HEALTH

ASSESSMENT
PHARMACOLOGY
Prepared by: Lexter King S. Jimenez, RN
Drugs and the Body
MEDICATION ADMINISTRATION
• BASIC nursing action that involves skillful
technique and consideration of the patient’s
development, health status and safety.
• Requires knowledge base about drugs, including
drugs name, preparation, classification, adverse effects,
and physiologic factors that affect drug action.

Medication
• Substance prescribed by client’s prescribing
practitioner to help in the treatment, relief or cure of the
cause of the client’s health alteration or in the
prevention of such alterations.

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DRUG
• Chemical substance intended for use in
the diagnosis, treatment, cure, mitigation or
prevention of a disease

Standards
• Have been developed to ensure drug
uniformity so that effects are predictable

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Drug action
• Refers to drug’s ability to combine with a cellular drug
receptor.
• For example; Benadryl cream = it applied to the skin. = it
elicits only a local effect. However, if this drug is
administered in tablet or injectable from: it causes both
systematic and local effects.

Pharmacology
• The study of the effects of drugs on living organism

Drugs usually work in one of four ways:

 To replace or act as substitutes for missing chemicals.
 •To increase or stimulate certain cellular activities.
 •To depress or slow cellular activities
 •To interfere with the functioning of foreign cells
Pharmacokinetics
 This involves the study of the
following:
ABSORPTION
DISTRIBUTION
METABOLISM
(BIOTRANSFORMATION)
EXCRETION
Routes of Drug Administration
 IV (Intravenous)
 IM (Intramuscular)
 Sub-Q (Subcutaneous)
 PO (Oral)
 PR (Rectal)
 Mucous membranes (sublingual, buccal)
 Topical (Skin)
 Inhalation
Factors Influencing Drug Effects
WEIGHT
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AGE
GENDER
PHYSIOLOGIC FACTORS
3 P’s of DM
1. Polyuria
2. Polydipsia
3. Polyphagia
PATHOLOGICAL FACTORS
GENETIC FACTORS
IMMUNOLOGICAL FACTORS
PSYCHOLOGICAL FACTORS
ENVIRONMENTAL FACTORS
Branches of Pharmacology
 Pharmacokinetics – the process by which the
drug moves through the body & out for
elimination
 Pharmacotherapeutics – deals with the
relative effect of drug into the human system
 Pharmacodynamics – refers to the
physiological & biochemical effects of a drug
on the body
 Toxicology
 Posology
 Pharmacy
 Pharmacognosy
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Pharmacodynamics
 Therapeutic Effect – the desired effect of the
drug
 Adverse Effect – is any effect other than the
therapeutic effect
 Interaction – is when effects are altered by
other medications or food

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Adverse Effects
 Side effect – is harmless effect
 Hypersensitivity reaction – occurs when the
client is unusually sensitive to medication
 Tolerance – occurs when a client develops a
decreased response
 Allergic reaction – results from immunologic
response to which client has been sensitized
 Toxicity – results from overdose

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The Three Checks
 Denotes that label on the medication package OR
CONTAINER SHOULD BE CHECKED THREE TIMES
DURING Medication preparation and administration the
label should be read:
 When the nurses reaches for the container or unit
dose package
 After retrieval from the drawer and compared with
MAR (medication administration Record) or compared
with the MAR immediately before pouring from a
multidose container
 When replacing the container to the drawer or
shelf or before giving the unit dose medication to the
patient.

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Rights of DrugAdministration
 Right client
 Right assessment
 Right medication
 Right documentation
 Right dosage
 Right route
 Right time
 Right evaluation
 Right Hx
 Right to refuse
 Right approach
 Right prescription
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Forms of Medication
Preparations: ORAL
 Tablets – compressed or molded substances
 Capsules – substances encased in either hard
or soft soluble container or gelatin shell that
dissolves in the stomach
 Caplets – gelatin coated tablets
 Powder & granules – finely ground substance
usually mixed with water/ juice

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Other Forms
 Troches and lozenges – designed to dissolve
in the mouth
 Enteric-coated – coated tablets that dissolve
in the intestines
 Time-released capsules – encased substances
that are further enclosed in smaller casings
 Sustained-release – compounded substances
designed to release the drug slowly

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Topical
 Powder – lightly dusted on skin
 Liniments- substances mixed with an alcohol
or oil
 Ointments – semi-solid substances
 Pastes – thicker than ointments
 Transdermal patches – contain medication
absorbed through the skin over an extended
period of time
 Suppositories –gelatinous substances

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TOPICAL ROUTES
• It is given to deliver a drug at, or immediately
beneath ,the point of application.
• Applied to the skin, other topical include eye ,nose, and
troat ,ear ,rectal, and vaginal preparations.
Transdermal patches another type of topical oreoaration
(nitroglycerin ( anti-anginal)

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INHALANTS
• Deliver gaseous or volatile substances that are
almost immediately absorbed into the systemic circulation.
Delivered into the alveoli of the lungs which promote fast
absorption owing to ;
• The permeability of the alveolar and vascular
epithelia
• An abundant blood flow
• A very large surface area for absorption
Inhalation
• Route to administer medications directly into the
lungs or airway passages
INTRAOCULAR ROUTE
• Administer by applying a clear, flexible, elliptical
shaped disk similar to a contact lens to the conjuctival sac.
Ex. Open-angle glaucoma.(pilocarpine =medicationto treat
glaucoma)

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Solutions
 Emulsion – a 2-phase system in which one
liquid is dispersed in the form of small
droplets throughout another liquid
 Douches - aqueous solutions as cleansing or
antiseptic agent
 Syrups – substances dissolved ina sugar liquid
 Elixir – nonaqueous solution that contain
water, varying alcohol content & glycerin
 Suspensions – particle or powder substances
that must be dissolved in a liquid before
administration
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Medication Orders
 Stat order – the drug should be given
immediately
 Single – dose order –one-time medication
 Standing order – scheduled order
- is in effect unless it is D/C
 PRN order – give the drug as necessary/ as
needed

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Parts of Medication Order
 Name of the patient
 Date & time when order is written
 Name of the drug to be administered
 Dosage
 Route
 Time and frequency
 Signature of the person writing the order

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Parenteral Route
• Means introduction of medication by ant route other than
the oral-gastrointestinal route.
• Injecting medication into body tissue. Sterile technique is
always used for any medication injection.

4 ROUTES
Intradermal (ID) = injection into the dermis
Subcutaneous (SC)= injection into the

subcutaneous tissue
Intramuscular (IM) = injection into the muscle
Intravenous (IV) = injection into a vein

OTHER ROUTES
Intrathecal or intraspinal
Intracardiac
Intrapleural
Intra-arterial
Intra –articular

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Injections:

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PARENTERAL
• Given through a route other
than the alimentary canal: these
routes are intradermal,
subcutaneous, intramuscular or
intravenous.

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Needle/syringe Selection technique
• When looking at a needle package ,the first number
is the gauge or diameter of the needle (ex. 18,20 and the
second number is the length in inches (ex. 1,1 ½ )
• As the gauge number becomes larger, the size of
the needle becomes smaller: for instance ,a 24 gauage
needle is smaller than an 18 gauge needle.
• When giving an injection ,the viscosity of the
medication directs the choice of gauage (diameter).A
thicker medication such as a hormone is given through a
bigger needle ,such as a 20 gauge. A thinner –consistency
medication ,such as morphine ,is given through a smaller
needle ,such as a 24 gauge.
• The size of the syringe is directed by the amount of
mediaction to be given

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TYPES OF SYRINGE
Hypodermic Syringe
• Comes in 2-2.5 and 3 ml sizes.
• The measurements calibrations are usually printed in
milliliters and minims.
Most syringes are marked in cubic centimeters (cc). 1cc =1
ml)
A hypodermic (hypo – under, dermic – the skin) needle is a
hollow needle commonly used with a syringe to inject
substances into the body or extract fluids from it. They may
also be used to take liquid samples from the body, for
example taking blood from a vein in venipuncture

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Insulin Syringe
• Designed especially for use with the ordered dose of
insulin. 30 units of U-100 or 100-unit insulin)
• 100 units of insulin = 1 ml of solution
Tuberculin Syringe
• A narrow syringe, calibrated in tenths and hundredths of
a milliliter on one scale and in sixteenths of a minim on the
scale.
Prefilled single-dose Syringes
• A single standard dose of medication. Use once and
discard
Epinephrine Auto-Injector
• This medication is used in emergencies to treat very
serious allergic reactions to insect stings/bites, foods, drugs, or
other substances. Epinephrine acts quickly to improve
breathing, stimulate the heart, raise a dropping blood pressure,
reverse hives, and reduce swelling of the face, lips, and throat.
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Side Effects
• Fast/pounding heartbeat, nervousness, sweating,
nausea, vomiting, trouble breathing, headache, dizziness, anxiety,
shakiness, or pale skin may occur. If any of these effects last or
get worse, tell your doctor or pharmacist promptly.

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NEEDLE
• generally, a thin, cylindrical object, often with a
sharp point on the end.
3 basic parts
1. Hub= fits onto the syringe
2. Cannula or shaft = attached to the hub
3. BEVEL= the slanted part at the tip of the shaft.

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GAUGE
• The needle refers to the diameter of the shaft: larger that
gauge number the smaller the diameter of the shaft.
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Intradermal Injection
 To introduce drugs, bacteria or their toxins
and other organic preparations to test
whether the body is sensitive to the
preparation to be injected.
 Site of Injection: Inner aspect of forearm or
upper arm

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Sites of ID injection
 Ventral mid forearm
 Clavicular area of the chest
 Scapular area of the back

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Needle & Syringe
 Gauge 25 to 27
 3/8 to ½ in
 Syringe: 1 ml

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Procedure
 Prepare the drug in the same manner as for hypodermic
injection.
 Explain to the patient. Make him comfortable. Support forearm
on a firm surface.
 Cleanse the skin area about 3 inches (diameter) on the inner
aspect of the forearm midway between the wrist, and the elbow
with alcohol sponge. (Preferably swab with other, and allow to
dry.)
 Insert the needle, into the skin as superficially as possible by the
needle only as far as the level edge to be sure that the injection
is intradermal.
 Inject the solution enough to make a wheal or circumscribed
elevation of the skin. Inject no more than 0.1 cc.
 Withdraw the needle gently, do not press. Do not cleanse or
massage site of injection.
 Wait for 10-15 minutes. Evaluate results.
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SQ injection

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• Subcutaneous injections are inserted at 45 to 90
degree angles, depending on amount of subcutaneous tissue
present and length of needle- a shorter, 3/8" needle is usually
inserted 90 degrees and a 5/8" needle is usually inserted at
45 degrees.
• Medication is administered slowly, about 10
seconds/milliliter
• A 25 to 31 gauge thick, 3/8" to 1" long needle can be
used.
• The size is determined by the amount of
subcutaneous tissue present, which is based on patient
build.

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Sites of SQ injection
 Outer aspect of upper arm- Patient’s arm
should be relaxed and at side of body.
 Anterior thighs- Patient may sit or lie with
leg relaxed.
 Abdomen-Patient may lie in a semirecumbent
position.

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Needle & syringe
 Gauge: 25-27
 ½ to 5/8 in
 Syringe: 1-3 ml

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 IM injections
 Usually more rapid effect than SQ
 Used for irritating drugs, aqueous suspensions and
solutions in oil
 • This allows the medication to be absorbed into
the bloodstream quickly
 • (also IM or im) injection is the injection of a
substance directly into a muscle. In medicine, it is one
of several alternative methods for the administration
of medications
 • Muscles have larger and more blood vessels than
subcutaneous tissue and injections here usually have
faster rates of absorption than subcutaneous injections
or intradermal injections.
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INJECTION SITE
• deltoid
• dorsogluteal,
• rectus femoris,
• vastus lateralis
• ventrogluteal muscles

Age of patient
Infants =vastus lateralis
Toddlers and children =vastus lateralis or
deltoid
Adultss= ventrogluteal or deltoid

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Sites:

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Patient positioning
Deltoid = May sit or stand. A child may be held in an
adults lap.
Ventrogluteal= may stand, sit, lay laterally lay supine
Vastus lateralis =sit or lay supine, be held in adults’ lap.

IM injection needle length

Site /age
• Vastus lateralis = 5/8” to 1”
• Deltoid (children) = 5/8” – 1 ¼”
• Deltoid (adults) 1 – 1 ½”
• Ventrogluteal (adults) = 1 ½

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Needle & Syringe:
 Gauge: 20-23
 1-1.5 in in length
 Syringe: 1-3 ml

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Z-track Injection (Zig-Zag) technique
• Refers to a method used in administering IM injection
• a type of IM injection technique used to prevent tracking
(leakage) of the medication into the subcutaneous tissue (underneath
the skin).
• During the procedure, skin and tissue are pulled and held firmly
while a long needle is inserted into the muscle.
• After the medication is injected, the skin and tissue are
released.
• When you insert a needle into the tissues, it leaves a very
small hole, or track.
• Small amounts of medication can sometimes leak backwards
through this track and be absorbed into other tissues.
• Pulling the skin and tissue before the injection causes the
needle track to take the shape of the letter “Z,” which gives the
procedure its name.
• This zigzag track line is what prevents medication from leaking
from the muscle into surrounding tissue.
• 10 secs and release

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DRUG-DRUG INTERACTIONS
Examples:
 Drug synergism
 Drug antagonism

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DRUG-FOOD INTERACTIONS
Toxic Effects of Drugs
Drug Allergy
 This occur when the body
form antibodies to a
particular drug, causing an
immune response when the
person is re-exposed to the
drug.
Erythema – redness
Pruritus – itchiness

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Drug-Induced Tissue and
Organ Damage
Dermatological Reactions
Rashes, Hives
 Procainamide
(Pronestyl) which
treats cardiac
arrhythmias can
cause a skin rash.
 Instruct patient to
avoid scratching or
rubbing the lesions
and avoid harsh
soaps and lotions.
Procainamide – anti-arrhythmic agent
- Tx of cardiac arrhythmia (abnormal heart rhythm)

Inflammation – process in the body of fighting

against foreign particles such as infections, injuries
and toxins in an attempt to heal & recover itself
1. Redness (rubor)
2. Heat (calor)
3. Swelling ( tumor)
4. Pain (dolor)
* functio laesa – loss of function of the affected
tissue
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Stomatitis
 Fluorouracil
(Adrucil) an
antineoplastic
agent causes
mouth sores or
stomatitis
 Provide frequent
mouth care
 Give frequent
small meals
Blood Dyscrasia
Blood Dyscrasia
 Bone marrow
suppresion caused by
drugs such as
antineoplastics
 Symptoms include
fever, chills, sore
throat, weakness,
back pain, or
pancytopenia.
 Monitor blood counts
and provide
protective measures
against bleeding and
infection.
Blood dyscrasia
 Anemia – decrease in hemoglobin/ RBC
(erythrocytes)
Implication: body malaise/weakness/fatigue
N.I. : Encourage adequate bed rest.
Give Iron supplements as ordered
 Leukopenia – decrease in WBCs/ leukocytes

Implication: risk for infection

N.I. : Protect the patient by instructing to
avoid exposure to crowd.
Assign to a private room.
Instruct the patient to perform frequent
handwashing & hygienic measures
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Thrombocytopenia – decrease in platelets
Implication: Risk for bleeding
N.I. : Avoid contact sports.
Refrain from using sharp utensils
Avoid taking anti-coagulants as ordered.

PANCYTOPENIA – decrease in all blood cell

components

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Signs of bleeding
 Hematemesis – presence of blood in the
vomit/vomitus
 Hemoptysis – coughing up of blood
 Gingivhorrhagia – bleeding of gums
 Hematochezia – fresh blood in the stool due
to lower GIT bleeding
 Melena – black tarry stool due to upper GIT
bleeding
 Hematuria – presence of blood in the urine

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Toxicity
Liver Injury
 Symptoms include
fever, malaise,
nausea, vomiting,
jaundice, change
in the color of
urine or stool
(steatorrhea-fatty
diarrhea),
elevated liver
enzymes (AST and
ALT)
 Discontinue the
drug if these
happens
Renal Injury
 Signs are elevated
BUN (blood urea
nitrogen) and
serum creatinine,
decreased
hematocrit,
electrolyte
imbalances.
 Discontinue the
drug as needed
Alterations in Glucose
Metabolism
Hypoglycemia
 Drugs such as
Glipizide (Glucotrol)
and glyburide
(DiaBeta) are
antidiabetic agents
(OHA-oral
hypoglycemic agents)
that can lower blood
glucose.
 Symptoms include
fatigue, drowsiness,
hunger, shaking and
trembling.
 Restore glucose
immediately.
 Diabetes Mellitus Type 1 – Insulin dependent
DM (IDDM)
- juvenile onset
 Diabetes Mellitus Type 2 – Non-insulin
dependent Diabetes Mellitus (NIDDM)
- adult onset
3 Classic Manifestations of DM
1. Polyuria- excessive urination
2. Polydipsia – excessive thirst
3. Polyphagia – excessive eating due to severe
hunger

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Hyperglycemia
 Ephedrine a drug used
as bronchodilator can
break down stored
glycogen and can
elevate the blood
glucose.
 Symptoms are
fatigue, increased
urination, increased
thirst, deep
respirations,
restlessness etc.
 Administer insulin to
decrease blood
glucose
Electrolyte Imbalances
Hypokalemia
 Loop diuretics such as
Furosemide (Lasix) can increase
potassium excretion.
 If postassium is below 3.5 mEq/L
replace serum potassium
Hyperkalemia
 Potassium-sparing diuretics such
as Spironolactone can increase
potassium serum levels.
 Institute measures to decrease
the serum potassium, monitor
cardiac effects.
 Kayexalate – decreases serum K
Sensory Effects
Ocular Toxicity
 Chloroquine a drug
used to treat some
rheumatoid disease
can cause retinal
damage even
blindness.
 Monitor patient’s
vision when receiving
oculotoxic drugs;
provide supportive
measures when there
is blurring of vision
Auditory Damage (Ototoxity)
 Aspirin is one of
the most
commonly ototoxic
drugs affecting the
8th cranial nerve
 Monitor the
patient’s
perceptual losses
or changes,
provide supportive
measure to cope
with drug effects
Neurologic Effects
General Central Nervous System
Effects
 Beta-blockers
(Propranolol,
Atenolol, Timolol,
Nadolol), used to
treat hypertension
can cause feelings of
anxiety, insomnia,
and nightmares.
 Provide safety
measures to prevent
injury. Tell patient to
avoid driving or
operating dangerous
machinery.
Atropine-Like (Anticholinergic effects)
 Atropine
sulfate(anticholinergic),
antidepressants, antipsychotics
have anticholinergic effects
 Provide hard candy for dry
mouth, arrange bowel program
for constipation, safety
measures if vision changes
occur, avoid sunlight etc.
ANTICHOLINERGIC EFFECTS
 Dry mouth
 Constipation
 Urinary retention
 Nasal congestion
 Blurring of vision
 Tachycardia
 Photosensitivity reaction

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Pseudoparkinsonism
 Many
antipsychotics and
neuroleptic drugs
can cause this
effect.
 Discontinue the
drugs or give
antiparkinsonian
drugs (CAPABLES)
ANTIPARKINSONIAN AGENTS
 Cogentin
 Artane
 Parlodel
 Akineton
 Benadryl
 Levodopa
 Encatapone
 Symmetrel

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Neuroleptic Malignant Syndrome
 General anesthetics and other drugs
that have direct central nervous
system effects can cause NMS.
 Symptoms are extrapyramidal
symptoms, hyperthermia are
present.
 Discontinue the drug.
Dosage Calculations
Conversions Between Systems of Measurement
Metric System Apothecary System Household System
Solid Measure
1 kg 2.2 lb
454 g 1.0 lb
1 g = 1000 mg 15 gr
60 mg 1 gr
30 mg ½ gr
Liquid Measure
1 l = 1000 ml About 1 qt
240 ml 8 f oz 1c
30 ml 1 f oz 2 tbsp
15-16 ml 4 f dr 1 tbsp = 3 tsp
8 ml 2 f dr 2 tsp
4-5 ml 1 f dr 1 tsp = 60 gtt
1 ml 15-16 min
Formulas for Pediatric Dosages
 Fried’s rule
Child’s dose (age <1 year)=
infant’s age in months x adult dose
150 months
 Young’s rule

Child’s dose (age 1 -12 years) =

child’s age in years x average adult dose
child’s age in years + 12
 Clark’s rule

Child’s dose =
weight of child in pounds x average adult dose
150 pounds
Solve for the Following
Digoxin 0.125 mg is ordered
for a patient who is having
trouble swallowing. The
bottle of digoxin elixir
reads 0.5mg/2ml. How
much would you give?
The usual adult dose of
Morphine Sulfate is 10
mg. what would be the
safe dose for a child
weighing 27 lbs?
Clark’s rule
Pedia dose = weight of child in lbs/ 150 lbs X
AAD
= 27/150 lbs X 10mg
= 0.18 X 10 mg
= 1.8 mg

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 The average adult dose of
meperidine is 5 mg. what
dose would be appropriate
for a 10 month old infant?
 Fried’s rule
 Pedia dose = age in months / 150 months X
AAD
 = 10 months/ 150 months X 5 mg
 = 0.067 X 5 mg
 = 0.33 mg or 0.3 mg

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 Theaverage adult dose of
paracetamol is 500 mg.
what would be the dose of
the drug for a child who is
8-years old?
 Paracetamol – analgesic ( pain reliever)
- Antipyretic (to decrease elevated body
temperature
- Antidote: Acetylcysteine

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 Young’s rule
 Pedia dose = age in years / age in years + 12

X AAD
= (8 / 8 +12 years) X 500 mg
= 0.4 X 500 mg
= 200 mg

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 The average adult dose of
paracetamol is 500 mg. what
would be the dose of the drug to
a child who is 24 months old?

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 Young’s rule
 Young’s rule
 Pedia dose = age in years / age in years + 12

X AAD
 (2 years / 2 +12) X AAD
 (2/14) X AAD
 0.143 X 500 mg 0.14X500 mg = 70 mg
 71 mg

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 The usual adult dose of Morphine Sulfate
is 10 mg. what would be the safe dose for
a child weighing 10 kg?

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 Clark’s rule
Pedia dose = weight of child in lbs/ 150 lbs X
AAD
 10 kg X 2.2 lbs = 22 lbs.
 22lbs/ 150 lbs X 10 mg
 0.15 X 10 = 1.5 mg

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DRUG COMPUTATION
I. Oral Medications
D/S X Q = the drug to administer

D= Drug order
S= Stock dose
Q= Quantity of the drug

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Practice Exercise
1. An order is written for 10 grains of Aspirin.
The drug available each contains 5 grains.
How many tablets should the nurse give?

D/S X Q
= 10 grains/ 5 grains X 1 tablet
= 2 tablets

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 Aspirin (ASA- Acetyl Salicylic Acid)
Drug Classification: Platelet aggregation
inhibitor drug
Properties:
1. Antipyretic
2. Analgesic
3. Anticoagulant
- Could affect the Cranial Nerve 8
(Vestibulocochlear/ Acoustic)

02/15/2024
2. An order is written for 0.05 g
Aldactone( Spironolactone) to be given
orally(PO). The Aldactone is available in 25-mg
tablet. How many tablets would the nurse has
to give?

0.05 g X 1000 mg = 50 mg
D/S X Q
50 mg/ 25 mg X 1 tablet
= 2 tablets

02/15/2024
 Spironolactone (Aldactone)
Drug Classification: Potassium sparing diuretic
A/E: Hyperkalemia (increased serum
Potassium)

02/15/2024
3. An order has been written for 250 mg of
Robitussin. The bottle states that the solution
contains 125 mg/ 5 mL. How much of the
liquid should you administer?
D/S X Q
= 250 mg / 125 mg X 5 ml
= 2 X 5 ml
= 10 ml

02/15/2024
IVF COMPUTATION
1.) Drip Rate or regulation

Total volume in ml. X DF

Gtts/minute = __________________
No. of hours X
60 minutes/hr.

02/15/2024
 Macro drip = 15 gtts/cc
 Microdrip = 60 ugtts/cc

02/15/2024
 2.) cc/hour or ml/hour
 1cc = 1 ml

Total volume to be infused

cc/hr = _____________________
total number of hours

02/15/2024
 3.) Number of Hours
Total volume X DF
 No. of hours = _________________

Drop rate X 60

02/15/2024
 Anorder is written for
1000 ml of normal saline
to be administered IV for
10 hours. The drop factor
on the tubing states 15
drops/ml. what is the IV
flow rate?
 Total volume in ml. X DF
Gtts/minute = __________________
No. of hours X
60 minutes/hr.
1000 ml X 15 gtts/cc
= ___________________
10 hours X 60 min/hour
15, 000
= ___________
600
= 25 gtts/minute 02/15/2024
 An order is written for 1000 ml of normal
saline to be administered IV at 25
gtts/min. using a macrodrip. How many
hours does the nurse will administer the
IVF?

02/15/2024
 Normal Saline Solution (PNSS)
- Plain Sodium Chloride Solution (PNaCl)
- Isotonic solution

02/15/2024
Number of Hours
Total volume X DF
 No. of hours = _________________

Drop rate X 60

= 1000 ml X 15 gtts/ml
____________________
25 gtts/min X 60 minutes/ hour
= 15000 / 1500 hours
= 10 hours 02/15/2024
 An order is written for 1000 ml of normal
saline to be administered IV for 10 hours.
The drop factor on the tubing states 15
drops/ml. What is the flow of IVF in an
hour?

02/15/2024
 Total volume to be infused
cc/hr = _____________________
total number of hours
= 1000 ml / 10 hours
= 100 ml/ hour
= 100 cc/ hour

02/15/2024
Practice Exercise

02/15/2024
 Total volume in ml. X DF
Gtts/minute = __________________
No. of hours X
60 minutes/hr.
= 1000 ml X 15 gtts/ml
12 hours X 60 min/hr
= 15, 000 gtts
720 mins.
= 20.83 gtts/min
= 21 gtts/min
02/15/2024
 Total volume to be infused
cc/hr = _____________________
total number of hours
= 1,000 ml/ 12 hours
= 83 ml/hour

02/15/2024
 2 hours X 83 ml/hour = 166 ml
 1, 000 ml – 166 ml = 834 ml

02/15/2024
 83 ml/hour X 8 hours
 = 664 ml

02/15/2024
 834 ml – 664 ml = 170 ml

02/15/2024
02/15/2024
 Total volume in ml. X DF
Gtts/minute = __________________
No. of hours X
60 minutes/hr.
= 1000 ml X 15 gtts/ml
14 hours X 60 min/hr
= 15, 000 gtts
840 mins.
= 17.86 gtts/min
= 18 gtts/min

02/15/2024
 Total volume to be infused
cc/hr = _____________________
total number of hours
= 1,000 ml/ 14 hours
= 71.43 ml/hour
= 71 ml/hour

02/15/2024
 1000 ml – 71ml = 929 ml

02/15/2024
 71 cc/hour X 12 hours = 852 cc

02/15/2024
 929 ml-852 ml
 = 77 ml

02/15/2024
STANDARD TIME

 OD – once a day / once daily

 BID – 2x a day / twice daily
 TID – 3x a day / thrice daily
 QID - 4x a day / 4x daily

02/15/2024
 RTC – ROUND THE CLOCK

 q h
 q 2h - 8am – 10am – 12pm – 2pm, RTC
 q 3h - 6am – 9 am – 12nn – 3pm, RTC
 q 4h - 8am – 12nn – 4pm – 8pm, RTC
 q 6h - 6am – 12nn – 6pm – 12mn, RTC
 q 8h - 8am – 4pm – 12mn – 8am, RTC
 q 12H - 8am – 8pm, RTC OR 6am – 6pm, RTC

02/15/2024
ANTIBIOTICS
Types of Antibiotics
 Aminoglycosides
 Cephalosporins
 Fluoroquinolones
 Macrolides
 Lincosamides
 Monobactam antibiotics
 Penicillins
 Penicillinase-resistant antibiotics
 Sulfonamides
 Tetracyclines
 Antimycobacterial antibiotics
Aminoglycosides
 Amikacin (Amikin)
 Gentamicin (Garamycin)
 Kanamycin (Kantrex)
 Neomycin (Mycifradin)
 Streptomycin (generic)
 Tobramycin (Nebcin, Tobrex)
Aminoglycoside
 Action – bactericidal because
they inhibit protein synthesis
that leads to the loss of integrity
of the bacterial cell wall.
 Notable adverse effect –
ototoxicity (especially
streptomycin)
Cephalosporins
 First generation treats gram-positive bacteria
and gram-negative bacteria such as (Proteus
mirabilis, E. coli, and Klebsiella pneumoniae
(PEcK)
 Second generation treats haemophilus
influenzae, enterobacter aerogenes and
neisseria species (Rememeber HENPEcK)
 Third generation are weak against gram-
positive bacteria but are more potent against
gram-negative as well as Serratia marcescens
(Remember HENPEcKS)
 Fourth generation cephalosporins are in
development.
First Generation
 Cefadroxil (Duricef)
 Cefazolin (Ancef, Zolicef)
 Cephalexin (Keflex, Biocef)
 Cephradine (Velosef)
Second Generation
 Cefaclor (Ceclor)
 Cefmetazole (Zefazone)
 Cefoxitin (Mefoxin)
 Cefprozil (Cefzil)
 Cefuroxime (Ceftin,
Zinacef)
Third Generation
 Cefdinir (Omnicef)
 Cefoperazone (Cefobid)
 Cefotaxime (Claforan)
 Cefpodoxime (Vantin)
 Ceftazidime (Ceptaz)
 Ceftibuten (Cedax)
 Ceftizoxime (Cefizox)
 Ceftriaxone (Rocephin)
Fourth Generation
 Cefditoren(Spectracef)
 Cefepime (Maxipime)
Cephalosporins
 Action is both bacteriostatic and
bactericidal.
 The most common adverse effects are
nausea, vomiting, diarrhea, anorexia,
abdominal pain and flatulence.
 When a patient consumes alcohol while
receiving cephalosporins or up to 72 hours
after discontinuation of the drug, it
creates a disulfiram-like reaction.
Symptoms include flushing, throbbing
headache, nausea, vomiting, chest pain,
palpitations, dyspnea, etc.
Fluoroquinolones (-FLoxacin)
 Ciprofloxacin (Cipro)
 Gemifloxacin (Factive)
 Levofloxacin (Levaquin)
 Lomefloxacin (Maxaquin)
 Moxifloxacin (Avelox)
 Norfloxacin (Noroxin)
 Ofloxacin (Floxin, Ocuflox)
 Sparfloxacin (Zagam)
Fluoroquinolones
 Action is to interfere with DNA
enzymes inside the bacterial cell
wall which is necessary for bacterial
growth and reproduction.
 Indicated for infections of gram-
negative bacteria.
 Common adverse effects are
headache, dizziness, insomnia, and
depression.
Macrolides (-thromycin)
 Erythromycin (Ery-Tab, Eryc)
 Azithromycin (Zithromax)
 Clarithromycin (Biaxin)
 Dirithromycin (Dynabac)
Macrolides
 Action is both bactericidal and
bacteriostatic
 Indicated to various type of
bacterial infections.
Glycosamides (-lin)

 Clindamycin (Cleocin)
 Lincomycin (Lincocin)
 These medications are
similar to macrolides but are
more toxic and are effective
against the same strains of
bacteria.
Monobactam
 Aztreonam (Azactam)
 Action is to disrupt cell wall
synthesis.
 Indicated for various type of
infection.
Penicillin and Penicillinase-Resistant
Antibiotics
 Was the first antibiotic introduced for
clinical use.
 Sir Alexander Fleming used Penicillium molds
to produce the original penicillin in the
1920s.
 Action of these medications are interfering
with cell wall synthesis.
 Treats various types of infections.
Penicillins
 Penicillin
 Amoxicillin (Amoxil, Trimox)
 Ampicillin (Principen)
 Carbanicillin (Geocillin)
 Ticarcillin (Ticar)

Penicillinase-Resistant Antibiotics
 Nafcillin
 Oxacillin
Sulfonamides
 These are drugs that inhibit folic acid
synthesis which is necessary for the synthesis
of DNA and RNA of the bacteria.
Examples are the following:
 Sulfadiazine (generic)
 Sulfisoxasole (Gantrisin)
 Sulfasalazine (Azulfidine)
 Cotrimoxazole (Septra, Bactrim)
 Treats various infections.
Tetracyclines (-cycline)
 Tetracyline (Sumycin)
 Demeclocycline (Declomycin)
 Doxycycline (Doryx)
 Minocylcine (Minocin)
 Oxytetracycline (Terramycin)
Tetracyclines
 They inhibit protein synthesis
leading to the inability for
bacteria to multiply.
 Treats a wide range of bacteria.
 Notable side effect is
hepatotoxicity, and weakens
both the teeth and bones.
Causes teeth and bone
deformities in fetus.
Antimycobacterial Drugs
Anti-Tuberculosis Drugs
 Rifampin (Rimactane)
 Isoniazid/INH (Nydrazid)
 Pyrazinamide (generic)
 Ethambutol (Myambutol)

Leprostatic Drugs
 Dapsone (generic)
 Thalidomide (Thalomid)
Antimycobacterial Drugs
 Most medications act on the DNA
which leads to a lack of growth and
eventually cell death.
 Notable adverse effects:
Rifampin – orange-tinged urine,
sweat and tears