PRINCIPLES OF DRUG ADMINISTRATION

The Rights of Drug Administration

1. Right client 5. Right time and frequency 8. Right documentation

2. Right medication of delivery 9. Right drug evaluation
3. Right dose 6. Right to refuse medication
4. Right route of 7. Right to receive drug
administration education/health teaching
3 Checks of Drug Administration

1. Checking the drug with the MAR on the medication information system when removing it from the medication
drawer, refrigerator, or controlled substance locket
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

Compliance – taking in medication in the manner prescribed by the practitioner or in the case of OTC drugs, following
the instruction in the label

Routes of Drug Administration

1. Enteral
2. Topical
3. Parenteral

Enteral Route

Drugs given orally and those administered through nasogastric or gastrostomy tube

Oral Drug Administration

• Most common, most convenient and usually the least costly of all routes
• Safest route because the skin barrier is not compromised

Routes and Forms of Medications

Oral Solids

• Tablets • Powder and granules

• Capsules • Troches, lozenges and pastilles
• Caplets
Tablets

Compressed or molded substances to be swallowed whole, chewed before swallowing, or placed in the buccal pocket or
under the tongue

Scored tablet Enteric coated

Enteric Coated Tablets

Designed to dissolve in the alkaline environment of the intestines

Capsules

Substances encased in either a hard or a soft soluble container or gelatin shell that dissolves in the stomach

Caplets

Gelatin coated tablets that dissolve in the stomach

Lozenges, Pastilles, Troches

Similar preparations of drugs designed to dissolve in the mouth

Solutions

• Enemas • Gargles
• Douches • Mouthwashes
• Suspension • Nasal solutions
• Emulsion • Optic and otic solutions
• Syrups • Elixirs

Enema

Aqueous solution for rectal instillation

Douches

Aqueous solution that functions as a cleansing or antiseptic agent that may be dispensed in a form of
powder with directions for dissolving in a specific quantity of warm water

Syrup

Substance dissolved in a sugar liquid

Suspension

Particle or powder substances that must be dissolved in a liquid (shaken vigorously) before
administration

Elixirs

Non aqueous solution that contain water varying alcohol content and glycerin or other sweeteners

Emulsions

a two-phased system in which one liquid is dispersed in the form of small droplets throughout
another liquid

Gargles/Mouthwashes

aqueous solution that may contain alcohol, glycerin and synthetic sweeteners and surface-active
flavoring and color agents

Nasal solution/Sprays and Eyedrops

Topical

Patches

Ointments

Semisolid substance for topical use

Pastes

Semisolid substance, thicker than an ointment, absorbed slowly

Suppositories

Gelatin substance designed to dissolve when inserted in the rectum, urethra or vagina
Metronidazole: vaginal/urethral suppository

Injectables

Vials Ampules

Inhalants

Drugs or dilution of drugs administered by the nasal or oral respiratory route for local or systemic effect

Routes of Administering Drugs

Sublingual Route

• Medication is placed under the tongue and allowed to dissolve slowly

• A rapid onset of action may occur because of the rich blood supply in this area

Buccal Route

• Tablet or capsule is placed in the oral cavity between the gum and check
• Provides slower absorption

Oral Route

• Safest, most convenient and least expensive method

• Slower acting than the other routes

Guidelines in Administering Drugs through the Oral Route

✓ Not given to clients who are vomiting, lacks gag reflex, or who are comatose
✓ Do not mix with large amount of food
✓ Do not mix with infant formula
✓ Enteric coated and timed released capsule must be swallowed whole to be effective
✓ Administer irritating drugs with food
✓ Administer on empty stomach if food interferes with absorption
✓ Drugs given sublingually or buccally must remain in place until fully absorbed
✓ Encourage use of child resistant cap
 Topical drugs

Drugs directly applied to the skin are absorbed through the epidermal layer into the dermis where they create local
effects or absorbed into the bloodstream

Guidelines in Administering Topical Drugs

✓ Can be applied to the skin with a glove, tongue blade or cotton tipped applicator
✓ Nurse must protect her own skin
✓ Do not contaminate the medication in a container
✓ Do not double dip

Inhalant

• Delivered into the alveoli of the lungs which promote fast absorption due to:
→ Permeability of the alveolar and vascular epithelium
→ An abundant blood flows
→ A very large surface area for absorption

Transdermal

Medication is stored in a patch placed on the skin and absorb through the skin, having a systemic effect

Instillation

Liquid medications usually administered as drops, ointment, or spray

Ophthalmic Administration

To treat local conditions of the eye and surrounding structures

Otic Administration

To treat local conditions of the ear, including infections and soft blockages of the auditory canal

Vaginal Administration

To deliver medications for treating local infections and to relieve vaginal pain and itching

Parenteral Drug Administration

Dispensing of medications by routes other than oral or topical

Parenteral Route

Delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles or veins

1. Intradermal 3. Intramuscular
2. Subcutaneous 4. Intravenous

Intradermal

• Injection administered into the dermis layer of the skin

• Sterile 1ml with gauge 26-27 needle
• Sites
→ Lightly pigmented, thinly keratinized and hairless such as ventral
mid-forearm, clavicular area of the chest or scapular area of the
back
Subcutaneous

• Delivered for the deepest layer of the skin

• Sites
→ Outer part of the upper arms, in the area above the triceps muscle
→ Middle two-thirds of the anterior thigh area
→ Subscapular areas of the upper back
→ Upper dorsogluteal and ventrogluteal areas
→ Abdominal areas, above the iliac crest and below the diaphragm, 1.5 to 2 inches out from the umbilicus

Intramuscular

• Delivers medication into specific muscles

• Sites
→ Ventrogluteal site
x Most preferred site for IM
x Slightly angle the needle toward the iliac crest
→ Deltoid
x Used in well-developed teens and adults for volumes of medication not to exceed 1ml
x Place the needle at a 90-degree angle to the skin or slightly toward the acromion
→ Dorsogluteal site
x For adults and children who have been walking for at least 6 months
x Safe as long as the nurse approximately locates the injection landmarks to avoid puncture or
irritation of the sciatic nerve and blood vessels
→ Vastus lateralis
x Thick and well developed in both adults

Intravenous (IV)

• 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 medications bypass the enzymatic process of the digestive system and first-pass effect of the liver just like the
other parenteral routes

3 Basic Types of IV Administration

1. Large-volume infusion
→ For fluid maintenance, replacement or supplementation
→ Compatible drugs maybe mixed into a large volume IV container with fluids like normal saline or ringer’s
lactate
2. Intermittent infusion
→ Small amount of IV solution that is arranged tandem with a piggybacked to the primary large-volume
infusion
→ Used to instill adjust medications, such as antibiotic or analgesics over a short period of time
3. IV bolus (Push) administration
→ Concentrated dose delivered directly to the circulation via syringe to administer single-dose medications
→ This can be given through an intermittent injection port or by direct IV push

NOTE: IV route offers the fastest onset of drug action, it is also the most dangerous. Patient receiving IV injections
must be closely monitored for adverse reaction that may occur immediately, or it takes hour or days to appear.
Antidote of the drugs must be readily available.
Medication Knowledge, Understanding and Responsibilities of the Nurse

What drug is ordered

• Name and drug classification

• Intended or proposed use
• Effects on the body
• Contraindication
• Special consideration
• Why this medication has been prescribed for this particular client
• How this medication is supplied by the pharmacy
• How the medication is to be administered
• What nursing process considerations related to the medication apply to this client

Drug Orders and Time Schedule

Types of Medication Order

Stat Order

→ Medication is to be given immediately and only once

→ Often associated with emergency medications that are needed for life threatening situations
→ Ex. Morphine sulfate 10 mg I.V. stat

ASAP (As Soon As Possible Order

→ Available for administration to the client within 30 minutes of the written order

Single Order

→ To be given only once at a specific time, such as preoperative order

→ Ex. Secosonal 100mg at bedtime before surgery

Standing Order

→ May or may not have a termination date

→ May be carried out indefinitely until an order is written to cancel
→ Ex. Multiple vitamins, 1 tab daily
→ May carried out for a specific number of days
→ KCl 1 tablet, 2x per day X 2 days

PRN order

→ As needed order
→ Administered as required by the client’s condition
→ Ex. Mefenamic acid 500mg q6 for pain

Routine orders

→ Carried out within 2 hours of the time the order is written by the physician
→ Not written as STAT, ASAP, NOW or PRN
Essential Parts of a Medication Order

• Full name of the client

• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of administration
• Route of administration
• Signature of the person writing the order

Communicating a Medication Order

How is a medication order communicated?

• A drug is written on the client’s chart by a primary care provider

• The medication order is copied by the nurse in the medication administration record (MAR) and in most
institutions in the country in the medication card and other sheets in the client’s chart

Parts of a Prescription

• Descriptive information about the client

• Date on which the prescription was written
• The RX symbol (take thou)
• Medication, name, dosage and strength
• Route of administration
• Dispensing instructions for the pharmacist
• Direction for administration to be given to the client “one tablet with meals”
• Refill and/or special labelling
• Prescribers signature

Considerations in Drug Administration on Special Age Group

Pregnancy and Lactation

• Exercise great caution when initiating pharmacotherapy during pregnancy

• In all cases health care practitioners evaluate the therapeutic benefits of a given medication against its potential
adverse effects
Pediatric Clients

• Knowledge of growth and development is essential

• Oral medications re usually prepared sweetened or flavored in liquid to make it more palatable
• Parents may provide which method is best for their child
• The nurse should need to acknowledge that pain sensation may be felt
• Accurate computation is necessary

Older Adults

• May have physiological changes associated with aging that influence medication administration or effectiveness
• May enhance the possibility of cumulative effects and toxicity
• Possibility of medication errors increase
• More medications taken leads to problem of drug interaction
• Usually requires smaller doses of drug
• Reactions to medications may be bizarre or unexpected
• Attitude of older adults towards medical care vary
• Nurse needs to develop simple, realistic plan for clients to follow if drugs are to be taken at home
 MEDICATIONS AND CALCULATIONS

Systems of Measurement

Metric System

• Logically organized into units of 10

• It is a decimal system
• Multiples are calculated by moving the decimal point to the right and division is accomplished by moving the
decimal point to the left
• Basic units of measurement are the meter, the liter and the gram

Latin Prefixes Greek Prefixes

• Deci (1/10 or 0.1) • Deka (10)

• Centi (1/100 or 0.01) • Hector (100)
• Milli (1/1000 or 0.001) • Kilo (1000)

Basic Metric Measurements of Volume and Weight

Converting Weight within the Metric System

• 3 metric units of weight for drug dosages

• Gram (g), milligram (mg) and microgram (mcg)
• 1,000mg or 1,000,000mcg = 1gm

EX. MG → G EX. G → MG

500 mg = ? g 0.006 g = ? mg
1𝑔 1000𝑚𝑔
500 mg x = 0.5g (move the decimal 3 places to 0.006 g x = 6mg (move decimal point three
1000𝑚𝑔 1𝑔
the left) places to the right)

Apothecaries’ System

• Older than the metric

• Basic unit of weight is the grain (gr) (size of a wheat)
• Basic unit of volume is the minim (volume of water equal to a grain of wheat)

Household System

• Maybe used when more accurate measure of measure is not required

Approximate Volume Equivalents between Systems of Measurement

Metric Apothecaries Households

1ml 15 minims 15 drops (gtt)
5ml 1 fluid dram 1 teaspoon
15ml 4 fluid drams 1 tablespoon
30ml 1 fluid ounce Same
500ml 1 pint (pt) Same
1,000ml 1 quart (qt) Same
4,000ml 1 gallon (gal) Same
 Approximate Weight Equivalents: Metric and Apothecaries System

Metric Apothecaries
1mg 1/60 grain
60mg 1 grain
1g 15 grains
4g 1 dram
30g 1 ounce
500mg 1.1 lbs
1000g 2.2 lbs

Converting Units of Volume

EX. ML → GTTS EX. MG → GRAIN EX. LBS → KG

50 ml = gtts 1000mg = grain 110 lbs = kg

15 𝑔𝑡𝑡𝑠 1 𝑔𝑟𝑎𝑖𝑛 1𝑘𝑔
50 ml x = 750 drops or gtts 1000mg x = 16.66 grain or 110 lbs x 2.2𝑙𝑏𝑠 = 50kgs
1𝑚𝑙 60𝑚𝑔
17 grain

Methods of Calculating Dosages

Basic Formula

• D = desired dose (that is dose ordered by the primary care provider)

• H = dose on hand (dose on the label of the bottle, ampule or vial)
• V = vehicle (form in which the drug comes such as tablet or liquid)

Formula
𝐷𝑥𝑉
= 𝑎𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑏𝑒 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟𝑒𝑑
𝐻
EX.1

Order: Erythromycin 500mg

On hand: 250mg in 5ml

Substitute Value
D = 500mg; H = 250mg; V = 5ml
500𝑚𝑔 𝑥 5𝑚𝑙
= 10𝑚𝑙
250𝑚𝑔
EX. 2

Order: Phenobarbital gr ii
On hand: Phenobarbital 30mg/tablet

Convert gr ii to mg

Substitute Value
D = 2; H = 1; V = 60mg
𝐺𝑟 𝑖𝑖 (2)𝑥 60𝑚𝑔
= 120𝑚𝑔
𝑔𝑟 𝑖 (1)
Body Weight Method

• Covert pounds to kilograms

• Determine drug dose per BW by multiplying as follows:
𝐷𝑟𝑢𝑔 𝑑𝑜𝑠𝑒 𝑥 𝐵𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 = 𝑐𝑙𝑖𝑒𝑛𝑡 ′ 𝑠 𝑑𝑜𝑠𝑒 𝑝𝑒𝑟 𝑑𝑎𝑦
• Follow the basic formula to calculate the drug dosage

EX. 1

Order: Fluorouracil (5-FU), 12mg/kg/day IV, not to exceed 800mg/day. The adult weighs 132lbs

• Covert pounds to kilogram

1𝑘𝑔
132𝑙𝑏𝑠 𝑥 = 60𝑘𝑔
2.2𝑙𝑏𝑠
• DD x BW = client’s dose per day

12𝑚𝑔 𝑥 60𝑘𝑔 = 720 𝑚𝑔 𝐼𝑉/𝑑𝑎𝑦

EX. 2

Order: Cefaclor (ceclor) 20 mg/kg/day in three divided doses. The child weighs 31lbs. Available drug is Ceclor suspension
125mg per 5ml.

• Convert lbs to kilograms

1𝑘𝑔
31 𝑙𝑏𝑠 𝑥 = 14𝑘𝑔
2.2𝑙𝑏𝑠
• Determine how many mg is needed per day

20𝑚𝑔 𝑥14 kg = 280𝑚𝑔/𝑑𝑎𝑦

• Determine how many ml/day

280𝑚𝑔 𝑥 5𝑚𝑙
= 11.2𝑚𝑙/𝑑𝑎𝑦
125𝑚𝑔
• Order said in 3 equal doses
11.2𝑚𝑙
= 3.7𝑚𝑙/𝑑𝑜𝑠𝑒
3
Body Surface Area Method

Considered as the most accurate way to calculate the drug dose for infants, children, older adults and on clients who are
on antineoplastic treatment or whose BW is low

West Nomogram for infants and Children

BSA Formula

• Multiply the drug dose ordered by the number of square meters

Order: Cyclophosphamide (Cytoxan) 100mg/m2/day IV

EX. 1

• Client is 70 inches tall and weighs 160lb

• 70 inches and 160lb intersect the nomogram scale at 1.97 m2 (BSA)
• 100 mg x 1.97 = 197 mg
• Administer cytoxan 197 mg or 200 mg/day

EX. 2

Order: mephenytoin (Mesantonin) 200 mg/m2 PO in three divided doses. Child is 42 inches tall and weighs 44lb.

• 42 inches and 44lb intersect the nomogram scale at 0.8 m2

• 200 mg x 0.8 = 160mg/day
160𝑚𝑔
• 3
= 53𝑚𝑔 𝑜𝑟 50𝑚𝑔

BSA with Square Root

𝐻𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛𝑐ℎ𝑒𝑠)𝑥 𝑤𝑡 (𝑙𝑏)

BSA = √ 3131 (𝑐𝑜𝑛𝑠𝑡𝑎𝑛𝑡)

EX. 1

Oder: Melphalan (Alkeran) 16mg/m2 q 2 weeks. Client is 68 inches tall and weighs 172 lb. Use the BSA inches and
pounds formula.

68 𝑖𝑛 𝑥 172 𝑙𝑏 10696
• BSA = √ 3131
= √ 3131 = √3.73 = 1.9 𝑚2
• 16mg x 1.9m2 = 30.4mg
• Client should receive 30 mg every 2 weeks
 INTRAVENOUS INFUSION

Intravenous Therapy

A common method of replacing water, electrolytes and blood products and is also used for the continuous
administration of drugs

2 Methods Use to Administer IV Fluids

1. Continuous IV infusion
• Replaces fluid loss, maintains fluid balance, and serves as a vehicle for drug administration
2. Intermit tend IV infusion
• Used primarily to give IV drugs

Purposes

• Direct IV, IV push, IV bolus, IV infusion

• Most rapid route of absorption
• Route that can be used for clients with compromised GI function or peripheral circulation
• Correct an underlying imbalance in fluids or electrolytes

Functions and Responsibilities of a Nurse During Drug Preparation

1. Knowing IV sets and their drop factors

2. Calculating IV flow rates
3. Mixing and diluting drugs in IV fluids
4. Gathering equipment
5. Knowing the drugs and the expected and untoward reactions

Types of IV Fluids

Isotonic

No effects on the cell

• Example
→ NaCl or Plain NSS or .9 NaCl
→ The only compatible IVF in blood transfusion
→ Restores circulatory volume, for hypovolemic hypotension and metabolic acidosis

Hypertonic
 Cell to shrink

• Examples
→ D10W → D5NS
→ D20W → D5LR
→ D500W → D5 .9% NaCl
→ D5 1/3 → D5 ½
→ D5IMB (Balanced Multiple Maintenance Solution with 5% Dextrose)
x For burns, increased ICP, and post-operative swelling of site

Hypotonic

Cells to Swell

• Examples
→ D5W (Carbohydrates in Water)
→ .45% NS
→ .33% NS
→ Treatment of cellular dehydration
→ NS means Normal Saline

Drop Factor

The number of drops per milliliter, is normally printed on the packaging cover of the IV set

Macrodrip

• A set that delivers large drops per milliliter (10-20 gtt/ml)

• Usually 500ml or less than 1000ml
• Used for adult patients
Microdrip

• A set that delivers small drops per milliliter (60 ugtt/ml)

• Usually 1000ml above
• Used for pediatric patients

Keep Vein Open (KVO) or To Keep vein Open (TKO)

• IV fluids are given in a slow rate

• Used for suspected or potential emergency situation for rapid administration of fluids and drugs and the need
for an open line to give IV drugs at specified hours
• 10mL/hr

Common Drop Factors

• Macro
→ 10ggts = 1ml → 15gtts = 1ml → 20gtts = 1ml
• Micro
→ 60gtts = 1ml

Calculation

3 Methods to Calculate IV Flow Rate

METHOD 1: Three-step

Amount of Solution

Formula
𝑇𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟
𝑇𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠 𝑥 60
Ex. Infuse 1000ml of PNSS in 8 hours. Drop factor 15.
1000𝑚𝑙 𝑥 15 15000
= = 31.25 𝑜𝑟 31 − 32 𝑔𝑡𝑡/𝑚𝑙
8 ℎ𝑜𝑢𝑟𝑠 𝑥 60 480

Ex. 2. D5IMB 500ml to run for 6 hours. Drop factor 60.

500 𝑥 60 30000
= = 83.33 𝑜𝑟 83 − 84 𝑢𝑔𝑡𝑡/𝑚𝑙
6 𝑥 60 360
Calculating Flow Rates

Formula
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙
𝑚𝑙/ℎ𝑟 =
𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠
Ex. Infuse 1000ml of PNSS in 8 hours.
1000𝑚𝑙
= 125𝑚𝑙/ℎ𝑟
8ℎ𝑟
Ex. 2. D5LR 1 liter to run for 6 hours.
1000𝑚𝑙
= 166.66 𝑜𝑟 167𝑚𝑙/ℎ𝑟
6ℎ𝑟
Calculating Time of Consumption

Formula
𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟
𝑇𝑖𝑚𝑒 =
𝑟𝑎𝑡𝑒 𝑥 60
Ex. At 10 am IVF Normosol is at 725 ml regulated at 30gtts/min. at what time it will be consumed?
725 𝑥 15 10875
= = 6 ℎ𝑜𝑢𝑟𝑠 = 10𝐴𝑀 + 6 ℎ𝑜𝑢𝑟𝑠 = 4𝑃𝑀 𝑤𝑖𝑙 𝑏𝑒 𝑡ℎ𝑒 ℎ𝑜𝑢𝑟 𝑜𝑓 𝑐𝑜𝑛𝑠𝑢𝑚𝑝𝑡𝑖𝑜𝑛
30𝑔𝑡𝑡𝑠 𝑥 60 1800

ADDITIONAL INFO AND NOTES

• Universal drop factor is 15

Do not forget to convert the ff. before computation

• L to ml = 1L = 1000ml
• g to mg = 1g = 1000mg

Important Formulas

• Calculating Dosage
𝐷𝑥𝑉
= 𝑎𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑏𝑒 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟𝑒𝑑
𝐻

Flow Rates

• Amount of Solution
𝑔𝑡𝑡𝑠 𝑢𝑔𝑡𝑡𝑠 𝑇𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟
𝑜𝑟 =
𝑚𝑙 𝑚𝑙 𝑡𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠 𝑥 60
• Calculating Flow Rates per hour
𝑚𝑙 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙
=
ℎ𝑟 𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠
• Time of Consumption
𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟
𝑇𝑖𝑚𝑒 =
𝑟𝑎𝑡𝑒 𝑥 60