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PHARMA

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PHARMACO OGY
What is Pharmacology?
Pharmacology is the scientific study of the
origin, nature, chemistry, effects, and uses
of drugs. This knowledge is essential to
providing safe and accurate medication
administration to your patients.
Three basic
concepts of
pharmacology:
Pharmacokinetics
the absorption,
distribution, metabolism,
and excretion of drugs
by the body.
PHARMACOKINETICS PHASES
Absorbtion
how does the drug enter
the body?
Pharmacodynamics
the biochemical and
physical effects of drugs
and the mechanisms of
drug actions.
Pharmacotherapeutics
the use of drugs to
prevent and treat
diseases.
Distribution
how does the drug get
where it needs to go?
Metabolization
how does the drug is
broken down?
Excretion
how does the drug leave
the body?
ABBREV AT ONS
ROUTES OF ADMINISTRATION
PO by mouth
IM intramuscularly
PR per rectum
SubQ subcutaneously
SL sublingual
ID intradermal
GT gastrostomy tube
IV intravenous
IVP intravenous push
IVPB intravenous piggyback
NG nasogastric tube
TIMES OF MEDICATIONS
ac
pc
daily
bid
tid
qid
qh
ad lib
stat
q2h
q4h
q6h
prn
hs
before meals
after meals
every day
2x a day
3x a day
4x a day
every hour
as desired
immediately
every 2 hours
every 4 hours
every 6 hours
as needed
at bedtime
ABBREV AT ONS
DRUG PREPARATION
tab, tabs
caps
gtt
EC
CR
susp
tablet
capsule
drop
enteric coated
controlled release
suspension
el, elix
sup, supp
suppository
SR
sustained release
elixir
DOSAGE
CALCULATION
Basic Dosage Calculation
D
________
xV
desired dose
H
amount on hand /
available dosage
of the medication
volume
=
IV Flow Rates
mL of solution
= mL/hr
________
total no. of hours
dose
IV Flow Rates
mL of solution
________
x drop factor =
total no. of minutes
gtt/min
sample:
1. Administer digoxin 0.5 mg IV
daily. The drug concentration
available from the pharmacy is
digoxin 0.25 mg/mL. How many
ML will you need to administer a
0.5 mg dose?
D / H x V = Dose
0.5 / 0.25 x 1 = 2mL
2. Nurse A will infuse 1 1/2 L of NS in
over 7 hours; drop factor is 15
gtt/mL. What flow rate (mL/hr) will
the nurse set on the IV infusion
pump?
3. A patient is receiving 250 mL
normal saline IV over 4 hours, using
tubing with a drip factor of 10
drops/mL. How many drops per
minute should be delivered?
mL of solution / total hours = mL/hr
1,500mL / 7hrs = 214.3 mL/hr
mL of solution / total minutes x
drop factor = gtt/min
250 mL x 10gtts per mL / 240 mins =
10.42 gtts/min
Dosage Calculation Conversions
1 kg
1,000 grams
2.2 pounds
1 pound
1 gram
1 mg
1 grain
1 liter
0.45 kg
1,000 mg
1,000 mcg
60 mg
1,000 mL
16 ounces
15-16 grains
1 quart
1 teaspoon 5 mL
60 drops
1 tablespoon 3 teaspoons
15 mL
30 mL
1 ounce
1 cup
1 pint
1 quart
1 gallon
2 tablespoons
1/2 pint
2 cups
2 pints
4 quarts
8 ounces
16 ounces
4 cups
8 pints
2 pints
4 cups
240-250 mL
480 mL
1 liter
32 ounces
16 cups
128 ounces
32 ounces
1,000 mL
3, 785 mL
DRUG ADMINISTRATION
Buccal, sublingual, and translingual
Buccal (in the pouch between the cheek and teeth),
Sublingual (under the tongue), or Translingual (on the
tongue)
This is to prevent their destruction or transformation in the
stomach or small intestine.
Gastric
Rectal and vaginal
Suppositories, ointments, creams, or gels may be instilled
into the rectum or vagina to treat local irritation or
infection.
Some drugs applied to the mucosa of the rectum or vagina
can also be absorbed systemically.
Respiratory
The gastric route allows direct administration of a drug into
the GI system.
Drugs that are available as gases can be administered into
the respiratory system through inhalation.
This route is used when patients can’t ingest the drug
orally. This route is accessed through a tube placed directly
into the GI system, such as a “G-tube.”
These drugs are rapidly absorbed. In addition, some of
these drugs can be self-administered by devices such as
the metered-dose inhaler.
Oral
Oral administration is usually the safest, most convenient,
and least expensive route.
Oral drugs are administered to patients who are conscious
and able to swallow.
Topical
The topical route is used to deliver a drug via the skin or a
mucous membrane.
This route is used for most dermatologic, ophthalmic, otic,
and nasal preparations.
The respiratory route is also used in emergencies—for
example, to administer some injectable drugs directly into
the lungs via an endotracheal tube.
Specialized infusions
epidural—injected into the epidural space
intrapleural—injected into the pleural cavity
intraperitoneal—injected into the peritoneal cavity
intraosseous—injected into the rich vascular network of a
long bone
intra-articular—injected into a joint
intrathecal—injected into the spinal canal.
Parenteral Administration
Intramuscular
Subcutaneous
·The IM route allows drugs to be injected directly into
various muscle groups at varying tissue depths.
·small amounts of a drug are injected beneath the dermis
and into the subcutaneous tissue, usually in the patient’s
upper arm, thigh, or abdomen.
This form of administration provides rapid systemic action
and allows for absorption of relatively large doses (up to 3
mL).
This allows the drug to move into the bloodstream more
rapidly than if given by mouth.
Aqueous suspensions and solutions in oil as well as drugs
that aren’t available in oral forms are given IM.
Drugs given by the subcutaneous route include
nonirritating aqueous solutions and suspensions contained
in up to 1 mL of fluid, such as heparin and insulin.
Needle size: 18-27 gauge
Uses Z-track method
Intramuscular
Needle size: 25-18 gauge
Note: Do not inject more than 15mL of solution
Subcutaneous
Intravenous
Intradermal
Parenteral Administration
Intravenous
Intradermal
The IV route allows injection of drugs and other substances
directly into the bloodstream through a vein.
Appropriate substances to administer IV include drugs,
fluids, blood or blood products, and diagnostic contrast
agents.
Administration can range from a single dose to an ongoing
infusion that’s delivered with great precision.
Needle size: 16 gauge- patients who have trauma
18 gauge- surgery and blood administration
22 to 24 gauge- children. older adults and
clients who have medical issues or are stable
post-op
Intramuscular
Drugs are injected into the skin.
A needle is inserted at a 10- to 15-degree angle so that it
punctures only the skin’s surface.
Used mainly for diagnostic purposes, such as testing for
allergies or tuberculosis.
Should form a "BLEB"
Needle size: 26-27 gauge
Subcutaneous
Intravenous
Intradermal
Intravenous Therapy
TYPES OF SOLUTIONS
Hypertonic Solution
Hypotonic Solution
D5N5
0.45% NS
Low levels of sodium or chloride; metabolic alkalosis
5% Dextrose in 0.45% Saline
5% Dextrose in LR
Maintenance Fluid
Replaces fluids
Used for burns, bleeding, dehydration
2.5% Dextrose
0.33% NS
Causes cell to shrink
Ringer's Solution
Treats intracellular
dehydration (DKA)
Never give to patients
with burns or liver
disease
Causes cell to swell
Isotonic Solution
0.9% saline (NS)
Helps kidneys excrete
excess fluids
Sodium or chloride replacement
Used with blood products
Replaces fluids
Used for burns, bleeding, dehydration
5% Dextrose in Water
No effect w/ same
concentration
Replaces deficits of total body water
Not used alone: dilution of electrolytes can occur
Intravenous Therapy
COMPLICATIONS
Air Embolism
air enters the vein
through the IV
tubing
Infiltration
IV fluid leaks into
the
surrounding
tissues
Infection
entry of microorganism
into the body via IV
Symptoms
Treatment
Tachycardia
Chest pain
Hypotension
Decreased LOC
Cyanosis
Clamp the tubing
Turn the patient on their left
side & place in Trendelenburg
position
Notify the HCP
Pain
Swelling
Coolness
Numbness in the site
No blood return
Remove the IV
Elevate the extremity
Apply warm or cool compress
Do not rub the area
Tachycardia
Redness
Swelling
Chills & fever
Malaise
Nausea & Vomiting
Remove the IV
Obtain cultures
Possible
administration
antibiotics
Intravenous Therapy
COMPLICATIONS
Circulatory Overload
administration of
fluids too rapidly
(FLUID
VOLUME
OVERLOAD)
Phlebitis
inflammation of the
veins that can lead
to thrombophlebitis
Hematoma
collection of blood
in the tissues
Symptoms
Treatment
Increase
blood
pressure
Distended neck veins
Dyspnea
Wet
cough
and
crackles
Decrease flow rate (keep
vein-open rate)
Elevate head of the bed
Keep the patient warm
Notify the physician
Heat
Redness
Tenderness at the site
Decrease flow of IV
Remove the IV
Notify the physician
Restart the IV on the
opposite side
Ecchymosis
Blood
Hard painful lump at
the site
Elevate the extremity
Apply pressure and ice
6 RIGHTS OF MEDICATION
ADMINISTRATION
RIGHT PATIENT
RIGHT TIME
RIGHT DOSE
RIGHT MEDICATION
RIGHT ROUTE
RIGHT DOCUMENTATION
DRUGS
ANTIBIOTICS/ANTIBACTERIALS
BROAD SPECTRUM ANTIBIOTICS
–oxacin
PENICILLINS
TETRACYCLINES
-cycline
AMINOGLYCOSIDES
SULFONAMIDES
sulf-
CEPHALOSPORINS
–cef
ceph-
& MACROLIDES
-cillin
-mycin
FLUOROQUINOLONES –floxacin
ANTIVIRALS
Antiviral (disrupts viral mutation)
–virimat
Antiviral (undefined group)
vir- -vir- -vir
Antiviral (neuraminidase inhibitors)
–cyclovir
HIV Protease Inhibitors
-navir
HIV/AIDS
–vudine
ANTIFUNGAL
Antifungal –azole
ANTIHYPERTENSIVES
ACE Inhibitors -pril
Beta Blockers
-olol
Angiotensin II receptor antagonists
Calcium channel blockers
–sartan
–pine -amill
Vasopressin receptor antagonist
Alpha-1 blockers
-osin
Loop diuretics
–ide -semide
-vaptan
Thiazide diuretics -thiazide
Potassium sparing diuretics
–actone
ANTIHYPERLIPIDEMICS
HMG-CoA reductase inhibitors
–statin
OTHERS
Anticoagulants (Factor Xa inhibitors)
–xaban
Anticoagulants (Dicumarol type)
–arol
Anticoagulants (Hirudin type)
–irudin
Low-molecular-weight heparin (LMWH)
–parin
Thrombolytics (clot-buster)
–teplase –ase
Antiarrhythmics
–arone
UPPER RESPIRATORY
Second-gen antihistamines (H1-antagonist)
Nasal decongestants
–adine; -trizine; -ticine
–ephrine –zoline
LOWER RESPIRATORY
Beta2-agonists (Bronchodilator)
–terol
Xanthine derivatives
–phylline
Cholinergic blockers
–tropium; -clindidiun
Immunomodulators & leukotriene modifiers
–zumab; –lukast
histamines (H1-antagonist)
ANESTHETICS
Local Anesthetics
–caine
ANTIANXIETY
Barbiturates (CNS depressant)
Barbiturates (used for anxiety/sedation)
–barbital
–zolam; -zepam
ANTIDEPRESSANTS
Serotonin Reuptake Inhibitors (SSRIs)
–oxetine; -talopram; -zodone
Serotonin- Norepinephrine Reuptake
–faxine; -zodone; -nacipram
Inhibitors (SNRI/DNRI)
Tricyclic antidepressants (TCAs )
–triptyline; -pramine
ANALGESICS/OPIODS
Opiods
–done; -one
NSAIDs
–olac; -profen
Salicylates
Aspirin (ASA)
Nonsalicylates
Acetaminophen
GASTROINTESTINAL
Histamine H2 Antagonist (H2-Blockers)
–tidine; dine
Proton Pump Inhibitors (PPIs)
-prazole
Laxative
-lax
ANTIDIABETIC
Oral hypoglycemic
–ide –tide –linide
Inhibitor of the DPP-4 enzyme
–gliptin
Thiazolidinedione
–glitazone
OTHERS
Corticosteroids
–asone; -olone; -inide
Triptans (anti-migraine)
–triptan
Ergotamines (anti-migraine)
–ergot-
Antiseptics
–chloro
Antituberculars (TB)
rifa-
Bisphosphonates
–dronate
OTHERS
Neuromuscular blockers
–nuim
Retinoids (anti-acne)
tretin-
Phosphodiesterase 5 inhibitors
–afil
Carbonic anhydrase inhibitors
–lamide
Progestin (female hormone)
–trel
Atypical antipsychotics
-ridone
Common Meds &
their
drug
classification
ANTIBIOTICS ANTIFUNGAL
AGENTS
Penicillin
Ampicillin
Oxacillin
Cefuroxime Sodium
Cefotaxime Sodium
Co-amoxiclav
Piperacillin + Tazobactam
Ciprofloxacin
Clindamycin
Erythromycin
ANTIVIRAL
DRUGS
Acyclovir
Zidovudine
Oseltamivir
Ribavirin
Ganciclovir
Indinavir
Amantadine
Zanamivir
Trifluridine
Penciclovir
Fluconazole
Ketoconazole
Itraconazole
Amphotericin-B
Flucytosine
Cystatin
Griseofulvin
ANTIHELMINTIC
Albendazole
Ivermectin
Mebendazole
Praziquantel
Pyrantel
ANTIPROTOZOAL
AGENTS
Metronidazole
Pentamidine
Tinidazole
Nitazoxanide
Atovaquone
ANTINEOPLASTIC
Cisplatin
Cyclophosphamide
Carboplatin
Dacarbazine
Chlorambucil
Opiods/narcotics
Warfarin
Heparin
Digoxin
Anticholinergics
Benzodiazepines
Cholinergic crisis
Acetaminophen (Tylenol)
Magnesium sulfate
Iron
Lead
Alcohol withdrawal
Beta blockers
Calcium channel blockers
Aspirin
Insulin
Pyridoxine
Tricyclic antidepressants
Cyanide
ANTIDOTES
Naloxone (Narcan)
Vitamin K
Protamine sulfate
Digibind
Physostigmine
Flumazenil (Romazicon)
Atropine (Atropen)
Acetylcysteine
Calcium gluconate
Deferoxamine
Chelation agents; Dimercaprol &disodium
chlordiazepoxide
Glucagon
Glucagon, insulin, calcium
Sodium bicarbonate
Glucose
Deferoxamine
Sodium bicarbonate
Hydroxocobalamin
Emergency drugs "LEAN"
L -Lidocaine
E -Epinephrine
Used for Ventricular arrhythmias,
topical/local anesthetic
Used
for
Bronchodilation;
anaphylaxis;
hypersensitivity
reaction; Acute asthma attack;
Chronic simple glaucoma
A -Atropine Sulfate
N -Narcan
Used
to
decrease
respiratory
secretions;
treats sinus bradycardia;
reverses
effects
of
anticholinesterase
medication
Used for Opioid-induced toxicity; opioid-induced
respiratory depression; used in neonates to
counteract or treat effects from narcotics given to
mother during labor
Non-Opiate Analgesics
Tylenol
acetaminophen
also an antipyretic
should not exceed 4g within 24 hours
no anti-inflammatory properties or GI
irritation
Hepatotoxicity
Nausea/vomiting and
gastric irritation
Monitor liver function,
assess for jaundice and
increase LFT
Educate the patient to
avoid alcohol while taking
acetaminophen
Aspirin
Acetylsalicylic acid
antipyretic, anti-inflammatory,
anti-platelet
side effects
GI irritation is expected
NOTE: if GI bleeding develops,
report immediately
Decreased
platelets
count and has higher
risk of bleeding
nursing considerations
Watch
for
signs
of
salicylism
(aspirin
overdose) which includes:
-Tinnitus
Impaired hearing and vision
-Fever
_Dizziness
-Confusion
-Nausea
and
vomiting
-Sweating
Non-Opiate Analgesics
NSAIDs
COX-1 inhibitors
COX-2 inhibitors
ibuprofen
vioxx
celebrex
NSAIDs should be avoided
in those patients with IBS or
ulcer disease because of
possible GI bleeding
Dizziness, drowsiness and
possible risk of stroke is
associated with the use of
NSAIDs
Educate patient to report for
any rashes, itching and vision
changes as this could be
Stevens-Johnsons Syndrome.
Take note that NSAIDs can also
impair kidney function.
Opiate Analgesics
Morphine
Fentanyl (Duragesic)
Methadone (Dolophine)
Codeine Sulfate
Oxycodone (Oxycontin)
Hydromorphone (Dilaudid)
Ultram (Tramadol)
Meperidine (Demerol)
Use
for
relieving
pain
w/o
producing loss of consciousness or
reflex activity.
Respiratory
Depression
Opiates act on opioid receptor by
altering
perception
of,
and
reducing severe pain.
Constipation
nursing considerations
Frequently
assess
pain
level
and
document its effectiveness.
Take VS before administering the
medication. Hold if RR drops to below 12
breaths per min.
Administer IV opioids SLOWLY.
Educate patient on long-term use of high
dosage of opioids to wean off slowly.
side effects
Monitor VS and have naloxone available.
Avoid
administering
w/other
CNS
depressants.
Ensure that patient is well-hydrated.
Encourage mobility
Administer stool softeners or stimulant
laxatives to avoid constipation
Urinary
Retention
Encourage patient to void at least 4 hours.
Monitor I&O, and obtain an order to
bladder scan if needed.
CNS
depression &
sedation
Advise patient to avoid hazardous activities
like driving.
Morphine Side Effects
"MORPHINE"
M -Myosis
O -Out of it (sedation)
R -Respiratory depression
P -Pneumonia (aspiration)
H -Hypotension
I -Infrequency (constipation, urinary retention)
N -Nausea
E -Emesis
I can do all things through Christ
who strengthens me.
PHILIPPIANS 4:13
Good luck future RN!
References
Chelsea (2020). Complete Nursing School Bundle. CeceStudyGuides.
Koharchik, L.S. & Hardy, E.C. (2013). As easy 1,2,3! Dosage calculations. Nursing Made Incredibly
Easy!, 11(1), 25-29. https://www.doi.org/10/.1097/01.NME.0000424170.34092.7a
Tuttle, K. (2020). The Complete Nursing School Bundle. NurseInTheMaking LLC.
Vera, M. (2019). Pharmacology Nursing Mnemonics & Tips. Nurses Labs. Retrieved from
https://nurseslabs.com/pharmacology-nursing-mnemonics-tips/
Wilson, K.M. (2013). The nurse's quick guide to I.V. drug calculations. Nursing Made Incredibly
Easy! 11(2), 1-2. https://www.doi.org/10.1097/01.NME.0000426306.10980.65
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