errors, this is indeed
enormous task. The nurse’s responsibilities include knowledge and understanding of the
following:
>What drug is ordered
>Name (generic and trade) and drug classification
>Intended or proposed use
>Effects on the body
>Contraindications
>Special considerations, (e.g., how age, weight, body fat distribution, and individual
pathophysiological states affect pharmacotherapeutic response)
>Side effects
>Why the medication has been prescribed for this particular client
>How the medication is supplied by the pharmacy
>How the medication is to be administered, including dosage ranges
>What nursing process considerations related to the medication apply to this client

Controlled Substance and Drug Schedules

Some drugs are frequently abused or have a high potential for addiction. >Addiction - refers
to the overwhelming feeling that drives someone to use a drug repeatedly. >Dependence -
defined as a physiologic or psychological need for a substance. >Physical dependence -
altered physical condition caused by adaptation of the nervous system to repeated drug.
>Withdrawal - when the drug is no longer available, the individual expresses physical signs of
discomfort.
>Psychological dependent - with few signs of physical discomfort when the drug is
withdrawn; however, the individual feels an intense compelling desire to continue drug use.
>Scheduled drugs
- drugs that have a significant potential for abuse
- With five categories that are classified according to their potential for
abuse. >Controlled substance
- drug whose use is restricted.
- Hospitals and pharmacies must maintain complete records of all quantities purchased and
sold.

Therapeutic, Side, and Adverse Drug Reaction

>Therapeutic effects are the desired effects of a drug being given.
>Side effects are the unintended effects of a drug that commonly occur in patients and are
mild in nature. Occur as a result of a drug's effects on the body. >Adverse effects
-are the unintended and unexpected effects of a drug that are more severe and can even be
life-threatening at a therapeutic dose.
-are also side effects of a drug but are more severe in nature.
>Hypersensitivity Reactions
-Hypersensitivity reactions occur secondary to administration of a drug that a patient’s body
sees as a foreign substance.
-An allergy to a drug usually occurs after more than one dose of a drug has been given. It
occurs secondary to the release of histamine which can cause generalized inflammation and
swelling of tissues (hives), increased mucous production, and in severe cases constriction of
the bronchioles. Mild to moderate cases of hypersensitivity reactions can be treated with an
antihistamine such as diphenhydramine.
>Anaphylactic shock
-is an exaggerated response of the body's immune system to a drug which precipitates a
massive release of histamine and other chemical mediators into the body. Symptoms of
anaphylactic shock can occur almost immediately after exposure and include: swelling of the
eyes face mouth and throat, difficulty breathing, wheezing, rapid heart rate, extremely low
blood pressure and cardiac arrest.

A patient in anaphylactic shock must be immediately brought to a medical facility where he

or she can receive cardiopulmonary support along with rescue drugs. Treatment of
anaphylactic shock focuses on reestablishment of an airway and oxygen therapy,
administration of epinephrine to raise the patient's blood pressure and dilate respiratory
bronchi, and administration of diphenhydramine to block the additional release of histamine.

NOTE: It is very important for nurses to ask patients if they have any allergies to drugs.
Even minor reactions to a drug are notable. If a patient admits to having an allergy to a drug,
ask them what type of reaction they had then note this information on the chart. The patient’s
wristband should list all known allergies and be placed on a patient immediately after
admission. When administering medication be sure to check both the chart and patient’s wrist
band for allergies. When checking new orders review the patient’s chart for allergies and
bring to the provider’s attention any drug that could precipitate a reaction. Some drugs can
display a cross-sensitivity to another drugs. Patients who report an allergy to penicillin may
have a cross-sensitivity to
cephalosporin drugs. If the patient has not received a cephalosporin on a prior occasion
monitor the patient very closely during the first few doses for signs of an allergic reaction.

Drug Tolerance, Cumulative Effects, and Drug Toxicity

Drug tolerance, cumulative effects, and drug toxicity are other undesirable effects related to
safe medication administration that the nurse must monitor for when caring for a patient
receiving drug therapy.
Drug tolerance - is a body’s decrease in response to a drug it receives over a period of time.
For the drug to continue to exert a therapeutic effect the dosage must be increased. Tolerance
is not synonymous with addiction. A patient can develop tolerance to a drug and not be
addicted. However, if the patient continues to take the drug in increasing doses over a longer
than recommended period of time addiction can occur. Narcotic analgesics and antianxiety
drugs are at high risk for development of tolerance and subsequent addiction. Nurses must
monitor patients for the development of tolerance if one of these medications has been given
over an extended period of time or if the prescribed amount of medication is no longer giving
the patient relief.
Cumulative effects -occur when the body is unable to metabolize and excrete a drug before
the next dose is given. If the next dose is given while some of the drug from the previous
dose is still in the patient’s body the drug begins to accumulate in the body. The gradual
increase in the amount of the drug in the patient’s body increases the risk of adverse reactions
and toxicity. The development of cumulative effects is a common occurrence in older adults
who have a decreased cardiac and kidney function and in patients of any age who have liver
or kidney disease. The nurse should ensure the proper dose of medication is given to these at
risk patients and monitor for adverse effects that could indicate too much of the drug is being
given in relation to the body’s ability to excrete it.
Drug toxicity - occurs when a drug is given in amounts greater than what the body is able to
excrete. Drug toxicity may occur when a patient receives drugs in greater than recommended
dosages. It can also occur when impaired excretion of the drug, secondary to impaired liver
or kidney function, allows it to build up in the body over a period of time. Eventually a toxic
level is reached causing the patient to experience severe and possibly fatal adverse effects.
Drugs that have a small margin of safety can quickly build up to a toxic level in the body.
Patients on drugs with a small margin of need to have their serum drug level regularly drawn
and be closely monitored for signs and symptoms of toxicity. The effects of drug toxicity
may be irreversible and life-threatening.

CLIENT COMPLIANCE AND SUCCESSFUL

PHARMACOTHERAPY Compliance
>major factor affecting pharmacotherapeutic success. It is taking a medication in the manner
prescribed by the practitioner. In the case of OTC drugs, following the instructions on the
label. >Before administering the medication, you should educate the patient about the drug to
enable the clients participation, but also it is imperative to remember that a responsible, well-
informed adult always has the legal option to refuse to take any medication.
Factors can influence Compliance
-The drug maybe too expensive or may not be approved by the client’s health insurance. Also,
forget doses of medication. Clients often discontinue the use of drugs that have annoying side
effects or those that impair major lifestyle choices.
-Some clients believed that if one tablet is good, two must be better; Others believe they will
become dependent on the medication if it is taken prescribed; thus, they take only half the
required dose.
TOPIC: Nursing Process in Administering Medications

OVERVIEW: The nursing process applies is a well-established, research supported

framework that applies to all that we do in nursing. This includes medication administration.
Our approach to pharmacology in nursing must be systematic and orderly in order to avoid
potential errors. It is a 5 steps process that is flexible and adaptable and it includes assessment,
diagnosis, planning, implementation and evaluation.
OBJECTIVES:
1. Review the steps of the nursing process and know the significance to drug
administration.
2. Describe how the nurse fulfills the responsibility for the rights of drug administration.
3. Describe the use of nursing process in drug administration.

LEARNING CONTENT:
NURSING PROCESS
The Nursing Process, a systematic method of problem solving, forms the foundation of all
nursing practices. The use of the Nursing Process is particularly essential during medication
administration. By using the steps of the Nursing Process, nurses can ensure that the
interdisciplinary practice of pharmacology results in safe, effective, and individualized
medication administration and outcomes for all clients under their care.

Elements of the Nursing Process

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

Assessment
>The first step in the nursing process
>It is the systemic, organized collection of data about the patient.
>Two key areas that need to be assessed are the patient’s history (past and present illness) and
his physical status
a. Past History
✔ Chronic conditions
✔ Drug use
✔ Allergies
✔ Level of education
✔ Social support
✔ Financial support
✔ Pattern of health care
✔ Level of understanding of disease and therapy
b. Physical Assessment
✔ Weight
✔ Age
✔ Vital signs
✔ Sensory and cognitive barriers
Nursing Diagnosis
>Shows actual or potential alterations in patient’s function based on the assessment of the
clinical situation.
Common Nursing Diagnoses r/t Drug Therapy:
✔ Ineffective health maintenance
✔ Risk for injury
✔ Noncompliance
✔ Knowledge deficit
✔ Ineffective management of therapeutic regimen
Planning
>Includes goal setting, setting priorities and determining nursing interventions >For
medications, planning includes activities as discussing the client’s medication needs >Nurses
also formulate instructional objectives and design client education programs to assist
individuals in the self-administration of drugs

In planning. Focus on:

✔ Why the drug is needed
✔ How the drug is administered
✔ Common indications of adverse effects
✔ Best schedule to administer the drug
✔ Drug Interactions

Implementation
>Includes the nursing actions necessary to accomplish the established goals. Client education
and teaching is our primary responsibility
>For drug therapy, implementation includes all aspects of medication administration (working
with the doctor, giving drugs as prescribed, preparing drugs, calculating dosages, using
appropriate admin techniques, staying alert for errors, documenting the drugs given)

3 types of interventions frequently involved in drug therapy

✔ Drug administration
✔ Provision of comfort measures
✔ Patient/family education

Proper Drug Administration Guidelines

✔ Administer medications as prescribed
✔ Never give a drug poured or prepared by somebody else
✔ Never allow the med cart or tray out of your sight once you have
prepared a dose
✔ Never leave a drug at a patient’s bedside; rather watch the patient
swallow the drug
✔ Never return unwrapped or prepared drugs to the stock supply
✔ Keep the medication cart locked at all times
✔ Follow standard precautions as appropriate
✔ Consider legal aspects associated with drug therapy
✔ Consider ethical principles when dealing with medication errors,
meds during pregnancy, and investigational protocols
✔ Medication errors can easily be caused by similar sounding names,
unclear orders, wrong route of administration, and miscalculation
of dosages; take care to avoid these errors

Comfort Measures
✔ Placebo effect
✔ Manage anticipated adverse
✔ Lifestyle adjustment

Patient and Family Education

 ✔ Name, dose and action of the drug
✔ Timing of administration
✔ Special storage and preparation instruction
✔ Specific OTC drugs or alternative therapies to avoid
✔ Special comfort and safety measures
✔ Specific points about drug toxicity
✔ Specific warning about drug discontinuation

Additional Teaching Tips:

✔ Provide written instructions
✔ Use colorful graphs and charts
✔ Encourage client and family to ask questions

Nursing Implications
✔ Ensure cleanliness of your hands, work area, and supplies
✔ Ensure availability of supplies
✔ Ensure adequate lighting
✔ Decrease environmental distractions

Evaluation
>Comparing the patient’s therapeutic goals with his actual response to drug therapy
>in this phase, the nurse must be able to answer the following questions: -What
therapeutic effects should the drug produce?
-What adverse reactions is the drug known to cause?
-By what mechanism of action does the drug work?
-What should the patient know about the drug
-Which therapeutic effects has the drug produced for the patient? If none, or if the effects
have been insufficient, which issues may be involved?

12Rights” of Drug Administration

1.RIGHT CLIENT
2.RIGHT DRUG
3.RIGHT DOSE
4.RIGHT ROUTE
5.RIGHT TIME
6.RIGHT ASSESSMENT
7.RIGHT MOTIVATION/ APPROACH
8.RIGHT OF THE CLIENT TO REFUSE
9.RIGHT OF THE CLIENT TO KNOW THE REASON FOR THE DRUG
10.RIGHT EVALUATION
11.RIGHT DOCUMENTATION
12.RIGHT DRUG PREPARATION

Three Checks of Drug Administration

1. Checking the drug with the MAR or the medication information system when removing it
from the medication drawer, refrigerator, or controlled substance locker. 2. Checking the drug
when preparing it, pouring it taking it out of the unit dose container, or connecting the IV
tubing to the bag
3. Checking the drug before administering it to the client
TOPIC: Drug Orders, Time Schedule, Abbreviations, Drug and Intravenous Fluid
Computations

OVERVIEW: Apothecary prescription abbreviations, like the ones you might see written by
your doctor on your prescription or a hospital medication order, can be a common source of
confusion for healthcare providers, too. In fact, an unclear, poorly written or wrong medical
abbreviation that leads to misinterpretation is one of the most common and preventable causes
of medication errors. All abbreviations can increase the risk for incorrect interpretation and
should be used with caution in the healthcare setting. Furthermore, nurses are often
intimidated by the math that occurs in everyday practice. Patient safety depends on the
practitioner's ability to calculate medications correctly and in a timely manner.

OBJECTIVES:
Upon completion of this module, the nursing student will be able to:
1. Identify the components of medication orders.
2. Interpret standard abbreviations used in medication and prescription orders. 3. Utilize a
simple and concise method for accurate computation using basic drug and IV fluid
calculations.

DRUG ORDERS, TIME SCHEDULE AND ABBREVIATIONS

Healthcare providers use accepted abbreviations to communicate the directions and times for
drug administration.

STAT order
>any medication that is needed immediately, and is to be given only once. It is often
associated with emergency medications that are needed for Life-threatening situations. >term
comes from statin the Latin word meaning “immediately”
>the time between writing the order and administering the drug should be 5minutes or less.

ASAP order
>should be available for administration to the client within 30minutes of the written order.

SINGLE order
>drug that is to be given only once, and at specific time, such as a preoperative order.

PRN order

>(Latin: pro re nata) administered as required by the client’s condition, nurse makes the
judgement, based on client’s assessment, as to when such a medication is to be administered.

ROUTINE orders
>orders not written as STAT, ASAP, NOW, or PRN
>usually carried out within 2hours of the time the order is written by the physician.

STANDING order
>written in advance of situation that is to be carried out under specific circumstances.

Some medications must be taken at specific times. If a drug causes stomach upset, it is usually
administered between meals to prevent epigastric pain, nausea, or vomiting. Other
medications should be administered between meals because food interferes with absorption.
Some CNS and hypertensives are best administered at bedtime, because they may cause
drowsiness.

Components of Drug Orders:

✔ Date and time the order is written
✔ Drug name
✔ Drug dosage
✔ Route of administration
✔ Frequency of administration
✔ Physician/ provider’s signature
Partial abbreviations

Abbreviation Latin Meaning

a.d. Auris dextra Right ear

a.l. , a.s. Auris laeva, auris sinisttra Left ear

agit agita Stir/shake

b.i.d. bis in die Twice daily

cap. , caps. capsula capsule

cf With food

g gram

gr grain

gtt(s) gutta(e) drop (s)

IM Intramuscular (with respect to

injections)

IV Intravenous

o.d. oculus dexter Right eye

o.s. Oculus sinister Left eye

o.u Oculus uterque Both eyes

prn pro re nata as needed

p.o. per os by mouth or orally

q.a.d. quoque alternis die every other day

q.i.d Quarter in die Four times a day

SC, subc, subcut, Subcutaneous
subq, SQ
 tab Tabella Tablet

Tbsp Tablespoon

tsp Teaspoon

t.i.d. Ter in die Three times a day

top Topical

DRUG CALCULATION
Systems of Measurement
Dosages are labeled and dispensed according to their weight or volume. Three systems of
measurement are used in pharmacology:
o Metric
o Apothecary
o Household

Metric system
>the most common system
>the volume of a drug is expressed in terms of liters (L) or milliliters (ml). >cubic centimeter
(cc) is a measurement of volume that is equivalent to 1ml of fluid, but the cc abbreviation is
no longer used because it can be mistaken for the abbreviation for unit (u) and cause
medication errors.

Apothecary and Household system

>older systems of measurement
>this includes teaspoon, tablespoon, pints, quarts, and gallons for measuring liquid

The nurse should encourage the use of accurate medical dosing at home, such as oral dosing
syringes, oral droppers, cylindrical spoons, and medication cups. These preferred over
traditional household measuring spoon because they are more accurate. Eating utensils that
are commonly referred to teaspoon or tablespoon often do not hold the volume that their
names imply.
I. Conversion table
COMMON VOLUME AND WEIGHTS EQUIVALENT

1 gram 1000mg

1mg 1000mcg

1 grain 60 mg
 1ml 15 drops

1tsp 5ml

1 tbsp 3 tsp or 15ml

1 oz 30 ml

180 ml 1 cup or 6 oz

240 ml 1 glass or 8 oz

Conversion Table:
1 kilogram (kg) = 1000 grams (g)
1 gram (g) = 1000 milligrams (mg)
- Convert Grams to Milligrams by Multiplying grams by 1,000
- Convert Milligrams to grams by dividing milligrams by 1,000
1 milligram (mg) = 1000 micrograms (mcg)
Grains (gr.) 15 = 1 Gram (g) or 1000 milligrams (mg)
– To convert g. to gr multiply by 15 – To convert gr to g divide by 15. • 1 Grain (gr.) = 60
Milligrams (mg) – To convert gr. to mg multiply gr. by 60
– To convert mg to gr. divide mg. by 60
1ml = 1 cc
1 ounce = 30 ml
1 tablespoon (T or tbsp) = 15 ml
1 teaspoon (t or tsp) = 5 ml
2.2 lb = 1 kg
- To convert pounds to kg divide pounds by 2.2
– To convert kg to pounds multiply by 2.2

Drug Calculation
Nurses are often intimidated by math that usually occurs in everyday practice. Patient’s safety
depends on the nurse’s ability to calculate medications correctly and in a timely manner.

Basic calculations
⮚ the universal formula is:

�� (�������������� ��������)
�� (���������� ��������)× ��
(����������������) = ��������
Example :
Administer heparin 5,000 units I.V. push. Available is heparin 10,000 units/mL. How many
mL will you need to administer to achieve a 5,000 units dose?

5,000 ���������� (��)

10,000 ���������� (��)× 1 ���� (��) =
��

Answer:�� = 0.5 ����

Calculations in mcg/minute
Follow these four steps to easily calculate your patient’s accurate drug dose. 1.Find out
what’s in your I.V. bottle (drug concentration or number of mL of fluid). 2.Determine in
which units your drug is measured (units/hour, mg/hour, or mcg/kg/minute). 3.Know the
patient’s weigh in kg if your calculation is weight based.
4.Use the universal formula below and then divide your final answer by the patient’s weight in
kg to arrive at mcg/kg/minute.
mg
mL ×1,000 mcg

1 mg×mL

hour ×1 hour

60 minute = mcg/minute

Example:
Dopamine is infusing. The bottle states dopamine 800 mg, and it’s mixed in 500 mL of D5W.
The I.V. pump in your patient’s room is 15 mL, and the patient weighs 60 kg. At how many
mcg/kg/minute is the patient’s dopamine infusing?

800 ����
500 ���� ×1,000 ������

1 ����×15 ����

1 ℎ������×1 ℎ������

60 ��������������÷ 60 ���� = ��

Answer: �� = 6.7 mcg/kg/minute

Example:
Dobutamine 200 mg in 250 mL of D5W is ordered to run at 5 mcg/kg/minute, at how many
mL/hour will you set the pump?

200 ����
250 ���� ×1,000 ������
 1 ������

1 ℎ������×1 ℎ������

60 ��������������÷ 60 ���� = 5 ������

/����/������������

Answer: �� = 22.5 mL / hour

Calculations in Units/Hour
To arrive at units/hour, the universal formula is:

�� ( ��������������)
�� (���� ℎ������)× �� (������������)

=����������

ℎ������(# ���� ���� × ����������/���� =

��������)

Example:
Heparin 20,000 units in 500 mL D5W is ordered to run at 1,000 units/hour. How will the I.V.
pump be set?
20,000 ����������
500 ���� = 40 ���������� /����
1,000 ���������� (��)
40 ���������� (��)× 1 ���� (��) = ��
Answer: �� = 25 ����/ℎ������
Example:
Heparin 20,000 units in 500 mL d5W is infusing at 20 mL/hour. At how many units/hour is
the heparin infusing?
20,000 ����������
500 ���� = 40 ����������/����
40 ����������
1 ���� ×20 ����

1 ℎ������= ��

Answer: �� = 800 ����������/ℎ������

Intravenous Infusion Calculation
Drip Rates – is when the infusion volume is calculated into drops.
The formula for the Drip Rate:

�������� ��������

=������������ (����)
 �������� (ℎ)

Example:
A patient is ordered to receive 1000 mL of intravenous fluids to run over 8 hours. Calculate
the drip rate.

�������� �������� =1000 ����

8 ℎ������= 125����/ℎ������
Note: When the drip rate is given in minutes, convert the minutes to hours by dividing the
required minutes by 60 (60 minutes in 1 hour)

Calculation of drips in drops per minute (dpm)

There are two standard giving sets of drip rates:
1. Macro Drop Factor – drop size is normally 20 drops in 1 mL.
2. Micro Drop Factor – drop size is normally 60 drops in 1 mL.

The formula to calculate drip rates in drops per minute (dpm):

�������� �������� =������������ ����
���������� (����)
�������� ���� ������ (ℎ)×��������
������������ (����������/����)
60 (������/ℎ)

Example:
A patient is to receive 1 L of Hartmann’s solution over the next 12 hours. What is the rate of
infusion in drops per minute (dpm), if the drop factor is 60 drops per mL.

�������� �������� (������) =1000

����
12 ℎ×60 ����������/����

60 min/ℎ= 83.833
Answer: 84 drops / minutes

The formula to calculate how many hours will it take for the IV to complete before it
runs out is:

�������� (ℎ��������)
=������������ (����)
�������� �������� (����/ℎ������)
Example: The volume of the fluid is 1000 mL and the IV pump set at 62 mL/hour. How long
will it take for the fluid to run?
�������� (ℎ��������) =1000 ����
 62 ����/ℎ������= 16 ℎ��������
Note:
Patient’s safety depends on accurate I.V./drug dosing, precise calculations are essential to this
process. Nurses shouldn’t be apprehensive when I.V. drug dosages are presented in practice.