Medication

 is a substance administered for the diagnosis, cure,

treatment or relief of a symptoms or for the
PHARMACOLOGY: study of the effect of drugs on
prevention of a disease?
living organisms
 In the health care context, the words
MEDICATION AND DRUG are generally used Pharmacy is the act of preparing, compounding and
interchangeably. dispensing drugs; also refers to the place where drugs
 DRUG has the connotation of an illicitly obtained are prepared and dispensed.
substance such as heroin, cocaine, amphetamines
Licensed pharmacist prepared, makes and dispense
 Usually dispensed on the order of a Physician
drugs.
Prescription
Clinical pharmacist is a specialist who often guides
 the written direction for the preparation and the primary care provider in prescribing drug.
administering of a drug.
Pharmacy technician is a member of the health team
who in some states administer drug to client.
Drug Standards
1. Drugs may have natural (plants, mineral,
animals) sources or they may be synthesized in
the laboratory.
 Example:
Digitalis and opium –plant derivatives Sodium
chloride- minerals
Insulin and vaccines- animal or human sources
Sulfonamides- laboratory synthesis

2. Drugs may vary in strength and activity

Four Kinds of Medication Names  drugs derived from plants may vary in strength
1. Generic Name according to the age of the plant, variety and
assigned by the United States adopted name place in which it is grown and the method used
(USAN) council and is used throughout the drug’s in preservation.
lifetime. Pharmacopoeia is a book containing a list of products
used in medicine, with description of the products,
2. Trade Name or Brand Name chemical tests for determining identity and purity and
A drug trade name (sometimes called the brand formulas and prescription.
name) is the name given by the drug manufacturer
and identifies it as property of the company. Effects of Drugs
1. Therapeutic Effect- (desired effect) is the primary
3. Official Name
effect intended, that’s the reason the drug is
is the name under which a drug is listed in one of
prescribed
the official publications.
2. Side Effect- (secondary effect) of a drug is one
that’s unintended. Usually predictable and may be
4. Chemical Name
either harmless or potentially harmful.
the name by which a chemist knows it; this name
describes the constituents of the drug precisely.
Example: Digitalis- nausea and vomiting
Example:
Some side
 Generic name- Aspirin effects are
 Brand Name: Aspilets, Ecotrin tolerated for
 Official Name: Aspirin drugs therapeutic
 Chemical Name- Acetylsalicylic Acid effect, more
 severe side effects called adverse effect or Disease caused by unintentionally medical therapy, can
reactions be a result to drug therapy.
Example: hepatic toxicity resulting to renal damage,
3. Drug Toxicity– (harmful effects of a drug on an
malformation of fetus as a result of specific drugs
organism or tissue) resulting from overdosage,
(teratogenic drugs).
ingestion, of a drug intended for external use or
buildup of the drug in the blood because of Medication Orders
impaired metabolism or excretion.
A physician usually determines the client’s medication
4. Drug Allergy - is an immunologic reaction to a needs and order medications
drug. A client can react to a drug in the same Types of medication orders:
manner as an antigen and thus develop symptoms
of an allergic reaction. Can be either mild or 1. Stat Order- indicates that the medication is to be
severe. A severe reaction usually occurs given immediately and only once.
immediately after the administration of drug called
anaphylactic reaction. Example: Morphine Sulfate 10mg IV stat

2. Single Order- one time order; is for medication to

be given once at a specified time
Example: Seconal 100mg at bedtime before
surgery
3. Standing Order- may or may not have a
termination date, may be carried out indefinitely
until an order is written to cancel it.
Example: Amoxicillin 500mg/ tab 1 tablet
TID
4. PRN- as needed order, permits the nurse when to
give medication (in the nurse’s judgement and if
the client requests it)
5. Drug Tolerance - exist in person who has
unusually low psychologic response to a drug and Example: Paracetamol 300mg IV q 4hrs PRN for
who requires increases in the dosage to maintain a fever
given therapeutic effect.
Abbreviations Commonly Used in The Hospitals

Drug Interaction Oral Standing Orders

OD Once a day
 Occurs when the administration of one drug BID 2x a day
before at the same time as or after another TID 3x a day
drug alters the effect of one or both drugs. QID 4x a day
 May be beneficial or harmful. May have HS Hours of sleep
potentiating effect (increased) or inhibiting p.o. By mouth (per Orem)
effect (decreased) or synergistic effect (when two Ear (Otic) Drops
different drugs increase the action of one or AS Left Ear
another drug). AD Right Ear
 The combination of aspirin with ethenzamide had AU Both Ears
Eye Drops/ Ointment
a potentiating effect on analgesic activity and
OS Left Eye
reduced motor incoordination and loss of righting
OD Right Eye
reflex.
OU Both/ Each Eyes
 The ibuprofen may reduce the diuretic’s Others Common Abbreviations
effectiveness because ibuprofen often causes the IV Intravenous
body to retain salt and fluid. SQ Subcutaneous
Iatrogenic disease q Every
@ At
cc Milliliter (ml)
 RTC Round the Clock  Minim (volume “at least”)
PRN As Needed 3. Household System
 Used when more accurate system of measures
are not required
Essential Parts of A Medication Order
 Included in household measures are drops,
1. Full Name of The Patient teaspoon, tablespoon, sups, and glasses.
2.

Basic Unit of Measurement

Meter, Liter and Gram
 PREFIXES derived from Latin designate
subdivisions of the basic unit:
 Deci (1/10 or 0.1)
 Centi (1/100 or 0.01)
 milli (1/1000 or 0.001)
 Multiples of the basic unit derived from
 Greek:
 Deka (10)
 Hecto (100)
 Kilo (1000)

Metric Apothecaries Household

1ml 15 minims 15 drops (gtts)

4-5 ml 1 fluid dram 1 teaspoon

(tsp)

15 ml 4 fluid drams 1 tbsp

30 ml 1 fluid ounce Same

500 ml 1 pint Same

Date And Time the Order Is Written
3. Name of the Drug to Be Administered 1000 ml 1 quart Same
4. Dosage of the Drug
5. Frequency of Administration 4000ml 1 gallon Same
6. Route of Administration
7. Signature of the Person Writing the Order 1 gram 15 grains Same

Medication Card 4 grams 1 dram Same

System of Measurement 30 g 1 ounce Same

1. Metric system- 1000g 2.2 lb Same

 Logically organized into units of 10 1. Weight (Gram)
 It’s a decimal system  Kilogram (kg) only multiple of gram used
 Basic units can be multiplied or divided by 10  Milligram (mg) and Microgram (mcg) are
to form secondary units. subdivisions
 Multiples are calculated by moving the  1kg= 1000mg
decimal point to the right and division is 2. Volume (Liter)
accomplished by moving the decimal point to  Expressed in Milliliters (ml) or Liters (L)
the left.  1L= 1000ml
2. Apothecaries’ System
 Older than metric system
 Grain (gr) basic unit of weight
In nursing practice, it is important to understand
the difference between the two (volume and Example:
weight). Doctors Order: give erythromycin 500mg IV now
A drug dosage may be ordered by weight (mg, g, Stock on hand: 250 mg; dilution 5ml
mcg) but administered in volume (mL). D-500mg
Converting units of weight and measure S-250mg
The doctor ordered morphine gr ¼ and the medication Q-5ml
is available only in milligram (mg). How many mg you X= 500 x 5
will give? 250
if 60 mg=1gr, then x mg = ¼ gr (0.25gr)
x= 60 x 0.25
1
x= 15mg

= 10ml
Order: Give paracetamol 500 mg IV q 4 hrs RT
Stock dose: 250mg/ml
Answer: 250mg (1ml)/ (500mg) = 2ml every for 4
hours

Celecoxib 500mg/ tab q 6 hours p.o.

Stock on hand: 250mg/ tab
Answer: 250 (1ml)/ (500mg) = 2 tablets

Basic Formula for Medications

Calculating Drug Dosage Formula: D x Q

S
D-desired dose (doctor’s order)
S- stock on hand (stock dose)
Q- Quantity (dilution)

Preparing Medications From Vial

 Is a small glass bottle with a sealed rubber cap
Vial
 Comes in different sizes, from single-use vials to  Commonly used diluent are sterile water or sterile
multiple- dose vials normal saline.
 They usually have a metal or plastic cap that
protects the rubber seal and must be remove to Single Dose Vial/Single-Use Vial
access the medication.  A single use vial contains only one dose of
 To access the medication in a vial the vial must be medication and should only be used once.
pierced with a needle.  Single- dose or single- use vials are labeled as such
 In addition, air must be injected into a vial before by the manufacturer and typically lack an
the medication can be withdrawn antimicrobial preservative.
 Failure to inject air before withdrawing the  How many times may individual single dose be
medication leaves a vacuum within the vial that entered for a single patient?
makes withdrawal difficult. The safest practice is to enter a single- dose or
 Some drugs may be dispensed as powders in vials- single- use vial only once so as to prevent
liquid diluent must be added to a powdered inadvertent contamination of the vial and infection
medication before it can be injected. transmission.
Reconstitution  Is it acceptable to combine (pool) leftover
 The technique of adding diluent to a powder drug medication from single- dose or single- use
to prepare it for administration. vials?
 Powdered drugs usually have printed instructions No.
(enclosed with each packaged vial) that described  When should single-use vials be discarded?
the amount and kind of solvent to be added. Medication vials should always be discarded
 Some preparations are supplied in individual dose whenever sterility is compromised or questionable
vials, others may come in multidose vials

Medication Preparation and Administration

Legal Aspect of Drug Administration vaccine and related products for safety, efficacy
 Within the US and Philippines, laws have been and quality in the PH.
enacted to control the development and  the RA no. 9711 otherwise known as "The Food
administration of drugs. and Drug Administration Act of 2009" requires
that labels be accurate and that all drugs be
tested for harmful effects.
Principles of Medication Administration

1. 10 Rights of Medication Administration

1. Right Medication
 The medication given was the medication
ordered.
 THE NURSE DOES THIS 3 TIMES
CHECKING:
 Before removing the container from the drawer
or shelf
Another aspect of nursing practice governed by  As the amount of medication ordered is
law is THE USE OF removed from the container
CONTROLLED/REGULATED DRUGS  Before returning the container to the storage
 In hospitals, controlled substances are kept in a
locked drawer, cupboard, medication cart, or 2. Right Dose
computer controlled dispensing system.  The dose ordered is appropriate for the client.
Food And Drug Administration Double check calculations that appear
 the agency responsible for licensing, monitoring questionable.
and regulation of cosmetics, drugs, foods, 3. Right Time
household hazardous products, medical devices,
  Give the medicine at the right frequency and 7. Return liquid that is cloudy in color to the
at the right time ordered according to agency pharmacy.
policy.
4. Right Route 8. Before administering medication, identify the
 Give the medication by the ordered route. client identification correctly.
Make certain that the route is safe and
appropriate for the client. 9. Do not leave the medication at the bedside. Nurse
5. Right Client who prepares the drug should be the one to
 The medication is given to the intended administer it.
client. Ask the client name and check the
client’s identification band with each 10. If the client vomits after taking the medication,
administration of a medication report this to the attending physician.
6. Right Client Education
 Explain information about the medication to 11. Pre-operative medications are usually
the client (why receiving, what to expect, any discontinued during the postoperative period unless
precautions). ordered to be continued.
7. Right Documentation
 Document medication administration after 12. When a medication is omitted for any reasons,
giving it. Follow agency policy.` record the fact together with the reason.
8. Right to Refuse
 Adult clients have the right to refuse any 13. When the medication error is made, report it
medication immediately to the nurse in charge or to the
attending physician.
 The nurse’s role it to ensure that the client is
fully informed of the potential consequences  Implementing necessary measures can prevent
of refusal. any adverse effects of drugs.
 Communicate the client’s refusal to the
Nurses need to:
attending physician.
9. Right Assessment  Know how nursing practice acts inn their areas
define and limit their functions.
 Some medications require specific
assessments prior to administration.  Be able to recognize the limits of their own
knowledge and skills.
 Medication orders may include specific
parameters for administration.  Under the law, nurses are responsible for their own
10. Right Evaluation actions regardless of whether there is a written
order.
 Conduct appropriate follow-up (desired effect
or experienced any side effects or adverse  Nurses should question any order that appears
effects.) unreasonable and refuse to give the medication
until the order is clarified.
2. Practice Asepsis Routes of Administration
 Wash hands before and after preparing the
1. Oral Administration
medication to reduce transfer of
microorganisms.  Advantages:
◦ Easiest and most desirable way to administer
3. Nurse who administers the medication is medication
responsible for their own action. ◦ Most convenient
◦ Does not break the skin barrier
4. Be knowledgeable about the medication that you ◦ Usually less expensive
administer  Disadvantages:
 Fundamental rule of safe drug  Inappropriate if client cannot swallow.
administration is “never on unfamiliar  Inappropriate for client with nausea and
medication” vomiting.
5. Keep the narcotics in locked place  Drug may have unpleasant taste.
 Drug may discolor teeth
6. Use only medications that are clearly in labeled  Drug may be aspirated by seriously ill patient
containers.  Drug forms for oral administration:
 Solid- tablet, capsule, pill, powder
 ◦ Use pill cutter for cutting tablets each subsequent does to avoid mucous
◦ Never crush enteric coated or sustained irritation.
release tablet  Advantages:
 Liquid- syrup, suspension, emulsion, elixir,  Same as oral
or other alkaline substances  Drug rapidly get absorbed in the blood
◦ Syrup- sugar-based liquid medication stream
◦ Suspension- water-based liquid  Disadvantages:
medication. Shake bottle before use of  If swallowed, drug may be inactivated by
medication to properly mix it. gastric juices.
◦ Emulsion- oil- based liquid medication  Drug must remain in the mucous membrane
◦ Elixir- alcohol- based liquid until dissolved and absorbed.
medication. After administration of
elixir, allow 30 minutes to elapse (pass 4. Nasogastriv tube
or go by) before giving water. This  Inserted by way of pharynx and placed into
allows maximum absorption of the stomach
medication
2. Sub-lingual Administration 5. Gastrostomy tube

 A drug that is placed under the tongue where it

dissolves.
 When the
medication is in
capsuled and
ordered sub-
lingual, the fluid
must be aspirated
from the capsule
and placed under
the tongue.
 A medication by the  Directly into the clients stomach and provides
sub-lingual route should not be swallowed, or route for medication and nutrition
desired effects will not be achieved.
 Advantages: 6. Topical Administration
 Same as oral
 Drug rapidly get absorbed in the blood
stream
 Disadvantages:

 If swallowed, drug may be inactivated by
gastric juices.
 Drug must remain under the tongue unlitil
dissolved and absorbed.
3. Buccal Administration
 A medication is held in the mouth against the
 Are those applied to a circumstances surface area
mucous membranes of the cheek until the drug
of the body.
dissolves.
 Applied locally to the skin/ mucous membrane
 Medication should
 Percutaneous- applied to intact skin
not be swallowed,
 Trans-dermal patch- administers sustained
or placed under
action medications via multilayered films
the tongue.
containing drug and adhesive layer
 Client should be
 Dermatologic preparations- applies to skin
taught to alternate
the cheeks with  Instillation and irrigation- applied to body
cavities/ orifices
  Inhalations- administered into the respiratory tract
by nebulize  Intamuscular injection sites:
1. Ventrogluteal site- in the gluteus
muscle which lies over the gluteus
minimus preferred sites for
intramuscular injection
2. Vastuslateralis site- intramuscular
injection fro infants 1 year and younger
3. Deltoid site- lateral aspect of the upper
arm
4. Rectus femoris site- belongs to
7. Parenteral Administration
quadriceps muscle group
 Common nursing procedures nurses give
intradermal (ID), subcutaneously, intramuscular
(IM) or intravenous
 Equipment:
 Syringe (connect with the needle, the barrel:
outside part, on which the scales are pointed,
plunger: which fits inside the barrel)
 Needles- made of stainless steel ad mostly
are disposable
 Sterile cotton
 Parenteral administration are supplied in:
 Ampules- glass container usually designed to
hold syringe dose of drug
 Vials- small glass bottle with a sealed rubber
cap
 Prefilled syringes
 Intradermal Injection- administered in the
dermal layer of skin beneath epidermis

Subcutaneous Injections- outer aspect of upper arms

and anterior aspect of thighs

Intramuscular injection- absorbed quickly than

subcutaneous
 11. Rectal Administration
8.  Inserting medication into the rectum in the form
of suppositories

Opthalmic Medication
 Administer to the eye using iriigation/ installation
 Eye irrigation- washing out the conjuctival sac to
remove
foreign

12. Vaginal Administration

secretions/ foreign substances
 Inserting medication into the vagina in the form of
 “Opthalmic” instilled in form of liquids/
suppositories
ointments

9. Otic Administration
 Installation or irrigation of the external auditory
canal referred to as otic and generally carried
out for cleaning purposes

10. Nasal Administration

 Nasal administration (nose drops and sprays)
usually instilled for the astringent effect (to
shrink/ swollen mucous membrane) to loosen
secretion and facilities drainage
 Ampule Administration
Ampule
 Glass containers in 1ml to 10ml sizes that hold a
single dose of medication in liquid form. Has a
scored neck to indicate where to break the ampule
 Medication is withdrawn using a syringe and a
filter needle. A blunt fill needle with filter must be
used when withdrawing medication to prevent
glass particles from being withdrawn up into the
syringe.
 Never use filter needle to inject medication
 IV Flow Rate
IV Therapy Fluids IV Orders
 IV Therapy fluids will come in sterile plastic bag
or glass bottles.  The prescriber is responsible for writing the order.
 Physician & health care providers order IV fluids  Administering and monitoring an IV is a Nursing
Responsibility.
 IV ORDER must specify the following:
1. Name of the IV
2. Name of the medication to be added if any
3. Amount (volume) to be administered
4. Time period during
Example: Give PNSS 1L x 8 hours (infuse PNSS 1L to
run 8 hours)

Iv Delivery Methods

Continuous
 Replace or maintain fluids and electrolytes
 Flows continuously

Intermittent
 IV piggy back
 Used to administer medications and supplemental
fluids.

and flow rate.

Regulation of Iv Drip Rate Manually
 TUBING for these sets
contains a roller clamp

 Can open or close and
regulate rate manually
 Use a watch with a
second hand to count
number of drops per
minute in the chamber
Electric Infusion Pump

 IV infusion pumps utilized to deliver IV fluids

accurately- set as ml/hour.

IV Complications
Infiltration Phlebitis is the inflammation of the vein which is
caused whenever the used cannula is too large for the
 Infiltration is the accidental leakage of non- chosen vein, or when the cannula is not secured in
vesicant solutions out of the vein into the place
surrounding tissue. This can occur with many
antibiotics, dexrose solutions, or even normal
salines.

 When left unchecked and untreated, IV infiltration

can result in pain, swelling, compartment
syndrome (Compartment syndrome is a painful
buildup of pressure around your muscles. Acute
compartment syndrome is a medical emergency
that happens after severe injuries or as a surgery
complication. Chronic compartment syndrome
happens over time when you exercise too hard or
too often. You can usually treat chronic
compartment syndrome by tweaking your
workout routine), and even amputation of the
affected limb.

Extravasation

 When the leaked solution from an infiltration is a

vesicant drug—one that causes tissue injury
blisters or severe tissue damage—it is referred to
as an extravasation.

 • Injuries from this type of IV failure can be

severe and can lead to the loss of function in an
extremity, and if the damage is severe enough,
tissue death—known as necrosis.